THE \@>

COMPLETE
BOOK OF
Vitamins
and
Minerals
for
Health
By the Edite rs of
Prevention Masazine
 — “THE
JOMPLE TE
BOOK OF
Vitamins
and
Minerals
for
Health
Are there specific vitamins and miner-
als that cure disease? Can nutritional changes
extend your life? Can special foods make you
happier? Are large doses of vitamins and
minerals safe?
These and dozens of other questions
about nutrition matter a lot to a health-
minded person like you. But the answers are
hard to come by—or hard to believe. Now
there’s a reliable, information-packed source
of practical ideas and advice about nutri-
tion: The Complete Book of Vitamins and Min-
erals for Health, written by the editors of
Prevention, America’s leading health maga-
zine. Here you'll find the latest, best facts
about using vitamins and minerals as a pow-
erful force for health and healing.
Part I, “Achieving the Nutrient-Rich
Lifestyle,” tells you who gets nutritional
deficiencies and why and explains how to
create different diets to meet the needs of
men, women and children—and single adults.
You'll even find a quiz to test how much you
really know about nutrition.
Part II, “Using Supplements Wisely,”
gives guidelines for how to select a multiple
vitamin/mineral formula that’s right for you,

(continued on back flap)

 THE
COMPLETE
at OI ¢ ¢— .

Vitamins
E and
Minerals
for
Health
ALL-NEW
EDITION
 Digitized by the Internet Archive
in 2021 with funding from
Kahle/Austin Foundation

https://archive.org/details/completebookofvid0000unse
 "THE
COM PLETE
=~ BOUIN oa
Vitamins
: and
Minerals
for
Health
ALL-NEW
EDITION

By the Editors of Prevention® Magazine

Ea Rodale Press, Emmaus, Pennsylvania

Copyright © 1988 by Rodale Press, Inc.

All rights reserved. No part of this publication may be

reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or
any information storage or retrieval system, without the written
permission of the publisher.

Printed in the United States of America on recycled paper

containing a high percentage of de-inked fiber.

Library of Congress Cataloging-in-Publication Data

The Complete book of vitamins and minerals for health/by the

editors of Prevention magazine.—All-new ed.
jo, oun
Compiled by Lewis Vaughn; editor, Sharon Faelten.
Includes index.
ISBN 0-87857-749-1
1. Nutrition. 2. Vitamins in human nutrition. 3. Minerals in
human nutrition. 4. Health. I. Vaughn, Lewis. II. Faelten,
Sharon.
RA784.C59 1988
613.2—dcl9 87-32933
CIP
ISBN 0-87857-749-1 hardcover

my AN Ay SS IO SS) of 6 3B hardcover
Contributors

Compiled by Lewis Vaughn, Assistant Managing Editor,

Prevention® Magazine
Editor: Sharon Faelten, Senior Editor, Prevention®
Magazine Health Books
Executive Editor, Prevention® Magazine Health Books:
William Gottlieb
Contributors: Stefan Bechtel, Diane Drabinsky, R.D.,
Paul Facinelli, Denise Foley, Judith Benn Hurley,
Jane Kinderlehrer, Gale Malesky, Jeff Meade, Maria
Mihalik, Eileen Nechas, Kerry Pechter, Tom Shealey,
Charles B. Simone, M.D., Deborah Spitz, M.D.,
Marguerite Thomas, Debora Tkac, Lewis Vaughn,
Susan Zarrow
Designer: Sandy Freeman
Copy Editor: Dolores Plikaitis
Editorial/Production Coordinator: Jane Sherman
Research Chief: Caro] Baldwin
Associate Research Chief, Prevention® Magazine Health
Books: Susan A. Nastasee
Assistant Research Chief, Prevention® Magazine Health
Books: Holly Clemson
Research Associates: Doreen Brill, Martha Capwell,
Ann Gossy, Alice Harris, Cemela Dee London, Paris
Mihely, Linda Miller, Sally Novack, Carole Piszczek,
Cindy Wagaman, Lisa Warner
Office Manager: Roberta Mulliner
Office Personnel: Kim Mohr, Kelly Trumbauer
Notice

This book is intended as a reference volume only, not as a

medical manual or a guide to self-treatment. If you suspect
that you have a medical problem, we urge you to seek
competent medical help. Keep in mind that nutritional
needs vary from person to person, depending on age, sex,
health status and total diet. Information here is intended to
help you make informed decisions about your diet, not to
substitute for any treatment that may have been prescribed
by your physician.
 Contents

Listofslables -o.s% oe cs’ aint htt Se ee ee XXV

PYClACC Miran rmtem peg tte ad) tale oe oiewahe SEAS Sa ete GIN XXVi

Achieving the Nutrient-Rich Lifestyle Part |

1. Spotting Your Nutritional Danger Zones ............ 1

Facts and fictions about food and nutrition... The
missing vitamins and minerals in high-protein, low-
calorie vegetarian menus. . . Nutritional tips for people
who hate vegetables...A realistic look at calcium
needs . . . Nutrition on the run: how to ensure that your
family gets their fair share of essential vitamins and
minerals.

2. Confronting the “Secret Threat”

of}Marginal Deficiencies 22. 7-7-1... er eee 9
Causes and effects of marginal vitamin and mineral
deficiencies. ..Some symptoms to look for...The
three phases of a deficiency . . . The high prevalence of
nutritional problems... Why older people are at spe-
cial risk... The role of zinc in a healthy pregnancy.

3. Nutrition for Women, Nutrition for Men ............ 16

How men and women differ in nutritional needs...

Why many women aren’t getting enough iron, folate,
vitamin B, and calcium and what they can do about
it... Why some men may be at high risk for vitamin C
deficiency.
viii Contents

4. Vitamins and Minerals for Singles ................

Why men and women who live alone risk being under-
nourished . .. How singles cheat themselves out of key
vitamins and minerals... Tips on how to avoid nutn-
tional traps of living—and eating—alone. . . Breaking
bad habits.

Better NutritionsfomNMidsimeen eee

ee eee

Why an occasional shortfall in your kids’ nutrition is

nothing to worry about... Vitamins and minerals that
children lack most... Beat finicky eaters at their own
game... How to pack a kid’s lunchbox with nutritious
goodies .. . Tips on how to prepare nutrient-rich meals
that kids will eat.

Test Your Nutritional Know-How .................

Take this quiz to find out how much you know about
vitamins and minerals—and how you can choose be-
tween foods that help or hurt you... Some answers
may surprise you.

Using Supplements Wisely Part Il

Who Takes Vitamins and Minerals?............... 4]

A close-up look at “typical” supplement users...
Which vitamins and minerals are most popular, and
why...Do people take too much?...Supplements
are only one part of a healthy lifestyle... How cost-
effective are supplements? . . Dietitians speak up for
supplements.

How to Choose and Use a Multiple ...............

How to determine if a multiple vitamin/mineral for-
mula is complete, balanced and right for your body... .
How to read and understand labels on vitamin/mineral
preparations... The value of ‘“‘stress formulas” and
other special multiples...A caution about health
claims... Comparison shopping for multiple formulas
before going to the store.
 Contents

9: Getting Vitamins and Minerals to Work Better ......

How to help your body absorb as much nutrition as
possible from food... Smaller meals are used more
efficiently... Spacing intake of vitamin C... Teaming
C with iron... Making the most of vitamin A and other
fat-soluble vitamins ...Team up milk and sunshine...
The best time to take calcium.

10. What You Should Know about Vitamin Tests .......

How doctors use vitamin tests to spot nutritional defi-
ciencies and detect disease... A review of the most
and least valuable vitamin tests... The reliability of
vitamin tests.

lt Answers to Your Questions

about Nutritional Supplements...................
Straightforward information about the effects of coffee
on supplements... The different forms of folate, nia-
cin and other B vitamins... The dangers of too much
B,... How brewer’s yeast rates as a B vitamin supple-
ment... The difference between organic and inor-
ganic iron... Getting the calcium you need from food
and supplements... How vitamin C supplements can
affect blood sugar tests... How beta-carotene com-
pares with retinoic acid... And answers to over 20
other frequently asked questions about vitamin and
mineral supplements.

From A to Zinc: Part Ill

A Guide to Vitamins and Minerals

4, Blocking Cancer with Vitamin A

andsBbeta-Carolene awe: ke eee eee ee Te

The latest research on how to prevent cancer through

diet... Why beta-carotene may be a potent cancer
fighter... How to make sure you get enough vitamin A
and beta-carotene . . New evidence on how vitamin A
or beta-carotene may help prevent oral or cervical
 Contents

cancer... How beta-carotene may be a “morning-

after” pill for people who are already exposed to
cancer-causing agents... Dramatic preliminary re-
search on beta-carotene and lung cancer... Lists of
the best food sources of beta-carotene.

13, Using the Healing Power of B Vitamins............

How to recognize the signs of possible B-vitamin defi-
ciency... Niacin may help protect cells against cancer
and reduce cholesterol... How vitamin B,, and vita-
min C team up to fight leukemia in mice. . . The role of
vitamin B,, in counteracting asthmatic reactions to sul-
fites in food . . . The link between folate deficiency and
cancer... Investigating the link between memory
problems in the elderly and thiamine deficiency...
How B, deficiency can lead to depression and “‘prema-
ture aging”...A list of the best food sources of B
vitamins.

14. Thiamine: Preventing a Common Deficiency .......

A guide to recognizing the subtle but serious symp-
toms of thiamine deficiency ... Why today’s teens are
at risk for thiamine deficiency...How weight-
conscious young women often fail to get enough thia-
mine... How thiamine deficiency has been linked to
hypothermia, slow wound healing, loss of memory and
muscle control... Where to find thiamine in foods.

15. Vitamin B,: More Reasons to Make Sure You’re

Getting Enough 7a: 2 cee Ae he ee a
How B, has been used to treat schizophrenia... How
B, is being used against seizures in children... An
alternative to steroids for a rare form of herpes...
Reports on how B, may be able to improve athletic
endurance... The latest news on treating carpal tun-
nel syndrome with Bg.

16. Test: Your VitaminiBs Status eee eee ee

An easy-to-take quiz to assess whether your body is
getting enough B,... A look at the lifestyle and dietary
factors that affect your B, levels . . . Solid guidelines for
ensuring that your B, status is A-Ok.
 Contents xi

17. Folate Gives Birth to Better Health ...............

Why folate may be the single most important nutrient

for pregnant women and their developing children...
How folate may help prevent birth defects... The role
of folate in deterring cleft palates in newborns. . . Fo-
late and successful pregnancies... A guide to making
sure you're getting enough folate.

18. Vitamin C Research: New Hope for Health .........

How vitamin C is being used to slow wound healing
and to prevent or treat gum disease, poor immunity,
bedsores, intolerance of cold or heat, asthma and in-
fertility... A list of the best food sources of vitamin C.

em Vitamin C: Other Helpful Discoveries .............

Medical reports on how vitamin C may help prevent
one form of reproductive cancer in women. . . Possi-
ble protection against stomach cancer. . . Intriguing
work on battling rheumatoid arthritis... A nutritional
ally against disease.

20. Vitamin D: How to Avoid a “Hidden Epidemic” .....

Why vitamin D deficiency may be a prevalent problem
among the elderly... How a D deficiency contributes
to bone disease and hip fractures. . . A guide to getting
enough D from sunshine, food and supplements...
Why vegetarians may be at risk... A list of the best
food sources of vitamin D.

21. Vitaminve brovectomol.CellSa ea eee

The latest research on vitamin E’s possible anti-aging

effects . . How vitamin E is being used to treat cancer
patients... How vitamin E and selenium team up to
fight breast tumors... Evidence that vitamin E may
protect the heart from alcohol damage... . A profile of
E as the ‘‘antismog” vitamin... A list of the best food
sources of vitamin E.

eae Calcium: A New Look at an Old Friend ............

Why scientists have recommended that the Recom-
mended Dietary Allowance for calcium be raised...
xii Contents

Calcium’s pivotal role in stopping the bone loss caused

by osteoporosis... How calcium can lower high
blood pressure... A list of the best food sources of
calcium.

Zor Copper: Essential to Life and Health ..............

Why copper is crucial to nerves, blood vessels and
bones... How copper may play a role in our ability to
fight off infections... How to maintain the right zinc-
to-copper ratio in your diet... How to make sure
you're getting enough copper—but not too much...
A list of the best food sources of copper.

24. What You Should Know about Iron ...............

Why your body can show symptoms of even mild iron
deficiency ... How iron helps protect you from infec-
tions . . Getting enough iron can help you better with-
stand cold, prevent psychological disorders and over-
come anemia...Why so many people have iron
deficiencies... A review of all the diet and lifestyle
factors that can lead to lack of iron. . . Practical tips on
making sure your diet is iron rich... A list of the best
food sources of iron.

25. Give Yourself the Iron Test

(and Rate Your Energy Reserves) ................
A quiz that will tell you if you’re at risk for iron defi-
ciency... A review of the factors that can help de-
plete—or restore—your iron reserves... Tips on how
to calibrate your diet for maximum iron potency... A
review of how exercise, diet, drugs, cooking methods
can affect your iron levels.

26. The Health Power of Magnesium:

A Medical, Roundups: 200? <5 eee ae.
A real-life story revealing how magnesium has helped
people with heart problems... How doctors are now
using magnesium to treat heartbeat irregularities, high
blood pressure, blood clots, migraines and epileptic
seizures... Why too many people aren't getting
enough magnesium... A list of the best food sources
of magnesium.
 Contents xili

Pal More Health Power from Magnesium .............

Reports on the medical use of magnesium to prevent
or treat angina, diabetic seizures, heart-attack damage,
high blood pressure, the ravages of stress and mental
dysfunction.

28. Selenium: The Great Protector ...................

Selenium shows promise against cancers of the skin,
lung, mouth and throat... News of selenium’s preven-
tive effect against colon cancer... How selenium is
helping to prevent tumors in the laboratory . . . A guide
to making sure you're getting enough selenium.

29: Zinc: the wWhole-Body Mineral 700 ck io. .2 as. ase a.

Why zinc may be the missing link in eating disorders
like anorexia and bulimia... How zinc may be able to
help people with drinking problems... Why lack of
zinc may be a big factor in obesity, gum disease, her-
pes, infertility, even osteoporosis . . How to avoid zinc
deficiency... A list of the best food sources of zinc.

Special Nutritional Allies for Health Part IV

30. Amino Acids: Building Blocks of Well-Being........

An update on how amino acids are being used to treat
disease . . . Using phenylalanine to fight serious depres-
sion and pain... Insight into cancer research using
arginine... The use of tryptophan against insomnia. . .
The connection between gallstones and taurine. . . Ty-
rosine, the “‘antistress” amino acid... Using lysine to
stop cold sores... Guidelines for taking amino acids
safely.

ol The Fish-Oil Factor: Healthy-Heart Gift

fromsthe/Sear ses sees ee a een ca 2 Sthahg cosigege is

Why fish oil may counteract heart disease better than

polyunsaturated vegetable oil... How omega-3 fatty
acids can possibly reduce the risk of heart attack and
XIV Contents
ae

stroke... A link between fish oil and lowering blood

pressure... The one oil people aren’t getting enough
of in their diets.

32. More Good News about Omega-3 ................- 247

An update on how scientists are using omega-3 against
arthritis, psoriasis, migraines, breast cancer and heart
disease . . . Guidelines for getting the right amount of
fish and fish oil in your diet . . How to select fish that
are high in omega-3 . . Good advice on the use of fish-
oil supplements.

33. Chromium and Choline:

Promising Possibilities for Health ................. 254
Chromium’s role in blood sugar control . .. Why chro-
mium-rich brewer’s yeast may help to lower choles-
terol... Evidence that choline helps us to reason,
learn and remember . . . Why a scientist thinks that lec-
ithin may help to keep our brains sharp as we age.

Solving Health Problems with Nutrition Part V

34. An Alternative Way to Fight Alcoholism ............ 261

How doctors are using nutrition to help alcoholics beat
their addiction...Case histories of alcoholics who
used nutrition to help them stay on the wagon... A
look at the role of B vitamins in the treatment of alco-
holics... How nutrition therapy compares with other
approaches to alcoholism.

35. Anemia: Who Gets It and What to Do about It ....... 269

Why you need iron and what happens when you don’t
get enough... A review of factors that can make you a
candidate for anemia... How certain dietary factors
can interfere with or enhance your body’s iron absorp-
tion...A list of foods that can help keep your iron
stores full.
 Contents

36. Arrhythmias: Heartthrobs You Can Live Without .... . 275

When irregular heartbeats are nothing to worry about
and when they’re a danger signal... What different
kinds of arrhythmias can tell you about your health...
How magnesium deficiency can lead to heartbeat ir-
regularities ... How coffee, stress, alcohol, cigarettes
and certain over-the-counter drugs can trigger arrhyth-
mias ... What to do when arrhythmias suddenly strike.

31. A Guide to Healthy Breasts: 2... .2a: «6 ative eens 282

A quick lesson in breast anatomy . . A complete guide
to fibrocystic disease—what it is, what its symptoms
are, what can be done about it... What to look for
during breast self-exams. .. A review of the risk factors
for breast cancer... A diet recommended for healthy
breasts...A possible role for vitamin E in treating
breast cysts... Research on the effects of vitamin A
and selenium on breast cancer... Why a low-fat, high-
fiber diet may protect breasts from cancer.

38. Bruises: What to Do When You’re Black and Blue .... 292

Factors to consider if you bruise easily: certain drugs,

vitamin deficiencies and viruses . .. How family history
can play a role in bruising problems.

39. Ten Ways to Guard against Cancer................. 295

A review of the latest research on what you can do to
help prevent cancer. . . Information on the anticancer
properties of dietary fiber, vitamins A and C, cabbage-
family vegetables, low-fat diets, weight control and
more.

40. One Doctor’s Prescription for Cancer Prevention... .. 302

A cancer researcher assesses the anticancer powers of
vitamins and minerals... A suggested nutritional plan
for reducing cancer risk.

41. The Pap Test and Nutrition:

Two Fronts against Cervical Problems.............. 309
What the Pap test is and what the various test results
mean... New developments in the diagnosis and
 Contents

treatment of cervical dysplasia... How nutrition can

change your risk of cervical dysplasia... Research
linking cervical dysplasia and vitamins A and C and
folate... A commonsense guide to when to have Pap
smears.

42. No More Cramps and Kinks ..................-..

Who gets muscle cramps and why... A guide to ap-
plying the “universal antidote” to muscle cramps... .
How mineral imbalances can cause cramps and what
to do about them... How lack of water can cause
cramps...How to handle a “‘stitch in the side’...
Preventing cramps before they start.

43. How to Stop Diabetic Complications

with Good (NUTItION $4 ce. ee ce ee eee

Why two scientists think that vitamin C may deter hard-

ening of the arteries in diabetics... A doctor who pre-
scribes vitamins for neuropathy... Using magnesium
to fight diabetic retinopathy ... Why dietary fiber may
flatten the “sugar curve.”

44. Lower Your Blood Pressure with Diet .............

A complete guide to antihypertension foods . _. Potas-
sium-rich produce. . . Calcium sources to lower blood
pressure... How to get more magnesium into your
diet ... Other essential menu items.

45. Fighting Mental Disorders with B Vitamins.........

B-vitamin deficiencies can lead to confusion, forgetful-
ness, depression or other mental problems... How
doctors are reversing psychological symptoms with
vitamins B, and B,, and folate . . . B vitamins may keep
people out of nursing homes... Who gets B-vitamin
deficiencies and why.

46. Psychiatric Symptoms: The B,, Connection ........

Mental problems may occur before other signs of B,»
deficiency, including anemia. .. Why the elderly are at
risk for B,, deficiency... How to ensure that you're
getting enough B,,.
 Contents xvii

47. Calciumiversus Osteoporosiseuee svi ns os

Osteoporosis can happen to anyone. Here’s why...
How much daily calcium you really need... Prevent a
midlife bone crisis with exercise . .. The pros and cons
of estrogen and fluoride treatments.

48. Who ‘Gets:Osteoporosis?#7% Ween a ane . 369

Evaluate your risk for brittle bones. . . Factors to con-
sider: age, sex, Menopause, race, diet, exercise, smok-
ing, alcohol abuse and more.

49. Vitamin D: Another Force against Bone Disease.....

Why vitamin D is so important to your bones... The
early warning signs of osteomalacia (soft bones)...
How certain drugs can counteract vitamin D... Why
some elderly people may be at risk for vitamin D defi-
ciency... Safe ways to get vitamin D.

50. Put Senility in Reverse with a Better Diet ..........

Deficiencies of Bs; and copper may lead to senility...
New research on senility and vitamins B,, and C, folate
and riboflavin... How thiamine deficiency may help
trigger postoperative confusion . . . Good nutrition may
help people suffering from Alzheimer’s disease.

51. A Nutritional Formula

fomiiealthy. 1eeth-and. Guns ok baie cee at
A look at evidence that vitamin C may protect gums
from infection and disease... Why some researchers
say calcium may help fight gum disease . . . How folate
may be able to counteract periodontal disease.

oe: Nutrients: Experimental Treatment

fOTMIMDAILCC nyISION rene, Hees net teA ete
Why zinc has been used in cataract treatment . . . Using
vitamins C and E to deter cataract-causing oxidation . . .
Nutritional weapons against diabetic retinopathy.

a A Pioneering Approach to Better Vision ...........

An ophthalmologist’s recommendations for a better-
vision diet . .. How he uses nutrients to treat or prevent
xviii Contents
ee

eye troubles... A review of evidence that vision prob-

lems may respond to vitamins A, C, E and B, and the
minerals zinc, selenium and chromium.

4. Nutritional Therapy: More Positive Evidence.......

A report on treating asthma with vitamin C... Using
better nutrition against bedsores... Combining vita-
min C with a cancer drug... A report on using vitamin
E to prevent chemotherapy-induced hair loss... Low
selenium and celiac disease... Zinc lozenges: treat-
ment for colds... A possible link between deafness
and vitamin D deficiency... Lupus and vitamin A...
Treating Wilson’s disease with zinc.

D0: How to Take Vitamins and Minerals Safely .........

A commonsense guide to maximum safe doses for
vitamins and minerals...Sound advice on safe and
sane use of nutritional supplements. . . A review of sci-
entific evidence regarding using supplements to pre-
vent or treat health problems.

Better Nutrition for the Stages of Your Life Part Vi

56. Getting Ready to Eat for Two ....................

Commonsense steps that will help to ensure a healthy
baby... How to maintain proper body weight...
Healthful advice about alcohol and caffeine... A sen-
sible guide to vitamin and mineral intake.

oe What Pregnant Women Should Know

about Nutrients and Birth Defects ................

How scientists are using vitamins and minerals against

neural tube defects (NTD)... Scientific research on
using nutrients to prevent cleft lip . . . Investigating the
link between zinc deficiencies and birth defects...
Treating rare birth abnormalities with vitamins.

58. How to Avoid Dieters’ Deficiencies ...............

Tips on recognizing bad weight-loss diets and picking
out the good ones...How easily people on low-
 Contents xix

calorie diets can run a deficiency... Ways to diet and

still get enough iron, calcium and other nutrients...
How to keep your diet on track nutritionally.

59. The Exerciser’s Guide to Vitamins and Minerals ....

Designing a safe, sane diet for people who exercise . . .
How active people can avoid nutrient deficiencies. . .
Ways to get enough energy-boosting iron... The facts
about minerals, sweat and athletic performance...
Avoiding a deficit of B’s.

60. BOOStHG YOU BraimpOWweL.- 6 osc aieirene rs

Practical tips on improving your brainpower... How
to improve your thinking by improving your posture. . .
What iron deficiencies can do to your intellect and
how to avoid them... How aerobic exercise can in-
crease brainpower... What scientists say about leci-
thin and mental performance... Brainpower and B
vitamins. . . Getting rid of emotional mind clutter.

61. Natural Sparks to Get Your Energy Sizzling.........

How using energy can give you more energy. . . Ten-
sion-releasing exercises that can pep you up. . . Losing
weight increases energy reserves... How to avoid the
“mineral blues”... Why a vitamin C deficiency can
sap your energy.

62. On the Mend with Better Nutrition ...............

Why injured people need top-notch nutrition...
Amino acids that promise to speed wound healing . .
Using vitamin C to boost immunity... Why burn vic-
tims may need vitamin A. . . Injuries call for more zinc.

63. Let’s Put “Recovery” on the Menu................

Why malnutrition is so prevalent in hospitals... Why
nutrient deficiencies are all too common in nursing
homes... Why the elderly in institutions risk low levels
of vitamin D... A guide to ensuring good nutrition for
someone who enters a hospital or nursing home.
 Contents

64. Can We Defeat the Aging Factor with Diet?.......... 483

Why some scientists believe that diet may slow the
aging of immune systems... How zinc may boost im-
munity in the elderly .. . Investigations into the role of
vitamin E in the aging immune system . . . Boosting im-
mune responses in the elderly with vitamin C.

65. More Good News on Nutrition and Aging..........

Detecting and reversing age-related nutrient deficien-
cies... How beta-carotene may protect cells from
harmful radiation . . . Protecting the cells with vitamins
E, Cand A and selenium. . . Detecting poor absorption
of nutrients.

Cooking and Eating for Maximum Nutrition Part Vil

66. The Top 25 Superioods ......<.. seteee

An analysis of the foods—from amaranth to yogurt—
that scientists say promote better health... Data on
the foods’ nutritional content and their role in disease
prevention... Tips on how to incorporate the super-
foods into your diet for maximum benefit.

67. Healthy 'Gourmet-Foods' 2.222.

.4-00 cee
How to prepare and enjoy great-tasting gourmet dishes
that are good to your body... A complete guide to
great gourmet foods like boniato, fava beans, flat-
breads, sapsago cheese, gourmet pasta, skirt steak and
pheasant... Recipes for Herb-Steamed Mussels with
Basmati Rice Pilaf, Yard-Long Beans with Oyster Sauce
and more.

68. The Fruits and Vegetables

Your Mother Never Mentioned...................

A guide to selecting, preparing and enjoying some

good-for-you exotic fruits and vegetables: bok choy,
tamarillo, guava, passion fruit, gooseberries and more.
 Contents

69. Rating Your Refrigerator’s “Health Quotient” .......

A revealing, fun quiz that assesses your eating habits
and shows you how to change them for the better.

70. The Good Meats: A Nutritional Storehouse.........

A commonsense guide to appreciating the “healthy
side” of meat dishes... How to select, trim and pre-
pare meats for low-fat eating ... A short course on the
grading system used for meat cuts.

(Re Happy Marriages: Foods That Go Together.........

Recipes for making healthy variations of some tradi-
tional duos: Fish and Chips, Spaghetti and Meatballs,
Macaroni and Three Cheeses, Chicken ’n’ Biscuits,
Tortillas and Beans, Liver and Onions.

ize High-Calchim:COOkeCiV ar ari teresa ei 2 4 he

Selecting the best calcium sources... Three tips for
adding calcium to your meals... Great high-calcium
recipes: Pizza Nicoise, Antipasto with Baked Oysters,
Pesto Cheese, Orange-Almond Cheese, Corn Crepes
with Bean Paté and more.

73. The Health: Scoop on.ice Cream#4240. 0.24.04 5-

The whole nutritional truth about ice cream—what’s in
it, what’s good and bad about it, how it compares with
other snack foods. . . Tips on how to fit ice cream into
a health-conscious lifestyle... A nutritional companri-
son of popular ice cream brands.

74. Selecting and Storing Vegetables

fOVAMANTMIUTeIN Uti
tlOne eee ee

Tips on maximizing nutrients in popular vegetables. . .

How to select the fresh ones. . . Storing highly perish-
able vegetables . . . Eating vegetables at their peak.

75. A Harvest of Delights

iG aghtens Your 5 100d [PTCSSUIC gars tas oa ee ies 2b a
A review of research suggesting that calcium and po-
tassium may reduce high blood pressure... How to
xxii Contents
aa a ee ee Tl an eee Cen ee nr eee eh Oe ee aS

plan diets, dishes and meals high in potassium- and

calcium-rich foods.

76._A Healthy Sandwich Sampler” 2.0.)

= acne es 2 o74
Tips on how to make countless tasty and healthy varia-
tions on the sandwich theme... Recipes for our best
sandwich ideas.

77. Low Sodium from Soup to Nuts ................... 581

A review of low-sodium dishes served at some great
American restaurants . . How to get your share of low-
sodium meals even when you're traveling... A guide
to low-sodium prepared foods from soy sauce to
crackers... 20 tips for low-salt entertaining... Tasty
low-sodium recipes.

78. More Sneaky Maneuvers for Cutting Back on Salt .... 597
Ingenious ways to reduce your sodium intake—with-
out letting your taste buds know it.

79. A Guide to Healthful Cooking Techniques........... 600

Cooking to conserve nutrients... The best—and the
worst—ways to cook . . . How to salvage vitamins and
minerals in your food.

80. A Guide to “Healthier” Kitchenware ............... 603

A review of the 11 most useful and healthful kitchen

gizmos.

81. The Microwave: Healthy Cooking Is Its Forte........ 607

Inside tips on the nutritional bonus of microwave
cooking . . . Secrets to microwaving perfect vegetables,
tender fish, velvety sauces and super stews.

82. Slices of Life: A Guide to Better Bread.............. 610

How various breads can differ in protein, fat content,

dietary fiber and magnesium... A comprehensive nu-
tritional profile of selected variety breads . .. A winning
recipe for whole wheat bread.
 Contents xxiii

83. Using More Whole Grains «2.2.42

toe Seah enters
A guide to cooking with barley, buckwheat groats,
bulgur, cornmeal, millet and oats.

84. WSing More Died sbealisnws tercae ar an tr ac cua

Tips on how to store beans, incorporate them into
recipes, make bean puree and use marinated beans
and bean flour.

85. UDSradineLEILOVETS nex dria tece na sakes ec Meer elcee

Smart ideas for making leftovers tasty and nutritious
the second time around.

86. SLADING UID.) Ollksr OLALO. cor wrycrottn Mievin is se SORES

Twelve tasty and innovative ways to enjoy the lowly
but nutritious spud.

87. Who’s Who in the New Health Milks..............

A guide to exactly what’s in those newcomers in the
dairy case: the low-fat milks, protein-fortified milk, but-
termilk, acidophilus milk, Lactaid and CalciMilk...
Tips for people who cannot digest milk but still need
calcium.

88. BottlediWaternhititowDrink =)... oe

How to select and enjoy sparkling waters, spring wa-

ters, distilled waters and unflavored soda beverages .. .
Tips for sodium-conscious bottled water fans.

89. Answers to Your Questions

aboutskood: and! Healthiwey.= 00.5 ne nee ee

Vitamins and minerals in blackberries, bancha tea,

milk shakes, orange and grapefruit rind, baked pota-
toes, honeydew, cantaloupe and other fruits and veg-
etables ... Also, straight talk about sushi, organ meats,
imitation crabmeat, hydrogenated fats, frozen pizzas,
chocolate, and more.
Xxiv Contents

Appendix A:
A Reader’s Guide to Recommended Dietary Allowances . .

Appendix B:
A Reader’s Guide to the Nutrient Content of Foods ......
 Tables

Getting Kids to Eat Better:

A Doctor Showsiow satis tks thw dg ee 30
What to Look For in a Multivitamin............... 52
AsGuide tosDeficiency SyMptOMsS) ke Fo eee oe 62
Best Food Sources of Beta-Carotene.............. 9]
Best Food Sources of B Vitamins ................ 100
Best Food. sources of Vitamin, Gre. sosnesin wissen se sas 130
Best FOO DOUFCES OF VitAMDIN: Dy sauce ce os ote ee ecess 147
Bese Food Sources Of Vitamin E. 24.2 00s se rete os ks 158
Best Food sources of Calcium “Sse. 2... .cnva re. x. 164
Best hood Sources: Of KCOPDEr ot, ae tenn eee sea es 174
Best rood -oources Of TFOM Ws ees Meek sae Pk oes 182
Best Food Sources of Magnesium................ 202
Bestlhood Sources.ob Zinc? eo: oe ines: 4 eae226
Selected:Food Sources of Omega-3 e208: 23. 3. 252
Rating the sBeeh samrac cde ance Geely 2 sate ooh tes 53D
Nutritional Value of Ice Cream
and:OtherSnackiFoods Mere og,..iei ee, ee Ae 560
Best.Food sources: of Calenum <4 cus cepts aces. 568
Best Food Sources of Potassium ................. 570
otis (Gee)
e)CalaLec6)Bal )| enaecpere ane ser wl SRL Sn capt RY 623
Ways to Tolerate Lactose Intolerance ............. 625
Sodium Content of Some Bottled Waters .......... 627
A Reader’s Guide to
Recommended Dietary Allowances ........... 637
A Reader’s Guide to
thesNutrientContentof FOOdSm wee see aetee 645
 Preface

an the right dose of vitamins or minerals cure

disease? Can nutrition head off health prob-
lems and extend your life? Can diet affect the mind as
well as the body? Do megadoses of nutrients help or
harm?
The Complete Book of Vitamins and Minerals for
Health appears in part because questions like these
matter a lot to people and because science is contin-
ually digging for the answers.
We answer many of those questions right here.
This volume is a nutritional update you can use now to
help you assess the value of vitamin and mineral sup-
plements, to plan healthier meals for you and your
family, to use nutrition to help confront disease and
enhance health. It reflects a new awareness among
many doctors and scientists: Food is not just fodder
but a force for improved health and well-being.
Part I introduces you to the basics of nutrition
and shows you how to use them to improve your
health and nourish your family. It tells you who gets
nutritional deficiencies and why, how to spot your
nutritional weaknesses, how to create diets that meet
the different needs of men and women, how to up-
grade the junk-food diets of kids and how to custom-
ize meals for the singles life. There’s even a quiz to test
how much you really know about nutrition.
Part II helps put nutritional supplements in per-
spective. It reveals survey results that show who takes
 Preface XXVil

supplements and why, tells you how to select a multi-

ple vitamin/mineral formula that’s right for you, de-
tails the uses and abuses of vitamin tests and helps
you decide when taking supplements makes sense
and when it doesn’t.
Scientists have been scrutinizing nutrients for de-
cades, piling up mounds of data. Part III] helps you sort
through much of this evidence. It covers a promising
anticancer vitamin, the facts and fallacies of B vita-
mins, the latest scientific news on vitamins C and E
and exciting research into calcium, magnesium, iron,
copper, selenium and zinc.
Part IV is a report on some upstart nutritional
factors that have been making headlines lately—
amino acids, fish oils, dietary fiber and others. It tells
you how these substances are being used in prelimi-
nary research to fight high cholesterol levels, insom-
nia, depression and other health problems.
Part V is a comprehensive review of ailments—
from alcoholism to zinc deficiency—and how scien-
tists and doctors are using nutrition to try to counter
them. It’s a massive catalog of intriguing possibilities
for the prevention and treatment of disease. It covers
B vitamins and mental health, magnesium and heart
trouble, beta-carotene and cancer, low-fat diets and
heart disease, dietary regimens and high blood pres-
sure, calcium and osteoporosis, nutritional formulas
and gum disease, nutrients and vision problems and
more. Plus, there’s sound advice on taking supple-
ments safely and charts listing the best food sources
of specific vitamins and minerals.
Scientists know now that there’s no such thing as
the perfect, one-size-fits-all diet. They’ve known for
years that what’s good for one person may not be
good for another. But now it’s clear that what’s good
for someone in one situation may not even be good in
the next. Part VI explains what science knows about
this new “‘situational nutrition.” It’s a guide to calibrat-
ing diets to meet the special needs of dieters, exercis-
XXVili Preface

ers, pregnant women, people in hospitals and nursing

homes, people over age 50 and others.
Part VII is a manual on the art and science of
healthful cooking and eating. It meshes what science
knows about good nutrition with what culinary artists
know about preparing great meals. It shows you how
to select foods high in specific nutrients, how to store
food for maximum nutrition, how to prepare nutri-
tious gourmet dishes, how to concoct deliciously
healthful meals using everything from arugula to zuc-
chini. It teaches you how to master low-sodium cook-
ing, healthful microwaving and nutritious, inventive
sandwich making. It includes scores of recipes and
consumer reports on the new healthier dairy prod-
ucts, America’s new vogue foods and healthful cook-
ware and kitchen aids.
Part VIl—indeed the whole book—reflects a
sound nutritional principle: The preferred source of
vitamins and minerals is your food. That means that
supplements, as the name implies, should not be used
as substitutes for food or good dietary habits. So if you
do take supplements, keep the following in mind as
you read this volume:

e Vitamins and minerals have a wide margin of

safety. Just the same, you should never assume that
any nutrient is completely safe in amounts much
larger than the Recommended Dietary Allowance
(RDA). Be especially careful to avoid excessive
amounts of the fat-soluble vitamins A and D.
e Researchers and clinicians may use higher
doses of supplements to treat some medical condi-
tions, but this does not mean these amounts are ap-
propriate therapy for you. For the proper diagnosis
and treatment of your medical problem, consult your
doctor.
e For some people, multiple-vitamin supple-
ments can be valuable dietary additions. Those that
contain all major nutrients in amounts from 25 to 100
 Preface

percent of the RDA are usually best. These amounts

are considered more than adequate to meet the re-
quirements of practically all healthy people. For in-
formation specific to your own medical needs, con-
sult a knowledgeable physician or a registered
dietitian.

Nel eb
Editor
Prevention® Magazine
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 Part |

ACHIEVING THE
NUTRIENT-RICH
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 Chapter l

Spotting Your
Nutritional
Danger Zones

esearch shows that many Americans are in-

creasingly concerned about what’s in the
1,500 pounds of food they chow down each year.
They’re eating fewer frankfurters and less luncheon
meat, sugar and candy, oils and fats. They’re eating
more chicken, cheese, dark green vegetables and cit-
rus fruits.
Their concern is certainly a step in the right di-
rection, but most still have a way to go, says Paul
Lachance, Ph.D., professor of nutrition and food sci- Mealtime. Do you know
ence at Rutgers University, New Brunswick, New Jer- where the vitamins and
minerals are?
sey. “The average American doesn’t know where the
nutrients are. He doesn’t go shopping and pick up a
vegetable and say, ‘Here’s my vitamin C.’ He’ll read
the label on a prepared food, but won’t know what it
means. When it comes to details, most people just
don’t know much about nutrition.”

What You Don’t Know

Can Hurt You
Many people have false notions about food—
misconceptions that can affect their nutritional status.
Phyllis Havens, R.D., a Hampden, Maine, consulting
nutritionist, says, “People think margarine is so much
better than butter, but then they’ll use twice as much
of it, not realizing there’s as much fat and calories in it
 Achieving the Nutrient-Rich Lifestyle

as butter. And they think granola bars are a healthy

snack, when they’re actually loaded with fat and
sugar.”
Havens is ‘“‘reeducating” the clients she sees in
her private practice and at the Holistic Center in South
Portland, using an updated version of an old teaching
tool—the basic four food groups. “I am encouraging
people to look at them again, as a guide, but with an
emphasis on specific nutrients and whole foods—
whole grains, low-fat dairy products, fresh fruits, dark
green, leafy vegetables, and fish and poultry.”
Good advice. But why exactly is it that so many
individuals score poorly on personal nutrition? Lack
Poor diet, poor health. of knowledge is one reason. But certain patterns of
eating, or even patterns of living, also predispose
many of us to dietary problems. And these dietary
problems can often turn into health problems. Let’s
check out several common eating patterns or diets
and ask, “Where are the hidden danger zones? How
can they be eliminated?”

The High-Protein Predicament

Jean and Jerry like the high-protein “quick-
weight-loss” diet. It lets them fill up on their favorite
foods—steak and shrimp—and still drop five pounds
in a week. It also allows them to eat plenty of chicken,
low-fat cheese, lean fish and hard-boiled eggs, and to
drink as much diet soda and coffee as their kidneys
can handle. It prohibits any other foods. No fruits or
vegetables. No carbohydrates. It’s a diet they go on
again and again, every time they regain those five
pounds.
What’s wrong with this diet? For starters, it’s high
in fat. Fifty percent or more of its calories come from
What’s wrong with this fat. “Anyone who’s worried about heart disease or
diet? Plenty. liver or kidney problems would want to avoid eating
this way,” Dr. Lachance says. “And it’s also higher in
sodium than is wise.”
 Spotting Your Nutritional Danger Zones

The amount of fiber in this diet would be minus-

cule. “You are begging for dependency on a laxa-
tive,” Dr. Lachance says. Low-fiber intake could ag-
gravate gallstones or diverticulosis, Havens adds. A
high-protein diet may also shortchange you on cal-
cium and other important vitamins and minerals. A
high-protein diet would make your body excrete up to
twice the calcium it normally would. “Unless you are
eating a lot of low-fat dairy products [a good source
of calcium], you could definitely increase the risk of
osteoporosis [thin, weak bones], especially with older
women, with this diet,’’ Havens says.
Other important vitamins and minerals found
mostly in fruits, vegetables and whole grains would be
missing in this diet—vitamins A and C, magnesium, Protein-only weight-
potassium, and, among the B complex, thiamine (B,), loss diets starve your
body of vitamins and
B, and folate. ‘““When you see the number of nutrients minerals.
that aren’t being delivered and the health risks in-
volved, you have to ask yourself, “Why should I use
this diet?’ ” Dr. Lachance says.
Adding insult to injury, much of that quick and
highly encouraging weight loss on the high-protein
diet is loss of water—water that gushes back into your
body the minute you resume eating carbohydrates.
Both nutritionists recommend a diet high in fiber and
low in fats for people who want to lose weight. “I
recommend a diet similar to the Pritikin diet [high in
grains and vegetables, very low in fat] but one that
allows about 20 percent fat,’ Havens says. Dr.
Lachance likes the diet outlined in The F- [for fiber]
Plan Diet.
Both diets allow you ample quantities of food
(and vitamins and minerals) while minimizing the
most concentrated source of calories—fat.

The Iron Impasse

Let’s look at another dieter, Joan, who’s proud of
her superslim figure and admits she practically lives
 Achieving the Nutrient-Rich Lifestyle

on a few low-cal staples—cottage cheese, yogurt,

Weight loss doesn’t broiled chicken and fish, lettuce and tomato, zucchini
have to mean vitamin and string beans. She’s also a big tea and coffee
loss.
drinker. She thinks caffeine helps dull her appetite
and perks her up. The trouble is, Joan hasn’t been
feeling very perky lately.
Joan’s big problem is iron. She’s getting less than
half of what she needs from her food, and her tea and
coffee drinking further inhibit absorption of the little
she does get, according to Havens.
“T would focus on lots of dark green, leafy veg-
etables like broccoli, spinach and even some of the
A list of iron-rich, low- more unusual greens like collard, mustard and kale,”
cal foods for the dieter. she says. ‘And I would try to convince her that some
iron-rich legumes like beans and lentils aren’t all that
fattening. A half cup of cooked kidney beans has only
110 calories.”
Dr. Lachance is very concerned about the diffi-
culty of absorbing iron from grains and vegetables.
“Td suggest, instead, some of the very lean red meats,
the muscle meats from the shoulder and rump.”
Women unwilling to eat much red meat will have to
take an iron supplement, he believes.
How about someone who’s eating no meat at all?

Meatless Menus
When they went vegetarian ten years ago, Tom
and Tina had the best of intentions and enough in-
formation to get them started. They'd read Frances
Moore Lappé’s Diet for a Small Planet and shifted
their preferences toward dairy products, eggs, grains
and plenty of fresh fruits and vegetables. They even
got to like tofu and miso. They were determined to
avoid all the ills associated with the typical Western
diet—obesity, high blood pressure, heart disease. But
were they setting themselves up for unseen troubles?
Deficiencies of both zinc and iron can be a prob-
lem in a vegetarian diet, especially for women, re-
searchers have found. And vegans, who eat no dairy
 Spotting Your Nutritional Danger Zones

products or eggs, often get less than the Recom-

mended Dietary Allowance (RDA) for calcium. “No Vegetarians may miss
vegetable is a reliable source of zinc, and I’m very out on zinc and other
essential minerals.
supportive of every vegetarian taking a zinc supple-
ment,” Havens says.
‘And I think it’s worthwhile if they’re not feeling
the highest energy level possible to have a blood test
to see if they are iron deficient.” If they are, she will try
adding iron-rich legumes, blackstrap molasses and
dark green, leafy vegetables to their diet for three
months, then have a second blood test done. If the
dietary changes aren’t working, she’ll then suggest an
iron supplement.
Vitamin B,, used to be considered an inevitable
deficiency for strict vegetarians. Now, though, re-
searchers have found significant amounts of vitamin Fermented foods can
B,. in cultured and fermented foods such as miso, soy help prevent a vitamin
B,, deficiency.
sauce and tempeh.
How about people who turn up their noses at
vegetables? They may face an entirely different set of
nutritional shortcomings.

Vegetable-Hater’s Plight
As far as Frank is concerned, the only vegetable
“real men” eat is potatoes—french-fried with a bur-
ger, boiled with a pot roast or hash-browned with
eggs. Like the picky little kid he was, Frank finds most
fruits and vegetables yucky. But his childish holdover
could be making him deficient in vitamins A and E,
folate and potassium.
Let’s not knock potatoes. A medium baked spud
with its skin has 944 milligrams of potassium (about a
third of what most adults require), 30 milligrams of How to cook potatoes
vitamin C (half the RDA) and 4 grams of fiber, about a for maximum nutrition.

third of what many people get in a day. The problem

is in the way most of us cook potatoes, says Georgene
Barte, associate professor of foods and nutrition at
Oregon State University, Corvallis. We peel the nutri-
ent- and fiber-rich skin off, and boil or fry away some
 Achieving the Nutrient-Rich Lifestyle

of the vitamin C. Frank and other meat-and-potato

lovers should be eating a baked potato, skin and all.
And adding even a few fruits and vegetables—as
snacks and salads—to his limited menu could raise
the vitamin and mineral content of Frank’s diet to a
healthful level.
“| find that some adults who are really turned off
by cooked vegetables do better with raw ones,” says
Havens. “If they don’t like cooked spinach, I suggest
they start eating it raw, mixed with iceberg lettuce,
gradually increasing the amount. Or they might enjoy
dips with carrots or green pepper strips.”
Like many children, some adults dislike strong-
flavored vegetables like cabbage, broccoli and on-
Some vegetables may ions. Instead, they may enjoy sweet-flavored carrots,
be served with maple winter squash and sweet potatoes, served with a smid-
syrup.
gen of butter and maple syrup. These vegetables
would certainly solve Frank’s vitamin A problem. A
four-ounce serving of sweet potatoes or carrots would
supply his RDA of 5,000 international units, as would
a half cup of butternut squash.
Citrus fruits and juices would be Frank’s best bet
for vitamin C. Just one cup of orange juice would give
him 124 milligrams of C and an additional bonus of
496 milligrams of potassium and 500 international
units of vitamin A.

Calcium Countdown
Mary’s daughter has been nagging her to get
more calcium in her diet ever since Mary fell and
broke her wrist a few years ago. Now she’s 70 and
unsteady on her feet. Her daughter fears she’ll fall and
break a hip one of these days.
The problem is that Mary thinks she gets all the
calcium she needs. She drinks about a cup of milk a
Are you getting as much day, with cereal and coffee, and usually eats a slice of
calcium as you think?
cheese or half a cup of cottage cheese every day.
Other calcium-containing foods boost her daily intake
to the RDA of 800 milligrams.
 Spotting Your Nutritional Danger Zones

But that’s not enough calcium to prevent osteo-

porosis, researchers say.
“T think the RDA for calcium for women past 30
should be 1,000 milligrams, and for those past meno-
pause, 1,200 to 1,500 milligrams,” says Barte.
Getting that much calcium in your diet would
mean getting the equivalent of four or five cups of
milk a day. Each cup has 290 milligrams of calcium, Cottage cheese is not
or 36 milligrams per ounce. One big misconception is as good a source of cal-
cium as milk.
that people think one serving of cottage cheese, usu-
ally about a quarter cup, equals the calcium in a cup
of milk. Actually, about two cups of cottage cheese
equals one cup of milk, Barte says.
The only foods that surpass dairy products for
calcium content are sardines and salmon, but only if
you eat the soft small bones mixed in the flesh. Sar-
dines have 124 milligrams of calcium per ounce;
salmon, 63 milligrams.

No Time for Nutrition

What if you’re concerned with getting an entire
busy family to eat better?
Marcia and her family are lucky if they see one
another long enough to nuzzle up and say, “Hello,
stranger.’ Both she and her husband work, and he’s
on the road a day or two each week. When her two
teenage sons aren’t in school, they’re at band practice
or a swimming meet. Marcia gave up on sit-down
meals when she realized the only family member will-
ing to show up on a regular basis was the dog.
Now meals are whenever they’re hungry and
whatever they manage to scrounge out of the refriger-
ator. She tries to keep it stocked with foods the kids Meals on-the-run can
like and can easily fix themselves—ground beef, tuna, fall short of the B vita-
mins and two essential
cheese, eggs, hot dogs and beans, bread, milk, cold minerals.
cuts, frozen pizzas. And, of course, sodas, potato
chips and ice cream. Her kids would mutiny if she
didn’t keep those things around the house. She’s
about the only one who eats the salad fixings she
 Achieving the Nutrient-Rich Lifestyle

brings home. She’d like her family to eat better, but

where to start?
The dangers in this diet are too much fat and
sugar and too little fiber, B and C vitamins, and miner-
als like magnesium and potassium, Havens says.
“If Marcia were willing to commit even a few
hours a week to cooking, she could make a huge pot
of nutritious soup with beans, brown rice and all kinds
of vegetables, keep part in the refrigerator and freeze
some for use later. | do that myself, and I’m a busy
professional.”
Planning ahead by making and freezing large
batches of other good foods—chili, corn bread,
Planning ahead is the beans (which could later be refried for tacos), pizzas
key to nutritious meals. cut up into individual slices—could actually save Mar-
cia time in the long run. And having cut-up crunchies
or low-sugar sweets like homemade oatmeal cookies
within a hungry hand’s reach might help wean her
sugar-loving adolescents off their regular fix.
A more realistic solution, says Dr. Lachance,
would be to simply supplement the family’s fast foods
with items to make a complete meal. “If you’re eating
a hamburger or a pizza, which is not such bad food,
make sure you have a salad and a glass of skim milk,
too, not a soda,” he says.
And you can choose convenience foods with an
eye toward more nourishment and less fat and salt.
Choose convenience Look for stir-fry meat and vegetable combinations
foods carefully. and dieter’s dinners, and pick store-brand frozen veg-
etables without butter or sauces.
Anyone’s eating habits may contain a nutritional
danger zone or two. In the next chapters, we'll take a
closer look at how these problems arise, their effect
on health—and what you can do to fill in any nutri-
tional gaps.
 Chapter y
Confronting the
“Secret Threat” of
Marginal Deficiencies

our doctor has had you tested for everything

from strep throat to cancer, examined you from
head to toe, and now he’s scratching his head.
His notes on your chart tell all: “Patient reports
irritability, diminished appetite and weight loss.
Chronic insomnia. Apparent malaise. All tests nega-
tive. Cause of symptoms: unknown.”
He suspects advancing age or excessive worry
and wonders if he’s overlooking something.
Maybe he is. Without even knowing it, your doc-
tor couid be staring at a textbook case of marginal
nutritional deficiency—a middle ground where you're Not sick, but not really
neither optimally nourished nor suffering from classic well? Check for vitamin
or mineral depletion.
signs of severe vitamin and mineral depletion (ike
scurvy or beriberi). You feel lousy, but not lousy
enough to go to a hospital. Or you feel normal, just a
little under par. And whatever symptoms you have are
too general (too nonspecific, as physicians say) to
point directly to a particular disease.

The Mystery behind

Hidden Deficiencies
“Generally speaking, doctors can’t detect mar-
ginal, or subclinical, deficiencies through conven-
tional techniques,” says Myron Brin, Ph.D., a nutrition Subtle deficiencies are
researcher at Hoffman La Roche in New Jersey. “Un- hard to detect.

less a doctor does appropriate biochemical testing

10 Achieving the Nutrient-Rich Lifestyle

[the kind designed to assess nutrient levels], he can’t

tell if the general symptoms indicate a marginal defi-
ciency. Most often it is difficult to connect the symp-
toms to vitamin or mineral depletion—they
re just not
classic enough.”
Yet for over ten years, scientists and clinicians
have been documenting this middle realm and taking
the terrain seriously. The accumulating evidence is
changing ideas about what is and is not a defi-
ciency—and demonstrating that ignoring marginal
cases can be a big mistake.
“Marginal vitamin deficiencies may have differ-
ent effects on the body’s metabolism, which depends
There are many health on the stage of life and the demands facing its normal
probiems associated development,” says D. I]. Thurnham, a London expert
with marginal nutrient
deficiencies.
on human nutrition. “Growth restrictions, degenera-
tive changes in tissues, fetal abnormalities, interfer-
ence with milk production or composition, increased
susceptibility to infection, altered response to dietary
constituents, diminished work ability are among the
possible effects of chronic marginal restrictions in the
diet” (Proceedings of the Nutrition Society).
But not everyone who feels out of sorts is border-
ing on nutritional deficiency, and most Americans
seem to be getting all the food they want. So just how
widespread can subclinical deficiencies be?
“The problem is much more pervasive than
many people realize,’ Dr. Brin says. “Certainly you
Vitamin and mineral de- cannot assume that a person who isn’t getting his
ficiencies are more com- Recommended Dietary Allowance [RDA] of a specific
mon than many people
realize. nutrient is in a state of marginal depletion, since it
takes time for such a state to occur. But it is clear that
the diets of large segments of the population are not
meeting the RDA for certain vitamins and minerals.
And such nutritional shortfalls can eventually lead to
marginal status.”
Indeed, several large-scale government surveys
of nutritional well-being have already shown that nu-
trient deficits are surprisingly common. They revealed
 Confronting the “Secret Threat” of Marginal Deficiencies 11

that approximately one-half the U.S. population gets

less than the RDA of one or more vitamins and miner-
als and that the nutrients most likely to be marginal
are magnesium, calcium and iron and vitamins A, B,
and C.
Nongovernment studies tell a similar tale of nutri-
tional poverty and confirm that some Americans are
more likely than others to drop below the line. They Certain people are at
show that menstruating women, expectant mothers, higher risk than others.

schoolchildren, teenagers and the elderly may be es-

pecially prone to low nutrient levels.

A Downward Slide
in Vitamin and Mineral Levels
But researchers are doing more than merely
demonstrating that marginal deficiencies may
threaten a lot of people. They’re also digging up data
on exactly what such depletions can do to the human
body—and they’re burying an old nutritional notion
along the way.
The traditional view has been that if you don't
have scurvy or rickets or some other classic manifes-
tation, you must be adequately nourished. So among You don’t have to have
doctors the idea of a marginal nutrient deficiency has scurvy to be low on
vitamin C.
been about as prevalent as belief in marginal broken
legs. But now it’s clear that a deficiency state—
whether marginal or classic—is the result of a long
chain of cellular reactions. And a reduced nutrient
level can set off a whole series of dire reverberations
long before classic symptoms appear.
Much of the evidence for such biochemical cata-
clysms has come from so-called depletion experi-
ments—studies in which people were monitored for
changes in their body or mental state as certain nutri-
ents were limited.
Several experiments revealed that when people
were put on lowered intakes of vitamin C, thiamine
12 Achieving the Nutrient-Rich Lifestyle

(B,) or riboflavin (B,), they actually developed be-

Studies show that too havior problems. Researchers reported cases of hypo-
little B,, B, or vitamin C chondria, depression, hysteria and even psychopathic
may cause depression.
abnormalities, all of which disappeared when the sub-
jects got adequate doses of the depleted vitamin.

Clues to Low Vitamin Levels

Meanwhile, Dr. Brin, one of the pioneers in such
work, has been able to identify three consecutive
phases of marginal vitamin deficiency in the body.
“In the preliminary stage,” he says, “the tissue
stores of the nutrient are gradually depleted.” Be-
cause of either low intake, poor absorption or abnor-
mal metabolism, the body’s nutrient silos get secretly
emptied, and there’s no physical damage to signal the
deficit.
“Then,” says Dr. Brin, ““there’s the biochemical
stage, in which tissue stores are sufficiently depleted
to result in reduced rates of biochemical reactions,
which require the presence of the particular nutrient.”
In this phase comes silent destruction: Enzymes
responsible for energizing bits of biochemistry break
Silent destruction is the down because the crucial vitamin is missing. And
second step of vitamin there isn’t the slightest clue in the body’s appearance
deficiency.
or growth to disclose the hidden ruin.
Such clues start showing up only in the next
physiological stage. “Here,” says Dr. Brin, “tissue and
biochemical depletion become so severe that there
are behavioral and psychological manifestations of
nutritional inadequacy.”
The symptoms range from sluggish thinking to
psychoses—and can easily be mistaken for ordinary
human frailties. Beyond this phase lies deep deple-
tion, with all its classic insignia.
“The rate of depletion varies from nutrient to
nutrient,” Dr. Brin says. “For example, a person may
reach the biochemical stage for thiamine in only two
days of deprivation. For vitamin C it may take from
two weeks to two months.”
 Confronting the “Secret Threat” of Marginal Deficiencies 13

Older, but Not Always Wiser

All this has looming implications for the diagno-
sis and treatment of disease, especially for mental
ailments. It’s hard to imagine a group for whom this
deficiency/brain connection has more relevance than
the elderly, who are known to be singularly prone to
nutritional shortcomings.
James S. Goodwin, M.D., and his colleagues, of
the University of New Mexico School of Medicine in
Albuquerque, would second that. They recently inves-

Curbing Vitamin Deficiencies in the Elderly

Elderly people who live in retire- ‘Vitamins A and C are impor-
ment homes are at risk of develop- tant in wound healing,” Dr.
ing nutritional deficiencies, ac- Heimburger continues, ‘“espe-
cording to a group of doctors who cially for patients recovering from
studied the residents of four surgery. Lung and urinary tract in-
homes. That is, if they don’t take fections are common in the el-
supplements. Of the 244 people derly, and it is possible that vita-
the doctors examined, 62 percent min C would have a role here. For
of those who did not take vitamins instance, C plays a part in the
had some deficiencies, but only function of white blood cells
10 percent who used supplements [scavenger cells] and also acidi-
had deficiencies. Thiamine defi- fies the urine to inhibit infection in
ciency showed up most fre- the bladder.
quently, followed by riboflavin “Thiamine deficiency is most
and vitamins A and C. implicated in the decreased men-
What are the implications for tal capacity often seen in nursing
these people? According to Doug- home __ residents,” adds _ Dr.
las Heimburger, M.D., of the Uni- Heimburger. “The confusion and
versity of Alabama Medical Cen- meandering thoughts in the el-
ter, an expert on the nutritional derly are frequently attributed to
needs of hospitalized patients, Alzheimer’s disease or the effects
various nutritional deficiencies of just sitting around all day. But it
can have a dramatic effect on the can also be caused by a thiamine
well-being of the elderly. deficiency.”
 Achieving the Nutrient-Rich Lifestyle

tigated the possibility that marginal deficiencies could

impair the thinking of men and women age 60 or
older, and their findings suggest ominous possibilities.
‘We knew that institutionalized elderly people
had been shown to improve mentally when supple-
Fuzzy thinking in older mented with vitamins,” Dr. Goodwin says. “But these
people may be due to a subjects had severe nutrient deficiencies and serious
mild vitamin deficiency.
mental impairments. We wanted to determine if mild
deficiencies might also be connected with cognitive
problems. The question is important because even
mild dementia is associated with a striking increase in
mortality in the aged.”
So the researchers selected 260 healthy people
(all of them living at home and showing no classic
symptoms of deficiency), assessed their intake and
blood levels of nutrients, and tested their memory and
abstract thinking.
Analysis of the data revealed that people with the
lowest nutrient levels got lower scores on the cogni-
People with low levels tive exams. Subjects with low blood levels of vitamins
of vitamin B,, or C had B,, or C demonstrated both poor memory and ab-
poor memory.
stract thinking skills. Subjects with low blood levels of
riboflavin or folate showed poor abstraction skills
only (Journal of the American Medical Association).
“The association between marginal deficiency
and impaired cognitive functioning was impressive,”
says Dr. Goodwin, “though we cannot yet say for sure
that the one causes the other. But considering previ-
ous evidence, | think it likely that in older people
subclinical deficiencies can indeed lead to less-than-
optimal mental performance.”

Pregnant Women
Are Most Vulnerable
_ And if marginal status can possibly harm the
elderly, can it also threaten people even more nutri-
tionally vulnerable—such as pregnant women?
 Confronting the “Secret Threat” of Marginal Deficiencies 15

Researchers at the University of California think

so. Recently they conducted a study to find out what
marginal zinc deficiency would do to pregnant rhesus Pregnant women need
monkeys. Previous studies had hinted that zinc defi- the best nutrition they
can get.
ciency may be harmful to pregnant women, but the
cause-and-effect relationship had never been nailed
down. The California investigators were hoping to
clarify the causal connection by restricting the ani-
mals’ zinc intake and gauging the results—an obvi-
ously unacceptable methodology for pregnant
women.
The researchers fed the monkeys a marginal zinc
diet throughout gestation, and by the third trimester
the resulting damage was apparent.
Despite “otherwise optimal dietary and environ-
mental conditions,” say the investigators, the animals
showed a “compromised physiological condition as Pregnant animals that
reflected in inadequate weight gain; reduced circulat- were deprived of zinc
developed a number of
ing [in the blood] glucose, triglycerides and vitamin A; health problems.
slight iron deficiency anemia and reduced immune
response.” As you would expect, a control group of
pregnant monkeys that were fed an adequate zinc diet
had fewer problems (American Journal of Clinical
Nutrition).
These findings, say the researchers, have signifi-
cant ramifications for humans, suggesting that even a
not-so-classic zinc deficit can produce serious ab-
normalities during pregnancy. This is simply another
piece of evidence that subterranean nutrition can be
dangerous ground—and that life is safer in the higher
dietary elevations.
 Chapter 5

Nutrition for Women,

Nutrition for Men

tudies show that men and women have differ-

ent tastes in food—and different nutritional
needs.
Food preference surveys, for instance, show that
men are nearly twice as likely as women to eat what-
Men and women are not ever they want, and what they want is a tender but
created equal. fatty cut of red meat. That’s one reason that even in
these health-conscious times, the typical man’s diet is
too high in fat and sometimes low in the vitamins and
minerals that are found in fruits, vegetables and dairy
products.
Women like meat, too, but they also want fruits
and vegetables. Their food shopping and cooking
skills make them likely to be more nutritionally aware
than men, but they also have special dietary demands,
particularly during pregnancy. And they’re twice as
likely as men to be watching their weight, possibly
eating too few calories to supply all the nourishment
they need, especially during their childbearing years.
The National Academy of Sciences’ Recom-
mended Dietary Allowances (RDAs) reflect most, but
Men need more B vita- not all, of the differences in nutritional requirements
mins than women—but between the sexes. At every age men require 10 to 30
half as much iron.
percent more protein, vitamins A, E and B,, thiamine
(B,), riboflavin (B,), niacin and magnesium than
women. They require equal amounts of vitamins D, C
and B,., folate, calcium, phosphorus, zinc and iodine.
They require only about half as much iron.
 Nutrition for Women, Nutrition for Men 17

Women who are pregnant or breastfeeding have

the highest nutritional requirements. They need vita-
mins and minerals in amounts equal to or greater than
those required by men. In some cases—with folate
and calcium, for instance—their needs jump dramati-
cally. Not meeting those needs can result in low-birth-
weight babies or seriously impair the mother’s health.

Are You Getting Enough Iron?

Iron is one nutrient women need more of than
men, according to the National Academy of Sciences.
Menstruating women require almost twice as much
iron as men (18 milligrams compared to 10 milli-
grams). And pregnant women may need 30 to 60
milligrams of iron each day.
Nutritional surveys show that about 40 percent of
women of childbearing age don’t get enough iron,
says Cecilia Davis, a registered dietitian and former
president of the nationwide dietitian’s referral service,
the Consulting Nutritionist Practice Group.
“Women absorb only about six milligrams of
iron per 1,000 calories of food in a typical diet,”’ she
says. “They would need to eat about 3,000 calories a Unless a woman eats
day to meet their iron RDA. Few eat that much, so 3,000 calories a day,
she may need extra
many women need supplemental iron.” iron.
Teenage girls are even worse off, Davis contends.
“Td say 80 percent could be iron deficient. Some eat
as few as 1,000 calories a day, and their food prefer-
ences are poor in iron.”
Among teenagers, boys can also develop iron
deficiencies, sometimes rather quickly when they start
the rapid growth of adolescence. There is an enor-
mous demand for blood-building materials at this
stage. “And I'd say this is more likely to be overlooked
in boys than in girls,” Davis says.
Both men and women may sometimes become
iron depleted during very strenuous athletic training,
says Paul Zabetakis, M.D., a research physician at the
18 Achieving the Nutrient-Rich Lifestyle

Institute of Sportsmedicine and Athletic Trauma in

Athletes can risk low New York. In superathletes, strenuous exercise can
iron levels. actually break down red blood cells and lead to ane-
mia (iron deficiency).
Dr. Zabetakis cautions that average runners as
well as ultramarathon athletes may also develop
‘‘pseudo-anemia.” Blood tests will show lower-than-
normal iron levels, but the larger volume of blood
they have developed as a result of their athletic activi-
ties means their oxygen-carrying capacity remains the
same. They'll have no physical symptoms of anemia.
When most adult men (and women past meno-
pause) develop iron deficiencies, though, diet or exer-
Overuse of aspirin or al- cise is rarely the cause, says Robert McGandy, M.D., a
cohol can cause blood Tufts University professor of medicine and consulting
loss—and iron loss. oe
doctor for the Boston-based Human Nutrition Re-
search Center for Aging. Internal bleeding—ulcers,
intestinal polyps, excessive aspirin or alcohol use,
even hemorrhoids—are too often the cause. “In this
case, it’s important to be checked for blood loss and
not to try to cure yourself with an iron supplement,”
Dr. McGandy says.
Anyone, but especially men, small children and
postmenopausal women, can develop iron overload.
Too much iron is as bad They can take in so much iron that it builds up in their
as too little—but not
nearly as common.
liver or spleen
oe
and begins to cause
:
damage. (It
:
can,
also make it difficult to travel by air. One man with this
problem found it impossible to get by the metal detec-
tor at an airport. He’d been getting frequent blood
transfusions for a medical problem.)
“Nobody is going to get an overload, though,
unless he’s getting at least five to ten times the RDA,”
Dr. McGandy says. “No man is going to get this just by
taking his wife’s multivitamin with iron.”

Too Little Folate and Bg—

Women Pay the Price
Sometimes what masquerades as an iron defi-
ciency is actually a folate problem. One common
nutritional problem in the United States is a low intake
 Nutrition for Women, Nutrition for Men

of this B vitamin. People just aren’t eating enough Dark green leafy veg-
folate-rich dark green, leafy vegetables, and women, etables are rich in fo-
late.
especially, pay the consequences.
Anemia can occur when there is not enough
folate in the body to produce red blood cells. Among
older women, especially, folate rather than iron may
be the culprit in this problem. And folate deficiencies
have been implicated in cervical dysplasia, a condi-
tion that can lead to cancer of the cervix. The vitamin
has also been found to reverse the disease in some
women.
Pregnant women need to double their folate in-
take from 400 to 800 micrograms, and those who are
breastfeeding need 500 micrograms. “Folate is Pregnant and nursing
needed for the manufacture of all cells,’ Dr. women need folate.
McGandy says. That’s why it’s so important to fetal
growth and growth of the newborn baby. In fact, both
spina bifida, a birth defect in which the tissue around
the spinal cord doesn’t close properly, and cleft pal-
ates have been associated with low folate intake. In
one study, women who had had one baby with spina
bifida were much less likely to have a second baby
with the same problem if they got adequate folate.
Vitamin B, has been associated with “women’s
problems” for some time now. It’s been used to treat
fluid retention and other symptoms associated with Taking birth control
premenstrual syndrome. It’s also been prescribed for pills? B, may be low.
women taking birth control pills, who often have
lower blood levels of this vitamin. Mood changes, like
depression, that some women taking birth-control
pills experience, have been attributed to lower levels
of B,, which some researchers speculate may lead to
decreased production of the brain neurotransmitter
serotonin. See your doctor if you think you need more
than the RDA of B,. High doses have been associated
with neurological changes.

Building Better Bones

The RDA table (see pages 637-43) lists the same
calcium requirements, 800 milligrams a day, for men
20 Achieving the Nutrient-Rich Lifestyle

and women. As we mentioned in chapter 1, this does

not reflect the growing belief among nutritionists that
women need more than this amount to prevent the
brittle, porous bones of osteoporosis. Some feel that
younger women need 1,000 milligrams and post-
menopausal women up to 1,500 milligrams a day of
calcium to help protect against this disabling disease
of older women.
The problem is that many women don’t even get
800 milligrams a day, Davis says. Calcium deficiencies
among women are second only to iron. The average
daily intake of calcium for women is 600 milligrams.
Next to iron, calcium is the mineral women most
often miss out on.
“Getting 1,000 milligrams a day of calcium
means consuming three or four servings of high-cal-
cium foods, mostly dairy products,” Davis says. “Al-
though you can get this amount of calcium through
foods—and that’s the best way—it does take quite a
bit of attention to do so without taking in a lot of
calories.”’ Low-fat dairy products or calcium supple-
ments provide bone-building material without the fat-
building side effects.

Real Men Need Vitamin C

You might think scurvy disappeared along with
pirates and wooden galleons, but that’s not what
some doctors have found.
It’s true that in these days of year-round availabil-
ity of fresh fruit and instant breakfast juices, scurvy is
Would your doctor rec- uncommon in the United States. Most people get at
ognize scurvy if he least the ten milligrams of vitamin C needed to ward
saw it?
off this disease.
Most, but not all, as doctors at the Veterans Ad-
ministration Medical Center in Portland, Oregon, re-
cently discovered. Each of the three men they saw
had swelling, pain and purplish bruising of their legs,
along with other symptoms like gum disease, fatigue,
blood in the stools or, the classic scurvy tipoff, cork-
screw hair. Two of them had undergone extensive
 Nutrition for Women, Nutrition for Men 21

medical testing to try to determine the cause of their

symptoms.
But it was an analysis of their diet and a check of
their blood levels of vitamin C that led to the correct
diagnosis—scurvy. It turned out all three lived alone Men who live alone and
and cooked for themselves or ate out. Each admitted cook for themselves
may skimp on vitamin C-
he rarely ate fresh fruits or vegetables. Supplemental rich foods.
vitamin C eliminated their symptoms in just a few days
(Joumal of the American Medical Association).
Because scurvy is rare, physicians may not recog-
nize it when they see it, the Portland doctors say. Men
who live alone and cook for themselves, especially
the elderly or heavy drinkers, are among those at
highest risk for developing scurvy, they point out.

The Nutritional Bonus

in Fruits and Vegetables
Turning up their noses at fruits and vegetables
can have other consequences for men. “We tend to
see too little fiber in their diets,’ says Rebecca Too little fiber—and too
McCully, R.D., administrator of Greenhouse Diet Ser- much fat—compound
nutritional losses.
vices and consulting nutritionist for the Cardiovascu-
lar Clinic in Oklahoma City. “Men who have very
sedentary jobs and eat low-fiber diets are more likely
to develop chronic constipation. Women are less
prone to this problem because they tend to eat a lot
more fresh fruits and vegetables.”
Admittedly, the men she sees may eat less well
than some—after all, they've had heart problems.
“The biggest problems | see in people’s diets are
excesses—too much fat, salt, calories,” she says. Nu-
tritional deficiencies are much less common, at least
in the middle-class midwestern men she sees. In any
case, her advice applies equally well to men and
women.
‘I tell my people that their doctors aren't respon-
sible and their spouses aren’t responsible for what
they put in their mouths. They are, and they must
accept that responsibility and learn to make healthy
food choices and decisions.”
22 Chapter 4
Vitamins and Minerals
for Singles

f you're one of the 23.2 percent of the American

population living in what the census bureau calls a
one-person household, it’s a safe bet your diet makes
World War II C-rations look like health food.
‘What do I usually eat?” says a 31-year-old single
personnel consultant in Washington, D.C. “TV din-
ners, M&M’s, Haagen-Dazs ice cream every Sunday
night. I wouldn’t eat this way if I weren't single. |
wouldn’t be so careless. But I want you to know I’ve
seen the error of my ways... all 20 pounds of the
error of my ways.”
Like this reformed careless consumer, many sin-
gles atone for their dietary indiscretions only after
Sad but true: Many sin- they learn the direct relationship between their waist
gles are undernourished. size and the number of disposable single-serving food
packages in their trash. But the damage they do with
their quickie over-the-sink meals and their fast-food
feasts is far from merely cosmetic. Next to the poor,
they may be the most undernourished people in
America.

Living Alone?
Nutrition Can Suffer
George Demetrakopoulos, M.D., M.PH., is medi-
cal director of the Medical Nutrition Center of greater
Washington, D.C. Among the patients who come to
him for nutritional assessments are people who
should know about nutrition: employees of several of
the government’s top health-regulation agencies. But,
 Vitamins and Minerals for Singles 23

he says, it doesn’t seem to give them an edge if they’re

single. In a study of 40 single men and women be-
tween 25 and 45, he found most were deficient in
zinc, folate and B,. The women were also deficient in
calcium and were getting only 57 percent of their
recommended daily allowance of iron.
“These are not typical people,’ says Dr.
Demetrakopoulos. “These are nutrition-conscious
people. They should have performed above average,
but they didn’t. Imagine,” he says, “the ones who are
not as informed.”
Though the research is meager, it seems to show
that living alone is a significant nutritional risk factor,
even if you’re nutritionally savvy. In fact, eating for
one seems to be most perilous for young single
women who are aware consumers and older single
men who don’t know their way around the kitchen
without a guide.
Researchers at Auburn University took a look at
the diets of 50 single professional women, most of
whom usually made food lists and menu plans and Single professional
avoided convenience foods. Despite those good in- women fall short on cal-
cium, iron, vitamin A
tentions, their diets were low in calories, calcium, and thiamine, says one
iron, vitamin A and thiamine (B,).What’s more, their study.
good food habits seemed to be done in by their fre-
quent lunches out.
In a study of 3,477 people between the ages of 65
and 74, researchers at the University of California and
the University of Texas found that poor men living
alone had the lowest intake of milk products, fruits,
vegetables, meat, poultry and fish of any group. And
they were more likely to be getting less than two-
thirds of the Recommended Dietary Allowance
(RDA) of protein, riboflavin, vitamins A and C, and
other nutrients.

Why Singles
Don’t Always Eat Right
Busy schedules, dieting, lack of motivation or
cooking skills, even loneliness and depression can
24 Achieving the Nutrient-Rich Lifestyle
ee

contribute to meager mealtimes for many singles, say

the experts. And unfortunately, there’s usually no im-
mediate retribution for bad diet that might persuade a
fast-food aficionado to change his ways.
‘Most nutritional problems don’t manifest them-
selves right away, so it’s easy to cheat,” says David
Don’t let loneliness or a Ostreicher, D.D.S., professor of nutrition at Bridgeport
busy schedule rob you University in Connecticut, who is single. “If you’re not
of good nutrition.
getting enough vitamins A and C, you might not know
until 20 years later when you develop cancer. If you’re
eating a diet high in saturated fats and salt—the sta-
ples of most convenience foods—you might not
know until you have your first heart attack at age 50.”

How to Upgrade
a Singles’ Diet
So what do you do? “Get married,” jokes Dr.
Demetrakopoulos. Or, failing that, simply steal some
tricks from your wedded friends who are following a
better diet.
Cook for four. “Never, never cook for one,”
says Dr. Ostreicher. “Cook for four, eat one serving
and freeze the rest in individual servings. You'll be
making your own convenience foods, you'll pay less
for it and you will be eating better.”
Make shopping lists. “All my married friends
have lists; none of my single friends do,” says Dr.
A shopping list reduces Ostreicher. Why a list? First, it will make you plan your
temptation and helps weekly meals. And it will keep you from straying into
build nutrition into your
menu. dangerous territory: the family pack of cookies that
looks too good to pass up, 500-calorie-a-slice frozen
pizza and the special on heavenly hash ice cream.
Needless to say, don’t go shopping when you're
hungry and, advises Dr. Ostreicher, have regular shop-
ping days, so you aren’t tempted to dash into the deli
for a hot pastrami on the way home because there’s
nothing in the fridge.
 Vitamins and Minerals for Singles 25

Shop with a friend. Going on the premise that

everything is better with a friend, try shopping on the
buddy system. Your companion will be your con- Two singles are better
science. “If you have a companion, you can discuss than one—shop with a
friend.
what you're going to buy and make with the other
person,” says Dr. Demetrakopoulos. “Alone, you'll
wind up buying things you’d be better off without.”
Steer for the freezer section. Many singles
have given up on fresh vegetables because they are
forgotten and then grow moldy in the refrigerator
before the week is up.
‘Psychologically, that stops you from buying
vegetables the next time,” says Dr. Ostreicher. “But
right next to the frozen convenience foods, you'll find Upgrade your diet with
plastic bags of vegetables with nothing added that are frozen foods.
just as nutritious as fresh. You can reseal the plastic
bags so you can use what you like and freeze the rest.
You don’t pay more, and they don’t give you all that
excess salt and fat.”
Don’t buy big. Those family packs and mam-
moth cans may be cheaper, but they’re no bargain if
you have to throw half of the food away. If you want
to buy the bigger packages, consider sharing them
with a friend. And if you see a cut of meat or produce
you like in a larger package, ask a store employee to
repackage it.
Develop good eating habits. If you have to,
pretend you're eating with a friend. Would you eat a
chicken leg over the sink or swig milk right out of the Avoid ‘‘stand-up’’ meals
bottle if you had a dining companion? Then don’t do and snacks.
it when you're alone. “Always set the table,” says Dr.
Ostreicher. “You decide how—with a tablecloth or
place mats. Candlelight might be excessive, but get
into the habit of having a place setting, even if you’re
just grabbing a piece of fruit.
“When you live alone, you often get into the
habit, when you've got nothing to do, of standing in
front of the open refrigerator snacking. Always eat at
the table, always with a place setting.”
26 Achieving the Nutrient-Rich Lifestyle

Make Dining a
Pleasant Experience
Lynn Shahan, author of Living Alone and Liking
It!, says that during her first year eating alone, she
Make dining an adven- became “‘a pretty skinny kid’’ because mealtime, pre-
ture. And share meals viously spent with family and friends, lost its appeal.
with friends.
Her solution for happier soloing at the dinner table
was to buy new and interesting foods and experiment
with recipes, so eating became more of an adventure.
Share your meals. Invite friends or neighbors
for dinner. Start a cooking club with your fellow sin-
gles. Call your local agency on aging to find out if your
neighborhood provides free or low-cost meals for
older people at community centers or churches.
Or join a group like Single Gourmet, a New York-
based organization that tackles the problems of eating
alone by arranging for up to 100 singles to eat out
together seven to ten times a month.
Cofounder Art Fischer says that not only will it
improve your social life and your outlook but it may
also improve your digestion. “Doctors have told us
that one of the problems with single people eating
alone is they not only eat all the wrong food, they eat
too fast, which can cause digestive problems,” says
Fischer, whose group numbers 3,000 members in the
New York metropolitan area. “In a group like ours,
you'll spend two to three hours eating a meal that, if
you ate it alone, would be gone in a matter of minutes.
People tell us that they’ve never been able to eat garlic
before without getting indigestion, but when they eat
it at a Single Gourmet dinner, it doesn’t bother them at
all. Really, it’s the single lifestyle that doesn’t agree
with them.”
The psychological boost of having pleasant com-
panions and good food is inestimable. ‘One is a very
lonely number,” says Effie Seaman, a writer who
joined Single Gourmet after the death of her physician
husband. “This gives you a reason to get dressed and
go Out, wearing your finery, which is far better than
sitting in front of the TV with a sandwich.”
 Vitamins and Minerals for Singles an

Dine Out Wisely

Ned Schnurman, executive producer of the ac-
claimed PBS television series /nside Story, regards
eating out “as a form of theater.” Dine out—but eat
“Eating is one of my principal interests. I eat out smart.

300 nights a year,” says Schnurman, who is in his

midfifties and single. By all logic, Schnurman should
be as wide as he is tall. Instead, even with his rigorous
restaurant schedule, he managed to lose 25 pounds in
the last few years. How? He eats out wisely. When he
chooses a dinner spot to please his palate, he adjusts
his other meals accordingly. A light breakfast and
lunch are the perfect preludes to the “good saloon
fare” he favors: simply grilled chicken, fresh vegeta-
Dles and “a little wine. . . very little.” He avoids heavy
- sauces and bypasses the dessert cart for fruit. “I don’t
think it matters where you eat,’ says Schnurman.
“Even if you eat out as much as I do, you can make
sure you're eating things of good nutritive value.”
Choose light fast-food fare. ‘It’s a real break
for singles that most fast-food restaurants now have
salad bars,” says Dr. Ostreicher. “But if you want to
have a burger, have a plain burger. Don’t order the
fancy burger with the special sauce. And especially
don’t order a cheeseburger.’’ Keep in mind that al-
most 90 percent of the calories in cheeses and special
sauces come from fat.
You may want to consider supplements, if neces-
sary. “People will not make drastic changes in their
diets, so | recommend supplementation,” says Dr. Don’t rely on supple-
Demetrakopoulos. Most women need calcium, he ments alone to make up
for poor eating habits.
says. And most of the patients he has tested don’t get
even a third of the RDA of zinc (15 milligrams). But
most single people are going to have to face up to it: A
bad diet can’t be rescued by pills entirely. “Going to
the trouble of taking supplements when your diet is
grossly inadequate,” he says, “‘is like having a nicely
painted house with no windows.”
28 Chapter 5
Better Nutrition
for Kids

etting kids to eat right is easier said than

done. Ask any mother of a two-year-old who
locks his jaw whenever she tries to spoon-feed him
carrots. Meanwhile, his older brother trades his nutni-
tious tuna-on-whole-wheat sandwich for a triple pack
of cupcakes in the school cafeteria.
How can parents possibly know for sure whether
children are properly nourished—getting at least the
Recommended Dietary Allowances (RDAs) for vita-
mins and minerals?
“Everyone who has any kids knows that they
don’t eat right every day,” says Lendon Smith, M.D.,
It’s unrealistic to expect an Oregon pediatrician and author of Dr. Smith’s Diet
kids to eat right every Plan for Teenagers and Feed Your Kids Right. “Even
day. The overall diet is
what counts.
though we'd like them to, it’s unrealistic to expect it.
You should look at the overall diet. It’s okay if your
child doesn’t get the RDA every day. But is he getting
it every week?” (Consult Appendix A to find out how
much of each nutrient children should be getting.)
Another thing to remember is that getting less
than 100 percent of the RDA for a nutrient does not
Don’t worry about occa- necessarily mean you will become instantly un-
sional lapses. healthy. Scientifically, a nutrient isn’t considered on
the low side until your intake falls below 67 percent of
the RDA, and even then, a deficiency disease isn’t
imminent. Knowing that alone should make you feel
better if your child lives on nothing but bananas and
graham crackers for a day or two.
 Better Nutrition for Kids 29

Vitamins and Minerals Kids

Miss Out On Most
Not surprisingly, certain vitamins and minerals
are more likely than others to be in short supply in a
child’s diet. One study conducted at the University of .
Washington in Seattle tested a group of healthy chil-
dren from the ages of 32 to 9 to see how they fared
on the RDA for vitamin C and the B vitamins thiamine
(B,), riboflavin (B,), B,, B,. and folate—all essential
nutrients in normal childhood development. While
intakes were adequate for most nutrients, some of the
children showed intakes below 70 percent for folate
and B, (Journal of the American Dietetic Association).
Dr. Smith feels that zinc, a trace element that aids
normal growth, also is often low in the average child’s
diet. But it’s iron, more than any other nutrient, he
says, that is most commonly in short supply.
Alvin N. Eden, M.D., agrees. This practicing pedi-
atrician in New York City and associate clinical pro-
fessor of pediatrics at the State University of New A lot of kids lack iron
York, Downstate Medical Center in Brooklyn, says but aren’t actually
anemic.
iron is a very neglected area. “I think there’s a large
group of children out there who are iron deficient
without being anemic. For this reason | think it’s im-
portant for parents to consider giving their children an
iron supplement. In fact, the most important thing |
tell parents is to ‘think iron.’ ”’

Meeting the Recommended

Dietary Allowance
If children would eat liver, the biggest source of
iron, there would never be a deficiency problem. Nor
would a deficiency of zinc, selenium, chromium, vita-
min A, riboflavin, B,, and folate ever occur. Unfortu-
nately, when it comes to liver, most kids consider
going to bed without any supper the better alternative.
(continued on page 32)
 Achieving the Nutrient-Rich Lifestyle

Getting Kids atrician Lendon Smith, M.D., to as-

to Eat Better: sess a typical day’s menu for two
typical children—Josh, age 11, and
A Doctor Shows How
his sister, Elizabeth, age 7. Menu A
lists Elizabeth’s intake for one day.
Many a parent wonders how a kid Menu B lists Josh’s. Neither meets
can survive on peanut butter and the daily allotment for all nutrients.
more peanut butter. We asked pedi- A computer analysis reveals that

MENU A
Menu of a Typical Dr. Lendon Smith’s Dr. Smith’s Comments
7-Year-Old Girl Improved Menu

& Breakfast
Ye cup sugar-coated ce- ¥% cup Grape-Nuts with “The Grape-Nuts will provide more
real with 4% cup low- raisins and % cup across-the-board nutrients (and less
fat milk low-fat milk sugar!) and the raisins a little extra
Ys cup orange juice 1 whole orange or 2 shot of this day’s allotment of iron.
(store brand) cup fresh orange A whole orange is more likely to
juice have more vitamin C, bioflavonoids
and fiber.”

@ Lunch
1 peanut butter and 1 peanut butter and ba- “It goes without saying that a ba-
jelly sandwich on a nana sandwich on nana is a far more nutritious choice
potato roll whole grain bread than jelly. Whole wheat bread might
1 package cheese and Thermos of homemade be a better choice to help give her
crackers soup, such as more B vitamins. The thermos of nu-
1 cup cran-raspberry chicken noodle or tritious soup will help fill a child up
Juice vegetable and help eliminate her desire for
3 Oreo cookies 1 cup apple juice cookies and candy. Apple juice will
1 peanut butter cup 3 oatmeal cookies help bolster this day’s low iron allot-
Celery stuffed with pea- ment, as will the oatmeal cookies.”
nut butter

@ Dinner
About 1 ounce baked 2 ounces baked ham “With the exception of the gelatin
ham 1 spear broccoli dessert, this is a decent meal, al-
1 bite steamed broccoli Ye cup scalloped pota- though the child may have eaten
Y% cup scalloped pota- toes, made with car- more had she not had such a large
toes, made with car- rots and onions lunch or so much sugary food at
rots and onions Ye cup applesauce breakfast and lunch.”
Ys cup gelatin dessert 1 cup low-fat milk
with a bit of
applesauce mixed in
¥% cup low-fat milk
 Better Nutrition for Kids

both diets are on the low side for to naturally add extra nutrients to
iron and zinc. Elizabeth’s diet for your child’s diet. In fact, with Dr.
this particular day is also low in Smith’s revision, Elizabeth’s total
some of the B vitamins, and Josh’s nutrient intake soared to over 100
falls short for vitamin A. percent. Josh’s vitamin intake more
By making a few substitutions, than tripled, and his calcium, zinc
adjustments and additions, Dr. and iron levels were boosted as
Smith illustrates how easy it can be well.

MENU B
Menu of a Typical Dr. Lendon Smith’s Dr. Smith’s Comments
11-Year-Old Boy Improved Menu

& Breakfast
Ye cup orange juice 1 whole orange “The fresh orange is included for vi-
2 slices 7-grain bread 2 slices 7-grain bread tamin C, bioflavonoids and fiber.
with peanut butter with “old-fashioned” The milk will help increase calcium.
peanut butter Use homemade—“‘old-fashioned”—
¥Y% cup low-fat milk spread. It doesn’t contain the salt
and sugar that store-bought varieties
contain.”

@ Lunch
1 peanut butter and 1 peanut butter and ba- “As with his sister, this boy should
jelly sandwich on 7- nana sandwich on be weaned from jelly to a more nu-
grain bread whole wheat bread tritious alternative—bananas. The
1 peanut butter and Trail mix (dried fruit, trail mix, unlike granola, will go a
chocolate granola raisin and nut mix- long way in improving the RDA, par-
bar ture) ticularly some of the B vitamins, vita-
1 raspberry fruit bar Carrot sticks mins A and E and magnesium. The
carrots will help restore this day’s vi-
tamin A supply.

@ Dinner
1 slice meat loaf, made 1 or 2 slices meat loaf, “A little extra meat loaf will add ex-
with lean beef made with extra-lean tra zinc and iron, which are low on
2 new potatoes, made beef this day. The butter seems an unnec-
with herb butter 2 new potatoes with essary addition of fat to this diet and
Y cup peas herbs adds nothing in terms of nutrition.
1 potato roll 1 spear broccoli The broccoli helps increase the cal-
1 cup low-fat milk 1 slice whole wheat cium intake.”
bread
1 cup low-fat milk
32 Achieving the Nutrient-Rich Lifestyle

Not to worry. There are plenty of other ways to

get your liver-shy kids to eat right. If you include
certain core foods in the diet each day, the doctors
we spoke to say you'll be doing your best to help your
children meet their RDA.
For breakfast, the most concentrated form of
nutrition is a whole grain cereal and a fruit, either
Breakfast tips for fin- whole or as juice. ‘““Hot oatmeal with applesauce and
icky eaters. raisins tastes great and is very nutritious,” says Dr.
Smith. Or, for a change of taste, try serving leftovers
from last night’s dinner. ‘““There’s nothing wrong with
a chicken leg for breakfast,” he says. “It’s protein.”
Our experts also suggested it’s best to pack a
child’s school lunch rather than depend on what's
How to pack a lunch being served in the cafeteria. Whole wheat bread or
box with nutrient-rich another whole grain should always be used on sand-
goodies.
wiches. It provides needed B vitamins. Peanut butter
is just fine, but eliminate—or at least cut down on—
the jelly. Instead, substitute a banana. Always include
fruit in the lunchbox, too. For snacks, opt for carrot
sticks or trail mix (an assortment of nuts, dried fruits
and raisins).
For dinner, serve lean meat or fish, steamed veg-
etables and fruit for dessert. If you want to feed your
kids pastry, think whole grains, and go for oatmeal
cookies instead of brownies.
Allow your kids to drink only low-fat or skim
milk. “Kids shouldn’t drink too much milk,” says Dr.
Eden. “I think milk is a little overrated. Too much
spoils an appetite, and it’s too high in fat to be good
for you. Two glasses a day is plenty.”
Is there anything else you can do?
Dr. Smith suggests giving a multiple vitamin, “for
insurance, not as a food substitute. It’s good to re-
Supplements are not a member that the RDA is only a minimum and an
substitute for food.
estimate at that,” he says. “And keep in mind that
every child is different. How each person absorbs
nutrients and their degree of wellness can vary.”
 Chapter 6 33

Test Your Nutritional

Know-How

o you know how to make sure you're getting

all the vitamins and minerals you need? Can
you correctly choose between foods that help or hurt
your body?
To test your nutritional know-how, we have com-
piled the following quiz. And here’s a little help: There
may be more than just one correct answer to each
question.

Q. You are on medication for high blood pres-

sure and your doctor told you to be sure to get lots of
potassium. Which of the following drinks should you Which has more potas-
order at lunch? (a) new Coke, (b) mineral water, (c) sium, orange juice or
mineral water?
iced tea, (d) orange juice, (e) a martini.
A. (d). Orange juice is highest in potassium, with
a six-ounce glass providing 354 milligrams. But other
fruit juices are rich in potassium, too. Apple juice,
apricot nectar, grapefruit juice and pineapple juice are
all good sources of the mineral. Mineral water, de-
spite its promising name, is a poor source.
Q. Your kids absolutely refuse to drink a glass of
juice in the morning and rarely eat any fruit or vegeta-
bles, for that matter. Sometimes it seems like all they’ll Should you worry about
eat is meat and potatoes. You’re concerned that how much vitamin C
your kids are getting?
they’re not getting enough vitamin C. You should (a)
consider brainwashing, (b) feed them more yogurt,
(c) feed them more meat, (d) feed them cod-liver oil,
(e) let them keep eating potatoes.
34 Achieving the Nutrient-Rich Lifestyle

A. (e). Luckily, potatoes are a very good source

of vitamin C. One baked potato has 26 milligrams; a
cup of mashed potatoes has up to 20 milligrams.
Tomato sauce is another good source, and since most
kids like spaghetti, that can help boost their vitamin C
intake, too. But you should try to get them interested
in at least some fruits and vegetables, because they're
missing out on a lot of other vitamins and minerals—
and fiber, too.

Q. You're either lactose intolerant, or milk just

doesn’t agree with you. Where else can you get vita-
How to get enough min D? (a) nowhere else, (b) from fresh air, (c) from a
vitamin D—even if you walk in the sun, (d) from leafy green vegetables, (e)
can’t drink milk.
from tuna fish.
A. (c) or (e). Fish and fish-liver oils do contain
vitamin D. So do egg yolks and butter. But the amount
varies. A walk in the sun, however, is a fairly reliable
source. Just 15 to 20 minutes of summer-afternoon
sun every other day can convert enough of the pro-
vitamin D in your skin to vitamin D to fulfill your
requirement.

Q. High blood pressure runs in your family.

You've heard about the link between sodium and
Snacks don’t have to hypertension, and you want to keep the sodium in
be salty. your diet to a minimum. As an inveterate snacker,
which of the following is the best choice to mollify
your craving for munchies? (a) celery sticks, (b) al-
monds, (c) regular twist pretzels, (d) cheddar cheese,
(e) popcorn.
A. (b) and (e). These snacks are the best choice,
provided they are unsalted. A cup of unsalted pop-
cor has only 1 milligram of sodium. A cup of al-
monds has only 4 milligrams, and they're high in
potassium, which may help fight off hypertension.
They’re fairly high in fat and calories, though, so you'll
want to be careful not to overdo it. Celery has more
sodium than you might expect—one stalk has 25 mil-
ligrams. That’s okay as long as you don’t have too
much. Cheddar cheese is high in sodium: 176 milli-
grams in one ounce. Most other cheeses are high in
 Test Your Nutritional Know-How 35

sodium, too, although some low-sodium cheeses are

now available. Forget the pretzels—they have 101
milligrams of sodium each.

Q. You want to get as much calcium as you can

in order to prevent osteoporosis, but your lunch usu-
ally consists of a quick stop at a fast-food salad bar. Calcium from the
Which items from the salad bar should you be sure to salad bar.

heap on your plate? (a) spinach, (b) broccoli, (c)

chick-peas, (d.) Swiss cheese, (e€) croutons.
A. (b), (c) and (d). Surprisingly, spinach is not a
very good source of calcium. It does contain calcium,
but it’s bound up chemically, so that it’s unavailable to
us. The lacy-leaf kale that’s often used to decorate the
salad bar, however, is actually a better source of cal-
cium than the spinach in the salad bowl. One ounce
of kale provides 38 milligrams of the mineral. Of
course, spinach is a fine source of fiber, vitamin A and
B vitamins, so you probably don’t want to pass it up.

Q. To prevent osteoporosis, you faithfully take a

calcium supplement every night before going to sleep.
You've been (a) wasting your time, (b) taking it at the
wrong time, (c) depleting your calcium reserves, (d)
doing exactly the right thing, (e) sleeping on the job.
A. (d). According to Morris Notelovitz, M.D.,
medical director of the Climacteric Clinic in Gaines-
ville, Florida, taking calcium supplements at bedtime
prevents calcium from being leached from your skele-
ton in your body’s attempt to maintain blood levels of
the mineral, as would normally be the case. He also
recommends taking the supplement with some milk
or yogurt, because the lactose in them helps the body
absorb more of the calcium.

Q. You've had a couple of bouts with iron-defi-

ciency anemia and you want to prevent it from hap-
pening again, so you're trying very hard to get lots of Where to look for iron.
iron. Which of the following should you look for on
your trip down the cafeteria line? (a) orange juice, (b)
green peppers, (c) cantaloupe, (d) tomatoes, (e)
three-penny nails.
36 Achieving the Nutrient-Rich Lifestyle

A. All of them except the nails, but not because

they’re high in iron. Orange juice, green peppers, can-
taloupe and tomatoes are all high in vitamin C, so
they’ll increase the amount of iron that you absorb
from other foods you eat at the same meal. In a study
done at the University of Goteberg, in Sweden, a glass
of orange juice served with a meal of hamburger,
string beans and mashed potatoes increased iron ab-
sorption by 85 percent. Some good sources of iron to
look for at the cafeteria are beef liver, beef, poultry,
fish, lima beans, broccoli and peas.

Q. You've been taking birth control pills for sev-

eral years and you've just heard that they’re a com-
On the Pill? Watch out mon cause of vitamin B, deficiency in women. Which
for B,. of the following should you bring home from the
supermarket if you want to stock up on B,? (a) organ
meats, (b) beets, (c) wheat bran, (d_) brown rice, (e)
brown sugar.
A. (a), (c) and (d). Besides these three, other
good sources to stock up on are wheat germ, walnuts,
salmon and blackstrap molasses.

Scoring: 7 to 8 correct answers: Congratula-

tions, you're a Nutritional Merit Scholar. 4 to 6 correct
answers: You've got the basics, now go for the fine
points. 0 to 3 correct answers: Remedial nutrition
study advised.
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USING
SUPPLEMENTS
WISELY
 Chapter 1 41

Who Takes Vitamins

and Minerals?

he’s younger, smarter, more affluent, more

self-reliant and more responsible than anyone
expected. And to top it off, she doesn’t even exist.
She’s an abstraction—a composite of the “typical”
supplement user.
We can thank research surveys for bringing her
to light and for giving us our first clear look at the
profiles and purposes of people who use vitamins and
minerals. Who are they? What nutrients do they take?
Why do they take them? What does supplementation
do for them? The answers to these questions and
others like them are real eye-openers.
For instance: The people who take supplements
(over half the adult population and most women) are
usually college-educated careerists with a household What kind of people
income of $30,000 or more. The data come from a take supplements?
1982 Gallup poll, as well as several other population
studies. The conclusions are crystal clear: People with
higher socioeconomic status are more likely to take
supplements.
“It makes perfect sense,’ states James P.
Frackelton, M.D., a preventive medicine specialist in
Cleveland. “People at the lower end of the socioeco-
nomic scale are more apt to believe the traditional
view that supplements are unnecessary. But those
higher up the ladder—those more informed on nutri-
tional matters—are more likely to reject that view and
take the supplements they think they need.”
42 Using Supplements Wisely

What People Take and When

Are people who take supplements more nutri-
tionally aware than those who don’t? Theoretically,
yes. But the theory gains some credence when you
look at how people use supplements day to day.
According to a massive survey conducted by
Simmons Market Research Bureau, the most popular
supplements are multiple vitamin/mineral formulas,
followed by individual supplements of vitamins C, E, B
complex, B,, and A. And many people take their vita-
mins once a day.
As for how much of each vitamin or mineral
people take, supplement users may show a strong
streak of nutritional sophistication.
For one thing, most of them apparently know
how to keep nutrient intakes at reasonable levels.
Overdosing on vitamins Take two of the “star” vitamins, for instance. Re-
is uncommon. search suggests that the most common daily intake of
vitamin C is 500 milligrams or less; for vitamin E, it’s
400 international units or less. A mountain of nutn-
tional studies says that these levels are safe. What’s
more, the scarcity of nutrient-toxicity cases (instances
of side effects caused by excessive supplement in-
takes) may be the best evidence that most people are
keeping their intakes within rational limits.
Indeed, it seems that whatever supplementation
levels are being used, most people are approaching
supplements with far more savvy than once thought.
When supplement users in the Gallup poll were asked
how they determined proper vitamin intake, 48 per-
cent of them said they scrutinized the label, and 29
percent said they relied on their doctor. When the
poll’s vitamin users were asked if they were aware of
the Recommended Dietary Allowances (RDAs),
about half of them said yes.
It’s clear that most people do not think taking
supplements can be a substitute for eating food. A
Supplements aren’t 1978 survey of consumer attitudes and practices
meant to replace foods. showed that 97 percent of those polled disagreed
 Who Takes Vitamins and Minerals? 43

with the statement, “‘It is okay to skip meals as long as

you take a vitamin supplement.”
We'd need a large-scale, in-depth study to more
accurately gauge how responsibly people use supple-
ments. But it’s already apparent that there are a whole
lot of supplement users who know exactly what
they’re doing.
‘Before I try a supplement, I discuss it with nutri-
tional experts,” says Barry Shapiro, a 34-year-old film

Dietitians Speak Up
about Nutritional Supplements
Registered dietitians, as a group, One Seattle dietitian says that
have traditionally maintained that her partner used to be strongly
a well-balanced diet alone will against the use of any supple-
support nutritional health for the ments when she first joined their
vast majority of people. practice. Now, several years into
Yet, in a survey of dietitians in it, she “encourages moderate use
the state of Washington, nearly 60 of supplements under certain con-
percent said that they take some ditions.”
form of nutritional supplements Adds Sue McFarlane, a regis-
(Journal of the American Dietetic tered dietitian in Spokane, ‘“We
Association). In contrast, only 47 cannot safely recommend dietary
to 54 percent of Americans use supplements to a group. But in
nutritional supplements. many cases, after individual con-
“The attitude of 20 years sultation, we may find a particular
ago—'If you eat right, you don’t deficiency that an individual is un-
need dietary supplements’—still able to satisfy by diet alone.”
prevails among most,” says “Even though meeting nutri-
Bonnie Worthington- Roberts, tional needs through diet alone is
Ph.D., of the University of Wash- the ideal,” says Dr. Worthington-
ington in Seattle, a coauthor of the Roberts, “use of multivitamin/min-
survey. “But some dietitians today eral supplements may be sup-
recognize that they themselves ported for individuals Gncluding
don’t always get what they need, dietitians) when personal dietary
especially if they are dieting.” patterns fall short of this goal.”
44 Using Supplements Wisely

Smart people read and producer. ‘‘Then | check the label. I never take any
analyze labels. supplement without that kind of deliberation.”
“When I first start taking a vitamin or mineral, I
use very low amounts,” says Gerry Patrick, a 63-year-
old homemaker. “‘I set intake limits for myself, based
on what I’ve learned about the nutrient. Then, if need
be, I slowly increase intake.”

The Logic behind Supplements

But why are people taking vitamins and minerals
in the first place? Is it because (a) they don’t always
Why do people take eat right; (b) they believe supplements help them stay
supplements? healthy; (c) they think there aren’t enough nutrients in
food; (d) they believe that nutrients help them feel
better and more energetic; or (e) all of the above?
The answer is (e), all of the above, according toa
1982 survey of 200 readers of Good Housekeeping. \n
fact, the poll disclosed about a dozen other reasons
as well, and other surveys have come up with similar
lists. People not only have rationales for supplementa-
tion in general but they also have specific reasons for
taking particular nutrients. They may take vitamin A to
maintain good eyesight, vitamin E to head off skin
problems, calcium and vitamin D to strengthen
bones.
So where do such judgments come from? It
would take a lot more studies to figure that one out.
But it’s difficult to ignore the fact that almost all these
rationales have been, in one way or another, bol-
stered by nutritional data from laboratories around
the world.
It’s also true that supplement users have—as you
might have guessed—a sincere interest in their own
People who take their health. The Gallup poll revealed that people who take
health seriously take vitamins are more likely to watch their diet, exercise
their supplements
seriously. and refrain from smoking. And other studies suggest
that among supplement users, nutrition is a priority
concern.
 Who Takes Vitamins and Minerals?

But there’s more to this pro-health attitude than

meets the eye. Saying that supplement users only
want health is an understatement. They apparently
want far more than that.
Says Barry Shapiro, ““To me health is more than
not being sick. It’s being able to perform at my peak
potential day in and day out—optimum functioning
all the time.”
Wellness—that’s what he’s talking about, a posi-
tive state beyond the so-called norm of nondisease.
It’s what a growing number of physicians are advocat-
ing and what, according to a U.S. Food and Drug
Administration survey of consumer health practices,
supplement users are seeking.

What’s the Payoff?

Are they finding what they’re looking for? Or,
more to the point, are supplements really doing them
any good?
Evidence of the health-enhancing powers of nu-
trients has been trickling in for decades, and doctors’
clinical experiences with supplements corroborates Supplements work, ac-
much of the research data. But for most people, the cording to four out of
five people who take
true test of supplementation is what it does for them them.
personally. And most people who use supplementa-
tion seem to think it does a lot of good: 61 to 80
percent of supplement users say that their supple-
ments are working or that they’re satisfied with the
results.
This is what formal surveys show, and judging
from accounts by health-care professionals who use
supplements to treat patients, these numbers are right
on target.
James D. Heffley, Ph.D., a nutrition counselor in
Austin, Texas, is one of many such professionals. “I
conducted a survey of about 2,000 of my patients for
whom I had recommended supplements. As it turned
out, 85 percent of them reported that they were happy
46 Using Supplements Wisely

with the outcome of the therapy. And | discovered

that 75 percent of those who weren't satisfied with the
results didn’t stick to the treatment program.”
So for many people, it seems, supplements pay
off in good health. But is the cost reasonable? Ac-
Are supplements worth cording to Market Research Corporation of America,
the money? in 1981 people spent an average of $28 annually on
vitamins—about eight cents a day. That’s small
change to most people—and a good bargain to sup-
plement users.
 Chapter 3 47

How to Choose and

Use a Multiple

ave you ever stared at a store shelf full of

vitamin bottles, totally bewildered? With vi-
sions of brightly colored pills spinning through your
head, you might well wish for an easier way. Could a
multiple vitamin/mineral formula be just the thing you
need?
A multiple combines many nutrients into one
tablet or capsule. It’s for people who don’t want to
take several different vitamin pills each day. Then, if it
falls short here or there (you may have some special
needs), it’s easy enough to supplement with addi-
tional individual nutrients.
Choosing the multivitamin that’s best for you re-
quires a bit of comparison shopping. You need to
know how vitamin and mineral supplements meet, or
miss, your particular nutrient needs. Here’s a step-by-
step guide.

Start with the Essentials

One of the best things you can do is compare the
list of nutrients on a vitamin bottle label with those in
the U.S. Recommended Daily Allowances (USRDAs). Does your multiple con-
Take the table on page 52 with you to the store. tain all the essential nu-
trients in adequate
Compare the label with the table, item for item. Does amounts?
the multiple include all of the vitamins and minerals
listed in the table? It should. These are the basic
ingredients of good nutrition.
48 Using Supplements Wisely

Some essential nutrients, especially trace ele-

ments, do not yet have USRDAs. They do have safe
and accepted ranges, which are also listed in the
table.
How many of these nutrients are in the multiple?
You may not feel you need every one, but you should
know which you want, and why. You may want chro-
mium if you’re concerned about diabetes, since chro-
mium seems to play a role in glucose metabolism;
selenium, a potent antioxidant, because of its possible
role in cancer protection; copper if you’re taking sup-
plemental zinc. (Copper is important in the formation
of red blood cells and capillary stability. Zinc may
affect copper absorption. Look for a ratio of about 7.5
to 10 units of zinc to 1 portion of copper. For exam-
ple, 15 milligrams of zinc should be taken with 2
milligrams of copper.)
You may find many other ingredients—from
bioflavonoids to tin—in multiple vitamins. While it’s
Many ingredients may true that these substances are found naturally in food,
not be essential. research has not determined any of them to be essen-
tial to human nutrition, at least not yet.

Decide How Much You Need

You also should look at the amount of each
nutrient in the supplement, measured in milligrams,
The percentage of micrograms (1/1000 of a milligram) or international
USRDA listed is a reli-
units. Compare each with the USRDA amounts. In
able benchmark.
addition to amounts, most labels list a nutrient’s per-
centages of the USRDA, and this may actually provide
you with the best information regarding the product’s
potency and balance, as you'll see below.
How potent a multiple do you want? If your goal
is “insurance,” look for those providing 50 to 150
percent of the USRDA. The American Medical Associ-
ation generally considers this a reasonable range,
with one important exception: The vitamin D level
should not exceed 100 percent.
 How to Choose and Use a Multiple 49

Some, but certainly not all, ‘“one-tablet-daily”

types are in this category. If you want more than the
USRDA, “high-potency” brands may provide it. But so One-tablet-a-day multivi-
will some other multiples without these labels, says tamins may provide 50
to 150 percent of the
Sheldon Hendler, M.D., Ph.D., formerly clinical in- USRDAs.
structor of medicine at the University of California at
San Diego, author of The Complete Guide to Anti-
Aging Nutrients.

Check Nutritional Balance

Look at the percentage of the USRDA of each
nutrient. If the formula is balanced by USRDA stan-
dards, each nutrient will have the same percentage of A “‘balanced”’ formula
the USRDA. A balanced multiple may contain 100 isn’t necessarily the
best.
percent of the USRDA for each nutrient, for instance.
If it's not balanced, some percentages will be high,
some low. That’s not necessarily bad. But you should
note how it varies and decide if that’s something you
want.
Some “women’s formulas,” for instance, contain
additional iron or calcium to accommodate increased
needs for those nutrients among many women. Some
“geri,” or geriatric, formulas have additional antioxi-
dants—vitamins A, E and C and selenium—nutrients
believed to play a role in slowing some aspects of
aging.
Most of the so-called stress formulas provide
much more vitamin C and B complex, and sometimes
zinc, than they do other nutrients (because of their
purported role in beating stress). Other formulas, like
B-100 types, provide nutrients in increments of 100
milligrams or 100 micrograms. As a result, the formu-
las may be far out of balance, since the USRDAs for
some B vitamins are less than one-tenth that of other
B vitamins.
“T personally think these products play on the
fact that people don’t know what ‘balanced’ is,” says
Annette Dickinson, technical counselor of the Coun-
50 Using Supplements Wisely
i

cil for Responsible Nutrition, a vitamin manufacturers’

trade association. “It makes no sense to have some of
the B vitamins present at 100 times the USRDA, others
at only a fraction of the USRDA.”

Beware of Advertising Claims

There are now supplement formulas for almost
every medical condition you can imagine—arthritis,
high blood pressure, heart disease, immunity, depres-
sion, fatigue, premenstrual discomfort and so forth.
“Be extremely wary of any formula that claims to
counteract any particular disease,’ Dr. Hendler says.
‘Most of the special formulas I’ve surveyed are very
poorly designed. I think you’re better off sticking with
a good basic regimen.”
But, with your doctor’s advice, you may want to
take additional vitamins or minerals for a medical
problem. If you’re a woman, you may take additional
iron for anemia or additional calcium to prevent os-
teoporosis.
If you have a leg cramping condition called inter-
mittent claudication, your doctor might suggest extra
Don’t use multivitamins vitamin E. Or he may prescribe extra B, and magne-
as over-the-counter sium to help prevent kidney stones or larger-than-
medicine.
normal amounts of vitamin C for bronchial asthma. In
this sense, the vitamins are going beyond the role of
nutrition. They are acting almost as drugs, in a thera-
peutic sense. Their advantage is that they often have
fewer side effects than drugs used for these same
conditions. But they still need to be used wisely and
under a doctor’s supervision. And typically, multiples
are not the best way because the target nutrient is
mixed with many others.

Does Your Multiple

Have a Deficiency?
Some vitamin manufacturers add inadequate
amounts of nutrients to their products just so they can
 How to Choose and Use a Multiple oi

list the nutrient on their label, Dr. Hendler says. And

even the better products sometimes contain only
small amounts of some nutrients. Here again, it’s im-
portant to read the label.
The once-daily multiple vitamin/mineral supple-
ments are often low in calcium and magnesium, be-
cause these two nutrients are bulky and make the pill Check the label: Some
big. There are many individual calcium supplements multiples may not con-
tain enough of certain
on the market to make up the difference, though. You nutrients like calcium or
can also find some good calcium/magnesium prod- magnesium.
ucts, which provide what some researchers think is an
important 2.5 to 1 ratio of these two minerals. (Mag-
nesium is an important mineral for calcium metabo-
lism.) If you are taking calcium to prevent or treat
osteoporosis, you should know that some researchers
think trace minerals, such as zinc and copper, are very
important for bones, too.

Other Shopping Tips

Here are some other things to be aware of as you
choose a supplement.
Check the expiration date. Many, but not all,
vitamin manufacturers now include an expiration date
on their products. It’s a good idea to avoid a product Make sure your supple-
beyond the expiration date, although most products ments are fresh.
retain their potency much longer. Oil-based supple-
ments deteriorate more quickly than others. If you're
selecting products from a store’s discount bin, check
to see that the vitamins aren't leftovers from the Stone
Age.
Too much to swallow? Some manufacturers
who try to cram everything into a once-daily tablet do
so at the expense of your esophagus. Check the pill Some pills are too big.
size before you buy. Sometimes the better choice is to
get a just-as-complete, but smaller, multiple that must
be taken not once but two or three times a day.
More is not better. You may be tempted to
think that if your multiple at its suggested dosage isn’t
good enough, you can just take it more often and not
bother to switch to some better-balanced product.
52 Using Supplements Wisely

You may want more calcium, for instance, but you

Taking more of an un- would need to take three pills daily, rather than one,
balanced multiple to get it from your present supplement. “Don’t do
doesn’t make it bal-
anced.
that,” Dr. Hendler emphasizes. “Taking an unbal-
anced supplement three times a day still may not
provide the recommended doses of some nutrients,

What to Look For

in a Multivitamin

Nutrient USRDA (adults and children

4 or more years of age)

Vitamin A 5,000 I.U.

Thiamine (B,) 1.5 mg.
Riboflavin (B,) 1.7 mg.
Niacin 20 mg.
Vitamin B, (pyridoxine) 2 mg.
Vitamin B,, 6 mcg.
Folate 0.4 mg.
Biotin 300 mcg.
Pantothenate . 10 mg.
Vitamin C (ascorbic acid) 60 mg.
Vitamin D 400 1.U.
Vitamin E 30 1.U.
Calcium 1,000 mg.
Copper 2 mg.
lodine 150 mcg.
Iron 18 mg.
Magnesium 400 mg.
Phosphorus 1,000 mg.
Zinc 15 mg.

Suggested Ranges*

Chromium 50-200 mcg.

Selenium 50-200 meg.t
nS

“These nutrients are considered essential, but they have no USRDA. Instead,
they have ranges that are considered safe and adequate.
t Supplements of selenium should not exceed 100 meg., since the average diet
supplies about 100 mcg.
 How to Choose and Use a Multiple 53

but you may end up taking too much of other nutri-

ents, throwing things even further out of balance.”
Do your homework. You can do some com-
parison shopping before you go to the store by look-
ing through the Handbook of Nonprescription Drugs, A convenient way to
published by the American Pharmaceutical Associa- comparison shop for a
multivitamin.
tion, Washington, D.C. 20037, and found in the refer-
ence section of large libraries, especially those affili-
ated with medical schools. This book contains a table
of many multiple vitamin products, their ingredients
and amounts. The table is a good way to do some
comparison shopping for supplements before you
head for the store.
54 Chapter 9
Getting Vitamins
and Minerals
to Work Better

f you eat three square meals a day or take vitamin

supplements, you might think you're getting ade-
quate nutrition. But you could be wrong.
Nutrition isn’t that simple or direct. Your body
doesn’t always make the best use of all the vitamins
you take in, either in food or in supplements. Some
vitamins never get to where they could do the most
good. Others sail through your system without being
absorbed.
The same is true of minerals. In fact, when it
comes to figuring out how to make the most of your
vitamins, minerals are often part of the plan.
If you want to squeeze every available microgram
from your vitamins and minerals, it helps to under-
stand some of the ways in which nutrients help each
other along.

A Booster Plan
for Better Nutrition
Here are some tips to help you make the most of
your nutrients.
Eat small, nutritious meals and snacks. All
the nutrients your body takes in at a big meal can be
Smaller, more frequent hard to swallow, says John Pinto, Ph.D., assistant pro-
meals help your system fessor of nutrition and medicine at Cornell University
absorb vitamins and
minerals better. Medical College and associate member at Memorial
Sloan-Kettering Cancer Center.
 Getting Vitamins and Minerals to Work Better 55

“If you stop and think how some people eat a

large amount of protein and carbohydrates at one
meal, they really swamp their system with this influx
of nutrients all at one time,” Dr. Pinto says. “And
many of those nutrients won’t be absorbed. That’s
because it’s easier for the gastrointestinal tract to ab-
sorb nutrients from small amounts of food over a
small period of time.”
If you want to squeeze more nutritional value
from your diet, scale down your main meals and eat
healthful snacks—like a piece of fruit, crisp, raw veg- A nutritional nudge from
etables, a whole grain muffin or a glass of milk—in snacks.

between. You'll give your body a chance to absorb

nutrients most efficiently, says Dr. Pinto.
Take your vitamin C in small, divided
doses. “The higher your dose at a single time, the
smaller the percentage of vitamin C you absorb,” ex-
plains Mark Levine, M.D., a researcher at the National
Institutes of Health in Bethesda, Maryland. “If you
take 100 milligrams at one time, you get something
like 90 percent absorption. If you go up to a gram
[1,000 milligrams], it’s approximately 50 percent ab-
sorption, and so on.”
Instead of taking one large tablet of vitamin C,
then, divide the same amount into smaller doses to be
taken throughout the day. A little vitamin C now
“Let’s say you chose to take two grams [2,000 and then is better than
one big dose at once.
milligrams] of vitamin C,” says Dr. Levine. “You would
increase the percentage of absorption if you took 500
milligrams four times a day or 1,000 milligrams twice
a day.”
If you want to make sure your iron is more
fully absorbed, get more vitamin C. “Vitamin C
will enhance absorption of other nutrients, particu- Think of vitamin C as a
larly iron,” says Dr. Levine. booster rocket for iron.

When we talk about iron, most of us think of

foods like beef, poultry, fish and eggs. But not all iron
is the same. Only about 10 percent of the iron in
vegetables and grain—called nonheme (nonblood)
iron—is absorbed. In contrast, we absorb from 15 to
56 Using Supplements Wisely
i

30 percent of the iron found in meats, which is called

heme iron.
Vitamin C is what is known as an iron enhancer.
It helps convert the nonabsorbed iron into a form the
body can use. So to make the most of your iron, eat
more foods that are rich in vitamin C, such as toma-
toes and oranges, along with iron-rich foods like lean
meat, fish, poultry, leafy green vegetables and whole
grains.
One way to improve the absorption of iron in
your beef, fish or chicken dish might be to add a thick,
Top off iron-rich meals spicy tomato sauce. A piece of fruit for dessert, in-
with vitamin C-rich stead of that slab of double-fudge cake you've been
foods.
coveting, is a healthier alternative if you want to boost
your absorption of iron from your meal. If you take an
iron supplement, wash it down with a little orange
juice.

Special Advice
for Vitamins A, D and E
Vitamins A, D and E are absorbed in the intestine
in the presence of fat. Consequently, if you take your
fat-soluble vitamins on an empty stomach, you might
flush out most of the vitamins before they can be
absorbed.
Take fat-soluble vitamins with foods that
contain fat. “It’s reasonable to take fat-soluble vita-
Low-fat milk helps you mins with foods that contain a small amount of fat—
absorb vitamins A, D for example, a glass of low-fat (1 or 2 percent) milk,”
and E.
says Cedric Garland, Dr.PH., assistant professor of
community and family medicine at the University of
California, San Diego. “A moderate amount of fat
would cause the secretion of digestive enzymes that
work on fats, which would enhance absorption of the
fat-soluble vitamins. Without a small amount of fat, a
portion of the vitamins will wash right through the
intestine without being absorbed.”
 Getting Vitamins and Minerals to Work Better 57

What about those of us on low-fat diets? Not to

worry, says Dr. Garland. “From a practical point of
view, a diet containing 15 to 20 percent fat would still
be sufficient to absorb fat-soluble vitamins.”

Getting the Most Out of Calcium

How and when you get calcium is important.
To move calcium along, get plenty of vita-
min D. You can take calcium supplements every day
and still leave your bones and teeth crying out for Without vitamin D, cal-
more—if you don’t get enough vitamin D along with cium can’t reach your
bones and teeth.
the mineral. Without vitamin D, calcium is not ab-
sorbed.
If you want to make sure you're getting enough
of both nutrients, says Dr. Garland, one convenient
way to do so is to drink milk, which contains plenty of
calcium and vitamin D.
But drinking milk is only one way to boost your
vitamin D. Perhaps the easiest way for most of us to
make sure we get enough vitamin D is to take a stroll
in the sunlight. Your skin manufactures vitamin D on
its own, but it needs ultraviolet rays from sunlight to
start the wheels turning. How much sun do you need
to make vitamin D? “Just 15 minutes a day, with sun-
light on your hands and face, should be enough in
most cases,” says Dr. Garland.
The walk will do you good, too, since weight-
bearing exercise enhances the movement of calcium
to your bones.
Take your calcium with food. Not all of us
consume enough dairy products to keep us in calcium
balance. If you don’t get enough dietary calcium, you Don’t take calcium on
might take a supplement, but merely taking a supple- an empty stomach.
ment doesn’t guarantee you the best results. If you
take calcium, it’s important to get your gastric juices
flowing because some calcium supplements are ab-
sorbed best in an acid environment. (This is also a
problem for many people over the age of 60, whose
58 Using Supplements Wisely

production of stomach acid may be lower.) The solu-

tion is to take your calcium with a meal, thus stimulat-
ing your stomach to produce enough acid.
Among healthy adults, pregnant and lactating
women need the most calcium. The Recommended
Three groups who need Dietary Allowance (RDA) for this group is 1,200 milli-
more calcium. grams of calcium daily. To get this amount of calcium,
you would have to drink four or five glasses of milk a
day. People who are at risk for osteoporosis may need
even more, though the precise amount hasn’t been
firmly established.
Food also helps improve the absorption of other
nutrients. “It’s best that nutrients be consumed with a
meal,” says Dr. Pinto. “The very sight of food begins
to stimulate the appetite, triggering the release of vari-
ous enzymes. Also, hormonal responses begin to reg-
ister. With food in the mouth, insulin rises. Intestinal
blood flow increases, preparing to help transport
food through the body and move nutrients from the
intestine into the bloodstream.”
Take your calcium supplements before bed.
The timing of the dose could improve your body’s
The calcium thieves absorption of the mineral, too. Morris Notelovitz,
work at night. M.D., medical director of the Climacteric Clinic in
Gainesville, Florida, has suggested taking calcium
supplements just before you turn in.
During the day, your body extracts the calcium it
needs from food. At night, when no food is coming in,
your body still needs to maintain normal blood levels
of calcium, so it raids the only source available to it—
your skeleton.
A calcium supplement just before bed should
keep your blood levels near normal and protect your
bones from this nightly pilferage. But if you’re going to
take calcium, remember the previous advice and
swallow it with a glass of low-fat milk to stimulate the
production of stomach acids.
 Chapter 10 59

What You
Should Know
about Vitamin Tests

an medical tests tell you whether you have a

vitamin or mineral deficiency—or excess? Is
such information really useful to you and your doctor?
And will the tests end up costing you more than
they're worth?
The answers, as testing experts point out, are yes,
maybe and sometimes.
Nowadays, doctors can indeed order laboratory
tests for most vitamins and minerals (though medical
labs are not equally equipped to assess nutrient lev- Tests tell whether you
els). Usually your physician gets a blood or urine have high or low levels
of nutrients.
sample from you and sends it to the lab with instruc-
tions to measure the amount of certain nutrients in the
sample. The test results may or may not reflect your
intake of nutrients but will, in most cases, indicate
whether you have high or low levels in your system.
The usefulness of such testing depends, in part,
on how widespread vitamin and mineral deficiencies
really are. Classic deficiencies—those with unmistak- Mild deficiencies may
able symptoms, like scurvy and beriberi—are few and be widespread.
far between. Other evidence, however, suggests that
milder deficiencies may be more prevalent than peo-
ple think. Gee the table, A Guide to Deficiency Symp-
toms, on page 62.)

A Useful Tool—
or a Waste of Time?
One of the researchers who has helped uncover
such nutritional deficits is Myron Brin, Ph.D., former
60 Using Supplements Wisely

adjunct professor at both Columbia Medical School

and Cornell Medical School. ‘We have to be aware,”
he says, ‘that national nutritional studies like the Ten-
State Survey, the Household Food Consumption Sur-
vey and the Health and Nutrition Examination Survey
demonstrated that there are many population groups
who consume appreciably below Recommended Di-
etary Allowance (RDA) levels for vitamins A, C and
B,, folate and other nutrients. Such biochemical inad-
equacy without classic deficiency symptoms is called
marginal deficiency—a condition often marked by
vague signs like irritability, insomnia and reduced ap-
petite. It’s this type of deficiency that nutrient tests can
help detect.”
But if a doctor suspects that a patient has a defi-
ciency, why can’t he forgo nutrient testing and simply
prescribe the missing nutrient and see if the symp-
toms disappear?
He can and often does.
‘This technique is called a therapeutic trial,” Dr.
Brin says. “In some cases, it may be cheaper than
Prescribing a vitamin nutrient testing. As long as physicians know precisely
can sometimes sub- what symptoms are associated with the deficiency,
stitute for nutritional
testing. they can easily assess the effects of the prescribed
supplements. If symptoms disappear in about three
months, that’s evidence that the patient may have
lacked the nutrients.”
There’s more to nutrient testing, however, than
just spotting nutritional deficits. Doctors sometimes
Nutrient tests can use it to help confirm the presence of serious medical
sometimes reveal seri-
conditions that may have little or nothing to do with
ous disease.
deficiencies. Calcium tests, for example, can help
doctors diagnose bone disorders and problems of the
parathyroid gland. Magnesium tests can help them
detect systemic poisoning, including drug abuse. And
the vitamin E test helps them pinpoint the cause of
anemia in infants.
None of which means that doctors find nutrient
tests as useful as old standbys like routine urinalysis
and the complete blood count (the most frequently
 What You Should Know about Vitamin Tests 61

performed lab test). The majority of physicians use

most vitamin and mineral tests sparingly, not rou-
tinely. And the consensus in the medical world seems
to be that performing nutrient tests on apparently
healthy people is a waste of time.

Testing the Tests

And, of course, some nutrient tests can yield
more useful data than others.
Calcium tests (done either on blood or urine) are
among the more revealing, which may be why they’re
often included in standard multiple-test batteries. The calcium test can
“They’re helpful in diagnosing numerous conditions,” help to diagnose over
a dozen medical
says Edward R. Pinckney, M.D., a California specialist conditions.
in preventive medicine and coauthor of The Patient’s
Guide to Medical Tests. ‘““They’re used primarily in
evaluating suspected abnormalities of the parathyroid
gland, memory problems, unusual sleepiness and
nerve or muscle dysfunctions. But they can also yield
information in the diagnosis of other gland problems
(such as lack of adrenal hormones), unexplained
bleeding, vitamin D poisoning, osteoporosis, even
cancer.”
Tests for iron and folate (done on blood only)
are especially valuable because they help physicians
diagnose anemias, usually those caused by lack of
these two nutrients. Iron tests, generally included in
multiple-test batteries, are also used to monitor pa-
tients on hemodialysis and for tracking down vitamin
and other food deficiencies. And folate tests are
sometimes used to distinguish between two deficien-
cies—folate and vitamin Bp».
Then there are those nutrient tests of dubious
worth. The niacin urine test is one of them, says Dr.
Pinckney. “The test is performed to confirm the diag- Some vitamin tests
nosis of pellagra, the classic niacin-deficiency dis- mean little.

ease,” he says. “But the symptoms and signs of the

disease, plus a successful therapeutic trial of niacin,
allow a diagnosis long before the test is needed.”
62 Using Supplements Wisely

A Guide to Deficiency Symptoms

Nutrient Possible Deficiency RDA for Adults

Symptoms* (age 23-50)

Vitamin A Night blindness; abnormal dryness of the eye- 5,000 I.U. (men)
balls; dry, rough, itchy skin; susceptibility to res- 4,000 I.U. (women)
piratory infection
Thiamine (B,) Confusion; weakness of eye muscles; loss of 1.4 mg. (men)
appetite; uncoordinated walk; poor memory; 1.0 mg. (women)
inability to concentrate
Riboflavin (B,) Discolored tongue; anemia; cracks at corners 1.6 mg. (men)
of mouth; scaly skin; burning, itchy eyes 1.2 mg. (women)
Niacin Dermatitis; insomnia; headache; diarrhea; de- 18 mg. (men)
mentia 13 mg. (women)
Vitamin B, Depression; skin lesions; extreme nervousness; 2.2 mg. (men)
(pyridoxine) water retention; lethargy 2.0 mg. (women)
Vitamin B,» Anemia, accompanied by symptoms such as 3.0 mcg.
heart palpitations, sore tongue, general weak-
ness; weight loss
Folate Anemia; dizziness; fatigue; intestinal disorders; 400 mcg.
diarrhea; shortness of breath

Vitamin C Easy bruising; spongy, bleeding gums; dental 60 mg.

(ascorbic acid) problems; slow wound healing; fatigue; listless-
ness; rough skin
Vitamin D Softening of bones (osteomalacia); bone pain; 200 L.U.
susceptibility to bone fracture (osteoporosis);
excessive tooth decay
Vitamin E Muscle degeneration; anemia; nerve dysfunc- 15 1.U. (men)
tion 12 1.U. Women)
Calcium Softening of bones (osteomalacia); susceptibil- 800 mg.
ity to bone fracture (osteoporosis); periodontal
disease
Iron Anemia, accompanied by symptoms such as 10 mg.
weakness, fatigue, headache, heart palpita-
tions, mouth soreness

Magnesium Foot and leg cramps; muscle weakness; irregu- 350 mg. (men)
lar pulse; nervousness 300 mg. (women)
Zinc Slow wound healing; skin and hair problems; 15 mg.
poor resistance to infection
ee eeEESSSSSSSSSSSSSSSSSSSSseF
*These symptoms can, of course, suggest medical conditions other than nutrient deficiencies. For a proper diagnosis
of
symptoms, see your doctor.
 What You Should Know about Vitamin Tests 63

The vitamin B, test (done on urine and blood)

may have similar problems. ‘‘A vitamin B, deficiency
is usually diagnosed long before a laboratory test con-
firms it,” says Dr. Pinckney. Plus, even when there’s
no deficiency present, several drugs and diseases can
change B, levels, rendering the test results suspect.

The Lowdown on Test Results

But regardless of what a test tells you, it’s impor-
tant to remember that test results do not a diagnosis
make. They’re only a piece of the diagnostic puzzle What tests can and can-
that your doctor tries to put together. The other pieces not tell you.
are your medical history, health habits, physical
exam, age, sex, symptoms, use of medications and
more.
It also helps to keep in mind that no medical test
is 100 percent reliable. In most medical tests it’s al-
ways possible, usually in a small percentage of cases,
to get “abnormal” test results and still be perfectly
healthy or get “normal” results and be sick. “For this
reason, you shouldn't worry if your test results do not
at first appear to be normal,” says endocrinologist
Bernard Kliman, M.D., of Massachusetts General Hos-
pital in Boston and coauthor of What You Should
Know about Medical Lab Tests.
So if you suspect a vitamin or mineral deficiency,
should you ask your physician to order nutrient tests?
“First of all,” Dr. Kliman advises, “don’t try to diag- Rule number one: Don’t
nose yourself. That’s your doctor’s job. Your symp- diagnose yourself.
toms could be completely unrelated to a nutrient defi-
ciency or be a deficiency syndrome caused by some
secondary disorder. So maybe nutrient tests would be
useless—or just what the doctor ordered.”
64 Chapter 1]
Answers to Your
Questions about
Nutritional
Supplements

lot of people want to know about vitamin

and mineral supplements and have asked
plenty of interesting questions about them. Here are
the answers to some typical—and some not so typi-
cal—inquiries.

Using Vitamins A and D

with Care
Q. I know that beta-carotene and retinoic acid
are both forms of vitamin A. What I don’t understand
is the difference between them. Can you explain?
A. Beta-carotene is a dietary source of vitamin A,
a raw material the body uses to make the vitamin. It’s
a natural pigment found in abundance in many green
and yellow vegetables. Retinoic acid, on the other
hand, is derived from vitamin A rather than being used
to make it.
Both forms of the vitamin help the body’s cells,
particularly those in the protective linings (of arteries,
The difference between for instance), grow and mature properly. But vitamin
beta-carotene and A has two other important functions—maintaining
retinoic acid.
normal vision and reproductive cells—in which
retinoic acid plays no known role.
Q. I have noticed what appears to be a high
dosage of vitamin A in several high-potency vitamin
supplements. | was wondering if these supplements
are safe.
 Answers to Your Questions about Nutritional Supplements 65

A. You don’t say how high is “high,” but U.S.

government guidelines are very clear on maximum
dosage. They recommend that adults take not more
than 25,000 international units a day of vitamin A.
That figure is distinct from the official Recommended
Dietary Allowance (RDA) of vitamin A—4,000 to
5,000 international units for adults—which is recom-
mended to ensure that the majority of the population
doesn’t become deficient.
Toxic effects—drying of the skin, hair loss, bone
pain and fragility, enlargement of the spleen and
liver—have been seen in adults taking a daily dose of Caution: Too much vita-
50,000 international units or more a day over a long min A does more harm
than good.
period of time. Remember, vitamin A is a fat-soluble
nutrient that the body is able to store—quite eff-
ciently—in the liver. Chances are the supplements
you've seen don’t approach the toxic doses. The U.S.
Food and Drug Administration (FDA) Advisory Re-
view Panel considers 10,000 international units safe
for use in over-the-counter supplements.
Q. I’m excited by studies showing that beta-caro-
tene may be responsible for lowering the incidence of
certain forms of cancer. Could | replace my daily
vitamin A supplement entirely with beta-carotene?
A. Yes, you could. Normally the body converts
about one-third of the beta-carotene to vitamin A.
Research is uncertain which form is responsible for
lowering the incidence of cancer, so it would be a
good idea to include both in your supplement pro-
gram.
Consider that the foods we typically eat are esti-
mated to provide about half the vitamin A preformed
and half as beta-carotene. A supplement program How beta-carotene acts
based on that same 50:50 ratio seems to make the as a vitamin A supple-
ment.
most sense.
Q. I’ve been told that taking excess amounts of
vitamin D may be dangerous. Is that correct?
A. Yes, it is. Vitamin D is the most potentially
toxic of all vitamins. Large doses can result in the
66 Using Supplements Wisely
EEE

deposition of calcium in soft tissues such as the arter-

ies, heart and kidneys and may lead to high blood
pressure.
In the past, toxic doses for adults were noted at a
level of from 25,000 to 50,000 international units
A safe level for daily, but new findings suggest that a safer level may
vitamin D. be about 1,000 international units daily or less. There
is probably little need to exceed the maximum RDA
of 400 international units a day. At this level vitamin D
is considered safe—and adequate to prevent a vita-
min D deficiency.

All about B Vitamins

Q. What is the difference between folate, folic
acid and folacin, or are they all the same?
A. Consider this a short course on biochemistry.
Folacin is the generic term for folic acid and its re-
Three names, one lated compounds. Folate is simply one form of folic
vitamin. acid.
Q. A few months ago | read in the paper about
cases of nerve damage in people taking too much
vitamin B,. Is it dangerous?
A. Not when taken in reasonable amounts. In the
particular study that was reported, people were taking
from two grams (2,000 milligrams) to six grams
(6,000 milligrams) per day for 2 to 40 months. Those
levels are far in excess (1,000 to 3,000 times) of the
RDA. Unfortunately, there are always some who take
abusive levels of vitamins as well as other substances.
The safety of vitamin B, has been thoroughly
reviewed. No evidence of adverse effects was found
Taking too much vi- in patients taking from 20 to 1,000 milligrams per day
tamin B, can be (10 to 500 times the RDA) for up to four years. Vita-
dangerous.
min B,, like most of the B vitamins, has a wide margin
of safety. However, excessively high levels should not
be taken. Commonsense supplemental levels range
from about 5 milligrams to 50 milligrams a day.
 Answers to Your Questions about Nutritional Supplements 67

Q. My two teenage children and I have been

taking a heaping tablespoon of brewer’s yeast every
day with our hot cereal. I believe it’s made a differ-
ence in our health. But someone told me it would be
simpler to take a B-complex tablet, and that the tablet
would have even more nutritional potency. Is that
true?
A. Depending on what dosage B-complex tablet
you would take, you would probably get more of the
B vitamins than in your heaping tablespoon of brew-
er’s yeast.
When the University of Massachusetts Nutrition
Data Bank compared the nutritional contents of yeast
and a popular B-complex tablet, they found far more Which has more nutri-
B vitamins in the tablet: 10 milligrams of thiamine (B,) tional value—brewer’s
yeast or a B-complex
in the tablet compared to 1.25 milligrams in the yeast, tablet?
for example. But don’t give up your brewer’s yeast yet.
It packs quite a few more things in that small spoonful.
It's about 50 percent protein and contains small
amounts of a number of important minerals, including
potassium, calcium and zinc.

Q. Is there B,, in brewer’s yeast? If so, how

much?
A. To find out, we went straight to the sourcee—a
brewer, Anheuser-Busch, in St. Louis. They told us
that uncontaminated brewer’s yeast, used in the man- Some brewer’s yeasts
ufacture of beer, does not contain B,, naturally. How- have more B,, than
others.
ever, some brewer’s yeast supplements are fortified
with the vitamin and may contain as much as 50
micrograms per tablet. Your best bet is to read labels,
which will tell you exactly how much B,, is in your
supplement.
Q. Do the B vitamins increase appetite? I’m on a
diet and have been taking the vitamins to help me get
the most out of my pared-down meals. But I’ve no-
ticed that I’m hungrier than I usually am when dieting.
The only thing I’m doing differently is taking a B-
complex supplement.
68 Using Supplements Wisely

A. To more intelligently—and accurately—an-

swer your question, we should know what foods and
the number of calories you’re consuming. But there
are a few things we can tell you.
The B vitamins in and of themselves aren’t in-
creasing your appetite. Though this scenario is rare,
B vitamins and appetite. this is what could be happening, our experts say: If
you have been on a severely restricted diet over a
period of time, you may have developed vitamin defi-
ciencies. Taking a vitamin supplement such as a B-
complex might stimulate the body to better absorb
the available nutrients. That, in turn, can promote a
feeling of well-being that leads to a perceived in-
crease in appetite. Though taking B-complex supple-
ments while dieting is probably an excellent idea,
make sure your diet isn’t too drastic—too low in calo-
ries or restricted to a few foods. Vitamins can’t re-
place food.
Q. When I was anemic, my doctor gave me B,,
injections. Couldn't I have taken a tablet? Are injec-
tions of vitamins more potent than pills?
A. If you were suffering from pernicious anemia,
the B,, shot was,\more potent because people with
B,, injections: better that serious condition lack something called intrinsic
than tablets? factor, which enables the body to absorb the vitamin
from the diet. But with other nutrients, injections
aren’t necessarily more potent, just faster acting. Nor-
mally, vitamin injections are recommended only in
those instances when nutrients cannot be taken orally
or when a medical condition, like pernicious anemia
or Crohn’s disease, inhibits absorption.

Q. What is the difference between niacin and

niacinamide?
A. Essentially, there is no difference from a nutri-
tional standpoint. Niacin and niacinamide may be
The big difference be- used interchangeably. Niacin can cause a flushing
tween niacin and reaction in some individuals, however, characterized
niacinamide.
by redness in the face, neck and other areas, ac-
companied in many cases by itching. This usually
 Answers to Your Questions about Nutritional Supplements 69

disappears in about a half hour. If you experience this

sensation, switch to a supplement containing niacin-
amide; it does not cause flushing.

Vitamin C at Work
Q. I take about 1,000 milligrams of vitamin C a
day and I’m a diabetic. Will vitamin C affect the results
of a urine diabetes test?
A. Yes. In fact, the results can go haywire if
you're taking large doses of vitamin C. According to
Tufts University experts, if you have diabetes and are Large doses of vitamin
taking large doses of vitamin C, you may get a false- C can actually skew the
results of a diabetes
negative result with the Testape urine test for sugar. In urine test.
other words, the test results may show that there’s no
sugar there when there really is. On the other hand,
large doses of vitamin C give you a false-positive read-
ing with the Clinitest urine test, making it appear as
though there is sugar in the urine when there isn't.
Q. Since vitamin C is an acid, can it cause or
aggravate an ulcer? My husband used to take his sup-
plement faithfully until he developed a gastric ulcer.
Now he not only won’t take any vitamin C but he even
avoids orange juice because he’s afraid it will cause
him pain.
A. There is no evidence that any food substance
can cause an ulcer. But you’re right, vitamin C is an
acid, a very weak one called ascorbic acid that, ac-
cording to one specialist we talked to, is even less
potent than your normal gastric juices.
So unless your husband has experienced some
pain after taking his vitamin C supplement or drinking
orange juice, he should be safe going back to his old Vitamin C isn’t acidic
habits. There are some people, however, who are enough to cause stom-
ach ulcers.
sensitive to some foods—tomato juice may give them
heartbum, for example—so your husband may want
to start back slowly, testing his own reaction to both
supplements and foods and beverages containing vi-
tamin C. He also might want to try a vitamin C supple-
70 Using Supplements Wisely

ment in buffered form (calcium or sodium ascorbate),

which reduces the acidity to nearly neutral.
Q. Is it true that there is an increased risk of
vitamin C deficiency if after taking high doses of vita-
min C, you suddenly stop taking the vitamin?
A. What you describe is known as “systemic
conditioning,’ and reports of this occurring are
Can taking too much vi- contradictory. Most researchers report that vitamin C
tamin C lead to a vita- is more rapidly broken down in both animals and man
min C deficiency?
maintained on a high vitamin C intake, increasing the
risk of vitamin C deficiency when vitamin C intake is
stopped. It has been proposed that high doses of
vitamin C result in the production of increased
amounts of the enzyme needed to metabolize the
vitamin. When vitamin C intake is suddenly stopped,
the higher levels of enzymes are still around, theoreti-
cally using up the remaining vitamin C and thereby
causing a deficiency.
One experiment dealing with this phenomenon
does not support the theory, however. Animals fed
high levels of vitamin C for seven months prior to
being placed on a diet designed to promote scurvy
(the vitamin C deficiency disease) did not show any
increased development of the disease.
Q. I’m on a low-sodium diet for hypertension.
Can I take vitamin C in the form of sodium ascorbate?
A. If you’re cutting your sodium intake to the
neighborhood of 500 to 1,000 milligrams a day, you
Avoiding sodium in vita- might want to consider taking something other than
min C supplements. sodium ascorbate as a vitamin C supplement. For
every 1,000 milligrams of vitamin C as sodium ascor-
bate, you are also getting about 130 milligrams of
sodium.
Taking calcium ascorbate is one alternative, or
take ascorbic acid at mealtime with a little milk if
you're concerned about the effects of the acidity on
your stomach.
Q. I heard somewhere that vitamin C can en-
hance the effects of certain drugs. Is this true? What
drugs are involved?
 Answers to Your Questions about Nutritional Supplements 71

A. What you are probably referring to is a study

by researchers at Indiana University who found that
vitamin C enhanced the effectiveness of haloperidol,
a drug widely used in the United States to reduce the
symptoms of schizophrenia and paranoid psychosis
brought on by amphetamine abuse.
The scientists tested the drug on rats that were
given amphetamines. What they discovered was that
the drug dramatically reduced the number of motor
responses triggered by the amphetamine—moving
around, repetitive head movements and rearing, for
instance. Even more dramatic was the action of the
drug when administered with a large dose of vitamin
C, which had no such effects when administered
alone.
The researchers noted, however, that vitamin C
at higher doses can block amphetamine responses
directly, and therapy with large doses of vitamin C has Vitamin C and drugs for
been used to successfully treat some forms of schizo- schizophrenia.
phrenia. Nevertheless, the significance of this study is
the possibility that by raising the blood concentra-
tions of vitamin C (which is not synthesized in the
human body), physicians may be able to increase the
effectiveness of haloperidol and other similar drugs
used to treat schizophrenics.

