Richard G. Petty, MD

Violence and Diet

We have talked before about the link between nutrition and violence.

The evidence has continued to mount and I was pleased to see that the Wellcome Trust is funding trials in three British prisons to investigate the link between nutrition and behavior. This is a placebo study that will examine which nutrients are most important and at what dosage.

Volunteers from three young offenders institutions housing male prisoners aged 16 to 21 will take nutritional supplements in addition to their normal choice of food to ensure they receive the necessary vitamins, minerals and essential fatty acids to meet daily guidelines. The investigators will monitor how levels of nutrients affect a range of behaviors including violence, drug-related offences and incidents of self-harm.

The new trials build on previous research published in the British Journal of Psychiatry that was conducted at the then maximum security Young Offenders Institution in Aylesbury, Buckinghamshire. That study was funded by Natural Justice, a research charity that investigates the social and physical causes of offending behavior. Nutritional supplements  - 2 grams per day of the omega-3 fatty acids EPA and DHA for three months - were given to ensure that inmates' diets reached recommended UK dietary standards. The researchers found that the prisoners who consumed the active nutrient capsule committed on average 26% fewer disciplinary offenses overall than those taking the placebo and 37% fewer violent offenses.

The most likely reason why supplements can have such a large effect is because the proper functioning of nerve cell membranes and signaling molecules depends upon adequate amounts of minerals, vitamins and essential fatty acids in the diet.

This is extremely important work. Clearly nutrition is not the only driver of violence but it has been wondered for a long time whether the industrialization of our diets has contributed to the enormous rise in violent crime between the 1950s and 1970s.

“Violence is the last resort of the incompetent.”
Isaac Asimov (Russian-born American Biochemist and Writer, 1920-1992)

“Blessings crown the head of the righteous, but violence overwhelms the mouth of the wicked.”
--The Bible (Proverbs 10:6)

“Peace cannot be achieved through violence, it can only be attained through understanding.”
--Ralph Waldo Emerson (American Poet and Essayist, 1803-1882)

Antioxidants May Raise Cancer Risk?

Regular readers will know that I have for some years now been raising a red flag the wholesale promotion of antioxidants.

The trouble is this: antioxidants are supposed to help rid us of some of the free radicals that have been implicated in a small number of diseases, and may also play a role in some of the physical aspects of aging. However, free radicals are also some of the major cancer killers in the body, so eradicating them – even if it were possible – hardly seems like a good idea.

According to an analysis of a dozen studies including more than 100,000 patients in the Mayo Clinic Proceedings taking antioxidant supplements do not reduce cancer risk.

In fact smokers who take beta carotene supplements could be increasing their risk of smoking-related cancer and death.

Different antioxidants have different effects, and their effects may also vary depending on the part of the body involved.

The researchers looked at 12 trials that compared antioxidant supplements with placebo on cancer incidence and mortality. Antioxidant supplements did not reduce the risk of cancer. When they looked separately at beta carotene, they found the nutrient actually increased cancer risk by 10 percent among smokers. There was also a trend toward a greater risk of dying from cancer with beta carotene supplementation.

Selenium supplements reduced cancer risk by 23 percent among men, the researchers found, but had no effect on women. While vitamin E had no anti-cancer effect overall, supplementation with the nutrient was tied to a 13 percent lower prostate cancer risk.

A large study looking at vitamin E supplementation for prostate cancer is currently underway. While future studies of beta carotene and vitamin E for cancer prevention are very unlikely to show effectiveness, it would be worth doing further studies on selenium.

The moral of the story: we should be going for a balanced diet and a balanced life in general rather than putting our hopes in an over-simplified nutritional message.

Nutrigenetics: A Peak Into the Future

At any given time only about ten percent of you genes are thought to be active. They are switched on and off in response to all kinds of internal and environmental changes. This is particularly true in the metabolic pathways, where gene activation is an essential part of the normal response to dietary changes. We also know that many of us have genetic reasons for varying in our nutritional requirements.

Anybody who has looked into diet and nutrition knows that there is no one approach that works for everyone, and the Holy Grail of weight management is to be able to identify which diet will work for whom.

This goal has just come a little closer with the publication of a report from researchers in Greece, London and Colorado that has been published in the Nutrition Journal.

The paper, “Improved weight management using genetic information to personalize a calorie controlled diet” is available for free download.” The study population consisted of 50 patients who had failed to lose weight. They were offered a nutrigenetic test screening 24 variants in 19 genes involved in metabolism. 43 patients attending the same clinic were selected for comparison using algorithms to match age, sex, frequency of clinical visits and BMI at initial clinic visit. The second group of 43 patients did not receive a nutrigenetic test. BMI reduction at 100 and over 300 days and blood fasting glucose were measured.

The results are very promising. After 300 days of follow-up individuals in the nutrigenetic group were more likely to have maintained some weight loss (73%) than those in the comparison group (32%). Average BMI reduction in the nutrigenetic group was 1.93 kg/m2 (5.6% loss) vs. an average BMI gain of 0.51 kg/m2 (2.2% gain). Among patients with a starting blood fasting glucose of >100 mg/dL, 57% (17/30) of the nutrigenetic group but only 25% (4/16) of the non-tested group had levels reduced to <100 mg/dL after >90 days of weight management therapy.

The paper concludes by saying that the addition of nutrigenetically tailored diets resulted in better compliance, longer-term BMI reduction and improvements in blood glucose levels.

This is a small “proof of concept” study, and the effects are not enormous, but there is easily enough here already to vigorously pursue this genetic approach.

Genes, Breastfeeding and IQ

Studies on intelligence and breastfeeding have come up with conflicting results. The major question has been whether the results have been skewed because more educated or more affluent mothers were more likely to breastfeed.

A new study by colleagues in London, New Zealand and here in the United States has just been published in the Proceedings of the National Academies of Sciences and indicates that a single gene influences whether breastfeeding improves a child's intelligence.

The gene in which the researchers were interested is a fatty acid delta desaturase – FADS2 – that is involved in the genetic control of fatty acid pathways. Children with one version of the FADS2 gene scored seven points higher in IQ tests if they were breastfed, but breastfeeding had no effect on the IQ of children with a different version of the gene.

Researchers at the Institute of Psychiatry, Kings College London, used data from two previous studies of breast-fed infants in Britain and New Zealand that had involved more than 3,000 children. IQ was measured at various points between the ages of five and 13 years in the studies. The only thing that we do not know is exactly how long the children were breastfed.

This is yet another study to show us why the nature/nurture debate needs a radical re-think. Nutrition and genetics act together. People have been arguing about the roots of intelligence for at least a hundred years, and this research shows nature working via nurture to create better outcomes.

Around 90% of people carry the version of the gene that was associated with better IQ scores in breastfed children. We do not know if there are any ethnic differences in those numbers, but there may be.

And that seven point difference in IQ? It s not going to determine how well someone is going to do in life, but in school it might be enough to put the child in the top third of the class.

Fat and Cancer

It is not every day that a medical story hits the front page of USA Today, but today one has, and for a very good reason.

The World Cancer Research Fund (WCRF) has just published a report that we have been eagerly awaiting for several years. It is the most comprehensive analysis ever published on the link between cancer and diet, weight and physical activity. Researches at nine academic institutions across the world looked for every relevant study published since records began in the 1960s. They initially found half a million, and in the end 7,000 of them were judged to be the most relevant and robust for inclusion in the report.

It includes 10 recommendations from a panel of 21 world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can prevent cancer. UNICEF and the World Health Organization were among the official observers of the report's process.

A key finding is that maintaining a healthy weight (a BMI of 20-25) is one of the most important things you can do to prevent cancer. The number of types of cancer where there is "convincing" evidence that body fat is a cause has risen from one to six since the last WCRF report was published in 1997, including colorectal cancer and post-menopausal breast cancer.

Prof Sir Michael Marmot, who was Chair of the Panel, said that,

“We are recommending that people aim to be as lean as possible within the healthy range, and that they avoid weight gain throughout adulthood.

"This might sound difficult, but this is what the science is telling us more clearly than ever before. The fact is that putting on weight can increase your cancer risk, even if you are still within the healthy range.

"So the best advice for cancer prevention is to avoid weight gain, and if you are already overweight then you should aim to lose weight."

Other findings in the report include:

There is "convincing" evidence that processed meats, including ham and bacon, increase the risk of colorectal cancer. People who consume them are advised to do so sparingly.

The evidence that red meat is a cause of colorectal cancer is stronger than ever before. People should not eat any more than 18 ounces (500g) of red meat a week.

This figure is for cooked meat, and is the equivalent of between 15-30 ounces (700-750g) of non-cooked meat.

Here is something that is almost a first, at least for a cancer report. It has made a breastfeeding recommendation: mothers are advised to breastfeed exclusively for six months and to continue with complementary breastfeeding after that. This is because of "convincing" evidence that breastfeeding protects the mother against breast cancer and "probable" evidence that it protects the child against obesity later in life.

Dietary supplements are not recommended for cancer prevention. The evidence that alcohol is a cause of cancer is stronger now than ever before.

Professor Martin Wiseman, Project Director of the Report, said:

"This report is a real milestone in the fight against cancer, because its recommendations represent the most definitive advice on preventing cancer that has ever been available anywhere in the world.

"When individual studies are published, it is impossible for the public to put them into context and know how seriously they should be taking the findings. But the great thing about this report is that it does this job for them.

"If people follow our recommendations, they can be confident they are following the best advice possible based on all the scientific research done up to this point. These recommendations are not based on one study but are based on 7,000." 

In the United Kingdom, plans are afoot to establish a Cancer Reform Strategy. Professor Mike Richards, the British Government's Clinical Director for Cancer, had this to say:

“The WCRF report is the most authoritative and exhaustive review done thus far on the prevention of cancer through food, nutrition and physical activity.

"For those of us wanting to lower our risk of developing cancer, the Report provides practical lifestyle recommendations. The Report also provides public health goals. Both will form an important element for the forthcoming Cancer Reform Strategy."

These are the main recommendations:

• Limit red meat
• Limit alcohol
• Avoid bacon, ham, and other processed meats
• No sugary drinks
• No weight gain after 21
• Exercise every day
• Breastfeed children

Have you seen those infomercials where someone tells you that there is some conspiracy by shadowy people who don’t want you to know the truth about diet, exercise and cancer?  Next time remember this research. If some expensive supplement or the juice of an exotic berry from the Himalayas could really reduce the risk of cancer, these studies should have noticed something by now.

Folic Acid: Too Much of a Good Thing?

If you believe everything that your read in the media or hear on those infomercials, you would think that you should spend all day munching pounds of fruits and vegetables while taking megadoses supplements chasers.

While that may sound good in theory, in practice things are not so simple and this approach may actually do you harm.

A good example has just come to light in a report from the Institute of Food Research in the United Kingdom that has just been published in the British Journal of Nutrition.

We have talked before about the potential value of fortifying food with folic acid. Apart from reducing the risk of neural tube defects in babies, it may also reduce the risk of depression.

The new report suggests that fortifying flour with folic acid may lead to a range of health problems.

Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and leafy green vegetables. Folates are metabolized in the intestine, whereas folic acid is metabolized in the liver. The liver is an easily saturated system, and at doses of half the amount being proposed for fortification that could lead to significant unmetabolized folic acid entering the blood stream.

This excess folic acid could cause a number of problems:
It may interfere with some treatments for leukemia and arthritis
Women being treated for ectopic pregnancies
Men with a family history of colon cancer
People with blocked arteries being treated with a stent 
In women undergoing in-vitro fertilization, it may increase the likelihood of conceiving multiple embryos
Unmetabolized folic acid accelerates cognitive decline in the elderly with low levels of vitamin B12 (If they have normal levels of B12, folic acid may slow brain aging)
While dietary folates have a protective effect against some cancers, folic acid supplementation may increase the incidence of colon cancer
Folic acid may increase the incidence of breast cancer in postmenopausal women, though other studies have shown the opposite

The trouble is that it could take 10-20 years for any potential harmful effects of unmetabolized folic acid to become apparent.

The latest study follows a letter to the Food Standards Agency from Sir Liam Donaldson, the Chief Medical Officer of England, requesting further expert consideration of two recent studies linking folic acid to bowel cancer before the government gives the final go-ahead for mandatory fortification of food with folic acid. However the Food Standards Agency has stuck to its position that fortification is safe. Mandatory fortification has already been introduced in the US, where it has been required since 1998, Canada and Chile, where it has cut neural tube defect rates by up to half.

Professor Nicholas Wald, director of the Wolfson Institute of Preventive Medicine, said:

“Fortification would prevent many cases of spina bifida and would also benefit the health of the country as a whole. Further delay in this public health measure will result in hundreds more babies being disabled by this serious disorder, or pregnancies being needlessly terminated due to a neural tube defect."

When it comes to analyzing risks and benefits, one of the most important things is to realize that more is not necessarily better, and that folate and folic acid are not the same thing at all.

Second is the point that we discussed before: some people have the right genes to be able to metabolize folic acid with impunity, while others may get a range of problems from taking it.

Chocolate, Comfort Foods and Depression

Most people have done a bit of comfort eating from time to time: candies and chocolates are usually the favorites. That’s not a coincidence. Not only do they taste good, but chocolate also contains chemicals that may improve mood, and sugar can have an indirect impact on the uptake of specific amino acids into the brain, where they go on to form the chemical neurotransmitters involved in inter-cellular communication and learning.

On the more serious side, some types of mood disorders, particularly seasonal affective disorder, premenstrual syndrome and the so-called “atypical depression” are often associated with quite sever cravings for chocolate.

So I was very interested to see a paper from colleagues in Australia in this month’s issue of the British Journal of Psychiatry.

Gordon Parker and Joanna Crawford examined links between chocolate craving in people who are depressed and both personality style and atypical depressive symptoms, with a web-based questionnaire completed by nearly 3000 individuals reporting clinical depression.

People accessing a mood disorder consumer information website (http://www.blackdoginstitute.org.au) were invited to participate in an online survey of lifetime treatments for a depressive episode, together with some interesting evaluation tools.

Half of the respondents said that they craved chocolate, and the number was slightly higher in women. They said that they felt that chocolate helped with depression, anxiety and irritability. The ones who said that chocolate helped were more likely to score higher on a “neuroticism” scale, particularly irritability and rejection sensitivity.

Five years ago the same team found that atypical depression was associated with a personality that was especially sensitive to rejection, and also tended to be linked with several symptoms - including food cravings – that tie in with behaviors aimed to try and make us feel better and to maintain internal balance.

The results suggest that people with certain personality styles derive personal benefit from comfort eating. Some research has linked carbohydrate craving to the opioid system in the brain, and it is possible that munching on chocolate may be an example of genuine self-medication. People eat to chocolate to calm down their ability to feel emotional distress.

The trouble is, of course, that although chocolate is yummy and may even be therapeutic, too much can be a bad thing. Weight problems are common in people with chronic depression, especially the “atypical” type.



“Chocolate causes certain endocrine glands to secrete hormones that affect your feelings and behavior by making you happy. Therefore, it counteracts depression, in turn reducing the stress of depression. Your stress-free life helps you maintain a youthful disposition, both physically and mentally. So, eat lots of chocolate!”
--Elaine Sherman (American Culinary Expert, Teacher and Writer, 1938-2001)

"Look, there’s no metaphysics on earth like chocolates.”
--Fernando Pessoa (Portuguese Poet, 1888-1935)

Nutrition, Learning and Memory

We have talked about the burgeoning data linking food with mood, behavior and cognition.

I have just seen a new study that really adds to our knowledge and contributes information that we can all use.

Scientists in Europe, Australia and Indonesia have published data in the American Journal of Clinical Nutrition suggesting that nutrition can improve verbal learning and memory in schoolchildren.

This study was undertaken by the NEMO study group (Nutrition Enhancement for Mental Optimization) that consists of the Unilever Food and Health Research Institute (Vlaardingen, The Netherlands); CSIRO, Human Nutrition (Adelaide, Australia) and the SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia (Jakarta Pusat, Indonesia).

It was a 12-month study of 780 children in Australia and Indonesia in which the researchers evaluated the effects of adding a specific vitamin and mineral mixture to a daily drink.

The study population consisted of 396 well-nourished children in Australia and 384 poorly nourished children in Indonesia. In each country, the children were randomly allocated to one of four groups, receiving a drink with either:

1. A mixture of micronutrients (iron, zinc, folate and vitamins A, B-6, B-12 and C)
2. Fish oil (DHA and EPA)
3. Both the micronutrient mixture and the fish oil
4. Nothing added, i.e. placebo

In Australia, children who received the daily drink with the added vitamin and mineral mixture performed significantly better on tests of mental performance tests than children in a control group who received the drink but without added nutrients. In Indonesia a similar trend was observed, but this time only in the girls.

