Ask Dr. J: Metabolic Typing -- No Science
In the Health News
Diet and Disease
Recipe of the Month: Pan Fried Buckwheat Noodles
A reader commented on my last editorial on the value of high-complex-carbohydrate
diets as opposed to the popular high-protein diets recently
being promoted, saying “carbs are unnecessary and that
meat is good.” I do not write to promote a vegetarian
philosophy, nor from a need to control how people eat. I simply
report the science behind various diet selections so that
my readers (and patients) can make informed choices.
The issue of whether eating a mostly-vegetarian diet is healthiest
is no longer a scientific question: the science is quite clear
on this. It is now a personal, emotional, and even a political
question. In spite of the evidence, many people and some doctors
still promote high-protein, non-vegetarian diets, but the
science consistently says a mostly vegetarian, high-fiber
diet is best.
My reader’s comment included a bit about two explorers
who lived in the north pole for a year, and “thrived
on an all meat diet.” What happened to just two people
for such a short time on a radical diet is irrelevant. Of
more concern is what happens to large numbers of people who
consume various diets over the long term. From this perspective,
mostly vegetarian diets are clearly healthiest. Paleolithic
diets are irrelevant to modern humans, who live decades longer
than our remote ancestors.
It is increasingly clear that many medications are overused
in both hospitals and in private medical visits (see below).
It is also being reported that doctors can safely prescribe
effective doses of medications that are much lower than the
levels commonly used. This would reduce both costs and side
Pharmaceutical companies usually set the recommended doses,
and if lower doses were just as effective, they would see
a reduction in sales and profits. Often, the drug company
representatives visit doctors offices and make suggestions
for drug use. Medical journals frequently have more ads for
drugs than they do research articles, so the physicians reading
these journals may have unscientific influences on their prescribing
You should be aware of this and not be afraid to ask questions
of your doctor to make sure that you are receiving proper
medications based on good scientific information. From a public
health perspective, antibiotic overuse is a particular problem,
contributing to the increasing appearance of antibiotic-resistant
organisms. This problem is only made worse by the extensive
use of antibiotics in feedlot animals meant for human consumption.
If you do use animal products in your diet, you can avoid
these problems by choosing organic sources. In any case, it
is important to be cautious about dietary choices or accepting
any prescription without an adequate medical reason.
Recent evidence shows that about eight percent of all seniors’
doctor visits resulted in inappropriate prescriptions, leading
to side effects that could be avoided. Pain relievers, anxiety
medications, anti-depressants, and sedatives were particularly
The problem was greatest among women. High risks from multiple
medications were also a significant problem as reported by
a researcher for the Centers for Disease Control. Eight percent
amounts to about 20 million incorrect prescriptions.
About one third of the time, visits by seniors to physicians
resulted in multiple drug prescriptions, compounding the risk
of side effects. It is always important to let your doctor
know what drugs you are taking, and to be sure to ask questions
about why you need a particular medication; often, you do
This problem is not confined to the elderly, particularly
when it comes to antibiotics. The use of antibiotics in children
and adults for viral infections, unaffected by such drugs,
leads to side effects, allergic reactions, and the risk of
developing infections with resistant organisms.
The real drug problem in the US is not from illegal drugs,
but the overuse and inappropriate use of prescription medications.
Even correct prescriptions lead to side effects that are responsible
for over 100,000 deaths per year, and we are continuing to
learn of negative effects from drugs.
An analysis of the anti-psychotic drug Zyprexa shows that
in elderly patients with dementia, this commonly prescribed
medication causes increases in strokes and overall mortality.
Another anti-psychotic drug, Risperdal, was also shown to
cause the same harm. These two drugs are often used in elderly
demented patients to control behavior.
Although commonly prescribed for this, Zyprexa is not approved
for use in dementia-related psychosis. A warning letter from
the Zyprexa manufacturer (Lilly) notes that overall mortality
risk is 133 percent higher in the elderly taking Zypreza compared
While these specific effects are not seen in younger patients
on the medications, this new evidence follows an all-too-familiar
pattern, in which a drug is approved, hailed as an advance
in medical therapy, and later found to have unexpected long-term
side effects. By the time this happens, many people have been
harmed, and the drug companies have had time to switch their
financial dependence to a newer drug, of which the side effects
have not yet been discovered.