Vitamin E for Better Health

Q. I have been taking 600 international units of
vitamin E, with my doctor’s approval, for three
months. I’d hoped it would help my leg cramps,
which keep me from walking anywhere. But it has not
helped. Is 600 international units a day enough?
A. You may have to take a dose of patience as
well. Studies have shown that vitamin E may ease
cramps caused by a decrease in blood flow to the legs Vitamin E may relieve
(intermittent claudication). But it’s proof of the old leg cramps, but it takes
time to work.
adage, “Good things take time.” The leading re-
searcher in the area, Knut Haeger, M.D., of Sweden,
says his patients show no signs of improvement until
at least 3 to 4 months after they begin supplementa-
(i Using Supplements Wisely
i

tion. Significant changes in the arterial flow in the legs

are even longer in coming—18 months.
Dr. Haeger originally gave his patients 600 inter-
national units of vitamin E a day but reduced it to 300
international units, given in three doses of 100 interna-
tional units each, when he discovered that the con-
centration of the nutrient in the blood was the same at
300 international units as at the higher dose.
Also talk with your doctor about the importance
of gradually increased walking: That was an essential
part of Dr. Haeger’s therapy.
Q. I’ve heard you can have an allergic reaction to
vitamin E when you use it on the skin. Can you actu-
ally be allergic to a vitamin?
A. Some people do seem to get a reaction when
they use the contents of a vitamin E capsule on their
Allergy to vitamin E cap- skin. But our experts tell us the culprit probably isn’t
sules? Try this. the vitamin itself but other elements in the capsule—
wheat germ oil, for instance. Most vitamin E capsules
available on the market aren’t pure vitamin E. If there
is a reaction, say our experts, it might help to try a
product that contains alpha tocopherol acetate and
mix about half a teaspoon of it into three ounces of
vegetable oil for a topical treatment.

Calcium from Food and

Supplements
Q. I’m 21 years old and concerned about my
calcium intake. My grandmother, who is 75, seems to
have osteoporosis pretty bad—she’s about two
inches shorter now than when she was younger. My
hope is to avoid this with enough calcium and exer-
cise. Right now, I eat yogurt every day and cheese
maybe three times a week. They’re my only dairy
products. My multiple supplement supplies 300 milli-
grams of calcium. Is that enough?
A. Without knowing more about your diet, it’s
difficult to judge. If you’re eating an eight-ounce serv-
 Answers to Your Questions about Nutritional Supplements 73

ing of yogurt, you’re getting about 300 milligrams of

calcium daily. Two to three ounces of cheese supplies
roughly 500 milligrams. With your 300-milligram sup-
plement, you're getting 1,100 milligrams of calcium
three days a week and about 600 milligrams for each
of the other four days. That’s about 5,700 milligrams
of calcium a week.
According to the recent recommendations of a
government panel, you should be getting 1,000 milli-
grams a day, or 7,000 milligrams a week. If you do Are you getting enough
some simple math, you'll see that unless the rest of calcium? Some simple
arithmetic can tell.
your diet supplies an additional 185 milligrams or so a
day, you're probably coming up short.
Q. I’ve been taking extra calcium to prevent
bone loss, but I’m concerned about calcium deposits.
Are they caused by too much calcium, or too little?
A. In most cases, neither. Calcium in the diet,
even when taken in supplements as great as 1,500
milligrams a day, doesn’t create the calcium deposits Calcium intake does not
sometimes found in the joints or the heart, or in kid- cause calcium deposits.

ney stones. Those deposits are caused by some un-

derlying damage to the tissues or by a hormonal im-
balance. Unless you have a history of kidney stones,
there is no apparent hazard in boosting the amount of
calcium in your diet. If you do have a history of kidney
stones, consult the physician who has been treating
you before you make any dietary changes.
Q. How much calcium am | actually getting in a
500-milligram calcium carbonate tablet? The label
says 200 milligrams of calcium. Can you explain the
difference?
A. You are actually getting 200 milligrams of the
element calcium in each tablet. The 500 milligrams
refers to the entire tablet—calcium weight plus the A 500-milligram calcium
weight of the carbonate. The compound calcium car- carbonate tablet may
not contain 500 milli-
bonate is 40 percent calcium and 60 percent carbon- grams of caicium.
ate. When purchasing mineral supplements such as Here’s why.
calcium, magnesium and zinc, look for the designated
amount of the mineral itself. That is the best way to be
74 Using Supplements Wisely

sure of how much of a particular mineral you are

receiving.
Q. I am a 41-year-old woman, convinced of the
need to take supplemental calcium. I have seen ad-
vertisements for calcium supplements made from
eggshells and oyster shells. Are these supplements
good sources of calcium?
A. Although we don’t ordinarily think of egg-
shells and oyster shells as food supplements, both are
Supplements made from excellent sources of calcium. When the shells are
eggshells and oyster cleaned and finely ground, the resulting product is
shells are excellent
sources of calcium.
almost pure calcium carbonate. Calcium carbonate is
one of the richest sources of elemental calcium, con-
taining 40 percent calcium, which is readily absorbed
and utilized by the body.
Q. What’s the best source of calcium—milk or
calcium supplements?
A. Calcium in a glass is superior to calcium in a
pill for postmenopausal women, according to re-
searchers at Creighton University in Omaha.
Doctors there studied a group of healthy women
aged 45 to 70 who drank 24 ounces (that’s three
Why milk is the best glasses) of low-fat milk a day for two years. Their
calcium ‘‘supplement’’ bone density was measured before and after the ex-
of all.
periment and then compared with that of women
who took calcium carbonate and others who didn’t
take any extra calcium at all. The result? Women who
drank milk had healthier bones than the women in the
other two groups.
It may just be, say the doctors, that other nutri-
ents in milk and milk products help bones metabolize
calcium better—a factor important in controlling os-
teoporosis, the fragile-bone disease that strikes post-
menopausal women (American Journal of Clinical
Nutrition).

The Iron Distinction

Q. What's the difference between organic and
inorganic iron? What kind do we get when we use
iron cookware?
 Answers to Your Questions about Nutritional Supplements 75

A. The iron we find in foods like meat, spinach

and whole grains is considered organic. On the other
hand, inorganic iron (primarily in the forms of ferrous What you should know
sulfate, ferric orthophosphate and sodium iron phos- about organic and inor-
ganic iron.
phate) is usually added to foods for purposes of forti-
fication. Both forms of iron are utilized by the body,
and either form can be found in iron supplements.
When acid foods, such as tomatoes, are pre-
pared in iron cookware, varying amounts of organic
iron are formed. Spaghetti sauce, for example,
cooked for about 20 minutes in an iron pot, contains
six milligrams of iron per 3% ounces. But iron levels in
that same amount of sauce prepared in a glass pot
amount to only three milligrams.

Clearing Up the Confusion

over Amino Acids
Q. Since I rarely eat red meat, only chicken and
fish, as well as some grains, should I be taking amino
acid supplements?
A. Not to worry. All animal proteins are consid- Amino-acid supplements
ered “complete.” That means they contain all of the are not necessary on
this diet.
nine essential amino acids your body must get from
what you eat.
Q. I’ve heard that lysine is effective in decreasing
attacks of herpes simplex (cold sores), but no one has
ever said what dosage is most effective.
A. Doctors at the Mayo Clinic have. In a study
involving a group of 41 otherwise healthy patients,
they found that an oral supplement of 1,248 milli-
grams a day of L-lysine monohydrochloride de-
creased the recurrence rate of herpes simplex attacks
and, in fact, helped decrease the severity of symptoms
such as burning, itching, redness, swelling and pain in
two-thirds of the volunteers. The researchers had no
such luck with a lower dose of 624 milligrams.
While that may at first appear to be good news
for the 50 to 70 percent of the population who suffer
from herpes simplex, the Mayo Clinic scientists—and
76 Using Supplements Wisely
i

we—urge you to approach those findings with cau-

Lysine may squelch cold tion. They are preliminary results from a relatively
sores, but use this nutri- small sample population. In any event, women who
ent with caution.
are pregnant or lactating should not take lysine be-
cause of reports of growth suppression in baby chicks
and rats fed the amino acid.

Thinking Zinc
Q. Sometimes I take as many as ten zinc loz-
enges a day when | have a cold. I use the flavored
ones, and they really work. Is ten too many?
A. Probably not, if you limit your treatment to
seven days or less. The researchers at the University of
How many zinc lozenges Texas who discovered this new use for zinc suggested
are too many? that their patients be given one lozenge every two
hours during the day, which meant the cold sufferers
were getting a 100- to 200-milligram dose of zinc
daily. This is considered excessive—after all, the rec-
ommended daily allowance for adults is only 15 milli-
grams a day—but it is far from toxic.
Though taking large doses of zinc can cause
stomach upset and vomiting, it’s regarded as non-
cumulative and nontoxic when taken for a brief time.
In this case, the researchers defined “‘brief” as a week
or less.

Bonus Questions
Q. | find it convenient to take my vitamins with
my morning coffee. Is there anything wrong with this?
A. In the case of at least two nutrients, it’s a little
like mud wrestling after a beauty treatment. Studies
Don’t take your vitamins have shown that coffee can rob you of both the B
with coffee. vitamin thiamine and iron. You can lose up to 39
percent of the iron you take with your morning coffee,
even more if your only iron source is in a multiple
vitamin/mineral tablet that contains other nutrients
that prevent your body from absorbing iron. Coffee
also appears to destroy thiamine in the body. In this
 Answers to Your Questions about Nutritional Supplements 77

instance, it’s not the caffeine that’s stealing nutrients

but chlorogenic acid, a coffee ingredient that isn’t
washed away in the decaffeinating process.
Q. I am confused. Can you explain the difference
between RDAs and USRDAs?
A. Recommended Dietary Allowances (RDAs)
are average daily amounts of vitamins and some min-
erals established by the National Research Council
that will prevent the development of obvious nutrient
deficiency in practically all healthy Americans. In
compiling the RDAs, nutrient allowances are broken
down for 17 population groups based on age and sex,
including allowances for pregnancy and lactation.
The U.S. Recommended Daily Allowances
(USRDAs) are based on the RDAs and are used spe-
cifically for the labeling of products that have added
nutrients or make nutritional claims. For practical pur-
poses, the many categories of dietary allowances for
males and females of different ages were essentially
condensed to one set of values for nutritional label-
ing. Usually the highest RDA value for a particular
nutrient was used to establish the USRDAs.
Q. I am puzzled about glandular products. I can-
not seem to find a clear-cut explanation of what they
are and what they’re supposed to do for me. Can you
help?
A. It is difficult to convey a healthful image of
products labeled raw prostate, raw ovary, raw pitu-
itary, raw orchic (from animal testes) and raw tranquil Glandular products sim-
(from the brains of cows). The word “‘raw” indicates ply don’t work.
that the products, which come from cow and pig
glands, haven’t been heated above body temperature.
But the supplements are processed in various ways—
they are often freeze-dried—before being packaged
in capsules.
The theory is that eating a certain gland from an
animal will somehow affect the corresponding gland
in a human being. For example, ingesting dehydrated
brains is supposed to calm a person down, and eating
78 Using Supplements Wisely

pituitary glands supposedly will help a person grow

taller. But in most cases the theory makes no scientific
sense. According to a researcher at Stanford Univer-
sity, “Most of the factors in the glands, especially if
they are proteins, are either destroyed in the manufac-
turing process or digested by the stomach acids when
orally ingested.” So while you may ingest traces of
proteins or hormones, there’s nothing to steer them
directly to the proper gland once they’re in your body.

More Information
about Supplements
Q. What is vitamin F? I saw a passing reference
to it in an article I was reading, but I’d never heard of it
before.
A. That’s understandable, because it’s an obso-
lete term for essential fatty acids, polyunsaturated fats
“Vitamin F’’ explained. the body needs for several important functions, but
which it cannot synthesize. So, like vitamins, the body
gets essential fatty acids from the diet. Three poly-
unsaturated fatty acids were once considered essen-
tial, but the most noteworthy—and the only one that
seems to be truly essential—is linoleic acid, found in
foods such as safflower, corn and soybean oils, mar-
garine, walnuts, almonds, peanut butter and pumpkin
seeds. As with vitamins, a lack of linoleic acid in the
diet can produce symptoms of a deficiency state,
usually drying and flaking of the skin. It is rare, seen in
infants and hospitalized adults being fed exclusively
fat-free formulas.
Q. Recently I saw an ad claiming that for a fee of
$50 and additional payments of $100 per month, I
could receive a monthly supply of supplements com-
puter-designed for my personal metabolic needs.
Does this offer sound legitimate?
A. No. Beware of any organization making exag-
gerated claims about the effects of supplements, ask-
Answers to Your Questions about Nutritional Supplements 79

ing outrageous prices for supplements or asserting

that some expert can determine the only supplemen- Beware of ads for mail-
tation regimen right for your body. When in doubt, order nutritional advice.

consult your personal physician, the Better Business

Bureau, a consumer protection agency or your local
district attorney.
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 Chapter 12 83

Blocking Cancer
with Vitamin A
and Beta-Carotene

he scientific evidence is still far from conclusive,

but that didn’t stop the National Academy of
Sciences from issuing an anticancer prescription in The new anticancer
1982 that sounded remarkably like something your formula includes
vegetables.
mother once told you: Eat your vegetables.
Even some cancer researchers who won't be
pinned down to anything more concrete than a
“maybe” admit that they haven't waited for the final
test results before changing their diets. “I’ve seen it in
this business for the last seven years,’ says one re-
searcher who studies vitamin A and skin cancer.
‘What I—and all my colleagues—eat has changed. |
used to be a typical junk-food eater. Now I eat a
vegetable-based, high-fiber diet. Does it prevent can-
cer? My scientific answer is that the data overwhelm-
ing suggest that diet makes a difference. My unscien-
tific answer is that what I eat has certainly changed.”

Scientists Say,
“Eat Your Vegetables”’
Even without the definitive proof in hand, the
normally conservative scientific community has be-
come the unabashed patron of the salad bar. What Why scientists are lin-
convinced them? A persuasive collection of studies ing up at the salad bar.
from all over the world that suggest that people who
heap their plates with green and yellow vegetables
and fruit reduce their risk of cancer.
84 From A to Zinc: A Guide to Vitamins and Minerals

e A Japanese study—one of the largest of its

kind—found that people who ate green-yellow veg-
etables every day had a decreased risk of developing
lung, stomach and other cancers. The 20-year-old
ongoing study also indicates that the damage wrought
by bad habits—spurning vegetables or smoking, for
instance—is reversible. Ex-smokers who had their
daily dose of green-yellow vegetables also experi-
enced a reduction in their risk of lung cancer, and
there was a more than 25 percent reduction in the
number of deaths from stomach cancer among those
who increased their vegetable consumption (Dietary
Aspects of Carcinogenesis).
@ A Harvard University study of more than 1,200
elderly Massachusetts residents found that those who
Elderly people who ate reported the highest consumption of carrots, squash,
the most fruits and veg- tomatoes, salads or leafy greens, dried fruits, fresh
etables had the least
cancer. strawberries or melon, broccoli or brussels sprouts
had a decreased risk of cancer (Community Health
Studies).
e A researcher comparing the diets of healthy
people and those with gastrointestinal cancer
in both
the United States and Norway found that the healthy
people ate more foods such as carrots, leafy green
vegetables and fresh fruits.

More Than Justa

Pretty Vegetable
What’s in a carrot that seems to counteract can-
cer? Buoyed by this impressive data, the National
Cancer Institute (NCI) is spending millions of dollars
to find out.
Starting with the only thing they knew for sure—
there's something about green-yellow vegetables that
Beta-carotene, a new acts as a buffer against cancer—NCI scientists latched
contender against
onto color as their first clue. What gives these vegeta-
cancer.
bles their hue? A naturally occurring pigment called
beta-carotene, now the subject of at least a half dozen
studies funded by NCI.
 Blocking Cancer with Vitamin A and Beta-Carotene 85

Of course, beta-carotene is more than just a pig-

ment. It is one of the dietary chemicals the body
converts into usable vitamin A. Because so little is
known about it, researchers are grappling with several
questions. Does beta-carotene inhibit cancer by its
own unique mechanism or simply because it is con-
verted into vitamin A, which has been shown in lab-
oratory studies to be a cancer preventive? If it has its
own potency, and since it is the common dietary
source of vitamin A, could some of the anticancer
claims made for vitamin A be more rightly credited to
beta-carotene?
What evidence there is suggests that beta-caro-
tene provides its own form of protection against can-
cer. And one cancer researcher, Richard Peto of Ox-
ford, England, believes it’s a strong possibility that it
could prevent about a third of the cancer deaths in the
United States.

A Shock Absorber
against Cellular Insults
One thing scientists do know is that beta-caro-
tene acts as what one researcher describes as a
“shock absorber,” protecting the valuable genetic
blueprints inside each cell from the damage caused
by reactive molecules known as free radicals. Theo-
retically, the havoc wrought by those excited mole-
cules, natural by-products of fat metabolism, can turn
a healthy cell into a cancerous one.
And beta-carotene has two major advantages
over other forms of vitamin A. First, it has no known
toxicity. Vitamin A taken in doses over 50,000 interna- Unlike vitamin A, an
tional units daily can be dangerous. “With an over- overdose of beta-caro-
tene has no major side
dose of beta-carotene, on the other hand, all you do is effects.
turn yellow,” says Frank L. Meyskens, Jr., M.D., of the
Larry Smith Cancer Center of the University of Arizona
in Tucson.
Second, the dietary sources of beta-carotene are
unarguably healthful foods. (See the table, Best Food
86 From A to Zinc: A Guide to Vitamins and Minerals
a

Sources of Beta-Carotene, on page 91.) For most peo-

ple, the main sources of the other major form of
dietary vitamin A—the retinoids—are milk and
cheese. “Unless you go with skim milk and low-fat
dairy products, that can mean a very high-fat diet,”
says Judith Wylie-Rosett, Ed.D. Beef and chicken liver
are also high in vitamin A: 3% ounces of fried beef
liver has 36,105 international units of vitamin A, and 3
ounces of cooked chicken liver has 10,461 interna-
tional units.

Lower Risk of Cervical Cancer

Dr. Wylie-Rosett and her colleagues at the Albert
Einstein College of Medicine in New York City are a
few of the handful of researchers who are adding to
the growing body of knowledge about this nutrient-
come-lately.
When they examined the diets of a group of
healthy women and women with abnormal PAP
Is too little beta-caro- smears, they found that women with a low vitamin A
tene a factor in cervical or beta-carotene intake had a threefold greater risk of
cancer?
developing cervical cancer or severe cervical dyspla-
sia, a precancerous condition (Nutrition and Cancer).
One of the reasons Dr. Wylie-Rosett and her as-
sociates looked at beta-carotene intake, aside from
their interest in the nutrient, was extremely practical.
“In our computer analysis, we have the ability to eval-
uate it,” she says. “Not all nutrition surveys do, which
is probably one reason why so little has been done on
it. The interest in beta-carotene is relatively recent.”
Interestingly, at almost the same time the Ameri-
can researchers were probing the connection be-
Vegetables have an tween beta-carotene and cervical cancer, so were a
edge over animal group of doctors in Milan, Italy. Their findings were
sources of this nutrient.
similar: Women who averaged 5,000 international
units of beta-carotene daily, as measured by their
consumption of carrots and green vegetables, had a
reduced risk of cervical cancer. Significantly, the re-
searchers found no such association with the
retinoids—measured by the consumption of milk,
 Blocking Cancer with Vitamin A and Beta-Carotene 87

liver and meats—when they compared the diets of

191 women with cervical cancer and 191 healthy
women in the same age group U/nternational Journal
of Cancer).

A Step against Oral Cancer

Of course, asking someone to recall the amount
of carrots or squash he or she ate over any given
period doesn’t give the kind of rock-solid results ex- Can beta-carotene head
perimental scientists prefer. These so-called retro- off oral cancer?

spective studies are often severely criticized. So re-

searchers at the British Columbia Cancer Research
Center in Vancouver made sure they knew exactly
how much beta-carotene and vitamin A their test sub-
jects were taking. They administered capsules of each
twice weekly to 40 rural Filipinos living on Luzon, the
largest island in the Philippines, who were chosen
because of their habit of quid chewing.
A quid is a concoction made from the areca nut,
the betel leaf, lime produced from heating and crush-
ing snail shells, and dried tobacco leaf. It is believed
responsible for several hundred thousand oral cancer
deaths each year in Asia. The Filipino tribesmen se-
lected for the trial, ranging in age from 30 to 60,
admitted to chewing from 4 to 15 quids a day.
Working with medical missionaries in this poor
community, where the daily fare was usually potatoes
and rice, the researchers made sure their volunteers
got 100,000 international units of vitamin A and
300,000 international units of beta-carotene each
week—well above the Recommended Dietary Allow-
ances (RDA). Because the study was so short (only
three months), the scientists knew they wouldn’t see
cancers develop, so they looked for the earliest warn-
ing sign: cell damage inside the mouth.
Needless to say, among the quid chewers there
were quite a few damaged cells in the tissue samples
scraped from the insides of their cheeks at the begin-
ning of the study. But at the end, 37 of the 40 had
substantially fewer damaged cells than they did at the
88 From A to Zinc: A Guide to Vitamins and Minerals

start. In fact, the number of damaged cells decreased

dramatically—by about 40 percent a month. The re-
maining 3 had no increase in the amount of damage.
The researchers found their results so “striking”
they suggested that it may be possible for people at
high risk of oral cancer to lessen their risk by simply
adding vitamin A and/or beta-carotene to their diets
(Lancet).

‘““Morning-After Pill”
for Cancer?
Like the 20-year Japanese study, the Canadian
research appears to indicate that we have a grace
period, a time when dietary intervention will save us
from the consequences of our bad health habits. Sev-
eral important animal studies are providing clues to
just how long it lasts.
Eli Seifter, Ph.D., professor of biochemistry and
surgery, and his colleagues at the Albert Einstein Col-
The sooner you begin to lege of Medicine found out more about that critical
take advantage of beta- grace period. They discovered the earlier beta-caro-
carotene, the more
health damage you may
tene is given, the better. When they gave a hefty dose
prevent. (equal to dozens of times the RDA for men) to rats at
intervals ranging from two to nine weeks after expo-
sure to a cancer-causing chemical, the researchers
discovered the grace period lasted for five to six
weeks. Rats given beta-carotene more than a month
after their exposure to the carcinogen did not develop
tumors.
While the results can’t yet be translated into a
human timetable, they still provide some valuable in-
Beta-carotene may fight formation. “What our study really shows,” says Dr.
tumors directly. Seifter, “is that beta-carotene is protective against ei-
ther late stages of tumor development or early stages
of tumor growth.
‘‘That’s very good, because it shows in a sense
that it’s a ‘morning-after pill.’ Even after exposure to
cancer-producing doses of some toxic chemicals,
beta-carotene still has its effect.”” For recent converts
 Blocking Cancer with Vitamin A and Beta-Carotene 89

to health-consciousness and those who still haven’t

kicked their bad habits, it’s not too late.
Dr. Seifter believes a daily intake of five to ten
milligrams (25,150 to 50,300 international units) of
beta-carotene—the equivalent of 8,375 to 16,750 in- One doctor’s Rx: For tu-
ternational units of vitamin A—will provide good pro- mor protection, a diet
supplying at least
tection against some tumors. “People at high risk for 25,150 international
developing cancer, smokers for instance, would re- units of beta-carotene a
quire twice that amount,” he says. day.

Can Vitamin A
Fight “Cancer Stress’’?
“Most chemotherapy makes some people
sick,” says Eli Seifter, Ph.D., professor of bio-
chemistry and surgery at the Albert Einstein
College of Medicine in New York City. ““Can-
cer and cancer therapy are very stressful to
the body, and those very stresses promote
cancer growth.”’
The result is an increased breakdown of
body tissue, weight loss, a suppressed im-
mune system and increased production of
hormones, such as adrenaline, which are as-
sociated with stress. But Dr. Seifter has found
that in mice “stressed’”’ through partial body
restraint, vitamin A reduced the physical
symptoms of stress. It shrank the size of the
stress-enlarged adrenal gland and enlarged
the thymus, otherwise shrunk by stress.
He believes stress reduction will give
people a real edge in fighting cancer. “Vita-
min A, in combination with conventional
therapy that reduces tumor size, along with
other nutritional, hormonal and psychologi-
cal treatments that help relieve stress, may
prove to be valuable in tumor treatment in the
near future,” he says.
90 From A to Zinc: A Guide to Vitamins and Minerals

A Force against Lung Cancer?

Richard B. Shekelle, Ph.D., a professor of epide-
miology at the University of Texas Health Science
Center in Houston, has explored another aspect of
beta-carotene’s reputed anticancer power.
Dr. Shekelle sent the cancer-research commu-
nity into a spin with the results of his long-term study
on beta-carotene and its effects on the deadliest of
malignancies to man—lung cancer.
Dr. Shekelle’s study actually began as a long-
term investigation into coronary heart disease on
Can beta-carotene stop 2,107 workers of a Chicago-based plant of Western
the deadliest cancer of Electric Company. One aspect of the study was to
all?
take dietary records of the participants. When it came
to plotting vitamin A intake, Dr. Shekelle and his col-
leagues decided to divide the vitamin intake into that
which came from animal sources (whole milk, liver,
cream, butter and cheese) and that which came from
beta-carotene-rich fruits and vegetables.
Over the next 19 years, 33 of the men developed
lung cancer—all positively related to cigarette smok-
ing. However, Dr. Shekelle and his colleagues noticed
something else very significant in those who devel-
oped lung cancer. The rate was highest in those who
ate the least amount of beta-carotene foods and low-
est in those who ate the greatest amount. The result:
an 8-to-1 difference in risk between the lowest and
highest carotene-intake groups (Lancef).
Despite all this research, science can’t yet tell us
precisely how much vitamin A or beta-carotene we
Beta-carotene: How to should get in our diets to avert cancer. But unless
make sure you’re get- you're the strictly meat-and-potatoes type, shunting
ting enough.
other vegetables to the corner of your plate, it’s hard
to avoid getting at least some beta-carotene in your
diet. (See the table, Best Food Sources of Beta-Caro-
tene, on page 91.) If you’re taking your beta-carotene
in its usual form (vegetables), you can even take more
than 25,150 to 50,300 international units. But more
than that—say, from eating pounds of carrots—is
overdoing it.
 Blocking Cancer with Vitamin A and Beta-Carotene

Best Food Sources

of Beta-Carotene

Food Portion Vitamin A

Value*
(1.U.)

Sweet potato, baked 1 24,877

Carrot, raw 1 20,253
Carrots, cooked, sliced Y% cup 19,150
Spinach, cooked Y cup YesyAl)
Squash, winter, butternut, Y% cup 7,141
cooked, cubed
Papaya 1 6,122
Kale, cooked, chopped Y cup 4,810
Cantaloupe Y 4,304
Turnip greens, cooked, chopped Y% 3,999
Apricots 3 2,769
Broccoli, cooked 1 spear Zoi
Watermelon Yeo 1,762
Tomato, raw 1 1,530
Avocado 1 1,230
Broccoli, cooked, chopped Ye cup 1,099
Nectarine 1 1,001
Tangerine 1 1H
Asparagus, cooked, sliced Y cup 746
Lettuce, loose-leaf, shredded Y cup 532
Peas, green, cooked Y% cup 478
Peach 1 465
Okra, cooked, sliced Y% cup 460
Lettuce, iceberg Y% head 445
Beans, green, cooked, sliced Y% cup 413

Sources: Adapted from

Composition of Foods: Vegetables and Vegetable Products, Agriculture Handbook
No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1984).
Composition of Foods: Fruits and Fruit Juices, Agriculture Handbook No. 8-9, by
Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information Ser-
vice, U.S. Department of Agriculture, 1982).
Nutritive Value of American Foods in Common Units, Agriculture Handbook No.
456, by Catherine F. Adams (Washington, D.C.: Agricultural Research Service, U.S.
Department of Agriculture, 1975).
Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Mermll (Washington, D.C.: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).

*Vitamin A value reflects the amount of vitamin A derived from the yellow,
orange and green pigments, including beta-carotene, that are found in fruits and
vegetables.
92 Chapter ik:
Using the
Healing Power
of B Vitamins

ou can get to know the B vitamins intimately.

Just skip a few meals or feast on candy bars and
colas between work and your workout. The B team
(by its absence) will introduce itself in no time flat—
leaving you grouchy and tired.
If you’re dragging as much as you're jogging, you
may be a victim of what might be called “jock’s syn-
“‘Jock’s syndrome’’— drome.” According to Jack Cooperman, Ph.D., direc-
the fitness buff’s vita- tor of nutrition at the New York Medical College, a
min deficiency.
subclinical, or marginal, vitamin deficiency is first sig-
naled by a low blood level of B’s—and it may be a
hidden epidemic among the otherwise health con-
scious.
If you can’t squeeze three squares a day in be-
tween your job and the gym, he says, you'll soon be
running on empty. It takes only a few weeks for the B
levels in your blood to drop. This increases the risk of
a subclinical deficiency, which can occur after active
forms of the B vitamins in the cells decrease.
The B’s—there are 11 members of the B family,
counting related compounds—help keep you going.
Some of the best-known ones are thiamine (B, ), ribo-
flavin (B,), niacin, B,, B,, and folate. They work to-
gether to help cells absorb and burn energy. Quite
simply, without these pepper-uppers, you poop out.
The B’s work in the body to help convert pro-
teins, carbohydrates and fats into fuel, and in the
brain to help synthesize the mood-controlling chemi-
cals. That’s why a B deficiency often manifests itself in
 Using the Healing Power of B Vitamins 93

extreme muscle weakness and in psychiatric prob-

lems ranging from mild irritability to full-blown psy- B vitamins are the spark
chosis. Fortunately, severe cases are rare, but even a plugs that ignite the
body’s fuel.
marginal deficiency can leave you with the blues and
the blahs.
The after-work athlete, the erratic eater and the
dedicated dieter run the risk of marginal deficits be-
cause they’re not replacing the B’s they’re using to
burn up energy. But deficiencies are also fairly com-
mon among the elderly and among people whose
diets are rich in refined foods and poor in nutrients.
Vegetarians, pregnant and nursing women and
women taking oral contraceptives also fall into the
serious risk category. (See the table, Best Food
Sources of B Vitamins, on pages 100-101, for a list of
foods that will help you beef up your intake of B’s.)
But keeping you peppy and perky isn’t the only
job of the B team. Certain discoveries offer some
promise that the B vitamins may also help you fight Can B vitamins fight
cancer, cardiovascular disease and even the mental cancer, cardiovascular
disease and senility?
deterioration of aging. Here are some of the latest—
and most intriguing—research results on the B’s you
know best.

News about Niacin

Cancer researchers in Omaha, Nebraska, used
nicotinamide, a form of the B vitamin niacin, to coun-
teract the toxic effects of a drug used to induce deadly
pancreatic cancer in hamsters. Niacin is an effective
antitoxin.
But what else it did surprised one of the research-
ers, Terrence Lawson, Ph.D., of the Eppley Institute
for Research in Cancer at the University of Nebraska
in Omaha.
‘When we took the animals to term in 52 weeks,
we noticed there were no pancreatic tumors at all,”
says Dr. Lawson.
In another study, Dr. Lawson also discovered
that the animals treated with a dose of nicotinamide
94 From A to Zinc: A Guide to Vitamins and Minerals

after a dose of the carcinogen had significantly less of

Niacin as an antidote to the DNA damage usually caused by cancer. (DNA is a
cancer-causing toxins. cellular molecule that carries genetic information.)
“It's reasonable to assume that somehow or
other, the nicotinamide was cleaning up the damaged
cells,” he says.
Eventually, says Dr. Lawson, niacin may prove to
be an effective “chemopreventive compound,” a nu-
trient that doesn’t cure cancer but prevents it.
Other research also suggests niacin may have
some therapeutic uses in the treatment of blood clots
that lead to cardiovascular diseases.
Using nicotinic acid (another form of niacin),

Niacin Reduces Post—Heart-Attack Risk

Sixteen years after 1,119 male clofibrate, dextrothyroxine and
heart attack survivors began tak- two types of estrogen, or female
ing niacin, the group had an 11 sex hormones.
percent lower death rate than a In the original trial, which
similar group of men given a pla- lasted from 1966 to 1975, 8,341
cebo (dummy pill), investigators male survivors aged 30 to 64 were
found. placed on one of these five agents
Overall, the men taking nia- or a placebo. At the end of this
cin lived about two years longer period, the niacin group showed a
than those in the placebo group, modest benefit in terms of nonfa-
reported Paul Canner, Ph.D., of tal heart attacks, but no clear ad-
the Maryland Medical Research vantage when it came to fatal at-
Institute in Baltimore. Niacin, tacks. But during a follow-up
which protects against atheroscle- survey, conducted from 1981 to
rosis by lowering blood lipids 1984, six to nine years after the
(cholesterol and _ triglycerides), conclusion of the study, niacin’s
was one of five lipid-lowering protective power showed up
agents tested on over 8,000 male clearly—perhaps, Dr. Canner sug-
heart attack survivors in the Coro- gests, because it slowed the
nary Drug Project. Niacin was progress of atherosclerosis (/nter-
found to be the most effective of nal Medicine News).
the five agents, which included
 Using the Healing Power of B Vitamins 95

Ravi Subbiah, Ph.D., of the Lipid Research Center of

the University of Cincinnati Medical Center, was able Niacin, says one scien-
to suppress a process in atherosclerosis-prone pi- tist, may even counter
clot-forming blood fats.
geons that causes the clotting of blood platelets.
Niacin has an added bonus. It also reduces
blood cholesterol and triglycerides—though at large
doses—making it “potentially useful” as therapy for
heart disease, says Dr. Subbiah.

B,. Teams Up with Vitamin C

Vitamin B,, is the vitamin that, with folate, helps
produce red blood cells in bone marrow. Without it,
red cell production diminishes and pernicious anemia Doctors sometimes
results. Scientists believe that red cells are affected manipulate B,, and fo-
late in the body to slow
more than others by a B,, deficiency because B,, is cancer growth.
part of the process that churns them out faster than
other cells. Cancer cells are produced at the same
quick pace, which is why doctors sometimes induce a
B,, (and folate) deficiency in certain cancer patients
to slow the growth of a malignancy.
But there is also some recent evidence that B,, in
conjunction with vitamin C is effective against cancer
in a different way. The clues have turned up in animal
studies conducted by Sister M. Eymard Poydock,
Ph.D., a researcher at Mercyhurst College in Erie,
Pennsylvania.
Dr. Poydock and her associates have had re-
markable results with supplemental B,, and vitamin C
in increasing the survival rate of mice with leukemia
and several forms of malignant tumors, including one
stubbomly resistant to other treatment. What is most
remarkable is how fast the vitamins work.
‘Even in the early stages, we see no increase of In laboratory animals,
malignant cells,” says Dr. Poydock. ‘After the seventh B,,. and C disintegrate
tumor cells.
treatment, no tumor cells at all are present. The tumor
cells just disintegrate. It’s very exciting.”
Although the cancer-conquering process is still a
mystery, Dr. Poydock suspects the vitamins work be-
cause they may alter the membranes of malignant
96 From A to Zinc: A Guide to Vitamins and Minerals

cells so that the T-lymphocytes, the body’s disease-

fighting “killer” cells, recognize them as foreign and
attack them. In fact, fluid extracted from their experi-
mental mice was a veritable battlefield, littered with
disintegrating tumor cells, lymphocytes and other dis-
ease-fighting cells (Experimental Cell Biology).
Though the day that B,, becomes a confirmed
cancer therapy is probably still far off, the vitamin may
Can B,, save the lives of be a lifesaver right now for the estimated half million
certain people with asthmatics who are sensitive to the chemicals used to
asthma?
keep restaurant food looking fresh.
The potentially dangerous substances are called
sulfites. They can keep sliced potatoes from turning
brown. They’re also a common additive in wine and
beer. Though there have been no documented
deaths, at least one researcher believes that some
restaurant fatalities written off as choking accidents
may have been caused by allergic reactions to sulfites.
He is Ronald Simon, M.D., of the Scripps Clinic
and Research Foundation in La Jolla, California. It
was the research of Dr. Simon and his co-workers that
originally piqued the interest of the producers of the
CBS news program <‘60 Minutes,” which first alerted
the public to the dangers of sulfites.
The Scripps group research paid off in another
way. They eventually discovered that an oral dose of
B,. worked better than vitamin B,, taken shortly before exposure to sulfites
some drugs to stymie completely blocks asthmatic reaction. In fact, vitamin
asthmatic attacks.
B,. worked better than three other drugs they tested
on six sulfite-sensitive patients, and at a lower
dosage, too.
Apparently, says Dr. Simon, B,, enhances the
chemical reaction that alters the sulfites in the body,
quickly and efficiently converting them into an inac-
tive substance.

Folate for Healthy Chromosomes

Folate works in partnership with B,, to form the
red blood cells. It also helps dividing cells synthesize
 Using the Healing Power of B Vitamins 97

proteins, amino acids and nucleic acids. And research

indicates that if your body isn’t using folate properly,
you risk serious damage to your chromosomes. That’s
important, because chromosome damage may be a
catalyst for cancer.
“Many researchers believe that chromosome
damage is an important part of the process that
causes malignancy,’ says Richard Branda, M.D., a
professor of medicine at the University of Vermont.
In fact, Dr. Branda has established a possible link
between defects in the cells’ use of folate, chromo-
some damage and cancer. The clue came from a Folate may help keep
study of a family with a history of chromosome dam- chromosomes intact.

age and serious blood disease, including leukemia.

Their cells weren’t absorbing and using folate nor-
mally. In one family member with aplastic anemia,
cell levels of folate were extremely low and remained
low even after he took supplemental folate.
Dr. Branda believes the folate defect may have
been the cause of the chromosome damage, which in
turn precipitated the aplastic anemia. The case,
though extremely rare, suggested to the researcher
that it is folate that keeps the chromosomes from
breaking.
There is other evidence linking folate deficiency
to cancer. Researchers at the University of Alabama
found that oral contraceptive users who had a pre- Women on the Pill, take
cancerous condition along with folate deficiency note.
were at less risk of developing cancer if they took
folate supplements.
C. E. Butterworth, M.D., and his associates tested
47 young women taking birth control pills who had
mild or moderate cervical dysplasia, a condition in
which cervical cells can become malignant. Both fo-
late deficiency and dysplasia are associated with the
use of oral contraceptives.
A control group of contraceptive users who did
not have the condition still had below-normal folate
concentrations in their red cells. But the women with Folate kept precancer-
dysplasia showed an even more marked decline in ous growths in check.
98 From A to Zinc: A Guide to Vitamins and Minerals
i

folate levels. Folate supplements kept their precancer-

ous condition from worsening.
The researchers believe that if their findings can
be confirmed, it could provide important new in-
formation about the role nutrients play in controlling
the growth of cancer (American Journal of Clinical
Nutrition).

Riboflavin, the
Exerciser’s Friend
The 13-year-old patient posed a puzzling prob-
lem. At rest, her strength was normal. But when she
moved her arms and legs, they grew weak. Her doc-
tors at Academic Hospital Rotterdam in the Nether-
lands suspected and subsequently isolated a marginal
enzyme deficiency that left her muscle cells unable to
absorb the amount of energy they needed to work
properly.
Although the teenager showed no signs of a vita-
min deficiency, her doctors suspected her condition
Riboflavin beat an en- might respond to vitamin therapy anyway. So they
zyme deficiency and gave her a supplement of riboflavin, the B vitamin
gave a teenager new
strength.
crucial to the enzyme action that turns foods into fuel.
Her doctors were right. Not only was her im-
provement “striking and sustained” but it wasn’t long
before she was riding her bike and active in sports
again (Lancef).
Riboflavin, plentiful in dairy products, should be
as much a part of your exercise gear as running shoes
or tennis racquets. But it’s easily lost from the body. In
fact, you can literally sweat it away. And, like the fuel
in your gas tank, you can lose it when you use it.
Health-conscious women who exercise rigorously
may be doing just that.
Researchers at Cornell University discovered that
very active women need about double the Recom-
Very active women may mended Dietary Allowance (RDA) of 1.2 milligrams
need twice the Recom- of riboflavin a day. They learned this by testing the
mended Dietary Allow-
ance of riboflavin. blood levels of the vitamin in a group of young female
university students and staff eating a controlled diet
 Using the Healing Power of B Vitamins 99

and jogging 25 to 50 minutes a day for six weeks

(American Journal of Clinical Nutrition).

Thiamine for Brain Power

A thiamine deficiency is characterized by severe
fatigue and depression. In its most severe form, pe-
ripheral nerve damage and possibly paralysis appear.
Rare in this country, it still has its victims, those whose
calories are highly restricted and alcoholics who sub-
stitute drinking for eating.
In a study at the National Institutes of Mental
Health, Bethesda, Maryland, researchers induced re-
peated thiamine deficiencies in a group of rhesus
monkeys. Not only did the animals exhibit all the
typical symptoms of human thiamine deficiency, they
also suffered similar nerve damage, which the re-
searchers found was reversible with supplemental thi-
amine. Their findings, the researchers said, point up
the need for early detection and treatment of thia-
mine deficiency (Annals of Neurology).
Other scientists are interested in thiamine defi-
ciency for a different reason. Resulting memory defi-
cits closely resemble the mental deterioration of Is thiamine the missing
Alzheimer’s disease, a degenerative brain disorder, link in Alzheimer’s dis-
ease?
and even normal aging.
Gary Gibson, Ph.D., of Cornell University’s Burke
Rehabilitation Center in New York, is involved in a
long-term study of the biochemistry of thiamine defi-
ciency in the hope that it can shed some light on the
course of chronic brain deterioration. “We're looking
for clues to see if there is some common element so
we can get closer to what the biochemical deficit is
and learn how to overcome it,”’ he says.

B, Linked to Mood Swings

Vitamin B,, also known as pyridoxine, is begin-
ning to be recognized as nature’s own antidepressant.
In fact, there is evidence that a B, deficiency, even a
marginal one, may be a cause of depression.
100 From A to Zinc: A Guide to Vitamins and Minerals

Researchers at the Virginia Polytechnic Institute

and State University tested the B, levels of a group of
Without B,, is depres- depressed patients and discovered that all had inade-
sion inevitable? quate amounts of the vitamin. The scientists believe
that without B, the brain is unable to produce an
adequate supply of the mood-controlling neurotrans-
mitter serotonin (Nutritional Reports International).
‘Our research indicates that depression could be
associated with inadequate B, levels,” says one of the
researchers, Carolyn Russ, currently a nutritionist and
assistant director of the Clinical Nutrition Center at
the University of California, Davis.

Best Food Sources of B Vitamins

Food Portion Thiamine Riboflavin Niacin Bs Bi Folate

(mg.) (mg.) (mg.) (mg.) (mcg.) (mcg.)
Beef, round, full
cut, separable
lean only, cooked 3 02. 0.086 0.195 0.430 2.53 3.540
Beef kidneys,
simmered DIOZs 0.162 3.450 0.440 43.60 5.110
Beef liver, braised 3 02. 0.167 3.480 0.770 60.35 9.110
Brewer's yeast 1 tbsp. 1.250 0.340 0.200 0.00 3.000
Chicken, light meat,
cooked 3 OZ. 0.060 0.100 0.510 0.29 10.560
Chick-peas, boiled Y% cup 0.095 0.052 0.114 0.00 0.431
Egg, hard-cooked 1 0.040 0.140 0.060 0.66 0.030
Kidney beans, all
types, boiled Y cup 0.141 0.051 0.106 0.00 0.509
Chicken liver, cooked 3 02. 0.130 1.490 0.500 16.49 3.780

Sources: Adapted from

Composition of Foods: Beef Products, Agriculture Handbook No. 8-13, by Nutrition Monitoring Division (Washington,
D.C.: Human Nutrition Information Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Breakfast Cereals, Agriculture Handbook No. 8-8, by Consumer Nutrition Center (Washington
D.C.: Human Nutrition Information Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1, by Consumer and Food Economics Insti-
tute (Washington, D.C.: Agricultural Research Service, U.S. Department of Agriculture, 1976).
Composition of Foods: Legumes and Legume Products, Agriculture Handbook No. 8-16, by Nutrition Monitoring Division
(Washington, D.C.: Human Nutrition Information Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12, by Nutrition Monitoring Division (Wash-
 Using the Healing Power of B Vitamins 101

What remains to be done, she says, is to test B,

therapy on depressed patients whose B, levels are
low. Whether or not more of the vitamin would help
those who aren't deficient in it is uncertain. In any
case, amounts over 50 milligrams a day should not be
taken.
Can a B, deficiency make you older than you
are? Two scientists at the University of Texas at Austin
induced signs of premature aging in rats by feeding In rats, B, deficiency
them diets deficient in B, or copper for two to three produced premature
aging.
months. Without B,, the delicate nerve branches,
called dendrites, which receive nerve impulses, de-

Food Portion Thiamine Riboflavin Niacin Be Bi Folate

(mg.) (mg.) (mg.) (mg.) (mcg.) (incg.)

Milk, whole 1 cup 0.090 0.400 0.100 0.87 0.210 12

Navy beans, boiled Y% cup 0.184 0.056 0.149 0.00 0.483 We
Peanuts, all types,
dry-roasted Y% cup 0.000 0.035 0.093 0.00 4.930 53
Brown rice, raw Y% cup 0.170 0.030 0.280 0.00 2.350 8
Rye flour Y% cup 0.200 0.070 0.100 0.00 0.880 17
Salmon steak, cooked 3 oz. 0.150 0.060 0.640 2.95 8.400 18
Soybeans, boiled Y cup 0.133 0.245 0.201 0.00 0.343 46
Sunflower seeds, dry Y% cup 0.820 0.090 0.450 0.00 1.620 85
Swiss cheese 2 OZ: 0.010 0.210 0.050 0.95 0.050 4
Wheat germ, toasted 1 tbsp. 0.120 0.060 0.070 0.00 0.400 25
Whole wheat flour Y4 cup 0.170 0.040 0.100 0.00 1.300 16

ington, D.C.: Human Nutrition Information Service, U.S. Department of Agriculture, 1984).
Composition of Foods: Poultry Products, Agriculture Handbook No. 8-5, by Consumer and Food Economics Institute
(Washington, D.C.: Science and Education Administration, U.S. Department of Agriculture, 1979).
“Folacin in Selected Foods,” by Betty P. Perloff and R. R. Butrum, Journal of the American Dietetic Association, February
SYA
Nutritive Value of American Foods in Common Units, Agriculture Handbook No. 456, by Catherine F Adams (Washing-
ton, D.C.: Agricultural Research Service, U.S. Department of Agriculture, 1975).
Pantothenic Acid, Vitamin B,; and Vitamin B,,, Home Economics Research Report No. 36, by Martha Louise Orr (Wash-
ington, D.C.: Agricultural Research Service, U.S. Department of Agriculture, 1969).
102 From A to Zinc: A Guide to Vitamins and Minerals

generated and died, effectively short-circuiting the

brain. The resulting damage closely resembled nor-
mal aging (American Journal of Clinical Nutrition).
But, says researcher Elizabeth Root, Ph.D., it’s
rare to find a B, deficiency without a drop in some or
Taking advantage of the all of the other B vitamins and other vital nutrients.
“B team.”’ They are, after all, a team.
‘What we can safely say,” Dr. Root says, “‘is that
people, especially elderly people, should make sure
that they get all of their minimum daily requirements
of nutrients.”
 Chapter 14 103

Thiamine: Preventing
a Common Deficiency

ony was a strapping teenager—tall, muscular

and handsome. But likable he wasn’t, at least
for the past few months. His growing neurotic behav-
ior and temper tantrums were making him lose friends
fast. Then one day during a small spat with his
mother, he knocked over a bookcase in a rage.
Mary lived the life of a typical professional
woman: busy and on the go. Ever conscious of slip-
ping her hips into her sizable size 7 wardrobe, she Three cases of thiamine-
settled into a one-meal-a-day eating routine on the poor eating habits.
lunchtime restaurant circuit, subsisting mostly on sal-
ads or other diet-wise platters. Dinner, if there was
one at all, was usually soup from a can or another
salad—she was just too busy to do any real food
shopping. Then one day she suddenly had no urge to
eat at all, and she started to lose weight. Her friends
urged her to see a doctor.
Billy was the star of his college soccer team.
Back in shape after a summer of dieting and body
building, he took his first loss on the chin—with a
gaping wound to the jaw. But unlike the scrapes from
his former fights, this one just didn’t seem to be heal-
ing well. Worried, he went to see his doctor.
So, you wonder, what have we found to link a
strung-out teen, an up-and-coming female executive
and a college jock? It’s thiamine (B,). Yes, thiamine Your body can’t store
was needed to get this trio back in shape. Thiamine is thiamine, so dietary
supplies are important.
the first of the B vitamins, and its importance to our
health stems from the part it plays in the oxidation
104 From A to Zinc: A Guide to Vitamins and Minerals

process that takes place in each and every cell. Since

our bodies don’t store it, our need for thiamine is
ongoing. A lack of it can cause nervous disorders,
such as that experienced by teenage Tony.
Tony is a character closely aligned to a group of
teens with neurotic behavior who were studied by
Derrick Lonsdale, M.D., a former pediatrician who is
now practicing preventive medicine in Westlake,
Ohio.

Too Many Sweets

Dr. Lonsdale found many of the teens ate large
amounts of junk food, particularly sweet soft drinks,
candy and high-carbohydrate foods with little nutri-
tive value. Since thiamine is essential to metabolize
carbohydrates, a diet high in carbohydrates and sug-
ars requires more of the vitamin. But these teens
weren't getting enough.
“These children displayed behavioral charac-
teristics that we have come to accept as normal,” Dr.
Thiamine nourishes your Lonsdale says. “They complained of headaches, ab-
nerves. dominal and chest pains and sleeping problems. They
were irritable, and some were aggressive and hard to
handle.
“What they were was nutritionally disoriented.
Our blood test showed them to be deficient in a
common form of thiamine. We changed their diets
and gave them thiamine supplements. Of the ten we
retested, all showed normal behavior.” Some even
lost their craving for sweets and soft drinks. Thiamine,
Dr. Lonsdale notes, nourishes the nervous system,
and a lack of it can cause abnormal behavior.
Dr. Lonsdale feels, however, the impact of this
study goes beyond the importance of just thiamine in
Consuming large the diet. “There does appear to be a fairly large mass
amounts of sweets and of kids in America who have behavior abnormalities
soft drinks can rob
teens of thiamine. because of a poor diet,” he asserts. “The thing is that
this is widely accepted as part of growing up. A high
 Thiamine: Preventing a Common Deficiency 105

intake of carbohydrates, and caffeine and sugar in the

form of soft drinks, increases the need for many vita-
mins and minerals,” he says.
Other signs of thiamine deficiency are not quite
as blatant as abnormal behavior. Such was the case
with Mary. Her lack of appetite was also a sign of
thiamine deficiency.

Crash Diets Lack Thiamine

Even the earliest studies of the vitamin pointed to
its effects on the appetite. Since metabolism of carbo-
hydrates depends on thiamine, a lack of it can slow Without thiamine, appe-
the process down, leaving the victim with a loss of tite plummets.

appetite.
Mary could be a typical victim, in light of a study
indicating that single professional women fail to get
even two-thirds of their Recommended Dietary Al-
lowance (RDA) of a number of essential vitamins and
minerals. One of the nutrients found in low supply
was thiamine. In fact, 36 percent of the women sur-
veyed were falling short of this nutrient (/Vutrition
Reports International).
“Thiamine is a problem in young women be-
cause so many of them, particularly those going after
the slender image, do not eat much. The amount of Starvation diets sacri-
thiamine you get pretty much depends on the amount fice thiamine.

of food you eat,” says Robert E. Keith, Ph.D., of the

Department of Nutrition and Foods at Auburn Univer-
sity in Alabama, who studied the dietary habits of 50
well-educated career women in the area. Although
their intake levels were marginal, the women were not
showing obvious symptoms of deficiency.
“They didn’t eat a lot of meat, and calorie intake
was generally low,” reports Dr. Keith. “They ate a lot
of salads, but salads are usually made up of iceberg
lettuce, which isn’t a good source of thiamine.
“Thiamine is well distributed in most foods.
There aren’t many things that contain a great amount
106 From A to Zinc: A Guide to Vitamins and Minerals

of thiamine, although pork, organ meats and whole

grains are good sources,” he says. “Young women
watching their diets don’t eat a lot of those things.”
Brewer’s yeast and wheat germ are two good
sources of thiamine that could fit into the diet of a
weight watcher.
A lack of thiamine has also been found to cause
hypothermia—a lowering of body temperature—in
Lack of thiamine: A con- those suffering from the psychologically induced
nection with lower body form of appetite loss, anorexia nervosa.
temperature?
This was illustrated in the case of a 32-year-old
woman with a history of the disorder who was admit-
ted to a hospital with a subnormal body temperature.
Her thiamine level was found to be low, and she was
put on 300 milligrams daily. After seven days, her
temperature returned to normal, and she regained her
appetite. Three months later, thiamine supplements
were withdrawn. In two weeks her symptoms re-
turned (American Society for Clinical Nutrition).

Aid for Wound Healing

And, as Billy’s story revealed, thiamine is neces-
sary not only for the metabolism of the foods that we
Thiamine helps long- eat. Research shows that it has an effect on the way
term wound healing. our wounds heal, too. Animal studies showed that
wound healing was significantly delayed in thiamine-
deficient rats compared to those with normal thia-
mine levels (Journal of Surgical Research).
“We found increased levels of thiamine did not
speed up the process, but it did do something signifi-
cant. It made the wounded area stronger and more
resilient after healing,” says Oscar M. Alvarez, Ph.D.
Dr. Alvarez, former director of the Wound Heal-
ing Research Laboratory of the Cornell University
Medical School, feels this finding could have an im-
portant impact for surgery patients. “The RDA for
thiamine may be wrong in stressful situations such as
wound healing, which is important in surgery,” re-
ports Dr. Alvarez.
 Thiamine: Preventing a Common Deficiency 107

Dr. Alvarez says he is not certain why thiamine is

so important in the healing of wounds, but he feels
that it has a lot to do with the overall reaction of the
body to an injury.
Thiamine deficiency can block the metabolism
of collagen, which is a protein of the body. “In order
for a wound to heal, collagen must be produced, and One more metabolic link
energy is required for its production. Thiamine may in the chain of healing.
be related to wound healing because of its direct
relationship to energy production,” Dr. Alvarez ex-
plains.

Other Nervous System Needs

for Thiamine
Another new use for thiamine is showing up in
the emergency room. At Bellevue Hospital Center in
New York City, Lewis R. Goldfrank, M.D., and his Thiamine at work in the
emergency room staff are using thiamine in treating emergency room.

unconscious patients.
The normal procedure in such a case is to give
intravenous dextrose and water to the patient. “This is
theoretically sound, but it can have disastrous practi-
cal consequences if a patient is thiamine deficient,”
says Dr. Goldfrank. “Since thiamine is needed to
metabolize sugar,” he says, “you simply cannot give
glucose and expect to get a high energy yield unless
thiamine is present.”
This is particularly relevant with alcoholics, who
are commonly thiamine deficient due to their gener-
ally poor nutrition and who often end up, uncon-
scious, in a hospital emergency room. Symptoms of
intoxication and thiamine deficiency are often simi-
lar—staggered walk, glazed eyes, loss of coordination
and confusion.
“In light of this, giving supplemental thiamine to
all alcoholics for whatever reason makes a lot of
sense from the viewpoint of nutritional and preventive
medicine, as does fortifying all alcoholic beverages,”
writes Dr. Goldfrank in Emergency Medicine.
108 From A to Zinc: A Guide to Vitamins and Minerals

Severe thiamine deficiency can cause a loss of

muscle control, loss of memory and even coma.
Replacing lost thiamine “Many of these symptoms can be successfully re-
can reverse some dam- versed if thiamine is used promptly, before permanent
age done by alcohol.
damage takes place,” says Dr. Goldfrank. “On the
other hand, giving glucose without thiamine can result
in a lifetime disability because you may precipitate
Wernicke-Korsakoff’s syndrome or considerably
worsen a preexisting condition.”
Wernicke syndrome is a nervous system disor-
der, characterized by loss of coordination, abnormal
eye movement and delirium. It can progress to
Korsakoff syndrome, which is permanent mental im-
pairment.
The importance of thiamine was discovered
about a century ago when a disease called beriberi,
Beriberi—the thiamine- which debilitated the Japanese navy, was found to be
deficiency disease— the result of a diet containing a lot of polished (re-
may not be as rare as
many people think.
fined) rice. When grains are refined, much of the
thiamine is removed. Researchers soon discovered
that a person who eats large amounts of white flour,
commeal, polished rice and refined cereals and sug-
ars is more likely to wind up sick than one who eats
unrefined foods.
Although beriberi is rare, Japanese researchers
have reported a reappearance of the disease over the
past decade, this time in the nation’s population of
young people.
The importance of thiamine should not be over-
looked. Without it we can lose our appetite, get de-
pressed and develop other psychological problems.
With it, our energy level is up, our minds are sharp and
our emotions are high. So, when it comes to the
basics of nutrition, thiamine should be at the top of
the list. CTo increase your intake of thiamine, see the
table, Best Food Sources of B Vitamins, on pages
100-101.)
 Chapter 15 109

Vitamin B,: More

Reasons to Make Sure
You're Getting Enough

t began as just another offbeat case of side effects

from medical treatment, but that’s not how it
turned out.
A 65-year-old woman was being treated for heart
trouble with a drug (amiodarone) that causes an odd
physical reaction. Doctors call the side effect photo-
sensitivity, a malady where even short exposure to
sunlight gives way to itching, rashes or, in the wom-
an’s case, sunburn.
This time, however, an unusual antidote was pre-
scribed: vitamin B,. When the woman was given daily
doses of the nutrient along with her heart medication, B, lessened drug-
her photosensitivity lessened. induced photo-
sensitivity.
The same thing happened with two other coro-
nary patients who mixed B, and the same heart drug.
And according to the medical investigator of these
three cases, the B, “in no way impaired the desired
pharmacological effects of amiodarone” (Lancet).

The Many Tasks Done by Bg

Is anyone surprised by such findings? Certainly
not researchers who know B, well. To them this re-
port is one outcropping of B, data in the landscape of B, has been suggested
nutritional research, an expanse already dotted with as a treatment for ev-
erything from asthma to
evidence of the nutrient’s influence. They've seen _ cancer.
studies hinting that B, may relieve asthma and hyper-
activity in children, ease premenstrual tension and
swelling, help prevent recurrence of bladder cancer,
110 From A to Zinc: A Guide to Vitamins and Minerals

decrease depression in women taking birth control

pills, reverse the nerve disorder called carpal tunnel
syndrome and help impede the development of ath-
erosclerosis.
Perhaps more than any other vitamin, some sci-
entists say, B, is multifunctional and multifaceted.
“It’s not at all astonishing that vitamin B, can
affect so many different physical conditions that
seemingly have nothing to do with one another,” says
Alan Gaby, M.D., a Maryland physician and author of
A Doctor’s Guide to Vitamin B,. “The nutrient is a
cofactor [biological activator] for at least 50 enzymes
responsible for hundreds of biochemical tasks. With-
out B, the enzymes couldn’t do their jobs, and body
chemistry would break down in countless ways. With
B, the biological functions can be activated and main-
tained.”
Adults and infants, pregnant and menstruating
women, body and mind—B,’s range of operations
stretches far and wide. And researchers have been
busy documenting it inch by inch.

B, for the Mind

And sometimes case by case. One example is a
case report from doctors at Arlington Hospital! in Ar-
Behind the scenes, B, lington, Virginia—a scientific account that lends sup-
research is going full port to some B, studies done more than ten years ago.
tilt.
The subject: schizophrenia. “An 18-year-old
male entered the hospital emergency room and was
diagnosed as having acute catatonic schizophrenia,”
says Lawrence D’Angelo, M.D., one of the investigat-
ing doctors. “He showed signs of restlessness, insom-
nia, mental confusion, anorexia, hallucinations, psy-
chomotor retardation and other symptoms. However,
we could find no evidence of organic brain damage,
drug toxicity or any other specific cause for his condi-
tion—even after about three weeks of intensive medi-
cal investigation.”
The doctors tried antipsychotic drugs on the pa-
tient, discontinued them because of severe side ef-
 Vitamin B,:
More Reasons to Make Sure You’re Getting Enough 111

fects, tested the patient some more, then considered After other attempts
B,. “We knew about other psychiatric case reports failed, the doctors tried
vitamin B,.
involving B,,” says Dr. D’Angelo. “So we started the
patient on a daily B, regimen.”
The dosage was 150 milligrams three times a
day, then 500 milligrams per day—a therapeutic in-
take far above normal levels. The Recommended Di-
etary Allowance (RDA) is 1.8 to 2.2 milligrams. (Be-
cause evidence suggests very large doses can be
dangerous, you should never exceed 50 milligrams
daily unless you are advised to do so by a knowledge-
able physician.) Within 48 hours after the dose was
increased, the patient started to improve—and he
kept improving as long as he stayed on the nutrient
therapy.
“Over a period of seven months, most of the
patient’s symptoms went away,” Dr. D'Angelo says.
‘He thought more logically and clearly and didn't B, caused dramatic im-
demonstrate any of the abnormal behavior he had provement in a schizo-
phrenic.
when he first came to the hospital.”
But when he reduced his B, intake, it resulted in
relapse. He was virtually back where he started. And
only the high therapeutic dose of the nutrient could
bring him back toward normal.
Do the investigators understand why B, had such
a profound effect? Not yet, but they do know that B,’s
power could not be due to a single biological action.
Vitamin B,, they say, causes a whole spectrum of
biochemical actions in the brain, and such multiplicity
is required to affect the bundles of symptoms known
as schizophrenia (Biological Psychiatry).

An Attempt
to Control Seizures
No doubt it was news of B,’s brain work that
prompted scientists to test the nutrient against sei-
zures, those neural disturbances that dim conscious-
ness and foment convulsions.
At Kobe University in Japan, researchers admin-
12 From A to Zinc: A Guide to Vitamins and Minerals
i

istered high doses of B, to 19 children suffering from

uncontrollable seizures, and 17 of them improved.
B, has been tested Three had complete relief from seizures, 6 showed
as a treatment for short-term absence of seizures and 8 experienced
seizures—with dra-
matic results.
fewer seizures and improved brainwaves. Overall, it
took only 2 to 14 days for the B, to have a positive
impact (Brain and Development).
Unfortunately, because of the high doses in-
volved, some of the children had temporary side ef-
fects. But a report from David S. Bachman, M.D., then
at Columbus Children’s Hospital in Columbus, Ohio,
suggests that such high intakes may not always be
necessary.
Dr. Bachman documents a case of an eight-
month-old boy with a history of seizures who did not
respond to standard antiseizure medication. The boy
did, however, respond to something not so standard.
‘‘He was given 50 milligrams of intravenous pyri-
doxine [B,],” says Dr. Bachman, “and the seizures
Antiseizure medication stopped within minutes. He remained seizure free for
couldn’t help one sei- the next six days, when seizure activity recurred and
zure-prone boy, but B,
did. again promptly stopped with intravenous administra-
tion of pyridoxine.”
For the next 22 months, the boy got 25 milli-
grams of oral pyridoxine daily and had no seizures at
all. Then his nutrient therapy was discontinued, and
the seizures began all over again. When he was put
back on pyridoxine, the seizures vanished (Annals of
Neurology).
‘At age six,” Dr. Bachman concludes, “he re-
mains seizure free on a daily dose of 25 milligrams of
pyridoxine.”

Soothing Mother and Child

In B, research there’s a growing number of such
Can vitamin B, reduce upbeat conclusions. Here’s one that reveals a side of
herpes during preg- B, that most people have never seen. ‘This case repre-
nancy?
sents another anecdotal report of the amazing result
 Vitamin B;:
More Reasons to Make Sure You’re Getting Enough 113

of pyridoxine therapy in the treatment of herpes

gestationis.”’
So says Craig G. Burkhart, M.D., a dermatologist
practicing in Toledo, Ohio. The problem he’s refer-
ring to is a rare skin disorder that afflicts pregnant
women, bringing blisters, severe itching and—no one
knows why—an increase in fetal mortality. And the
case in question is that of a 26-year-old expectant
mother who had the blisters on her abdomen and
thighs.
The usual treatment for the disease is steroid
drugs, like prednisone, but such therapy can be risky
for mother and fetus. So this time Dr. Burkhart pre- In this case, B, seemed
scribed large daily doses of vitamin B,, and within two to work as an alterna-
tive to steroid drugs.
weeks new blisters stopped forming and old ones
receded.
The woman continued her B, intake right up to
the birth of her healthy baby girl, then stopped—and
the blisters started. She then got back on the B,, and
the herpes went into another remission (Archives of
Dermatology).
In the past, a few other doctors have tested B,
against this malady and also found it effective. It’s
necessary to watch out for side effects from large
doses of B,, says Dr. Burkhart, but the nutrient is still
much safer than steroids.

B, for VO, Max

That’s something athletes might want to remem-
ber—especially since some researchers have sug-
gested that B, may improve stamina. B, may boost stamina.
One link in the B,/stamina connection comes
from the University of Geneva in Switzerland. There,
researchers were trying to find out if giving people B,
along with a derivative of amino acid metabolism
could increase their bodies’ ability to burn oxygen.
Scientists call this capacity VO, max, and it’s one of
the most critical measures of your body’s cardiovas-
114 From A to Zinc: A Guide to Vitamins and Minerals

cular and respiratory performance. A high VO, max

means you can transport and use a lot of fuel (oxy-
gen) and put out a lot of peak effort in the process.
So the researchers selected 20 young men in
excellent condition and assessed their VO, max. Then
they divided the subjects into two groups, gave one
group the B, plus derivative every day for 30 days,
gave the other group a placebo (dummy pill) for the
same length of time, then tested all the subjects again.
The result: The placebo group experienced al-
most no change in VO, max, but the supplemented
B, improved oxygen group had a 6 percent increase. “Such an increase,”
metabolism in men. say the researchers, “is moderate, but it is highly sta-
tistically significant’ (European Journal of Applied
Physiology).
To boost VO, max 10 to 20 percent, the average
person would have to train for up to ten weeks. A 6
percent boost in VO, max in 30 days for men already
in perfect shape looks very good indeed. Whether B,
by itself could increase oxygen utilization remains to
be seen.

B,: Better than Medicine?

Clinically, the condition is referred to as carpal
tunnel syndrome, but to those who suffer with the
swollen fingers, the stiffness, numbness and tingling
in their hands, relief is more important than labels.
The usual treatment is anti-inflammatory medication
or cortisone injections to reduce swelling. If the drugs
fail, surgery is recommended, which sometimes
doesn’t relieve the pressure on the median nerve
that’s causing the problem. Vitamin B, may offer some
hope.
The connection between B, and carpal tunnel
syndrome has been a topic of heated debate within
Use of B, for carpal tun- the research community for years. Britain’s medical
nel syndrome is still
journal Lancet fanned the embers by reporting the
controversial.
successful use of B, to treat carpal tunnel syndrome.
 Vitamin Bs:
More Reasons to Make Sure You’re Getting Enough 115

A West Coast neurologist has added even more

tinder to the B, fire. Allan L. Bernstein, M.D., chief of
neurology at Kaiser Hospital, Hayward, California, has
found that 150 milligrams a day brings improvement
in 3 to 4 months, with the daily dosage dropping to
about 25 milligrams after 6 to 12 months. “It took
longer for the older patients to respond because their
systems had to be resaturated with B,, and their de-
gree of compression was greater, whereas the youn-
ger ones had a less severe injury and responded in a
shorter amount of time,” he says.
While there have been no side effects from the
dosages, Dr. Bernstein cautions that excessive B, can
be toxic and cause neurological problems. (Don’t B, therapy should al-
take more than 50 milligrams a day without medical ways be pursued with
caution.
guidance.) He advises that people who suspect they
are suffering from the syndrome discuss B, therapy
with their physician, especially if more drastic mea-
sures—especially surgery—are suggested.
For a list of foods that are high in vitamin B,, see
the table, Best Food Sources of B vitamins, on pages
100-101.
116
Chapter 16

Test Your
Vitamin B, Status

re you getting enough B,? The Recom-

mended Dietary Allowance (RDA) is just
2.2 milligrams, but some people have trouble getting
even that much. And some people have increased
needs for B,.
Take this quiz to find out if it’s likely that you’re
meeting your B, needs. It’s just a rough guide, so if you
have serious symptoms or suspect that you have a B,
deficiency, check with a qualified medical profes-
sional.
Review each of the following factors that can
affect your vitamin B, status, add or subtract points for
each factor as indicated, then tally your score and
read what it means at the end of the quiz.

1. You take birth control pills (-3). Oral con-

traceptives are a common cause of B, deficiency in
The Pill can steal your women. In one study, half the women taking birth
body’s reserves of B,. control pills were low in B,.
2. You eat at least four servings a week of any
of these B, rich foods (+4). At least three servings a
week (+3). At least two servings a week (+2): wheat
bran, walnuts, wheat germ, peanuts, organ meats, av-
ocados, brown rice, salmon, blackstrap molasses.
3. You’re depressed for no apparent reason.
You may also have tingling in your hands (—4). In one
B, may be the answer study, one-fifth of the people treated for depression at
for some people with an outpatient clinic had low B, levels. Doctors have
depression.
successfully treated some cases of depression with B,.
 Test Your Vitamin B, Status 117

4. You get plenty of magnesium-rich beans and

nuts, plus soy products like tofu and tempeh (+3). B;
and magnesium work hand in hand.
5. You suffer premenstrual syndrome (—3).
6. You’re under a lot of stress (—3).
7. You have carpal tunnel syndrome, a nerve
disorder that produces numbness, tingling, pain and
weakness in the hand and fingers (—4). Additional B,
may be an alternative to surgery for some people with
this condition, studies show.
8. You smoke cigarettes or drink: Heavily (—5).
Moderately (—3). You’re a heavy smoker and drinker
(-10). About half of the heavy drinkers tested If you drink heavily, you
showed signs of B, deficiency. Moderate drinking may be deficient in B,.
doesn’t cause severe problems, but it may strain B,
metabolism. In a study of pregnant women, twice as
many smokers as nonsmokers were deficient.
9. You’re careful to limit fried foods that con-
tain substances that interfere with B, metabolism
(2):
10. You’re pregnant or nursing a baby (—2).
There’s good evidence to show that higher amounts
of B,, up to 20 milligrams a day, may be needed to If you’re pregnant or
ward off deficiency in pregnant women, and lactating lactating, you may
need more B,.
women also need increased amounts. A B, deficiency
may affect birth weight and nervous system develop-
ment in infants.
11. You experience Chinese restaurant syn-
drome: You get a headache or flush shortly after eat-
ing MSG-containing foods (—2).

What’s Your B, Status?

If your pluses and minuses total:
+3 to +9. Both your diet and lifestyle are keep-
ing your B, levels high. Congratulations. No need for
changes.
—5 to +3. Your B, intake may be borderline.
Watch for symptoms and lifestyle habits that deplete
B,. Get more through foods.
118 From A to Zinc: A Guide to Vitamins and Minerals

—5 to —15. You're at risk for a B, deficiency.

Stop drinking or smoking or taking birth control pills.
Add B,-rich foods to your diet. (See the table, Best
Food Sources of B Vitamins, on pages 100-101.)
—15 or more. You're at high risk for a B, defi-
ciency, and you may have additional nutritional prob-
lems. See a nutrition-knowledgeable doctor for the
special help you need.
 Chapter 17 119

Folate Gives Birth

to Better Health

hen Miriam L., a coal-miner’s wife in the

village of Gwent, Wales, gave birth to a
healthy girl, she experienced all of the joy and relief
that a woman feels at the end of a successful preg-
nancy, and then some. Her previous child had been
born with spina bifida, a crippling neural tube defect
(NTD), and the 5 percent risk of having another
handicapped child had hovered over her second
pregnancy like a malignant cloud.
The two deliveries couldn’t have been less alike,
and yet the difference between them may have been
nothing more than a few hundred micrograms a day Did daily doses of folate
of aB vitamin called folate. Miriam had taken part in a head off a mother’s
nightmare?
study conducted by Welsh researchers, who asked
her and more than 100 women like herself to eat a
good diet including high-folate foods before and dur-
ing their next pregnancies. Like her, every woman
who followed the researchers’ advice later gave birth
to a healthy baby.
Seldom has so little gone so far, and these results
seemed to support something that’s long been sus-
pected: Folate (also called folic acid) is the single
most important nutrient for pregnant women and
their developing children. In fact, eating fresh fruit
and vegetables (which are rich in folate) from con-
ception until the due date might be the best policy a
woman can adopt to ensure that her pregnancy will
be a happy and healthy one.
120 From A to Zinc: A Guide to Vitamins and Minerals

Folate, the “Molecular Midwife”

Why folate? Because, on the cellular level, folate
is a kind of “molecular midwife.” It is one of the
Folate fosters the birth catalysts that helps bring new cells into this world. It is
of healthy new cells. a key element in an enzyme that makes possible the

Things a Mother
Should Know about Folate
When it comes to protecting the health of the
mother as well as her child, folate also plays a
role. Deficiency, in or out of pregnancy, in-
creases the risk of cervical cancer, gum in-
flammation and anemia.
As for anemia, researchers say, ‘In preg-
nancy, unless folate supplementation is pro-
vided, the extra requirement for folate fre-
quently produces folate deficiency.” In some
cases, this progresses to anemia, which is
sometimes accompanied by sleeplessness, ir-
ritability or depression (American Journal of
Clinical Nutrition).
Some women who use oral contracep-
tives have a localized folate deficiency in the
cervix. One sign of this deficiency is cervical
dysplasia—abnormalities among the cells in
that region. Dysplasia often leads to cancer,
but folate supplements may help arrest or re-
verse that tendency (American Journal of
Clinical Nutrition).
Then there’s gum disease: Many preg-
nant women have gingivitis, or inflamed
gums. But a Swedish study has shown that
gargling twice a day for one minute each time
with a high-folate mouthwash can reduce that
inflammation considerably (Journal of Clini-
cal Periodontology).
 Folate Gives Birth to Better Health 121

duplication of DNA, which in turn enables one cell to

split into two, then two into four, and so on. Without
folate, growth simply slows down. Or it may be dis-
torted and produce birth defects.
Besides NTDs, cleft palate and low birth weight
or even miscarriage can come of a low-folate preg-
nancy. Aside from that, a woman may develop ane- If you’re pregnant, you
mia or an inflammation of the gums called gingivitis as need twice as much fo-
late as other adults.
a result of the unborn infant’s demands on her folate
supply. When it comes to folate, a pregnant woman is
truly eating for two, and the National Academy of
Sciences has decreed that pregnant women need
twice as much folate a day as other adults.

Preventing Neural Tube Defects

It was to find out whether or not folate could
prevent a second NTD delivery that the investigators,
headed by Dr. K. M. Laurence, of the Welsh National
School of Medicine, chose to study several hundred
women in Wales. These women had, for the most
part, delivered children with spina bifida or
anencephaly, two potentially crippling or fatal NTDs
in which the spine or skull fails to form around the
spinal cord or brain. On the average, 15 of every
10,000 women in the United States deliver NTD ba-
bies. But in this group, because of their history, the
risk was 1 in 20.
Dr. Laurence and his assistants made a two-part
study of these women. First, they took a survey and
discovered that fully half of them had had a poor diet
during the pregnancy that ended with an NTD birth.
Then they counseled 103 women to improve their
diets in time for their next pregnancies. An additional
71 women were given no special dietary counseling.
Of the women who did improve their diets, none
delivered a second handicapped child. All eight of the
NTD children (out of 186 newborns) were born to In birth defects, diet
women who ate a poor diet during their first six made the difference.

months of pregnancy CVutrition and Health).

122 From A to Zinc: A Guide to Vitamins and Minerals

“It seems likely that the main cause, in the British

Isles at least, is a lack of folate available to the devel-
When high-risk pregnant oping embryo,” says Dr. Laurence, adding that the
women take folate, results of earlier work by himself and others “suggest
they boost their
chances of delivering
that folic acid given to high-risk women greatly re-
healthy babies. duces the [NTD] recurrence rate,” when taken before
conception and continued until the end of the first
trimester. Although Dr. Laurence concludes that
some of the women in this latest study obtained
enough folate from their diet alone to prevent a sec-
ond NTD birth, he previously used a supplement of
four milligrams a day—much more than would be
available or advisable in the usual daily diet—for
women at high risk for an NTD baby.

A Broader Role for Folate

Cleft palate, another birth abnormality, may also
yield to a high-folate diet. Cleft palate occurs when an
unborn child’s facial bones fail to form properly, cre-
ating a distorting split in the roof of the mouth.
Though not as traumatic as NTD, cleft palate can be
socially crippling. »
On hearing about the results of the English NTD
studies, doctors in Czechoslovakia asked over 80
Folate may deter the women who had already had a child with cleft palate
birth defect known as to take ten milligrams of folate a day, along with a
cleft palate.
multivitamin, for at least three months before concep-
tion and then until at least the end of their first trimes-
ter. In 85 pregnancies, only one child was born with a
cleft palate. In 212 pregnancies among a similar group
where there was no supplementation, 15 cleft palates
occurred (Lancef).
There are even references in the medical litera-
ture linking low folate in a mother’s diet to unwanted
abortion and to low birth weight. As long ago as 1977,
British researchers found that mothers with low folate
levels at the time of delivery were more likely to de-
liver low-birth-weight children (Archives of Disease in
Childhood).
 Folate Gives Birth to Better Health 123

As for spontaneous abortion, Carl C. Pfeiffer,

M.D., Ph.D., director of the Brain Bio Center in Prince-
ton, New Jersey, writes that “Many women with his- Folate fights spontane-
tories of abortion and miscarriage have been able to ous abortions.
complete successful childbirth subsequent to folate
supplementation Cnternational Journal of Environ-
mental Studies).

Fragile-X Syndrome:
Handle with Folate
Sometimes folate can help repair the effects of
birth defects after they occur—perhaps even long
after they occur. Folate supplements have been used
to improve the mental function and quality of life
among mentally retarded children who suffer from
what is called fragile-X syndrome. This syndrome,
which appears under the microscope as a breakage in
certain chromosomes, affects about 1 in every 1,000
newborns. In some cases, folate—if given early
enough and in the right anounts—can raise the IQs of
these children. In borderline cases, it might enable
them to return to the mainstream of life.
Much work in this area has been done at the
Children’s Hospital Child Development Unit in Den-
ver. Tad Jackson, a clinical researcher there, and After taking folate, the
Randi Hagerman, M.D., gave ten milligrams of folate a IQ of a retarded boy
went from 63 to 93.
day to a group of boys with fragile-X syndrome. In the
most remarkable case, one boy’s IQ rose from 63 to a
near-normal 86, then fell to 83 after folate was with-
drawn. When the supplement was reintroduced, his
IQ stabilized at 93.
“It’s not a cure,” says Jackson, “but in most
cases folate seems to improve the interaction be-
tween these children and the world around them.
They talk more; they make better eye contact.
“The most encouraging sign has been that the
parents of seven out of the eight boys under age 12
could tell by their behavior when their sons were
124 From A to Zinc: A Guide to Vitamins and Minerals

taking folate, or not. In the boys over 12, however, not

much improvement was seen.”

Requirements Rise
with Pregnancy
How much folate does a pregnant woman need?
The National Academy of Sciences sets the Recom-
mended Dietary Allowance (RDA) of folate for ex-
pectant mothers at 800 micrograms (0.8 milligram) a
day and at 400 micrograms for other adults. These
figures are low compared to the 4 milligrams some
studies have suggested for NTD mothers.
Folate taken in even normal amounts can mask
the symptoms of megaloblastic anemia, which is an
Guidelines for folate in- early sign of vitamin B,, deficiency. Testing their pa-
take. tients for vitamin B,, deficiency before prescribing
greater-than-RDA doses of folate is one way that doc-
tors avoid this problem.
Certain drugs can deprive us of folate and in-
crease our need. Drugs for epilepsy, such as Dilantin,
A checklist of folate as well as_ barbiturates and methotrexate, an
robbers. antipsoriasis drug, have this effect. Oral contracep-
tives, estrogen and alcohol are also known to reduce
body folate levels.
Keep in mind, too, that the folate in foods can
easily decrease during cooking or processing. Heat-
ing or merely storing foods at room temperature can
cut their folate content in half. And beware of the
folate vicious circle. A folate deficiency can actually
make it more difficult for the walls of the intestines to
absorb the folate it badly needs. Supplementation can
interrupt this cycle.
You may already be getting the folate you need
from your diet, however. If fresh vegetables, espe-
The top food sources of cially spinach, romaine lettuce and asparagus are a
folate.
part of your diet, you are halfway there. Lentils and
dried beans, two foods that are high in fiber, also
contain large amounts of folate. So does brewer’s
 Folate Gives Birth to Better Health £25

yeast, whole wheat bread and orange juice. (See the

table, Best Food Sources of B Vitamins, on pages
100-101, for more information on folate-rich foods.)

Looking Ahead
“At this point, we're not ready to recommend
folate supplements to all women,” says M. J. Adams,
M.D., of the U.S. Centers for Disease Control in At- A promising future for
lanta. ““We can’t say for sure whether they are helpful stopping birth defects.
or harmful. Some women may need more or less than
others. But it’s an exciting hypothesis, and | think
women who are at risk for an NTD should become
familiar with the uses of multivitamins that include
folate before their next pregnancy.”
126 Chapter 18
Vitamin C Research:
New Hope for Health

cientists have been delving into the biological

secrets of vitamin C for years. Here’s a sum-
mary of what they’ve discovered. Some of the data are
surprising; some of it expected. All of it is preliminary
(and requires more research)—but suggests tantaliz-
ing possibilities for health.

A Treatment for Gum Disease

This problem affects gum tissue and jawbone,
leading ultimately to the loss of teeth. Hopefully it
Vitamin C: a new force won't go that far, though, not when vitamin C could
against dental disease? help turn it around. That’s what a team of researchers
from the University of Alabama School of Dentistry
found when they compared the gum health of a group
taking 300 milligrams of vitamin C with a group taking
a placebo (dummy pill) for 21 days. Each volunteer
also received a thorough cleaning and polishing of
the teeth (prophylaxis) on one side of the mouth at
the beginning of the experiment.
As one might expect, the research showed there
was no significant change in the gums not receiving
prophylaxis or vitamin C. Improvement was greatest
with prophylaxis plus C, which led to a 58 percent
reduction in gum inflammation. Vitamin C alone and
prophylaxis alone also improved gum health, but the
researchers concluded that combining the two treat-
ments worked best of all.
 Vitamin C Research: New Hope for Health 127

In another study, from Yugoslavia, researchers

found that supplementation with 70 milligrams of vita-
min C may be enough to initiate gum tissue regenera- Can vitamin C help re-
tion in people whose C intake is low—between 20 grow deteriorated gum
tissue?
and 40 milligrams per day U/nternational Journal for
Vitamin and Nutrition Research).

Boosting Immunity
Lymphocytes (white blood cells) have a high
concentration of vitamin C and use up vitamin C rap-
idly when fighting infection. Vitamin C may possibly Vitamin C may help your
increase the metabolism of some kinds of lympho- body fight germs.
cytes, making them react faster, says Benjamin Siegel,
Ph.D., of the University of Oregon’s Department of
Pathology. Vitamin C may also increase the number
of what are known as receptor sites on a lymphocyte’s
membrane, making it easier for the lymphocyte to
latch onto bacteria or a virus. ‘“We’re not exactly sure
how vitamin C works, but these are some theories,”
Dr. Siegel says.
Doctors in Brussels found that even in the el-
derly, who often have a weak immune response, 500
milligrams daily of vitamin C stimulated their produc-
tion of lymphocytes (Gerontology).
Dr. Siegel’s own studies have shown that 250
milligrams of vitamin C daily in the drinking water of
mice significantly increased the level of interferon in
their blood and reduced their susceptibility to leuke-
mia. Interferon is produced by a cell that has been
invaded by a virus. It induces surrounding cells to
produce proteins that protect them from the virus.

Wounds That Heal Faster

Vitamin C is an important ingredient in a wound-
healing nutrient solution developed by Anthony N.
Silvett, M.D., formerly of the Wound Healing Intensive Vitamin C: part of a
Care Unit at West Lake Community Hospital in Mel- solution to bedsores.
128 From A to Zinc: A Guide to Vitamins and Minerals

rose Park, Illinois. At the time, the unit specialized in

treating severe bedsores.
‘“Bedsores are caused by the pressure of lying
immobile for long periods of time,” Dr. Silvetti ex-
plains. ““The skin and tissues on which the body rests
are deprived of nourishment because the tiny blood
vessels that provide it are squeezed shut by the body’s
weight, and they eventually clot. The tissue in that
area dies, and an ugly crater forms in the skin.”
Dr. Silvetti provides the nutrients—a mixture of
essential amino acids, vitamin C and complex sug-
ars—directly in a solution or in powder form. “‘Vita-
min C helps to stimulate skin cells called fibroblasts to
produce new tissue in wounds,” Dr. Silvetti says. “It
also helps fight infection by providing a slightly acid
environment that discourages bacterial growth.”
The doctor reports his results have been “excel-
lent.” Within 24 to 72 hours after treatment begins,
A mixture containing infection diminishes. Within a few days, fresh tissue
vitamin C puts healing full of tiny blood vessels begins to grow over the
in high gear.
wound. Small or medium-size bedsores (up to six
inches wide) heal in about two months; large wounds
take slightly longer and may require grafting.

Fighting Heat and Cold

In research by S. D. Livingstone of the Defence
and Civil Institute of Environmental Medicine,
Downsview, Ontario, vitamin C relieved the constric-
tion of blood vessels in the skin that comes with
exposure to cold.
Livingstone gave four people 2,000 milligrams of
vitamin C each day for a month, then monitored the
skin temperature of one finger that was immersed in
ice water or exposed to cold air@9°F) for 30 minutes.
After six weeks with no supplementation, he repeated
the tests.
He found that the skin temperatures tended to
remain higher during supplementation. Skin tempera-
Can vitamin C protect tures were as much as 15 degrees higher during the air
your skin from the cold? exposure test. Vitamin C could have caused an in-
 Vitamin C Research: New Hope for Health 129

creased blood flow that warmed the surface of the

skin (Lancet).
At the other end of the thermic scale, studies
have shown that vitamin C helps people adjust faster
to hot weather. In a study by researchers in South Vitamin C may counter-
Africa, mining workers not previously exposed to heat act the stress of high
temperatures.
were given either 250 or 500 milligrams of vitamin C
or a placebo. Then they exercised in an “acclimatiz-
ing room” at a temperature of 90°F Both groups of
men receiving vitamin C adjusted to the heat a full day
faster than those not supplemented.
The researchers say vitamin C may counter some
of the stressful effects of working in high-temperature
conditions by delaying fatigue in the adrenal glands
(Journal of Applied Physiology).
All of which goes to show that while our indoor
environment may respond to the flick of a switch, our
internal thermostat needs proper nutrition.

Asthmatics May Benefit

Wheezing or bronchial constriction brought on
by exercise is something most asthmatics have come
to expect. Typically, sufferers will experience chest
tightness and trouble breathing within 3 to 5 minutes
after exercising, and it will get progressively worse
over the next 30 minutes.
With vitamin C, however, there is now hope for
improving that condition, according to two doctors
from New Haven, Connecticut. In their experiment, Wheezing lessened with
Alan Schlesinger, M.D., and Neil Schacter, M.D., gave vitamin C.
12 asthmatics either a placebo or 500 milligrams of
vitamin C six hours or less before exercise testing.
Using measurements of airflow, the researchers found
that the group treated with vitamin C had significantly
less chest tightness than the placebo group.

Fertility Restored
When infertility is due to sticky sperm, vitamin C
may be the answer. Normally, sperm should swim
130 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Vitamin C

Food Portion Vitamin C

(mg.)
Orange juice, freshly squeezed 1 cup 124
Grapefruit juice, freshly 1 cup 94
squeezed
Papaya Y% medium 94
Guava WY 83
Kiwi fruit 1 medium (hs
Orange 1 70
Brussels sprouts, raw 4 65
Green peppers, raw, chopped Ye cup 64
Cantaloupe "% 56
Watermelon Me 47
Tomato juice 1 cup 45
Strawberries Ye cup 42
Broccoli, raw, chopped Ye cup 4]
Grapefruit VY : 39
Cauliflower, raw, chopped Y cup 36
Potato, baked 1 medium 26
Tangerine 1 26
Tomato, raw : 1 22
Lemon 1 wedge 21
Turnip greens, cooked, chopped Ye cup 20
Cabbage, raw, chopped Ye cup 17
Blackberries Y% cup 15
Raspberries Ye cup 15
Banana 1 11
Blueberries Y% cup 9
Spinach, raw, chopped Y cup 8
Snap beans, green, boiled Ye cup 6
Cherries, sweet Y cup 5
Mung bean sprouts Y% cup =
EEE
ee ee
Sources: Adapted from
Composition of Foods: Fruits and Fruit Juices, Agriculture Handbook No. 8-9, by
Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information Ser-
vice, U.S. Department of Agriculture, 1982).
Composition of Foods: Vegetables and Vegetable Products, Agriculture Handbook
No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1984).
 Vitamin C Research: New Hope for Health 131

singly. When more than 20 percent stay clumped to-

gether (called sperm agglutination), it’s virtually im-
possible for conception to occur.
To test the effectiveness of vitamin C, Earl B.
Dawson, Ph.D., and his colleagues from the Depart-
ment of Obstetrics and Gynecology at the University After taking vitamin C
of Texas Medical Branch in Galveston selected 35 for one month, the
men’s fertility was re-
men who could not impregnate their wives because stored.
more than 20 percent of their sperm stuck together.
Each was told to take one 500-milligram capsule of
vitamin C every 12 hours for one month. By the end of
the first week, fertility was restored, since clumped
sperm had dropped to 14 percent. By the end of three
weeks, clumping was down to only 11 percent.
In another study, Dr. Dawson says that preg-
nancy occurred in the wives of each of 12 men whom
his group placed on a 60-day vitamin C regimen, while
the wives of 8 subjects not given vitamin C did not
become pregnant (Journal of the American Medical
Association).

Stopping Colds Short

There is no firm evidence yet that extra doses of
vitamin C can cure or prevent the common cold. But
C may be able to reduce the misery that a cold brings. Vitamin C can’t cure a
Researchers of the University of Sydney in Aus- cold but may ease its
symptoms.
tralia separated 95 pairs of identical twins into two
groups. One twin from each pair took a placebo every
day, and the other took 1,000 milligrams of vitamin C
every day for a total of 100 days. The researchers
found that the vitamin C group had a significantly
shorter average duration of colds (Medical Journal of
Australia).
To help plan a diet rich in vitamin C, see the
table, Best Food Sources of Vitamin C, on page 130.
132 Chapter 19
Vitamin C:
Other Helpful
Discoveries

Ithough you may have considered vitamin

C, or ascorbic acid, essential to everyday
good health, a growing body of medical evidence
suggests this versatile nutrient may play a more impor-
tant role in the prevention of disease. Consider these
reports from the medical news grapevine.

e Eighty women seeking Pap smears at the

Bronx Municipal Hospital Center may have helped
medical science narrow down one of the causes of
cervical cancer.
e At a medical research institution in Philadel-
phia, a laboratory experiment turned up unexpected
results that may someday lead to much-needed relief
for rheumatoid arthritis sufferers.
e A leading cancer journal has reported evi-
dence supporting the role of a key food element in
relief of certain kinds of cancer.
e From 1964 to 1978, consumption of vegeta-
bles and fruits high in a particular nutrient increased.
At the same time, cardiovascular deaths declined.
And at least one medical researcher thinks that it was
no coincidence.

The surprising common denominator, in all

cases, is vitamin C. Much of this new information is
A new ally in preventing still in the theoretical stage, but it is intriguing. Here’s
disease. a wrap-up of recent developments. (See the table,
Best Food Sources of Vitamin C, on page 130, for
additional sources of vitamin C in the diet.)
 Vitamin C: Other Helpful Discoveries 133

Vitamin C May Keep

Cervical Dysplasia in Check
A low dietary intake of vitamin C is related to
cervical abnormalities. That’s what Seymour Romney,
M.D., found when he tallied up the results of tests
comparing women with normal Pap smears and those
with cervical cancer or dysplasia—abnormal cell
growth that may or may not lead to cancer.
Of the 80 women at the Bronx Municipal Hospi-
tal Center who had Pap smears taken, 34 had normal
results. Their dietary intake of vitamin C was relatively Women with normal Pap
high. The remaining 46 women took in considerably smears had higher in-
takes of vitamin C.
less vitamin C in the diet, and their diagnoses ranged
from mild cervical inflammation to cancer (American
Journal of Obstetrics and Gynecology).
Just a coincidence—or a connection? While
there’s still a lot of work to be done, Dr. Romney
believes there is a definite relationship between cervi-
cal cancer and low vitamin C in the diet.
“A lot of people have been intrigued by the pros-
pect that vitamin C may have antitumor properties,
and there are reasonable scientific studies that sup- Vitamin C may fight
port that idea,” explains Dr. Romney. tumors.

How and why vitamin C may prevent tumors

from forming isn’t well understood, however. In fact,
says Dr. Romney, vitamin C is probably just one part
of the picture.
“Cancer is a terribly complicated disease,” he
says. “With regard to the role of any nutrients, their
actions surely involve interactions with other chemi-
cals in the body, which need to be looked into. It’s
not likely that a single nutrient, per se, is the cause and
effect of a disease as complex as cancer.”
The preliminary research suggests that women
may not be getting enough vitamin C to prevent cervi-
cal cancer. Why? Because, says Dr. Romney, “Tf Can vitamin C prevent
there’s a disorder in the cervix, that increases the cervical cancer?
demand for ascorbic acid.”
Whether you need more than the Recommended
Dietary Allowance (RDA) of 60 milligrams of vitamin
134 From A to Zinc: A Guide to Vitamins and Minerals

C daily just isn’t clear. However, Dr. Romney and his

research staff would like to find out. ““We’re going to
try to get some solid information on dosage and the
effects of that dosage, whether there are side effects
and how well it works.”

Vitamin C versus Nitrosamines

Of course, cervical cancer is just one of many
cancers, and research continues to determine how
vitamin C affects other types of cancer, too.
You might have heard about the link between
vitamin C and nitrosamines, cancer-causing sub-
stances formed by the interaction of nitrite—a com-
mon food additive—and chemicals in your body.
Vitamin C has long been believed to prevent
nitrosamines from forming. A study reported in the
journal Carcinogenesis lends strong support to that
theory.
Researchers in Britain asked eight volunteers to
take a gram (1,000 milligrams) of vitamin C every day
Vitamin C may break up for a week. Before and after the experiment, research-
cancer-causing agents ers siphoned off gastric juice from the volunteers’
inthe stoma: stomachs. In all but one of the volunteers, the levels of
nitrosamines in the gastric juice were significantly
lower at the end of the test.
Does this mean vitamin C prevents gastric can-
cer? No, but it may reduce the risk. Are the results
definitive—that is, is this the last word? No. Further
studies, and on a wider scale, should be done before
coming to any definite conclusions. But the results of
this study do give reason for optimism.

Relief for Arthritis—

without Side Effects
Picture the body at war with itself. That’s what
happens in rheumatoid arthritis. The body's own cells
mistake body tissues for foreign substances. To repel
 Vitamin C: Other Helpful Discoveries 135

the “invaders,” the cells manufacture antibodies to

attack the tissue.
There is no cure for rheumatoid arthritis. Treat-
ment often involves using steroids to reduce the pain
and tissue swelling brought about by this disfiguring
disease. But these anti-inflammatory drugs in them-
selves can cause side effects.
That’s why Robert H. Davis, Ph.D., a professor in
the Department of Physiology at the Pennsylvania
College of Podiatric Medicine, has been exploring the Vitamin C and aloe were
use of vitamin C and aloe, two natural substances that teamed up to fight rheu-
matoid arthritis.
cause few if any known side effects.
“It’s an idea that goes back, for me, almost 30
years,” says Dr. Davis. “Steroids and synthetic drugs
have their place in the treatment of arthritis, but the
side effects can sometimes be worse than the cure.”
Why vitamin C? Simply this, says Dr. Davis: Vita-
min C is an essential building block in the manufac-
ture of the connective tissue called collagen. In rheu- One scientist says vita-
matoid arthritis, this connective tissue breaks down. min C may reduce the
inflammation of rheuma-
But Dr. Davis believes that vitamin C, applied to the toid arthritis.
skin, may prevent or slow this tissue breakdown, re-
ducing inflammation. And aloe also is believed to
have healing properties.
In a prize-winning study that put his theory to the
test, Dr. Davis and two students combined vitamin C,
aloe and ribonucleic acid—a cellular building block
also thought to reduce inflammation—in a cream
ointment. Then they applied the cream to the arthritic
hind paws of laboratory rats. The results were surpris-
ing. Joint-tissue swelling was reduced dramatically,
both in the early stages of arthritis and later on, after
the disease had progressed for several days (Journal
of the American Podiatric Medical Association). “‘I
honestly didn’t think it would work,” says Dr. Davis.
‘But I was able to repeat the results.”
Of course, it is too soon to say what impact these
studies will have on humans. Furthermore, it’s impor-
tant to understand that this report doesn’t suggest that
vitamin C is a cure for rheumatoid arthritis. But it
136 From A to Zinc: A Guide to Vitamins and Minerals
Ale lS ea ee ee ee ee eee eee

offers some hope for an effective treatment that

doesn’t rely on steroids.
“IT wouldn’t recommend this kind of treatment to
anyone until we get some real statistical data,” says
Dr. Davis. “I would like to say yes because rheumatoid
arthritis is one of the tough ones. But I think it first has
to go into a clinical trial and be evaluated. If some-

A Little Vitamin C
May Go a Long Way
Elderly people with low vitamin C levels in
their blood are usually given heavy doses of
the vitamin to bring their plasma levels up to
normal. Now a group of researchers in Eng-
land says that may be overkill. A little vitamin
C may go a long way.
Researchers at the University of Leeds
and High Royds Hospital found that low
blood levels usually meant low intake of
foods rich in vitamin C—in part because of
food preparation procedures in institutions
and dental problems that made eating fruit
impossible for the older people.
But by simply adding fresh orange juice
or a vitamin C tablet to the diet—no more
than the Recommended Dietary Allowance
of 60 milligrams a day—the scientists found
that they could bring those elderly with mar-
ginal deficiencies up to normal. Those who
had deficiencies in the scurvy range, the re-
searchers said, obviously need a larger dose.
However, they added, the evidence indicates
that there are far more elderly at risk of mar-
ginal deficiencies, which have their own po-
tential health consequences, such as the de-
layed healing of injuries.
 Vitamin C: Other Helpful Discoveries 137

body has a real bad case of arthritis, they should be

treated by a doctor.”

Vitamin C Up,
Heart Disease Down
Most animals make their own vitamin C. In fact,
there are only a few species—humans, guinea pigs,
monkeys and certain fruit bats—that have to get their
vitamin C from what they eat.
Members of the one civilized, self-aware species
in that group appear to suffer a chronic dietary short-
age of vitamin C, says Anthony Verlangieri, Ph.D., of
the University of Mississippi. And because of that defi-
ciency, he says, “they may be more susceptible to
heart disease.”
Dr. Verlangieri theorizes that vitamin C defi-
ciency causes atherosclerosis. True, cholesterol does
clog arteries. But in Dr. Verlangieri’s view, cholesterol One startling theory:
is really a Johnny-come-lately, a cardiovascular bad Low vitamin C may
cause heart disease.
guy who takes advantage of an already bad situation
caused by a vitamin C deficiency.
One study by Dr. Verlangieri and colleagues at
the University of Mississippi lends support to his
controversial theory of vitamin C’s role. Dr. When Americans ate
Verlangieri and his staff reviewed health statistics more foods containing
vitamin C, heart disease
from the period between 1964 and 1978. During that deaths decreased.
time, he noticed, Americans increased their intake of
fruits and vegetables rich in vitamin C. Deaths from
cardiovascular disease during that period declined.
Other experts also have noted the decline in car-
diovascular deaths and have attributed the slide to a
number of factors, including a reduction in smoking,
better eating habits and an increase in physical activ-
ity. But in his study, Dr. Verlangieri credited the in-
creased intake of foods rich in vitamin C for the de-
cline in heart deaths (Medical Hypotheses).
According to Dr. Verlangieri’s research, vitamin
C turns off an enzyme that attacks what are called
138 From A to Zinc: A Guide to Vitamins and Minerals

endothelial cells in blood vessel walls. If you are vita-

min C deficient—that is, if your cells aren’t saturated
with vitamin C—the enzyme is free to do its dirty
work.
“The cells of blood vessels can be compared to
bricks in a wall,’ explains Dr. Verlangieri. “Mortar
Vitamin C may help holds the bricks in the wall together, but in blood
keep cholesterol off the vessels, a cement called the extracellular matrix holds
walls of your arteries.
the cells together. If the cement becomes defective,
the cells loosen up. That leaves some bare spots.
Normally, the cells provide a barrier to keep choles-
terol off the blood vessel walls. But when the choles-
terol gets into those bare spots, it causes inflamma-
tion. Vitamin C actually works at the level of the cell to
inhibit an enzyme that chews up that cement.”
If the body is low in vitamin C, the blood vessel
walls become denuded in spots, says Dr. Verlangieri,
leaving convenient places for cholesterol to take root.
So cholesterol is an important part of the process
once the disease begins, but it isn’t how the disease
begins.
If the theory is true, how much vitamin C would
people need to prevent cardiovascular disease? Ac-
Is the Recommended Di- cording to Dr. Verlangieri, the Recommended Dietary
etary Allowance for vita- Allowance (RDA) of 60 milligrams isn’t enough. “I
min C too low?
think the evidence suggests that from 1,000 to 2,000
milligrams is probably what we need,” he says.

Not a Do-It-Yourself Treatment

Before you consider increasing your intake of C,
bear in mind that in many quarters this theory is still
controversial. Many scientists do not think vitamin C is
involved in coronary artery disease. Others do believe
vitamin C appears to reduce coronary risks, but for
altogether different reasons.
One study, for instance, suggests vitamin C in
1,000-milligram doses prevents blood platelets from
clumping together and adhering to blood vessel
walls. To find out whether this is true, researchers at
 Vitamin C: Other Helpful Discoveries 139

Tagore Medical College and Hospital in India gave

volunteers 1,000 milligrams of vitamin C every eight Vitamin C stopped the
hours for ten days. At the end of that period, they clumping that can lead
to artery-clogging blood
drew blood samples and found a significant drop in clots.
the rate at which blood platelets clumped together
and adhered.
But at the same time, researchers noted that they
were administering vitamin C in “pharmacologic
doses’’—doses so high they should be taken only
under a doctor's supervision. They concluded that
further studies needed to be done to confirm their
findings (Clinical Cardiology). But whatever the con-
nection, research at least suggests there might be one.
140 Chapter 20

Vitamin D:
How to Avoid a
“Hidden Epidemic”

e was certain he was about to die. At 82, the

infirmities of old age had been limited to a
mild case of diabetes and a hip fracture, from which
he had recently recovered. Now he found himself
back in the hospital, his bones weak and aching from
what he was sure was an insidious cancer eating him
alive.
Fortunately, his doctor’s diagnosis wasn’t made
in such terrified haste. In fact, this physician even
refused to jump to an easy conclusion when the X-
rays showed the classic symptoms of osteoporosis: a
wasting of bone.mass and many collapsed vertebrae.
His decision to prescribe vitamin D and calcium was
based in part on something his frightened elderly pa-
tient told him in conversation: that he avoided sun-
light and didn’t drink milk or take vitamins.
Uriel A. Barzel, M.D., of New York City’s
Montefiore Medical Group and Albert Einstein School
A startling case of vita- of Medicine, suspected that what he was seeing, X-
min D deficiency. rays and patient’s fears aside, was osteomalacia, an
adult version of a now rare childhood vitamin D defi-
ciency disease called rickets. Both conditions are
characterized by painful, thinning bones that, left un-
treated, can lead to deformities.
Until recent years, vitamin D deficiency was
thought to be almost as rare as the bubonic plague,
eradicated by D-fortified foods such as milk. But in
the past few years, researchers and clinicians alike
have become concerned that it may be a serious
 Vitamin D: How to Avoid a “Hidden Epidemic’”’ 141

Four New Healing Possibilities for Vitamin D

Vitamin D is converted by the liver lea needs vitamin D and calcium
and kidneys into its active form, a just as much as the skeleton and
hormone called calcitriol that reg- teeth do. When a deficiency oc-
ulates the calcium balance in the curs, minerals and hearing slowly
body. Research in Japan has fade. So far, hearing has been re-
found that the hormone sup- stored in some cases with daily
presses leukemia cells by causing supplements of calcium and vita-
them to be turned into noncan- min D. (Refer your physician to
cerous cells. the Journal of Laryngology and
“Where this will go therapeu- Otology, May 1983, pages 405-
tically isn’t clear at this stage,” 420.)
says Hector DeLuca, Ph.D., pro- Preventing the hearing condi-
fessor of biochemistry at the Uni- tion or catching it in the early
versity of Wisconsin, Madison. “In phase is essential, since the deaf-
the long run, someday we may be ness may be reversible. Just as im-
able to control some types of leu- portant is the fact that early detec-
kemia. This may also have appli- tion could point to the onset of
cations for controlling other types osteomalacia, a bone-degenerat-
of malignancies.” ing condition, before more seri-
Dr. DeLuca’s own research ous skeletal problems occur.
also suggests that a vitamin D defi- As if the case for getting out
ciency may lead to problems with in the sunshine weren’t strong
glucose metabolism and, _ulti- enough, a study spanning almost
mately, insulin secretion. “Part of two decades found that men who
the falloff in glucose tolerance developed colorectal cancer had
that occurs in many older people lower intakes of vitamin D and
could be due to a lack of vitamin calcium. A research team of scien-
D, so if we can prevent the defi- tists from across the country dis-
ciency of calcitriol, perhaps we covered that those men who de-
can control some cases of dia- veloped cancer also weighed
betes.” more and got less exercise than
There’s also a chance that a those who remained free of the
form of hearing loss associated disease, which, according to the
with the cochlea, a tube shaped researchers, ‘‘supports the sugges-
like a snail shell that forms a cru- tion that physical activity is in-
cial part of the inner ear, can be versely associated with the risk of
prevented. Apparently, the coch- colon cancer” (Lancef).
142 From A to Zinc: A Guide to Vitamins and Minerals
Oe

hidden problem among the nation’s elderly. One re-

A jack of vitamin D may searcher calls it “an unrecognized epidemic,” and it
be rampant among el- may be implicated as a factor in that scourge of old
derly people.
age, hip fracture. What’s more, it’s often difficult to
diagnose, frequently masquerading as that other
bone-thinning condition, osteoporosis.
Dr. Barzel took an educated guess with his pa-
tient and was proved correct in the best possible
way—the man got well in three weeks of treatment
with supplements. But, Dr. Barzel acknowledges, os-
teomalacia is a diagnosis that’s easy to miss.

A Disease in Disguise
‘Because vitamin D deficiency is uncommon in
the general population, the family physician or inter-
Doctors may overlook nist may fail to consider vitamin D and may miss this
even obvious signs diagnosis in the elderly,’ the physician says. “The
of a deficiency.
symptoms and signs of early vitamin D deficiency may
be difficult to recognize. The patient may have weak-
ness, which may be attributed to coexisting disease.
Although bone pain is quite specific, it may be mis-
taken for metastatic disease [cancer] or osteoporosis
not only by the patient but also by the physician.”
Though a bone biopsy may tell the most accurate
story, Dr. Barzel has advised other physicians to first
ask the right questions to pinpoint whether a patient is
getting an adequate amount of D. If not, a short thera-
peutic trial with moderate amounts of vitamin D and
calcium can be diagnosis and cure in one. “The re-
sponse of the patient is both quick and dramatic and
confirms the diagnosis,’”’ Dr. Barzel says.
Better diagnostic techniques are imperative be-
cause a number of studies give every indication that
One out of every two vitamin D deficiency is not rare. In fact, there may be
older people may get cause for alarm. Studies of health-conscious and ap-
too little vitamin D.
parently healthy elderly participants showed that at
least half got less than the minimum daily requirement
of vitamin D—200 international units. A third were
getting less than 100 international units. In a study of
 Vitamin D: How to Avoid a “Hidden Epidemic’ ’
143

142 elderly hip fracture patients at Massachusetts

General Hospital in Boston, 40 percent were D defi-
cient and three-quarters of them had osteomalacia.
“As many as 30 to 40 percent of all hip fracture
patients in the United States have osteomalacia,” says
researcher Samuel H. Doppelt, M.D., assistant profes-
sor of orthopaedic surgery and medicine at Harvard
Medical School.

How Vitamin D Works

To understand these figures, it’s first necessary to
understand how vitamin D works. In the body, the raw
vitamin is changed into its active form, a hormone
known as calcitriol, by the kidneys and the liver. This
active form enhances the absorption of calcium to
nourish the nerves, muscles and skeleton. Without D,
the body begins to strip-mine the bones for calcium to
meet the needs of the nerves and muscles, leaving the
bones thin, brittle and breakable.
In its advanced stages, osteomalacia can be ex-
tremely painful and may be accompanied by tetany,
muscle spasms that are caused by a calcium imbal- A severe lack of D can
ance. But even before pain starts, a D deficiency can be crippling.

do enough damage to cripple. It is a hidden epidemic

in many ways. “A D deficiency of less severity can
cause an accumulated bone loss with age and can be
painless until a bone break occurs,” says A. Michael
Parfitt, M.D., director of the Bone and Mineral Re-
search Laboratory at Henry Ford Hospital in Detroit.
‘And I’m afraid this is rather common among elderly
people.”
The reason? Although it is difficult for most of us
to avoid getting enough vitamin D, it’s even more
difficult for elderly people to get enough. It’s abun- Older people often
dant only in foods that are hardly a staple of the skimp on vitamin D-rich
foods like milk.
American menu: fatty fish such as mackerel and
swordfish. (See the table, Best Food Sources of Vita-
min D, on page 147.) In the United States, vitamin D is
added to milk, which many elderly people use simply
144 From A to Zinc: A Guide to Vitamins and Minerals
e
Ce ae ee

to color tea or coffee. But it’s most abundantly sup-

plied when the sun’s ultraviolet rays strike the skin,
activating a vitamin D precursor. About 90 percent of
the major circulating form of D comes from our skin
supply. In fact, basking in the sun for about 30 minutes
a day is enough to eliminate the need for any dietary
D at all in healthy adults.
But, like Dr. Barzel’s patient, many elderly people
don’t get enough sun. They may be housebound by

Older Skin Needs Its Day in the Sun

Researchers aren’t sure why, but How much sunlight does
the skin of young people appears older skin need to make enough
to be a more efficient vitamin D vitamin D?
factory than the skin of older ‘That is almost impossible to
adults. As skin ages and becomes say precisely,” says Michael F
thinner, it becomes less produc- Holick, M.D., Ph.D., director of
tive at turning out vitamin D from the Vitamin D and Bone Metabo-
sunlight, according to one study. lism Laboratory at Tufts University
To prove the point, scientists in Massachusetts. Dr. Holick was
took skin samples from a number one of the researchers in this
of surgical patients. The patients study. “It depends on so many
ranged in age from 8 to 92. Each things—skin pigmentation, time
sample was bathed in ultraviolet of year, location and so on. But
light—similar to the ultraviolet we can Say this: If, say, you’re in
light in sunlight. When they Boston in June at noontime, you
checked the samples, they found should expose your hands, face
that young skin produced the and arms, 15 minutes at a time,
most vitamin D. In the older, thin- two or three times a week. In the
ner skin samples, vitamin D pro- winter, you'd probably have to ex-
duction decreased in proportion pose a much larger area of the
to the age of the individual. The skin for a much longer period of
skin of one 82-year-old produced time because the sun’s rays are
less than half the amount of vita- much weaker [and even that may
min D churned out by the 8-year- be insufficient]. In this case, vita-
old skin (Journal of Clinical Inves- min D supplements are a desirable
tigation). alternative,” he says.
 Vitamin D: How to Avoid a “Hidden Epidemic” 145

illness or disability, or simply less physically active

and less likely to spend time outdoors. But, for what- Sunshine is a primary
ever reason, they simply don’t tap into the most avail- source of vitamin D.

able supply of D there is.

A Place in the Sun

Theoretically, doctors could solve the problem
by prescribing cruises to warm, sunny islands or, at
the very least, daily strolls in the afternoon sun. A
group of British doctors stopped just short of recom-
mending that when they assessed the vitamin D status
of 110 men and women nearing retirement age. They
extolled the virtues of “a sunny holiday” when they
saw what it did to the vitamin D levels of their sub-
jects. Almost all of those who had the highest con-
centrations of circulating D had been on vacation in
sunnier climates, some as long as four months previ-
ously. One woman, whose diet was relatively poor in
D, nevertheless had the highest concentration of D in
her bloodstream. The reason? She had just gotten a
two-week dose of sunshine on Malta (Human Nutri-
tion: Clinical Nutrition).
But for many, a vacation in the sun simply isn’t
possible. And the sun isn’t always an entirely reliable
source of the sunshine vitamin either. During the win- Pollution can block the
ter months, the sun slants its rays through the ozone production of vitamin D.

layer of the atmosphere, which filters out much of the

ultraviolet light the skin needs to manufacture D. Stud-
ies show that blood levels of the vitamin tend to drop
in the winter, especially among elderly women. Urban
dwellers may see the sun even less than the house-
bound, especially if they live and work in the shadows
of tall buildings. Pollution may also be a factor. A
progressive increase in atmospheric ozone and pol-
lutants between 1951 and 1972 produced a 20 per-
cent decrease in the amount of ultraviolet radiation
reaching the earth. Some researchers believe the de-
crease in ultraviolet light parallels a progressive in-
crease in hip fracture mortality.
 From A to Zinc: A Guide to Vitamins and Minerals

Vegetarians Need Vitamin D, Too

The elderly aren’t the only people that country were hospitalized for
who need vitamin D. Everyone rickets, or osteomalacia, a disease
needs vitamin D for strong bones, characterized by progressive bone
but not everyone gets enough. softening.
Among the most vulnerable are These children also may have
vegetarians, whose diets don’t al- been predisposed to rickets be-
ways provide sufficient vitamin D. cause of the vitamin D-deficient
Additionally, the high percentage diets of their vegetarian mothers,
of roughage in a vegetarian’s diet according to researchers.
may interfere with the absorption After they were diagnosed,
of this important vitamin. the children were given vitamin D
Consider, for example, the supplements, and the painful
severe deficiencies reported by re- symptoms of rickets disappeared
searchers in Norway among vege- altogether (Acta Paediatrica
tarian children. Several children in Scandinavica).

There is another confounding factor. Elderly

people also may have faulty vitamin D metabolism—
Oider people’s metabo- an inability to convert vitamin D into its active form in
lism may have trouble adequate amounts. Hector DeLuca, Ph.D., professor
putting vitamin D to
work. of biochemistry at the University of Wisconsin, Madi-
son, with his colleagues, was the first to demonstrate
that D has to be changed into an active hormonal
form before it can function. Since isolating the hor-
mone, Dr. DeLuca and others have been experiment-
ing with ways to use it pharmacologically to treat
postmenopausal and old-age osteoporosis.

Faulty Metabolism
Can Cause Trouble
“In both old age and the postmenopausal state,
the vitamin D hormone doesn’t respond as it should,”
says Dr. DeLuca. “Calcium absorption is low; bone
turnover—the tearing down of old bone and the re-
 Vitamin D: How to Avoid a “Hidden Epidemic” 147

building of new bone—is low. If you have low cal-

cium absorption, the body continues to draw on bone
calcium to meet nerve and muscle needs. This con-
tributes to the thinning of bones. When they become
thin enough, they fracture.”
Several clinical tests have been “promising,” says
Dr. DeLuca. Postmenopausal women given small
doses of the vitamin D hormone had increased cal- A special form of vita-
cium retention in the bones, increased bone mass and min D helped prevent
broken bones.
a decrease in bone-fracture rates. The hormone
works, apparently, because it circumvents the metab-
olism problem. Giving D alone is ineffective, says Dr.
DeLuca.
But if your metabolism is working up to par and
youre in the high-risk category, a supplement may be
needed. “Without D, you can’t make the hormonal
form,” says the researcher. “I personally think the
best way to get D is by sunlight. But, unlike some

Best Food Sources of Vitamin D

Food Portion Vitamin D

(1.U.)

Halibut-liver oil 2 tsp. 9,636

Herring, grilled 3 OZ. 850
Mackerel, fried SIOZ, 717
Cod-liver oil 2 tsp. 675
Mackerel, raw 3 OZ. 595
Salmon, Pacific, steamed 3 OZ. 425
Sardines, canned in oil, drained 3 OZ. 255
Tuna, canned in oil, drained 3107: 197
Milk, 1% fat 1 cup 102

Sources: Adapted from

McCance and Widdowson’s The Composition of Foods, by A. A. Paul and
D. A. T. Southgate (New York: Elsevier/North-Holland Biomedical, 1978).
Bowes and Church’s Food Values of Portions Commonly Used, by Jean A. T.
Pennington and Helen Nichols Church (New York: Harper & Row, 1980).
Handbook of Lipid Research: The Fat-Soluble Vitamins, by Hector F. DeLuca
(New York: Plenum Press, 1978).
148 From A to Zinc: A Guide to Vitamins and Minerals

other nutrition people, | recommend a multivitamin

so you can get all the basic nutrients you need, includ-
ing D.”
If you are taking a D supplement, make sure it’s
no more than 400 international units a day. Vitamin D
One doctor’s Rx: 400 in- in larger amounts can be toxic. “Taking 400 interna-
ternational units of vita- tional units once a day will keep you well below the
min D daily.
level that can cause any harm,” says Dr. Parfitt.
 Chapter ZA 149

Vitamin E:
Protector of Cells

itamin E has been promoted as nothing short

of a magical potion that restores everything
from sexual potency to youth. Its widespread use led
one wag at the Harvard Medical School Health Letter
to suggest that vitamin E be classified as a “recre-
ational drug.”
All of this unfortunate ballyhoo has nearly ob-
scured the facts about vitamin E, which in this case
are proving to be far more remarkable than fiction.
Vitamin E is being tested not only as a potential
wound healer but as an anticancer agent and as a
biochemical, not magical, antidote to aging. And
there is some evidence that it may do all of these
things because of its ability to protect healthy cells
from damage.
In wound healing, scientists believe that vitamin
E protects the lymphocytes, cells that produce anti-
bodies against disease-causing organisms. An aid to wound
In cancer, some scientists believe E may dili- healing.

gently defend cell membranes against the assault of

cancer-causing substances, notably the free radicals,
highly unstable molecules that can scramble the ge-
netic information the cells contain.
Those damaged cells can become, literally, an
accident looking for a place to happen, starting a
chain reaction that can lead to cancer.
Free radicals may play a role in aging, too. One E may be a cellular
theory—highly controversial—says that aging is not shield against cancer-
causing substances.
simply the inevitable ticking away of a programmed
(continued on page 152)
150 From A to Zinc: A Guide to Vitamins and Minerals

Using Vitamin E Externally

Vitamin E has a long history of by a mild “sunburn.” Mice were
being used topically by the public irradiated with just enough ultra-
to soothe and heal everything violet light to produce a mild in-
from burns to warts. Researchers, flammatory response. Thirty min-
though, are just beginning to ex- utes before the exposure, they had
amine vitamin E’s topical use. vitamin E rubbed into their skin.
There are some indications it can (The vitamin needs this time to
penetrate easily to the growing penetrate to the growing layers of
layers of the skin, work to reduce the skin, Dr. Pugliese says.)
inflammation and heat in sun- The mice treated with a 5
burned skin and protect tissues percent solution of vitamin E were
from the damage of cancer drugs. later found to have about a third
less of a chemical secreted by the
The “Cell-Saver” Vitamin cells to initiate the inflammatory
Most of these benefits come response. The mice treated with a
from vitamin E’s role as an antioxi- 100 percent solution of vitamin E
dant. It can neutralize harmful par- had a 93 percent reduction in this
ticles called free radicals formed chemical.
by inflammation, ultraviolet light “Vitamin E on the surface of
or chemotherapy, saving the cells the skin acts as a filter for ultravio-
from damage. let light,” Dr. Pugliese says. “But
“Much more research must more important, it has a biochem-
be done, but right now it appears ical ability to short-circuit ultravio-
that vitamin E has much more of a let light’s damaging effects by act-
biological effect than any of us ing as an antioxidant.”
ever dreamed of,” says Peter T. According to Dr. Pugliese, vi-
Pugliese, M.D., vice-president of tamin E also affects the tiny blood
research and development at the vessels in the lower layers of the
Xienta Institute for Skin Research skin. These capillaries tend to leak
in Bernville, Pennsylvania. There’s excessively when they are
good evidence, for instance, that stressed.
vitamin E works as an anti-inflam- Researchers at Sapporo Med-
matory when applied to the skin, ical College in Japan found that
he says. vitamin E applied to the skin con-
Dr. Pugliese used vitamin E to Stricts the capillaries and reduces
reduce the amount of inflamma- their permeability, so less fluid
tion produced in the skin of mice leaks into surrounding tissues and
 Vitamin E: Protector of Cells 151

less swelling occurs. This action min E and those receiving none.
also cuts down on surface skin Every one of the guinea pigs that
temperatures by up to two de- received no vitamin E had com-
grees, creating a slight cooling ef- plete ulceration of the skin by the
fect, Dr. Pugliese says. ninth day after the injection of
high doses of Adriamycin. And
Reducing Side Effects most were still completely ulcer-
of Chemotherapy ated when the experiment ended
Researchers have noted that 21 days later.
vitamin E used orally seems to Skin ulceration was present
help people better withstand can- in all animals receiving high doses
cer drug therapy. They think vita- of Adriamycin, but in the groups
min E acts to protect the body’s also receiving vitamin E, some of
healthy cells from these powerful the animals showed evidence of
free-radical-producing drugs. healing. In animals receiving low
Could vitamin E work to doses of the chemotherapy drug
clean up a “spill” of chemo- (doses equivalent to accidental
therapy drugs into the skin? Spills leakage during treatment), vitamin
sometimes happen when these E not only diminished the amount
drugs are administered intrave- of skin damage but also promoted
nously, and they can cause skin more rapid healing.
ulcers, says Ronald Barr, M.D., “Vitamin E may help to re-
professor of pediatrics, McMaster duce soft tissue damage by scav-
University, Hamilton, Ontario. enging the free radicals produced
Dr. Barr injected either low by chemotherapy,” Dr. Barr says.
or high doses of the chemo- “We recommend that a solution
therapy drug Adriamycin just be- of 50 percent vitamin E in an or-
low the skin layers of guinea pigs, ganic solvent be readily available
then coated the site with either an at all times in locations in which
organic solvent alone or in com- patients are receiving intravenous
bination with a 10 or 50 percent chemotherapy drugs, so that it
solution of vitamin E. He contin- may be applied promptly to any
ued coating the skin every three site of a suspected spill into the
days. tissue, with the view of preventing
The difference was dramatic or at least diminishing the conse-
between those guinea pigs receiv- quent tissue damage” (British
ing either concentration of vita- Journal of Cancer).
BZ From A to Zinc: A Guide to Vitamins and Minerals

biological clock but the result of a lifetime of avoid-

able damage caused by these molecules running
amok.

Consider the Rotifer

‘What E probably does is maintain the integrity
of individual cell membranes,” says James R. Litton,
Jr., Ph.D., former assistant professor of biology at St.
Mary’s College, University of Notre Dame, South
Bend, Indiana. “If we relate aging to the degradation
of cell membranes, then, the theory is, if we maintain
their integrity, we live longer.”
That theory is based on research such as studies
conducted by Dr. Litton on very small animals called
Is vitamin E an anti- rotifers. The rotifer is a tiny aquatic creature that has a
aging factor? head that seems to spin like an outboard motor and
also has a peculiar appetite for vitamin E. When the
vitamin is added to a watery colony of rotifers, more
of them live to a ripe old age. “We never increase their
average life span,” Dr. Litton stresses. “But we allow
more of them to live a full life, which in the case of
rotifers is 20-some days. They also have more off-
spring. Of course, if you live longer, chances are you
produce more.”
The rotifer is a minute, often microscopic, inver-
tebrate that has just a little more in common with man
than bacteria have. Is it possible that its reaction to
vitamin E could have any human implications? “I'd be
very hesitant to say that,” says Dr. Litton. “But I would
like to hope so.”

The Anticancer Connection

One area of research in which the human impli-
cations have extended beyond mere hope is in vita-
Vitamin E may have the min E’s effect on cancer. A synthetic version of the
power to fight pain. vitamin is being used with cancer patients who have
failed to respond to other therapies. Researchers re-
port “some antitumor and analgesic effects.” Though
 Vitamin E: Protector of Cells 153

hardly a major breakthrough, they admit, “even a

partial response by the infusion of vitamin E alone can
be considered encouraging” (Proceedings of the Soci-
ety for Experimental Biology and Medicine).
Animal studies suggest that the effects of E on
one particular kind of cancer—breast cancer—are
particularly encouraging, although the studies are lim-
ited to animals. In fact, even when E has no effect on
other cancers, as in a British study on rats, it still
lowers the incidence of breast tumors (/nternational
Journal for Vitamin and Nutrition Research).
The connection may be dietary fat. Some epide-
miological studies show a correlation between breast
cancer and high-fat intake. One of the end results of
fat breakdown is the cell-damaging free radicals so
strongly implicated in cancer. And, as we've noted,
many scientists believe that vitamin E can protect the
cells from free-radical assault.
Why does E have an effect on breast cancer?
Theoretically, it could be E’s stimulatory effect on the
immune system—protecting the disease-fighting cells
so they can do their work.

The Team Approach

That possibility was considered by Clement Ip,
Ph.D., associate research scientist in the Department
of Breast Surgery and the Breast Cancer Research
Unit of Roswell Park Memorial Institute in Buffalo,
New York. Dr. Ip used vitamin E as part of a one-two
punch, along with the trace mineral selenium, on
breast tumors in rats.
Vitamin E and selenium are both antioxidants,
substances that protect cells from the damage caused
during fat breakdown. Both have been shown in lab-
oratory experiments to halt tumor growth.
In Dr. Ip’s studies involving rats fed a high-fat
diet, the vitamin E alone had no effect on chemically In the laboratory, E and
induced breast tumors. But when he paired vitamin E selenium paired up to
fight cancer.
with selenium, there was a lower incidence of cancer.
154 From A to Zinc: A Guide to Vitamins and Minerals

Why? Dr. Ip has two theories. One is that the

vitamin E, a more powerful antioxidant than selenium,
protected the cells from damage caused during the
breakdown of fats and created a more favorable cli-
mate for selenium to inhibit tumor growth “via some
other mechanism” as yet unknown.

Can Vitamin E
Help Prevent Heart Attacks and Strokes?
Vitamin E helps to prevent platelet To test vitamin E’s effects on
aggregation—the “clumping” that these two chemicals, Dr.
occurs when red blood cells stick Panganamala used two groups of
together like stacked poker chips, rabbits. One group got a diet high
according to research by R. V. in vitamin E; the other, no vitamin
Panganamala, Ph.D., of the De- E at all. After 10 to 12 weeks,
partment of Physiological Chemis- those animals deficient in vitamin
try at Ohio State University School E had significantly higher amounts
of Medicine. While such clumping of thromboxane, and their blood
is essential in the event of a cut, if vessels had lost the capacity to
it occurs in an intact blood vessel, produce prostacyclin. Giving vita-
it can trigger a heart attack or min E returned these animals to
stroke. normal.
Dr. Panganamala found that “There must be a proper ratio
vitamin E maintains a healthy bal- of thromboxane to prostacyclin
ance between two chemicals in- for blood to flow without clump-
volved in platelet clumping. “Vita- ing,” Dr. Panganamala _ says.
min E works by blocking the “When the ratio gets out of bal-
production of a fatty acid that is ance, clumping is much more
used in the formation of a com- likely to occur. Vitamin E keeps
pound called thromboxane,” he these two substances in optimum
explains. “Thromboxane makes balance.”
the cells stick together.” Other work he’s done with
Vitamin E also stimulates the animals and humans makes Dr.
production of prostacyclin, a Panganamala hopeful that vitamin
chemical secreted by the blood E will alleviate some of the circu-
vessel wall, which helps keep the latory problems facing people
platelets “slippery.” with this illness.
 Vitamin E: Protector of Cells 155

Dr. Ip’s second theory is that vitamin E and sele-

nium stimulated the immune system, allowing the
body’s own disease-battling cells to rid it of the can- These nutrients may
cer. In at least one experimental model, a deficiency help your immune sys-
tem fight cancer.
of antioxidants stimulates tumor growth. More impor-
tant, when vitamin E and selenium are added to the
diet in quantities in excess of the recommended daily
requirement, the immune system seems to be stimu-
lated. (Caution: Very high amounts of selenium are
toxic. The suggested range is 50 to 200 milligrams a
day.)
Vitamin E’s stimulatory effect on the immune
system may have been responsible for the remarkable
recovery rate of laboratory rats from both gum
wounds and oral cancer in tests by researcher Gerald
Shklar, D.D.S., of the department of oral medicine
and oral pathology of the Harvard School of Dental
Medicine in Boston.
In the gum-wound study, the rats given daily
doses of vitamin E began to heal within two days of
their injury. The results of the cancer study were even Vitamin E was used
more astounding. “There,” says Dr. Shklar, “vitamin E against gum wounds
and oral cancer.
very significantly delayed oral cancer formation and
in some cases even prevented it.”

Alcohol Antidote?
Existing evidence hints that vitamin E may be
able to protect the heart from alcohol damage. Stud-
ies show too much alcohol can damage your heart,
leading to circulatory problems or cardiac failure.
Helmut Redetzki, Ph.D., a professor of pharmacology
at Louisiana State University School of Medicine, and
his co-workers found that in rats even a single intoxi-
cating dose of alcohol hurts heart muscle cells. ‘‘Al-
cohol generates free radicals that cause heart cells to
malfunction or die,” he says.
But giving rats vitamin E first significantly re-
duced signs of cellular damage. Although the rats
received much larger doses than would be currenily
156 From A to Zinc: A Guide to Vitamins and Minerals

considered appropriate in humans, normal amounts

Buffering the effects of of vitamin E provide some protection from alcohol’s
alcohol on the heart. effects, too, Dr. Redetzki says.
“We know that E-deficient animals suffer more
heart damage from drinking than animals fed ade-
quate E. Alcoholics often have lower blood levels of
vitamin E, so they may be particularly prone to this
kind of heart damage. And we know that in animals
receiving adequate E in their diets, additional E
boosted their protection from alcohol.”
In humans, Dr. Redetzki theorizes, it may be that
the more you drink, the more vitamin E you need.
Heavy drinkers may ben- (See the table, Best Food Sources of Vitamin E, on
efit from E. page 158, for a list of vitamin E-rich foods.)

E-zier Breathing?
Air pollutants and cigarette smoke both generate
plenty of free radicals that line up for a direct assault
on the cells lining the lungs. A microscopic view of
the lung cells of rats after 24 hours of exposure to a
laboratory-concocted concentration of smog—the
equivalent of a day in downtown Los Angeles—cre-
ates as much damage to the lungs as you'd see in a
chronic cigarette smoker, says James Mead, Ph.D.,
professor emeritus of biological chemistry and nutri-
tion at the University of California’s Laboratory of
Biomedical and Environmental Sciences. “It’s horrify-
ing to see the damage that takes place with smog or
cigarette smoke,” he says. “And even oxygen is some-
what toxic because it is the basis of free-radical for-
mation.”
Dr. Mead found that rats given vitamin E before
exposure to pollutants had much less cell damage.
The problem, though, was that massive doses were
required to get the vitamin to the lungs in amounts
large enough to provide optimum protection.
The solution, discovered by one of Dr. Mead’s
colleagues, was to put the vitamin into an aerosol
spray that could be delivered directly to the lungs. He
 Vitamin E: Protector of Cells 157

uses a water-based spray with a water-soluble vitamin

E derivative. Rats that inhale this solution for half an A vitamin E aerosol
hour and are then exposed to a typical day’s smog spray protected against
air pollution.
show almost no lung damage, Dr. Mead says. “‘Vita-
min E spray appears to work very well against air
pollutants. We know the protection we give the rats
lasts at least four days, and it may last considerably
longer.”” He hopes next to try aerosol E on people in
smog-heavy areas, smokers and those with lung dis-
eases. “I’m already convinced of its safety and bene-
fits, and I'd be happy to be the first volunteer,” Dr.
Mead says.

Good News—Maybe
A group of researchers in Minnesota, interested
in vitamin E’s relationship to aging, did do their stud-
ies with humans. Because of suggestions that E could
retard the aging process, they tested the blood levels
of the vitamin in older people to determine if the
concentrations declined with age.
What they discovered was that total vitamin E
levels in the plasma, the fluid portion of the blood,
remained stable, although one form of the vitamin, Levels of vitamin E drop
called gamma-tocopherol, declined significantly. with aging.
However, there were sharp declines of vitamin E in
the platelets, small disk-shaped components of blood
that assist in blood clotting (Journal of the American
College of Nutrition).
Their findings raise a question with serious impli-
cations for the elderly: Are the platelets harmed by
this loss of vitamin E in aging? The researchers don’t
know. But they say “‘it is of crucial importance” to find
out.
One of them cautions against jumping to conclu-
sions. “It may be that there is no added requirement
of vitamin E in the aging,” suggests Govind Vatassery,
Ph.D., research chemist at the Geriatric Research,
Education and Clinical Center of the Veterans Admin-
istration Medical Center in Minneapolis.
158 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Vitamin E

Food Portion Vitamin E

(1.U.)

Wheat germ oil 1 tbsp. 36.3

Sunflower seeds Ys cup 26.8
Almonds, whole, dried,
unblanched , Y%4 cup 152
Wheat germ, raw Ye cup 12.8

Sunflower oil 1 tbsp. 10.9

Hazelnuts, dried, unblanched,
chopped Y% cup 10.2
Safflower oil 1 tbsp. 8.2
Peanuts, shelled, dried Y cup 6.0

Cod-liver oil 1 tbsp. O20)

Peanut butter 2 tbsp. 3.8
Corn oil 1 tbsp. 28)
Peanut oil 1 tbsp. 29
Corn oil margarine _ 1 tbsp. 27,
Lobster, boiled 3 02. 2.3
Salmon steak, broiled 3 02. 2.0
Soybean oil, hydrogenated 1 tbsp. 2.0
Pecans, halves, dried Y% cup les

Sources: Adapted from

Composition of Foods: Fats and Oils, Agriculture Handbook No. 8-4, by Con-
sumer and Food Economics Institute (Washington, D.C.: Science and Education
Administration, U.S. Department of Agriculture, 1979).
Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).
“Vitamin E Content of Foods,” by P. J. McLaughlin and John L. Weihrauch, Jour-
nal of the American Dietetic Association, December, 1979.
Nutritive Value of American Foods in Common Units, Agriculture Handbook No.
456, by Catherine F Adams (Washington, D.C.: Agricultural Research Service,
U.S. Department of Agriculture, 1975).
McCance and Widdowson’s The Composition of Foods, by A. A. Paul and
D. A. T. Southgate (New York: Elsevier/North-Holland Biomedical, 1978).
 Vitamin E: Protector of Cells 159

Or, he speculates, it may be that enough E is

stored in the liver and fat tissue that it can be mobi-
lized to the bloodstream when it’s needed. “You store
it over the years, a little at a time. Vitamin E con-
centrations in the liver and fat tissues do go up with
aging in experimental animals. It’s as if you're writing
a nutritional history of vitamin E in these tissues,” he
explains. “Whether that amount is rapidly and readily
available in times of need is still controversial. Further
study is absolutely essential.”
Further study needed—these are the key words
when it comes to vitamin E. Ultimate understanding
of the health benefits of the much-hyped vitamin may
be countless experiments away. But we have only to
look at the direction research is taking to realize that
all of the hullabaloo may not be wrong after all—just
premature.
160 Chapter yy
Calcium: A New Look
at an Old Friend

he milk mineral, the builder of bones, the maker

of molars, is fast losing its ho-hum image bred in
high school health classes of yesteryear.
For example: Just a couple of years ago, a panel
of experts decided to rethink women’s calcium Rec-
Experts say the RDA for ommended Dietary Allowance (RDA) set by the Na-
calcium may be too low. tional Research Council. The panelists, deliberating
for the National Institutes of Health, proposed that the
current RDA of 800 milligrams per day be bumped to
a daily 1,000 milligrams before menopause and 1,500
milligrams after menopause.
Why all the fuss about more calcium for women?
Osteoporosis. It’s the bone-thinning, bone-fracturing
disease that some experts say is virtually epidemic
among older American women. For years medical
people have suspected that calcium could prevent or
impede the malady, and now the case for calcium
therapy seems stronger than ever.

Why Many People

May Need More Calcium
“It is by no means certain that lack of calcium
causes osteoporosis,” says Robert P. Heaney, M.D.,
Calcium may slow down an expert in bone physiology at Creighton University
or stop osteoporosis. in Omaha. “But available evidence suggests that di-
etary calcium may have a positive effect on the dis-
 Calcium: A New Look at an Old Friend 161

ease, which is a gradual loss of bone mass. We now

know that bone loss happens to everyone after 35 or
45, but it’s greatly accelerated in women past meno-
pause. Osteoporosis is frequently the result, and cal-
cium may counteract it.”
So say several studies, including one from Aus-
tralia. There, researchers selected 14 postmenopausal
women with osteoporosis, gave them 1,000 milli-
grams of calcium daily for eight days, then measured
the impact of the supplements on bone resorption, or
degeneration. The effect was dramatic—the women
showed “significant reduction in bone resorption”
(American Journal of Clinical Nutrition).
Such data may be slowly changing the way doc-
tors treat their osteoporotic patients. Most physicians
now view calcium intake as an adjunct to estrogen An alternative to
therapy, a standard treatment for the disease. And estrogen.

some suggest trying calcium before resorting to estro-

gen, an agent whose long-term use is linked to an
increased risk of uterine cancer.
“Certainly the case for calcium as osteoporosis
therapy isn’t yet proved,’ Dr. Heaney says. “But I
think it’s best to take the course of least risk. If we say
that increased calcium is ineffective, the damage can
be great if we’re wrong. If we recommend increased
calcium and it does nothing, no one is harmed.” (To
help plan a calcium-rich diet, see the table, Best Food
Sources of Calcium, on pages 164-65.)

Calcium and
High Blood Pressure
But what of the case for calcium as a treatment
for hypertension, the biological accomplice in thou-
sands of American deaths?
More than a decade has come and gone since Scientists want to know
researchers first suggested that calcium in drinking if calcium can lower
high blood pressure.
water was related to lower blood pressure. And over
162 From A to Zinc: A Guide to Vitamins and Minerals

the years the calcium/hypertension link has grown

stronger in surprising ways.
One of the biggest studies of the connection
comes from a group of researchers at Oregon Health
Sciences University in Portland and Temple University
in Philadelphia. They borrowed data from a massive
government study of the American population and
analyzed the information for correlations between nu-
trient intake and high blood pressure. In over 10,000
men and women claiming they never had hyperten-
sion, the investigators assessed blood pressure and
consumption of 17 nutrients, including vitamins A and
C, iron, potassium and calcium.
As it turned out, about 9 percent had hyperten-
sion, which was more consistently associated with
low-calcium intakes than deficits of any other nutri-
ent. In fact, say the researchers, ‘‘none of the hyper-
tensive subgroups had a mean intake of calcium equal
to the current recommendation” of 800 milligrams
per day.
And, not surprisingly, the consumption of dairy
products—rich sources of calcium and potassium—
More dairy products, was a strong indicator of whether someone over age
less risk of high blood 34 had high blood pressure. “The greater an individ-
pressure.
ual’s consumption of dairy products,” say the investi-
gators, “the less likely it was that he or she was hyper-
tensive” (Science).
But an even more intriguing look at calcium’s
influence on errant blood pressure comes from a
team of researchers at Cornell University Medical
School, located in New York City. In one of the first
research studies to actually test the power of calcium
supplements against hypertension in humans, the re-
searchers gave 26 mildly hypertensive patients 2,000
milligrams of oral calcium for six months. The result
was a “modest but consistent” drop in pressure—
from an average of 161/94 at the start of the study to
154/89 six months later.
For some of the subjects, the change was even
 Calcium: A New Look at an Old Friend 163

more dramatic. “The patients who started with lower

levels of calcium in their blood showed the greatest A 20 percent reduction
decrease in pressures,” says Lawrence M. Resnick, in pressure levels.

M.D., head of the research team. “In some cases,

diastolic pressures dropped 10 to 20 percent. Patients
with higher calcium levels, however, weren't helped
at all by the calcium supplements. So the nutrient can
benefit some, but not all, hypertensives.”
But how? “No one knows for sure,’ says Dr.
Resnick. ““My theory is that supplemental calcium al-
ters the hormones that help regulate blood pressure.
But a lot more research needs to be done before we
figure out what’s going on.”

Moderate Amounts
May Work Well
And more work is being done. In fact, Dr.
Resnick’s results have been corroborated by the in-
vestigators from Oregon Health Sciences University.
They, too, found that oral calcium could lower blood
pressure, but at a much lower dose.
For eight weeks they gave 1,000 milligrams of
calcium or a placebo (dummy pill) to 70 patients,
some with high blood pressure and some without. As 1,000 milligrams of cal-
expected, the nutrient pulled pressures down—in 42 cium daily pulled blood
pressure down.
percent of the hypertensives and 13 percent of those
with normal pressures. And what’s just as significant,
none of the patients had to stop the calcium supple-
ments because of side effects (Clinical Research).
“These results,” the researchers say, “suggest
that long-term oral calcium may be effective
nonpharmacologic [nondrug] therapy for reducing a Is calcium just as effec-
subset of hypertensives’ blood pressure and may also tive as blood pressure
medication?
reduce blood pressure in_ selected normals
[nonhypertensives].”’
And judging from the ongoing boom in calcium
research, the calcium lessons in high school health
class may never be the same.
164 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Calcium

Food Portion Calcium

(mg.)

Tofu, raw, firm, coagulated with

calcium sulfate 3 02. 581
Swiss cheese 2 oz. 544
Provolone cheese ZiOZ: 428
Monterey Jack cheese 2 02. 424
Yogurt, low-fat 1 cup 415
Cheddar cheese 2 oz. 408
Muenster cheese 2 Oz. 406
Colby cheese Zioz 388
Brick cheese DOZ: 382
Sardines, Atlantic, drained solids SIOZ: Siz
American cheese 2 02. 348
Ricotta cheese, part-skim Y% cup 337
Milk, skim 1 cup 302
Mozzarella cheese ZiOZ: 294
Milk, whole 1 cup XM |
Buttermilk 1 cup 285
Limburger cheese 2 Oz. 282
Ice milk, soft-serve ‘ 1 cup 274
Salmon, sockeye, drained solids 3 OZ. 2
_——

Sources: Adapted from

Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Merrill (Washington, D.C.: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1,
by Consumer and Food Economics Institute (Washington, D.C.: Agricultural
Research Service, U.S. Department of Agriculture, 1976),
 Calcium: A New Look at an Old Friend 165

Food Portion Calcium

(mg.)

Ice cream 1 cup 176

Ice milk 1 cup 176
Tofu, raw, firm, coagulated with
nigari 3 02. 174
Pizza, cheese ¥% of 14” pie 144
Blackstrap molasses 1 tbsp. 137
Almonds Ys cup 100
Scallops, steamed SIOZ: 98
Broccoli, cooked Ye cup 89
Soybeans, cooked Ye cup
Parmesan cheese 1 tbsp.
Collards, cooked Ye cup
Dandelion greens, cooked Ye cup
Navy beans, cooked Ye cup
Soy flour, defatted Ys cup
Shrimp, raw OZ:
Mustard greens, cooked Y% cup
Kale, cooked Ye cup
Broccoli, raw 1 cup

Nutritive Value of American Foods in Common Units, Agriculture Handbook No.

456, by Catherine F. Adams (Washington, D.C.: Agricultural Research Service,
U.S. Department of Agriculture, 1975).
Nutrient Data Research Branch, U.S. Department of Agriculture, Washington,
D.C.
166 Chapter Zs
Copper: Essential
to Life and Health

hen you think of copper, do you picture a

roll of shiny new pennies? How about the
pipes that bring water into your home? Or the gleam-
ing pots and pans hanging in the kitchen? How about
a healthy heart and a sound mind?
Probably not the latter. Even though it’s abso-
lutely vital to our good health, copper is just not a
A trace of copper is all member of the nutrition Hall of Fame. Yet having the
we need. correct amount of this trace mineral (one we need in
only tiny amounts) is indispensable to the develop-
ment and maintenance of our nerves, blood vessels
and bones. And although most of us have no difficulty
keeping the amount of copper in our bodies at the
proper level, for the few who encounter too little or
too much, the results can be devastating.
That’s because copper is both essential to human
health and, like other heavy metals such as lead, cad-
mium and mercury, potentially toxic. Luckily, our
bodies have mechanisms that control the amount of
copper we retain. When there’s a temporary defi-
ciency of copper in our diet, we absorb more from the
food we eat and excrete less. When there’s an excess,
we absorb less and excrete more.