After twelve months, children in Australia who received the drink with the nutrient mix showed higher blood levels of these micronutrients, which means that their bodies were taking up the nutrients. In addition, they performed significantly better on tests measuring their learning and memory capabilities compared to children in the other groups. A similar trend was observed in Indonesia, but only in the girls. The addition of fish oil to the fortified drink did not conclusively show any additional effects on cognition.

This study adds to the mounting evidence that nutrition plays an important role in cognitive development in children, even in children who are enjoying a “normal” diet. Deficiencies in iron and iodine have been linked to impaired cognitive development in young children for over a century and there is now emerging evidence that deficiencies in zinc, folate and vitamin B12 may each compromise mental development in children. More recently, fish oils (EPA, DHA) have also been linked to child cognitive development.

Most previous studies have focused on deficiencies in single nutrients in young age groups, despite the well-known observation that the brain continues to grow and develop during childhood, adolescence and early adulthood. Little is known about the role of nutrition on mental development after the age of 2. In addition very other few studies have looked at the effect of offering a mix of nutrients. Until this study, there were very few randomized controlled intervention studies assessing the impact of a multiple-micronutrient intervention on cognitive function in schoolchildren.

The investigators recommend further research to investigate the exact role of DHA and EPA in healthy school-aged children. Another research focus is the further optimization of cognitive development tests with respect to their validity and sensitivity across cultures. The scientists suggest that the smaller effects of the vitamins and minerals in Indonesia could be a result of a lower sensitivity of the cognitive tests in that country.


This research raises many interesting points:

• Is it possible that the healthy Australian diet is actually nothing of the sort?
• Is it possible that if the diet is adequate, that “super-nutrition” can help a child to exceed his or her potential?
• Are there key ages when nutrition can help, or is the effect maintained across the age range?
• Does nutritional supplementation have a long-term impact on a child?
• Have we even found the optimal mixture for child cognitive development? Might higher amounts of any nutrients – particularly fish oils – produce better effects, or might they be toxic, as we saw in the case of vitamin A supplementation?
• Are we using the correct cognitive development tests to pick up changes in different cultures? As an example, could the smaller effects of the vitamins and minerals in Indonesia be a result of a lower sensitivity of the cognitive tests in that country? Or is it that the children are also missing out on some other trace nutrients?

Many questions, but the take home message is this: careful nutritional supplementation may have considerable benefits to a child, even one growing up in an affluent culture.

“Learning is a weightless treasure you always carry easily.”
--Chinese Proverb

Food Additives, Food Colorings and Hyperactivity

Regular readers will know that I am very interested in the impact of food and food additives on cognition and behavior. Unfortunately it is a field that has generated more heat than light, with some patients associations and commercial organizations providing rather unbalanced assessments about the whole issue and how best to deal with it.

What we do on this website is to provide you with information that has a solid foundation. A good example is a new study published this week in the Lancet by a team of researchers from Southampton University in the United Kingdom. (The full article is available here).

An alarming number of foods contain artificial food color and additives (AFCAs), and there has been a great deal of concern about their potential impact not only on behavior, but also on the developing brain.

A study published three years ago examined the impact of specific mixtures of additives on hyperactivity in three-year-old children. It was an important piece of work, but the worry was that the study focused on parental rather than objective ratings of hyperactivity. Though parents are usually very good at observing their own children, most of us also have our own ideas about the things that may cause problems.

In this new study was sponsored by the British Food Standards Agency and the researchers looked at the effects of additives on changes in children's behavior in a community-based, double-blinded, placebo-controlled, crossover trial.

The study involved 153 children aged 3, plus 144 children aged 8-9. They were given either a drink containing sodium benzoate plus one of two AFCA mixes, or a placebo drink. The two AFCA mixes contained:

• Mix A - included 20 mg of artificial food colorings (5 mg sunset yellow [E110], 2⋅5 mg carmoisinetartrazine [E102], and 5 mg ponceau 4R [E124, and 45 mg of sodium benzoate [E211]. (These were the same ingredients used in the previous study). [E122], 7⋅5 mg
• Mix B was designed to be what the average 3 year-old and 8-9 year old may be consuming today, and included 30 mg of artificial food colorings (7⋅5 mg sunset yellow, 7⋅5 mg carmoisine, 7⋅5 mg quinoline yellow [E110], and 7⋅5 mg allura red AC [E129]) and 45 mg of sodium benzoate.

The children's behaviors were measured by a “global hyperactivity aggregate” (GHA) that is based on teachers' and parents' ratings. The older children also received a computerized test for attention.

The main findings were that:

• Mix A had a significant adverse effect on children in GHA for all the 3 year-olds, compared to the placebo.
• Mix B produced mixed results for 3 year-olds
• Both Mix A and Mix B had significant adverse effects on the 8-9 year olds, compared to the 8-9 year-olds on the placebo
• Children vary greatly in their levels of adverse effects from consuming AFCA

So this new research indicates that foods containing AFCAs may fuel hyperactive behaviors in children from early to middle childhood. An important point is that AFCAs may impact any child: the effect is not restricted to children who are already hyperactive or have attention-deficit/hyperactivity disorder (ADHD). The problem with hyperactivity is not so much the challenge of living with an overly energetic child, but rather the impact of hyperactivity on development and education, particularly on reading skills. The hyperactive child may not get the full benefit of a conventional education.

The researchers do not yet know whether their findings apply to older children. But they raise the question whether complete withdrawal of AFCAs from the food supply might decreases the overall rate of hyperactivity in the population.

However, they ask whether the general levels of hyperactivity in children in the general population might not go down significantly if AFCAs were withdrawn completely.

Depression, Folic Acid and Bread

A remarkable study was published in the July edition of the Journal of Epidemiology and Community Health, by researchers at the University of York and Hull York Medical School.

They reviewed 11 studies involving 15,315 individuals and confirmed that there is a link between depression and low levels of folate, a vitamin that comes primarily from leaf vegetables such as spinachturnip greens, dried beans and peas, fortified cereal products, sunflower seeds and certain other fruits and vegetables are rich sources of folate, as is liver. and

Last month, the British Food Standards Agency  recommended to Health Ministers that they should introduce mandatory fortification of either bread or flour with folic acid to prevent neural tube defects, which can result in miscarriage, neonatal death or lifelong disability. This new study suggests that the measure may also help to reduce the frequency and severity of depression.

Lead author Simon Gilbody said:

"Our study is unique in that for the first time all the relevant evidence in this controversial area has been brought together. Although the research does not prove that low folate causes depression, we can now be sure that the two are linked. Interestingly, there is also some trial evidence that suggests folic acid supplements can benefit people with depression. We recommend that large trials should be carried out to further test this suggestion."

Recent research from the same team published in the American Journal of Epidemiology has also shown that people with depression, bipolar disorder and schizophrenia commonly have a genetic mutation named MTHFR C677T in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene on chromosome 1. The enzyme that the gene codes for is involved in folate metabolism, and the mutation (polymorphism) means that they process folate less efficiently. Folate is linked to the production of some of the chemicals in the brain, including serotonin, that in some part some the brain elevate mood. The identification of this gene provides a plausible explanation as to why folic acid supplements may help people with depression.

There is also another implication of the finding: it is well known that some diseases are more common in people who have depression, bipolar disorder and schizophrenia, including coronary artery disease ad some forms of cancer.

This same genetic polymorphism has been linked to cancers of the breast and lung, as well as coronary artery disease. It may be that folate is one of the factors involved in both.

Yet another research project!

Tomatoes and Prostate Cancer: What to Do? What to Do?

In June a new study on tomato intake and prostate cancer was  published in the journal Cancer Epidemiology Biomarkers and Prevention and it really put the cat among the pigeons.

I am sure that you have heard a bit about the studies that seemed to show a protective effect of tomatoes on prostate cancer, and those studies have lead to large advertising campaigns by the manufacturers of the phytochemical lycopene, which is though to be a key component of the protective effect. Lycopene has attracted particular attention because it happens to be concentrated in some of the cells of the prostate gland.

Then along comes this study suggesting that lycopene offered no protection against prostate cancer in a group of 28,000 men.

It is just the latest in a long line of research into the effects of lycopene-containing foods, and as I said, the majority of previous studies have suggested that tomatoes and tomato-based products offer some measure of protection against prostate cancer.

One of the key points that is so often not discussed, is that loading up on any one food or food supplement is not a good idea and certainly not supported by the research. For foods to be effective in humans, they may well have to be in their natural form, and the strongest evidence shows that diets high in a variety of different fruits, vegetables, whole grains and beans are associated with lower risk of developing heart disease, cancer and several other problems.

It is certainly true that in the laboratory, tomato components have stopped the proliferation of several types of cancer cells including breast, lung, and endometrium. In animal models, consumption of large amounts of compounds extracted form tomatoes has been linked to large decreases in prostate cancer risk. 

The best known study recruited 47,894 men and evaluated their diets for six years. The data showed that those who ate the most tomato products – raw, cooked tomatoes, tomato sauce, pizza and tomato juice - had a 35% lower risk of early prostate cancer and a 53% lower risk of advanced prostate cancer than men who ate the least of these foods.

We are all eagerly awaiting the publication by the American Institute of Cancer Research and its international affiliate organizations on November 1st of this year, of the most comprehensive assessment of the scientific literature on diet, physical activity and cancer risk ever undertaken.

That report, Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective, will synthesize data from thousands of studies and provide guidelines for the public and for the scientific/medical community. It is bound to be controversial, but hopefully it will provide answers to questions about nutrition and cancer that are based on a thorough review of the available science.

(You can find out more about the WCRF/AICR Expert Report here. I am looking forward to reading the report and I shall be taking you through the highlights as soon as I get a copy)

Let me re-iterate one of the principles of Integrated Medicine, that is so very important when considering the impact of nutrition on health:

Combinations are Key for they create a powerful synergy.

Whole Grains

Every day of the week I talk to people who say that they do not have time to eat a healthy diet or hunt for the right type of victuals, and so off they go to the health food store to buy some capsules.

How many advertisements have you seen for some capsule or powder that gives you all the nutrients and fiber that you need? But think about that for a moment: does that make sense? For millions of years our far-distant ancestors co-evolved with the plants and minerals around them. So does it make sense that we can pull out one dietary component and ignore the rest? Or that the berries of some plant growing thousands of miles from early humankind could contain some magic potion that will solve all of our problems? That would imply a rather capricious Universe that only wants you to find that essential something when you have the money and the wherewithal to find.

Back when the world was new – well, come to think, it was 1974 – I was impressed to see some early data that showed dramatic differences between the exquisitely balanced nutrient profile of an orange compared with commercially prepared orange juice. A few years later we even did a bit of research on the subject.

This topic has re-emerged with some new research that has received justified plaudits from experts at the American Institute for Cancer Research. The study has indicated that whole grain fiber rather than fiber from other food sources, is associated with lower risk of colorectal cancer.

The study was recently published in the American Journal of Clinical Nutrition and found that consumption of whole grains was associated with lower risk for colorectal cancer. The same study found no significant link between consumption of fiber from other food sources and colorectal cancer risk.

Researchers at the National Institutes of Health analyzed survey results from a huge prospective cohort study called the NIH-AARP Study involving more than 291,000 men and 197,000 women aged 50 to 71.

The scientists analyzed the participant's intake of fiber from many different food sources, but only fiber from whole grains was associated with lower risk of colorectal cancer. In the study, those subjects who ate the most whole grains had a 20 percent lower risk of colorectal cancer than those who ate the least.

The observed protective effect of whole grain consumption was stronger for rectal cancer, with a 35 percent lower risk.

Experts have been following the conflicting and often contradictory findings on fiber and colorectal cancer for years.

Much of the previous research simply measured the participants' total fiber intake. The trouble is that so much of the American diet is now made up of heavily processed grains in foods like pasta, cereals and breads, so “Fiber” is a really mixed bag. So it seemed that it might be helpful to distinguish between different food sources of fiber. 

Let’s have a quick refresher course. All grains, from the familiar, like wheat, oats, rye, corn, to the less well known such as barley, bulgur, millet, quinoa start out as kernels. The bran is the outermost layer of the kernel, and that is where most of the fiber is found. The germ lies at the center of the kernel, and that is where most of the vitamins, minerals and fatty acids reside. In between the brain and the germ lies the endosperm, which contains a few vitamins and minerals and most of the starch.

Because the refining process removes the bran and germ, the main component of white bread and other products made from refined grains or white flour is starch. Whole grain products are darker and chewier than refined grain products is because all three layers of the kernel are ground together to make whole grain flour. This provides the kernel's full complement of protein, fatty acids and a range of phytochemicals. Most importantly, perhaps, the fiber content of whole grains can be as much as four times that of refined grains.

The evidence connecting consumption of whole grains to reduced risk for cancer, cardiovascular disease, stroke and diabetes comes chiefly from population studies and laboratory work. Only recently have researchers begun to identify specific ways a diet high in whole grains promotes health.

In February 2006 a study also published in the American Journal of Clinical Nutrition found that a high whole-grain intake had a number of objective effects on physiological markers - homocysteine, plasma markers of glycemic control (fasting insulin, hemoglobin A1c, C-peptide, and leptin), lipids (total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol), and inflammation (C-reactive protein, fibrinogen, and interleukin 6 – that may be associated with both diabetes and cardiovascular disease almost all improved and none became worse.

The evidence for whole grains specifically lowering cancer risk is less strong. However, in 2003 European Prospective Investigation into Cancer (EPIC) prospectively examined the association between dietary fiber intake and incidence of colorectal cancer in 519,978 individuals aged 25 to 70 years, recruited from 10 European countries. The data showed that high consumption of fiber (from fruits, vegetables and whole grains) reduced risk for colon cancer by 25 percent.

Although most experts have been recommending “whole grain foods” for years, this new study finally proves that the fiber that we get from whole grains is different from the fiber we get from "starchy" foods like white bread and processed cereal, and that these differences are not only important for the vascular system and diabetes, but also for cancer risk.

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 11. Integrated Medicine

The whole point of Integrated Medicine and Integrated Health is to help the person with attention-deficit hyperactivity disorder (ADHD) to become integrated as a person by using an integrated approach to treatment. This kind of comprehensive approach is particularly important for many people with ADHD. I also want to re-emphasize that although ADHD is the approved term for the problem, many people, particularly adults, may have little overt evidence of hyperactivity, and they are better thought of as having “ADD.”

Attentional problems come in all shapes and sizes. Some are so mild that people just need to be shown how to use a day planner and implement some time management scheme. Others need a more aggressive and comprehensive approach. Whatever we do has to be individualized to the person with the problem. Not only do we have to match the plan with the person, we also need to match it with his or her belief system.

It is important to recognize that no one approach is likely to work on its own. Medications may be very helpful, but they are only tools to help people get organized so that they can fulfill their potential. And medications are unlikely to be effective unless we also deal with nutrition, posture, breathing, sleep and environmental stress.

It is also essential to realize that ADHD is highly co-morbid: there is evidence of increased rates of physical problems, including disturbances in thyroid function and cell membrane function throughout the body. The rates of conduct disorder, oppositional defiant disorder, learning disabilities, tics and Tourette’s, worry, anxiety and mood disorders are all much higher in people with ADHD. So high that until recently, many experts believed that ADHD was a symptom rather than a clearly delineated illness. This overlap is also one of the reasons why some people persist in saying that the diagnosis of ADHD is nothing more than a stigmatizing label for socially unacceptable behavior.

Physical

• Medications
• Nutrition
• Posture
• Exercise
• Environment

Over the last few weeks we have spent a lot of time looking at some of the options for treating the physical components of the problem. Now let us look at the rest.