Another such drug treatment is hormone replacement therapy
(HRT). Regarded for many years as not only a symptom reliever
in menopause, but also a way to reduce risks of heart disease
and brain dysfunction, the combination of Premarin and Provera
(Prem-Pro—estrogens and a progesterone-like drug) has
now been shown to increase the risks of heart disease and
strokes, leading to a sharp drop in its use.
This is in addition to the known risk of breast cancer, and
a newly reported side effect from HRT—an increase in
adult asthma. Although development of asthma in later life
is uncommon, that risk is more than doubled in women who take
estrogen alone or in combination with Provera. (No such risks
have yet been described in women who take bio-identical hormones.)
Another potential problem with HRT is hearing loss. In a
small study (only 64 subjects), women between 60 and 86 years
old who were taking HRT had a 10 to 30 percent greater hearing
deficit than those not taking the treatment. While not a lethal
problem, hearing loss significantly affects quality of life.
I am not saying that prescription medications are not an
important part of medical care, or that they should never
be used. I recommend them when necessary, including heart
medications, antibiotics, and others. They can be lifesaving,
and they can improve the quality of life, and modern medical
care would be almost impossible without the use of many drugs.
However, in many cases drugs are prescribed when they are
unnecessary, sometimes at too high a dose when less would
be effective, or when safer natural products will do the same
job or better, without the side effects. Using coenzyme Q10
for heart disease and hypertension, vitamin B3 for mental
illness, black cohosh for menopausal symptoms, and glucosamine
sulfate for arthritis are all examples of safer approaches
to health care at lower expense.
St. John’s wort is often helpful in mild to moderate
depression, and safer than prescriptions. Saw palmetto is
equal to or better than the prescription drug, Proscar, for
prostate symptoms, and policosanol is superior to statin drugs
for vascular disease and cholesterol elevations.
It is apparent that many people are already looking for alternatives
to their medications, and not always by taking supplements
or making other lifestyle changes. In a recent poll by the
Associated Press, many people reported that they either stopped
taking their medications because they were too expensive,
or they reduced their dose (in some cases, perhaps unwittingly,
giving themselves both better medical care and fewer side
effects at the same time, as many drugs are prescribed in
too high a dose).
My advice is to manage health problems with lifestyle changes
and dietary supplements before medications, unless the situation
is urgent or clearly responsive to specific medications. Also,
try to avoid long-term use of prescription or over-the-counter
drugs, at least without frequent review of their necessity.
If the more benign methods are not adequate, it is always
easy to add medication later. Often you won’t have to.
Q. Do you think a person needs to find out
their metabolic type to know what foods are healthy, or is
this just another fad?
—SR, New Mexico, via Internet
I have been unable to find scientific support for a way to
assess dietary needs through metabolic typing, variants of
which have been around since before I started practice almost
30 years ago. Many physicians would like to find out precisely
what you need to eat (how much protein, carbohydrate, and
fat) by analyzing your metabolism, but evidence is scarce.
One practitioner mentioned as a researcher in the field has
no listings in the database of medical publications. The idea
is that you can divide people into protein types, carbohydrate
types, and mixed types. Even the so-called “carbohydrate
types” are supposed to eat “only” 25 percent
of calories as protein, which is quite high, at about 80 to
100 grams. This makes typing seem more like a promotion of
protein diets, even for the “carb” types, while
a healthy carbohydrate intake is 65 to 70 percent of caloric
People clearly differ in size, shape, personality, digestion,
hormones, and biochemistry, but their similarities are far
greater than their differences. Individual differences have
not yet been typed. Your protein, carbohydrate, and fat needs
are more dependent on your activity level than your metabolism.
The need for micronutrients to achieve optimal health (vitamins,
minerals, essential fatty acids) is much more varied. However,
the amount that will prevent serious deficiency is probably
similar for most people with minor variations.
While we have differences, no one has published reasonable
studies that show how to determine what an individual needs.
Most species have a fairly consistent dietary pattern between
individuals, and humans are probably much the same. Avoiding
food allergens is a different and very important issue.
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McKeown NM, et al., Carbohydrate nutrition,
insulin resistance, and ... metabolic syndrome... Diabetes
Care. 2004 Feb;27(2):538-46.