What We Know about Copper

The copper that we do retain performs its func-
tions as an integral part of more than a dozen proteins
called enzymes. Cloaking the copper in these large
 Copper: Essential to Life and Health 167

protein molecules protects us from the toxic effects it

would have if allowed to roam free.
Because we're so well protected from copper
feast or famine, significant deficiency and poisoning
are both uncommon. For that reason, much of what Copper deficiency is
we know about those conditions comes from experi- uncommon.
ments with animals. Direct knowledge of their effects
in humans comes from a few special cases.
“Our best evidence for copper’s role in humans
comes from children who have Menkes’ disease,”
explains Joseph R. Prohaska, Ph.D., associate profes-
sor of biochemistry at the University of Minnesota
School of Medicine in Duluth. “Menkes’ is a fatal
genetic disease of abnormal copper metabolism, in
which the children die at two or three years of age.”
It's sometimes called kinky-hair syndrome because
affected infants have peculiar kinky, white hair. Their
symptoms are thought to reflect deficiencies of the
copper enzymes.
“What happens to children with Menkes’ disease
is almost exactly what we see in copper-deficient
experimental animals,” Dr. Prohaska says. “Some of With too little copper,
their brain cells die, some degenerate and in some laboratory animals ex-
perience brain damage.
there is a delay in the process of myelination, the
formation of an insulating sheath around the neurons
(the characteristic cells of the brain).
“These children also have abnormal blood ves-
sels,” he says. ““They’re twisted and have a tendency
to rupture if blood pressure gets too high. The chil- In children, a copper ab-
dren’s bones are weakened, too.” normality may result in
fragile blood vessels.
Those abnormalities are thought to be a conse-
quence of a low concentration of a copper enzyme
involved in the cross-linking of collagen and elastin,
connective tissue proteins. When strands of those
molecules are properly cross-linked, the arteries are
strong, elastic and capable of stretching as blood
pulses through them, and the bones are formed with a
solid matrix.
Unfortunately, there’s no cure yet for Menkes’
disease. Merely giving the children copper doesn’t
168 From A to Zinc: A Guide to Vitamins and Minerals

improve their condition or keep them from dying. The

condition is still not completely understood.

A Kind of Nutritional Chore Boy

As you can see from the lethal effects of Menkes’
disease, copper performs a number of crucial tasks.
Copper: essential for It's needed for the proper development of the brain,
heaithy blood vessels, the cardiovascular system and the skeletal system.
brain cells and bones.
“The reason it affects so many different things,”
says Dr. Prohaska, “‘is that copper enzymes are ubiqui-
tous in nature. Almost all cells in the body contain
them. So when you start changing the copper
nutriture, you’re going to be changing the biological
system in many different kinds of cells.”
For instance, copper is part of a cell enzyme that
is required for the release of energy. It’s also part of an
enzyme that is needed for the production of melanin,
the dark pigment in hair and skin. The absence of this
enzyme results in albinism.
Copper is involved in iron metabolism, too. With-
out it, iron cannot be properly incorporated into he-
Copper and iron keep moglobin, the oxygen-carrying protein in the blood,
anemia at bay. and anemia ensues. Someone who has anemia
caused by copper deficiency can’t be cured by taking
extra iron.

Copper-Clad Defense
Research suggests that copper may even have a
role in immunity. “I knew that almost all of the infants
with Menkes’ disease die of some sort of an infec-
tion,” says Dr. Prohaska. “That may or may not be
due to an alteration in the immune system. But it was
enough of a reason for me to suspect that might be
the case.”
In one study, Dr. Prohaska found that mice defi-
cient in copper could not produce enough antibodies
to a particular antigen (foreign protein) that they were
given (Science). The mouse immune system is similar
to our Own.
 Copper: Essential to Life and Health 169

“The number of cells that were able to make

antibodies against that particular antigen was de-
creased in these mice roughly in proportion to how
deficient they were,” Dr. Prohaska reports.
“Some of the mice had only a marginal defi-
ciency. Probably if they had checked into a mouse
clinic, they'd have come out with a clean bill of
health. Yet we were still able to detect a small change
in the immune system.
“The ability to form antibodies is called the hu-
moral immune response,” he explains. ‘““Another arm
of the immune system, the cell-mediated immune re- Is copper a vital factor
sponse, relies not primarily on the production of anti- in our immunity?
bodies but on cells in the immune system called T-
cells. Subsequently we’ve shown that this arm of the
immune system is also impaired in copper-deficient
animals.
“We don’t know yet exactly how copper is af-
fecting these things,” says Dr. Prohaska. ‘‘My research
now is trying to elucidate whether there is a specific
role for copper in the process or whether it’s a secon-
dary effect on something we already know about.”

A Role in Heart Disease?

One of the most intriguing areas of copper re-
search revolves around the theory that copper defi-
ciency, or a relative copper deficiency, may be related
to heart disease.
“The theory is based on the observation that
there are a large number of similarities between ani-
mals that are deficient in copper and people with Copper-deficient ani-
coronary heart disease,’”’ explains Leslie M. Klevay, mals have heart disease
symptoms. Is this a clue
M.D., research medical officer at the Human Nutrition to preventing the disor-
Research Center in Grand Forks, North Dakota. “They der in humans?
both have abnormal electrocardiograms, abnormal
connective tissue in the arteries and heart, death of
some areas of the arteries, enlarged heart, a low cop-
per level in the heart muscle and sometimes a rup-
tured heart.
170 From A to Zinc: A Guide to Vitamins and Minerals

“There are also biochemical similarities. The

most important are glucose intolerance, hypercholes-
terolemia [high levels of cholesterol in the blood] and
hyperuricemia [high levels of uric acid in the blood].
Glucose intolerance and hypercholesterolemia are
two of the major risk factors for heart disease. And we
know from the Framingham study that people with
gout, who have high levels of uric acid, have twice the
heart disease risk of people without gout. And the
higher the uric acid, the higher the heart disease risk.
“I want to emphasize that we don’t know
whether these characteristics in humans are really
due to copper deficiency,” stresses Dr. Klevay. At this
point it’s still a theory.
An interesting corollary to that theory is that it’s
not only a deficiency of copper that might be related
How zinc and copper co- to heart disease but a relative deficiency of copper
operate for health. with respect to zinc. “In one of my earlier experi-
ments, rats that were fed a diet with a high zinc-to-
copper ratio had raised cholesterol levels,” says Dr.
Klevay.
‘And it’s been shown in humans that too much
zinc drives down HDL [high-density lipoprotein] cho-
lesterol, the kind that is thought to be protective
against heart disease. There’s a lot of evidence that
too much zinc can interfere with copper. That’s how |
explain those results.”
One way zinc takes copper out of the picture is
by blocking its absorption. ‘‘Metallothionein is a pro-
tein in the intestines that binds both zinc and copper
and keeps them from being absorbed into the body,”
says Dr. Prohaska. “Normally, there’s a very small
amount of this protein. It can be induced to rather
high levels, though, if presented with a large amount
of zinc. But the protein tends to bind copper even
tighter than zinc. Even in the face of a lot of zinc, this
protein will preferentially bind to copper. Therefore
you decrease the absorption of copper by giving large
doses of zinc.”
‘From our animal studies, the ideal zinc-to-cop-
per ratio seems to be four to one,” says Dr. Klevay.
 Copper: Essential to Life and Health 171

“Meddling” with Your

Copper Supply
Just how much copper should we try to get?
Because of insufficient information, the National Re-
search Council hasn’t set a Recommended Dietary A safe daily ration of
Allowance. But based on all of the information they copper: two to three
milligrams.
do have, they have estimated that a safe and adequate
daily intake of copper for adults is two to three milli-
grams.
If that estimate is correct, there may be some
cause for concern. Several studies have shown that
we don’t get that much copper.
“Considering several dietary studies, we found
that 75 percent of the diets we checked contain less
than two milligrams [2,000 micrograms] of copper,”
says Dr. Klevay. “Only 25 percent contained two or
more milligrams.
“The best way to ensure you're getting enough
copper is to eat foods that provide it in ample
amounts,” he recommends. Liver, shellfish, nuts and
seeds, dried beans, wheat, barley and chicken are
some of the best sources. (For others, see the table,
Best Food Sources of Copper, on pages 174-75.)
‘My feeling is that it’s most important to get
enough copper during growth and development,”
says Dr. Prohaska. “It’s critical from pregnancy A critical nutrient for
through the child’s adolescence. It’s especially impor- children and young
mothers.
tant in adolescent pregnancies, where the growth of
the mother as well as the baby adds to the require-
ments. In adults, especially the elderly, we just don’t
know yet. There’s been very little research into their
particular needs.”
But there are some special situations to look out
for. Some infants fed a diet of cow’s milk have devel-
oped copper deficiency. That’s because cow’s milk
contains almost no copper. People on total parenteral
nutrition (intravenous feeding) may also be at risk of
copper deficiency. So may those taking excessive
quantities of antacids, those who've had intestinal by-
pass surgery and those on liquid protein diets.
172 From A to Zinc: A Guide to Vitamins and Minerals

In addition, there is evidence, based on animal

studies, that large doses of vitamin C can interfere
Too much vitamin C can with copper absorption. To maximize vitamin C’s
meddle with copper ab- benefits while minimizing its adverse effect on cop-
sorption.
per, it may help to divide the day’s allowance into
several smaller doses taken at intervals. Of course, it’s
equally important that the diet doesn’t fall short of
copper.

Copper’s Tarnished Reputation

But what about the other side of the coin? Too
much copper is just as dangerous as too little. “Be-
cause our bodies have mechanisms to detoxify cop-
per and get rid of it, it’s hard to get copper poisoning,”
says I. Herbert Scheinberg, M.D., professor of medi-
cine and head of the division of genetic medicine at
Albert Einstein College of Medicine in New York City.
‘You'd really have to work at it.”
Chronic occupational exposure to copper in a
form that could have toxic effects is relatively rare.
Too much copper in Acute poisoning is also uncommon but can occur
the body is rare but when too much copper is ingested by mistake. That
dangerous.
can happen when acidic food or drinks, such as vine-
gar, carbonated beverages or citrus juices have pro-
longed contact with a copper container. It can also
happen when water stands in copper pipes for a long
period of time, only if the water is acidic. However,
the problem is self-limiting. The vomiting and diarrhea
caused by ingesting too much copper generally pro-
tect us from its more serious toxic effects.
But people with Wilson’s disease are not pro-
tected. Wilson’s disease results from a genetic defect
in the mechanism that excretes copper, causing cop-
per to accumulate in the liver, where it does great
harm. Eventually it circulates out of the liver as free
copper, causing damage to the brain, nervous system
and kidneys, too. The disease first appears between
the ages of 5 and 50, but most commonly around the
age of 17.
 Copper: Essential to Life and Health 3

Too Much Copper

Can Be Hazardous
‘In about one-third of patients, the first symp-
toms are signs of copper poisoning in the liver, such
as jaundice, swelling of the abdomen and other signs The signs of copper
similar to those found in hepatitis,’ Dr. Scheinberg poisoning.
explains. “In the other patients, psychiatric and neu-
rologic symptoms may appear first. The psychiatric
symptoms include behavioral disturbances, neurosis
and psychosis. The neurological signs look like a
combination of Parkinson’s disease and multiple scle-
rosis. They include tremors, stiffness and difficulty
speaking, walking, swallowing and writing. These
eventually progress to the point of total incapacity.
“The disease is always fatal unless it’s treated.
The treatment is a drug called penicillamine, a deriva-
tive of penicillin. It combines with the excess copper
so it can be excreted in the urine. If patients are
treated before there is any irreversible damage, they
can be brought back to normal health.
“There are an estimated 8,000 people with Wil-
son’s disease in the United States,” Dr. Scheinberg
says. “Seven thousand of them will die because they
are not properly diagnosed. Because the symptoms
mimic hepatitis, neurological and psychiatric disor-
ders, most of these people will get wrong treatment.”
There are tests, however, that can diagnose Wil-
son’s disease. One is a blood test for the copper
protein ceruloplasmin. This protein, which normally
protects us from copper poisoning, is deficient or
absent in patients with the disease. If it’s low, a liver
biopsy can confirm the diagnosis.
“If someone in the family had Wilson’s disease,
it’s important that a child be tested for it before the
age of five,” says Dr. Scheinberg. “And anyone who An alert for families of
has unexplained symptoms of neurologic or psychi- people with Wilson’s
disease.
atric disorders, hepatitis or cirrhosis, especially if
they’re under 30, should be tested.”
174 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Copper

Food Portion Copper

(mcg.)

Crab, boiled 3 Oz. 4,080

Liver, beef, braised 4 oz. 3,161
Cashews, dry-roasted Y4 cup 760
Sunflower seeds, dry-roasted Ys cup 586
Sesame seeds, whole, dried 1 tbsp. 367
Peanuts, dried Y cup 366
Almonds, dried, unblanched,
whole Y% cup 335
Pecans, dried Y% cup 320
Walnuts, black, dried Y% cup 320
Whole wheat flour Y% cup 300
Prunes, dried, uncooked Y% cup 173
Apricots, dried, sulfured,
uncooked Y% cup 140

Sources: Adapted from

Composition of Foods: Beef Products, Agriculture Handbook No. 8-13, by
Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Breakfast Cereals, Agriculture Handbook No. 8-8, by
Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Fruits and Fruit Juices, Agriculture Handbook No. 8-9,
by Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Legumes and Legume Products, Agriculture Handbook
No. 8-16, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).
 Copper: Essential to Life and Health 175

Food Portion Copper

(mcg.)

Navy beans, cooked, boiled Y%4 cup 134

Banana 1 medium 124
Raisins, seedless, not packed Y% cup 1
Chicken, dark meat, cooked, ;
without skin 4 oz. 91
Barley, raw Y cup 60
Halibut, steamed 3 02. 60
Chicken, light meat, cooked,
without skin 4 oz. 57
Wheat germ, plain, toasted 1 tbsp. 44
Mushrooms, raw, pieces Ye cup 39

Composition of Foods: Poultry Products, Agriculture Handbook No. 8-5, by

Consumer and Food Economics Institute (Washington, D.C.: Science and Educa-
tion Administration, U.S. Department of Agriculture, 1979).
Composition of Foods: Vegetables and Vegetable Products, Agriculture Hand-
book No. 8-11, by Nutrition Monitoring Division (Washington, D.C: Human
Nutrition Information Service, U.S. Department of Agriculture, 1984).
“Copper Content of Foods,” by Jean T. Pennington and Doris Howes Calloway,
Research, August, 1973.
McCance and Widdowson’s The Composition of Foods, by A. A. Paul and
D. A. T. Southgate (New York: Elsevier/North-Holland Biomedical, 1978).
176 Chapter 24

What You
Should Know
about Iron

hen it comes to iron, some of us may fool

ourselves into thinking we know it all. Iron
is certainly something we’ve heard enough about,
thanks to advertising. It doesn’t take a Ph.D. in bio-
chemistry to understand that iron-packed red blood
cells carry energy-giving oxygen to every part of our
bodies, nor to realize that the end result of an iron-
poor diet can be a foot-dragging weariness that leaves
hardly enough pep to push a dustcloth, much less
conduct an executive board meeting.
Further research, though, is taking iron beyond
common knowledge and advertising clichés. With
You don’t have to be newer ways to assess how our bodies absorb, trans-
anemic to show signs of port and store iron, doctors can now pinpoint body
iron deficiency.
iron levels. They are finding that what once might
have been considered an adequate amount of iron
may not always be optimal, that the body can show
symptoms even in mild iron deficiency, not just out-
right anemia. They are beginning to view iron defi-
ciency as a “whole-body disease,” one that affects
immune response, body temperature and even learn-
ing and concentration.

Iron for Immunity

Researchers have known for a long time that iron
is important to our ability to ward off infections in
some way, says José I. Santos, M.D., an assistant pro-
 What You Should Know about Iron 177

fessor of pediatrics and pathology at Boston Univer-

sity School of Medicine.
It’s known that phagocytes, white blood cells
that serve as the body’s primary defense mechanism
against bacterial infections, depend on iron-contain- Without enough iron,
ing enzymes to do their job, Dr. Santos says. These our body’s defenses
against infection start
cells engulf bacteria and secrete a variety of corrosive to break down.
substances known as oxidants, which digest the in-
vading microbe once it is engulfed. Phagocytes need
plenty of oxygen to produce peroxides, and iron
brings it to them. “Certainly iron deficiency is going to
directly impede this process,” Dr. Santos says.
Other white blood cells, known as lymphocytes,
function even less well with inadequate iron. ‘““Lym-
phocytes need iron for energy metabolism and for the
production of enzymes important to their very spe-
cialized roles in the immune response,” Dr. Santos
says. The production of antibodies also requires iron-
dependent enzymes, he adds.
But germs, especially bacteria, also need iron to
survive and multiply, once they have invaded the
body. That’s why, when faced with some infections—
malaria, for instance, or tuberculosis—the body be-
gins to take iron out of circulation and store it in the
bone marrow, liver and other areas where bacteria
can’t reach it. As if to counter this, bacteria produce
chemical chelators (derived from the Greek word for
claw), which grab iron away from the bloodstream or
body tissues. So, paradoxically, low blood levels of
iron are beneficial in resisting infection.
But the exact opposite is true where viral infec-
tions are concerned, Dr. Santos says. “Most viral dis-
eases, including genital herpes, may become worse Low iron levels leave
with iron deficiency.’ This is not surprising, since you more vulnerable to
viral attack.
lymphocytes, the major defense against viral infec-
tions, also need iron for optimal activity.
Viruses also need iron to multiply, but they can-
not garner it the way bacteria can. “Faced with a viral
infection, the best thing we can do is to keep our iron
levels up,” Dr. Santos says.
178 From A to Zinc: A Guide to Vitamins and Minerals

Chill Resistance
Faced with a chilly winter, we may consider iron
as essential as long johns. The ability to stay warm
when it’s cold out is affected by iron deficiency, ac-
cording to researchers at the University of Washing-
ton Medical School, Seattle.
They found that after being exposed to 39°F tem-
peratures for 24 hours, anemic rats became ill,
Does the cold really get whereas normal animals tolerated exposure. The ane-
to you? Maybe you need mic rats had lowered body temperatures, reduced
more iron.
oxygen consumption, and a less active thyroid, and
one of their major heat-producing tissues, brown fat,
showed markedly less metabolic activity than that of
nonanemic control rats.
‘Abnormalities similar to those found in the rat
seem to exist in iron-deficient humans,” says Clement
Finch, M.D., professor of medicine at the University of
Washington Medical School. “We have found that
people with iron-deficiency anemia aren’t able to
maintain their body temperature well when exposed
to mild hypothermia.”
The rats also showed a buildup of chemicals
called catecholamines, which are secreted by the
brain. Synthetic forms of these chemicals are used to
treat shock, hypoglycemia and cardiac arrest. Along
with thyroid hormone, catecholamines drive meta-
bolic processes. But in this case, Dr. Finch says, they
do double duty, acting as a reserve mechanism to try
to keep the body generating enough energy to main-
tain its temperature.
In fact, some researchers believe that an imbal-
ance in neurotransmitting chemicals, which require
lron deficiencies may af- iron-containing enzymes, may be associated with the
fect the way you think behavior and learning abnormalities seen in iron defi-
and behave.
ciencies. Infants and children with iron deficiencies
often display symptoms of learning disability. They
have been described as “solemn, irritable and inatten-
tive.” Teenagers with iron deficiencies have been de-
scribed as restless, disruptive and inattentive.
 What You Should Know about Iron 179

But, at least with the children, only a few days of

supplemental iron reversed this behavior. In Chile,
researchers found that both anemic and nonanemic Giving iron to iron-defi-
(but iron-deficient) 15-month-old youngsters showed cient kids can improve
their dispositions.
a significant improvement in attention span and co-
Operativeness and did better in a psychological test
ten days after starting iron supplementation.
Ermesto Pollitt, Ph.D., professor of human devel-
opment in the Department of Applied Behavioral Sci-
ences at the University of California at Davis, found
that abnormalities in the ability to “receive” informa-
tion in both mildly and severely iron-deficient chil-
dren could be reversed with iron therapy.
“The findings suggest that the motivation to per-
sist in intellectually challenging tasks may be lowered,
attention span shortened, and overall intellectual per-
formance diminished in iron-deficient children,” Dr.
Pollitt says.

Low Iron Leads

Nutritional Deficiencies
These findings are particularly worrisome when
we consider the following: Although severe anemia is
now becoming uncommon in the United States, iron lron depletion may be
deficiency is a leading nutritional deficiency problem, the nation’s number one
nutritional deficiency
with infants, teenagers, women and the elderly its problem.
main victims.
A child from the age of nine months to two years
is at high risk because the infant has used up its body
stores of iron and may be weaned from iron-rich
breast milk or iron-fortified formula to iron-poor
cow’s milk during this time, says Frank Oski, M.D., a
pediatrician at Johns Hopkins Hospital and a profes-
sor of pediatrics at Johns Hopkins University School
of Medicine in Baltimore, Maryland. Dr. Oski has
found that iron deficiencies range from 10 to 25 per-
cent in affluent suburban infants to as high as 50
percent in infants of lower socioeconomic classes.
180 From A to Zinc: A Guide to Vitamins and Minerals

Iron deficiencies affect about 5 percent of all

five- to eight-year-olds, 2.6 percent of all adolescents
Up to one-half of Amer- and 25 percent of pregnant teenagers. A screening of
ican women of child- Yale University undergraduate women under age 21
bearing age are iron
deficient.
found 18 percent mildly iron deficient. Surprising?
“Maybe it is,” says Dr. Oski, “when you think that here
is a group of presumably very high socioeconomic
status, yet they show this degree of anemia. But it’s
not surprising when you know that anywhere from 25
to 50 percent of American women in their childbear-
ing years are iron deficient.”
Older people, especially if they have low income
and are over 60, are also vulnerable to iron deficien-
cies, studies have shown. Twenty-three percent of a
group of low-income, older black residents of Wash-
ington, D.C., were found to be iron deficient by Allan
Johnson, Ph.D., associate professor in the Depart-
ment of Human Nutrition and Food at the School of
Human. Ecology, Howard University. Forty-one per-
cent consumed less than the Recommended Dietary
Allowance (RDA) of iron.

Absorption Factors
Poor diet is certainly one cause of iron defi-
ciency, but it’s not the only cause. We may be eating
Is your body absorbing enough iron but not absorbing enough of it to stay
all the iron it needs? healthy, especially as we get older.
‘Lack of iron could be the result of poor bioavail-
ability rather than inadequate iron intake,” says James
D. Cook, M.D., director of the Division of Hematology
of the University of Kansas Medical Center in Kansas
City. He and colleague Sean Lynch, M.D., have tagged
iron with radioactive particles to determine how well
it is absorbed by the body in different situations.
Normally, we absorb only about 10 percent of all
the iron we eat. And that’s figured into the RDA. A
young woman's RDA is 18 milligrams, but her body
requires only 1.8 milligrams. (The RDA for men and
for women 23 to 50 is 10 milligrams.)
 What You Should Know about Iron 181

There are two kinds of iron. Found only in beef,

chicken, fish and other animal meats, “heme” iron is
the easiest for our bodies to absorb. Two kinds of iron—and
“Heme iron makes up only about 5 percent of the best sources of
both.
the iron we eat, but we can absorb about 25 percent
of it,” Dr. Cook says. And contrary to what you tried
to make your mother believe, liver is definitely the
best food source of iron. A 3-ounce serving of chicken
liver has 7.2 milligrams of iron; sirloin, 2.9 milligrams
and dark meat chicken, 1.1 milligrams.
But 95 percent of our iron comes from what are
known as nonheme sources, iron compounds that are
found in vegetables and grains and in meats. Liver is
also the best source of nonheme iron, Dr. Cook says.
Normally, only about 5 percent of the nonheme iron
in foods is absorbed. (For a more complete list of
sources of dietary iron, see the table, Best Food
Sources of Iron, on pages 182-83.)

Boosting Iron Absorption

Unlike heme iron, the availability of nonheme
iron is greatly influenced by what we eat along with it.
It all has to do with about three feet of small intestine.
In the acid environment of the stomach, the iron
molecule is free, but as soon as food moves into the
small intestine and acidity drops, iron scrambles for a
partner. How bioavailable the iron remains to us de-
pends on how willing its partner is to give it up to the
intestinal mucosa.
Amino acids in meats and vitamin C (ascorbic
acid) are proving to be nonheme iron’s indispensable
escorts. Both can more than double the amount of Meat and vitamin C can
iron absorbed, Dr. Cook says. double iron absorption.
The addition of just 60 milligrams of vitamin C to
a meal of rice will more than triple iron absorption.
Adding papaya juice containing 66 milligrams of vita-
min C to a meal of corn will boost iron absorption by
500 percent.
(continued on page 184)
182 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Iron

Food Portion Iron

(mg. )

Chicken liver, cooked 3 Oz. Tez.

Crab, pieces, steamed Y cup 6.0
Beef liver, fried OZ: 5.3
Soybeans, boiled Y cup 4.4
Blackstrap molasses 1 tbsp. Sie
Spinach, cooked Ye cup 3.2
Beef, rump roast, lean, cooked 3 OZ. Sal
Beef, sirloin, broiled 3 Oz. 2.9
Potato, baked I! 2.8
Scallops, steamed 3 OZ. 25
Sunflower seeds, dried Y% cup 2.4
Pistachios, dried Y cup De
Broccoli, cooked 1 spear a)
Cashews, dry-roasted Ys cup |
Lima beans, large, boiled Y% cup |
Beef, ground, extra lean, broiled,
medium 3 Oz. 2.0
Swiss chard, cooked Y cup 2.0
Turkey, dark-meat, cooked,
without skin OZ. 2.0
Soybeans, dry-roasted Ys cup elt
Lobster, broiled Y% cup ES

Sources: Adapted from

Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Merrill (Washington, D.C.: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).
Composition of Foods: Beef Products, Agriculture Handbook No. 8-13, by Nutri-
tion Monitoring Division (Washington, D.C.: Human Nutrition Information Ser-
vice, U.S. Department of Agriculture, 1986).
Composition of Foods: Fruits and Fruit Juices, Agriculture Handbook No. 8-9,
by Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Legumes and Legume Products, Agriculture Handbook
No. 8-16, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1986).
 What You Should Know about Iron 183

Food Portion Iron

(mg.)

Beet greens, cooked Ye cup 1.4

Tuna, canned in water StOZ. 1.4
Almonds, dried, unblanched Y% cup eS
Broccoli, raw 1 spear es!
Sesame seeds, whole, dried 1 tbsp. 13
Peanuts, dried Ys cup 2
Peas, cooked Y cup 1.2
Prunes, dried, cooked Y cup eZ
Chicken, dark-meat, cooked,
without skin 3 Oz. its
Turkey, light-meat, cooked,
without skin 3 OZ. ifs
Apricots, dried, sulfured, cooked Y% cup 1.0
Brussels sprouts, cooked Y cup 0.9
Chicken, light-meat, cooked,
without skin 3 OZ. 0.9
Cod, cooked 3 Oz. 0.9
Raisins, seedless, packed Y% cup 0.8
Spinach, raw, chopped ¥% cup 0.8
Haddock, raw SIOZ. 0.6
Endive, raw Ye cup 0.2

Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).
Composition of Foods: Poultry Products, Agriculture Handbook No. 8-5, by
Consumer and Food Economics Institute (Washington, D.C.: Science and Educa-
tion Administration, U.S. Department of Agriculture, 1979).
Composition of Foods: Vegetables and Vegetable Products, Agriculture Hand-
book No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human
Nutrition Information Service, U.S. Department of Agriculture, 1984).
Nutritive Value of American Foods in Common Units, Agriculture Handbook No.
456, by Catherine F Adams (Washington, D.C.: Agricultural Research Service,
U.S. Department of Agriculture, 1975).
184 From A to Zinc: A Guide to Vitamins and Minerals

Some escorts are notoriously unwilling to relin-

quish the iron they’re teamed up with. In laboratory
studies, Dr. Cook has found that the tannic acid in tea
inhibits absorption by 64 percent and that in coffee by
about 40 percent.
‘Soy protein does inhibit iron absorption by 70
to 80 percent,” Dr. Cook says. “But if you’re adding it
to a meal rather than using it to replace meat proteins,
it has more than enough of its own iron to offset the
inhibiting effect.”
A phosphate compound found in egg yolks
strongly binds the iron plentiful in the yolks and
Eggs are a poor source makes eggs a poor source of iron. The availability of
of iron. iron in dairy products is also very low, but Dr. Cook is
not sure why.
Calcium tablets should not be taken with iron,
Dr. Cook says, since inorganic calcium compounds
are potent iron blockers. And taking iron as part of a
multivitamin may not be a good idea because iron will
bind with many of the ingredients. The absorbed frac-
tion of a 65-milligram iron supplement may drop from
8.1 milligrams when taken alone to 1.8 milligrams
when part of a multivitamin that contains calcium,
reports Gabe Mirkin, M.D., associate professor of pe-
diatrics at Georgetown University School of Medicine,
Washington, D.C.
Simply eating food at the same time you take
your iron supplement can cut the amount of iron
absorbed in half, Dr. Cook says. For maximum ab-
sorption, take iron tablets between meals, with vita-
min C.

More Tips
You can rearrange your diet to take full advan-
tage of the iron you do eat. Here are some dietary
considerations for better iron absorption.

e Get some vitamin C with every meal. Drink

orange or tomato juice, eat half a grapefruit or some
strawberries. Include vegetables rich in C—tomatoes,
 What You Should Know about Iron 185

green peppers, broccoli, radishes and green leafy veg-

etables like kale and turnip and collard greens. Sea-
son dishes with lemon or lime juice or parsley.
e Without necessarily increasing the amount of
meat you eat, you may want to spread your meat
protein out over more meals. Chicken and fish work Don’t eat more meat,
as well as red meat. Serve smaller portions combined but eat it more often.

with whole grains and fresh vegetables.

e Imitate the Italians. Long-simmering tomato
sauces bring out the iron in any food. Or make like the
Mexicans, whose ingenious use of a little beef with
plenty of beans, rice and red chilies makes the most
of each bit of iron.
e Use iron cookware. Simply cooking spaghetti Cooking in iron cook-
sauce for three hours in an iron utensil increases its ware can boost the iron
content of your food.
iron content to almost 30 times what it would be if
prepared in glassware.

Eating right will help keep you rich in iron—and

all the other vitamins and minerals you need for maxi-
mum performance.
186 Chapter Ds
Give Yourself the
Iron Test (and Rate
Your Energy Reserves)

hen it comes to your health, iron is a metal

more precious than gold.
Though you may hoard it like a miser—banking
the iron from a weekly serving of liver, a daily iron
Your body may be losing supplement and plates full of spinach and broccoli—
iron as fast as it’s tak- your account may be regularly depleted by the iron
ing it in.
robbers. If you are a menstruating woman, a dieter, a
vegetarian, even a heavy tea drinker, you can find
yourself overdrawn at the iron bank despite all your
good intentions. In fact, you could be making with-
drawals as fast as you’re making deposits.
When that happens, your energy stores go bank-
rupt. Even before you're in the throes of full-blown
anemia, you may experience fatigue, dizziness, nau-
sea, loss of appetite and a shortened attention span.

Are You Food Rich but

Iron Poor?
How do you rate your iron levels? It’s much like
auditing any other account. First, you start by looking
in the deposit column.
Part I of this quick and easy quiz will let you know
roughly whether your weekly menu is iron rich or iron
How to audit your poor. It won't tell you if you’re meeting the Recom-
body’s iron account. mended Dietary Allowance (10 milligrams daily for
men, 18 milligrams for women). It’s not that precise.
But it will give you some idea of what kind of an iron-
saver you are.
 Give Yourself the Iron Test
(and Rate Your Energy Reserves) 187

But the total of your deposits means nothing until

you fill in the withdrawal column, part II of the quiz.
These are the risk factors, each one a Willie Sutton What your score may
eager to pocket your savings of this most precious mean.
metal. Needless to say, if your part II total equals or
exceeds the total from part I (+16, -19, for example),
you may have to make some dietary or lifestyle
changes to avoid the penalties of iron deficiency. If
your part I score is low, yet still higher than your score
for part II (+9, -7, for example), you are probably not
getting many iron-rich foods in your diet and, conse-
quently, you may not be getting enough iron despite
your low risk-factor score. If the scores are close
(+15, -14, for example), you may still want to make
some lifestyle or dietary changes that will shrink your
withdrawals and boost your deposits.
Now take the following quiz, calculate two totals
(don’t add them), and compare. Then read the ex-
planation of what it all means to your health.

Test Your Iron Level

Part I: Deposits
1. Do you eat beef liver at least once a week?
(+3 points) __
2. Do you eat a portion of beef, turkey,
chicken, fish or shellfish at least once a day?
(+3 points) __
3. If you answered “no” to question 2, do you
eat a portion of beef, turkey, chicken, fish or shellfish
two to four times a week?
(+1 point) __
Bonus: Give yourself +3 points if you eat meat
for three meals a day. _—
4. Does your diet include a serving of
blackstrap molasses, almonds, lima beans, peas, sun-
flower seeds, prunes, dried apricots or broccoli at
least twice a week?
(42 points) __—
188 From A to Zinc: A Guide to Vitamins and Minerals
et Se ge eer ee eee ee ee eee

Answer the next five questions and bonus ques-

tions only if you answered “‘yes” to any of the previ-
ous questions.

5. Does your diet include a serving of orange

juice, green peppers, grapefruit juice, papaya, brussels
sprouts, oranges, turnip greens, cantaloupe, cauli-
flower, strawberries, tomato juice, grapefruit, pota-
toes, raw tomatoes, cabbage, blackberries, blueber-
ries or cherries at least twice a week?
(+2 points) __
6. Does your diet include a serving of organ
meats, yogurt, almonds, wild rice, ricotta cheese,
Swiss cheese, Camembert cheese or Roquefort
cheese at least twice a week?
G2 points) =
7. Does your diet include a serving of cashews,
mushrooms, pecans, bananas, walnuts, peanuts,
wheat germ, prunes or sesame seeds at least twice a
week?
(£2; points) ==
Bonus: Give yourself +1 point each if your diet
frequently includes broccoli, dried apricots or al-
monds. __ Give yourself + point each if your diet
frequently includes brussels sprouts, cauliflower,
peas, bananas, strawberries, cashews, sunflower
seeds, chicken, chicken livers or brewer’s yeast. __
8. Do you take a B-complex or riboflavin sup-
plement (no score for multivitamins)?
CkZspoints <==
9. Do you take vitamin C supplements?
(42 points) __
10. Do you take an iron supplement?
(+3 points) __
11. Does your typical meal include meat, a vege-
table and one of the following: orange juice, green
peppers, grapefruit juice, papaya, brussels sprouts,
broccoli, oranges, turnip greens, cantaloupe, cauli-
flower, strawberries, tomato juice, grapefruit, pota-
 Give Yourself the Iron Test
(and Rate Your Energy Reserves) 189

toes, tomatoes, cabbage, blackberries, blueberries or

cherries?
C3 points) 2
12. Do you frequently cook in iron pots?
(+3 points) __

Part I Total

Part II: Withdrawals

1. Are you a menstruating woman?
(-3 points) __
2. Do you have heavy menstrual flow?
(-3 points) __
3. If you are a woman, do you give blood twice
or more a year?
(-2 points) __
4. Have you recently had surgery?
(-3 points) __
5. Do you have a peptic ulcer, colitis or hemor-
rhoids?
(-3 points) __
6. Do you take aspirin often?
(-2 points) __
7. Are you on a low-calorie diet?
(-3 points) —__
8. Are you over 65?
(-3 points) __
9. Do you drink a lot of tea, especially during or
after meals?
(-3 points) __
10. Do you eat a lot of foods containing the
preservative EDTA and phosphate additives?
(-3 points) __
11. Do you drink a lot of coffee, especially dur-
ing and after meals?
(-2 points) __
12. Do you eat a high-fiber diet?
(-% point) __
190 From A to Zinc: A Guide to Vitamins and Minerals
i

13. Are you a vegetarian?

(-2 points) __—
14. Do you take calcium supplements?
(-% point) __
15. Do you frequently take antacids?
(-% point) __
16. Do you live in an area exposed to industrial
pollution, particularly cadmium and lead?
(-1 point) __
17. Are you involved in strenuous activity, such
as long-distance running?
(-1 point) __
18. Do you feel you are under a great deal of
stress?
(-2 points) __

Part II Total

Explanation
Part I: Deposits .
1. Beef liver is one of the best sources of di-
etary iron, containing 5.3 milligrams per three-ounce
Liver: high levels, well serving. That doesn’t mean your body can absorb the
absorbed. total amount. Only about 25 percent of the iron from
animal sources is bioavailable—that is, absorbed by
the body. Some medical experts believe many iron
deficiency problems are the result of poor bioavail-
ability rather than low-iron intake. That’s why beef
liver is so important: It gets high scores not only for
iron content but also for bioavailability.
In fact, you’d have to eat about 14 pounds of
broccoli to get the amount of iron absorbed from six
to seven ounces of liver. And there’s a bonus, too.
Liver also contains three other important nutrients:
vitamin C, riboflavin and copper, all of which enhance
the absorption of iron.
 Give Yourself the Iron Test
(and Rate Your Energy Reserves) 191

2-3. Again, only meat and fish have that dou-

ble whammy, high iron and _ high bioavailability.
Though red meat is highest on both counts, both Poultry and fish are
poultry and fish are good substitutes. Three ounces of good choices.
dark-meat turkey contain 2 milligrams of iron; a three-
ounce slice of light-meat chicken provides 0.9 milli-
grams, but it also contains the enhancer riboflavin,
which increases iron bioavailability. And if you
choose lean cuts of meat, you can keep calorie and
cholesterol levels down near those of fish and poultry.
Bonus: Not only do you get a hefty dose of iron
from meat but its presence in a meal will help you
absorb iron from other foods you're eating. You can Don’t eat a day’s worth
increase your iron intake by spreading out your meat of meat at one meal.
protein—not necessarily increasing the amount you
eat—over three meals instead of one or two.
4. If you don’t eat meat, and even if you do, you
might want to consider including as many of these
foods in your diet as possible. They're all iron rich, but
only about 5 percent of the iron they contain is
bioavailable.
But there are ways to increase bioavailability.
Take a look at the foods listed in questions 5, 6 and 7
and the bonus question. If you can design your menu A method to triple
around these foods, you can sometimes double or absorption.

triple iron absorption from both animal and plant

sources.
5. The foods listed in this question are high in
vitamin C. In one study done at the University of
Goteborg, in Sweden, a glass of orange juice served
with a meal of hamburger, string beans and mashed
potatoes increased iron absorption from the meal by
85 percent (Human Nutrition: Applied Nutrition). The
same researchers were also able to significantly boost
the iron absorption from a vegetarian meal by making
sure it had a high C content (American Journal of
Clinical Nutrition).
6-7. These are the high-riboflavin and high-
copper foods, respectively. Again, they’re the helper
192 From A to Zinc: A Guide to Vitamins and Minerals

nutrients that make sure you get the most out of your
iron deposits.
Bonus: Why extra points for these foods? Broc-
coli, dried apricots and almonds not only contain iron
Dried apricots and other but they also contain at least two iron enhancers. The
iron enhancers. foods in the second bonus list contain iron and at
least one enhancer nutrient.
8-10. Needless to say, taking supplements of
iron and the enhancer nutrients can help if you can’t
eat enough to boost your iron savings.
11. You may recognize this food list. These are
the vitamin C foods, and this is the ideal iron-rich
meal: meat, iron-rich vegetable and vitamin C food.
12. Iron pans for iron nutrition? It sounds far-
fetched, but it really helps. The cooking process per-
mits a considerable amount of iron to be absorbed by
the food. In some cases, food cooked in iron cook-
ware can have three or four times more iron than the
same foods cooked in aluminum or glass. If you do a
lot of wok cooking, you can bring up your deposit
score.

Part II: Withdrawals

1-6. A government survey estimated that about
93 percent of all American women eat less than the
Recommended Dietary Allowance of iron. That’s the
first strike against women. The second is blood loss
from menstruation.
Iron is used by the body to form hemoglobin in
the blood to help circulate oxygen and carbon diox-
Why women need al- ide. Because of its presence in the blood, any blood
most twice as much loss—from menstruation, surgery, ulcers, colitis,
daily iron as men.
hemorrhoids, blood donations, even minor bleeding
caused by aspirin—can leach iron from your system.
Though men can certainly undergo surgery, have coli-
tis or take aspirin, they’re not as vulnerable as women.
Why? Because menstruation, especially heavy men-
struation (such as that caused by intrauterine de-
vices), is a regular, monthly blood loss. It’s an iron
withdrawal women can, unfortunately, count on.
 Give Yourself the Iron Test
(and Rate Your Energy Reserves) 193

That’s why the Recommended Dietary Allowance for

women is almost twice that for men. And women also
often face a third strike: a low-calorie (and often low-
meat) diet.
7. Even when women aren't dieting, they sim-
ply do not eat as many calories as men, and their
intake of red meat and liver is lower. Some research-
ers believe they would have to eat at least as much as
men to get that precious 18 milligrams of iron a day.
8. Here’s another rub for women. When meno-
pause hits, it becomes much easier for a woman to get
enough iron. But menopause means you're getting
older, and studies have shown the risk of iron defi-
ciency increases with age for both men and women.
9. Drinking a cup of tea with a meal, even a
meal containing a large quantity of meat and vitamin
C, can reduce your iron absorption by one-half to Tea with meals can
almost two-thirds, according to several studies. Why? cheat your body of iron.
Researchers believe it’s the tannic acid in tea that
binds to the iron in the meal and makes it impossible
for the body to absorb it. There are a number of other
iron inhibitors.
10. The common additives EDTA and phos-
phates, which are added to soft drinks, baked goods
and other foods, can prevent iron from being ab-
sorbed.
11. Though not as potent as tea, coffee taken Coffee, too, can block
during or after a meal can decrease iron absorption iron uptake.

by about 39 percent.
12. Diets high in fiber can also inhibit iron ab-
sorption, so if you’re taking an iron supplement, it
would be best to take it well before meals.
13. Because the most bioavailable iron is in
meat, vegetarians have a harder time getting the iron
they need. More careful diet management—assem-
bling a menu rich in iron-containing vegetables and
nutrient enhancers—as well as supplementation
might be in order for these individuals.
14. Inorganic calcium can be a potent iron
blocker. Researchers have also looked at dairy prod-
194 From A to Zinc: A Guide to Vitamins and Minerals

ucts that are high in calcium, but there’s no clear

evidence available to include them in the risk-factor
category.
15. Why antacids? They can decrease the ability
of gastric juices in the body to dissolve dietary iron.
Antacids, pollution and 16. Cadmium and lead, common industrial pol-
stress also take their lutants, are known iron inhibitors.
toll.
17. Strenuous exercise can rob you of iron. So-
called sports anemia is relatively rare and may, in fact,
be more related to diet than to exercise. Unless you
are a very active person eating a low-calorie, iron-
poor diet, you probably do not have to worry about
this risk factor.
18. Stress robs us of so many things that it
should be no surprise that iron is among them.
 Chapter 26 195

The Health Power

of Magnesium:
A Medical Roundup

rs. C. B. arrived in the hospital in really bad

shape. The 82-year-old woman was so
weak and unresponsive that the admitting doctors
suspected that she had had a stroke or had low-grade
spinal meningitis, but tests for those conditions
proved negative.
John Sheehan, M.D., examined her. She had
long-term but controlled congestive heart failure. For
several years she had been taking both a diuretic and A dramatic case of too
digitalis. She also took potassium chloride to counter- little magnesium.
act the potassium-draining effect of the diuretic. In the
past year, she had become increasingly drowsy and
weak and then completely bedridden.
Dr. Sheehan did two very simple things. He
tested the woman’s blood for its level of magnesium.
Her level fell within what some doctors consider a
low but normal range, but one that Dr. Sheehan con-
sidered too low. Then he started Mrs. C. B. on intrave-
nous magnesium sulfate. Some 24 hours later, the
treatment completed, Mrs. C. B. got out of bed and
walked—for the first time in six months.

The Secret of Her Success

Mrs. C. B.’s almost instant rejuvenation may seem
miraculous, but it came as no surprise to Dr. Sheehan.
First in Dublin, Ireland, then at the Cleveland Clinic
Foundation’s Department of Endocrinology, and now
at University Hospital’s Department of Medicine, also
196 From A to Zinc: A Guide to Vitamins and Minerals

in Cleveland, he has been using different forms of

magnesium for several years to treat patients like Mrs.
C. B. for a variety of arrhythmias (heartbeat irregular-
ities), all with success.
Over an 18-month period, for example, Dr.
Sheehan examined 25 patients with uncontrolled
Alcohol can flush out atrial fibrillation—heartbeat irregularities—that were
magnesium. not responding to traditional treatment. He found that
20 of the patients were magnesium deficient. The
fibrillation stabilized in every case when they were
given magnesium by injection. And it remained stable
as long as their magnesium levels remained normal
and they avoided alcohol, which causes magnesium
to be excreted in the urine. One man who had con-
trolled his heart palpitations very nicely for three
months by eating four magnesium-rich bananas a day
and staying on the wagon found his heart arrythmia
returned after a weekend of beer drinking. Magne-
sium corrected the problem promptly.
Work by other researchers indicates that magne-
sium deficiencies may play a crucial role in many of
Magnesium deficiencies the major diseases that plague us—congestive heart
may be involved in ma- disease, heart attacks (particularly sudden attacks),
jor circulatory diseases.
angina, arrhythmia, strokes, high blood pressure and
even epilepsy and migraine headaches.
Burton M. Altura, Ph.D., of the Downstate Medi-
cal Center in Brooklyn, and his wife, Bella T. Altura,
Ph.D., are probably the world’s experts on magne-
sium. It is their belief that magnesium deficiencies are
a likely factor in many diseases or conditions that
involve constriction or spasm of the heart and circu-
latory system. Their findings also indicate that an opti-
mum intake of magnesium can go a long way toward
preventing those diseases and alleviating their symp-
toms.
In fact, the only really surprising thing about
magnesium is that so few doctors outside the research
field diagnose and treat its deficiency or use it to help
maintain health.
Just what is magnesium and how does it work?
 The Health Power of Magnesium: A Medical Roundup 197

Magnesium Involved
in Many Body Functions
Magnesium is one of the body’s major electro-
lytes, along with potassium, calcium and sodium.
When dissolved, these minerals form the salty, elec-
tricity-conducting soup that bathes and permeates the
cells of our body —in blood serum, spinal fluid and
intracellular liquid.
Magnesium is known to be involved in many
functions, including enzyme and hormonal actions,
the metabolism of carbohydrates and DNA produc-
tion. But one of its more important and better-studied
roles is in nerve and muscle tissue function. Magne-
sium seems to regulate the balance of calcium and
sodium in our cells, particularly in our heart and
blood vessels.
The Alturas, in a review article of 30 years of
research, published in the journal Magnesium, say
magnesium may control what they call the “sodium-
calcium pump,” which is essential for the mainte-
nance of normal coronary artery muscle tone.
Too little magnesium allows calcium and sodium
to flood the cells. And since those two minerals are
constricting agents, the muscle tissue turns to knots.
All this means is that an adequate intake of mag-
nesium helps our hearts to beat smoothly and regu-
larly and withstand the stress and abuse of daily life. It A buffer against life’s
also means magnesium helps our blood vessels re- stresses and strains.

main open and relaxed, lowering our blood pressure.

Hard Water Provides a Clue

to Heart Health
Numerous studies done in England, Finland, Ire-
land, Canada and the United States show that people
who live in areas with magnesium-rich “hard” water
have a lower rate of cardiovascular disease and sud-
den-death heart attacks than people who live in areas
198 From A to Zinc: A Guide to Vitamins and Minerals

with magnesium-poor “‘soft’” water. People living in

many soft-water regions are also found to have
higher-than-normal blood pressure levels.
Researchers have known for years that inducing
a magnesium deficiency in dogs raises their blood
pressure and, conversely, that an infusion of magne-
sium lowers their blood pressure. It hasn’t been until
relatively recently, though, that magnesium has been
tried in clinical experiments to reduce blood pressure
in people.
In 1982, doctors at the Veterans Administration
Medical Center in Oklahoma City found that patients
Magnesium can make it with low serum magnesium required more drugs to
easier to control blood control their high blood pressure than those with nor-
pressure with drugs.
mal levels.
They also noted that low magnesium levels may
be caused by the diuretics given for high blood pres-
sure, which in turn may interfere with the effective-
ness of other blood pressure medications.
And at University Hospital in Umea, Sweden, 20
patients receiving long-term diuretics—18 for high
blood pressure, 2 for congestive heart failure—were
given 365 milligrams of magnesium supplements for
six months. Nineteen of the 20 showed a drop in
blood pressure. In 3 patients, blood pressure dropped
so low that the amount of magnesium was reduced. In
3 others, the amount of diuretic being used to treat the
hypertension was reduced (British Medical Journal).

Magnesium and Artery Health

According to Dr. Burton Altura, high magnesium
levels correspond with lowered levels of cholesterol.
He said that it is possible to prevent the formation of
the plaque found in degenerated and thickened blood
vessel tissue experimentally by increasing the dietary
intake of magnesium.
Magnesium deficiency is known to be accompa-
An intriguing possibility: nied by an increased tendency of blood to clot. Says
preventing life-threaten- Dr. Altura, “Since magnesium is also known to pos-
ing blood clots.
sess platelet-stabilizing action, one must consider the
 The Health Power of Magnesium: A Medical Roundup 199

strong possibility that this mineral may either reduce

the incidence of, or prevent, thrombosis [blood clot-
ting] in the coronary, pulmonary and cerebral” blood
vessels, which can be life-threatening.
The brain’s blood vessel tissues have twice the
concentration of magnesium of any other tissue in the
body, and they seem particularly sensitive to changes
in its concentration. A magnesium deficiency causes
these vessels to clamp down just as surely as it does
heart vessels.
Using dogs, the Alturas measured the degree of
tension in cerebral arteries, first in a magnesium-free
solution, then in a magnesium-rich one. Without mag- Can magnesium reduce
nesium, the arteries showed a rapid increase in ten- the risk of stroke?
sion, the Alturas report. In contrast, a sudden increase
in magnesium resulted in a rapid relaxation of tension
in the cerebral arteries.
The Alturas also found that potent brain blood
vessel spasms brought on by other substances such as
serotonin and prostaglandins were relaxed “rather
easily and dramatically” by the addition of magne-
sium.
The Alturas suggest that magnesium therapy may
be beneficial in brain ischemia (blood deficiency)
and blood vessel spasm of unknown origin, and for
the prevention of strokes and the blockage of the
brain’s blood vessels.

Magnesium
May Relieve Migraines
Migraine headaches are also known to be caused
by blood vessel spasm. In fact, migraines are common
in early and late pregnancy, a time when women are
often magnesium deficient. They can also suffer from Migraines respond to
another deadly disease, preeclampsia, which current magnesium.

research shows is related to magnesium deficiency.

Migraines are particularly responsive to magne-
sium therapy, says Kenneth Weaver, M.D., of East
Tennessee State University. He studied 500 women:
200 From A to Zinc: A Guide to Vitamins and Minerals

300 were pregnant, and about 60 were taking oral

contraceptives, which often induce migraine. All 500
suffered from migraine headaches. Each began taking
200 milligrams a day of magnesium. Eighty percent
soon found their migraines were completely gone. In
fact, relief was so quick that a woman feeling a mi-
graine headache coming on could take magnesium,
and within half an hour, the symptoms would disap-
pear.
Researchers at the International Center for the
Disabled (ICD) in New York City have found magne-
A dietary approach to sium deficiencies in the red blood cells of a number
epilepsy. of epileptics whose seizures were not being con-
trolled by medication. Robert Fried, Ph.D., director of
research, and Richard Carlton, M.D., have reported
that by using biofeedback, controlled breathing exer-
cises and a diet free of excess dairy products, sugar,
coffee and alcohol, they were able to cut the number
of seizures from up to five a week to one or less a
month. Some of the patients have been seizure free
for months at a time for the first time in many years.
The researchers said they plan to add magne-
sium supplements to their patients’ diets. They expect
this will lead to even fewer seizures for their epileptic
patients.

A True Deficiency
Fifteen or 20 years ago, magnesium deficiencies
were considered rare. Now, those in the forefront of
magnesium research say this mineral deficiency is
much more widespread than most doctors realize and
that it is rapidly becoming more common.
“Nutritional statistics, especially in the Western
world, indicate that our dietary intake of magnesium
Are doctors overlook- has been steadily declining since the turn of the cen-
ing magnesium defi-
tury, to where many of us now border on a ‘true’
ciencies?
deficiency,” say the Alturas. A study done at the Uni-
versity of Tennessee at Knoxville found that most of
the pregnant women questioned got 60 percent or
 The Health Power of Magnesium: A Medical Roundup 201

less of the Recommended Dietary Allowance (RDA)

of magnesium. Dr. Weaver estimates that ‘“‘at least” 50
percent of the young women he sees are magnesium
deficient. Dr. Sheehan believes that about one-half of
the older adults he treats suffer from magnesium
deficiency.
Many doctors rarely think of the possibility of a
magnesium deficiency, Dr. Sheehan says. In the pa-
tients he sees, for instance, the attending doctor often
assumes symptoms of weakness, heart irregularities
and depression are the untreatable result of the un-
derlying disease, which is often congestive heart fail-
ure. In the patients whose heart arrhythmias he suc-
cessfully treated with magnesium, none of the
physicians taking care of the patients acknowledged
the low-magnesium laboratory report or treated the
patient with magnesium.
Dr. Sheehan also says the lower limit of what is
considered a “normal’’ serum magnesium level keeps
dropping, which it shouldn't. “If I had accepted what
some doctors say is a normal serum blood level of
magnesium, I would have had to drop half of the
patients in my study, all of whom benefited greatly
from magnesium treatment.”
Certainly one of the reasons for an increase in
magnesium deficiencies is that people are living
longer and surviving chronic diseases with treat-
ments—diuretics, digitalis, antibiotics, _chemo-
therapy—that are all magnesium depleting.
Poor diet is a major cause, and one we can do
something about. The RDA for magnesium is 350 to
400 milligrams a day, and many researchers say that Balancing magnesium
amount is too low. Nuts, beans, whole grains and with other nutrients.

green leafy vegetables are good sources of magne-

sium. (For others, see the table, Best Food Sources of
Magnesium, on pages 202-3.) Alcohol, fats and too
much protein deplete magnesium. And magnesium
works in close balance with calcium. You should be
getting about 1% times more calcium than magne-
sium. You can enhance magnesium’s healing proper-
ties by getting adequate amounts of vitamin B,.
202 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Magnesium

Food Portion Magnesium

(mg.)

Soy flour, full fat, raw Ye cup 180

Tofu, regular, raw Ye cup 127
Almonds, dried, unblanched Y% cup 105
Black-eyed peas, dried Y% cup 98
Soybeans, dry-roasted Y% cup 98
Wheat germ, toasted Y cup OL
Cashews, dry-roasted Y% cup 89
Brazil nuts, dried, unblanched Y cup 79
Spinach, cooked Ye cup 79
Swiss chard, cooked, chopped Y cup 75
Rye flour, light Ye cup 74
Soybeans, boiled Ye cup 74
Whole wheat flour Y% cup 68
Peanuts, all types, dry-roasted Y% cup 64
Walnuts, black, dried Y% cup 63
Oatmeal, regular, quick 1 cup 56
Peanut flour, defatted Y% cup 56
Potato, baked 1 medium 55

Sources: Adapted from

Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Merrill (Washington, D.C: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).
Composition of Foods: Beef Products, Agriculture Handbook No. 8-13, by
Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Research
Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Breakfast Cereals, Agriculture Handbook No. 8-8, by
Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1,
by Consumer and Food Economics Institute (Washington, D.C.: Agricultural
Research Service, U.S. Department of Agriculture, 1976).
Composition of Foods: Fruits and Fruit Juices, Agriculture Handbook No. 8-9,
by Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982),
 The Health Power of Magnesium: A Medical Roundup 203

Food Portion Magnesium

(mg.)

Shredded wheat, small biscuit 1 cup 55

Blackstrap molasses 1 tbsp. 52
Beet greens, cooked Ye cup 49
Lima beans, baby, boiled Y% cup 49
Avocado Y% 40
Kidney beans, all types, boiled VY cup 40
Banana 1 35
Pecans, halves, dried Y% cup 35
Salmon, sockeye, canned 4 oz. 33
Brown rice, cooked Y% cup 28
Milk, skim 1 cup 28
Peanut butter, smooth 1 tbsp. 25
Beef, round, full cut, separable
lean only, broiled S202 24
Buckwheat flour, light Ye cup 24
Chestnuts, European, roasted Y cup 24
Spinach, raw, chopped Ye cup 22
Collards, cooked, chopped Y% cup 1]

Composition of Foods: Legumes and Legume Products, Agriculture Handbook

No. 8-16, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).
Composition of Foods: Vegetables and Vegetable Products, Agriculture Hand-
book No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human
Nutrition Information Service, U.S. Department of Agriculture, 1984).
Nutrient Data Research Branch, U.S. Department of Agriculture, Washington,
D.C.
204 Chapter Dl

More Health Power

from Magnesium

verybody needs it, some owe their lives to it

and doctors are starting to give it serious at-
tention—magnesium is a little mineral with a big fu-
ture. And the main reason is that scientific evidence
on the health benefits of this mineral is coming in too
fast to ignore.
Here’s a rundown on further developments in
this research.

Angina Attacks Stopped Cold

Following in the footsteps of other scientists, re-
searchers in Israel have successfully treated 15 people
afflicted with recurring spasm angina. At each bout of
chest pains, the doctors injected the patients with
magnesium. And 30 seconds to 5 minutes later, the
attacks ceased. Ordinarily such attacks would last 5 to
15 minutes.
After these scientists demonstrated that they
could use magnesium in angina treatment, they set
Magnesium stopped an- out to test the mineral in angina prevention. They
gina attacks before found that in several patients they could consistently
they got started.
provoke an angina attack by immersing the patients’
hands in cold water. But if they injected the patients
with magnesium before immersion, no attacks oc-
curred. Magnesium apparently stopped the chest
pains before they got started.
The results of these and other studies suggest
that magnesium may one day replace or complement
drugs as therapy for angina.
 More Health Power from Magnesium 205

Diabetic Seizures Vanish

It’s well established that intravenous magnesium
is an anticonvulsant (agent for preventing or relieving
convulsions) and that people with magnesium defi-
ciencies sometimes suffer convulsions and tremors.
Doctors at the Bronx-Lebanon Hospital Center in
the Bronx, New York, have used magnesium to stop
seizures in people who have uncontrolled diabetes
mellitus.
The seizures—marked by convulsive muscle
contractions and jerky movements—afflicted three
women with the disease. When the women were ad- Magnesium relieved
mitted to the hospital, their seizures were lasting from seizures in diabetic
women.
30 seconds to three minutes, occurring every five to
ten minutes. The doctors treated the patients’ dia-
betes, but the seizures wouldn't stop. Since the physi-
cians knew that magnesium deficiency is common in
people with severe diabetes mellitus, they decided to
inject the women with the mineral—and the injec-
tions worked. The seizures vanished within 24 hours
after starting magnesium therapy.
“It therefore appears,” the doctors report, “‘that
magnesium deficiency was the main cause of the neu-
romuscular abnormality.”
These results will have to be confirmed by addi-
tional research. But they do suggest an intriguing
question: Can magnesium quell other kinds of sei-
zures, including epileptic ones? Scientists surely will
try to find out.

Heart Attack Damage Reduced

Research in both animals and people has hinted Magnesium may reduce
that magnesium may do “damage control” work dur- damage from heart at-
tacks.
ing a heart attack, lessening the destruction of vital
heart tissue.
Sherman Bloom, M.D., of George Washington
University School of Medicine in Washington, D.C.,
has confirmed the earlier investigations. In a study
focusing on heart attacks in dogs, he discovered that
206 From A to Zinc: A Guide to Vitamins and Minerals

the animals on a low-magnesium diet suffered twice

as much heart damage after an attack as animals on
diets with adequate magnesium.
‘When people have heart attacks—and they can
have them without even knowing it—the critical con-
sideration is how much damage is done to the heart
muscle,” Dr. Bloom says. “Every increase in infarcted
area [destroyed tissue] increases your chances of dy-
ing in the aftermath of an attack. My study and re-
search done by others indicate that magnesium is one
very important determinant of how much damage a
heart attack does.”
“The data suggest,” says Dr. Bloom, “that dietary
magnesium intake is an important determining factor
in your ability to withstand a heart attack. You should
ensure that you're getting adequate amounts of mag-
nesium in your diet.”

Type-A Behavior and

High Blood Pressure
The available evidence has suggested a compel-
ling hypothesis: Type-A people (those who are hard-
Stress depletes the driving, impatient and excitable) react to stress by
body of magnesium. developing magnesium deficiencies, which in turn ex-
aggerate the ill effects of stress and lead to high blood
pressure.
Not too long ago, investigators in Paris rein-
forced the hypothesis when they studied 20 Type-A
young men under stress.
When they gave those Type-A young men a
stress-producing task to perform and monitored the
magnesium in their bodies, the researchers uncov-
ered an odd biochemical routine. Magnesium
leached out of red blood cells and was shunted out of
the body via the urine. This magnesium depletion
happened in almost twice as many of the Type-A
people as in a comparable group of more relaxed
Type-B subjects.
“Type-A behavior personalities,” says head re-
searcher Jean-Georges Henrotte, M.D., “would be in-
 More Health Power from Magnesium 207

volved in a vicious circle in which their tendency to

chronic self-induced stress would lead them to a pro-
gressively increasing state of magnesium deficiency.”
And a lack of magnesium, as other research indi-
cates, is probably a contributor to high blood pres-
sure. Conversely, magnesium supplementation has Magnesium has been
actually been used to lower blood pressure. used to lower high blood
pressure.
‘These results,” says Dr. Henrotte, “should be, of
course, confirmed on a larger group of individuals.”

The Unhealthful Impact of Stress

Researchers have concluded that Type-A people
may not be the only ones caught in a cycle of stress
and magnesium deficiency. Studies have suggested
that stress in almost anyone can deplete magnesium
and that such depletion can magnify stress-induced
ills.
Scientists at the University of Hohenheim in West
Germany uncovered evidence that this stress/deple-
tion cycle may be halted with magnesium supple-
ments.
In studies of thousands of pigs subjected to the
typical stresses of confinement, the researchers found
that they could reduce the death rate of the animals Magnesium supple-
by giving them extra magnesium. In fact, the death ments reduced the
death rate.
rates of supplemented pigs were one-seventh to one-
half as high as the death rates of pigs getting normal
levels of magnesium.
“These studies and others like them,” says chief
investigator Hans G. Classen, Ph.D., “indicate that
with adequate magnesium stores, people may be bet-
ter able to withstand the ravages of stress in their daily
lives.”

Irregular Heartbeat Normalized

Doctors have shown that magnesium may play a
key role in the treatment of the potentially dangerous
condition of arrhythmia, or irregular heartbeat.
208 From A to Zinc: A Guide to Vitamins and Minerals
ee
pats

Investigators at the University of California-Irvine

College of Medicine corroborated the earlier evi-
Magnesium halted ar- dence by using magnesium successfully to treat ar-
rhythmias. rhythmia patients after standard therapies had failed.
“We've studied several patients with acute, life-
threatening arrhythmias that wouldn’t respond to ei-
ther drugs or shock therapy,” says chief researcher
Lloyd T. Iseri, M.D. “But when the patients received
magnesium, their heartbeats reverted to normal
rhythm. The magnesium had an almost instant effect,
whereas some drugs may take minutes to influence
the arrhythmias.”
It remains to be seen whether magnesium will
become the therapy of choice in the treatment of
arrhythmia.

Better Brain Function

Medical people have firmly documented the
harm done to muscles and nerves by magnesium defi-
ciency, but they know much less about what a lack of
the mineral can do to the brain.
Paul G. Cohen, M.D., of Atlanta, reports that he’s
treated three adults suffering from brain disease and
Magnesium brought pa- low magnesium levels. All three eventually lapsed into
tients out of comas. a coma. But when he gave them magnesium, they
responded immediately. There was, Dr. Cohen says,
‘prompt reversal of encephalopathy [brain dysfunc-
tion] and coma.”
Just how common are such symptoms in people
lacking magnesium? How often is the magnesium
connection overlooked? Future research and clinical
experience will have to supply the answers.

Toxic Shock Syndrome Responds

to Mineral Replacement
In toxic shock syndrome (TSS), the rare but
sometimes fatal disorder found predominantly but
 More Health Power from Magnesium 209

not exclusively in menstruating women, doctors know __ Is magnesium deficiency

that calcium deficiency is common. What they don’t 4 key to toxic shock
know is what role magnesium plays in this disease. eh
J. H. Rudick, M.D., of Case Western Reserve Uni-
versity in Cleveland, and a colleague discovered that
magnesium depletion may be a little-known finding in

Dossier on Magnesium
Here’s an abbreviated report on magnesium:
how much you need, who may be deficient,
and why it’s necessary.
Recommended Dietary Allowance (RDA)
300 milligrams daily for nonpregnant
women.
450 milligrams daily for pregnant
women.
350 milligrams daily for men.
Maximum Recommended Dosage
400 milligrams for nonpregnant women.
(Although dosages slightly above this are
considered safe, medical supervision is
recommended when this limit is ex-
ceeded.)
Possible Deficiency Symptoms
Irritability, nervousness, muscle weak-
ness, high blood pressure, convulsions,
tremors, arrhythmia.

Prevalence of Deficiencies
Surveys indicate that average daily diets
contain only 200 to 250 milligrams of
magnesium. Deficiencies may be espe-
cially widespread in pregnant women.
One study of expectant mothers re-
vealed that most got only 60 percent or
less of the RDA of magnesium.
210 From A to Zinc: A Guide to Vitamins and Minerals

TSS—a feature that could contribute to the severity of

hypocalcemia (low levels of calcium in the blood)
found in TSS patients.
The doctors examined two women with TSS and
found low magnesium levels and functional hypo-
parathyroidism—two conditions known to some-
times accompany one another. “We conclude,” Dr.
Rudick says, “‘that life-threatening hypocalcemia in
certain magnesium-depleted TSS patients may be
averted by magnesium replacement therapy. And it
seems reasonable that physicians should consider
testing magnesium levels in TSS cases.”
 Chapter 28 211

Selenium:
The Great Protector

elenium is best known as a cancer fighter. That

exciting news was first heralded a decade or
so ago when selenium—initially thought to cause can-
cer—was found in low levels in the soil in areas where
cancer incidence was high. And a lot has been hap-
pening in selenium research ever since. Positive—but
preliminary—anticancer results have been found in
people as well as in animals for skin, lung, mouth and
throat cancers. Let’s take a look at some of the evi-
dence of that research.

A Roundup
of Encouraging Studies
At the University of North Carolina in Chapel Hill,
240 people with skin cancer were compared with
people who were similar in all respects except they Evidence shows sele-
had no cancer. Patients with low selenium levels had nium is an anticancer
agent.
a consistent increase in the risk of skin cancer (Di-
etary Aspects of Carcinogenesis).
At the University of Miami, researchers tested the
theory that people who live in geographical areas
where the soil and crops contain higher levels of
selenium are less likely to get head and neck cancer.
(in Florida, selenium levels are among the lowest in
the nation.) They found that the 52 cancer victims in
their study had depressed levels of selenium in their
red blood cells as well as low levels of the important
212 From A to Zinc: A Guide to Vitamins and Minerals

enzyme GSH-Px. However, selenium levels in their

blood plasma were high compared to the control
group, indicating to the scientists that the cancer pa-
tients had a blunted ability to transport selenium into
their cells (Cancer). These results, say the researchers,
suggest that selenium supplements might help correct
this problem.
Then there’s a lung cancer study published in
China. ‘There was an area of China that had a very
People living in areas high incidence of lung cancer, and the researchers
with selenium-rich soil wanted to find out why,” says Gerhard N. Schrauzer,
had less lung cancer.
Ph.D., a pioneer in selenium research who is familiar
with the Chinese study. ““When the subjects were ana-
lyzed, it turned out they had very low selenium levels.
The soil in the area in which they lived had very low
selenium levels also. So they went to an area where
the selenium in the soil was very rich. The people
there had a very low lung cancer rate.”
Finally, there are animal studies: At Baylor Col-
lege of Medicine in Houston, researchers found that
selenium supplementation reduced the incidence of
breast tumors from 80 percent to 18 percent in mice.
Selenium also reduced the incidence of other cancer-
induced tumors from 40 percent to 6 percent (Dietary
Aspects of Carcinogenesis).
At the Eppley Institute for Research in Cancer, at
the University of Nebraska Medical Center, Omaha,
In animals, high doses both very high (toxic) and very low doses of selenium
of selenium meant a low were fed to male and female rats. Colon cancer was
incidence of cancer.
found in only 16 out of 30 male rats fed very high
doses of selenium but in 28 out of 29 of the male rats
on the low-selenium diet. Lung cancer was found in
none of the 30 male rats fed the high-selenium diet,
while the incidence of cancer for those on the low-
selenium diet was 14 percent. None of the female rats
developed cancer at either selenium dosage (Cancer
Research).
In Germany, animals were fed selenium to test its
cancer-preventive ability. Of 50 mice not treated with
selenium, 31 developed tumors. Of the 50 animals
 Selenium: The Great Protector 213

treated with selenium, only 14 developed tumors.

And these tumors were less than half the size of the
tumors that developed in the nontreated animals
(Journal of Cancer Research and Clinical Oncology).
‘We must infer that selenium must be one of the few
chemical elements to which a tumor-preventive effect
can be attributed,” noted the researchers. ‘‘The re-
sults of our own investigations enhance and amplify
present knowledge of this anticarcinogenic action of
selenium.”

How Selenium Battles Disease

Why does selenium work so well against cancer?
‘Selenium stimulates the immune system,” says Dr.
Schrauzer. “It also alters the metabolism of carcino-
genic substances, thus preventing an accumulation of
free radicals.”
One of the biggest mysteries in selenium re-
search is still in the investigative stage: How much
selenium do we actually metabolize from the foods How much selenium can
we eat? Ara Nahapetian, Ph.D., was among a group of our bodies derive from
food?
researchers at the Massachusetts Institute of Technol-
ogy (MIT) who tried to answer just that question.
‘Selenium is an essential micronutrient,’ he says.
“Without it, we will die. But we also know that taking
too much can have harmful effects. What we’re trying
to find out is how much is absorbed and how much is
excreted.” Using a state-of-the-art technique, the MIT
researchers measured small amounts of the trace min-
eral as it goes through the human system. But a full
understanding of how efficiently our bodies use the
nutrient is still up in the air, says Dr. Nahapetian.

Where to Find Selenium?

Think “Protein”
But until we find out, it’s good to know that there
are plenty of foods that contain selenium. Fish is by
214 From A to Zinc: A Guide to Vitamins and Minerals

Selenium and Vitamin E

versus Aging
Large doses of vitamin E and the trace min-
eral selenium significantly improved the over-
all well-being of a group of elderly nursing-
home residents, Finnish researchers reported
in Biological Trace Element Research.
The researchers gave daily doses of 400
milligrams of vitamin E, 8 milligrams of so-
dium selenate and 50 micrograms of organic
selenium to 15 residents (average age 76) for
a year. Compared with a similar, untreated
control group, the vitamin-treated subjects
showed significant improvement in mental
alertness, emotional stability, depression,
anxiety, fatigue and other measures of overall
health. “A distinct improvement of the gen-
eral condition was noticed after only two
months, and the improvement continued up
to the end of the one-year study period,” the
researchers noted. “There were no side ef-
fects whatsoever,” they added.
Warning: In large doses, selenium can be
toxic. Moral: Let the dust settle on this excit-
ing new discovery until safe guidelines can be
established.

The best sources of far the richest source of selenium, and tuna fish is one
selenium. of the best. Whole wheat bread, liver, kidneys, Brazil
nuts and rice are other rich sources of selenium. The
mineral can also be found in many protein-rich foods.
While the Recommended Dietary Allowance
(RDA) for selenium is 50 to 200 micrograms per day,
Americans get, on average, only 85 micrograms a day.
Dr. Schrauzer thinks that just isn’t enough. “‘I feel 200
micrograms is the minimum and from 250 to 350
 Selenium: The Great Protector 215

micrograms is the optimal total intake for preventive

measures,” he says.
Too much selenium can be toxic; in supplement
form, probably no more than about 100 micrograms a
day should be taken.
‘Selenium is probably one of the least-thought-
about trace minerals there is. But the evidence keeps
piling up that selenium is important in preventing a
whole list of conditions, and at the top of the list is
cancer,’ says Dr. Schrauzer.
“A lot of people worry about their intakes of
calcium and iron,” he continues. “I predict in a few
years selenium will also be a common concern. When
it comes to trace minerals, don’t forget selenium!”
216 Chapter DS
Zinc:
The Whole-Body
Mineral

t has only been since 1974 that zinc was recog-

nized as essential and given a Recommended Di-
etary Allowance (RDA) of 15 milligrams daily. But in
that short time, this trace mineral has been shown to
have a profound influence on the body’s ability to
grow and to resist disease. Male sexual maturity and
fertility depend on adequate zinc. And some re-
searchers think our declining ability to absorb zinc,
along with other nutrients, as we age is one reason we
become more vulnerable to disease.
So far, researchers have found more than 90
zinc-dependent enzymes in the body—more than
Over 90 enzymes in your those of all the other minerals combined, including
body need zinc to do iron. Each is involved in a different biochemical reac-
their job.
tion. But we need to know only two closely related
facts about zinc to understand a good part of its
importance.

The Facts about Zinc and

Basic Good Health
First, zinc is needed for the body to make pro-
tein. Zinc-containing enzymes help to string together
the long chains of amino acids that make up each
molecule of protein.
Second, every cell’s genetic material, its DNA
and RNA, is derived from protein.
What this means is that your body needs zinc to
make every one of its cells—from the hair on your
 Zinc: The Whole-Body Mineral PAW

head to the soles of your feet. Severe deficiencies

mean that needed cells may not get made. They also
mean that it is more difficult to repair damaged ge-
netic material.
Because cell growth is so dependent on zinc, it’s
first missed when or where rapid cell growth oc-
curs—in pregnancy, childhood, wound healing and Rapid cell growth—in
any other situation involving rapidly dividing cells. wound healing, for ex-
ample-—demands zinc.
One of these areas is the immune response.
‘Severe zinc deficiency has been shown to cause
major abnormalities in the body’s immune defense,”
says Susanna Cunningham-Rundles, Ph.D., at the New
York Hospital, Cornell Medical Center in New York
City.
One reason for this impact is that any effective
immune response involves a massive buildup of the
white blood cells that fight bacteria, viruses and can- Immunity lags without
cer. For instance, one type of white blood cell, called enough zinc.
a neutrophil, can multiply five times within a few
hours after infection sets in. And another kind of
white blood cell, called a lymphocyte, can divide and
form up to 500 new cells in four days.
“Studies show that if zinc is not present in the
quantities needed, this sort of cell proliferation is re-
duced, and the immune response will be lessened,”’
Dr. Cunningham-Rundles says.
And there are other roles zinc plays in the im-
mune response.
“Zinc is probably essential for the work of thymic
hormones,” Dr. Cunningham-Rundles says. These
hormones, secreted by the thymus gland, are respon-
sible for the development of T-cells, types of lympho-
cytes central to the fight against viral and bacterial
infections.
Zinc will also increase the activity of lympho-
cytes called natural killer cells, even when there is not
an apparent zinc deficiency. Because these cells are Your body needs zinc
able to destroy a virus- or bacteria-invaded cell with- to fight off bacteria and
viruses.
out the prior sensitization that all other lymphocytes
require, they are considered part of the body’s first
line of defense against disease.
218 From A to Zinc: A Guide to Vitamins and Minerals

Zinc also seems to interact with vitamin A, a

nutrient that seems to have a protective effect against
Zinc teams up with A to cancer. Certain cells, called epithelial cells, may be
protect skin cells. particularly dependent on both A and zinc. These
cells cover a surface, like the skin, or line a cavity, like
the bladder. It’s not incidental that these cells also
have the most rapid turnover of any in the body. Or
that throat cancers have been linked with both vita-
min A and zinc deficiencies.
One area where epithelial cells are found is in the
mammary gland. Michael Bunk, Ph.D., a research sci-
entist at Memorial Sloan-Kettering Cancer Center in
New York City, found that mice made zinc deficient
also became deficient in vitamin A.

Zinc, the Thymus and Immunity

We all know that it’s our immune system that
comes between us and disease. But for some
(especially older people and children with
Down’s syndrome), the system all too often
fails. In the past, doctors usually placed the
blame on a faulty thymus gland.
Italian researchers have found that a de-
ficiency of zinc (and not the thymus) may be
directly responsible for at least part of that
failure in these two groups of people. Here’s
how.
The thymus puts out a hormone called
FTS, which is needed for immunity. But this
hormone’s activity is dependent on zinc.
When the researchers measured FTS and zinc
levels in these patients, they found both a zinc
deficiency and diminished FTS activity.
The researchers think that even marginal
zinc deficiencies (which are widespread) may
impair FTS activity. Therefore, “careful zinc
monitoring should be applied to all patients
who show low FTS activity” (Lancef).
 Zinc: The Whole-Body Mineral Zio

“It’s pretty well known that zinc deficiency af-

fects the release of stored vitamin A from the liver,”
Dr. Bunk says. He thinks there may be a second con- Zinc and vitamin A work
nection, that a zinc deficiency impairs the uptake of hand in hand.

vitamin A by the epithelial cells, putting them at risk

for developing cancer or other diseases.

Links with Eating Disorders

Doctors have known for some time that too little
zinc can alter the senses of taste and smell. A lack of
zinc changes the chemistry of saliva, which directly
affects the way things taste in the mouth. Zinc-poor
people have trouble tasting sweets, for instance.
But zinc may also affect areas of the brain that
receive and process information from taste and smell
sensors. And that, in part, has led some researchers to
speculate that zinc could influence areas of the brain
that control eating and drinking behavior.
‘Animal studies seem to indicate that zinc defi-
ciencies could play a role in eating disorders like
anorexia and bulimia,” says Craig McClain, M.D., as- Animals without zinc
sociate professor of medicine and director of the Divi- act like people with bu-
limia or anorexia.
sion of Gastroenterology at the University of Kentucky
School of Medicine, Lexington. Studies he and his
colleagues have done indicate that zinc-deprived rats
develop the same bizarre eating habits as teenage girls
diagnosed as anorexic, bulimic or bulimirexic, a com-
bination of both disorders. Like the girls, the zinc-
deprived rats ate less and less until they were consum-
ing only about a third the normal amount. When they
did eat, they tended to pig out, and they also tended
to easily regurgitate their food. What’s more, when
they were subjected to stress (mildly pinched tails),
they headed straight for the rat chow! When adequate
zinc was added to their diet, the rats’ eating behavior
returned to normal (Physiology and Behavior).
In another study, Dr. McClain found that nine
bulimirexic women were extremely low in zinc, even
when they were within normal weight ranges, and
other nutritional signs were normal. “Many of these
220 From A to Zinc: A Guide to Vitamins and Minerals
Neen ee ee ee ee ee ee ee ee ee ee ee ee ___ EE

women’s habits—laxative abuse, vomiting, dieting—

would definitely put them at risk for a zinc defi-
ciency,” Dr. McClain says (Clinical Research).
One question is, which comes first: the zinc defi-
ciency or the eating problem? “It’s possible that a
zinc-poor diet, which wouldn't be all that unusual in
teenage girls, could trigger eating problems,” Dr.
McClain says. “Or the eating problem could be trig-
gered by psychological or social problems.”
Can zinc supplements help anorexics break the
habit? Perhaps, Dr. McClain says. “That’s what we
Advice for people with intend to study next. Until results are in with humans,
eating disorders: Get though, about the only recommendation | can give
your daily ration of zinc.
people with eating disorders is to make sure they're
getting the RDA of zinc.”

Zinc, Alcohol and Obesity

Surprising connections also seem to exist be-
tween zinc deficiencies, alcohol abuse and obesity,
says Platon Collipp, M.D., former professor of pediat-
rics at State University of New York, Stony Brook.
He found that rats fed zinc-deficient diets volun-
tarily drank much more alcohol than rats fed ade-
Can zinc help solve quate zinc. (The rats could choose between water
drinking problems? and alcohol in their cages.) When they were then
given enough zinc, their drinking declined to normal
(Alcoholism: Clinical and Experimental Research).
‘People have been speculating for some time
now that food intake can influence drinking behavior.
I think zinc is one nutrient that could have a possible
effect,” says Dr. Collipp. “It would be very interesting
to see how or if zinc reduces the craving for alcohol in
alcoholics. I haven’t been able to do that study, but it
should be done. So should a study to see whether zinc
supplementation in the children of alcoholics, who
may be genetically zinc deficient, reduces their five-
times-greater-than-normal chances of becoming alco-
holics themselves.”
Dr. Collipp also made an interesting discovery
that may help some heavyweights. He found that a
 Zinc: The Whole-Body Mineral 221

zinc deficiency is associated with the way the body

handles glucose (blood sugar).
A zinc-dependent enzyme in the liver acts as a
kind of railroad switch in glucose metabolism. Called
a branch-point enzyme, it’s located right at the spot in The zinc/blood sugar
glucose metabolism where one reaction leads to en- link.
ergy burning and the other to fat storage.
“Studies of rat livers show that when there’s not
enough zinc to go around, this enzyme becomes inac-
tive,’ Dr. Collipp says. “The result is that glucose is
shunted toward making triglycerides [blood fats] that
can be stored in the fatty tissues rather than being
burned for energy (Pediatrics Annals).
“There are some people who say that everything
they eat turns to fat,” he says. “Well, those people
may be zinc deficient.”

A Satiation Link?
Dr. Collipp also thinks there may be psychologi-
cal connections in zinc’s effect on eating and drink-
ing. Zinc-deficient children don’t seem to rely on “‘in-
ternal cues” for their behavior, he says. Such children
might not be able to discern the difference between
feeling hungry and feeling full, for instance.
“Quite a few studies link zinc deficiencies with
brain disorders, like learning problems,” Dr. Collipp
says. “I think a zinc deficiency may also affect some
part of the brain involved in the self-monitoring of the
body, a kind of satiation center that lets you know
when you've had enough to eat or drink.”

Healthy Gums Need Zinc

Zinc deficiency is especially detrimental to the
gums. The tissue is loaded with fibrous protein
strands, and the thin layer of cells right next to the You need zinc to keep
tooth’s root is epithelium, says Henry Mallek, D.M.D., your gums in the pink.
Ph.D., professor at the Georgetown University School
of Dentistry in Washington, D.C.
A zinc deficiency doesn’t actually cause gum
disease. Plaque does. But a deficiency makes the
222 From A to Zinc: A Guide to Vitamins and Minerals
eee ee eee eee eee ee

gums much less likely to be able to withstand the

bacterial assault of plaque that inflames gums and
loosens teeth.
“There are many reasons to think that people
with gum disease may have zinc deficiencies,” Dr.
Mallek says. “I’ve seen people with long-term gum
problems who had conventional treatment. Although
it helped, the gums were not completely healthy. But
when the zinc deficiency was corrected, the gum
problems were resolved.”

Zinc for Herpes?

Herpes infections—both the cold-sore and the
genital kind—have been found to respond to applica-
Zinc helped cold sores tions of zinc in experimental treatment. Doctors at
heal rapidly. Hadassah University Hospital in Jerusalem found that
herpes simplex sores treated with zinc healed in
about 9% days, compared with an average of 16 days
with other forms of treatment (Acta Dermato-
Venereologica). In Swedish studies, continued use of
zinc solution after the sores healed prevented a recur-
rence (British Journal of Dermatology).
Could zinc someday offer hope to genital herpes
victims? An animal study by Patrick Tennican, M.D.,
Zinc may offer hope for director of internal medicine, Spokane, and a clinical
genital herpes. associate professor at the University of Washington,
Seattle, indicates it might, but only if it’s used very
early in the course of the disease.
Female mice with genital herpes were treated
with either a zinc-soaked sponge, a nonmedicated
sponge or oral zinc, which was started two days be-
fore they were infected. The difference between the
topically treated group and the other two groups was
great. Thirty-two percent of the untreated group had
moderate to severe herpes symptoms by the ninth day
after treatment. Only one animal with topical zinc
treatment had these symptoms, and for one day only.
The mice receiving oral zinc actually had more symp-
toms than the control group.
 Zinc: The Whole-Body Mineral 223

Encephalitis, another sign of herpes infection (in

mice only, not in humans) was greater in the oral zinc
and untreated groups. Both had a 40 percent death _ Topical zine may pre-
rate by the 15th day of the experiment, while none of _—_-vent the herpes virus
the topically treated mice died. Dr. Tennican thinks LeU lobe
the zinc prevented the herpes virus from multiplying
by interfering with essential enzyme systems neces-
sary for its replication.
‘“T’m afraid the problem with genital herpes is
that the virus quickly moves away from the site of
infection to where no topical agent is going to reach
it,’ Dr. Tennican says. “The idea of using a zinc solu-

Zinc and Vaccinations

Keeping your body’s immune function at its
best does more than prevent disease from
occurring. It’s also what helps make you well
again when a nasty germ does get in. Either
way, it can’t do the job alone. That’s where
zinc comes in.
In one study, scientists from Michigan
State University in East Lansing found that
without enough zinc, the body may lose its
ability to remember what it’s been immunized
against. The zinc deficiency may actually de-
stroy the so-called immune memory cells,
making it virtually impossible to successfully
vaccinate against common diseases.
The researchers point out that simply im-
proving the diets of malnourished people may
not be enough to restore their immune re-
sponse to some diseases they’ve previously
been exposed to or vaccinated for. These
people may need to be vaccinated after their
bodies’ nutritional stores of zinc have once
again been brought up to optimal levels (Jour-
nal of Nutrition).
224 From A to Zinc: A Guide to Vitamins and Minerals

tion as a kind of ‘morning after’ treatment is interest-

ing, but the fact is that there is no known topical
treatment that has prevented the recurrence of genital
herpes.”

Zinc and Fertility

There is probably more zinc in seminal fluid than
in any other fluid in the body. That finding led urolo-
gist Joel L. Marmar, M.D., to wonder if certain male
fertility problems might be caused by a zinc defi-
ciency.
He tested some patients in his Cherry Hill, New
Jersey, practice. He reports, “Out of our infertile
Zinc may be important population, 10 to 15 percent have truly low zinc lev-
to the motility of sperm. els.” Zinc, he says, has an apparent influence on the
swimming ability of sperm, which must be strong
enough to reach a woman’s fallopian tubes and pene-
trate the egg for fertilization to take place.
Dr. Marmar isn’t sure exactly why it works, but he
has had some success using zinc supplements with
that small, select group of infertile patients.
Of course, not every malfunction in our body is
necessarily the result of a drop in a nutrient stockpile.
But new technology, allowing scientists to examine
functioning nutrients in living tissue, are helping pin-
point the ones that are.

Zinc for Osteoporosis?

Osteoporosis is a hot topic these days. Increased
calcium intake and weight-bearing exercises can help
head it off. And it seems zinc might help, too.
Bone metabolism is another area where zinc-
dependent enzymes play a role, says Joseph Soares,
Ph.D., a professor of nutrition at the University of
Maryland, College Park.
In bone calcification in children, the role is clear,
Dr. Soares says. Zinc is needed to produce a matrix of
protein threads onto which the bone-forming calcium
 Zinc: The Whole-Body Mineral 225

is laid. In older people, though, the process is much

slower. ‘Calcium deposition and removal continues
into old age, but if more calcium is lost than is depos-
ited, osteoporosis will be the result,” Dr. Soares says.
‘We'd like to find out if zinc can help to boost
calcium deposition in the elderly. It would seem to
make sense, but it’s a difficult question to answer.” Dr. A promising prospect:
Soares’s continuing work will determine the role of Zinc may help weak
bones attract calcium.
supplementation in bone calcification in quail and
rats. If it does, he says, “an important new develop-
ment in the study and control of osteoporosis may be
available.”
One study by researchers in Turkey showed that
victims of osteoporosis had zinc levels 25 percent
lower than those without the disease. “Many older
people are getting too little zinc, just as they’re getting
too little calcium, because of overall poor nutrition,”
Dr. Soares says. In fact, there’s evidence to indicate
that zinc intake is below the RDA for other groups as
well.
A survey by the Beltsville Human Nutrition Re-
search Center in Maryland found that middle-class
adults were getting only about three-fourths of the Many middle-class
RDA for zinc, averaging 9.9 milligrams a day. Women adults are not getting
enough daily zinc.
fared worst. Their intake was only 57 percent of the
15-milligram requirement.
Make your food choices zinc-wise. Oysters are
the richest source of zinc. Organ meats and beef are
the next-best source. Three ounces of lean beef has
nearly four milligrams of zinc. Grains and nuts contain
fairly good, but probably less absorbable, amounts.
(For a list of other zinc-rich foods, see the table, Best
Food Sources of Zinc, on pages 226-27.) In fact, a
nutritional survey showed vegetarians on low-calorie
diets to be at particular risk for zinc deficiencies. (If
you feel you need supplemental zinc, be sure not to
take more than 30 milligrams a day without medical
supervision.)
Zinc research can only continue to confirm how
important it is to get the right amount of this essential
trace mineral.
226 From A to Zinc: A Guide to Vitamins and Minerals

Best Food Sources of Zinc

Food Portion Zinc

(mg.)

Oysters, raw, meat only Ys cup eZ

Chicken heart, cooked 3 OZ. 6.00
Calves’ liver, cooked 307: 5:20
Beef liver, braised 3 Oz. 5.16
Beef, ground, lean, broiled,
medium LOZ! 4.56
Lamb, lean, cooked 3 Oz. 4.20
Pumpkin seeds, roasted Y% cup 4.20
Tuna, canned in oil, drained Y% cup 4.01
Beef, round, full cut, separable
lean only, broiled 3 OZ. 3.98
Turkey, dark-meat, cooked 3 Oz. 3.80
Chicken liver, cooked 3 Oz. 3.70
Chicken, dark-meat, cooked 3 Oz. 2.40
Swiss cheese 2 Oz. 2.20
Cashews, dry-roasted Y% cup 1.90

Sources: Adapted from

Composition of Foods: Beef Products, Agriculture Handbook No. 8-13, by Nutri-
tion Monitoring Division (Washington, D.C.: Human Nutrition Information Ser-
vice, U.S. Department of Agriculture, 1986).
Composition of Foods: Breakfast Cereals, Agriculture Handbook No. 8-8, by
Consumer Nutrition Center (Washington, D.C.: Human Nutrition Information
Service, U.S. Department of Agriculture, 1982).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1,
by Consumer and Food Economics Institute (Washington, D.C.: Agricultural
Research Service, U.S. Department of Agriculture, 1976).
Composition of Foods: Legumes and Legume Products, Agriculture Handbook
No. 8-16, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1986).
 Zinc: The Whole-Body Mineral 227

Food Portion Zinc

(mg.)

Cheddar cheese ZIOZ: 1.80

Sunflower seeds, dry-roasted Y% cup 1.70
Turkey, light-meat, cooked SIOZ: 1.70
Brazil nuts, dried Y% cup 1.60
Black-eyed peas, cooked Ye cup 1.50
Clams, raw, meat only SIOZ 1.34
Chick-peas, boiled Y cup 125
Lentils, boiled Y cup 1e25
Peanuts, all types, dry-roasted Y% cup 1.20
Chicken, light-meat, cooked 3 02. 1.10
Peas, cooked Ye cup 1.00
Filberts, dried Y% cup 0.70
Tuna, light, canned in water Y cup 0.70
Oats, regular, cooked Ye cup 0.60

Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).
Composition of Foods: Poultry Products, Agriculture Handbook No. 8-5, by
Consumer and Food Economics Institute (Washington, D.C: Science and Educa-
tion Administration, U.S. Department of Agriculture, 1979).
Composition of Foods: Vegetables and Vegetable Products, Agriculture Hand-
book No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human
Nutrition Information Service, U.S. Department of Agriculture, 1984).
Journal of the American Dietetic Association, April, 1975.
McCance and Widdowson’s The Composition of Foods, by A. A. Paul and
D. A. T. Southgate (New York: Elsevier/North-Holland Biomedical, 1978).
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 Chapter 30 231

Amino Acids:
Building Blocks
of Well-Being

o make muscle, you need protein. To make

protein, you need amino acids.
That’s one side of the amino acid picture. Scien-
tists believe there’s another side, though, one in which
amino acids are no longer confined to the limited role
of microscopic puzzle pieces that fit together to make
protein.
Amino acids may be more than just building
blocks. These essential nutrients may help regulate
our emotions, lower cholesterol and reduce the pain Identifying new health
of serious injury. Science continues to methodically roles for protein’s build-
ing blocks.
peel back the layers on many amino acids, learning
more about how they work in our bodies.

Phenylalanine and Depression

A serious shortage of certain amino acids—in-
cluding phenylalanine (PHE)—may account for
some depressive disorders, according to the research-
ers at Rush-Presbyterian/St. Luke’s Medical Center in
Chicago.
The Chicago researchers supplemented the diet
of depressed patients with phenylalanine and discov-
ered that, in many cases, the depression eased. It When some seriously
didn’t work for everybody, but for some people depressed people took
PHE, their depression
whose lives are devastated by black moods, phenylal- decreased.
anine can be a godsend.
“In general, phenylalanine is a useful alternative
to antidepressant drugs in a limited number of cases
232 Special Nutritional Allies for Health

involving depression of the bipolar type,” says Hector

C. Sabelli, M.D., Ph.D., a psychopharmacologist on
the Chicago research team. “ ‘Bipolar’ patients can be
recognized by the fact that they have recurrent de-
pressions, they tend to be impulsive rather than anx-
ious and they sleep too much rather than too little.”
The Chicago study evolved from years of study
into the brain chemistry of depressive patients.
“In the body, phenylalanine turns into the active
compound phenylethylamine (PEA), which functions
PHE can work like an something like an amphetamine,” says Dr. Sabelli.
amphetamine to elevate “It’s a natural amphetamine of the brain. The question
mood.
is, why do some people not form enough
phenylethylamine? Is it because they don’t get
enough phenylalanine in the diet or they don’t absorb
enough, or is it that they can’t transform the phenylal-
anine into phenylethylamine? We don’t really know
yet.”
Most people get all the phenylalanine they need
in their diet—about two grams—says Dr. Sabelli.
There’s some phenylalanine in all protein foods, he
adds. In treating depressives, the Chicago researchers
usually give two to‘four grams a day.
Until more is known about phenylalanine, how-
ever, Dr. Sabelli says it would be wise for those who
suffer from depression to consult their family doctors
or psychiatrists. He says too much phenylalanine can
function like a mild amphetamine. But for many de-
pressed people, in a clinical setting, he adds, ‘““Phenyl-
alanine can help a lot.”
As useful as phenylalanine may be in treating the
emotional pain of depression, it may also be helpful in
PHE can ease aches and easing some physical aches and pains. But, as with
pains. clinical depression, phenylalanine doesn’t appear to
help everyone.
British researchers tested phenylalanine on 22
volunteers who suffered from a wide variety of long-
standing ills, from lower back pain to spinal fusion. In
seven patients, the phenylalanine, given in 250-milli-
gram daily doses, did ease the pain. But for all the rest
 Amino Acids: Building Blocks of Well-Being 233

of the patients, phenylalanine had no effect (Ad-

vances in Pain Research and Therapy).
Phenylalanine may be a boon for some people,
but for a small minority born with a rare genetic disor-
der, the problem is not too little but too much phenyl-
alanine. The disorder is called phenylketonuria, or
PKU.
People with PKU have chronically elevated levels
of phenylalanine. If left untreated, a child born with
PKU could become mentally retarded. With treat- A low-PHE diet to treat
ment—that is, a diet in which the phenylalanine con- a rare genetic disorder.
tent is very closely regulated—normal mental devel-
opment is all but assured. But there can be serious
problems—hyperactivity, short attention span and
impaired motor skills—for those who go off the pre-
scribed low-protein diet.

The Recovery Team:

Valine, Isoleucine, Leucine
One solution to the behavioral problems caused
by PKU might be found in three other amino acids—
valine, isoleucine and leucine. These aminos appear
to compete with phenylalanine for transport into the
brain, according to researchers at the College of
Mount St. Joseph in Cincinnati. Tests on six PKU pa-
tients showed that with these three neutral amino
acids, behavioral and motor problems improved
(Developmental Medicine & Child Neurology).
These three—also known as _ branched-chain
amino acids, or BCAAs—may also help alleviate the
suffering of seriously injured patients.
Studies are under way at the University of Ala-
bama in Birmingham to confirm the theory. Palmer Q.
Bessey, M.D., assistant professor of surgery, believes A way to protect trauma
this amino trio might change the way the body re- patients.
sponds to trauma.
Studies have shown that when the body is seri-
ously injured, muscle tissue is broken down rapidly as
234 Special Nutritional Allies for Health

a source of protein which, in tum, is a source of

BCAAs. It’s also thought that injured people are more
resistant to insulin than normal, healthy people. This
may be partly responsible for the breakdown of mus-
cle protein during trauma. BCAAs may prove useful in
decreasing muscle breakdown in injured patients.

Arginine:
Potential against Cancer
Cancer is a complex medical puzzle for which
there is no miracle cure. Bearing that in mind, it’s also
Arginine as an antican- fair to say that scientists are making some headway.
cer drug. One potential anticancer drug, in fact, is not really a
drug at all, but the amino acid arginine.
Tests on laboratory rats have demonstrated that
arginine discourages tumor growth, though the rea-
sons for this aren’t clear. Scientists suspect arginine
boosts the cancer-fighting powers of the white blood
cells (Journal of Parenteral and Enteral Nutrition).
Arginine may also help the skin heal after major
surgery, according to Hans Fisher, Ph.D., professor
Helping skin to heal and chairman of the Department of Nutrition at
faster after surgery. Rutgers University. “Healing involves the formation of
scar tissue, and scar tissue is made up of collagen,” he
says. “And collagen contains a high percentage of
arginine and another amino acid, glycine.”

Sleeplessness and Tryptophan

Try to find something tryptophan doesn’t do. It
has been proposed in the past as a painkiller, a natural
antidepressant and as a nondrug means of bringing
the sandman.
Tryptophan is converted in the body to seroto-
nin, a powerful neurotransmitter, a biochemical used
to relay nerve impulses. That’s the key to this amino
acid’s versatility.
 Amino Acids: Building Blocks of Well-Being 235

Tryptophan has been used as an experimental

treatment for the mental disorder called mania. Re-
searchers suspect tryptophan stimulates the produc-
tion of more serotonin, which reduces the symptoms
of mania (Biological Psychiatry).

Tryptophan Better than Counting Sheep

For thousands of people who also the next day. Tryptophan
have trouble falling asleep, trypto- ‘“‘may be preferable to such drugs,
phan (the amino acid commonly particularly if a less potent hyp-
found in milk) has become as notic would be sufficient,” say the
popular as counting sheep used to researchers (American Journal of
be. But does it really work-—scien- Clinical Nutrition).
tifically—to induce sleepiness? Investigators from the Univer-
Yes, say a group of researchers sity of California at Los Angeles
from the Massachusetts Institute also got positive results with tryp-
of Technology in Cambridge. tophan. They tested it on elderly
The researchers adminis- patients with persistent insomnia.
tered various tests to measure the Although it doesn’t work for all
mood state and performance of a types of insomnia, the doctors say
group of men after they had taken that for those responsive to it
tryptophan and after they had (about 30 percent of those
taken a placebo (dummy pill). Af- tested), there was a “dramatic and
ter the tryptophan, the men re- sustained relief of insomnia”
ported increased drowsiness and (Journal of the American Geriatric
decreased vigor, while their per- Society). As for side effects, they
formance was not impaired on seem to be virtually nonexistent.
any of the tests given by the re- Even so, the researchers caution
searchers. that there are some patients who
Because of this, the research- should not take tryptophan—
ers think tryptophan is a good those with liver disease and those
choice for use in inducing sleepi- on certain medications. In fact,
ness. Most prescription drugs cur- anyone who is undergoing any
rently used as hypnotics, they say, medical treatment should check
impair performance not only im- with his doctor first before using
mediately after administration but the amino acid.
236 Special Nutritional Allies for Health

Earlier medical reports suggest the possibility of

help for those who periodically become depressed,
Tryptophan may help suffer from sleeplessness or require pain relief. Dr.
battle depression, in- Fisher points out that tryptophan supplements tend to
somnia and pain.
work best when taken along with carbohydrates—
starchy foods such as bread, cereal or potatoes—and
not with proteins. Protein foods, says Dr. Fisher, tend
to send other amino acids rushing to compete with
tryptophan for delivery to the brain.
Note: Since relatively little is known about the
safety of amino acids, be guided by your physician in
the medical use of any of these substances.

Taurine for Gallstone Control?

Gallstones are painful, but until recently science
hasn’t been able to come up with a way to control
Can taurine prevent for- them. A Japanese study of the amino acid taurine,
mation of gallstones? however, may provide hope for gallstone sufferers.
Researchers fed mice a high-cholesterol diet supple-
mented with taurine. After a few weeks, cholesterol
levels in the liver dropped significantly, despite the
continuous influx.of cholesterol. As a result, gall-
stones, which are formed from cholesterol-laden bile,
weren't able to form.
If the relationship between taurine and gallstones
can be confirmed, the implications for humans are
obvious. But, the researchers stress, further studies
should be done before drawing any firm conclusions
(Journal of Nutrition and Scientific Vitaminology).

Tyrosine versus Stress

If we can call tryptophan the anti-insomnia
amino acid, then we can call tyrosine the antistress
amino acid.
When certain laboratory mice are placed under
physical or emotional stress, they stop probing their
environment, poking their way through mazes or sit-
ting up on their haunches to look around. But if those
 Amino Acids: Building Blocks of Well-Being Zot

mice are supplemented with tyrosine before being

exposed to stress, they don’t lose their natural inquisi-
tiveness. Their bodies apparently convert tyrosine into
norepinephrine, a brain neurotransmitter that is
known to be depleted by stress.
Do these findings apply to people? Yes, says
Richard Wurtman, Ph.D., of the Massachusetts Insti-
tute of Technology, the experiment’s author. “Supple- An antidote for unrelent-
mental tyrosine may be useful therapeutically in peo- ing stress.
ple exposed chronically to stress,” he says. The catch,
however, is that only those people who are under
stress would receive a boost from tyrosine. “We did
not observe behavioral effects when unstressed rats
were given tyrosine,’ Dr. Wurtman adds (Brain Re-
search).
Tyrosine may also help fight depression, or at
least magnify the effects of antidepressant medica-
tion. One of Dr. Wurtman’s depressed patients ‘“‘im-
proved markedly” after two weeks of tyrosine ther-
apy, and her symptoms returned within a week after
she stopped taking the supplements.
One thing to keep in mind: Don’t take a supple-
ment of valine, another essential amino acid, when
you take tyrosine. Valine may block tyrosine’s entry to
the brain.
Parkinson's disease may also respond to tyrosine
supplementation, though the evidence is weak. By a
series of biochemical reactions, the body can turn Tyrosine may help in the
tyrosine into dopamine, a vital neurotransmitter that treatment of Parkin-
son’s disease.
Parkinson’s patients are usually low in. The tyrosine
seems to work best when the disease is still in its mild,
early stages (Veurology).

Lysine Reputed to Reduce

Herpes Attacks
Few people had ever heard of this amino acid
before it was publicized in the late 1970s as a natural
remedy for cold sores, shingles and genital herpes.
238 Special Nutritional Allies for Health

Can lysine cure cold Lysine is now popular with those afflicted with her-
sores? pes—especially those people who suffer frequent at-
tacks.
The theory behind lysine supplementation is this:
Researchers discovered in the 1950s that the herpes
virus can’t survive without a diet of arginine. Arginine,
like lysine, is an amino acid, one that is plentiful in
nuts, seeds and chocolate. Researchers also discov-
ered that lysine competes with arginine, somehow

Fighting Cholesterol with Amino Acids

Eating a low-fat, high-fiber diet happens, blood cholesterol levels
can help lower cholesterol levels go down, too.
in the blood, but it may also as- Additionally, Loma Linda re-
sure that we get the right balance searchers found out, many other
of amino acids to maintain good amino acid levels change when
health. And, in a roundabout fash- diet is changed from high fat to
ion, a proper amino balance, too, high fiber. Glycine and serine, for
may lower cholesterol. example, increase; valine, leucine,
The positive health benefits histidine and tyrosine decrease. Is
of a diet high in plant protein— it a coincidence or is there a
fruit, whole grains, beans, vegeta- cause-and-effect relationship?
bles, nuts—are well known. Still, “We're still trying to find out.
researchers wondered, is there But anything that appears to regu-
more to plant protein than high late cholesterol is important,”
fiber and low fat? The answer isn’t says Albert Sanchez, Dr.PH., pro-
clear, but researchers at Loma fessor of nutrition at Loma Linda
Linda University in California be- University School of Health. ‘‘Fats,
lieve that in addition to low fat carbohydrates, fiber and simple
and high fiber, plant protein offers sugars—all these factors seem to
a balance of amino acids that reg- regulate cholesterol. But we’re
ulates cholesterol. looking at another aspect of diet
When you eat a diet that is that appears to be regulating cho-
high in plant protein, the lysine lesterol. And what this could
levels in your blood go down in mean is that we may have to go to
relation to arginine levels. Scien- a higher plant-food diet if we want
tists have observed that when this to avoid cholesterol problems.”
 Amino Acids: Building Blocks of Well-Being 239

elbowing it out of the way and making it inaccessible

to the herpes virus. If lysine could prevent arginine
from reaching the virus, the theory went, it could
prevent the viruses from multiplying and setting off an
active infection.
In a study published in 1983, a group of research-
ers polled more than 1,500 people who had pur-
chased lysine. Among those polled (whose average Many say that 88 per-
daily intake of lysine was over 900 milligrams), 88 cent of those polled
said lysine helped.
percent said that the amino acid has indeed helped
them. Lysine, they said, seemed to reduce the severity
of their attacks and accelerated the healing time
(Journal of Antimicrobial Chemotherapy).
These results have been disputed, however, by
scientists who attribute them to the placebo effect.
University of Miami researchers found that when they
gave sugar pills to herpes sufferers and told them it
was lysine, most of the patients reported an improve-
ment. The same researchers found that giving 1,200
milligrams of lysine a day failed to help those people
with severe, frequent herpes episodes (Archives of
Dermatology).

Glutamine of Interest
to Alcoholics
Twenty-five years ago, nutritionist Roger J. Wil-
liams, Ph.D., wrote a book called Alcoholism: The
Nutritional Approach. The regimen that he recom- Glutamine may reduce
mended for alcoholics included supplements of gluta- the craving for alcohol.
mine, one of the nonessential amino acids. Dr. Wil-
liams claimed that glutamine reduces the usually
irresistible craving for alcohol that recovering drink-
ers almost inevitably encounter.
Many authorities on alcoholism reject the very
notion that a “sobriety nutrient” exists. But others say
glutamine seems to help.
“T've been using a combination of glutamine,
vitamin C and niacinamide, 500 milligrams of each,
240 Special Nutritional Allies for Health

one to three times a day,” says Harry K. Panjwani,

A triple nutrient mixture M.D., a Ridgewood, New Jersey, psychiatrist and a
for alcoholics. former member of the Advisory Committee of the
National Council on Alcoholism. “We don’t know
how it works. We can only say that somehow the
craving is gone. We’ve used it extensively, and the
findings have been the same in every case.”
Dr. Panjwani isn’t alone. Jerzy Meduski, M.D.,
Ph.D., a professor at the University of Southern Cali-
fornia and a member of the Task Force for Nutrition
and Behavior in Los Angeles County, also reports that
he has had success with glutamine. “The craving for
alcohol seems to be the effect of an imbalance in
nutrition,” he says. “There is no doubt that there is a
positive response to nutritional supplementation.”

Safety Is the Bottom Line

Until more is known about the safety of amino
acids, they shouldn't be used for the self-treatment of
When you think about serious illnesses. At the same time, they shouldn’t be
amino acids, think taken in large amounts for long periods.
safety.
But many of‘those who are researching amino
acids feel that it is only a matter of time before the
benefits of these nutrients are fully appreciated. They
believe that amino acids may eventually replace cer-
tain drugs in the treatment of diseases such as those
mentioned here and potentially many others.
 Chapter Sl 241

The Fish-Oil Factor:

Healthy-Heart
Gift from the Sea

hou Shalt Not Eat Shellfish, for It Hath Choles-

terol. Remember this dietary commandment
legislated by science?
It may now be rescinded by something that has
been changing minds and turning heads in scientific
circles for over a decade—fish oil.
The news comes from William E. Connor, M.D.,
professor of medicine, and a colleague at Oregon
Health Sciences University in Portland. There, they Shellfish is not taboo.
put a group of patients on control diets that were very
low in cholesterol, then later on diets high in shellfish
(and therefore high in cholesterol). To gauge the ef-
fects of the regimens, the researchers monitored the
levels of cholesterol and triglycerides (circulating
fats) in the patients’ blood. And the results were just
what shellfish lovers want to hear: Overall, the two
kinds of diets had virtually the same impact on both
blood factors (Metabolism).

Moderate Amounts
of Shellfish Are Okay
“This means that eating moderate amounts of
shellfish—three or four ounces a day—is perfectly
acceptable,” says Dr. Connor.
To some people that makes about as much sense
as a flat earth. Research has shown time and again
that cholesterol-rich foods drive up cholesterol in the
242 Special Nutritional Allies for Health

blood, so what’s so different about shrimp and lobster

and scallops?
The big difference is a class of polyunsaturated
fatty acids called omega-3, says Dr. Connor. They're
Introducing a true friend the healthy-heart factors found mostly in fish oils,
of the heart: omega-3 including the oil in shellfish. Among researchers
fatty acids.
they’ve earned a reputation as arch foes of elements
that clog the circulation.
“The implication of our findings,” says Dr. Con-
nor, “is that the omega-3 fatty acids helped neutralize
the impact of the high-cholesterol shellfish diets.”
And so it goes. Reports like this have been com-
ing in for years, consistently defining certain elements
of fish oils as potent forces for coronary health.
First came news that Greenland Eskimos were
practically immune to heart disease despite diets
Omega-3 oils were the loaded with fat, a known cause of heart trouble. The
Eskimos’ secret to natives ate staggering amounts of whale blubber, seal
healthy hearts.
and fatty fish but appeared to have some of the
healthiest hearts in the world. Then there was word
that scientists had found a clue: The Eskimos had high
levels of omega-3 fatty acids in their blood—sub-
stances derived directly from their marine food. It
soon became clear that the fatty acids might some-
how be compensating for the fatty meals. Researchers
had uncovered a dietary ally in the war on heart
disease.
It wasn’t long after this first bit of detective work
that investigators figured out which members of the
EPA and DHA decreased omega-3 class were chalking up most of the good
blood fats and exces-
deeds. Scientists called them eicosapentanoic acid
sive blood clotting.
(EPA) and docosahexanoic acid (DHA). In patient
after patient, researchers pitted these against high lev-
els of cholesterol and triglycerides as well as exces-
sive blood clotting, a process that can cause a heart
attack or stroke. And EPA and DHA almost always
came out ahead.
Consequently, the questions surrounding omega-
3 today are more intriguing than ever. Just how far can
fish oil go toward the prevention of heart disease? Can
 The Fish-Oil Factor: Healthy-Heart Gift from the Sea 243

omega-3 do any more for your heart than other poly-

unsaturated fatty acids? Are omega-3 supplements
just as good as a seafood diet? How much fish oil do
you really need each day? Since there are now many
omega-3 research projects going full tilt, the answers
are getting better by the minute.

Omega-3, Gram for Gram

William S. Harris, Ph.D., formerly of Oregon
Health Sciences University, can attest to that. He and
his colleagues may have settled a scientific argument Which is better for your
that’s been around for years—whether polyunsatu- heart—polyunsaturated
vegetable oils or fish
rated fish oil is better for your heart than polyunsatu- oil?
rated vegetable oils. Researchers have known for two
decades that moderate intakes of such vegetable oils
could push down cholesterol levels, but can fish oil
do just as good a job—or better?
To find out, Dr. Harris and his colleagues put
seven people on three consecutive diets, each con-
taining equal amounts of cholesterol and 40 percent
of their calories in fat. A control diet imitated the
American standard, making up its 40 percent in satu-
rated fat. Another of the diets got its fat from poly-
unsaturated safflower and corn oil. And the third diet
had its fat derived from salmon and salmon oil, both
rich in EPA and DHA.
The researchers checked the subjects’ levels of
cholesterol and triglycerides each step of the way.
And when all the data were in, there was plenty to
think about. The salmon and the vegetable-oil diets
reduced cholesterol by about the same margin—an
average of 11 percent below control-diet levels. But
the salmon regimen did something that its vegetable-
oil counterpart couldn't: It forced down triglycerides.
It reduced triglycerides an amazing 33 percent below
control levels (Metabolism).
‘‘No other polyunsaturated oils have been able to
get triglyceride levels to drop in this way,” says Dr.
Harris. “So the impact of the fish-oil diet is really
244 Special Nutritional Allies for Health

significant. For a person with high triglyceride levels, a

The fish-oil diet reduced 33 percent reduction would be an important change
triglyceride levels by an toward better cardiovascular health.”
amazing 33 percent.
But there was more meaning embedded in the
study than this. With the information the researchers
had acquired, they were able to directly compare the
effects of the two major classes of polyunsaturated
fatty acids—omega-3 and omega-6 (the principal
cholesterol-lowering agent in polyunsaturated vege-
table oils).
“There’s no question,” says Dr. Harris. “Gram for
gram, omega-3 fatty acids were far more potent than
omega-6 fatty acids, not only in reducing triglycerides
but in lowering cholesterol levels as well.”

On Omega-3 Frontiers
A group of scientists in Munich would no doubt
salute this kind of research, for they’ve been scrutiniz-
A new way to cut the ing omega-3 themselves—but from a different angle.
risk of heart attack and They've been looking at the effect that this class of
stroke.
fatty acids has on something called platelet function,
that secretive process of the blood that can tilt the
scales between coronary health or heart attack and
stroke.
Platelets are those tiny blood elements so crucial
to the clotting process. When you cut yourself, you
need them there at the wound. Otherwise you want
them to stay loose and out of mischief—to not aggre-
gate, or clump up, choking off the flow of blood,
begging for some coronary catastrophe.
But sometimes platelets become too “sticky”
and start to aggregate at the wrong times. Or there’s
an overabundance of thromboxane in the blood-
stream, a substance that sets platelets to clumping
and causes vessels to constrict.
These are the problems that the West German
researchers hoped omega-3 fatty acids could take on.
And in a definitive study on the subject, they demon-
strated that these simple derivatives of fish oil are up
to the job.
 The Fish-Oil Factor: Healthy-Heart Gift from the Sea 245

For 25 days they supplemented the diets of a

group of men with daily doses of nearly three table-
spoons of cod-liver oil—rich in EPA and DHA. Then Cod-liver oil reduced the
they ran a battery of tests to evaluate the men’s car- risk of blood clots.

diovascular systems, particularly the action of plate-

lets. (For the sake of comparison, the men also took
the tests either just before the 25-day trial or a month
after.) And in factors measuring clotting activity, the
men registered significant improvements because of
their fish-oil intake. Platelet aggregation decreased,
the production of thromboxane went down, the num-
ber of platelets diminished, even bleeding times in-
creased, anoiher indication that the risk of dangerous
clotting had been reduced (Circulation).
“The findings,” say the investigators, “paralleled
observations in active Eskimos, who have unique nu-
trition and low morbidity from atherothrombotic dis-
ease [heart trouble caused by fatty deposits and blood
clots].”
But the biggest surprise of all was what the fish
oil did for the men’s blood pressure: It actually pulled A scientific surprise:
it down. While they were taking the cod-liver oil, their Fish oil lowered blood
pressure.
systolic blood pressure dropped an average of nearly
ten points.
And, the researchers say, there were no side
effects at all from the treatment, even though three
tablespoons of cod-liver oil is normally an excessive
dose, containing exceptionally large amounts of vita-
mins A and D. (Caution: These amounts were used
under controlled medical conditions. Routine supple-
mentation should never approach those levels.)
Omega-3 fatty acids, the researchers note, may
be a new preventive for atherothrombotic disease—a
preventive that should be stacked against the best
conventional therapies currently available, including
antiplatelet drugs and omega-6 fatty acid diets.

A Lack of Omega-3
All of which is worth taking to heart. But amid
these signs that a little bit of fish oil goes a long way,
246 Special Nutritional Allies for Health

there are warnings from scientists that a little bit is far

more than most people are getting.
Donald O. Rudin, M.D., former director of the
Molecular Biology Department at Eastern Pennsylva-
nia Psychiatric Institute in Philadelphia, thinks that the
situation may be worse than expected.
‘After years of research,” he says, “we now
know that omega-3 fatty acids are absolutely required
Most of the population by the human body. They’re not optional nutrients.
is deficient in omega-3 Yet most of the population is deficient in them. The
fatty acids.
consumption of cholesterol and fat is way up at a time
when omega-3 consumption is way down.
“We obviously need these fatty acids more than
ever. They’re the last major nutrient family to be rec-
ognized. In more ways than one, they’re our nutri-
tional missing link,” says Dr. Rudin.
 Chapter SW 247

More Good News

about Omega-3

eart disease, psoriasis, rheumatoid arthritis,

breast cancer, migraine headaches. There’s
a common thread running through this rogues’ gallery
of modern ills: an unsaturated fat called omega-3.
With this thread, scientists hope to unravel the myster-
ies of some of our most perplexing diseases.
Every new study demonstrates the heart-healing
properties of this important group of fatty acids. Most
medical experts now greet each new bit of informa-
tion about omega-3 with enthusiasm.
‘These highly unsaturated fats seem to give ben-
efit in every study we've reviewed,” says William
Castelli, M.D., director of the Framingham Heart
Study.

Reel in the Fish

Another prominent omega-3 researcher, William
E. M. Lands, Ph.D., professor of biological chemistry
at the University of Illinois at Chicago, also favors
including more fish in the diet.
“The best way to obtain the beneficial omega-3
fatty acids is to eat more seafood,” he says. “‘All the
reasons for eating polyunsaturated oils from vegeta- Why doctors say, ‘‘Eat
bles remain, certainly. But we need to balance them more seafood.’’

with omega-3 oils from fish. Omega-3 moderates the

body's overutilization of chemicals called eico-
sanoids, formed from polyunsaturates.”
248 Special Nutritional Allies for Health
EEE

One of the prime beneficiaries of a diet high in

omega-3 is your heart. That’s where the most inten-
sive research has been done. Studies cited in the
preceding chapter show that omega-3 reduces harm-
ful cholesterol and triglycerides and helps keep arter-
ies clear of blood clots that can cause a heart attack
or stroke. But more recently, scientists have been
finding other uses for this highly unsaturated fat.

Fishing for Arthritis Relief

One of the most intriguing areas of research in-
volves rheumatoid arthritis.
There is no cure for this painful disease. But
some researchers have found that omega-3 fatty acids
A reduction in arthritic might offer some relief from the pain and sweiling.
pain and swelling. “We may be recommending omega-3 as an adjunct to
traditional therapy in the future,” says arthritis re-
searcher Joel M. Kremer, M.D., of Albany Medical
College.
A group of eicosanoids called leukotrienes,
formed in the body, is thought to cause the charac-
teristic pain and inflammation of rheumatoid arthritis.
But omega-3 appears to change the chemical compo-
sition of the leukotrienes, making them less inflamma-
tory.
In a study conducted by Dr. Kremer and asso-
ciates, 23 arthritis patients each were given 1.8 grams
of a concentrated fish-oil supplement every day for 12
weeks. Twenty-one other patients received place-
bos—capsules filled with nothing but wax. As the
study progressed, the pain and swelling were reduced
in the patients taking supplements. The patients taking
placebos showed no improvement (Lance?). “‘The re-
sults are very encouraging,” says Dr. Kremer.
Patients with psoriasis may also benefit from
omega-3, since leukotrienes are believed to trigger the
Relief from the itching characteristic inflammation and scaling of this skin
and scaling of psoriasis. — disorder. In British and U.S. studies, omega-3 fatty
acids appeared to render leukotrienes less active, re-
 More Good News about Omega-3 249

sulting in some improvement—but not in all cases. In

any event, omega-3 may give some relief from the
itching and scaling of psoriasis (Annals of Allergy).
Omega-3 also appears to reduce the body’s re-
jection of tissue grafts, though it isn’t clear how or
why. It’s believed graft failure has something to do
with the function of blood platelets, which are in-
volved in blood clotting. Tests on laboratory animals
show that a diet high in omega-3 reduces tissue-graft
failure, presumably by changing the function of the
blood platelets (Journal of Surgical Research).

Help for Migraines

One reason why migraine sufferers are predis-
posed to these unusually painful headaches might be
a shortage of eicosapentanoic acid, or EPA, one of Migraine sufferers may
the omega-3 fatty acids found in fish. Without EPA, be deficient in omega-3.
says Robert J. Hitzemann, Ph.D., associate professor
of psychiatry and behavioral sciences at the State
University of New York at Stony Brook, the body
releases too much serotonin, a brain chemical that
has the capability of either tightening or loosening
blood vessel walls in the brain. All that excess seroto-
nin appears to put the squeeze on blood vessels, re-
sulting in pain.
To test the theory, Dr. Hitzemann and his col-
leagues gave omega-3 supplements to 15 migraine
patients. For about half the test subjects, the supple-
ments alleviated pain and resulted in fewer head-
aches. But all the news wasn’t as good, says Dr.
Hitzemann. Three of the migraine sufferers didn’t no-
tice any change and 4 actually became worse.
It’s too soon to tell whether eating fish or taking
fish-oil supplements can help relieve most migraines,
says Dr. Hitzemann. But, he adds, if you've already
sought conventional medical advice, it might be
worth a try.
“IT can’t make sweeping recommendations on
the basis of a 15-patient study,” says Dr. Hitzemann.
250 Special Nutritional Allies for Health

“Nevertheless, I think we’re all convinced this is a

breakthrough.” (Guidelines for the safe intake of fish-
oil supplements conclude this chapter.)

Tumor Prevention?
Scientists studying omega-3 also appear to have
taken a hopeful step in the battle against breast can-
cer. Studies linking omega-3 to prevention of breast
tumors are still in a very early stage, but they seem to
hold promise.
A group of eicosanoids known as prostaglandins
lowers immunity and encourages tumor growth, says
Rashida A. Karmali, Ph.D., associate professor of nu-
trition at Cook College, Rutgers University.
As a result of an overabundance of these chemi-
cals, says Dr. Karmali, “tumors form faster, and the
body can’t fight them off.”
Omega-3 appears to fight off the harmful effects
of these overactive chemicals. Dr. Karmali fed fish oil
In laboratory animals, to laboratory rats with breast tumors. The result was a
fish oil reduced the reduction in the number of tumors. “Even when we
number of breast
tumors.
transplanted tumors from one rat into another, the
growth of those established tumors was much slower
when we fed them fish oils,” she says.
It is one thing to prevent cancer in rats. It is quite
another to prevent cancer in people, Dr. Karmali cau-
tions. But the preliminary results of her studies offer
some encouragement.
Other studies in the United States tend to support
Dr. Karmali’s theory. In one study, conducted at the
University of Rochester School of Medicine, rats fed
fish oil developed fewer tumors (Journal of the Na-
tional Cancer Institute).
Researchers at Cornell University had encourag-
ing results, too, when they fed fish oil to laboratory
rats. There were fewer tumors, and the tumors that
did develop were smaller (Federation Proceedings).
No one can guarantee that eating fish will defi-
nitely help prevent breast cancer. But if you want to
hedge your bets, Dr. Karmali advises eating more fish.
 More Good News about Omega-3 251

Back to the Heart

Omega-3 may be very beneficial to people
whose cholesterol levels are on the high side—be-
tween 230 and 260 milligrams per deciliter of blood.
According to Dr. Castelli, people with cholesterol lev-
els this high are particularly at risk for heart attack.
Despite this, he says, many doctors don’t express
concern until the levels reach 300 or higher.
“Doctors are missing three-quarters of all the
heart attacks in their town by overlooking all the
lower numbers,” Dr. Castelli says. “The bulk of all our
heart attacks occur at cholesterol levels between 230
and 260. If you do not lower cholesterol, you will not
have a favorable effect on heart disease.”
One way to lower your cholesterol, says Dr.
Castelli, is simply to eat more fish.
In one study at Vanderbilt University School of
Medicine in Nashville, patients took about three table- Three tablespoons of
spoons of an omega-3-rich fish-oil supplement every fish oil a day lowered
cholesterol by 15 per-
day. At the end of the four-week study, serum choles- cent.
terol was reduced by 15 percent Unternal Medicine
News).

Adding Fish to Your Diet

You don’t have to eat as much fish as the Eski-
mos do to decrease your risks of heart disease, cancer
and other illnesses. Experts think we might prevent
disease by eating comparatively little.
Most researchers believe as few as two to four
fish meals a week might be sufficient. The more you
eat, obviously, the better.
“The ideal amount to eat probably varies from
person to person,” says William E. Connor, M.D.,
professor of medicine at the Oregon Health Sciences A prescription for heart
University in Portland and one of the pioneers in health: at least two six-
ounce fish meals a
omega-3 research. ‘‘A couple of six-ounce fish meals week.
a week is probably the minimum. I certainly enjoy
three or four servings of fish a week.”
252 Special Nutritional Allies for Health

Selected Food Sources

of Omega-3

Seafood Omega-3
(g.)

Mackerel, Atlantic 2.6

Mackerel, chub 22,
Mackerel, king Zee
Scad, muroaji 7.)|
Dogfish, spiny 2.0
Trout, lake 2.0
Mackerel, Japanese horse 129
Herring, Pacific 1.8
Herring, Atlantic JLaft
Tuna, bluefin 1.6
Sablefish ss
Salmon, chinook ik
Sturgeon, Atlantic LS
Tuna, albacore 1
Whitefish, lake 1.5
Anchovy, European 1.4
Salmon, Atlantic 1.4
Saury 1.4
Herring, round | 1S
Salmon, sockeye 133
Sprat (small herring) 1.3
Bluefish 1.2
Capelin 12
Mullet igi
Salmon, chum ul
Conch 1.0
Salmon, coho 1.0
Salmon, pink 1.0
Eel, European 0.9
Halibut, Greenland 0.9
Bass, striped 0.8
Smelt, rainbow 0.8
Periwinkle, common 0.7
Rockfish, brown ON

Source: Adapted from “Provisional Tables on the Content of Omega-3 Fatty Ac-
ids and Other Fat Components of Selected Foods,” by Frank N. Hepburn, Jacob
Exler, and John L. Weihrauch, Journal of the American Dietetic Association, June
1986.

Notes:
All portions are raw. Cooking does not decrease the omega-3 content of fish.
Figures are based on a 3¥%-0z. serving.
 More Good News about Omega-3 253

Of course, Dr. Connor adds, you ought to watch

your weight, keep your blood pressure under control,
avoid stress, eat fewer saturated fats and stop smok-
ing. “The omega-3 theory is a tremendous advance,”
Dr. Connor told a symposium audience. “But there
are other basic things to consider.”
Most experts agree that fish should be substi-
tuted for red meat and poultry and not eaten in addi-
tion to what you normally consume. The meat we get
from farm animals is low in omega-3.
Not all fish contain the same amount of omega-3. Fatty ocean fish are
Generally, fattier fish—salmon and mackerel, for ex- the richest sources
of omega-3.
ample—contain more. Ocean fish have more than
freshwater fish. (See the table, Selected Food Sources
of Omega-3, on page 252, for a more complete list.)
If you don’t like fish, supplements may be an
alternative. Ten capsules of concentrated marine lip-
ids supply 1.8 grams of eicosapentanoic acid. A serv- Supplements are an
ing of salmon (about four ounces) contains about an alternative.
average of 2 grams of EPA. Cod-liver oil also contains
EPA, but the amount varies according to brand. Cod-
liver oil usually contains high amounts of vitamins A
and D, however, and in large amounts these can be
toxic, so cod-liver oil should not be used for this
purpose.
254 Chapter 55.

Chromium and Choline:

Promising Possibilities
for Health

he research into chromium and choline is in its

infancy—tentative, preliminary, unconfirmed.
But the little that is known about these two nutrients is
encouraging.

Chromium, the Insulin Regulator

Our bodies require only the tiniest bit of the trace
mineral chromium—50 to 200 micrograms a day—
Older people may not but many of us don’t get enough of it, particularly as
get enough chromium. we get older. Chromium is a natural, and very effec-
tive, insulin regulator. It is essential for insulin to work
efficiently in our bodies.
“Insulin is required to remove glucose [sugars]
from the blood,” explains Richard A. Anderson,
Ph.D., of the U.S. Department of Agriculture’s Human
Nutrition Research Center in Beltsville, Maryland.
When blood glucose levels are high, as they are
shortly after eating, the pancreas secretes insulin,
which stimulates cells to take up the glucose and burn
it for energy. “Chromium makes the insulin more effi-
cient at stimulating the cells. The body needs less to
do the job, and so blood insulin stays at a healthy
lower level,” Dr. Anderson says.
In one study, Dr. Anderson gave healthy volun-
teers 200 micrograms of chromium a day for three
Supplements normalized months. He reports that chromium supplements or
blood sugar metabolism. brewer’s yeast (which is rich in chromium) normal-
ized glucose metabolism.
 Chromium and Choline: Promising Possibilities for Health 255

In the volunteers who had slightly elevated blood

sugar levels before taking chromium, there was a sig-
nificant drop of about 20 points in blood sugar level.
And in those who started out with moderately /ow
blood sugar (hypoglycemia), chromium supplemen-
tation was associated with about a 10-point increase
in blood sugar levels.
“Chromium truly is a regulator of insulin,” says
Dr. Anderson, whose work suggests that chromium
may alleviate many of the major symptoms of low
blood sugar. “With chromium, you don’t have insulin
‘overshooting’ its target,” he says. “You don’t get too
much insulin in the blood, or too little. You avoid the
seesaws in blood sugar that come as a result of fluctu-
ating insulin levels.”
Brewer’s yeast containing chromium also may
help to regulate fats in the blood. People who took
about two tablespoons of chromium-rich brewer's Brewer’s yeast may help
yeast each day for eight weeks had significant drops lower cholesterol.
in their cholesterol levels, according to research by J.
Clint Elwood, Ph.D., professor of biochemistry at
State University of New York and Health Science Cen-
ter at Syracuse. The average decrease for all the sub-
jects was 10 percent, but a few of the volunteers had
dramatically larger drops. Their cholesterol levels
went from over 300 to within a normal range of less
than 250.
“The higher the cholesterol level, the better the
response was to the brewer's yeast,” Dr. Elwood says.
“But what interested us most was that what we con-
sider to be normal cholesterol levels could also be
lowered with brewer's yeast. We still don’t know the
best level of cholesterol for optimum health.”

What Choline Can Do

for the Brain
Many of the foods touted as “brain foods’ —fish,
for instance, and liver and eggs—contain choline, a
256 Special Nutritional Allies for Health

substance researchers think may help preserve the

brain’s ability to reason, learn and remember.
Researchers at Ohio State University, for in-
stance, found that mice fed a diet heavy in choline-
Can choline improve rich lecithin, or one of lecithin’s “brain active” in-
your memory? gredients, phosphatidylcholine, had much better
memory retention than mice on regular diets. They
took much longer to go into a back room in their
cages where they had received a mild electric shock,
meaning they hadn’t forgotten their unpleasant ex-
perience.
What’s more, their brain cells, examined under a
microscope, showed fewer of the expected signs of
aging, says Ronald Mervis, Ph.D., of Ohio State Uni-
versity’s Brain Aging and Neuronal Plasticity Research
Group.
“Normally, as the brain ages, its cell membranes
become more rigid with fatty deposits and lose their
ability to take in and release brain chemicals and to
relay messages,” Dr. Mervis says. This can cause
memory loss and confused thinking. But a lecithin-
rich diet seems to repress or delay this membrane
hardening. :
As part of the deterioration process, aging brain
cells also tend to lose dendritic spines, the chemical
Why lecithin is consid- receptor areas that are vitally important in passing
ered ‘‘brain food.”’ along information. Having too few dendritic spines is
like having a bad phone connection. Messages get
distorted and lost. But lecithin-fed older mice had the
same number of dendritic spines as much younger
mice.
‘Despite the differences between mice and men,
there are, nevertheless, remarkable similarities in the
structure of their nerve cells,” says Dr. Mervis. “I be-
lieve lecithin could help to repress or delay similar
problems in man, although we have yet to verify that.”
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SOLVING
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 Chapter 34
An Alternative Way
to Fight Alcoholism

GC
don't think I could have stayed sober this
long if] hadn't found out about nutrition.” —
James A.
At the age of 29, James A. had been an alcoholic
for 15 years. During that time, he was committed to
hospitals and “dried out” twice. He was asked to
dredge up memories of an alcoholic father who died
when he was only 10. He listened to countless
“drunkologues’’—life stories of recovered alcoholics
who “had been there’””—and met doctors who tried to
scare him with greenish dissected livers. But after
both treatments, he returned to his job as a bartender
in a Minneapolis singles club and to his habit of drink-
ing a quart of vodka and 12 cans of beer a day.
Sobriety just didn’t work out for him.
“T stayed sober for a year the last time,” he says,
“but it wasn’t a pleasant experience. I had problems
with depression and anxiety. I’d be walking down the The misery—and nutri-
street and—whap—I’d have an anxiety attack. And | tional backlash—of one
man’s post-alcoholic
had a bad sweet tooth. I drank several quarts of pop a sobriety.
day. | remember thinking to myself, ‘If this is what
being sober is like, I don’t want it.’ ”

Standard Treatment Often Fails

The treatment James received was typical of that
given in many hospital-based rehabilitation centers
and ARUs, or alcohol recovery units. The first stage is
detoxification, when an alcoholic goes cold turkey for
262 Solving Health Problems with Nutrition

a week—sometimes with the help of tranquilizers.

The next step includes encounter sessions and lec-
tures in the hospital. The third step, when the patient
goes home, calls for regular attendance at Alcoholics
Anonymous meetings. The treatment’s customary
goal is to heal the alcoholic’s psyche and spirit. It’s
hoped that he’ll discover the emotional and psycho-
logical roots of his addiction and “talk them out.”
Those methods have saved many alcoholics
from a miserable life and a premature death. But, as
Eighty-five percent of all valuable as such techniques may be in individual
dried-out alcoholics cases, their overall performance record has not been
eventually go back to
drinking. outstanding. They haven’t put a dent in these vital
Statistics: An estimated 85 percent of all dried-out
alcoholics eventually go back to drinking; half of all
traffic fatalities are linked to alcohol; 20 percent of all
hospital beds are filled by people with alcohol-related
illnesses. In all, the public pays billions of dollars a
year in terms of medical care and lost productivity as
a result of alcoholism.

A Different Approach
That rate of failure has motivated a lot of people
in the alcoholism treatment field to look for more
An unusual kind of effective therapies. Although they’re still very much in
alcoholism treatment:
the minority, there’s a growing number of M.D.’s and
nutrition.
others who say that more attention should be paid to
the physical disease of alcoholism. They agree that
emotional problems have to be faced. But they also
argue that the alcoholic, in order to recover, must
discover the underlying biochemical factors that cre-
ated his disease and treat them. They say that the
alcoholic who undergoes a radical nutritional over-
haul—a switch from sugar, cigarettes and coffee to
whole grains, fresh produce and vitamin supple-
ments—has a much better chance of staying perma-
nently dry than one who doesn’t.
One member of this new and vocal minority is
Joan Mathews-Larson, Ph.D., director of Health Re-
covery Center, a state-licensed clinic for alcoholics in
 An Alternative Way to Fight Alcoholism 263

Minneapolis. Motivated by the suicide of her alco-

holic son a few years ago, she decided to pursue a According to one ex-
doctorate in nutrition and to open a treatment center pert, the nutritional
treatment of alcoholism
where alcoholism would be treated by restoring the works.
normal biochemical balance through diet and supple-
ments as well as with psychological counseling. She
knows she is a maverick, but she thinks her controver-
sial program works.
“Only a small percentage of the alcohol treat-
ment centers in the United States use the nutritional
approach,” she says. Much of the field still treats
alcoholism as a psychological disorder. And most
members of Alcoholics Anonymous don’t even know
that there’s a physical and nutritional approach.
“But people recover very nicely here without
confessing their sins in group therapy sessions and
without being made to feel ashamed of their disease.
What we’re doing is much more basic to their recov-
ery. You wouldn’t put a diabetic in group therapy and
expect him to ‘talk out’ his disease. Yet this is what
many people expect alcoholics to do.”
Alcoholism, for Dr. Mathews-Larson (she is a
certified chemical-dependency practitioner in Minne-
sota), is an inherited physical disorder that has severe Is alcoholism the result
psychological complications. She says that alcoholics of a genetic defect?
have a peculiar genetic defect that causes their bodies
to metabolize alcohol into a highly addictive,
morphinelike substance called tetrahydro-isoquino-
line, or THIQ. Most alcoholics also develop hypogly-
cemia, or low blood sugar, she says. They crave alco-
hol and sugar in any form, but both substances put
them on a physical and emotional roller coaster that
only more of the same can bring to a temporary halt.
Certain food and chemical allergies, she says, can
also cause a craving for alcohol.

Do Alcoholics Need
Extra Vitamins?
This vicious cycle can be broken, she says. When
alcoholics first enter her six-week program, she sends
264 Solving Health Problems with Nutrition

them through a battery of tests to check for hypogly-

cemia and nutrient deficiencies. She puts them on a
fast to unmask potential food allergies and has a staff
doctor check for hidden physical and psychiatric
problems.
Then come the nutrients. Recovering alcoholics
need replacement of the B vitamins, plus plenty of
No more coffee, to- vitamin C and certain amino acids, she says. To stay in
bacco, white flour or her program, they must also kick their coffee, to-
sugar.
bacco, white flour and sugar habits. While most alco-
holism counselors say that their patients need those
crutches in order to cope with withdrawal, Dr.
Mathews-Larson believes they just delay recovery.

Success Stories
James A. was one of Dr. Mathews-Larson’s cli-
ents. With the aid of emotional counseling, he has
“| was on an even keel been sober ever since going through her program in
oe the first time in my 1982. He has only good things to say about it. “I
ife.”’
remember the first group meeting I went to there,” he
says. “I heard people saying that alcoholism was a
biochemical problem, not a mental problem. And |
thought, ‘Maybe it’s just a problem in my biochem-
istry. Maybe I’m not going crazy.’ After the program, |
felt like I was on a fairly even keel for the first time in
my life. People who knew me couldn't believe it.”
Other patients at the Health Recovery Center
have had similar success. Mary W., a 27-year-old
mother of two boys, was one of them.
“Both of my parents were alcoholics, and |
started drinking when | was 14,” she says. “I was
always very depressed, and when | started drinking, it
made me feel good. I could hold my liquor better than
anybody, but I was still always tired and unhappy.”
Mary went to the Health Recovery Center when
she was planning her second pregnancy. She had
been drinking and using drugs during her first preg-
nancy, and her son grew more slowly than normal.
He later became hyperactive and suffered from multi-
 An Alternative Way to Fight Alcoholism 265

ple allergies. With her second child, she wanted to

avoid making that mistake again. Having known Dr.
Mathews-Larson from a prior attempt to dry out, she
went to see her. She found out that hidden food
allergies may have made her depressed and added
momentum to her alcohol abuse.
“I found out that I was allergic to beef, wheat and
dairy products,” she said. She also learned a lot about
healthy food. “In group therapy, we didn’t talk about Confession of an alco-
what was wrong with our marriages. Instead, we holic: Food was part of
the problem.
talked about good places to buy wholesome food and
ways to cook it. We found out what to have for break-
fast and what to snack on during the day. And one of
the workers took us on a tour of natural food co-ops.”
After going through the program, Mary said she
was happier than she had ever been. “I wake up
feeling good, and | feel good all day. And my second
baby was much bigger and stronger than the first.”

The Role of B Vitamins

One mainstay in the Health Recovery Center
treatment regimen is glutamine, a little-known amino
acid. More than 25 years ago, nutrition pioneer Roger
J. Williams, Ph.D., professor emeritus in chemistry at
the University of Texas, began recommending this
amino acid to alcoholics. Glutamine, he said, could
allay the unendurable craving that causes so many
alcoholics to backslide. Dr. Mathews-Larson agrees.
‘We've found that glutamine does everything that Dr.
Williams says it does,” she says.
The B vitamins can also reduce the craving for
alcohol, Dr. Williams believes. That alcoholism can
cause B vitamin deficiencies, most experts in the field B vitamins may reduce
agree. But Dr. Williams reversed that formula and the craving for alcohol,
says one scientist.
took the unorthodox position that a deficiency of the
B’s can cause excessive drinking. He may be night,
though the case is far from proven. Some years ago,
experiments in Finland showed that rats made defi-
cient in B vitamins are more likely to choose alcohol
266 Solving Health Problems with Nutrition

than water when both are offered to them. But vitamin

supplementation reversed their tastes (British Journal
of Addiction).
Some M.D.’s share Dr. Mathews-Larson’s views.
One of them is Harry K. Panjwani, M.D., a Ridgewood,
New Jersey, psychiatrist and former member of the
Advisory Committee of the National Council on Alco-
holism. He says that by mixing vitamins and psycho-
therapy he has helped many alcoholics turn their lives
around within a few months.
Dr. Panjwani puts each new patient on a regimen
of glutamine, niacinamide and vitamin C. He believes
A regimen of glutamine, that alcoholics who regain their health via good nutri-
niacinamide and vi- tion are much better at working out the problems that
tamin C.
gave rise to their addiction. Just taking the liquor away
and leaving a person with addictions to cigarettes,
coffee and sugar isn’t enough, he says. ““That’s treat-
ing the disease, not the whole person.”

A New Regimen
Nutrition is also stressed at Brunswick House, an
alcoholism treatment facility at the Brunswick Hospi-
tal Center in Amityville, New York. Joseph Beasley,
M.D., who is the medical director of the 86-bed facil-
ity, says that his patients are asked to give up sugar,
cut back on refined food, and begin a multivitamin
program after rigorous individualized diagnoses.
They’re also encouraged to participate in the entire
treatment program, including therapy, lectures and
activities such as using the paddleball courts and Nau-
tilus machines at the facility. “We feel that this, along
with traditional therapies, is where alcoholism treat-
ment is now,” Dr. Beasley says.
In California, Jerzy Meduski, M.D., Ph.D., a pro-
fessor at the University of Southern California and a
member of the Task Force for Nutrition and Behavior
in Los Angeles County, also believes in giving vitamins
and glutamine to recovering alcoholics. In one study,
he supplemented the diets of 100 alcoholic prison
inmates for two years and achieved great results.
 An Alternative Way to Fight Alcoholism 267

“The craving for alcohol seems to be the effect

of an imbalance in nutrition. That is almost always the
case,’’ Dr. Meduski says. “There is no doubt that there A positive response to
is a positive response to nutritional supplementation.” nutritional supplements.
Yet another nutrition-minded alcoholism coun-
selor is Mark Worden, former editor of Alcoholism:
The National Magazine.
“Does a poor diet increase the chances that an
alcoholic will go back to drinking?” Worden asks
rhetorically. “You can say that if an alcoholic’s body
is well prepared for stress by good nutrition and a
healthy lifestyle, then the likelihood of his going back
to his old way of dealing with stress—alcohol—is
probably less.”

