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October 2003

Healthy Foods Abroad
Pandemic Diabetes
Diabetes Treatment
Gingivitis and Heart Disease
Ask Dr. J: Vitamin E Safety
In The Health News
Diet and Disease
Recipe of the Month: Rice Lentil Mujadara

Healthy Foods Abroad

Dear Friends,

I have just returned from a very rewarding consulting and teaching trip to Japan. I was impressed with the rapid expansion of interest in nutritional medicine and chelation therapy, among both doctors, dentists, and the public. It was also exciting that a number of businesses are interested in bringing better health to the Japanese consumer.

They are increasingly aware of the relationship between dietary supplements and health. I am pleased to report that the American College for Advancement in Medicine (ACAM) now has a sister organization in Japan (Japanese ACAM), and anti-aging medical societies are growing.

The Japanese are also advanced in their appreciation of natural and organic foods. There is a growing movement (pardon the pun) toward organic farming and gardening, and a significant skepticism of pesticides, food additives, and genetically modified foods.
My hosts were aware of my very particular dietary habits, and they made every effort to accommodate my nutritional needs. I was again surprised and delighted with the proliferation of organic restaurants. Most lunches were “bento boxes” with organic brown rice, tofu, and vegetables.

Virtually every night we were able to go to a different organic restaurant in many areas of the city. They served whole, natural foods that were elegantly and deliciously prepared. I never recommend sacrificing pleasure for health, primarily because it is unnecessary to do so. Natural food preparation can provide a wide variety of delights for the palate, and many of these dishes are easy to prepare at home with commonly available ingredients (although sometimes organic foods are harder to find).

However, I was once again dismayed to see the proliferation of a wide variety of North American “fast junk” outlets. These are the same restaurants we see all the time in the US, but it always comes as a shock to me to see how widespread they are when I travel abroad. They are both the cause and the harbingers of a looming medical and health catastrophe in the US and worldwide. A few years ago I was informed about a Greek government initiative to educate the public about the benefits of the traditional Greek (or Mediterranean) diet. This diet is low in meats, and depends on vegetables, fruits, beans, grains, yogurt, and nuts, and is relatively high in olive oil as a source of fatty acids.

As healthy as the Mediterranean diet is compared with the US diet, the mortality from a variety of ailments is still higher in these countries than in Japan, where they also eat far more vegetables, grains (brown rice is increasingly available), fresh fruits, tofu, nuts, seeds, and fish than are consumed in other industrialized countries. In spite of the high rate of smoking, longevity is high in Japan. I can only speculate as to what will happen when smoking is reduced.

Pandemic Diabetes

One of the consequences of the growth of fast food outlets (as well as other poor dietary choices and lack of exercise) in the United States, Japan, Europe, and other countries is the parallel growing rate of obesity and diabetes around the world. In fact, diabetes is increasing so much that it can now be considered pandemic (a disease occurring over a wide geographic area and affecting a high proportion of the population).

At a recent meeting of the International Diabetes Federation an expert analysis of the annual cost of diabetes care came to $153 billion. It is estimated that in 20 years, 333 million people will be at risk of developing adult onset diabetes, and the annual cost could rise to almost $400 billion by that time. This is far greater than the social and financial costs of AIDS. Most of this disease rate is due to modifiable lifestyle choices.

This is an enormous economic burden not only for developing countries, but also in industrialized societies. In addition, it is an extreme personal and family burden for those who develop the complications of diabetes. These can be debilitating and lead to dependency on family, friends, and society, and early death.
The complications of diabetes include heart disease, loss of vision (from macular degeneration, retinal atherosclerosis, and cataracts), premature dementia, kidney disease, peripheral neuropathy (numbness and tingling of the extremities), and loss of limbs to gangrene from hardening of the arteries. It is not a pretty picture, especially considering that it is almost totally preventable and reversible with lifestyle changes, and a variety of dietary supplements.
Some of these experts were urging food companies, and particularly those who make and sell fast foods, to make healthier products. To paraphrase my colleague, Bernard Rimland, this is like promoting vegetarianism to a shark.

Considering the effects of fast foods and the health damage from tobacco, it seems that the most “successful” US export is disease. (Now, in support of large US companies, the goverment wants to force genetically modified foods on the world’s population, in spite of widespread public opposition, and without any scientific studies to suggest that these foods are safe.)

On the positive side, the United States is one of the leaders in the development and expansion of organic foods, and the enlightened, liberal availability of dietary supplements is one of the most important counterbalances to unhealthy habits. It is also funding studies on nutrition, health habits, and dietary supplements, as well as alternative treatments such as chelation therapy.