Hays NP, Effects of an ad libitum low-fat,
high-carbohydrate diet on body weight, body composition, and
fat distribution in older men and women: a randomized controlled
trial. Arch Intern Med. 2004 Jan 26;164(2):210-7.
Goulding MR, Inappropriate medication prescribing
for elderly ambulatory care patients. Arch Intern Med. 2004
Lilly Warns of Zyprexa Risks for Elderly
Patients, Reuters, Feb 20, 2004.
Wooltorton E, Risperidone (Risperdal):
increased rate of cerebrovascular events in dementia trials.
CMAJ. 2002 Nov 26;167(11):1269-70.
Scott JG, et al., Antibiotic use in acute
respiratory infections and the ways patients pressure physicians
for a prescription. J Fam Pract 2001 Oct;50(10):853-8.
Zdziarski P, et al., Overuse of high stability
antibiotics and its consequences... Acta Microbiol Pol. 2003;52(1):5-13.
Garbutt J, et al., Diagnosis and treatment
of acute otitis media: an assessment. Pediatrics. 2003 Jul;112(1
Barr RG, et al., Prospective Study of Postmenopausal
Hormone Use and...Asthma...Arch Intern Med. 2004 Feb 23;164(4):379-386.
Hormone Therapy May Affect Hearing, Study
Shows, Reuters, Report on the meeting of the Association for
Research in Otolaryngology, February 24, 2004.
AP Poll: Drugs Costly for U.S. Families,
Associated Press, Feb 23, 2004.
Cohen JS, Do standard doses of frequently
prescribed drugs cause preventable adverse effects in women?
J Am Med Womens Assoc. 2002 Spring;57(2):105-10, 114.
McPherson K, Hemminki E, Synthesising licensing
data to assess drug safety. BMJ 2004 Feb 28;328(7438):518-520.
No references are available, as none appear
in the medical literature
The National Center for Health Statistics reviews the disturbing
but familiar lifestyle habits in the U.S. (www.cdc.gov/nchs/releases/04facts/healthbehaviors.htm).
Only one in ten adults engaged in vigorous physical activity,
and only 25 percent in any physical activity. While 60 percent
of the population was overweight, only two percent were underweight
(concerns that weight obsession has led to anorexia are overstated).
One fifth of adults smoke a pack of cigarettes a day, making
it important for everyone to protect themselves from second-hand
smoke by taking appropriate antioxidant supplements and flavonoids.
Light alcohol intake (1 to 8 drinks a week) reduces inflammatory
markers (CRP and IL-6) associated with higher heart disease
risk (Volpato S, et al., Relationship of alcohol intake with
inflammatory markers...Circulation. 2004 Feb 10;109(5):607-12).
It would be interesting to know if within the 1-to-8 group
risk varied from the lowest to the highest intake (that is,
is it better to be in the lower or higher category?). It is
likely that flavonoids and antioxidants from non-alcoholic
sources could provide similar benefits, as could supplements
of curcumin, ginger, coenzyme Q10, niacin, policosanol, and
omega-3 fatty acids.
Diabetes risk is reduced if you consume more antioxidants.
A study of 4300 subjects showed 30 to 40 percent lower risk
in the group with the highest compared to those with the lowest
intake of vitamin E or carotenoids (Montonen J, et al., Dietary
antioxidant intake and risk of type 2 diabetes. Diabetes Care.
2004 Feb;27(2):362-6.) Avoid diabetes by watching your diet
and weight, exercising, and taking chromium and other supplements.
I’ve mentioned buckwheat noodles (called soba
in Japan) made from a combination of whole wheat, kamut, or
spelt plus the buckwheat (an organic brand is Sobaya from
health food stores) as a base for pesto, but I also like other
recipes with them. Boil the noodles in adequate water and
drain them in a collander. Meanwhile, stir fry some onions
and garlic in olive oil, add tofu cubes until they sizzle,
and then add half of some very dilute soy sauce with cider
vinegar. When that is stirred in, add broccoli florets and
any green vegetable that you like (be aware of the different
cooking times, for example, the broccoli should be added before
any chard or spinach as they cook so fast). When all of this
is stirred together, add the noodles and sauté the
mixture, add in the remaining soy sauce-vinegar mix, and turn
off the flame before folding in some chopped cilantro. Delicious.
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