Comparing Recovery Rates

Is the nutritional approach, then, the most effec-
tive form of treatment? The only way to find out
would be to compare recovery rates. The program
that kept the most alcoholics dry for the longest
amouni of time would emerge the winner. Such data
are hard to come by. It’s just too impractical to keep
tabs on a large group of people for several months or
years. But the few figures that are available on this
subject lend credence to the nutritional approach.
Dr. Mathews-Larson claims, for instance, that
one year after leaving her program, about 82 percent
of her patients are still sober. Those results are far Still sober a year after
better, she says, than the numbers reported by other, trying the nutritional
treatment.
more traditional, programs, which generally show
that only one-third of their clients are alcohol free by
the end of one year.
A nutritionist at the Elmhurst Alcoholism Pro-
gram in New York City also came up with pronutrition
figures. Lillian Yung, Ed.D., studied a group of 64
alcoholics to see whether the ones who stayed sober
the longest ate differently than those who quickly
went back to the bottle.
The results surprised her. She found that 45 per-
cent of the alcoholics who stayed sober for more than
268 Solving Health Problems with Nutrition

50 days after leaving treatment were using vitamin

Did supplements make supplements. But only 19 percent of those who
the difference? couldn’t stay sober for 50 days used supplements.
“The failure rate for conventional alcoholism
treatment is in the upper 80th or even 90th percen-
tile,’ Dr. Yung says. “There have been reports that
much of the counseling and group therapy that alco-
holics get has no effect on how long they stay sober.
That encouraged me to look at the problem from a
nutritional standpoint.”
A study in Texas adds more evidence to the
nutrition theory. At a Veterans Hospital Medical Cen-
Alcoholics who ate well ter in Waco, Ruth Guenther, Ph.D., looked at the ef-
stayed sober longer. fects of nutrition on a group of hard-core alcoholics.
These were men who had been drinking, on the aver-
age, the equivalent of 13 ounces of alcohol a day for
the previous 15 to 20 years. She discovered that alco-
holics who ate well could stay sober longer.
The men were studied in two groups. Dr.
Guenther asked the first group to stay on the standard
hospital diet and asked the second group to switch to
a special diet plan that she had prepared. This experi-
mental diet included foods like wheat germ, bran,
decaffeinated coffee and unsweetened fruit in con-
junction with the regular hospital diet. She also asked
the second group to swear off all snacks except for
the nuts, cheese, peanut butter and milk that she pro-
vided. Finally, she asked them each to keep taking a
multivitamin supplement for six months after their
release from the clinic.
The results were gratifying. When interviewed,
the alcoholics on the special diet told Dr. Guenther
The special diet made a that they felt “calmer and more relaxed.” More im-
difference in mood and portant, their recovery rate was very high. Six months
sobriety.
after they went home, 81 percent of the vitamin group
was still sober. By comparison, only 38 percent of the
control group had not taken a drink U/nternational
Journal of Biosocial Research).
 Chapter 55 269

Anemia:
Who Gets It and
What to Do about It

G6
feel so much better—I never realized |
haven't had the energy | should.”
This is a common reaction from people who’ve
bounced back from iron-deficiency anemia, a com-
mon blood disorder whose hallmark is feeling tired
and washed out.
“Very often, we'll give an iron supplement to
people who are only slightly anemic, and they'll re-
port feeling more energetic,” says Suzanne McClure, Restoring energy with
M.D., assistant professor of medicine in the Division iron.
of Hematology-Oncology at the University of Texas
Medical Branch in Galveston.
“We have seen reports,’ adds Annette Natow,
R.D., Ph.D., professor of nutrition at Adelphi Univer-
sity in Garden City, New York, showing “that just
having low-iron intake—without being full-blown
anemic—might result in some people having con-
centration ability and immune-system responses that
aren't up to par.”
People who develop more pronounced iron defi-
ciency may have fatigue compounded by depression,
fainting spells, headaches, heartburn, irritability, itch- The many symptoms of
ing, pale lips and skin, poor appetite or memory, a severe iron deficiency.
sore tongue or brittle nails. Also, people with angina
may notice their condition getting worse.

Supply Down, Demand Up

The body’s energy levels are taxed when it
doesn’t get enough iron for one of the mineral’s chief
270 Solving Health Problems with Nutrition

functions: producing hemoglobin. It’s iron-based he-

moglobin that carries oxygen to tissues and cells to
energize them. If iron levels drop, then hemoglobin
and energy fade, too.
Doctors first look at what factors in a person’s
lifestyle might be acting alone or in combination to
deplete iron stores.
Iron deficiency and anemia often hit people
who’ve set themselves up this way: Neglecting to put
Too many people are in enough iron-rich foods in their diet, they don’t have
“iron debt’’—-and suf- enough of the mineral packed away in their bone
fer the consequences.
marrow for “emergencies” like they should. Then
they start to lose blood for expected reasons (men-
struation, pregnancy) or unexpected reasons (ulcers,
hemorrhoids). The blood loss bills the body for extra
iron to make up for what’s lost—and the body can’t
pay the balance.
This is just one anemia scenario. Prolonged, pal-
try iron intake alone, without a blood loss condition,
can make some people anemic. On the other hand,
it’s possible to not get enough iron and escape any
adverse effects.
A doctor can do a full-scale blood chemistry test
to analyze several factors, one being hemoglobin lev-
els, and determine if iron is in short supply. He or she
will also check to see if any of the following risk
factors are coming into play.

Menstruation Puts You at Risk

If you’re a menstruating female, you’re the most
likely candidate for anemia. “It’s almost impossible
The number one candi- for most women to get anywhere near the iron they
date for iron-deficiency need from their diets,” says Dr. Natow. “If a woman’s
anemia.
on a 1,000-calorie reducing diet, for example, she’s
probably only taking in 6 milligrams of iron—pitifully
less than the Recommended Dietary Allowance
(RDA) of 18 milligrams. Even if she eats 2,000 calo-
ries a day, which is generally way more than figure-
conscious women will allow themselves, her iron in-
take will average only about 12 milligrams. Add to
 Anemia: Who Gets It and What to Do about It 271

that the fact most women choose iron-poor ‘diet

foods’ like cottage cheese, yogurt, lettuce and fruit
juice for a good percentage of what calories they do
consume, and iron deficiency becomes even more
likely.” (Editor’s note: The RDA for women 11 to 22 is
18 milligrams; for women over 22, the RDA is 10
milligrams.)
Menstruation compounds the iron problem even
more. Women with heavier flows face greater odds of
being iron deficient; birth control pill users run a less-
ened risk due to usually lighter periods. Pregnancy
especially takes its toll on iron by assigning the moth-
er’s iron supply to double-duty nourishing.
‘‘A woman can suffer from somewhat of an iron
deficit after years of simply being female,” Dr. Mc-
Clure notes. She once attended a health fair for hospi- Recommendation for
tal employees where all female nurses had their iron women: Have your blood
checked regularly for
levels evaluated. “Over one-quarter of the women low iron.
were iron deficient and a few were outright anemic.
These were health-conscious people who knew all
about, and cared about, eating well, but menstrual
blood loss was still sapping their iron. This is why
women should have their blood checked at regular
intervals,” says Dr. McClure.

Iron Losses in the GI Tract

Gastrointestinal disorders may contribute to ane-
mia. This is the main thing that puts a man at risk for
iron-deficiency anemia, because men easily consume
their RDA of 10 milligrams of iron each day.
Many things might cause gastrointestinal bleed-
ing. Some, like hemorrhoids, can obviously be no-
ticed by a person. Other conditions—benign or ma- For unexpected rea-
lignant polyps, or bleeding ulcers, for example—may sons, some men are
also at risk for iron
go undetected without an internal exam. Irritable deficiency.
bowel syndrome can sometimes cause blood loss,
too. “When you hit 40 and older, you enter a higher
risk group for GI conditions,” Dr. McClure explains.
“You can’t always notice blood in your stool, either,
because it may not be red. It’s a good idea to do one
272 Solving Health Problems with Nutrition

of the home stool tests, or get one from your doctor,

every year. This isn’t on people’s list of top ten things
to do, but it’s an important diagnostic test that
shouldn’t be avoided.” The American Cancer Soci-
ety’s guidelines of having a thorough colon and rectal
exam between ages 40 and 50, followed by another
exam every three to five years, are also wise measures.
One additional stomach irritant: aspirin. It can
cause bleeding in people who take large amounts.
(It’s not uncommon for arthritis sufferers to take four
tablets every four hours, says Dr. Natow, to relieve
pain.)

Children Need Plenty of Iron

“A growing child needs to get lots of iron to
handle the job of building all the new red blood cells
in the growing volume of blood,” explains Myron
Winick, M.D., a New York City pediatrician and direc-
tor of the Institute of Human Nutrition at Columbia
University College of Physicians and Surgeons. “His
or her diet needs lots of iron-rich meats and vegeta-
bles, or iron-fortified cereals. If the child’s a picky
eater, iron supplements are in order to make sure the
body can keep up with the increased iron need.
“Babies, until about their first birthday, should
either keep receiving breast milk or iron-fortified for-
Good sources of iron for mula,” stresses Dr. Winick. “Starting a baby on whole
babies: breast milk or milk earlier than this deprives him or her of iron. Not
iron-fortified formula.
only because whole milk simply doesn’t have any but
also because it contains high amounts of protein
which can cause microscopic bleeding in the gastro-
intestinal tract and cause blood to be lost in the stool.
Breast milk’s iron is very well absorbed, on the other
hand.”

Iron Blockers to Watch Out For

Certain dietary factors inhibit iron absorption.
Coffee and tea contain tannin, a substance which, if
 Anemia: Who Gets It and What to Do about It 273

the beverages are taken with meals, can cut the

amount of iron absorbed by 40 to 95 percent. If these
drinks are one of your favorite pleasures, try waiting
until an hour or two after a meal to have them.
Iron is also blocked by the phosphates in ice
cream, candy bars, baked goods, beer and soft drinks.
EDTA, an additive in many canned and processed Two additives that sub-
foods, has the same inhibiting trait. (Check labels for tract iron.

EDTA if you’re concerned.)

Calcium, important for bones though it may be,
may also be guilty of iron inhibition when it’s taken as
a supplement with meals. To avoid interfering with
iron absorption, women seeking to guard against os-
teoporosis should not take their calcium supplements
with foods serving as a primary source of iron.

Gatekeepers of Iron
In addition to being aware of iron sappers, you
can make the most of iron enhancers. Beef, veal, fish,
lamb, poultry and game all multiply iron absorption
fourfoid. These meats encourage your body to take in
nonheme iron, a form of the mineral that isn’t easy to
absorb.
Vitamin C lends a hand in nonheme iron absorp-
tion, too. Dr. Natow suggests if you take an iron sup-
plement, you drink vitamin C-rich orange juice at the Vitamin C helps your
same time. Good vitamin C bets are citrus fruits, cab- body absorb iron.
bage, peppers, tomatoes, broccoli, cantaloupe and
strawberries. Still another iron pick-up from vegeta-
bles and citrus fruits: lots of folate, a B vitamin that
iron needs to pair up with for optimal performance.
Folate is also abundant in liver and beans.
The iron-pot trick can boost iron intake three-
fold. As your food simmers in the skillet, some of the
pot’s iron comes off into the food and strengthens its
nutritional value.
Finally, these foods, and perhaps an iron supple-
ment if needed, are the best at keeping your iron
stores stocked:
274 Solving Health Problems with Nutrition

e Beef and chicken liver, roast beef, lean ground

beef, chicken, dark-meat turkey.
lron-boosting foods. e Prunes, dried apricots, blackstrap molasses,
sunflower seeds.
e Lima beans, soybeans, broccoli, spinach, peas,
beet greens or kidney beans.
 Chapter 36 275

Arrhythmias:
Heartthrobs You Can
Live Without

here you are, sitting down with a mug of coffee

in the tranquillity of your own kitchen, when
your heart races as if you'd just run up a flight of stairs.
Or, while sleeping on your left side, you’re suddenly
awakened by the pounding of your heart. Or, for no
reason at all, you feel as if butterflies are fluttering
where your heart should be. When this happens, it’s
scary—scary enough to make you consider an imme-
diate trip to the cardiologist.
Sometimes these arrhythmias, as they’re called,
do mean that something is wrong with the heart.
Ventricular fibrillation, in which the heart beats ran- When the beating of
domly and recklessly, can lead to death. Certain kinds your heart is cause for
concern.
of bradycardia or tachycardia, which means the pulse
is too slow or too fast, may mean that there is some
underlying ailment.
But more often than not, temporary arrhythmias
aren't cause for mental anguish. “Mild arrhythmias
are the most common reason for referral to a cardi-
ologist,” says one doctor, and others say that occa-
sional mild arrhythmias “no more augur sudden death
than a sneeze portends pneumonia.” In fact, healthy
people whose hearts never miss a beat are very much
in the minority.

Irregular but Not Abnormal

A significant advance in cardiology in recent
years has been the discovery that arrhythmias are
276 Solving Health Problems with Nutrition

common among normal, healthy people. Irregular-

Arrhythmias: worrisome, ities once thought to be life-threatening—fast pulse,
but not rare. ventricular ectopic beats (irregular beats) and even
some types of heart block (a failure in the flow of
electric impulses across the heart muscle)—happen
to, but seem not to bother, people who are otherwise
in good health.
In England a few years ago, researchers set out to
discover ‘“‘the rhythm of the normal human heart,”
Some heartbeat irregu- studying the electrocardiographs of 86 healthy people
larities are perfectly who had no trace of heart disease. To the scientists’
normal.
surprise, most of the study group possessed a rhythm
disturbance of some kind. The normal, in other
words, was abnormal. To explain why these people
seemed to do just fine even with arrhythmias, the
researchers said, ‘Perhaps these disturbances may
well be tolerated by a normal heart” (Lance?).
Others have agreed with them. “When ventricu-
lar ectopic beats occur in someone who has heart
irregularities, they can generate a lethal disturbance,”
says Bart Gershen, M.D., “but in a healthy person, this
arrhythmia might have no effects at all.”
Indeed, even the healthiest people suffer arrhyth-
mias. Dr. Gershen surveyed 50 healthy medical stu-
dents at Holy Cross Hospital in Silver Spring, Mary-
land, and found that at least half showed skipped
beats, palpitations or pounding in their chests, while
their pulses at times soared as high as 180 and as low
as 37 beats per minute. Other cardiologists have
found that harmless arrhythmias commonly show up
in superfit distance runners, even while they run
(American Heart Journal).
It is also entirely normal, apparently, for arrhyth-
mias to become more frequent as we get older. Even
As we get older, erratic the elderly shouldn’t become alarmed just because a
heartbeats become few mild ventricular arrhythmias show up on their
more common.
electrocardiograms. A survey of 106 active people
over age 75 showed that most of them had signs such
as irregular beats or racing pulse, but the symptoms
didn’t cramp their lifestyle. In fact, among those 106
relatively healthy elderly persons, only 24 (23 per-
 Arrhythmias: Heartthrobs You Can Live Without 277

cent) could boast of a “normal” heart rate for 24

hours straight (American Heart Journal).

Causes of Arrhythmias
Of course, cardiac arrhythmias are sometimes an
indication that something has gone awry with the
heart. This “something” could be anything from ad-
vanced heart disease to nothing more serious than a
reaction to strong coffee.

Heart Attack
Ventricular arrhythmias, for instance, often ac-
company a heart attack, appearing at the time of the
attack and in the weeks that follow. It used to be Are arrhythmias that ac-
gospel that post-heart-attack arrhythmias could trig- company heart attacks
a cause for alarm?
ger a second attack. For that reason, doctors often
plied their heart patients with antiarrhythmia drugs.
But studies have shown that those arrhythmias are an
effect rather than a cause of heart attack and may not
require medication (British Medical Journal).
Similarly, atrial fibrillation, in which the heart
may have an irregular rhythm, is also associated with
diabetes, and it greatly increases the chance of a fatal
heart attack. But there’s a more positive note: Atrial
fibrillation is much less dangerous when it strikes
someone with a fairly healthy heart (Vew England
Journal of Medicine).

Lack of Magnesium
On the other hand, arrhythmias may not indicate
a heart attack at all. They might be a symptom of
magnesium deficiency. Magnesium deficiency
Anyone who uses diuretic medication to control causes out-of-sync
heartbeats.
high blood pressure is a candidate for magnesium
deficiency. Diuretics drain the body of magnesium,
and they are among the most commonly prescribed
types of drugs in America.
But those not on diuretics are also vulnerable.
The average magnesium intake by Americans in 1900
was 475 milligrams a day. Today, however, the aver-
278 Solving Health Problems with Nutrition

age intake is only 245 milligrams a day—well below

the 300 to 350 milligrams a day recommended by the
National Academy of Sciences.
“Any patient who is on diuretic therapy and has
irregularities in the heart rhythm should be checked
Diuretics can lead to a for serum magnesium levels,” says Eugene Coodley,
lack of magnesium— M.D., of the Veterans Administration Medical Center
which may warp heart
rhythm.
in Long Beach, California. “If they are low, they
should be brought up with magnesium sulfate.”
It should come as little surprise that magnesium
is essential for a regular pulse. On a cellular level, a
magnesium-dependent enzyme helps generate the
energy that gives each heartbeat its oomph, and there
have been cases in which people with life-threatening
arrhythmias have recovered their natural rhythm with
no other treatment than magnesium supplementation
(Acta Medica Scandinavica).

Caffeine
Caffeine has been implicated as a dietary inducer
of arrhythmia. Americans consume about 2.2 billion
pounds of coffee a year, and the caffeine in that cof-
fee disturbs the pulse possibly in the same way that it
creates alertness and insomnia—by triggering the re-
lease of adrenaline. People with existing heart prob-
lems are especially vulnerable to caffeine, and for that
reason most cardiac care units allow only decaf-
feinated beverages as a matter of policy (New Eng-
land Journal of Medicine).
Coffee-induced arrhythmias, in fact, can be
frightening, and they send many anxious people in
Palpitations after morn- search of a cardiologist. ““We see a number of people
ing coffee. who developed palpitations after their morning cof-
fee,” says Carl V. Leier, M.D., of Ohio State University.
‘Some people are more sensitive than others, and the
phenomenon isn’t universal,” he says, ‘but about half
of the people we see with arrhythmias also are coffee
drinkers. If you have an arrhythmia and drink a lot of
coffee, our advice would be to cut down.”
 Arrhythmias: Heartthrobs You Can Live Without 279

Stressful Lifestyle
Emotional stress can also raise the body’s adren-
aline levels and increase the likelihood of arrhyth-
mias. The same high-stress life agenda that gives heart Is stress throwing your
attacks to driven executives often gives them arrhyth- heartbeat off its pace?
mias as well. Researchers at Harvard School of Public
Health say that “psychological stress profoundly low-
ers the cardiac threshold for ventricular fibrillation”—
the arrhythmia that causes sudden death.
Almost any kind of stress seems to do. Studies
with animals have shown that such things as offering
and denying food and mild physical restraint in unfa-
miliar surroundings may cause arrhythmia. In
humans, feelings of abandonment, depression, alien-
ation and even violent dreams are thought to cause
arrhythmia.
Acute anger, researchers think, disrupts heart Warning: Anger can be
rhythms the most. Anger releases body chemicals that hazardous to your heart-
beat.
may constrict the arteries that supply the heart itself
with blood (Annual Reviews in Physiology).

Alcohol and Cigarettes

There is also a link between alcohol, cigarettes
and cardiac arrhythmias, but doctors aren’t sure how
strong it is. In one of the studies mentioned here,
British researchers found no obvious relationship be-
tween smoking and the type or number of arrhyth-
mias in people over age 75. Another study has shown
that, in a group of men and women of good health,
smokers had faster but not less-regular heart rates.
But nicotine, like anger, unleashes adrenaline,
and “‘cigarette smoking has been shown to lower the
threshold for ventricular fibrillation during a heart at-
tack.” Dr. Coodley urges his heart patients to “reduce
all coffee and alcohol and eliminate tobacco” be-
cause all “are capable of initiating arrhythmias.”
As for alcohol, this oft-abused substance is
known to be responsible for a syndrome called “‘holi-
day heart.” Every year between Christmas Eve and
280 Solving Health Problems with Nutrition

New Year's Day, apparently, hospital emergency

Alcohol: The cause of rooms are frequented by people who develop severe
the frightening ‘‘holiday arrhythmias as a result of alcoholic binges. In many
heart.”’
cases, the specific arrhythmia is atrial fibrillation. It
usually subsides when the alcohol wears off.
Many doctors believe that holiday heart occurs
only among alcoholics or those with a long history of
immoderate drinking. But Dr. Gershen says, “Any
time someone overdrinks, there’s the possibility of an
irregular heartbeat. Alcohol is a potential toxin to the
heart, and you don’t have to be an alcoholic to be
affected by it.”

Drugs
Almost any stimulant can adversely affect the
heart, Dr. Gershen says, even the low-grade stimulants
Watch out for stimu- that are found in over-the-counter drugs. ‘‘A lot of the
lants in over-the-counter cold remedies that are available without a prescrip-
medicine.
tion contain ingredients that affect the heart,” he says.
“Most of them contain cardiac stimulants, and you'll
see if you read the package that they shouldn’t be
taken by people with high blood pressure.
“Even people without heart disease can develop
rhythm disturbances from these drugs,” he adds,
“and they definitely can scare people” who might
experience sudden palpitation without knowing why.
If an arrhythmia doesn’t respond to changes in
diet or lifestyle, a cardiologist may prescribe medica-
Some heart drugs may tion for them. These medications sometimes backfire
backfire. and aggravate the very problem they were meant to
solve, however. “Drugs are given to prevent a simple
arrhythmia from developing into a more serious one,”
says Arthur Selzer, M.D., a San Francisco cardiologist.
“But once in a while they can have the opposite
effect.” Other doctors have pointed out that “‘all the
antiarrhythmic drugs that we have studied may aggra-
vate arrhythmias.”
Pacemakers are an option for those with a spe-
cific kind of arrhythmia called heart block, in which
the heart’s own electrical circuitry fails. Pacemakers
 Arrhythmias: Heartthrobs You Can Live Without

are implanted in a heart patient’s body, and they can

run for several years. They’re intended mainly for the Are you a candidate for
heart patient who suffers frequent fainting spells. a pacemaker?
Some doctors feel that pacemakers are too often in-
stalled unnecessarily. Dr. Selzer points out that pace-
makers are used twice as often in the United States as
they are in Europe, and that anyone who hasn’t
fainted and feels generally healthy should get a sec-
ond opinion before accepting a pacemaker.

Take Charge of Your Heart

Can the average person participate in relieving
his or her own arrhythmia? Yes, says Dr. Gershen. The
first step is to identify it. Sudden flushing is sometimes
a sign of arrhythmia. So is fatigue, especially if it’s
accompanied by difficulty with sleeping on the left
side, where the heart is pressed between chest and
mattress. And there are other signs.
“If someone is constantly aware of his or her
heart, and if the rhythm disturbances occur fre-
quently—several times a week—or if they last a long How to deal with ar-
time, for several hours or so, then the person should rhythmias.
probably see a doctor,” Dr. Gershen says.
The next step might be to increase your intake of
magnesium-rich foods, such as whole grains, dark
green vegetables and beans. Giving up coffee and
cigarettes, if you use them, is another tactic. Avoiding
alcohol would probably be a good idea. And an at-
tempt to resolve emotional stress may also help.
The most important strategy is the prevention of
heart disease in the first place. Experts agree that
cardiac arrhythmias are more common among heart
disease sufferers, and that, when they do occur, ar-
rhythmias are much more likely to damage a frail
heart than a strong one. The way to keep the heart
strong is to adopt a healthy, low-fat, high-fiber diet, a
regimen of regular exercise, and a relaxed, positive
attitude. That’s also the best way to prevent cardiac
arrhythmias.
282 Chapter 3)

A Guide to
Healthy Breasts

inding a lump in your breast can be frighten-

ing. Even when it’s happily resolved with the
diagnosis of “benign,” the experience can leave you
feeling vulnerable about this part of your body, won-
dering what you can do to avoid being a victim of
chronic breast pain, or worse, being the one in ten
women who gets breast cancer.
Knowing about your breasts—how they function
and their disorders—is a good way to minimize that
feeling of vulnerability.
Breasts consist mainly of fat, honeycombed with
milk-producing glands and ducts that respond to
How hormones affect changes in body chemistry. The milk-producing cells
breast comfort. lining the glands are controlled cyclically by three
major female hormones—estrogen, progesterone
and prolactin. In a woman of childbearing age, each
month these cells are stimulated to grow and to accu-
mulate fluids. This makes many women’s breasts feel
heavy, and sometimes painful and lumpy, three or
four days before their period. When menstruation be-
gins, this hormonal stimulation stops. In a healthy
breast, cell growth and fluids subside and pain disap-
pears.

What Breast Pain Means

In some women, though, premenstrual pain is
severe or becomes a month-long problem. Why this
happens is something researchers are still figuring out.
It’s most likely related to imbalances in hormone lev-
 A Guide to Healthy Breasts 283

els—too much estrogen or too little progesterone,

says Robinson Baker, M.D., director of the Breast
Clinic at Johns Hopkins Hospital, Baltimore. And it
may be influenced by other body chemicals pro-
duced by stress or stimulated by certain foods.
Lumpy, painful breasts are one of many ailments
that doctors place in the catchall category
“fibrocystic disease.”
“Most doctors will agree that lumpy, painful
breasts are perfectly normal,” says Susan M. Love,
M.D., director of the Breast Clinic at Beth Israel Hospi- The good news: Painful
tal. “Sixty percent of women have breasts painful breasts are normal.
enough to go to the doctor sometime during their
lives. Not because they want relief from the pain but
because they’re worried that they have cancer. If you
can reassure them that this is okay and that they do
not need treatment, most are perfectly happy.”
Other doctors do agree that painful, lumpy
breasts are common. But, as we'll see later, they don’t
all agree that the condition is normal or necessarily
healthy.
More severe forms of fibrocystic disease involve
three separate types of breast conditions—fibrosis,
the formation of cysts and changes in the cells lining The facts about
the milk ducts, says Dr. Baker. fibrocystic disease.
In fibrosis, the connective tissue that supports the
milk ducts grows and thickens into scar tissue, per-
haps as a result of too much estrogen, Dr. Baker says.
In itself, fibrosis is not painful. But frequently it is
accompanied by the formation of cysts. The milk
ducts, blocked by tissue growth, are unable to drain
properly and swell up into tender, fluid-filled sacs.
Cysts can range in size from barely palpable to large
enough to hold more than a quarter of a cup of water,
and they can form in a week or two, Dr. Baker says.

Cysts Are Painful but

Not Cancerous
Small cysts often shrink on their own; larger cysts
are often punctured and drained with a needle. If they
284 Solving Health Problems with Nutrition

recur several times in the same spot, they may be

removed surgically.
Does having fibrocystic disease increase your
risks of developing breast cancer? For years, doctors
More good news: had been saying it does increase your risk two to four
Fibrocystic disease it- times. Today, though, most say fibrocystic disease in
self doesn’t increase
your risk of cancer.
itself does not lead to breast cancer—that is, cysts do
not become cancerous.
Sometimes, though, some forms of this disease
include overgrowth and abnormalities in the cells lin-
ing the milk ducts. This condition, known as prolifera-
tive, or hyperplastic, disease, can develop into a ma-
lignancy, although only a small number do, Dr. Baker
says. The only way to diagnose this condition is by
tissue biopsy.
All women, whether they are at risk for cancer or
not, should examine their breasts each month. For a
Breast self-exams can woman with fibrocystic disease, though, the question
detect problems in time. is how to distinguish all those lumps and bumps from
one that might actually be cancerous. This is where
regular breast self-exams are important. The idea is to
become so familiar with your breasts, lumps and all,
that when you find:something different or unusual,
you recognize it for what it is and have it checked out.
“Any discrete [distinct] mass should be biopsied, re-
gardless of a patient’s age,” Dr. Baker says. But there
are ways to distinguish between benign and malig-
nant lumps.
A cyst will be tender and move easily. It feels
similar to an eyeball felt through an eyelid. A cancer-
ous lump is often painless. It will seem to be anchored
to the chest wall or to the breast tissue. Cysts can
occur in both breasts simultaneously, but cancer usu-
ally occurs in one breast only, most often in the up-
per-right quarter nearest the shoulder.
The greatest risks for developing breast cancer
are, unfortunately, things you cannot control. If your
Breast cancer: the fam- mother, sister or grandmother developed breast can-
ily factor. cer, your own chances of getting it are two to three
times greater than those of the general population. If
 A Guide to Healthy Breasts 285

the cancer developed prior to menopause or was in

both breasts, the risk is even higher. If you’ve already
had cancer in one breast, your chances of getting it in
the other breast are five times greater than if you’d
never had cancer.
Breast cancer is unusual in women under age 30.
Its incidence begins to rise in the early forties, but it’s
still relatively uncommon up to age 50. Most breast
cancers are found in women ages 55 to 60.

A Diet to Discourage
Breast Problems
There are ways, though, to decrease your odds,
both for bothersome but benign breast ailments and
breast cancer. More and more prevention-minded Fighting breast disease
health professionals are observing, and researchers with diet.
are confirming, that breast disease is influenced by
one factor we can do something about—diet.
‘I believe in taking a broad approach,” states
Phyllis Havens, a registered dietitian with the Whole
Health Group in South Portland, Maine, who counsels
many women with breast tenderness and swelling
and other premenstrual symptoms. “I recommend
some major dietary changes and vitamin supplemen-
tation.”
These include eliminating caffeine-containing
foods and fat-rich dairy products, cutting back on red
meats, sugars and fats, and adding safflower oil, fiber-
rich vegetables and vitamins E and B complex.
The observations of Havens and others that this
sort of diet relieves breast disease and problems with
other estrogen-sensitive tissues like the uterus and
ovaries are yet to be confirmed scientifically but are
suggested in part by laboratory research.

Caffeine Is Out
John Minton, M.D., Ph.D., of the Department of
Surgery, Ohio State University College of Medicine,
286 Solving Health Problems with Nutrition

Columbus, has found that substances contained in

certain foods can aggravate breast symptoms. These
substances produce biochemical signals that activate
enzymes that promote fibrous tissue and cyst fluid
development in women with fibrocystic disease.
“I know that most women can reverse lumpy,
painful breasts completely with changes in their diet,”
he says.
Dr. Minton discovered that eliminating foods
containing substances called methylxanthines (which
A change in diet meant include caffeine and are found in coffee, tea, cola and
fewer breast cysts. chocolate) was associated with the disappearance of
breast cysts in most women within a few months.
But he also noted that some women who initially
got much better on the diet later got worse. ‘“We
discovered that when they stopped drinking coffee,
they were somehow attracted to other foods that
were giving them the same biochemical kick,’ Dr.
Minton says.

Can Vitamin E Help?

Christiane Northrup, M.D., a Yarmouth, Maine,
gynecologist who refers some of her patients to the
Can vitamin E counter- Whole Health Group for nutritional counseling, pre-
act fibrocystic disease? scribes 400 to 800 international units daily of vitamin
E for her patients with fibrocystic disease. “I find it
sometimes helps a great deal to relieve pain and
swelling, especially when the symptoms occur be-
cause of rapidly changing hormone levels that come
with menopause,” she says.
Preliminary research by Robert London, M.D.,
director of reproductive medicine at North Charles
General Hospital in Baltimore, suggests that vitamin E
may be of value in treating breast cysts.
In one study, 80 percent of the women re-
sponded to 600 international units of vitamin E daily
for two months with decreased symptoms of pain.
His current work does not indicate that vitamin E
lowers levels of estrogen or progesterone.
 A Guide to Healthy Breasts 287

Vitamin A Offers Hope

What about vitamin A? Can this apparent cancer
inhibitor protect against breast disease? The answers
aren't in yet, but there’s a tremendous amount of
interest in its possible use, says Marc Lippman, M.D.,
director of the National Institutes of Health, Breast
Cancer Division, Bethesda, Maryland.
“The data from animal studies is quite encourag- Vitamin A: a force
ing,” Dr. Lippman says. “Forms of vitamin A can pre- against abnormal
growth of breast cells
vent the action of some tumor promoters, there’s no in the test tube.
doubt about it.” In tissue cultures, vitamin A prevents
the proliferation, or uncontrolled growth, of breast
tissue cells.
One of the most promising forms of vitamin A for
breast cancer, based on work done by Richard Moon,
Ph.D., is a retinoid called 4-hydroxyphenylretinamide,
which was surprisingly effective in the prevention of
breast tumors in mice exposed to carcinogens, says
Frank L. Meyskens, Jr., M.D., associate professor in
the Department of Medicine at the University of Ari-
zona in Tucson.
Researchers in Milan, Italy, may soon be con-
ducting a trial using this and other vitamin A forms
with women who have already had one breast cancer
to see if it reduces the rate at which a second tumor
appears.
In the United States, Maurice Black, M.D., of the
Institute for Breast Disease of the New York Medical
College, is using short-term high oral doses of both
vitamins A and E in women who have had one breast
cancer. This study arose as an offshoot of an ongoing
investigation of the protective effect of specific cell-
mediated immunity against the patient’s own tumor.
In the course of these studies, patients were identified
who lacked this immunity. It was those nonreactive
patients who participated in the high-dose vitamin
studies.
These women don’t naturally show the kind of
immune response associated with good survival rates,
288 Solving Health Problems with Nutrition

Dr. Black says. But with large doses of either A or E,

Promising results with 50 to 60 percent do show this immune response, and
vitamins A and E. with both A and E 80 percent show the response, Dr.
Black says. ‘““We don’t yet know if this induced re-
sponse works as well as a spontaneous response. We
haven’t been following these women long enough to
see if they have a reduced incidence of recurrent and/
or second primary breast cancer.” (Large doses of
vitamin A or E shouldn’t be taken without medical
guidance.)

Selenium Shows Promise

Selenium may have a protective effect. “The re-
sults of animal and human population studies con-
In mice, selenium seems tinue to be encouraging that the risk of breast cancer
to counteract breast does decline if selenium intakes are high,” says
cancer.
Gerhard N. Schrauzer, Ph.D., professor of chemistry
at the University of California at San Diego. In mice
bred to carry a virus that puts them at high risk of
developing breast cancer, those receiving extra sele-
nium had an incidence of breast tumors that was 10
percent lower than those that received no additional
selenium. “‘And there’s increasing evidence that many
human breast cancers have a similar viral influence,”
Dr. Schrauzer says. Mice that had been fed a high-fat
diet and exposed to cancer-causing chemicals also
had fewer, slower-forming tumors with selenium sup-
plementation.
‘Human studies with selenium and breast cancer
have yet to be done on a large scale, but ongoing
Can selenium fight studies in Finland and Australia with women with
breast disease in benign fibrocystic disease are showing that selenium
humans?
supplementation does seem to have beneficial ef-
fects,’ Dr. Schrauzer says. This is a hopeful sign that
this unpleasant condition will, in the future, become
preventable and treatable by nutritional means. Foods
high in selenium include seafoods, liver, kidneys,
meat and some whole grains. Supplements of more
than 100 micrograms shouldn’t be taken.
 A Guide to Healthy Breasts 289

Cut Back on Fat

Your best bet against both benign breast disease
and breast cancer may be the same thing that helps
protect against heart disease—a low-fat diet. Popula-
tion studies show a strong parallel between fat con-
sumption and the incidence of breast cancer. Low-fat
countries like Japan and Thailand have only about
one-quarter the number of breast cancer deaths as the
United States, Denmark and the Netherlands, where
people consume up to twice as much fat.
And in animal studies, the evidence is “over-
whelming” that a high-fat diet enhances the develop-
ment of breast tumors, says Clifford Welsch, Ph.D., a
tumor biologist with a special interest in breast dis-
_ ease and professor of anatomy at Michigan State Uni-
versity. Dr. Welsch and colleagues are trying to figure
out just what it is that links fat with breast disease.
“One idea is that it promotes the secretion of
hormones that stimulate the development of both
hormone-responsive, normal and cancerous breast Theory: more fat,
tissue,’ Dr. Welsch says. “It’s my opinion that the more hormones, more
disease.
evidence favors the theory that a high-fat diet in-
creases the susceptibility of the breast tissue to hor-
mone stimulus.”
Forty percent of the calories in the average
American diet come from fat, mostly in meat and
dairy products like butter, cheese and milk. “I think
we'd all do well to cut that by one-third to one-half,”
Dr. Welsch says.

Increase Fiber, Decrease Stress

And it might be a good idea to replace some of
that fat with high-fiber foods, such as whole grains
and vegetables. Chronic constipation, something few A place for fiber in the
people eating high-fiber diets experience, has been healthy-breast diet.
associated with breast disease. Researchers at the
University of California at San Francisco found that
women with severe constipation (two or fewer bowel
movements a week) were five times more likely to
290 Solving Health Problems with Nutrition
i

show signs of possible abnormal cell proliferation in

aspirated breast fluids than were women with normal
bowel functions.

News Flash on Fat and Breast Cancer

Breast cancer is a major killer of Karmali, Ph.D., of Rutgers Univer-
American women, and among sity, and her colleagues say that
those age 40 to 44, it causes more they were able to protect labora-
deaths than anything else. tory rats against breast cancer by
In 1942 a scientist demon- feeding them fish oil. “Fish oil,”
strated that there’s a probable link says Dr. Karmali, “inhibited the
between breast cancer and fat in growth of transplanted tumors,
the diet. And the evidence for that helped block development of
link has been getting stronger— chemically induced tumors and
and more complex—ever since. lowered levels of a biochemical
Now it seems clear that the more indicator of cancer activity.” Pre-
fat you have in your diet, the more venting cancer in rats is a long
likely you are to get breast cancer. way from preventing it in people,
But there are some new wrin- she says. However, these prelimi-
kles in the data. There’s accumu- nary findings hint at promising
lating evidence that a low-fat diet possibilities.
may actually prolong the lives of Do scientists now have
women who already have breast enough information to devise a
cancer. diet that prevents breast cancer, a
In one study of 953 women diet including the right dietary fats
with breast cancer, researchers in specific amounts?
discovered that the women’s risk Not yet. So far all they know
of death increased 1.4 times for is that cutting overall fat intake is
every 1,000 grams of fat eaten per likely to reduce the risk of breast
month (equivalent to one extra cancer. The National Research
pat of butter or margarine per Council advises that, to lower the
day). This connection between risk of this disease and colon can-
life expectancy and fat intake was cer, dietary fat should be reduced
especially strong for women with to 30 percent of total calories.
cancers that were spreading. “Indeed,” the council ad-
Echoing the reports of other mits, “the data could be used to
scientists, researcher Rashida A. justify an even greater reduction.”
 A Guide to Healthy Breasts 291

“It may be that estrogen secreted by the liver is

reabsorbed more readily by women with sluggish di-
gestion,” says Nicholas Petrakis, M.D., professor of
preventive medicine at the University of California,
San Francisco. “This could have a stimulating effect
on the breasts.”
One other thing the doctors who treat breast
disease frequently mention is stress. “Most of the
women I see feel their symptoms are aggravated Can stress make breast
when they’re upset or overworked,” Havens says. One symptoms worse?
of Dr. Love’s patients, a politician, suffers from breast
pain only when she is campaigning.
“One’s attitude, what we call the neuroendocrine
aspect of tumorigenesis, can markedly control the
development of breast disease,’ Dr. Welsch says. “It Preventing breast can-
affects the entire central nervous system and can cer with a new attitude.
really throw it out of whack.”
What’s a “good attitude” to have? It’s not being
so paranoid about getting cancer that you live in fear,
but it’s also not being negligent about checking your
breasts for lumps each month—or taking other mea-
sures to reduce the risks, Dr. Welsch says.
292 Chapter 38
Bruises:
What to Do When
You’re Black and Blue

o you bruise easily, even when you can’t

recall hurting yourself? Do you wonder why
youre black and blue? If so, you’re not alone. Many
people bruise easily. For most, it is not a serious prob-
lem, but tracking down the cause may be worthwhile.
In some cases, bruising can be prevented. In others,
bruises point to an underlying illness.
A blow to the body injures blood vessels and can
make a bruise appear. Further bleeding is prevented
The anatomy of a through a process called hemostasis. First, the blood
bruise. vessels narrow in response to the injury, and the clot-
ting cells, or platelets, are attracted to the areas of
blood-vessel damage. The platelets stick to these ar-
eas and cause a tight, but temporary, plug to form.
Then proteins called clotting factors are activated,
and the plug becomes permanent. This strong struc-
tural barrier is what prevents blood loss. If something
goes wrong at any point in this chain of events, bleed-
ing or bruising may result.
The appearance of bruises can sometimes sug-
gest which part of the chain is functioning improperly.
When to worry about If your bruises look like clusters of small dots, you
bruises. may have a platelet disorder. Bigger bruises generally
indicate an abnormality in blood vessels or clotting
factors.

Bruising Has Many Causes

If your bruises are larger than an inch across, if
you've had no injury that you can recall and if you
 Bruises: What to Do When You’re Black and Blue 293

haven't bruised easily in the past, your bruising may

be caused by one of several factors known to interfere
with hemostasis.

Drug-Induced Bruises
Certain common drugs can adversely affect the
hemostatic process. A single aspirin can reduce plate-
let function for an entire week. Anti-inflammatory Cough remedies are one
medications, antidepressants, asthma medications possible offender.
and substances found in many cough remedies also
inhibit platelet action. The number of circulating
platelets can be reduced by estrogen pills, diuretics
and large amounts of alcohol. Steroids may weaken
the supporting tissue of blood vessels in the skin,
making them tear more easily. Spontaneous or easy
bruising may result.

Nutrition-Related Bruises
Deficiencies in vitamin B,, and folate may cause a
decrease in production of mature platelets and con-
tribute to easy bruising. Drugs like Dilantin, a seizure-
control medication, may inhibit folate absorption.
Over a period of time, a poor diet could result in a
vitamin B,, deficiency.
Vitamin C plays a major role in the synthesis of
collagen, the main protein in the supporting fibers of
the blood vessel walis. If you lack vitamin C, these Vitamin C: a possible
fibers could weaken, making the blood vessels fragile. link to easy bruising.
It’s not certain whether increased doses of vitamin C
will cure easy bruising. But it has been shown that
vitamin C in doses eight times the Recommended
Dietary Allowance (RDA) of 60 milligrams speeds
wound healing, which also requires the production of
collagen.

Autoimmunity and Bruises

Easy bruising may result from viruses and autoim-
mune diseases. Viruses can occasionally cause a tem-
porary drop in the platelet count. Lupus, an autoim-
mune disease in which the body attacks its own cell
components, may cause a reduction in platelets and a
294 Solving Health Problems with Nutrition

production of substances that inhibit the clotting fac-

tors. Autoimmune diseases brought on by a reaction
to certain hair dyes, insecticides, common drugs or
quinine in tonic water destroy the circulating platelets.

Hereditary Bruising
If you have a family history of bruising or bleed-
ing, you should consider having an evaluation for Von
Cautions for bruise- Willebrand’s disease. This is an inherited disorder of
prone families. one of the clotting factors. For unknown reasons, it
affects women more often than men. Since the symp-
toms are often mild, this disorder may go unrec-
ognized for a long time. You might notice prolonged
bleeding after a wisdom tooth extraction, frequent
nosebleeds, heavy periods or continued bleeding
from a small cut. Individuals with Von Willebrand’s
disease should be especially careful to avoid aspirin
and other drugs that inhibit hemostasis. Sometimes it
may be necessary to treat this disorder by replacing
the clotting factor.

Beating the Bruises

It is comforting to know that bruising is usually
not associated with serious disease and generally has
Three vitamins that may no serious consequences. If you bruise easily, ask
help.
your doctor about discontinuing unnecessary medica-
tion, especially aspirin. Make sure you eat a well-
balanced diet that includes plenty of folate and vita-
mins C and B,. If your bruising persists, see your
physician for evaluation for an underlying illness.
 Chapter 39 295

Ten Ways to Guard

against Cancer

any of us have lived with a feeling of help-

lessness about cancer for so long that it’s
hard to change our thinking. But a massive body of Eighty-five percent of
research now refutes the long-held belief that we are all cancers could be
prevented.
at the mercy of cancer and instead shows that we can
prevent it.
How much of an impact could we have if we all
practiced prevention? “If it were possible that we
could carry it out ideally, as much as 80 to 85 percent
of all cancers today might not occur,” says Charles A.
LeMaistre, M.D., president of the American Cancer
Society. “For too long we have regarded cancer as
the dominant factor in its relationship with human-
kind. Now, preventing this disease is becoming more
and more realistic.”

Hallmarks of an Anticancer Diet

By avoiding the things that are known to cause
cancer and incorporating into our lives factors that
protect against it, we can reduce our risk of develop-
ing the disease.
“In some areas, the information is now so com-
plete that it’s unequivocal, such as the causal role of
smoking in the development of cancer,” says Dr. We now have enough in-
LeMaistre, who is also president of the University of formation to take action
against cancer.
Texas’s M. D. Anderson Hospital and Tumor Institute
in Houston. “In other areas, such as diet and nutrition,
information is not yet complete, but it is sufficient to
take action.”
296 Solving Health Problems with Nutrition

Seven Dietary Steps

to Ward Off Cancer
The following steps, recommended by the Ameri-
can Cancer Society, summarize what we can do. Fol-
lowing these steps will also contribute to a healthier
life in general.

1. Eat more high-fiber foods. There is a lot of

evidence that colon cancer is less common in popula-
tions that eat a diet high in fiber, such as whole grains,
fruit and vegetables. In a study comparing Finnish and
Danish people, for example, colon cancer was much
lower among the Finns. The diets of the two groups
are similar, except that the Finns eat large amounts of
high-fiber, whole-grain rye bread, while the Danes
have a low-fiber diet.
Fiber may work by hastening the travel time of
fecal matter through the bowel, so that carcinogens
How fiber works. (cancer-causing substances) are whisked away before
they can do their damage. Another theory is that by
increasing the bulk of the stool, fiber dilutes the con-
centration of carcinogens.
2. Eat more foods rich in vitamin A. Spinach,
carrots, sweet potatoes and apricots and other
sources of vitamin A may help protect you against
cancers of the lung, esophagus and larynx. In a major
study, Norwegian men whose intake of vitamin A was
above average had less than half the rate of lung
cancer of men whose intake of the vitamin was below
average.
Right now it’s unclear whether the effects are due
to vitamin A itself or a precursor of vitamin A called
Vegetable ‘‘colors’’ that beta-carotene, a pigment found in plants. The empha-
may stop cancer. sis now is on the naturally occurring pigment because
the precursors of vitamin A are the most probable
agents that have this effect.
Beta-carotene is found in dark green and deep
yellow vegetables and in deep yellow fruits.
3. Get plenty of vitamin C. Studies indicate
that people whose diets are rich in vitamin C are less
 Ten Ways to Guard against Cancer 257

likely to get cancer, particularly of the stomach and

esophagus.
We know that vitamin C can inhibit the formation
of nitrosamines, cancer-causing chemicals, in the
stomach. That may be how it protects against cancer.
Fruits and vegetables, particularly oranges,
grapefruit, green peppers, broccoli, tomatoes and po-
tatoes, are good sources of the vitamin.
4. Eat more cabbage-family vegetables.
Broccoli, cauliflower, brussels sprouts, cabbage, kale
and kohlrabi are known as cruciferous vegetables. A possible cancer
Studies in large groups of people have suggested that fighter: the lowly cab-
bage family.
consuming cruciferous vegetables may reduce the
risk of cancer, particularly of the gastrointestinal and
respiratory tracts. And tests in laboratory animals re-
veal that cruciferous vegetables may be highly effec-
tive in preventing chemically induced cancer.
What is it about these foods that is protective?
‘We have to look upon these vegetables as a source
of vitamins A and C and fiber, but there are other
possibilities under investigation,’ Dr. LeMaistre says.
5. Trim fat from your diet. Studies in humans
and laboratory studies point out that excessive fat
intake increases the chance of developing cancers of
the breast, colon and prostate. And it’s not just one
kind of fat that’s a problem. Both saturated and unsat-
urated fats, whether of plant or animal origin, have
been found to enhance cancer growth when eaten in
excess.
The National Academy of Sciences recommends
that we decrease the amount of fat in our diet to 30
percent of the total calories we eat. (Americans cur- A healthy level of fat:
rently consume about 40 percent of total calories as 30 percent.
fat.)
You can cut your fat intake by using less fats and
oils in cooking, and by switching to lean meat, fish,
and low-fat dairy products.
6. Control your weight. ‘The long-standing
and repeated observation that obesity is correlated
with cancer is sufficiently substantiated to take ac-
tion,” says Dr. LeMaistre. In one massive study con-
298 Solving Health Problems with Nutrition

ducted by the American Cancer Society over 12 years,

40 percent overweight researchers found an increased incidence of cancers
and more likely to get of the uterus, gallbladder, breast, colon, kidney and
cancer.
stomach in obese people. In that study, women and
men who were 40 percent or more overweight had a
55 and 33 percent greater risk of cancer respectively
than people of normal weight.
Regular exercise and lower calorie intake can
help you avoid gaining weight. It’s advisable to check
with your doctor before embarking on a special diet
or strenuous exercise routine, though.
7. Avoid salt-cured, smoked and nitrite-
cured foods. Cancers of the esophagus and stomach
are common in countries where large quantities of
ham, bacon, hot dogs and salt-cured or smoked fish
and similar foods are eaten.

Calcium against Colon Cancer

Colorectal cancer is the second from the equator—places with
deadliest cancer in the nation, kill- less sunshine. The hypothesis was
ing about 60,000 people a year. that since sunlight helps the body
(Lung cancer is number one, make vitamin D, and vitamin D en-
felling about 126,000 people a ables the body to absorb calcium,
year.) it was this nutritional pair that re-
Among scientists there’s a duced colon cancer.
growing suspicion that manipulat- On top of this, scientists re-
ing certain factors in the diet may ported that in Scandinavia colon
help prevent colorectal cancer. In cancer occurs least where con-
addition to lowered dietary fat sumption of milk is greatest. And a
and increased fiber, researchers 19-year study in Chicago revealed
are now looking at a new possibil- that men with the lowest intake of
ity: calcium. vitamin D and calcium had about
The idea that calcium might three times the risk of colorectal
help deter colon cancer got a cancer as those who had the high-
boost when researchers noticed est intake.
that the disease seemed to strike Further evidence comes from
more frequently in latitudes far researchers at Memorial Sloan-
 Ten Ways to Guard against Cancer 299

Smoked foods absorb some of the tars from the

smoke they’re cured with. The tars contain cancer-
causing chemicals similar to those in tobacco smoke.
There is also good evidence that nitrates and nitrites
can enhance the formation of nitrosamines in our
food and digestive tracts.

Three More Important

Precautions
In addition to diet, certain health habits can help
stave off specific kinds of cancer.
1. Don’t smoke cigarettes. “About 30 percent
of all cancer is clearly and unequivocally due to ciga-
rette smoking,” says Dr. LeMaistre. “It’s been 20 years _—A deadly vice.

Kettering Cancer Center and Cor- lower—comparable to that of

nell University Medical College in people with a lower risk of colon
New York City. They gave daily cancer. “Calcium modifies the
doses of 1,250 milligrams of cal- environment in the colon,” says
cium to people with family histo- chief researcher Martin Lipkin,
ries of colon cancer. The idea was M.D. “We think that calcium binds
to discover what effect the cal- [captures] bile and fatty acids, re-
cium might have on excessive ducing their irritation to the colon
proliferation (duplication) of cells lining and thus decreasing the
in the lining of the colon. Exces- proliferation of cells. The result is
sive proliferation is often found in a lower risk of colon cancer.
people prone to developing colon ‘We intend to conduct more
cancer. The researchers report research on calcium and colon
that before the calcium supple- cancer. We want to see what ef-
ments, cell proliferation was just fect calcium might have on ulcer-
what you’d expect in people sus- ative colitis, familial polyposis and
ceptible to colon cancer, but that other conditions that may lead to
after two to three months of tak- cancer of the colon,” Dr. Lipkin
ing calcium, proliferation was says.
300 Solving Health Problems with Nutrition

since the Surgeon General’s ‘Report on Smoking and

Health’, without any significant findings having been
refuted.” Smoking poses a risk to the nonsmoker
(passive smoking) as well, he points out.
If you’re a smoker and haven't quit because you
think “‘the damage has already been done,” take heart
It’s never too late to in the findings of a British study of over 18,000 people.
quit smoking. Researchers found that people who had smoked for
as long as 20 years—but who had been off cigarettes
for 10 years or more—had no greater risk of lung
cancer than people who had never smoked at all
(British Medical Journal).
2. Go easy on alcohol. Heavy drinkers, espe-
cially those who also smoke, are at very high risk for
cancers of the mouth and throat. Your risk of liver
cancer also increases if you drink a lot.
3. Shield yourself from the sun. Too much
sun causes skin cancer and other skin damage. “Like
most other Americans, I’m learning that the tanning of
hide is neither healthy nor beautiful,’ says Dr.
LeMaistre. ‘‘] use maximum-strength sunblocks and
also use hats and other ways of shading myself.”
A sunscreen with a sun protection factor (SPF)
of 15 or more gives maximum protection. Be espe-
A sunscreen for maxi- cially wary during the midday hours—from 11:00 AM.
mum protection. to 3:00 pm—when sunlight is strongest. And don’t use
indoor sunlamps or tanning booths—they’re not safe,
either.
Although they affect fewer people than the risk
factors already mentioned, excessive x-rays, certain
estrogen treatments and exposure at work to harmful
chemicals and fibers like asbestos should also be
avoided. “I think every effort should be made to pro-
tect a human being from excessive x-rays and from
the other known causes of cancer, albeit they cause a
very small percentage of cancer today,’ says Dr.
LeMaistre. You can ask your doctor about the need
for x-rays and estrogens and be familiar with proper
safety procedures on the job.
 Ten Ways to Guard against Cancer 301

Following all the preventive steps may reduce

your risk of cancer dramatically. But there’s another
side to cancer prevention—early detection. Uncover cancers
Sigmoidoscopy, Pap tests and breast exams, for ex- early—and live longer.

ample, can catch cancers when there’s still a very

good chance of curing them. For details on these and
other lifesaving early-detection methods, contact
your local American Cancer Society chapter or ask
your doctor.
302 Chapter AO

One Doctor’s
Prescription for
Cancer Prevention
By Charles B. Simone, M.D.

here has been a great interest in nutrition and

vitamins and minerals in the past several years. |
got involved with nutrients as cancer-preventive
agents in a very interesting way. While at the National
Cancer Institute in Bethesda, Maryland, a young man
with a rare cancer was referred to me for treatment. |
was a medical oncologist (chemotherapist), radiation
therapist and clinical immunologist.
Both he and his wife feared the word cancer, as
most of us do. They knew that cancer is the number
Why ‘‘cancer phobia’’ is two killer in this country. He asked me why he got
widespread. cancer: ‘““Why me?” I told him | didn’t know.

A Frighteningly Common Disease

One of every three people in America does get
cancer. This young man was my age, and his wife was
several weeks pregnant before his diagnosis was
made. My wife was also pregnant for the same period
of time. You can readily understand that an unusually
close bond between us was inevitable.
In our initial conversation, he requested that I do
all that was possible to cure him, but if that was
impossible, he wanted to live long enough to see the
birth of his child. As I said before, he had a rare

Charles B. Simone, M.D., is a radiation therapist and an associate

professor of radiation therapy at Thomas Jefferson University
Hospital's Bodine Center for Cancer Treatment in Philadelphia,
Pennsylvania.
 One Doctor’s Prescription for Cancer Prevention 303

cancer that had spread to many parts of his body by

the time I saw him. Both he and his wife were devoutly
religious.
When he first came to me as a patient, I was very
much involved with basic science. I had discovered
the fundamental mechanism of how our white blood The nutritional approach
cells kill foreign cells like cancer. White blood cells to cancer prevention
used to be considered
are one army of our immune system. The immune quackery.
system defends against infections and cancer. I was
also heavily involved with administering chemo-
therapy. And in addition, I was on the road to discov-
ering a new immunology technique to treat cancer
victims. None of my interests or training “permitted”
me to even think about nutrition as a therapy or as a
preventive agent. Only a few short years ago, nutri-
tional manipulation was considered quackery.
I began treating him with chemotherapy, and
after a number of months, all of his cancer was gone.
We were very encouraged. I continued on with the
chemotherapy, as was standard practice. After about
seven months he looked worse, but no cancer could
be found. | had several different consultants see him,
including a neurologist. No one could tell me why he
looked so bad in spite of the fact that we could not
detect any cancer. After several discussions, it was
suggested that he looked as though he had pellagra
(niacin-deficiency disease).
Since I had tried everything else, | decided, as a
last resort, to put him on high doses of vitamins and
minerals taken by mouth. He perked up within several To my surprise, the vita-
days. I couldn’t believe it. Because it was so hard for mins and minerals
seemed to work.
me to accept, I decided to stop the vitamins and
minerals after three weeks to see what would happen.
After I stopped them, he slumped down within days.
Even then I was still a doubting Thomas, but I put him
back on the same vitamins and minerals. Again, he
perked up.
Ultimately, however, the cancer consumed him,
but only after he had seen the birth of his son. Before
he died, he asked me what his son and wife could do
so that they would not get cancer.
304 Solving Health Problems with Nutrition

Investigating Vitamins and

Minerals
It was during that period of time that I began to
investigate the effects of nutrition on cancer, but more
| discovered that many, important, the effects of nutrition and vitamins and
many cancers are re- minerals in the prevention of cancer. (I found that
lated to what we eat or
don’t eat.
nutrition should not be used as the only treatment for
cancer but rather as an adjunct to conventional can-
cer therapies.) Other important factors bolstered my
interest also. I had heard estimates that nutritional
factors account for 60 percent of all women’s cancers
and 40 percent of all men’s cancers. That is a stagger-
ing amount of cancer related to what we eat or don’t
eat. Despite all of our various treatments for cancer,
the results, in general, are quite limited.
The question asked by that patient has often
been asked: ‘What can my family do so that they will
not get cancer?” Since there was limited progress in
treating cancer, I decided to turn some of my atten-
tion to preventing cancer.
After doing an extensive amount of research, |
realized that the tremendous increase in cancer could
Most cancer can be be halted. Most cancers can be prevented, since the
prevented. majority are related to preventable factors: nutrition
and tobacco use. I wanted to share this information
with people, so | wrote Cancer and Nutrition, which
was published by McGraw-Hill. In it I outlined a ““Ten-
Point Plan to Reduce Your Chances of Getting Can-
cer.” Point one discusses nutrition, and one important
aspect of it concerns vitamins and minerals.
Vitamins and minerals have many important can-
cer-preventive functions. One of the major protective
Vitamins and minerals effects appears to be their ability to neutralize or scav-
against ‘‘free radicals.”’ enge free-radical chemicals. Free radicals are by-
products of normal chemical reactions in your body
that can make a cell develop into a cancer if not
destroyed. They are also increased by harmful chemi-
cals that are known to cause cancer. We all have
natural protection against free radicals, thanks to cer-
 One Doctor’s Prescription for Cancer Prevention 305

tain vitamins and minerals called antioxidants, which

are free-radical scavengers.
Other cancer-preventive properties or actions of
some vitamins and minerals include killing cancer
cells directly, reversing precancerous conditions, en-
hancing the immune system and neutralizing toxic
chemicals. Here’s a brief outline of each micronu-
trient’s cancer-preventive properties.
Beta-carotene is heavy artillery. The body
uses beta-carotene to make vitamin A. Over the years
at least two dozen studies from around the world
have found that people who consume higher-than-
average amounts of beta-carotene and vitamin A have
a lower incidence of cancer.
Beta-carotene may inhibit the development of
cancer in the following ways:

1. It is a powerful antioxidant, or free-radical How beta-carotene may

neutralizer. help your body deter
cancer.
2. It greatly enhances the immune system, which
protects you from many diseases, including cancer.
3. It is the most powerful inhibitor of another
very destructive molecule, called “singlet oxygen,”
which can cause cancer.
Vitamin A gets into the act. Vitamin A has
many important functions. It decreases the growth of
human breast cancer cells and exerts a protective
effect for both smokers and nonsmokers against lung
cancer.
Several clinical studies have used vitamin A to Vitamin A: a promising
treat patients with skin cancer, lung cancer and cervix anticancer agent.
cancer. The results are very promising.
Robert Gallo, M.D., chief of the laboratory of
tumor cell biology, and his associates at the National
Cancer Institute have shown that high levels of a form
of vitamin A (retinoic acid) suppress a certain
oncogene. Oncogenes, very simply, are thought to
cause cancer once they are triggered to act.
How vitamin E works. Vitamin E is a potent
antioxidant. It inhibits the growth of certain cancer
306 Solving Health Problems with Nutrition

cells and neutralizes a potent chemical, called nitro-

samine, that can cause cancer.
Teaming B vitamins and pantothenic acid.
This group has been shown to be exceedingly impor-
tant for the immune system.
Vitamin C protection. Vitamin C is a potent
antioxidant that helps protect the body against blad-
Vitamin C against blad- der cancer. Researchers report a protective role of
der cancer. vitamin C in larynx cancer, cervical cancer and many
animal cancers.
Vitamin C may have a protective role in viral
illnesses. This may be important with a discovery that
a certain human cancer of the lymph glands is caused
by a virus. Also, AIDS seems to be related to a virus.
A deficiency in vitamin C causes a malfunction of
the immune system.
Other vitamins play a basic role. Niacin, vita-
mins D and B,,, folate and biotin have no known
direct anticancer or immune system effects. But they
are important for maintaining a healthy body that can
better fight off all diseases, including cancer.
Selenium and other defensive minerals. Se-
lenium is a potent antioxidant. My own research
Selenium: another force shows that selenium protects the cell membrane from
against destructive free-radical attack. Many animal studies show that
‘free radicals.”’
high levels of selenium inhibit the growth of various
cancers. The higher the selenium content of the soil,
the lower the cancer rate.
Copper and zinc are other minerals that are free-
radical scavengers. Zinc deficiency results in a mal-
functioning immune system. Iodine deficiency has
been related to thyroid cancer in several studies.

Marginal Intake
Means Marginal Protection
Vitamin or mineral deficiencies that are severe
enough to cause diseases can be detected with our
current capabilities. Marginal deficiencies, those
 One Doctor’s Prescription for Cancer Prevention 307

which do not show any outward signs of disease, are

very difficult to detect, however.
Many conditions (stress, smoking, advanced
age) require higher amounts of vitamins and minerals.
Also, it has been estimated that 25 percent of all Avoid marginal defi-
households do not have nutritionally balanced diets. ciencies and beef up
your protection against
These circumstances may produce marginal deficien- disease.
cies. These marginal deficiencies may result in less
than full protection against free radicals and may in-
hibit the immune system from functioning properly,
among other things.
Many people have advocated that taking certain
vitamins and minerals may prevent cancer. R. Lee
Clark, M.D., president emeritus of M. D. Anderson Can taking supplements
Hospital and Tumor Institute in Houston, has said, help you to prevent
cancer?
“Certain vitamins definitely help to prevent cancer.”
Raymond J. Shamberger, Ph.D., head of the enzymol-
ogy section of the Cleveland Clinic, says, “There’s no
question that certain vitamins and minerals can help
prevent cancer.” And Dr. Heinrick Wrba, head of the
cancer research institute at the University of Vienna,
states, “Vitamin supplements along with proper diet
can cut your risk of cancer.”
I]am advocating simple common sense. I believe
that the following nutrients, if taken daily as part of a
comprehensive plan, would be useful to all adults:
beta-carotene (10 milligrams), vitamin E (500 interna-
tional units), vitamin C (650 milligrams), selenium
(200 micrograms), copper (8 milligrams), zinc (24
milligrams), vitamins B,, B,, B, and B,. (higher than
average RDAs), plus vitamins A and D, niacin, folate,
pantothenic acid, biotin and iodine in at least RDA
amounts. (Editor’s note: Many experts feel that peo-
ple should get their vitamins and minerals from food
rather than supplements, whenever possible.)
Keep in mind that while such a supplement pro-
gram may modify an individual’s risk of developing
cancer, it has not been proved to prevent, mitigate or The total diet is what
cure cancer. Furthermore, it is the total diet, not an matters in fighting
disease.
individual dietary supplement, that establishes the
308 Solving Health Problems with Nutrition

role of nutrition in determining health and reducing

the risk of diet-related disease.
The nutrients listed previously could be taken
daily unless otherwise specified by your physician.
Pregnant and lactating women should take them only
with the approval of their physician.

Heading Off Cancer Early

In closing, I would like to give an example of a
precancerous condition and its relationship to possi-
ble vitamin/mineral marginal deficiencies. Precancer-
ous conditions are not rare. If nothing is done about
them, they can ultimately lead to a full-blown cancer.
A certain kind of abnormal Pap smear, for instance,
indicates a precancerous condition. A Pap smear is
taken from the cervix in a woman’s vagina as a check
to see if that part of her body has cancer. There are
five classes of readings for a Pap smear. Class V is
outright cancer, for example, and Class III represents
a precancerous condition.
Several women who had Class II] Pap smears
representing precancerous conditions took the sup-
Stopping precancer with plements mentioned earlier for four to six months.
supplements. After that time, their Pap smears became completely
normal. After a year, their Pap smears remained nor-
mal. This was obviously very encouraging.
If you read and follow the Ten-Point Plan, which
is more fully described in my book, your chances of
developing cancer and heart disease will be greatly
reduced. Highlights of the plan include a low-fat, low-
cholesterol, high-fiber diet, supplemented with vita-
mins and minerals, the elimination of all tobacco use,
the reduction of alcohol intake, limited exposure to
radiation (including sunlight), exercise and a physical
exam every year beginning at age 35 or 40.
 Chapter 4 309

The Pap Test

and Nutrition:
Two Fronts against
Cervical Problems

t has probably happened to someone you know,

or perhaps it has even happened to you. Instead
of a follow-up postcard or phone call from your gyne-
cologist’s secretary, you get an ominous call from the
doctor himself. “Your Pap smear wasn’t quite normal.
I'd like to see you again in my office.” Despite his
reassurances, your mind spins with questions and
dark imaginings. This is a time when you need all of
the information you can lay your hands on.
The Pap smear is a scraping of cells from the
cervix, the tip of the uterus that extends into the va-
gina. The sample includes cells from the cervix, va- The Pap test: what it
gina and uterine lining (called the endometrium). The really means.
cells are checked by a laboratory for any signs of
abnormal change and classified according to the de-
gree of abnormality found.
The Pap smear can usually detect inflammation
or infection of the cervix and endometrium, which
can occur with intrauterine devices (IUDs), pelvic in-
flammatory disease, or Chlamydia infections. It is not
as useful for detecting cancer of the endometrium or
ovaries.
But it is of great value in detecting possibly pre-
cancerous changes on the cervix long before any
signs are visible to the doctor’s eye. These changes The Pap test sees what
are known as cervical dysplasia. (Dysplasia simply the doctor can’t.

means ‘“‘abnormal development of cells.’”)

310 Solving Health Problems with Nutrition

Understanding the Pap Test

Currently, Pap smears are categorized in one of
two ways—either they are divided into five classes
and several subclasses, according to the severity of
tissue change, or, increasingly, the abnormality found
in the cells is more fully described.
Class I is a normal smear with no abnormal cells.
Class II is a kind of catchall category of minor cell
How to ‘‘read’’ Pap changes that can include inflammation and infection
smear results. or very early signs of dysplasia. Class III includes mild
and moderate dysplasia. These are also known as
cervical intraepithelial neoplasms (CIN) 1 and 2.
(Neoplasm means “new and abnormal tissue
growth,’ which may or may not be cancerous.
Intraepithelial means “among the cells lining the cer-
vix.
Class IV Pap smears include severe dysplasia and
cancer confined to the lining of the cervix, both
called CIN 3. Class V is invasive cancer—cancer that
has spread beyond the cervix to the uterus and possi-
bly to other parts of the body.
While it’s important to know into what class or
category your Pap smear has been placed, it’s even
more crucial to know why it’s been put there, says
Ralph Richart, M.D., director of the Division of Obstet-
rics and Gynecologic Pathology and Cytology at Co-
lumbia Presbyterian Medical Center in New York City.
“The current classification system is simply not
precise enough to keep up with new knowledge of the
Get a full explanation of cause and process of cervical dysplasia,” Dr. Richart
Pap test results from says. “Every doctor should request from the labora-
your doctor.
tory a written description of the cell changes found in
the Pap smear. And he should be able to explain in
detail to his patient the reason for the abnormality,
especially in the catchall Class II category.”
The cervix may be reacting to a vaginal infection
like Trichomonas, or to uterine inflammation from an
IUD. More important, it may be showing signs of hav-
ing been exposed to one of the viruses that cause
 The Pap Test and Nutrition:
Two Fronts against Cervical Problems 311

venereal warts that have been associated with cancer.

Since treatment varies in each of these cases, these
distinctions are crucial. Unfortunately, they are not
always made, Dr. Richart says.

The Link between Sex

and Cervical Dysplasia
The whole school of thought concerning cervi-
cal dysplasia and cancer has been turned upside-
down in the last year or two as the result of findings
that many of these tissue changes are caused by a
group of sexually transmitted viruses known as human
papilloma virus (HPV) or, commonly, as the condy-
loma virus, Dr. Richart says. If they are allowed to
flourish, all these viruses will cause abnormal tissue
growth or breakdown. Some will form tiny flat warts
that can grow undetected on the cervix or in the
vagina, on the male urinary opening or on the penis.
Others form large cauliflower-shaped warts.
“Tt is now generally agreed that the condyloma
virus is the major agent responsible for abnormal Pap
smears,” Dr. Richart says. “The genetic material of The primary cause of ab-
this virus has been found in a large percentage of normal Pap tests.
dysplastic tissue samples.”
The condyloma viruses are named by numbers
according to their order of discovery. There are ap-
proximately 40 now known. “Several of them—par-
ticularly HPV 6 and 11—are thought to be essentially
benign,” Dr. Richart says. “Their association with
neoplasia is not very strong.”
On the other hand, HPV viruses 16, 18 and 33 are
routinely associated with cancer and cancer precur-
sors. The main sign of exposure to these viruses is the
development of flat genital warts, which often go un-
detected until they're discovered during a gynecologi-
cal examination in women or a penile exam in men.
Practically all abnormal Pap smears show signs
of the condyloma virus. One percent of all women,
312 Solving Health Problems with Nutrition

2.5 percent of women under 30 and about 4.5 percent

of women in high-risk groups have the virus detected
by the Pap smear.
“Recent studies have not confirmed the original
suggestion that herpes is a factor in cervical dysplasia
or cancer, and I believe most authorities now believe
that herpes plays no role or only a minor role,” Dr.
Richart says.

Are You at High Risk?

What’s a high-risk group? “The most important
risk factor is multiple sex partners,” Dr. Richart says.
“It’s just like any other sexually transmitted disease.
Every time a woman climbs into bed with a new
partner or a man climbs into bed with a new partner,
they run the risk of that person being a carrier of this
virus. Every other risk factor is secondary.”
The statistics confirm that sexual activity plays a
major role. Among nuns, cervical cancer is rare.
Sexual activity: a big Among prostitutes, it’s almost an occupational haz-
factor in cervical ard. And there’s an unfortunate increased risk for the
cancer.
one-man woman whose mate tends to roam, as seen
in Latin America. In those countries, tradition dictates
that wives be strictly monogamous. But there’s an
equally strong tradition for men to frequent prosti-
tutes. In those countries, cervical cancer rates are
high.
And there’s an especially disturbing risk factor
for some other women. The wife of a man whose
previous wife died of cervical cancer is herself three
times more likely than normal to develop the disease.
Obviously, these findings point to the need for
the woman who is diagnosed as having dysplasia to
Cervical dysplasia: a insist that her husband or boyfriend see a doctor, too.
man’s concern, too. In fact, one study by researchers at Columbia Univer-
sity found that 53 percent of the male partners of
women with cervical dysplasia had condyloma le-
sions on their penis or in their urinary opening. This
could be especially important in cases where the virus
returns again and again.
 The Pap Test and Nutrition:
Two Fronts against Cervical Problems 313

‘“‘“A woman who has recurrent infections proba-

bly should have her husband checked to see if he is a
carrier, but that’s ahead of where we are now,” says
Rosemary Zuna, M.D., director of cytopathology in
the Department of Pathology at the State University of
New York, Stony Brook. “It’s probably the thing to do,
but it’s not being done routinely at this time.”

The Pill Seems Safe,

but Smoking Is Not
While researchers believe the condyloma virus
triggers most dysplastic symptoms, they also think
other risk factors may make some people more vul-
nerable to the virus, or may trigger forms of dysplasia
that are not virus related. ‘““We know that in some
women, these lesions go away by themselves,” says
Dr. Zuna. “And we know that in some women, they
develop into cancer. What we don’t know is the real
key that causes some lesions to actually invade the
tissues and become malignant.”
Tobacco is a known risk factor. Women who
smoke more than 15 cigarettes a day are twice as
likely as nonsmokers to have cervical dysplasia or Women who smoke
cervical cancer. And they are 3.5 times more likely to double their risk.

develop invasive cancer (British Journal of Cancer).

Samples of cervical mucus taken from women smok-
ers contain chemicals that cause cancerous cell
changes (American Journal of Epidemiology).
The daughters of women who took the drug di-
ethylstilbestrol (DES) during pregnancy may be a
high-risk group. But women using birth control pills or
menopausal estrogen are apparently not at risk.
It’s true that there have been one or two English
studies linking the use of birth control pills with cervi-
cal dysplasia. But many top researchers contest their
findings. “These studies are criticized because they
did not adequately take into account the increased
sexual activity that might be seen in women using
birth control pills,” Dr. Richart says. ‘““When this factor
314 Solving Health Problems with Nutrition

is controlled for, these women seem to develop no

more cervical dysplasia than normal.”
Women who choose diaphragm and condom
use may have lower-than-usual cervical cancer rates,
Condoms may protect possibly because the devices protect the cervix from
against cancer. contact. Male circumcision is no longer considered a
factor. Neither is the number of children you have had
nor a family history of cervical cancer.

Vitamins That Lower Risk

Until recently, eating habits were not considered
an important factor in cervical dysplasia. Now,
Poor nutrition may though, researchers are finding that nutritional status
weaken defenses. apparently plays a role in the development of cervical
dysplasia and cervical cancer, just as it may with other
cancers or precancerous conditions. Poor nutrition
may make cervical cells less able to withstand the
mutagenic effects of some viruses or the carcinogens
found in the cervical mucus of women who smoke. It
can also weaken the body’s immune system, making it
less able to fight infection.
Lower-than-normal intake of selenium, vitamins
C and A and the B-complex vitamin folate have been
found in women with cervical dysplasia or newly di-
agnosed cancer.
Researchers at the Albert Einstein College of
Medicine in New York City found that women whose
A lower intake of vita- intake of vitamin C was less than 30 milligrams daily
min C meant a greater (only half the Recommended Dietary Allowance, and
risk of developing
cervical dysplasia. equal to about half a medium orange or two ounces of
juice from concentrate) had a risk of developing cer-
vical dysplasia ten times greater than that of women
whose daily intake was higher (American Journal of
Epidemiology).
They also found that women were three times
more likely to have severe cervical dysplasia or cervi-
Cervical problems: a cal cancer if their vitamin A intake was below the
possible link to vitamin group median of 3,450 international units daily (equiv-
A intake.
alent to about a third of a cup of shredded carrots or
four dried apricots).
 The Pap Test and Nutrition:
Two Fronts against Cervical Problems 315

“Whether nutritional factors and their interaction

in cervical epithelial cells have antitumor properties
that may influence the host’s immune system or even
influence the maturation or development of normal
cervical epithelium is a challenging scientific prob-
lem,” says Seymour Romney, M.D., director of gyne-
cologic cancer research at the Albert Einstein College
of Medicine.
Dr. Romney is involved in two research projects.
In one, women with mild or moderate dysplasia are
being given supplemental vitamin C to see if their
condition improves. In another, they are being treated
with topical applications to the cervix of a synthetic
form of vitamin A, retinyl acetate gel. “We have no
results yet on these studies,’ Dr. Romney says. But
researchers at the University of Arizona may have an
inkling of what to expect. They did a study very similar
to Dr. Romney’s vitamin A study, using a different
form of vitamin A, transretinoic acid. The treatment
showed encouraging activity in preventing worsening
of the condition in women with mild to severe cervi-
cal dysplasia.
Folate also seems to play a role in dysplasia,
especially in women using birth control pills who may
have lower body levels of this vitamin, according to If you’re on the Pill,
researchers at the University of Alabama at Birming- make sure you get
enough folate.
ham. Their research involved 47 young women with
cervical dysplasia. Half were given ten milligrams of
folate (25 times the Recommended Dietary Allow-
ance) each day, while the other half received a pla-
cebo (dummy pill). After three months, the cervical
dysplasia had regressed to normal in four of the
women in the folate group. There was no improve-
ment in the placebo group. In fact, the dysplasia had
worsened in four of the women. (Vote: Large doses of
vitamins require a doctor’s supervision.)
‘Just what kind of nutritional recommendations
will come out of further research is yet to be seen,”
Dr. Romney says. But the indications are now that A diet for preventing
preventing cervical dysplasia is yet another good rea- dysplasia.
son to make sure you're getting plenty of fresh fruits
316 Solving Health Problems with Nutrition

and vegetables rich in vitamins C and A and folate-

rich dark leafy greens.

Why Yearly Checkups Are Vital

It may be frightening to find yourself in the high-
risk group. But there are two important—and reassur-
ing—things to remember about Pap smears. First,
quite a few women at some time in their lives will have
smears showing mild, moderate and even severe dys-
plasia, but they won’t go on to develop cancer. Their
condition will be successfully treated.
Second, if you’re getting Pap smears every year,
it’s very unlikely that you'll suddenly discover you
Regular Pap tests can have cervical cancer. Most cell changes in the cervix
detect problems early. follow a long, slow continuum. Most cervical cancers
take about ten years to develop and appear years
earlier as treatable dysplasia. The women who end up
with invasive cancer either do not get yearly Pap
smears or are among the unlucky few who develop a
rapidly growing cancer.
How your doctor treats your cervical dysplasia
depends on several factors—the classification of your
smear, whether you intend to have children, other risk
factors, your doctor’s own opinions and experience,
even how reliable you are at coming in for follow-ups.
Nevertheless, there are some generally accepted pro-
cedures for diagnosis and treatment, Dr. Zuna says.
If your smear is Class II, your doctor should de-
termine the reason for the classification and treat it.
Inflammation or infection can be treated with antibi-
otics or other drugs.
If your smear shows signs of the condyloma vi-
rus, however, treatment is needed, whether the dys-
If you have the condy- plasia is mild, moderate or severe. ‘Some doctors will
loma virus, don’t take wait a few months and do another smear, but I’d
chances.
rather get a firm diagnosis and treat,” Dr. Richart says.
“It's a sexually transmitted disease, whether you cur-
rently have symptoms or not. Why risk infecting
someone else?”
 The Pap Test and Nutrition:
Two Fronts against Cervical Problems 317

Biopsies Tell the Story

Treatment is basically the same for all classifica-
tions of dysplasia. First, your doctor will view the
cervix with a colposcope. This instrument provides a A biopsy can rule out
magnified view of the cervix, allowing the doctor to cancer.
see growths, from which he will take a small bit of
tissue for biopsy. “A biopsy is important, because it’s
the only way to rule out invasive cancer,” Dr. Richart
says.
If no growth is seen, but another Pap smear still
shows abnormal cells, your doctor will probably want
to do a conization, Dr. Richart says. “Conization is
usually done when you cannot absolutely rule out the
possibility of invasive cancer.” In this procedure, a
cone-shaped piece of tissue is cut from the center of
the cervix for analysis. This may reveal a lesion in the
cervical canal. The procedure usually does not affect
your ability to bear children.
If either of these procedures confirms dysplasia
or exposure to the condyloma virus, the treatment is
the same—the lesions are removed. They are treated The recommended treat-
just as some forms of skin cancer are. They can be ment for dysplasia or
the condyloma virus.
coated with chemicals that make them slough off,
frozen in a procedure called cryosurgery, vaporized
with a laser beam or, less frequently, burned off with
cauterization.
Several months later, you have a follow-up Pap
smear. If it is not normal, the treatment may be re-
peated. If it is normal, you and your doctor will deter-
mine a schedule of smears to monitor for possible
recurrences. Even though your condition is cured,
you are now in the high-risk group and should have
Pap smears at least once a year.

How Often
Are Pap Tests Necessary?
The American College of Obstetrics and Gyne-
cology recommends a Pap smear every year. The
318 Solving Health Problems with Nutrition

American Cancer Society recommends an annual Pap

smear and pelvic exam for all women who are 18
years or older or who are sexually active, with less
frequent exams after three satisfactory tests, at the
discretion of the woman’s physician.
There are two good reasons for an annual Pap
smear. One is the remote possibility that you may
A smart choice. develop a fast-growing cancer. The other is that the
Pap smear does have a 15 to 30 percent rate of error
of false negatives—that is, it indicates your cervix is
normal when it isn’t. More frequent tests minimize
your chances of walking around with an undetected
dysplasia.
Dysplasia occurs most often in women ages 25 to
35; cancer in situ (confined to the uterus) in women
30 to 40; and invasive cancer, in women ages 40 to 60.
Women who have had a hysterectomy should still be
getting regular Pap smears, Dr. Zuna says. The cells in
the upper vagina can develop cancer, and sometimes
a partial hysterectomy is done, leaving the cervix. A
Pap smear doesn’t always detect cancer of the endo-
metrium or ovaries. Always inform your doctor of any
abnormal bleeding or pain, even if your Pap smear is
normal, Dr. Zuna says.
 Chapter 42 319

No More Cramps
and Kinks

ew York City Ballet dancer Patrick Hinson

was in the middle of a pirouette-packed per-
formance when, suddenly, his calf kinked out.
His show-must-go-on attitude kept Hinson on his
toes. “I just kept telling myself, ‘If you can get through
this to a point where you can put your foot down flat,
the cramp will go away.’ ”’ That’s just what happened,
and not a moment too soon.
Most of us can sympathize with the agonized
dancer. We've all had muscle cramps in the calf of a
leg, the arch of a foot or just under the ribs. It’s a few A common ailment:
moments of intense, grabbing pain that then begins to muscle cramps when
you least expect them.
ease off. Reach down to rub that recalcitrant calf and
you can actually feel a knot or thickening in the lame
leg. Severe cramps, like those that sometimes occur
during convulsive seizures, can be so strong they snap
bones. Even ordinary cramps frequently tear muscle
tissue. That’s why they so often leave a lingering ache.
Muscle cramps may seem to strike out of the
blue, but that’s only because their warning signals go
unnoticed. If you’re a frequent victim, you may be
putting yourself into a position or situation where a
cramp is unavoidable.

How Muscles Cramp

Many cramps, especially those that strike your
legs at night, occur because your body has assumed a
compromising position, says Israel Weiner, M.D., as-
sistant professor of neurological surgery at the Univer-
320 Solving Health Problems with Nutrition

sity of Maryland School of Medicine, Baltimore. Per-

haps you've let your foot point downward, which
automatically contracts the calf muscle somewhat.
Then, consciously or unconsciously, you’ve tensed
your calf muscle, contracting it still more. This posi-
tion is the ideal setup for a cramp.
“When you contract the muscle, if there is noth-
ing counteracting that movement, like another muscle
Looser blankets can pre- or a tendon being stretched in opposition, the con-
vent cramps. tracted muscle can shorten beyond its normal limit
and go into an uncontrollable shortened state—in
other words, a cramp,” Dr. Weiner says. In bed, heavy
or tucked-in blankets may push your feet down. Then,
if you tense your leg muscles, as you inevitably do
when you stretch or turn over, it’s... gotcha!
Older people seem particularly prone to night-
time cramps, and they are sometimes overtreated for
this problem, Dr. Weiner says. “It’s important for them
to know that this problem is usually not serious and
that it can almost always be resolved without drugs.”
How? By loosening bed covers or using a board to
keep the weight of the covers off your feet. If you
sleep on your stomach, hang your feet over the edge
of the bed. And keep your feet flexed upward toward
your head when you're stretching your legs. That
makes the muscles on the front of your legs contract,
providing opposition to the calf muscles.
High heels also throw the legs and feet into a
cramp-prone position, as some fashion-conscious
How high heels insti- women have discovered. The plump and shapely calf
gate cramps. is actually a contracted muscle. In fact, women who
wear high heels constantly may so shorten their calf
muscles that when they take the shoes off, they’re
unable to touch their heels to the ground. Their leg
muscles act like they are constantly walking around
on tiptoe, which is exactly what they are doing.

Relieve Cramps in Seconds

Doctors, coaches and sufferers agree that the
fastest, surest cure for a cramp is to stretch the af-
 No More Cramps and Kinks 321

fected muscles. If your calf cramps, for example, you

can simply stand firmly on your flat foot and press
down as hard as you can, or you can do more elabo-
rate stretches.
Cramps actually start when the nerves that con-
trol the muscles are prompted to misfire, for any num-
ber of reasons. Stretching, apparently, changes neural Stretch a muscle, kill a
impulses, making the nerves change their signal from cramp.
“contract” to “relax.’’ Usually stretching relieves a
cramp within seconds. And staying fit and limber can
help prevent cramps.
Cramps that occur when you are active can be
due to bad positioning, but they frequently have other
causes, like an insufficient blood supply to the tissue,
muscle fatigue or mineral depletion. When the cramp
occurs can be the tip-off to what’s causing the prob-
lem, says Mona Shangold, M.D., director of George-
town University’s Sports Gynecology Center and co-
author (with husband Gabe Mirkin, M.D.) of The
Complete Sports Medicine Book for Women.

What about Minerals?

“Cramps that occur when you first start to exer-
cise are usually due to a mineral imbalance, such as a
calcium, sodium or potassium deficiency or excess,” How minerals affect
Dr. Shangold says. “Abnormal blood levels of these cramps.

minerals usually allow the muscle to contract but pre-

vent it from relaxing.”
The minerals work in fairly complex ways that
are not entirely understood, says James Knochel,
M.D., chief of medical services with the Veterans Ad-
ministration Hospital in Dallas, who has spent many
years studying mineral-related muscular disorders.
‘Mineral deficiencies can affect blood flow to
muscles,” Dr. Knochel says. “When you contract a
muscle, for instance, it releases potassium into the
surrounding tissue, where it acts as a dilator of arteries
in the muscle bed. This doesn’t occur in someone
who is potassium deficient. It’s equivalent to putting a
tourniquet around your arm and then attempting to
322 Solving Health Problems with Nutrition

use the arm, which produces a cramp.” Perhaps that’s

one reason ballet dancer Patrick Hinson swears by
potassium-packed bananas and baked potatoes.
A potassium deficiency also impairs the ability of
the muscles to use glycogen, a sugar that is their main
Potassium deficiency: source of energy, Dr. Knochel says. This makes them
an invitation to muscle weak and cramp-prone. Potassium and other mineral
cramps.
deficiencies may also affect the “excitability” of
nerves—their tendency to fire off a series of muscle-
cramping messages. And they may affect the muscles’
“fatigue threshold’—their ability to do more work
without becoming tired and spasm-prone.
Body mineral levels may be affected by hor-
monal changes or unusual physical demands. Preg-
nancy, too, can make women particularly prone to leg
cramps.
In one study, researchers at Brigham Young Uni-
versity in Provo, Utah, found that 266 milligrams a day
Magnesium helped re- of supplemental magnesium reduced cramping in all
duce cramps in preg- their groups of pregnant women. The women were
nant women.
followed during the final two months of their preg-
nancy. The group with the most cramps—women
over age 27 who already had at least one child—was
helped the most by the magnesium. Their cramps
were reduced by 57 percent.
Some clinical studies seem to indicate that addi-
tional calcium may reduce muscle cramps in preg-
nant women and growing children who may be defi-
cient in these minerals because of increased
nutritional needs. Calcium and magnesium work
closely together in the muscles, Dr. Knochel says.
While sodium deficiencies are another well-
known cause of muscle cramps, most doctors no
An uncommon cause longer recommend salt tablets, since most people’s
of cramps: too little diets already contain more than adequate salt. But,
sodium.
Dr. Knochel says, if you are on a low-sodium diet and
find you have muscle cramps, especially when you
sweat heavily while working or exercising, too little
salt may be your problem.
 No More Cramps and Kinks 323

In any case, it’s good to check with a doctor if

you suspect a mineral deficiency is causing your mus-
cle cramps. Mineral imbalances aren’t particularly Who’s at risk for min-
common, Dr. Shangold says. At risk are those taking eral imbalances?

diuretics or steroids, heavy drinkers, pregnant women

and older people who may not be eating well.

Other Causes—and Cures—

for Cramps
Cramps that occur after you have exercised for a
little while are most frequently caused by an inade-
quate blood supply to the muscle, Dr. Shangold says.
‘At rest, your arteries may be large enough to trans-
port the small amount of blood that your muscles
require to function properly. When you exercise, how-
ever, your muscles require large amounts of oxygen-
rich blood. If your arteries are not large enough to
transport enough blood, your muscles suffer from
lack of oxygen and go into spasm.”
What some older people mistake for a leg cramp
is a condition known as intermittent claudication. It’s
a cramplike pain that comes on after a bit of exercise. The exercise cramp.
It makes the leg feel heavy and weak.
Intermittent claudication is caused by clogged
arteries in the leg, and its symptoms are similar to
angina in the heart muscle, says Robert Layzer, M.D.,
professor of neurology at the University of California
at San Francisco. It’s important to see a doctor if you
have such symptoms, or any cramping pain in the legs
accompanied by numbness or coldness in the af-
fected leg or foot.
Most doctors recommend exercise, stopping
smoking, a low-fat diet, and drugs for this condition
when it occurs in the lower leg. In some studies, A possible remedy for
vitamin E has also relieved symptoms, perhaps by intermittent claudica-
tion: vitamin E.
reducing the tendency for red blood cells to clump
together and form clots. In one study, supplementa-
324 Solving Health Problems with Nutrition
eT

tion with 600 international units of vitamin E daily for

at least three months provided improvement for a
number of patients. Those who got the vitamin E
required far fewer leg amputations than those treated
with placebos (dummy pills) or other drugs. They
were better able to walk. Blood circulation improved
in their legs, although it sometimes took up to 25
months of supplementation before this result was ap-
parent (Vasa).

Exercise-Related Cramps
Cramps that occur after you have been exercis-
ing for a long time are most often due to dehydration,
Dr. Shangold says. “When you exercise for a long
time, particularly in hot weather, you lose a lot of
fluid. During a vigorous tennis match, for instance, a
player can lose as much as two quarts of water per
hour. Your blood volume is reduced, and there may
not be enough blood to supply oxygen to all your
exercising muscles. As a result, the most actively exer-
cised muscles may not get enough blood, and they
can go into spasm and hurt.”
Drinking water can pre- You can protect yourself from developing these
vent cramps. kinds of cramps by drinking a glass of water before
you exercise and at least every 15 minutes while you
exercise, Dr. Shangold says.

Side Stitches and Swimmer’s Cramps

A stitch, or a side sticker, is a cramp in the dia-
phragm, the large muscle that separates your chest
How to get rid of a from your gut and controls breathing. The cramp oc-
“stitch in the side.’’ curs when this muscle doesn’t get enough blood dur-
ing exercise, Dr. Shangold says. ““When you run, you
lift your knees and contract your belly muscles, so
that the pressure inside your belly increases and
pushes on the diaphragm from below. At the same
time, if you’re breathing heavily, you are expanding
your lungs, which presses down on the diaphragm
from above. This dual pressure squeezes the dia-
phragm and shuts off blood flow to it. The muscle
can’t get enough oxygen and goes into spasm.”
 No More Cramps and Kinks 325

If you develop a stitch, stop exercising, Dr.

Shangold says. Push your fingers deep into your belly
just below your ribs on the right side to stretch the
diaphragm muscle with your hand. At the same time,
purse your lips tightly and blow out as hard as you
can. This should release the pressure on your dia-
phragm and stop the stitch.
It’s true that if a swimmer gets an abdominal
cramp, he may have trouble reaching shore safely.
But contrary to popular belief, swimmer’s cramps It’s okay to swim shortly
don’t seem to depend on how recently you have after eating.
eaten. They’re more likely to be caused by fatigue or
extreme exertion. “It’s true that digesting food re-
quires that some blood be shunted away from the
heart and muscles,” Dr. Shangold says. “But no
healthy person should have trouble digesting food
and swimming at the same time.” In fact, the Red
Cross no longer recommends that you wait for an
hour after eating before you hit the surf.

Unknotting an Unexpected Cramp

Preventive measures should keep most cramps at
bay. But if an occasional one still sneaks up on you,
try stretching it away with the simple exercises men-
tioned earlier. Then, doctors say, if the area still hurts,
treat it as you would an injured muscle, which is
exactly what it is.
Rest the limb to avoid pain from further cramps
or spasms and to keep from injuring the muscle even
more. Apply ice to reduce swelling and pain.
Avoid getting a cramp in the first place by check-
ing your body posture. Don’t point your toes or let
your feet get pushed over by bed covers. Don't set Good posture prevents
yourself up for a muscle injury, which may make you cramps.
more susceptible to cramps. Train carefully. Avoid
intense, jerky movements. Stretch to warm up and
cool down. Don’t bounce. Don’t exercise beyond the
point of fatigue. But do exercise. Sedentary people are
prone to cramps, too. And see a doctor if you think a
mineral deficiency may be your problem.
326 Chapter 43

How to Stop Diabetic

Complications with
Good Nutrition

ost of the 11 million Americans who suffer

from diabetes know that the worst part of
their illness isn’t their blood-sugar imbalance itself but
the complications that arise from it. Hardening of the
arteries, stroke, blindness and kidney damage—older
diabetics are much more likely to come down with
those and other afflictions than are their nondiabetic
friends and neighbors.
But surprisingly little has been done to remedy
this state of affairs. Synthetic insulin and the so-called
oral agents give diabetics day-to-day protection from
their disease. But’ neither drugs nor do-it-yourself
urine tests offer the kind of long-range protection that
diabetics really need.
That’s why more and more diabetics and their
doctors are turing to nutrition. It makes perfect
Three reasons nutrition sense, for three reasons: Diet control is already the
works. primary form of therapy for the 10.5 million non-
insulin-dependent diabetics; nutrition may help pre-
vent heart disease (the real killer in diabetes); and
supplements may let diabetics stock up on nutrients
without violating their special diets.

Diabetes and Heart Disease:

Breaking the Deadly Link
For every diabetic, avoiding complications
means avoiding atherosclerosis, or hardening of the
 How to Stop Diabetic Complications with Good Nutrition 327

arteries. This is the primary complication, the one that

sets the stage for the rest. Diabetics develop this form
of heart disease much faster and earlier than the aver-
age person, and their risk of heart attack or stroke is
roughly double the average. If someone could break
the link between atherosclerosis and diabetes, the
plight of diabetics would be halfway solved.
Actually, that is exactly what a pair of researchers
at the University of Mississippi’s Atherosclerosis Re-
search Laboratories think they have finally done after The role of vitamin C.
more than a decade of hard work. Anthony
Verlangieri, Ph.D., and John C. Kapeghian, Ph.D., be-
lieve that vitamin C (ascorbic acid) can prevent hard-
ening of the arteries in diabetics—and perhaps in
everyone else.
“Up until now, there’s never been a good ex-
planation why diabetics develop atherosclerosis so
much faster than the rest of the population,” Dr.
Verlangieri says. ‘But we think we now have evidence
that shows why. Ultimately, we think vitamin C might
prevent some of the renal [kidney] and retinal [eye]
progression of the disease.”
Sugar molecules and vitamin C molecules, he
explains, seem to “compete” with each other as they
circulate in the blood. Like two pedestrians flagging
down the same taxi, they vie for the same molecular
“transport system” that will carry them out of the
blood and into the endothelial cells that line every
blood vessel.
When sugar levels are high in diabetics, less vita-
min C reaches the endothelial cells. If too little of the
vitamin gets through, Dr. Verlangieri says, the “‘ce- A cellular cement that
ment” that holds the cells in place on the arterial may stop cholesterol
buildup.
walls may deteriorate. If that happens, single cells
may break off and fly loose. Each missing cell, appar-
ently, can leave behind it a hollow space that quickly
provides a toehold for cholesterol. One chunk of cho-
lesterol leads to another, until eventually the arteries
are almost choked. The stage is then set for high
blood pressure, stroke or heart attack. In theory, vita-
328 Solving Health Problems with Nutrition

min C supplements can interrupt this process before

atherosclerosis sets in.
While Dr. Verlangieri’s conclusions about the
powers of vitamin C are still controversial, he is not
alone in recommending this nutrient to people with
high blood sugar. In fact, Stanley Mirsky, M.D., former
president of the New York affiliate of the American
Diabetes Association and author of the book Dia-
betes: Controlling It the Easy Way, agrees with him.
‘We tell our diabetes patients to add 500 milli-
grams of vitamin C to their daily regimen,” Dr. Mirsky
Possible Rx for diabet- says. “It’s part of our belief that controlling the diet is
ics: 500 milligrams of the primary goal in preventing diabetic complications.
vitamin C daily.
Diet is more important than insulin or other oral
agents.”
Those diabetics who plan to take ascorbic acid
supplements must keep one thing in mind, however.
Before taking vitamin C Vitamin C can skew the results of certain at-home
for diabetes, check with urine tests. In one of the many test kits marketed to
your doctor.
diabetics, vitamin C can trigger a false-positive read-
ing, while in another test kit it can produce a false-
negative reading. “If you seem to be getting unreliable
test results, stop the vitamin C for a few days and see if
your results are different,” Dr. Mirsky says.

Nutrition for Nerves

Dr. Mirsky has also found that good nutrition can
soothe neuropathy, another common complication of
diabetes. Pain, burning, itching and numbness are
typical of this mysterious nervous system disorder,
whose symptoms appear and disappear without ap-
parent reason at spots all over the body. It can attack
any part of the nervous system without warning. It can
even disrupt the nerves of the digestive tract or the
bladder, causing constipation, diarrhea or urinary
tract infections.
The feet, however, seem to be the most common
target for neuropathy. Indeed, diabetics have to take
exquisite care of their feet, washing them daily, soft-
 How to Stop Diabetic Complications with Good Nutrition 329

ening them with special creams, checking for any sign

of a cut or blister, and seeing a podiatrist often. Poor
circulation in the feet means that something as minor
as a stubbed toe can lead to an uncontrollable infec-
tion. No wonder diabetes accounts for 20,000 foot
and leg amputations in the United States every year.

Thiamine for Foot Pain

Dr. Mirsky prescribes thiamine, or vitamin B,, for
those of his patients who are kept awake at night by
pain or sensitivity in their feet.
“Even though lots of people say that it won't
work, I’ve found that about 80 percent of my patients
improve by taking B,,” he claims. “I prescribe be- Vitamin B for foot pain
tween 50 and 100 milligrams a day. A week or two in diabetics.
after they start taking it, they find that their feet don’t
bother them, and they can enjoy their sleep.
“We don’t know exactly why this vitamin
works,” he adds. “Thiamine has always been used to
treat nervous disorders, and I think it just improves the Can vitamin E help
tone of the nerves. A lot of doctors give their patients diabetics?
Dilantin [a seizure-control medication that’s some-
times used to help diabetics] even though it has po-
tentially harmful side effects and often doesn’t work
at all. With B,, the worst thing that can happen is that
it won’t work. But it usually does.” Vitamin E supple-
ments can also help the diabetic, Dr. Mirsky claims. “I
often recommend vitamin E in capsules of 400 inter-
national units, three times a day. | don’t know exactly
how it works, but I think it acts as an antioxidant,
which helps prevent harmful peroxide molecules
from damaging healthy cells. I prescribe it when |
need everything I can get to control the disease.” (By
comparison, the U.S. Recommended Daily Allowance
for vitamin E is 30 international units.)

E for Better Circulation

Harvey Walker, Jr., M.D., Ph.D., of Clayton, Mis-
souni, agrees. “We also use vitamin E in our therapy
330 Solving Health Problems with Nutrition
LL

for diabetic patients who have circulation problems,”

he says. “Let me explain. There are two pulse sites in
each foot. A diabetic patient may lose one or both
pulses, which is an indication of reduced circulation
in the foot.
‘‘Now, loss of a pulse has always been thought to
be irreversible, which, of course, has serious conse-
A suggested remedy for quences for the diabetic. But using a year of vitamin E
“‘loss of pulse’’ in di- and lecithin supplementation, we have actually re-
abetics’ feet: vitamin E
and lecithin.
stored the pulse at one or both sites in one-third of the
150 patients we've treated this way.”

Magnesium for the Eyes

Perhaps the most frightening of all the complica-
tions of diabetes is retinopathy. Nine out of ten diabet-
ics who've had the disease for 20 years or more begin
to show pinpoint hemorrhages on the retina, the area
at the back of the eye that receives incoming light and
relays it to the brain for interpretation. The hemor-
rhages sometimes lead to a loss of vision. Diabetic
retinopathy, in fact, is the leading cause of blindness
in Americans over.age 20.
There is some evidence that a deficiency of mag-
nesium might cause or at least aggravate the develop-
Retinopathy patients ment of diabetic retinopathy. A study conducted a
had low magnesium few years ago in England showed that retinopathy
levels.
patients had low blood levels of magnesium. Those
results suggested that “low concentrations of magne-
sium may be an additional risk factor” for the eye
disease. Since then, there have been a few reports of
doctors prescribing magnesium for their diabetic pa-
tients. Dr. Mirsky, for example, tells his patients to
consume plenty of magnesium-rich foods, like whole
grains, nuts and meat.
Most recently, researchers in Japan also con-
cluded that “a derangement of magnesium metabo-
lism may have some relationship to the onset and/or
development of diabetic retinopathy.” Of 109 diabet-
ics studied, those who failed to keep their blood sugar
 How to Stop Diabetic Complications with Good Nutrition 331

levels under control tended to have low blood levels

of magnesium and tended to excrete more of the A strong link between
mineral in their urine. Those with the lowest magne- low magnesium levels
and diabetic retino-
sium levels of all were the patients who suffered from pathy.
“proliferative” diabetic retinopathy, the most serious
stage of the disease (Magnesium Bulletin).

Fiber Flattens Sugar Curve

While it’s important to stress the prevention of
diabetic complications, it would be wrong for a dia-
betic to forget that controlling the rise and fall of his
or her blood sugar level after a meal is the first con-
cem. “The major complications—kidney failure,
heart disease, blindness, neuropathy—can all be pre-
vented by keeping blood sugar levels as close to nor-
mal as possible all the time,” Dr. Mirsky says.
Making sure that there’s plenty of fiber in your
diet is one excellent way to do that.
While fiber comes in many forms, one type of
fiber that has excited researchers lately is guar gum.
Extracted from the bean of a plant that grows in India, A possibly important di-
guar gum has in the past been used as a thickener in etary fiber for diabetics:
guar gum.
products such as ice cream. In the future, however, it
may be added to granola bars or pasta as an extra
boost of fiber.
Like some other kinds of fiber, guar gum delays
the rise in blood sugar that ordinarily follows a carbo-
hydrate-rich meal of, for instance, spaghetti. To dem-
onstrate this effect, researchers in Italy recently fed
five diabetics a meal of spaghetti alla carbonara (a
pasta dish made with eggs, Parmesan cheese, butter
and ham) and later an identical meal in which the
regular pasta was replaced with pasta that was 20
percent guar gum.
Comparing blood samples after each meal, the
researchers discovered that sugar levels rose more
slowly after the meal made with guar gum spaghetti. After a meal with guar
In fact, glucose levels at 60 minutes after the guar gum gum, blood sugar levels
were ‘‘flatter.”’
meal were roughly equal to the glucose levels at 30
332 Solving Health Problems with Nutrition

minutes after the meal with ordinary spaghetti. The

researchers aren’t sure why it happened this way, but
they feel confident guar gum may someday be a valu-
able tool for the diabetic, whether insulin-dependent
or not, who wants to control his or her blood sugar
while still enjoying high-carbohydrate foods (Annals
of Nutrition and Metabolism).

Think Positive
Fiber and nutrients aren’t the only tools available
to the diabetic who wants to avoid heart disease and
Other steps to help con- other complications. The many diabetics who are
trol diabetes. obese or who smoke would be wise to lose weight
and crush their nicotine habits as soon as possible.
Starting an aerobics or jogging program is an excel-
lent idea. One therapist even suggests stair climbing
for exercise. But whatever you do to counteract dia-
betes, you need to discuss it with your doctor, espe-
cially if it concerns nutrition.
A positive mental attitude can make a big differ-
ence, too. Many people are at first depressed and
bewildered when they learn they are diabetic—de-
pressed by the fear that it may shorten their lives and
bewildered by the complexly cautious lifestyle they
must adopt. However, with proper care, including
good nutrition, a diabetic can lead a full, happy, pro-
ductive life.
 Chapter 44 333

Lower Your
Blood Pressure
with Diet

ou begin your day with a juicy half-moon of

cantaloupe, a glass of freshly squeezed orange
juice and a bowl of bran cereal with half a cup of skim
milk.
Lunch is broiled mackerel, parsley potatoes and
a side salad of watercress, carrot medallions and al-
monds, tossed with your own dressing made of fresh The perfect diet for low-
garlic in com oil and apple-cider vinegar. ering blood pressure?
Midafternoon, you calm your rumbling stomach
with a cup of low-fat yogurt into which you've sliced
half a banana.
For dinner, you whip up a luscious casserole of
brown rice, onions, broccoli, cashews and melted
part-skim mozzarella, lightly seasoned with garlic.
If you have high blood pressure, theoretically
you've just done everything right. Your one day’s
menu contains every nutrient known to help lower Your blood-pressure
blood pressure. Today, medical research has uncov- ‘‘medication’’ may be
in many of the foods
ered a way to fight hypertension that’s more positive you eat.
than just avoiding salt and saturated fat. There are
actually foods you can eat more of that help you win
this often-deadly numbers game.
And if you didn’t know already, high blood pres-
sure can be deadly. According to Michael Rees, M.D.,
author of The Complete Family Guide to Living with
High Blood Pressure, hypertension is the single most
important cause of strokes, a major cause of diseases
of the brain, kidneys and eyes and, in fact, is the cause
of an estimated one-third of all heart disease. Some 60
334 Solving Health Problems with Nutrition

million Americans have blood pressure that is too

high—blood pressure that might just respond to some
dietary fine-tuning. They might want to start with this
menu.

Potassium-Rich Foods
Cantaloupe, winter squash, potatoes, broccoli,
orange juice, some fresh fruits, and milk contain hefty

What Type of High Blood Pressure Do You Have?

Did you know there’s more than “People who are low in free
one type of high blood pressure? calcium are the ones whose blood
And that the kind you have should pressure is most likely to respond
determine the type of treatment favorably to calcium supple-
you receive? Rather than treat all ments,” Dr. Resnick says. And he
high blood pressure the same estimates that about one-third of
(with weight loss, salt restriction all hypertensives are “calcium
and drugs), doctors need to be sensitive.” “Also, people with low
able to determine what category free-calcium levels are more sen-
you fit into—a tricky affair to say sitive to sodium—eating salt raises
the least. their blood pressure. We can also
Two Cornell University doc- predict which drugs will work bet-
tors have found that a simple, two- ter. Calcium-sensitive patients, for
minute blood test may make that example, respond better to
task a bit easier, at least if low diuretics, alpha-blockers and cal-
calcium levels are part of your cium channel blockers, whereas
problem. ““The test measures lev- beta-blockers work better in peo-
els of free calcium in the blood- ple who have higher free-calcium
stream,” explains Lawrence M. levels to begin with.
Resnick, M.D., assistant professor “Our goal,” says Dr. Resnick,
of medicine at Cornell. Other rou- “is to be able to find out what type
tine tests for calcium measure to- of high blood pressure a patient
tal calcium, which includes the has, so that treatment can be indi-
free (available to tissues) as well vidualized according to his or her
as that bound to protein (which is needs. This blood test is a good
not available to tissues). start in that direction.”
 Lower Your Blood Pressure with Diet 335

amounts of potassium. The fact is, how much potas-

sium you have in your diet may be just as important as Which one is more im-
how little sodium you eat. Studies of vegetarians, who portant to your blood
pressure—sodium or
tend to have lower blood pressures than meat eaters, potassium?
found that their sodium intake was no different from
that of hypertensives, but their potassium intake was
significantly higher.
A group of scientists in Israel looked at the eating
habits of 98 vegetarians whose average age was 60
and compared them to a similar group of meat eaters.
What they found was a very low prevalence of hyper-
tension—only 2 percent—among the vegetarians, al-
though they lived in an adult population where the
expected prevalence was 20 to 25 percent. The vege-
tarians ate as much salt as their neighbors and had the
same genetic predisposition to developing hyperten-
sion. But they didn’t. The researchers concluded that
it was their potassium-rich diets of vegetables, fruits
and nuts that kept them from developing hyperten-
sion (American Journal of Clinical Nutrition).
Just how does potassium protect the body from
hypertension, even when sodium intake isn’t re-
stricted? No one really knows, although there are a Potassium helps the
number of theories. For one, potassium is an effective body get rid of excess
water and sodium.
diuretic—and has been used as one for nearly four
centuries. But in addition to helping the body rid itself
of water, potassium also helps slough off sodium, an
effect called natriuresis. Potassium also appears to act
on several important physiological systems that regu-
late blood pressure and control the workings of the
vascular system.
In both animal and human studies, potassium
seems to have little effect on people whose blood
pressure is normal. But it can produce a significant
drop in both systolic and diastolic pressures of
hypertensives.
And there may be one group of people for whom
potassium is literally a shield against the ravages of
excess sodium. According to George R. Meneely,
M.D., emeritus professor of medicine at Louisiana
336 Solving Health Problems with Nutrition

State University Medical Center in Shreveport, there

The danger zone: more may be ‘‘a substantial fraction of the population
than four grams of salt worldwide, including primitive societies, who develop
a day.
elevation of the blood pressure if they eat more than
four grams of sodium as sodium chloride [everyday
table salt] a day.
“There is extensive animal evidence,” says Dr.
Meneely, “that the hypertensogenic [hypertension-
causing] effect of excess sodium is counteracted by
extra dietary potassium. There is pretty good literature
on its effect in humans, too.”
For anyone who wants to increase his or her
dietary potassium, here’s a cooking tip from a group
How to preserve potas- of Swedish scientists: To avoid potassium loss in
sium when you cook. cooking, steam rather than boil vegetables. When
doctors at a Swedish hospital tested the two cooking
methods with potatoes, a rich source of potassium,
they discovered that boiled potatoes lose 10 to 50
percent of their potassium, while steamed potatoes
lose only 3 to 6 percent. They had similar results with
carrots, beans and peas (Lance?).

A Calcium Bounty
in Your Refrigerator
Dairy products, leafy green vegetables like kale
and watercress, and nuts contain calcium. If you’ve
Calcium may help lower been scrupulous about cutting sodium out of your
blood pressure, too.
diet, you may be cutting out calcium, too. There’s a
convincing amount of evidence from all corners of
the world indicating calcium can lower your blood
pressure. Unfortunately, the best sources of cal-
cium—dairy products—also have a fair amount of
sodium. A two-ounce serving of Swiss cheese con-
tains 544 milligrams of calcium (the Recommended
Dietary Allowance is 800 milligrams), but there’s a
hefty 148 milligrams of sodium in there, too. But the
evidence is too overwhelming in favor of calcium as
an antidote to hypertension for anyone to give up milk
and cheese entirely.
 Lower Your Blood Pressure with Diet 337

Consider, for example, a study of 82 percent of

the adult residents of Rancho Bernardo, an upper-
middle-class community in Southern California. What
separated male hypertensives from normotensives,
according to researchers at the University of Califor-
nia, San Diego, was milk. Milk consumption was
lower in borderline, untreated and treated hyperten-
sives (American Journal of Clinical Nutrition).
In an even larger study, involving 20,749 people
across the country, calcium was the only one of 17
nutrients evaluated that differed in the hypertensives. People with high blood
Those people with high blood pressure consumed 18 pressure were getting
less calcium than others
percent less calcium (Annals of Internal Medicine). were.
That figure alarms researcher David McCarron,
M.D., professor of medical nephrology in the Division
of Nephrology and Hypertension at the Oregon
Health Sciences University in Portland. He conducted
that particular study—and several others linking cal-
cium and blood pressure—and he’s convinced that a
good hypertensive diet has to contain dairy products,
regardless of the fact that they contain sodium and
cholesterol.
“If you have to, switch to low-sodium or low-
cholesterol cheeses, which are an excellent source of
calcium and low in saturated fatty acids,” he says. “If
you don’t have a cholesterol problem and you're near
your ideal body weight, you don’t necessarily have to
worry about the cholesterol.”
As for sodium, Dr. McCarron’s work indicates
that calcium may actually negate the harmful effects
of salt on the system. An increased calcium load
tends to facilitate the body’s excretion of sodium, he
notes.
Calcium works on blood pressure in another
way—by relaxing the blood vessels. “You'll rarely
hear a doctor say that because the most doctors are Dr. McCarron: Calcium
ever taught in medical school is that calcium makes helps lower blood pres-
sure by relaxing blood
blood vessels contract,” he says. “When blood ves- vessels.
sels contract, blood pressure goes up. But calcium
actually regulates contraction and relaxation of the
blood vessels.”
338 Solving Health Problems with Nutrition

But one of the most interesting things to come

out of Dr. McCarron’s research is not how calcium
Balancing minerals to works alone to lower blood pressure but how it works
lower blood pressure. with potassium, sodium and magnesium to regulate
pressure. “It’s the proportions of these minerals in the
body that seem to be the most important thing,” says
Dr. McCarron. “The possibility exists that the more
you want to eat of one, the more you'd better eat of
the others. We, of course, consider calcium the most
important. But if you’re not taking in enough sodium,
potassium and magnesium, the probability is that
you're not getting enough calcium either.”
And, not coincidentally, the foods that are abun-
dant in one tend to be abundant in the others.

Vitamin C:
A Role in Preventing
High Blood Pressure?
Since high blood pressure is a risk factor for
heart disease, it’s important to get it down to
normal levels. Preventing its occurrence in
the first place is better yet. Now a group of
Japanese researchers has suggested that high
vitamin C intake may, in fact, help prevent
high blood pressure from developing.
The researchers tested a group of
healthy men (aged 30 to 39) to determine
both their blood pressure and their blood lev-
els of vitamin C. They found that the higher
the vitamin C levels, the lower the incidence
of high blood pressure. These results, say the
researchers, could help explain why some
populations with high dietary intake of vita-
min C have a low mortality rate from heart
disease and atherosclerosis, or hardening of
the arteries (international Journal for Vitamin
and Nutrition Research).
 Lower Your Blood Pressure with Diet 339

Magnesium as a Partner
in Health
Nuts, brown rice, molasses, milk, wheat germ,
bananas, potatoes and soy products provide magne-
sium. Inadequate dietary magnesium has been shown Magnesium: a blood-
to increase blood pressure in animals and humans pressure lowering
agent?
both. Though the exact mechanism isn’t known, there
is some indication that magnesium exerts its pressure-
lowering effect by regulating the entry and exit of
calcium in the smooth muscle cells of the vascular
system. Together, the two minerals produce the regu-
lar contraction and relaxation of blood vessels.
In a test involving untreated, newly diagnosed
hypertensives, Dr. McCarron found that they con-
sumed less calcium and magnesium than a similar
group whose blood pressures were normal. Their so-
dium intake didn’t seem to matter (Annals of Internal
Medicine).
“The interaction of magnesium and calcium
gives the calcium the ability to get where it has to ina
cell,” says Dr. McCarron. “Magnesium facilitates cal-
cium getting to the right place where it can have this
relaxing effect.”

Some Fats Are Good

for Your Blood Pressure
In a pilot study of healthy people in Italy, Finland
and the United States, researchers discovered that the
level of dietary linoleic acid—polyunsaturated fats—
was associated with incidences of high blood pres-
sure. There were more hypertensives among the Finn-
ish population than among the Italians and Ameri-
cans. The Finns consumed more saturated and less
polyunsaturated fats than the others.
When a group of Finns aged 40 to 50 was placed
on a low-fat diet high in polyunsaturated fats and low
in saturated fats, even when salt consumption wasn’t
340 Solving Health Problems with Nutrition

reduced, blood pressures dropped significantly.

The power of When they returned to their old eating habits, their
polyunsaturates. old blood pressures returned, too (American Journal
of Clinical Nutrition).
What’s the magic? James M. Iacono, Ph.D., di-
rector of agricultural research services at the U.S. De-
partment of Agriculture’s Western Human Nutrition
Research Center in San Francisco, and other re-
searchers have one theory. They believe polyunsatu-
rated fats lower blood pressure because when they’re
metabolized by the body, they yield a substance that
is essential for making prostaglandins. These are fatty
acids that seem to control blood pressure by aiding in
the sloughing off of water and salt from the kidneys
(Hypertension).

Fish Are Helpful, Too

Mackerel and other marine fish are high in
eicosapentanoic acid, one of the omega-3 fatty acids.
A new antihypertension Tests in Germany involving 15 volunteers on a mack-
possibility: fish. erel diet provided some heartening results. After only
two weeks, serum triglycerides and total cholesterol
dropped significantly, mirrored by ‘‘markedly lower”
systolic and diastolic blood pressures.
The Germans didn’t simply pull mackerel out of
their hats. They were attempting to approximate the
diet of Greenland Eskimos and Japanese fishermen,
who enjoy a very low incidence of cardiovascular
disease. The key appears to be the omega-3 fatty
acids found in many fish (Atherosclerosis).
Another study tested the effects of cod-liver oil
on the Western diet. Cod-liver oil also contains
Cod-liver oil may omega-3 fatty acids. A group of volunteers added
have lowered blood
three tablespoons of cod-liver oil a day to their nor-
pressures.
mal diets and wound up with lower blood pressures
(Circulation).

Fiber Up, Blood Pressure Down

Bran, fresh fruit and vegetables, beans and whole
grain breads supply fiber. There are some early indica-
 Lower Your Blood Pressure with Diet

tions that plant fiber can significantly lower blood

pressure, though precisely why is still a mystery.
Researcher James W. Anderson, M.D., chief of
endocrinology at the Veterans Administration Medi-
cal Center in Lexington, Kentucky, placed 12 diabetic A 10 percent drop in
men on a 14-day diet containing more than three blood pressure.
times the dietary fiber (and fat) of a control diet.
Average blood pressures dropped 10 percent. In pa-
tients whose blood pressures had been normal, sys-
tolic pressures were 8 percent lower, and diastolic
figures had dropped 10 percent.
The news was even better for the men who had
high blood pressure to begin with. Their systolic pres-
sures dropped by 11 percent and diastolic pressures
by 10 percent (Annals of Internal Medicine).
Dr. Anderson was pleased with his results, but
he’s not sure why he got them. “My strongest hunch is
that it’s related to certain changes in insulin. The pa-
tients’ insulin needs were low on the high-fiber diet.
There’s a lot of evidence that insulin contributes to
high blood pressure. It’s basically a salt-retentive hor-
mone. We also reported a small increase in sodium
loss in feces. I didn’t think at the time it was meaning-
ful, but thinking about it later, having two different
mechanisms working together like that—the insulin
and the sodium excretion—you can get a synergistic
effect.”
What makes the results even more significant is
that salt use was not restricted during the diet. “In
fact,” says Dr. Anderson, “there was a 50 percent Fiber may help to lower
increase in sodium intake. But potassium also went blood pressure.
up, so the sodium:potassium ratio stayed the same.”

Onions and Garlic Benefit

Your Blood Pressure
The old wives were right. Their tale of onions
lowering blood pressure was on target. They do. What
the old wives didn’t know was why. According to Why onions are a friend
Moses Attrep, Jr., Ph.D., formerly a chemist at East of the heart.
342 Solving Health Problems with Nutrition

Texas State University, it may be a hormonelike sub-

stance called prostaglandin A,, which he isolated in
yellow onions and which also occurs in the human
kidney. When injected into humans and animals,
prostaglandin A, lowers blood pressure, at least for
brief periods.

Low-Fat Diets and High Blood Pressure

There’s mounting evidence that man Nutrition Research Center,
dietary fat can have an effect on says that the data he gathered sug-
blood pressure. gest a cause for the decrease in
A recent study—one of a blood pressure. “The bodies of
long line of similar investiga- the men in the low-fat group ex-
tions—suggests that it may actu- creted 4 percent more sodium
ally be possible for people to and 11 percent more potassium
lower their blood pressure by cut- than those in the normal!-fat
ting back on (or changing the type group,” he says. “The excretion of
of) fat in their diet. In the three- these two minerals, one of which
month trial, middle-aged men is known to sometimes raise
with normal blood pressure fol- blood pressure with higher daily
lowed either a low-fat diet (25 intake, may be what triggers the
percent of calories from fat, equal reductions in blood pressure.”
amounts of polyunsaturated and If such low-fat diets can pull
saturated fats) or a more typically down blood pressure as well as
American diet (about 40 percent research suggests, they may soon
of calories from fat, mostly satu- become as crucial as low-salt eat-
rated). They all consumed the ing in the nondrug treatment of
same kinds of foods, but the low- hypertension.
fat group ate leaner fare—like “Until scientists can define
meat trimmed of fat, low-fat milk the most effective low-fat diet for
and margarine. reducing blood pressure,” says
And in line with the results of Dr. Iacono, “the wisest approach
other studies, there was a 9 per- is to follow the current recom-
cent drop in blood pressure in the mendations to reduce your overall
group that was on the low-fat diet. fat to about 30 percent of total
Researcher James M. Iacono, calories and to maintain equal
Ph.D., director of the U.S. Depart- amounts of polyunsaturated and
ment of Agriculture’s Western Hu- saturated fats.”
 Lower Your Blood Pressure with Diet 343

The old wives were right about garlic, too. The

Japanese and Chinese have used garlic to lower
blood pressure for centuries. Its effect is possibly simi-
lar to that of onions, since it might also contain pros-
taglandins.
Note: If you are being treated for high blood
pressure, consult your doctor before making any di-
etary changes. He or she may need to adjust your
medication.
344 Chapter 45
Fighting Mental
Disorders
with B Vitamins

unt Mary wasn’t all that old when her hus-

band died—only 65—but in the past 3 years
Three typical cases of B it seems as though she’s aged 20 years, at least as far
vitamin deficiency. as her mind goes. She’s forgetful, irritable and tired.
And some days she’s so confused, it’s heartbreaking.
You hate to think she’s becoming senile, but what else
could it be?
Teenagers are supposed to be rebellious, it’s
true, but you’re beginning to wonder if your 14-year-
old daughter’s moodiness and hyperactivity aren’t
above and beyond normal adolescent turmoil. You're
also wondering how anyone can live on french fries
and soft drinks, which are about the only foods she’ll
eat these days. Could that be part of the problem?
The divorce was hard on Tim, but he was deter-
mined to pick up and go on with his life. Instead,
though, he began feeling so emotionally and physi-
cally exhausted he found it hard to do his job, much
less look after himself. Instead of getting better, Tim is
slowly getting worse and worse. Could the stress be
catching up with him?
Nutrition-oriented doctors see these kinds of
cases again and again, in different combinations of
the same factors—aging, long-term stress, poor eat-
ing habits, even special metabolic needs. They also
see the unfortunate consequences. Aunt Mary could
end up in a nursing home before her time, that wall-
climbing teenager might become a high-school drop-
out, and perhaps Tim will find himself severely de-
pressed, even suicidal.
 Fighting Mental Disorders with B Vitamins 345

But all three share a common problem—a B-

complex vitamin deficiency. And they all could have
gotten relief from their mental woes—perhaps pre-
vented them altogether—if they'd been getting
enough of these nutrients to meet their personal
needs.

When Stress Runs High,

B Vitamins Run Low
“Take someone who’s just a little depressed or a
little stressed because of things going on in his life.
That person might find himself eating poorly. And that Could you fall into the
could lead to nutritional deficiencies that push him dangerous cycle of nu-
trient depletion?
over the brink, into true depression or mental prob-
lems,’’ says Charles Tkacz, M.D., medical director of
the North Nassau Mental Health Center in Manhasset,
New York. The center’s specialty is finding and cor-
recting nutritional deficiencies in psychiatric patients,
an aspect of treatment that’s all too often overlooked
in traditional medical care.
Robert Picker, M.D., a Walnut Creek, California,
psychiatrist, agrees. “I’ve run into this kind of situation
too many times to count,” he says. “The body’s nutri- What is normally
tional needs are increased during times of stress. adequate is suddenly
a deficiency.
What may normally be adequate suddenly becomes a
deficiency. And that deficiency could begin a vicious
circle of mental symptoms that the person just doesn’t
seem to be able to shake. In fact, as a psychiatrist, |
am painfully aware that many of these people are in
psychotherapy for long periods of time without ever
realizing that the correction of a nutritional deficiency
could have significantly helped or possibly cured their
problem, or perhaps have prevented it in the first
place.”
Overall nutrition is essential, but doctors should
take a special look at the B-complex vitamins, espe-
cially B,, B,2, thiamine, niacin and folate.
Why are the B vitamins important for our mental
health? The brain, it seems, is more sensitive to fluc-
346 Solving Health Problems with Nutrition

tuations in dietary nutrients than neurologists once

thought. It has a special need for B vitamins to per-
form at its best.
The role of B vitamins is extensive and complex.
They are co-enzymes, or catalysts, in many of the
B vitamins help supply body’s most basic functions, including the process of
the brain with its energy oxidation, or the body’s burning of food to provide
source.
fuel. What this means is that they’re needed to supply
the brain with its energy source, glucose. Without
enough glucose, the brain begins to perform poorly.
Fatigue, depression, even hallucinations can be symp-
toms of a low glucose level in the brain. B, and niacin
are the B vitamins most involved in this process.

Depressed People May Have a Bg Deficiency

Seriously depressed patients may vitamin B, levels are in fact caus-
have another problem to contend ing the depression. It’s conceiv-
with, according to Jonathan W. able that B, has a role because the
Stewart, M.D., of the New York enzyme processes that convert
State Psychiatric Institute and Co- foodstuffs into neurotransmitters
lumbia University College of Phy- [chemicals in the body that carry
sicians and Surgeons. ‘‘About 20 electrical signals from nerve to
percent of the depressed patients nerve] require vitamin B, at several
we looked at showed neurologi- critical stages. In B, deficiency,
cal symptoms as well—numbness patients might not produce
and tingling in the hands, like enough neurotransmitters, which
‘pins and needles’ or ‘electric in turn could lead to the symp-
shock’ sensations. And those with toms of depression.”
the symptoms had significantly If a patient is admitted with
lower vitamin B, levels than did both depression and neurological
those without symptoms. symptoms, the possibility of B, de-
“T feel quite certain that low ficiency should be considered,
vitamin B, levels are responsible says Dr. Stewart. “B, may relieve
for those neurological symp- the neurological symptoms, and
toms,’’ Dr. Stewart says. “What we we suspect it may even have a
don’t know yet is whether the low positive effect on depression.”
 Fighting Mental Disorders with B Vitamins 347

Low Levels of B Vitamins

Can Lead to Confusion
But the B vitamins play a second crucial role in
our mental health. Several are known to be involved
in the production of neurotransmitters, biochemicals
that allow the brain cells to pass messages along their
nerve pathways.
“B, is needed for the production of serotonin, a
major neurotransmitter in many body functions,” says
Eric Braverman, M.D., of the Princeton Brain Bio Cen- B vitamins help the
ter in Skillman, New Jersey. “Folate helps produce brain cells transmit
information.
catecholamines, which control many body functions.
B,, is needed to produce acetylcholine, another neu-
rotransmitter. In other words, all the chemicals pro-
duced by the brain cells depend on nutrients taken
into the body, and in many cases, they seem to de-
pend on certain B vitamins.”
What happens when they’re not there?
“We know that people who aren't getting
enough of these nutrients get a whole host of psychi-
atric and neurological symptoms, like depression,
confusion, fatigue and psychosis,” Dr. Tkacz says.
It was seeing that volunteers deprived of B, soon
sunk into a funk, that prisoners of war fed thiamine-
poor polished rice lost muscle coordination and rea- Doctors want to know:
soning power, and that diets short on B,, or folate Can doses of B vitamins
clear up psychological
could cause symptoms of senility or psychosis that symptoms?
led doctors to begin thinking backward. If nutrient
deficiencies caused such problems, perhaps people
with these symptoms could be helped with doses of
the nutrients they seemed to be missing.
That’s exactly what doctors like Dr. Tkacz, Dr.
Braverman and Dr. Picker are doing. “We take blood
samples for special nutritional testing, then initially
put most patients on therapeutic doses of many nutri-
ents, including 40 to 50 milligrams a day of all the B
vitamins,” Dr. Tkacz says. When the nutritional tests
have been evaluated, the patient may be given more
348 Solving Health Problems with Nutrition

of a specific vitamin, mineral or amino acid that’s

been found to be lacking in his body.
‘We've found, and studies confirm, that many
depressed patients are low in B,,” Dr. Tkacz says. “A
Can taking B, help cure certain number are helped to recover from their de-
depression? pression by taking B, under medical supervision.”

Bad Nerves? Check for Thiamine

Derrick Lonsdale, M.D., a Cleveland physician
with a special interest in biochemistry and nutrition,
found that one of the first signs of a thiamine defi-
ciency was changes in behavior—neurotic symptoms
like depression, insomnia, chest pain and chronic fa-
tigue. All 20 of the patients he studied improved with
additional thiamine.
Not incidentally, these nervous patients also had
poor diets. They were eating lots of “empty calories,”
usually refined carbohydrates or sugar-laden drinks,
foods that used up their thiamine reserves without
putting any back, Dr. Lonsdale reports.

Folate Deficiency and

Depression
And several doctors are looking into folate defi-
ciency as a cause of depression, insomnia, irritability,
forgetfulness and some supposedly psychosomatic
disorders.
In reviewing medical literature, A. Missagh
Ghadirian, M.D., of the Royal Victoria Hospital, Mon-
A lack of folate treal, found folate-deficiency depression in people
may Cause various emo-
taking medications for rheumatoid arthritis, antibiot-
tional and psychological
problems. ics, birth control pills and anticonvulsants. “Some-
times the deficiencies are quite severe, but sometimes
they are more marginal and might even escape no-
tice,” he says. “If the depression is due to deficiency,
making sure the patient gets enough additional folate
works well to relieve the condition.”
 Fighting Mental Disorders with B Vitamins 349

Mental Woes Linked to Low B,.

Doctors are realizing now, too, that sometimes
the first sign of a B,, deficiency can be bizarre mental
misfirings that resemble psychosis or senility. One 47- Hallucinations: a pos-
year-old woman who had been “‘seeing”’ flying sau- sible sign of a B,,
deficiency.
cers was found to have low B,, levels. Four days after
starting B,, supplementation, her hallucinations were
gone (American Journal of Psychiatry).

Low on B Vitamins?
How many of these risk factors for nal, or anxious than you'd like or
a B vitamin deficiency fit you? than you think is normal.
e You are older and have
e You eat a diet that’s high in suddenly developed emotional or
sugar. mental problems, especially de-
e You seldom eat liver, brew- pression, even though you have
er’s yeast or whole grains. no prior history of any mental
e You've been under a lot of problems.
stress lately. e Counseling and _ psycho-
e You have digestion prob- therapy haven’t helped you.
lems or have had stomach or e You have skin rashes that
small intestine surgery. won't go away.
e You take any one of these: e You have sores inside your
birth control pills, diuretics, cho- mouth or cracks around the cor-
lesterol-lowering drugs, antibiot- ners of your mouth.
ics, psychoactive or anticonvul- e You have numbness, tin-
sant drugs. gling, twitching in your legs, or
e You drink alcohol regu- your feet burn.
larly. e You suffer from premen-
e You drink a lot of coffee. strual tension or from postpartum
e You smoke cigarettes. depression.

Do you have any of these Note: These problems may

symptoms? well have causes other than, or
besides, B vitamin deficiency.
e You feel more tired, irrita- Work out the solution with a good
ble, depressed, emotional, irratio- physician.
350 Solving Health Problems with Nutrition

One of Dr. Tkacz’s patients was a confused, for-

getful woman in her early sixties. She’d been diag-
nosed as senile, but her family had decided to check
for a nutritional deficiency. It turned out the woman
had a very low level of B,., and with just a few injec-
tions she recovered completely, Dr. Tkacz says. She'll
have to have B,, injections for the rest of her life, but
that’s certainly better than being prematurely con-
signed to a nursing home.
‘A lot of families would have simply written off
her symptoms as part of aging, but that’s not usually
Is it Alzheimer’s dis- the case,’ Dr. Tkacz says. ““That’s why it’s so impor-
ease—or a nutrient tant to be careful when you’re dealing with a possible
deficiency?
diagnosis of dementia or Alzheimer’s disease. You
want to make sure you're not dealing with a B,. or a
folate deficiency. I’d say 5 to 10 percent, easily, of
elderly people with mental problems really have nutri-
tional deficiencies, and many involve the B-complex
vitamins.”

Beware the
‘Tea and Toast” Syndrome
It’s the borderline B vitamin deficiencies that are
most likely to slip through the cracks of traditional
medicine—those that might present themselves only
as depression, fatigue, irritability, which are symptoms
for which most doctors would find no cause.
“I think the borderline deficiencies are extremely
common,” Dr. Tkacz says. “It’s what’s called the ‘tea
and toast’ syndrome. Older people living on Social
Security or a pension find themselves short of money
and don’t eat as well as they should.” Add to that
teenagers subsisting on fast foods and people of any
age who let life’s stresses overtake their daily intake of
B vitamins, and you’ve got quite a crowd.
So what’s the best protection against a defi-
The best sources of B- ciency? Eating foods rich in the B-complex vitamins is
complex nutrients.
important. Gee the table, Best Food Sources of Vita-
 Fighting Mental Disorders with B Vitamins 351

min C, on page 130, for a list of good sources of B-

complex vitamins.) Whole grains, peanuts, seeds and
beans also contain good amounts. An alternative is
B,.-fortified brewer’s yeast or a good B-complex sup-
plement.
“IT have my patients take from one teaspoon to
one tablespoon of brewer’s yeast a day,” Dr. Picker
says. He also has them follow a diet that’s high in fiber Caution: Alcohol, coffee
and complex carbohydrates and low in fats and and cigarettes burn up
sweets. “I advise them to minimize or eliminate alco- ““@™NS-
hol or caffeine intake, and | always give them a big
lecture about smoking. All three of those are big users
of the B vitamins.”
‘Just one simple step of providing B complex or
brewer's yeast in the diet can eliminate a whole host
of potential neurological and psychological prob-
lems,” adds Dr. Tkacz.
352 Chapter A6

Psychiatric Symptoms:
The B,. Connection

he patient’s behavior changed quite suddenly

and became increasingly bizarre. He was irrita-
Can a B,, deficiency ble and agitated. He was hardly sleeping at all and
make you this crazy? was hyperactive. And he had delusions that he was of
great importance. In fact, he was convinced that his
hometown was planning a day of celebration in his
honor and that several Hollywood celebrities would
attend. When he was finally admitted to a hospital, it
took six men to restrain him. And the patient was 81
years old!
His doctor performed all of the proper physical
and neurological tests, but the results were normal.
And all of his blood tests were normal, too, except for
one. The test for vitamin B,, showed that he had an
abnormally low level of the vitamin in his blood.
The doctor prescribed daily B,, intravenously,
and by the end of one week, the patient’s mental
status had returned to normal. He continued to re-
ceive weekly B,, by injection and six months later was
still completely normal.
“That particular syndrome, called mania, has
never before been traced to B,, deficiency, so most
B,, deficiency is a possi- general physicians may not be aware of that possibil-
ble cause of mania. ity,’ says Frederick Goggans, M.D., the doctor who
treated that patient. “But what makes the case even
more unusual is that the patient’s mental problems
appeared before any other signs of B,. deficiency.”
 Psychiatric Symptoms: The B,, Connection 353

The Secret Signs

of a B,. Deficiency
Usually, a B,. deficiency is easy to spot, because
even though it’s needed only in tiny amounts (the
Recommended Dietary Allowance, or RDA, is three
micrograms), B,. works for us in a big way. It’s needed
for the production of healthy red blood cells and for
the proper functioning of the nervous system.
When there’s not enough B,, to go around, the
nerves and spinal cord are affected, leading to numb-
ness and tingling in the hands and feet and an un- The physical signs of
steady gait. The red blood cells become enlarged and low B,,.
misshapen and are unable to carry oxygen properly,
which is their main job. The condition is called perni-
cious anemia, and other symptoms are pallor, weak-
ness, fatigue and diarrhea. Mental problems can even-
tually occur, but not until much later. Or that’s what
doctors used to think. New reports are proving that’s
not always true.
At the University of North Carolina, doctors re-
cently described the cases of two patients with psy-
choses (severe mental disorders) caused by vitamin
B,. deficiencies. Both of the patients had no other
symptoms of B,, deficiency, and both returned to
normal after receiving B,, injections.
The doctors warn that “psychiatric manifesta-
tions may be the first symptoms of a vitamin B,, defi-
ciency,” and they recommend that all patients with
psychoses caused by brain-tissue dysfunction be
checked for a B,, deficiency (American Journal of
Psychiatry).
“Even though most doctors are aware that B,,
deficiency can lead to psychiatric symptoms, they
may not be aware that it can happen before any signs In B,, deficiency, psychi-
of anemia,” says Lorrin Koran, M.D., an associate atric symptoms can
show up before anemia.
professor of psychiatry at the Stanford University
Medical Center.
354 Solving Health Problems with Nutrition

“So upon finding normal red blood cells, a doc-

tor may be likely to dismiss the possibility of B,, defi-
ciency prematurely,” adds Dr. Goggans.

Not Necessarily Senile

How does a doctor know when to check further?
“Severe mental disorders usually begin when people
are in their twenties,” explains Dr. Goggans, who is
medical director of Charter Hospital of Fort Worth,
Texas. “So when an older person comes into the
hospital with mental problems and has no prior his-
tory of a mental disorder, I’m sure to screen for B,
deficiency.”
Other, more common, psychiatric problems can
be caused by B,. deficiency, too. “Depression and
Is ‘‘senility’’ sometimes dementia in the elderly are the two syndromes most
caused by lack of B,,? classically associated with B,, deficiency,” says Dr.
Goggans. ‘“‘Dementia closely resembles senility, with
its loss of intellectual function. But when it’s caused
by B,, deficiency, it’s reversible.” Unfortunately, many
elderly people may be written off as senile when their
condition is actually treatable.
‘Biochemical depression is also very common in
the elderly,” adds Dr. Goggans. “It causes sleep and
appetite disturbances, lack of energy and intellectual
decline. But it’s also easily treatable by standard anti-
depressants and is exceptionally responsive to B,, re-
placement therapy.”
“We're careful to check for B,, deficiency in
older people,” says Todd Estroff, M.D., former assis-
Older people take note: tant director of neuropsychiatric evaluation at Fair
You’re at risk for B,, Oaks Hospital in Summit, New Jersey. “They're espe-
deficiency.
cially susceptible because they don’t eat well. The
older person with poor teeth who tries to survive on
tea and toast is more likely to develop a deficiency.”
One study of 49 patients in the geriatric psychia-
try unit of a Massachusetts hospital found B,, defi-
ciency more than any other undiagnosed medical
problem. ““None of these patients had frank perni-
 Psychiatric Symptoms: The B,, Connection 355

cious anemia. . . nor was there evidence of peripheral

neuropathy [nerve damage],” say the researchers
(Journal of the American Geriatrics Society).
In another study, published by three doctors
from Denmark, low values of B,, were found in one
out of every three patients admitted to a geriatric
center (Acta Medica Scandinavica).
But the elderly aren’t the only ones at risk. “I’ve
seen teenagers with B,, levels so low you wonder how
they can be walking,” says Charles Tkacz, M.D., medi- Also at risk for B,, de-
cal director of the North Nassau Mental Health Center pletion: teenagers.
in Manhasset, New York. “It’s amazing they didn’t
need to be carried in on a stretcher. They’re getting
into trouble because of a junk-food/fast-food diet.”

Reliable Dietary Sources of Bi,

Beef liver packs in a big wallop of B,», but it’s also
found in other meats, fish, dairy products and eggs.
Because B,, is found almost exclusively in foods of A special caution for
animal origin, anyone who avoids those foods runs vegetarians.
the risk of developing a deficiency. That’s why vegans,
strict vegetarians who eat no eggs or dairy products,
can become deficient if they’re not careful.
But even those of us who aren't vegetarians
should be extra sure to get enough B,,. One govern-
ment study showed that the amount of B,,. we’re eat-
ing has decreased dramatically over the last two de-
cades. According to the researchers, our intake of B,,
dropped by 8 percent during that period, more than
any other vitamin. The reason? A lower consumption
of liver and dairy products, say the researchers.
The trouble is, even if you do eat plenty of B,.-
rich foods, you may still end up with a deficiency.
Some people can’t absorb B,, from their digestive
system because they lack what is known as intrinsic
factor, a molecule that latches onto B,,. and escorts it
to the site on the intestinal wall where it is absorbed.
Because intrinsic factor is produced in the stomach,
people who have had stomach surgery are also likely
356 Solving Health Problems with Nutrition

candidates for B,, deficiency. They remain healthy

only as long as they receive B,, injections, which by-
pass the digestive problems.
Other factors can upset the precarious balance
of this vitally important substance, too. Cholesterol-
Are your medications lowering medications, potassium-replacement agents
interfering with B,, and anticonvulsants can all interfere with B,, absorp-
absorption?
tion. And studies have shown that antiulcer drugs can
have the same effect because they reduce stomach
acidity, which is important for B,, absorption. “Certain
parasites, such as some tapeworms, can also steal
B,., Dr. Koran says.
“Luckily, vitamin B,. deficiency is usually among
the easiest deficiencies to correct,’ says Dr. Tkacz.
“And since depression is so common, we check ev-
eryone who is admitted to our hospital.”
‘‘My chief job is to screen patients for underlying
medical illness, so everyone in my hospital gets

Zinc and By May Halt

Brain Disorders
Doctors have known for years that a vitamin
B,. deficiency can lead to all kinds of psychi-
atric problems. A Dutch study has taken that
one step further. Doctors there evaluated pa-
tients who had Alzheimer’s-type senility and
alcohol-related brain damage, and they found
low levels of B,, and zinc in both groups. On
top of that, the low zinc levels threw off the
zinc-to-copper ratio, creating a relative cop-
per toxicity.
The researchers believe that early recog-
nition and adequate treatment with B,, and
zinc can possibly prevent irreversible damage
in patients with these disorders (Journal of
Orthomolecular Psychiatry).
 Psychiatric Symptoms: The B,, Connection 357

checked for B,,. deficiency,” says Dr. Estroff. ““They

must get by me before they can be called psychiatric
patients.”

A Deficiency That’s Often

Overlooked
Unfortunately, if you go to your family doctor
because of a mental problem, he probably won’t
check for B,,. “When most doctors see behavioral
symptoms, they refer the patient to a psychiatrist,” Dr.
Estroff says.
“They tend not to look for physical disorders.
And most psychiatrists don’t look for B,. deficiency
because they rely on the general practitioners to clear
the patients medically. The way it ends up, nobody
covers it.
“The result is that the patient may not receive the
proper treatment. They may be given shock treat-
ments, antidepressants or other medication because
‘their problems are mistakenly labeled as psychiatric.”
Dr. Tkacz has found the same thing. “Some doc-
tors don’t check for vitamin deficiencies in psychiatric
patients. I’ve seen patients who've been to four or five Lack of B,,: an easily
other doctors or hospitals before coming to our cen- overlooked diagnosis.
ter, and it’s not unusual for us to find that they have B,,
deficiencies.”
“And if you don’t look for it,” says Dr. Estroff,
‘you don’t find it.”
The problem is that even if the doctor does
check for B,, deficiency, the test results may not be
accurate. Several studies have shown that the usual
test for B,,, called the radiodilution assay, is unreli-
able.
“The standard test measures B,, as well as some
similar but inactive forms,” Dr. Estroff explains. “So
the test may show a normal result when the patient is Checking for B,.
actually deficient. That fact is not widely known by depletion.

physicians and psychiatrists. There is another, more

358 Solving Health Problems with Nutrition

reliable test, but it’s more difficult to do, takes longer

and is more expensive, so most labs don’t use it.”
No one is sure how many people may be suffer-
ing needlessly because of undiagnosed B,, deficiency.
‘Psychiatric symptoms can be caused by medi-
cal illness,” Dr. Estroff maintains. “B,, deficiency is
one cause, but it’s just the tip of the iceberg. It’s a
small aspect of a highly neglected area of medicine
and psychiatry.”
 Chapter A’ 359

Calcium versus
Osteoporosis

here are knowledgeable people in the world

who are, for lack of a better phrase, slightly
bone dumb—people who think milk is for children
and that fibula and tibia are Shakespearean charac-
ters; people who believe that brittle bones and the
“dowager’s hump” are inevitable aspects of growing
old. Young women shrug off that clinical-sounding
word “osteoporosis” as something that afflicts only
grandmothers, and young men tune out talk of the
bone-degenerating condition because it’s a woman’s
problem.
It is these people, those whose knowledge of
bones comes from cutting apart a frozen chicken,
who should consider the words of experts like Jon Stopping osteoporesis
Block, M.D. “Worrying about osteoporosis after it before it starts.
shows up is like closing the barn door after the horse
has already gone. We need to take precautions earlier
because you can do very little to reverse the condition
once it occurs,’ says Dr. Block, a member of the
osteoporosis research program in the University of
California at San Francisco’s Radiology Department.
Previously, medical efforts have concentrated on
treating osteoporosis, but today there’s more atten-
tion paid to prevention. The target audience is young A new approach to the
women, preferably in the teen years, and the goal is to bone-thinning disease.
make them aware of changes they can make that
could help them avoid the crippling bone condition.
360 Solving Health Problems with Nutrition

A “Modern” Disease
Osteoporosis was once scarcely recognized be-
cause most people didn’t live long enough for their
Menopause—when bones to deteriorate. As average life expectancy in-
women are at highest creased, however, doctors noticed that older women
risk for osteoporosis.
broke their wrists more often than older men, which
one German surgeon in 1882 blamed on tripping on
long skirts. Wiser men have since put fashion aside
and learned that menopause’s hormonal changes trig-
ger the loss of bone strength. That’s because follow-
ing menopause, there is a dramatic decrease in the
production of estrogen, a sex hormone that maintains
bone strength.
Today, the average woman will live to see at least
78 candles on her birthday cake, which means she
will also spend more than one-third of her life in the
postmenopausal stage, when osteoporosis is a high
risk. “More women are getting older and living longer,
as are men, so the situation for both sexes stands to
get much worse unless something is done,” says
James A. Nicotero, M.D., director of the Osteoporosis
Diagnostic Center at St. Francis Medical Center in
Pittsburgh.
Almost 20 million people have some form of
osteoporosis, and at least 1 million people annually
break bones that are weakened by osteoporosis.
About 50,000 people die each year from complica-
tions due to osteoporosis, and many victims are inca-
pacitated for life.