Psychological

• Find out and work with a person’s interests. ADHD is highly dependent on context. A child or adult may have terrible problems with schoolwork, but be able to play a video game for hours on end
• There are multiple intelligences: uncover which are of the greatest importance. It is essential for a person to discover their strengths rather than being forced to focus on the weaknesses. Many people with ADHD find that highlighting text in a book can be useful, while others learn by doing
• People are more likely to follow instructions if they are interesting and emotionally charged
• Bear in mind that many people have poor self-esteem and others suffer from enormous feelings of regret. This is a particular issue for people who may have reached middle age before being diagnosed. We have seen countless people who feel that they have missed out on life. A man working in construction realized that he could have gone to college thirty years ago if only his ADHD had been diagnosed and treated
• Teach visualization skills
• Discover which times of the day are best in terms of attention and alertness
• Learn some simple relaxation techniques
• Learn problem-solving skills

Social

• ADHD can play havoc with relationships. If a child has it, there can be enormous stress on the parents and siblings, all of whom are at higher risk of some features of ADHD themselves. It is essential to help the family with coping skills. ADHD can also put a great deal of stress on a spouse or children. It is also important to know that many people with ADHD have sexual problems that stem from impatience, a low frustration threshold if they cannot have sex when they want it, and real problems with enjoying the moment and taking time to enjoy a romantic interlude. Some people also use sex as a form of self-medication. So it is essential to find out if there are sex or relationship problems and to deal with them, which may need outside help
• Many people with ADHD are socially awkward and may need to learn some social and communication skills
• ADHD and social awkwardness can be magnets for bullies, and it is remarkable how many young people with untreated or inadequately treated ADHD have been bullied. Occasionally they become the perpetrators of bullying to compensate for their difficulties. In either case it is important to discover and deal with bullying. It is one of several reasons why some experts have recommended enrolling a child in martial arts classes. Not only can they help with self-defense, but also the discipline of a martial arts class can work wonders for some people with ADHD
• Role models are important for people with ADHD. It is very helpful, particularly for young people to see that other sufferers have become extremely successful
• It is also important for parents and other family members to develop and maintain a positive image of the person with ADHD
• Develop positive yet realistic career and life goals

Subtle

• Poor breathing techniques can engender many problems. Learning to breath effectively can have profound physical effects as well as stimulating and balancing the subtle systems of the body
• As we have seen, although the research base is very small, yoga, t’ai chi ch’uan or qigong can all be very helpful
• Many people with ADHD are acutely sensitive to “atmosphere:” to the thoughts, feelings and attitudes of other people, and they need specific help to remain grounded and to protect their senses. Some of the flower essences can very helpful for that, as well as some other techniques that we shall be publishing shortly

Spiritual

• How can there be a spiritual component to ADHD? Some people find it difficult to engage in prayer or meditation because of problems with attention. However, with a little perseverance, we have evidence that some forms of meditation may actually help.
• Second the rituals of religion can sometimes provide a wonderful anchor for the person who is having a had time with ADHD.
• Another point is that ADHD is not all bad. Some people who have it become more attuned to nature, animals and to a mystical understanding of the world: an over-reliance on reasoning and linear learning can stifle those perceptions.
• Some people have suggested that ADHD may for the same reasons unlock a rich vein of creativity that might otherwise never have appeared.

There are plenty of books and websites that portray ADHD as a gift. While I have the greatest respect for this approach, it is still important for us not to forget the demonstrable problems caused by inadequately treated ADHD.

ADHD exists, it is treatable, and though it can bring many problems, it can also bring many opportunities. Just so long as we remember to respect every dimension of the person who has it, and remember that if we do not manage it, it will manage us.

Goldilocks and the, err, Vitamins

We are often told that we should take much higher amounts of many vitamins than the doses that are usually recommended.

The late Linus Pauling was one of the most famous proponents of the idea of using huge amounts to Vitamin C to present colds and an array of other health problems. Over the years I have heard enough recommendations to confuse anyone: and one of my degrees is in biochemistry! The only answer with so many conflicting pieces of advice is to do some good research.

Vitamin A is an important fat-soluble vitamin involved in the maintenance of many of many key systems in the body. The recommended daily allowance for vitamin A is 5000 international units (IU) for adults and 8000 IU for pregnant or lactating women.

Vitamin A deficiency is one of the major nutritional problems worldwide and it threatens the survival and health of millions of children. According to a report published in 2002, 127 million preschool children and 7·2 million pregnant women are deficient in vitamin A.

Vitamin A deficiency can cause night blindness, drying and degeneration of the cornea that can lead on to total blindness, as well as impairment of the immune system.

Children living in regions where vitamin A intake is insufficient need to receive adequate amounts of vitamin A through breastfeeding, together with improved diets, food fortification and supplementation with vitamin A.

Providing vitamin A supplementation in countries where there is a deficiency of the vitamin has been proven to decrease mortality. As a result, most developing countries have adopted a standard World Health Organization (WHO) dosing schedule for vitamin supplementation, which calls for 200,000 IU to mothers early postpartum and then 200,000 IU every 4 to 6 months. For infants, the recommendation is 100,000 IU at 9 months and 200,000 IU at 12 months.

However, in 2002 the International Vitamin A Consultative Group (IVACG) Annecy Accord recommended a new high-dose regimen for mothers and infants which includes a doubling of the initial postpartum dose for mothers, and adding 50,000 IU at 2, 3 and 4 months for infants.

An article just published in the Lancet indicates that this high dose protocol does not have any benefit over the older recommendation.

Professor Andrew Prentice and a team of researchers at the International Nutrition Group at the London School of Hygiene and Tropical Medicine in London and colleagues, studied 220 women-infant pairs in an area of moderate vitamin A deficiency in Gambia. One group received the WHO recommended dose, while the other received the IVACG recommended dose.

They measured blood plasma levels of vitamin A, the incidence of Helicobacter pylori infection, how many of them had pneumococcus in the nasopharynx and the integrity of the infants’ intestines. 

The problem is that too much vitamin A can also create problems, including nausea and vomiting, jaundice, irritability, anorexia, blurred vision and worst of all, increased intracranial pressure that can cause headaches, drowsiness and even death. These are not such big problems in well-nourished adults living in the Western world, but in malnourished infants, particularly if they are also being vaccinated, this can be a big problem.

There is one specific occasion when a high dose of Vitamin A can be helpful: if a child in a deficient area gets severe measles, the WHO recommendation is that two doses of 200,000 IU should be given to the child. It is easy to forget that in some parts of the world measles can be a killer.

The authors of the article, as well as an accompanying editorial suggest that we should be looking at lower, rather than higher doses of vitamin A.

The editorial is by Professor Bernard Brabin of the Child and Reproductive Health Group in Liverpool, England and he finishes by saying,

“Future trials should emphasize the importance of exclusive breastfeeding, because early feeding with formula milk might reduce potential benefits from early supplementation with vitamin A in infants."

This story shows us once again the extreme importance of having just the right amount of a vitamin or nutrient.

If someone claiming to be an expert in nutrition or vitamin therapy tells you to “take as much as you want” of anything, please be careful.

Just remember the story of Goldilocks and the Three Bears….

Red Meat and Breast Cancer

There is an important study that was published in the April issue of the British Journal of Cancer, but which I haven't seen reported in the United States.

The researchers did a survival analysis to assess the effect of meat consumption and meat type on the risk of breast cancer in the UK Women's Cohort Study. Between 1995 and 1998 a cohort of 35,372 women was recruited, aged between 35 and 69 years with a wide range of dietary intakes, assessed by a 217-item food frequency questionnaire. The researchers also took into account smoking, weight, fruit and vegetable intake, class, education and use of hormone replacement therapy.

The results showed that eating even small amounts of red meat daily can increase the risk of breast cancer by 56 per cent in older women.

As little as 2oz (57g) of beef, lamb or pork a day showed an effect. Post-menopausal woman who ate larger amounts, 3.6oz (103g), of processed meats such as sausage, bacon or ham had an increased risk of 64 per cent.

Even younger, pre-menopausal women had a slightly raised risk if they ate red meat daily.

Earlier analysis from the study found that pre-menopausal women who had the greatest intake of fibre cut their breast cancer risk by half.

The Leeds work supports other studies. In November, a study from the United States found that women who ate the largest amounts of red meat had a rising risk of breast cancer. But different studies have presented conflicting views.

One reason why red meat may contribute to a raised risk of breast cancer is that it is a rich source of saturated fat. The women who ate the most meat were also more likely to be fatter.

The publication of the study in the United Kingdom generated a great many negative comments from the meat industry.

One spokesperson, on hearing that as little as two ounces may be enough to increse the cancer risk said,

"Two ounces is absolutely tiny. I have never heard such rubbish. It's a tiny amount. This is ridiculous, it's silly."

I doubt very much that it is "silly," though it is a surprise that the study has not attracted more attention.

The best way to look at this data is not to say that everyone should become vegetarian, but to recommend that women should:

• Eat a balanced diet
• Limit alcohol consumption
• Exercise regularly
• Keep and maintain a healthy weight
• Try to maintain a regular sleep schedule

Neurological Complications of Gastric Bypass Surgery

Our bodies are highly complex systems. They are not just bags of randomly assorted organs. So tinkering with one part of the system can have an impact in an entirely different part of the body. Many of us have worried for some time about the long-term consequences of gastric bypass surgery for weight loss. We know that some people who have had the surgery develop “substitution addictions.” If they had a real addiction to food before the surgery, after it they may begin to develop an addiction to something else, such as drugs or alcohol.

Now neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock have reported the results of a ten-year study found a link between gastric bypass surgery and several serious neurological conditions.

The study was published online May 22 in the medical journal Neurology and concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and as a result may develop a variety of neurological symptoms.

We know that ever more of these operations are being done every year, and so long as people are motivated they are usually successful in reducing weight. But they are not without risk, and we always have to balance that risk against the risk of being morbidly obese. This work is important because it suggests that there is an extra risk about which we previously knew very little.  Many of the complications that patients experience affect the nervous system, and they are often disabling and irreversible.

More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients a link between the surgery and their neurological condition was found.

All of the patients involved in the study had previously undergone what is known as the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.

The neurological problems involved many different parts of the nervous system, and the symptoms included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.

Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.

This study underlines something very important. Many heavy people are actually malnourished, because they eat the wrong things and an excess of fat in the diet can create problems in the absorption of some vitamins and minerals. In addition, surgery like this can cause a form of malabsorption.

It is therefore essential to make sure that people who have this kind of surgery have an adequate long-term intake of vitamin and mineral supplements to prevent these neurological complications. It is important for everyone to know about these potential problems and to be on the lookout for neurological symptoms.

The Integrated Approach to Maintaining a Healthy Weight

Regular readers will have noticed that I have been posting much less than usual over the last couple of months. It is not that I have run out of things to say (!), but I have been working on some new projects that I shall be telling you about fairly soon.

There has also been something else that I had not planned to talk about until a conversation that I had a couple of days ago. I mentioned in passing that I had noticed that my weight had crept up a bit over the last couple of years, but that I had identified the reasons, corrected it, and lost twenty pounds over the last eight weeks. I was immediately surrounded by people wanting to know the secret. Well it’s no secret. It is a series of techniques that I, and people that I have trained, have used with thousands of people over the last thirty years. Then I realized that this secret had somehow not got as much coverage or publicity as it should have.

The other day I was talking to someone who has had some legitimate concerns about her weight for over ten years. She has tried every fad diet going, and has spent a fortune on books, tapes and courses. All to no avail.

I asked her, “Why do you keep falling for these fad diets? They are the nutritional equivalent of get-rich-quick schemes!”

“But there must be an answer somewhere,” she replied.

Well, she was half right: there is an Answer that is based on impeccable scientific research, and has been validated with tens of thousands of people. But it is not a fancy diet, supplement or exercise plan.

The first point is that we never recommend, “dieting” to get healthy. You get healthy so that your body can keep you do the work that it was designed to do. And that includes keeping you at your ideal weight.

Humans participate in multiple relationships, from our cells to our soul, and from the smallest atoms to the largest galaxies: we are connected to all of them. Weight problems invariably imply an imbalance in one or more of these relationships. We are more than physical bodies. We are also psychological, social and spiritual beings who are engaged in these multiple relationships. And the quality of these relationships is essential to our well bring.

The approach that we have used for three decades is very precise and consists of two parts.

First is the Plan: a series of steps that involve the re-integrations of your body with your mind, your relationships, the subtle systems of your body and your spirituality. Part Two consists of a series of “Rescues and Re-starts.” Anybody who has ever tried a weight management program knows that it is easy to fall off the wagon. There are times when things happen. You are tempted to miss an exercise session or to eat something that your body does not need. The beginner’s mistake is to respond by feeling bad, becoming disheartened or having someone reprimand you. Those are all a waste of energy. The smart thing is to have a series of sixty-second strategies that rescue you and start you on the Plan.

The first step is to treat you body so that you are ready to achieve and maintain a healthy weight. Remember the “hidden” causes of weight gain:

• Stress
• Salt
• Pesticides
• Viruses
• Intestinal bacteria

It can he hard to rid ourselves of all of these, but we can certainly reduce the effect that they have on us.

There may be other physical factors that contribute to weight problems. One that has recently attracted some publicity has been the idea that some people have a “leaky gut” – and increase in intestinal permeability - that allows them to absorb toxins that should stay out of the circulation. I have a friend and colleague who, starting in the early 1980s, did a ton of research on intestinal permeability in illnesses like alcoholism, celiac disease, inflammatory bowel disease, arthritis and schizophrenia. I also did a study of intestinal permeability in migraine, which was negative. There certainly are ways in which intestinal permeability can be increased: alcohol, allergies and some drugs will do it. But so far the evidence that increased intestinal permeability is a common cause of weight problems or other symptoms is not good. That could always change: that is what science is all about: testing falsifiable hypotheses and changing models, practice and recommendations if the evidence changes.

After attending to the physical side of weight maintenance, we go on to recommend some simple psychological work. As I said at the beginning, if your brain thinks that you are trying to kill yourself by starving to death, it will sabotage you: millions of years of evolution have designed you to stay alive and to put on weight whenever possible. So we it is essential to understand and work with those psychological mechanisms from the very beginning.

But it is not enough to simply change your thinking: much of your behavior is driven by unconscious, preconscious and subconscious “thoughts.” We also have several sets of emotional systems that drive our behavior. What’s more, there are separate sets of habits and automatic behaviors that we need to identify and deal with. We also have to deal with the effects of certain foods on your moods and perceptions: countless eating plans have failed because nobody considered that a person might be sensitive or allergic to some foods, or that changes in diet can have a big impact on the way in which our brains function. When we work with all of them the results start to come in very quickly.

We also have to deal with the social aspects of weight: have you been stigmatized because of weight? Have you been sabotaged by people around you, or family members? Do you or your family use meal times to socialize? Do you constantly eat out? There are a huge number of social issues that can mess with healthy eating. Ignore them, and it will be nearly impossible to achieve your aims.

We then also work on any disorganization or blockages in the subtle systems of the body, as well as the spiritual aspects of health and wellness.

It may sound odd to talk about spirituality when considering weight management and health, but they are inseparable.

It is only after we have done all of those things that we look at the precise composition of your diet, tailored to your age and gender. Just as important as what you eat, is when you eat. The way in which you exercise, stretch, breath and sleep can be as important as what and when you eat, and each has to be carefully tailored to the individual.

On a future occasion I shall explain exactly how your can work with each of the five systems of you body – Physical, Psychological, Social, Subtle and Spiritual – to create and maintain vibrant health and a radiance that at the moment you can only dream about.

That’s a promise!

“I don't eat junk foods, and I don't think junk thoughts.”
--Peace Pilgrim (a.k.a. Mildred Norman, American Peace Activist, 1908-1981)

“He that takes medicine and neglects diet, wastes the skill of the physician.”
--Chinese Proverb

“Give the body the attention it deserves, but not more. When you cultivate the attitude that you are the body, the body will demand from you more food, more variety in food, more attention to appearance and physical comfort.”
--Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

Diets Make You Fat

Most people who have tried dieting know a sad truth: they do not usually work for very long. Our bodies are designed to form and retain fat stores and millions of years of evolution have created sophisticated and elegant systems to thwart any attempt at self-starvation. That is the real reason why most quick fix promises are doomed to failure. As day follows night, every time that a scientist somewhere publishes another piece of the obesity puzzle, a flurry of articles and books will follow, claiming that they have The Answer, never realizing that there are several hundred interlocking pieces to the puzzle.

Yet more research  has confirmed that diets rarely help. A group of investigators from UCLA published their findings in the April issue of American Psychologist,  the journal of the American Psychological Association. 

Traci Mann and her co-authors have conducted the most comprehensive and rigorous analysis of diet studies that I have ever seen. They analyzed 31 long-term studies in which people were followed for two to five years. What they found clearly mirrors clinical experience. Most people can initially lose 5 to 10 percent of their weight on any number of diets: low carb; low fat; high protein or pretty much anything else. But then the weight comes back: in the majority of people they regained all the weight plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority.

Their conclusion: diets do not lead to sustained weight loss or health benefits for the majority of people. And since people who regain weight usually have the “bounce” where they regain with interest, most people would have been better off not going on the diet at all. This is important: aggressive dieting can be dangerous to the body. It has been suggested that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function. So if people had not dieted, their weight would be pretty much the same and their bodies would not have suffered the wear and tear from losing weight and gaining it all back.

Over the years, many diet studies have looked good, but the results have often been skewed by a number of factors. For example, in some studies participants self-reported their weight by phone or mail rather than having an objective weight measurement. Many studies also had very low follow-up rates: eight of the studies had follow-up rates lower than 50 percent.

Traci Mann, the lead investigator was asked, “If dieting doesn't work, what does?”