Diabetes—Prevent and Treat

While diabetes is an increasing problem in the US and worldwide, you can choose to prevent and treat it with diet, exercise, and supplements. This does not mean that you can be assured of eliminating the need for medications or insulin, but it usually makes it possible to at least reduce the dose. Of course, good health habits also prevent and treat other ailments.

As with so many health issues, a high fiber diet, rich in vegetables, legumes, fresh fruits, seeds, nuts, and whole grains is likely to provide the most benefits. Being physical every day is beneficial, and a regular exercise program is essential to increase insulin sensitivity and improve blood sugar control.

Several supplements help control blood sugar. Chromium increases insulin sensitivity, but you may need up to 1000 mcg per day, far more than the nutritional dose of 200 mcg. Alpha-lipoic acid (100 to 300 mg) improves sugar levels, and higher doses (1000 mg) can treat diabetic neuropathy.

Gamma linolenic acid (240 mg) also helps treat neuropathy, as well as having numerous other benefits. Increasing magnesium intake is associated with a reduced risk of diabetes. It is also beneficial to take vitamins C, E, and B complex (including thiamine, which is associated with reduced risk of diabetic kidney disease).

Periodontal Health—Beyond the Mouth

Gingivitis or periodontitis is the most common cause of tooth loss. Inflammation of the gums and surrounding tissues is the result of poor diet and poor oral hygiene. Avoiding refined sugar, eating whole foods, and regular flossing, brushing, and irrigating are essential if you want to maintain your teeth throughout your life.

Chronic gingivitis has implications far beyond the mouth. It may increase the risk of heart disease, adverse pregnancy outcomes, diabetes, and lung infections. Elevation of CRP, the inflammatory marker, is associated with increased heart disease risk, and many gingivitis patients have higher CRP. In those patients, treating the gingivitis and eliminating the infections helps to reduce the level of the CRP in the blood.

Heart patients are more likely to have lost their teeth or have antibodies to gingival bacteria. In a study, of 159 men with heart disease they were 50 percent more likely to have lost their teeth or have antibodies to periodontal bacteria than a comparable group without heart disease. This suggests that the chronic gingival infection could contribute to their atherosclerosis.

Another study shows an increased risk of heart disease in gingivitis patients, and in addition it suggested an association between gingivitis and the risk of strokes, although this did not reach statistical significance. The research is not consistent, but the weight of evidence suggests that gingivitis has serious health implications.
Compared with just brushing, a comprehensive multivitamin plus brushing can reduce signs of gingivitis, such as bleeding index, pocket depth, and gingival index. Antioxidant supplements, including vitamins C and E and bioflavonoids, help maintain healthy gums, partly becaue they can reduce inflammation.

Some supplements are specifically helpful if they are applied topically. Coenzyme Q10 helps when taken as a supplement and when applied to the gums. I usually recommend 100 to 200 mg of a chewable coQ supplement, which helps in both ways (in addition to its benefits for blood pressure, heart disease, and immune enhancement).
The B vitamin folic acid helps treat gingivitis when it is applied topically. The usual dose in studies is 5 mg, twice per day, as a mouth rinse.

Diabetics and smokers have increased risks and greater severity of gingivitis. It also helps to strengthen the immune system to maintain resistance to infections. Diet, exercise, and many supplements all support immunity.

Lifestyle changes, careful oral hygiene, and regular dental care can eliminate gingivitis and the serious risks associated with it. Keep healthy teeth and you will be able to continue for many years to eat those foods that are essential for your overall health.

Ask Dr. J: Vitamin E Safety

Q. Don’t recent studies show vitamin E is not helpful in disease prevention, and that gamma tocopherol may even be harmful? RS, by Email.

This is misleading information. Evidence suggests that you may need to take antioxidants, such as vitamin E, for ten years or more to get the most (and statistically significant) benefits.

In the study on vitamin E that associated gamma tocopherol with potential harm, the authors (but not the media headlines) indicated that gamma tocopherol is a marker for trans fat intake. Most people get little vitamin E, but if what they do get comes from hydrogenated vegetable oils with trans fats they are likeley to be harmed by those fats, rather than the vitamin E (including gamma tocopherol). This does not mean that supplements of healthy sources of vitamin E with gamma tocopherol are risky. I continue to take large amounts of vitamin E, including a high percentage of gamma tocopherol, as numerous studies suggest that this is beneficial.

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Pandemic Diabetes:

World Facing Diabetes Catastrophe, Reuters, August 25, 2003.

Cameron NE, Cotter MA Metabolic and vascular factors in ...diabetic
neuropathy. Diabetes 1997 Sep;46 Suppl 2:S31-7.