What Your Mother Didn’t Know

How osteoporosis occurs is clearer now than in
your mother’s day. Calcium, a silver-white metal that’s
Many men and women a dominant element in bone, is stored in the skeleton.
don’t get enough
When more is needed to maintain bones, teeth and
calcium.
bodily functions than is taken in, a calcium deficiency
is created. A federal survey shows that up to 50 per-
 Calcium versus Osteoporosis 361

cent of males between 18 and 34 have diets deficient

in calcium, while two-thirds of women between 18
and 74 fail to take in enough calcium each day.
When the reserves are taxed day after day with-
out being adequately restocked, bones become po-
rous and brittle (hence the name “brittle bone dis-
ease’’) and break easily. Vertebrae can collapse, and
the resulting dowager’s hump can cause severe back
pain. Once bone weakens, it is difficult to rebuild it to
its original strength; there’s no cure per se, and the
objective is to keep the deterioration from worsening.

Latest Theory:
Salt Contributes to Calcium Loss
As if there weren’t already enough the daily diet of young women in-
reasons to take the saltshaker off creased the amount of calcium
the table, there’s now evidence lost. Dr. Goulding also found that
that sodium may play a role in cal- a single teaspoon a day can cause
cium loss. enough of a calcium loss to de-
Ailsa Goulding, Ph.D., senior crease bone mass 1.5 percent a
research officer, Department of year.
Medicine at the University of The relationship between salt
Otago in New Zealand, believes and calcium excretion may be
that consumption of common ta- one reason why women in primi-
ble salt increases the amount of tive societies that add no sodium
calcium lost through the kidneys. to food suffer less bone loss than
In one study, animals given salt U.S. women, even though their
supplements lost more calcium calcium intakes are low by our
and phosphate—another element standards. It may also help ex-
in bone—in their urine and had plain the relationship between
less of the minerals in their skele- low-calcium intake and_ high
tons than those animals not re- blood pressure in countries with
ceiving salt. Another study found high salt consumption, such as the
that adding a teaspoon of salt to United States.
362 Solving Health Problems with Nutrition

Women have more trouble with calcium than

men and lose bone mass faster, which is why osteo-
Why women have more porosis is eight times more common in women. There
trouble holding onto are plenty of factors: Because of smaller body size,
calcium.
women generally have less bone mass to start with;
bone loss begins at an earlier age; pregnancy and
breastfeeding appear to take a heavy toll, since one
skeleton supplies calcium for two lives; women are
more likely to go on weight-reducing diets that typi-
cally are low in calcium; and women live longer than
men.
There are also social factors: Women smoke and
drink alcohol more than their grandmothers did, and
The calcium thieves. both have been implicated in calcium loss; soft drinks
and fast foods low in calcium are dietary staples; the
think-thin mentality keeps many women away from
calcium-rich foods; and although activity appears to
stimulate bone development, many women live sed-
entary lifestyles. For a more detailed discussion of the
risk factors, see chapter 48.

Bone Loss Starts Earlier

than Expected
“Some bone loss is going to occur in men and
women, which is a normal part of the aging process,”
says Robert Recker, M.D., who has conducted bone
research at the Creighton University School of Medi-
cine in Omaha. “But if lifestyle changes are made
early and not just when the prospect of osteoporosis
looms ahead, then there’s a good chance fractures
can be avoided.”
Bone mass stops developing at age 35, and
bones slowly start losing calcium thereafter, until
Getting your bones menopause occurs at about age 50 and triggers a
ready for the future. more drastic calcium drain. “The strength of a wom-
an’s bones at age 35 will determine how she handles
the high-risk years,” says Stanton Cohn, Ph.D., former
professor of medicine, School of Medicine, State Uni-
 Calcium versus Osteoporosis 363

versity of New York at Stony Brook, and head of the

Medical Physics Division of the Brookhaven National
Laboratory, New York. “The years before age 35 are
crucial. A woman can increase calcium intake and
exercise between ages 35 and 50 and have some
impact, but by that time, all she’s trying to do is
maintain what’s already there.”
The amount of calcium needed daily depends on
several factors. The government’s Recommended Di-
etary Allowance (RDA) is 800 milligrams. Experts How much calcium do
generally agree, however, that the calcium allowance you really need?
should be higher, possibly 1,200 milligrams for teen-
agers, 1,000 milligrams for women age 20 through
menopause, 1,200 milligrams for pregnant and lactat-
ing women, and anywhere from 1,000 to 1,500 milli-
grams after menopause, depending on whether estro-
gen is also being taken.
How to get the necessary calcium depends on
personal preference. A glass of low-fat milk contains
about 300 milligrams of calcium, so several would
meet the RDA. But there are plenty of other sources:
low-fat cheeses, yogurt and ice cream; red kidney
beans, lima beans and soybeans; blackstrap molasses;
fruits such as watermelon, oranges, raisins and straw-
berries; fish, especially sardines and salmon when
they have soft bones that can be eaten; Brazil nuts,
almonds and sunflower seeds; and green, leafy veg-
etables, which is where the cow gets the calcium for
milk in the first place.
Enough calcium can be obtained from food
alone. A report in the New England Journal of Medi-
cine concluded that the calcium intake of hunter- Diet is the best source
gatherer tribes still roaming the earth and living life- of calcium.

styles similar to people who lived in preagricultural

days is more that 1,500 milligrams a day, which ex-
ceeds the current highest suggested daily require-
ment. They ingest no dairy products and assure sturdy
bones just by eating what they pluck, pull or catch.
Some people have trouble sticking to a balanced
diet, and others just don’t like dairy products, in
364 Solving Health Problems with Nutrition

which case calcium supplements may be in order.

The most widely recommended are calcium-carbon-
ate tablets, which contain almost three times more
calcium than other types of supplements (and that
means fewer tablets to swallow).
Some people prefer to take their supplements
with meals, while others take them at bedtime; both
Don’t take more calcium approaches seem to work, although the experts ques-
than you need. tion whether taking large doses at once is wise. “It’s
probably best to take it slowly throughout the day
instead of in a sudden shot all at once. If you over-
load, there’s a chance that a good bit will be lost
through body wastes,” says Dr. Cohn.
Moderation is the watchword. Megadoses of cal-
cium that exceed 2,000 milligrams a day can in rare
cases lead to kidney stones and constipation.

Develop an Appetite
for Exercise
Swallowing isn’t the only activity that’s funda-
mental in osteoporosis prevention. Exercise is
Keep moving to stressed, since the evidence suggests that activity
strengthen your bones. strengthens bone mass. In the younger years, almost
any form of exercise is beneficial, experts say. For the
elderly, brisk walking is recommended. Enjoyment is
the key, since the activity must become a routine part
of everyday life.
Ironically, it appears that too much exercise can
lead to an early onset of osteoporosis. ‘‘Young
women who exercise to extremes and reduce their
body fat levels down to 17 to 20 percent seem to
trigger normal changes that alter their regular men-
strual cycle and cause calcium loss,” says Henry A.
Solomon, M.D., professor of medicine and cardiology
at Comell University Medical Center. “This applies to
any actively menstruating woman. Most of the cases
that have been seen are women in their twenties and
thirties.”
 Calcium versus Osteoporosis 365

The Debate
over Drug Treatments
Taking preventive steps early in life could spare a
woman from becoming entangled in the debate over
medical treatments of osteoporosis in later years. At The pros and cons of
the center of the controversy is estrogen. Some physi- hormone therapy.
cians routinely prescribe the drug to postmenopausal
women, along with progestogen, which is supposed
to protect the uterine lining from cancer that could be
caused by the estrogen. Others in the medical com-
munity say the treatment hasn’t been proved safe.
Meanwhile, sodium fluoride has joined the fra-
cas. This experimental drug has some practitioners
anxiously waiting because there is initial evidence that
whereas calcium and estrogen only prevent further
bone loss in postmenopausal women, sodium flu-
oride may make bones stronger.
A new diagnostic device may help prevent
women from reaching the stage where any of the
synthetic bone drugs are needed. In a 15-minute of- A better way to detect
fice procedure, the bone densitometer measures the osteoporosis.
mineral content of the wristbone at two precise loca-
tions, which correspond respectively to both the hip-
bone and spinal column. The densitometer uses only
one one-hundredth the radiation of a standard fore-
arm x-ray and concentrates the radiation in an area of
only two inches; an x-ray scatters radiation to other
organs, says Dr. Nicotero, whose diagnostic center
includes a densitometer.
“Conventional x-rays can’t detect osteoporosis
until 30 to 40 percent of the bone mass is lost, in
which case bone loss is so extensive that fractures
may occur. At that stage, estrogen is often prescribed.
The beauty of the densitometer is that we can detect
as little as a 2 percent change in bone mass, which
means we can initiate therapies before too much
damage is done,” he says. “So this device could de-
crease the use of estrogen because a woman wouldn't
366 Solving Health Problems with Nutrition

be given estrogen if she were found to have excellent

bone density at the time of her menopause.’

Osteoporosis:
Not a Simple Calcium Deficiency
With all the information that’s surfacing, it would
seem that avoiding osteoporosis is simply a matter of
drinking milk while exercising in the sun. In this case,
however, simplicity is confusing.
“One of the big problems is that the issue of
calcium and osteoporosis has been blown out of fo-
Calcium is only part of cus,” says David Fardon, M.D., a Knoxville, Tennes-
the solution. see, orthopedic surgeon and author of Osteoporosis:
Your Head Start on the Prevention and Treatment of
Brittle Bones. ‘“We've paid a lot of attention to the fact
that there’s not enough calcium in the diet, but the
situation has been oversimplified. It’s not just a cal-
cium-deficiency disease, because there are other fac-
tors involved. Some people assume that getting extra
calcium will automatically shield them from osteo-
porosis, but it’s not,that simple.”
Robert P. Heaney, M.D., who has conducted
joint research with Dr. Recker at Creighton University
To fight osteoporosis, School of Medicine, agrees: “If you go out and buy a
consider all the factors. bottle of calcium supplements without considering
the importance of the other factors, you'll realize
some benefit. But if you’re striving for the maximum
results, you must make sure the other pieces of the
puzzle are there also.”
Researchers at the University of lowa College of
Medicine, for example, found that calcium intake
alone wasn’t related to bone density, but bone density
was greater when calcium and vitamin D were ade-
quate (American Joumal of Clinical Nutrition). But be
aware that vitamin D supplements, if taken in excess
(the Recommended Dietary Allowance is 400 interna-
tional units), can build up to toxic levels.
Other mysteries of osteoporosis are just begin-
ning to unravel. In a case involving young and middle-
 Calcium versus Osteoporosis 367

aged men, two groups thought to be safe from osteo-

porosis, researchers at a Veterans Administration Does alcohol confound
hospital in Illinois found extensive bone loss in those calcium metabolism?

who were chronic alcoholics. The finding enhances

previous theories about alcohol interfering with the
integrity of the bone.
Of all the questions that remain, one may be the
hardest to answer: How do you get a teenager to drink
enough milk?

Is It Possible to Reverse Bone Loss?

Scientists have reported that cal- bones of another 29 patients
cium supplements are likely to showed no change.
help slow down bone loss and Dr. Miller reports that the cal-
thus put the brakes on osteoporo- cium and vitamin D_ therapy
sis. That’s why so many doctors seemed to work for some women
prescribe calcium (up to 1,000 regardless of whether they took
milligrams a day) to their patients estrogen.
with the disease, along with vita- And taking fluoride along
min D (400 international units a with the nutrients didn’t seem to
day), plus estrogen, exercise and have any effect on bone loss at all.
fluoride. “The increase in bone mass
But there’s been precious lit- was very unusual,” says Dr. Miller.
tle evidence that calcium supple- “We are quite excited about the
ments could actually help reverse apparent reversibility of osteo-
bone loss. Until now. porosis.”’
In a study conducted by Paul Up to this point, osteoporosis
D. Miller, M.D., of the University of has been regarded as merely treat-
Colorado School of Medicine in able, not curable. But if Dr.
Denver, 21 patients with osteo- Miller's findings are corroborated
porosis actually gained bone by other research, calcium (with
mass after a year of taking daily vitamin D) may emerge as the
doses of 1,500 to 2,000 milligrams core ingredient in a long-awaited
of calcium plus vitamin D. cure.
In fact, by the end of the year, Until then, we can heed cur-
their bones had returned to nor- rent advice from a growing medi-
mal mass. And instead of showing cal consensus: Make sure you’re
a continuing decline in mass, the getting enough calcium.
368 Solving Health Problems with Nutrition

“Brittle bones just don’t make a profound im-

pression on the public,” says Dr. Fardon. “Also, peo-
ple want results. They want the satisfaction of seeing
their efforts work, and it’s not as rewarding to change
your lifestyle in the hope of preventing a broken hip
decades down the road.”
The answer? “Instill good habits while they're
children, then they won’t have to make any drastic
changes later in life when they are set in their ways,”
Dr. Fardon says. “The best place to start is in the
womb, so the child has strong bones when born.”
Adds Dr. Block, “Women are flocking to get
mammograms because they realize there is the likeli-
A prime deterrent hood they could get cancer. But this wasn’t always
against osteoporosis: the case, and it took time to get the message out.
early detection.
Today, you don’t find women asking doctors to mea-
sure their bone mass, even though there’s a good
chance they'll develop osteoporosis. Women don’t
realize that some of these diagnostic techniques exist.
Family physicians will have to do a lot of the motivat-
ing, and groups like the Osteoporosis Foundation
should help get the message out. The awareness will
come, but it will take time.”
 Chapter AS 369

Who Gets
Osteoporosis?

ou lock your doors, buy a smoke detector and

perhaps install a security system to protect the
valuables in your home. Do you give the same protec-
tion to the valuable strength in your bones?
You may be in greater need than others of pre-
vention against osteoporosis, a disease that gradually
steals strength-building calcium from bones.

Take Stock of Your Skeleton

To get an idea whether you'll be standing tall in
years to come or whether you'll be one of the millions
for whom even a simple task could be backbreaking,
see if any of the following risk factors of osteoporosis
fit you.
Advancing age means bone strength re-
treats. It usually isn’t until after age 50 or so that
neglected bones start demanding attention—usually if you’re over age 50,
by fracturing or shortening your stature. Menopause your bones are at risk
for calcium loss.
occurs around this time, taking the biggest toll of all
on the skeletal system. The diet of an older person is
often too poor to maintain bone integrity. And with
increasing age, the intestines become less efficient at
absorbing what calcium there is in the diet. The num-
ber of people over age 65 in the United States is
expected to reach 22 percent of the population by the
year 2050, making osteoporosis one of the medical
profession’s top research priorities.
370 Solving Health Problems with Nutrition

If you’re a woman, you should be con-

cerned about your bones. While both sexes un-
avoidably lose some bone mass simply due to aging,
most of the 15 to 20 million cases of advanced osteo-
porosis are in women. The fact that women have
smaller frames than men may be one explanation for
the inequity—when the body needs calcium else-
where and calls on bones to give up part of their
supply, men’s bones simply have more on reserve.
Menopause, either natural or surgical,
means increased risk. Estrogen, the multitalented
The hormone/bone- hormone produced by a woman’s ovaries, helps
strength connection. maintain bone mass and strength in addition to its
sex-related duties. When menopause shuts down the
supply, bones are more susceptible to fractures. Sci-
entists confirmed this estrogen/bone-strength link
when they began seeing premature osteoporosis in
premenopausal women who had had their ovaries
removed. Hormones may also help account for the
female bias in osteoporosis. Testosterone, a male hor-
mone helpful for bone mass, has a more gradual
decline in production than estrogen’s somewhat here-
today, gone-tomorrow departure. Women who have
spent years taking estrogen-containing birth control
pills are thought to enjoy greater protection from os-
teoporosis, also.
Caucasian and oriental women are at
greater risk than black women. Large-scale stud-
Two theories why black ies have repeatedly shown much higher rates of os-
women have a lower
teoporosis in fairer-skinned races. Two theories may
risk.
account for this, says Diane Meier, M.D., co-director
of the Osteoporosis and Metabolic Bone-Disease Pro-
gram at Mount Sinai Medical Center, New York City.
She’s conducting a study of 150 white women and
150 black women, ages 26 to 65, to see if the former
have a genetic predisposition to excessive bone loss,
or if nutritional habits and body composition are the
key. “Blacks, at least in the North American popula-
tion, tend to have higher obesity rates. And obesity is
protective against bone loss,” Dr. Meier explains.
 Who Gets Osteoporosis? 371

(Very thin people, then, are also at greater risk.) Black

people may have larger and denser bone structures,
too, which may give them an advantage against osteo-
porosis.
A diet short on calcium will mean bone loss
in the long run. Scientists found women who had a
calcium-rich diet in childhood and early adulthood Optimum calcium intake
built a bone mass more able to withstand osteoporo- should start early.
sis in later years. Lactose, a carbohydrate in calcium-
laden milk, may help the body absorb calcium. Major
health organizations are urging people to start getting
the Recommended Dietary Allowance (RDA) of cal-
cium (800 milligrams for children 1 through 10 and
for adults, and 1,200 milligrams for children 11
through 18 and for pregnant and lactating women)
early in life, but most Americans obtain barely half
these amounts.
Constant dieters lose more than pounds.
They risk losing bone mass, too, after years of passing
up high-fat (but also high-calcium) dairy products.
Low-fat dairy products like skim milk and cottage
cheese can help dieters meet their calcium needs.
Strict vegetarians may restrict their bones’
strength. “Pure vegetarians who don't eat any dairy
products have a hard time getting adequate calcium,”
says Dr. Meier. “The green vegetables they eat, like
broccoli and spinach, do have calcium, but they also
contain oxalates, which block the absorption of cal-
cium in the gut.”
A meat-eater’s diet may eat away at bone
strength. A culinary love affair with red meat puts
overindulgers at greater risk. Studies indicate high Too much protein could
protein levels speed up the excretion of calcium in be a problem.

urine and keep the mineral from making its way to

bones.
A vitamin D deficiency could mean low-
grade bone strength. Vitamin D is normally ob-
tained in adequate amounts through a healthy diet
and through the skin with 10 to 20 minutes of sun
exposure daily. It’s crucial for intestinal absorption of
372 Solving Health Problems with Nutrition

calcium and bone remodeling. But older people may

run into a vitamin D shortage due to poor nutrition
and long housebound periods due to illness or injury.
The sunshine/vitamin D connection is also why peo-
ple who live in rainier, cloudier climates are thought
to be at higher risk than those on whom the sun
always shines.
A family history of osteoporosis is related
to your risk of getting the disease. A woman's
grandmother, mother and aunt may be a clue to what
may be in store for her. One theory behind this: If
female relatives reached menopause at a rather early
age, they may pass along that tendency. So more
years are spent without estrogen’s bone protection.
A lazybones lifestyle leads to thinner bones
later. One of the many beneficial effects of exercise
Stimulate your skeleton. on the body is the way it helps build bones. Any
weight-bearing exercise stimulates the skeleton to put
down new bone. Tennis players, weight lifters, ballet
dancers and other athletes show wider bones and
more cortical, or outside-layer, bone in limbs involved
in their particular sport. And astronauts are prime
examples of gravity’s usefulness—when they’re
weightless in space, they lose a significant amount of
bone mass. Patients confined to bed face a similar
situation and can lose as much as | percent of their
trabecular, or inner, bone per week. Resuming normal
weight-bearing activity gradually restores the bone.
Certain substances make calcium seep
away. Prolonged use of aluminum-containing antac-
Three types of drugs ids, prednisone- or cortisone-containing drugs and
that can erode bones. diuretics can increase the risk of bone loss. Excessive
sodium in the diet is also being explored as a possible
cause of calcium excretion, but this research is still
very preliminary.
Medical disorders may be additional risk
factors for bone loss. Diabetes, hyperthyroidism,
hyperparathyroidism, Cushing’s disease, rheumatoid
arthritis and gastrectomy have been reported to cause
 Who Gets Osteoporosis? 373

osteoporosis, but scientists note the need for more

research in this area.
Cigarette smoking may weaken bones.
Smoking is suspected of exerting a possibly toxic ef-
fect on bone mass. Women who smoke have lower
estrogen levels, tend to be thinner than nonsmokers
and undergo menopause at an earlier age. Overall,
women smokers appear to have lower cortical bone
mass.
Alcohol may abuse bones. Heavy alcohol use
is one of the few things that puts a man at risk for
osteoporosis. Alcoholic men have lower bone mass One risk factor for men.
and lose bone more rapidly than nonalcoholics. In
women, the incidence of hip fractures increases as
alcohol intake rises. These associations could stem
from a direct toxic effect of alcohol, poor nutrition,
lower body weight, liver disease or other alcohol-
related factors.
374 Chapter 49
Vitamin D:
Another Force
against Bone Disease

ne of the best friends your bones ever had

just traveled 93 million miles to get here. It’s
sunlight, and if you aren’t outside welcoming it, well,
maybe you don’t know what you're missing. But your
bones do.
The sun, that untiring nuclear furnace, brightens
our days, warms our cold bodies and melts the snow.
Sunshine: your best But the sun is more than just a pretty face. The sun’s
source of vitamin D. rays also trigger an ingenious biochemical process in
our skin that stimulates the production of vitamin D,
and that’s good for our bones, too.
Get enough sunlight—just 10 to 20 minutes a
day, experts say—and your skin will manufacture all
the vitamin D your body needs.

An Urgent Need for Vitamin D

Fortunately, most Americans get plenty of vita-
min D. But a number of the nation’s elderly—though
no one knows exactly how many—live in the shad-
ows, locked away from the light of Earth’s shining
star. As a result, their bodies don’t make enough vita-
min D. Neither do they get enough vitamin D in their
diet, a secondary but important source of the vital
nutrient.
Why is vitamin D so important?
Think of vitamin D as a bus. Every day, calcitum—
an essential mineral—takes a ride on that bus. Its
destination: your bones. Calcium makes your bones
 Vitamin D: Another Force against Bone Disease 375

strong and hard. Without calcium, your bones can

become dangerously soft or brittle. But calcium has to Vitamin D’s job is to
have a way of getting from your gastrointestinal tract transport calcium into
your bones.
to your bones. That’s where vitamin D comes in.
Vitamin D formed in the skin is converted in the
liver to a prohormone, 25-hydroxyvitamin D. It’s then
converted once again in the kidney to an active hor-
mone, 1,25 vitamin D, or calciferol. This hormone is
what moves calcium along on its way to your waiting
skeleton.
“The main thing vitamin D does is help the gas-
trointestinal tract absorb calcium,” says Patrick Ober,
M.D., of the Bowman Gray School of Medicine in
Winston-Salem, North Carolina. “Calcium won’t be
absorbed, and it won’t ever be utilized unless it can be
transported into the bloodstream. And that’s the func-
tion of vitamin D.”

D Deficiency Can Be Crippling

Exactly how much vitamin D does the average
person need? The U.S. Recommended Daily Allow-
ance (USRDA) of vitamin D is 400 international units
daily.
Thanks to the sun, most of us get enough vitamin
D without even trying. But for those who spend little
time outdoors or who cover up every available patch
of sun-receptive skin, vitamin D deficiency can be
both painful and potentially crippling.
In adults, prolonged vitamin D deficiency may
lead to osteomalacia (soft bones) or osteoporosis
(brittle bones).
There’s more to osteomalacia and osteoporosis
than just a reduction in the amount of calcium going
to your bones. Your body needs calcium for other A shortage of vitamin
purposes—to keep your heart beating rhythmically, to D and calcium means
trouble.
regulate muscle contractions, to promote blood co-
agulation and, in general, to keep your body’s cells
glued together. When your body doesn’t get enough
vitamin D, the bones don’t get calcium, but neither
376 Solving Health Problems with Nutrition

does the rest of your body. So it responds to immedi-

ate calcium needs by siphoning calcium from the
bones.
The early warning signs of osteomalacia are
bone tenderness or pain, back pain, irritability and
Know the warning signs weakness. These symptoms often are dismissed as the
of osteomalacia. inevitable consequences of old age. But it’s not neces-
sarily so. Left undiagnosed, osteomalacia sufferers ul-
timately may have trouble making it up a flight of stairs
and, in the worst cases, might not be able to walk.

Other Conditions
Can Threaten D Status
The link between vitamin D deficiency and os-
teoporosis is not as clear. Osteoporosis patients are
believed to suffer a calcium deficiency. Some patients
do absorb calcium more efficiently with the adminis-
tration of vitamin D in its hormonal form. Research
suggests, however, that not all cases of osteoporosis
respond as well to increased vitamin D. An estimated
20 million Americans, most of them postmenopausal
women, suffer from osteoporosis, believed to be a
result of reduced production of estrogen in the body.
This condition interferes with the conversion of vita-
min D to a hormone, so the bones are deprived of
calcium.
Certain illnesses make it hard for some people’s
bodies to process vitamin D. These include liver, kid-
ney or parathyroid disease, and vitamin D-depen-
dency rickets, a hereditary disorder. Vitamin D along
with calcium has been found useful in treating these
problems, but in doses well beyond the USRDA of
400 international units.
Certain anticonvulsant drugs—phenobarbital
and phenytoin, for instance—also can abnormally
Some drugs and vitamin speed up the breakdown of vitamin D. Supplementa-
D don’t get along.
tion is required to reverse osteomalacia caused by
these drugs but, again, in doses that must be medi-
cally prescribed.
 Vitamin D: Another Force against Bone Disease 377

Nursing mothers and pregnant women also may

require additional vitamin D and calcium. In these
cases, however, supplements should not be taken
without a doctor’s recommendation.
Children can also suffer vitamin D deficiency,
and their bones, too, can turn soft. This condition in
young people, characterized by bowlegs and pigeon
chest, is called rickets.

Sunshine-Shy Oldsters
Face Trouble
In the early days of the Industrial Revolution, as
soot, smoke and dust rose high into the sky, blocking
sunlight, rickets emerged as a serious problem among Among American kids,
children. Today, thanks in large part to vitamin D- vitamin D deficiency is
rare.
fortified dairy products, vitamin D deficiency is un-
common among American children.
Of growing concern, however, are reports of vita-
min D deficiency among senior citizens, even in the
midst of America’s Sun Belt.
‘What we see happening in our society is that
people, particularly as they get older, have a tendency
to avoid sunlight purposely,” says John L. Omdahl,
Ph.D., a biochemist in the University of New Mexico
School of Medicine.
All things being equal, says Dr. Omdahl, a 70-
year-old man shouldn’t need more vitamin D than a
man 50 years younger. As a practical matter, though,
many older Americans do need more vitamin D be-
cause their bodies don’t make enough to begin with.
Why not?
There are a variety of reasons, Dr. Omdahl ex-
plains. Many older people worry that exposure to
sunlight may lead to skin cancer. Or perhaps they just Why many older people
have trouble getting around, so they remain indoors. don’t get enough sun-
shine.
And in the winter, in particular, they are reluctant to
venture outside into the cold.
Contributing to the deficiency is insufficient vita-
min D in the diet. Many older people have trouble
378 Solving Health Problems with Nutrition

digesting milk products, says Dr. Omdahl, so they

don’t consume enough dairy foods to meet nutritional
requirements.
It also is believed that as we get older, our bodies
become less able to absorb calcium. Likewise, blood
levels of vitamin D hormone also diminish.
Particularly telling is a 1982 study of elderly resi-
dents in Albuquerque, New Mexico. According to the
Are you getting enough study, which Dr. Omdahl coauthored, elderly Ameri-
vitamin D? cans appear to be getting less vitamin D than the
USRDA of 400 international units. Sixty percent of the
elderly New Mexicans took in less than 100 units a
day. Most were not taking vitamin D supplements, and
they avoided sunlight, which was abundantly avail-
able.
Vitamin D deficiency is uncommon in the United
States, says Dr. Omdahl. But among the elderly, par-
ticularly city dwellers, vitamin D deficiency does oc-
cur. “What percentage of the elderly that is, we’re still
trying to determine,” says Dr. Omdahl. “But it is
something that should be of concern to the general
population.”

Less Sunlight,
Lower Vitamin D Intake
In the winter, getting enough vitamin D can be a
problem for anyone living in the northern latitudes.
How climate can influ- One reason is that the sun is lower in the sky. The
ence your vitamin D sun’s ultraviolet rays have trouble punching through
levels.
the atmosphere, which is thicker at that low angle.
There are also fewer hours of daylight and more
clouds. Also, when it’s cold outside, few of us are
inspired to sunbathe. Sitting next to a nice, sunny
window doesn’t help, either. Glass filters out Sol’s
ultraviolet rays.
Suppose you live in West Thumb, Wyoming, and
it's been snowing there continually since October.
Can you still get enough sunshine to meet your needs?
 Vitamin D: Another Force against Bone Disease 379

Maybe not. “In the winter, in the northern part of the

United States, I'd say the chances are you aren't going
to get enough vitamin D by skin,” says Hector
DeLuca, Ph.D., chairman of biochemistry at the Uni-
versity of Wisconsin.
For the vulnerable elderly, some of whom may
get very little sunlight even in the summer, the need
for vitamin D can be particularly acute.
Fortunately, the sun is not the only source of
vitamin D. There are some simple ways for the el-
derly—and the rest of us—to get enough vitamin D
while we're huddled up next to the radiator waiting
for spring.
We can consume more dairy foods. If you're
tallying up international units of vitamin D, a quart of
fortified milk holds 400. Vitamin D also is abundant in Good food sources of
certain oily fish, such as salmon, mackerel and sar- vitamin D.

dines. You'll find 500 international units of vitamin D

in a 3%-ounce helping of salmon and 575 units in the
same size serving of mackerel.
Fish-liver oils are very rich in vitamin D. There
are, for example, 1,000 international units of vitamin
D in a tablespoon of cod-liver oil. Other foods contain
vitamin D, including liver, butter, cheese, eggs and
beef. Some cereal products also are fortified. Vitamin
D, however, is not plentiful in vegetables.

How Not to Overdose

on Vitamin D
Be aware that because the body can store excess
vitamin D in fat, large doses of vitamin D, taken over
time, can cause serious health problems. That’s a very
unusual problem but something to keep in mind.
When vitamin D dosage hits the level of thousands of
international units, that’s when trouble can begin.
If too much vitamin D in the diet can cause ill-
ness, what about sunshine? Can you overdose on
vitamin D after a relaxing afternoon on the golf
380 Solving Health Problems with Nutrition

course? Not to worry. At a certain point, your body

knows when to turn off the vitamin D tap. It’s self-
regulating, like a thermostat.
“Sunshine is the way you were meant to get your
vitamin D,” says Dr. DeLuca. “The amount of vitamin
Multivitamins may sup- D that can be made in the skin is limited.” We can
ply all of the vitamin D safely get all the vitamin D most of us require in a
you need.
multivitamin tablet, which Dr. Ober and Dr. DeLuca
recommend as “insurance.”
‘‘Most of these vitamins have 400 units of vitamin
D, which is a safe amount. But I really wouldn’t want
most people going beyond that,” says Dr. Ober.
 Chapter 50
Put Senility
in Reverse
with a Better Diet

hen asked a few years ago to name three

wishes, scientist and novelist Isaac Asimov
answered: to live so happily and effectively that no
one would mourn his passing, to leave this world
knowing that civilization would survive into the 21st
century and beyond and, finally, not to outlive his
intelligence—that is, to remain productive and quick-
witted to the end, without senility.
Like Dr. Asimov, most of us worry about the
possibility of mental decline in later life. We can toler-
ate the predictable aspects of the aging process—
mild forgetfulness, blurred near vision, difficulty hear-
ing—but none of us wants to be among the estimated
15 percent of those over 65 who suffer from some
degree of senility.
And for the most part, there’s nothing that says
we must. Doctors once accepted senility as one of the
irreversible penalties of old age, but some now say the
opposite: that in many cases the symptoms of senility
can be prevented or reversed.

Antisenility Nutrients
in the Spotlight
If there were a contest for the antisenility “nutri-
ents of the year,” the prize might be awarded to vita-
min B, and copper. Two University of Texas nutrition- A link between senility
ists reported the remarkable news that a deficiency of and low copper or B,.
382 Solving Health Problems with Nutrition

B, or copper in young rats causes some of the same

kind of brain cell abnormalities as those seen in senile
humans.
The researchers found, among other things, that
in rats and humans, the dendrites—delicate, branch-
ing roots that carry electrical impulses from one brain
cell to another—tend to shrivel up and die when
deprived of B, or copper. Without the all-important
dendrites, brain circuitry breaks down (American
Journal of Clinical Nutrition).
Though the rats were fed a diet skimpier in the
two nutrients than any comparable human diet would
be, the researchers said that a mild deficiency of

It Takes Zinc to Think

According to British physician Roy Hullin,
M.D., the difference between a sharp mind
and a fuzzy one could depend on the amount
of zinc in your diet. When Dr. Hullin studied
1,200 patients over 65, he found that the 220
senile people in the group had significantly
lower zinc levels than those who were not
senile. And, he says, he got similar results in a
younger group (under 65) who were just start-
ing to show signs of senility.
“Tt is not generally appreciated,” says Dr.
Hullin, “that as much zinc as iron is required
in the diet.” The fact is, over 80 enzymes
require zinc to work, many of them involved
in the function of the central nervous system.
But the elderly may not be getting an
adequate supply, since many can’t afford the
foods (such as meats and seafoods) that are
high in this nutrient. Dr. Hullin says there’s a
“strong case’”’ for more work in this area and
possibly for “zinc supplementation to the
population at risk.”
 Put Senility in Reverse with a Better Diet 383

those nutrients over the years could have the same

devastating effect. The Texas researchers, Elizabeth Liver, for example, is
Root, Ph.D., and John Longenecker, Ph.D., recom- high in ‘‘antisenility’”’
nutrients.
mended getting adequate amounts of B,, copper and
other nutrients into the diet as soon as possible for the
sake of prevention. (Liver is a fine source of both.)
“Tf you catch these changes early, then you might
prevent some of the neurological damage from occur-
ring,’ Dr. Root says. “But it’s not just B, and copper.
People who have a poor diet in general are the most
likely to get in trouble. We’re starting some more
experiments on the possible effects of deficiencies in
magnesium and folate, two nutrients that also come
up low in most diet surveys.”
Experiments with rats are one thing, but what
about studies of people like you and me? What about
people who feel fairly fit mentally but who want to be Can nutrition give your
even sharper in the years ahead? What about people brain an edge?
who want to learn how to use a home computer or
write a book when they retire—or just keep their
bridge game sharp? Can nutrition give them the extra
edge they want?

Keeping a Keen Mind

Actually, there’s recent evidence that physically
healthy people over age 60 can be measurably keener
of mind than their peers if they maintain sufficient For maximum brain
dietary levels of vitamins B,, and C, folate and ribofla- power, avoid deficien-
cies of vitamins B,, and
vin (B,). Even mild, virtually unnoticeable deficien- C, folate and riboflavin.
cies of those nutrients can mean less-than-optimum
brain function.
At the University of New Mexico, senility experts
Jean M. Goodwin, M.D., and her husband, James S.
Goodwin, M.D., and others placed advertisements in
newspapers and on TV and radio in the Albuquerque
area asking for volunteers for an experiment. Each
volunteer had to be at least 60 years old, free of all
serious diseases and not on medication. After a
screening process, the Goodwins chose 260 men and
384 Solving Health Problems with Nutrition

women between the ages of 60 and 94 from various

social and income levels.
All the volunteers gave a sample of their blood
and filled out a three-day food diary, stating exactly
what they had eaten during that period. Taken to-
gether, the blood test and diet survey showed the
researchers almost exactly what each person’s levels
of most vitamins and minerals were.
After this process, the volunteers underwent two
mental performance tests. In the first one, a re-
searcher read a one-paragraph story to each person
and asked him to repeat it as quickly and accurately as
possible. A half hour later, the volunteers had to recite
the paragraph from memory, with no cues. The sec-
ond test measured each person's ability to solve non-
verbal problems and to think abstractly.
The researchers fed all the test scores and nutnri-
tional profiles into a computer and waited to see if
The people with the low- good nutrition would correlate with quicker thinking.
est nutrient levels had It turned out that the volunteers with the lowest B,,
the lowest mental test
scores. and C levels scored worst on the memory test. Those
with the lowest levels of B,., C, folate and riboflavin
did worst on the problem-solving test (Journal of the
American Medical Association).
“We showed that in a population of healthy
older people, those people who had a deficient intake
and low blood levels of certain vitamins scored sig-
nificantly worse on the tests,” says Dr. Jean Goodwin,
who is now at Milwaukee City County Medical Com-
plex in Milwaukee, Wisconsin. “Our recommendation
is that everyone maintain an adequate intake of those
nutrients.”

Vitamins Separate the

Sharp and the Not-So-Sharp
“Giving older people extra vitamins sounds to us
like a sensible course,’ Dr. James Goodwin adds.
“Studies in nursing homes have shown that when you
put half the residents on a multivitamin and the other
 Put Senility in Reverse with a Better Diet 385

half on a placebo [dummy pill], the staff will eventu- Scientists say that, in
ally be able to tell, with great accuracy, which half nursing homes, multivi-
tamins may make the
was supplemented and which wasn’t. The group on difference.
the vitamins is always ‘doing better.’ ”
One of the nursing home studies referred to
above took place at a long-term-care hospital in
Leeds, England. It showed that a supplement of vita-
min C could, in many cases, help even people who
are weak and listless to actually improve mentally and
physically.
The trial involved 115 men and women, ages 59
to 97, half of whom received a plain soft drink every
day and the other half a soft drink with 1,000 milli-
grams of vitamin C added to it. The experiment lasted
28 days, and the medical staff, not knowing which
group was which, observed the patients to see whose
appetite, interest in the life around them and general
demeanor changed for better or worse.
It turned out that in less than a month, there was
greater improvement in the supplemented group. On
the average, they gained more weight and became Vitamin C seemed to im-
more active than usual. Some of the patients who had prove the well-being of
nursing-home residents.
seemed beyond help surprised the staff with their
improvements (Lancet).

Confusion Cleared Up
Thiamine (B,) may also keep the brain thinking
straighter and younger. An orthopedic surgeon in
England thinks that thiamine deficiency can cause
confusion, and that confusion can lead to stumbles
and broken bones.
The surgeon, M. W. J. Older, M.D., had noticed
that people who came to him for hip and thighbone
surgery all experienced a dip in their thiamine levels A surgeon’s opinion:
as a result of the stress of the operation. He also Thiamine deficiency can
cause mental confusion.
noticed that until the thiamine shortage passed, the
patients suffered a bout of confusion.
Digging a little deeper, Dr. Older found that pa-
tients who came in for elective hip surgery—planned
in advance, that is—weren’t thiamine deficient before
386 Solving Health Problems with Nutrition

the operation, and their postsurgical thiamine defi-

ciency didn’t last as long. But the patients with emer-
gency fractures, he discovered, were deficient before,
during and after their operations. That raised the pos-
sibility that preoperative thiamine-related confusion
may even have helped cause the emergencies.
‘Mental confusion in the elderly awaits further
study,’ Dr. Older notes, “but our data support the
A link between thiamine concept that thiamine deficiency may be a contribu-
deficiency and bone tory factor to postoperative confusion. We suggest
fractures.
that the causation of the fracture itself may be attribut-
able to thiamine deficiency, with confusion precipitat-
ing the fall” (Age and Aging).

Can Vitamin C Boost the

Immunity of the Elderly?
Your body generally puts up a good fight
against incoming germs—when it can. But
sometimes, keeping up your immunity isn’t so
easy, especially when you're old.
Now help may be on the way in the form
of vitamin C, according to researchers in Bel-
gium. The doctors there found that a 500-
milligram daily injection of the vitamin signifi-
cantly bolstered the immune system in a
group of people over 70. The group receiving
the placebo shot, they report, had no im-
provement.
In a similar experiment, the researchers
tested a 500-milligram oral dose of vitamin C
and found that it worked nearly as well as the
injected form. The researchers conclude that
vitamin C should be considered as a possibly
“successful, nontoxic and _ inexpensive”
means of improving the immunity of the el-
derly (Gerontology).
 Put Senility in Reverse with a Better Diet 387

Heading Off Alzheimer’s Disease

Good nutrition may even help people suffering
from Alzheimer’s disease. This most-feared form of
senility strikes in middle age and gradually destroys its
victims mentally and physically. Alzheimer’s is re-
garded as unexplainable and untreatable, but there is
hope.
“Let’s say that someone has a mild case of
Alzheimer’s,” geriatric specialist Charles H.
Weingarten, M.D., of McLean Hospital in Massachu- Can better nutrition help
setts, says. “They may fall into poor dietary habits that people with Alzheimer’s
disease?
make the situation worse. You may not be able to
reverse the disease. But good nutrition might enable
that person to function better. It might make a signifi-
cant difference in the amount of care a person re-
quires—perhaps even allowing someone to stay at
home rather than being institutionalized,” says Dr.
Weingarten.

Be Alert to Signs
of Pseudosenility
Nutrition aside, people who want to avoid men-
tal decline in themselves or their relatives would be
wise to learn that certain conditions can masquerade Warning: Certain condi-
as senility but aren’t senility at all. In the past, many tions (including medica-
tion side effects) can
people have been diagnosed as demented and pass as senility—but
wrongfully sent to institutions because their families aren’t senility at all.
and physicians didn’t know the real cause of their
strange behavior.
The side effects of certain prescription drugs, for
example, can imitate senility. In one case, a 66-year-
old man became disoriented and obsessed with
events that had happened 20 years before, and he lost
most of his short-term memory. He recovered after
being taken off propranolol, a drug that stops angina
pain in heart patients (Journal of the American Medi-
cal Association).
388 Solving Health Problems with Nutrition

“The high frequency of adverse drug reactions

causing central nervous system symptoms in the el-
derly is well documented,” Dr. Weingarten says. He
stresses the importance of “scrutinizing all medica-
tions to search for reversible factors in psychiatric
illness requiring hospital care.” He also feels that un-
detected physical illnesses can look like mental ill-
ness in older people (Journal of the American Geriat-
rics Society).
Depression, which is treatable, may also disguise
itself as senile dementia. Both illnesses, says one au-
Is it dementia or just thority on psychiatry and aging, are marked by poor
depression? concentration, loss of interest, disorientation, self-
neglect, weight loss and slow, shuffling gait. ““Demen-
tia is sometimes more apparent than real,” he says
(Medical Journal of Australia).
One lesson is clear: If any elderly relative or
friend of yours is diagnosed as having irreversible
senile dementia, don’t accept the doctor’s verdict
automatically. Ask the doctor to make sure there are
no hidden illnesses, no vitamin deficiencies, no side
effects of drugs and no milder, more treatable mental
illnesses to blame. Get a second opinion, if necessary.
And remember that senility in late life is the exception,
not the rule.
 Chapter 51 389

A Nutritional
Formula for Healthy
Teeth and Gums

hree out of four people over age 35 have peri-

odontal (gum) disease to some extent, the
American Dental Association says, and almost 40 per-
cent of all 60-year-olds have lost several teeth be-
cause of it. Tooth decay is what ruins children’s teeth,
but for adults the enemy is gum disease.
The disease starts when a coating of plaque
forms on the teeth. Plaque is a sticky film of food and
bacteria that accumulates between teeth, along the How gum disease
gum line and behind poorly fitted dentures. If you begins.
don't carefully remove all of the plaque every day, the
overlooked bacteria will attack your gums. The gums
may start to bleed and pull away from your teeth, and
when they do, you're in trouble: The infection can
strike at the tooth sockets (called the alveolar bone),
and the teeth may eventually loosen and fall out.
The scary part of periodontal disease is that, like
glaucoma, it can sneak up on you. One doctor says,
“You don’t know you have it until your teeth get Gum disease is sneaky,
loose.” Actually, there are warning signs. Bad breath with few warning signs.

is one, and so are bleeding gums. But the bleeding

may stop, and there may not be any pain, even when
the disease is silently progressing. Antibiotics are
sometimes used to halt infection, and surgery might
be needed to repair the damage.
Unfortunately, the treatment is painful, expensive
and time-consuming. The process of stripping away
the infected gums can take six to eight months and
cost hundreds—even thousands—of dollars. But
that’s less than half of it. Only skin grafts can replace
390 Solving Health Problems with Nutrition

the lost gums, and if any teeth come out, the price of
fancy gold and porcelain bridgework can be as-
tronomical.
Indeed, nature has been unfair to the gums. Not
only are they continuously bathed in an infectious
mixture of bacteria and food particles but they also
may be the last to get their share of indispensable
vitamins and minerals. Even when the rest of the body
has enough vitamin C and folate, the gums may still be
deficient, and, when the blood needs more calcium, it
robs the tooth sockets first. As a result, the gums need
extra amounts of those three nutrients.

Holding the Line with Vitamin C

There is some evidence that vitamin C protects
gums from infection, but no one knows how exactly.
A possible protector of Some researchers think that vitamin C makes white
the gums: vitamin C. blood cells tougher and faster and better at killing
bacteria. Others say that vitamin C promotes the for-
mation of healthy new gum tissue. And still others
think that it latches onto iron molecules, thus depriv-
ing bacteria of one of its essential foods.
One dentist who uses vitamin C in his practice is
Robert C. Miner, D.M.D., of Hancock, New Hamp-
shire.
“If I see someone with periodontal disease, |
recommend vitamin C, along with calcium,” Dr.
One dentist’s Rx for Miner says. ‘‘As far as results go, it’s hard to document
periodontal disease: vi- the effects. But I know that if people with trench
tamin C and calcium.
mouth [a gum disease caused by poor nutrition and
stress] start taking a gram of vitamin C a day and take
a short course of antibiotics, I know that the condition
will improve.”
Dr. Miner inherited a good deal of his expertise
from his father, who was also a dentist. “‘He was dean
of the Harvard School of Dentistry between 1919 and
1944,” Dr. Miner says, “‘and he was a pioneer in the
use of nutrition in dentistry. At the time, he was a
 A Nutritional Formula for Healthy Teeth and Gums 391

maverick, but today the things he suggested have be-

come common practice. I grew up with those ideas,
and I’ve tried to carry them further.
‘My feeling is that if the body has adequate nu-
trition, it is more likely to resist disease. In people who
are well-nourished, you don’t see the kind of break-
down that you see in people who are undernourished.
And I should add that 80 to 85 percent of the people
who wear dentures are undernourished, because they
avoid most of the foods they have trouble chewing.”

Saving Your Gums

Experimental data suggest the importance of vi-
tamin C in gum disease. Researcher Millicent
Goldschmidt, Ph.D., for instance, of the University of In monkeys, vitamin C
Texas Health Science Center at Houston, has mixed seemed to help kill off
disease-promoting bac-
vitamin C in liquid and given it to monkeys. The vita- teria in the mouth.
min reduced to very low levels the population of one
of the disease-promoting types of bacteria in the mon-
keys’ mouths. The bacteria need iron to survive, and
the vitamin C may somehow keep it away from them.
Similar research has been going on in Seattle and
in Europe. In Seattle, Olav Alvares, D.D.S., Ph.D., and
a team of researchers put a group of monkeys on a
vitamin C-deficient diet for 25 weeks and discovered
that it made their gums easy prey to inflammation.
The “pockets’—that is, undesirable pouches be-
tween teeth and gum where bacteria like to hide and
flourish—were larger than normal in the vitamin C-
deficient animals. A diet low in vitamin C apparently
elevates the risk of gum disease, they conclude Jour-
nal of Periodontal Research).
In Yugoslavia, experiments have shown that vita-
min C might be able to reverse the kind of gum break-
down seen in periodontal disease. Researchers there Can vitamin C actually
looked at samples of cells taken from the gums of 21 rebuild deteriorated
gums?
volunteers whose diets contained very little vitamin C.
Under an electron microscope, the researchers saw
the biological equivalent of a tumbled-down brick
 Solving Health Problems with Nutrition

wall. Collagen and other structural components,

which are the bricks and mortar of healthy tissue,
were literally broken and disheveled.
But after the volunteers were given 70 milligrams
of vitamin C daily for six weeks, the cells pulled them-

Eight Tips for Tougher Teeth

Getting enough of the right nutri- cles from between teeth and away
ents is one way to help head off from sensitive gum lines. Flossing
dental problems. Here are eight is also a good way of “massaging
others, culled from the best ad- and stimulating the gums,” says
vice of leading experts in the field. Vincent Cali, D.D.S. Dr. Cali rec-
1. Brush your teeth, but ommends flossing before brush-
don’t obliterate them. Doctors ing (so that brushing can sweep
discovered why one man’s teeth away the plaque and food parti-
were almost hanging by threads cles that flossing has loosened),
when they asked him to demon- and he says not to be alarmed by
strate how he brushed: He was the sight of a little blood. It’s nor-
scrubbing hard enough to bend mal for the first week or two after
his toothbrush’s handle. “I call it starting to floss, and it’s a sign that
the dental-chainsaw massacre,” you're doing a good job.
says Michael Lerner, D.M.D., who 3. Treat your teeth and
sees signs of “dental abrasion” in gums to the “exercise” of
about one-third of his new pa- heavy-duty chewing. Just as
tients. The problem arises with a flossing can stimulate and
too-firm brush being used in a too- strengthen the gums, so can
firm horizontal, back-and-forth chomping on fresh vegetables,
fashion. It can wear off not just a fruits and whole grain breads.
tooth’s protective enamel but also These foods also encourage
skin along the gumline, exposing healthy saliva flow. And there’s
the unprotected root of a tooth. even evidence that vigorous
So brush regularly (at least daily), chewing, especially in children,
but brush gently, preferably in a can help teeth come in straight by
circular motion. increasing growth of the jawbone.
2. Don’t forget flossing. It 4. Eat sweets (if you must)
may be a bit awkward at first, but with meals rather than be-
flossing is the best way to remove tween them. Sweets subject your
plaque and stubborn food parti- teeth to a decay-causing process
 A Nutritional Formula for Healthy Teeth and Gums 393

selves together and began to look organized and vig-

orous. The changes “correspond to a very early phase Too little vitamin C can
in tissue regeneration,” say the researchers. They note make periodontal dis-
ease worse.
that vitamin C is necessary for the formation of colla-
gen, which is a protein, and that collagen is a critical

that lasts about 20 minutes; at that water—a 3 percent solution of hy-

point, enough saliva has been drogen peroxide with an equal
mustered to shut the process amount of water,” says Dr. Cali.
down. But if you restrict sweets to “Swish it around in your mouth for
mealtimes, you minimize the dam- 30 seconds or so. Two or three
age because saliva flow during a mouthfuls should do the trick.”
meal is at its peak. (You also keep Do not swallow, however.
the number of decay-causing epi- 7. Brush your tongue.
sodes to a minimum of three a “Dentists often refer to the upper
day.) The worst time to eat palate as the roof of the mouth,”
sweets, say experts, is before bed, Dr. Cali says, “but we seldom
when saliva production is almost think of the tongue as the floor.”
at a standstill. That’s what it is, though, and it
5. Don’t smoke. In a study can attract a lot of dirt in the form
of women over the age of 50, sci- of bacteria. For that reason, Dr.
entists found that a far greater Cali recommends giving the
number of smokers than non- tongue a light brushing.
smokers wore dentures. “The Brushing your tongue can go
study confirms the association be- a long way toward tidying the
tween [tooth loss] and cigarette breath, too.
smoking,” says a summary of the 8. Make regular visits to
findings. Smoking’s ability to inter- your dentist and hygienist. Ev-
fere with the body’s uptake of cal- ery six months is what’s recom-
cium may be the reason, research- mended; it gives the hygienist a
ers Say. chance to clean the plaque you
6. Use mouthwash. Bacte- may have missed. But are you
ria cause tooth decay, and those afraid the dentist will find a target
bacteria can thrive on the tissues for the drill? Well, if you’ve been
of the mouth as well as on the heeding the above advice, you
teeth. “I recommend using a mix- should have nothing to worry
ture of hydrogen peroxide and about, right?
394 Solving Health Problems with Nutrition

building block for the gums and a lot of other tissues.

Vitamin C deficiency alone won’t cause periodontal
disease, the researchers say, but it can make it worse
CUntemational Journal of Vitamin and Nutritional Re-
search).

Calcium and Folate,

Hard at Work
Calcium is the other key ingredient in the preven-
tion or arrest of periodontal disease. A growing num-
Another nutrient that is ber of researchers say that calcium deficiency can
crucial to dental health: weaken the alveolar bone, making it more vulnerable
calcium.
to infection and ruining its ability to grip and anchor
the teeth.
“Calcium has nothing to do with the teeth, actu-
ally,” says Anthony Albanese, Ph.D., past director of
research at the Burke Rehabilitation Center in White
Plains, New York. “It has to do with the alveolar bone,
which surrounds the tooth. This is the most active
bone in the body; it turns over its calcium frequently,
picking up calcium from the blood and giving it
back.” \
Women should be especially conscious of their
calcium intake. Like the rest of the bones in a wom-
Why women may need an’s body, the alveolar bone tends to become more
extra calcium for better fragile and calcium deficient after menopause. “We
teeth.
find that women’s teeth become loose after they’ve
had two or three pregnancies,” Dr. Albanese says.
“That’s because the unbom child needs 400 milli-
grams of calcium a day, and its needs take prece-
dence over its mother’s. Beyond that, women fre-
quently go on diets, which limit their calcium intake,
and when they reach menopause, they lose even
more.” He recommends extra calcium along with a
vitamin D supplement to improve calcium utilization.
“We start our women patients on calcium as
early as we can,” agrees John M. Cusano, D.D.S., a
nutrition-oriented dentist in West Hempstead, New
York. “We tell them that even the American Medical
 A Nutritional Formula for Healthy Teeth and Gums 395

Association recommends a gram of calcium a day for

postmenopausal women.”
Dr. Cusano is something of a model among nutri-
tion-minded dentists. ““We started using nutrition in
our practice about seven years ago, and we've had
excellent results,” he says. “We explain to our new
patients what it means to eat a balanced diet. When
they first come in, more than half of them are eating
an inadequate amount of vegetables. We try to get
them to eat more vegetables, and we try to get the big
coffee drinkers and smokers to cut down.
“Then we put them on a supplement program. At
first, we ‘shotgun it’ by giving them a small multivita-
min supplement. After the body acclimates itself to
the vitamins, we start them on 1,500 milligrams of
vitamin C per day, or 500 milligrams with each meal.
Then, if they have periodontal disease, we start them
on calcium supplements. After four to five weeks, we
have them on the full program, which includes all the
B vitamins, vitamin C, vitamin E and calcium.
“Some of the patients ask me why they need
more than the minimum daily requirement of the vita-
mins. | tell them that the minimum daily requirement
is fine if they’re looking for minimum daily health. But
we're looking for maximum daily health. A lot of it
depends on whether we can motivate the patients.
We have a microscope here, and we let them look at
the bacteria that are damaging their teeth. When they
see them, they believe it,” Dr. Cusano says.
The B vitamin folate also seems to play an impor-
tant role in stopping the advance of periodontal dis-
ease. According to one theory, the gums themselves Folate: an important nu-
can be deficient in folate even when blood tests show trient for healthy gums.
that the rest of the body has enough. And a lack of
folate apparently weakens the gums’ ability to fend off
bacteria.
Under experimental conditions, folate deficiency
has been corrected with a mouthwash that contains
folate. At the New Jersey Dental School in Newark,
researchers asked a group of 15 volunteers with in-
396 Solving Health Problems with Nutrition

flamed gums to gargle twice a day—after breakfast

A mouthwash contain- and right before bed—with some folate-rich water.
ing folate may aid in- After 60 days of gargling, the researchers examined
flamed gums.
the group’s gums.
The gums soaked up folate like a sponge, and the
volunteers’ gums were much less inflamed. They were
also less inflamed than the gums of a 15-member
control group that had been asked to gargle with plain
water for 60 days (Joumal of Oral Medicine).

The Telltale Signs of Gum Disease

Healthy teeth depend on healthy ing tobacco), but to play it safe, be
gums. And yet it’s been estimated alert for the signs of gum disease
that more than half of all adults listed below. Dentists warn that
over the age of 18 do not have symptoms can progress to serious
healthy gums. They have peri- levels before any pain is experi-
odontal (gum) disease to some enced, so keep on the watch for
degree. Even children as young as all or any of the following, and see
five can have beginning stages. a dentist immediately if you think
What causes gum disease? you're developing a problem.
The same demon that causes Look for the following:
tooth decay: dental plaque, that
sticky film of food particles and e Guns that bleed when you
bacteria that is the bugaboo of brush.
mouths everywhere. The bacteria e Gums that are red, swollen
in plaque produce by-products or tender.
that can irritate the gums and, in e Gums | that have pulled
time, seriously damage the struc- away from the teeth.
tures that hold teeth in place. Gum e Pus between the teeth and
disease is the number one reason gums when gums are pressed.
teeth fall out. (As a result, one out e Permanent teeth that are
of five adults wears dentures.) loose or separating.
Fortunately, many of the e Any change in the way
same procedures for protecting your teeth fit together when you
your teeth can help protect your bite.
gums (regular brushing and e Any change in the fit of
flossing, eating a balanced diet partial dentures.
and avoiding smoking and chew- e Inescapably bad breath.
 Chapter 52 397

Nutrients:
Experimental
Treatment
for Impaired Vision

esearch supports the theory that cataracts

can be caused by an excess of free radicals
in the lens of the eye. Free radicals are highly reactive
chemicals that are generated by a normal chemical
process in the body called oxidation. Left unchecked,
free radicals can initiate reactions that result in un-
wanted tissue changes. Because light also promotes
oxidation, the transparent tissues of the eye are par-
ticularly susceptible to free-radical damage.
Shambhu D. Varma, Ph.D., professor and direc-
tor of research in the Department of Ophthalmology
at the University of Maryland Medical School, is inves- Another possible cause
tigating the role of free radicals in cataract formation of cataracts: oxidation.
and cataract prevention by antioxidant nutrients. In
test-tube experiments, Dr. Varma maintained rat
lenses in a fluid that generates free radicals when
exposed to light. He found that the lenses lost their
transparency. “Oxidation is one of the factors contrib-
uting to the pathogenesis of cataracts,’ says Dr.
Varma, “although there might be other causes, too.”
Because vitamin C is an antioxidant, Dr. Varma
and his colleagues wanted to see if it would have a
beneficial effect. Again, rat lenses were maintained in Vitamins C and E pro-
a special mixture that caused free-radical damage. But tected animal lenses
against oxidation.
lenses maintained in the same mixture fortified with
vitamin C were significantly protected from damage
by free radicals. According to the researchers, that
may explain why there is such a high level of vitamin C
in the eye (Proceedings of the National Academy of
Sciences). In a similar study, Dr. Varma and his co-
398 Solving Health Problems with Nutrition

workers found that vitamin E also offered protection

against cataracts (Photochemistry and Photobiology).
“I did one study with a strain of mice that have a
tendency to develop cataracts. I found they don't
Good nutrition is essen- develop them as much as expected if they’re given
tial to healthy, clear vitamin E,” Dr. Varma says. “A good diet is estab-
lenses.
lished to be necessary for the maintenance of a
healthy, transparent, pliable lens. If your diet is defi-
cient in antioxidant vitamins E and C, chances of
developing cataracts might be accelerated,” he says.

Preventing Retina Damage

The retina, the membrane at the back of the eye
that receives the image formed by the lens, may also
Vitamin C and other be susceptible to free-radical damage. After seven
antioxidants prevented years of ongoing study, Ely J. Crary, M.D., of Austell,
further loss of vision.
Georgia, says he has found a way to retard the pro-
gression of diabetic retinopathy, a disease of the ret-
ina that frequently leads to blindness. He uses a com-
bination of the antioxidants selenium and vitamins E,
Cand A.
He theorizes that in diabetics, decreased metab-
olism in the cells of the eye’s blood vessels is caused
by a buildup of free radicals, or oxidants. This weak-
ens the capillary cell walls, leading to blood leakage.
It's this vascular leakage that’s responsible for the
early loss of sight. Antioxidants remove the oxidants,
he says, preventing further damage.
“T’ve worked with close to 1,000 patients with
diabetic retinopathy and senile macular degenera-
Dr. Crary: Nutrients may tion,” Dr. Crary says, “and have seen the diseases
curb diabetic retino- retarded in about 70 percent of the cases. This pro-
pathy and senile macu-
lar degeneration. gram of nutritional supplementation has shown no
adverse effects, either. If someone has early diabetic
retinopathy or senile macular degeneration, they
should at least consider this program in addition to
regular therapy—under a doctor’s care, of course.
The earlier the treatment is started, the better the
response. I’m still amazed at the results we get from
this method.”
 Nutrients: Experimental Treatment for Impaired Vision 399

Take E and See?

Many research studies have tied vitamin E to the
health of the retina. In a study at Comell University,
dogs fed diets deficient in vitamin E were found to Vitamin E deficiency is
develop damaged retinas. Damage could be detected linked to damaged
retinas.
after only three months of the E-deficient diet. “Night
blindness and eventual severe day visual impairment”
followed, say the researchers (American Journal of
Veterinary Research).
Retrolental fibroplasia (RLF) is a disease of the
retina that occurs in premature infants and causes
blindness. In the 1950s, it was discovered that oxygen
therapy in incubators was the cause, and careful mon-
itoring of oxygen levels caused a decline in the inci-
dence of severe RLF There was resurgence of the
disease, however, as more very small premature in-
fants were able to survive.
More recently, researchers from the Department
of Newborn Medicine at the Royal Alexandra Hospi-
tal in Edmonton, Alberta, found that vitamin E can Researchers use vitamin
prevent RLF in infants given oxygen. In the study, 17 E to treat a rare visual
disorder in premature
percent of the tiny infants who received no vitamin E infants.
developed RLF, while none of the infants given oral
vitamin E within 12 hours of birth developed RLF Say
the researchers, “It is recommended that vitamin E be
given within 12 hours of birth to all [low-birth-weight]
infants...who require supplemental oxygen’
(Ophthalmology).
400 Chapter 53
A Pioneering Approach
to Better Vision

ost patients would probably think it strange

for an eye doctor to ask them how often
they exercise, the last time they had a chocolate bar
or whether they enjoy their job. After all, what could
any of these things possibly have to do with cataracts,
glaucoma or even a simple case of dry, itchy eyes?
But for Joseph M. Ortiz, M.D., a suburban Phila-
delphia ophthalmologist, getting answers to questions
Can you solve eye trou- about diet, exercise, stress and allergies is an impor-
bles with changes in tant part of the detective work involved in tracking
lifestyle?
down the cause of an eye problem, or, better yet,
stopping one before it starts.
That is because Dr. Ortiz believes that the most
important requirement for healthy eyes is a healthy
body. “You can never forget that your eyes are con-
nected to the rest of your body,” he says. ““The two
are inseparable.”
He’s seen the connection again and again—an
uncontrollable twitch, traced to the stress of a new
job and aggravated by too much coffee; a bad case of
dry eyes, caused by an extremely low-fat diet; com-
puter-induced eyestrain, relieved by a new prescrip-
tion for reading glasses and a no-glare screen. And it
goes beyond that.
Your eyes can be hurt by whole-body diseases
like high blood pressure, heart disease and diabetes.
In fact, looking into the eyes is a good way to see
signs of those illnesses. They are the only place in the
 A Pioneering Approach to Better Vision 401

body where blood vessels can be viewed directly.

Clogged, bleeding or scarred vessels in the back part
of the eye, called the retina, mean the same problems
are occurring elsewhere in the body, Dr. Ortiz says.
“They say the eye is the mirror of the soul. Well, it’s
also a window to look in on the rest of your body.”
That’s why it’s no surprise to him that some of his
patients who start out treating an eye problem end up
with lower blood pressure or extra energy—and a
new faith in whole-body healing.

A Whole Body Approach

to Better Vision
Dr. Ortiz is one of a still-rare breed of preventive
ophthalmologists. His training is traditional, with a
medical degree from New York Medical College and The making of a preven-
a residency and research work at Yale and the Univer- tive ophthalmologist.
sity of Pennsylvania. He helps supervise a resident-
staffed eye clinic at the Hospital of the University of
Pennsylvania and admits many of his surgical patients
to Wills Eye Hospital of Scheie Eye Institute in Phila-
delphia.
But his conversion to preventive medicine is
wholehearted. After a bout with hepatitis during his
freshman year in medical school left him wondering if
he would survive to grow old, he gradually changed
his diet to emphasize whole grains, vegetables, fruits
and some dairy products. Along the way, he moni-
tored the effects of dietary changes with blood tests.
“Those tests really helped me see how cutting out red
meat, sugar, coffee, white flour and alcohol improved
my blood cholesterol and overall health,” he says.
And no one can accuse him of not preaching what he
practices. He suggests the same menu for his patients.
Every one of his patients, whether they have an
eye problem or not, is encouraged to change his or
her diet toward whole grains and fresh produce, to
402 Solving Health Problems with Nutrition

stop smoking and to get plenty of exercise and rest.

The doctor’s orders: He recommends vitamin supplements to patients with
whole grains, fresh pro- special problems and to older patients.
duce, exercise, rest, nu-
trients and no smoking.
“If I see previous eye damage—scar tissue or
injured blood vessels in the retina—I’ll recommend
vitamin E and zinc to help maintain the health of the
blood vessels and the cells of the retina,” he says. “If
someone is old, has dentures, or doesn’t eat much
meat, I’ll suggest B vitamins, since they may not be
getting enough. I think most people get enough vita-
min A in their diet, so I reserve that for people with
absorption or storage problems—colitis, cirrhosis or
a history of alcoholism.”
His surgical patients are “prepped” with 2,000
milligrams of vitamin C, 50 milligrams of zinc and 200
Extra vitamins and min- international units of vitamin E daily for a week before
erals prepare patients their operation, and they stay on those supplements
for eye surgery.
until they heal. “This reduces inflammation after sur-
gery and cuts up to two weeks off their period of
recuperation,” Dr. Ortiz claims.
For night blindness, the inability of our eyes to
adapt to the dark, Dr. Ortiz prescribes vitamin A and
zinc. Vitamin A is essential for the health of the cells
lining the retina, which are called rods and cones.
And in low-light situations, the chemical impulses of
those cells, which send visual images to our brains,
require vitamin A to form a light-sensitive pigment
known as rhodopsin, or visual purple. Without the
pigment, we become virtually blind after dark.
Zinc, Dr. Ortiz says, enhances the eye’s ability to
use vitamin A. It is important in the conversion of
Why vitamins A and E vitamin A to its active form, retinaldehyde. Vitamin E
and zinc are important also has an important effect on how much vitamin A is
to healthy eyes.
available for use in the eye and has been found to be
of help as a cataract fighter, Dr. Ortiz claims.

Slowing or Reversing Cataracts

Cataracts, the clouding of the eyes’ lenses, are an
inevitable feature of aging, Dr. Ortiz admits. “Anyone
 A Pioneering Approach to Better Vision 403

who lives long enough is going to get them.”’ But his

own work with some of his patients and laboratory
studies with animals have shown that cataract forma-
tion in its early stages may be significantly slowed
and, in some cases, even reversed.
Most researchers believe that a type of cataract
found in the aging eye (radiation cataracts) is caused
by years of exposure to the sun. “Sunlight absorbed
by the lens reacts with an amino acid called trypto-
phan, breaking it up into particles called free radi-
cals,” Dr. Ortiz explains. These destructive, unpaired
electrons bind with proteins in the lens, forming the
dense pigment that blocks sunlight from the eye and
gives it a yellow-brown color.
But laboratory studies have shown that vitamins Vitamins that neutralize
E and C and the trace mineral selenium block free the hazards of sunlight.
radicals’ destructiveness. Instead of attacking the pro-
teins, free radicals combine with these nutrients and
are neutralized.
In patients at an age where cataracts are likely to
occur (starting at around 55), Dr. Ortiz suggests vita-
min C and vitamin E. If they have high blood pressure, The doctor’s prescrip-
he recommends that instead of vitamin E they get tion for people likely to
get cataracts includes
more selenium—preferably in the form of two or vitamins E and C and
three bulbs of garlic each week. (Selenium supple- selenium.
ments should not be taken in amounts of more than
100 micrograms daily without the guidance of your
physician.)
In patients already showing signs of cataracts,
Dr. Ortiz may prescribe vitamin C, vitamin E, selenium
if needed and riboflavin (vitamin B,). Vitamin E may
enhance glutathione, a substance that apparently pro-
tects the proteins in the eyes’ lenses from free-radical
damage.

A Sight-Saving Regimen
One of Dr. Ortiz’s cataract patients is spry, 80-
year-old Dr. Ibraham Marker. This man lost the use of
one eye several years earlier when blood vessels in his
404 Solving Health Problems with Nutrition

retina burst. When he realized cataracts were destroy-

ing his remaining vision, he was determined to find a
doctor who would help him without requiring surgery.
After three months of Dr. Ortiz’s eye regimen, Dr.
Marker’s eyesight had improved dramatically. With
glasses, visual acuity in his “good” eye had improved
from 20/100 to 20/60. Even his retina-damaged eye
showed an improvement—from 20/400 to 20/200.
‘This man is a remarkable example of how nutri-
tional supplements can work to improve the health of
A remarkable improve- the retina,” Dr. Ortiz says. “You have to use total body
ment in vision. care to help your eyes. This man is in good health. He
eats carefully, is very active and does a lot of walking.
I think the reason supplements helped him so much is
that he takes such good care of himself. Eventually he
may need cataract surgery, but at this time both he
and I are satisfied with his improved vision.”

Special Advice for Diabetics

Dr. Ortiz’s diabetic patients, because they are
especially prone to cataracts and retinal damage, re-
ceive additional advice and supplements.
“T tell them to bring their blood glucose level
down to 140, not by increasing their medication but
A recommendation for by changing their diet. | also recommend daily chro-
diabetic patients: better mium. Chromium makes insulin work more efficiently
diet and chromium.
in the body and so helps lower blood sugar levels.” A
too-high blood sugar level can damage blood vessels
in the retina, creating a condition called diabetic ret-
inopathy, which eventually leads to blindness.
To further protect the eyes’ blood source, Dr.
Ortiz recommends a supplement of eicosapentanoic
acid (EPA, a substance in fish oil that helps lower
blood cholesterol and triglyceride levels and prevents
clumping of blood platelets). This helps to lessen the
fatty buildup, clotting and hemorrhaging that can de-
stroy the retina, Dr. Ortiz claims.
In some _ cases, he also recommends
bioflavonoids, nutrients that are found in the white
 A Pioneering Approach to Better Vision 405

peel of citrus fruits. Bioflavonoids keep capillary walls

strong, helping to prevent leakage from blood vessels.
Some bioflavonoids may also work to inhibit an en-
zyme, aldose reductase, that promotes some kinds of
cataracts.
Sidney Cohen, 69, of Philadelphia, a diabetic for
30 years, came to Dr. Ortiz in 1983. “My vision was
failing fast,” he says. “‘I’d been to a number of eye “My vision was failing
clinics, and they all said the same thing. They could fast.”’
control my insulin and perform laser surgery to cau-
terize the leaking blood vessels in my eyes. They
never said I could get better.”
With Dr. Ortiz’s help, Cohen started on nutri-
tional therapy for the first time in his life. From his
regular diabetic diet, he eliminated dried fruits,
grapes, concentrated fruit juices, white flour and red
meat. He added whole grains, fish, vegetables and
low-fat dairy foods. In addition to chromium, EPA
and two grams of bioflavonoids, he took vitamin C,
vitamin E, selenium, zinc and vitamin A.
‘And you know what? My vision has improved
by at least 40 percent. I can see better in the day and
at night. My blood cholesterol is lower, I have much Forty percent better
more energy, and I sleep better at night.” eyesight, day or night.

Vitamin C and Glaucoma

Glaucoma, a dangerous buildup of fluid in the
eye, which can permanently damage the retina, is
another condition that can respond to nutritional
therapy, though it usually first requires traditional
medical treatment.
“T never start off using vitamins to treat glau-
coma,” Dr. Ortiz says. “The main thing is to get the
pressure down as quickly as possible, using eyedrops The first step in treating
sometimes supplemented by laser surgery to ‘drill’ glaucoma is to reduce
the pressure.
pinpoint holes in the eye through which the fluid can
drain.”
Then, if the pressure has to be brought down a
little further, Dr. Ortiz will suggest vitamin C. This
406 Solving Health Problems with Nutrition
ee

treatment is effective only in large doses. ‘““The vitamin

C acts as an osmotic agent,” he explains. “It draws
fluid away from the eye.”
Using vitamin C is Mrs. Catherine Laws, an 82-
year-old widow from Media, Pennsylvania, who
proudly says she can see well enough to drive, even
though she only putters around town.
“T still use my eyedrops, but I’m also taking vita-
min C every day now,” she says. “I take it in divided
doses, four or five times a day, as crystals mixed with
water.”
The eyedrops lowered the pressure in her eyes
by about 10 millimeters of mercury. Dr. Ortiz says that
Vitamin C helps, too. vitamin C lowered them an additional two to four
points, putting her eye pressure within normal limits.
“I feel the vitamin C helped me a great deal,”
Mrs. Laws says. “I’ve had this condition about 20
years, and now it’s getting a little better. Something
has to be responsible for that, and | think it’s the
vitamin C.”

Retraining the Brain

to See Better
Echoing thoughts similar to those of Mrs. Laws is
another of Dr. Ortiz’s patients, Myrna Miller, who saw
her eyesight improve for the first time in her life when
she began going without her glasses several hours
each day.
“In the beginning, I could hardly see at all, but
after three or four months, I noticed my vision had
become much clearer and that my glasses were too
strong,” she says. “By the end of four months, I wasn’t
wearing my glasses around the house at all.” An
examination showed her sight had improved from 20/
400 to 20/200, without glasses. And that improvement
has remained even though she wears her new, weaker
glasses most of the time.
 A Pioneering Approach to Better Vision 407

In myopia, or nearsightedness, glasses can cause

the tiny muscles that focus the eyes’ lenses to become
very strong, thereby stretching the outer layer of the Sometimes, not wearing
eyes, Dr. Ortiz explains. Removing the glasses makes eyeglasses helps.
the muscles work less, and the eye stretching is de-
creased. This may stabilize the myopia. It also trains
your brain to interpret visual messages even though
they're not clearly in focus.
‘‘My glasses had gotten thicker and thicker, and I
always thought the end result of it would be that |
would go blind or something,” Mrs. Miller says. “It’s With patience, vision
really heartening when you can put that in reverse and can improve.
keep it there.”
Mrs. Miller had the time and patience to go with-
out her glasses. Not everyone can do that or have the
results Mrs. Miller had, but they still can be active
participants in their eye care, Dr. Ortiz says.
“The saddest people I see are those I can’t do
anything for, those who are blind,” he says. “You
can’t turn back time, but you can make the most of
the time you have. The main thing people must realize
is that they are the masters of their own health.”
408 Chapter 54
Nutritional Therapy:
More Positive
Evidence

oday, the role of vitamins and minerals in the

treatment of disease is being investigated in
countless ways. Most of the research is very prelimi-
nary, but some of it is promising in unexpected ways.
Here’s a roundup of some of the less publicized, but
intriguing, nutritional therapy news.

Asthma: Can Vitamin C Help?

Researchers from the John B. Pierce Foundation
Laboratory in New Haven, Connecticut, have found
A way to breathe easier. that vitamin C may dilate your swollen bronchial
tubes.
How? By causing an increase in the production
of prostanoids—your body’s own bronchial-tube di-
lating agents. According to James S. Douglas, Ph.D., a
pharmacologist involved in the study, a 500-milligram
dose of vitamin C increases prostanoids a small but
significant amount. These results may also explain
why asthma incidence is greater among those with a
dietary deficiency of vitamin C, he says.

Bedsores:
A Nutritional Prescription
Elderly patients who suffer from bedsores may
find relief with nutritional supplementation, say doc-
tors from Our Lady of Mercy Medical Center in New
York City. They found that hospitalized older patients
 Nutritional Therapy: More Positive Evidence 409

became more susceptible to bedsores as their nutri-

tional status deteriorated. To improve this situation, In 11 out of 12 pa-
the patients were given at least 2,000 calories per day, tients, bedsores im-
proved.
including carbohydrates, protein, trace minerals and
vitamins. Nutritional supplementation improved the
bedsores in 11 of 12 patients, say the doctors. What’s
more, when the sores healed, the patients were found
to have greatly improved nutritional status.

Cancer:
Vitamin C Teams Up with Drug
What do you get if you combine vitamin C with
the toxic drug acetyl acrolein? You get a new, non-
toxic drug that has a “marked ability” to stimulate or Can vitamin C help a
restore your own natural immunity. It’s called drug fight cancer?
Nafocare, and researcher Robert Veltri, Ph.D., of the
National Foundation for Cancer Research in Philadel-
phia, thinks it may have real potential in the fight
against cancer and other diseases where immunity is
compromised.
‘Most cancer drugs work by destroying the cells’
DNA,” Dr. Veltri says. “Unfortunately, it kills the DNA
in normal cells right along with the cancerous ones.”
Nafocare doesn’t work directly on individual
cells. It enhances the body’s immune response, which
in turn kills the tumor just like it would any foreign
substance in the body.
“Right now, we are about to begin to test the
substance on human cancer patients,” says Dr. Veltri,
“and hope to get FDA approval soon.”

Can Vitamin E Prevent Hair Loss

in Cancer Chemotherapy?
Hair loss as a result of chemotherapy may be
prevented if vitamin E is given in advance of the drug,
according to Lee Wood, M.D., of Covina, California. Cancer patients lose
Of the 16 patients he treated with vitamin E, 11 had less hair than usual.
410 Solving Health Problems with Nutrition

only slight or moderate loss of hair. Of the 5 who did

suffer complete hair loss, says Dr. Wood, 3 had taken
the vitamin less than 72 hours before the first dose of
the drug. In the future, Dr. Wood plans to give the
vitamin E five to seven days before chemotherapy is
begun (New England Journal of Medicine).

Celiac Disease:
The Selenium Connection
British researchers think it’s no coincidence that
victims of celiac disease (a chronic intestinal disorder
caused by intolerance to wheat gluten) have a high
incidence of cancer along with a low body level of
selenium.
Selenium is a component of an enzyme responsi-
ble for preventing the buildup of free radicals and
Selenium: a force lipid peroxides—chemicals that have the potential to
against free radicals. damage cell membranes and increase the risk of ma-
lignancy. When the researchers compared the sele-
nium levels of 16 celiac patients with 32 healthy vol-
unteers, the celiac patients’ were far lower.
There are two possible explanations for this, say
the scientists. First, the gluten-free diet may not con-
tain enough selenium. Second, selenium is absorbed
primarily in the duodenum, a portion of the small
intestine which, in celiac patients, is abnormal (British
Medical Journal).

Colds:
A Link with Zinc Lozenges?
A group of researchers associated with the Uni-
versity of Texas at Austin may have stumbled upon a
remedy that licks cold symptoms. It’s zinc gluconate
tablets, the same ones available as nutritional supple-
ments. But instead of swallowing them whole, you
suck them like lozenges or cough drops.
 Nutritional Therapy: More Positive Evidence 411

The researchers discovered this possible use for

zinc from a child being treated for acute leukemia
who also suffered from frequent colds. One day at the Did the zinc lozenges
onset of a new cold, she refused to swallow the zinc make the difference?
gluconate tablet that was being given to improve her
immunity and dissolved it in her mouth instead.
‘‘Within several hours,” say the researchers, “her cold
disappeared without further treatment.”
The researchers decided it was worth testing the
zinc against a placebo (dummy pill) in a group of
patients suffering from colds. After seven days, 86
percent of the zinc-treated group had no symptoms
compared with only 46 percent of the group taking
the placebo.
The doctors speculate that the zinc attacks the
cold viruses living in the throat and keeps them from
reproducing, so the sooner the germs are zapped, the Zinc may attack cold
better. And they suggest the treatment (one lozenge viruses.

every two hours during the day) be continued until a

few hours after the last symptom has gone, since the
antiviral effect of zinc may be reversible. Since such a
cumulative dose (from 100 to 200 milligrams) of zinc
daily is normally considered excessive, the doctors
caution that this treatment be used only seven days or
less. In that way there’s no danger of toxicity, they say,
because zinc is “generally regarded as noncumulative
and nontoxic when briefly ingested” (Antimicrobial
Agents and Chemotherapy).

Deafness:
A Vitamin D Deficiency?
Nutritional help for hearing problems? Possibly.
Dr. Gerald B. Brookes, a London ear, nose and throat
specialist, has linked one form of deafness with a
vitamin D deficiency.
It has to do with the cochlea, the snail-shaped
bone inside the ear, considered to be the essential
412 Solving Health Problems with Nutrition
i
a

organ of hearing. A lack of vitamin D is thought to

cause a demineralization of the tiny bone, which
leads to progressive cochlear deafness.
So far, Dr. Brookes says, he has studied 22 pa-
tients with the disorder and all of them had low or
A possible cause of borderline vitamin D levels. But he’s only just begun
some types of deafness: to evaluate treatment with calciferol, a synthetic vita-
vitamin D deficiency.
min D metabolite. He has found that 4 out of 6 people
taking calciferol have had some improvement in their
hearing.
Because treatment is generally “harmless and
cheap,” Dr. Brookes recommends screening for vita-
min D deficiency in patients with certain types of
progressive deafness (Journal of the American Medi-
cal Association).

Dialysis Dementia
from a Biotin Deficiency?
As if having kidney failure isn’t bad enough, peo-
ple on long-term dialysis often develop an additional
burden to cope with. It’s called “dialysis dementia,”
and it leaves its sufferers with dizziness, restless legs,
memory loss, even psychosis. Worst of all, the disor-
der is progressive, leading to total disability.
Until just a few years ago, doctors had no idea
what caused the problem nor how to correct it. Nowa
group of Greek researchers has changed forever that
bleak outlook. They discovered that long-term dialy-
sis patients often become deficient in an essential
nutrient—biotin. It’s easy to see why, say the doctors.
“The dietary restriction routinely imposed in such pa-
tients decreases the intake of biotin.” And the various
supplementary vitamins given to them were found to
be “completely biotin free.”
The doctors decided to try ten milligrams of bio-
tin daily on nine dialysis patients with dialysis demen-
tia. “Within three months,” say the researchers,
 Nutritional Therapy: More Positive Evidence 413

“there was a marked improvement in all patients” in

respect to disorientation, loss of memory, restless legs Daily doses of biotin re-
and more. One of the patients, who had been unable lieved symptoms of ‘‘di-
alysis dementia.’’
to even stand up, improved so much after six months
of treatment that he now walks several miles each
day, unassisted, and has for the past two years.
Naturally, the doctors urge routine biotin supple-
mentation for all dialysis patients (Vephron).

Lupus: A Need for Vitamin A?

Scientists are finally tuning in to the effects of
nutrition on the body’s immune system—your own
natural defense against disease. That’s especially true
with autoimmune diseases, the ones that cause your
body to turn against itself.
At the University of California at Davis, research-
ers are working with animals susceptible to a disease
similar to systemic lupus erythematosus (SLE), an
autoimmune disease that often affects young women.
The researchers suspected that a vitamin A defi-
ciency might reduce the production of autoantibodies
(the ones that attack your own cells). To test their Testing the vitamin A
theory, they fed lab animals a normal diet, until there theory on animals.
were clinical signs of the disease. Then they were put
on a vitamin A-deficient diet.
Far from improving their condition, the vitamin A
deficiency accelerated it. These results have implica-
tions for human patients with SLE, say the research- Lupus patients: Ask
ers, since “vitamin A deficiency is one of the most your doctor about the vi-
tamin A connection.
common nutritional deficiencies throughout the
world and occurs even in developed nations. On the
basis of these results, a lupus patient who was A
deficient might experience significant acceleration of
the disease process.
“Patients with lupus should not try to adjust their
intake of vitamin A until further studies have been
done or at the suggestion of their doctor” (Journal of
Immunology).
414 Solving Health Problems with Nutrition

Wilson’s Disease:
Zinc May Replace Penicillamine
For those who have Wilson’s disease, a rare he-
reditary disorder involving abnormal copper metabo-
lism, therapy has always centered around the drug
penicillamine. And it worked well to ‘““decopper” the
patients and reduce symptoms of copper toxicity—
muscle tremors, psychotic behavior and cirrhosis of
the liver.
So what’s the problem, you say? Drug toxicity.
Penicillamine causes severe side effects in about 30
Zinc seemed to rid the percent of the people who take it. The good news,
body of excess copper however, is that now there appears to be a safe, easily
in Wilson’s disease
patients. tolerated alternative. According to doctors from uni-
versities in Michigan, oral zinc therapy worked well to
rid the body of excess copper in all five patients they
treated. Although more research is needed, the doc-
tors say that “eventually it may be desirable to switch
even those patients who tolerate penicillamine to zinc
therapy,” since the only adverse effect of zinc is some
stomach upset in an occasional patient (Annals of
Internal Medicine).
People with Wilson’s disease, however, should
not switch to zinc without consulting their physician.
 Chapter Bi: 415

How to Take Vitamins

and Minerals Safely

O many, vitamins are as harmless as a kiss on the

cheek. They are those tiny tablets or capsules
that they take regularly to compensate for what may
be lacking in an unbalanced diet.
Things can get a bit out of hand, however. After a
report in the morning newspaper that vitamin X may
prevent cancer, or a spot on the evening news that a Caution: Don’t be
certain mineral may help you live to be 100, some tempted to overdose on
vitamins.
people are tempted to add larger doses to their daily
routine.
The problem comes as the dosages start to inch
upward. Without realizing it, you could unintention-
ally be close to a megadose level, which should be Too much vitamin A or D
taken only under a physician’s direction. There’s in- can hurt you.
creasing evidence that too much of some nutrients
may be harmful. The fat-soluble vitamins that can
accumulate in the body, such as vitamins A and D, are
particularly suspect.

Heed the Vitamin Safety Zone

If you take supplements, your goal is to stay
within the vitamin safety zone, that range beginning at
the U.S. Recommended Daily Allowance CUSRDA)
and ending “at a level that is still safe and well below
the toxicity level,” says John Hathcock, Ph.D., a vita-
min-toxicity expert with the U.S. Food and Drug Ad-
ministration’s (FDA) experimental nutritional section.
416 Solving Health Problems with Nutrition

It’s not easy for a vitamin-consuming public to

decide where to draw the line between safe and ex-
cessive micrograms, milligrams or international units.
“There are no Officially established limits for maxi-
mum doses. We’ve spent a lot of time debating and
establishing the USRDAs at the low end, but no one’s
set suggested guidelines for the other end,” says Dr.
Hathcock.
The simplest and safest solution is to rely on food
for most of your essential nutrients. “Nature has
The best source of vita- helped us out tremendously by giving our bodies the
mins and minerals: food. ability to get almost all the necessary vitamins and
minerals we need from logical food consumption, ”
says nutrition researcher Virginia Vivian, Ph.D., of
Ohio State University. “Granted, you may need extra
amounts of some nutrients, but a multiple vitamin will
usually do.”
That’s easier said than done, however, for some
people. Research has shown that many people either
don’t eat enough or do not eat balanced meals. Then
there are people with medical conditions, pregnant
women, the elderly and others who may have in-
creased needs for specific nutrients.
Which is why so many people tur to supple-
ments. An FDA survey shows that about 40 percent of
Right or wrong, many the general population take supplements daily, with
people take supple- women taking more than men. Among the elderly,
ments.
surveys show that between 66 and 72 percent take
supplements.

Avoid Megadoses
It’s also estimated that 5 to 10 percent of the
people who take supplements ingest megadoses, de-
fined by some researchers as ten times the USRDA or
more, of certain vitamins and minerals. In light of this,
some nutrition experts have stopped trying to tell peo-
ple that they don’t need vitamins and instead have
started advising them how to supplement wisely.
If you’re wondering whether your personal vita-
min program falls within safe bounds, the answer’s
 417
How to Take Vitamins and Minerals Safely

not easily had. “There are no reference guides or

tables you can check to see what levels of vitamins There’s no evidence
that megadoses work.
trigger harmful effects,” says Paul Saltman, Ph.D., a
professor of biology doing research in nutrition at the
University of California at San Diego. ‘That's because
the danger levels vary from person to person and
depend on factors such as weight, health status,
metabolism, diet, nutritional status, the form of the
nutrient and how often you take it. The safest ap-
proach is to accept the fact that there is no scientific
evidence that massive doses have any benefits.”

Guidelines for
Sensible Supplement Use
You may wish to check the following list of the
more common vitamins and minerals to see where
your dosages fit in. The “maximum” levels are ap-
proximations compiled from discussions with experts
and surveys of the latest available data. These num-
bers should be viewed as general guidelines only,
intended to help you make sure you're safe. This does
not necessarily mean that it’s appropriate or advisable
to increase your intake to these limits. Also keep in
mind that all metabolisms are not created equal. Al-
though the most current information may suggest that
a vitamin is relatively harmless, some people with
unusual metabolic traits may react adversely to even
the safest nutrient.
When considering your current total intake,
don’t neglect to add in the amounts in your multiple, if
you take one each day, and the nutrients from food. In Calculating your total
intake.
other words, if you’re taking a vitamin A supplement,
don't think that’s all the A you’re getting. It’s in your
meals and probably in your multiple.

Vitamin A
Scientists have a keen, new interest in this fat-
soluble vitamin because of its link to cancer preven-
tion. It speeds healing, aids vision and fights infection
418 Solving Health Problems with Nutrition

and skin diseases. It’s also highly toxic in large doses

because vitamin A accumulates in organ tissues, pri-
marily the liver. Headaches, blurred vision, nausea,
hearing loss, itchy eyes, aching bones or skin sores
are signs that you may be taking too much. USRDA:
5,000 international units; MAXIMUM: 25,000 interna-
tional units.
(Beta-carotene, a carotenoid that offers many of
the same benefits as vitamin A, appears to be safer
Beta-carotene may be than A in large doses. “So far, it looks relatively harm-
safer than vitamin A. less, and you should consider taking it instead of the
riskier vitamin A,” says Dr. Saltman. Be aware, how-
ever, that large doses of vitamin E can interfere with
beta-carotene absorption.)

Thiamine (Vitamin B,) and

Riboflavin (Vitamin B, )
There are very few reports of people experienc-
ing adverse effects from either of these two B vita-
mins, partly because there’s little if any evidence that
large doses offer health benefits. USRDA FOR B,: 1.5
milligrams; USRDA FOR B,: 1.7 milligrams; MAXI-
MUM FOR EACH: 25 milligrams.

Niacin
Studies have shown that this B vitamin may play a
role in lowering cholesterol and triglyceride levels.
A possible way to lower But some people who take large doses in the form of
cholesterol.
nicotinic acid may experience niacin flush—a burn-
ing, itching, tingling sensation usually in the face,
neck, arms, and upper chest that may persist for half
an hour or longer. Doses large enough to trigger this
reaction may also cause reddening of the skin, nau-
sea, headaches, cramps, diarrhea and feelings of
faintness. USRDA: 20 milligrams; MAXIMUM: 50 milli-
grams.

Vitamin B, (Pyridoxine)
Many women went running for this member of
the B-complex family after reports that it helps ease
 How to Take Vitamins and Minerals Safely 419

premenstrual stress symptoms. ‘“‘More research is

needed to confirm that claim, but we have established Do not take too
that large doses can cause nerve damage,” says Dr. much B,.
Saltman. Numbness of the feet or hands may be a sign
to reduce your intake. USRDA: 2 milligrams; MAXI-
MUM: 50 milligrams.

Vitamin B,.
Vitamin B,, is vital to healthy blood and a normal
nervous system, but there’s little scientific evidence
that massive doses will either harm or help. USRDA: 6 Vitamin B,,: Large
micrograms; MAXIMUM: 25 micrograms. doses don’t help.

Pantothenate
There is no known toxicity level, but caution
should still be exercised, since “‘we’re just beginning
to explore the effects of megadoses of some of these
vitamins,’ says Dr. Saltman. USRDA: 10 milligrams;
MAXIMUM: 50 milligrams.

Vitamin C (Ascorbic Acid)

Surveys continue to show that ascorbic acid is
the most popular vitamin supplement, dominating the
nutritional supermarket for the past decade. Claims Excessive doses of C
that it helps fight cancer, boosts immunity against may hurt you.
colds and infections, speeds the healing of wounds
and aids in combating cardiovascular disease have
made it one of the most megadosed vitamins. Al-
though it’s water soluble, and excesses are usually
excreted, large doses have been known to cause diar-
rhea and abdominal cramps in some people. Too
much vitamin C may also interfere with certain medi-
cal tests, such as checking sugar levels in diabetics or
looking for blood in stools. USRDA: 60 milligrams;
MAXIMUM: 500 to 1,000 milligrams.
(The need for ascorbic acid varies from one per-
son to the next. Exposure to illness, tobacco smoke,
pollutants, certain drugs, burns, trauma, surgery, alco-
hol and other stressors may increase the need. So
may pregnancy and aging. Some nutritional research-
420 Solving Health Problems with Nutrition
EE

ers now regard the USRDA as too low for optimal

health.)

Vitamin D
Another fat-soluble vitamin that can accumulate
in your body, vitamin D is usually obtained from sun-
Taking too much shine. It’s a crucial link in the process that helps cal-
vitamin D can be cium strengthen bones and is essential for women in
dangerous.
their osteoporosis-prone years. People who live in
regions where winters are long and exposure to sun-
light is infrequent may need to take supplemental
vitamin D. Muscle weakness, joint pain, headaches,
nausea and vomiting may be signs that you should
reduce your dosage. USRDA: 400 international units;
MAXIMUM: 400 international units.
(if you drink a quart of vitamin D-enriched milk
daily or get out in the sun year-round, you may not
need D supplementation.)

Vitamin E
Many people take vitamin E for its possible use-
fulness as an antioxidant, allegedly preventing prema-
Signs of too much ture aging or damage to body cells. “But in exces-
vitamin E. sively large doses, vitamin E can upset the balance of
other fat-soluble vitamins, and it can interfere with the
functions of vitamins A and K,” says Dr. Vivian. Nau-
sea, gastric problems or muscle weakness may be
signs of too much. USRDA: 30 international units;
MAXIMUM: 600 international units.

Calcium
More and more scientific investigations are sug-
gesting that calcium may help slow osteoporosis, the
Excessive doses of cal- disease of weakened, brittle bones. It also appears
cium may cause kidney that postmenopausal women need more than the
stones in some people.
USRDA because their bodies’ natural calcium-absorb-
ing abilities decrease with age. Large doses may cause
kidney stones in people prone to stone formation.
USRDA: 1,000 milligrams; MAXIMUM: 1,500 milli-
grams.
 How to Take Vitamins and Minerals Safely 421

Chromium and Selenium

The USRDAs for these two trace minerals have
yet to be set. SUGGESTED RANGE FOR EACH: 50 to
200 micrograms; RECOMMENDED MAXIMUM FOR
EACH: 100 micrograms.

Iron
This mineral is enormously important to human
health, preventing and curing iron-deficiency anemia.
Iron supplements are widely used in the United States,
but reports of iron overload are rare. In those cases
where too much is taken, nausea, abdominal cramp-
ing, constipation and diarrhea can result. USRDA: 18
milligrams; MAXIMUM: 30 milligrams.
Cron supplemental needs will vary. Women who
are on low-calorie diets or who are pregnant or nurs-
ing, vegetarians, and the elderly, who often have poor Do you need more iron?
dietary habits, for instance, may have increased
needs.)

Magnesium
Although there’s little evidence of harm from
moderately large doses of this mineral, caution is
urged, since scientists are just beginning to study its
effects in large doses. USRDA: 400 milligrams; MAXI-
MUM: 400 milligrams.

Zinc
The noticeable side effects of too much zinc can
include nausea, vomiting and diarrhea. Yet, it’s the
unseen that may be of more concern. High doses of Balancing zinc and
zinc can create a copper deficiency, a condition that copper.
has been shown to increase levels of LDL cholesterol
(the kind that causes coronary heart disease) in lab-
oratory animals. To be safe, the ratio of zinc to copper
should be about 10:1. If, for instance, your multiple
contains 20 milligrams of zinc, it should also have 2
milligrams of copper. USRDA: 15 milligrams; MAXI-
MUM: 30 milligrams.
422 Solving Health Problems with Nutrition

Don’t Stop Cold Turkey

If you suspect that you’re taking too much of a
vitamin or mineral, don’t stop completely. “Cut back
to about half of your current dosage,” says Dr. Vivian.
“Your body has adjusted itself to handle a massive
dose, so if you stop altogether, it could trigger a defi-
ciency.”
As a general rule, Dr. Saltman concludes, it’s best
to stay below five times the USRDA for minerals and
vitamins.
If you’re thinking about increasing the dosage of
some nutrients or are just curious about your present
For advice on supple- vitamin regimen, consult your doctor or a registered
ments, see your doctor dietitian. This is especially important if you have an
or a registered dietitian.
illness such as diabetes or high blood pressure, since
large doses of some supplements can interfere with
the function of medications.
“It’s a multifaceted issue. It’s not as simple as
popping the top off a bottle and swallowing a few
pills,” says Dr. Saltman. “The most positive step that
people can take is to realize that there is a real poten-
tial for harm when taking megadoses of some vita-
mins and minerals.”
And before you use supplements, ask the key
question: Do I really need them? Most nutrition ex-
Do you really need sup- perts say supplementation is rarely necessary. Many
plements? people think otherwise. Only your body knows for
sure. So before you supplement, find out from your
doctor, a nutritionist or your personal analysis of your
own diet whether you really require extra nutrients.
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 Chapter 56 427

Getting Ready
to Eat for Two

he kind of nourishment you're getting (or not

getting )today may help (or harm) the baby you
may be carrying tomorrow. Studies have shown that
the stores of fat, protein and other nutrients that are
called upon for fetal nourishment during pregnancy
are built up over the years.
We also know now that the fetus is profoundly
affected by what and how much the mother eats. And
the most critical effects often occur in the early weeks Your unborn baby
of fetal development—even before you know you're depends on you for
nutrients.
pregnant.
“Sometimes all it takes is a gradual modification
of your own nutritional habits to give the fetus the best
chance at healthy development,” says David Paige,
M.D., professor of maternal and child health at the
Department of Public Health, Johns Hopkins Hospi-
tal. So start taking inventory of your current food
habits, and let your health-care provider in on your
pregnancy plans.
Here are some changes to make today to guard
against fetal damage and to ensure yourself a healthy
baby (while it’s still but a twinkle in your eye).

Aim for Your Ideal Weight

before Conception
“Pregnancy is not the time to worry about
pounds,” says Dr. Paige. In fact, most physicians to-
428 Better Nutrition for the Stages of Your Life

day agree that maternal weight gain has more effect

on the development of a healthy baby than anything
else. So when you do get pregnant, you'll likely be
instructed to “eat to appetite” and to gain weight—an
average of 28 pounds or so. (But you can take the
worry out of weight gain during pregnancy if you
breastfeed after your baby is born—it will help you
lose pounds faster.)
So lose weight gradually before conceiving.
Don’t crash diet. “Women should not enter preg-
Gradual weight loss is nancy with depleted body stores,” says Roy Pitkin,
better than crash diet- M.D., professor and head of nutrition, Department of
ing if you want to slim
down before pregnancy.
Obstetrics and Gynecology, University of Iowa. That
also means underweight women should gain weight
prior to pregnancy.

Wean Yourself
from Wine and Spirits
The National Institute on Alcohol Abuse and Al-
coholism says you should abstain altogether. But
many doctors continue to suggest limiting drinks to
one or two a day. “There’s no known safe drinking
level, so play it safe during pregnancy—don’t drink,”
says Dr. Pitkin. And now—before pregnancy—is a
great time to start discovering nonalcoholic ways to
quench your thirst, socialize or entertain.

Cut Caffeine Consumption

Start brewing a weaker cup of coffee. Caffeine
crosses the placenta and reaches the fetus. While
If you consume caffeine, caffeine may or may not cause birth defects, the U.S.
so will your unborn Food and Drug Administration (FDA) warns pregnant
baby.
women to eliminate or limit caffeine-containing prod-
ucts such as cola, tea, chocolate and common cold
remedies.
What’s more, caffeine can suppress your appetite
and rob you of sleep—both pregnancy no-nos. So it’s
 Getting Ready to Eat for Two 429

better that you go through the caffeine-withdrawal

jitters now. And urge the father-to-be to cut caffeine,
too. Studies have shown that “reproductive loss” oc-
curred when the man’s caffeine intake was high be-
fore conception.
To get going in the moming—and keep going—
look for other breakfast boosters (like cheesy eggs)
that pack plenty of protein, a nutrient you'll need
once you are pregnant anyway.

Rev Up Your Nutrient Intake

Everything you eat counts when you're pregnant,
but certain nutrients are especially critical.
Iron. Like many women, you probably have an
iron-deficient diet. After you conceive, you will need
even more iron to keep your blood rich for the baby. Make sure you’re get-
But even vegetarians can build up iron stores by eat- ting enough iron in your
diet.
ing plenty of prunes, leafy green vegetables, dried
beans and blackstrap molasses. Enhance iron absorp-
tion by eating those foods along with foods contain-
ing vitamin C.
Calcium. Before you’re pregnant, you'll need
about 1,000 milligrams of this mineral per day to ward
off osteoporosis, a bone-loss condition. After you get When you’re pregnant,
pregnant, be certain to get 1,200 milligrams per day your need for calcium
increases.
for the proper development of your baby’s bones and
teeth. Start cultivating a taste for calcium-rich foods,
such as milk, tofu, yogurt, cheese, broccoli and al-
monds.
Folate. A deficiency during pregnancy could
mean your unborn baby may develop neural tube
defects. Start eating more wheat germ, brewer’s yeast
and raw spinach now.
Vitamin B,. The Pill robs you of this nutrient,
which some medical people say can combat cramp-
ing and swelling during pregnancy. Use a barrier
method of birth control for three months prior to
conception, and increase your B, supply by eating
bananas, wheat germ and poultry.
430 Better Nutrition for the Stages of Your Life

In general, don’t take vitamin megadoses if you

plan a pregnancy. Large doses of some vitamins, like
A and D, have resulted in fetal defects.

Stick to Several Small Meals

Meal skipping is strictly forbidden during preg-
nancy, so you might as well get into the habit of eating
During pregnancy, skip- regularly. Eating minimeals throughout the day will
ping meals is a no-no. help you to stabilize your blood sugar and to maintain
your energy and weight both before pregnancy and
after delivery. During pregnancy, eating several small
meals a day will help you gain the weight you need
and prevent morning sickness.
 Chapter 57 431

What Pregnant Women

Should Know
about Nutrients
and Birth Defects

efore the sleeping potion thalidomide

wrought its infamous fetal deformities, before
rubella was found to work dark changes in the un-
born, before researchers showed that alcohol and
cigarettes were the enemies of the fetus, people be-
lieved that the womb was a kind of fortress. Babies,
they thought, huddled there, shielded from the harm
originating beyond the placental wails.
But we learned the hard way that the walls are
thin and that the life inside often responds readily to
forces from outside, whether they’re good or evil. The fetus is more vulner-
And we're still learning. Right now, there’s a race able than we once
thought.
on among scientists to identify and deal with such
forces, and there’s plenty of evidence—especially in
the area of nutrition—that the effort is paying off.

Vitamins and Minerals

May Prevent Birth Defects
Researchers have known for decades that mal-
nourished women often give birth to deformed in-
fants, and doctors and laymen alike have vaguely Fetal health is critically
acknowledged the importance of prenatal nutrition linked to its mother’s
nutrition.
(‘You're eating for two now’). But it’s only recently
that research has started to focus heavily on specific
nutrients in the expectant mother’s diet. So far the
data coming in are incomplete, but some of the latest
results hold out a tantalizing prospect: the prevention
and treatment of many birth defects with vitamins and
minerals.
432 Better Nutrition for the Stages of Your Life
i ee

“We don’t yet fully understand the biochemical

impact of certain nutrients on fetal deformities. But it’s
clear that each is crucial,’ says Thomas Brewer, M.D..,
a San Francisco obstetrician and author of Metabolic
Toxemia of Late Pregnancy. “The challenge is to con-
vince the medical profession and pregnant women
that a balanced diet of protein, carbohydrates, fats,
vitamins and minerals, including a moderate amount
of salt, is necessary. The biochemistry behind this
remains an exciting academic problem.”
The sense of urgency here is understandable. In
this country the rate of birth defects is about 7 percent
Scientists hope that nu- of all births—amounting to a quarter of a million
trition will be a new babies born each year with mental or physical ab-
weapon against birth
defects.
normalities. And in 60 to 70 percent of these cases,
medical people don’t have the slightest idea what the
cause is. If the nutrient approach pans out—and lots
of researchers think it will—a whole new front could
open up in the conflict between science and the “ac-
cidents” of birth.

Battling Parental Nightmares

The most intriguing news of the nutrient connec-
tion comes from Great Britain. There, R. W. Smithells,
New hope in the war on M.B., of the University of Leeds, and his colleagues
neural tube defects. have been amassing evidence that vitamins and min-
erals may be able to prevent a class of birth deformi-
ties known as neural tube defects (NTD).
These relatively common malformations (which
include spina bifida) are the embodiment of parents’
nightmares—fetal vertebrae fail to fuse and the spinal
cord protrudes through the gap, or the head is too
small, or the brain is missing, or there’s some other
neural calamity. NTD children usually must endure
lifelong handicaps. Some can’t walk. Some can’t con-
trol their bowels or bladder. And many must repeat-
edly submit to surgery to correct congenital errors.
Early on, Dr. Smithells realized that whatever
caused NTD (and there may be several factors), the
mother’s nutrition probably played a major role. After
 What Pregnant Women Should Know
about Nutrients and Birth Defects 433

all, he noted, circumstantial evidence suggests that

women who have the worst diets seem to have the
greatest chance of delivering a baby with an NTD, and
women with low levels of certain nutrients appear
more likely to have babies with defects in the central
nervous system.
So the question was—and a radical query in-
deed—could supplementing a woman’s diet with spe-
cific nutrients lower her chances of having an NTD A study of women who
baby? To find out, Dr. Smithells and his associates were at high risk.
gave a daily multivitamin/mineral supplement to 454
women who had already delivered at least one NTD
infant (and who were therefore at higher risk for deliv-
ering another) and who planned to become pregnant
again. Since NTDs develop near conception, the
women took the supplements from at least 28 days
before conception to the time of the second missed
period. The investigators compared the pregnancy
outcome of this group to that of 519 women taking no
supplements at all, who also had had one or more
NTD babies.
The results are still reverberating in the medical
world. The rate of NTD births among the
unsupplemented women was 4.7 percent. But the rate For those concerned
among those taking the vitamins and minerals was about neural tube de-
fects, some startling
only 0.7 percent, about one-seventh as high (Lancef). data.
The researchers concluded, “The presumptive evi-
dence of a protective effect of vitamin supplementa-
tion remains very strong.”
But if nutrients administered in moderate
amounts do alter the congenital throw of the dice,
how do they do it? The most favored explanation is
that women prone to deliver NTD babies suffer from
vitamin or mineral deficiencies or the inability to
properly metabolize certain nutrients.
Dr. Smithells’s hunch was that the key nutrient in
his supplement formula was folate, or folic acid,
which was supplied at a level of 360 micrograms. Dr. Smithells: The likely
Another group of researchers has already found that birth-defect preventive
is folate.
supplementing high-risk women with only folate re-
duces their risk of having NTD babies. (Of course,
434 Better Nutrition for the Stages of Your Life

pregnant women should not consider use of folate

supplements without the consent of their physician.)
There could be more than one active agent in the
formula, of course, so Dr. Smithells and his colleagues
are still looking.

Nutrients against Cleft Lip

Such compelling study results are bound to
prompt a few scientific minds to ponder a most attrac-
tive possibility: If it’s true that supplements can work
against one class of birth defects, maybe they can
make war on a related class.
Dr. M. Tolarova of the Institute of Experimental
Medicine in Prague has suggested just that. It wouldn’t
Can supplements pre- be surprising, says Dr. Tolarova, if supplementing
vent cleft lips? women who’ve delivered babies with cleft (split) lips
could reduce the chances of the deformities recur-
ring. After all, NTD and cleft lips Gnaccurately and
unkindly labeled harelips) are physiologically related.
At any rate, a trio of early studies has hinted at
the idea, and Dr. Tolarova has done some testing, toc.
The researcher first selected women who had given
birth to cleft-lip babies but had no other family history
of mouth or facial clefts. Then the women were given
supplements (similar to Dr. Smithells’s formula) to
take daily from at least three months before concep-
tion to the end of the first trimester of pregnancy. For
comparison, a group of unsupplemented women with
a similar cleft-lip history was also chosen.
When all the women had delivered and the re-
sults were tabulated, the numbers seemed just as im-
pressive as the NTD data.
“In 85 pregnancies, fully supplemented,” says
Dr. Tolarova, “‘there was just one recurrence [of cleft
lip]. Acting as control, 212 pregnancies, not supple-
mented, ended in 15 recurrences.” Which means that
the women who took the vitamins and minerals had
one-seventh the risk of bearing cleft-lip children as the
unsupplemented women (Lancef).
 What Pregnant Women Should Know
about Nutrients and Birth Defects 435

Folate Deficiency Implicated

in Some Premature Births
Women who experience a lifetime preterm deliveries in the patients
of poor nutrition are at high risk of they studied (American Journal of
delivering premature babies. The Clinical Nutrition).
consequences of that can be dev- “Folate deficiency may not
astating. According to the experts, be recognized as much as it
it’s the most significant contribu- should be,” adds James Carter,
tor to infant mortality, and even M.D., chairman and professor, De-
the babies who do survive—espe- partment of Nutrition at Tulane
cially the really tiny ones—often University School of Public Health
have some residual defects. in New Orleans. “Sometimes it’s
Besides that, the medical masked by an iron deficiency,
costs are staggering—up _ to which is most common and easy
$100,000 for 30 to 60 days in the to diagnose.
preemie nursery. That’s why re- “Clearly, it would help to in-
search that helps uncover the spe- crease the amount of folate in the
cific factors that cause these prob- diet with foods such as broccoli,
lems is so important. liver, spinach, cabbage, romaine
Now a group of doctors from lettuce and black-eyed peas—all
the University of Mississippi Medi- good sources.
cal Center in Jackson may have “Still,” says Dr. Carter, “it
isolated one of the contributors— would be wrong to give the im-
a deficiency of folate, a B vitamin. pression that you can correct the
Of the women they studied (85 problem of low-birth-weight ba-
percent of whom were poor and bies that simply. Black women in
black), the doctors found that 32 particular have a high incidence of
percent giving birth to premature this problem because they them-
babies were folate deficient. By selves were often raised on a mar-
comparison, only 6 percent of ginal diet or were low-birth-
those having full-term babies were weight babies themselves. It may
deficient. take a full generation to bring their
The researchers say that fo- reproductive performance up to
late deficiency may be a factor in what we see in affluent white
as many as one-third of the women.”
436 Better Nutrition for the Stages of Your Life

A Catastrophic Deficiency
There is, however, an even more heavily re-
searched nutrient link with birth defects: zinc. For at
The zinc link to birth least 15 years, scientists have been scrutinizing the
defects. effect that zinc deficiencies have on birth defects, and
the evidence has been consistently provocative.
First came reports that pregnant rats deficient in
zinc gave birth to offspring with a variety of abnormal-
ities. Then there was word that people in Egypt and
Iran have widespread zinc deficiencies, as well as
high rates of birth defects involving the central ner-
vous system. Later, researchers established a similar
relationship in Turkey.
Lowell E. Sever, Ph.D., formerly of the University
of Washington School of Public Health in Seattle, was
one of the first to identify the zinc/malformation phe-
nomenon in the Near East and has since surveyed the
full spectrum of the research.
“Data support the idea that a lack of zinc in
pregnancy may precipitate human birth abnormali-
A zinc deficiency in ties,” he says. “And none of the investigations suggest
pregnancy may threaten that moderate levels of dietary zinc are in any way
the unborn child.
harmful.”
But can the research tell women precisely what
zinc intakes may be protective? “Not yet,” says Dr.
Sever. ‘“‘All we know so far is that under normal cir-
cumstances the Recommended Dietary Allowance
[RDA] for a pregnant woman—20 milligrams per
day—should be enough.”

Vitamin Therapy
for Birth Defects
Fortunately, beyond the safety net of prevention,
there’s treatment. To be sure, treating abnormalities in
Some rare successes: fetuses is still highly experimental and far less preva-
reversing birth defects
lent than preventive measures. And certainly many
with vitamins.
congenital mistakes simply can’t be corrected. But the
work goes on, and vitamins are a small part of it.
 What Pregnant Women Should Know
about Nutrients and Birth Defects 437

At Yale University School of Medicine in New

Haven, Connecticut, Maurice Mahoney, M.D., has
treated a potentially lethal birth defect with high
doses of vitamin B,. The defect is called
methylmalonic acidemia, a rare metabolic disorder.
“In this abnormality, there’s a blockage of vita-
min B,, in the fetus’s system,” Dr. Mahoney says. “The
vitamin is prevented from facilitating the metabolism
of certain amino acids, and that allows other acids to
increase in the fetus’s bloodstream. An infant born
with such a problem will be lethargic, unable to feed
properly, even semicomatose. Ultimately, he will be-
come severely retarded or die if treatment is not
started shortly after birth.”
Dr. Mahoney overcomes the blockage by supple-
menting the expectant mother with B,, as soon as the
diagnosis is made (at about 16 or 17 weeks).
‘We administer the vitamin either orally or intra-
muscularly,” he says. “It crosses the placenta to the
fetus and causes a very sharp decline in With vitamin B,,, 100
methylmalonic acids in the blood. If we continue percent success.
therapy until delivery, the baby will be virtually nor-
mai.’”’ When last contacted, Dr. Mahoney said his suc-
cess record was 100 percent.
The story is much the same with a similar fetal
disorder called multiple carboxylase deficiency. It,
too, is marked by faulty metabolism—failure to break Saving babies with
down amino acids and carbohydrates with a resulting biotin.
buildup of acids in the blood and cells. And it, too,
leaves newborns lingering between retardation and
death. The stabilizing influence this time, however, is
biotin, another B vitamin.
‘We administer the biotin the same way we do
the B,,,” says Dr. Mahoney. “And the result is simi-
lar—fairly rapid normalization of the metabolism.”
All of which intimates that in pregnancy, getting
enough to eat and shunning alcohol and cigarettes
are a big part of the battle against birth defects.
Remember, however, that you should never take
any supplements during pregnancy without first
checking with your doctor.
438 Chapter 58

How to Avoid
Dieters’ Deficiencies

re you losing vitamins and minerals as well

as pounds? Maybe you’d better count nutn-
ents along with calories.
Researchers have found that immune system re-
sponse drops in people on very low-calorie diets, says
Caution: Very low- Peter Lindner, M.D., director of continuing medical
calorie diets may education for the American Society of Bariatric Physi-
weaken your immunity.
cians (obesity specialists). “In one study, the re-
searchers were interested in the changes in disease-
fighting white blood cells when exposed to vaccine.
What they found was that the immune response was
reduced in those individuals on improperly adminis-
tered ultralow-calorie diets, making them more sub-
ject to infection. That is probably one of the most
dangerous aspects of very low-calorie diets.”

Starvation Diets Are Dangerous

If you’re a dieter—and surveys show two out of
three people are—there’s a very good chance you
may be endangering your health, warns Dr. Lindner.
You may be able to take nutrition for granted when
you're eating like a horse, but it becomes critical
when you start eating like a bird.
“A good balanced diet in the higher caloric
range probably gives you all the vitamins and minerals
you need. It gives you some leeway to play with,” says
the physician. “Drop it down to 800 or 1,000 calories,
and everything counts.”
 How to Avoid Dieters’ Deficiencies 439

In fact, according to the Food and Nutrition

Board of the National Academy of Sciences—which
sets our Recommended Dietary Allowances Are you getting enough
(RDAs)—it is difficult to get adequate nutrition on calories?

diets that provide less than 1,800 to 2,000 calories.

Most popular reducing diets call for 1,200 or less.
It’s hard enough to juggle the four food groups
into a nutritionally balanced diet when you've got a
few thousand calories to work with. Dieters have a
tougher task. They have to concoct three healthful
meals with roughly half the calories they’re used to
consuming. And they start out with a handicap—they
don’t know beans about nutrition.
Following a diet guide may not help. Many of the
popular diet plans are full of dubious nutritional ad-
vice. And most dieters know only enough to plan a
1,200-calorie menu down to the last morsel. But
knowing calories isn’t enough. You can create three
low-calorie meals a day without ever straying from the
candy counter.

The Problem
with Weight-Loss Diets
Perhaps the most important thing to remember
when you're counting calories is that it’s the nutri-
tional value of the calorie that counts. If you don’t Count nutritional value,
know the value of a calorie, you don’t know what not just calories.

you're missing.
But Paul LaChance, Ph.D., does. Dr. LaChance,
professor of nutrition and food science at Rutgers
University, evaluated the nutritional content of 11
published weight-loss diets. He chose the 11 because
they ran the gamut of popular weight-reducing
plans—from high protein/flow carbohydrate to low
protein/high carbohydrate, with variations in be-
tween. They carried such familiar names as Scarsdale,
Stillman, Atkins and the Beverly Hills Diet.
Using the RDAs as a frame of reference, Dr.
LaChance and his associate, dietitian Michele C.
440 Better Nutrition for the Stages of Your Life

Fisher, R.D., Ph.D., found that most of the diets were

low in thiamine (B,),vitamin B,, vitamin B,,., calcium,
Popular diets get a bad iron, zinc and magnesium. Thiamine, vitamins B, and
report card. B,. and magnesium were often at levels less than 70
percent of the RDA. One, the Beverly Hills Diet, sup-
plied less than 70 percent of the RDAs for more than
half of the vitamins and minerals the researchers eval-
uated, and it was so low in protein they predicted it
would lead to a serious protein deficiency over a long
period of time.
And there’s the rub. Most diets are protracted, if
not forever. “Most people stay on a diet for a long
time. After all, weight loss doesn’t occur overnight,”
says Dr. LaChance. “If a diet lasts only two weeks, the
vitamin and mineral loss is not going to be significant.
As far as I’m concerned, women are dieting all the
time and may have other risk factors—smoking, con-
traceptive pill use—that can affect nutrient metabo-
lism. For them, the loss can be very significant.”
In fact, researchers studying otherwise healthy
men found that even without those extra risk factors, a
prolonged low-calorie diet had a damaging effect on
their health. One group, which had previously eaten
more than 3,000 calories daily, ate about half that for
a period of six months. Even though they were eating
more calories than prescribed by most reducing diets,
the men suffered from depression, anemia, edema,
slowing of heartbeat and loss of sex drive. They also
tired easily and lacked endurance.
Some weight-loss regimens, specifically those
that are mainly protein, can lead to a potentially seri-
Fasting can be hazard- ous condition called acidosis, which also can occur
ous to your health. on fasting diets. In one study, people fed a diet of
solely protein and fat lost about two pounds a day—
along with large amounts of nitrogen and salt in their
urine. They suffered from the symptoms of acidosis,
which can include weakness, malaise, headache and
heart arrhythmias.
Acidosis can be remedied by adding as little as
about three ounces of carbohydrate to the diet.
 How to Avoid Dieters’ Deficiencies 441

Needless to say, bizarre diets that rely heavily on

one food—such as grapefruit—are going to be nutri-
tionally bankrupt. Very low-calorie liquid diets can be
deadly.

Women’s Nutritional Needs

May Exceed Supply
Women are always going to have to pay extra
attention to the nutrient content of their diets because
of their increased needs for certain nutrients. “For
women it’s hard enough to get things like calcium and
iron,” says Cindy Rubin, a clinical nutritionist formerly
with the obesity research group at the University of
Pennsylvania.
Women generally need more iron and calcium
than men.
“Many women are going to have to supplement
their diets with calcium and iron,” says noted weight
and fitness expert Gabe Mirkin, M.D., who ordinarily Are you getting enough
doesn’t advocate dietary supplements. “One out of iron and calcium?
four women between 12 and 50 is iron deficient.”
Though an iron deficiency may eventually lead to
anemia, it has its own immediate health conse-
quences. “When you're iron deficient, even though
you're not anemic,” says Dr. Mirkin, “you can’t clear
lactic acid as rapidly as normal from your blood-
stream, so you tire earlier at work and play.”
“The problem with calcium is that it’s scarce
except in milk products—the first thing many dieters
cut out. Unless you choose skim milk, dairy products
can be high in fat and calories,” says Dr. Lindner. “It’s
difficult to get adequate calcium without milk unless
you want to eat sardines, small bones and all.”
How food is prepared may also affect a dieter’s
nutrition. “If you’re eating a salad that was tossed
three days ago, vitamins are lost simply by exposure,” How cooking can de-
says Dr. Lindner. “If food is cooked too much, you stroy vitamins.
can lose more. Especially at risk are the water-soluble
vitamins, such as C and the B vitamins.”
442 Better Nutrition for the Stages of Your Life

One of those B vitamins is folate. Women are

particularly at risk of developing anemia when they
aren't taking in enough folate, which is found in leafy
greens. A form of anemia occurs when there isn’t
enough folate in the body to produce red blood cells.
Folate deficiency also has been pinpointed as a factor
in an often-precancerous condition called cervical
dysplasia.
Studies have also shown that low-calorie and
starvation diets can lead to an excessive loss of zinc,
Another risk of low- possibly as a result of tissue breakdown. Researchers
calorie diets: zinc at the Veterans Administration Hospital in Hines, Iili-
deficiency.
nois, found that weight-loss diets between 600 and
1,240 calories can be zinc deficient, depending on the
type and source of dietary protein from which the
zinc is derived. Diets that derive most of their protein
from red meat tend to supply more zinc than those
that rely on chicken, fish, milk products and eggs,
which are, unfortunately, the main protein sources of
many low-calorie diets.

Tips for the Diet-Wise

If it all sounds discouraging, rest assured that the
obesity experts understand—and have more than one
Solving the dieter’s solution to a dieter’s nutritional dilemma.
nutritional dilemma.
Use a supplement to help fill the gap. If you
don’t feel you can add red meat to your diet or if time
and money constraints make it impossible to eat only
freshly prepared foods, you can take supplements.
“Theoretically, it’s not necessary to supplement your
diet,” says Dr. Lindner, “but realistically, most people
don’t have the knowledge or the time to do it right.
Especially if you’re a woman, a standard multiple vita-
min that contains iron, B,, folacin [folate] and zinc
along with a calcium supplement should help you
make sure you're getting all of the 26 micronutrients
you need.”
Learn the value of a calorie. You know there’s
a big nutritional difference between a 200-calorie
 How to Avoid Dieters’ Deficiencies 443

candy bar and a 200-calorie protein salad. But even

so-called diet foods aren’t created equal. “Choose
nutrient-dense foods,” suggests Cindy Rubin. “For in- Not ail calories are cre-
stance, eat broccoli as opposed to lettuce. Both are ated equal.

low in calories, but lettuce is mainly water. You’re not

getting the heavy doses of vitamin A that you get in
broccoli.”
Go for variety. Not only is it the spice of life but
it also improves your chances of getting all the vita-
mins and minerals you need.
Plan your diet menu from the four basic
food groups. “Each of the major categories repre-
sents certain vitamins and minerals,” says Dr. Mirkin.
“Grains and cereals, for example, give you E and the B
vitamins. Fruits and vegetables supply C and A. If you
take in at least 1,500 calories a day and distribute your
calories over the four food groups, you'll probably be
taking in the nutrients you need.”
Eat more calories. This may come as a sur-
prise, but by eating more, naturally, you’re more likely
to meet your nutritional needs. But will you lose How to eat well and still
weight? Yes, say the experts, as long as you burn up lose weight.
some of those calories through exercise.
In his book Getting Thin, Dr. Mirkin advises eat-
ing 1,500 calories a day—and using an hour of exer-
cise to burn off 300.
There are some unique advantages to this plan.
Aside from losing weight healthfully, you'll stimulate
your metabolism to burn even more calories. “You
see, diets don’t work,” says Dr. Mirkin. “When you go
on a diet, your metabolism slows down. When you're
lying in bed, not even moving, you burn 60 calories an
hour. If you’re on a diet, you burn only 50. If you
exercise, you burn 70—without even moving. Exer-
cise speeds up your metabolism, not to mention sup-
pressing your appetite.”
Dr. Mirkin recommends picking two sports—aer-
obic dancing and biking, for instance—and working
up slowly to an hour of each on alternating days. “I
specify two sports because it takes you 48 hours to
444 Better Nutrition for the Stages of Your Life

recover, and you should rotate the stressors on your

body,” he says.
Older people especially need exercise as an inte-
gral part of any diet plan. “The two have to be to-
Why older people need gether,’ says Dr. LaChance. “When you’re young,
exercise. your metabolism is higher, and you can get away with
more. When you get older, your body changes. Your
metabolism slows, your lean body mass goes down
and your propensity for adipose [fat] tissue goes up.
You lower your need for calories, so if you don’t add
exercise, you get fat.”
 Chapter 59 445

The Exerciser’s
Guide to
Vitamins and Minerals

egend has it that the ancient Greek wrestler

Milo of Croton killed a bull with a single blow
and ate it in just one day, thereby setting the tone for
the millions of athletes who came after him, whose
training tables would be a smorgasbord of nutrition
fads.
Milo reputedly built his prodigious strength by
eating 20 pounds of meat a day. And, until about a
decade ago, everyone from the high school track star
to the mile-a-day jogger thought the magic potion was
a slab of marbled steak at every meal. Once they
discovered carbohydrate loading, it was goodbye
beef and hello pasta. In fact, athletes have always
been the first to pounce on the “‘perfect”’ elixir, which
could make them the biggest, the fastest, the stron-
gest, the . . . (fill in your favorite superlative). Athletes
sang the praises of bee pollen, glorified ginseng and
gulped down handfuls of vitamins and minerals as if
they were candy.

How to Achieve
Your Personal Best
But does any of this wishful eating do any good?
Separating nutrition fact from fancy is not as easy as it
seems. There’s been more agreement among warring
factions in the Middle East than among nutritionists
and fitness experts talking about the special needs of
the physically active. Should you load up on potas-
446 Better Nutrition for the Stages of Your Life

sium-rich foods? Should you take supplemental vita-

min C? Are you sweating away more zinc and ribofla-
vin than you're getting in your diet? In answer,
authorities’ voices rise like a discordant choir.
If you aren’t planning to challenge Navratilova at
Wimbledon or break records at the Boston Marathon,
Doing some nutritional the controversy surrounding performance boosting
fine-tuning. can remain academic. But what if you are looking for
a way to improve your personal best—or at least not
lose ground while you're getting fit? Is there some
nutritional fine-tuning you might be doing?
Though some of it is contradictory, the evidence
indicates you might, particularly if you are a woman
or a vegetarian, if you are losing weight or eating a
poor diet. Your nutritional needs may be altered by
exercise, especially if you are training hard or in-
volved in an endurance sport like marathon running.
The first thing you may have to do is eat more.
Most nutrition experts agree that the diet that meets
Advice for the physically the needs of a sedentary individual is not adequate for
active: Eat more. a person involved in vigorous physical activity. So if
your three-mile-a-week run has whetted your appetite
for half-marathons, you will probably have to adjust
your diet to include more foods with high energy
concentration. That means calories.
If you’re a recent convert to physical fitness, that
probably sounds ominously like the first step on the
More calories but not road to fat. But when was the last time you saw a fat
more fat. marathoner? Long-distance runners monitored along
a 312-mile course in Hawaii ate an average of 4,800
calories a day. (“They were eating their way through
312 miles,” commented one researcher.) Had they
not been averaging over 16 miles a day on this run-
ner’s holiday, they would have gone home like a flo-
tilla of blimps. But because they were running, they
were using—as fuel—every last calorie they ate.

In Search of a Good Diet

“High-mileage runners—greater than 60 miles
per week—need not worry about excessive calorie
 The Exerciser’s Guide to Vitamins and Minerals 447

intake. If their diet is well balanced and contains a

variety of foods, they will be receiving the necessary
vitamins and minerals,’ says Rudolph Dressendorfer,
Ph.D., professor of physical education at the Califor-
nia PolyTechnic State University in San Luis Obispo,
California.
Many nutrition specialists believe that the prover-
bial “good mixed diet” is high-octane fuel for the
exerciser. But others aren’t so sure the average jogger Is the average jogger
or tennis player is so scrupulous about his three really getting enough vi-
tamins and minerals?
squares a day. Jack Cooperman, Ph.D., director of
nutrition at the New York Medical College, believes
marginal B-vitamin deficiencies are epidemic among
the otherwise health-conscious because of dieting
and meal skipping. Two University of Missouri re-
searchers, testing the iron, zinc and copper intakes of
women track team members, discovered nearly half
of them consumed less than two-thirds of the Recom-
mended Dietary Allowance (RDA) for iron and zinc
in diets that were generally poor.
One thing science seems clear on is that dietary
deficiencies can impair athletic performance. Studies
have shown that when thiamine (B,), a B vitamin
found mainly in high-carbohydrate foods, is added to
a thiamine-deficient diet, muscular endurance is en-
hanced in a very short time. Researchers also found
that people whose diets are lacking sufficient
amounts of vitamin C grow fatigued more quickly than
those who have higher intakes.
Add exercise to a nutrient-deficient diet and you
could run—or bike or walk—right into trouble. Unfor-
tunately, research on the nutritional requirements of Nutritional deficiencies
ardent exercisers is as sparse as a toddler’s vocabu- + exercise = trouble.

lary—but there is enough to signal a few dietary

warnings.

Watch Your Iron Intake

If you are involved in an endurance sport and are
a woman and/or a vegetarian, you should pay close
attention to your iron intake. Doug Clement, M.D., co-
448 Better Nutrition for the Stages of Your Life

director of the University of British Columbia’s Sports

Medicine Clinic, believes “the vast majority” of female
runners and a quarter of male runners have what he
terms a nonanemic ferritin deficiency. Ferritin is an
iron compound, and its levels are a sensitive gauge of
the body’s iron stores. A deficiency may result in a
runner’s failure to improve with training, Dr. Clement
says.
The most prominent victim of ferritin deficiency
is Olympic marathoner Alberto Salazar, who in just
Alberto Salazar learned two years went from setting records to straggling in
about iron deficiency dead last. Dr. Clement, a college running teammate of
the hard way.
Salazar’s coach, diagnosed the troubled runner long-
distance. Tests later confirmed his diagnosis, and Sa-
lazar was placed on an iron-enriched diet. He showed
improvement, enough to qualify for an Olympic berth,
a feat his previous performances had placed in doubt.
Iron can be easily lost through sweat, urine, feces
and, in women, menstrual flow. Studies also indicate
It’s easy to lose too runners can actually break iron-laden red blood cells
much iron. when the thin-skinned soles of their feet batter relent-
lessly on hard surfaces. Red blood cells have been
found in runners’ urine.
‘As a result of one study we've done, we suspect
runners are not absorbing iron from their diets as well
as they should,” says Dr. Clement. “One speculated
factor is their decreased transit time. Runners gener-
ally have more active bowels, decreasing the time
between intake and exit, so the iron isn’t in the body
long enough to be absorbed properly.”
At greatest risk are active vegetarians—because
iron is not as readily absorbed from plant sources—
At risk for iron defi- and women, whose need for iron is almost twice as
ciency: women and great as men’s. Women should get 18 milligrams of
vegetarians.
iron a day, and Dr. Clement believes running and
other equally strenuous sports add 6 to 8 milligrams to
that requirement. The average woman gets only about
10 to 12 milligrams a day.
One study of women in an aerobics class at the
University of Illinois, conducted by Scott Blum and
Adria Sherman, Ph.D., of the Department of Foods
 The Exerciser’s Guide to Vitamins and Minerals 449

and Nutrition, found that the women’s ferritin levels

dropped after only six weeks, though not into the
deficient range.
There is some evidence, however, that perfor-
mance can suffer in the absence of full-blown anemia,
particularly when there is a depletion of tissue iron.

Getting More Iron

in the Active Person’s Diet
How does a fitness buff make sure the iron in
his or her diet is sufficient—short of becom-
ing a ravaging meat eater?
Nancy Clark, a nutritionist with Sports
Medicine Resource and the author of The Ath-
lete’s Kitchen, offers some helpful advice.
Include a food rich in vitamin C with
meals. Vitamin C has been shown to make
iron more absorbable. In one study, a glass of
orange juice increased the amount of iron
absorbed from an iron-enriched breakfast ce-
real by 250 percent.
Cook with cast iron rather than alu-
minum or stainless steel. Frying scrambled
eggs in a cast-iron pan can increase iron con-
tent threefold. Simmering a half cup of spa-
ghetti sauce for three hours in a cast-iron pot
can raise iron from 3 milligrams to 88 milli-
grams.
Try to eat breads, cereals and pastas
that have been iron fortified. A quick look
at the label will tell you.
Avoid drinking coffee and tea with
meals. These beverages can reduce iron ab-
sorption by as much as 50 percent. A glass of
wine with a meal, on the other hand, can
boost your iron absorption by as much as 300
percent.
450 Better Nutrition for the Stages of Your Life

Several iron-containing proteins in the muscle play a

key role in energy metabolism.

Minerals Lost in Sweat

There is far from a consensus on the effects of
mineral loss in exercise, but add a few more to the list
of nutrients to monitor. Potassium, magnesium and
zinc are lost in sweat, though losses vary widely from
one person to the next.
A nutrition expert and a runner himself, Gabe
Mirkin, M.D., coauthor of the Sportsmedicine Book,
Are you suffering from says exercisers who feel weak and tired may be suffer-
‘‘mineral blues’’? ing from “the mineral blues,” a deficiency of potas-
sium and magnesium inside muscle cells. When Dr.
Mirkin, who ran 100 miles a month, suddenly found
that running a quarter-mile ‘“‘felt like a marathon,” he
had his blood tested. He learned that he was potas-
sium deficient, something he remedied with copious
quantities of fruit juices. (Other potassium-rich foods
include ail vegetables, molasses, wheat germ, soy-
beans, pecans and walnuts.)
Researchers at the University of Florida in
Gainesville found that experienced long-distance run-
You can lose potassium ners training in hot, humid weather needed more than
by working out in hot, the recommended amount of 2.6 grams of potassium
humid weather.
to maintain potassium balance, even if they were ac-
customed to the heat. In fact, if they were sweating
profusely, they needed at least 3 grams. Runners who
were not acclimatized had even greater sweat losses
and so may have been losing even more potassium.
A loss of magnesium through sweat can bring on
fatigue and muscle cramps because of the role the
mineral plays in controlling muscle contraction and
regulating the conversion of carbohydrates to energy.
A French doctor perked up a soccer team plagued by
chronic fatigue by giving them magnesium supple-
ments, though you might choose to defend against
magnesium loss by eating more nuts, dairy products,
soybeans and green leafy vegetables.
 The Exerciser’s Guide to Vitamins and Minerals 451

Studies on marathon runners show that zinc lev-

els tend to decrease with hard training, though just
how that might affect performance is not known. Are marathoners risking
“Very few studies have looked at the effects of zinc deficiencies?

plasma-level deficiencies on performance,” says Dr.

Dressendorfer, who has been studying the mineral
needs of marathoners. In one of his early studies,
about 23 percent of his marathoner subjects had zinc
levels in the extreme lower limit of normal. At the time
he speculated that endurance athletes might need to
increase their zinc intake when training. He found ina
subsequent study, however, that even over long dis-
tances, a well-balanced, high-calorie diet kept zinc
and other mineral levels in normal ranges.
“If people are exercising hard and not losing
weight, they are probably getting enough calories,
vitamins and minerals. But,” he cautions, “people
who are losing weight might not be getting enough
calories or enough of the right vitamins and minerals,
either. And vegetarians have to be especially careful
in order to get vitamins and minerals like zinc and
iron, which are found in higher quantities in animal
sources.”

Getting Your B’s

So should women, who may be sweating away
more than minerals. In that valuable perspiration may
be riboflavin (B,),one of the B vitamins that helps the Sweating away
body convert food into energy. Several studies done riboflavin.
at Cornell University led researchers to suggest that
the Recommended Dietary Allowance for active
women is too low. Daphne Roe, Ph.D., and her asso-
ciates found that the more active a woman is, the
more riboflavin she requires. The RDA for riboflavin is
1.2 milligrams a day, or 0.6 milligrams for every 1,000
calories consumed. According to Dr. Roe’s research,
a young woman exercising regularly should be taking
in 1.2 milligrams for every 1,000 calories she eats, or
almost double the RDA.
452 Better Nutrition for the Stages of Your Life

The need for thiamine increases in proportion to

how much energy you expend, at about 0.5 milli-
When you’re active, grams per 1,000 calories consumed. Fortunately, it’s
your body needs more readily available in the high-carbohydrate diets many
thiamine.
athletes have adopted. Like riboflavin, thiamine is a
part of the body’s food-to-fuel system—it helps the
body use sugar—so it’s no surprise there’s additional
need when the body is rewed up by exercise.
In the same way, the body seems to call up its
stores of vitamin B, when it goes into high gear. Scien-
tists at Oregon State University studying teenage
cross-country runners and cyclists found B, levels
rose after their subjects worked out. Since there was
no extra B, in their diets and the body cannot manu-
facture its own, the researchers theorized that the
vitamin was being mobilized from the tissues to meet
the body’s need. There is also some indication that B,
may play a role in increasing muscle endurance.
You'll find B, plentiful in foods like wheat germ,
beans, bananas, lentils, soybeans and chicken. But,
The B’s work as a team. according to one source, getting a lot of one B vitamin
is virtually worthless if you aren’t getting sufficient
amounts of the other B vitamins in your diet, because
these nutrients operate as a team.
Researchers are still studying possible increased
requirements for vitamins C and E, sodium and some
of the trace minerals, but early results are ambiguous.
Though we may know more about good training table
fare than Milo of Croton, science still hasn’t filled in
all the gaps on the menu.
 Chapter 60 453

Boosting Your
Brainpower

ater lilies double in area every 24 hours. At

the beginning of the summer, there is one
water lily on a lake. It takes 60 days for the lake to
become covered with water lilies. On what day is the
lake half covered?
How does your mind work when you read a
brainteaser like this? Is it tickled pink—or tormented
to tears? Is it too tired to tackle the task? Do you Teasing your brain.
spend time puzzling over an answer, or lose interest if
it doesn’t jump right out at you? Do you logically
begin counting lily pads from day one? Or, without
much apparent effort, does your mind leap to the
solution? If the lake is totally covered on day 60, it
must be half covered on... why, day 59, of course.
Why didn’t I think of that?
We all have days when our thinking is fuzzy,
when our logic defies reason, or when we can’t for
the life of us remember some name or fact that was so
familiar just the day before. On days like those, you
might want to trade in your gray matter for a new,
improved model with rechargeable batteries and a
software system that lets you discover the unknown
secrets of the universe in one easy lesson.
Unfortunately, we have to make do with what
Mother Nature has given us. Luckily, that’s usually
more than adequate. But it doesn’t mean we can’t
make better use of the brainpower we do have. Here
are some ways to do just that.
454 Better Nutrition for the Stages of Your Life

Poor Posture, Poor Thinking?

Ever feel like you just can’t think straight? Check
to see if your posture is putting a crimp on the blood
supply to your brain, says E. Fritz Schmerl, M.D.,
teacher of gerontology at Chabot College, Hayward,
California.
“The brain needs up to 30 times more blood than
other organs,”’ Dr. Schmerl says. “But allowing your
Why fuzzy thinking and upper body to sag—with rounded shoulders, head
bad posture go to- hung over and chin jutting outward—can create kinks
gether.
in the spine that squeeze the two arteries passing
through the spinal column to the brain, causing an
inadequate blood supply.” The result? “Fuzzy think-
ing and forgetfulness, especially as we age,”’ says Dr.
Schmerl.
Hunched-over posture can contribute to
strokelike symptoms, known as transient ischemic at-
tacks, which are brief blackout periods. Worse yet,
disturbances in the blood flow of the pinched artery
might cause a buildup of fatty deposits that can cause
partial blockage, according to Dr. Schmerl.
“It’s important to get a head start on proper
alignment while you’re young,” Dr. Schmerl says.
‘Poor posture is a hard habit to break when you’re
older. Be consciously on guard to prevent this pro-
cess by holding yourself straight, with your head back
and your chin in,” he says.

Iron-Poor Intellect
The brain needs large amounts of oxygen to
function effectively, and the only way it can get it is
through iron-packed red blood cells, says Don M.
Tucker, Ph.D., associate professor of psychology at
the University of Oregon at Eugene.
Some studies show that children who have iron-
deficiency anemia have short attention spans and
trouble learning new material. They also know that
boosting iron intake reverses these problems.
And Dr. Tucker’s research shows that adults can
suffer from related problems with alertness and mem-
 Boosting Your Brainpower 455

ory when their iron levels are in the “low but normal”
range. In one study, for instance, the higher the blood Are you too iron-poor to
iron levels, the greater the word fluency. (Volunteers think straight?
were asked to come up with as many words as they
could that begin with “Q” and end with “L.”) In
another, in adults over age 60, blood iron levels were
one of the more important measures in determining
whether or not the person had normal brain-wave
patterns.
“Getting enough oxygen to the brain is certainly
part of its function, but we think iron also influences
brain chemicals and pathways,”’ Dr. Tucker says. “We How iron turns the
know now that iron is heavily concentrated in a part brain on.

of the reticular activating system. This area of the

brain turns the brain on, so to speak. It maintains
alertness. So we can’t help but think that iron plays an
important role in awareness and alertness.”

Aerobic Aptitude
Exercise makes people feel good and can help
lift depression. Now researchers are finding it also
builds mental “muscles” and may postpone aging’s
effects on the brain.
Researchers in Utah recently found that reaction
time, short-term memory and the ability to reason all
greatly improved in a group of out-of-shape people Exercise boosted the
aged 55 to 70 who were put on a four-month program thinking power of
elderly people.
of brisk walking. They were better able to remember
sequences of numbers, for instance, or to use abstract
thinking to correctly match numbers and symbols.
“I was surprised at the amount of improvement
we saw,” says Robert Dustman, Ph.D., of the Salt Lake
City Veterans Administration Hospital. ‘““We expected
to see some results in some people, but we didn’t
think it would be across the board.”
Aerobic exercise makes the body better at trans-
porting oxygen to all its organs, “so we are assuming
that the brain benefits by receiving more oxygen,” Dr.
Dustman says. Those who showed the most improve-
ment (their scores rose by 27 percent) had walked
long and hard enough to be aerobically fit.
456 Better Nutrition for the Stages of Your Life

Stay Stimulated
Mental gymnastics may do as much as physical
exercise to keep our brains healthy. In fact, there’s
Keep your thinking evidence that the brain may actually increase in size
sharp with mental when it’s regularly “stretched” out.
exercise.
Being in an environment that makes you use your
brain helps keep your thinking sharp and efficient,
says Marion C. Diamond, Ph.D., a professor in the
University of California's Department of Physiology
and Anatomy. Boredom, on the other hand, can
cause restlessness, depression and a lack of fulfill-
ment, all of which can interfere with thinking at your
best.
Dr. Diamond has studied the effects of an en-
riched environment on the brain cells of young rats.
Can a stimulating envi- After a month-long stay in a roomy cage that included
ronment make you playmates and plenty of gizmos to fiddle around with,
smarter?
rats’ brains actually showed an increased thickness in
the outer layers of the cerebral cortex, which repre-
sents an increase in the dendrites. “The rats’ brains
became heavier and more chemically active,” says
Dr. Diamond. The rats also went on to run a maze
better than those that hadn’t been in the enriched
environment. “So they became better learners, too,”
she says. “I’ve seen the same results raising my chil-
dren and teaching my students. The greater the expo-
sure, the more adaptable they are to facing other
problems.”
Keeping yourself stimulated should be a lifetime
pursuit, Dr. Diamond says. “Keep dreaming and sat-
isfying those dreams. Keep looking forward, and each
time you come to a lull, decide what new thing you
want to do with your life, the new people you want to
meet, how you're going to help people. Make
changes, and make each change a new beginning.”

