Healthy Foods Abroad
Gingivitis and Heart Disease
Ask Dr. J: Vitamin E Safety
In The Health News
Diet and Disease
Recipe of the Month: Rice Lentil Mujadara
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
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
However, I was once again dismayed to see the proliferation
of a wide variety of North American “fast junk”
outlets. These are the same restaurants we see all the time
in the US, but it always comes as a shock to me to see how
widespread they are when I travel abroad. They are both the
cause and the harbingers of a looming medical and health catastrophe
in the US and worldwide. A few years ago I was informed about
a Greek government initiative to educate the public about
the benefits of the traditional Greek (or Mediterranean) diet.
This diet is low in meats, and depends on vegetables, fruits,
beans, grains, yogurt, and nuts, and is relatively high in
olive oil as a source of fatty acids.
As healthy as the Mediterranean diet is compared with the
US diet, the mortality from a variety of ailments is still
higher in these countries than in Japan, where they also eat
far more vegetables, grains (brown rice is increasingly available),
fresh fruits, tofu, nuts, seeds, and fish than are consumed
in other industrialized countries. In spite of the high rate
of smoking, longevity is high in Japan. I can only speculate
as to what will happen when smoking is reduced.
One of the consequences of the growth of fast food outlets
(as well as other poor dietary choices and lack of exercise)
in the United States, Japan, Europe, and other countries is
the parallel growing rate of obesity and diabetes around the
world. In fact, diabetes is increasing so much that it can
now be considered pandemic (a disease occurring over a wide
geographic area and affecting a high proportion of the population).
At a recent meeting of the International Diabetes Federation
an expert analysis of the annual cost of diabetes care came
to $153 billion. It is estimated that in 20 years, 333 million
people will be at risk of developing adult onset diabetes,
and the annual cost could rise to almost $400 billion by that
time. This is far greater than the social and financial costs
of AIDS. Most of this disease rate is due to modifiable lifestyle
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
The complications of diabetes include heart disease, loss
of vision (from macular degeneration, retinal atherosclerosis,
and cataracts), premature dementia, kidney disease, peripheral
neuropathy (numbness and tingling of the extremities), and
loss of limbs to gangrene from hardening of the arteries.
It is not a pretty picture, especially considering that it
is almost totally preventable and reversible with lifestyle
changes, and a variety of dietary supplements.
Some of these experts were urging food companies, and particularly
those who make and sell fast foods, to make healthier products.
To paraphrase my colleague, Bernard Rimland, this is like
promoting vegetarianism to a shark.
Considering the effects of fast foods and the health damage
from tobacco, it seems that the most “successful”
US export is disease. (Now, in support of large US companies,
the goverment wants to force genetically modified foods on
the world’s population, in spite of widespread public
opposition, and without any scientific studies to suggest
that these foods are safe.)
On the positive side, the United States is one of the leaders
in the development and expansion of organic foods, and the
enlightened, liberal availability of dietary supplements is
one of the most important counterbalances to unhealthy habits.
It is also funding studies on nutrition, health habits, and
dietary supplements, as well as alternative treatments such
as chelation therapy.
While diabetes is an increasing problem in the US and worldwide,
you can choose to prevent and treat it with diet, exercise,
and supplements. This does not mean that you can be assured
of eliminating the need for medications or insulin, but it
usually makes it possible to at least reduce the dose. Of
course, good health habits also prevent and treat other ailments.
As with so many health issues, a high fiber diet, rich in
vegetables, legumes, fresh fruits, seeds, nuts, and whole
grains is likely to provide the most benefits. Being physical
every day is beneficial, and a regular exercise program is
essential to increase insulin sensitivity and improve blood
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
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
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
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
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)
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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World Facing Diabetes Catastrophe, Reuters,
August 25, 2003.
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J Am Coll Nutr
Meyer KA, et al., Carbohydrates, dietary
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Babaei-Jadidi R, et al., Prevention of
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Anderson RA, et al., Elevated intakes of
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Ziegler D, Therapy with antioxidants in human diabetic neuropathy.
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Genco R, et al., Periodontal disease and
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Hanioka T, et al., Effect of topical application
of coenzyme Q10 on adult
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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.
Long-term multivitamin supplementation is beneficial in
protecting health. Among 145,000 men and women, colon cancer
was reduced by 30 percent among those regularly taking multivitamins
10 years prior to the start of the study, but those who started
them later or did not take any were not so protected. (Multivitamin
Use and Colorectal Cancer Incidence in a US Cohort: Does Timing
Matter? Am J Epidemiol 2003 Oct 1;158(7):621-8.)
It is no surprise that fast food restaurants serve unhealthy
products (one of their defenses against lawsuits is that everyone
knows they are unhealthy). Now a review of fast food habits
shows that 37 percent of adults and 42 percent of children
eat these foods (Paeratakul S, et
al., Fast-food consumption among US adults and children....
J Am Diet Assoc 2003 Oct;103(10):1332-1338). As a result,
their diets are high in calories, fat, saturated fat, salt,
sugar, and soft drinks. They are depriving themselves of fresh
fruits and vegetables and their nutrients, including vitamin
C and carotenoids. This contributes to the high rate of obesity
and related illnesses, including childhood asthma.
This Middle Eastern dish is simple and tasty, with few ingredients
that cook fairly quickly. Have cooked brown rice available
(I use a rice cooker, which is inexpensive and does a great
job in 45 minutes with little attention). Cook green lentils
in adequate water. They usually take about 30 minutes, but
they will finish cooking later. Sauté onions in olive
oil until brown (one of my few dishes without garlic, although
you can add that too, if you like), and add cumin (the main
flavor) in liberal amounts, and a small amount of sea salt.
Mix equal amounts of rice and lentils with the onions in a
sauce pan, and let them simmer until it is a thick stew with
all the flavors blended. I add a little fresh cayenne, although
this is not traditional. Serve this dish with whole wheat
pita bread, and use it to dip into the stew.