"Eating in moderation is a good idea for everybody, and so is regular exercise," Mann said. "That is not what we looked at in this study. Exercise may well be the key factor leading to sustained weight loss. Studies consistently find that people who reported the most exercise also had the most weight loss."

Happily there ARE genuine solutions to the problems of weight, but they do not begin with a diet. They begin with a totally new understanding of how our bodies operate, how to deal with the psychological and social barriers to health and how to activate the natural abilities of the body balance and heal itself.

I am going to talk about those a little more in the next post.

“I've been on a diet for two weeks and all I've lost is fourteen days.”
--Totie Fields (American Comedian, 1930-1978)

“The Diet Mentality has come about because there is agreement in our society that the only way to lose weight is by dieting. But dieting produces absolutely no permanent, positive results. In fact, it makes you feel worse about yourself and probably does more damage than good to your health.”
--Bob Schwartz (American Health Expert and Author)

“Gluttony is the source of all our infirmities and the fountain of all our diseases. As a lamp is choked by a superabundance of oil, and a fire extinguished by excess of fuel, so is the natural health of the body destroyed by intemperate diet.”
--Robert Burton (English Cleric and Writer, 1577-1640)

Genes, Geography and Culture

The science bug bit me early in life. As a young schoolboy I was fascinated to read the exploits of explorers and collectors. Charles Darwin’s amazing adventures were stirring stuff to a teenager.

The other day I was thinking about all those books that I read after I spotted an interesting article in the Daily Telegraph by Professor Steve Jones, who is a geneticist at University College London, and someone who always makes you think.

Bob Geldof - he of the Boomtown Rats and Live Aid fame - has set up an ambitious project to map cultural differences around the globe before the peoples of the world sacrifice their cultural individuality on the altar of Western consumerism, blue jeans and cell phones.

Anyone who travels as much as I do cannot help but be dismayed at the cultural homogenization that’s happened over the last 25 years. A bit jet lagged, I once woke up in a hotel in the wee small hours and called the front desk to ask which country I was in. I had been in seven in the last two days and there were no clues as to my location when the chauffeur dropped me off just before midnight. It turned out to be Switzerland and the man at the desk told me that it was a common question.

Although I lament the loss of cultural identity, it is not all bad. But it raises some very interesting questions.

While Bob is recording vanishing cultures, geneticists are trying to establish which behavior is determined by DNA and which by our environment.

Steve Jones was meditating on the question of whether local changes in customs inborn or learnt. My schoolboy hero Darwin was also interested in that question and set out to discover whether expressions of fear or joy varied from place to place. The idea was that they might if they were passed on culturally rather than genetically. He corresponded widely on the subject and Steve reminded me of something that I had not read in 30 years:

"Mr. B F Hartshorne... states in the most positive manner that the Weddas of Ceylon never laugh. Every conceivable incitive to laughter was used in vain. When asked whether they ever laughed, they replied: 'No, what is there to laugh at?"

Darwin finally concluded that expressions of happiness or anger were universal. They had, he thought, evolved, because he fancied that he could detect hints of human laughter in the grin of a tickled chimpanzee.

Some behaviors have a genetic basis. The absence of cheese and milk from Chinese cuisine is normally attributed to the few cows in the country, or the influence of traditional Taoist notions of what items may appear in the same space. But it may have just as much to do with the high rates of lactose intolerance amongst Chinese populations. The Scots have a high frequency of a gene that makes it easier for them to digest cows’ milk, so milk – sometimes cleverly disguised - seems to appear on almost every Scottish menu.

There is an interesting sidebar here. A recent study that analyzed DNA in Neolithic human remains seems to have uncovered the first direct evidence that modern humans have evolved changes in response to natural selection.

According to a new analysis of fossilized bone samples, as recently as 7000 years ago, Europeans were unable to digest milk. Today more than 90% of the Northern European population can. It is most likely that Europeans incurred a rapid change in their genetic make-up because it held an evolutionary advantage for them to be able to digest milk.

Lactose is a sugar in milk, and around the world the majority of humans lose the ability to digest it before reaching adulthood. This is because their gene for the enzyme lactase, that is responsible for breaking down lactose, is switched off by late adolescence. However, over 90% of northern Europeans have a version of the lactase gene that remains active throughout life, enabling them to continue drinking milk as adults. This genetic change appears to have happened around 7,000 years ago and spread rapidly. In the climatic conditions of the time, milk drinking could have conferred a huge survival advantage: unlike water, milk in usually uncontaminated by parasites, and is available year round, unlike seasonal crops. Milk also contains vitamin D and calcium, and in the dim sunlight of Northern Europe, where people may not be able to make enough vitamin D in their bodies, making calcium absorption difficult. Milk would have solved both problems.

So what we might be seeing here is an environmental factor changing gene expression, which in turn has a social and cultural outcome.

Steve Jones’ article talks about some other cultural differences that may have genetic roots. One very recent study purports to show that the number of sexual partners of American male (but not female) college students is related to variation in a gene called dopamine transporter gene (DAT1). The gene codes for a dopamine transporter protein that limits the level and duration of dopamine receptor activation. It is a strong candidate gene for reward-seeking behavior. Dopamine is known to be involved in the reward or “salience” systems of the brain and is known to influence sexual behavior in mice.

The DAT1 gene comes in two distinct forms. Young men with a single or double copy of one of the variants have, it is claimed, twice as many sexual partners on average as do those with a double hit of the different and less common form of the gene. The latter group, about one young man in 10, are far less romantically daring than average. They are also less likely to be involved in drug abuse or to get in trouble with the law. Research like this is complex. To quote Gregory House, “People lie.” And when it comes to doing research on sexual behavior they lie a lot. And it is a fool’s game to try and reduce human behavior to a single gene. I am sure that if you think about it for a moment, you can come up with at least a dozen reasons why people are likely to have more sexual partners.

Levels of promiscuity vary greatly from place to place. There has been a myth circulating that the AIDS pandemic in Africa is caused by promiscuity. In fact there is less promiscuity in Africa than in the West. It is no surprise that young people less sexually active in Bangladesh than in Britain. For years now, anthropologists have speculated about what lies behind these variations, from the wild and socially sanctioned polygamy of a few males in certain ancient – and some not so ancient societies to the modern Western practice of serial (and approximate) monogamy. Recently researchers have begun to ask whether the differences might be due to genetics rather than the ownership of land or cattle, or social or religious mores.

The American DAT1 study shows that although DNA might have a strong effect on the behavior of individual men, it is unlikely to be responsible for cultural differences in sexual behavior. The students in the study were classified as of European, Black, and Asian or Hispanic origin. There are problems about racial classification: few are clear-cut. We are most of us far more mixed than some people would like to believe. The overall frequencies of the two variants were roughly the same within each ethnic group; and within each seemed to have the same effect. The Asian Americans, though, had fewer than half as many partners compared with the others. Social differences, that were most likely imported by their families from the sexually restrained populations of their native lands, overwhelmed any effects of the DNA.

For anyone interested in the complex interactions of genes, the environment, the psyche and culture, this study is yet another nail in the coffin of genetic determinism: that you are the victim of your genes.

Most mice and chimpanzees behave in much the same way from place to place. Yes, there are some subtle differences here and there, but as a general rule, and English mouse and a Chinese mouse will behave in much the same way. But humans show enormous cultural variation. But here is the paradox: at the genetic level we are the most boring of creatures. Yes, there is some genetic variation form place to place, and certain genes are more active, depending on environmental and cultural factors. Just think milk drinking and skin color. Human social diversity is matched by genetic homogeneity: the overall DNA difference between an American and a Chinese is less than that between two groups of chimpanzees living 100 miles apart in Africa.

Though our cultures have evolved over the centuries, it an evolution of mind rather than genes.

Insulin, Intestinal Metabolism and Arteriosclerosis

Here is some research that provides further evidence of the links between systems of the body.

Diets high in sugar and fats can cause chronic elevations of insulin. High levels of insulin are a key feature of insulin resistance, a metabolic problem that affects at least a third of people living in the Western world and is also growing extremely rapidly in much of the developing world. Insulin resistance may be caused by a diet or genetics, or most commonly a combination of the two. It is known that insulin resistance can lead to the development of diabetes and arterial disease. The question has been how?

Almost forty years ago it was first suggested that insulin itself might be the problem. Not only is insulin involved in metabolism, it is also a potent growth factor for some of the smooth muscle cells found in the wall of major blood vessels. There has also been a suspicion that some of the metabolic effects of insulin increase the risk of arteriosclerosis by actions in the liver and intestines.

In research published in the journal Atherosclerosis, nutritional scientists at the University of Alberta have found a connection between high insulin levels and dysfunction of intestinal lipid metabolism. The finding provides critical support for the notion that impaired intestinal metabolic function plays a critical role in the development of cardiovascular disease.

Using a type of obese rat, the researchers found that excessive insulin slows the removal of chylomicrons from the blood stream following a fatty meal. Chylomicrons transport dietary fat from the intestine to the rest of the body.

Excessive amounts of insulin appear to alter the dynamics of the walls of blood vessels, allowing chylomicrons and cholesterol to build up in them. Over time this build up may creates blockages in the flow of blood.

It is good to see research that is re-examining the role of chylomicrons in vascular disease. Interest in them began to wane about twenty years ago, and since then most of the research and most of the screening recommendations have been based on cholesterol. Most doctors have been taught that cardiovascular disease is connected to increased levels of low-density lipoprotein (LDL) cholesterol, which is derived from the liver. However, fifty per cent of cardiovascular disease events occur in the presence of normal LDL-cholesterol levels. That is one of the reasons why many experts in metabolism have been saying for years that we must not forget the contribution of triglyceride and chylomicrons. This research confirms that we were right.

Although there are no accepted guidelines on this, people at risk of developing cardiovascular disease should not only have their LDL-cholesterol and HDL-cholesterol levels checked, but should also have the level of chylomicrons measured.

Technically it is not a difficult thing to do, although not all laboratories are able to do it. If chylomicron levels are high, it is an extra incentive to reduce fat consumption, and there are new medicine being tested that may help reduce chylomicron levels.

This research provides yet more evidence about the importance of the intestine in general health and disease. I constantly have people telling me that certain diets, colonic irrigation or probiotics may improve intestinal health and therefore general health and well-being. They may be correct. But what we really need is research to discover if there are viable ways of improving intestinal health that can prevent disease onset and progression.

Empowerment

It is sometimes frustrating to see peoples’ medical problems reduced – incorrectly - to a single factor. Worse yet, failing to see that all the systems of the body, the mind, our relationships, environment and spirituality all have a part to play in the maintenance of our health and the treatment of disease.

I grew up in England and benefited from and then trained and worked in the National Health Service. Which is nothing of the sort: it is a disease management service.

The problem lies not with money or inefficient systems, but with an emphasis on management rather than prevention of disease.

The next revolution in healthcare is not being driven by science and technology, but by empowerment: being given the tools for taking personal responsibility for our own health and well-being.

Not just so that we feel better and may have the chance of avoiding costly medicines, but so that we can grow as individuals.

The ultimate goal of any form of personal development, of psychotherapy and indeed of medicine, is to remove restrictions from people.

Freedom unlocks human potential.

We are inundated with information about health. Much of the information is confused and confusing. Integrated Medicine is based on the idea of integrating different approaches and integrating the different parts of a person and all of his or her relationships form cell to soul.

The key to that is understanding how to fit all the pieces together, whether a person is a Buddhist or a Baptist, a meat-eater, vegan or junk food addict. To be able to answer these kinds of questions:

• What diet is right for me personally?
• What type of exercise should I do at my age, level of fitness and time constraints?
• How can I get the quality sleep that I need with all the demands on my time?
• How can I manage the stress in my life?
• How can I manage my emotions so that I run them instead of them running me?
• How can I have satisfying connections with other people?
• How can I find my meaning and purpose in life?

The good news is that we already have answers to most of those questions and we have developed hundreds of tips and techniques that people can do in minutes a day.

I revealed some in the book and CD series Healing, Meaning and Purpose, and in response to a great many requests, I shall be sharing many of these techniques in the months to come.

“Health is a state of complete harmony of the body, mind and spirit.  When one is free from physical disabilities and mental distractions, the gates of the soul open.”
--B.K.S. Iyengar (Indian Yoga teacher, 1918-)

“If we could learn how to balance rest against effort, calmness against strain, quiet against turmoil, we would assure ourselves of joy in living and psychological health for life.”
--Josephine L. Rathbone (American Sports Physiologist and Pioneer in Health and Relaxation, 1899-)

“Personal transformation can and does have global effects. As we go, so goes the world, for the world is us. The revolution that will save the world is ultimately a personal one.”
--Marianne Williamson (American Author, Unity Church Minister and Lecturer on Spirituality, 1952-)

“Questions focus our thinking. Ask empowering questions like: What's good about this? What's not perfect about it yet? What am I going to do next time? How can I do this and have fun doing it?”
--Charles Connolly (American Psychologist)

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 2. Nutritional Supplements

It sometimes surprises people to learn that the FDA does not currently regulate the production of supplements and herbal products. Therefore their purity and contents may vary considerably. Though most of them are fine, there have been endless examples of supplements that contained no active ingredients or were adulterated with heavy metals or prescription medicines.

Amino Acid Supplementation
The idea of using amino acid supplementation is based on reports of low levels of amino acids in ADHD, including the particular amino acids – tyrosine, phenylalanine and tryptophan - that are the building blocks of catecholamines and serotonin.

Several open and controlled studies in both adults and children have reported a short-term benefit from tryptophan (precursor of serotonin), tyrosine (precursor of catecholamines), or phenylalanine (precursor of catecholamines) and S-adenosyl-methionine supplementation.

However, no lasting benefit beyond 2–3 months has been demonstrated: both children and adults develop tolerance. Even short term, there is a lot of dispute about whether these supplements work at all.

Vitamins
Three strategies for vitamin supplementation are:

1. Recommended Daily Allowance (RDA) multivitamin preparations
2. Megavitamin multiple combinations
3. Megadoses of specific vitamins

The first is not controversial, although there is always a discussion about whether the RDA's is correct. There has not been any credible research on the effects of his kind of supplementation in diagnosed ADHD even though some reports suggest mild deficiencies in diet and blood levels. There is some evidence that micro-nutrient supplementation will help the intelligence and ability to concentrate in children without ADHD, but whether the same holds in ADHD, we simply do not know.

The second strategy, megavitamin multiple combinations, has not been found effective in double-blind placebo-controlled short (2 weeks) and longer (up to 6 months) trials in ADHD and the related comorbidity of learning disorder, although it is always possible that the researchers did not use the correct mixture of vitamins and minerals.

As things stand megavitamin combinations do not seem worth pursuing for children or adults, and some may be risky.

The third strategy, the use of single vitamins in huge doses to alter neural metabolism has not been explored despite some encouraging early reports.

Minerals
Deficiencies of iron, zinc, and magnesium have been noted more commonly among children with ADHD than among normal children.

Iron
Iron is a coenzyme involved in the synthesis of catecholamines, so there has been a lot of interest in iron deficiency as a possible cause of a number of neurocognitive problems. Iron deficiency may be due to poor diet, celiac disease, excessive milk ingestion, infection, gastrointestinal losses or lead. And of course in adults, many women are chronically iron deficient. Children with ADHD may have lower iron stores and in a study of nearly 100 children, there was a significant inverse correlation between ferritin levels and scores on a standard ADHD rating scale.

Zinc
Zinc is a co-factor for 100 enzymes, many involved in neural metabolism. It is also necessary for fatty acid absorption and for the production of melatonin, the light–related hormone that helps regulate dopamine function. Zinc is so important for the normal functioning of the brain that it is plausible that deficiency would adversely affect behavior and that restoring optimal levels may provide some benefit.

Zinc has been found to be lower in some children with ADHD. In a study of 44 children with diagnosed ADHD, zinc had a significant inverse correlation with attention, even controlling for gender, age, income, and diagnostic subtype. In large randomized, controlled trial, children given zinc sulfate (150 mg/day) or placebo, the zinc-takers had significantly more improvement for impulsive behavior and socialization; the best response was observed in those children who had low zinc levels to begin with. We do not know if using mega-doses of zinc will confer any benefit.

Magnesium
Magnesium deficiency can cause a wide spectrum of neurological and psychiatric disturbances and can result from a many factors including increased requirement during childhood.

In one study, 30 out of 52 children with ADHD had low levels of magnesium in their red blood cells. An open-label study supplementing them with 100 mg daily of magnesium and viamin B6 for 3-24 weeks led to reduced symptoms of hyper-excitability (physical aggression, instability, attention to school work, muscle tension and spasms) after 1 to 6 months of treatment.

Conclusions
It is usually just enough to ensure that children with ADHD have a decent diet. But in some it may be necessary to take supplements to ensure that they are getting an adequate dietary intake of iron, zinc, and magnesium.