Is Lecithin a Brain Booster?

Many of the foods touted as “brain foods’ —fish,
for instance, and liver and eggs—contain choline, a
 Boosting Your Brainpower 457

substance some researchers think may help preserve

the brain’s ability to reason, learn and remember.
Researchers at Ohio State University, for in-
stance, found that mice fed a diet heavy in choline-
rich lecithin or one of lecithin’s “brain-active” ingredi- Is lecithin brain food?
ents, phosphatidylcholine, had much better memory
retention than mice on regular diets. They took much
longer to go into a back room in their cages where
they had received a mild electric shock, meaning they
hadn't forgotten their unpleasant experience.
What’s more, their brain cells, examined under a
microscope, showed fewer of the expected signs of
aging, says Ronald Mervis, Ph.D., of Ohio State Uni-
versity’s Brain Aging and Neuronal Plasticity Research
Group.
‘‘Normally, as the brain ages, its cell membranes
become more rigid with fatty deposits and lose their
ability to take in and release brain chemicals and to
relay messages,” Dr. Mervis says. This can cause
memory loss and confused thinking.
As part of the deterioration process, aging brain
cells also tend to lose dendritic spines, the chemical
receptor areas that are vitally important in passing Lecithin-fed older mice
along information. Having too few dendritic spines is had brains similar to
those of younger mice.
like having a bad phone connection. Messages get
distorted and lost. But older mice that were fed leci-
thin had the same number of dendritic spines as much
younger mice.
“Despite the differences between mice and men,
there are, nevertheless, remarkable similarities in the
structure of their nerve cells,” says Dr. Mervis. “I be-
lieve lecithin could help to repress or delay similar
problems in man, although we have yet to verify that.”

“B” Smart
The brain seems to have a special need for the B Without enough B vita-
vitamins. Memory loss, disorientation, hallucination, mins, your brain mal-
functions.
depression, lack of coordination and personality
changes can occur with B-complex deficiencies.
458 Better Nutrition for the Stages of Your Life

Alcoholics, for instance, who sometimes de-

velop thiamine (B,)deficiencies, have problems with
short-term memory. They may remember in detail
that little café in Paris 20 years ago, but not what they
had for supper the previous night. Thiamine-deficient
mice have trouble balancing on a tightrope, a skill
that’s normally a snap for them.
B,. deficiencies have been linked with poor
memory and an inability to concentrate. Researchers
Elderly people with B,, at the University of New Mexico School of Medicine
deficiencies had poor in Albuquerque found that people age 60 or older
memories and thinking
skills.
with even a mild B,, deficiency had poor memories
and abstract thinking skills. (They had trouble repeat-
ing a short story and matching symbols with num-
bers.) “I think it’s likely that in older people, subclini-
cal deficiencies can indeed lead to less-than-optimal
mental performance,” says James Goodwin, M.D.,
one of the study’s researchers.
Thiamine is needed to produce and use one of
the brain’s major chemical messengers, acetylcho-
line, says Gary E. Gibson, Ph.D., a thiamine researcher
at the Comell-Burke Rehabilitation Hospital, White
Plains, New York. And since the B-complex vitamins
are chemically related and may perform some similar
functions, it’s possible that others are also involved in
brain chemical actions, Dr. Gibson says.

Clear Away Mind “Clutter”

How well your brain performs often hinges on
your emotional state. Anxiety, with its turmoil of
Strong emotions can thoughts and rush of adrenaline, can enhance mem-
short-circuit your ory in some rare moments, but more often it dulls it.
thinking.
Physical tension all too often means mental confu-
sion, aS anyone who's ever botched a crucial job
interview or important exam can tell you. A state of
calm alertness, on the other hand, can help you think
and learn at your best, says Stanford University psy-
chiatry professor Jerome Yesavage, M.D.
 Boosting Your Brainpower 459

Dr. Yesavage studied two groups of elderly peo-

ple. Both were taught what’s known as mnemonic
technique to improve their ability to recall names and
faces. (They associated a prominent feature of the
face with a fanciful, visual image of the name. If the
name were Yesavage and the person had a distinctive
chin, for instance, the image might be of a savage
grabbing the person’s chin.)
But members of one group also learned a tech-
nique to relax their bodies before using the memory
trick. They went on to recall 25 percent more faces With relaxation, their
and names than the group that wasn’t taught to relax. memories improved
dramatically.
“Anxiety and worry actually clutter your
thoughts and decrease your thinking ability,’ Dr.
Yesavage says. “We talk about processing capacity,
which is the amount of information someone can be
actively thinking about at any one time. The brain can
handle only a certain amount of information at once,
so if half its capacity is being used for anxiety and
rumination, it can’t be used for learning or remember-
ing. It’s being wasted. Getting rid of anxiety opens up
more space in the brain to work on the task at hand,”
he says.
Convincing someone not to worry isn’t an easy
task, but worry goes hand in hand with physical ten-
sion, according to Dr. Yesavage: “Ease the physical
tension and the mind follows.” Calming music, deep
breathing exercises, meditation, yoga, biofeedback
and progressive relaxation training all help to soothe
the body and free the mind.

Think You Can

Telling yourself you just weren’t born smart, that
you can never remember things, or that you’re too old
to learn are good ways to sabotage your true intellec- Positive thinking helps
tual potential, say David Lewis, Ph.D., and James you reach your intellec-
tual potential.
Greene, authors of Thinking Better. Such negative
thoughts “put your brain behind bars.” They keep you
460 Better Nutrition for the Stages of Your Life

from pursuing knowledge and learning better ways to

remember. They can push you into a mental rut as you
age.
Feeling good about your ability to learn is impor-
tant to intellectual functioning, and it’s one of the first
things to be tackled at Mankind Research Unlimited, a
Silver Spring, Maryland, “‘superlearning” center that
has turned high school dropouts into gifted learners
and blind people into computer programmers.
‘We tell people who don’t think they can learn
that they really have a lot more brain than they think
and that they can learn to use more of it than they ever
thought possible,” says director Carl Schleicher,
Ph.D.
His learning program uses a number of different
techniques—listening to stately baroque music, visu-
The power of positive alizing a quiet, private getaway place for thinking, and
images. breathing deeply to create an aura of relaxed aware-
ness. Then, the student receives suggestions—that he
will do better, that he can learn. He begins to picture
himself doing that successfully, and his successes in
real life are praised. He may also use creative imagery
to bolster a sagging self-image. An insecure scientist
might practice imagining himself in the role of a suc-
cessful professional in his own field—Albert Einstein,
let’s say, or, if he prefers a neater-looking appearance,
Robert Oppenheimer.
“Limits on learning are self-imposed,” says Dr.
Schleicher. Make the sky your limit by keeping your
thinking powers fit.
 Chapter 61 461

Natural Sparks
to Get Your
Energy Sizzling

ichard Curtis may have done what hitherto

has been thought impossible. He may have
discovered a perpetual-motion machine: himself.
In the morning he teaches creative writing and
journalism at a private boys’ school in Connecticut. In
the afternoon, he’s a chimney sweep—The Sultan of
Soot, as he’s listed in the Yellow Pages. At night, he
grades papers, books chimney-cleaning appoint-
ments and attends committee meetings. In his spare
time, he is a competitive rower and coach, a writer
(one book published, two more on the way), and he’s
teaching himself to play the piano.
In short, Richard Curtis usually wrings 20 waking
hours out of each day, sleeping catnap-style for only
about 4. It’s a schedule that would leave most of us Wringing 20 waking
with eyelids permanently at half-mast, but Richard hours out of each day.
Curtis says he never runs out of energy.
“T love it,” he says. “I keep discovering some-
thing else that fascinates me. I never stop to think if I
have the energy for it. When you love something, it
creates its own energy. In fact, your energy level can
depend on how much you love life in general. I mean,
if you’re at a good party, you don’t leave when it’s still
going great.”

High-Energy Living
Is Not Just for a Lucky Few
There are some who would say Richard Curtis is
a genetic anomaly, a man who moves to the ticking of
462 Better Nutrition for the Stages of Your Life

a different clock. And they would be right—in part.

“We all come with different energy levels,” says
Charles Kuntzleman, Ed.D., author of Maximum Per-
sonal Energy. “Some people have God-given high-
level energy even though they do everything wrong,
just as some people are born beautiful and some are
born average.”
It’s true that Richard Curtis is the recipient of
some genetic good fortune. But that’s not his only
How to beat your ge- edge. He improves on what nature gave him by lead-
netic programming. ing a full, active life, doing things he loves. He has a
good reason to get up in the morning and a good
reason not to be in such a hurry to go to bed at night.

Fourteen Ways to Boost

Your Energy Levels
Like Richard Curtis, you can beat your genetic
programming, too. You may not be able to go from a
shuffle to a sprint, but you can quicken your step. And
you can start right now.

1. Lead the active life. It’s the best lesson you

can learn from Richard Curtis: Energy begets energy.
Decide what you want Don’t give in to boredom and malaise. Get up and do
to do—then do it. something you really want to do, even if you think
you're too tired to do it. You'll be amazed at how
much energy you really have. “Love is energy, being
creative is energy, health is energy,” says Harold H.
Bloomfield, M.D., author of The Holistic Way to
Health and Happiness. “The more good things you
do for yourself, the more energetic you’re going to
be.” In fact, the very act of doing can help you shake
the ennui that made you tired in the first place.
2. Get physical. A regular aerobic workout,
one that gets your pulse rate galloping, won’t poop
How to rev up by work- you out. It will actually pump you up. You'll have
ing out. more oxygen-carrying hemoglobin in your red blood
cells. Your heart will eject more blood with each beat,
so it has to work less to circulate it through your body.
 Natural Sparks to Get Your Energy Sizzling 463

Your skeletal muscles will gain a greater capacity to

use oxygen, and your muscle cells will be better able
to burn fats as fuel. With your trained muscles able to
use oxygen more efficiently, your breathing rate
drops, so you won't get winded so easily. In fact, your
whole body will work so efficiently you'll have even
more energy to expend. Not only that, studies have
shown that regular exercise can help you beat stress,
one of life’s biggest energy zappers.
3. Take a minibreak. When your motor’s
about to die on the expressway, you rev it up. When
you're about to die at your desk at quarter of three in Stretch away tension.
the afternoon, you’ve got to put a figurative pedal to
the metal. Get up! Remind your body that it’s awake.
Do a few tension-relieving exercises, advises Dr.
Kuntzleman. Shrug your shoulders, roll your head or,
better yet, do a lap around the office, the building or
the block.
4. Know thyself. Schedule tough jobs for when
you're at your energy peak. If you're full of spit and
polish in the morning, don’t tackle the Great Ameri-
can Novel at 10:00 pm., after a busy day at the office. If
youre a night owl, don’t set your alarm for an early
start on refinishing the kitchen cabinets. Listen to the
ticking of your own biological clock, say the experts.
Otherwise, you'll wind up fatigued from all that swim-
ming upstream.
5. Lose weight. Picture yourself climbing two
flights of stairs with a bowling ball under each arm. It
would be a lot easier without them, wouldn’t it? If Get rid of the bowling
you're overweight, you're doing roughly the equiva- balls.

lent every time you exert yourself. “Physically carrying

30 to 40 extra pounds is going to make you more
fatigued,” says Dr. Kuntzleman.
That’s just common sense. But obesity loads you
with a weight of a different kind. “It can wear you out
psychologically, too,” he says. “It affects your percep-
tion of yourself, making you self-conscious, which is
energy draining. You’re always mentally defending
yourself: ‘Hey, I’m okay, my waistline is just a little
large.’ ”’
464 Better Nutrition for the Stages of Your Life

6. Check your iron levels. Your body uses

iron to help manufacture hemoglobin, a protein in red
blood cells that carries oxygen to all your tissues and
cells. Deprived of that oxygen, your cells—and you—
will soon be running on empty. Menstruating women
and people over 65 are particularly prone to iron
deficiency, which, even before it becomes full-blown
anemia, can lead to chronic, foot-dragging fatigue.
Iron is abundant in meats, especially beef liver, and to
a lesser extent in foods like sunflower seeds, broccoli,
apricots, almonds and raisins.
7. Grab a handful of nuts. If you're feeling
fatigued, especially after a strenuous exercise pro-
Replace potassium and gram, you may have what one medical expert calls
magnesium. “the mineral blues’ —a deficiency of potassium and
magnesium in muscle cells. Both minerals can be lost
through sweat. When stores drop below normal, even
a mild deficiency can bring on fatigue. Both potas-
sium and magnesium are abundant in nuts and soy-
beans. You'll also find potassium plentiful in fruits and
vegetables and magnesium in grains.
8. Take C and see. Several medical studies
have suggested that people whose diets are lacking in
Is a vitamin C deficiency vitamin C grow fatigued more quickly than those
slowing you down? whose C intakes are high. There’s a bonus with C. It
also helps increase your absorption of dietary iron,
sometimes as much as 300 percent. But don’t pop
C—or any other nutrient supplement for that mat-
ter—expecting it to act like a pep pill. It will only have
its energizing effect if your lack of energy is the result
of a nutrient lack. Besides, food is the best source of
any nutrient.
9. Eat a light lunch. It’s 2:00 in the afternoon
and you and the pile of work on your desk have slid
into a mirror-image slump. What happened? You
might review your lunch menu. If you ate a heavy
meal, you're the victim of postprandial dip, character-
ized by a drop in body temperature, blood sugar,
work efficiency and mood. In many countries, lunch
is followed by a siesta. If you can’t get a daily nap
 Natural Sparks to Get Your Energy Sizzling 465

written into your benefit package, most experts advise

eating a light meal—raw veggies or salads—at noon.
10. Eat a good breakfast. Depending on how
much you toss and turn, you can use up 500 to 600
calories getting a good night’s sleep. Even if you don’t Why skipping breakfast
wake up hungry, your body has still been depleted of is a drag.
the vitamins and minerals that give you the energy to
tackle a brand-new day. If you don’t eat breakfast,
wams Max M. Novich, M.D., coauthor of The High-
Energy Diet for Dynamic Living, you're likely to “drag
along” all morning, feeling tired, headachy and with a
touch of low blood sugar.
11. Make upbeat friends. Did you ever get
trapped in a conversation with a chronic griper? As
each complaint drones into your consciousness, you
feel yourself turning to lead, cell by cell. Unhappy,
unpleasant people are downers who sap your energy.
You can’t avoid them entirely, short of taking up resi-
dence in a cave. The next best thing is to make them
the minority in your circle of acquaintances. Fill your
life with energetic, upbeat people, and you'll be
known by the company you keep. ‘‘People who love,
have fun and care give you good feelings about your-
self and your energy levels,” says Dr. Kuntzleman.
12. Get enough B’s. If you have even a mar-
ginal deficiency of B-complex vitamins, you could
find yourself with a case of the blahs. The B’s work Beating the blahs with
together to help convert proteins, carbohydrates and adequate B vitamins.

fats into fuel. Without them, you're out of gas.

13. Give yourself something to look for-
ward to. Anticipation of good things to come can
give you a burst of energy that can very nearly rouse
you out of a coma. That sense of excitement is like
‘‘an amphetamine response,” says Michael Liebowitz,
M.D., author of The Chemistry of Love. ‘‘When we are
looking forward to things, especially when pursuing a
valued goal, we liven up, have more energy and con-
centrate better.”
14. Get away from it all. You'll learn the se-
cret of this energy booster when you get back from it.
466 Better Nutrition for the Stages of Your Life

Taking a vacation—whether it’s skiing in the Alps or

boating on the local lake—is a sure-fire way to re-
charge.
“The reason is pretty simple,” says ball-of-fire
Richard Curtis, who explored the vacation phenome-
Vacations put your life non in his book Taking Off. “Getting away from it all
in a new context. gets you out of your rut. Putting some distance be-
tween yourself and whatever you’re working on
makes you feel relaxed. In addition to physically sepa-
rating yourself from your problems, you're opening
yourself up to other things. Essentially you’re taking
your mind off one thing and putting it on something
else. When you come back, you’ve gotten yourself
into the mode of seeing new things. You begin to see
your life in a new context, and that’s invigorating.”
 Chapter 62 467

On the Mend
with Better Nutrition

ne minute, Kathleen Lynch was the picture

of good health and vitality. The next, the 27-
year-old Delaware woman was as close to death as
she'd ever been in her life. While stopped by the side
of a road to fix a flat tire on her car, she was hit by a
car. The impact left her head “looking like ham-
burger,” as she puts it.
Thanks to her youth and good health and a diet
emphasizing protein, fresh fruit, vegetables and whole
grains, Kathleen is alive and well today.
The only evidence of her injury is a thin scar
across her forehead. Doctors had said she would re-
quire three months in the hospital to recover. She was Out of the hospital in
discharged in 16 days. “They were all amazed at how just 16 days: a story
about nutrition.
quickly I recovered, but none of the doctors wanted
to believe it had anything to do with nutrition,” Mrs.
Lynch says. ‘My husband and | happen to believe that
it had everything to do with nutrition.”
So, apparently, do some researchers, who call
trauma “‘the forgotten disease” simply because rela-
tively little attention has been focused on the care and The care and feeding of
nutrition of the millions of people each year who trauma patients.
suffer from auto accidents, burns, falls, head injuries,
gunshot wounds and chainsaw accidents.

‘Emergency Rations”
for Accident Victims
Certainly, important work has been done to help
victims of trauma survive the crucial first few hours
468 Better Nutrition for the Stages of Your Life

after injury occurs, says Ronald Birkhahn, Ph.D., asso-

ciate professor of surgery and director of trauma stud-
ies at the Medical College of Ohio in Toledo.
“Helicopters, emergency medical teams, fluid
therapy, antibiotics—all help the patient survive,’’ he
says. But after the excitement dies down, guess who is
left to virtually fend for himself?
“They've got him out of the emergency room,
got him stabilized, and they say, well, now, he is going
Vitamins and minerals to recover,’ Dr. Birkhahn says. “But the patient
are critical to survival. doesn’t recover. He ends up getting infected, his mus-
cles waste away, and he dies, not from the initial
injury but from malnutrition. That’s the problem we're
working on solving.”
And solving it has not been easy, for a body in
trauma acts much differently than a healthy body.
Faced with any severe injury, the body goes into
a true emergency state. “Real trauma makes your
body mobilize everything it’s got in an effort to sur-
vive,” says Sheldon V. Pollack, M.D., associate profes-
sor of medicine and chief of chemosurgery at Duke
University School of Medicine, Durham, North Caro-
lina. Dr. Pollack has a special interest in nutrition and
wound healing.
The body’s energy requirements go up 25 to 100
percent higher than normal, and it immediately starts
Why you need top-notch breaking down protein in the muscles to provide itself
nutrition when you’re with the energy it needs to repair damaged tissues and
injured.
to maintain essential organs like the heart, liver, kid-
neys and brain, Dr. Pollack says.
The body’s stores of vitamins and minerals are
mobilized, used and quickly excreted. Vitamins C, B-
complex and A, zinc and calcium pour out of the
body as a result of trauma. What it all adds up to is a
body that’s in desperate need of all the nutritional
help it can get. But researchers have found extra
amounts of some nutrients to be particularly crucial to
repairing body tissues, preventing infection and
counteracting some of the stress of trauma.
 On the Mend with Better Nutrition 469

Rebuilding Broken Bodies

with Protein
Absolutely essential for rebuilding body tissue is
protein, which contains the amino acids needed for
the body’s growth and maintenance. Normally, the
body breaks down protein from foods into amino
acids, then reassembles them as body tissue. In intra-
venous or tube feeding, the proteins are already bro-
ken down into amino acids.
Certain amino acids may help alleviate the mus-
cle wasting and tissue loss seen in trauma victims.
Some may also help speed wound healing. Can certain amino acids
“There have been some hypotheses that three help rescue trauma
patients?
essential amino acids, what we call branched-chain
amino acids—leucine, isoleucine and valine—will
help reduce the loss of body protein, because those
are the three amino acids that are primarily being
used for energy for the muscles,” Dr. Birkhahn says.
Another amino acid, arginine, also seems to help
save body tissue and to have immunity-stimulating
benefits. Researchers at Sinai Hospital in Baltimore, In rats, arginine
for instance, found that adding arginine to the diets of speeded up wound
healing.
injured rats significantly increased the rate at which
reparative connective tissue, called collagen, was de-
posited in the wound. And once healed, wounds were
more likely to stay healed.
Arginine also minimized the quick weight loss
that comes with trauma. It apparently gave the rats’
immune systems a boost, increasing the weight of the
thymus, a gland behind the breastbone that produces
infection-fighting white blood cells. Normally, this
gland tends to shrink when faced with severe trauma
(American Journal of Clinical Nutrition).
The significance of this study, says Adrian
Barbul, M.D., Sinai’s assistant surgeon-in-chief, is that
arginine accelerated wound-healing time beyond
what is considered its normal rate. That certainly
could be good news for trauma patients.
470 Better Nutrition for the Stages of Your Life

Vitamin C
Hastens Wound Healing
Faced with trauma, the body’s stores of vitamin C
are rapidly depleted. Possibly as part of the effect of
For injuries, the body being mobilized to fight injury, vitamin C goes directly
needs more vitamin C. to the site of the injury. This means a deficiency can
appear in a matter of days, and at a time when C is
needed most. In studies of postsurgical patients,
blood levels dropped sharply even in patients receiv-
ing 500 milligrams a day. Doctors using vitamin C in
trauma recommend that patients get doses much
higher than the Recommended Dietary Allowance
(RDA).
Many studies have shown that vitamin C is essen-
tial for the formation of wound-repairing collagen tis-
sue. Vitamin C’s role in bolstering the immune system
is also well researched. It has been shown to increase
the activity of white blood cells and to stimulate the
immune response of cells under attack.
New ways to benefit from vitamin C are still being
discovered. Researchers at the New Jersey Medical
Can vitamin C benefit School in Newark found that vitamin C helped lessen
burn victims? the degree of severity of burns in mice. Starting 30
minutes after being burned, the mice were given ei-
ther 12.5 or 25 milligrams of vitamin C twice a day for
five days. The burns of the mice in the group receiving
no vitamin C were judged to be almost twice as bad as
those receiving the larger amount of the vitamin. And
in both supplemented groups, vitamin C kept the
burns from progressing from second to third degree
(Clinical Research).

Burn Victims Need Vitamin A

Vitamin A also plays a major role in the body's
ability to fight back in the face of disaster. Body levels
Using vitamin A to fight of vitamin A have been found to drop sharply one to
trauma.
three days after trauma, especially in burn victims.
Enormous amounts—up to 300,000 international
 On the Mend with Better Nutrition 471

units a day—have been found to be required to re-

store blood levels to normal. (The RDA is 4,000 inter-
national units for women and 5,000 international units
for men.) Surprisingly enough, there have been no
reports of toxicity in patients taking these large
amounts under medical supervision—although no
more than 25,000 international units should be taken
without supervision.
“When the body is injured, through infection,
physical injury, burns, disease, whatever, the immune
mechanism will begin to fail,” says Merrill S. Chernov,
M.D., a Phoenix surgeon who has done research with
vitamin A and burn victims.
‘‘For some reason, vitamin A will get the immune
mechanism activated again. Vitamin A stimulates
what we call the intercellular killing power of the
white blood cells, which are the most important
means of protection in the human body. The white
blood cells not only destroy bacteria in the blood, but
in burn patients they may engulf bacteria that are
invading through the burnt skin.”
Dr. Chernov also found that vitamin A prevents
what are known as stress ulcers. In fact, it does such a
good job that it’s now fairly common to see it used Burn victims taking vita-
preventively in burn centers. min A had fewer stress
ulcers.
Stress ulcers are multiple superficial ulcers that
often develop in the stomachs of people who have
been burned or severely injured. They can cause
heavy bleeding, require surgery and jeopardize a pa-
tient’s chances of recovery.
Dr. Chernov studied 35 severely stressed pa-
tients—those with burns over more than 25 percent of
the body or major injury to two or more organs. He
divided them into two groups. One group received
10,000 to 400,000 international units of vitamin A a
day; the other received no supplemental vitamin A.
Evidence of stress ulcers was found in 15 of the 22
patients who did not receive vitamin A, and bleeding
was serious in 14. But stress ulcers occurred in only 2
of the 14 patients treated with vitamin A.
472 Better Nutrition for the Stages of Your Life

“Vitamin A apparently stimulates the production

of mucous cells lining the stomach,” Dr. Chernov
says. “These cells have a very short life—only 36
hours—so the stomach is one of the first body organs
to be affected in the event of serious trauma. The cells
die, and the body can’t manufacture new ones be-
cause it is under too much stress. Vitamin A makes
these cells grow and stimulates their mucous produc-
tion. The mucus protects the stomach from its own
acid, and the ulcers are prevented.”

Vitamin E, Too, Speeds Healing

Vitamin E has its own special function in burn
and wound healing. It may indirectly help speed the
healing of wounds when found in the company of
vitamin A.
“Vitamin E may protect vitamin A from oxidation
[breakdown] in the digestive tract and in the wound,
making more vitamin A available,’ Dr. Pollack says.
And because it somewhat delays the formation
of collagen, applying vitamin E to a wound or burn
Vitamin E and cosmetic may help produce a thin, flexible scar. This effect is
surgery. particularly welcome in cosmetic surgery, Dr. Pollack
says, where a delicate scar line is desirable. Vitamin E
also may help prevent wounds from contracting too
much as they heal, which can be a crippling conse-
quence of severe burns.

Don’t Forget Zinc and Calcium

People suffering from severe injuries, burns or
extensive abdominal surgery can rapidly become de-
ficient in zinc, which will slow the rate at which
wounds heal, says Augusta Askari, Ph.D., assistant
professor in the Department of Surgery at the Medical
College of Ohio. Dr. Askari’s specialty is the role of
trace minerals in the nutrition of trauma victims.
“Zinc is an essential nutrient,” she says. “The
body requires zinc to make the protein it uses to repair
 On the Mend with Better Nutrition 473

damaged tissue. The need for zinc increases greatly

when the body needs to heal itself.”
Just how much more zinc the injured body needs
is something Dr. Askari would like to find out. “You
can’t just give a lot of zinc,” she says. The reason is The body uses zinc in
that zinc competes with other minerals that are im- damage control.

portant in healing, including copper, which is needed

for the formation of blood vessels. Excess zinc can
also retard bone healing because it interferes with the
body’s ability to use calcium.
Broken bones can mean double trouble if you
are not getting enough calcium in your diet to heal
them properly. Being immobilized with an injury can Mending bones with
cause a patient to lose up to 1.1 percent of his bone calcium.
mass in just one week.
If you’re not getting enough calcium in your diet
to heal a fractured bone, your body will dissolve this
mineral from your other bones to use to mend the
broken one. The result is that you'll have less calcium
in allyour bones, which could lead to more fractures,
says Joseph Lane, M.D., professor of orthopedics at
Comell University Medical School and chief of ortho-
pedics at Memorial Sloan-Kettering Cancer Center in
New York City.
Many people with bone fractures show signs of
having been calcium deficient long before their break,
Dr. Lane says. “Many have metabolic bone diseases Broken bones may
like osteoporosis, associated with a chronic calcium signal a calcium
deficiency.
deficiency,” he says. “Often, it’s not until a fracture
occurs that the deficiency is recognized, and some-
times not even then.
“Anyone with a fracture, young or old, should be
getting at least their RDA of calcium, and a little bit
more,” he says. Women past menopause should be
taking 1,500 milligrams of calcium a day.
474 Chapter 63
Let’s Put “Recovery”
on the Menu

hen you think of malnutrition, does your

mind conjure up images of hungry chil-
dren in faraway places like Africa or Asia? After all, it’s
not very likely that you’d ever experience such a thing
firsthand. Unless you happen to spend a couple of
weeks in a hospital, that is.
“Roughly half the patients in some general hospi-
tal wards have been found to exhibit protein calorie
Malnutrition: it happens malnutrition,” says Marion Nestle, Ph.D., formerly as-
in hospitals. sociate dean, School of Medicine, University of Cali-
fornia, San Francisco. “That observation has been
repeated in at least ten studies, ranging from general
medical and surgical patients to pediatric patients and
residents in nursing homes. And the longer someone
is in a hospital, the higher the risk for malnutrition.”

Malnutrition Where You

Least Expect It
According to a study by Roland L. Weinsier,
M.D., Dr.PH., and co-workers at the University of
Alabama, a large proportion of patients hospitalized
for two weeks or longer have a high likelihood of
malnutrition. And the study took place in a teaching
hospital, where you’d expect the care to be the very
best (American Journal of Clinical Nutrition).
“Protein calorie malnutrition is basically starva-
tion,” explains Dr. Nestle. “It refers to the loss of
 Let’s Put “Recovery” on the Menu 475

muscle mass and body protein that occurs when peo-

ple just don’t have enough to eat.
“Starvation affects every organ system and every
metabolic process. The effects we’re most concerned
about in hospitals or nursing homes are the effects on Starving under medical
the immune system. People who have been starving care.
are well known to be more susceptible to infection. In
fact, the major cause of death in hunger strikers or
people who have been fasting is pneumonia, because
their resistance to infection has gone down.
“In addition, people often lose their appetite dur-
ing an infection. They don’t want to eat or can’t eat.
So you get into a cycle where the infection makes the
malnutrition worse, and the malnutrition makes the
immune response worse.”’

A Woeful Lack
of Vitamins and Minerals
Of course, vitamin and mineral deficiencies ac-
company starvation. But they can happen on their
own, too. Researchers in Colorado, for instance, Risking nutrient defi-
found diminished iron stores in 40 percent of nursing ciencies in nursing
homes.
home patients studied. And the incidence of iron lack
was greater for nursing home patients than for resi-
dents of private homes. Iron deficiency is dangerous
because it can cause anemia. “Whether the cause of a
given deficiency is nutritional or pathological, nutri-
tional intervention is a crucial part of programs de-
signed for comprehensive care of the elderly,” say the
researchers (American Journal of Clinical Nutrition).
A study in Ireland found vitamin D deficiency to
be common among the elderly and found lower vita-
min D levels in institutionalized people than in individ- A not-so-rare problem
uals living at home. Part of the problem was that more among the elderly: vita-
min D deficiency.
of the institutionalized people were confined indoors.
Without exposure to the sun, their bodies could not
produce enough vitamin D, and their dietary intake
was inadequate. Low levels of vitamin D, say the re-
476 Better Nutrition for the Stages of Your Life

searchers, predispose to the development of osteo-

malacia, a bone disease. And a broken bone is the last
thing an elderly person needs. “The value of in-
creased vitamin D intake, either by direct supplemen-
tation or augmented fortification of foodstuffs with
vitamin D, is manifest,” they say (American Journal of
Clinical Nutrition).
Why is malnutrition so rampant in hospitals and
nursing homes? It’s a multifaceted problem. “The
Reasons for hospital main reason why patients in hospitals are malnour-
malnutrition. ished is because they’re sick,” says Dr. Nestle. “Can-
cer, surgery, infection—any severe illness or injury is
stressful to the body and raises the nutrient require-
ments.”
There are other reasons, too. Someone recover-
ing from gastrointestinal surgery, for instance, may
not be able to eat. And certain diseases can cause
nutrient deficiencies. So can drugs that induce an-

Good Nutrition
Adds Power to Flu Shots
Good nutrition can help prevent flu, even if
you've had a flu shot. Researchers in Canada
gave flu vaccine to 30 malnourished elderly
patients and then divided them into two
groups. The first group learned to eat more
nutritiously and received supplements. The
second group got no dietary improvement or
supplementation. Four weeks after the flu
shot, the nutritionally boosted patients had
significantly more antibodies to flu virus than
those whose nutrition wasn’t improved.
“The correction of... undernutrition in
the elderly may be expected to improve im-
mune responses,” say the researchers, ‘“‘and
perhaps result in better protective immunity”
(British Medical Journal).
 Let’s Put “Recovery” on the Menu 477

orexia or interfere with absorption, utilization or ex-

cretion of nutrients.
“There’s a whole slew of drugs that can make
you develop a vitamin deficiency,” says Herman
Baker, Ph.D., professor of preventive medicine and
medicine at the New Jersey Medical School.
‘‘Levodopa, a drug used in the treatment of parkin-
sonism, for instance, interferes with vitamin B,. Anti-
convulsants, barbiturates, anticoagulants, diuretics,
tranquilizers and prolonged use of antibiotics can all
interfere with vitamins. The problem is of particular
concer among the elderly because about 25 percent
of all prescriptions in the United States go to the
elderly.”
But the aged are at risk for other reasons, too.
“The elderly don’t absorb enough vitamins out of
their food,” explains Dr. Baker. “They suffer from a Not absorbing enough
chronic hypovitaminemia [low levels of vitamins in vitamins and minerals.

the blood], usually involving the B vitamins. It’s a

subclinical vitamin deficiency, which means there are
no clinical signs. But it’s very debilitating because it
doesn’t permit them to feel well, concentrate or func-
tion properly, and it has a dire effect on their ability to
resist disease and infection. That can be very deleteri-
ous, especially at an old age.” You can see why nutri-
tional problems might become magnified in nursing
homes, where people tend to be older and more
seriously ill.

Many Meals Go Untouched

But how can someone actually starve in a hospi-
tal or nursing home? “Patients in hospitals don’t want
to eat because they don’t feel like it,” explains Dr. Why many patients shun
Nestle. “People in hospitals are just not ravenously hospital food.
hungry.” Add to that the fact that many patients find
institutional food tasteless, bland and uninteresting,
plus poorly prepared and frequently cold, and you
can see why people don’t eat as well as they should.
Why is institutional food so bad? “The econom-
ics of hospital food are very important,” explains Dr.
478 Better Nutrition for the Stages of Your Life
a

Nestle. “Hospitals are paid for these days by fixed

room charges. Food is part of that charge. So the
object of the game from the hospital director’s point
of view is to keep the cost of the food to a minimum,
in order to keep the fixed room charge as low as
possible.” The reason institutional food is so bad is
that everybody’s trying to keep costs down.
Another reason people don’t eat in hospitals is
that they frequently don’t get the chance. “When peo-
Not getting a chance to ple have tests over and over again, they can miss
eat. meals,” says Alice L. Tobias, Ed.D., R.D., director of
the nutrition program at Herbert H. Lehman College
of the City University of New York. “Someone must go
out of their way to make sure a replacement meal is
delivered.
‘In addition, patients might not eat enough if
they don’t see foods they like. In cities, for instance,
some hospitals may cater to one ethnic group and
some of the patients may be in another. That’s why I
think the selective menu (with a number of choices) is
very important. But it’s not available everywhere.”

Vitamins and Minerals

Not on the Menu
But even if patients eat a normal amount of food,
they may not get what they need. John P. Sheehan,
Does hospital food have M.D., then at the Cleveland Clinic, found that meals in
enough nutrients? two different hospitals provided only 200 to 300 milli-
grams of magnesium daily; the Recommended Di-
etary Allowance (RDA) is 300 to 350 milligrams. Dr.
Sheehan identified 35 magnesium-deficient patients
over an 18-month period. The deficiencies went un-
noticed because the symptoms—depression, sleepi-
ness and weakness—were attributed to old age or
illness.
Another study of hospital food by researchers at
Washington State University turned up thiamine (B,),
riboflavin (B,) and vitamin C values low enough that
 Let’s Put “Recovery” on the Menu 479

the researchers “suggest that it may be advisable to

consider vitamin supplementation for hospital pa- Should hospital patients
tients, especially those on restricted diets or with lim- take supplements?
ited appetites, whose needs may not be met by institu-
tional foods’ (Journal of the American Dietetic
Association).
And when researchers at the Veterans Adminis-
tration Hospital in Washington, D.C., analyzed meals
for zinc content, they found that the regular hospital
diet provided 97 percent of the RDA for zinc, while
the vegetarian diet provided 81 percent and the renal
(kidney-patient) diet provided only 49 percent of the
allowance! “In view of the osteomalacia problems
apparent in kidney disease and experimental evi-
dence that zinc may be involved in bone metabolism,
the zinc intake of rena! patients should be more care-
fully monitored,” they say.
“The allowances assume that the individual is
healthy .... [However] many hospital patients un-
dergo alterations in zinc metabolism and may require
more dietary zinc than healthy individuals. Yet [the]
regular diet did not provide any extra zinc beyond the
recommended allowances” (Journal of the American
Dietetic Association).
Unfortunately, doctors are still largely unaware
of the problem. “In the hospital, when you're dealing
with someone who’s acutely ill, and you're the physi- Why some doctors for-
cian, then your main concern is to take care of that get about nutrition.
illness,” says Dr. Nestle. “Because of this, sometimes
the doctor forgets about nutrition. Similarly, in a nurs-
ing home you might be most concerned about keep-
ing the patient clean or infection free and not pay
attention to the total amount of food that’s being
taken in.”
“Although the terms /atrogenic and hospital-
induced have been used in connection with malnu-
trition, they do not imply malicious intent or callous
disregard for a patient’s welfare,” explain Dr. Weinsier
and his colleagues. ‘Nevertheless, malnutrition does
occur as a result of what the physician does or does
480 Better Nutrition for the Stages of Your Life

not do. To a considerable extent, physician-induced

malnutrition is caused by emphasis on some complex
modern treatment program, while fundamental prin-
ciples of nutrition remain in the background....
Whatever the cause may be, the result is the same:
Many patients fail to receive the full benefit of existing
nutritional knowledge” (Alabama Journal of Medical
Sciences).
In a survey of nutritional practices in two teach-
ing hospitals in New York City, Dr. Tobias and a co-
Overlooking the clues to worker reported discouraging findings. In the 67 pa-
bad nutrition. tients studied, nutritional problems were common.
But nutritional status was not adequately assessed by
the physician or dietitian, and often the patients’ nutri-
tional problems went untreated. Many of the clues
suggestive of nutritional problems—alcoholism, gas-
trointestinal problems, kidney disease, excessive
weight loss—often went unheeded.
“This preliminary survey provides evidence that
many basic principles of nutrition are neglected in the
Nutrition should be an diagnosis and care of hospital inpatients,” say the
integral part of medical researchers. “Major omissions include the failure to
care.
obtain a dietary history when indicated, to provide
specific dietary management and appropriate vitamin
and mineral supplementation in a variety of clinical
situations, to record height and weight, and to give
nutritional counseling” (Journal of the American Di-
etetic Association).

What You Can Do

to Prevent Hospital Malnutrition
When someone you know enters a hospital or
nursing home, you like to take comfort in the fact that
they’re in good hands. But it’s becoming clear that it’s
dangerous to assume they'll be given adequate nutri-
tional care. So what can you do?
‘‘A blood test is of prime importance in the el-
derly to detect marginal vitamin deficiencies as well
 Let’s Put “Recovery” on the Menu 481

as acute vitamin deficiencies where there are clinical

signs,’’ says Dr. Baker. “The best thing to do is find out
what they’re deficient in and see that they’re treated,
without waiting for clinical signs to appear.”
“If you have a family member in the hospital
who’s not eating, it’s important that you go feed him
[or her],” recommends Dr. Tobias. “If it’s a hospital How to make sure
that has a selective menu, make sure it’s filled out, so you’re properly nour-
ished in the hospital.
he gets what he likes. Speak to the dietitian who has
responsibility for that patient. Describe his likes and
dislikes, ethnic background, cultural patterns, food
allergies, food intolerances, his previous diet and any
medical conditions the staff might not know about. If
he’s on a special diet, don’t bring in food unless you
check with the nutritionist to make sure it’s not
contraindicated.”
If he’s not on a special diet, though, food from
home might be just what the patient ordered. “If the
patient can eat and has relatives or friends who are An alternative to hospi-
willing to bring more interesting foods—that should tal food: bringing food
from home.
be encouraged,” says Dr. Nestle. “I really believe in
patients taking responsibility for their own illness.
Sometimes they can’t, but maybe their relatives can.
Or their friends can.
“T think it’s very important to ask for a nutritional
assessment if somebody’s going to be in the hospital
for a long period of time. Get an estimation of their
requirements, and then discuss with the physician
how those nutrients will be supplied. Then monitor to
make sure that it’s being done,” she says.
“Some of the major teaching hospitals are now
using nutrition support teams,” Dr. Tobias says. “It’s a
sophisticated team consisting of a registered dietitian, A new approach to nu-
a physician, possibly a pharmacist, a nurse and a trition in hospitals.
technician. They screen to find patients at risk of
nutritional deficiencies, perform tests to determine
their status and make sure they’re given what they
need. It’s a relatively new concept, though, and in a
hospital with a staff of two dietitians, you're not going
to find somebody trained in that area.”
482 Better Nutrition for the Stages of Your Life

Awareness of nutritional considerations is com-

ing slowly to doctors. According to Dr. Weinsier and
The dawning of nutri- his colleagues, ‘“‘Hospital-associated malnutrition is
tional awareness. being disclosed with a heretofore unexpected high
frequency . . . . This fact changes the mistaken impres-
sion that hospital malnutrition is overrated and re-
served for the unfortunate few who have malignant
disease. Conversely, too often patients had been ex-
pected to tolerate illness well and to recuperate rap-
idly without regard for the importance of nutritional
support. It is now realized that conventional forms of
medical and surgical therapy may not be sufficient:
that antibiotics do not replace host defenses, that
sterile gauzes and sutures do not heal wounds, and
that even the most sophisticated life-support systems,
when applied out of the context of adequate nutri-
tional support, will neither sustain nor revitalize the
malnourished patient.”
 Chapter 64 483

Can We Defeat
the Aging Factor
with Diet?

he Aging Scenario. It is as familiar and predict-

able as the outcome of a John Wayne movie. It
is human planned obsolescence. At a certain age—
different for each of us—we begin to run down. Our
hair drains of its color, our skin sags like melted can-
dle wax, our hands gnarl and ache. In time, we build a
battlement of medicine bottles to repel the illnesses
that attack us like a ravaging horde. In the end, the
invaders win.
But there are scientists who challenge the inev-
itabilities of aging, who believe that anywhere along
the line, this scenario can be rewritten, often by some- Revitalizing a declining
thing as simple as diet. And they have set about to do immune system.

it. They have begun by taking the eraser ends of their

pencils to one of the most critical manifestations of
human aging—the decline of the immune system.

Keeping Your
Immune System Young
A hundred years ago, scientists discovered an
interesting phenomenon. As people grew older, their
organ weights changed. The lungs, liver and brain
weigh slightly less in an 80-year-old than they do ina
20-year-old. And the thymus actually shrinks to a
mere fraction of its original size.
It was only about 20 years ago that that phenom-
enon went from interesting to significant. That was
484 Better Nutrition for the Stages of Your Life

Looking for a mecha- when scientists learned the function of the thymus, a
nism of aging. flat, pinkish gray, two-lobed gland that nestles behind
the sternum and lungs high in the chest. Put simply,
the thymus distributes and nourishes (with its hor-
mones) white blood cells, called lymphocytes, that
act as the body’s army against disease.
The thymus appears to be the command head-
quarters for an army of cells known as T-lymphocytes,
The thymus: base camp which, when they meet a foreign invader like a virus
for an army of white or cancer cell, can be stimulated to divide into larger,
knights.
active cells that react with the invader and kill it. At
the same time, the T-cells seem to stimulate other
parts of the immune system into action: the macro-
phages, PacMan-like scavengers that literally gobble
up the enemy (known as antigens), and B-cells, which
the T-cells encourage to produce antibodies against
the antigen.
If your immune system is working at its optimum,
right now the T-cells in your body could be leading a
battle against cancer or infection without your even
knowing it.
In aging, the thymus, at its maximum when we
are teenagers, shrinks markedly, leaving us with less
of the nourishing thymic hormones and fewer young
T-cells to replenish our aged army. The aged T-cells
decline in their ability to reproduce and stimulate the
B-cells to produce antibodies. “As a unifying concept,
what is happening is that the control of the immune
system begins to decline with age,” states William
Adler, M.D., chief of the clinical immunology section,
Gerontology Research Center, National Institute of
Aging, Baltimore.

The Role of Diet

This shrinking of the thymus and resultant de-
cline in T-cell function is believed to be largely re-
sponsible for the increasing illness and death rates
among the elderly, particularly for cancer and infec-
tion, which until now have been considered simply
part of the aging process.
 Can We Defeat the Aging Factor with Diet? 485

Fortunately, that assumption has been called into

question. “There is at least a distinct possibility that
some illness and abnormalities we are seeing in the A bright possibility:
immune response in the elderly may not be a part of To some extent, the
aging process may be
the normal aging process, that there are environmen- controllable.
tal factors, particularly diet, that may have a causal
role to play,” says Ranjit Kumar Chandra, M.D., of the
Health Sciences Center, Memorial University of New-
foundland, and the Department of Immunology at the
Dr. Charles A. Janeway Child Health Center in New-
foundland.
In 1984, Dr. Chandra organized an international
conference on nutrition, immunity and illness in the
elderly, drawing scientists from North America, Eu-
rope, Scandinavia and even Japan to St. Johns, New-
foundland, to discuss the possibilities for intervening
in the process that leaves the elderly so vulnerable to
disease.
One prime area of research involves the thymic
hormones. Researcher William Ershler, M.D., now at
the University of Wisconsin, has studied the effects of Boosting immunity with
the thymic hormone thymosin on human lympho- thymic hormones.
cytes in the test tube. When he added a dose of
thymosin to test tubes containing white blood cells of
aged subjects who had received shots for tetanus and
influenza, the cells of the elderly were stimulated to
produce a normal amount of antibodies, something
they were unable to do before. Dr. Ershler says he
hopes to test thymosins outside the test tube in elderly
people inoculated against flu. But it may be some time
before thymosins become the treatment of choice for
the aging immune system.

Zinc Is Critical
to Peak Immunity
Another area of immune research focuses on
zinc. The thymus is chock-full of zinc, which is essen-
tial to both protein synthesis and cell division. And the
efficient working of the immune system depends on
the rapid proliferation of cells.
486 Better Nutrition for the Stages of Your Life
ED

Zinc was the answer to a paradox that con-

fronted Robert Good, M.D., Ph.D., professor and
chairman of the Department of Pediatrics at the Uni-
versity of South Florida, St. Petersburg campus, and
physician-in-chief of All Children’s Hospital. In his
fieldwork among malnourished children, he and his
colleagues noted that malnutrition was accompanied
by a profound decline in immunity. Children whose
calories and protein were restricted were far more
susceptible to disease and infection. Yet, in well-
known laboratory studies, the restriction of protein
and calories in animals prolonged their lives.
What Dr. Good discovered was that it was nei-
ther the protein nor calorie deprivation that caused
Correcting an immune the drop in immunological function, but the lack of
problem with zinc. zinc. And other researchers have found that it is possi-
ble to correct the immunological malfunction just by
giving the children zinc, before correcting anything
else, says Dr. Good.
Dr. Chandra, who has also done extensive field
research on immunodeficiency among malnourished
children, tested the immune response in a group of
elderly people whose diets were supplemented with
zinc for six weeks.
He gave them a skin test, injecting a variety of
antigens largely derived from bacteria and molds into
A test for disease resis- the superficial layers of their skin. In a normal, healthy
tance that many fail. person, at least one of the spots should show a swol-
len, inflamed reaction in about two days, meaning the
lymphocytes are proliferating and the immune system
has swung into action. It is not unusual for many
elderly people to show no reaction to the skin test,
indicating their immune systems are not mobilized to
fight a threatening disease. Not surprisingly, this lack
of reaction is a fairly accurate predictor of death.
“Those elderly individuals who are found to be
anergic [nonreactive] often die in the next three to five
years,” says Dr. Chandra.
But zinc may be able to change those odds. In
Dr. Chandra’s zinc-supplemented group, at least half
 Can We Defeat the Aging Factor with Diet? 487

increased their number of responses to the skin test, Boosting immune power
indicating there was some new life in their immune in the elderly with zinc.
systems.

A Little Zinc Goes a Long Way

More recent research strengthens the case for
zinc. A group of scientists in Italy has discovered that
at least one of the thymic hormones, called FTS, is not
so much affected by the shrinking of the thymus as it
is by the kind of marginal zinc deficiencies so preva-
lent among the elderly.
They noticed that children with Down’s syn-
drome and elderly people had a similar lack of active
circulating FTS and zinc. The finding intrigued them
because Down’s syndrome children “show at an early
age normal subjective factors of aging, such as auto-
immunity, an increase in leukemia, the graying of hair,
and cataracts,”’ says researcher Claudio Franceschi,
M.D., professor of immunology at the University of
Padua, Italy.
That led him to consider the possibility that the
shrinking thymus was taking the blame for a failure of
the FTS hormone. “The glands work,” says the re- Can zinc make the thy-
searcher, “but produce inactive molecules.” Blood mus gland young again?
samples taken from the two groups turned up a sub-
stance that was capable of inhibiting the activity of
FTS in the test tube. When zinc was added to the
culture, it induced concentrations of FTS comparable
to those of normal, healthy young people.
What Dr. Franceschi and his colleagues believe is
that FTS is biologically bound to zinc and needs it to
be active and effective. Dr. Franceschi speculates that
this inhibitory factor found in the blood samples was
FTS hormone not bound to zinc. “When we added
zinc, the hormone was able to bind itself to the zinc
molecules to become active,” he says.
But the clinical results speak more than the test-
tube studies. When the Down’s syndrome children
were given relatively small amounts of zinc as a di-
488 Better Nutrition for the Stages of Your Life

etary supplement (1 milligram per kilogram [22

pounds] of body weight), the results were remarkable.
“Though it’s difficult to measure,” says Dr.
Franceschi, ‘“‘the children had less infections and lost
fewer days of school. We think this is directly related
to the zinc.”

Vitamins E and C
Boost Immunity
But zinc isn’t the only nutrient under investiga-
tion. Several researchers are probing the effects of
vitamin E on the aging immune system. One of them is
Simin Meydani, a scientist with a unique pedigree—
she is a veterinarian with a Ph.D. in human nutrition.
Dr. Meydani, a consultant at the U.S. Department of
Agriculture’s Human Nutrition Center at Tufts Univer-
sity in Boston, tested vitamin E on immune respon-
siveness in aged mice.
“We supplemented aged mice with vitamin E
and compared the effects by measuring different pa-
In mice, vitamin E rameters of immune response,” she explains. The
boosted immune supplemented mice showed an improvement in their
response.
responses to skin tests, similar to those given by Dr.
Chandra to his elderly human subjects. And in the test
tube, lymphocyte proliferation was significantly im-
proved by vitamin E supplementation.
And Dr. Meydani thinks she and her colleagues
obtained those results because vitamin E inhibits sub-
stances called prostaglandins, which can significantly
influence the effectiveness of the immune system.
‘Prostaglandins derive from polyunsaturated fatty ac-
ids and, though they’re not hormones, they act like
hormones. They have a lot of different functions. In
the immune system, they generally have an inhibitory
effect, and vitamin E appears to inhibit the synthesis
of prostaglandins,” she explains.
Another group of scientists in Belgium tested the
effects of another potential immunity booster, vitamin
C, in a group of healthy volunteers over 70. One group
 Can We Defeat the Aging Factor with Diet? 489

was treated for a month with intramuscular injections

of 500 milligrams of vitamin C—many times the Rec- Can vitamin C boost im-
ommended Dietary Allowance—while the other munity in the elderly?
group was treated with a placebo injection of saline
solution.
The group that received the vitamin C had better
skin test responses to tuberculin antigens and, in the
test tube, their lymphocytes were more active when
exposed to a stimulatory substance. One of the rea-
sons for the results may be the role vitamin C plays in
helping thymic hormones in their job of changing
immature, inactive T-lymphocytes into cells ready to
battle disease, the researchers suggest (Gerontology).

Vitamins and Minerals

for Lifelong Resistance
The practical implications of this exciting re-
search are obvious. It could mean a major reediting of
the aging scenario. It is particularly important now
because the world’s population is graying.
“In the year 2020 the proportion of the elderly
will increase to at least 15 percent of the population of
North America and Europe,” says Dr. Chandra. “Even Nutrition and the
at present, though they constitute only about 10 per- graying of the world’s
population.
cent of the population, they use up at least one-third
of the health-care dollars, perhaps more. If we can
make any dent in the illness of this age group, we are
likely to save a considerable amount of health-care
costs. My own feeling is that if we can identify those
individuals who have nutritional problems that lead to
immune deficiencies and can correct those nutri-
tional problems, we can expect an improvement in
immunity and also, hopefully, a reduction in illness.”
490 Chapter 65

More Good News on

Nutrition and Aging

o you've left dissipated youth and its wild ex-

cesses behind. You’ve reached whatever the
current generation considers middle age—anywhere
from 40 to 60. You’re on top of the hill, enjoying the
view, and you want to be able to stay there a good
long time. You want the second half of your life to be
as healthy and active as possible.
Your concerns are shared by scientists exploring
the connection between aging and nutrition. These
Slowing ‘‘old age’’ in researchers, several of whom presented their work at
the middle years. the Bristol-Myers/Tufts University Symposium on Nu-
trition and Aging in 1985, are discovering that many
diseases traditionally associated with aging are
strongly influenced by other factors, especially poor
nutrition. They’re looking at the possibility of in-
creased nutrient needs for older adults. And they’re
seeing that any good nutritional program intended to
lighten the load of old age is best started during mid-
dle age—before you head down the hill.

A Diet for the Sunset Years

It’s well known that older people are at higher
risk for developing low nutrient levels, even when
they’re healthy, educated and well off.
One reason for this is simply a matter of num-
bers, says Walter Mertz, M.D., director of the U.S.
Why older people are Department of Agriculture’s (USDA) Human Nutrition
at risk for nutrient Research Center in Beltsville, Maryland. “As they age,
deficiencies.
people eat less and less, until at about age 70 they’re
 More Good News on Nutrition and Aging 491

getting 20 percent fewer calories than they were at

age 40. Their average calorie intake becomes too low
to meet the Recommended Dietary Allowance [RDA]
for a number of nutrients.” Combine this with less-
than-ideal food choices and you're setting the stage
for the marginal intakes found among older adults for
calcium, B complex, vitamins C and A, zinc, iron,
copper, chromium, even protein.

Minerals for Young Bones

Dr. Mertz is particularly interested in pinpointing
the consequences of chronic marginal intakes of
trace minerals like zinc, copper, chromium and sili-
con (an element proved necessary for animals but not
humans).
Zinc, copper and silicon, for instance, are impor-
tant in maintaining bone tissue. Dr. Mertz would like
to see if people with osteoporosis are deficient in Osteoporosis: Is it
these trace elements. “We must get away from focus- caused by multiple
deficiencies?
ing just on calcium while we ignore other nutrients
involved in osteoporosis,” he says. “This condition
may be the result of multiple deficiencies and requires
a total nutritional approach.”
While supplements may help, they aren’t always
the answer, Dr. Mertz says. “The ideal solution would
be to increase your activity level as much as you can,
to boost your appetite and food intake,” he says.

A Bone Builder
in Milk and Sunshine
People with osteoporosis may also have osteo-
malacia, says Michael F. Holick, M.D., Ph.D., director
of the Vitamin D and Bone Metabolism Laboratory at
the USDA Human Nutrition Research Center on Aging
at Tufts University in Boston.
Osteomalacia is a vitamin D-deficiency disease
that keeps bone tissue from mineralizing and becom-
ing hard. It’s common in northern Europe, where milk
492 Better Nutrition for the Stages of Your Life

“Soft bones disease’’: It is not fortified with vitamin D. It was thought uncom-
may be more common mon in the United States, but that’s not what Dr.
than you think.
Holick found when he collaborated in a survey of
patients coming into Massachusetts General Hospital
with hip fractures. ‘““We found 40 percent were vitamin
D deficient, and 30 percent had clear signs of osteo-
malacia,” he says.
Getting this vitamin’s maximum RDA of 400 in-
ternational units is sufficient, Dr. Holick says. That’s
How to get enough daily the amount found in most multivitamin tablets, or in
vitamin D. four eight-ounce glasses of fortified milk. Another
source of vitamin D is sunlight. (Vitamin D is made in
the skin on exposure to sunlight, but this ability de-
creases with age.) Wearing a sunscreen of an SPF of 8
or more will block vitamin D production, so Dr.
Holick suggests waiting 10 to 30 minutes (but before
sunburning occurs) before applying.

Vitamins That Keep

Your Skin Young
But you don’t have to trade off osteoporosis for
skin cancer, insists Barbara Gilchrest, M.D., chairman
of the dermatology department at Boston University’s
School of Medicine.
Like other organs in the body, the skin’s function
declines as we age. It becomes dry, wrinkled and
Slow down aging skin. takes longer to heal. But that decline may be more a
matter of diet and exposure to sunlight than to pass-
ing years, Dr. Gilchrest says.
“Diet and exposure to sun probably cause most
of the changes we think of as aging. We know the sun
can damage cell membranes and genetic structure
and that diet can exert positive or negative effects on
the skin.”
Dr. Gilchrest discovered one positive nutritional
effect using beta-carotene, a form of vitamin A found
in green, yellow and orange vegetables. She grew
human skin cells in culture, some with and some
 More Good News on Nutrition and Aging 493

without beta-carotene. Then she exposed the cells to

increasingly strong amounts of harmful sunlight. At Can beta-carotene pro-
the first two exposures (equivalent to moderate sun- tect you from harmful
radiation?
burn), the cells receiving the beta-carotene showed
significantly fewer signs of damage than the cells
without beta-carotene. “They grew normally and
looked better,” Dr. Gilchrest says. “In fact, they
looked just like the control cells, which had received
no radiation at all.” At the highest level of exposure,
the cells did show some damage but still not as much
as those without beta-carotene.
It would be premature to translate this finding
into recommendations for people, Dr. Gilchrest says.
“Beta-carotene does seem to protect cells from dam-
age, but I can’t tell you how many carrots a day you
should be eating.” At least not yet.

As Goes the Skin,

So Goes the Body
Skin might provide an easy-to-observe model for
testing theories of nutrient protection for other parts
of the body, Dr. Gilchrest says. ““There’s evidence that The theory of chemically
damage similar to the type sunlight causes to the skin induced aging.
is produced inside the body by some foods, chemi-
cals and everyday metabolic reactions.” Exposure to
these things can cause the formation of errant mole-
cules called free radicals, which damage body parts
just as surely as they rust iron or spoil food. In fact,
one “theory” of aging contends that the process is a
buildup of free-radical damage to body tissues.
That’s probably not the whole story, but it’s a
place to start, at least when you are looking at possi-
ble nutritional intervention, says Jeffrey B. Blumberg,
Ph.D., associate professor of nutrition at Tufts and
acting associate director at the USDA Human Nutri-
tion Research Center on Aging at Tufts.
‘We know that animals deficient in antioxidants
like vitamins E, C and A and selenium develop cell
494 Better Nutrition for the Stages of Your Life

damage similar to that seen with aging,” Dr. Blumberg

Antioxidants: increasing says. ‘‘But in experiments where animals are given
the average life span of supplemental antioxidants, it’s not clearly shown that
animals.
these nutrients alter the basic aging rate. That is, it’s
not clear that they extend the maximum life span of
the animals, although they do seem to increase the
average life span because they reduce the incidence
of early death from diseases like cancer.”

The Power of Vitamin E

As pieces of the aging puzzle come together,
though, evidence seems to indicate an increased
need for certain antioxidants in some tissues. Dr.
Blumberg’s work so far has focused mostly on the
cells of the immune system and their interaction with
vitamin E.
With age, the immune system slows, leaving the
body more open to infection. Important to the im-
Vitamin E boosts im- mune response are white blood cells known as lym-
mune power in labora- phocytes. When the body senses a “foreign invader”
tory animals.
like a bacterial infection, the lymphocytes proliferate
in great numbers, then move in to destroy the bacte-
ria. This process is slower in old than in young ani-
mals. But Dr. Blumberg found that old animals given
supplemental vitamin E had a significant boost in the
proliferation and activity of lymphocytes. He’s now
doing an experiment to see if the same thing happens
in humans.
“We are giving 800 international units a day of
vitamin E to healthy elderly volunteers to see whether
the animal results we found are matched in humans.
We'll be measuring a number of immune-response
parameters, including lymphocyte proliferation,” he
says.
One thing Dr. Blumberg noticed in his lympho-
cyte study were changes in body balance of an impor-
tant group of biochemicals called prostaglandins.
These chemicals influence many functions in the
body, including blood clotting, the production of neu-
 More Good News on Nutrition and Aging 495

rotransmitters and the production of the body’s own

free-radical “quenchers.” The balance of prostaglan-
dins changes to an apparently less-favorable mix as
we age, and Dr. Blumberg believes that this may be
an important mechanism in the development of age-
related declines in function. If he’s right, it could
mean that vitamin E’s effect is pervasive throughout
the body and that it could influence a number of
aging-related conditions—kidney failure, cataracts,
atherosclerosis, and even some nervous system and
brain functions.
He’s found, for instance, that the cerebellum and
brain stem have high metabolic needs for vitamin E.
Among other things, these two regions of the brain Could vitamin E slow
control reflexes. One of the first symptoms of vitamin the progress of age-
related conditions?
E deficiency is the loss of reflex response. Could older
people be losing their reflexes because of low vitamin
E intake? Dr. Blumberg would love to find out.
With further study, there may well be recommen-
dations for the increased intake of antioxidants as we
age, Dr. Blumberg says. “But there’s a certain irony in
talking about higher doses when we know that many
older people are not getting even the RDA of these
vitamins and minerals.”

Older People Do Not Always

Absorb Nutrients
Eating well does not guarantee that you are ab-
sorbing the nutrients you need, and that’s especially
true for older people, says Robert M. Russell, M.D.,
associate professor of medicine at Tufts and associate
director of the USDA Human Nutrition Research Cen-
ter on Aging.
Nutrients may be less readily absorbed because
stomach-acid secretion slows down in many older
people. In 20 percent it becomes a potential problem, Poor absorption can
according to Dr. Russell. It changes the acid content spell trouble.

of the small bowel, where most nutrients are ab-

496 Better Nutrition for the Stages of Your Life

sorbed, and it prevents foods from breaking down

into particles small enough to be absorbed through
the lining of the bowel. It can inhibit absorption of
iron, calcium and folate, and affect the bacteria in the
bowel that produce vitamin B,».
Unfortunately, the condition is usually symptom-
less. “Like high blood pressure, it’s silent, with no
Diagnosing absorption particular discomfort,” Dr. Russell says. Severe cases
problems. are discovered when the person develops pernicious
anemia, a vitamin B,.-deficiency disease. Less serious
cases are picked up by accident.
‘We know it is a prevalent condition,’ Dr. Rus-
sell says. “What we are trying to pin down right now is
just how important this condition is to diagnose be-
cause of possible long-term nutritional effects.”
The “cure” may be simple: More of whatever
nutrients are being affected by this condition.

No Magic Potion—Yet
‘‘People are always looking for it, but there sim-
ply is no single magic bullet or fountain of youth to let
The real ‘‘fountain of us stay young forever,’ Dr. Blumberg says. Healthy
youth’’ is a set of health lifestyle and nutrition habits are currently about as
habits anyone can
adopt. close to the magic bullet as we can get. Some of those
habits are “negatives” —don’t smoke, don’t overeat
or eat too much fat, don’t drink and drive. Others are
dos—the positive, active things we can do to stay
active and healthy as long as possible. Among those,
researchers would list regular exercise, staying men-
tally active and, of course, good nutrition. “No area
has greater potential for improving people’s health
and well-being,” Dr. Blumberg says.
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 Chapter 66 501

The Top 25
Superfoods

here was a time when the phrase health food

conjured up the image of a monastic meal with
all the lip-smacking lusciousness of grass and moon
dust.
Today, healthy foods have taken on a whole new
mainstream meaning. No longer esoteric edibles
available only in health food stores, they are foods
fresh from the supermarket and produce stand,
superfoods that medical researchers believe really
may make us healthy.
Their evidence? Healthy people like the Eskimos,
whose snacks of whale blubber should make them
prime candidates for heart disease before the age of Diets that make a
40, but whose fish diet actually seems to protect their difference.

hearts from harm; Italy’s Neapolitans, whose high-

fiber, low-fat natural foods keep them fit; the Seventh-
Day Adventists, a group composed largely of vegetari-
ans, who serve up a menu for long life.
There’s evidence from the laboratory, too. As
reported elsewhere in this book, there is a substance
in cabbage and its clan that actually may “trap” can- Some foods may reduce
cer-causing agents in your body before they do any your risk of cancer.
harm. Plain old carrots, rich in beta-carotene, can
decrease your risk of lung cancer. And something
called a protease inhibitor, which is found in seeds,
beans and rice, may actually be an antidote to the
cancer-causing effects of a high-fat diet.
502 Cooking and Eating for Maximum Nutrition

Raiding Nature’s Pantry

for Health-Building Foods
Like medical researchers, we turned to the lab-
oratory and to healthy people when we put together
our own well-balanced menu of superfoods. We also
filled in with some of the foods nature endowed with
a comucopia of nutrients, such as liver, oysters and
green and red peppers. To make shopping easier, we
included foods that, with perhaps one exception, you
can find in any supermarket. And now we offer them
to you with a toast: To your health!

Amaranth: A Versatile Source

of Iron and Magnesium
You might not find this little-known grain on your
market shelves—yet. Amaranth is a food of the future.
A new grain with big It is literally manna to the millions of malnourished
benefits. people of the Third World because it is remarkably
high in protein and lysine, an essential amino acid—
far higher than any other cereal grain. It also contains
significant amounts, of iron and magnesium. And it’s
versatile. You can use its leaves in salad and its seeds
for breakfast cereal, snacks or flour for baking.

B’s from Bananas

The banana disputes the old theory that if some-
thing tastes good, it can’t be good for you. Bananas
are a great-tasting source of potassium, vitamin B, and
biotin, another B vitamin. A medium-size banana con-
tains about 100 calories, making it a delicious snack
or dessert for dieters.

Beans Have Magnesium and B Vitamins

If you don’t know about beans, consider this: In
several tests on patients with high blood lipids (a risk
Why beans may improve factor for heart disease), a bean diet brought down
your health. cholesterol and triglyceride levels significantly, with
no serious side effects. Beans are also high in magne-
sium, a good heart mineral, and the B vitamins thia-
 The Top 25 Superfoods 503

mine (B,), B, and riboflavin (B,). They’re also an

excellent nonmeat source of iron.

Bran’s Many Benefits

One researcher calls wheat bran “‘the gold stan-
dard” against which the other brans, like oat and
com, are measured. Well, these days the other two
are measuring up just fine. In a study of the effect of
bran on constipation, corn bran was found to be
therapeutically superior to wheat bran, probably be-
cause com bran is 92 percent fiber compared to
wheat bran’s 52 percent fiber. Another group of re-
searchers, at the University of Texas Health Science
Center, also found in a feeding study with rats that
cor bran cereal, even though it contained sucrose,
helped prevent cavities.
And oat bran has been found to lower choles-
terol as much as 13 percent in studies that were done
by James Anderson, M.D., and his associates at the Oat bran—a powerful
Veterans Administration Medical Center in Lexington, cholesterol fighter.

Kentucky.

Cabbage and Its Clan

Include broccoli, brussels sprouts and cauli-
flower in this happy family. They all figure promi-
nently in the anticancer diet prescribed by the Na-
tional Academy of Sciences a few years ago. They all
appear to have some cancer-fighting properties, in-
cluding vitamin A. And three cooked stalks of broc-
coli have all the Recommended Dietary Allowance
(RDA) of vitamin A and five times the RDA of vitamin
C, another cancer fighter, as well as calcium and
potassium. Cabbage, brussels sprouts and cauliflower
contain a substance that has been shown to “trap”
certain carcinogens before they do any damage to the
body. University of Minnesota researcher Lee
Wattenberg, M.D., found that these vegetables en-
hance a natural detoxification system in the small
intestine that keeps the carcinogen away from suscep-
tible tissues.
504 Cooking and Eating for Maximum Nutrition

Carrots: Raw Material for Vitamin A

Carrots are very high in beta-carotene, a precur-
sor of vitamin A that is associated with a decreased
Carrot power. risk of cancer. Carrots are high in fiber and low in
calories, and crunching on carrots tones and strength-
ens the gums.

Citrus Fruits Shine on Health

A group of Florida researchers noticed an inter-
esting statistic. Residents of southeastern Florida,
Can an orange a day many of whom have backyard citrus trees, have a
keep cancer away? lower incidence of colon and rectal cancers than
people in the northern parts of the nation. The scien-
tists at Florida Atlantic University in Boca Raton be-
lieve the secret is in the fruit. They say the vitamins A,
C and E and pectin fiber have a synergistic effect that
may prevent cancer.

Fish Is So Fine
Holy mackerel! Would you believe you could
lower your blood pressure and cholesterol and tri-
glyceride levels by.eating mackerel and salmon? Re-
searchers worldwide have discovered that certain
types of fish—those containing eicosapentanoic acid
(EPA), a fatty acid—protect against heart disease.
They were tipped off by the healthy hearts of Green-
land Eskimos, whose diets were otherwise high in fat.
Apparently, it’s a special kind of fat, which research-
ers at the Oregon Health Sciences University say may
be “metabolically unique” and useful in controlling
other fats that can clog the bloodstream.

Garlic and Onions: The Good-for-You Duo

These two may be bad for your breath, but
they’re wonderful for the rest of you. A spate of stud-
Science probes the ies found these two odoriferous roots can lower cho-
health benefits of garlic lesterol, and their oils inhibit tumor growth in the
and onions.
laboratory. Onions have been used to slow down
platelet aggregation, or clumping, which can lead to
deadly blood clots.
 The Top 25 Superfoods 505

Herbs and Spices Add Zip to Food

Before you throw away your saltshaker and sugar
bowl, consider refilling them—with herbs and spices.
They’re actually more flavorful substitutes. A couple
of dashes of curry powder on fresh roasted nuts or
popcom, and you'll never miss the salt. And as for
sweets, a panel of tasters for the American Spice
Trade Association gave rave reviews to desserts and
beverages flavored with spices instead of sugar and
other sweeteners. They even loved blueberry short-
cake sweetened with fruit juice and cinnamon, as well
as creamy custard with reduced sugar and a surprising
bay leaf added for sweetness.

Kale, Spinach and the Leafy Greens

Your mother—and the National Academy of Sci-
ences—insisted that you eat your leafy green vegeta-
bles. Here’s why you should: Greens like spinach con- The health-promoting
tain chlorophyll, a substance that helps plants turn power of leafy greens.
sunlight into food. Chlorophyll also has been found to
lower the tendency of cancer-causing agents to cause
genetic damage to your body’s cells. Spinach and
other greens also contain significant amounts of vita-
min A and calcium, although their oxalic acid content
can change calcium into an indigestible compound in
the body. Kale, on the other hand, has far more cal-
cium than oxalic acid, so it’s a good source of this
bone-strengthening mineral.

Liver: A Storehouse of
Vitamins and Minerals
Usually found smothered in another superfood,
onions, beef liver contains almost every nutrient go-
ing. It’s rich in iron, zinc, copper, vitamins A, E, K, Is liver nature’s multi-
thiamine, riboflavin, biotin, folate, B,,, choline and vitamin?

inositol. Who can ask for anything more?

Melons Make the Grade

Cantaloupes and honeydews are low-calorie
treats or high-energy breakfast sources of vitamin C.
506 Cooking and Eating for Maximum Nutrition

One cup of cubed honeydew, for example, has only

60 calories but supplies more than half the RDA of
vitamin C.

Nuts Are Chock-full of Zinc

You can consume a considerable portion of your
minimum daily requirement of zinc during an after-
noon snack if you’re snacking on nuts. Nuts, espe-
cially cashews and almonds, are very high in this trace
mineral that’s so necessary for cell growth. But don’t
go nutty with nuts. Zinc, notwithstanding, you're also
munching a handful of calories, so enjoy them in
moderation.

Oysters for Minerals

Legend has it that oysters are an aphrodisiac. We
don’t make any claims for that, but oysters are high in
Zinc and your sex life. zinc, which is shown to be necessary for proper pros-
tate and sexual functioning and sperm motility. Oys-
ters are also rich in calcium, iron, copper and iodine.
But a word of caution that we rarely give about any-
thing else: Don’t eat them raw. If they’re not cooked,
oysters tend to pick up bacteria that can make you ill.

Peppers Supply C
Which has more vitamin C, an orange or a pep-
per? Better bet on the pepper. One of these gorgeous
green beauties contains more vitamin C than an or-
ange. And an amazing thing happens when peppers
age. They turn red—and fill up with a good supply of
vitamin A.

Poultry Fills the Bill

Let’s talk turkey—and chicken, while we’re at it.
They’re low in calories, low in fat and high in essential
Poultry—loaded with vi- nutrients and taste. An average half a chicken breast
tamins, minerals and contains 26.7 grams of protein, just 3.1 grams of fat
protein.
and only 142 calories. With that you get a side order
of vitamin A, riboflavin and niacin, not to mention
iron. A chicken drumstick contains only 76 calories
 The Top 25 Superfoods 507

and 2.5 grams of fat. Turkey is equally good news.

Three ounces of light meat without skin totals 119
calories, 26 grams of protein and 1 gram of fat, with
respectable amounts of B vitamins.

Seeds Yield Zinc

High in zinc and protein, seeds (such as pump-
kin, sunflower and sesame) also contain something
called a protease inhibitor, which seems to help pro- Why seeds aren’t just
tect us against cancer. Protease inhibitors have been for the birds.
shown to prevent liver, mammary and colon cancer in
cancer-prone laboratory animals.

Soup Keeps You Trim

It's not only good food but it’s the food that
makes you eat less. A study that analyzed the food
diaries of 90 patients determined that those who ate
soup more than four times a week ate fewer calories a
day and lost more weight than those who didn’t eat as
much soup. In fact, the researchers found, a soup
meal contained an average of 54.5 percent fewer cal-
ories than a nonsoup meal.

Soybeans Stand In for Meat

They're good protein—as good as animal
sources, say nutritionists at the Massachusetts Institute
of Technology. They lower cholesterol, say research- How soybeans may
ers at Washington University School of Medicine. And fight cancer and heart
disease.
there’s some indication that soybeans are cancer
fighters. Like seeds, soybeans contain protease inhibi-
tors. And soybean products like tofu (bean curd) and
miso (soybean paste) tested by researchers in Tokyo
seemed to inhibit potential carcinogens called nitro-
samines in the stomach.

Sprouts Add C—and More

They’re more than just a grassy accoutrement to
salads and sandwiches. Studies show that the ascor-
bic acid (vitamin C) in some sprouted seeds and
beans increases 19- to 86-fold after germination!
508 Cooking and Eating for Maximum Nutrition

Mung bean sprouts are especially high in magnesium

and calcium. But the best news concerns the wheat
sprout. It’s been shown to inhibit the genetic damage
to cells caused by some cancer-causing agents.

Sweet Potatoes: Rich in A

This superfood is a sleeper that deserves to ap-
pear on the dinner table at times other than Thanks-
Sweet potatoes—low- giving and Christmas. Besides being tastier than white
calorie cancer fighters. potatoes (which are not related), they’re high in vita-
min A, the substance that makes carrots such a potent
cancer fighter. Sweet potatoes are also low in calo-
ries. One five-inch potato contains only 148 calories.

Wheat Germ Is More

than Just Breakfast Fare
The B vitamin thiamine is abundant in only a few
foods. But one of them is wheat germ, which is also
rich in vitamin B,. This versatile food was once rele-
gated to the breakfast table but is now being used in
everything from breads to salads.

Yogurt: A Valuable Source of Calcium

African Masai warriors eat large portions of fer-
mented cow’s milk daily, which makes their already
Lowering your choles- low cholesterol levels drop even lower. In the United
terol with yogurt. States, fermented cow’s milk is marketed as yogurt
and appears to have a similar effect on American
cholesterol levels. When 26 people in a study at Van-
derbilt University went on a diet of whole- and skim-
milk yogurt, their cholesterol levels dropped signifi-
cantly. Rich in calcium and all the nutrients in a glass
of milk, yogurt is also easier to digest for people who
are intolerant to plain milk.
 Chapter 67 509

Healthy
Gourmet Foods

f a friend offered to treat you to a delicious gour-

met meal, would you feel cheated if the menu
didn’t include a tempter like huitres a la créme
(creamed oysters) but featured such fare as steamed
squash instead? “‘That’s gourmet?” you might ask dis-
appointedly.
You bet your brioche it is.
“Gourmet” doesn’t have to mean high-fat, high-
calorie, hard-to-get food. You can find a whole new
menu of healthful, exciting foods as easily as reaching The new world of low-fat
past the tomatoes and other typical fare at the super- gourmet foods.
market or perusing the bins and baskets at ethnic
markets or specialty stores.

Guilt-Free
Gourmet Pleasures
From main dishes to beverages, you'll discover
items that lend themselves to healthier preparation
methods—items that are higher in nutrients, lower in The path to healthy, pal-
calories and as palate pleasing as the more expensive ate-pleasing cuisine.

traditional gourmet cuisine.

So to sate your adventurous appetite and still
respect your body, head to the kitchen with the un-
usual foods and recipes suggested here.
Most large supermarkets and grocery stores
should carry the healthful gourmet foods that follow.
510 Cooking and Eating for Maximum Nutrition

Arugula, Mache, Radicchio and Vitamin A

These greens make a salad snappier and, with
only a minimal amount of calories, give the go-ahead
Exotic, tasty and for an all-you-can-eat serving. Each green has a dis-
healthful greens. tinctive taste and is a good source of vitamin A.
Arugula’s pungent, peppery taste intensifies into
a fiery tingle as the narrow, pointed leaves grow
larger.
Mache, or lamb’s lettuce, has a sweet, hazelnut
taste. The spoon-shaped, blue-green leaves are firm
and chewy with an agreeable texture.
Radicchio (Ra-DEECK-i-o) is appealingly bitter,
with vivid red, baseball-size heads. It also contains
vitamin C.

Belgian Endive:
More Versatile than It Looks
This versatile vegetable can be braised and
served with meats, tossed into salads (a great partner
for radicchio) or rolled up and filled with low-calorie
cheese, spread or a scallion dip. Three and a half
ounces of the creamy, ivory petals have just 15 calo-
ries and provide good roughage. Avoid brown-tipped
petals, as the taste will be too bitter.

Boniato: Another “Sweet” Potato

This South American version of the sweet potato
has a brown-red skin and very sweet flesh. The
A true ‘‘sweet”’ potato boniato is excellent baked, boiled, steamed or even
with lots of fiber. creamed like pumpkin for pie filling. (Health bonus: It
is a delicious source of fiber and no additional sweet-
ener is needed.)

Café au Lait with a Calcium Bonus

If you’re looking for ways to cut down on caf-
feine, add one part hot skim milk to one part strongly
brewed, decaffeinated coffee. Skim milk spares you
the fat and calories of cream, and it adds calcium. The
decaffeinated coffee spares your nerves. The taste is
smooth and rich.
 Healthy Gourmet Foods oA

Fava Beans Supply Iron and Potassium

Favas pleasantly blend the taste of lima beans
and peas, and they contain comparable amounts of
iron, potassium and protein.
When bought fresh, favas have green skins cover-
ing their plump, 1%-inch-long, kidney-shaped beans.
Canned favas are often skinless and a pale mustard A change-of-pace
color. Young beans are excellent simmered, steamed loaded with minerals.

or stir-fried, while older beans are best for stewing.

Mashed favas mixed with olive oil and garlic are
a popular first course in Italy. Middle-Eastern cultures
star the fava in a healthful dish called fool (fa-hool),
where the beans are mashed, laced with lemon juice
and garlic and eaten with pita bread.

Cornish Game Hens

Are Leaner than Chicken
Here’s a novel alternative to chicken. Cornish
game hens are so small that a whole hen serves only
one or two people. With its neutral taste, the meat Even lower in fat than
takes well to marinades. When stuffed, Cornish game chicken.

hens complement the flavor of the filling. Nutrition-

ally, you get slightly less fat than with chicken.

Flatbreads: Low Salt and Crunchy

Beautifully textured and hearty in flavor,
flatbreads are more like crackers than bread. They’re
made from whole grain flours such as wheat, rye, The makings of high-
barley or a combination of all three. Some are sprin- fiber snacks or
hors d’oeuvres.
kled with seeds or herbs, and some are fortified with
bran.
Check package labels for nutritional information;
some brands are high in fiber and low in salt and
calories. All flatbreads are low in fat.
Create healthy hors d’oeuvres by pairing
flatbreads with cheeses, fruits, vegetables or thinly
sliced smoked fish. An herbed chicken salad with
flatbread makes a great casual lunch.
512 Cooking and Eating for Maximum Nutrition

Flavored Carbonated Waters ‘‘Taste” Crisp

Flavored sparkling seltzer or mineral waters re-
fresh you without added sugar, salt or calories—only
a tingle of lemon, lime or orange essence is added.
The taste is clean and crisp.
Try mixing a flavored water with fruit juice or
punch to “mellow out” the juice’s sweet taste. To
Adding a splash of good concoct a nonalcoholic Sparkling Sunrise, for exam-
health. ple, pour chilled apple juice into a tall, fluted glass,
leaving about an inch of space at the top. Pour in
about % inch of chilled sparkling mineral water (any
flavor), and let it settle. Add a splash of grenadine,
which will slowly sink to the bottom of the glass,
creating a layered effect. Garnish with a nasturtium
bloom or sprig of mint.

Goat’s-Milk Cheese:
A Low-Fat Source of Calcium
From French imported to American farmers’
country-fresh own, goat cheese is becoming one of
the most sought-after gourmet items.
Until now, the nutritional makeup of goat cheese
was unknown. Five Samples analysed for this book,
High in taste, low in fat. however, revealed that the rich, savory cheese has a
lot more going for it than great taste. In addition to
being an excellent source of calcium, goat cheese
turns out to be lower in fat than many other cheeses.
A serving of goat cheese, in general, delivers
between 40 and 50 percent of its calories from fat,
depending on whether it is an aged, imported, soft or
semisoft version. This is comparable to creamed cot-
tage cheese. By contrast, you’re faced with 74 percent
calories from fat in cow’s milk cheddar, and 67 per-
cent calories from fat in ricotta cheese.

Gourmet Pastas: Two Foods in One

The new “specialty” pastas add excitement and
variety to recipes. Vegetables like spinach, tomatoes,
com, Jerusalem artichokes and mung beans enhance
 Healthy Gourmet Foods 513

the flavor of the noodles and may give them festive

coloring. Garlic, basil and other herbs can also be
added to the pasta flour. In moderation, pasta serves
up just minimal amounts of fat and sodium. An aver-
age serving (one cup) contains approximately 192
calories, rectifying the ‘fattening food” reputation
pasta has had.

Kabocha Squash:
A “New” Source of Vitamin A
This Japanese squash is a good source of vitamin
A. Its orange flesh has a bland, slightly honeyish taste
and is delicious steamed or baked with a light sprinkle A squash of a different
of spices. These short, fat squashes vary in appear- color.

ance—ranging from pale orange on the outside to

striped with green and white.

Mussels: An Iron Source from the Sea

Beautiful, blue-black shells enclose these highly
flavorful bivalves. They’re available in fish stores year-
round on the East Coast and from November through
April on the West Coast. Mussels now being cultivated
in Maine are clean, sand free, uniform in size and very
tasty.
Mussels, which are a better source of iron than
sirloin, should be bought fresh from a reputable
source and cooked well. Pull off the ropelike beard Cooking up the iron-rich
that hangs out of the shell, then prepare the mussels in mussel.

the same way as clams. Their outstanding flavor can

suffice without any sauces or butters at all. Tossing
some lemon juice and herbs like basil and garlic into
the water during steaming will add a little lift to their
taste.

Papaya Packs A and C

What looks like a large green pear with bumpy
skin is actually a sweet, fragrant papaya, whose
creamy orange flesh packs lots of vitamins A and C.
The fruit is smooth and soft in texture and can be
514 Cooking and Eating for Maximum Nutrition

used as a dessert or a tossed-salad ingredient. When

eaten alone, papaya needs no sweetener.
Papaya stores a surprise inside: soft little BB-like
black seeds that are very crunchy and flavorful. Rinse
Secret goodies inside them, place them in a jar with vinegar, refrigerate and
papayas. then sprinkle them over a salad or grind them to flavor
dressings and marinades. Papayas that are ready to
eat are slightly soft to the touch and have a flowery
scent at the stem end.

Sapsago Cheese: Grated for Goodness

A little of this hard, low-fat cheese goes a long,
flavorful way. Made from slightly sour, skimmed
cow’s milk, it is not a cheese-and-crackers cheese—
the sharp, pungent, herby taste makes it suitable for
grating. (Hot pasta welcomes a judicious dusting of
sapsago. And a salad comes alive with a sprinkling.)
This cheese is packaged into four-inch cones. The
greenish tint comes from Alpine clover.

Mango: A Vitamin A Powerhouse

A fragrant, tropical fruit, the mango is shaped like
a rather flat football with rounded ends and a mottled
How to enjoy a mango. green to rosy rind. (The skin is not edible.) The pale,
orange-pink flesh has a very smooth texture. A huge
stone nestled in the center makes cutting the fruit into
attractive slices nearly impossible, and as a result the
most popular uses of mangoes are in beverages, pu-
rees and sorbets.
For a low-calorie treat, mix mango, yogurt and
vanilla with a touch of honey, then freeze.
Mangoes pack lots of vitamin A and are good
sources of vitamin C. Three and a half ounces contain
just 65 calories.

Skirt Steak, with Removable Fat

Skirt steak appears to be very fatty when you see
it in grocery stores, but the fat isn’t marbled through-
out. It is on the outside, so you can easily cut it off.
 Healthy Gourmet Foods 515

When skirt steak is thinly sliced and served in Mexican

or Chinese dishes, you end up eating less meat than In search of a good,
usual, because the accompanying vegetables ‘“‘will fill lean steak.
you up.”
Skirt steak adopts the taste of a marinade very
well, prompting less use of oil and salt.

Oils Add Savor to Veggies and Salads

Gourmet-variety oils such as chili, hazelnut, wal-
nut and sesame taste great and are very aromatic.
With the exception of chili oil, they have a short shelf
life and should be bought in small amounts. All are
low in saturated fat. Their biggest health boon is their
prominent flavor. You'll use less and won’t be
tempted to add salty enhancers, thereby cutting your
intake of both fat and sodium.
Red-chili oil is hot! Popular in Szechuan and Hu-
nan cooking, it’s made by either steeping chilies in the
oil or adding chili extract.
Hazelnut and walnut oils look like regular oil, but
they can complement flavors very well—for example,
chop walnut pieces into a salad drizzled with walnut- Layering on the taste.
oil vinaigrette for a layering of tastes.
Sesame oil is extremely nutty and is available in
light, dark and spicy-hot versions.

Spaghetti Squash’s Hidden Delights

Inside this oval, yellow squash waits delightful,
stringy flesh that, when fluffed out with a fork, be-
comes true “vegetable pasta’! The delicate, slightly
sweet, low-calorie strands can be used instead of
noodles in spaghetti-type Italian recipes. Or chill them
and toss into a green salad.
The texture of the strands is bumpy, so sauce Serving up tasty squash
clings well. You may wish to use a special sauce— “‘noodles.”’
perhaps with a yogurt base—to perk up the squash
flavor.
For an attractive presentation, bake, boil or
steam the squash. Then cut it in half, fluff the strands,
516 Cooking and Eating for Maximum Nutrition

add sauce and put the “noodles” back into the hol-
low shell to serve.

Split Salmon Gets High Marks

This nutritious fish should probably be featured
on your menu quite often. It’s very high in a substance
called eicosapentanoic acid (EPA), which has been
linked with reducing the risk of heart disease.
The term split refers to the way the fish is cut
down the middle. That lets you open it up flat for
easier cooking.

Yard-Long Beans Feature Fiber

The name is a slight size exaggeration, as the
actual length of yard-long beans is only about a foot
Long on taste, high in and a half. The Chinese feel the beans shouldn’t be
fiber. cut but simply steamed enough to tenderize the skin,
stir-fried and then served as an elegant “edible nest”
along with fish, meat, poultry or seafood. Fiber is one
of this bean’s nutritional benefits.

Some Not-So-Common
Specialties
Specialty stores or ethnic markets will feature
these foods that are slightly harder to find.

Basmati Rice Soaks Up Surrounding Flavor

Basmati rice has little taste of its own, but it does
have an enticing, buttered-popcorn aroma. The rice
absorbs flavors around it (try cumin and coriander).
The aromatic grains are thin and fragile. Look for
the brown type (the bran has not been removed),
which is higher in fiber than white (branless) Basmati.

Nopalito Adds A and C to Salads

You'll recognize this unusual vegetable (also
called nopal) as a cactus! After the spiky cover is cut
off, the insides resemble soft cucumber. In fact, salads
 Healthy Gourmet Foods 517

get the same lift from nopalitos that cucumbers give.

This tangy vegetable is a source of vitamins A and C.

Pheasant: A Lean and Flavorful Bird

Pheasant is mild, not overwhelming or gamy,
which makes it good for herbing and spicing. Young
pheasant is prime for roasting; older pheasants are Low-fat meat for stews
better in stews. A hen pheasant is more tender than or roasting.

the male. You'll get lean meat from this bird.

Redfish and Amberjack:

Tasty, Flaky and Low Fat
These meaty, nonoily fish are extremely popular
in Cajun cooking.
Redfish is one of the lower-fat fish, having only
2.5 grams of fat per 3’2-ounce raw fillet. It is usually
featured in the tasty Cajun recipe Blackened Redfish.
Amberjack, although it doesn’t have the chic im-
age of redfish, is still a low-fat fish and is flakier than
redfish.

Yellow Finnish Potatoes for Still More C

Nature has already ‘“‘buttered” these potatoes for
you! A creamy, buttery taste actually does permeate
this potato, so there’s no need to heap on golden Self-buttered potatoes
globs of extra fat. They’re best steamed in a regular with lots of C.

vegetable steamer, not baked. (Small potatoes can be

steamed whole, while larger potatoes should be
sliced or cubed.) Try them in any nonbaked recipe
calling for white potatoes. Or top a steamed potato
with plain yogurt and chopped scallions. Yellow Finn-
ish potatoes are a good source of vitamin C.

A Portfolio of Healthful
Gourmet Recipes
Here are a week’s worth of dinner recipes to help
you introduce healthful gourmet foods to your menus.
518 Cooking and Eating for Maximum Nutrition

BELGIAN ENDIVE
WITH WALNUT VINAIGRETTE
This makes a vivid salad, first course or lunch dish.
You may use mache and arugula in addition to or
instead of radicchio. And although you may eat this
salad in a conventional manner, it’s more fun to use
the radicchio petals as scoops for the endive and
other ingredients.
2 small heads radicchio
2 heads Belgian endive
Y% cup chopped walnuts
Y% cup crumbled blue cheese
3 tablespoons minced scallions
(green part only)
2 tablespoons rice vinegar
1 tablespoon French walnut oil
Ye teaspoon French-style mustard
Separate the radicchio and endive into petals.
Arrange radicchio on four individual plates, then
place endive petals in daisy patterns on top of
radicchio. Sprinkle with walnuts, cheese and scal-
lions, so each endive petal contains a bit of each.
In a small bowl, whisk together vinegar, oil
and mustard. Drizzle over salads.

Yield: 4 servings
 Healthy Gourmet Foods 519

HERB-STEAMED MUSSELS
WITH BASMATI RICE PILAF
You may substitute clams for the mussels, but the
cooking time will be slightly longer.
2 teaspoons olive oil
1 cup chopped Spanish onions
3 cloves garlic, minced
1 cup Basmati rice
2 tablespoons minced fresh oregano
2 cups chicken stock
24 mussels, scrubbed and beards removed
1 medium carrot, cut into julienne strips
1 cup snow peas

Heat oil in a 14-inch paella pan (or other

slope-sided pan). Add onions and garlic; sauté for 5
minutes. Add rice and oregano; sauté for 3 minutes.
Add stock and bring to a boil. Reduce heat and sim-
mer for 5 minutes.
Add mussels and carrots. Cover pan loosely
with foil. When mussels begin to open, add snow
peas. Cover and simmer until mussels are fully open,
about 6 minutes. Discard any mussels that don’t open.
Serve immediately.
Yield: 4 servings
Cooking and Eating for Maximum Nutrition

YARD-LONG BEANS
WITH OYSTER SAUCE
The Chinese consider it bad luck to cut these beans,
so they eat them bite by bite, using chopsticks to hold
the bean as they eat.
5 dried shiitake mushrooms
(1 to 2 inches each)
1 slice gingerroot
3%4 pound yard-long beans
2 tablespoons oyster sauce
1 tablespoon rice vinegar
1 teaspoon cornstarch
2 teaspoons oil”
2 cloves garlic
dash of sesame oil
1 tablespoon sesame seeds
Rinse mushrooms and remove stems. Soak in
very hot water for 15 to 20 minutes, or until soft.
(Weigh mushrooms down if they float.)
Place about an inch of water in a large sauce-
pan. Add ginger. Cover. Bring to a boil. Place beans in
a steamer basket, then add to pan. Cover and steam
for 2 or 3 minutes. Remove pan from heat and let
stand for 3 minutes. Remove beans and set aside.
Drain mushrooms, then pat dry and cut into
slivers. Combine oyster sauce, vinegar and cornstarch
in a small bowl and stir until smooth. Set aside.
Heat a wok over medium-high heat. Add oil
and garlic and stir for about 30 seconds, then discard
garlic. Quickly add beans and mushrooms. Stir-fry for
2 minutes. Make a space in the bottom of the wok and
add the oyster sauce mixture. Stir quickly until thick
(be careful not to burn the sauce). Toss beans and
mushrooms to coat with sauce. Sprinkle with a little
sesame oil and toss again. Remove from wok and
arrange on a round platter in a nest shape. Sprinkle
with sesame seeds.
Yield: 4 servings
 Healthy Gourmet Foods 521

APRICOT-STUFFED
CORNISH GAME HENS
1 cup apple juice
1 cup apricot nectar
Y teaspoon crushed star anise (about 2 stars)
¥Y% teaspoon crushed cardamom seeds
Ye teaspoon ground ginger
5 whole black peppercorns
2 teaspoons low-sodium soy sauce
4 Commish game hens
1% cups chicken stock
Ye cup wild rice
1 bay leaf
¥3 cup minced onions
Y% cup chopped dried apricots
2 tablespoons coarsely chopped pine nuts
In a large, deep dish, combine juice, nectar,
anise, cardamom, ginger, peppercorns and soy sauce.
Place hens in dish, then cover and marinate over-
night.
In a 1-quart saucepan, combine stock, rice and
bay leaf. Bring to a boil, then reduce heat, cover and
simmer for about 40 minutes, or until liquid is ab-
sorbed and rice is tender. Set aside.
Remove hens from marinade and set aside,
reserving marinade.
In a 2-quart saucepan, cook onions in 1 or 2
tablespoons of marinade until wilted. Add apricots,
pine nuts and cooked rice. Heat through, adding
more marinade if mixture becomes too dry.
Preheat oven to 350°F
Spoon stuffing into body cavities of hens. Set
in a lightly oiled baking pan. Bake for 1 hour, basting
occasionally with marinade. If hens appear to be get-
ting too brown, cover with foil.

Yield: 8 servings
Cooking and Eating for Maximum Nutrition

SIZZLING FAJITAS
1 skirt steak (1 pound)
Y% cup lime juice
1 teaspoon olive oil
1 tablespoon minced fresh coriander
3%4 teaspoon ground cumin
Y teaspoon dried oregano, crushed
1 clove garlic, minced
freshly ground black pepper, to taste
% cup thinly sliced onions
1cup seeded, diced tomatoes
1lime
6 flour tortillas, warmed
1ripe avocado, chopped
lime wedges
3 chili peppers, cut into thin strips
1 cup canned nopalitos (optional)
Trim fat from steak. Cut meat into %-inch
slices, cutting across the grain and slightly on the bias.
In a large bowl, combine lime juice, oil, cori-
ander, cumin, oregano, garlic and pepper. Add meat
strips. Cover and let stand for 2 hours, stirring occa-
sionally.
With tongs, remove meat strips from manri-
nade. Place meat in a single layer on a broiler pan and
broil about 5 inches from heat for 5 to 7 minutes, or
until lightly browned, turning once during cooking.
Coat a large nonstick skillet with vegetable
spray. Add onions and cook for 3 or 4 minutes, or
until crisp-tender. Add tomatoes and cook, stirring
occasionally, for 1 or 2 minutes, or until just heated.
Combine meat and vegetables in a heated
cast-iron skillet or platter. Cut lime in half and squeeze
juice over meat and vegetables. Serve as filling for
tortillas, along with avocado, lime wedges, chilies and
nopalitos, if used.
Yield: 6 servings
 Healthy Gourmet Foods 523

PASTA WITH SALMON AND

SUN-DRIED TOMATOES
1 cup water
1 tablespoon rice vinegar
1 bay leaf
Y pound salmon fillets
% cup low-fat cottage cheese
2 tablespoons skim milk
freshly grated nutmeg
¥Y% pound spinach pasta, cooked
12 sun-dried tomatoes, sliced (about % cup)
1 tablespoon grated locatelli cheese
In a large skillet, combine water, vinegar and
bay leaf. Bring to a boil. Reduce heat to very low, add
salmon and cover pan. Cook for 4 to 6 minutes, or
until salmon is opaque pink. Remove salmon with a
large slotted spoon or spatula and let cool. Gently
pulling against the grain, separate fish into 1-inch
chunks. Set aside.
In a blender or food processor, combine cot-
tage cheese, milk and a pinch of nutmeg. Process
until smooth.
In a large warmed bowl, toss together pasta,
tomatoes, locatelli and half of cottage cheese mix-
ture. Add salmon and remaining cheese mixture and
gently toss together.
Yield: 4 servings
524 Cooking and Eating for Maximum Nutrition

SOUP OF PHEASANT,
PORCINI AND TRUFFLES
Make this soup a day ahead to heighten its delicate
flavors. If pheasant isn’t available, substitute dark
chicken meat.
Y% cup dried porcini mushrooms
1 teaspoon margarine or butter
34 cup minced onions
3 cups chicken stock
Y% cup grated carrots
1% tablespoons minced celery leaves
1 tablespoon red wine vinegar
1 teaspoon mushroom ketchup (optional)*
34 cup cooked pheasant, shredded
1 white Piemonte truffle, finely minced with a
razor blade
Soak mushrooms in enough water to cover for
about 20 minutes. Drain, reserving the soaking water.
Remove any stems and mince mushrooms.
In a 3-quart saucepan, melt margarine or but-
ter. Add onions and sauté until rich brown, about 10
to 15 minutes. Add stock, carrots, celery, vinegar,
ketchup, if used, mushrooms and soaking liquid.
Bring to a boil, then reduce heat and simmer for 15
minutes. Add pheasant and truffle and cook for 15
minutes.
If not serving immediately, let soup cool to
room temperature before refrigerating. When ready to
serve, heat slowly.

Yield: 4 servings

*Mushroom ketchup is available in oriental food markets.

 Chapter 68 525

The Fruits
and Vegetables
Your Mother
Never Mentioned

f the advice you’ve been hearing lately from

groups bent on preventing heart disease and can-
cer sounds suspiciously like something your mother Reasons to eat your
once said, there’s a reason for that. The scientific veggies.
community has confirmed mom’s age-old command
to eat more fruits and vegetables. Study after study of
large populations has indicated that people who eat
more of these foods suffer less coronary problems,
stroke and cancer.
Fruits and vegetables tend to be low in fat and
salt and high in fiber and vitamins A and C—all traits
that contribute to their disease-preventive status.
So you've started including more of those foods
in your diet. At restaurants, you'll order a salad in-
stead of paté; at home, you end more meals with an
apple instead of chocolate cream pie. But let’s face it,
the same old salad greens, apples, oranges and ba-
nanas get a little boring after a while.
There are alternatives. These days, it’s not un-
usual for supermarkets to stock not one but three, four
or five different kinds of fresh peppers, half a dozen or Out-of-the-ordinary but
more varieties of squash and a dizzying array of tu- nutrient-rich fruits and
vegetables.
bers, cabbages and tropical fruits. During the summer,
roadside produce stands and farmers’ markets offer
lots of variety. If you live in a large city, you might also
try ethnic markets, such as Italian, Hispanic and orien-
tal, where novel foodstuffs often are featured.
526 Cooking and Eating for Maximum Nutrition

Nutritious Additions
to Your Shopping Bag
Whether you’re shopping for unusual fruits and
vegetables or you're just seeing more of them on
restaurant menus, here’s a brief rundown on some
that are growing in popularity.
Bok choy. A Chinese chard or cabbage that
resembles celery, bok choy has good, fresh flavor and
A new source of crunch, and it’s high in vitamin A. Steam for about 10
vitamin A. minutes, stir-fry, or add it to other dishes. It comple-
ments the flavor and texture of many foods, including
beef and seafood. It can be found at Chinese markets
or as a popular ingredient in Chinese restaurant food.
Boysenberries. These are large, soft berries
with a purplish black cast, large seeds and an excel-
lent tart flavor. They are a good source of vitamin C
and are available in local markets.
Crenshaw melon. A hybrid variety of musk-
melon with a yellow skin and salmon-colored flesh,
crenshaw melon is high in vitamins A and C. It has a
delicate flavor and iis available in local markets.
Gooseberries. Similar to currants, gooseberries
have translucent skins that vary in color: green, yel-
Colorful fruits with fiber low, white, pink or red. There are sweet and tart-
and vitamins. tasting varieties. Gooseberries are a good source of
fiber and vitamin C and a fair source of vitamin A.
They are available in local markets.
Guava. A native of Mexico and South America,
guavas are now grown extensively in California, Flor-
ida and Hawaii. They are reddish purple on the out-
side and white on the inside. They are high in fiber
and an excellent source of vitamin C. You can cook
guavas or eat them raw, and they taste great with
pineapples and bananas. They can also be used in
pies and tarts. They can be found in various markets.
Jicama. This Mexican potato, whose name is
pronounced he-CA-ma, is a good source of vitamin C.
You can peel and slice it, then dice and toss with
 The Fruits and Vegetables Your Mother Never Mentioned 527

salads, or stir-fry, like water chestnuts. It should be

available in various markets.
Passion fruit. This tropical fruit (a native of
Brazil) is not an aphrodisiac, though it may sound like
one. It has a deep, dusty purple color and can look Fruit with a punch.
uneven and lumpy when ripe. It’s a good source of
fiber, however. To eat passion fruit, cut it in half and
eat the greenish yellow pulp and seeds with a spoon.
Its juice is often used in punch. It can be found in
various markets.
Tamarillo. A New Zealand fruit that’s about the
size of a kiwi fruit, with bright orange flesh and black
seeds, tamarillo is rich in vitamin C. Its texture is A New Zealand delight
similar to a kiwi’s, but the taste is more complex, that’s high in C.
combining sweet and sour flavors. It’s eaten fresh
without the skin or stewed in a compote. It can be
found in various markets.
528 Chapter 69
Rating Your
Refrigerator’s
“Health Quotient”

here’s a housewife in New York who claims she

can spot a troubled marriage, a family that pays
its bills on time or one in which husband and wife are
struggling with their self-esteem—all by studying the
art gallery on their refrigerator doors. You know: the
Snoopy-shaped magnets and cartoons, the lists and
messages, reminders (“Think Thin!’”), pictures, calen-
dars, bills and everything else that ends up enshrined
in that household Louvre and communications cen-
ter. If your refrigerator door is an unholy mess, don’t
worry, she says—that may well be a sign of a happy
marriage.

What’s in Your Refrigerator?

But if refrigerator doors are revealing, think
about what’s behind them. The contents of your
What your refrigerator fridge paint a fairly complete, very up-to-date picture
reveals about your diet. of what your eating habits are really like. Not what you
wish or intend them to be, not what they once were,
not what they’re going to be, but what they are. And
since we all foster illusions about ourselves, a cold,
objective inspection of your refrigerator’s innards
might produce some real surprises.
You might find out that much of what you know
about nutrition isn’t actually making it into practice.
An honest look at your Then again, you might discover you've been treating
eating habits. yourself better than you realized. Either way, the point
is: How can you expect to improve your eating habits
 Rating Your Refrigerator’s “Health Quotient” 529

if you're not entirely sure what they are? Which is the

point of the following “health consciousness-raising”
game.
All you need to play is a pencil and paper, your
refrigerator and a pitiless sense of objectivity. All you
have to do is open your refrigerator, see what’s there
and assign a number value (plus or minus) to each
kind of food you find. Once you’ve added up all the
pluses and minuses, you'll end up with a total score—
your refrigerator’s “health quotient,” if you will. You
will be able to tell from your score whether your
“HQ” is terrific, merely great or awful (compared with
others who’ve taken the test).
The rankings have been worked out with the help
of a computer, which evaluated a representative
“market basket” of foods that might be likely to wind Computer rankings
up in your refrigerator. Foods from each of eight dif- based on nutrition.
ferent food groups were judged according to the food
values (good or bad) that that group is especially
noted for. Each dairy product, for example, was
ranked according to its protein and fat content, so-
dium, total calories, riboflavin and calcium; fish were
ranked by protein, fat, sodium, vitamin B,, potassium,
iron and niacin; and so on.
The rankings have been refined a bit, based on
nutritional or healing properties a particular food
might have that the computer didn’t know about. For
example, haddock was bumped up a notch because
it’s relatively rich in eicosapentanoic acid (EPA), a
substance that has been shown to be beneficial to
cardiovascular health (but which the computer didn’t
take into consideration).

How to Keep Score

Please remember that a negative score for a par-
ticular food doesn’t mean it’s a total nutritional loser.
It’s just a way of giving certain foods a relative weight
compared to other foods. Also, the list is not meant to
be an exhaustive one. There will be a few things in
530 Cooking and Eating for Maximum Nutrition

your fridge that have not been included on the list—

just disregard them.
Here are a few other things to remember.

e Try to pick a day when the refrigerator is rela-

tively full, preferably the day you do the week’s food
shopping.
e Give each type of food only one score. For
example, if you have two cartons of skim milk, give
yourself five points (not ten). Don’t give each carrot
three points.
e Count fresh and frozen vegetables the same.
e Disregard condiments such as ketchup, Ta-
basco sauce, soy sauce and others.
e Count only the contents of your refrigerator
(including its freezer compartment). Certainly, what
you've got squirreled away in detached freezers and
pantry cupboards is a part of your total personal
health picture—but that’s a different game.

Refrigerator Health Quotient Scorecard

A. Congratulations!
You win five points for trying!__

B. Award yourself five points for each of these foods

you find:
_— any kind of sprouts __ red peppers
__ blackberries ___ salmon
__ bran flakes ___. sesame seeds
_— broccoli _— shrimp
__. cantaloupe _— skim milk
___ collards ___. strawberries
__ flounder ___ sunflower seeds
___ haddock ___ Swiss chard
_— halibut ___. tahini (sesame
__ kale butter)
__ liver “= =stonh
___ mangoes E=htrout
—— plain low-fat yogurt | __ wheat germ
___ raspberries
 Rating Your Refrigerator’s ‘Health Quotient” 531

C. Give yourself three points for each of these foods:

__. acorn squash _— lima beans
_——. almonds __ limes
___ apricots _—__ mushrooms
_— artichokes __ oranges
__ avocados _— part-skim mozzarella
_— beet greens ___ peaches
__— blueberries ___ radishes
_— brussels sprouts _ raw peanuts
_— buttermilk __— rhubarb
__— cabbage ___ ricotta cheese
_— carrots _— rockfish
_— cauliflower __ romaine lettuce
_— chicken —_ snow peas
See ra| —— spinach
__. dates _— Swiss or Gruyére
___ endive cheese
_— orange juice __ tangerines
_— grapefruit = culia
___ green peppers —— turkey
___ homemade or low- ___ two percent low-fat
fat salad dressing cottage cheese
_— honeydew __— two percent low-fat
_— kefir milk
___. lemons _— veal cutlet

D. Give yourself one point for any of these foods:

___ American cheese _— clams
___. apples —— coconut
____ asparagus _— colby cheese
_— beef rib = erap
__. beets —— creamed cottage
_— bottled water cheese
___ Brie cheese —— cucumbers
——~ Dulter. _—. eggplant
___ Camembert cheese ==) C895
_— celery _— figs
___ cheddar cheese _— flank steak
__ chuck steak _— fruit yogurt
532 Cooking and Eating for Maximum Nutrition

___ Gouda cheese ____ rump roast

___ grapes ___ Salt-free pickles
__ green snap beans ____ salt-free spaghetti
___ ground beef (regular sauce
or lean) ___.sardines
___ half-and-half _— scallions
= ham _— scallops
_— iceberg lettuce __ sweet com
_— lamb loin ___ sweet or sour
_— lamb nib or leg cherries
__ leeks __ T-bone steak
_— lobster ___ tomatoes
___ margarine __— turnips
—— Monterey Jack ___ unsweetened fruit
cheese juice
_— Muenster cheese ___ veal breast
_—— mussels _— watermelon
_— oysters _— whiting
___ Parmesan cheese _—— whole milk
___ peanut butter ___ whole wheat bread
= pears or any other whole
__ pineapple grain product
_— plums __ yellow squash
_— pork chops zucchini
___ Romano cheese
—__ round or sirloin
steak

E. Subtract three points for each of these foods:

—— anchovies —— ice milk
Seer _— light or heavy whip-
_— black or green olives ping cream
_— Canadian bacon ___ mayonnaise
—— commercial salad _— pickles
dressing —— sour cream
___ cream cheese _— sweetened fruit
__ fish cakes juices
____ fish sticks ___ wine
 Rating Your Refrigerator’s “Health Quotient” 533

F. Subtract five points for each of these foods:

_— anything with sugar, ___ jams and jellies
com sweeteners or _— knockwurst
honey listed as first _— liverwurst
ingredient __ luncheon meats
_— bacon _— Polish sausage
—— boiled ham _— salami
_— bologna __— sherbet
__ brown-and-serve __ soda pop
sausage —— Spareribs
_— chicken roll _— turkey loaf or roll
—— cooked canned ham __— turkey or chicken
__ corned beef franks
—— cured ham __— white bread or any
__— dried beef other white flour
_— frozen layer cakes product such as
_— hot dogs cakes or cookies
ee ce cream

Scoring: Here’s how your refrigerator’s “HQ” stacks

up against the rest of the world: 60 or above: excel-
lent; 50-60: superior; 40-50: good; 30-40: fair; 30 and
below: needs work. (Can you isolate any particular
place to begin?)
534 Chapter 10
The Good Meats:
A Nutritional
Storehouse

eef’s been on the grill for quite a few years

now. ‘Eat less red meat,” medical research-
ers have said, and we've listened. Fearful of choles-
terol and fat, we’ve switched to more chicken and fish
and heaped our salad bowls high.
And—make no mistake—you can eat too much
meat. A diet that serves up bacon, sausage, luncheon
Two sides to the meat meats, steaks, chops, hamburgers or hot dogs several
story. times a day is a diet almost certainly too high in fat
and too low in fiber to be optimally healthful.
But there’s another side to the meat story. If you
choose the right cuts, prepare the meat properly, and
eat it in moderation, meat can be a positively health-
building food.

Meat Is More Healthful

than You Think
Consider, first of all, this question. Which has
more cholesterol, beef, chicken or fish? Almost every-
Beef has the same one gets that one partially wrong. The answer is that
amount of cholesterol beef and chicken have essentially the same amount of
as chicken.
cholesterol—100 milligrams or so—and fish has
about 80 milligrams in a four-ounce serving.
Second, the fat and calorie content of various
cuts of beef and other meats varies from mammoth to
surprisingly modest. Generalizations just don’t work.
Take a sirloin steak, for instance. Broil a six-ouncer as
 The Good Meats: A Nutritional Storehouse 535

it comes out of a butcher’s case and you've got 476

calories, including lots of fat. But the same cut of
steak that weighs six ounces after trimming away all
the visible fat has only 354 calories, with 26 percent
fewer calories from fat.
Even more interesting, certain cuts of beef, such
as round and flank steak, are quite lean to begin with.
A broiled six-ounce round steak, untrimmed, has 466
calories. But a well-trimmed, broiled six-ounce round
steak drops you down to 330 calories and a very
respectable fat level.
Don’t make the mistake, though, of cooking
meat with its fat, then trimming it off at the table.
Some of the fat that melts during cooking will actually Trim fat before, not af-
be absorbed into the meat. So trim before cooking, ter, you cook the meat.

Rating the Beef

Cut Calories Fat Calories from Fat

(g.) (%)

Eye round 209 7 32

Sirloin 238 10 33
Chuck roast 264 il 39
Rump 236 11 40
T-Bone* 245 12 44
Porterhouse f 249 be 45
Rib eye £ 257 13 47
Club steak iki 1S 48
Flank 278 17 56
Ground beef § 293 19 57

Source: Adapted from Composition of Foods: Beef Products, Agriculture Hand-

book No. 8-13, by Nutrition Monitoring Division (Washington, D.C.: Human Nu-
trition Information Service, U.S. Department of Agriculture, 1986).

Note: Figures are based on a 4-oz. serving, trimmed of visible fat, and cooked.
On average, these cuts provide about 33 g. of protein and about 3 mg. of iron,
as well as about 93 mg. of cholesterol.

* Strip loin and New York strip are synonyms for this cut.
t+ Filet mignon and chateaubriand can be included in this cut.
+ Delmonico and Spencer steak are synonyms for this cut.
§ Extra lean ground sirloin and round, broiled to medium doneness.
536 Cooking and Eating for Maximum Nutrition

then broil on a slotted pan that permits some of the

remaining fat to drip away. The result is good, lean,
nutritious eating.
And, of course, if you’re cooking meat that’s low
in fat to begin with, you're better off yet. (For details,
see our list of various beef cuts and their percentage
of calories from fat in the table, Rating the Beef, on
page 535.)
But what about saturated fat? Isn’t beef higher in
this kind of fat—believed to push cholesterol levels
up—than chicken or fish? Generally, yes. But remem-
ber, generalizations can be deceiving. Choose the
really lean cuts, like round, and ounce for ounce
you've got a lot less saturated fat than we get from
such common foods as stewed chicken, peanuts,
cheese or even sunflower seeds.

A Good Source
of Vitamins and Minerals
On the plus side, beef is an extremely good
source of protein, B vitamins, iron and zinc. The latter
two minerals are believed to be deficient in many
diets, particularly those of women who are watching
their weight.
And even a small amount of beef can greatly
increase the amount of iron our bodies can absorb
Meat boosts iron from grains, potatoes and vegetables. (Enter beef
absorption. stew, stage right.)
However you cut it—or cook it—beef does have
more fat than vegetables or fruits. But this is true of
most protein-rich foods, including dairy products,
nuts and seeds. The trick is to balance these foods
with others that are extremely low in fat—fruits, veg-
etables, corn, rice, wheat and other grains, beans of
all kinds, potatoes and pasta. Go easy on the butter,
and you wind up with a daily diet that includes meat
but excludes excess fat.
 The Good Meats: A Nutritional Storehouse 537

Putting Meat in Perspective

Many health authorities recommend a diet that
derives no more than 30 percent of its total calories
from fat. To see how that works in practice, let’s begin A low-fat meal with
with a well-trimmed porterhouse steak—not an espe- porterhouse steak.

cially lean piece of meat. About 45 percent of its

calories come from fat. But if you include a four-
ounce baked potato, one slice of whole wheat bread,
four ounces of broccoli, one pat of butter and eight
ounces of skim milk with your broiled steak (a four-
ounce serving), you've reduced the ratio of calories
from fat to 27 percent. The total calories from this
typical dinner is a quite moderate 596.
Perhaps some comparisons with meatless dishes
will help put beef’s benefits in perspective.
A macaroni-and-cheese dish, made with 1%
cups of ricotta, fontina and cheddar cheeses, eight
ounces of macaroni and 1 cup of milk, has about 45 Macaroni and cheese
percent of its calories tied up in fat. A sirloin steak, on has more fat than sirloin
steak.
the other hand, has only 33 percent of its calories in
fat. In fact, many cuts of beef contain significantly less
fat than comparable amounts of many cheeses (Brie,
Gouda, cheddar, ricotta, Swiss and Romano among
them).
A quiche made with two cups of cheddar, spin-
ach, rice, three eggs and one cup of light cream has a
staggering 74 percent of its calories coming from fat.
No wonder real men don’t touch the stuff.

Decoding Meat-Packing Labels

But short of taking a course in butcher-shop ba-
sics, what can a health-conscious consumer do to
negotiate the meat morass? A good start would be to Prime is high in fat.
familiarize yourself with the meat industry's grading
system. Its top rating is “prime,” which means that,
according to the U.S. Department of Agriculture
(USDA), the meat is “‘the most tender, juicy and fla-
538 Cooking and Eating for Maximum Nutrition

vorful.” What makes a prime cut flavorful and juicy is

fat, not only the trimmable fat but also the marbling,
the flecks of fat within the lean that are impossible to
eliminate. If you purchase a prime cut, it’s best to cut
away the trimmable fat before cooking.
The meat industry’s “choice” rating goes to cuts
that don’t have quite enough marbling to warrant the
prime label. Still, these cuts are high in fat content and
so should be carefully trimmed.
Ironically, as one moves down the meat indus-
try’s rating chart, one makes a healthful ascent. The
The healthiest cuts of “good” and “standard” ratings are given to cuts
meat are neither “which lack the juiciness and flavor of the higher
“‘prime’’ nor ‘“‘choice.”’
grades,” according to the USDA. The reason? There’s
less fat, so you have less waste, fewer calories and less
cholesterol. Perhaps best of all, the healthier cuts cost
less. Fortunately, the meat industry has been offering
more of the leaner cuts in the market recently.
So your choices are many. Beef’s gamut runs
from the cuts of the loin portion, which should be
How to choose meat consumed in moderation and in careful balance with
that’s lean and tender. other foods, to the cuts of the round portion of the
steer, which fall close to the government’s 30 percent
of calories from fat recommendation.

Identifying Meats on the Menu

When you eat out, however, another problem
arises: identifying the cuts. While most supermarkets
A guide to popular res- use standard names for the cuts of beef, restaurants
taurant cuts. use many aliases. And since there is no beef eater’s
thesaurus, you need a guide. Here are a few of the
more common designations.
Chateaubriand. This is a large tenderloin,
sometimes called filet mignon. This is always at least a
choice cut, and it might be prime. It costs the restau-
rant more to get, and it will cost you more.
Surf ’n’ turf. You can ask the waiter wishfully if
this is haddock and round steak, but typically this is a
 The Good Meats: A Nutritional Storehouse 539

shellfish (usually lobster) and a tenderloin cut of beef

that by itself would be filet mignon.
London broil. This is a flank steak and a highly
recommended cut at home or out. It will cost you less
in a market or a restaurant, and from a nutritional
standpoint, it is one of the best cuts of beef.
Whether you’re buying meat at the supermarket
or ordering it at a restaurant, be assertive. Don’t feel
that you're inconveniencing the meat cutter by asking How to get the beef you
him to trim fat for you. And make it clear to the waiter want.

that the size of the tip depends on whether or not you

get the beef exactly the way you want it. This allows
you to enjoy beef not only without reservation but
also with the knowledge that you’re doing something
good for yourself.
540 Chapter (Ol

Happy Marriages:
Foods That
Go Together

omeo and Juliet, Anthony and Cleopatra,

Macaroni and Cheese... .
Although it’s true that Shakespeare never got
around to immortalizing that last famous couple, it
seems clear that certain foods are made for each
other just the way people sometimes are. Liver and
onions, spaghetti and meatballs, chicken and bis-
cuits—the chemistry is just right.
And that’s not all that’s right. As luck would have
it, many traditional food duos are compatible nutri-
Enjoying tasty, healthy tionally as well as gastronomically. Corn tortillas and
food duos. beans get together to form a more efficient form of
protein. Cheese or meat adds protein to a pasta din-
ner, and the pasta helps stretch a modest amount of
either. Fish and chips need only a green vegetable or
salad to round out the dish. The same goes for
chicken and biscuits.
Like many couples that have been together for a
long time, however, some food partners can occa-
Splicing up popular sionally benefit from having their lives, well, spiced up
combos. a bit. Chili peppers added to liver and onions keep
boredom at bay. So do herbs in biscuits and yogurt in
chicken sauce. And who says macaroni and cheese
can’t have a little mustard added, and that you can’t
use three cheeses instead of just one? Or that fish and
chips always have to be deep-fried and greasy? No
one. So enjoy these variations on favorite old themes.
 Happy Marriages: Foods That Go Together 541

LIVER AND ONIONS

Overcooking is what usually gives liver that old-shoe
texture. You can avoid that by cooking these liver
strips a mere 2 minutes.
1 pound calves’ liver
3 tablespoons lemon juice
1 canned green chili pepper, seeded and
minced
2 cloves garlic, minced
1 teaspoon dried oregano
Y% teaspoon dried rosemary, crushed
4 large baking potatoes
3 medium-size onions, thinly sliced
Y% cup beef stock
2 teaspoons vegetable oil
Cut liver into strips about % inch wide and
place in a shallow bowl. In a small bowl, mix lemon
juice, chili pepper, garlic, oregano and rosemary.
Pour over liver and toss to coat. Let stand for at least 2
hours.
About 1 hour before serving time, preheat
oven to 425°F Scrub potatoes and pat dry, then
pierce each with a fork and bake for 1 hour.
In a large nonstick skillet, cook onions in stock
over medium-low heat, stirring occasionally, for 15 to
20 minutes, or until stock evaporates and onions are
tender and lightly browned. Remove onions to a
plate.
Increase heat to medium-high. Heat oil in skil-
let for a few seconds, then add liver, reserving any
marinade that remains in the bowl. Cook, stirring fre-
quently, for about 2 minutes. Return onions to skillet,
pour in reserved marinade, and toss to reheat onions.
Serve over baked potatoes.
Yield: 4 servings
542 Cooking and Eating for Maximum Nutrition

FISH AND CHIPS

Baked instead of fried, this rendition of the British
favorite is much lower in calories. Although almost
any kind of potato will work well for the chips, the
small red type is exceptionally good for these crunchy
morsels.
CHIPS
10 to 12 small red potatoes
1 teaspoon vegetable oil
FISH
1 pound flounder fillets
Y% cup whole wheat flour
pinch of ground red pepper
1 tablespoon vegetable oil
1 tablespoon margarine or butter
Y% cup lemon juice
paprika
To make the chips: Scrub potatoes, then dry
thoroughly. Leaving skins on, cut them into strips
roughly 2 inches long by ¥% inch thick and wide. Pat
dry again.
Preheat oven to 450°F.
Spread oil evenly over the bottom ofa jelly-roll
pan and distribute potatoes in a single layer in the
pan. Bake for 30 minutes, turning frequently.
To make the fish: Pat fish dry. Place flour and
ground red pepper in a plastic bag and add fish, one
piece at a time. Shake well to coat lightly with flour.
After coating each fillet, fold it in half or roll length-
wise. Set aside.
Heat a large cast-iron skillet or other heavy,
ovenproof pan over medium-high heat until quite hot.
Add oil and margarine or butter, then add fillets to
pan in a single layer. Immediately tilt the pan so you
can spoon some oil mixture over fish.
Place pan in the oven with chips. Bake for 10
to 15 minutes (depending on thickness of fillets), until
fish is opaque and cooked through.
 Happy Marriages: Foods That Go Together 543

Remove chips and place on serving dish. Re-

move fish to a serving platter, then add lemon juice to
the pan. Stir to loosen any browned bits from the
bottom, then pour liquid over fish and sprinkle with
paprika. Serve with chips.
Yield: 4 servings

TORTILLAS AND BEANS

Take your choice of beans. Serve with a salad of
mixed greens or with marinated vegetables.
12 corn tortillas (66-inch diameter)
*%% cup plain yogurt
Y% cup sour cream
3 scallions, thinly sliced
2 cloves garlic, minced
1 tablespoon chili powder, or to taste
’%& teaspoon ground cumin
4 cups coarsely chopped tomatoes
1% cups cooked pinto, kidney or black beans,
lightly mashed
%4 cup shredded cheddar or Monterey Jack
cheese
Coat a deep-dish, 9-inch pie plate with vege-
table spray. Use 4 tortillas to cover the bottom of the
plate, overlapping them in the center.
Preheat oven to 375°F.
In a small bowl, mix yogurt, sour cream, scal-
lions, garlic, chili powder and cumin. Spread a third of
the mixture over tortillas. Top with 1% cups tomatoes
and 2 cup beans.
Repeat layering twice to use all tortillas, yogurt
mixture, tomatoes and beans. Top with cheese.
Bake for 20 to 30 minutes, or until cheese has
melted and ingredients are bubbly.
Yield: 4 servings
544 Cooking and Eating for Maximum Nutrition

SPAGHETTI AND MEATBALLS

Serve up these favorites for a filling but not fatty sup-
per entrée.
%4 pound lean ground beef
Y% cup bran
1 onion, minced
2 cloves garlic, minced
1 teaspoon dried thyme
¥% teaspoon dried rosemary, crushed
1 egg
1 can (85 ounces) Italian plum tomatoes
Y% cup tomato paste
Y% teaspoon dried oregano
Y teaspoon dried basil
Y teaspoon crushed red pepper flakes
1 bay leaf
8 ounces spaghetti
In a large bowl, mix beef, bran, onions, garlic,
thyme, rosemary and egg until thoroughly combined.
Using your hands or two soup spoons, shape meat
into balls roughly the size of golf balls. Set aside.
In a 3-quart saucepan, combine tomatoes, to-
mato paste, oregano, basil, red pepper flakes and bay
leaf. Bring to a boil, then reduce heat and simmer for
15 minutes. Add meatballs to pan and cook for 45
minutes. Stir occasionally. Before serving, remove bay
leaf.
In a large pot, cook spaghetti in boiling water
until just tender. Drain and place in a large serving
bowl, then cover with meatballs and sauce.

Yield: 4 servings
 Happy Marriages: Foods That Go Together 545

MACARONI AND THREE CHEESES

This variation on the traditional dish is nice served
with steamed peas and spinach salad.
Ye pound macaroni
2 tablespoons whole wheat flour
1% cups skim milk
1% cups low-fat cottage cheese
Y% cup grated Parmesan cheese
Y% cup shredded cheddar cheese
1 teaspoon dry mustard
¥3 cup seasoned bread crumbs
In a large pot, cook macaroni in boiling water
until just tender. Do not overcook. Drain and set
aside.
Coat an 8 X 8-inch baking dish with vegetable
spray.
In a 3-quart saucepan, whisk flour with about 2
tablespoons milk until blended to a smooth paste.
Gradually whisk in remaining milk. Cook over me-
dium heat, stirring constantly, until thickened. Re-
move from heat.
Preheat oven to 375°F.
Add macaroni, cheeses and mustard to the
pan. Stir to mix. Pour into baking dish and sprinkle
with bread crumbs. Bake for 30 minutes.
Yield: 4 servings
546 Cooking and Eating for Maximum Nutrition
ER

CHICKEN ’N’ BISCUITS

This all-American combo gets added zip from chili
powder. Start preparing the chicken. While it sim-
mers, you can make the biscuits.
CHICKEN
6 whole chicken legs, with skin and all visible
fat removed
3 tablespoons whole wheat flour
1% teaspoons chili powder
1 tablespoon vegetable oil
1% cups chicken stock
1 cup plain yogurt
BISCUITS
2 cups whole wheat flour
2% teaspoons baking powder
Y% teaspoon baking soda
3 tablespoons margarine or butter
¥% cup plain yogurt
Y% cup skim milk
¥% cup minced fresh parsley or chives

To make the chicken: With a sharp knife, cut

each leg at the joint to make 2 pieces. Rinse pieces
and pat dry. Place flour and 1 teaspoon chili powder
in a plastic bag. Add chicken, 1 piece at a time, and
shake to coat lightly with flour.
Heat oil in a large, heavy, well-seasoned skillet
over medium heat for 30 seconds. Add chicken
pieces, being careful not to crowd them. (If neces-
sary, do chicken in several batches.) Cook over me-
dium heat, turning pieces occasionally until lightly
browned.
Pour 1 cup stock into skillet. Cover and sim-
mer for 30 to 40 minutes, or until chicken is tender
and juices run clear when you pierce a thigh with a
fork.
 Happy Marriages: Foods That Go Together 547

To make the biscuits: In a large bowl, combine

flour, baking powder and baking soda. With two
knives or a pastry blender, cut in margarine or butter
until mixture is crumbly and resembles coarse meal.
Make a well in the center and add yogurt, milk and
parsley or chives. Stir with a fork until all flour is
moistened. Do not overmix.
Preheat oven to 450°F. Coat a baking sheet
with vegetable spray.
Turn dough out onto a floured surface and
gently knead for about 30 seconds. Pat or roll dough
into a rectangle about % inch thick. Cut into about 12
rounds with a floured 2!-inch biscuit cutter. Arrange
on baking sheet and bake for 12 to 15 minutes, or
until lightly browned.
To assemble: Remove chicken to a serving
platter and keep warm. Add remaining stock and chili
powder to skillet. Cook over medium heat for 3 min-
utes, stirring with a wooden spoon to scrape up
browned bits. Turn off heat and whisk in yogurt. Pour
sauce over chicken and serve immediately with warm
biscuits.
Yield: 6 servings
548 Chapter 12

High-Calcium Cookery

hat are the best food sources of calcium?

Dairy products are particularly good, but
Low-fat dairy products you have to be selective. Full-fat products like whole
are the best. milk, whole-milk yogurt, ice cream and many types of
cheeses are too high in fat to be smart choices. Opt
instead for skim milk, low-fat yogurt, buttermilk and
low-fat or part-skim cheeses. Other good sources are
salmon and sardines (bones included), broccoli,
dried beans, blackstrap molasses, tofu, raisins, dried
figs, oysters and green leafy vegetables.
You can beef up the calcium in foods by making
a few adjustments as you cook.
When cooking stock, soups or stews that contain
bones, add a little vinegar or lemon juice or some
A tip for increasing cal- chopped tomatoes to the pot. The acid in these in-
cium in stock. gredients will help leach the calcium from the bones.
Stock made this way may have as much as 125 milli-
grams of calcium in each cup. That’s as much as you'll
find in % cup of cottage cheese.
Add skim milk to your finished soups just before
serving to increase calcium even further.
Make good use of instant nonfat dry milk. With
52 milligrams of calcium (and only 15 calories) per
tablespoon, it’s an excellent calcium booster. Add it
to fluid milk, yogurt, sauces, desserts, blender bever-
ages, dips, soups, salad dressings and hot cereal.
 High-Calcium Cookery 949

Bone-Builder Recipes
The following recipes can help you get started on
high-calcium cookery.

PIZZA NICOISE
DOUGH
Y% cup plus 2 tablespoons unbleached flour
Y% cup plus 2 tablespoons whole wheat pastry
flour
Ya teaspoon dry yeast
Ye cup skim milk
1 teaspoon olive oil
Ye teaspoon honey
TOPPING
cup thick tomato sauce
Y% cup red onion slices
teaspoon dried basil
clove garlic, minced
SX
— can (3% ounces) low-sodium water-packed
sardines
— cup shredded part-skim mozzarella cheese

To make the dough: In a medium-size bowl,

combine flours, yeast, milk, oil and honey. Knead for
5 minutes. Cover and let rest for about 10 minutes.
Preheat oven to 500°F.
Coat a pizza pan or baking sheet with vege-
table spray. Press dough in pan to form a 12-inch
round with raised edges. Bake for 5 minutes, or until
light brown.
To make the topping: In a medium-size bowl,
combine tomato sauce, onions, basil and _ garlic.
Spread on baked pizza shell. Arrange sardines over
sauce, then sprinkle with mozzarella. Bake for 5 min-
utes, or until cheese is golden and bubbly.
Yield: 4 servings
550 Cooking and Eating for Maximum Nutrition

CORN CREPES WITH BEAN PATE

Masa harina, used in these crepes, is a fine corn flour
popular throughout Mexico and Latin America.
Soaked in lime water, masa harina gives tortillas
their characteristic nutty-sweet flavor. Purchase the
commeal in Mexican or Spanish grocery stores or in
gourmet departments.
CREPES
Y cup masa harina
Y% cup unbleached flour
Y teaspoon turmeric
1 egg
Y% cup skim milk
Y% cup pureed com kernels
2 teaspoons oil
1 tablespoon snipped chives
PATE
cup cooked white beans
cup cooked pinto beans
cup minced fresh parsley
clove garlic, chopped
tablespoon lemon juice
teaspoon French-style mustard
KKK
eee

ASSEMBLY
10 thin stalks broccoli, steamed
cup shredded Monterey Jack cheese
SEEScup chopped tomatoes

To make the crepes: In a large bowl, mix masa

harina, flour, turmeric, egg, milk, corn, oil and chives.
Let stand for 10 minutes. The batter should be the
consistency of heavy cream. If it isn’t, thin with addi-
tional milk.
Heat a nonstick crepe pan over medium heat
and brush very lightly with oil. Add 2 tablespoons
batter to pan, swirl to cover the bottom completely,
then cook until top is dry and underside is lightly
brown. Flip and cook other side briefly. Cool on a
 High-Calcium Cookery 551

wire rack. Repeat with remaining batter, lightly brush-

ing pan with oil, when necessary.
To make the pate: In a blender or food proces-
sor, puree beans, parsley, garlic, lemon juice and mus-
tard until smooth.
To assemble: Place a portion of paté along
edge of each crepe. Lay a broccoli stalk on top, then
roll crepes to enclose filling. Arrange, seam-side
down, on an ovenproof serving platter. Sprinkle with
cheese. Broil for several minutes to warm crepes and
melt cheese. Sprinkle with tomatoes.
Yield: 10 crepes

PESTO; CHEESE
Serve as a spread for raw vegetables or whole grain
crackers or as a topping for baked potatoes.
4 cups plain yogurt
¥% cup tightly packed basil leaves
2 tablespoons sunflower seeds
1 teaspoon olive oil
1 teaspoon French-style mustard
1 clove garlic
Spoon yogurt into a sieve lined with cheese-
cloth and allow to drain overnight. Transfer to a me-
dium-size bowl.
Place basil, sunflower seeds, oil, mustard and
garlic in a food processor or blender and process for
10 to 15 seconds, or until a paste forms. Add to
yogurt, mixing with a spoon or wire whisk. Store in a
covered container in the refrigerator.
Yield: about 1% cups
552 Cooking and Eating for Maximum Nutrition

SMILING TOFU
This marinated tofu makes a face when you stuff it
with savory shrimp filling.
MARINADE
¥% cup chicken stock
1 tablespoon low-sodium soy sauce
1 tablespoon rice vinegar
1 teaspoon sesame oil
2 slices gingerroot, minced
1 clove garlic, minced
FILLING
3 ounces shelled, deveined shrimp
(7 or 8 medium)
3 scallions, chopped
2 slices gingerroot, chopped
Y% cup sliced water chestnuts
1 clove garlic, chopped
1% teaspoons cornstarch
1 tablespoon reserved marinade (above)
Y teaspoon sesame oil
ASSEMBLY
1 block (16 ounces) smooth, firm tofu
%, cup chicken stock
2 scallions, chopped
To make the marinade: In a shallow dish,
combine stock, soy sauce, vinegar, sesame oil, ginger
and garlic.
To make the filling: In a food processor or
blender, combine shrimp, scallions, ginger, water
chestnuts, garlic, cornstarch, marinade and sesame
oil, and process until well mixed. Set aside.
To assemble: Cut tofu into 4 equal triangles by
slicing an ““X” through block. Cut each triangle in half
horizontally to make 8 equal triangles. Make a pocket
in each triangle by slicing each piece as you would a
hamburger roll, starting at point and stopping % inch
 High-Calcium Cookery 593

from wide end. Place tofu in marinade. Soak for 10

minutes, then turn and soak for 10 minutes more.
Divide filling into 8 portions. Gently stuff trian-
gles, smoothing filled edges with your finger. Gee the
tofu smile?)
Coat a nonstick skillet with vegetable spray.
Place 4 triangles in the pan, standing them on their
filled edges. (The filling will not come out.) Cook for
1 minute on each edge. Then cook for 1 minute on
each flat side. Add % cup stock and simmer for 3
minutes. Flip triangles and simmer for 3 minutes
more. Remove to a serving platter. Repeat with re-
maining triangles and stock.
Add marinade to pan and reduce by half. Pour
marinade over tofu and sprinkle with scallions.
Yield: 4 servings

ORANGE-ALMOND CHEESE
Serve this as a breakfast cheese with warm muffins or
toast, or mixed into hot cereal. Or enjoy it as a dessert
with sliced apples or fruit kabobs.
4 cups plain yogurt
2 tablespoons raisins, minced
1 tablespoon slivered almonds, toasted and
chopped
1% teaspoons honey
1% teaspoons frozen orange juice concentrate
pinch of ground cinnamon
Spoon yogurt into a sieve lined with cheese-
cloth and allow to drain overnight. Transfer to a me-
dium-size bowl. Mix in raisins, almonds, honey, or-
ange juice concentrate and cinnamon. Store in a
covered container in the refrigerator.
Yield: about 1% cups
Cooking and Eating for Maximum Nutrition

ANTIPASTO WITH BAKED OYSTERS

OYSTERS
8 oysters on the half shell
Y% teaspoon French-style mustard
Y teaspoon fennel seeds, crushed
Y4 cup minced tomato, well drained
1% tablespoons minced scallions
SAUCE
Y cup plain yogurt
1 tablespoon instant nonfat dry milk
Y teaspoon French-style mustard
Y% teaspoon fennel seeds, crushed
ANTIPASTO
5 leaves kale (purple and green)
1 cup broccoli, steamed
1 can (6 ounces) salmon, drained and
chunked
8 dried figs
Y% cup ricotta cheese
To prepare the oysters: Preheat oven to 450°F.
In a 9-inch pie plate, arrange oysters in their shells. In
a small bowl, combine mustard and fennel. Spoon
over oysters. Bake for 10 minutes, or until oysters
change color from gray to whitish. Sprinkle with to-
matoes and scallions.
To make the sauce: In a small bowl, combine
yogurt, dry milk, mustard and fennel.
To make the antipasto: Line a serving platter
with kale. Arrange broccoli, salmon and oysters on
kale.
Slit the fat part of each fig with a sharp knife.
Using a small spoon or a pastry bag fitted with a small
tube, fill each fig with ricotta. Add to platter. Serve
with yogurt sauce. Use kale leaves to scoop up other
ingredients.
Yield: 4 to 6 servings
 Chapter (hee 595

The Health Scoop

on Ice Cream

mericans are notorious trend followers, es-

pecially when it comes to edibles. One year
crepes are in; the next year it’s quiche, followed by
pasta and kiwi dishes. But through all these years and
fickle food fads, one thing has remained constant—
our unflagging passion for ice cream.
Through thick (so to speak) and thin, feast or
famine, recession, depression, rainy days and holi-
days, Americans have consistently taken their licks Even health-conscious
and come back for more. Even now, when it seems people can’t resist ice
cream.
slightly out of character for a nation whose health
consciousness has recently been raised, ice cream
continues to be our major frozen asset.
According to the International Ice Cream Associ-
ation (IICA) in Washington, D.C., almost 924 million
gallons of ice cream were sold in 1986—that’s up
more than 4 percent from 1983 and almost 20 percent
from 1973, with the greatest growth in the newer high-
fat, super-premium ice creams.

Is Ice Cream More Nutritious

than Other Snacks?
While ice cream’s popularity has almost every-
thing to do with taste, there persists the belief that it’s
somehow a step above other snack foods on the
nutritional ladder. And that may indeed account for
its appeal among both the health-conscious and the
health-unconscious.
556 Cooking and Eating for Maximum Nutrition

Whichever you are, we think it’s time you were

exposed to the cold facts about ice cream’s nutri-
tional status and how it stacks up against other com-
mon snack foods.
First of all, you have to know what goes into ice
cream—and we’re talking about commercial variet-
Fancier brands are ies, not homemade—before you can level any judg-
higher in fat. ment against it. Basically, ice cream is made up of
cream and milk combined with sugar (table sugar,
corn syrup or honey), flavorings and fruits and nuts, in
various proportions. To be called ice cream, federal
standards require that vanilla contain at least 10 per-
cent butterfat and chocolate 8 percent. Most super-
market store brands fall into this “economy” cate-
gory. The more butterfat in the mix, the fancier the
name, so there are the upscale, premium and super-
premium (or gourmet) ice creams, with butterfat lev-
els reaching 18 to 20 percent in certain cases.
The amount of sugar in ice cream, on the other
hand, doesn’t vary. Since ice cream is formulated to
Why cold confections contain 15 to 16 percent sugar, sweetness is some-
are so sweet. times the most prominent taste. “Ice cream has to be
extra sweet,”’ says Gabe Mirkin, M.D., author of Get-
ting Thin, “because cold numbs the taste buds for
sweetness. Just let ice cream melt and see how much
sweeter it tastes than when it was frozen,” he says.

Cold, Creamy, Sweet—

and Not All Bad
On a more positive note, ice cream is, after all, a
dairy product and contains many of the same good
Ice cream contains things that other dairy products do. It can boast rea-
some protein, calcium
sonable amounts of protein, bone-strengthening cal-
and vitamin A.
cium (though this should never be a main dietary
source) and vitamin A—from 272 international units
for a typical ¥-cup (one large scoop) serving of the
lower-fat ice cream to 449 international units for
 The Health Scoop on Ice Cream 557

higher-fat ones. And it’s moderately low in choles-

terol and sodium.
If you read the labels, you'll also notice that
some manufacturers add stabilizers—such as guar
gum, carrageenan, locust bean gum (which all come
from plants) and gelatin—to protect the ice cream
from the temperature fluctuations known as “heat
shock.” These additives help prevent large ice crys-
tals, which tend to form when ice cream is partially
melted and then refrozen. Emulsifiers (such as
monoglycerides and diglycerides) help ensure easy
scooping.
According to Michael Jacobson, Ph.D., execu-
tive director of the Center for Science in the Public
Interest in Washington, D.C., “these additives never
killed anybody like eating too much fat will.”

Now for the Bad News....

Naturally, fat is about the worst thing (calorie-
wise and health-wise) going for ice cream, and
wouldn't you know, it’s the main ingredient that sepa-
rates ordinary ice cream from gourmet.
If you’re going to eat ice cream, you should
choose the one that’s the lowest in fat and also get the
one that’s lowest in calories, right? Yes, but there’s a ““Fluffier’’ ice creams
hitch, and it has to do with the amount of air that’s are lower in fat.

pumped into the ice cream (called ‘“‘overrun’’). The

lower-fat (economy) ones are usually the fluffiest, so
that a %-cup serving may not be satisfying, and you
might be inclined to eat more.
The denser or heavier (gourmet) ice creams have
very little added air, and because they are so concen-
trated, you may be satisfied with less.
Is ice cream really a superior snack? That de-
pends on what you’re comparing it with. Put against
apples, oranges or just about any other fruit or vege- How ice cream com-
table, no. What about other snacks? Let’s add up the pares with other
snacks.
calories of some common snacks and see how they
598 Cooking and Eating for Maximum Nutrition

compare to a dish of economy and gourmet ice

creams. The table, Nutritional Value of Ice Cream and
Other Snack Foods, on pages 560-61, lists typical
servings of popular snack foods, but if you’re not
typical, you could be getting less or more than the
amounts listed.
For the sake of comparison, we’ll use the lowest-
calorie ice cream (159 calories per serving) and the
highest (275 calories) and assume you'll be able to
hold it to the average /4-cup serving.
Let’s start with pretzels and beer. A typical serv-
ing of both adds up to 263 calories. By adding just one
more beer, you’ve managed to tally up 409 calories.
Cookies and milk add up to a quick 300 calories,
and that’s if you can stop at two cookies.
If you decide on a serving of soda and chips,
that’s 312 calories. You can see that in calories alone
a serving of the lower-fat ice cream is a clear winner.
Besides, with the exception of milk, the snack foods
we've mentioned don’t have the nutrients that ice
cream does, while they do contain some baddies,
such as excessive salt, fat and/or sugar.