Liu S, Intake of refined carbohydrates and whole grain foods in relation to
risk of type 2 diabetes mellitus and coronary heart disease. J Am Coll Nutr
2002 Aug;21(4):298-306.

Meyer KA, et al., Carbohydrates, dietary fiber, and incident type 2 diabetes
in older women. Am J Clin Nutr. 2000 Apr;71(4):921-30.

Babaei-Jadidi R, et al., Prevention of incipient diabetic nephropathy by
high-dose thiamine... Diabetes 2003 Aug;52(8):2110-20.

Anderson RA, et al., Elevated intakes of supplemental
individuals with type 2 diabetes. Diabetes 1997 Nov;46(11):1786-91.
Ziegler D, Therapy with antioxidants in human diabetic neuropathy. J
Neurochem 2003 Jun;85 Suppl 2:15.

Periodontal Disease:

Jin LJ, et al., Are periodontal diseases risk factors for certain systemic
disorders... Hong Kong Med J 2003 Feb;9(1):31-7.

Genco R, et al., Periodontal disease and cardiovascular disease:
epidemiology and possible mechanisms. J Am Dent Assoc 2002 Jun;133

Pussinen PJ, et al., Antibodies to periodontal pathogens are associated with
coronary heart disease. Arterioscler Thromb Vasc Biol 2003 Jul
1;23(7):1250-4. Epub 2003 Apr 24.

Morrison HI, et al., Periodontal disease and...coronary heart and
cerebrovascular diseases. J Cardiovasc Risk 1999 Feb;6(1):7-11.

Mattila K, et al., Effect of treating periodontitis on C-reactive protein
levels: a pilot study. BMC Infect Dis 2002 Dec 10;2(1):30.

Nishida M, et al., Dietary vitamin C and the risk for periodontal disease. J
Periodontol 2000 Aug;71(8):1215-23.

Munoz CA, et al., Effects of a nutritional supplement on periodontal status.
Compend Contin Educ Dent 2001 May;22(5):425-8.

Hanioka T, et al., Effect of topical application of coenzyme Q10 on adult
periodontitis. Mol Aspects Med 1994;15 Suppl:s241-8.

Pack AR, Folate mouthwash: effects on established gingivitis in periodontal
patients. J Clin Periodontol 1984 Oct;11(9):619-28.

In the Health News

A study of elderly women shows that long-term use of vitamins C and E can enhance cognitive function. Of 15,000 women in their 70s, those who had taken supplements for more than 10 years performed better on tests of memory and mental clarity than others who had not taken supplements or had taken them for a shorter time. It is never too soon to start taking antioxidant supplements, as other studies also suggest that long-term use has health advantages. (Grodstein F, et al., High-dose antioxidant supplements and cognitive function in community-dwelling elderly women. Am J Clin Nutr. 2003 Apr;77(4):975-84.)

Long-term multivitamin supplementation is beneficial in protecting health. Among 145,000 men and women, colon cancer was reduced by 30 percent among those regularly taking multivitamins 10 years prior to the start of the study, but those who started them later or did not take any were not so protected. (Multivitamin Use and Colorectal Cancer Incidence in a US Cohort: Does Timing Matter? Am J Epidemiol 2003 Oct 1;158(7):621-8.)

Diet and Disease

It is no surprise that fast food restaurants serve unhealthy products (one of their defenses against lawsuits is that everyone knows they are unhealthy). Now a review of fast food habits shows that 37 percent of adults and 42 percent of children eat these foods (Paeratakul S, et al., Fast-food consumption among US adults and children.... J Am Diet Assoc 2003 Oct;103(10):1332-1338). As a result, their diets are high in calories, fat, saturated fat, salt, sugar, and soft drinks. They are depriving themselves of fresh fruits and vegetables and their nutrients, including vitamin C and carotenoids. This contributes to the high rate of obesity and related illnesses, including childhood asthma.

Recipe of the Month: Lentils and Brown Rice (Mujadara)

This Middle Eastern dish is simple and tasty, with few ingredients that cook fairly quickly. Have cooked brown rice available (I use a rice cooker, which is inexpensive and does a great job in 45 minutes with little attention). Cook green lentils in adequate water. They usually take about 30 minutes, but they will finish cooking later. Sauté onions in olive oil until brown (one of my few dishes without garlic, although you can add that too, if you like), and add cumin (the main flavor) in liberal amounts, and a small amount of sea salt. Mix equal amounts of rice and lentils with the onions in a sauce pan, and let them simmer until it is a thick stew with all the flavors blended. I add a little fresh cayenne, although this is not traditional. Serve this dish with whole wheat pita bread, and use it to dip into the stew.


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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.

Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.