Other Supplements

Essential Fatty Acid Supplementation
The membranes of nerve cells are composed of phospholipids containing large amounts of polyunsaturated fatty acids, especially the n-3 and n-6 (or omega-3 and omega-6) acids. What these terms mean is simply that the first unsaturated bond is 3 or 6 carbons, respectively, from the noncarboxyl “tail” of the molecule). Humans cannot manufacture these fatty acids and hence are “essential” and needed in the diet. Essential fatty acids (EFAs) are also metabolized to prostaglandins and other eicosanoids, which modify many metabolic processes, activate eicosanoid receptors, and interact with pro-inflammatory cytokines.

Rats that have low levels of omega-3 fatty acids in their brains, tend to be hyperkinetic.

Fish oil/omega-3 fatty acids
Children with lower levels of omega-3 fatty acids seem to have significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of omega-3 fatty acids.

In a 4-month trial of 63 children with ADHD, DHA (one of the essential fatty acids found in fish oil) supplements alone had no significant impact on behavior. In a randomized, controlled trial of fatty acids supplementation for 117 children with developmental coordination disorder, there were significant improvements for children on active treatment in reading, spelling, and behavior over 3 months of treatment. But when the tratments were crossed over, similar changes were seen in the placebo group. We definitely need more research on fish oils. Most experts think that children need around 1000mg/day and adults up to 3000mg/day.

There may be a downside: large doses of fish oil may inhibit platelet aggregation and increase the risk of bleeding; its use should be discontinued 48 hours before having surgery. Many people do not like the taste of fish oil, though in capsules that is not normally a problem.

Gamma-Linolenic Acid
Evening primrose oil contains gamma linoleic acid. Two small randomized, controlled trials conducted in the 1980s showed only marginal benefits of evening primrose oil for children with ADHD.

L-Carnitine
The mixed results with essential fatty acids might have something to do with the transport and metabolism of the fatty acids. One essential component of these metabolic pathways is L-carnitine, so it too has been tried in ADHD, but so far there are no good trials to help us.

Glyconutritional Supplements
Glyconutritional supplement contains basic saccharides necessary for cell communication and the formation of glycoproteins and glycolipids.

In an open trial of glyconutritional and phytonutritional (flash freeze-dried fruits and vegetables) supplementation with 17 ADHD children, researchers found significant reductions in parent ratings of inattention, hyperactivity, impulsivity, and oppositional symptoms, with similar trends on teacher ratings. In a second open trial of the same supplements in 18 children, researchers found reductions in parent inattention ratings from 2.47 to 2.05 and hyperactivity-impulsivity ratings from 2.23 to 1.54. There was an impressive statistical value for this trial and the results were sustained for 6 weeks. However, a third open trial reportedly failed to duplicate such results. There have not been any reported trials of glyconutritional supplements in adults.

Dimethylaminoethanol
Dimethylaminoethanol (DMAE) has several accepted names, including deanol and dimethylethanolamine. It is the immediate precursor of choline (trimethylaminoethanol) and is claimed to increase production of acetylcholine. There have been several studies claiming a small effect on vigilance, alertness and mood, but there are questions about its safety.

Melatonin
Melatonin helps regulate dopamine function in the brain, so it has been a natural candidate for the treatment of ADHD. A randomized, controlled trial 25 children with ADHD and chronic insomnia were either given melatonin (5 mg) or placebo daily at 6pm; the melatonin significantly improved sleep onset, decreased sleep latency, and increased total sleep time. Although there was no significant change in ADHD behavior over the 4-week study, all the parents in the trial felt the improvements in sleep were enough to justify continuing to give it for 1 year after the study. These results have been replicated in another study: melatonin helps with sleep problems in chdlren wth ADHD, but had no efect on problem behavior, cognitive performance or quaity of life. Melatonin may be helpful for children with ADHD who have trouble with sleep.

As you can see there are a great many options, but despite all those articles in magazines and online that promise the earth, the evidence for most of the approaches is thin.

At the moment the best option that may help seems to be fish oils. Choosing the best supplement is not easy, but the one for which there is most evidence, and which seems to be the most pure and mercury-free is OmegaBrite.




Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 1. Diet

You can find some articles on Attention-Deficit/Hyperactivity Disorder (ADHD) here, and also some of the evidence that ADHD is a “real” illness and not just a label for socially unacceptable behavior. That being said, it is essential to take extra care when making the diagnosis. Mud sticks, and diagnostic mud sticks like glue. It can be hard to “unmake” a diagnosis.

As with any problem, the most effective way of helping it is to address the physical, psychological, social, subtle and spiritual aspects of the situation.

Medicines can definitely have a place in the management of ADHD, and the reason for treating ADHD is not so that people get better grades in school or do better at their jobs. It is to prevent the long term problems that may follow from inadequately treated ADHD.

There is a large and growing body of research on non-pharmacological approaches to treating ADHD. A literature search has turned up over two hundred papers, over half of which report some empirical research. Some of the research is summarized in a short paper aimed at health care professionals.

Research has shown that more than 50% of American families who receive care for ADHD in specialty clinics also use complementary or alternative medical (CAM) therapies, if you include things like modifying their diet or other aspects of their lifestyle. Despite that, only about 12% of families report their use of CAM to their clinician. Despite that low rate of families reporting the use of unorthodox therapies, a national survey of pediatricians showed that 92% of them had been asked by parents about complementary therapies for ADHD. The trouble is that many pediatricians have not been taught very much about the pros and cons of these approaches.

The most commonly used CAM therapies for ADHD are dietary changes (76%) and dietary supplements (> 59%). I have talked about food additives and one type of diet in the past. Now let’s look in a little more detail.

The 3 main dietary therapies for ADHD are:

• The Feingold diet,

• Sugar restriction, and

• Avoiding suspected allergens.

Sometimes these diets are used in combination.

The Feingold Diet
The Feingold diet is the most well known dietary intervention for ADHD. It aims to eliminate 3 groups of synthetic food additives and 1 class of synthetic sweeteners:
Synthetic colors (petroleum-based certified FD&C and D&C colors);

Synthetic flavors;

BHA, BHT and TBHQ ; and

The artificial sweeteners Aspartame, Neotame, and Alitame.

Some artificial colorings such as titanium dioxide are allowed.

During the initial weeks of the Feingold program, foods containing salicylates (such as apples, almonds, and grapes) are removed and are later reintroduced one at a time so that the child can be tested for tolerance. Most of the problematic salicylate-rich foods are common temperate-zone fruits, as well as a few vegetables, spices, and one tree nut.

During phase 1 of the Feingold diet, foods like pears, cashews, and bananas are used instead of salicylate-containing fruits. These foods are slowly reintroduced into the diet as tolerated by the child.

The effectiveness of this diet is controversial. In an open trial from Australia, 40 out of 55 children with ADHD had significant improvements in behavior after a 6-week trial of the Feingold. 26 of the children – 47.3% -  remained improved following liberalization of the diet over a period of 3-6 months.

In another study, 19 out of 26 of children responded favorably to an elimination diet. What  is particularly interesting is that when the children were gradually put back on to a regular diet, all 19 of them reacted to many foods, dyes, and/or preservatives.

In yet another study, this one a double-blind, placebo-controlled food challenge in 16 children, there was a significant improvement on placebo days compared with days on which children were given possible problem foods. Children with allergies had better responses than children who had no allergies.

Despite this research many pediatricians, particularly in the United States, do not believe the evidence regarding the effectiveness of elimination diets or additive-free diets warrants this challenging therapy for most children.

There is an interesting difference in Europe. In 2004 a large randomized, blinded, cross-over trial of over 1800 three-year-old children was published. The results showed consistent, significant improvements in the children's hyperactive behavior when they were on a diet free of benzoate-preservatives and artificial flavors. They had worsening behavior during the weeks when these items were reintroduced. On the basis of this and other studies, in 2004 schools in Wales banned foods containing additives from school lunches. It has been claimed that since the ban, there has been an improvement in the afternoon behavior of students.

The biggest problem with the Feingold and other elimination diets is that they are hard to follow and to maintain. But for some children and families, the inconvenience and stricter attention to food have worthwhile results.

It is also essential to ensure that children on any kind of diet maintain adequate nutrition: there have been many examples of that simple rule not being followed.

Sugar Restriction
The notion that sugar can make children “hyper” entered the mainstream over twenty years ago, and is now on the list of things that “everyone knows.” But happily it is not true. At least 12 double-blind studies have failed to show that sugar causes hyperactive behavior. Some researchers suggest that sugar or ingestion of high-carbohydrate "comfort foods" is actually calming, and that children who seek these foods may be attempting to "self-medicate."

There are plenty of very good reasons for children to avoid candy, but hyperactivity is not one of them.

Food Allergies
There is clear evidence that children, and perhaps adults with ADHD are more likely to have allergies. That lead to the obvious question whether children with ADHD allergic or sensitive to certain foods. (It is useful to differentiate “allergies” that are the result of abnormal reactivity of the immune system to proteins in food, from “sensitivities” that are the direct result of substances in food: the two have different treatments.)

It is certainly true that food allergies and food sensitivities can generate a wide range of biological and behavioral effects. Gluten sensitivity (celiac disease) is known to be linked to an increased risk of ADHD and other symptoms.

In an open study of 78 children with ADHD referred to a nutrition clinic, 59 improved on a few foods trial that eliminated foods to which children are commonly sensitive. For the 19 children in this study who were able to participate in a double-blind cross-over trial of the suspected food, there was a significant effect for the provoking foods to worsen ratings of behavior and to impair psychological test performance.

For more than 30 years one of the tests used to track allergies has been the radioallergosorbent test (RAST). It is not much used these days since technology has moved on. In an allergy testing study of 43 food extracts 52% of 90 children with ADHD had an allergy to one or more of the foods tested. Over the next few years several researchers carried out open-label studies in which children with ADHD and food allergies were treated with a medicine called sodium cromoglycate, that prevents the release of inflammatory chemicals such as histamine from mast cells. Some of the reports suggested that it could help in some children.

Other popular dietary interventions include eating a low glycemic index diet to avoid large swings in blood sugar. Another strategy has been to “go organic” to reduce the burden of pesticides, hormones, antibiotics, and synthetic chemicals in the child's system. These diets need more scientific study but they are probably safe if expensive.

There are plenty of practitioners and commercial entities who claim to be able to identify food sensitivities with all kinds of methods from blood and muscle testing to electrical and energetic techniques. Some may be helpful, but few have been proven to be effective.


What Should Parents do About Diet, Nutrition, Allergies and Sensitivities?
It is very difficult to predict whether an individual child will be helped by changes in diet. However, as long as the child’s needs for essential nutrients are met these diets should be safe.

It is an extremely good idea for parents to keep a diet diary for one to two weeks to see if anything obvious jumps out. Then trying an additive-free diet, low in sugar and avoiding foods that are suspected of exacerbating symptoms. You will normally find the answer - yes or no - within a few weeks.


What is the Evidence for Food Sensitivities and ADHD in Adults?
Not a lot!

There are plenty of people who have reported that dietary restrictions have helped them, but there is very little evidence. One of the problems about looking for food sensitivities is that there is a high placebo response rate. But if you have adult ADHD, it may be worth investigating. Just make sure that any diet that you use is nutritionally sound. And if you don't find anything reconsider another approach.

Blood Pressure and the Brain

We have known for almost a century that regions of the brain are involved in the control of blood pressure.

Yet over the last three decades most of the emphasis in research into hypertension (high blood pressure) has focused on blood vessels, the heart and kidneys.

Now research from Bristol University in England has been published in this month’s issue of the journal Hypertension, and it may put the brain back into the center of research into the causes and treatment of high blood pressure.

Working with rats, the researchers isolated a protein called JAM-1 (junctional adhesion molecule-1), that is located in the walls of blood vessels in the brain. It appears to trap white blood cells causing obstruction of blood flow in some of the smallest blood vessels. This can cause inflammation and result in poor oxygen supply to the brain, which may in turn trigger events that raise blood pressure.

Though this work is in its early stages, this is exciting stuff: if confirmed, it might be possible to treat hypertension with drugs that reduce blood vessel inflammation and increase blood flow within the brain.

It also ties in with other recent research from Imperial College, London and Oxford University, in which a team of neurosurgeons and physiologists discovered changes in blood pressure while fitting brain electrodes to 15 patients for pain control.

Deep brain stimulation involves placing very thin electrodes on very exact locations in the brain and is already used to relieve pain and to help Parkinson's disease patients with their movement.

The researchers found that they could make patients' blood pressure increase or decrease by stimulating very specific regions of the brain with the electrodes. Regions that have been associated with blood pressure control in the past. If they stimulated an area deep down in the midbrain called the ventral periventricular/periaqueductal gray matter, blood pressure went down, and if they stimulated the dorsal periventricular/periaqueductal gray matter it went up.

Nobody is suggesting that we should start sticking electrodes in peoples’ brain, but this chance observation may have profound implications, particularly for people who drop their blood pressure too far when they are treated with standard medicines.

These two pieces of research may also help explain why a balanced inflammation–reducing diet and relaxation may both reduce blood pressure.

Fats, Inflammation and Depression

We have talked before about the associations between inflammation and psychiatric illnesses.

There is yet more evidence in the shape of a study just published in the journal Psychosomatic Medicine. by Janice K. Kiecolt-Glaser and her colleagues from Ohio State University College of Medicine in Columbus.

The study involved 43 older adults with a mean age of 66.67 years, and the results suggests that the imbalance of omega-6 and omega-3 fatty acids in the typical American diet could be associated with the sharp increase in heart disease and depression seen over the past century. The more omega-6 fatty acids people had in their blood compared with omega-3 fatty acid levels, the higher their levels of the inflammatory mediators tumor necrosis factor-alpha and interleukin-6, and the greater the chance that they would suffer from depression. These are the same inflammatory mediators associated with insulin resistance, type 2 diabetes and coronary artery disease, all of which are more common in depression. And depression is more common in diabetes, arthritis and coronary artery disease than expected.

Our hunter-gatherer ancestors consumed two or three times as much omega-6 as omega-3, but today the average Western diet contains 15- to 17-times more omega-6 than omega-3. There were 6 individuals in the study who had been diagnosed with major depression, and they had nearly 18 times as much omega-6 as omega-3 in their blood, compared with about 13 times as much for subjects who didn't meet the criteria for major depression.

Depressed patients also had higher levels of tumor necrosis factor alpha, interleukin-6, and other inflammatory compounds. And as levels of depressive symptoms rose, so did the omega 6 and omega 3 ratio. So it seems as if the effects of diet and depression enhance each other. People who had few depressive symptoms and/or were on a well-balanced diet had low levels of inflammation in their blood. But when they became more depressed and their diets became worse – which is very common when people are depressed – then the inflammatory mediators in the blood surged.

Omega-3 fatty acids are found in foods such as fish, flax seed oil and walnuts, while omega-6 fatty acids are found in refined vegetable oils used to make everything from margarine to baked goods and snack foods. The amount of omega-6 fatty acids in the Western diet increased sharply once refined vegetable oils became part of the average diet in the early 20th century.

Depression alone is known to increase inflammation, the researchers note in their report, while a number of studies have found omega-3 supplements prevent depression.

So this more evidence for the value of eating fatty fish like salmon, mackerel or sardines two or three times a week, but be sure to avoid fish that may contain a lot of mercury. If you add more fruits and vegetables to your diet, you will also reduce your levels of omega-6 fatty acids.

I have just finished analyzing all the new literature on using fish oils for the prevention and treatment of psychological and psychiatric problems, and I am going to post my findings in the next couple of days.

Blueberries and Colon Cancer

I have been delighted to see how many people have read and downloaded my Twelve Tips to Reduce Your Risk of Colon Cancer.

There is some new research that was just presented at the shows tha there is a compound in blueberries called pterostilbene that may help protect against the development of colon cancer.

Researchers from Rutgers University and the US Department of Agriculture presented their findings at the meeting of the American Chemical Society in Chicago.

Pterostilbene is a natural antioxidant that mops up free radicals that may, in excess, trigger the growth of some cancers. Similar antioxidants have already been identified in grapes and red wine. Work in mice suggests that pterostilbene may also lower cholesterol levels. The compound also reduced inflammation and the rate of cell division in the bowel both of which are considered to be cancer risk factors.

Pterostilbene is also found in cranberries, sparkleberries, lingonberries and grapes.

It is an extremely good idea to add blueberries to your diet. Do not overdo it! I worry when people extol the virtues of some super-food or super-drink that is supposed to abolish all of your free radicals. Despite the claims of at least one medical correspondent on Fox New, there is usually no evidence that they do so. And in any case, you do not want to abolish all your free radicals: they are key cancer killers.