Calcium in Your Snacks

‘What about a snack of crackers and cheese?”
you may ask. “‘That’s not as bad as other snacks, is it?”
Not as calorie-rich as As usual, there are pluses and minuses. How much
cheese and crackers. cheese do you eat? For the purposes of compiling the
table, two slices of American cheese sounded reason-
able. If you cut them into quarters, you’d lay them on
top of eight crackers, right? Want to wash it down
with anything? A soda, maybe? Okay, you've just
eaten 406 calories. That’s too much for one snack,
you say? Then let’s cut it back to one slice of cheese
and four crackers, plus the soda. Now the total is 278,
still more than the lower-fat ice cream.
We can’t forget to mention, however, that cheese
is a good source of calcium and protein. Unfortu-
nately, it’s also high in sodium and fat.
 The Health Scoop on Ice Cream 599

Or, say you've decided to be very responsible

about snacking, so you've switched to strawberry yo-
gurt. And you’re right—mostly. Yogurt is an excellent
source of protein, calcium and some vitamins. Best of
all, it’s very low in fat. But even strawberry yogurt has
a major drawback—sugar. And because of that, the
calories mount up to 260 for an eight-ounce serving.
But what’s lowest in calories may fail the per-
cent-of-fat test. In fact, that’s ice cream’s greatest
downfall. Look at the fat and calorie table again. Ice cream’s biggest
You'll see that ice cream rates as high as or higher drawback.
than candy bars, cheese, cookies, milk, and potato
chips, and tortilla chips rate as high or higher than ice
cream in percentage of calories from fat. The only
positive note here is that while the fat levels are unfor-
tunately high, the amount of cholesterol is on the low
side—about 30 milligrams for the lower-fat varieties
and 44 milligrams for the higher-fat ones. (Many doc-
tors recommend that cholesterol be kept to a maxi-
mum of 300 milligrams per day.)
Like any snack food, ice cream has its negatives
and positives. But there are more positives for ice
cream than for many other snacks. So we’re not about
to tell you to never, ever put a spoon in your mouth
again.
Instead, take a close look at your own diet and
lifestyle. Are you overweight? Do your meals consist
of lots of fast-food burgers and french fries? Do you
routinely eat sausage, bacon and other fatty meats? Is
the only exercise you get drawing your chair to the
table? Then adding ice cream to your diet could help
push both your calorie and fat consumption into the
danger zone.
But if fresh vegetables, fruits, whole grains,
chicken and fish are your mainstays and exercise is as
routine as brushing your teeth, then go ahead and When ice cream is the
enjoy your just desserts—once in a while. Only con- right choice.
sider softening the blow a little by choosing an ice
cream that’s lower in fat. Then put less in your dish
and smother it with fresh fruit, like peaches or berries.
 560 Cooking and Eating for Maximum Nutrition

Nutritional Value of Ice Cream

and Other Snack Foods

Product Portion Calcium

(mg.)

Vanilla ice cream*

Giant’s Wellesley Farms, 10.2% fat Y% cup 55
Acme’s Econo Buy, 10.2% fat Y% cup 64
Haagen-Dazs, 16.6% fat Ye cup 103
Frusen Gladje, 17.5% fat Y% cup 82
Apple t 1 10
Beer T 1 can (12 02z.) 18
Brownies, prepared from mix + 1 piece (2” sq.) Less than 0.02
Candy bar ft 1 2 oz.) 130
Cheese, processed American ¢ 2 slices (%4 oz. ea.) 261
Chocolate chip cookies, prepared
from mix £ 2 Less than 0.02
Milk, whole, 3.3% fat T 1 cup 291
Milk shake, vanilla, fast-food § 10 oz. 344
Orange fT 1 Se
Potato chips fF 1 oz. (14) 11
Pretzels + 1 oz. ©) 6.5
Saltines fF 8 4
Soda, cola flavor + 1 can (12 oz.) )
Strawberry yogurt £ 8 02. 280
Tortilla chips + 1 oz. (15) 30
ee

Nore: Where a dash appears, no data are available; food may or may not contain this element.

“Ice creams were analyzed by private laboratory.

+ Nutritional information from USDA Handbooks No. 8-1, 8-14.
+ Nutritional information calculated directly from package.
§ Nutritional information supplied by McDonald's.
 The Health Scoop on Ice Cream 561

Total Calories Protein

Calories from Fat (% of RDA
(%) for Adult Male)

159
181
aie
Zio
81
146
130
302
159 16.8

150
150 14.3
od L739
62
161 As high as 284
Ly 1,008
96 123
151 14
260
145 183
562 Chapter 14

Selecting and Storing

Vegetables for
Maximum Nutrition

egetables are generally good sources of potas-

sium, fiber and vitamins A and C. Some are
good sources of B complex vitamins, calcium, mag-
nesium and iron. Most are low in calories and fat. To
maximize those nutrients, keep the following points in
mind.

e The longer vegetables are exposed to air, heat,

and water, the more nutrients they lose.
Overexposure to air, e Vegetables consumed raw immediately after
heat and water destroys harvesting have the most nutrients and best taste.
nutrients.
e Freshly picked produce from a nearby farmers’
market or roadside stand is generally superior to veg-
etables that have been stored and then shipped in
from faraway places.
e When shopping, look for healthy-colored,
crisp vegetables with no signs of wilting or spoilage.

Here is a listing of some specific vegetables and

how to choose them.
Artichokes. Look for compact scales of a deep
green color. If artichokes are fresh, they will squeak
Giving artichokes the when rubbed against each other. If the leaves have
“rub’’ test. started to spread, they are past their prime. Store in
plastic bags or closed containers in the refrigerator for
up to five days.
Asparagus. Look for straight stalks with closed
tips. Wrap in moist paper towels, enclose in a plastic
 Selecting and Storing Vegetables for Maximum Nutrition 563

bag, and store in the refrigerator for up to five days.

An alternate storage method: Cut a thin piece off the
bottom of each stalk, then stand the stalk upright in a
tall container that has about an inch of water in the
bottom. Slip a plastic bag over the top to hold in
moisture.
Avocados. Also known as alligator pears, avo-
cados are really fruit, but they’re mostly used as a
vegetable. Look for avocados that are fairly heavy, Ripen them in a paper
solid and free of bruises or black spots. Allow hard bag.
avocados to ripen at room temperature in a paper
bag. When ready to eat, they'll feel soft if pressed
gently between the palms. Ripe uncut avocados can
keep in the refrigerator for four to seven days.
Broccoli. Stalks should be tender and firm, not
woody or limp. Flower buds should be tightly closed
and dark green. If flowers are yellow or starting to
open, the broccoli is past its prime. Plan to use soon
after purchase. Store broccoli in a plastic bag in the
refrigerator.
Garlic. Select firm, filled-out bulbs with clean
skins. Store in a cool, dry place in a ventilated garlic
jar or net bag. A hanging braid lasts a long time if How to store garlic.
properly cared for. If you must store garlic in the
refrigerator, keep it in a closed container to prevent
odor exchange with other foods.
Eggplant. Look for heavy, shiny eggplants that
have almost black, patent-leather-like skins and bright
green stem caps. The skin should feel firm when you
press it with your thumb. Large eggplants contain
more seeds and have tougher skins than small ones.
Store in the refrigerator in a covered container or
wrapped in plastic to minimize moisture loss. Use as
soon as possible.
Mushrooms. Look for firm mushrooms with
closed caps. Clean them with a damp paper towel ora
mushroom brush. Store in the refrigerator, either on a How to keep mush-
shallow tray covered loosely with a damp paper towel rooms fresh longer.
or in a paper bag. Use within a few days.
564 Cooking and Eating for Maximum Nutrition

Onions. Choose only firm bulbs with papery

skins. Avoid onions that have begun to sprout. Store
in a cool, dark, dry spot, preferably in a net sack for
good circulation. Don’t store near potatoes, which
give off moisture and can cause onions to sprout or
to rot. ;
 Chapter its 565

A Harvest of
Delights to Lighten
Your Blood Pressure

ou might want to go out today and hug a farmer.

The prescription to keep your blood pressure
down may be growing in his fields and orchards or
grazing in his pastures right now.
Potassium, abundant in fresh fruits and vegeta-
bles, and calcium, found largely in dairy products,
may be science’s latest dietary one-two punch in the
fight against hypertension.
During the last few years, studies have uncovered
what may be an important link between dietary cal-
cium and potassium and blood pressure. Researchers Battling high blood
have found that people whose diets are potassium- pressure with calcium
and potassium.
rich—vegetarians, for example—have a low inci-
dence of hypertension even if they’re genetically dis-
posed to the condition and don’t control their salt
intake.
Large-population surveys revealed the calcium
connection: People with high blood pressure don’t
seem to get much calcium in the form of dairy prod-
ucts (and it’s hard to get much without them). In one
test, people who were mildly hypertensive and had
lower levels of serum calcium experienced a moder-
ate but consistent drop in blood pressure when they
were given oral calcium supplements. The biggest
improvement was seen in those people who had the
lowest levels of calcium to start with. Studies like that
are leading doctors to believe that there’s much,
much more to controlling blood pressure than cutting
back on salt.
566 Cooking and Eating for Maximum Nutrition

Foods to Lower
Your Blood Pressure
The exact mechanisms by which the two essen-
tial nutrients regulate blood pressure continue to
evade researchers. But both appear to help the body
slough off excess sodium and are involved in impor-
tant functions that control the workings of the vascu-
lar system.
Of course, the studies are relatively recent, and
the evidence is far from voluminous. The calcium
The calcium/hyperten- theory, in particular, is still so novel it falls into the
sion link: ‘‘preliminary hot-controversy category. But even some of the most
but promising.”’
cautious find it convincing, such as the nutritionist
Patricia Hausman, author of The Calcium Bible. “It’s a
new idea,” says Hausman. “There aren't a lot of stud-
ies, as there are on sodium. I'd call it preliminary but
promising. The data there are impressive. I’m leaning
toward thinking there’s some effect here.”
For people who are used to the no-no diets for
hypertension, the studies are promising in another
way. “The thing that’s nice about potassium and cal-
cium is that they’re positive nutrients, things people
should eat more of,” says Arlene Caggiula, Ph.D.,
associate professor of nutrition at the University of
Pittsburgh Graduate School of Public Health. Dr.
Caggiula’s research focuses on dietary approaches to
hypertension, and she has designed well-balanced
diets for people with high blood pressure and educa-
tion programs to help them stick to them. ‘“‘With so-
dium you're saying to people, “You can’t eat it.’ With
potassium and calcium you're saying, ‘You can and
you should.’ ”’

A Summer Harvest
of “Good Medicine”
The other nice thing about potassium and cal-
cium is that they’re easy to swallow, especially in the
 A Harvest of Delights to Lighten Your Blood Pressure 567

form of fruits and vegetables. Not only is it easy to

work these two pressure-lowering nutrients into your Tasty calcium-
menu, you can get them—deliciously—in the same potassium dishes.

dish. In fact, you can virtually build a diet around the

- foods they’re in. All it takes is a little knowledge and a
lot of ingenuity.
Getting potassium isn’t tough. “It’s in almost ev-
erything,” says Hausman. It’s abundant in foods that
are wonderful for you: fruits, vegetables, beans, fish,
poultry and lean cuts of meat.
Getting calcium is not quite as easy. Unfortu-
nately, the foods that contain the most calcium tend
to contain a fair amount of fat and sodium, too, which
can spell trouble for hypertensives on fat- and salt-
controlled diets. Difficult does not mean impossible,
however. There are plenty of low-fat, low-sodium
dairy alternatives—and some calcium-rich foods that
haven’t even been near the barnyard.
If you aren’t hypertensive, by all means don’t
scratch milk and milk products off your shopping list.
‘‘For people to avoid milk because of sodium—unless The number one food
you have hypertension—is not a good idea,” says source of calcium.

Leonard Braitman, Ph.D., a statistical consultant who

worked on early calcium and hypertension studies.
‘For some people, like the lactose intolerant, it’s not a
good food. For other people, it’s hard to beat. It’s
hard to make up your calcium intake with other foods.
People should be aware that for people who have
hypertension, sodium is a problem. But for others it’s
probably not.”

Creative Cookery
in Ten Easy Steps
Ready to start a diet that may last—and
lengthen—a lifetime? The first rule of all good menu
planning is to make a list. Refer to the tables, Best Designing your own
Food Sources of Calcium, on pages 568-69, and Best antihypertension diet.
Food Sources of Potassium, on pages 570-71, to help
Cooking and Eating for Maximum Nutrition

Best Food Sources of Calcium

Food Portion Calcium

(mg.)

Swiss cheese (LS) 2 02. 544

Provolone cheese DiOzZ: 428
Monterey Jack cheese 2 02. 424
Yogurt, low-fat* (LS) 1 cup 415
Cheddar cheese 2 oz. 408
Muenster cheese 2ZiOz 406
Colby cheese 207; 388
Brick cheese 2 02. 382
Sardines, Atlantic, drained
solids* 3 02. 372
American cheese 2 oz. 348
Ricotta cheese, part-skim Ye cup 337
Milk, skim* CLF, LS) 1 cup 302
Mozzarella cheese 2 oz. 294
Buttermilk* 1 cup 285
Limburger cheese 2i0z! 282
Ice milk, soft-serve* (LF, LS) 1 cup 274
Salmon, sockeye, drained
solids* CLS) 3 02. 271

Sources: Adapted from

Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Merrill (Washington, D.C: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1,
by Consumer and Food Economics Institute (Washington, D.C.: Agricultural
Research Service, U.S. Department of Agriculture, 1976).
Nutritive Value of American Foods in Common Units, Agriculture Handbook No.
456, by Catherine F. Adams (Washington, D.C.: Agricultural Research Service,
U.S. Department of Agriculture, 1975).

you design your own hypertension diet. We've

marked the high-calcium foods that are low in fat and
salt and high in potassium to help you make healthy
choices. And here are a few tips to get you started.
1. Exercise your ingenuity. When you take a
look at that list, envision new combinations of familiar
foods: yogurt and bananas, salmon fillet with potatoes
and broccoli, raisins and nuts. Imagine half a canta-
 A Harvest of Delights to Lighten Your Blood Pressure 569

Food Portion Calcium

(mg.)

Ice cream* 1 cup 176

Ice milk* CLF, LS) 1 cup 176
Tofu CLE LS) 3 oz. 174
Pizza, cheese ¥% of 144
14” pie
Blackstrap molasses (LF) 1 tbsp. 137
Soy flour, defatted Y% cup 120
Almonds* (LS) Y% cup 100
Broccoli, cooked* (LF, LS) % cup 89
Soybeans, cooked* (LS) Y% cup 88
Parmesan cheese 1 tbsp. 86
Collards, cooked (LF, LS) Y% cup 74
Dandelion greens, cooked Ye cup 74
Mustard greens, cooked (LF, LS) Y% cup 52
Kale, cooked (LF, LS) Y% cup 47
Broccoli, raw* CLF, LS) 1 cup 42
Chick-peas, cooked (LS) Y% cup 40

Nutrient Data Research Branch, U.S. Department of Agriculture, Washington,

D.C.
NOTES:
If LF follows a food name, it indicates a low-fat food.
If LS follows a food name, it indicates a low-sodium food.

*Food is also high in potassium.

loupe filled with a scoop of ice milk or ricotta cheese.

Think about a summer cooler made in the blender
from orange juice, bananas and nonfat dry milk. Be-
fore you crack open a cookbook, experiment with
your own combinations.
2. Browse through your cookbooks. Every
home cookbook library is chock-full of recipes that
are bypassed in lieu of family favorites. To rediscover
570 Cooking and Eating for Maximum Nutrition

Best Food Sources of Potassium

Food Portion Potassium

(mg.)

Potato, baked 1 medium 844

Avocado VY 602
Raisins Y% cup 545
Sardines, Atlantic, drained
solids* 3 oz. 501
Flounder, baked 3/02: 498
Orange juice 1 cup 496
Banana 1 471
Apricots, dried Y% cup 448
Squash, winter, cooked Y cup 445
Cantaloupe Y% medium 413
Skim milk* 1 cup 406
Sweet potato, baked 1 medium 397
Salmon fillet, cooked* 3. OZ. 378
Buttermilk* 1 cup 371
Whole milk* 1 cup 370
Round steak, trimmed of fat,
broiled SO. 302

Sources: Adapted from

Composition of Foods, Agriculture Handbook No. 8, by Bernice K. Watt and
Annabel L. Merrill (Washington, D.C.: Agricultural Research Service, U.S. Depart-
ment of Agriculture, 1975).
Composition of Foods: Dairy and Egg Products, Agriculture Handbook No. 8-1,
by Consumer and Food Economics Institute (Washington, D.C.: Agricultural
Research Service, U.S. Department of Agriculture, 1976).
Composition of Foods: Legumes and Legume Products, Agriculture Handbook
No. 8-16, by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition
Information Service, U.S. Department of Agriculture, 1986).
Composition of Foods: Nut and Seed Products, Agriculture Handbook No. 8-12,
by Nutrition Monitoring Division (Washington, D.C.: Human Nutrition Informa-
tion Service, U.S. Department of Agriculture, 1984).

Scanning recipes that combos that will help lower your blood pressure, start
are high in potassium by consulting the indexes of your old standbys for the
and calcium.
ingredients featured in the two tables. Then zero in on
dishes that are low in calories, fat and sodium. (Many
recipes will still work even if you cut back on salt and
fat.) You may discover new combinations of potas-
sium- and calcium-rich foods that have been right
under your nose for years. (If you reach a dead end,
 A Harvest of Delights to Lighten Your Blood Pressure 571

Food Portion Potassium

(mg.)

Cod, baked 3 02. 345

Great Northern beans, cooked Y% cup 344
Sirloin, trimmed of fat, broiled 3 Oz. 342
Apricots, fresh 3 313
Beef liver, pan-fried 3 Oz. 309
Haddock, fried SIOZ: 297
Pork, trimmed of fat, cooked 3 oz. 283
Tomato, raw 1 279
Leg of lamb, trimmed of fat,
cooked 3 Oz. 274
Turkey, light meat, roasted 3 02. 259
Perch, fried 3 02. 243
Tuna, drained solids SIOZ: 225
Chicken, light meat, roasted 3 02. 210
Broccoli, cooked * Y cup 12

Composition of Foods: Vegetables and Vegetable Products, Agriculture Hand-

book No. 8-11, by Nutrition Monitoring Division (Washington, D.C.: Human
Nutrition Information Service, U.S. Department of Agriculture, 1984).
Nutritive Value of American Foods in Common Units, Agriculture Handbook No.
456, by Catherine F. Adams (Washington, D.C.: Agricultural Research Service,
U.S. Department of Agriculture, 1975).
The Calcium Bible, by Patricia Hausman (New York: Rawson Associates, 1985).
Nutrient Data Research Branch, U.S. Department of Agriculture, Washington,
Byer

*Food is also high in calcium.

your local library probably has shelves of cookbooks

to give you ideas, and many may feature recipes low
in calories, fat and sodium.)
3. Feature foods with high amounts of po-
tassium and calcium. Not only can you get potas-
sium and calcium in the same dish, you can get them
in the same food. A few of the foods that are high in
both nutrients are: sardines, scallops, skim milk, broc-
572 Cooking and Eating for Maximum Nutrition

coli, salmon, buttermilk, whole milk, soybeans,

blackstrap molasses, navy beans, almonds, ice milk
and yogurt. If you’re exercising your ingenuity, you
can probably see a whole meal literally from soup to
nuts, using just a few of these double-duty foods.
4. Stock up on low-fat yogurt. “It’s a real bo-
nanza food,” says Dr. Caggiula. Not only is it low in fat
A nearly perfect and relatively low in sodium, it’s high in calcium and
antihypertension food. potassium and can be used for everything from salad
dressing to dessert. “Plain low-fat yogurt alone has
350 milligrams of potassium, and flavored low-fat yo-
gurt has an average value of 450 milligrams,” says Dr.
Caggiula. ‘“The best thing is that the low fat is even
higher in potassium than regular yogurt.” For high
amounts of calcium, look for low-fat yogurt to which
the manufacturer has added nonfat milk solids, sug-
gests Patricia Hausman. It adds considerably more
calcium and no more fat. She also suggests “dressing
up” plain yogurt with potassium-rich foods such as
frozen orange juice concentrate, raisins, sliced fresh
fruit or shredded raw vegetables. If you’re not a yogurt
fan, you can get all its benefits by hiding it in blender
shakes with fresh fruit and a sweetener such as honey
or aspartame or in cold fruit soups.
5. Treat yourself to a Banana Smoothie.
You can add high potassium and calcium nonfat milk
A supercharged potas- solids to dishes simply by adding nonfat dry milk.
sium/calcium breakfast. Two tablespoons of nonfat dry milk added to half a
glass of skim milk boosts the calcium from 150 to 255
milligrams. Add a banana, as Hausman does in her
Banana Smoothie, and you've got a supercharged po-
tassium/calcium breakfast.
To make a Banana Smoothie, combine % cup
skim milk, 4 cup nonfat dry milk, 4% tablespoon pea-
nut butter, a very ripe banana, one to two packets
aspartame or 1 tablespoon honey and two ice cubes
in a blender and process until smooth. One caveat:
Though low in fat and sodium, this delicious drink is
high in calories—282 per serving. If you're dieting, it’s
not the best snack or thirst quencher but a great and
nutritious breakfast or lunch.
 A Harvest of Delights to Lighten Your Blood Pressure 573

When adding nonfat dry milk to milk products,

use these proportions: 2 tablespoons milk powder to
Y% cup milk, 4 cup milk powder to 1 cup milk; 6
tablespoons milk powder to 14% cups milk and 2 cup
milk powder to 2 cups milk.
6. Reach for ricotta. While cottage cheese and
fruit may be a favorite summer lunch, you can sub-
stantially increase the amount of calcium in the meal A high-calcium cheese.
by substituting ricotta. Though it also has more fat and
calories than cottage cheese, ricotta has about 260
milligrams of calcium in % cup compared to only
about 80 milligrams in cottage cheese. You can cut
out some fat by using part-skim ricotta or by mixing it
with low-fat cottage cheese. It’s great served with
high-potassium vegetables, too.
7. Toss together a stir-fry pizza. Make your
own pizza dough—or buy it ready-made—but don’t
use the usual toppings. Vegetables like carrots, on- Special toppings for
ions, peppers and broccoli (which is also high in pizza.

calcium), either stir-fried in a bit of oil or steamed,

take the place of tomato sauce. Top with part-skim
mozzarella cheese and bake as usual.
8. Improvise with canned pink salmon.
Salmon is high in potassium and calcium—because of
the tiny bones you can eat—and mixes well with
cheese and vegetables. Served hot with vegetables or
as the star of a cold vegetable-pasta salad, salmon can
become a staple of your blood pressure diet.
9. Use soy foods for a calcium payoff. If you
have to restrict your dairy intake, soy foods such as
tofu and some cooked beans can provide a modest A good alternative to
amount of calcium. Tofu, in particular, can be used in milk products.
place of cheese in many dishes. It has about 150
milligrams of calcium per four-ounce serving. And it
now comes packaged and tastes just like that summer
treat, ice cream.
10. Enjoy shrimp, the special occasion star.
Though high in cholesterol, shrimp is a fair source of
calcium and a delicious ingredient of a vegetable stir-
fry high in potassium.
574 Chapter 16
A Healthy
Sandwich Sampler

lot of folks think there’s nothing new under

the bun. “Sandwiches are just sandwiches,’
they say. “Big deal.”
But sandwiches—with plenty of nutritious good-
ies tucked between two slices of whole grain bread—
can be both handy and healthy.
There’s really no trick to it—you just have to be
willing to experiment. You can stuff your sandwiches
Try no-salt condiments. with vegetables, fish, fruit, nuts or eggs in any com-
bination that pleases your taste buds. For toppers, you
can use dressings made with tasty herbs and low-fat
yogurt instead of salt and mayonnaise. And give the
new no-salt mustards, ketchups and pickles a try.
But that’s not all. You can vary the outside as well
as the inside of your sandwiches. Of course, whole
Experiment with breads. wheat bread is always welcome, but rye, pumper-
nickel or pita may be just the thing to make your
sandwiches sing.
Whether you like them hot or cold, plain or
fancy, open-faced or closed, you can make sand-
wiches that stack up against the best. Just think of the
possibilities.

Choice Sandwiches,
Fast and Easy
We've done a little of the thinking for you, and
here are some of our best sandwich ideas.
 A Healthy Sandwich Sampler 575

PETITE PATE SANDWICHES

— pound chicken livers
small onion, chopped
_ tablespoon butter or margarine
pinch of ground sage
pinch of dried thyme
pinch of dried rosemary
1 teaspoon prepared mustard
dash of hot pepper sauce
4to6 crescent rolls
Ywto% cup coarsely chopped pimientos
wYton cup parsley sprigs
In a medium-size skillet, sauté chicken livers
and onions in butter or margarine for 1 to 2 minutes.
Add sage, thyme, rosemary, mustard and hot pepper
sauce and sauté until livers are cooked. Place mixture
in a food processor and puree, then chill.
Slice rolls in half horizontally. Spread bottoms
with paté. Top with pimientos and parsley and replace
tops of rolls.
Yield: 4 to 6 servings

GUACO TACOS
2 avocados, chopped
¥%to’ cup thinly sliced scallions
Z tablespoons lemon juice
% to 2 teaspoon hot pepper sauce
8 taco shells
cup shredded cheddar cheese
cup shredded lettuce
—S— cup chopped tomatoes
In a large bowl, combine avocados, scallions,
lemon juice and hot pepper sauce. Spoon into taco
shells. Top with cheese, lettuce and tomatoes.

Yield: 4 servings
576 Cooking and Eating for Maximum Nutrition

SIMPLE SALMON SANDWICHES

1 tablespoon mayonnaise
Y% cup plain yogurt
2 tablespoons chopped fresh dill
— can (15% ounces) salmon, drained and
flaked
8 slices whole wheat bread, toasted
8 scallions
8 thin slices Swiss cheese
In a small bowl, combine mayonnaise, yogurt
and dill. In a medium-size bowl, mix salmon with half
of the dressing.
Spread salmon salad on four slices of toast.
Place two scallions on top of each sandwich. Roll up
slices of Swiss cheese and place two on each sand-
wich. Spread remaining slices of bread with remain-
ing dressing and place on top.
Yield: 4 servings

MED CLUB
2 tablespoons olive oil or other vegetable oil
1 large eggplant, cut into 42-inch cubes
1 sweet red pepper, minced
1 onion, minced
3 cloves garlic, minced
% cup tomato sauce
2 tablespoons chopped fresh parsley
6 whole wheat pitas
Y% pound thinly sliced cooked turkey breast
4 hard-cooked eggs, thinly sliced
¥% pound thinly sliced provolone cheese
In a large, heavy skillet, heat 1 tablespoon oil
and sauté eggplant over medium-high heat, stirring
often, for 5 minutes, or until almost cooked through.
Add remaining oil, peppers, onions and garlic. Sauté
for 1 to 2 minutes. Add tomato sauce, reduce heat to
medium and continue cooking until thick, about 5
minutes. Stir in parsley.
 A Healthy Sandwich Sampler 577

Cut pitas in half horizontally to make 12 slices.

Roll up turkey slices and place on four of the pita
bottoms, then top with sliced egg. Place a pita slice on
each sandwich as the middle layer. Spoon on egg-
plant mixture. Roll up provolone slices and place on
top of eggplant. Place remaining pita slices on top
and cut sandwiches into quarters.
Yield: 4 servings

ZESTY PESTO HERO

Pesto, the Genoese sauce based on basil, cheese,
garlic and oil, is not just for pasta or potatoes. As a
sandwich spread, it blends beautifully with any salad
vegetable from arugula to zucchini, stacked as high
as you please!
2 cloves garlic
1% cups loosely packed fresh basil
Y cup pine nuts
%4 cup grated Parmesan cheese
3 to 5 tablespoons olive oil or other vegetable oil
2 loaves whole wheat French bread
2 tomatoes, thinly sliced
1 red onion, thinly sliced
12 mushrooms, thinly sliced
In a food processor, mince garlic. Add basil
and pine nuts and process until well minced. Add
cheese and process until well blended. With the mo-
tor running, slowly pour in oil, adding only enough to
make a thick spread. Continue processing until well
blended.
Cut loaves of bread in half crosswise, then
slice each piece in half horizontally. Spread cut side
of each piece with pesto. On four bottom pieces,
place a layer of tomatoes, then onions, then mush-
rooms. Place remaining pieces on top.
Yield: 4 servings
578 Cooking and Eating for Maximum Nutrition

CURRIED CHICKEN AND

FRUIT SANDWICHES
cups cubed cooked chicken
cup chopped walnuts
cup halved grapes
scallions, sliced
tablespoons chopped fresh parsley
tablespoons mayonnaise
cup yogurt
teaspoons curry powder
slices pumpernickel bread
nectarines, peaches, apples or pears, thinly
sliced
In a large bowl, combine chicken, walnuts,
grapes, scallions and parsley. In a small bowl, com-
bine mayonnaise, yogurt and curry powder.
Mix dressing into chicken mixture, then spoon
salad onto six slices of bread. Top with fruit slices and
remaining slices of bread.
Yield: 6 servings

ELEGANT MUSHROOM-CHEESE
SANDWICHES
2 tablespoons butter or margarine
1 cup minced mushrooms
1 tablespoon whole wheat pastry flour
| cup milk
2 tablespoons minced fresh basil or
1 tablespoon dried basil
16 asparagus spears
4 slices whole wheat toast
cup shredded cheddar cheese
In a medium-size saucepan, melt butter or
margarine. Add mushrooms and sauté for 3 to 5 min-
utes. Stir in flour, reduce heat to low and cook for 1 to
2 minutes. Stir in milk gradually, blending well. Add
 A Healthy Sandwich Sampler 579

basil and continue cooking over low heat, stirring

frequently, until thick.
While sauce cooks, cut bottoms of asparagus,
leaving 4- to 5-inch spears. Steam asparagus. Lay four
asparagus spears on each slice of toast, then top each
with one-quarter of the cheese. Place sandwiches on
broiler pan and broil until cheese is bubbly. Place on
serving plates and top with sauce.
Yield: 2 to 4 servings

SALAD-BAR SANDWICHES
WITH SIX-HERB DRESSING
Y% cup plain yogurt
1 tablespoon mayonnaise
1 tablespoon ketchup
1 teaspoon minced fresh parsley
1 teaspoon minced chives
Y% teaspoon dillweed
Y% teaspoon dried basil
pinch of dried tarragon
pinch of dried thyme
1 cup shredded or chopped cabbage
1 cup shredded carrots
¥% cup alfalfa sprouts
¥Y% cup chopped tomatoes
¥% cup chopped cucumbers
¥Y cup shredded cheddar cheese
4 whole wheat pitas
In a medium-size bowl, combine yogurt, may-
onnaise, ketchup, parsley, chives, dillweed, basil, tar-
ragon and thyme and mix well.
In a large bowl, toss together cabbage, carrots,
sprouts, tomatoes, cucumbers and cheese. Cut off an
edge of each pita to form pockets. Spread inside of
each pita with dressing, then stuff with the vegetable
mixture.

Yield: 4 servings
Cooking and Eating for Maximum Nutrition

WOK ’N’ ROLL

4 whole wheat sandwich rolls, cut in half
horizontally
Y% cup beef stock
1% teaspoons cornstarch
2 teaspoons low-sodium soy sauce
Y% pound beef round or sirloin, cut into thin
strips
1 tablespoon peanut oil
1 green or sweet red pepper, cut into thin
strips
1 carrot, shredded
1 onion, cut in half crosswise and sliced
3 cloves garlic, minced
Y% pound mushrooms, sliced
pinch of ground red pepper
Hollow out each roll slightly by carefully re-
moving some of the bread from the inside. Place rolls
hollow-side up on serving plates.
In a medium-size bowl, combine stock, corn-
starch and soy sauce and set aside.
In a wok or large skillet, stir-fry beef in oil just
until browned. Add peppers, carrots and onions and
stir-fry for about 30 seconds. Add garlic and stir-fry for
another 30 seconds. Add mushrooms and continue
stir-frying for 1 minute.
Add ground red pepper, pour in stock mixture
and cook just until sauce thickens slightly, stirring
occasionally. Spoon mixture onto rolls and serve im-
mediately.
Yield: 4 servings
 Chapter a 581

Low Sodium
from Soup to Nuts

reat news! The food accent of the 1980s is

on zingy flavor without salt.
Around the country, chefs are being trained to
season their dishes so that when salt is removed,
flavor isn’t. The nation’s food companies are develop- The new era of low-
ing lines of low-salt and no-salt products, and super- sodium eating.
markets are stocking them. Restaurants are offering
no-salt gourmet dinners. Airlines and cruise lines are
happy to serve low-sodium dishes.
Yes, it’s now possible to travel, entertain or go
out on the town and enjoy foods that dance in your
mouth but have hardly a grain of salt.
Of course, that makes not only your taste buds
happy but your heart as well. Innumerable scientific
studies have shown that there’s a link between high-
sodium intake and high blood pressure and that cut-
ting back on sodium may help normalize blood pres-
sure.
So be good to yourself and get in on the low-
sodium boom. How? Do a little preliminary sodium
sleuthing before you venture forth. Are you dining out, Dining out the low-salt
for instance? Check the restaurant to ascertain how way.
they are using the saltshaker back in the kitchen.
That’s what we did, and here’s what we discovered.

How the Pros Cut the Salt

We present here, of course, only a sampling of
the use—or nonuse—of the saltshaker in the nation’s
582 Cooking and Eating for Maximum Nutrition

restaurants. We suggest you do your own research in

your hometown. Most chefs, we have found, are
aware of the public’s desire for less salt and are both
creative and cooperative in their efforts to prepare
healthy food without sacrificing good taste.
At the elegant Four Seasons in New York City,
where chef Seppi Renggli has developed some inno-
Special seasonings re- vative techniques for enhancing flavor without salt,
place salt. you will find many items on the menu that are skill-
fully prepared without a grain of the stuff. For exam-
ple, the whole wheat linguine with breast of quail is
seasoned with garlic, shallots and cilantro. The bass
and eggplant dish is flavored with a sweet red pepper
pureé, spiked with a bit of hot red pepper. These salt-
free menu items, dubbed Spa Cuisine, are proving to
be very popular, manager Alex vonBidder told us.
If, however, you would prefer another item on
the menu not included in the Spa Cuisine, you can
Ask the chef to skip the request that no salt be added to the dish of your
salt. choice. In dishes that are made entirely from scratch,
on the spot, that’s rarely a problem. Soups and sauces
may be exceptions. And the chef will compensate for
the lack of salt with a judicious use of herbs and
spices that will enhance the flavors of your particular
dish.
In Hanover, New Hampshire, at the Hanover Inn,
chef Michael Gray told us that very little salt is used
behind the scenes. Since everything is made to order,
that little bit can be eliminated and flavors enhanced
with herbs, spices, fruit juices or vegetables. ‘‘Almost
any dish, because it’s cooked to order, can be pre-
pared with little or no salt. And, when food is cooked
fresh with local seasonal ingredients, flavors need
little or no enhancement.”
At the Blue Willow, also in New York City, they
use nary a grain of salt in their cooking and make their
A salt-free tomato own salt-free tomato sauce and salt-free spaghetti
sauce. sauce, says chef Seth Lowenstein. They also provide
commercial salt-free dill pickles and no-salt mustard,
chutney and ketchup. Dishes that contain substances
 Low Sodium from Soup to Nuts 583

containing salt, such as cheese and bacon, are noted

on the menu. Hamburgers and cheeseburgers have
no added salt but are served in rolls that contain some
salt. You may request low-sodium whole wheat Italian
bread to replace the bun.
At La Normande and Le Bistro in Pittsburgh,
where all dishes are made to order, chef Cathy

How Difficult Is It
to Shake the Habit?
As with yogurt and brussels sprouts, acquiring
a taste for low-sodium fare takes time—about
two months.
That’s what a group of volunteers found
out when they attempted to gradually reduce
their salt consumption for an experiment con-
ducted by scientists at the University of Penn-
sylvania. For the first two months, they were
allowed to eat anything they wanted, giving
no thought to the amount of salt they were
eating. They were then instructed to start re-
ducing their sodium intake and were given a
list of foods to avoid. Within two months, they
discovered they were getting by quite happily
on half the amount of salt they used to prefer
(American Journal of Clinical Nutrition).
Their taste preference was tested by us-
ing Campbell’s low-sodium soup and having
salt added until the soup reached a level they
considered tasty.
“Before they started restricting sodium,
the level of salt they desired equaled about
the same as in a regular can of soup,” says
Gary K. Beauchamp, Ph.D. “After two to three
months, their preference was reduced by
two-thirds to half the amount of salt.”
584 Cooking and Eating for Maximum Nutrition

Armburger uses very little salt in food preparation.

Using salt-free stocks. Upon request, she will eliminate salt entirely. “I pre-
pare my own salt-free stocks using the process of
reduction to intensify flavors,” says Armburger.

Travel Meals
Can Be Low in Sodium
To cut sodium intake while you travel, plan
ahead. If you are planning a trip by air, you have only
to call the airline and request low-salt or salt-free
meals at least 24 hours before takeoff.
“If you are planning a short cruise, say one or
two weeks, just inform your travel agent when you
Taking a low-salt cruise. book. If you neglect to do that, inform the cruise line
at least one week before departure,” says Tom Mittl of
the Mitt] Travel Agency in Allentown, Pennsylvania.
“On the Carnivale line, it is suggested that you explain
your dietary needs to the maitre d’ on the day of
embarking. You may then see the menus for the week
and choose the items you desire. That way there will
be no waiting at mealtime.
“If you're taking a longer cruise—on an ocean
liner, for instance—you should notify your travel
agent or the cruise line as far in advance as possible—
at least one month before departure. There are as
many as seven meals a day served on these luxury
cruises, and if your cruise is for 14 to 30 days, that’s a
lot of food to shop for.”

“No Salt” at the Supermarket

Not too long ago, it was impossible to find pre-
pared foods without added salt. But now you have a
variety to choose from, and the number is growing.
Too busy to cook soup for dinner? Campbell’s
offers several varieties, all nicely flavored without
Less salt in canned added salt, including the ever-popular Chicken with
soups. Noodles, Chunky Vegetable Beef, Tomato, Split Pea,
Chunky Chicken Vegetable, Chunky Beef and Mush-
room. And as a boon to your quick, creative endeav-
 Low Sodium from Soup to Nuts 585

ors, several soups can double as sauces: Cream of

Mushroom, Chicken Broth and French Onion.
That great refresher, V-8 juice, is now available
without added salt, and so is Prego spaghetti sauce. In
response to consumer interest, Campbell’s has also
reduced the sodium in its regular line.
And that’s only the beginning. You can now en-
joy all your favorite tomato foods from pasta to pizza
the low-sodium way with Hunt’s no-salt-added prod- Low-salt tomato
ucts: tomato sauce, tomato paste, tomato juice, whole products
tomatoes, stewed tomatoes, ketchup and spaghetti
sauce.
Even canned vegetables have split with salt. Del
Monte no-salt-added green beans, corn, peas, beets
and tomato products are now on the grocer’s shelf.
A pioneer in the field, Libby’s offers a Natural
Pack line of mushrooms and several varieties of veg-
etables that are free of added salt and sugar. “We pick
that produce at its peak,”’ says a company spokesper-
son, “in order to get the best flavor nature provides.”
As a change from butter on your morning toast,
for sandwiches and as a lift for your uncooked con-
fections and baked goods, try the Westbrae line of Salt-free peanut butter.
sodium-free nut butters: almond, peanut, cashew and
sesame tahini. To make your snack low-sodium all the
way, spread any one of these butters on no-salt brown
rice wafers.
LaChoy Food Products has introduced three no-
salt-added oriental vegetables: bean sprouts, chop
suey vegetables and fancy mixed Chinese vegetables.
A welcome addition to the no-salt menu are the
Beatrice Foods’ Eckrich delicatessen and luncheon
meats, a category of foods that are usually highly Luncheon meats, minus
salted. The no-salt versions will certainly enhance the the salt.

low-sodium picnic basket.

Kikkoman Lite Soy Sauce, now generally avail-
able in supermarkets all over the country, provides
that rich soy flavor with 40 percent less sodium than
the standard sauce.
Lawry’s Season Salt-Free, available nationally,
provides the same pungent herb blend as the original
586 Cooking and Eating for Maximum Nutrition

An herb blend with po- Lawry’s—with an important difference. “Potassium

tassium instead of salt. = replaces the sodium,” says Robin Saylor, head of
Lawry’s test kitchen. Other Lawry products that pro-
vide flavor without added salt are Season Pepper,
Minced Onion with Green Onion Flakes and course-
ground Garlic Powder with Parsley.
Chico-San’s very popular rice cakes provide an
excellent low-sodium alternative to bread. All four
varieties are available with either no sodium or low
sodium. You'll find them in supermarkets and in
health food stores all over the country.
If you have been passing up the pickles because
of their traditionally high-sodium content, rejoice! Un-
A delightful new breed: der the Country Cuisine label, Salt Free Gourmet com-
pickles without salt. bines a blend of spices that delivers to your tongue a
delightful taste sensation that makes the lack of salt
go unnoticed. To perk up your picnic, try Country
Cuisine Kosher dill slices in your tuna, egg, potato and
macaroni salads. Country Cuisine no-salt-added spa-
ghetti sauce is available at gourmet shops and many
supermarkets. Soon you'll find Country Cuisine Dijon-
style mustard and a,salt-free ketchup.
“Quaker’s Mother’s Brand of cereals has no
added salt and is available now in health food stores
Some cereals with no and supermarket nutrition centers across the coun-
added salt. try,” says product manager Barbara Hinkes. “They
include Oat Bran, Whole Wheat Rolled Flakes, Rolled
Oats that make a thick porridge, Instant Oatmeal (a
finer flake that needs no stove-top cooking) and
Quick-Cooking Barley that is great for soups and vege-
table pilafs.” Quaker Rolled Oats in the familiar blue
and red tube, both quick and old-fashioned, have no
salt added and are available in most supermarkets.

Reduced-Salt Snacks and

Condiments
Would you believe that Angostura bitters has
been around since 1824? That’s right—for over 160
 Low Sodium from Soup to Nuts 587

years, and from the very beginning, according to a A 160-year-old flavor

company spokesperson, it has been a no-salt-added enhancer.
flavor enhancer made from exotic herbs and spices.
And it’s all natural! It’s a great condiment to pep up
your no-sodium soups, casseroles, pilafs and bever-
ages. Try it in tomato juice or ask for it with Perrier
and a twist of lime or lemon so you can socialize at
the bar and drive home! Because it is so versatile, you
may find it in the condiment, gourmet, sodium-free or
cocktail-mix section of your supermarket.
Diamond Crystal Specialty Foods has a great line
of no-salt products that they've been providing to
hospitals for five years and are now making available No-salt salad dressings.
to the public by direct mail. They are offering five
different types of low-sodium, sprinkle-on seasonings,
seven sauce mixes, four soup mixes and two bouillon
mixes—great for making low-sodium stock. Their
lemon crystals are a convenient flavor enhancer for
vegetables, salads and soups. Their meat loaf mix is
popular because it acts as a binder, retaining flavorful
juices. They also offer three flavors of low-calorie, no-
salt-added salad dressings, which are dry mixes to be
blended with yogurt, mayonnaise or buttermilk. To
get their catalog, write to Diamond Crystal Specialty
Foods, Inc., 10 Burlington Avenue, Wilmington, MA
01887.
Interestingly, the Contadina Company’s tomato
paste not only has no salt added now but it never did!
The same goes for their tomato puree. Furthermore,
Contadina has successfully reduced the salt in their
new tomato sauces by 25 percent.
The Hain Pure Foods Company makes many
healthful, no-salt products, among them canned and
dry soups, crackers, salad dressings, nut butters and
condiments.
As if that weren’t enough, you can now fill your
snack dish with unsalted, dry-roasted or whole natural
almonds, which are produced by Blue Diamond and
literally go from low-sodium soup to nuts!
588 Cooking and Eating for Maximum Nutrition

More Tasty, Low-Salt Foods

for You and Your Guests
One thing you don’t want to give visiting friends
and relatives is a big dose of sodium when they eat at
Low-salt entertaining. your house. Not too long ago, hosting low-sodium
dinners and parties was a bit of a problem. To control
the amount of salt, you had to make nearly everything
from scratch. Today, you can get a healthy hand from
the scores of no-salt and reduced-sodium products
available in stores. Here’s how to make every milli-
gram count when setting the buffet table.

e Make lavish use of club soda and sparkling

water. Most contain less than 50 milligrams of sodium
Great low-sodium in an eight-ounce glass. The best have less than 10
mixers. milligrams. Read labels and choose brands that say
they’re low sodium or unsalted.
e Choose low-sodium vegetable-juice cocktails.
A typical six-ounce serving has only 60 milligrams,
compared with more than 500 milligrams for the
salted kind.
e In the same vein, look for no-salt-added and
reduced-sodium tomato juices.
e Zip up tomato-based drinks with a bit of horse-
radish, a pinch of ground red pepper, a few drops of
hot-pepper sauce, a dash of bitters or a generous
squeeze of lemon or lime juice.
e Many low-sodium cheeses are making their
way into dairy cases. The sodium savings can be im-
Swiss cheese: naturally pressive. For instance, choosing a 50 percent re-
lower in sodium. duced-sodium cheddar can help you drop 130 milli-
grams of sodium per 1%-ounce piece. A 75 percent
reduced-sodium Swiss cheese can have as few as 26
milligrams per 1%-ounce slice. Even regular Swiss
cheese is a good idea because Swiss is naturally lower
in sodium than most other cheeses. Swiss cheese has
about half the sodium of cheddar or brick, for exam-
ple, and only about one-fifth as much as blue cheese.
Among other cheeses available in low- or reduced-
 Low Sodium from Soup to Nuts 589

sodium form are Gouda, Monterey Jack, Muenster

and colby.
e No-salt and low-sodium crackers abound.
Choose from wheat wafers, cracked-wheat wafers,
bran wafers, rye wafers, melba rounds, melba toast,
whole grain flatbreads, matzo, sesame crackers,
herbed wheat crackers, rice crackers, plain bread
sticks and sesame bread sticks. Other no-salt snack
foods include potato chips, pretzels, corn chips and
tortilla chips.
e Popcorn is a perennial holiday favorite. Make
your own in a hot-air popper (to cut calories), then
sprinkle it with your favorite herbs, no-salt herb Popping a low-salt
blends or cinnamon. snack.
e Pick no-salt and reduced-salt pickles. Choose
from kosher dills or spears, dill chips and bread-and-
butter chips.
e Add variety and color to a relish dish with no-
salt hot cherry peppers or pickled sweet peppers.
e If you use olives, be aware that black olives
usually contain about one-third the sodium of green
ones. But also be aware that neither is low sodium.
e Set out no-salt ketchup, mayonnaise, chili
sauce, spicy chutney, green-peppercom sauce and
barbecue sauce. Use low-sodium soy sauce.
e Seek out no-sodium mustards. Salted mustards
average 100 to 200 milligrams per tablespoon. Some
types go as high as 445 milligrams. No-salt and low-
sodium brands can slash that amount. Among the
varieties available are hot, mild, sweet, sassy, coarse,
smooth and lemon sesame.
e Season your homemade dips with no-salt herb
blends. There are a million (almost) to choose from.
Try lemon herb, hot and spicy, Italian, oriental, Herb blends make
French, Mexican, and curry. Look for blends that are great dips.
targeted especially for vegetables, fish, chicken and
steak.
e For fish dips, use no-salt tuna, salmon and
sardines. If you've got salted varieties you'd like to use
up, empty the cans into a colander, then rinse under
590 Cooking and Eating for Maximum Nutrition

cold water for a full minute. You’ll wash away up to 90

percent of the sodium.
e When shopping, scan the shelves for salt-free
vegetable dips, salsas, taco sauces, curry sauces, and
sweet-and-sour sauces, often sold with dietetic foods.
e Serve unsalted roasted almonds, cashews,
peanuts, sunflower seeds and mixed nuts. An ounce
Serve unsalted nuts. of unsalted cashews, for instance, can have less than
10 milligrams of sodium; salted cashews can weigh in
at around 180 milligrams.
e Buy peanuts that were roasted in their shell.
Roast chestnuts on an open fire (or in your oven). Be
sure to cut an X-shaped steam vent in each chestnut
before heating.
e Cook with unsalted margarine and butter. Or
use oil, which is salt-free.
e Standard baking powders contain a lot of so-
dium. A typical brand has 405 milligrams in a tea-
spoon. A low-sodium version can contain as little as 2
milligrams.

Quick ’n’ Tasty

Low-Sodium Recipes
Cooking from scratch, of course, gives you even
more control over sodium input. Here are seven reci-
pes that offer good taste without superfluous salt.
 Low Sodium from Soup to Nuts 591

CORNY MEAT LOAF

Serve at supper, then slice for “cold cuts.”
2 pounds ground beef
¥% cup rolled oats
¥% cup wheat germ
¥Y% cup minced onions
Y cup chopped fresh parsley
1 can (17 ounces) no-salt corn, drained
2 tablespoons no-salt herb blend
1 tablespoon low-sodium soy sauce
2 eggs, beaten
Y cup plain yogurt
Y% cup no-salt tomato juice or tomato soup
no-salt ketchup (optional)
In a large bowl, combine beef, oats, wheat
germ, onions, parsley, com, herb blend and soy
sauce. In a small bowl, mix eggs and yogurt, then add
to meat mixture. Add tomato juice and mix well.
Coat a 9 X 5-inch loaf pan with vegetable
spray. Place meat mixture in pan, packing firmly.
Place in refrigerator and allow to rest for 10 minutes.
Preheat oven to 350°F
Run a knife around edge of meat loaf to
loosen, then carefully turn out onto a large, shallow
baking pan. Coat loaf with ketchup, if desired. Place
pan on middle rack of oven and bake for 1% hours.
Remove from oven and allow to rest for 10 minutes
before slicing.
Yield: 6 to 8 servings
592 Cooking and Eating for Maximum Nutrition

STRING BEANS
IN TARRAGON MARINADE
Help yourself to these savory beans—you'll never
miss the salt.
tablespoons olive oil
cup plain yogurt
cup tarragon vinegar
large clove garlic, minced or crushed
pound string beans, lightly steamed
large onion, thinly sliced
cup shredded low-sodium cheddar cheese
In a large bowl, combine oil, yogurt, vinegar
and garlic. Add beans and toss, then marinate for 20
minutes at room temperature. Add onions, cover and
refrigerate for several hours, then toss with cheese.

Yield: 4 to 6 servings

NUTTY PATE APPETIZER

A zippy make-ahead paté to please the crowd.
tablespoons no-salt butter or margarine
cups sliced mushrooms
cup shredded zucchini or yellow squash
cup chopped onions
cloves garlic, crushed
cup cooked brown rice
egs
cups ground no-salt or low-salt nuts
cup chopped fresh parsley
cup wheat germ
teaspoons Worcestershire sauce
tablespoon no-salt herb blend
pinch of ground red pepper (optional)
In a large skillet, melt butter or margarine over
medium heat. Add mushrooms, squash and onions.
Sauté until onions are translucent but not brown. Add
 Low Sodium from Soup to Nuts 593

garlic and cook for 2 minutes. In a food processor or

blender, puree vegetables. Transfer mixture to a large
bowl.
In a food processor or blender, puree rice and
egg. Add rice mixture to vegetable mixture, then add
nuts, parsley, wheat germ, Worcestershire sauce, herb
blend and ground red pepper, if used. Mix well.
Preheat oven to 375°F.
Coat a 9 X 5-inch loaf pan with vegetable
spray. Turn paté mixture into pan, packing firmly.
Bake for 30 minutes, or until edges are golden. Re-
move from oven and let stand for 30 minutes. Unmold
paté and allow to cool to room temperature. Wrap
and refrigerate. Slice to serve.
Yield: 6 servings

TANGY RELISH SALAD

This soft-set relish makes a nice accompaniment to
meats, chicken or fish.
1 packet low-calorie lime gelatin dessert
1 cup boiling water
1% cups cold water
2 tablespoons lime juice
1% cups shredded cabbage
Y% cup chopped no-salt dill pickles
2 tablespoons prepared horseradish
1 tablespoon chopped pimientos
pinch of ground red pepper (optional)
In a 2- or 3-quart saucepan, add gelatin to
boiling water, then turn off heat and stir until gelatin is
dissolved, about 2 minutes. Add cold water and lime
juice. Chill until slightly thickened.
Stir in cabbage, pickles, horseradish, pimien-
tos and ground red pepper. Pour into a serving bowl
and chill until firm.
Yield: 6 to 8 servings
594 Cooking and Eating for Maximum Nutrition

QUICK CHICKEN DIVAN

A good way to use leftovers.
1 tablespoon no-salt butter or margarine
small onion, minced
small green or sweet red pepper, minced
clove garlic, crushed
cups broccoli florets, lightly steamed
cups cubed cooked chicken
— can (10% ounces) low-sodium
DOD
KK cream of
mushroom soup
tablespoon no-salt herb blend
teaspoon low-sodium soy sauce
teaspoon cornstarch
SScup shredded low-sodium cheddar or Swiss
cheese
In a medium-size skillet, melt butter or marga-
rine over medium heat. Add onions and peppers and
sauté until onions are translucent but not brown. Add
garlic and sauté for 2 minutes more. Set aside.
Arrange broccoli evenly in a 1%-quart baking
dish, then arrange chicken over broccoli.
Preheat oven to 450°F.
In a medium-size bowl, combine sautéed pep-
pers and onions, soup, herb blend, soy sauce and
comstarch. Pour over chicken and sprinkle with
cheese. Bake for 15 minutes.

Yield: 4 servings
 Low Sodium from Soup to Nuts 595

GARBURE
This is a traditional, thick soup of southwestern
France.

1 cup dried navy or pea beans, soaked

overnight
8 cups water
2 potatoes, sliced
2 onions, sliced
Lior 2 leeks, sliced
2 medium-size turnips, sliced
2 carrots, sliced
¥% cup dried split peas
1 bay leaf
1 teaspoon thyme
1 teaspoon marjoram
Y cup minced fresh parsley
3 cloves garlic, minced
1 hot chili pepper
Y% small head cabbage, shredded
¥% to 1 pound roasted pork, chicken, goose, duck or
other meat (optional)
Y% cup finely shredded low-sodium cheddar or
Swiss cheese
Drain beans and set aside.
In a large stock pot, bring water to a boil. Add
beans, potatoes, onions, leeks, turnips, carrots, split
peas, bay leaf, thyme, marjoram, parsley, garlic and
chili pepper. Cover and bring quickly to a boil, then
reduce heat and simmer for 1 hour.
Add cabbage and meat, if used. Cover and
bring quickly to a boil, then reduce heat and simmer
for 30 minutes.
Discard bay leaf and chili pepper. If meat was
used, remove and slice it, then place a serving in each
bowl. Add soup. Garnish with cheese.
Yield: 4 to 6 servings
596 Cooking and Eating for Maximum Nutrition

CHUNKY SALSA
Use this crunchy southwestern sauce on tacos,
tosadas, burritos—you name it!
1 medium carrot
¥Y small onion
1 can (14% ounces) no-salt stewed tomatoes,
drained
1 can (4 ounces) chopped green chili peppers
Y2 teaspoon ground cumin
Y% teaspoon dried oregano
hot pepper sauce, to taste
In a food processor, coarsely chop carrot and
onion. Add tomatoes and chop coarsely. (If working
by hand, chop carrot and onion, then chop tomatoes
and blend them in a bowl.)
Transfer tomato mixture to a serving bowl. Stir
in chilies, cumin, oregano and pepper sauce. Let
stand for 1 hour to blend flavors. Then serve at room
temperature.
Yield: 242 cups
 Chapter 18 597

More Sneaky
Maneuvers for
Cutting Back on Salt

here are a lot of outrageous ways to cut back on

your salt intake—like plugging up the holes in
your saltshakers, declaring the anchovy an endan-
gered species or sealing the golden gateway to fast-
food land.
Then there are subtle ways.
Take a cup of no-salt-added tomato sauce, for
instance. Add it to your stew in lieu of the salted
variety, and you'll be eliminating over 1,400 milli- Simple ways to cut
grams of sodium from your meal! sodium.
If life with green beans is just not bearable with-
out salt, then try them with half the salt. Blend the
unsalted variety Cless than 10 milligrams of sodium A 50 percent reduction.
per % cup) with the salted (442 milligrams). No loss
of the flavor here, either.

Sodium Cutbacks Are a Cinch

Getting the picture? With all of the brand-new
no-salt-added products on the market today, there are
literally hundreds of low-salt cuts you can make in
your meals without surrendering a smack of flavor.
And they aren’t all limited to the can.
So you say you really like that salty taste you get
when biting into a peanut butter cracker? Well, you
can go halfway here, too. Regular peanut butter atop Unsalted crackers are a
an unsalted cracker (or vice versa) can still have you plus.

yearning for more. The same is true of dip. Unsalted

crackers can only enhance the flavor of the dip. The
savings may be small, but they add up in the long run.
598 Cooking and Eating for Maximum Nutrition
2 _________ EEE

Low-sodium cheeses can be a boon to the cook

who wants to cut back. Some people missed sodium
when eating cheese out-of-hand, but the difference is
not as pronounced when a mixture of low-sodium
cheddar and Swiss is melted on a homemade pizza or
casserole.

Enhancing Flavors and

Seasoning with Less Salt
With some of the new flavor enhancers and
some knowledge of how to use the right blends of
herbs and spices, you really could plug up the holes in
the saltshaker if you wanted to.

e Kikkoman makes “lite” soy sauce with 43 per-

cent less salt—or 170 milligrams of sodium per tea-
spoon. That’s something that can really add up to
savings in the long run.
A no-salt tenderizer. e Adolph’s has a tenderizer that enables you to
enhance the flavor of meat without any added salt.
e A dash of Angostura aromatic bitters can make
up for that “missing something” when making gravies,
sauces or salad dressings.
e A bay leaf, a generous sprinkling of oregano
and a dash of garlic powder can spruce up a low-
Three tasty herbs. sodium spaghetti sauce if the taste doesn’t suit you.
e Certain spices and fruits are natural for some
foods. Curry, paprika, parsley, sage, tarragon, marjo-
ram, orange, cherries and pineapple are well suited
for chicken dishes. For fish, try bay leaf, marjoram,
parsley, anise, dry mustard, green pepper and ginger.
For pork, try applesauce (there’s no salt added there),
apples and sage.
e Sweet peppers, paprika, chili peppers and
ground chilies go well in soups and stews. Nutmeg
Peppers are a good can really highlight a vegetable dish. Don’t be afraid
choice. to experiment with some bold flavors—coriander,
cardamom, cumin, cloves, anise and ginger—but pro-
ceed cautiously.
 More Sneaky Maneuvers for Cutting Back on Salt 599

e When a recipe calls for bread crumbs and you

haven't any no-salt bread, substitute no-salt dry cereal
reduced to crumbs in a food mill, food processor or
electric blender.
e To pep up a meat loaf, use chopped onions,
low-salt vegetable juice and celery, including the tops.
e Low-salt or no-salt vegetable juice makes an
excellent stock for a vegetable beef soup.
e Allspice does wonders for low-salt cottage
cheese and ricotta dishes.
e A few drops of lemon juice add zip to salt-free A few drops of lemon
chicken, nut breads and vegetables. Chicken soup juice.
without salt, for example, gets a nice lift from a bay
leaf and a little lemon juice.

Is Your Saltshaker
Oversalting Your Food?
Trying to shake the salt habit? Start with your
saltshaker, says a group of researchers from
Australia. They found that the size and num-
ber of the holes in a shaker can have a dra-
matic effect on the amount of salt sprinkled
on food at the table.
“Consumers have a poor perception of
the amount of salt being delivered to the food
and apply a similar manual action to all shak-
ers, regardless of hole size,’ the researchers
say. This results in higher amounts of salt be-
ing used from shakers with bigger holes.
Multiholed saltshakers are okay to use,
they say, if the holes are small enough. But for
best restriction, the Australians recommend a
shaker with a single three-millimeter (about 4%
inch) hole. That can reduce total salt shaken
from a maximum of 1.2 grams to a mere 0.37
grams per meal (Human Nutrition: Applied
Nutrition).
600
Chapter 19

A Guide to Healthful
Cooking Techniques

here’s more than one way to cook your

goose—baking, frying, stewing, boiling, poach-
ing, braising, roasting—you get the idea. But putting
convenience aside, are there any nutritional advan-
tages to some cooking techniques over others? Or is
heat heat—and a fried potato just as healthful as a
baked one?

The Nutritional Effects

of Cooking Methods
Scientists have been playing Julia Child in their
laboratories for quite some time, trying to figure out
just exactly what cooking does to the nutritional value
of our food. What follows is a brief summary of those
findings.
Baking. If you do it to bread (or pastry or pota-
toes), it’s called baking; if you do it to a piece of meat
or fowl, it sometimes goes by the name of roasting.
It’s the same process, however—cooking with hot air
as opposed to hot water or hot oil. And it does have
its nutritional advantage: There is no water for nutri-
ents to leach into.
Boiling. Is boiling healthful? It depends. If you
use lots of water and boil for a long time, you're going
Boil quickly. to lose more nutrients than if you boil quickly and use
relatively little water. (Even then, use the cooking
 A Guide to Healthful Cooking Techniques 601

water for broths or soups to save nutrients that would

otherwise be lost.)
Broiling. Broiling is healthful in the sense that it
lets fats drip out and away from what’s being
cooked—hence cutting calories—but it can be un- Broil from above.
healthful if these fats are allowed to ignite, forming
smoke and the suspected carcinogen, benzof[a]-
pyrene. The solution? Broil from above (as opposed
to charcoal-grilling, from below). Studies have shown
that by broiling from above, you can keep the produc-
tion of benzo[a]pyrene to a minimum.
Charcoal-grilling. There are ways to minimize
problems with this method of cooking: (1) Cook only
lean meats (steak rather than spareribs, for instance) Three ways to grill.
over charcoal because it’s the fat dripping into the fire
that forms the chemical; (2) don’t keep the meat right
next to the coals; and (8) place meats on foil to shield
them from benzo[a]pyrene.
Deep-frying. While baking, broiling and bar-
becuing uses hot air to cook food, deep-frying uses
hot oil. What are the advantages? There are none. Deep-frying adds calo-
There are only disadvantages, as a matter of fact. Oil is ries and expense.
an added expense, and it also adds a lot of calories. A
piece of broiled fish, for example, might contain 100
calories; if it is breaded and deep-fried, it can contain
twice that many.
Pressure-cooking. Pressure-cooking is actually
a better way of steaming. By shortening the amount of
time foods need to be in contact with heat, pressure-
cooking reduces the amount of vitamin and mineral
loss.
Steaming. Steaming involves cooking over
rather than in water and can be healthful (with vegeta-
bles, especially) because it doesn’t allow water to Minimizing nutrient
come into actual contact with what’s being cooked. A losses.
drawback, however, is that some vegetables may re-
quire longer steaming, thus offsetting the nutritional
advantage gained by avoiding immersion. Steaming
can also leave vegetables pale.
602 Cooking and Eating for Maximum Nutrition

Stewing. Stewing’s blessings are mixed. Unless

you brown meats first and pour off the fat, all that fat
How to remove fat from stays in either the meat or the broth. Stewing can,
a stew. however, be healthful if you’re including lots of veg-
etables with your meat, because any vitamins that
leach out of the veggies leach into the broth. (A trick
for removing some of the fat from a stew is to refriger-
ate it and then scoop off the hardened, white lard that
rises to the surface.)
Stir-frying. Stir-frying is a relatively new tech-
nique to the Western world (although Orientals have
Lock in nutrients with been using it for centuries), and it’s potentially very
wok cookery. healthful if you use lean cuts of meat and low to
moderate amounts of oil. Because it’s fast, stir-frying
sears the outside of what’s being cooked, locking
nutrients inside. This is an especially healthful way to
cook vegetables. (One or two teaspoons of oil, inci-
dentally, is plenty for cooking four or five servings of
vegetables.)

Two Nutrient-Saving Reminders

So there you have it: a guide to healthful cooking.
Is there a rule of thumb or two to be discerned from it
all?
Yes. For vegetables, “cook them, don’t kill
them.” And for meats, “you're better off cooking the
fat out than in.”
For the lowdown on microwave cooking, see
chapter 81.
 Chapter 80 603

A Guide to
“Healthier”
Kitchenware

here was a time when all it took to be a good

cook was a wooden club. As long as your main
course wasn’t kicking you in the face, it was pretty
much as ready for the fire as it was ever going to be.
Meat tenderizing was an act of self-defense.
Nowadays, though, we've got everything from
waffle irons to popcorn poppers to help us prepare
our food. This is great, but it’s also a little confusing.
With so much to choose from, where is a good cook
to draw the line?
We posed that question to some experts in the
field—people who either cook or write about cooking
for a living—and here are the instruments they find We asked the experts.
most useful and the most healthful. A cotton-candy
machine might be fun, but it’s not worth its counter
space as far as whipping up good nutrition is con-
cemed.

A Roundup
of Nutrient-Saving Equipment
So here we go: healthful cooking’s “Basic 11”
kitchen gizmos.

1. Good pots and pans. Quality pays off in

cookware, not only in terms of durability but also in
terms of saving nutrients and energy. Good cookware Why metals make a
has tight-fitting lids @educing cooking time and hence difference.
604 Cooking and Eating for Maximum Nutrition

vitamin damage), and it tends to be made of energy-

wise and nutrient-wise materials (such as enameled
iron, heavy stainless steel and specially anodized alu-
minum) that distribute heat evenly and quickly.
2. Good knives and cutting boards. Again,
the word good makes a difference. A sharp, well-
balanced knife just might encourage you to do more
trimming of unhealthful fats from your meats and
more slicing of healthful fruits and vegetables as well.
A good-sized acrylic cutting board is important, too: It
acts as the proper “shock absorber’ for top-notch
cutlery and gives you plenty of “elbow room” for
cutting up meat and veggies for vitamin- and mineral-
packed stews, stir-fries and casseroles. (Always wash
knives and cutting boards in hot, soapy water and
rinse thoroughly after using them to cut or chop
meat. )
3. A steamer. Perhaps no other kitchen device
safeguards the nutritional value of food the way a
Cooking gentiy saves steamer does. Anything it cooks, it cooks gently, but
nutrients. quickly. Nutrient losses are kept to a bare minimum,
whether it’s meat, vegetables or rice that you’re sub-
jecting to a steamer’s care. Better yet, steamers come
in all shapes and sizes, from fold-out basket types that
work on top of your stove to the new electric models
that can steam practically anywhere.
4. A wok. “If I could have only one pot or pan,
I'd have a wok,” says one gourmet cook. That’s how
“If | could have only one adaptable the “oriental frying pan” is. You can stir-fry
pot or pan....”’ with a wok (using oil), but you can also boil an egg,
cook cereal, simmer soup, steam vegetables—it’s a
very versatile and nutrition-oriented device. It’s great
for cooking foods fast enough so that a minimum of
vitamins is lost, and it’s inexpensive, too.
5. A colander. This simple, sturdy strainer is
ideal for draining pastas, rinsing fruits and vegetables,
making cottage cheese or yogurt cheese or draining
tuna fish of its salt brine.
6. A blender. No, not made obsolete by the
food processor, the blender still deserves its counter
 A Guide to “Healthier” Kitchenware 605

space. For pureeing vegetables, blending batters,

emulsifying sauces, grinding seeds and spices and An ever-useful standby:
whipping up frothy fruit punches and “health cock- the blender.
tails,” the good old blender, whether it’s a 5-speed or
a 15-speed, is still hard to beat.
7. A juicer. For getting down to the nectar of
things, the juicer is tops. Whether it’s the liquid es-
sence of an orange, peach or carrot you're after, a
juicer is the gadget for the job. Great for thirsty fitness
buffs and kids who seem to be hooked on soda pop.
8. A mixer. Not just for blending cake batter,
the electric mixer is proudest of all to put muscle into
the wholesome art of baking bread. Kneading is a
cinch for most of the new models, and attachments
are available that will even allow you to grind your
own grains.
9. A toaster oven. So who needs a toaster oven
in addition to a regular oven? You do if you’re energy-
conscious and an aficionado of top-browned, open- Saving energy while
faced sandwiches, of if you frequently bake or reheat toasting food.
quantities of food that look lost inside the oven of
your stove. A toaster oven also can be just what the
chef ordered for toasting homemade breads that are
just too voluptuous (or crumbly) for your regular
toaster.
10. A food processor. It’s the Cadillac of
kitchen gizmos, but a food processor performs many
tasks fast. Slice or shred pounds of fruit or vegetables
in minutes. Process meat or fish into a paté without
adding eggs or cream, or make cream soups without
thickeners. Indeed, uses for the food processor are
limited by imagination only.
11. A pressure cooker. A pressure cooker can
save time (by cooking some foods four times as fast
as an oven or ordinary pot), it can save money (via the The pressure cooker—a
energy savings from those shortened cooking times), top-notch nutrient
saver.
and it can save nutrients (studies show that pressure-
cooking is one of the kindest methods of all on nutri-
ents). Pressure cookers work their magic by doing just
as their name implies—cooking under pressure—and
606 Cooking and Eating for Maximum Nutrition

they can do this to nearly any type of food. Soups,

stews, pot roasts, even casseroles and individually
wrapped items such as fillets can feel right at home in
a pressure cooker. Pressure cookers are available in
both stove-top and electric models.
 Chapter 8] 607

The Microwave:
Healthy Cooking
Is Its Forte

f you're part of a two-career couple, you're proba-

bly already sold on the incredible convenience of
a microwave appliance. But what you may not realize
is that it’s also a superb way to make healthful, low-fat
meals that taste great and look even better. That’s
because microwaves work particularly well on fresh
foods with a high water content, such as vegetables,
fish and fruits.
A microwave will not brown, grill or roast meats
well; you may not be able to use it for pies or breads.
But when it comes to poaching fish, cooking vegeta- Perfect potatoes in
bles or making stews, it’s wonderful. For busy week- minutes.
nights, when it’s impractical to conventionally cook
such vegetables as potatoes and squash, a microwave
can have them done in minutes. Instead of sautéing
fish in a lot of butter, you can microwave it tenderly
using lemon and herbs for flavoring. Best of all, be-
cause microwaves cook so quickly, fewer nutrients
are lost in the process.

Healthy Food Cooked in a Flash

Successful microwave cooking is a learned art.
Here are a few tips for busy cooks who like to eat well
but don’t have the time for conventional ovens.

Tips for Perfect Vegetables

It’s important that each piece you’re cooking is
the same size to ensure even cooking. For vegetables
608 Cooking and Eating for Maximum Nutrition

like broccoli and asparagus, which have tough, thick

Arranging veggies for stalks, arrange the stalks in a circle, with the delicate
just-right cooking. buds facing toward the middle. This will ensure that
the stalks get a more intense cooking.
If you like crisp skin on baked potatoes, don’t
depend on your microwave. It simply won't do it.
Instead, when the potato is nearly cooked, heat it
under a conventional broiler for a few minutes.
For very crisp vegetables, don’t use any water.
Just cover them with waxed paper or plastic wrap and
cook. For fresh corn, leave the green outer leaves on
to retain the corn’s moisture.
Be sure to cover everything to help preserve fla-
vors and keep moisture from escaping.

Moist, Tender Fish—in Four Minutes

The key to microwaving fish well is to be sure it’s
at room temperature before starting. If the fish is
The secret of tasty, chilled, it creates a texture problem. Because it takes
evenly cooked fish. so long for the microwaves to warm the outside, you
wind up overcooking.
The best fish for microwaving also happen to be
the ones lowest in fat and highest in water: whitefish
such as flounder and shellfish such as scallops.
Smother the fish in chopped fresh tomatoes and basil
and microwave it on full power for approximately four
minutes.

How to Make Rich, Thick Sauces and Stews

A microwave can be a great convenience when
making long-cooking sauces and stews. But there’s
Melding flavors. one problem. One of the delights of a stew is the slow
blending of flavors. Since a microwave cooks every-
thing so quickly, herbs, spices and other flavorings
don’t have time to work their magic. The solution? Put
the sauce together the night before, cook it quickly in
the microwave, then leave it in your refrigerator over-
night. By the time you arrive home at the end of a long
day, the flavors will have melded and all you'll have to
do is heat it up.
 The Microwave: Healthy Cooking Is Its Forte 609

When preparing a stew, try to use vegetables that

are similar in texture, such as all root vegetables. This
will ensure that the stew ingredients cook evenly. If
you want to add some delicate vegetable like mush-
rooms, do so at the last minute.
610 Chapter 82
Slices of Life:
A Guide
to Better Bread

hich bread is the most nutritious? Which is

the least? Those are questions that a lot of
A report card on re- people have wanted to know the answer to for a long
gional breads. time. The Kansas-based American Institute of Baking
(AIB) has been curious, too. So it undertook a study
of eight types of variety breads—pumpernickel, raisin,
oatmeal, whole wheat, cracked wheat, mixed grain,
Italian, French—and three other kinds—bagels, pita
and tortillas. AIB researchers looked at these bread
types as produced in four representative cities: New
York, Atlanta, San Francisco and Kansas City.
What they found was that there is nearly as much
variation from city to city as there is from bread to
Pumpernickel: a tale of bread. One man’s nutrient-filled croissant, it seems, is
two cities. another dough-schlepper’s heap of empty calories. Or
worse. AIB discovered, for example, that even though
the level of sodium is especially high in pumpernickel
bread in general, where you buy it can make a world
of difference: In Atlanta, 100 grams (about 3%
ounces) of pumpernickel contained 849 milligrams of
sodium, while the same amount of pumpernickel in
San Francisco had only about half as much. That’s a
pretty wide gap for two items labeled “pumper-
nickel.”
The same lack of standardization and uniformity
was found in each of the 11 bread categories. It may,
to some extent, reflect regional taste or texture prefer-
ences. Still, there are a few overall trends that can be
discerned.
 Slices of Life: A Guide to Better Bread 611

e Most whole wheat, French, Italian and pita

breads and bagels were high in protein.
e Raisin and whole wheat breads were high in
fat.
e Whole wheat, cracked wheat, and mixed-grain
breads and tortillas were high in dietary fiber and
magnesium.

For benchmark nutrient values for various types

of bread, see Appendix B. Perhaps this information
will help you to become the well-bread individual you
always thought you were.

Why Whole Wheat Bread

Stands above the Rest
Whole wheat bread is on the rise—in the kitchen
and in popularity—and for very good reasons. White
bread simply can’t measure up in flavor and health-
giving qualities.
That’s because to become white flour, the wheat
kernel undergoes a lot of processing that strips it of
valuable vitamins, minerals and fiber. And the label Nutrients that are never
“enriched” on many white breads only means that replaced.

food manufacturers returned a few of those nutrients.

Most are junked for good.
Take fiber, for instance. Whole wheat bread con-
tains three times more fiber than white bread—three
times more health power to help lower your choles-
terol, discourage diabetes and keep away hemor-
rhoids and varicose veins.
Whole wheat bread also contains three times
more magnesium than white bread, a nutrient that
some scientists say is a must to prevent heart attacks. Three times more mag-
And whole wheat is loaded with B vitamins. In fact, nesium—and loaded
with B vitamins.
whole wheat has more of just about everything but
calories. It has 15 fewer calories per slice than white
bread.
612 Cooking and Eating for Maximum Nutrition

Whole Wheat Bread

That’s Easy to Bake
There’s no whole wheat bread like homemade.
The smell alone is enough to make you healthy. But
when you think of actually baking that bread, you
probably conjure up an image of your grandma
kneading dough for half the afternoon. Baking bread
seems like about as much fun as washing clothes in
the river.
Well, our recipe is for life on the go. You won't
have to knead it, it requires very little time, and it’s
easy. Even inexperienced bread bakers can whip it up
like a pro.

WHOLE WHEAT BREAD

Y% cup plus % tablespoon honey
Ys cup warm water
1 package dry yeast
6 to 7 cups whole wheat flour
1 teaspoon salt (optional)
2% cups hot water
¥ cup oil
Dissolve 42 tablespoon honey in warm water
and sprinkle yeast on top. Do not stir. Set aside to
proof.
In a large mixing bowl, combine 4 cups flour
with salt, if used, hot water, remaining honey and oil.
With an electric mixer, blend on low speed until thor-
oughly mixed. Add yeast mixture.
Add remaining flour 1 cup at a time, blending
after each addition, until dough is consistency of
cookie dough. Knead for 10 minutes on low speed.
Grease 2 large bread pans with solid shorten-
ing. Oil hands and mold dough into 2 loaves. (Lightly
oil countertop so dough doesn’t stick.) Place dough
 Slices of Life: A Guide to Better Bread 613

in pans, cover and let rise in a warm place until in-

creased in bulk by one-third.
Preheat oven to 350°F.
Bake for 40 to 45 minutes, or until loaves
sound hollow when tapped. Remove from pans and
cool on wire racks.
Yield: 2 large loaves
614 Chapter 83

Using More
Whole Grains

hole grains are excellent sources of fiber,

nutrients and complex carbohydrates. Use
a variety of grains to provide low-cost, vitamin-rich
eating pleasure and to add new interest to your meals.
Replace some of the meat in your menu with grains to
cut saturated fat and calories.

Wonderful Ways with Grains

To help you, here is a handy guide to the grains.
Barley. Available as pearl barley (which is white
and translucent and has had its outer husk removed)
Two choices. and pot, or Scotch, barley (which has had only a
single outer layer removed and must be soaked over-
night before cooking). Either makes a delicious pilaf
when cooked in broth with mushrooms and onions.
Also used to flavor and thicken soups and stews. To
prepare, cook one cup barley in three cups water for
55 minutes.
Buckwheat groats. This is not a true grain, but
it is treated as such. It is used most often as flour in
A great substitute for pancakes, biscuits and muffins. The groats make a
potatoes. fine breakfast cereal or pilaf. Kasha is the name given
to toasted groats, which make a delicious substitute
for potatoes. Cook one cup groats in two cups water
for 15 minutes.
Bulgur. This is cracked wheat that has been
hulled and parboiled, which conserves most of the
nutrients by leaching them from the outer layer into
 Using More Whole Grains 615

the center of the grain. Use in casseroles, tabbouleh, A grain that holds onto
vegetable dishes and as a rice substitute. Cook one its nutrients.

cup bulgur in two cups water for 15 to 20 minutes.

Cornmeal. Available in white, yellow and blue
varieties—the blue is favored in Tex-Mex and Ameri-
can Indian foods—cornmeal can be used to thicken
sauces, gravies and soups. It can also be made into
polenta and used in unleavened breads, pones, muf-
fins, griddle cakes and tortillas. Cook one cup corn-
meal in four cups water for 25 minutes.
Millet. Also known as proso and broomcom,
millet makes a delicious breakfast cereal when
topped with fruit and maple syrup. Boil like rice for Try it for breakfast.
main dishes or use to thicken and flavor soups and
stews. Cook one cup millet in three cups water for 45
minutes.
Oats. Steel-cut and rolled oats are available.
Steel-cut oats are made by cutting the groats into
pieces with steel rollers. Rolled oats, the more familiar The most versatile grain
form, are made by flaking the groats, which make the of all.
nutrients more available for digestion. Use to thicken
and enrich soups or to extend meat dishes. Also great
in stuffings, pilafs, breads, pancakes and granola.
Cook one cup of steel-cut oats in three cups water for
30 to 40 minutes. Cook rolled oats in two cups water
for 8 to 10 minutes, or until thick.
616 Chapter 84
Using More
Dried Beans

eans in their infinite variety can bring new

vitality to your menu. They’re high in protein
and a good source of iron, calcium, magnesium and
fiber. They’re low in fat, easy to store and inexpensive.

The ABCs of Beans

Here are some tips on how to make good use of
beans.

How to store dried e Store dried beans in tightly covered jars in a

beans. cool, dry place. Add a couple of bay leaves to each jar
to discourage insects.
e Most dried beans should be presoaked to re-
store water lost in drying and to shorten cooking time.
e When soaking beans, use a container large
enough to permit expansion by 2/4 times. Use six cups
How to soak beans. of water for one pound of beans. Let stand overnight
in a cool place. (Split peas and lentils need no pre-
soaking.)
e To have presoaked beans always on hand,
soak some overnight and the next moming, pour off
the soaking water, spread beans on a cookie sheet
and freeze. When they’re as hard as marbles, transfer
to a plastic bag. They will not stick together and can
be used directly from the freezer.
e If you forget to presoak your beans, place them
in boiling water and boil for two minutes, then let
stand for one hour, covered. Then cook them in the
usual way.
 Using More Dried Beans 617

e If you are one of those who get a lot of “back

talk” from beans, try this cooking method: Discard
the soaking water, cover beans with fresh water and How to ‘‘de-gas’’ beans.
cook for 30 minutes. Discard that water, too. Add
more fresh water and resume cooking.
e If molasses or tomatoes is called for in a rec-
ipe, don’t add it at the beginning of the cooking pro-
cess because there is a substance in molasses and
tomatoes that will toughen the outside covering of the
beans. Add the molasses or tomatoes later, when the
beans are tender.

A Nutritional “Supplement”
You can also use bean puree made in the blender
or processor to boost the nutritional value and flavor
of baked goods, casseroles, stuffings, soups and sand-
wich fillings. Use immediately, refrigerate for up to six
days or freeze for up to six weeks.
Here are some other tips.

e Keep a jar of marinated beans in the refriger-

ator. Spoon some over salads or over mounds of
cottage cheese, or serve in bowls with crackers or
crisp raw vegetables.
e Add bean flour to baked goods as a nutritional
booster. Grind any kind of dried beans very finely, but
grind only as much as you need for immediate use— Try bean flour.
bean flour has a short shelf life.
e To use bean flour in baked goods, substitute
two or three tablespoons for an equal amount of
wheat flour. The protein in beans complements and
enhances the protein of baked goods.
618 Chapter 85
Upgrading Leftovers

hy build nutrition into your meals only to

discard the leftovers? With a little ingenu-
ity, you can make leftovers tasty and nutritious the
second time around.

Stovetop Magic
with Odds and Ends
Here are some suggestions on ways to incorpo-
rate orphaned foods into tasty new dishes.

e Leftover brown rice can add body to today’s

soup or ground meat. So can leftover oatmeal.
e For leftover liver sauté onions, mushrooms and
peppers in a tablespoon of oil and a little chicken
A delicious way to re- broth. Cut the liver into small cubes, then add to the
work leftover liver. vegetables, along with some cooked brown rice, if
you have any. Bring to serving temperature. It’s deli-
cious and goes a long way. Or chop the liver with
hard-cooked eggs, an onion, a few lettuce leaves for
moisture and some soy nuts for nutrients and crunch.
Add a bit of chicken fat for flavor, if you wish. Serve as
a paté with crisp raw vegetables and whole grain
crackers.
e Leftover boiled or baked potatoes make a
creamy, heartwarming soup. Sauté onions briefly,
then puree with potatoes in a blender or processor.
 Upgrading Leftovers 619

Add milk or stock and a few herbs, such as parsley, Leftover spuds make
dill, bay leaf or a bit of allspice. great soup.
e The next time you make ratatouille, plan to
have some of this great eggplant, pepper, zucchini
and tomato dish left over. Then use it as the filling for
a Spanish omelet. Or heat it slightly, add a tablespoon
of nutritional yeast and place about % cup of the
mixture in individual heatproof serving dishes. Drop
an egg on each serving and heat in the oven until eggs
are set.
You can also mix ratatouille with cooked brown
rice, cover with a few slices of mozzarella cheese and
heat until the cheese melts. Fantastic! Or use
ratatouille as a filling for crepes.
e A cup of leftover sautéed sliced mushrooms,
minced and combined with one tablespoon of
minced onions, % cup of bread or cracker crumbs
and a little melted butter or margarine makes a great
crust for a quiche. You can freeze the crust until
you're ready to make the quiche.
e Leftover corn can be cut off the cob and joined
with sliced red peppers and onions in the sauté pan
for delicious Mexican corn as a side dish. Or cover Corn—even better the
cooked vegetables with shredded cheese, broil until second time around.

the cheese melts and serve as a main dish.

620 Chapter 86

Shaping Up
Your Potato

ashed, baked or steamed, the versatile po-

tato can fill you up without filling you out.
It’s low in fat, high in fiber, packed with vitamins and
minerals, and by itself has only a few more calories
than an apple. So where did its fattening reputation
come from? From the company it too often keeps:
butter, sour cream and other diet stressors.

12 Ways to Perk Up Potatoes

Jettison those heavyweights and try these lighter
alternatives.

1. Sprinkle with fresh or dried herbs (alone or

in combination). For starters, try basil, caraway seeds,
celery seeds, dill, chives, oregano or thyme.
2. Top your baked potato with low-fat yogurt
and chopped chives or dill. For a “richer” topping,
Baked potato topping drain the yogurt for an hour in a sieve lined with
without the fat. cheesecloth. The yogurt will thicken to the consis-
tency of sour cream.
3. Another sour cream alternative: Blend low-
fat cottage cheese until smooth in a blender or food
processor. Add a tablespoon of lemon juice for tang.
If needed, thin with a bit of skim milk.
4. Combine a cup of low-fat cottage cheese
with 2 cup of low-fat yogurt and chopped herbs for a
high-protein spud topper.
 Shaping Up Your Potato 621

5. For a gourmet presentation, lightly sauté

mushrooms and onions. Blend about % cup of this A gourmet spud.
mixture into your baked or mashed potatoes.
6. For added flavor and unusual color, add a
cup of mashed, cooked butternut squash to your
mashed potatoes.
7. If you’re in a hurry, mix a dollop of cream of
mushroom soup with your mashed spuds.
8. Mix some cream of tomato soup with a dash
of Worcestershire sauce, a bit of powdered mustard
and a little shredded cheddar cheese. Use to top
baked potatoes.
9. Stuck with a few leftovers but not enough for Combine with leftovers.
a full meal? Serve them over baked potatoes. Good
choices include stir-fried vegetables, meat sauce,
chicken Parmesan and tuna casserole.
10. For pizza lovers: Top baked potatoes with A potato pizza.
spaghetti sauce, a touch of oregano and some part-
skim mozzarella. Broil to melt the cheese.
11. Enjoy home fries without frying. Cut pota-
toes into slabs % inch thick. Brush lightly with oil on
both sides. Bake on a cookie sheet for 20 minutes at Try ‘‘oven fries.’’
450°F; turn once during baking.
12. Cut the calories in potato salad by using yo-
gurt, flavored with mustard in place of mayonnaise.
622 Chapter 87
Who’s Who in the
New Health Milks

emember when buying a carton of milk was

easy? There was regular and skim. But now
there’s 1 percent fat, 2 percent fat, protein-fortified
milk, cultured buttermilk, acidophilus milk, Lactaid
(for the lactose intolerant) and now something called
CalciMilk, which is beefed up with extra calcium.
It’s enough to make you wonder what was wrong
with milk-the-original.
Milk-the-original was, and still is, a little high in
fat. The American Heart Association recommends
Whole milk is high in that no more than 30 percent of our calories come
fat. from fat, but nearly 50 percent of the calories in whole
milk comes from fat. Whole milk also can be a real
pain for some people to digest, namely those who
lack the enzymes necessary for breaking down the
sugar (called lactose) in milk.
So the dairy industry has been busy, not just
slimming milk down but also pumping it up—with
added protein, enzymes (to make it more digestible)
and now even calcium (to make it better still for the
bones). Few foods have been as responsive to the
health and fitness movement as milk.

Milk That’s Fit to Drink

Be confused no longer by all those newcomers
to your dairy case. What you're looking at are exam-
ples of a good food made even better.
Low-fat milk. Low-fat milks start with 2 percent
milk fat by weight and go as low as 0.5 percent milk
 Who’s Who in the New Health Milks 623

Fat Content of Milk

Type Calories from Fat Calories* Cholesterol

(%) (mg.)

Whole milk
(3.3% milk fat
by weight) 48.0 150 33
2% fat milk 34.0 121 18
1% fat milk 22.0 102 10
Skim milk 4.5 86 4

Note: Figures are based on an 8-ounce serving.

* Figure may be slightly higher if milk is fortified with nonfat milk solids or
protein.

fat. Any milk lower than 0.5 is called skim. These Low-fat milks reduce
might not seem like significant reductions from whole __ the percentage of calo-
milk’s fat content of around 3.5 percent, but in terms nes fromutats
of calories and percentage of calories from fat, these
reductions are significant, as the table above shows.
Protein-fortified milk. This is usually low-fat
milk to which protein, in the form of nonfat milk
solids, has been added. Per eight-ounce serving, the
increase comes to more than 1.5 grams, or 20 percent
more protein than normal milk.
Buttermilk. Buttermilk can be made from
whole milk, low-fat milk or skim milk. The process
involves exposing the milk to bacteria similar to that —_Buttermilk may contain
which produces yogurt. In some cases, flakes of ac- _—Salt.
tual butter may be added, as may salt. Read the label.
Acidophilus milk. Acidophilus refers to the
friendly type of bacteria that give this milk its slightly
sweet taste. The bacteria are friendly in that they are =A milk to control
thought to improve the bacterial environment of the cholesterol.
intestines, so they may do more than just aid in the
digestion of milk. There is also preliminary evidence
from an animal study that acidophilus milk, if con-
sumed regularly, may help control cholesterol by re-
ducing the amount the body absorbs.
624 Cooking and Eating for Maximum Nutrition

Lactaid. Lactaid is a specially formulated milk

for people who are unable to digest regular milk. It
also is a low-fat milk, containing only 1 percent milk
fat, but otherwise it is the same as regular milk in
nutritional content.
CalciMilk. CalciMilk is a low-fat milk (contain-
ing only 100 calories and two grams of fat per serv-
Two glasses will give ing) to which calcium has been added—enough, in
you the RDA. fact, so that just two eight-ounce glasses a day satisfy
100 percent of an adult’s Recommended Dietary Al-
lowance for this important, bone-building mineral.

If Milk Doesn’t Agree

with You...
How do you know if you are lactose intolerant? If
your tummy rumbles or feels crampy and bloated 15
The symptoms of lac- to 30 minutes after you have drunk a glass of milk, you
tose intolerance. probably have lactose intolerance. And if you experi-
ence gas or diarrhea an hour or two later, you almost
certainly have the problem.
If you do, you’re not alone. Seventy percent of
the people of the world cannot digest milk. And that
Orientals, Jews and is especially true of adults of certain ethnic groups like
blacks have the highest Orientals, Jews and blacks. What’s more, many peo-
incidence.
ple don’t become aware of their intolerance until after
they've suffered from intestinal flu (which breaks
down lactose activity) or increased their milk con-
sumption, such as during pregnancy.
That reaction is only natural, says Theodore
Bayless, M.D., who is associated with the National
A problem of aging. Digestive Diseases Education and Information Clear-
inghouse in Baltimore. What happens as we grow
older is that we develop a decline in the amount of
lactose, the enzyme that is responsible for digesting
lactose, or milk sugar. Our intestines, which produce
the enzyme in the first place, fail to make enough, so
the milk sugar passes directly into the colon. There it
eventually breaks down, leaving behind gas, bloated
bellies, cramps and even diarrhea.
 Who’s Who in the New Health Milks 625

If you suspect or discover that you have lactose

intolerance, you need not be deprived of milk’s nutri-
ents or taste, says Dr. Bayless. (See the table below for Sources of calcium for
a list of food alternatives.) Besides drinking Lactaid, nondrinkers.

you can get calcium from almonds, leafy green veg-

etables and fish such as sardines, which have edible
bones, as well as from calcium supplements. Just re-
member to avoid those labeled “calcium lactate.”
You might also try eating smaller amounts of milk
products or having them with your meals, a trick that
may delay the release of lactose in the intestines.
Reading labels can lead you to satisfying milk-
free alternatives. Some watchwords to look for are
“pareve” and “parve,” found in bread and baked
goods, which mean that they conform to kosher food
laws and are made without milk. Beware, however, of
words like “caseinate,” “lactose” and “‘whey,” which
are all milk additives. If you like to cook without milk,
you can try substituting water, eggs, oil or fruit juice in
recipes.

Ways to Tolerate
Lactose Intolerance

“No” Foods “Yes” Foods

Milk Buttermilk; milk and milk products treated

with Lactaid (a lactase enzyme that
comes in powdered, liquid and tablet
forms) or acidophilus (bacteria that break
down lactose)
Ice cream Frozen yogurt; Tofutti; Ice Bean and other
soybean desserts
Butter Nut butters; soy margarine
Soft cheese Firm cheeses like brick, Swiss, Edam,
cheddar, provolone; cottage cheese
626 Chapter 83
Bottled Water
Fit to Drink

here’s a whole new group of beverage connois-

seurs emerging from the ranks of thirsty con-
sumers. They’re skipping the soft drinks, dumping the
diet colas and reaching for. . . water?
That’s right. Today, water is the number one bev-
erage of choice for health-conscious people. It helps
regularity and provides important minerals like cal-
cium and potassium. For the weight-conscious, it’s
lower than low-cal—it’s no-cal. For the athlete, it
helps replenish lost fluids. For the no-sugar-alcohol-
caffeine-or-additives buffs, it’s simply a pure and
pleasant way to quench their thirst.

Tips for the Sodium-Conscious

The “real’’ question, though, is just what kind of
water is best? Water running from the tap has its
problems. It may be softened to make it suitable for
sudsing, and that means that good minerals like cal-
cium (and the taste) have often been sacrificed for
bad minerals like sodium. Then there is the matter of
substances either left in or added to tap water, such as
bacteria or chlorine or toxic minerals like lead and
mercury.
But bottled water can be contaminated, too, and
there’s often no way of knowing whether it is. Brands
Hard facts about the sold exclusively in the state where they’re bottled are
content of water. not subject to federal purity regulations. Furthermore,
no standards are set for the amount of sodium al-
 Bottled Water Fit to Drink 627

lowed in bottled water. Sodium levels can vary and

may be quite high (see the table below). The U.S.
Food and Drug Administration requires that only bot-
tlers who make low-salt or no-salt claims must list
sodium content. Now, granted, there is still a lot less
sodium in water than in most diet drinks, but the
sodium content may be as changeable as the seasons.
And that’s something people on salt-restricted diets
should know.
One thing that is crystal clear, however, is that as
the grocery aisles become flooded with bottled wa- Sorting out your
ters, our decisions get more difficult. Here are some choices.
pointers to help you make a naturally good selection.

e Look for labels that say natural spring water

(that means the water naturally rises to the earth’s
surface without pumping or processing). If the word
natural is left off the label, minerals have been artifi-
cially added.

Sodium Content
of Some Bottled Waters

Brand Sodium*
(mg.)

Still Waters
Poland Spring 0.32
Deer Park 0.39
Mountain Valley 0.65
Evian 1.18

Sparkling Waters
Perrier 3.04
San Pellegrino 10.02
Canada Dry Club Soda 44.00
Vichy (Celestins) 277.40

Norte: Figures are based on an 8-ounce serving.

* The recommended safe sodium levels are from 1,100 to 3,300 mg. a day.
628 Cooking and Eating for Maximum Nutrition

e Keep in mind that minerals give water its

taste—the more there are, the stronger the flavor.
The more minerals, the Some sparkling waters, like the imported Vichy, are so
more taste. mineral rich that they may take on an alkaline, soapy
or even bicarbonate taste. Still waters (those without
bubbles) may refresh more because they have little
aftertaste.
e Remember that while most waters contain im-
portant minerals like calcium, phosphorus and mag-
nesium, they are no substitute for mineral-rich foods.
e If you are avoiding your tap water because you
are unsure of its quality or taste, don’t forget to make
your ice cubes from bottled water, too.
e Seltzer and unflavored soda beverages are sim-
ply tap water that has been filtered and carbonated
Finding a healthful club with bubbles. Club soda has had minerals and mineral
soda. salts added, so look for the ones labeled low-sodium
or no-salt. Note also that club soda may contain small
amounts of alcohol or caffeine.
 Chapter 89 629

Answers to Your
Questions about
Food and Health

n some respects, the cornucopia of new and ex-

citing foods on the market makes choosing a nu-
tritious diet easier than ever. In other respects, though,
the choices are harder: Unfamiliar choices raise intel-
ligent questions among nutrition-conscious consum-
ers. Here are answers to questions commonly posed
by curious and concerned shoppers.

Blackberries, Bancha Tea and

“Milk” Shakes
Q. | believe I read that blackberries are high in
vitamin C. Is that right? What about blackberry jam?
A. Blackberries are a fairly good source of vita-
min C. One cup has 30.2 milligrams. By comparison, a
cup of blueberries has 18.9 milligrams, a cup of rasp-
berries, 30.8 milligrams and a cup of strawberries,
84.5 milligrams. By the way, that classic source of
vitamin C, the orange, holds 95.8 milligrams per cup
of segments.
Unfortunately, when you make jam out of black-
berries—or any fruit, for that matter—only a trace of
vitamin C remains, for two reasons. First, heating the Jam is low in vitamin C.
fruit destroys at least one-third to one-half of the vita-
min. Second, the actual fruit is diluted in the jam by
the addition of other ingredients such as honey, sugar
and pectin.
630 Cooking and Eating for Maximum Nutrition

Q. A friend told me that a kind of tea called

bancha has a lot of vitamin A and calcium in it. What
exactly is bancha, and is it nutritious?
A. Bancha is a poor grade of green tea made
from the leaves of the common tea plant. Samples
tested in a laboratory showed that brewed bancha
contains no vitamin A (or beta-carotene) and insig-
nificant amounts of calcium and magnesium.
Bancha does contain caffeine, however; one cup
has about 44 milligrams of caffeine. That compares to
Bancha tea has caf- an average of 117 milligrams in a cup of brewed
feine, but little nutri- coffee and an average of 80 milligrams in a cup of
tional value.
brewed black tea.
Q. A friend told me that “shakes” sold in fast-
food restaurants actually contain no milk, which is
why they aren’t called milk shakes. Is that correct?
A. A drink’s name can be an important clue to its
ingredients. In most states, to be called a milk shake, a
drink must include a milk product with a certain
amount of butterfat in it. But in others, only a drink
made with ice cream can be called a milk shake.
If a drink is just called a shake, you can’t tell for
sure whether it contains butterfat, vegetable fat substi-
tuted for the butterfat, or a combination of both.
One way you can be sure that your drink has real
milk in it is to look for the “Real” seal of the American
“Real’’ milk shakes are Dairy Association. For instance, a ten-ounce McDon-
usually labeled. ald’s shake—with whole milk or cream, sugar, butter-
fat and stabilizers—carries the “Real” seal and pro-
vides 324 milligrams of calcium, 9.4 grams of protein
and about 331 calories. In a ten-ounce glass of milk,
you would get 363 milligrams of calcium and 10
grams of protein, but only 186 calories.

Nutritional Gold
in Citrus, Potatoes, and Melons
Q. My neighbor told me that the white inner rind
of oranges and grapefruits is full of nutrients and that I
should eat some of the rind. Is my neighbor right?
 Answers to Your Questions about Food and Health 631

A. Your neighbor is a smart cookie. If you eat the

white inner rind of oranges or grapefruits, you'll be Inner rinds are nutrient
getting extra vitamin C, bioflavonoids, pectin and po- rich.

tassium.
Q. I know that when you french-fry potatoes,
youre adding fat and, of course, calories. But is there
a nutritional difference between french-fried and, say,
baked potatoes?
A. Yes, there is, and baked potatoes come out on
top. In a study done at Cornell University, researchers
compared the effect of deep-fat frying and baking on
the protein and mineral content of several varieties of
potatoes. The fried potatoes lost from 35 to 45 per-
cent of their amino acids. The baked potatoes lost
only 5 percent of their amino acids in the skin and the
area directly under the skin (cortex), but the amino
acid content in the center (pith) actually increased by
13 percent, apparently because protein migrates to-
ward the middle during baking.
As for minerals, the loss was consistently greater
for fried potatoes. For example, the fried potatoes lost
an average of 24 percent of their pith calcium, 31 Why baked potatoes are
percent of their cortex calcium, 13 percent of their better than fried.
pith potassium and 40 percent of their cortex potas-
sium. By contrast, the baked potatoes lost only 4
percent of their cortex calcium but gained 5 percent
in their pith, and they lost 16 percent of their cortex
potassium but gained 22 percent in their pith.
So, for better nutrition, baked potatoes are your
best bet.
Q. | know that cantaloupe is high in vitamin A. I
assume that honeydew, because it isn’t orange,
doesn’t have very much. Am I right?
A. Yes, but you can’t always go by color alone.
It’s true that cantaloupe’s orange color indicates it’s a
good source of beta-carotene—a food pigment the
body converts to vitamin A. One cup of cubed canta-
loupe holds the equivalent of 5,158 international units
of vitamin A (a good day’s supply), while honeydew
has a mere 68 international units. Other orange or red
632 Cooking and Eating for Maximum Nutrition

fruits and vegetables—apricots, winter squash, red

peppers and carrots, for instance—are likewise
loaded with vitamin A.
But here’s the tricky part. Some foods that have
lots of beta-carotene pigment, explains Micheline
Some ‘‘green’’ foods Mathews Roth, M.D., a carotenoid expert from Har-
are high in A. vard Medical School, also contain chlorophyll, a
green pigment that hides the beta-carotene. A cup of
raw spinach, for example, has 3,760 international
units of vitamin A; a cup of raw broccoli, 1,356 inter-
national units; a cup of cooked asparagus, 1,492; and
a cup of cooked kale, 9,620.

Sushi: Proceed with Caution

Q. A few months ago, | read that eating sushi is
unsafe because of possible parasites in raw fish. My
wife and I have enjoyed sushi for years and never had
a bad experience. Is sushi safe, or are we taking a risk?
A. A parasitologist at the Centers for Disease
Control (CDC) in Atlanta says that eating sashimi, or
raw fish (sushi is merely the most popular way to
serve sashimi), is reasonably safe. There is always a
chance that uncooked fresh fish harbors parasitic
worms, but this rarely happens at a sushi bar. The
researcher at the CDC says that eating sushi is safer
than eating raw clams or oysters.
At the worst, you could pick up an anisakis worm
from sushi. But in the past ten years, fewer than ten
people in the United States have reported this hap-
pening.
Although anisakis can cause abdominal pain,
bowel inflammation and possibly death, if untreated,
a doctor who knows what’s ailing you (and you
should definitely mention that you’ve eaten raw fish)
can easily treat you.
So far, public health officials have given sushi a
tentative green light. The U.S. Food and Drug Admin-
istration (FDA) has been under mild pressure to regu-
late sushi’s use by restaurants and the public, but
 Answers to Your Questions About Food and Health 633

without harder evidence of a hazard, the agency is

hesitant to tarnish sushi’s good reputation or to harm
its popularity.
Where does that leave the sushi lover? If you How to safeguard
want to enjoy sushi while minimizing the risk, you against bad sushi.
should do the following.

e Eat only fish that has light-colored flesh. Fish

with dark-colored flesh is more likely to carry unde-
tected parasites.
e Find out whether the fish has been frozen solid
and defrosted before being served. Freezing may de-
tract a bit from the texture, but it also kills any para-
Sites.
e Dine at a restaurant where the chefs are Japa-
nese or Japanese-trained. They’re more likely to know
good raw fish from bad.
e If possible, find out if your fish came from one
of the fishing fleets that specializes in catching fish for
sushi. Fish intended for sushi requires special han-
dling as soon as it is caught.

Organ Meats, Imitation Crab

and Hydrogenated Fats
Q. Are organ meats like sweetbreads, liver and
kidneys good or bad for you?
A. Sweetbreads, which are the thymus glands of
very young animals, give you plenty of protein but not
too many other nutrients. Other organ meats, how- Most organ meats are
ever, provide not only protein but high levels of vita- iron rich.

min C andiron. Also, livers, kidneys, hearts and brains

are all relatively low in fat when compared with red
meats.
Some people think that certain animal organs
aren’t safe to eat because they collect and concen-
trate the toxins in an animal’s body. But the U.S.
Department of Agriculture carefully monitors the lev-
els of organ toxins to ensure they don’t reach con-
centrations that would be dangerous.
634 Cooking and Eating for Maximum Nutrition

So if you enjoy organ meats, use them in modera-

tion. They're all relatively high in cholesterol. Com-
pare 3% ounces of beef, containing 70 milligrams of
cholesterol, with equal portions of organ meats.
You'll find 150 milligrams of cholesterol in hearts, 250
milligrams in sweetbreads, 300 milligrams in liver, 375
milligrams in kidneys and 2,000 milligrams in brains.
Q. My store recently began carrying what they
say is imitation crabmeat. What is this stuff? Is it good
for you?
A. The product you're referring to is called
surimi (sur-EE-mee).
Technically, surimi is a “‘structured fish product.”
That means it contains a relatively inexpensive and
Surimi: It’s inexpensive, available fish, such as pollack or turbot, mixed with
but content varies. some crabmeat or just crab flavoring and processed
with egg whites, wheat starch, sugar and sometimes
salt. Some brands may also contain monosodium glu-
tamate (MSG) and Red Dye No. 3. At least one brand,
called Wakefield Gems, is said to have no MSG and to
be comparable to canned crabmeat for protein, fat
and calories.
Q. I know that hydrogenated fats aren’t good for
me, so I try to avoid products that have hydrogenated
Labels must list hy- fats listed on the ingredients label. But now I’m won-
drogenated fat. dering: If the label doesn’t list hydrogenated fats, does
that mean all fats in the product are unhydrogenated?
A. Yes. According to the FDA, if a label doesn’t
list hydrogenated fats and the label complies with
FDA regulations, then there are no hydrogenated fats
in the product. Conversely, if a fat has been com-
pletely or partially hydrogenated, then this must be
stated on the label.

Notes on Frozen Pizza,

Chocolate and Parsnips
Q. I like to eat frozen pizzas, but I hear they
contain a lot of sodium. Is that true? And what about
the sodium content of other frozen entrees?
 Answers to Your Questions About Food and Health 635

A. Yes. In a study of the sodium content of fro-

zen pizzas, researchers discovered that a six-ounce
serving of baked frozen cheese pizza provides about Some frozen pizzas may
1,100 milligrams of sodium. That’s quite a hefty be high in sodium.
amount: You could get along quite nicely on a daily
total of only 200 to 300 milligrams.
And the National Academy of Sciences recom-
mends people without high blood pressure consume
no more than 1,100 to 3,300 milligrams of sodium per
day. Frozen pizzas with bacon or pepperoni toppings
have even more than 1,100 milligrams per six ounces.
But frozen pizza is certainly not unique in having
lots of sodium. For example, a 5.5-ounce portion of a
certain commercial frozen fried chicken breast has
1,362 milligrams of sodium; an 8-ounce frozen
chicken pie has 999 milligrams; 6.5 ounces of frozen
beef-and-bean burritos, 910 milligrams; and a 5-
ounce portion of frozen veal Parmesan has 1,014 mil-
ligrams. (Some frozen entrées have slightly less so-
dium than those mentioned above.)
Q. I’ve heard that chocolate has a lot of caffeine
in it. Does it?
A. Not really. A typical chocolate bar has any-
where from 4 to 10 milligrams of caffeine per ounce,
and a cup of cocoa has between 0.5 and 5 milligrams. Chocolate not high in
By comparison, a cup of regular percolated coffee has caffeine.
from 64 to 124 milligrams; a cup of regular instant
coffee, 40 to 108 milligrams; and a cup of decaf-
feinated coffee, 2 to 8 milligrams.
Q. Recently I was served whipped parsnips in a
fancy restaurant. I was surprised that they tasted
sweet. The waiter claimed no sugar had been added
to them. Are parsnips quite naturally sweet?
A. Yes, they are. On the average, 3.4 percent of a
parsnip is composed of the sugars glucose, fructose
and sucrose. But other vegetables have even more Some vegetables are
sugars. Carrots, for instance, are 5.94 percent sugar, naturally sweet.
and beets are 6.45 percent. In contrast, vegetables
that are low in sugar include broccoli (1.82 percent),
celery (1.23 percent) and escarole (0.58 percent).
636 Cooking and Eating for Maximum Nutrition

Understanding Vinegar and Nuts

Q. A while ago, I found a strange-looking “clot”
in my vinegar bottle. I threw it all out, but then some-
one told me this was the “mother” and was not harm-
ful. What’s going on?
A. A “clot” is an unsightly addition to your vine-
gar bottle, but that vinegar you threw out wasn’t harm-
Don’t let vinegar clots ful. Vinegar is made from fruit juice that first under-
alarm you. goes an alcoholic fermentation by yeast, then an
oxidative fermentation by bacteria. The oxidizing bac-
teria are called the “mother of vinegar.’’ They convert
the alcohol into acetic acid, the stuff that gives vinegar
its sour flavor. The “mother” is normally skimmed off
or filtered out of the finished product. Your “mother”
obviously slipped through this step. It would have
been perfectly safe to strain out the mother and use
the vinegar.
Q. I’ve always been told that some foods, like
nuts, are more difficult to digest than others. Is that
true?
A. Not exactly. It would be accurate to say that
some foods take /onger to digest than others.
How quickly you digest a food depends on how
much carbohydrate, protein and fat it contains. You
can digest carbohydrate the fastest, followed by pro-
tein and then fat.
Since nuts are high in fat, they may take a little
longer to digest. Also, remember to chew nuts thor-
Nuts take longer to di- oughly to ensure complete digestion of their valuable
gest. Chew them well. nutrients—unchewed pieces may pass through the
digestive tract undigested.
 Appendix A 637

A Reader’s Guide to
Recommended
Dietary Allowances

hese charts show the Recommended Di-

etary Allowances (RDAs) of essential nutri-
ents for men, women and children—the recognized
yardstick for measuring nutritional needs. The nutri-
ent intakes listed are based on available scientific
evidence and are considered adequate for practi-
cally all healthy persons. The Food and Nutrition
Board of the National Research Council of the
National Academy of Sciences established these
values. The U.S. Recommended Daily Allowances
CUSRDAs), referred to from time to time throughout
this book, are simplified versions of the RDAs. They
were proposed by the U.S. Food and Drug Adminis-
tration to be used primarily in food labeling.
638 Appendix A

Recommended Dietary Allowances

ITAMINS
Age Weight Height Protein Vitamin A Thiamine (B,) Riboflavin (B,)
(yr) (Ib.) (g.) (1.U.) (mg.) (mg.)

@ Men
11-14 oo eB" 45 5,000 1.4 1.6
15-18 145 5/9” 56 5,000 1.4 1.7
19-22 154 5/10” 56 5,000 LS er
23-50 154 5108 56 5,000 1.4 1.6
51+ 154 S107 56 5,000 he 1.4

@ Women
11-14 101 bea 46 4,000 al 1.3
15-18 120 5'4” 46 4,000 1.1 i3
19-22 120 54 44 4,000 Mi 1.3
23-50 120 5/4” 44 4,000 1.0 12
Dilsr 120 yaw 44 4,000 1.0 a2

@ Pregnant
— ee ey +30 +1,000 +0.4 +0.3

B@ Lactating
a — ess +20 +2,000 +0.5 +0.5

@ Infants
0-0.5 13 20% 13 2,100 0.3 0.4
0.5-1 20 Zan 18 2,000 0.5 0.6

@ Children
1-3 29 ome Oe 23 2,000 0.7 0.8
4-6 44 3’8” 30 2,500 0.9 1.0
7-10 62 4’4” 34 3,500 i2 1.4
 Appendix A 639

Niacin Vitamin B, Vitamin B,, Folate Vitamin C Vitamin D Vitamin E

(mg.) (mg.) (mcg.) (mcg.) (mg.) €1.U.) CLUE)

18 1.8 3.0 400 50 400 12

18 2.0 3.0 400 60 400 15
19 Ads 3.0 400 60 300 15
18 2.2 3.0 400 60 200 15
16 Ze 3.0 400 60 200 15

15 1.8 3.0 400 50 400 12

14 2.0 3.0 400 60 400 12
14 2.0 3.0 400 60 300 12
13 2.0 3.0 400 60 200 12
13 2.0 3.0 400 60 200 12

ae +0.6 aalidl) +400 +20 +200 +3.0

FS +05 +1.0 +100 +40 +200 +4.5

6 0.3 0.5 30 35 400 4.5

8 0.6 os 45 35 400 6

9 0.9 2.0 100 45 400 9

11 Lis 220 200 45 400 9
16 1.6 3.0 300 45 400 10.5

(continued)
640 Appendix A

INERALS
Age Weight Height Calcium Iodine
(yr.) Clb.) (mg.) (mcg.)

@ Men
11-14 99 Bene 1,200 150
15-18 145 5/9” 1,200 150
19-22 154 Halo” 800 150
23-50 154 SAO” 800 150
51+ 154 5/10” 800 150

@ Women
11-14 101 ie 1,200 150
15-18 120 5/4” 1,200 150
19-22 120 Am 800 150
23-50 120 Hae 800 150
51+ 120 5/4” : 800 150

@ Pregnant
es aos ais +400 +25

@ Lactating
os ae Livs +400 +50

B Infants
0-0.5 13 Zoe 360 40
0.5-1 20 2A" 540 50

@ Children
1-3 29 2elele 800 70
4-6 44 3/8” 800 90
7-10 62 4’4" 800 120
 Appendix A 641

Magnesium Phosphorus
(mg.) (mg.)

350 1,200
400 1,200
350 800
350. 800
350 800

300 1,200
300 1,200
300 800
300 800
300 800

+150 +400

+150 +400 +10

50 240
70 360

150 800 10
200 800 10
250 800

(continued)
642 Appendix A

STIMATED SAFE AND ADEQUATE DAILY INTAKES

FOR OTHER MINERALS AND TRACE ELEMENTS
Age Chloride Chromium Copper Fluoride
Gr.) (mg.) (mcg.) (mg.) (mg.)
@ Men
All 1,700-5, 100 50-200 2.0-3.0 1.5-4.0

B@ Women
All 1,700-5,100 50-200 2.0-3.0 1.5-4.0

@ Infants
0-0.5 275-700 10-40 0.5-0.7 0.1-0.5
O5=1 400-1,200 20-60 0.7-1.0 0.2-1.0

@ Children
1-3 500-1,500 20-80 1.0-1.5 0.5-1.5
4-6 700-2,100 30-120 1.5-2.0 1.0-2.5
7-10 925=-2.775 50-200 2.0-2.5 1.5-2.5
Jiytete 1,400-4,200 50-200 2.0-3.0 1.5-2.5

Source: Recommended Dietary Allowances, 9th ed. (Washington, D.C.: National Academy of Sciences, 1980).
 Appendix A 643

Manganese Molybdenum Potassium Selenium Sodium

(mg.) (mg.) (mg.) (meg.) (mg.)

2.5-5.0 0.15-0.50 1,875-5,625 50-200 1,100-3,300

2.5-5.0 0.15-0.50 1,875-5,625 50-200 1,100-3,300

0.5-0.7 0.03-0.06 350-925 10-40 115-350

0.7-1.0 0.04-0.08 425-1,275 20-60 250-750

1.0-1.5 0.05-0.10 550-1,650 20-80 325-975

1.5-2.0 0.06-0.15 775-2,325 30-120 450-1,350
2.0-3.0 0.10-0.30 1,000-3,000 50-200 600-1,800
2.5-5.0 0.15-0.50 1,525-4,575 50-200 900-2,700
 WELK ATE Cah
,
= 5 ov or Dai
ee

Sealed
if ae s » =

a). ~ ti
~. ‘ BL 6 =

. ees
>

OE Ata ete eee > - ore

7 Oa *

we ad! os
a ee -

aremne
4 ‘
 Appendix B 645

A Reader’s Guide to
the Nutrient Content
of Foods

he following is a nutritional analysis of over

500 foods, listing the precise amount of se-
lected vitamins and minerals contained in each one.
Consult this data bank when you're trying to incorpo-
rate more of a specific nutrient into your diet, when
you're planning meals and menus for your family or
when you want to assess your daily nutrient intake.
646 Appendix B

Nutrient Content of Foods

< v & mol oa

ae ee & 2 s CP eee
So 8S 33 3¢ 3s 58 =?
Food Portion co 6S ge 2& Se. Ss 2a

@ Beverages (See also Dairy Products; Fruits and Fruit Juices)

Alcoholic
Beer, regular 12 fl. oz. 0.000 0.021 0.093 1.613 0.178 0.060 21.400
Cordial/liqueur, coffee,
53 proof 1% fl. oz. 0.000 0.002 0.006 0.075 = _—- 0.000
Whiskey, gin, rum,
vodka, 80, 86, 90
proof 1% fl. oz. 0.000 0.003 0.002 0.005 0.000 0.000 0.000
Wine, dessert 2 leoz, — 0.011 0.011 0.126 0.000 0.000 0.200
Wine, red, table 3% fl. oz. 0.000 0.005 0.029 0.083 0.035 0.010 2.100
Wine, white, table 3% fl. oz. 0.000 0.004 0.005 0.069 0.014 0.000 0.200
Carbonated
Club soda 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Cola, aspartame-
sweetened 12 fl. oz. 0.000 0.018 ‘0.082 0.000 0.000 0.000 0.000
Cola, Dr. Pepper-type 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Cola, regular 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0:000 0.000
Cream soda 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Ginger ale 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Grape soda 12 fl. oz. 0.000 0.000 0.000 a 0.000 0.000 0.000
Root beer 12 fl. oz. 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Chocolate
Cocoa, home recipe,
w/milk 1 cup 318.000 0.102 0.435 0.365 0.107 0.870 12.000
Drink powder, no milk 1 serving 5.080 0.010 0.030 0.100 0.004 0.000 —
Malted milk, fortified
mix, w/milk 1 cup 3058.000 0.734 1.259 10.902 1.020 0.870 31.800
Milk, mix, w/milk 1 cup 312.000 0.101 0.428 0.317 0.104 0.870 12.200
Coffee
Brewed 6 fl. oz. a 0.000 0.000 0.393 0.000 0.000 0.300
Instant, prepared 6 fl. oz. 0.000 0.000 0.002 0.507 0.000 0.000 0.000
Substitute, prepared 6 fl. oz. —. — 0.002 0.389 — 0.000 a
Fruit punch drink, canned 6 fl. oz. 26.000 0.041 0.043 0.039 0.000 0.000 2.300
SE ene eS Sey ene Ee
 Appendix B 647

Ss) =) i 5 =
i=] i= i=} & he n i

dees eee ee ee es ee ee
i=Tan BO as 25 Rime on Tan 2 a a
Sa), SS SS SE& One SS, Sey, A Se Ae gE

0.000 —— oe 18.000 32.000 0.110 23.000 89.000 19.000 0.060

0.000 od -— 1.000 45.000 0.030 1.000 15.000 4.000 0.010

0.000 — a 0.000 9.000 0.020 0.000 1.000 0.000 0.020

0.000 -—— ood 5.000 27.000 0.140 5.000 54.000 5.000 0.040
0.000 —- —— 8.000 21.000 0.440 13.000 115.000 6.000 0.100
0.000 oa —- 9.000 22.000 0.330 11.000 82.000 5.000 0.070

0.000 a = 17.000 —: — 4.000 6.000 75.000 0.360

0.000 cad od 12.000 —- 0.110 4.000 —- 21.000 0.280

0.000 ad —— 12.000 22.000 0.140 1.000 2.000 38.000 0.150
0.000 oo — 9.000 41.000 0.130 3.000 4.000 14.000 0.050
0.000 a — 19.000 30.000 0.190 3.000 4.000 43.000 0.240
0.000 — —- 12.000 66.000 0.660 3.000 5.000 25.000 0.180
0.000 oe a 12.000 82.000 0.310 4.000 3.000 57.000 0.260
0.000 ad a 19.000 26.000 0.180 4.000 3.000 49.000 0.260

2.400 100.000 — 298.000 — 0.780 56.000 480.000 123.000 1.220

0.000 aa 0.083 10.400 197.000 0.600 22.900 142.000 75.000 0.343

33.800 278.000 — 384.000 156.000 3.770 53.000 620.000 244.000 1.150

2.500 100.000 — 300.000 176.000 0.800 54.000 498.000 165.000 1.260

0.000 od — 3.00 12.000 0.720 10.000 96.000 4.000 0.030

0.000 — a 6.00 13.000 0.090 8.000 64.000 6.000 0.050
—— — — 5.00 16.000 0.120 7.000 43.000 7.000 0.060
55.100 — —- 14.000 95.000 0.380 4.000 47.000 41.000 0.230

(continued )
648 Appendix B

Food Portion (1.U.)* Thiamine

Vitamin
A (mg.)
(mg.) Riboflavin B, (mg.) Vitamin
Vitamin B,,(mceg.)

Beverages—continued
Mineral water, Perrier 1 cup 0.000
Tea
Brewed 6 fl. oz. 0.000
Instant, lemon flavor 1 cup 0.000
Instant, sugar and
lemon flavor 1 cup 0.000

@ Breads
Bagels
Egg 0.209
Water 0.209
Biscuit, home recipe 0.080
Bread
Corbread, home
recipe 1 slice 61.700 0.081
Cracked wheat 1 slice 0.000 0.095
French, enriched 1 slice 0.000 0.161
Italian, enriched 1 slice 0.000 0.120
Mixed grain 1 slice 0.000 0.098
Mixed grain, toasted 1 slice 0.000 0.079
Pita 1 pocket 0.000 0.171
Pumpernickel 1 slice 0.000 0.109
Raisin, enriched 1 slice 0.000 0.083
Rye, American, light 1 slice 0.000 0.103
Vienna, enriched 1 slice 0.000 0.115
Wheat, home recipe,
toasted 1 slice 11.000 0.055
White, firm 1 slice 0.000 0.108
Whole wheat, home
recipe 1 slice 10.800 0.068
Bread stick, Vienna-type 1 0.000 0.020
English muffin, plain,
toasted 0.000 0.239
French toast, home
recipe 1 slice 111.000 0.124
Muffins
Blueberry, home
recipe 90.000 0.090 0.100
 Appendix B 649

iS) a 23) 5 =
(=| (= = = a
ED Ea go =a) ae an Tan BO 2S >
sf §5 $3 sf 8&8 se 2P sp oP 22
= So So Se oF £E SE ae BE HEé

0.000 _—- —- 32.000 0.000 0.000 1.000 0.000 3.000 0.000

0.000 — —— 0.000 18.000 0.040 5.000 66.000 14.250 0.040

0.000 —- ——: 5.00 19.000 0.020 4.000 49.000 14.000 0.080

0.000 — —— 6.000 210.000 0.050 5.000 50.000 —. 0.080

0.000 — —— 23.100 46.000 1.460 11.000 40.700 198.000 0.286

0.000 — — 23.100 46.000 1.460 11.000 40.700 198.000 0.286
0.000 — — 34.000 — 0.400 6.160 33.000 175.000 —

0.000 7.000 — 48.600 18.000 0.671 8.100 42.300 126.000 0.212

0.000 — 0.037 16.300 — 0.665 8.750 33.300 108.000 —.
0.000 — 0.063 38.500 51.000 1.080 7.000 30.100 193.000 0.221
0.000 — 0.054 5.000 — 0.700 — 22.000 152.000 —
0.000 — 0.037 26.000 71.000 0.815 12.300 54.500 103.000 0.300
0.000 — 0.037 26.600 72.000 0.832 12.500 55.700 105.000 0.306
0.000 ——— — 30.800 — 0.916 —— 44.800 215.000 —
0.000 — —— 22.700 — 0.877 21.800 139.000 173.000 0.365
0.000 a —— 25.500 34.000 0.775 6.250 60.000 94.000 0.155
0.000 —— — 20.000 25.000 0.680 6.000 51.000 174.000 0.318
0.000 — 0.045 27.500 36.000 0.770 5.000 21.500 138.000 0.158

0.000 — 0.037 20.000 65.000 0.682 23.500 86.500 90.600 0.572

0.000 — 0.042 29.000 50.000 0.653 4.830 25.800 118.000 0.143

0.000 — 0.037 19.800 64.000 0.670 23.300 85.000 89.000 0.562

0.000 —— —— 16.000 — 0.300 — 33.000 548.000 —.

0.000 — — 105.000 201.000 1.830 12.200 364.000 414.000 0.466

0.000 10.000 — 72.200 59.000 1.340 11.700 85.800 257.000 0.553

0.000 a — 34.000 32.000 0.600 10.000 46.000 252.000 —

(continued)
650 Appendix B

< v & oo oa

om. #2 28 88 32 828 22 32
ae. ae co SAN ae aS ee

Food Portion Se eo wo CARS, ES, a nwo

Breads—continued
Muffins—continued
Bran, home recipe 1 206.000 0.100 0.112 1.260 0.111 0.092 16.800
Corn, mix, w/egg and
milk 1 100.000 0.080 0.090 0.700 —- aa —
Rolls
Hamburger/hot dog 1 0.000 0.196 0.132 1.580 0.014 — 14.800
Hard, enriched 1 0.000 0.200 0.120 1.700 0.018 0.000 29.500
Submarine/hoagie,
enriched 1 0.000 0.540 0.320 4.500 0.047 — —
Stuffing, mix, prepared 1 cup 910.000 0.130 0.170 2.100 — — —

@ Cereals
All Bran 1 oz. 1250.000 0.369 0.426 4.991 0.509 — 100.200
Bran Buds 1 oz. 1250.000 0.369 0.426 4.991 0.509 — 100.200
Bran flakes, Kellogg OZ 1250.000 0.363 0.436 5.016 0.509 1.527 100.300
Cheerios 1 oz. 1250.000 0.368 0.426 4:996 9051) 1.499 6.232
Cornflakes, Kellogg 1 oz. 1250.000 0.368 0.426 4.996 0.511 — 100.000
Corn grits, enriched 1 cup — 0.240 0.150 1.960 0.058 — 1.000
Cream of wheat, regular 1 cup — 0.200 0.100 1.500 —— —_ 9.000
Grape-Nuts 1 oz. 1250.000 0.368 0.425 4.999 0.510 1502 ~*99:970
Millet, cooked 1 cup 92.000 0.180 0.060 2.280 0.280 —— 0.000
Oatmeal
Cooked 1 cup 38.000 0.260 0.050 0.300 0.047 ae 9.000
Instant 1 packet 1514.000 0.530 0.290 5.490 0.742 — 150.000
Oats, rolled, regular, dry 1 cup — 0.480 0.110 0.800 — —. 0.000
100% Bran 1 cup 0.000 0.687 0.773 8.978 0.902 2.706 0.000
Raisin bran, Ralston 1:33%0z: 1247.000 0.404 0.404 4.983 0.471 1.481 99.650
Rice Chex 1 oz. 16.990 0.369 — 4.995 0.511 1.507 100.100
Total 1 oz. 5000.000 1.460 1.718 20.020 1.976 6.014 400.300
Wheat germ, toasted 1 oz. 47.170 0.474 0.233 1.583 0.278 — 99.850
Wheaties 1 oz. 1250.000 0.391 0.391 4.986 0.489 1.466 8.798
a a re tie Ee a
@ Combination Dishes
Beans and frankfurters,
canned 1 cup 330.000 0.180 0.150 3.300 oa —- —
Beans w/pork and tomato
sauce, canned 1 cup 330.000 0.200 0.080 1.500 — — ——
eee
 Appendix B 651

1S) a a] g E
f=} = = oi n 4

So §as, Gsetda, be:

av Ss bs is fo .2
y

Bo Peete eees ea Oe 4 Se. SE nes. ey gS

= =

2.480 —- — 53.600 85.000 1.260 35.200 98.800 168.000 1.080

0.000 — — 96.000 — 0.600 ——= 44.000 ~ 191.000 —

0.000 — 0.024 53.600 66.000 1.190 7.600 36.800 241.000 0.248

0.000 — 0.030 24.000 50.000 1.200 11:500 49.000 312.000 0.300

0.000 — 0.080 58.000 — 3.000 —— 122.000 761.000 —

0.000 — — 92.000 — 2.200 — 126.000 1254.000 —

15.040 —- 0.630 22.960 324.000 4492 105.800 349.700 319.800 Se

15.040 — 0.447 19.000 300.000 4.492 90.170 474.200 174.000 3.727
— 101.000 0.177 13.810 210.000 8.142 51.610 180.300 263.900 3.707
14.990 — — 48.460 144.000 4.509 39.090 101.200 307.200 0.786
14.990 50.580 0.043 0.851 19.000 1.786 3.397 26.100 350.900 0.080
— — 0.432 1.000 29.000 1.560 11.000 54.000 0.000 0.170
— —— —— 51.000 75.000 10.300 10.000 43.000 2.000 0.330
— 49.990 ——— 10.770 94.000 23 18.970 94.750 197.000 0.624
0.200 — — 4.000 — 2.300 48.000 76.000 8.000 1.820

—- — 5.260 20.000 129.000 1.590 56.000 132.000 1.000 1.150

—— — 1.579 163.000 98.000 6.320 — 100.000 286.000 —
—= —= — 42.000 — 3.600 — 282.000 2.000 —
27.060 — — 19.760 447.000 3.488 134.000 353.900 196.300 2.466
1.347 98.980 —— 18.180 205.000 4.511 56.560 193.200 327.200 1.124
15.080 —- 0.016 3.971 75.000 1.789 7.087 32.850 237.400 0.392
60.140 — — 48.110 122.000 18.040 31.790 105.700 351.400 0.670
1.756 8.505 5.944 12.540 176.000 2.584 90.820 268.400 1.004 4.717
14.660 0.000 0.177 43.010 131.000 4.497 31.280 105.600 354.900 0.635

0.000 — 0.836 94.000 = 4.800 — 668.000 1392.000 —=

5.000 — 0.836 138.000 — 4.600 — 536.000 1180.000 =

(continued)
652 Appendix B
a LL

& A oy co
& & F g c & oN EA o>

Food Portion Ste, atl eS ee ae Se

Combination Dishes—continued
Beef and vegetable stew 1 cup 2400.000 = 0.150 0.170 4.700 — 0.002 —
Beef potpie, home recipe 1 serving 1720.000 0.300 0.300 5.500 — — —
Chili con carne w/ beans,
canned 1 cup 150.000 0.080 0.180 3.300 0.263 —— —
Enchilada 1 0.000 0.184 0.253 — 0.253 2.070 a
Macaroni and cheese
Canned, enriched 1 cup 260.000 0.120 0.240 1.000 — — —
Home recipe, enriched 1 cup 860.00 0.200 0.400 1.800 — —- —
Pizza
Cheese, baked 1 slice 750.000 0.336 0.288 4.210 0.120 0.480 55.200
Pepperoni, baked 1 slice 532.000 0.324 0.288 5.150 0.096 0.360 78.000
Soufflés
Cheese, home recipe 1 cup 760.000 0.050 0.230 0.200 — — ——
Spinach 1 cup 3461.000 0.091 0.305 0.477 0.120 0.680 61.900
Spaghetti
Tomato and cheese,
home recipe 1 cup 1080.000 0.250 0.180 2.300 — --a so
Tomato and meat,
home recipe 1 cup 1590.000 0.250 0.300 4.000 es —— ——
Taco 1 420.000 0.089 0.065 1.410 0.122 0.405 11.300

@ Dairy Products
Cheese
American, processed 1 oz. 347.300 0.008 0.101 0.020 0.020 0.199 2.025
Blue 1 oz. 206.600 0.008 0.109 0.292 0.048 0.349 10.130
Brick 1 oz. 310.800 0.004 0.101 0.033 0.018 0.360 6.075
Brie oz, 191.400 0.020 0.149 0.109 0.068 0.474 18.230
Cheddar, cut pieces 1 oz. 303.800 0.008 0.107 0.023 0.021 0.237 5.063
Cheddar, shredded Y cup 299.300 0.008 0.106 0.023 0.021 0.234 5.250
Cottage, 1% fat 1 cup 84.000 0.047 0.373 0.289 0.154 1.430 28.000
Cottage, 2% fat 1 cup 158.000 0.054 0.418 OS 25mm yOiz 1.610 30.000
Cottage, large-curd,
4% fat 1 cup 367.000 0.047 0.367 0.284 0.151 1.400 27.000
Cream 1 oz. 410.100 0.005 0.057 0.029 0.013 0.122 4.050
Edam 1 oz. 263.300 0.010 0.111 0.023 0.022 0.440 5.063
Feta 1 oz. — —- — —— —— —— ———
Gouda 1 oz. 185.300 0.009 0.096 0.018 0.023 —— 6.075
Gruyeére 1 oz. 350.300 0.017 0.080 0.030 0.023 0.460 3.038
— —..0_€0C—
 Appendix B 653

iS) fa) 23) a S

ao Puselicetays 8&2 as ts is ds is
= S & a n A

SS
~
See
~ =)
eset
~ =)
Ss8 > 86 ag
86 £5; cy
.88 B22. ge
i=]

17.000 0.000 0.767 29.000 183.000 2.900 ——— 613.000 1006.000 ——-
6.000 — 1.758 29.000 — 3.800 — 334.000 596.000 —

— 0.000 — 82.000 —- 4.300 — 594.000 - 1354.000 ——

— —— 0.411 96.600 299.000 3.290 75.900 653.000 1332.000 1.290

0.000 ——— 0.572 199.000 —— 1.000 —_ 139.000 729.000 —

0.000 — 0.477 362.000 — 1.800 52.000 240.000 1086.000 —

2.400 ——— —— 220.000 144.000 1.610 31.200 230.000 698.000 1.670

2.400 — — 196.000 — 2.520 — 216.000 817.000 —

0.000 —— — 191.000 — 1.000 — 115.000 346.000 —

2.900 — —— 230.000 120.000 1.340 37.000 202.000 763.000 1.290

13.000 ——— — 80.000 — 2.300 — 408.000 955.000 —

22.000 5.000 0.000 124.000 — 3.700 ——— 665.000 1009.000 —

0.810 5.860 ———— 109.000 105.000 1.150 36.500 263.000 456.000 1.560

0.000 —. 0.270 176.200 17.000 0.111 6.075 46.580 411.100 0.861

0.000 — 0.270 151.900 11.000 0.091 7.088 73.910 401.000 0.759
0.000 — 0.270 193.400 7.000 0.122 7.088 38.480 161.000 0.749
0.000 — 0.270 52.650 — 0.142 0.000 43.540 180.200 —
0.000 —— 0.270 206.600 31.000 0.192 8.100 28.350 178.200 0.891
0.000 — 0.270 203.800 31.000 0.193 7.750 27.750 175.300 0.878
0.000 5.000 2.161 138.000 — 0.320 12.000 193.000 918.000 0.860
0.000 5.000 2.161 155.000 — 0.360 14.000 217.000 918.000 0.950

0.000 5.000 2.146 135.000 43.000 0.315 11.300 189.000 911.000 0.833
0.000 — 0.270 23.290 11.000 0.344 2.025 34.430 85.050 0.152
0.000 23.790 0.270 209.600 8.000 0.122 8.100 53.660 277.400 1.073
0.000 — 0.270 141.800 — 0.182 5.063 18.230 320.000 0.830
0.000 — 0.270 200.500 — 0.071 8.100 34.430 234.900 1.124
0.000 — 0.270 290.600 — — — 23.290 96.190 ———

(continued)
 654 Appendix B

* E E S F aN o>

Food Portion SS Se") er ea2c- Se eS oS Vee

Dairy Products—continued
Cheese—continued
Limburger 1 oz. 367.500 0.023 0.145 0.046 0.024 0.299 16.200
Monterey Jack 1 oz. 272.400 — 0.112 0.000
Mozzarella, skim-milk loz: 168.100 0.005 0.087 0.030 0.020 0.235 2.025
Mozzarella, whole-milk 1 oz. 227.800 0.004 0.070 0.024 0.016 0.187 2.025
Muenster 1 oz. 322.000 0.004 0.092 0.029 0.016 0.423 3.038
Neufchatel 1 oz. 325.000 0.004 0.056 0.036 0.012 0.076 3.038
Parmesan, grated 1 tbsp. 43.810 0.003 0.024 0.020 0.007 oe 0.500
Provolone 1 oz. 233.900 0.005 0.092 0.045 0.021 0.420 3.038
Ricotta, skim-milk 1 cup 1063.00 0.052 0.455 0.192 0.049 0.716 a
Ricotta, whole-milk 1 cup 1205.000 0.032 0.480 0.256 0.106 0.831 —
Romano 1 oz. 164.000 ——. 0.106 0.022 —- a 2.025
Roquefort 1 oz. 300.700 0.011 0.168 0.211 0.035 0.184 14.180
Swiss 1 oz. 243.000 0.006 0.104 0.026 0.024 0.481 2.025
Cream
Half-and-half 1 tbsp. 65.630 0.005 0.023 0.012 0.006 0.050 0.375
Light 1 tbsp. 108.000 0.005 0.022 0.009 0.005 0.033 0.375
Sour, cultured 1 tbsp. 113.600 0.005 0.021 0.010 0.002 0.043 1.563
Whipped, imitation,
frozen 1 tbsp. 40.380 0.000 0.000 0.000 0.000 0.000 0.000
Whipped, pressurized
can 1 tbsp. 34.250 0.001 0.002 0.003 0.002 0.011 moos
Eggnog, commercial 1 cup 894.000 0.086 0.483 0.267 0.127 1.140 2.000
Milk
Chocolate, whole 1 cup 302.000 0.092 0.405 0.313 0.100 0.835 12.000
Evaporated, skim,
canned 1 fl. oz. 125.000 0.014 0.099 0.056 0.018 0.076 2.875
Nonfat, fluid 1 cup 500.000 0.088 0.343 0.216 0.098 0.926 13.000
1% fat 1 cup 500.000 0.095 0.407 0.212 0.105 0.898 12.000
2% fat 1 cup 500.000 0.095 0.403 0.210 0.105 0.888 12.000
Whole, 3.3% fat 1 cup 307.000 0.093 0.395 0.205 0.102 0.871 12.000
Milk shakes
Chocolate, thick 10 fl. oz. 258.000 0.141 0.666 0.372 0.075 0.945 15.000
Vanilla, thick 10 fl. oz. 357.000 0.094 0.610 0.457 0.131 1.630 21.000
Yogurt
Fruit flavor, low-fat 1 cup 104.000 0.084 0.404 0.216 0.091 1.060 21.000
Plain, low-fat 1 cup 150.000 0.100 0.486 0.259 0.111 1.280 25.000
Plain, nonfat 1 cup 16.000 0.109 =0.531 0.281 0.120 1.390 28.000
Plain, whole-milk 1 cup 279.000 0.066 0.322 0.170 0.073 0.844 17.000
 Appendix B 655

'S) a 2a) 5 5
S =} (= = 77) os
EO ea EA 2m go > Tan Bo En D>
sg ow aS sD YL ow av & op 30 06 & 00 > 00 & 0
Bee aa oS See toes SS 2 Sek sauwicc mes as

0.000 — 0.270 142.800 == 0.041 6.075 36.450 229.800 0.608

0.000 — 0.270 214.700 9.000 0.203 8.100 23.290 153.900 0.861
0.000 oe 0.270 185.300 8.000 0.061 7.088 24.300 - 133.700 0.790
0.000 a 0.270 148.800 oe 0.051 5.063 19.240 107.300 0.638
0.000 == 0.270 205.500 9.000 0.122 8.100 38.480 180.200 0.810
0.000 Ss 0.270 21.260 == 0.081 2.025 32.400 114.400 0.152
0.000 ——— 0.060 86.000 23.000 0.059 3.188 6.688 116.400 0.199
0.000 —— 0.270 216.700 7.000 0.152 8.100 39.490 251.100 0.932
0.000 == 2.339 669.000 == 1.080 36.000 308.000 307.000 3.300
0.000 == 2.339 509.000 85.000 0.940 28.000 257.000 207.000 2.850
0.000 —— 0.270 305.800 == a == — 344.300 se
0.000 == 0.270 190.400 10.000 0.162 8.100 26.330 519.400 0.597
0.000 28.350 0.270 275.400 36.000 0.051 10.230 31.390 74.930 1.124

0.130 —— =_— 15.880 oe 0.011 1.563 19.630 6.125 0.077

0.114 — — 14.440 33.000 0.006 ilrajila} 18.250 5.938 0.041
0.124 1.200 — 16.750 == 0.009 1.625 20.690 7.688 0.039

0.000 = = 0.313 Ss 0.006 0.063 0.875 1.188 0.001

0.000 ——- —— 3.813 as 0.002 0.375 5.500 4.875 0.014

3.810 57.000 = 330.000 18.000 0.510 47.000 420.000 138.000 1.170

2.280 103.000 0.335 280.000 == 0.600 33.000 417.000 149.000 1.020

0.395 28.000 — 92.500 a 0.093 8.613 105.900 36.630 0.287

2.400 103.000 0.219 302.000 100.000 0.100 28.000 406.000 126.000 0.980
2.370 102.000 0.218 300.000 —— 0.120 34.000 381.000 123.000 0.950
2.320 102.000 0.218 297.000 == 0.120 33.000 377.000 122.000 0.950
2.290 102.000 0.218 291.000 500.000 0.120 33.000 370.000 120.000 0.930

0.000 39.000 oo 396.000 aes 0.930 48.000 672.000 333.000 1.440

0.000 42.200 —— 457.000 = 0.310 37.000 572.000 299.000 1.220

1.500 ase = 345.000 == 0.160 33.000 442.000 133.000 1.680

1.820 a — 415.000 = 0.180 40.000 531.000 159.000 2.020
1.980 —— —— 452.000 wea 0.200 43.000 579.000 174.000 2.200
1.200 —— — 274.000 — 0.110 26.000 351.000 105.000 1.340

(continued)
 656 Appendix B

< oy Py
& & En x
5a ES E 0b 2 vo
£ 22) sw 3) aS)
Food Portion sles) (mg.)
Thiamine Riboflavin (mg.) Se
(mg.) Niacin oS 5 S28
@ Desserts
Brownie, home recipe,
w/nuts l 40.000 0.040 0.030 0.200
Cake
Angel food, mix,
prepared 1 slice 0.000 0.007 0.015 4.770
Coffee, mix, prepared 1 slice 120.000
Devil’s food, mix,
w/icing, prepared 1 slice 100.000 —— — 4.140
Pineapple upside-
down, home recipe 1 slice 272.000 0.044 0.059 8.400
Pound, home recipe 1 slice 80.000 — se 1.980
Sponge, home recipe 1 slice 125.000 0.037 0.332 14.500
White, w/chocolate
icing, home recipe 1 slice 21.300 0.017 0.058 3.550
Cheesecake, commercial 1 slice 216.000 0.054 0.421 15.300
Cookies
Chocolate chip, home
recipe 1 4.300 0.002 0.010 0.900
Chocolate chip, mix 1 6.090 0.002 wae 0.945
Fig bar 1 15.700 0.015 0.000 0.840
Gingersnap, home
recipe 1 2.520 0.004 0.006 0.560
Cupcake, w/chocolate
icing 1 60.000
Custard, baked Y% cup 465.000
Danish pastry, plain 1 69.600
Doughnut, cake, plain 1 14.300 0.009 a 2.000
Eclair, custard,
w/chocolate icing l 340.000
Fruitcake, dark, home
recipe 1 slice 20.000
Granola bar l == — 0.000 a
Ice cream
Sundae, hot fudge l 231.000 0.132 0.660 9.900
Vanilla, hard, 10% fat 1 cup 543.000 0.061 0.625 3.000
Ice Milk
Vanilla, hard, 4.3% fat 1 cup 214.000 0.085 0.875 3.000
Vanilla, soft, 2.6% fat 1 cup 175.000 0.133 1.370 5.000
 Appendix B 657

iS) a 25) 5 5
i= i=] S n =
=a
5 it)
Eo
Ss 5
ee
s>
Be
Y oD
33
a0
>
5 it)
ED
= ior)
a>
$ it)
a
Ss ee
D>
g =
se So es! SE SE £E SE c&& RE ge

0.000 a 0.766 8.000 es 0.400 3.000 38.000 50.000 0.000

0.000 —— 2.131 50.000 20.000 0.451 5.830 51.900 142.000 0.106

0.000 aa 2.891 44.000 —- 1.200 —- 78.000 310.000 —

0.000 — PU 41.000 — 1.000 — 90.000 180.000 ——

3.500 — 0.887 50.400 84.000 1.110 11.900 119.000 167.000 0.378

0.000 — e326 6.000 — 0.500 20.000 58.000 —:
0.000 —. 2.652 25.100 33.000 1.110 7.260 59.400 164.000 0.799

0.000 -— 2.846 70.000 78.000 0.682 13.500 76.700 200.000 0.263

4.250 18.200 —— 47.600 51.000 0.408 8.500 83.300 189.000 0.357

0.000 —— 0.398 3.300 32.000 0.249 3.500 20.500 20.600 0.044

0.000 — 0.417 2.940 12.000 0.228 2.520 13.500 37.800 0.053
0.000 — 0.557 10.100 41.000 0.339 3.640 40.600 44.900 0.090

0.000 “oS 0.279 2.590 9.000 0.161 1.330 13.700 19.700 0.031

0.000 — 0.075 47.000 — 0.400 — 42.000 120.000 —

0.500 — 0.000 148.500 - 0.550 oS 193.500 104.500 —
0.000 —- 0.000 68.900 — 1.200 9.750 60.500 249.000 0.546
0.000 — 0.268 11.000 33.000 0.365 5.750 27.300 139.000 0.128

0.000 —- 0.000 80.000 a 0.700 a 122.000 82.000 —.