You want to balance and modulate the free radicals in your body, and blueberries, together with four other portions of fruit and vegetables a day are one excellent way of doing so.

Pesticides, Weight Gain and Insulin Resistance

On this blog and in Healing, Meaning and Purpose, I have talked about some of the less well recognized contributors to obesity, including:

1. Stress
2. Salt
3. Viruses
4. Pesticides
5. Intestinal bacteria

There is some new evidence from Korea published in the journal Diabetes Care, supporting the possible contribution of pesticides to insulin resistance.

People with high levels of persistent organic pollutants (POPs) in their blood were more likely to develop insulin resistance, which may lead to type 2 diabetes. Insulin resistance may also lead to obesity, hypertension and an array of other diseases. It is well recognized that increasing amounts of intra-abdominal fat may increase insulin resistance. It is less well known that this obesity is part of a viscous circle, with insulin resistance being associated with elevated insulin levels that may cause fat to be laid down throughout the body. Once the fat is laid down in the abdomen, it can break down, releasing fatty acids and triglycerides that in turn affect the breakdown of insulin by the liver and the release of insulin by the pancreas.

Previous research by the same group found a link between POPs and type 2 diabetes. This study confirms that background exposure to some POPs, chemicals such as organochlorine pesticides and polychlorinated biphenyls (PCBs), is also associated with insulin resistance among people who do not yet have diabetes.

The researchers also found that the association between organochlorine pesticides and insulin resistance became stronger as people got fatter. However, among people who had very low concentrations of pesticides in their blood, the researchers found little association between waist size and insulin resistance.

Some studies have suggested an association between background exposure to POPs and a variety of adverse health effects in humans and wildlife. POPs can be particularly problematic because they persist for long periods of time in the environment, accumulate up the food chain, and can travel great distances through the air and water. Therefore, even people and animals that live nowhere near a place where POPs are being applied often show high levels of these chemicals in their bloodstream.

An international treaty banning a dozen of the world's most dangerous POPs has helped reduce exposures, but many harmful chemicals remain in use and even those that have been banned may linger in our environment for years to come. For example, chlordane was banned two decades ago in the United States but continues to be present at high levels in our food supply.

The researchers concluded that some POPs "may be involved in the pathogenesis of insulin resistance." They advise urgent prospective studies among those who have background exposure to POPs, which mostly comes from eating fatty animal foods. Since obesity may increase the toxicity of POPs, controlling weight could also help to reduce the impacts of these molecules.

In separate research involving mice, Frederick vom Saal from the University of Missouri in Columbia, Missouri has studied the effects of a different class of endocrine-disrupting chemicals, including bisphenol-A (BPA). Not long ago, BPA made news in San Francisco, where there was a lot of controversy over an ordinance that seeks to ban its use in children's products. vom Saal's most recent work was presented at the 2007 Annual Meeting of the American Association for the Advancement of Science (AAAS). He found that endocrine-disrupting chemicals cause mice to be born at very low birth weights and then very rapidly gain abnormally large amounts of weight: they could more than double their body weight in just seven days. Vom Saal followed the mice as they got older and found that these mice were obese throughout their lives. He said studies of low-birth-weight children have shown a similar overcompensation after birth resulting in lifelong obesity.

(Regular readers might remember the concept of the thrifty phenotype, and see how this research ties in with that concept). More research must be done to determine which chemicals cause this metabolic effect. According to vom Saal, there are approximately 55,000 manmade chemicals in the world, and 1,000 of those might fall into the category of endocrine disrupting. These chemicals are found in common products, from plastic bottles and containers to pesticides and electronics.

These chemicals are so pervasive that it is difficult to avoid them, and there is scant evidence that "detoxification" helps clear them. That being said, and depsite the lack of evidence, we recommend certified organic produce and regular mild detoxification programs, together with nutritional support and  tapping therapies.

Juices, Cardiovascular Disease and Cancer

There was an important study that came out a few months ago in the International Journal of Food Science and Nutrition.

Investigators from Dundee in Scotland decided to look at the health benefits of fresh fruit juice. While it is widely accepted that fruit and vegetables lower the risk of some cancers and of most cardiovascular diseases, the role of pure fruit and vegetable juices has never been clear. In fact many textbooks have said that 100 percent juices play a less significant role in reducing risk for both cancer and cardiovascular disease than whole fruits and vegetables since they contain less fiber, and it had been assumed that it was the fiber that was the key to their value.

The researchers analyzed a variety of studies that looked at risk reduction attributed to the effects of both fiber and antioxidants. They found that the positive impact offered by fruits and vegetables is derived not from just the fiber but also from antioxidants which are present in both juice and the whole fruit and vegetables. Juices are comparable in their ability to reduce cancer and cardiovascular risk compared to their whole fruit/vegetable counterparts.

This research  goes a long way in demonstrating that fruit and vegetable juices may play an important role in reducing the risk of various diseases.

A study published in the American Journal of Medicine in September found that consuming a variety of 100 percent fruit and vegetable juices was associated with a reduced risk for Alzheimer's disease. Japanese American individuals who drank three or more servings of fruit and vegetable juices per week had a 76 percent lower risk of developing Alzheimer's disease than those who drank juice less than once per week. That finding seemed robust, even taking into account other potential variables. So I think that we may be able to add juices to our strategies for reducing the risk of developing Alzheimer's disease as we get older.

There is another point of importance. Some of the fad diets claim that fruit juices should be avoided at all costs, since they can cause the release of insulin, and insulin is bad. Those proclamations have usually come from people with a limited background in biochemistry or metabolism. The research shows that they were not correct. The key is balance, and as part of a comprehensive nutritional approach, juicing can be very helpful.

And a final point: careful use of juices has long been one of the "secret" components of our system of weight management.

“Drinking freshly made juices and eating enough whole foods to provide adequate fiber is a sensible approach to a healthful diet.”
--Jay Kordich (American Health Expert, Author and Lecturer, 1921-)

“If people would only stop putting into their bodies the things that are creating their physical problems, and eat a predominantly raw vegetarian diet, along with raw vegetable juices, almost all physical problems would soon disappear from the face of the earth!”
--Reverend George M. Malkmus
 (American Minister and Originator of the Hallelujah Diet, 1934-)

Mindless Eating

One of the keys to any successful weight management strategy is awareness:

1. Awareness of our bodies
2. Awareness of our bodies' needs
3. Awareness of what we are doing physically
4. Awareness of what we are eating
5. Awareness of the impact of food on our bodies and our minds
6. Awareness of the content and consequences of our diets
7. Awareness of our eating on other people
8. Awareness of our food choices on animals and our physical and emotional environment
9. Awareness of the things that drive us to eat even if we are not hungry
10. Awareness of the spiritual consequences of eating

I have looked at hundreds of books on diet, health and nutrition and it constantly astonishes me that hardly any of them address this central component, not just of weight management, but of life management. There is some fine exceptions: one is a new book by Brian Wansink called Mindless Eating, that does a good job of discussing some of these problems of awareness about eating.

The author is a practicing researcher and Professor at Cornell, and he has an interesting paper in the current issue of the Journal of Marketing Research. Part of his thesis is that “low fat” nutrition labels may lead to the over-consumption of nutrient-poor and calorie-rich snack foods. 

I was pleased to see the experimental data, which exactly confirms my observations. After nearly thirty years of working with people with weight challenges, one of the more common problems is that some people have been brain washed into thinking that if it says “low fat” on the label, you can eat as much as you want. The trouble is that if you know how to read labels, some of the low fat foods are also low health foods. The authors of the paper make some good suggestions for changing policy to help rectify the situation.

When it comes to what we eat, part of the problem is that most of us are so comfortable with the status quo that we rarely notice much that is going on inside or around us.

A fish only becomes aware that it lives in water once it’s dragged up on shore!

And we only realize our own potential for growth and change when we become aware of the dynamic, interconnected beauty and complexity of a world that lies just beyond the reach of our senses. Growing our awareness of food, nutrition and eating can be a transformative experience. I have known some spiritual teachers who would not accept heavy people as students, saying that if they could not even control their weight, then how could they control their minds or any energies that might be released from meditation, qigong, yoga and the like?

Although I understand what they are saying, I respectfully disagree. As I have discussed many times, there are physical as well as psychological, social, subtle and spiritual reasons for having trouble with weight, and I don’t think that these are grounds for excluding people from learning these practices. For today I urge you to spend a few minutes working on your own “Ten Awarenesses” about food and nutrition. It could be the best thing that you do for yourself all year.



“Neither the body with its senses nor the mind with its thoughts is the ultimate being that I am. The body acts and the mind moves, but behind them is the thought-free Awareness, the Knowing Principle.”
--Paul Brunton (English Spiritual Teacher and Author, 1898-1981)

“The voyage of discovery lies not in finding new landscapes, but in having new eyes.”
--Marcel Proust (French Novelist, 1871-1922)

Do Healthy Foods Taste Bad?

There is a valuable study in the Journal of Marketing, which I must confess is not normally on my overloaded reading list. At least it wasn’t until I discovered an astonishing number of articles that are highly relevant to our basic themes of Health, Integrated Medicine, Meaning and Purpose.

We are all constantly puzzled by the way in which so many people seem to enjoy unhealthy foods. This is a matter of enormous importance: countries like China and India are now getting fattest the fastest, partly because of their peoples’ craving for Western junk food, coupled, in many cases, with a metabolic inability to process the food in the same way that most Europeans do.

Well, according to this study, foods that we think are healthy taste worse. This is the "unhealthy = tasty intuition." In one of the experiments, test subjects were offered a mango lassi, an Indian yogurt drink that has the consistency of a thick milkshake. Those who were told that the lassi was "unhealthy" liked the drink significantly more than those who were told the drink was "healthy.”

When I was a young student one of my teachers told me that patients always believe that if something tastes foul then it must be doing them some good. A lesson that I had learned from my grandmother when still a small child. By the age of five I already knew that any rash or snivel would mean having to take some pungent and disgusting potion: some secret recipe that had been in the family for generations. Even then I wondered how it was that so many family members had lived to great ages. It didn’t seem possible.

This research fits in with the teachings of my grandmother and my professor. People assume an inverse relationship between tastiness and healthiness. In the study people believed that what they were consuming was unhealthy, they guessed that it would taste better, be more enjoyable to eat and that they would be more likely to choose it in a test.

This is important research and has a number of practical implications for helping people to adopt more healthy eating patterns.

This reminded me of a salutary lesson. Some years ago I spent a very happy year doing a part time course in wine tasting. Fascinating topic taught by Masters of Wine who said that they could tell incredible things about a wine after the smallest taste. A couple of years ago such claims were put to the test in Bordeaux in France, which is, of course, famous for its wines. In the first experiment 54 acknowledged wine experts were asked to give their impressions of two glasses of wine: one white and one red. The wines were actually the same white wine, one of which had been tinted red with an odorless food coloring. But here it gets interesting: the experts described the "red" wine in language typically used to describe red wines. For instance one said tat the colored wine had a “flavor of crushed red fruit.” Not a single one noticed it was actually a white wine.

In a second experiment an inexpensive wine was presented to the experts in two different bottles, one fancy and one plain. The experts gave the two bottles completely different evaluations. The experimenters described their results in terms of the interaction between vision of colors and odor determination. But we can also interpret the data in terms of expectation and perspective. If we expect something to taste good it tends to do so. Yes of course you can get a nasty surprise, but there is a powerful subjective component in how we interpret sensations.

I strongly suggest that you analyze your own reactions to food. Do you believe that healthy foods have to taste awful?

This may be an important key to changing your own eating patterns.

"Life expectancy would grow by leaps and bounds if green vegetables smelled as good as bacon.”
--“Doug Larson”



“As for food, half of my friends have dug their graves with their teeth.”
--Chauncey M. Depew (American Politician and, from 1899-1911, Senator from New York, 1834-1928)

“To lengthen thy life, lessen thy meals.”
--Benjamin Franklin (American Author, Inventor and Diplomat, 1706-1790)

“If you have formed the habit of checking on every new diet that comes along, you will find that, mercifully, they all blur together, leaving you with only one definite piece of information: french-fried potatoes are out.”
-- Jean Collins Kerr


(American Author and Playwright, 1923-2003_

Tea and Milk

Growing up in England, tea is a great deal more than a drink.

Always drunk hot, of course. No normal person would want it served cold.

It is a major social lubricant and is considered by most to be a separate food group. And the health benefits conferred by a nice cup of tea are now known to just about everyone in Britain.

But from an early age I knew that one day I would have to leave the country.

Why?

Because I could never abide the way in which the vast majority of tea drunk in England is destroyed by the addition of milk and sugar. There are even long technical debates about whether to add the milk before pouring in the tea or after? How fast to add the white stuff? How to stir it in?

Since I was knee high to a puppy I was always the odd one out, wanting nothing to do with this wanton destruction of a sublime beverage.

Which should always be enjoyed au naturel. The only thing that might ever sully a cup of fine Earl Grey or Darjeeling might be a little lemon. Anything else?

Yuk.

Well, it now transpires that this isn’t just a matter of taste buds.

A study just published in the European Heart Journal says it all in the title, “Addition of milk prevents vascular protective effects of tea.”

Tests on sixteen healthy postmenopausal female volunteers showed that black tea significantly improved the ability of the arteries to relax and expand, but adding milk completely blunts the effect. The research was supplemented by tests on rat blood vessels. Tea caused the muscle in the vessel wall to relax by producing nitric oxide from the endothelial cells that line blood vessels. Adding milk blocked the production of nitric oxide and the relaxation of the muscles.

Now bear in mind that they were testing black tea. The researchers are now looking at the potentially more potent green tea to see whether its effects are also blocked by milk.

The villain of the piece is a group of proteins called caseins, which they found interacted with the tea to decrease the concentration of catechins in the beverage. Catechins are the flavonoids in tea that mainly contribute to its protection against cardiovascular disease.

The moral of the story? Tea can be wonderful on so many levels. Not only does it taste good, but also it can do wonders for your health.

But please, please, please don’t lose all the benefits by sloshing in a load of milk!

Raw, naked tea is the way to go...

"Thank God for tea! What would the world do without tea? How did it exist? I am glad I was not born before tea."
--Sydney Smith (English Clergyman and Essayist, 1771-1845)

Food Additives and Behavior

Few things generate as much heat and as little light as the debate about a possible association between food additives and cognition, mood and behavior.

There are a number of ways in which food may influence all three, including:

1. Malnutrition
2. Composition of the diet
3. Nutrient quality of the diet
4. Eating habits
5. Pharmacological effects of foods
6. Food allergy
7. Food sensitivity
8. Contamination of food with heavy metals, hormones and pesticides
9. Fatty acid deficiency
10. Food additives

It is often surprising to learn that many people do not realize that in children – particularly if malnourished – omitting breakfast can have a marked effect on cognitive functioning. But it is the last of those that I want to look at today.

Until the 1950s if food manufacturers wanted to add color to a food it was done primarily with natural plant and vegetable based compounds: pale red colors could be achieved from beets; green from chlorophyll-containing vegetables; yellows and orange could be achieved from extracts from a number of other plants and spices.  But then things began rapidly to change as we outlined in Healing, Meaning and Purpose.   

The notion that food additives could be a cause of hyperactivity is at least 30 years old. I think that Ben Feingold was the first to introduce the idea and with it his notoriously difficult diet.

Over the years there have been some positive clinical trials of the diet and some negative. But I think that every clinician working with behavior problems has seen some startling improvements in some children and adolescents when they go on an elimination diet.

In 1985 a controversial study published in the Lancet claimed to show that 79% of hyperactive children had symptomatic improvement when food chemicals were removed from their diet. Then when the food chemicals were re-introduced the symptoms returned. No other study has ever produced figures anything like that high.

It is also important that in young children, though additives may cause a problem in some, there does not seem to be a link between allergies and food sensitivities, and parents often pick up behavior changes that simple clinical screening tools do not. So mom and dad may really know best.

Several years ago we tried to look at the impact of food additive not on behavior, but on headache. When the additives were administered double blind, we were unable to replicate most people’s symptoms, even when they were sure that a certain food caused a problem.

However, unsupervised restriction diets are not without their dangers. And we also need to make sure that practitioners know what they are doing: I once saw a young woman who had seen by an “alternative allergist,” who had left her on a diet consisting of spring water, rice and lettuce. And nothing else.

Another problem is that many of us do not know what additives are lurking in the food that we eat. There was a recent study in the United Kingdom indicated that on average, Britons consume 20 different food additives every day, with some eating up to 50. Yet most people were unaware of this figure, with nearly half of the 1,006 people surveyed thinking they ate only 10 additives each day.
The research also found that many people did not understand which foods are most likely to contain additives. I have not yet seen the raw data from this study, but I shall have more to say about it once it becomes available.