0.000 — = 11.000 — 0.400 —. 74.000 23.000 —

— — 0.000 14.400 —. 0.763 —— 78.200 66.700 0.000

3.300 16.000 0.148 216.000 132.000 0.611 34.700 413.000 177.000 0.990
0.700 — 0.119 176.000 200.000 0.120 18.000 257.000 116.000 1.410

0.760 — 0.118 176.000 ad 0.180 19.000 265.000 105.000 0.550

1.170 ae 0.000 274.000 — 0.280 29.000 412.000 163.000 0.860

(continued)
658 Appendix B
ES

< w & oy on
&, = z a & fm go
g> 83 33 $3 &: Ef 82
Food Portion eae EE Ze ze sé SE £6

Desserts—continued
Pie
Apple, home recipe 1 slice 25.700 0.149 0.108 1.240 0.035 0.000 6.750
Blueberry, home
recipe 1 slice 40.000 0.150 0.110 1.400 —_ 0.000 —
Cherry, home recipe 1 slice 590.000 0.160 0.120 1.400 — 0.000 —
Chocolate cream,
home recipe 1 slice 264.000 0.100 0.170 0.720 0.047 0.366 9.000
Lemon meringue,
home recipe 1 slice 167.000 0.096 0.120 0.720 0.029 0.191 10.800
Pumpkin, home recipe 1 slice 3210.00 0.110 0.180 1.000 — a —
Pudding
Chocolate, mix,
cooked, w/milk Ye cup 170.000 0.025 0.195 0.150 — aa —
Rice, w/raisins Y% cup 145.000 0.040 0.185 0.250 a — —.
Tapioca cream, home
recipe Ye cup 240.000 0.035 0.150 0.100 — ee aa
Sherbet, orange, 2% fat 1 cup 185.000 0.033 0.089 0.131 0.025 0.158 14.000
Turnover, apple 1 11.400 0.028 0.020 0.332 0.011 0.028 1.140

@ Eggs
Large, fried w/butter 1 286.000 0.033 0.126 0.026 0.050 0.581 22.000
Large, hard-cooked, no
shell 1 260.000 0.037 0.143 0.030 0.057 0.657 24.000
Substitute, liquid Y cup 1356.000 0.069 0.188 0.069 eS 0.187 eS
White only, large, raw 1 0.000 0.002 0.094 0.029 0.001 0.021 5.000
Whole, large, poached 1 259.000 0.035 0.127 0.026 0.051 0.616 24.000
Whole, large, raw l 260.000 0.044 0.150 0.031 0.060 0.773 32.000
Yolk only, large, raw 1 313.000 0.043 0.074 0.012 0.053 0.647 26.000

@ Fats and Oils

Butter, regular 1 tsp. 142.700 0.000 0.002 0.002 0.000 — 0.140
Margarine
Corn oil, regular, hard 1 tsp. 155.000 0.000 0.002 0.001 0.000 0.004 0.060
Corn oil, regular, soft 1 tsp. 155.000 0.000 0.002 0.001 0.000 0.004 0.050
Safflower oil, soft 1 tsp. 155.000 0.000 0.002 0.001 0.000 0.004 0.050
Mayonnaise
Imitation, soy 1 tbsp. — —— — —— a = =
Soy, commercial 1 tbsp. 39.000 0.000 0.000 0.000 — — —
 Appendix B 659

C (mg.)
Vitamin .U.)
DVitamin (1.U.)
EVitamin (mg.)
Calcium )
(meg.
Copper Iron(mg.) (mg.) Potassium
Magnesium (mg.)
(mg.) Sodium (mg.)
Zinc

12.200 115.000 207.000

15.000 88.000- 361.000

19.000 142.000 410.000

84.000 119.000 142.000 273.000

15.600 28.000 52.800 223.000

66.000 208.000 278.000

132.500 177.000 167.500

130.000 234.500 94.000

86.500 111.500 128.500

103.000 198.000 88.000
3.980 13.900 109.000

26.000 92.000 58.000 144.000

28.000 100.000 65.000 69.000

33.250 207.000 111.000
4.000 25.000 45.000 50.000
28.000 100.000 65.000 146.000
28.000 100.000 65.000 69.000
26.000 45.000 15.000 8.000

1.000 38.670

44.300
50.700
50.700

74.600 0.020
34.000 78.400 0.020

(continued)
660 Appendix B

ae meg: a ae
Food Portion SA ae (oS FANS ae SS mS

Fats and Oils—continued

Salad Dressing
Blue Cheese 1 tbsp. 32.100 0.000 0.020 0.000 — — —
French 1 tbsp. — ——— —= = —— = =<
Italian 1 tbsp. — 0.000 0.000 0.000 — — ==
Russian 1 tbsp. 106.000 0.010 0.010 0.100 — — —
Thousand Island 1 tbsp. 50.000 0.000 0.000 0.000 — a ——
Vegetable oil
Corn 1 tbsp. ee 0.000 0.000 0.000 0.000 0.000 0.000
Olive 1 tbsp. ae 0.000 0.000 0.000 0.000 0.000 0.000
Soybean 1 tbsp. — 0.000 0.000 0.000 0.000 0.000 0.000

@ Fish and Shellfish

Bass, striped, broiled 3 02. 98.660 0.128 0.119 2.466 — -—— —
Bluefish, raw 3% 02. 398.000 0.058 0.080 5.950 0.402 5.390 1.590
Caviar, from sturgeon 1 tsp. — — oa a —- ad ——
Clams, meat only, raw 3% 02. 300.000 — 0.213 1.765 0.079 49.440 2.650
Cod, Atlantic, cooked,
dry heat 3 02. 39.200 0.075 0.067 2.140 0.241 0.890 oe
Crab
Blue, cooked,
moist heat Ye cup 1680.00 O25 0.060 2.150 —— 5.690 a
Deviled Ys cup — 0.063 0.086 1.188 - — —
Crabcake 3 02. 249.000 0.061 0.091 L519 oo 5.040 —
Fish sticks and portions,
frozen, reheated 3 02. 89.900 0.108 0.151 1.809 0.051 1.530 15.490
Haddock, cooked, dry
heat 3 02. 53.900 0.034 0.038 3.940 0.294 1.180 ——
Halibut, cooked, dry heat 3 02. 150.000 0.081 OO 760500337 1.160 a
Lobster, cooked, moist
heat 3 02. 74.000 0.006 0.056 0.909 0.065 2.640 9.450
Mackerel, Atlantic,
cooked, dry heat SIOZ 152.800 0.135 0.350 5.820 0.390 16.150 -_—
Perch, cooked, dry heat 3 Oz. — — — — —e es nee
Oysters
Eastern, breaded, fried 3 02. —— —— 0.170 1.400 0.050 13.280 11.550
Eastern, raw ¥% cup aa — 0.133 1.040 0.040 15.300 7.900
 Appendix B 661

Ss) a 3) 5 E

Few
i= i=)

pieneet
(=
a bPige ae fF.
n ome
FR xe
se
SS
45
SS
39
Sty
383
Ow
#82
Ow
s#
ee,
#8
Sy
EF
Ks
SF
B S
eg?
No

0.300 — — 12.400 — 0.000 —. 6.120 167.000 —

a —= — 1.700 — 0.100 — 12.300 214.000 0.010
ee == SS 1.000 103.000 0.000 — 2.000 116.000 0.020
1.000 — — 3.000 — 0.100 — 24.000 133.000 0.070
0.000 — —— 2.000 — 0.100 0.000 18.000 109.000 0.020

0.000 —. 2.897 0.000 — 0.000 0.000 0.000 0.000 0.000

0.000 0.000 2.398 0.024 10.000 0.052 0.001 0.000 0.005 0.008
0.000 —— 1.648 0.000 56.000 0.000 0.000 0.000 0.000 0.000

0.000 0.740 —— 39.970 — 1.616 36.570 — 57.070 —

6.880 53.400 0.477 33.250 372.200 59.900 0.807
14.670 — 0.633 — 9.667 117.300 —
— — 0.530 46.140 344.240 13.979 9.240 314.100 55.800 1.365

0.870 — — 11.800 30.600 0.414 35.800 207.700 66.400 0.490

— — — 33.500 503.000 0.600 26.350 252.300 286.000 3.290

4.620 — — 37.290 — 0.957 — 131.300 686.700 —-
0.000 —. — 89.500 518.500 0.917 28.020 275.700 280.100 3.480

— —— -— 17.000 85.900 0.630 21.250 222.200 495.000 0.563

—— —_—. — 36.100 28.050 1.140 42.590 339.000 74.360 0.406

—- aa aa 50.880 29.750 — 90.540 489.900 58.850 0.450

— — — 51.600 1649.000 0.330 29.660 299.200 323.000 2.480

0.349 —— ao 13.000 79.900 1.330 82.560 340.500 70.900 0.800

—— —-— a 86.960 163.200 0.980 32.700 292.800 67.300 1.210

a —_— — 52.620 3650.000 5.910 48.900 207.700 354.800 74.100

aa — 1.180 357.200 3569.00 5.400 43.520 183.200 89.400 72.760

(continued)
662 Appendix B
a

< ra) & oy cA

e 5 z ss & Bim gh
Bb. BGs So. *tS mee eee. eae
Food Se
Portion ee ee 6€8 B28 Ze €& SE & &
REE Se ee ee ee ee ee ee

Fish and Shellfish—continued

Salmon
Pink, solids w/bones
and liquid, canned/
water 3 oz. 46.800 0.020 0.158 5.560 a — 13.060
Smoked 3 02. 74.970 0.020 0.086 4.010 0.240 2.770 1.650
Sockeye, cooked, dry
heat 3 oz. 177.800 0.180 0.145 5.670 0.186 4.930 —
Sardines
Atlantic, canned/oil,
drained 3 02. 190.100 0.680 0.193 4.460 0.140 7.600 10.030
Pacific, canned/tomato
sauce, drained 3 oz. 310.300 0.040 0.198 3.570 0.105 7.650 20.700
Scallops, raw 3% oz. — 0.012 0.065 1.150 se 1.530 ——
Shrimp
Breaded, fried 3 oz. oa 0.110 0.120 2.610 0.080 1.590 6.900
Raw 3% oz. a 0.028 0.034 2.550 0.104 1.610 3.000
Swordfish, raw 3% oz. 119.000 0.037 0.095 9.680 0.330 1.750 ee
Tuna
Canned/water Ye cup — — — — 0.302 ae 3.760
Light, canned/oil Ye cup 62500 0.030. —= = 0.088 ) =.) 4900
Tuna salad Y% cup 99.400 0.032 oa a 0.083 ao 7.460

@ Fruits and Fruit Juices

Apple butter 1 tbsp. 0.000 a soo — — —— —
Apples
Canned, sweetened,
heated Ye cup 56.500 0.009 0.010 0.083 0.045 0.000 0.150
Dried, uncooked Y% cup 0.000 0.000 0.034 0.199 0.027 0.000 —
Juice, canned or
bottled 1 cup 2.000 0.052 0.042 0.248 0.074 0.000 0.200
Raw, unpeeled 1 74.000 0.023 0.019 0.106 0.066 0.000 3.900
Applesauce, canned,
unsweetened Y cup 35.000 0.016 0.031 0.230 0.032 0.000 0.700
Apricots
Canned/juice Ye cup 2098.000 0.023 0.024 0.427 —— 0.000 0.000
Dried, uncooked Y% cup 2353.000 0.003 0.049 0.975 0.051 0.000 3.350
Nectar, canned 1 cup 3304.000 0.023 0.035 0.653 — 0.000 3.300
Raw 3 2790.000 0.033 0.042 0.642 0.057 0.000 9.180
 Appendix B

C (mg.)
Vitamin D (1.U.)
Vitamin E (1.U.)
Vitamin (mg.)
Calcium )
(meg.
Copper Iron(mg.) (mg.) Potassium
Magnesium (mg.) (mg.)
Zinc

0.000 181.400 86.300 0.720 28.500 277.400 470.700 0.780

8.900 195.500 0.720 15.400 148.750 666.400 0.260

5.990 57.000 319.000 59.800

324.300 158.100 337.000 429.300

0.870 203.700 231.200 290.000 352.000

24.200 53.300 321.900 161.000

57.200 223.000 190.900 292.000

51.900 264.000 185.100 148.400
4.400 126.000 228.000

9.600 8.800 251.000 285.000

10.700 56.900
17.660 148.600

3.000 0.100 50.000 0.000

4.000 52.000 0.245 71.000 3.500 0.050

3.000 41.000 0.302 96.750 18.750 0.043

16.000 55.000 0.920 296.000 7.000 0.070

10.000 52.000 0.250 159.000 1.000 0.050

3.500 32.000 0.145 91.500 2.500 0.030

15.000 67.000 0.370 204.500 4.500 0.135

14.750 140.000 O24 447.800 3.250 0.243
17.000 183.000 0.960 286.000 9.000 0.230
14.940 96.000 0.576 315.000 1.068 0.279

(continued)
664 Appendix B

Food Portion A (LuU.* Thiamine

Vitamin (mg.) Riboflavin
(mg.) Niacin
(mg.) B, (mg.) Vitamin
Vitamin B,,(mcg.) Folate
(mcg.)

Fruits and Fruit Juices—continued

Avocado, California,
raw 1 1322.000 0.264
Banana, raw, peeled 96.400 0.119
Blackberries, raw 237.000 0.058
Blueberries, raw 145.000 0.073
Boysenberries, frozen,
unsweetened 89.000 0.049
Carambola, raw 626.000 0.034
Cherries
Sour, frozen,
unsweetened 1 cup 1349.000 0.053
Sweet, raw 10 146.000 0.040
Cranberries
Juice, bottled 1 cup 0.000 0.040
Raw, chopped 1 cup 50.000 0.022
Sauce, canned,
sweetened Ye cup 27.500 0.029
Currants, Zante, dried Y cup 26.000 0.051
Dates
Natural, dried,
chopped Y cup 22.250 0.045
Natural, dried, whole 5 21.000 0.040
Elderberries, raw 1 cup 870.000 0.087
Figs
Dried, uncooked Y cup 66.000 0.044
Raw 1 71.000 0.025
Fruit cocktail
Canned/juice Ye cup 378.500 0.020
Canned/syrup Ye cup 261.000 0.024
Fruit salad
Canned/juice Y% cup 747.000 0.018
Canned/water Y% cup 538.500 0.026
Grapefruit
Juice, canned, raw 1 cup 1082.000 0.049
Juice, canned,
sweetened 1 cup 0.000 0.058
Juice, canned,
unsweetened 1 cup 18.000 0.049
 Appendix B 665

‘S) a a) § =
f= = i=} >) ome

Be §&S> 4&3
8S D> aot ee
Oo este fo fs
od $3 us
Be to es eoeese © S65 88 $6 £2 -RE. 8

17.100 23.800 575.000 2.550 88.600 1369.000 25.900 0.907

10.800 7.140 124.000 0.369 34.500 471.000 1.190 0.190
30.200 46.000 202.000 0.830 29.000 282.000- 0.000 0.390
18.900 9.000 88.000 0.240 7.000 129.000 9.000 0.160

4.100 36.000 106.000 1.120 21.000 183.000 2.000 0.290

26.900 6.000 152.000 0.330 12.000 207.000 2.000 0.140

2.600 20.000 140.000 0.820 13.000 192.000 1.000 0.160

4.800 10.000 70.000 0.260 8.000 152.000 0.000 0.040

108.000 8.000 33.000 0.400 8.000 61.000 10.000 0.050

14.800 8.000 — 0.220 6.000 78.000 1.000 0.140

2.750 5.000 28.000 0.305 4.000 35.500 40.000 0.070

1.675 31.000 169.000 1.173 14.750 321.300 2.750 0.235

0.000 14.500 128.000 0.512 15.750 290.300 1.250 0.130

0.000 13.500 120.000 0.480 14.500 270.500 0.100 0.120
52.200 55.00 — 2.320 ——— 406.000 9.000 —

0.425 71.500 156.000 12 29.500 354.500 5.500 0.250

1.000 18.000 35.000 0.180 8.000 116.000 1.000 0.070

3.400 10.000 77.000 0.265 8.500 117.500 4.500 0.105

2.450 8.000 88.000 0.365 7.000 112.000 7.500 0.105

4.150 14.000 63.000 0.310 10.500 144.000 6.500 0.180

2.350 8.500 82.000 0.365 6.500 95.500 4.500 0.090

93.900 22.000 82.000 0.490 30.000 400.000 2.000 0.130

67.300 20.000 120.000 0.890 24.000 405.000 4.000 0.150

72.000 18.000 94.000 0.500 24.000 378.000 3.000 0.210

(continued)
666 Appendix B

< o) & oo oA
s, & & i 2. 8A ge
oo 864 a oleetise eae ee
Food Portion SG €6° ZBESezso Be = Se 222

Fruits and Fruit Juices—continued

Grapefruit—continued
Pink and red, raw Y, 318.500 0.049 0.025 0.246 0.052 0.000 11.550
White, raw Y% 11.800 0.044 0.024 0.318 0.051 0.000 11.800
Grapes
American type, raw 1 cup 92.000 0.085 0.052 0.276 0.101 0.000 3.600
Juice, canned and
bottled 1 cup 20.000 09.066 0.094 0.663 0.164 0.000 6.580
Guava, common, raw 1 713.000 0.045 0.045 1.080 0.129 .000 0.000
Kiwi fruit, raw 1 133.000 0.015 0.038 0.380 a 0.000 0.000
Kumquats, raw 4 228.000 0.060 0.076 —_—. a 0.000 0.000
Lemons
Juice, raw 1 tbsp. 3.063 0.005 0.002 0.015 0.007 0.000 0.000
Raw, peeled 1 21.500 0.030 0.015 0.074 0.059 0.000 7.840
Limes
Juice, raw 1 cup 1082.000 0.099 0.049 0.494 — 0.000 51.200
Raw, peeled 1 21.500 0.030 0.015 0.074 0.059 0.000 7.840
Mango, raw Y% 4030.000 0.060 0.059 0.605 0.139 0.000 0.000
Melons
Cantaloupe, raw,
cubed 1 cup 5158.000 0.058 0.034 0.918 0.184 0.000 27.300
Casaba, raw, cubed 1 cup 51.000 0.102 0.034 0.680 — 0.000 0.000
Honeydew, raw, cubed 1 cup 68.000 0.131 0.031 1.020 0.100 0.000 0.000
Watermelon, raw,
cubed 1 cup 585.000 0.128 0.032 0.320 0.230 0.000 3.400
Mixed fruit, canned/syuup % cup 247.500 0.019 0.051 0.765 — 0.000 0.000
Mulberries, raw 1 cup 35.000 0.041 0.141 0.868 —— 0.000 0.000
Nectarine, raw ] 1001.000 0.023 0.056 1.350 0.340 0.000 5.100
Oranges
All varieties, raw 1 269.000 0.114 0.052 0.369 0.079 0.000 39.700
Juice, frozen, diluted 1 cup 194.000 0.197 0.045 0.503 0.110 0.000 109.000
Juice, raw 1 cup 496.000 0.223 0.074 0.992 0.099 0.000 136.000
Papayas
Nectar, canned 1 cup 277.000 0.015 0.010 0.375 0.023 0.000 5.200
Raw, cubed 1 cup 2819.000 0.038 0.045 0.473 0.027 0.000 0.000
Passionfruit
Juice, yellow 1 cup 5953.000 — 0.249 = 5.530 — 0.000 0.000
Purple, raw 4 504.000 —_—. 0.092 1.080 — 0.000 0.000
—
Eee
 Appendix B 667

Ss) =) i E E

22 GF gf
S i=} =| Qn a

se aS
Ea
Se
EA
SS 22
aa
SiS, 22
§
3}S 82
ee
Ow
sB
aS
>
gf
ES
ey,
2
awe
EA
Aw NO
an

45.500 — 0.459 18.450 54.000 0.148 9.850 156.000 0.000 0.086

39.300 —— 0.440 14.150 59.000 0.071 10.600 174.500 0.000 0.083

3.700 — 0.960 13.000 37.000 0.270 5.000 176.000 2.000 0.040

0.200 a a 22.000 71.000 0.600 24.000 334.000 7.000 0.130

165.000 —- —— 18.000 93.000 0.280 9.000 256.000 2.000 0.210
74.500 — a 20.000 — 0.310 23.000 252.000 4.000 a
28.400 ——- — 32.000 80.000 0.280 8.000 148.000 4.000 0.080

4.506 —- a 1.375 5.000 0.005 0.875 16.750 0.125 0.009

39.200 — a 19.200 27.000 0.444 — 102.000 1.480 0.044

93.900 — 0.146 22.000 82.000 0.490 30.000 400.000 2.000 0.130

39.200 — — 19.200 27.000 0.444 — 102.000 1.480 0.044
28.650 — 1.728 10.500 114.000 0.130 9.000 161.000 2.000 0.035

67.500 — 0.334 17.000 67.000 0.340 17.000 494.000 14.000 0.250

27.200 — 0.355 9.000 a 0.680 14.000 357.000 20.000 a
42.100 — 0.355 10.000 70.000 0.120 12.000 461.000 17.000 ——

15.400 -— a 13.000 51.000 0.280 17.000 186.000 3.000 0.110

88.000 — — 1.500 74.000 0.460 6.500 107.000 5.000 0.090
51.000 — — 55.000 — 2.590 25.000 271.000 14.000 oe
7.300 ee na 6.000 99.000 0.210 11.000 288.000 0.000 0.120

69.700 —— 0.468 52.000 59.000 0.130 13.000 237.000 0.000 0.090

96.900 — 0.149 22.000 110.000 0.240 24.000 474.000 2.000 0.130
124.000 — 0.148 27.000 109.000 0.500 27.000 496.000 2.000 0.130

7.500 — — 24.000 33.000 0.860 8.000 78.000 14.000 “0.380

86.500 — —_— 33.000 22.000 0.140 14.000 359.000 4.000 0.100

45.000 —, — 9.000 — 0.890 41.000 687.000 15.000 —

21.600 — — 8.000 — 1.160 20.000 252.000 20.000 —

(continued)
668 Appendix B

Food Portion A (1.U.)* Thiamine

Vitamin (mg.) Riboflavin
(mg.) Niacin
(mg.) Vitamin B,,(mcg.) Folate
B, (mg.) Vitamin (mcg.)

Fruits and Fruit Juices—continued

Peaches
Canned/heavy syrup 1 cup 849.000 8.200
Canned/water 1 cup 1298.000 8.200
Raw, sliced 1 cup 910.000 5.800
Raw, unpeeled 465.000 3.000
Pears
Bartlett, raw,
unpeeled 33.000 12.100
Canned/heavy syrup 0.000 3.000
Canned/juice 14.000 0.000
Canned/water 0.000 3.000
Persimmon, Japanese,
raw 3640.000 12.600
Pineapple
Bits, canned/juice 95.000 0.000
Bits, canned/syrup 37.00 11.900
Bits, canned/water 37.000 11.900
Juice, canned 12.000 57.800
Raw, diced 35.000 16.400
Plantains, cooked 1400.000 40.000
Plums
Japanese hybrid, raw 213.000 1.450
Purple, canned/juice 2542.000
Purple, canned/syrup 668.000 6.500
Purple, canned/water 2276.000 6.600
Pomegranate, raw
Prunes
Dried, cooked Ye cup 324.500
Dried, uncooked Y% cup 799.800
Quince, raw 1 37.000
Raisins, seedless Y4 cup 2.750
Raspberries, raw 1 cup 16.000
Rhubarb, cooked,
w/sugar Ye cup 110.000
Strawberries, whole, raw 1 cup 41.000
Tangerine, raw, peeled 1 773.000
 Appendix B 669

Ss) a a) 5 E
i=} S i=] N A

Fis
8 Ea
s5 Ea
s5 ae
ob ee
ao = >op Boob SB vo 3Envo en
Y
SE So fo 8& SE Z£E sé cb -gs HE

7.100 —— — 8.000 131.000 0.690 13.000 235.000 16.000 0.220

7.000 — — 6.000 132.000 0.770 12.000 241.000 8.000 0.220
11.200 —. 0.253 9.000 116.000 0.190 11.000 334.000- 1.000 0.230
5.700 — 0.130 5.000 59.000 0.100 6.000 171.000 0.000 0.120

6.600 — 1.222 19.000 188.000 0.410 9.000 208.000 1.000 0.200

2.900 — 0.380 12.000 125.000 0.560 11.000 165.000 13.000 0.210
4.000 — — 21.000 131.000 0.710 17.000 238.000 10.000 0.220
2.500 —-. — 9.000 124.000 0.520 9.000 130.000 5.000 0.210

12.600 — —- 13.000 190.00 0.260 15.000 270.000 3.000 0.180

23.800 —- 0.373 34.000 215.000 0.700 35.000 304.000 4.000 0.240

19.000 — 0.380 36.000 260.000 0.980 40.000 266.000 3.000 0.290
18.900 — 0.367 37.000 258.000 0.980 44.000 313.000 3.000 0.290
26.700 — — 42.000 225.000 0.650 34.000 334.000 2.000 0.290
23.900 — 0.231 11.000 171.000 0.570 21.000 175.000 1.000 0.120
16.800 —— — 3.000 102.000 0.890 49.000 716.000 8.000 0.200

6.300 — 0.688 2.000 28.000 0.070 4.000 113.000 0.000 0.060

7.000 — — 25.000 136.000 0.840 20.000 389.000 3.000 0.270
1.100 — — 24.000 95.000 2.170 13.000 234.000 50.000 0.190
6.700 — — 17.000 97.000 0.400 13.000 314.000 2.000 0.190
9.400 — — 5.000 — 0.460 0.000 399.000 5.000 ——

3.100 — — 24.000 205.000 1.175 21.500 354.000 2.000 2.250

1.350 — — 20.500 173.000 0.998 18.250 300.000 1.500 0.213
13.800 — — 10.000 120.000 0.640 7.000 181.000 4.000 —=——
1.200 — 0.380 17.750 112.000 0.755 12.000 272.300 4.250 0.095
30.800 — 0.550 27.000 91.000 0.700 22.000 187.000 0.000 0.570

8.000 —— 0.402 105.500 26.000 0.800 16.200 274.000 2.500 0.108

84.500 — 0.267 21.000 73.000 0.570 16.000 247.000 2.000 0.190
25.900 — —— 12.000 24.000 0.090 10.000 132.000 1.000 =

(continued)
670 Appendix B
eee
i

Food Portion A (1.U.)* Thiamine

Vitamin (mg.)
(mg.) Riboflavin B, (mg.)
Vitamin Vitamin
B,, (mcg.)
(mcg.) Folate
ee
eee ES eee

@ Grains and Grain Products (See also Breads; Cereals)

Barley
Cooked 1 cup — 0.108 0.080 2.790 0.160 — 1.780
Pearl, light, uncooked 1 cup 0.000 0.240 0.100 6.200 0.448 0.000 40.000
Bulgur, dry, commercial 1 cup 0.000 0.530 0.180 7.400 — — —
Corn fritters 3 420.000 0.180 0.210 1.800
Cornmeal, unbolted, dry 1 cup 620.000 0.460 0.130 2.400 0.305 0.000 29.300
Flour
Buckwheat, light, sifted 1 cup 0.000 0.080 0.040 0.400 0.566 0.000 43.100
Soybean, low-fat 1 cup 70.000 0.730 0.320 2.300 — — —
Wheat, enriched,
unsifted 1 cup 0.000 0.800 0.500 6.600 0.075 0.000 26.300
Whole wheat, stirred 1 cup 0.000 0.230 0.130 1.800 0.083 0.000 15.600
Macaroni, cooked, firm 1 cup 0.000 0.230 0.130 1.800 0.083 0.000 15.600
Noodles, egg, enriched,
cooked 1 cup 110.000 0.220 0.130 1.900 0.141 0.000 19.200
Pancakes
Buckwheat, mix 3 180.000 0.120 0.150 0.600 0.171 1.065 8.910
Plain, home recipe 3 90.000 0.180 0.210 1.500 0.171 1.065 8.910
Rice
Brown, long-grain,
cooked 1 cup 0.000 0.180 0.040 2.700
White, instant 1 cup 0.000 0.210 0.000 1.700 0.056 0.000 16.500
White, long grain,
cooked 1 cup 0.000 0.230 0.020 2.100 0.871 0.000 22.600
Wild, cooked 1 cup — 0.066 0.110 1.600 0.170 — 25.400
Spaghetti, cooked, firm 1 cup 0.000 0.230 0.130 1.800 0.083 0.000 15,600
Taco shell 1 —- 0.032 0.017 0.189 — 0.000 ae
Tortilla, corn 1 — 0.048 0.030 0.384 0.091 0.000 5.700

@ Meats
Bacon
Canadian, pork, grilled _—1 slice 0.000 0.192 0.046 1610 0.105 0.180 1.000
Pork, broiled or fried 3 slices 0.000 0.132 0.054 1.392 0.051 0.330 0.999
Beef
Arm roast, cooked 3 02. a 0.058 0.201 2.672 0.240 2.490 8.000
Brisket, lean, braised S807 — 0.006 0.185 3.189 0.260 2.170 7.000
Hamburger, patty,
extra-lean, broiled 3 02. —— 0.051 0.230 4.216 0.230 1.840 8.000
 Appendix B 671

Ss) a a) E S 5

AoGeiooe Seat fe cs 40 Se Be 43
S i= i= be Nn =

= £2 £2 a=} =|
pops ees oem Cen SS Gn ee ae: Ae

0.000 — — 14900 137.000 1.760 29.800 126.000 12.200 ~—1.080

0.000 — 0.060 32000 — 4.200 74.000 320.000 6.000 = —
©0007 ==) 901566 958000) == 8200!) 459.00emadie mee —
31000 ten) ek 66. 600.0 See.
0.000 — 0.273 24.000 156.000 2200 — 346.000 1.000 =—
0.000 — 0468 11.000 700.000 1.000 47.000 314.000 0.000 2s—
000 One— a etstcoo =) ¥e.000 = |= 511436.000 - "roto ee
0.000 — 0.075 20.000 239.000 +3.600-31.300 119.000 ~—-2.000 0.800
0.000 — 0.039 14.000 26.000 -~—=«1.400-«-26.000 103.000 ~=—1.000 0.700
0.000 — 0.039 14.000 26.000 -—«1.400-—-26.000 103.000 ~—1.000 0.700
0.000 — — 16.000 270.000 1400 43.200 70.000 3.000 =—
0.000 0.000 — 177.000 — 1200 15.390 198.000 480.000 0.576
0.000 0.000 +=— 81.000 60.000 «1.200 «15.390 99.000 480.000 0.576

0,000 =e GSD Z9 0000 “SEE 83000 © == = 11371000" 0. 000ee—

0.000 — 0.271 5.000 169.000 1.300 13.200 =— 13.000 0.700
0.000 — 0.337 21.000 210.000 +=—1.800- 16.400 57.000 ~—-6.000-—0.700
Se in Sh 123-5000 1470003 0.800 40.6001 128.000. 29,200merNe70
0.000 — 0.116 14.000 — 1400 24.700 103.000 1.000 -—0.700
15 600), (250007 0286 a0 ON
0.000 — — 42.000 90.000 0570 19.500 52.200 53.400 0.426

5.000 8320 — 2500 13.000 0.190 5.000 90.500 360.000 0.395

6.390 9.000 0.148 «2.001 «33.000 «0.309» 5.010 92.100 303.000 0.618
0.000 — — 9000 112.000 2610 17.000 207.000 51.000 5.730
0.000 — — — 5.000 102.000 2360 20.000 244.000 61.000 5.850
0.000 — — 6.000 60.000 2.000 18.010 266.000 59.000 4.630
(continued)
672 Appendix B

< co) & oy oa

Food Portion
83
Ss
22
ie
82
ee
sf
Zo
SP
oS
82
easy
3
mS

Meats—continued
Beef—continued
Hamburger, patty,
lean, broiled 3 Oz. — 0.043 0.179 4.386 0.220 2.000 8.00
Hamburger, w/bacon
and cheese ] 368.000 0.150 0.270 4.890 0.240 1.800 25.500
Heart, simmered 3 oz. 0.000 0.119 1.309 3.462 0.180 12.160 2.001
Liver, pan-fried 30z. 30689.000 0.179 3.519 12.274 1.221 95.030 187.100
Rib Roast, lean,
roasted 3 Oz. --— 0.070 0.179 3.497 0.260 2.480 7.000
Round steak, lean and
fat, broiled 3 oz. a 0.077 0.175 3.181 0.380 2.340 8.000
Sirloin steak, lean and
fat, broiled 3 02. —— 0.095 0.224 3.289 0.330 2.260 8.000
Tenderloin, lean and
fat, cooked 3 Oz. ——— 0.099 0.230 3.072 0.340 2.080 6.000
Tip round, lean only,
roasted 3 Oz. oe 0.083 0.228 Si l7/s) 0.340 2.460 7.000
Bologna, pork 1 slice — 0.120 0.036 0.897 0.060 0.210 1.000
Comed beef, canned 3 02. 0.000 0.018 0.126 2.067 0.120 1.380 ——
Corned beef hash,
canned 1 cup — 0.020 0.200 4.600 — —— eS
Deviled ham, canned 10z: 0.000 0.044 0.022 0.436 0.092 0.198 —
Frankfurters
With bun 1 0.000 0.197 0.230 3.050 0.000 0.000 0.000
Without bun 1 aa 0.113 0.068 1.500 0.080 0.740 2.000
Ham
Canned, 13% fat,
roasted 3 02. — 0.699 0.221 4.508 0.255 0.899 4.253
Extra-lean, 5% fat,
roasted 3 oz. 0.000 0.644 0.172 3.420 0.340 0.553 3.038
Lean only, roasted 3 oz. — 0.578 0.216 4.271 0.395 0.595 3.038
Lunch meat, regular,
11% fat 1 slice 0.000 0.244 0.071 1.490 0.100 0.240 1.000
Lamb
Chop, lean and fat,
broiled 3 02. ——- 0.105 0.182 3.918 0.234 1.720 2.552
Leg, lean and fat,
roasted 3 02. a 0.130 0.230 4.703 0.234 1.831 2.552
 Appendix B 673

'S) a a) E § g
i=} i=] S n A=
aye
s
EO
is) =
Ea
s =
33 Pea
ao
>
cS oo
BS20 BS0
S$
sa0
>
me
sw
Sabre i2ss.. 6f2 SEA ES B6nr€S .B2& ge

0.000 — — 9.000 56.000 1.790 18.000 256.000 65.000 4.560

1.500 no 0.119 116.000 120.000 2.740 34.500 339.000 660.000 5.250

1.201 — — 5.003 629.000 6.380 22.000 198.100 54.000 2.660
19.410 mae — 9.000 2400.000 5.343 20.010 309.000 90.000 4.630

0.000 — —- 9.000 83.000 2.220 21.000 320.000 63.000 5.900

0.000 — — 6.000 82.000 2.050 21.000 311.000 51.000 3.510

0.000 a a 9.000 116.000 2.560 24.000 306.000 53.000 4.880

0.000 — ——- 7.000 142.000 2.760 23.000 323.000 52.000 4.280

0.000 oe —- 5.000 106.000 2.500 23.000 328.000 55.000 6.010

8.100 0.000 0.021 3.000 17.000 0.180 3.000 65.000 272.000 0.470
1.200 — — — 54,000 1.770 12.000 116.100 855.000 3.030

—-- —— 0.098 29.000 oe 4.400 — 440.000 1188.000 —

oe 13.520 0.000 2.181 — 0.654 3.685 — 348.900 0.519

0.000 19.100 0.171 27.100 107.000 1.530 13.100 140.000 636.000 2.050
15.000 20.300 0.119 6.000 50.000 0.660 6.000 95.000 639.000 1.050

11.910 22.110 0.355 7.290 111.000 1.166 14.580 303.800 800.100 2.126

17.860 22.110 0.355 6.683 67.000 1.258 12.150 244.200 1023.000 2.448
— — 0.355 6.075 74.000 0.796 18.830 269.100 1129.000 2.187

8.000 0.000 —— 2.000 30.000 0.280 5.000 94.000 373.000 0.610

— 0.000 0.203 7.645 137.000 0.956 14.430 191.100 59.250 3.345

— 0.000 0.064 9.005 50.000 1.401 17.010 241.000 59.030 3.502

(continued)
674 Appendix B
a

<t ) & nal cA

6, Sew 28 0 es Bee
Food Portion
a5 22 32
Sa eo moe
32 EF af 32
ZS a= ou nw

Meats—continued
Lamb—continued
Shoulder, lean and fat,
roasted 3 Oz. a 0.110 0.200 4.002 0.234 1.831 2.552
Liverwurst/liver sausage,
pork 1 slice — 0.049 0.185 — 0.030 2.420 5.000
Pepperoni, pork/beef 1 slice — 0.018 0.014 0.273 0.010 0.140 —
Pork
Chop, lean and fat,
broiled SIOZ: 7.260 0.716 0.305 4.481 0.322 0.840 4.149
Loin, lean, roasted 3 oz. 5.989 0.770 0.222 4.642 0.380 0.509 0.997
Sausage, link, cooked 1 — 0.096 0.033 0.587 0.040 0.220 a
Sausage, link, Italian 1 —_ 0.417 0.156 2.790 0.220 0.870 a
Sausage, patty, cooked 1 aa 0.200 0.069 1.220 0.090 0.470 ——
Sausage, Polish,
cooked 1 oz. —— 0.014 0.004 0.098 0.005 0.027 ——
Spareribs, braised 3 02. 8.984 0.347 0.323 4.642 0.299 0.919 3.983
Tenderloin, lean,
roasted 3 02. 5.989 0.797 0.332 3.983 0.359 0.470 5.001
Rabbit, stewed, no skin 3 02z. so 0.043 0.061 9.599 — — a
Salami, dry or hard, pork 1 slice —- 0.093 0.033 0.560 0.060 0.280 —
Veal
Cutlet, medium fat,
broiled 3 02. -— 0.060 0.210 4.603 — 1.361 ——
Rib, no bone, roasted SoZ —— 0.110 0.260 6.604 — 1.401 a
Venison, roasted 3 oz. 0.000 0.315 0.238 6.294 — — —

@ Miscellaneous
Gelatin, dry 1 envelope — 0.000 0.000 0.000 0.000 — —
Ketchup 1 tbsp. 210.000 0.010 0.010 0.200 0.016 0.000 0.750
Mustard, yellow,
prepared 1 tbsp. —- —- — — — — =
Olives, green, pickled,
canned 2 20.000 a ee — — 0.000 0.080
Pickle relish, sweet 1 tbsp. — — a — as —s oe
Pickles
Cucumber, dill,
medium 1 70.000 0.000 0.010 0.000 0.005 0.000 0.650
 Appendix B 675

‘S) Qa a § 5
i=] i=) i=} n A
ita Eo Ea a go > Tan 2 =p4 >
ge
Ske),
285
So
Geos
Sy
ese
(Oyces,
Pei
Ore
se:
SS
Pe
Pes
£3
Gans,
SF
a S
ge
N=

a 0.000 0.203 9.005 —— 1.001 14.510 206.100 59.030 3.502

—— 2.600 0.094 5.000 a 1.150 _— — 215.000 ——

oe — 0.013 1.000 0.000 0.080 1.000 19.000 112.000 0.140

0.207 0.000 0.203 5.186 76.000 0.685 20.740 297.700 56.010 2.085
0.299 0.000 0.201 5.001 59.000 0.928 17.970 305.500 59.000 1.938
0.000 0.000 0.031 4.000 20.000 0.160 2.000 47.000 168.000 0.330
1.300 —— 0.159 16.000 54.000 1.010 12.000 204.000 618.000 1.590
0.000 23.000 0.064 9.000 40.000 0.340 5.000 97.000 349.000 0.680

0.025 —. 0.067 0.375 3.000 0.041 0.375 6.744 24.850 0.055

— —. 0.201 39.830 120.000 1.578 20.960 455.200 56.900 2.546

0.299 0.000 0.504 6.978 135.000 1.309 20.960 455.200 56.900 2.546
—— — 0.507 17.620 —— 1.276 0.000 312.900 34.630 —
—— 6.000 0.016 1.000 20.000. 0.130 2.000 — 226.000 0.420

—— 0.000 0.064 9.005 213.000 2.702 15.310 258.200 68.040 3.502

— 0.000 0.064 10.010 213.000 2.902 17.010 259.200 68.040 3.502
0.000 — — 17.010 — 2.977 24.660 285.800 59.540 —

2000. mene= =H 20:00 = 04002 yan 180000? 48.0005 ae

2.000 — — 3.000 32.000 0.100 3.600 54.000 156.000 0.034

— — 0.393 12.000 —— 0.300 6.000 21.000 195.000 —

—. — — 4.000 — 0.100 a 3.500 161.600 ———

a —. — 3.000 — 0.100 — — 124.000 —

4.000 0.000 —. 17.000 oe 0.700 7.800 130.000 928.000 0.176

(continued)
676 Appendix B

< v & oa oa

Food Portion
s5
Se
22
eS
4P
(am ey,
s2
Zi
82
She,
SE
NY)
3E
fee ey,

Miscellaneous—continued
Pickles—continued
Cucumber, fresh-pack 4 40.000 0.000 0.000 0.000 0.004 0.000 0.300
Sweet/gherkin, small 1 10.000 0.000 0.000 0.000 0.001 0.000 0.150
Vinegar, cider 1 tbsp. —— — —— —— 0.000 ne a
Yeast, brewer’s, dry 1 tbsp. 0.000 1.250 0.340 3.000 0.200 0.000 313.000

@ Nuts and Seeds

Almond butter, plain 4 tbsp. 0.000 0.084 0.392 1.840 0.048 0.000 41.600
Coconut milk, raw 1 cup 0.000 0.062 0.000 1.820 — 0.000 a
Nuts
Almonds, shelled,
slivered Y% cup 0.000 0.061 0.224 0.967 0.033 0.000 16.880
Brazil nuts, dried,
shelled Y% cup es 0.350 0.043 0.568 0.088 0.000 1.400
Cashews, dry-roasted Y% cup 0.000 0.069 0.069 0.480 0.088 0.000 23.700
Chestnuts, roasted 1 oz. 0.998 0.043 0.026 0.425 a 0.000 ae
Coconut, raw,
shredded Ys cup 0.000 0.013 0.004 0.108 0.011 0.000 5.275
Filberts/hazelnuts,
dried, chopped Y% cup 19.250 0.144 0.032 0.325 0.176 0.000 20.650
Macadamia nuts, dried Y% cup 0.000 0.117 0.037 0.717 — 0.000 ae
Mixed nuts,
dry-roasted Y% cup 5.250 0.069 0.069 1.610 0.102 0.000 17.250
Peanuts, Spanish, dried % cup 0.000 0.242 0.048 5.175 0.108 0.000 36.750
Pecans, halves, dried Y% cup 34.500 0.229 0.035 0.240 0.051 0.000 10.570
Pistachios, dry-roasted Ys cup — 0.135 0.079 0.450 — 0.000 —
Walnuts, black, dried,
chopped Y% cup 92.500 0.068 0.034 0.216 —-- a —
Peanut butter, smooth 4 tbsp. oo 0.096 0.068 8.600 0.248 0.000 52.400
Seeds
Pumpkin or squash
seeds, dried Y% cup 131.300 0.073 0.111 0.602 0.031 0.000 +
Sesame seeds, dried,
whole Y cup 3.250 0.285 0.089 1.625 0.285 0.000 34.750
Sunflower seeds, dried Y% cup 18.000 0.822 0.090 1.620 0.452 0.000 85.000
Sesame butter (tahini) 4 tbsp. —-- 0.732 0.284 3.272 — 0.000 ~
a
 Appendix B 677

Ss) a tx 5 =
=ES gEA sEA E
2
ae
B. ‘eo >
8 3 E
ee) 2 2D eel
Sees Gite stas 4 Bee 52, 22 32 Be 282

2.000 0.000 oe 10.000 -—— 0.600 a — 200.000 0.080

1.000 0.000 oa 2.000 —- 0.200 0.150 — 128.000 0.020
—. 0.000 —— 1.000 —-- 0.100 -— 15.000 -— 0.125 0.020
0.000 — — 17.000 — 1.400 18.400 152.000 9.000 no

0.400 — 8.702 172.000 576.000 2.360 192.000 484.000 8.000 1.960

6.700 — — 39.000 638.000 3.940 89.000 630.000 37.000 1.610

0.173 0.000 10.281 76.500 270.000 1.053 85.000 210.500 Bia Was) 0.840

0.250 0.000 3.342 61.500 6520.000 1.190 78.750 210.000 0.500 1.605
0.000 — 0.291 15.500 760.000 2.055 89.000 193.500 5.250 1.917
—- —e 0.212 4.991 110.000 0.429 25.950 134.800 0.998 0.260

0.650 0.000 0.209 3.000 87.000 0.485 6.500 71.250 4.000 0.220

0.300 0.000 10.169 54.000 435.000 0.940 82.000 128.000 0.750 0.690
— — — 23.500 99.000 0.808 38.750 123.300 1.500 0.572

0.150 — — 24.000 438.000 1.267 77.000 204.300 4.000 1.303

0.000 — 4.247 21.250 365.000 1.178 65.500 261.800 5.750 1.195
0.525 0.000 1.247 9.750 320.000 0.575 34.500 105.800 0.250 1.477
— — 2.485 22.500 387.000 1.015 41.500 310.500 2.000 0.435

——- 0.000 0.390 18.000 320.000 0.960 63.000 163.800 0.500 1.070
0.000 0.000 6.675 20.000 376.000 1.160 112.000 440.000 300.000 1.880

— — 14.750 477.000 5.175 184.500 278.500 6.000 Zot

0.000 — 1.219 351.000 1470.000 5.250 126.300 168.500 4.000 2.800

— — 26.716 42.000 630.000 2.438 127.300 248.000 1.000 1.822
0.000 —— — 256.000 968.000 5.360 56.000 248.000 68.000 2.760

(continued)
678 Appendix B

< ro) & or ca

Food
A¢
Portion
go5
SS
go2
BS
25
ae
(43 cee
Ze, Se
Gee
Se
Se
me

@ Peas and Beans (Legumes)

Beans
Great Northern, dry,
cooked 1 cup 2.000 0.280 0.104 1.205 0.207 0.000 180.900
Kidney, red, canned 1 cup 0.000 0.269 0.225 1.167 0.056 0.000 129.400
Lima, boiled, drained Y% cup 315.000 0.119 0.082 0.885 0.164 0.000 -——
Navy pea, dry, cooked 1 cup 3.000 0.368 0.111 0.966 0.298 0.000 254.600
Cowpeas, black-eyed,
boiled 1 cup 26.000 0.345 0.094 0.846 0.171 0.000 355.500
Lentils, whole, cooked 1 cup 15.000 0.335 0.145 2.099 0.352 0.000 357.900
Peas
Green, frozen, boiled,
drained ¥% cup 534.000 0.226 0.080 1.185 0.090 0.000 46.900
Green, raw 1 cup 998.000 0.414 0.206 3.260 0.264 0.000 102.000
In pods, raw 1 cup 211.000 0.218 0.116 0.870 0.232 0.000 —
Split, dry, cooked 1 cup 14.000 0.372 0.110 1.744 0.094 0.000 127.300
Soybean(s)
Curd (tofu) 4 oz. 95.200 0.091 0.058 0.21 0.053 0.000 16.800
Dry, cooked 1 cup 50.000 0.380 0.160 1.100 —- aH oa
Green, boiled, drained 1 cup 281.000 0.468 0.279 2.250 — 0.000 —_—
Kernels, roasted Y% cup 54.000 0.027 0.039 0.475 0.081 0.000 61.000

@ Poultry
Chicken
Breast, no skin, roasted 3702 17.800 0.059 0.097 11.670 0.504 0.287 2.967
Breast, w/skin, roasted 3 02. 78.970 0.056 0.102 10.800 0.469 0.278 2.604
Liver paté, canned 2 tbsp. 188.000 0.014 0.364 1.954 — —_— a
Liver, simmered 3 oz. 13930.000 0.130 1.488 3.785 0.498 16.460 654.300
Leg, no skin, roasted DAOZs 53.720 0.064 0.197 Diot2 0.313 0.278 7.162
Leg, w/skin, roasted 3 02. 114.900 0.058 0.181 5:20 0:2 OmmO.2 611 5.968
Thigh, no skin, roasted 3 02. 55.610 0.062 0.196 5.545 0.294 0.262 6.542
Wing, roasted 3 02. 135.100 0.035 0.110 5.653 0.350 0.250 2.501
Wing, steamed 3 Oz. 112.700 0.034 0.087 3.934 0.191 0.149 2.126
Duck
No skin, roasted 3 Oz. 65.810 0.221 0.400 At3
2 Si Ore 2 0.339 8.467
With skin, roasted 3 OZ. 179.000 0.148 0.229 4.108 0.156 0.252 5.566
Goose
No skin, roasted SIOZ: — 0.078 0.332 3.468 0.396 — —
With skin, roasted 3 Oz. 59.450 0.065 0.275 3.544 0.318 aa 1.868
 Appendix B 679

Oo a a) 2 =
By Sea piesereae’ iee-.6 fe fa Es 22ee
S i=} i=} nN a

Be eos eet hse ee Be. Fknde 32,

2.300 —— —. 121.000 437.000 3.770 88.000 692.000 4.000 1.550

2.900 — — 62.000 384.000 3.220 73.000 658.000 - 873.000 1.410
8.600 —- 0.000 27.000 260.000 2.085 63.000 484.500 14.500 0.670
1.600 — —— 128.000 537.000 4.510 107.000 669.000 2.000 1.930

0.600 —. — 42.000 458.000 4.290 96.000 476.000 6.000 2.200

2.900 0.000 0.000 37.000 497.000 6.590 71.000 731.000 4.000 2.500

7.900 — 0.143 19.000 111.000 1.260 23.000 134.000 70.000 0.750

62.400 — — 38.000 274.000 2.300 52.000 380.000 8.000 1.940
87.000 — 0.282 62.000 330.000 3.010 35.000 290.000 6.000 —
0.800 —. — 22.000 355.000 2.520 71.000 710.000 4.000 1.960

0.100 — — 392.000 216.000 6.003 33.600 135.520 7.840 0.896

0.000 — — 131.000 -_— 4.900 — 972.000 4.000 —
30.600 —. — 261.000 —— 4.500 — — — —
0.600 — — 37.250 287.000 1.202 46.500 397.000 1.000 0.977

0.000 ss 0.444 12.860 42.000 0.880 24.720 217.600 62.300 0.850

0.000 — 0.444 12.150 43.000 0.903 23.430 208.300 59.880 0.868
2.600 — 0.107 2.000 — 2.380 — — — —
13.490 56.980 — 12.150 315.000 7.229 17.620 119.100 43.130 3.688
0.000 —.- 0.444 10.740 68.000 1.110 20.590 205.900 77.890 2.426
0.000 —— 0.444 10.440 66.000 1.134 19.400 191.000 73.860 2.208
0.000 — 0.444 9.813 69.000 1.112 19.630 202.800 75.240 2.192
0.000 — 0.444 12.510 48.000 1.076 Web lORe 5 5s100 70.040 1.551
0.000 — 0.444 10.630 38.000 0.957 12.760 119.100 57.410 1.382

0.000 — 0.444 10.010 196.000 2.290 16.930 214.400 55.030 22213

0.000 — 0.444 9.574 193.000 2.293 13.800 173.700 50.540 1.581

0.000 — — 12.090 235.000 2.439 21.300 329.700 64.330 ——

0.000 — —— 11.430 225.000 2.406 18.570 279.800 59.670 —

(continued)
680 Appendix B

< wo & oy oo
Coe er ee a Cre
Food 5
Portion Ff. #8 22 22:22 2: G22
Se Ba eo 2S] ee Ses Be

Poultry—continued
Turkey
Breast, no skin, roasted 3 02. 0.000 0.037 0.111 6.379 0.475 0.328 5.281
Dark meat, no skin,
roasted 3 oz. 0.000 0.053 0.211 3.104 0.304 0.316 7.898
Light meat, no skin,
roasted 3 oz. 0.000 0.052 0.110 5.814 0.456 0.316 4.860
Turkey roll, light and dark 1 slice — 0.026 0.081 1.360 — — —

@ Sauces and Gravies

Sauces
Barbecue 1 tbsp. 135.600 0.005 0.003 0.141 0.012 0.000 —-
Chili, bottled 1 tbsp. 210.000 0.010 0.010 0.200 -— oo ~——
Marinara, canned Ye cup 1202.000 0.057 0.074 1.990 — 0.000 —
Soy 1 tbsp. 0.000 0.009 0.023 0.605 0.031 0.000 1.900
Spaghetti, canned Y cup 1528.000 0.069 0.074 1.875 — 0.000 oe
Tabasco 1 tsp. —— 0.000 0.010 0.000 se es —-
Tartar, regular 1 tbsp. 30.000 0.000 0.000 0.000 — — —
Teriyaki, bottled 1 tbsp. 0.000 0.005 0.013 0.229 0.018 0.000 3.600
Tomato, canned, salt ’
added Y% cup 1200.000 0.081 0.071 1.410 a 0.000 a
White, medium,
enriched 2 tbsp. 143.800 0.015 0.054 0.088 0.008 ae —
Gravies
Beef, canned 2 tbsp. 0.000 0.009 0.011 0.192 0.003 0.029 0.000
Chicken, canned 2 tbsp. 110.000 0.005 0.013 0.132 0.003 a na
Mushroom, canned 2 tbsp. 0.000 0.010 0.019 0.200 0.006 0.000 —

@ Snacks
Corn chips loz — 0.048 0.026 0.553 —. 0.000 wae
Popcorn, popped, plain 1 cup = — 0.010 0.100 0.012 0.000 ae
Potato chips, salt added 1 oz. 0.000 0.043 0.000 1.191 0.142 0.000 12.760
Pretzels, Dutch, twisted Koz 0.000 0.089 0.071 1.240 0.005 0.000 4.536

@ Soups
Beef
Broth, canned,
w/water 1 cup 0.000 0.005 0.050 1.870 — —— —
————— eeeeeeeeeaeaoeoen
 Appendix B 681

E
377)

<=
>oO 5S
he's)

C (mg.)
Vitamin (1.U.)
EVitamin (mg.)
Calcium (mcg.)
Copper Z£E s& Potassium (mg.)
(mg.) Sodium (mg.)
Zinc

10.560 59.000 1301 24.740 247.900 44.190 1.473

27.340 136.000 1.987 20.660 246.600 ~ 66.830 SE (AY

16.400 36.000 1.142 23,690 258.800 54.070 sf

9.000 21.000 0.380 5,000 77.000 166.000 0.570

3.000 0.141 0.000 27.190 127.000

3.000 (1008 4== 56.000 201.000
22.000 177.000 1,000 29.500 530.500 786.000
3.000 18.000 0.490 8,000 64.000 1029.000
35.000 142.000 0.810 30.000 478.500 618.000
3.000 22.000
3.000 O10 | wee 11.000 98.000
4.000 18.000 0.310 11.000 41.000 690.000

17.000 240.000 0.940 23.000 454.000 740.500

36.000 0.063 4.688 43.500 99.500

0.000 0.000 1.750 0.204 0,000 23.630 14.630

6.000 O14 32.500 171.900
BNE: pisces 31.630 169.900

ZINES R60
0.200 — 0.000
0.340 17.010 368.600 133.200
0.354 6.804 37.210 457.100

0.000 15.000 (410), ee 130.000 782.000

(continued)
682 Appendix B
a

<
&
E>
£2
Food Portion SS (mg.) Riboflavin
Thiamine (mg.)
(mg.) Niacin B, (mg.)
Vitamin B,,
Vitamin
(mcg.) (mcg.)
Folate

Soups—continued
Beef—continued
Broth, dehydrated 1 cube === 0.007 0.009 0.119
Chunky, canned 1 cup 2611.000 0.058 0.151 2.710 0.610
With noodles, canned,
w/water 1 cup 629.000 0.068 0.059 1.070 0.200
Chicken
Broth, canned 1 cup 0.000 0.010 0.071 3.350 0.240
With dumplings,
canned 1 cup 518.000 0.017 0.072 1.750 0.160
With noodles, canned,
w/water 1 cup 711.000 0.053 0.060 1.390
Clam chowder
Manhattan, canned,
w/water 1 cup 920.000 0.063 0.049 1.340
New England, canned,
w/milk 1 cup 164.000 0.067 0.236 1.030
Cream of asparagus,
canned, w/milk 1 cup 599.000 0.102 0.275 0.880
Cream of chicken,
canned, w/milk 1 cup 715.000 0.074 ‘0.258 0.923
Cream of mushroom,
canned, w/milk 1 cup 154.000 0.077 0.280 0.913
Cream of potato, canned,
w/milk 1 cup 443.000 0.082 0.236 0.642
Split pea, canned,
w/water 1 cup 444.000 0.147 0.076 1.480
Tomato, canned/ w/milk 1 cup 849.000 0.134 0.248 1.520
Vegetable beef, canned,
w/water 1 cup 1891.000 0.037 0.049 1.030
Vegetarian, canned,
w/water 1 cup 3005.000 0.053 0.046 0.916

@ Sugars and Sweets

Candy
Caramel, plain,
chocolate 1 oz. 0.000 0.010 0.051 0.101
Fudge, chocolate,
plain 1 oz. 0.000 0.010 0.030 0.101
 Appendix B 683

Ss) a a) E E

ES Eo Eo a9 RG 8g eS iG Sa ee
Be eee Eos tse, = SE £5 Phnetl Ey As

== = — —- 0.080 2.000 15.000 864.000 0.008

7.000 == === 31.000 240.000 2.320 — 336.000 867.000 2.640

0.300 == === 15.000 139.000 1.100 6.000 99.000 : 952.000 1.540

0.000 === =—— 9.000 124.000 0.510 2.000 210.000 776.000 0.249

0.000 — 0.000 15.000 123.000 0.620 4.000 116.000 861.000 0.366

0.200 == = 17.000 195.000 0.780 5.000 55.000 1107.000 0.395

3.200 = = 34.000 148.000 1.890 10.000 262.000 1808.000 0.927

3.500 ss SS 187.000 139.000 1.480 23.000 = 300.000 +=992.000 0.799

3.900 == = 175.000 139.000 0.870 20.000 359.000 1041.000 0.925

1.300 === aa 180.000 139.000 0.670 18.000 273.000 1046.000 0.675

2.300 = == 178.000 139.000 0.590 20.000 270.000 1076.000 0.640

1.100 == == 166.000 263.000 0.540 17.000 323.000 1060.000 0.675

1.400 == = 22.000 369.000 2.280 48.000 399.000 1008.000 1.320

67.700 0.000 == 159.000 263.000 1.820 23.000 450.000 932.000 0.290

2.400 — = 17.000 183.000 1.110 6.000 173.000 957.000 1.550

1.400 ==S = 21.000 123.000 1.080 7.000 209.000 823.000 0.460

0.000 — 0.073 42.530 — 0.405 1.013 54.680 74.930 —

0.000 —— 0.295 22.280 — 0.304 12.760 42.530 54.680 —

(continued)
684 Appendix B
EE

gyda
< v &
We a
ee
oa

Food Portion Ste RS oa Sy Zo SS So) nS

Sugars and Sweets—continued

Candy—continued
Milk chocolate
w/almonds 1 oz. 70.880 0.020 0.122 0.203 ee —— as
Milk chocolate
w/peanuts 1 oz. 50.630 0.071 0.071 1.418 — —— —~
Honey, strained/
extracted 1 tbsp 0.000 0.000 0.010 0.100 0.004 0.000 —-
Jam/preserves, regular 1 tbsp 0.000 0.000 0.010 0.000 0.004 0.000 1.600
Jelly, regular 1 tbsp 0.000 0.000 0.010 0.000 — —— —
Marshmallows Oz: 0.000 0.000 0.000 0.000 — —— —
Molasses, cane,
blackstrap 1 tbsp a 0.020 0.040 0.400 0.040 0.000 -—
Sugar
Brown, pressed down 1 tbsp 0.000 0.001 0.004 0.025 — — a
White, granulated 1 tbsp 0.000 0.000 0.000 0.000 — —— a
White, powdered,
sifted 1 tbsp 0.000 0.000 0.000 0.000 — —
Syrup, maple 1 tbsp 0.000 oa ee — — a -—

H Vegetables
Alfalfa sprouts, raw 1 cup 51.000 0.025 0.042 0.159 0.011 0.000 12.200
Amaranth, boiled,
drained Y% cup 1828.000 0.013 0.089 0.369 wo 0.000 oo
Artichoke, boiled,
drained 1 172.000 0.068 0.059 0.709 0.104 0.000 53.400
Asparagus, spears, boiled % cup 746.000 0.089 0.109 0.945 0.127 0.000 88.000
Beet greens
Boiled, drained Y% cup 3672.000 0.084 0.208 0.360 0.095 0.000 a
Raw 1 cup 2318.000 0.038 0.084 0.152 0.040 0.000 ae
Beets, sliced, boiled,
drained Y% cup 11.000 0.025 0.012 0.232 0.027 0.000 45.200
Broccoli
Boiled, drained Y% cup 1099.000 0.064 0.161 0.590 0.154 0.000 53.500
Raw Y% cup 1356.000 0.058 0.104 0.562 0.140 0.000 62.400
Brussels sprouts, boiled Y% cup 561.000 0.083 0.062 0.473 0.139 0.000 46.800
Cabbage
Bok choy, raw,
shredded 1 cup 2100.000 0.028 0.049 0.350 — 0.000 ——
 Appendix B 685

oO a i 5 E
g £ £ E Bs 3 A E
Shey ES ES 2 B co > lan B > aes >
SP §>5 s§5 3P #2 se sf 32 sf 2F

0.000 10.130 0.465 65.810 — 0.506 0.000 126.600 23.290 od

0.000 10.130 0.465 49.610 —. 0.405 0.000 139.700 19.240 —

0.000 0.000 noe 1.000 8.000 0.100 0.630 11.000 1.000 0.020
0.000 0.000 0.027 4.000 62.000 0.200 — 18.000 2.000 aa
1.000 0.000 0.024 4.000 16.000 0.300 0.900 14.000 3.000 —
0.000 as ood 5.063 — 0.506 — 2.025 11.140 0.010

— 0.000 0.122 137.000 284.000 3.200 52.000 585.000 18.000 ce

0.000 0.000 — 11.690 48.000 0.469 — 47.310 4.125 a

0.000 0.000 —— 0.000 2.000 0.000 -— 0.000 0.120 0.006

0.000 0.000 a 0.000 1.000 0.006 ao 0.188 0.052 —

0.000 — ee 33.000 — 0.200 2.000 26.000 3.000 ao

2.700 — —= 10.000 52.000 0.320 9.000 26.000 2.000 0.300

27.150 —— — 138.000 _— 1.490 36.500 423.000 14.000 —

8.900 — 0.340 47.000 73.000 1.620 47.000 316.000 79.000 0.430

18.200 — 2.652 22.000 90.000 0.590 17.000 279.000 4.000 0.430

17.950 — 1.624 82.500 181.000 1.370 48.500 654.000 173.000 0.360

11.400 — —- 46.000 72.000 1.260 28.000 208.000 76.000 0.140

4.675 — 0.039 9.000 48.000 0.525 31.000 266.000 42.000 0.215

49.000 — 0.532 89.000 54.000 0.890 47.000 127.000 8.000 0.120

82.000 — 0.603 42.000 40.000 0.780 22.000 286.000 24.000 0.360
48.400 — 0.983 28.000 65.000 0.940 16.000 247.000 17.000 0.250

31.500 —— —— 74.000 oa 0.560 13.000 176.000 45.000 —

(continued)
686 Appendix B

Food Portion A (1.U.)* Thiamine

Vitamin (mg.) Niacin
(mg.) Riboflavin (mg.) B, (mg.)
Vitamin B,, (mcg.)
Vitamin (mcg.)
Folate

Vegetables—continued
Cabbage—continued
Common, boiled,
drained Ye cup 62.500
Common, raw,
shredded 1 cup 113.000
Red, raw, shredded 1 cup 28.000
Sauerkraut, canned Ye cup 21.000
Carrots
Juice, canned 1 cup 63350.000
Sliced, boiled, drained Y% cup 19150.000
Whole, raw, scraped 1 20250.000
Cauliflower
Boiled, drained Ye cup 9.000
Raw, chopped 1 cup 16.000
Celery
Pascal, raw, diced 1 cup 152.000
Pascal, raw, stalk 1 51.000
Celery cabbage, raw 1 cup 912.000
Chives, raw, chopped 1 tbsp. 192.000
Coleslaw Ye cup 408.000
Collards, boiled, drained Ye cup 2109.000
Corn
Cream style, sweet,
canned Y% cup 124.000
Kernels, frozen, boiled Ye cup 204.000
Sweet, on cob, boiled 1 ear 167.000
Cress, garden, raw 1 cup 4650.000
Cucumber, raw, sliced 1 cup 46.000
Dandelion greens, boiled Y% cup 6145.000
Eggplant, boiled, drained Y% cup 30.500
Endive, raw, chopped 1 cup 1026.000
Garlic, clove, raw l 0.000
Gingerroot, raw, sliced 1 tbsp. 0.000
Jerusalem artichokes, raw 1 cup 30.000
Kale
Chopped, boiled Ye cup 4810.000
Raw, chopped 1 cup 5963.000
 Appendix B 687

=
=
n

=
>on ae
jo!)

C (mg.)
Vitamin (LU.)
DVitamin E (1.U.)
Vitamin (mg.)
Calcium (mcg.)
Copper Ze 6 Potassium (mg.)
(mg.) Sodium (mg.)
Zinc

17.600 23.950 21.000 0.283 10.900 148.500 13.800

42.600 42.300 21.000 0.504 13.500 221.000 16.200

39.900 36.000 68.000 0.350 11.000 144.000 7.000
17.400 36.000 114.000 1.735 15.500 200.500 780.500

21.000 58.000 114.000 1.140 34.000 720.000 72.000

1.800 24.000 105.000 0.480 10.000 177.000 52.000
6.700 19.000 34.000 0.360 11.000 233.000 25.000

34.300 17.000 56.000 0.260 7.000 200.000 4.000

71.500 29.000 32.000 0.580 14.000 355.000 15.000

7.600 44.000 42.000 0.580 14.000 340.000 106.000

2.500 14.000 14.000 0.190 5.000 114.000 35.000
20.500 58.000 27.000 0.230 10.000 181.000 7.000
2.400 2.000 3.000 0.050 2.000 8.000 0.000
20.800 1.560 32.000 16.000 0.400 8.000 112.000 16.000
9.300 74.000 143.000 0.390 10.500 88.500 18.000

4.000 0.490 22.000 172.000 365.000

2.000 0.250 15.000 114.000 4.000
2.000 0.470 24.000 192.000 13.000
40.000 0.660 0.000 304.000 8.000
14.000 0.280 12.000 156.000 2.000
73.500 0.945 0.000 122.000 23.000
2.500 0.170 6.500 119.000 1.500
26.000 0.420 8.000 158.000 12.000
5.000 0.050 1.000 12.000 1.000
1.000 0.030 2.500 25.000 0.750
21.000 5.100 26.000

47.000 102.000 0.585 11.500 148.000 0.155

90.000 194.000 1.140 23.000 299.000 0.290

(continued)
688 Appendix B

< ) & al oa

Food Portion
BS
Pie
29
RS
82
Se
a2 2
PS
32
eS
35
eS

Vegetables—continued
Kohlrabi
Boiled, drained Ye cup 29.000 0.033 0.016 0.322 aa — —
Raw 1 cup 50.000 0.070 0.028 0.560 0.210 0.000 —
Leeks
Boiled, drained 1 57.000 0.032 0.025 0.248 one 0.000 30.100
Raw 1 118.000 0.074 0.037 0.496 a 0.000 79.500
Lettuce
Iceberg, raw, chopped 1 cup 182.000 0.025 0.017 0.103 0.022 0.000 30.800
Loose-leaf, raw 1 cup 1045.000 0.028 0.044 0.220 0.030 0.000 76.000
Romaine, raw,
shredded 1 cup 1456.000 0.056 0.056 0.280 —— 0.000 76.000
Mushrooms
Boiled, drained Y% cup 0.000 0.059 0.234 3.478 0.072 0.000 14.300
Raw, chopped 1 cup 0.000 0.072 0.314 2.880 0.068 0.000 14.800
Mustard greens, boiled,
drained Y% cup 2122.000 0.029 0.044 0.303 0.000 0.000 oa
Okra, boiled, drained Y cup 460.000 0.106 0.044 0.695 0.150 0.000 36.500
Onions
Mature, boiled, drained Y% cup 0.000 0.044 0.008 0.084 0.189 0.000 13.300
Mature, raw, chopped 1 cup 0.000 0.102 0.017 0.170 0.267 0.000 33.800
Young, green 1 250.000 0.004 0.007 0.001 oa 0.000 0.685
Parsley, raw, chopped 1 cup 3328.000 0.048 0.064 0.448 0.096 0.000 117.100
Parsnips, sliced, boiled,
drained Ye cup 0.000 0.065 0.040 0.565 0.073 0.000 45.400
Peppers
Hot, chili, raw 1 tbsp. 72.250 0.009 0.000 0.089 0.026 0.000 2.188
Hot, red, dried 1 tsp. 1300.000 0.000 0.020 0.200 —— 0.000 —
Sweet, green, boiled,
drained 1 283.000 0.039 0.026 0.265 0.079 0.000 7.200
Sweet, green, raw ] 392.000 0.063 0.037 0.407 0.121 0.000 12.500
Sweet, red, raw 1 4218.000 0.063 0.037 0.407 0.121 0.000 12.500
Potato(es)
Mashed, w/milk and
butter Y% cup 177.500 0.088 0.042 1.135 0.235 0.000 8.350
Skin, baked 1 oz. — 0.035 0.030 0.870 0.174 0.000 6.110
Strips, frozen, french-
fried 10 0.000 0.060 0.020 1.150 0.120 0.000 8.300
Whole, w/skin, baked 1 a 0.216 0.067 3.320 0.701 0.000 22.200
 Appendix B 689

'S) eS a) 5 =
sES sae 5EA E ie 3= 5BO g
ge feo Stee
25
ge.
Beco
ee
D>
22 bE Re.
35
CB?
>

44.550 — oS 20.500 116.000 0.330 15.500 280.500 17.000 -—

86.800 — — 34.000 196.000 0.560 27.000 490.000 28.000 a

5.200 — 1.699 37.000 — 1.360 18.000 108.000 13.000 —

14.900 — 1.699 73.000 — 2.600 35.000 223.000 25.000 ——

2.150 —. 0.328 10.500 17.000 0.275 4.950 86.900 4.950 0.121

9.900 — 0.328 37.400 — 0.770 6.050 145.000 4.950 0.121

13.400 — 0.334 20.000 —— 0.620 4.000 162.000 4.000 —

3.250 — 0.097 6.500 390.000 1.365 6.500 279.500 0.000 0.650

2.400 — 0.083 4.000 78.000 0.860 8.000 260.000 2.000 0.344

17.700 —— 2.093 51.500 -_— 0.490 10.500 141.500 11.000 —

13.100 — oe 50.000 69.000 0.360 46.000 257.000 4.000 0.440

6.000 —— 0.188 29.000 42.000 0.210 11.000 159.000 8.000 0.190

14.300 —— 0.785 42.500 68.000 0.629 17.000 264.000 3.400 0.306
2.250 — 0.009 3.000 — 0.095 1.000 12.800 0.200 0.022
57.600 wo 1.669 83.200 32.000 3.968 25.600 345.600 25.600 0.448

10.100 — 1.155 29.000 108.000 0.450 23.000 287.000 8.000 —

22.750 a — 1.625 16.000 0.112 PABYAS 31.880 0.625 0.029

0.000 aa — 5.000 —— 0.300 3.400 20.000 20.000 0.054

81.300 —— 0.739 3.000 52.000 0.640 7.000 94.000 2.000 0.090

94.700 —_— 0.749 4.000 76.000 0.940 10.000 144.000 2.000 0.130
141.000 —- — — aa 0.940 10.000 144.000 2.000 0.130

6.450 —- 0.063 27.000 144.000 0275 18.500 303.500 309.500 0.290

3.813 —— — 9.776 232.000 1.994 12.220 162.300 5.866 0.137

5.500 — 0.149 4.000 80.000 0.670 11.000 229.000 15.000 0.210

26.100 — 0.091 20.000 616.000 2.750 55.000 844.000 16.000 0.650

(continued)
690 Appendix B

< a) & oy oa
eo Se 5 s g Bin a
BS, age Rar keachie Dae eae
Food Portion So £8 °2 zSo-e5 Cee Me

Vegetables—continued
Potato salad Ye cup 261.500 0.097 0.075 LS. 0.177 0.193 8.400
Pumpkin, boiled, drained,
mashed Y% cup 1326.000 0.038 0.096 0.505 a 0.000 a
Pumpkin pie mix, canned Y% cup 11205.000 0.022 0.160 0.505 a 0.000 —
Radishes
Daikon, sliced, boiled Y% cup 0.000 0.000 0.017 0.111 — 0.000 —
Raw 4 1.200 0.000 0.008 0.056 0.012 0.000 4.880
Rutabagas, boiled,
drained Y% cup 0.000 0.061 0.031 0.535 0.077 0.000 13.200
Shallots, raw 1 tbsp. a 0.006 0.002 0.020 wan 0.000 —
Snap beans
Green, boiled Y% cup 416.500 0.047 0.061 0.384 0.035 0.000 20.800
Wax, boiled Y% cup 416.500 0.047 0.061 0.384 0.035 0.000 20.800
Spinach
Boiled, drained Ye cup 7370.000 0.086 0.213 0.441 0.218 0.000 131.000
Raw, chopped 1 cup 3760.000 0.044 0.106 0.406 0.110 0.000 108.000
Squash
Acorn, baked Ye cup 439.000 0.171 0.014 0.905 0.199 0.000 19.200
Butternut, baked Ye cup 7175.000 0.074 0.018 0.995 0.127 0.000 19.650
Hubbard, boiled,
mashed Y% cup 4726.000 0.050 0.033 0.394 0.122 0.000 11.500
Summer, boiled, sliced % cup 258.500 0.040 0.037 0.462 0.059 0.000 18.100
Zucchini, raw, sliced 1 cup 442.000 0.091 0.039 0.520 0.116 0.000 28.800
Sweet potatoes
Baked, peeled 1 24880.000 0.083 0.145 0.689 0.275 0.000 25.700
Boiled, mashed Y% cup 27970.000 0.087 0.230 1.050 0.400 0.000 18.150
Swiss chard
Boiled, drained Ye cup 2747.000 0.030 0.075 0.315 0.000 0.000 —
Raw 1 cup 1188.000 0.014 0.032 0.144 0.000 0.000 ao
Tomato(es)
Juice, canned 1 cup 1351.000 0.114 0.075 1.640 0.270 0.000 48.400
Juice, canned, low-
sodium 1 cup 1356.000 0.114 0.076 1.640 0.270 0.000 48.400
Paste, canned, salt
added 1 tbsp. 404.100 0.025 OOS = 0:527, 0.062 0.000 ae
Red, canned, stewed Ye cup 707.500 0.059 0.045 0.910 — 0.000 3.700
Red, raw 1 1530.000 0.081 0.068 0.810 0.065 0.000 12.700
 AppendixB 691

E
o n
fa eee Je) Somme
= vd 0 vb S wo
C (mg.)
Vitamin D (1.U.)
Vitamin (1.U.)
EVitamin (mg.)
Calcium £& 36 && (mg.)
Sodium

24.000 0.815 19500 e317-500 661.500

1.863 18.500 0.700 11.000 282.000 1.500

49.500 1.435 21.500 186.000 - 280.500

12.500 0.110 6.500 209.500 9.500

3.600 0.052 1.600 41.600 4.400

36.000 0.400 18.000 244.000 15.000

4.000 0.120 — 33.000 1.000

29.000 65.000 0.800 16.000 186.500 2.000

29.000 65.000 0.800 16.000 186.500 2.000

122.000 157.000 3.210 78.500 419.000 63.000

56.000 72.000 1.520 44.000 312.000 44.000

45.000 88.000 0.955 43.500 448.000 4.500

42.000 67.000 0.610 29.500 291.500 3.500

11.500 56.000 0.335 16.000 252.000 6.000

24.000 93.000 0.320 22.000 173.000 1.000
20.000 74.000 0.550 28.000 322.000 3.000

32.000 237.000 0.520 23.000 397.000 12.000

35.000 264.000 0.915 16.000 301.000 21.000

51.000 97.000 1.980 75.000 480.500 156.500

18.000 40.000 0.640 30.000 136.000 76.000

21.900 245.000 1.410 26.700 535.000 877.000 0.340

20.000 246.000 1.420 28.000 536.000 24.400 0.360

5.131 97.000 0.489 8.375 152.600 129.400 0.131

42.000 143.000 0.930 14.500 305.500 323.500 0.210
9.450 104.000 0.648 14.900 279.000 10.800 0.149

(continued)
692 Appendix B

< 7) = oo oa
Ee 2 = =eg Oe =BED a ae
atx) (Ra Sa Es See
Food Portion
$2
SS
=2f
BROS
22
(oa SE
sf
PARE,
82
So
SE
SS
SE
mS

Vegetables—continued
Turnip greens, boiled Y cup 3959.000 0.033 0.052 0.296 0.130 0.000 85.500
Turnips, boiled, drained,
diced Y% cup 0.000 0.021 0.018 0.233 0.053 0.000 7.200
Vegetable juice, canned 1 cup 2831.000 0.104 0.068 1.760 0.339 —— 0.000
Water chestnuts, Chinese,
canned Y% cup 2.800 0.008 0.017 0.252 — 0.000 a
Watercress, raw 1 cup 1598.000 0.031 0.041 0.068 0.044 0.000 —

Source: Table prepared by Diane L. Drabinsky, Registered Dietitian, of the Rodale Food Center.

Notes:
Values for chromium, iodine and selenium have been omitted. Present technology cannot yet distinguish between biologi-
cally available factors and inorganic forms of chromium. The iodine and selenium content of food varies considerably, de-
pending on soil content or animal diets, so only limited data are available for those nutrients.
Where a dash appears, no data are available; food may or may not contain this nutrient.

*For fruits and vegetables, vitamin A value reflects the amount of vitamin A derived from the yellow, orange and green pig-
ments in these foods.
 Appendix B 693

oO (=) tx G =
S E S a 2
ivan
gs 0
EA
SD
Eo
SD
ait) aa
ag
=
S 00
ES
BP 00
Bm
S$ o0
=
> OO
ae
ew
SE i) Se) SE SE £E sé cé& BE ge

19.750 — 2.421 99.000 182.000 0.575 16.000 146.500 20.500 0.100

9.050 — 0.36 17.150 54.000 0.172 6.250 105.500 39.000 ——

67.000 —— aa 26.600 486.000 1.020 26.600 467.000 - 883.000 0.484

0.910 —- — 2.800 70.000 0.610 3.500 82.500 5.600 0.266

14.600 —- 0.507 40.800 32.000 0.068 7.140 112.000 13.900 =
694

Index

Note: Page numbers in boldface type refer to entire chapters; page numbers in italics refer to
tables.

A Alcohol
Acetyl acrolein, 409 arrhythmias and, 279-80
Acetylcholine, 347, 458 bone loss and, 367
Acidosis, 440 bruising and, 293
Adolescents cancer and, 300
iron and, 17, 178 folate and, 124
marginal deficiency in, 11 magnesium and, 196
thiamine deficiency in, 104 osteoporosis and, 373
vitamin B,, deficiency in, 355 pregnancy and, 428
Adrenal glands, vitamin C and, 129 vitamin B deficiency and, 349
Adrenaline, 279 vitamin B, deficiency from, 117
Adriamycin, 151 vitamin E and, 155-56
Aging. See also Elderly; Senility Alcohol abuse, from zinc deficiency,
diet and, 483-89 220-21
free radicals promoting, 149, 152 Alcoholics, short-term memory of, 458
nutrition and, 49, 490-96 Alcoholism, 261-68, 402, 480
osteoporosis and, 369 as biochemical problem, 263, 264
selenium and vitamin E versus, 214 diet and, 268
vitamin B and, 344, 349, 350 glutamine for, 239-40
vitamin B, and, 101-2 recovery rates from, 267-68
vitamin B,, and, 354-55 standard treatment of, 261-62
vitamin D and, 377-78, 379 thiamine deficiency and, 99, 107
vitamin E and, 157, 159 vitamins for, 263-64, 265-66
Aging skin, vitamin D and, 144, 145 Alcohol-related brain damage, 356
AIDS, 306 Alertness, iron and, 454, 455
Air pollution, vitamin E and, 156 Allergic reaction, to vitamin E, 72
Albinism, 168 Aloe, arthritis and, 135
 Index 695

Alpha tocopherol acetate, 72 Anticonvulsants, 348, 349, 356, 376, 477

Alveolar bone, calcium and, 394 Antidepressants, 293
Alzheimer’s disease, 387. Anti-inflammatory medications, 293
See also Senility Antioxidant, vitamin E as, 150, 153, 329,
Amaranth, 502 420
Amino acids, 231-40. See also Arginine; Antioxidants, 305, 306, 493-94, 495
Glutamine, for alcoholism; Lysine; Anxiety, memory and, 458-59
Phenylalanine; Taurine, for gallstone Appetite, B vitamins and, 67-68
control; Tryptophan; Tyrosine, for Appetite loss ;
stress from anemia, 269
for alcoholism, 264, 265 from iron deficiency, 186
branched-chain, 233-34, 469 from marginal deficiency, 60
for healing, 469 from thiamine deficiency, 103, 105,
safety of, 240 106
to lower cholesterol, 238 Arginine, 234, 238-39, 469
Amino acid supplements, 75 Arrhythmias, 275-81
Amiodarone, 109 from acidosis, 440
Amphetamines, 71 alcohol and, 279-80
Anemia from caffeine, 278, 279, 281
aplastic, 97 cigarettes and, 279, 281
from copper deficiency, 168 from drugs, 280
folate and, 19, 97, 120, 121, 124 in heart attack, 277
in infants, vitamin E test and, 60 magnesium and, 196, 207-8,
iron deficiency. See Iron deficiency 277-78, 281
anemia from stress, 279
itching from, 269 treatment of, 281
from low-calorie diet, 440 Artery health, magnesium for, 198-99
megaloblastic, 124 Arthritis, rheumatoid, 134-37, 348, 372
pernicious, 68, 95, 353, 354-55, Artichokes, 562
496 Asbestos, cancer and, 300
sports, 194 Ascorbic acid. See Vitamin C
tests to diagnose, 61 Asparagus, 562
vitamin B,, and, 68, 95 Aspirin, 272, 293, 294
in women, 441, 442 Asthma, 50, 96, 109, 129, 408
Anencephaly, 121 Asthma medications, 293
Anger, heart rhythms and, 279 Atherosclerosis
Angina, 196, 204, 269 diabetes and, 326-27
Anisakis, 632 niacin and, 94, 95
Anorexia, 106, 219-20, 476-77 vitamin B, and, 110
Antacids, 194, 372 vitamin C and, 137, 327-28, 338
Antibiotics, 348, 349, 477 vitamin E and, 495
Antibodies, 168-69, 177, 484, 485 Atrial fibrillation, 196
Anticoagulants, 477 Attention span, 179, 186
696 Index

Autoimmunity, bruises and, 293-94 from vitamin megadoses, 430

vitamin therapy for, 436-37
B Bladder cancer, 109, 306
Back pain, lower, 232-33 Bleeding, 61, 271-72, 294
Bacteria, iron and, 177 Bloating, from lactose intolerance, 624
Baking, 600 Blood, vitamin B,, for healthy, 419
Banana drink recipe, 572 Blood cells, red, vitamin B,, and, 95
Bananas, 502 Blood circulation, 128-29, 329-30
Barbiturates, 124, 477 Blood clotting, 292, 294. See also
Barley, 615 Platelet function; Platelets, vitamin E
B-cells, 484 and
Beans, 502-3 magnesium deficiency and, 198-99
dried, 616-17 nicotinic acid to treat, 94-95
nutrient content of, 678-79 omega-3 fatty acids and, 242,
in recipes, 520, 543, 550, 592 244-45, 249
Bedsores, 408-9 onions and, 504
Beef, 535-39, 535 vitamin C and, 138-39
Behavioral problems, 233 vitamin E and, 154
Beriberi, 59, 108 Blood levels, low, vitamin C for, 136
Berries, vitamin C in, 629 Blood loss, iron and, 192
Beta-carotene, 83-91 Blood pressure
best food sources of, 9] fish (oil) lowering, 245, 504
cancer and, 65, 85-90, 296, 305 foods lowering, 565-73
cells and, 492-93 high. See High blood pressure
versus retinoic acid, 64 magnesium and, 197, 198
safe use of, 418 Blood vessel spasm, magnesium and,
versus vitamin A, 65, 85 199
Beverages, nutrient content of, 646-49 Boiling of food, 600-601
Bioflavonoids, 404-5 Bone calcification, zinc for, 224-25
Biotin, 306, 412-13, 437 Bone densitometer, 365
Birth, premature, 435 Bone disease, vitamin D and, 374-80
Birth control pills Bone disorders, calcium tests to
cervical problems and, 97-98, 313 diagnose, 60
depression from, 110 Bone health, vitamin D and, 143
folate and, 124 Bone pain and fragility, 65, 418
iron and, 271 Bones, calcium and, 360-61. See also
vitamin B deficiency and, 348, 349 Osteoporosis
vitamin B, and, 19, 36, 110, 116, Boredom, thinking and, 456
429 Bradycardia, 275
Birth defects. See also Neural tube Brain aging, 256, 457
defects Brain disease, magnesium for, 208
folate and, 119, 121-23 Brain disorders, zinc and, 221
nutrients and, 431-37 Brain function, vitamin E and, 495
 Index 697

Brain ischemia, magnesium and, 199 C

Brain stimulation, 456 Cabbage, 503
Bran, 503 Cadmium, iron loss and, 194
Bread, whole wheat, recipe for, 612-13 Caffeine
Breads, 610-13 arrhythmias from, 278, 279, 281
nutrient content of, 648-5] breast disease and, 285-86
Breast cancer, 284-85, 287-88, 289, in chocolate, 635
290 pregnancy and, 428-29
fat and, 297 Calciferol, for cochlear deafness, 412
fish oil for, 290 Calcitrol, 141
obesity and, 298 Calcium, 160-65
omega-3 fatty acids and, 250 best food sources of, 164, 568
protease inhibitors and, 507 bodily need for, 375-76
stress and, 291 colorectal cancer and, 298-99
vitamin A and, 305 in diet, 6-7
vitamin E and, 153-54 from eggshells and oyster shells, 74
Breast cysts, 283-84, 286 food sources of, 548-54
Breast disease for gum disease, 395
constipation and, 289-90 for high blood pressure, 161-63,
diet and, 285, 289-90 334, 336-38, 565, 566-67
nutrients and, 286-88 iron and, 193-94, 273
Breast examination, 284, 301 magnesium and, 197, 201, 339
Breastfeeding, 308 marginal deficiency of, 11
calcium and, 58, 377 in milk versus supplements, 74
folate deficiency during, 19 in multivitamin, 49
iron and, 421 muscle cramps and, 322
lysine and, 76 osteoporosis and, 58, 160-61,
nutritional requirements during, 17 224-25, 359-68
vitamin B, during, 117 potassium, sodium, and
vitamin D and, 377 magnesium interacting with, 338
Breast lumps, 282, 283, 284, 286, 291 pregnancy and, 17, 429
Breast pain, 282-83, 286 RDA of, 640
Breasts, guide to healthy, 282-91 recipes for, 549-54
Brewer's yeast, 67, 254, 255, 351 safe use of, 420
Broccoli, 503, 563 in snacks, 558-59
Broiling, 601 trauma reducing, 468
Bronchial asthma, 50 vitamin D and, 142, 143, 146-47,
Bruises, 292-94 374-75
Brussels sprouts, 503 women and, 441
Bulimia, from zinc deficiency, 219-20 in yogurt and cheese, 72-73
Burns, 470-71 zine and, 224-25, 473
Butter, versus margarine, 1-2 Calcium absorption, 57-58, 375, 496
B vitamins. See Vitamin B (complex) Calcium carbonate tablets, 73
698 Index

Calcium deficiency Carpal tunnel syndrome, vitamin B, for,

bone loss and, 371 110, 114-15, 117
in elderly, 491 Carrots, 504
gum disease from, 394-95 Cataracts, 397, 398, 402-4, 405, 495
in high-protein diet, 3 Catecholamines, 178, 347
osteoporosis from, 20 Cauliflower, 503
in single women, 23 Celiac disease, 410
and toxic shock syndrome, 208-10 Cell damage, 87-88, 493-94
in vegan diet, 4-5 Cell growth, zinc for, 216-17
in weight-loss diets, 440 Cells
Calcium deposits, 65-66, 73 B-, 484
Calcium loss, salt and, 361 epithelial, zinc and, 218-19
Calcium supplements, 35, 50, 51, 184, T-, 169, 217, 484
364, 442 vitamin A and, 64
Calcium tests, 60, 61 vitamin E and, 150, 152, 153, 154,
Calories, nutrients and, 442-43 155, 156
Cancer. See also Tumors; names of spe- Cereals, nutrient content of, 650-5/
cific types Ceruloplasmin, in Wilson’s disease, 173
arginine for, 234 Cervical cancer
beta-carotene and, 65, 85-90 folate deficiency and, 120
calcium tests to diagnose, 61 nutrition and, 314-16
chlorophyll and, 505 risk of, 312
chromosome damage in, 97 vitamin A and beta-carotene and,
from folate deficiency, 97 . 86, 305
fruits and, 525 vitamin C and, 133-34, 306
immunity and, 484 Cervical dysplasia, 309
niacin and, 93-94 biopsy for, 317
nutritional therapy for, 303-8 birth control pills and, 97-98
Pap smears and, 308 folate and, 19, 120, 442
prevention of, 295-301, 302-8 nutrition and, 314-16
selenium and, 48, 211-13 sex and, 311-13
soybeans fighting, 507 from vitamin A or beta-carotene
vegetables and, 83-84, 503, 525 deficiency, 86
vitamin A and, 417 vitamin C and, 133-34
vitamin B,, and, 95-96 Cervical intraepithelial neoplasms, 310
vitamin C and, 95-96, 133-34, 409, Cervical problems, 309-18
419 Charcoal-grilling, 601
from vitamin deficiency, 24 Cheese, 573
vitamin E and, 149, 152-55 calcium in, 6, 7
wheat sprouts and, 508 in recipes, 545, 551, 553, 575, 577,
Cancer stress, vitamin A and, 89 578-79
Capillaries, vitamin E and, 150 Chemotherapy, cancer, 151, 303,
Carbohydrate metabolism, 104-5 409-10
 Index 699

Chest pains, 204, 348 Cirrhosis, 402, 414

Chest tightness, in asthmatics, 129 Citrus fruits, 6, 504, 630-31
Childbirth, folate and, 123 Cleft lip, 434
Children Cleft palate, 19, 122
better nutrition for, 28-32, 30 Clotting, blood. See Blood clotting
iron and, 178, 179, 272 Cochlea, vitamin D and, 141, 411-12
marginal deficiency in, 11 Cod liver oil, 253, 340
Chill resistance, 178-79 Coffee. See also Caffeine
Chlamydia infections, 309 decaffeinated, 510°
Chloride, safe and adequate intakes of, iron absorption and, 184, 193, 272,
642 449
Chlorogenic acid, 77 nutrient absorption and, 76-77
Chlorophyll, 505 vitamin B deficiency and, 349
Chocolate, caffeine in, 635 Cognitive function, in elderly, 13-14
Cholesterol Cold medicines, arrhythmias from, 280
amino acids lowering, 238 Colds, 76, 131, 410-11
in atherosclerosis, 327 Cold sores, lysine for, 237-39
beans lowering, 502 Colitis, 299, 402
bran lowering, 503 Collagen, 107
brewer’s yeast lowering, 255 vitamin C and, 293, 392, 393-94
fish (oil) and, 241-44, 504 wound healing and, 469, 470, 472
garlic and onions lowering, 504 Colon cancer
high blood pressure and, 337 cell proliferation in, 299
magnesium and, 198 fat and, 297
in meat, 534, 536, 538, 634 fiber and, 296
niacin lowering, 94, 95, 418 obesity and, 298
omega-3 fatty acids lowering, protease inhibitors and, 507
241-44, 251, 340 selenium for, 212
soybeans lowering, 507 Colon examination, 272
taurine and, 236 Colorectal cancer, 141, 298-99, 504
vitamin C and, 137, 138 Coma, 108, 208
yogurt lowering, 508 Concentration, anemia and, 269
zine and, 170, 421 Condiments, nutrient content of, 674-76
Cholesterol-lowering drugs, 349, 356 Condyloma virus, 311, 312, 313, 316,
Choline, 255-56, 456-57 S17
Chromium, 254-55 Confusion, 347, 385-86
diabetes and, 48, 404, 405 Conization, 317
safe use of, 421, 642 Constipation, 289-90, 421, 503
Chromium deficiency, in elderly, 491 Contraceptives, oral. See Birth control
Chromosomes, folate and, 96-98 pills
Cigarette smoke, vitamin E and, 156 Convulsions, 205
Cigarette smoking. See Smoking Cooking. See also Food(s); Meals
Circulation, 128-29, 329-30 healthful, 600-602
700 Index

Cooking (continued) from folate deficiency, 348

with microwave oven, 607-9 from low-calorie diet, 440
of potatoes, 5-6 from magnesium deficiency, 478
by singles, 24 mimicking senile dementia, 388
Cookware, 603-6 phenylalanine and, 231-32
Coordination, lack of, 457 from thiamine deficiency, 99, 348
Copper, 166-75, 306 tryptophan for, 234, 236
best food sources of, 174 tyrosine for, 237
for bone health, 51 vitamin B and, 345, 347, 349, 350,
heart disease and, 169-70 457
immunity and, 168-69 vitamin B, and, 99-101, 116, 346,
intake of, 171-72 348
Menkes’ disease and, 167-68 from vitamin B,, deficiency, 354
role in body, 166-67 from vitamin deficiency, 12
safe and adequate intakes of, 642 Desserts, nutrient content of, 656-59
zinc and, 48, 170, 356, 473 Diabetes
Copper absorption, vitamin C and, 172 atrial fibrillation in, 277
Copper deficiency chromium and, 48
in elderly, 381-83, 491 complications of, 326-32
from zinc, 421 fiber and, 331-32
Copper toxicity, 172, 173, 414 heart disease and, 326-28
Corn, in recipe, 550 magnesium deficiency in, 205
Cortisone, 372 nerves and, 328-29
Cramps. See Muscle cramps; Stomach osteoporosis from, 372
cramps sugar in, 327, 331-32
Crohn’s disease, 68 supplements and, 422
Cushing’s disease, 372 vitamin D and, 141
Cysts, breast, 283-84 Diabetes tests, vitamin C and, 69, 328
Diabetic retinopathy, 330-31, 398,
D 404-5
Dairy products Diabetics, attitude of, 332
calcium in, 72-73 Dialysis dementia, 412-13
nutrient content of, 652-55 Diarrhea
Deafness, vitamin D and, 411-12 from iron, 421
Deep-frying, 601 from lactose intolerance, 624
Deficiency. See also Marginal defi- from niacin, 418
ciency; names of specific vitamins from vitamin B,, deficiency, 353
Deficiency symptoms, guide to, 62 from vitamin C, 419
Dementia, 14, 354 from zinc, 421
Dendnites, 382, 457 Diet. See also Food(s); Meals; Nutrition
Depression alcoholism and, 268
from anemia, 269 anticancer, 295-99
from birth control pills, 110 best foods in, 501-8
 Index 701

eye problems and, 401-2 Eating habits

high blood pressure and, 333-43 poor, vitamin B deficiency and, 344
high-protein, 2-3 for singles, 25
magnesium deficiency and, 201 Edema, from low-calorie diet, 440
during pregnancy, 430 EDTA, iron loss and, 193, 273
Pritikin, 3 Eggplant, selection and storage of, 563
senility and, 381-88 Eggs, nutrient content of, 658-59
starvation, 438-39 Eicosanoids, 247, 248
vegetarian. See Vegetarian diet Eicosapentanoic acid (EPA), 242, 245,
weight-loss, 439-41 504
Diethylstilbestrol (DES), 313 diabetic retinopathy and, 404, 405
Dieting. See also Weight loss for high blood pressure, 340
bone mass and, 371 migraines and, 249-50
deficiency from, 438-44 in supplements, 253
thiamine deficiency from, 105 Elderly. See also Aging
vitamin B supplements and, 67-68 FTS and zinc in, 487
Dietitians, supplements and, 43 iron and, 421
Diet tips, for iron absorption, 184-85 marginal deficiency in, 11, 13-14
Digestive problems, 328, 349 mental function in, 382, 383-85
Dilantin, 124, 293, 329 nutrient absorption in, 495-96
Dining, by singles, 26-27 nutritional deficiency in, 475-76,
Diuretics, 293 477, 490-91
bone loss and, 372 selenium and vitamin E in, 214
magnesium and, 195, 198, 277, 278 sunlight for, 377, 379
nutrient levels and, 477 supplements for, 49
vitamin B deficiency and, 349 vitamin C and, 127, 386
Diverticulosis, low fiber and, 3 vitamin D and, 144, 145, 146, 377
Dizziness, from iron deficiency, 186 zinc deficiency in, 225
Docosahexanoic acid (DHA), 242, 245 Encephalitis, zinc and, 223
Dopamine, 237 Encephalopathy, magnesium for, 208
Down's syndrome, 218, 487-88 Endometrium, 309
Drug abuse, magnesium tests to detect, Energy, 461-66. See also Fatigue
60 Enzyme deficiency, strength and, 98
Drugs Enzymes, 110, 216, 221, 224
arrhythmias from, 280 Epilepsy, magnesium for, 196, 200, 205
bruises from, 293 Esophageal cancer, 296, 297, 298-99
folate and, 124 Estrogen, 282, 283, 286, 291
senility and, 387-88 bone strength and, 360, 370
vitamin B deficiency and, 349, 356 cervical problems and, 313
vitamin deficiency from, 476-77 folate and, 124
for osteoporosis, 161, 365-66, 367
E Estrogen pills, 293
Eating disorders, zinc and, 219-20 Estrogen treatments, cancer and, 300
702 Index

Exercise Fatty acids, 78, 242. See also Omega-3

by asthmatics, vitamin C and, 129 fatty acids
energy from, 462-63 Feet, diabetes and, 328-29, 330
improving thinking with, 455 Ferritin deficiency, 448
iron and, 17-18, 194, 447-50 Fertility, 129, 131, 216, 224
mineral loss from, 450-51 Fetal abnormalities, 10
muscle cramps and, 323, 324-25 Fiber
nutrition and, 445-52 for breast disease, 289
osteoporosis and, 364, 367, 372 cancer and, 296, 297
riboflavin and, 98-99, 451 diabetes and, 331-32
thiamine and, 452 in diet, 3, 5, 8
to lose weight, 443-44 for high-blood pressure, 340-41
vitamin B, and, 452 iron loss and, 193
Eyes. See also Vision in unusual fruits and vegetables,
diabetes and, 330-31, 398, 404-5 525,526,520
itchy, from vitamin A, 418 Fiber deficiency, in men, 21
problems with, 400, 401-2 Fibrillations, 275, 277, 279, 280
Fibroblasts, vitamin C and, 128
F Fibrocystic disease, 283, 284, 286, 288
Fainting, from anemia, 269 Fish, 504
Faintness, from niacin, 418 cooked in microwave oven, 608
Fast-food, for singles, 27 in diet, 251
Fat(s) nutrient content of, 660-63
breast disease and, 153-54, 285, in recipe, 542
289, 290 Fish oil, 241-46, 290, 379. See also
cancer and, 153-54, 297 Omega-3 fatty acids
in diet, 2, 3, 8 Flossing, 392
heart attack from saturated, 24 Fluoride, safe and adequate intakes of,
high blood pressure and, 339-40, 642
342 Flushing, 68-69, 281
hydrogenated, 634 Flu shots, nutrition and, 476
in ice cream, 557, 559 Folacin, versus folate and folic acid, 66
in meat, 534-35, 536, 537, 538 Folate, 119-25, 306
in milk, 622-24, 623 brain function and, 383, 384
nutrient content of, 658-60 cervical problems and, 314, 315
polyunsaturated, 339-40, 342 childbirth and, 123
Fatigue, 464. See also Energy drugs and, 124
B vitamins and, 347, 348, 350 versus folic acid and folacin, 66
from arrhythmias, 281 food preparation affecting content
from iron deficiency, 186 of, 124
from thiamine deficiency, 99 for fragile-X syndrome, 123
from vitamin B,, deficiency, 353 for gum disease, 395-96
Fat-soluble vitamins, 56-57 for healthy chromosomes, 96-98
 Index 703

iron absorption and, 273 sandwiches, 574-80

mental disorders and, 347 snack, nutritional value of, 560
pregnancy and, 17, 429 to lower blood pressure, 565-73
to prevent neural tube defects, Food allergies, depression and, 265
433-34 Food groups, dieting and, 443
RDA of, 639 Food preparation, affecting folate con-
Folate absorption, in elderly, 496 tent, 124
Folate deficiency, 5 Food shopping, by singles, 24-25
bruises from, 293, 294 Food sources é
cancer from, 97 of beta-carotene, 9/
cervical dysplasia and, 97-98 of calcium, /64, 568
in children, 29 of copper, 174
cleft palate from, 122 of iron, /82
depression from, 348 of magnesium, 202
disorders related to, 120 of omega-3, 252
impaired cognition from, 14 of potassium, 570
neural tube defects from, 121-22 of vitamin B, /00
premature birth and, 435 of vitamin C, 130
senility and, 383 of vitamin D, 147
in singles, 23 of vitamin E, /58
versus vitamin B,. deficiency, 61 of zinc, 226
in women, 18-19, 442 Forgetfulness, 348
Folate supplements, 125, 442 4-Hydroxyphenylretinamide, 287
Folate tests, to diagnose anemia, 61 Fractures, 473
Folic acid, versus folate and folacin, 66 Fragile-X syndrome, folate for, 123
Food(s). See also names of specific Free radicals, 304-5, 306, 307
foods; Meals; Recipe(s) aging and, 149, 152, 493
compatible, 540-47 beta-carotene and, 85
cookware for, 603-6 cataracts and, 397, 403
health and, 629-36 retinal damage and, 398
healthful cooking of, 600-602 selenium and, 410
healthy, 501-8 vitamin E defending against, 149,
healthy gourmet, 509-24 150;,151,:153" 1557156
in recipes, 518-24 Fruits
high-calcium, 548-54 citrus, 6, 504, 630-31
institutional, 477-79 for men, 21
leftover, 618-19 unusual nutritious, 525-27
low-sodium, 581-96 Fruits and fruit juices, nutrient content
nutrient content of, 1-8, 645 of, 662-69
in refrigerator, nutritiousness of, Frying
528-33 deep-, 601
salt-cured, smoked, and nitrite- stir-, 602
cured, 298-99 FTS, zinc and, 218, 487
704 Index

G Hallucinations, 349, 457

Gait, unsteady, 353 Haloperidol, vitamin C and, 71
Gallbladder cancer, obesity and, 298 Headaches
Gallstones, 3, 236 from acidosis, 440
Gamma-tocopherol, 157 from anemia, 269
Garlic, 343, 504, 563 migraine. See Migraines
Gastrectomy, osteoporosis from, 372 from niacin, 418
Gastrointestinal cancer, 84, 134, 297 from vitamin A, 418
Gastrointestinal problems, 271-72, 420, from vitamin D, 420
480 Head and neck cancer, 211-12
Genital warts, 311 Healing, nutrition for, 467-73
Gingivitis, 120, 121 Health, food and, 629-36
Gland problems, calcium tests to evalu- Hearing loss, 141, 418
ate, 61 Heart attack
Glandular products, 77-78 arrhythmias in, 277
Glaucoma, vitamin C and, 405 from fats and salt, 24
Glucose, thiamine and, 107, 108 magnesium and, 196, 205-6
Glucose levels, 331-32, 346 vitamin E preventing, 154
Glucose metabolism, 141, 221, 254 Heart-attack survivors, niacin for, 94
Glutamine, for alcoholism, 239-40, 265, Heartbeat
266 irregular. See Arrhythmias
Glycine, 238 slowing of, 440
Gourmet foods, healthy, 509-24 Heart block, 276, 280
Grains, whole, 614-15 Heartburn, from anemia, 269
Grains and grain products, nutrient con- Heart disease
tent of, 670-71 copper and, 169-70
Gravies, nutrient content of, 680-8] diabetes and, 326-28
Grilling, charcoal-, 601 fat and, 2
Growth, 10, 120-21, 171 fatty acids and, 242-43, 245, 247,
Guar gum, 331-32 248, 251
Gum disease fruits and vegetables and, 525
nutritional supplements for, 395 vitamin C and, 137-38, 419
signs of, 389, 396 Heart problems
treatment of, 389-90 from alcohol, vitamin E and,
vitamin C and, 126-27, 390, 391-94 155-56
zinc deficiency and, 221-22 magnesium and, 195-96, 197-98
Gum inflammation, 120, 121 Heme iron, 181
Gums, nutrition for healthy, 389-96 Hemodialysis, 61
Gum wounds, vitamin E healing, 155 Hemoglobin, 270, 462, 464
Hemorrhoids, 271
H Hemostasis, 292, 293, 294
Hair dyes, 294 Hepatitis, Wilson’s disease mimicking,
Hair loss, 65, 409-10 173
 Index 705

Herbs, 505 Hyperthyroidism, osteoporosis from,

Herpes, genital 372
cervical dysplasia and, 312 Hypocalcemia, 210
iron deficiency worsening, 177 Hypochondria, 12
lysine for, 237-39 Hypoglycemia, 255, 263, 264
zinc for, 222-24 Hypothermia, 106
Herpes gestationis, pyridoxine for, 113 Hysteria, from vitamin deficiency, 12
Herpes simplex, 75, 222
I y
High blood pressure, 403
calcium and, 161-63, 334, 336-38 Ice cream, 555-61, 560
diet to lower, 333-43 Immunity
diseases caused by, 333 aging and, 483-89
fat and, 342 anemia reducing, 269
fiber for, 340-41 arginine and, 469
fish oil for, 340 copper affecting, 168-69
magnesium lowering, 196, 198, iron aiding, 176-77
206, 207, 339 low-calorie diets lowering, 438
onions and garlic for, 341-43 lupus and, 413
polyunsaturated fats and, 339-40 marginal deficiency and, 307
potassium for, 334-36 selenium and, 155, 213
prostaglandins and, 340, 342, 343 vitamin A and, 471
shrimp for, 573 vitamin C aiding, 127, 306, 386,
sodium ascorbate and, 70 409, 419, 470, 488
supplements and, 422 vitamin E aiding, 155, 488, 494-95
vitamin C for, 338 zinc aiding, 217, 218, 223, 306,
from vitamin D toxicity, 66 485-88
High-protein diet, 2-3 Infants
Hip fracture, 142, 143, 145 copper deficiency in, 171
Histidine, 238 iron deficiency in, 178, 179
Hormonal changes, affecting mineral Infection(s), 484
levels, 322 increased susceptibility to, 10
Hormones iron and, 176-77
female, 282-83, 289 lung, vitamin C and, 13
osteoporosis and, 370 starvation and, 475
thymic, 217, 218, 485, 486, 489 vaginal, 310
Hospital meals, nutritional deficiency in, viral, 177
475, 476, 477, 478-82 vitamin A and, 417
Hot weather, vitamin C aiding adjust- vitamin C fighting, 128
ment to, 129 Inflammation, 150, 248
Human papilloma virus, 311 Injections, of nutrients, 68
Hyperactivity, in children, 109 Insecticides, 294
Hyperparathyroidism, 372 Insomnia, 60, 234, 235, 236, 348
Hypertension. See High blood pressure Insulin, 404, 405
706 Index

Insulin (continued) causes of, 18

chromium regulating, 254-55 in children, 29
for diabetes, 326 in elderly, 491
high blood pressure and, 341 in nursing home patients, 475
Insulin secretion, vitamin D and, 141 strenuous exercise and, 17-18
Interferon, vitamin C increasing, 127 in vegetarian diet, 4, 5
Intermittent claudication, 50, 71, 323 in weight-loss diets, 440
Intrauterine devices, 309, 310 in women, 17, 23, 441
Intrinsic factor, 355 Iron deficiency anemia, 178, 179-80,
Iodine, RDA of, 640 269-74, 421
Iodine deficiency, thyroid cancer and, gastrointestinal disorders and,
306 271-72
Iron, 176-85 from menstruation, 270-71
best food sources of, /82 supplements for, 50
calcium and, 184, 193-94 symptoms of, 269
children and, 272 lron-fortified grains, 449
coffee and, 76 Iron levels, testing, 186-94
in diet, 449 Iron metabolism, copper and, 168
endurance and, 447-50, 464 Iron overload, 18
immunity aided by, 176-77 Iron supplements, 50, 442
improving chill resistance, 178-79 Iron tests, to diagnose anemia, 61
intake of, 187-89, 190-92 Irritability, 60, 93, 269, 348, 350
loss of, 189-90, 192-94 Irritable bowel syndrome, 271
marginal deficiency of, 11 Isoleucine, 233, 469
mental function and, 454-55
in multivitamins, 49 J
organic versus inorganic, 74-75 Jock’s syndrome, 92
during pregnancy, 429 Joint pain, from vitamin D, 420
RDA of, 64] Juices, nutrients in, 6, 662-69
safe use of, 421
types of, 181 K
vitamin C and, 191, 192 Kidney cancer, obesity and, 298
women’s need for, 17 Kidney problems, 2, 412, 480, 495
Iron absorption, 4, 180, 181, 184-85, Kidney stones, 50, 73, 420
191, 193 Korsakoff syndrome, 108
agents blocking, 272-73
agents enhancing, 273-74 L
in elderly, 496 Laboratory tests, to assess nutrition,
vitamin C enhancing, 55-56 59-63
Iron cookware, 192, 273, 449 Lactation. See Breastfeeding
Iron deficiency, 3-4, 176, 177, 178-80 J Lactose, 371
447 Lactose intolerance, 624-25, 625
in adolescents, 17 Laryngeal cancer, 296, 306
 Index 707

Lead, iron loss and, 194 for artery health, 198-99

Learning disabilities, 178, 179 best food sources of, 202
Lecithin, 256, 330, 456-57 blood pressure and, 197, 198, 206,
Leftovers, 618-19 207,339
Leg cramps, 71-72, 319-21, 322, 323 in body functions, 197
Legumes, iron and, 4, 5 for brain disease, 208
Leucine, 233, 238, 469 calcium and, 201, 339
Leukemia, 95, 97, 127, 141 calcium-sodium balance and, 197
Leukotrienes, 248-49 for diabetic seizures, 205
Levodopa, 477 dosage of, 209
Life extension, vitamin E and, 152 for epilepsy, 196, 200, 205
Linoleic acid, 78 in “hard” water, 197-98
Lipid peroxides, selenium and, 410 heart disorders and, 195, 204-8
Lipids, lowered by niacin, 94, 95 lost through exercise, 450
Lips, pale, from anemia, 269 marginal deficiency of, 11
Liver (as food), 181, 190, 505 for migraines, 196, 199-200
in recipes, 541, 575 muscle cramps and, 322
Liver (human), copper poisoning in, 173 RDA of, 64/
Liver cancer, 507 for retinopathy, 330-31
Liver enlargement, 65 safe use of, 421
Liver problems, fat and, 2, 65 vitamin B, and, 117, 201
Lung cancer Magnesium deficiency, 196, 198, 199,
cigarette smoking and, 299-300 200-201
selenium for, 212 arrhythmias from, 277-78, 281
vegetables and, 84 fatigue from, 464
vitamin A and, 90, 296, 305 in high-protein diet, 3
Lung disease, vitamin E and, 156-57 in hospital meals, 478
Lung infections, vitamin C and, 13 prevalence of, 209
Lupus, 293, 413 senility and, 383
Lymphocytes from stress, 206-7
iron and, 177 symptoms of, 209
role in immunity, 494 in weight-loss diets, 440
T-, 96, 484, 489 Magnesium levels, in toxic shock syn-
vitamin C and, 127 drome, 208-10
vitamin E protecting, 149 Magnesium loss, from medical treat-
zinc and, 217 ments, 201
Lysine, 75, 237-39 Magnesium research, 204-10
Magnesium supplements, 50, 51
M Magnesium tests, for systemic poison-
Macrophages, 484 ing, 60
Macular degeneration, senile, 398 Malaise, from acidosis, 440
Magnesium, 195-203, 204-10 Malaria, 177
alcohol and, 196 Malnutrition, 474-82, 486
708 Index

Manganese, safe and adequate intakes breasts and, 282

of, 643 exercise and, 364
Mania, 235, 352 iron and, 17, 192
Margarine, versus butter, 1-2 marginal deficiency and, 11
Marginal deficiency, 306-7, 308 Mental disorders. See also Psychiatric
symptoms of, 9, 10, 60 symptoms/problems
Meals from excessive phenylalanine, 233
for children, 32 vitamin B for, 344-51
energy and, 464-65 Mental function(s). See also Memory,
nutrient content of, 650-53 anxiety and; Memory loss; Memory
nutritious, 7-8 problems
size of, 54-55 Thinking
Meat(s) choline improving, 256
bone strength and, 371 in elderly, 13-14
calories from, 534-35 nutrition and, 453-60
cholesterol in, 534, 536, 538 thiamine and, 99
fat in, 534-35, 536, 537, 538 vitamin B and, 457-58
grades of, 537-38 zinc and, 382
iron in, 4 Menus, for children, 30-32
nutrient content of, 670-75 Metabolic disorders, 437
nutritious, 534-39 Metallothionein, 170
organ, 633 Methotrexate, 124
in recipes, 522, 544, 591 Methylmalonic acidemia, 437
Medical tests, vitamin C affecting, 419 Methylxanthines, 286
Medications. See Drugs; names of spe- Microwave cooking, 607-9
cific drugs and drug classes Migraines, 196, 199-200, 249-50
Melons, 505-6, 631-32 Milk, 622-25
Memory, anxiety and, 458-59 calcium and, 6, 7, 57
Memory loss, 108, 269, 457 fat content of, 623
Memory problems, calcium tests to high blood pressure and, 337
evaluate, 61 types of, 622-24
Men vitamin D from, 57
anemia in, 271 Milk production/composition, 10
nutrition for, 16, 17, 18, 20-21 Milk shakes, 630
zine and, 216 Millet, 615
Menkes’ disease, copper and, 167-68 Mineral loss, from exercise, 450-51
Menopause Minerals
calcium and, 394 RDAs of specific, 52
iron and, 193 safe use of, 415-22
osteoporosis and, 160, 161, 360, Molybdenum, safe and adequate intakes
362, 369, 370 of, 643
Menstruation Mood changes, 19
anemia from, 270-71 Motor problems, amino acids for, 233
 Index 709

Mouth sores, 349 Nerves

MSG, 117, 634 diabetes and, 328-29
Multiple carboxylase deficiency, 437 magnesium deficiency and, 197,
Multivitamin(s). See also Supplements 208
amount required, 48-49 Nervous disorders, from thiamine defi-
balance of nutrients in, 51-53 ciency, 103, 104, 108
dieting and, 442 Nervous system
expiration date of, 51 vitamin B,, and, 419
optimal, 52 vitamin E and, 495 ~
reference source for, 53 Neural tube defects, 121-22, 429,
size of, 51 432-34
Muscle control, loss of, 108 Neurotransmitters, 346, 347
Muscle cramps, 319-25 Neutrophils, zinc and, 217
exercise and, 323, 324-25 Niacin, 306. See also Nicotinamide; Nic-
mechanism of, 319-20 otinic acid
minerals and, 321-23 atherosclerosis and, 94, 95
in swimmers, 325 cancer and, 93-94
treatment of, 320-21, 325 for heart-attack survivors, 94
Muscle dysfunction, 61 mental disorders and, 346
Muscles, magnesium and, 197, 208 versus niacinamide, 68-69
Muscle tissue breakdown, 233-34 RDA of, 639
Muscle tremors, 414 safe use of, 418
Muscle wasting, 468, 469 Niacinamide, 68-69, 239, 266
Muscle weakness, 93, 420 Niacin deficiency, 303
Mushrooms, 563 Niacin flush, 418
in sandwich recipes, 578-79, 580 Niacin urine tests, pellagra and, 61
Mussels, in recipe, 519 Nicotinamide, 93, 94
Myopia, 407 Nicotine, arrhythmias and, 279
Nicotinic acid, 94-95
N Night blindness, 402
Nafocare, 409 Nitrite-cured foods, 299
Nails, brittle, 269 Nitrosamines, 134, 297, 306
Natural killer cells, zinc and, 217 Norepinephrine, 237
Nausea Numbness, in hands or feet, 346, 349,
iron and, 186, 421 353, 419
from niacin, 418 Nursing home meals, nutritional defi-
from vitamin A, 418 ciency in, 475, 476, 477
from vitamin D, 420 Nutrients
from vitamin E, 420 bodily absorption of, 54-58
from zinc, 421 in foods, 645
Nearsightedness, 407 safe use of, 415-22
Nerve damage, 66, 99, 101-2, 419 Nutrition
Nerve problems, 61, 173, 348, 349 for alcoholism, 262-68
710 Index

Nutrition (continued) Osteomalacia, 140, 141, 143, 146, 479,

cervical problems and, 314-16 491-92
for children, 28-32, 30 vitamin D and, 375, 376, 476
for family, 7, 8 Osteoporosis, 72, 74, 142, 273, 429
gender and, 16-21 calcium and, 3, 20, 35, 58, 359-68,
laboratory tests to assess, 59-63 420
for singles, 22-27 calcium RDA to prevent, 6-7
snack foods and, 560 calcium supplements for, 50
testing knowledge of, 33-36 calcium tests to evaluate, 61
to prevent cancer, 295-99, 303-8 drug treatments for, 365
Nutritional danger zones, 1-8 exercise and, 364
Nutritional deficiency minerals and, 491
from dieting, 438-44 osteomalacia and, 491-92
marginal, 9-15 prevention of, 359, 368
senility and, 381-83 risk groups for, 369-73
Nutritional supplements, 64-79 supplements for, 51
Nutritional therapy, 408-14 vitamin D and, 375, 376, 420
Nuts, 506, 636 zinc for, 224-25
nutrient content of, 676-77 Oxidation, 397, 398
in recipe, 592 Oxygen, energy and, 463, 464
Oysters, 506
O in recipe, 554
Oats, 615
Obesity, 220-21, 297-98 P .
Oils, nutrient content of, 658-60 Pacemakers, 280-81
Omega-3 fatty acids, 243-46, 247-53. Pain, from rheumatoid arthritis, 248
See also Eicosapentanoic acid (EPA) Pain relief, tryptophan for, 234, 236
for heart health, 247, 248 Pallor, 353
lowering blood pressure, 245, 340 Palpitations, 276, 278
lowering cholesterol, 242-44, 251 Pantothenate, safe use of, 419
platelet function and, 244-45, 249 Pantothenic acid, cancer and, 306
preventing breast tumors, 250 Pap smear/test, 301, 309, 317
for psoriasis, 248-49 cancer and, 308
reducing tissue-graft rejection, 249 classification of smears from, 310,
rheumatoid arthritis and, 248 316
selected food sources of, 252 frequency of, 316, 317-18
Omega-3 fatty acids deficiency, 245-46 virus and, 311-12
Omega-6 fatty acids, 244 Paralysis, 99
Oncogenes, 305 Parathyroid gland problems, 60, 61
Onions, 341-42, 504, 564 Parkinsonism, 477
Oral cancer, 87-88, 155, 300 Parkinson’s disease, tyrosine for, 237
Oral contraceptives. See Birth control Parsnips, 635
pills Pasta, in recipes, 523, 544, 545
 Index 711

Peas, nutrient content of, 678-79 sweet, 508

Pellagra, 61, 303 Poultry, 506
Pelvic inflammatory disease, 309 nutrient content of, 678-8]
Penicillamine, 173, 414 in recipes, 521, 546, 576-77, 578,
Peppers, 506 594
Periodontal disease. See Gum disease Prednisone, 372
Personality changes, 457 Preeclampsia, 199
Phagocytes, iron and, 177 Pregnancy, 308. See also Birth defects;
Phenobarbital, 376 Childbirth, folate and
Phenylalanine, 231-33 alcohol and, 428
Phenylethylamine, 232 caffeine and, 428-29
Phenylketonuria, 233 calcium and, 58, 377, 394, 429
Phenytoin, 376 copper during, 171
Phosphates, iron and, 193, 273 diet during, 430
Phosphatidylcholine, 256, 457 folate during, 19, 119-22,
Phosphorus, RDA of, 64/7 124-25, 429
Photosensitivity, 109 iron during, 271, 421, 429
Pizza, frozen, 634-35 lysine and, 76
Pizza recipe, 549 marginal deficiency and, 11,
Plaque (dental), 221-22, 389, 396 14-15
Platelet aggregation, 138-39, 154, 504 migraines in, 199-200
Platelet function, 244-45, 249, 292, muscle cramps during, 322
293-94 nutrition during, 17, 427-30
Platelets, vitamin E and, 157 spontaneous abortion in, 123
Poisoning, systemic, 60 vitamin B, during, 117, 429
Polyposis, familial, 299 vitamin D and, 377
Polyps, gastrointestinal, 271 weight before and during,
Posture, 454 427-28
Potassium Premature birth, 435
best food sources of, 570 Premenstrual syndrome, 19, 109, 117,
beverages containing, 33 419
in citrus fruits and juices, 6 Pressure-cooking, 601
for high blood pressure, 334-36, Pritikin diet, 3
565, 566-67 Progesterone, 282, 283, 286
lost through exercise, 450 Progestogen, 365
muscle cramps and, 321-22 Prolactin, 282
safe and adequate intakes of, 643 Propranolol, 387
sodium and, 335-36, 341 Prostacyclin, vitamin E and, 154
Potassium deficiency, 3, 5, 8, 464 Prostaglandin A,, 342
Potassium-replacement agents, vitamin Prostaglandins
B,. deficiency and, 356 aging and, 494-95
Potatoes, 620-21, 631 high blood pressure and, 340, 342,
nutrients in, 5-6 343
u2 Index

Prostaglandins (continued) Recommended Daily Allowances. See

omega-3 fatty acids and, 250 RDA
vitamin E and, 488 Rectal examination, 272
Prostanoids, 408 Red blood cells, vitamin B,, and, 95
Prostate, zinc and, 506 Reflexes, vitamin E and, 495
Prostate cancer, fat and, 297 Respiratory tract, cancer of, 297
Protease inhibitor, 507 Restaurants, singles and, 27
Protein, 231 Retina, 398, 399, 402, 404
diet high in, 2-3 diabetes and, 330-31, 398, 404-5
for healing, 469 Retinoic acid, 64, 305
plant, cholesterol and, 238 Retinoids, 86
pregnancy and, 429 Retrolental fibroplasia, 399
RDA of, 638 Rheumatoid arthritis, 134-37, 348, 372
Protein calorie malnutrition, 474 Riboflavin
Protein deficiency, 23, 440, 491 active women and, 451
Psoriasis, 248-49 brain function and, 383, 384
Psychiatric symptoms/problems, 93, for cataracts, 403
173, 352-58. See also Mental exercise and, 98-99
disorders RDA of, 638
Psychosis(es), 12, 93, 347, 353, 414 safe use of, 418
Psychosomatic disorders, 348 Riboflavin deficiency
Pulse irregularities, 275, 276 behavior problems from, 12
Pyridoxine. See Vitamin B, in elderly, 13
‘in hospital meals, 478-79
Q impaired cognition from, 14
Quinine, 294 in single men, 23
Rice, in recipe, 519
R Rickets, 140, 146, 376, 377
RDA, 10, 11 Running, 446-47, 448
for children, 28, 29, 32
gender differences and, 16 S
guide to, 637 Salad recipe, 593
marginal deficiency and, 10-11 Salmon
multivitamin supplement and, calcium in, 7, 573
47-50, 52 in recipes, 523, 576
of specific nutrients, 52 Salt. See also Sodium
versus USRDA, 77 calcium excretion and, 361
Recipe(s) heart attack from, 24
for bread, 612-13 high blood pressure and, 333, 334,
for compatible foods, 541-47 SS5RSS TSA
for healthy gourmet foods, 518-24 reducing intake of, 581-90,
low-sodium, 590-96 597-99
for sandwiches, 575-80 Salt-cured foods, 298
 Index Wis

Sandwiches, 574-80 Skin diseases, vitamin A and, 418

Sardines, calcium in, 7 Skin rashes, 349
Sauce recipe, 596 Skin reddening, from niacin, 418
Sauces Skin sores, from vitamin A, 418
cooked in microwave oven, 608 Skin temperature, vitamin C increasing,
nutrient content of, 680-8] 128-29
Schizophrenia, 71, 110-11 Skin ulcers, vitamin E and, 151
Scurvy, 20-21, 59, 70 Sleepiness, 61, 478
Seeds, 507 Smell, zinc and, 219
nutrient content of, 676-77 Smoked foods, 298-99
Seizures, 111-12, 200, 205 Smoking
Selenium, 211-15 arrhythmias and, 279, 281
bodily use of, 213 bone mass and, 373
breast cancer and, 153-55 cancer and, 299-300
breast disease and, 288 tooth loss and, 393
cancer and, 48, 211-13, 306 vegetables and, 84
for cataracts, 403 vitamin B deficiency and, 349
celiac disease and, 410 vitamin B, deficiency from, 117
cell damage and, 493-94 Snacks, nutrient content of, 560, 680-81
cervical problems and, 314 Sodium
for diabetic retinopathy, 398, 405 in bottled water, 626-27, 627
dosage of, 214-15, 643 calcium excretion and, 372
in elderly, 214 foods low in, 581-96
in multivitamins, 49 in frozen foods, 634-35
safe use of, 421, 643 high blood pressure and, 335, 336,
Senility, 356, 381-88 337, 341, 342
Serine, 238 in high-protein diet, 2
Serotonin, 19, 100, 249, 347 magnesium and, 197
Sex muscle cramps and, 322
cervical dysplasia and, 311-13 reducing intake of, 581-90,
reduced interest in, 440 597-99
Shellfish, cholesterol and, 241-43 safe and adequate intakes of, 643
Shingles, lysine for, 237 Sodium ascorbate, 70
Sigmoidoscopy, 301 Sodium fluoride, 365, 367
Silicon, 491 Soil, selenium in, 211, 212
Simone, Dr. Charles B., 302-8 Soup(s), 507
Singles, nutrition for, 22-27 nutrient content of, 680-83
Skin, 492-93 Soup recipes, 524, 595
aging, vitamin D and, 144 Soy, for high blood pressure, 573
drying of, 65, 78 Soybeans, 507
healing after surgery, 234 Sperm, 131, 224, 506
pale, from anemia, 269 Spices, 505
Skin cancer, 211, 300, 305 Spina bifida, 19, 119, 121, 432
714 Index

Spinach, 505 dieting and, 442

Spinal fusion, 232-33 dietitians and, 43
Spleen enlargement, 65 expiration date of, 51
Sprouts, 507-8 iron, for children, 29
Stamina, vitamin B, for, 113-14 mail-order fraud and, 78-79
Steaming of food, 601 megadoses of, 416-17
Steroids, 135, 293 multiple vitamin/mineral, 47-53
Stewing of food, 602 questions and answers on, 64-79
Stews, cooked in microwave oven, 608, safe levels of, 42
609 for singles, 27
Stir-frying, 602 users of, 41-46
Stitches, side, 324-25 withdrawal from, 422
Stomach-acid secretion, in elderly, Sushi, 632-33
495-96 Swimmer’s cramps, 325
Stomach cancer, 84, 297, 298-99 Systemic lupus erythematosus, 413
Stomach cramps, 418, 419, 421, 624
Stomach upset, from zinc, 76 T
Strength, enzyme deficiency and, 98 Tachycardia, 275
Stress Tannin, 272-73
arrhythmias from, 279 Tapeworms, vitamin B,, and, 356
breast cancer and, 291 Taste, zinc and, 219
iron loss from, 194 Taurine, for gallstone control, 236
magnesium deficiency from, 206-7 T-cells, 169, 217, 484
supplements for, 49 Tea,
tyrosine for, 236-37 bancha, 630
vitamin B and, 344, 345, 349 iron absorption and, 184, 186, 193,
vitamin Bg and, 117 272-73, 449
Stroke, 154, 196, 199, 525 Teenagers. See Adolescents
Sugar(s) Teeth, 389-96. See also Gum disease
in diabetes, 327, 331-32 Testosterone, 370
in diet, 8 Tests, to assess nutrition, 59-63
nutrient content of, 682-85 Tetany, 143
tooth decay and, 392-93 Tetrahydro-isoquinoline, 263
Sulfites, vitamin B,, and, 96 Thiamine, 103-8
Sunlight coffee and, 76-77
cancer and, 300 exercise and, 452
for elderly, 377, 379 for foot pain, 329
skin and, 492 mental function and, 99
vitamin D from, 57, 144-45, muscular endurance and, 447
371-72, 374, 378-79, 492 RDA of, 638
Supplements, 13, 416. See also safe use of, 418
Multivitamin(s) Thiamine deficiency, 347
cost of, 46 alcoholism and, 107
 Index 715

appetite loss from, 103, 105 Triglycerides

behavior problems from, 11-12, beans lowering, 502
103, 104 fish (oil) lowering, 241, 242,
beriberi from, 108 243-44, 340, 504
confusion from, 385-86 niacin lowering, 94, 95, 418
delaying wound healing, 103, Tryptophan, 234, 235, 236
106-7 Tuberculosis, 177
in elderly, 13 Tumor growth, 153, 154, 504
in high-protein diet, 3 Tumors
in hospital meals, 478-79 breast, 287, 288, 289, 290
mental function and, 458 omega-3 fatty acids preventing, 250
in single women, 23 selenium for, 212-13
symptoms of, 99, 108, 348 vitamin A and beta-carotene and,
in weight-loss diets, 440 88-89
Thinking vitamin B,. and vitamin C and, 95
choline improving, 456-57 vitamin C preventing, 133
exercise improving, 455 Type A people, 206-7
nutrition and, 453-60 Tyrosine, for stress, 236-37, 238
positive versus negative, 459-60
posture and, 454 U
vitamin B deficiency and, 457-58 Ulcerative colitis, 299
Throat cancer, 218 Ulcers, 69-70, 151, 271, 471
Thromboxane, 154 Ultraviolet light, 144, 145, 150, 378
Thymic hormones, 217, 218, 485, 486, Unconsciousness, thiamine and, 107
489 Urinary tract infections, 13
Thymus, 469, 484, 485, 487 USRDAs, versus RDAs, 77
Thyroid cancer, 306 Uterine cancer, 298
Tingling, in hands or feet, 346, 349, 353 Uterine inflammation, 310
Tissue graft rejection, 249
Tissue loss, from trauma, 468, 469 Vv
Tissues, degenerative changes in, 10 Vaginal infection, 310
T-lymphocytes, 96, 484, 489 Valine, 233, 237, 238, 469
Tobacco, cervical problems and, 313 Vegans, 4-5, 355
Tofu, in recipe, 552 Vegetables
Tomato, in recipe, 523 buying frozen, 25
Tongue, sore, from anemia, 269 cancer and, 83-84, 297
Tongue brushing, 393 cooked in microwave oven, 607-8
Toxic shock syndrome, 208-10 cruciferous, 297
Tranquilizers, 477 dislike of, 5-6
Transient ischemic attacks, 454 iron and, 4, 5
Trauma, 233-34, 467-73 leafy green, 505
Trench mouth, 390 for men, 21
Trichomonas, 310 nutrient content of, 648-93
716 Index

Vegetables (continued) oral cancer and, 87-88

in sandwich recipes, 579, 580 preventing stress ulcers, 471
selection and storage of, 562-64 RDA of, 638
unusual nutritious, 525-27 safe use of, 418
Vegetarian diet, 4-5 toxicity of, 65, 85
Vegetarians trauma and, 468, 472
blood pressure of, 335 in unusual fruits and vegetables,
bone strength and, 371 525, 526
iron and, 193, 421, 447, 448, 451 in vegetables, 6, 297
vitamin B,, deficiency in, 355 vision and, 402
vitamin D needs of, 146 vitamin E and, 420, 472
zinc needs of, 451 zinc and, 218-19
Vinegar, 636 Vitamin A deficiency, 5
Virus(es), 177, 293, 306, 311 cancer from, 24
Condyloma, 311, 312, 313, 316, in elderly, 13, 491
317 in high-protein diet, 3
Vision lupus and, 413
impaired, 397-99 in singles, 23
improving, 400-407 Vitamin B (complex), 92-102
vitamin A and, 64, 417, 418 for alcoholism, 264, 265-66
Vitamin(s) appetite and, 67-68
fat-soluble, 56-57 best food sources of, 100
marginal deficiency of, 12 breast disease and, 285
optimal multi-, 52 . cancer and, 306
RDAs of specific, 52 cooking reducing, 441
safe use of, 415-22 for gum disease, 395
Vitamin A, 83-91. See also for mental disorders, 344-51
Beta-carotene; Retinoic acid mental function and, 457-58
versus beta-carotene, 65, 85 in supplements, 49-50
birth defects from, 430 trauma reducing, 468
bodily absorption of, 56-57 vision and, 402
breast disease and, 287-88 Vitamin B deficiency, 92-93
burns and, 470-71 confusion from, 347
cancer and, 85-90, 296, 297, 305 in elderly, 477, 491
cell damage and, 493-94 fatigue from, 465
cervical disease and, 86-87, 314, mental disorders from, 344-45
315,316 risk factors for, 349
in citrus fruits and juices, 6 stress from, 345
for diabetic retinopathy, 398, 405 Vitamin B supplements, versus brewer's
dosages of, 64-65 yeast, 67
immunity and, 471 Vitamin B,. See Thiamine
marginal deficiency of, 11 Vitamin B,. See Riboflavin
in multivitamins, 49 Vitamin By, 109-15
 Index Gali,

for asthma, 109 for methylmalonic acidemia, 437

atherosclerosis and, 110 psychiatric symptoms and, 352-58
bladder cancer and, 109 RDA of, 639
for carpal tunnel syndrome, 110, red blood cells and, 95
114-15, 117 safe use of, 419
depression and, 110, 346, 348 sulfites and, 96
exercise and, 452 vegetarian diet and, 5
for herpes gestationis, 113 vitamin C and, cancer and, 95-96
for hyperactivity in children, 109 Vitamin B,. absorption, 355-56
magnesium and, 117, 201 Vitamin B,, deficiency
marginal deficiency of, 11 aging and, 354-55
mental disorders and, 110-11, 346, bruises from, 293, 294
347 cancer and, 95
nerve damage from, 66 diagnosis and testing of, 357-58
during pregnancy, 429 versus folate deficiency, 61
for premenstrual symptoms, 109 impaired mental function from, 14,
RDA of, 639 458
safe use of, 66, 418-19 signs and symptoms of, 353-54
for seizures, 111-12 in weight-loss diets, 440
for stamina, 113-14 Vitamin B,, injections, for pernicious
testing personal status of, 116-18 anemia, 68
Vitamin B, deficiency Vitamin C, 132-39
from alcohol, 117 for alcoholism, 239, 264, 266
from birth control pills, 116 asthma and, 129, 408
in children, 29 atherosclerosis and, 327-28, 338
depression from, 116 best food sources of, 130
in diet, 8 blood and, 128-29, 138-39
in high-protein diet, 3 brain function and, 383, 384, 385
mood swings from, 99-101 bruising and, 293, 294
premature aging from, 101-2 burns and, 470
senility and, 381-83 cancer and, 296-97, 306, 409
in singles, 23 for cataracts, 403
from smoking, 117 cell damage and, 493-94
in weight-loss diets, 440 cervical disease and, 133-34, 314,
in women, 19 315, 316
Vitamin B, supplements, 50, 442 cholesterol and, 137, 138
Vitamin B, test, 63 in citrus fruits and juices, 6
Vitamin B,»., 306 collagen and, 392, 393-94
aging and, 350, 496 cooking reducing, 441
brain function and, 383, 384 copper absorption and, 172
brewer's yeast and, 67 diabetes tests and, 69, 328
mental disorders and, 347, 349-50, for diabetic retinopathy, 398, 405
356 eyes and, 397, 398, 402
718 Index

Vitamin C (continued) Vitamin C withdrawal, 70

fatigue and, 447, 464 Vitamin D, 140-48, 306
glaucoma and, 405 aging skin and, 144
gum disease and, 126-27, 390, best food sources of, 147
391-94, 395 birth defects from, 430
haloperidol and, 71 bodily absorption of, 56-57
for high blood pressure, 338 bodily use of, 143
for immunity, 127, 386, 470, 488 bone disease and, 374-80
improving fertility, 129, 131 calcium and, 57, 142, 143, 146-47,
iron and, 55-56, 181, 184-85, 191, 374-75
192, 273, 449 for cochlear deafness, 411-12
marginal deficiency of, 11 colorectal cancer and, 298-99
in multivitamins, 49 elderly and, 144, 145, 146
nitrosamine formation and, 134 healing possibilities of, 141
optimal doses of, 55 hormonal form of, 146, 147
raising skin temperature, 128-29 osteoporosis and, 366, 367
RDA of, 639 overdose of, 379-80
reducing duration of colds, 131 RDA of, 639
safe use of, 42, 419-20 safe use of, 48, 420
scurvy and, 70 sources of, 34
sodium ascorbate form of, 70 from sunlight, 144-45, 378-79
trauma reducing, 468 toxicity of, 65-66
ulcers and, 69-70 vegetarian needs of, 146
in unusual fruits and vegetables, Vitamin D deficiency, 140, 142-43,
525; 020027 375-76
in vegetables, 297 bone strength and, 371-72
vitamin B,, and, cancer and, 95-96 in elderly, 377, 475
for wound healing, 127-28, 470 osteomalacia from, 491-92
Vitamin C deficiency Vitamin D metabolism, 143, 146-47
behavior problems from, 11-12 Vitamin D poisoning, 61
cancer from, 24 Vitamin D supplements, 147-48, 394
in diet, 8 Vitamin E, 149-59
in elderly, 13, 136, 491 aging and, 157, 159
heart disease from, 137 allergic reaction to, 72
in high-protein diet, 3 as antioxidant, 150, 153
in hospital meals, 478-79 best food sources of, 158
impaired cognition from, 14 bodily absorption of, 56-57
scurvy from, 20-21 boosting immunity, 488, 494-95
in single men, 23 breast disease and, 285, 286, 287,
vitamin C withdrawal and, 70 288
Vitamin C research, 126-31 cancer and, 149, 152-55, 305-6
Vitamin C supplements, for bronchial cataracts and, 398, 403
asthma, 50 cell damage and, 493-94
 Index 719

chemotherapy and, 151 fats and, 3

circulation and, 329-30 fiber and, 3
for diabetic retinopathy, 405 in high-protein diet, 3
in elderly, 214 from trauma, 469
for gum disease, 395 Weight-loss diets, 439-41
for hair loss from chemotherapy, Wernicke-Korsakoff’s syndrome, 108
409-10 Wheat bread, 611-12
for intermittent claudication, 50, Wheat germ, 508
323-24 White blood cells, 471, 484, 485
for leg cramps, 71-72 Wilson’s disease, 172-73, 414
lung disease and, 156-57 Wine, increasing iron absorption, 449
in multivitamins, 49 Women
preventing heart attacks and active, riboflavin needs of, 98
strokes, 154 anemia in, 270-71
protecting heart from alcohol dam- calcium and, 394
age, 155-56 iron and, 192-93, 421, 447, 448-49
RDA of, 639 nutrition for, 16-17, 18-20, 441-42
reflexes and, 495 osteoporosis and, 160-61, 362, 370
retina and, 398, 399, 402, 405 riboflavin and, 451
safe use of, 42, 420 supplements for, 49, 50
topical use of, 150 thiamine deficiency in, 105
vision and, 402 zinc deficiency in, 225
vitamin A and, 472 Wound healing
vitamin A and vitamin K and, 420 arginine for, 469
for wound healing, 149, 155, 472 thiamine and, 103, 106-7
Vitamin E deficiency, 5 vitamin A for, 13
Vitamin E test, for infant anemia, 60 vitamin C for, 13, 127-28, 419, 470
Vitamin F, 78 vitamin E for, 149, 155, 472
Vitamin K, vitamin E and, 420 zinc for, 472-73
VO, max, vitamin B, for, 113-14
Vomiting, 76, 420, 421 X
Von Willebrand’s disease, 294 X-rays, cancer and, 300

WwW Y
Warts, genital, 311 Yogurt, 508, 572
Water, bottled, 626-28
sodium content of, 627 Z
Weakness, 353, 440, 478 Zinc, 216-27
Weight, before and during pregnancy, alcohol and obesity and, 220-21
427-28 best food sources of, 226
Weight loss, 480 bodily use of, 216-18
energy and, 463 for bone health, 51
exercise for, 443-44 brain disorders and, 356
720 Index

Zinc (continued) for Wilson’s disease, 414

calcium and, 224-25, 473 for wound healing, 472-73
copper and, 48, 170, 356, 421, 473 Zinc deficiency, 217, 218, 225, 447
for diabetic retinopathy, 405 birth defects from, 436
FTS and, 487 in children, 29
glucose metabolism and, 221 eating disorders from, 219-20
for herpes, 222-24 in elderly, 491
for immunity, 217, 218, 223, gum disease and, 221-22
485-88 in hospital meals, 479
lost through exercise, 450, 451 immunity and, 306
mental function and, 382 in low-calorie diet, 442
in multivitamins, 49 male fertility from, 224
for osteoporosis, 224-25 pregnancy and, 15
for prostate, 506 in renal patients, 479
RDA of, 64/ in singles, 23, 27
safe use of, 76, 421 in vegetarian diet, 4, 5
trauma reducing, 468 in weight-loss diets, 440
vaccinations and, 223 Zinc gluconate tablets, 410, 411
vision and, 402 Zinc lozenges, for colds, 76, 410-11
vitamin A and, 218-19 Zinc supplements, dieting and, 442

Rodale Press, Inc., publishes PREVENTION®, the better health magazine.

For information on how to order your subscription,
write to PREVENTION®, Emmaus, PA 18098.
 i)

rc

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(continued from front flap)

helps you decide when taking supplements

makes sense and when it doesn’t, and de-
tails the uses and abuses of vitamin tests— all
to help you become a smarter health care
consumer.
Part III, “From A to Zinc: A Guide to
Vitamins and Minerals,” examines the health-
improving powers of individual vitamins and
minerals, including: the latest research on
how to prevent cancer through diet; how to
recognize the signs of a possible B-vitamin
deficiency; how thiamine deficiency may con-
tribute to poor memory and depression; ten
newly discovered roles for vitamin C; and
the anti-aging powers of vitamins A and E
and selenium, and much, much more.
Part IV, “Special Nutritional Allies for
Health,” reports on amino acids, fish oils
and other food factors now making headlines.
Part V, “Solving Health Problems with
Nutrition,” is a comprehensive review of
dozens of ailments— from alcoholism to zinc
deficiency —and how scientists and doctors
are using nutrition in the prevention and
treatment of disease. It covers magnesium and
heart trouble, calcium and osteoporosis, nu-
tritional formulas for gum disease and more.
Part VI, “Better Nutrition for the Stages
of Your Life,” is devoted to “situational
nutrition.” It’s a guide to adjusting diets to
meet the special needs of dieters, exercisers,
pregnant women, people in hospitals and
nursing homes, people over age 50 and others.
Part VII, “Cooking and Eating for Max-
imum Nutrition,” is a manual on the art and
science of healthful cooking and eating, with
dozens of recipes, shopping tips and “how-to”
information for selecting and cooking
nutrient-packed foods (and avoiding a lot of
fat, sodium or other unhealthful ingredients).
And that’s not all. For quick and easy
reference, “A Reader’s Guide to Recom-
mended Dietary Allowances” (Appendix A)
helps you to determine personal needs for 24
essential vitamins and minerals, as estab-
lished by the National Research Council.
And “A Reader’s Guide to Nutrient Con-
tent of Foods” (Appendix B) gives the vita-
min and mineral content of over 500 foods
and beverages, to help you assess daily nutri-
ent intake and plan meals.
The authors read hundreds of medical
reports and interviewed scores of doctors to
gather the information into this one handy
reference volume. Use it in good health.
THE COMPLETE BOOK OF

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How to choose the best vitamin supplement.
A vitamin that helps protect against smog.
The four nutrients missing from many women’s diets.
The best anti-aging vitamin.
Which vitamin tests are reliable.
The mineral that guards against infection.
A vitamin deficiency that causes easy bruising.
How to help your body absorb vitamins and minerals.
The number one anticancer vitamin.
‘The best time to take calcium.
The vitamin you may need to keep your memory sharp.
How to prevent cramps with better nutrition.
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