A number of large independent studies are currently underway (for example, here) which should help us to better identify who is susceptible to additives, how to test for sensitivity to additives and who might benefit from their withdrawal.

The trouble with a lot of the discussion about food additives, behavior, mood and cognition is that it usually begins from a false premise: that there is a single cause for a behavior.

When I am teaching it continues to astonish me that most health care professionals still expect there to be one “cause” for a problem. Yet as I have mentioned before, this is rarely clinical reality.

A food additive may be associated with problems, but only in a minority of children, and only if they are genetically predisposed and if the right set of environmental circumstances are in place.

If you suspect a problem, first, learn to look at labels. And see if simple exclusion helps. An allergist is the next stop, but also ask whether an additive could be causing a biochemical rather than an allergic problem. If it is a biochemical effect, it may not show up on routine allergy tests, but there are other ways of testing.

The Ape Diet

The BBC is carrying an article today about an experiment done for a television program in the United Kingdom.

Nine volunteers aged 36 to 49 set up home in a tented enclosure at Paignton Zoo, Devon, right next door to the ape house.

They were then put on what was essentially a vegan diet for a week followed by a vegan and fish diet for five days. They didn't call it a vegan diet, choosing the more catchy name of an Evo Diet. The nutritionist who designed the eating plan was inspired by the diet consumed by apes in the wild.

She devised a three-day rotating menu of fruit, vegetables, nuts and honey. The prescribed menu was designed to be safe to eat raw; to meet adult human daily nutritional requirements; and it provided 2,300 calories - between the 2,000 recommended for women and 2,500 for men.

They typically ate 5kgs {Yes, ELEVEN POUNDS (!)} or 2,300 calories of fruit, vegetables, nuts and honey.

On a 3-day rota, they typically ate broccoli, carrots, radishes, cabbage, tomatoes, watercress, strawberries, apricots, bananas, mangoes, melons, figs, plums, oranges and hazelnuts.

Volunteers could also drink water. In the second week, standard portions of cooked oily fish were introduced. The idea was that this was to simulate the diet of a hunter gatherer.

Although this is really a mock experiment, it was a shame that they added the fish in the second week: it would have been nice to have seen the impact of just twelve days on a vegan diet.

Even so, the results were remarkable. The average cholesterol of the group fell by 23%, they lost an average of just under ten pounds and average blood pressures fell from 140/83 to 122/76.

I don't find any of this at all surprising: I've done countless experimental diets on healthy volunteers, on patients and I've also tested them all on myself.

Eating the kind of diet to which we adapted over hundreds of millenia obviously makes good sense. And is far more likely to be successful than the latest fad diet based on some highly unnatural approach. The trouble with this experiment was that it actually did not simulate our ancestral diet: some - but not all - people do much better if they "eat with the seasons:" eating summer fruits in the summer, winter vegetables in the winter and so on. From what we know from the fossil record, it appears that our ancestors became omnivorous a very long time ago, and fish may have been a relatively recent addition to our diet.

Apart from those nit picky theoretical objections, the main problem with this diet is practical: it can be hard to carry around eleven pounds of fruit and vegetables. I've done it as part of an experiment, so I know that it is doable: it depends on how much you want to take control of your body.

There are, of course, loads of supplements for sale that claim to give you all the goodies packed into those eleven pounds of food, but in one convenient little pill. The trouble is that natural foods contain many other nutrients, not all of which have yet been identified. The bulk and the fiber are also important components of your diet.

The second problem is psychological: in Healing, Meaning and Purpose we spend a whole chapter/CD on methods for maintaining motivation and overcoming the psychological, social, subtle and even spiritual problems that often prevent us from looking after our bodies.

“As houses well stored with provisions are likely to be full of mice, so the bodies of those who eat much are full of diseases.”
--Diogenes (a.k.a. Diogenes Laertius, a.k.a. Diogenes the Cynic, Greek Philosopher and Founder of the Cynic School, c.412-323 B.C.E.)

“To become vegetarian is to step into the stream which leads to nirvana.”
--Buddha (a.k.a. “The Awakened”, a.k.a. Siddhartha Gautama, Indian Religious Figure and Founder of Buddhism, c.563 B.C.E. – c.483 B.C.E.)

“It's bizarre that the produce manager is more important to my children's health than the pediatrician.”
--Meryl Streep (American Emmy and Oscar-winning Actress, 1949-)

Healthy Aging

I have talked about the small number of simple steps that can dramatically reduce your risk of getting congnitive decline as your get older and some new evidence to show the benefits of non-drug treatments for dementia. I am pleased to say that my conclusions have just been supported by an editorial in the Journal of the American Medical Association.

I would like to let you know about another great resource: the International Council on Active Aging (ICAA) which has produced a great package of action items that are all rooted in good quality scientific research. The list is very similar to the ones that I have created for you here, and are very precise.

1. Invest in good shoes and socks
2. Play games
3. Walk
4. Increases your physical activity
5. Do exercises to improve your balance
6. Get regular eye checks, not only for corrective lenses, but to be checked for early evidence of diabetes or high blood pressure
7. Seek out friends family and neighbors
8. Modify your diet toward a "Mediterranean" one
9. Laugh
10. Get enought sleep

Whatever your age, I urge you to spend a few minutes working on a simple plan that will fit your schedule: your mind and body, family and friends will thank you forever.

Reducing Your Cancer Risk

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
-- Thomas Alva Edison (American Inventor, 1847-1931)

I am sure that you will agree that prevention is better than cure. And this is a good time of the year to review where you are in your life and what you want or need to do for yourself and your loved ones.

According to a study reported in the Lancet in November 2005 more than one third of cancer deaths are attributable to nine modifiable risk factors.

To evaluate exposure to risk factors and relative risk by age, sex, and region, the investigators analyzed data from the Comparative Risk Assessment project and from new sources, and they applied population-attributable fractions for individual and multiple risk factors to site-specific cancer mortality provided by the World Health Organization.

Of the seven million deaths from cancer worldwide in 2001, approximately 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these deaths, 0.76 million were in high-income and 1.67 million in low- and middle-income nations; 1.6 million were in men and 0.83 million deaths were in women.

Smoking, alcohol use, and low consumption of fruits and vegetables were the leading risk factors for death from cancer worldwide and in low- and middle-income countries. In low- and middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the nine risk factors studied.

For women in low- and middle-income countries, sexual transmission of human papilloma virus (HPV) was also the leading risk factor for cervical cancer. Smoking, alcohol use, and overweight and obesity were the most important causes of cancer in high-income countries.

Between 1990 and 2001 mortality from cancer decreased by 17% in those aged 30 to 69 years and rose by 0.4% in those older than 70 years, according to the authors, but this decline was lower than the decline in mortality rates from cardiovascular disease for men and women. The decline in mortality in men was largely due to reduction in mortality from lung, prostate, and colorectal cancers, while in women, lung cancer increased in the 1990s, and death rates for breast and colorectal cancer decreased. An article published almost ten years ago in the journal Cancer Epidemiology, Biomarkers, and Prevention, it was estimated the worldwide attributable risk for cancer to infectious agents as 16%.

The nine factors were:

1. High body mass index
2. Low fruit and vegetable intake
3. Physical inactivity
4. Smoking
5. Alcohol abuse
6. Unsafe sex
7. Urban air pollution
8. Indoor use of solid fuels
9. Injections from healthcare settings contaminated with hepatitis B or C virus

This all makes good sense, but it is good to see high quality research in reputable journals confirming what we suspected. The research also gives us further compelling reasons for taking a good look at our lifestyles and hopefully the motivation to do something to improve them. And in the case of air pollution and injection of contaminated products, to be active in getting things cleaned up.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
-- Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

“Length of life does not depend so much on a good physical constitution as it does on the best use of the six non natural things, which if we rule aright, we shall live long and healthy lives: to divide the day properly between sleep and waking; to adjust our air to the needs of the body; to take more or less food and drink according to our age, our temperament and whether we live an active or inactive life; to take exercise or rest according to the quantity of food and whether we are lean or fat; to know ourselves and be able to rule our emotions and subject them to our reason.  Whoever handles these wisely will live long and seldom need a doctor.”
--Giorgio Bagliivi (Italian Physician, Pathologist, Researcher and Author of De Fibra Motrice, 1669-1707)

“The best doctor prevents illness, a mediocre one treats illnesses that are about to occur, and an unskilled one treats current illnesses.”
--Chinese Proverb

Psychiatry Below the Neck

There is more and more evidence that schizophrenia and bipolar disorder and perhaps also major depressive disorder, are illnesses affecting the whole body and not just the brain and mind.

It has been known for over a century that some physical problems, including type 2 diabetes mellitus, obesity, cardiovascular diseases and some forms of cancer appear to be more common in people with major mental illnesses. All of this was known long before the current concerns about obesity, diabetes and some antipsychotic medicines. It is also clear that the physical problems cannot just be explained away by social deprivation and poor lifestyle choices.

The new understanding of mental illness as a systemic problem, opens up some extraordinary opportunities for treatment and perhaps even for prevention. In some new research due to be published next month, investigators have identified some abnormal proteins in the liver and on red blood cells that are similar to some abnormal proteins already identified in the brain.

These proteins are primarily involved in energy metabolism in cells and in protection against oxidative stress. The implication from this is that schizophrenia and many of the associated health problems may be a consequence of impaired energy metabolism together with damage by free radicals.

You will see why this is so exciting: it looks as if we have an entirely new way of approaching, treating and perhaps preventing the most serious of mental illnesses.

Another Reason Why Breast Is Usually Best

Last month we looked at some of the extraordinary benefits of breast feeding.

There is an interesting paper in this month's issue of the journal Pediatrics.

Approximately 19 percent of children are prone to the chronic and recurrent ear infections collectively known as otitis media. These infections can cause deafness and thereefore interfere with the development of language and lead to learning difficulties. We have known for many years that there can be a genetic predisposition to otitis media, but there has been little research to try and pinpoint the specific genes involved. There is also a complex relationship between genes, specific infectious agents and environmental factors such as exposure to cigarette smoke and breast-feeding.

The new research from the University of Texas Medical Branch at Galveston examined genetic samples taken from 505 children in Texas and Kentucky, about 60 percent of whom were classified as "otitis media susceptible" because they had:

• Suffered an ear infection before the age of 6 months
• Or undergone three or more episodes of acute otitis media within a six-month period
• Or four or more episodes within a 12-month period
• Or had six or more episodes by age 6.
• Or had required drainage tubes to reduce recurrent or persistent ear infections

The researchers looked for small genetic variations called "single-nucleotide polymorphisms," - or SNPs - in three important genes that produce inflammatory signaling molecules for the immune system.

Two genes known known to generate the immune proteins known as tumor necrosis factor-alpha (TNF-alpha) and  interleukin 6 (IL-6). SNPs in each individual gene were enough to create an increased risk for childhood ear infections, and simultaneous SNPs in both genes increased the risk even further. These particular genetic variations cause a greater production of inflammatory signaling molecules and reduce the effectiveness of the immune system.

But here is the fascinating thing: the researchers found that the genetic effect could be counteracted by breast-feeding, which is well known to increase immune resistance.

We have here another fine example of how a healthy practice can overcome a genetic predisposition to illness. Remember what I have said many times before: Biology is not destiny.

On the hand another environmental factor - exposure to cigarette smoke - increased vulnerability to otitis media in children with the TNF-alpha gene variation. Cigarette smoke exposure alone was not enough to increase the risk for ear infections. 

Attention Deficit Disorder and Omega-3 Fatty Acids

Six months ago we discussed some of the research linking allergy, disturbances of cell membranes and attention deficit disorder with or without hyperactivity (ADD/ADHD). I also drew attention to the work indicating that there might be a role for omega-3 fatty acids in treatment, the essential fatty acid found primarily in seafood and flaxseed oil. The link between omega-3 fatty acids and ADD/ADHD has come from five lines of evidence:

1. If animals are deprived of this nutrient, they become hyperactive and their offspring have reduced cognitive abilities
2. Omega-3 fatty acids are essential to the normal growth of the brain
3. Studies in animals indicate that changing the dietary intake of omega-3 fatty acids impacts the all-important dopamine systems of the brain
4. Children who are breast fed have lower rates of ADD/ADHD, which is independent of any maternal characteristics ,and breast milk contains many essential nutrients including omega-3 fatty acids
5. Anecdotes and some clinical trials of omega-3 fatty acids in children with ADD/ADHD, though we still don't know the best way to supplement

Well, the research continues to come thick and fast:

• Omega-3 fatty acid deficiency may be involved in aggression, hyperactivity and conduct disorder, though the evidence is not as strong as it is for some other nutrients: Iron, zinc and protein deficiency all seem to contribute to aggressive, hyperactive behavior.
• Another recent study has found low levels of omega-3 fatty acids in children with ADHD.
• There seems to be an association between ADHD and a deficiecny of a key enzyme in fatty acid metabolism called fatty acid desaturase 1.

All of this led to the announcemet on Friday that the Murdoch Childrens Research Institute in Melbourne, Australia is recruiting for a clinical trial of the effects of omega-3 fatty acids on the brain function of children with ADHD. The study will examine the effects of these fatty acids on the learning skills, attention span, memory, reaction time and behaviour of 150 children with ADHD over 12 weeks. The effects will also be explored in 100 children without ADHD.

I am encouraged by the way in which the investigators plan to do this work, and I shall keep you posted as data - whether positive or negative - continues to emerge from this study and others.

Multiple Sclerosis and Integrated Medicine

Although there are some fairly effective conventional therapies for multiple sclerosis (MS), many people with MS explore complementary and alternative medicine (CAM) therapies for their symptoms. The most effective strategies are to combine conventional and unorthodox treatments that address the physical, psychological, social, subtle and spiritual aspects of the illness. This combined approach also avoids the problem of people taking herbs or supplements that may either interact with each other or with conventional treatments.

It is also essential for us to get over the idea that MS is just something to be conquered. That may seem like an odd comment, but the language and the mindset of fighting, battles and warfare can be problematic. Let me explain something that I discuss at length in Healing, Meaning and Purpose.

There have been two distinct approaches to health in the Western medical tradition. The first is that the role of a physician is to treat diseases. That is the way that all my colleagues and I were trained. The second approach is to consider that health is the natural order of things. So in the first case we constantly hear the use of military metaphors: People speak of  “a war on cancer,” “killer cells,” “magic bullets,” and the need to adopt a “fighting spirit.” Sadly this aggressive attitude by the medical profession may be at odds with the wishes and needs of an individual, the family and the other people in a person’s life. We have to try to strike a balance between the whole instinct to fight and expressions of healing and acceptance.

In the second case, the philosophy is grounded in the idea that we need to work in harmony with nature. The maintenance of health and well being comes from reestablishing balance and harmony not just in ourselves but also in our relationships with each other, with society and with the entire environment around us.

Some of the most commonly CAM therapies include dietary modification, nutritional and herbal supplementation, and mind-body therapies. There has been a revival of interest among MS researchers about the therapeutic potential of low-fat diet and essential fatty acid supplementation in MS. The research on CAM therapies in MS is still exploratory, but considering peoples' interest and common use of these therapies, further research in this area is clearly warranted. Many sufferers show “spontaneous” recoveries, so reports of cures with unorthodox remedies are often treated with skepticism.

Diet, Vitamins and Supplements: There have been scattered reports of symptoms improving after the removal of dental amalgam, but there is scant evidence that this is really worthwhile. There is some evidence 1. 2. 3. 4. that polyunsaturated fatty acid (PUFA) supplementation may help MS. There used to be a lot of support for something called the “Swank diet,” but over the years the evidence has not been very good. In a small number of people with MS certain foods can make them worse. This is to expected if there is an autoimmune component to the illness. It is always a good idea to see if there is something that makes a person feel worse. The other important qestion is whether food additives may be causing symptoms. Although this must be uncommon, I have written elsewhere about occasional cases of MS symptoms with all the classical neurological, biochemical, radiological and electrical signs that have improved or become completely better after removing aspartame from the diet.

Physical exercise: Exercise is highly recommended for people with MS, though it is best to avoid it during an attack. There is evidence that over-exertion can actually bring on an attack. There is some literature about the use of Feldenkrais bodywork in MS, but a study from the University of North Carolina failed to find any benefit. T’ai Chi Ch’uan, qigong, yoga and graduated exercise have all been helpful to some people with MS, but it is essential to discuss it with a healthcare provider to see how any one of these fits in to an package of care. There is no published data on the use of Pilates in MS. At least not in any of the languages that I can read. But since it has been shown to improve posture and flexibility, it is logical to think that Pilates might be helpful, and it would be very valuable to see some research on it.

Acupuncture: Although widely used, the research on acupuncture in MS is not yet convincing. Like most acupuncturists I’ve had some good results in treating pain, muscle stiffness and fatigue. I’ve also seen people achieve some remarkable recoveries, but there are two issues: MS is a relapsing and remitting illness. And second, many of the people who did well only did so because they shifted their thinking: acupuncture became the vehicle for their personal transformation rather than a device for removing nasty symptoms.

Homeopathic remedies: Even the most enthusiastic homeopaths have fairly limited expectations of what homeopathy can achieve in MS.

From the point of view of homeopathy there is little point in making the diagnosis on multiple sclerosis because the disease has such a variable course with highly variable symptoms. To a homeopath the diagnosis is not useful: it is the symptoms that are all important. The homeopathic treatment of MS is highly individualized: one of the key items is the timing of symptoms and associated features. Some of the most common remedies for people with MS are:

• Agaricus
• Alumina
• Argentum Nitricum
• Arsenicum
• Aurum Metallicum
• Causticum
• Cocculus
• Conium Maculatum
• Ignatia
• Lachesis
• Nux Vomica
• Natrum Muriaticum
• Phosphorus
• Plumbum

This is not the whole list of homeopathic remedies that we have sometimes found helpful, but it highlights some of the more commonly used ones in people with the symptoms of MS.

Herbal remedies: Many herbal remedies have been tried in MS, and many experts have told me that they have had some good results. There is an important issue in MS called “apitherapy,” a.k.a. bee venom therapy (BVT). Several reports suggest that bee venom may be an effective treatment for patients with MS. But formal trials suggest that although the treatment appears relatively safe apart from itching and swelling of the skin, it does not seem to be helpful. 

The best approach is to embrace the best of what conventional medicine has to offer, combine unorthodox approaches and to realize that management of a chronic illness is not about dominating it but learning from it and learning strategies for peacefully co-existing with it.

Violence and Nutrition

There is a small but impressive body of evidence about the impact of nutrition on violence. It started with some simple observations concerning nutrient content and behavior in animals. In 1942 the wartime British government was persuaded to supplement the diet of all children with cod-liver oil and orange juice. It was speculated that among other ills, poor diets could lead to antisocial behavior. You humble reporter was still required to take this foul-tasting concoction when he was a child in England very many years after the War.

Over the years evidence has grown to support this link between nutrition and antisocial behavior and a longstanding debate developed about the possible role of nutrition and food additives on the ever-increasing rates of violence in society as a whole. Regular readers may remember the publication several months ago of a report entitled Feeding Minds that implicated nutritional changes in the burgeoning rates of mental illness in the United Kingdom.

Part of the problem with much of the work on nutrition and violence has been that there were vested interested involved. Some people have been trying to prove that all the world’s ills are the result of food additives and others have been trying just as hard to prove that their products are safe. The other problem has been the simplistic notion that it is possible to reduce human behavior to a single nutrient.

Humans are complex creatures. Coffee may make you irritable. If you happen to be a small coffee-drinking furry rodent, you may not be you may not have much choice in the matter. But one of the points about developing frontal lobes is that you should have the ability to override the coffee: you can choose whether or not you want to be irritable. A teenager may not be able to do that: he or she does not yet have fully formed frontal lobes. Alcohol can be such a big problem because not only does the alcohol stimulate some of the emotional regions of the brain but it also suppresses the frontal lobes. Whatever you may have done while under the influence probably seemed like a really good idea at the time!

There have now been a couple of very interesting studies that do suggest that nutritional supplementation may have a significant impact on violent behavior in prisoners.

The first modern experiment was reported in the British Journal of Psychiatry in 2002. 231 young adult prisoners were enrolled in a double blind, placebo-controlled, randomized trial of nutritional supplements comparing disciplinary offences before and during supplementation. The prisoners were given a capsule of “Forceval” as well as a combination of essential fatty acids (A daily dosage of four capsules providing 1260 mg linoleic acid, 160 mg gamma linolenic acid, 80 mg eicosapentaenoic acid and 44 mg docosahexaenoic acid). Those receiving the supplements committed an average of 26.3% fewer offences, which improved yet further with longer supplementation. The conclusion of the study was that, “Antisocial behavior in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.”

The British Guardian newspaper recently ran a well-balanced article about some of these research initiatives.

This research is being replicated at various sites because if it is true it has enormous implications for personal well-being and for the whole concept of legal responsibility.

Could it be that some of society’s ills are the result of a failed uncontrolled experiment in force-feeding the population?

Hidden Harbingers of Weight: Salt Intake and Obesity

In Healing, Meaning and Purpose, I discuss some of the evidence for four previously little recognized causes of obesity:

1. Stress
2. Salt intake
3. Pesticides
4. Viruses

Each of these has been widely discussed in the professional literature, but little has percolated out into the general population except in advertisements for agents like Cortislim. I remain skeptical about these products. Tinkering with just one of the 260 hormones and neurotransmitters implicated in the control of weight is unlikely to be crowned with success. And their ingredients may also have the potential for causing problems. Recent advertisements have also mentioned that one of these products may elevate mood. Sad to say, in the last year we have seen two people who developed manic symptoms after taking one of the supplements. We are urging colleagues to see if there are any other cases, or whether these two were just coincidental.

I recently mentioned some of the evidence for viruses as a cause of weight gain.

Now a new publication from the Universities of Helsinki and Kuopio is out in this month's journal Progress in Cardiovascular Diseases, that provides powerful support for the salt hypothesis.

The researchers report that an average 30-35 % reduction in salt intake during 30 years in Finland was associated with an extraordinary 75 % to 80 % decrease in both stroke and coronary heart disease mortality in the population under 65 years. During the same period the life expectancy of both male and female Finns increased by 6 to 7 years.

As expected, reducing salt intake has a beneficial effect on blood pressure.

But in my view the most interesting finding of the study is the close link between salt intake and obesity.

As bartenders, pub landlords and tavern owners have known since the beginning of time, increasing a person's intake of sodium produces a progressive increase in thirst. (You didn't think that those peanuts on the bar were put there out of the goodness of the establishment's heart did you??!)

The progressive increase in the average intake of salt explains the observed increase in the intake of sugar-containing beverages which, in turn, has caused a marked net increase in the intake of calories during the same period in the United States.

Here is an extraordinary statistic: Between 1977 and 2001, energy intake from sweetened beverages increased on the average by 135 % in the United States. During the same period, the energy intake from milk was reduced by 38 %. The net effect on energy intake was a 278 kcal increase per person a day. The American Heart Association has estimated that, to burn the average increase of 278 kcal a day and avoid the development or worsening of obesity, each American should now walk or vacuum 1 hour 10 minutes more every day than in 1977. As we all know, that has not happened.

In the decade from 1976-1980 to 1988-1994 the overall prevalence of obesity increased 61 % among men and 52 % among women. During 1999 to 2002, the prevalence of obesity was 120 % higher among men and 99 % higher among women as compared with the 1976 to 1980 figures. The increased intake of salt, through induction of thirst with increased intake of high-energy beverages has clearly made a significant contribution to the increase of obesity in the United States.

It is also of note that until 1983 the use of salt did not change or even showed a continuous decreasing trend in the United States. The prevalence of obesity was relatively low and remained essentially unchanged from early 1960s to early 1980s.

This new study suggests that a comprehensive reduction in salt intake, which would reduce the intake of high-energy beverages, would be a potentially powerful means in the so far failed attempts to combat obesity in industrialized societies.

There is now conclusive population-wide evidence that indicates that we could achieve powerful beneficial health effects simply by reducing our overall salt intake. These benefits include a decrease in obesity.

As an aside, the population-wide long-term experience from Finland indicated that a remarkable decrease in the salt intake has not caused any adverse effects.

A number of years ago we were engaged in some experiments in which we replaced regular table salt - sodium chloride - with potassium chloride. For the first three weeks food seemed rather tasteless. But then we all suddenly discovered a new universe of flavors that had previously been hidden under a thick coating of salt. So a dietary change does have a temporary effect on your taste buds.

Although the paper doesn't say so, there is also some data that salt may itself increase cortisol release.

The bottom line?

We now have clear, empirical data to support three out of the four points that I made in Healing, Meaning and Purpose, and there is some less robust data for the fourth.

I urge you to try gradually to reduce your personal intake or salt, and to encourage your family and friends to do the same. I mentioned that food may initially seem a little less flavorful, but then things change rapidly and for the better.

And your body will love you for the change!

Renal Cell Carcinoma and Bread

Renal cell carcinoma (RCC) is the most common type of kidney cancer, and accounts for 2 percent of all adult cancers. It has been known for some time that diet plays a role in RCC risk, but attempts to identify which foods have harmful or beneficial effects have been inconclusive.

The smart money has been on foods that elevate insulin levels, because RCC is one of the cancers associated with obesity, and some RCC cell lines grow when exposed to insulin or insulin-like growth factors.

A new study by researchers form the Institute of Pharmacological Research "Mario Negri" in Milan, conducted a large case-control study of 2301 Italians. They found a significant association between high bread consumption and renal cell carcinoma. Eating a lot of pasta and rice may also raise the risk, while eating many vegetables may lower the risk. The study published online October 20, 2006 in the International Journal of Cancer, the official journal of the International Union Against Cancer (UICC), and is available via Wiley InterScience.

The researchers enrolled 767 adults diagnosed with RCC and 1534 controls who did not have the disease between 1992 and 2004. Two controls were matched to each case by gender, age range, and location. The researchers collected sociodemographic information, height, weight, lifestyle habits and personal and family medical history from each participant. They also administered a 78-item food frequency questionnaire which asked about the average weekly consumption for each item over the previous two years. They then performed statistical analyses to discover odds ratios (OR) with a 95 percent confidence interval.

They found a significant direct association was observed for bread consumption and a higher RCC risk. A modest non-significant risk increase was also observed for pasta and rice. On the other hand an increasing intake of poultry, processed meat, and all vegetables, both raw and cooked, all reduced the risk of RCC.

These findings confirm our guess about insulin and/or insulin-like growth factors. This association between elevated cereal intake (bread, pasta and rice) is most likely due to the high glycemic index  of these foods, leading to an over-production of insulin and insulin-like growth factors.

The inverse relationship between vegetable consumption is consistent with previous studies and may be related to their content of vitamins, micronutrients or elements such as carotenoids, flavonoids and phytosterols.

This is not a perfect study: it is limited by the fact that the interviewers who gathered each participant's information and administered the food questionnaire were not blind to who was who. But its big strengths include the sample size and the reproducibility and validity of diet information.

This study is important and speaks to the point that we have made before: a balanced diet is key, and your body does not want to be exposed to constant variations in glucose or insulin.

It also confirms all the advice that we have been offering you about what and when to eat. Click on the links to review what I have said before!

Breast is Best, But…

I think that everyone knows that breastfeeding confers considerable advantages on a baby. So much so that the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. Though some mothers cannot manage this for a whole range of reasons, and it’s always a real shame when women are made to feel guilty if they cannot breastfeed.

Amongst some of the likely health benefits for both mother a baby:

1. Mother and child are more likely to bond
2. A reduced risk of the child developing some respiratory problems, ear infections and gastrointestinal problems
3. A reduced risk of developing allergies later in life
4. A reduced risk of obesity in adulthood
5. A reduced rate of attention deficit disorder
6. A reduced risk of developing type I diabetes
7. There may also be a reduced risk of developing osteoporosis in later life
8. The mother has a reduced level of stress and postpartum bleeding
9. Mothers who breastfeed have a slightly reduced risk of some types of cancer

To this list we can add that breastfed children are more intelligent. That is not a new discovery. It was first reported in the 1920s. A new study published in the British Medical Journal has re-examined the question. Most of the earlier studies failed to consider the mother’s intelligence, despite the well-recognized association between maternal education and breastfeeding. That association often breaks down in professional women who have to go straight back to work after giving birth, but it remains a key variable.

The researchers examined data from 3,161 mothers and 5,475 children, who were followed in a twenty-five year prospective study. Premature babies were excluded and the children’s’ intelligence was measured up to age five.

The breastfed babies had slightly higher IQs, but the effect was entirely accounted for by their mothers’ intelligence. Breastfeeding itself had little or no effect on intelligence scores. The mothers of the breast-fed children tended to be older and to be more likely to provide the growing child with a stimulating and supportive home environment.

In a separate study from the Australian Raine Study at the Telethon Institute for Child Health Research, that has tracked the growth and development of more than 2500 West Australian children over the past 16 years, it now emerges that children who were breastfed for longer than six months have significantly better mental health in childhood.

Children that were breastfed had particularly lower rates of delinquent, aggressive and anti-social behavior, and overall were less depressed, anxious or withdrawn. This makes sense: apart from the psychological impact of having a mother who is willing and able to breastfeed, breast milk is a rich source of polyunsaturated fatty acids - examples include docosahexaenoic acid and arachidonic acid - that are important for brain development and the growth of nerve cells.

There is also evidence that breastfeeding may reduce the risk of developing schizophrenia later in life, although it is difficult to be sure if it because of the breast milk itself or the kinds of mothers who breastfeed.

Another Reason to Eat Your Greens

“Health requires healthy food.”
--Roger Williams (Indian-born American Chemist who did pioneering work on the Vitamin B Complex, 1893-1988)

Earlier this year several news outlets including Time picked up a story that has been causing a great deal of discussion in medical circles.

Most of us have been extolling the virtues of fruits and vegetables for decades, but it’s always nice to have an extra piece of evidence to support what we’ve been saying. The question has been how to go from large-scale epidemiological studies proving the benefits of vegetables to the inner workings of a person’s arteries.

Investigators from Wake Forest University School of Medicine in Winston-Salem, North Carolina published an important study in the Journal of Nutrition. What they did was to study genetically altered mice, who had been bred to have a very high risk of developing rapid arteriosclerosis: the formation of fatty plaques in the arterial wall that can eventually block blood flow and lead to heart attacks and stroke.

Half the mice were fed a vegetable-free diet and half the mice were fed a diet that included broccoli, green beans, corn, peas and carrots.

After 16 weeks, the researchers measured the cholesterol content in the blood vessels and estimated that plaques in the arteries of the mice were 38% smaller. Cholesterol, and particularly the “bad” cholesterols VLDL and ILDL fell markedly in the mice on the healthy diet, but these improvements were not on their own enough to explain the improvement in the blood vessels: the anti-atherogenic effects of the vegetable diet remained largely unexplained by the variation in plasma lipoproteins or body weight.

There was a 37% reduction in serum amyloid - a marker of inflammation in mice - suggesting that consuming vegetables may inhibit inflammatory activity. This is line with data from other studies indicating that fruit and vegetables should be key components of an inflammation-lowering program. This is very important: in the last twenty years it has become very clear that arteriosclerosis is intimately associated with inflammation in the arterial wall.

Many inflammatory conditions including rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus and psoriasis, are all associated with an increased risk of developing arteriosclerosis.

Interestingly some years ago Dean Ornish presented evidence indicating that diet and exercise could reverse arteriosclerosis. I’ve always found Dean’s work interesting, well done and persuasive. It surprises me to see how many people remain unconvinced. This new research provides indirect support for his work.

The average person only eats three portions of fruit and vegetables a day: we should all be eating at least five, and they should be of as many different colors and types as possible: there is excellent evidence that combinations of fruits and vegetables are much better for your health than just eating one or two types.

As an aside, I must admit that I’m no fan of animal experiments: I don’t and won’t do them. And every time that I hear about them, I think that we need to say a sincere thank you to the animal kingdom for their sacrifice in helping us.

“God, in His infinite wisdom, neglected nothing and if we would eat our food without trying to improve, change or refine it, thereby destroying its life-giving elements, it would meet all requirements of the body.”
--Jethro Kloss (American Nutritionist and Writer 1863-1943)

“In fresh fruit and vegetables and nuts are all the vitamins and minerals and high grade proteins the human body needs to bring it to a state of physical perfection and to MAINTAIN it in that state indefinitely.”
--Herbert Shelton (English Evolutionary Philosopher, 1820-1903)

“Nothing will benefit human health and increase the chances for survival of life on earth as much as the evolution to a vegetarian diet.”
--Albert Einstein (German-born American Physicist and, in 1921, Winner of the Nobel Prize in Physics, 1879-1955)

Glycemic Index Revisited

If you are anything like me, you probably find loads of adverts in your mailbox for magical ways to lose weight, either by using some form of the Atkins diet, manipulating cortisol (it doesn’t work), or by paying attention to the glycemic index of the food that you eat.

Last January I summarized some of the recent research that showed that glycemic index and glycemic load were not related to measures of insulin sensitivity or secretion, or to the amount of fat in the body. However, the intake of fiber in the diet was found to have beneficial effects on insulin sensitivity, adiposity and the secretion of insulin by the pancreas. I went on to give some uncontroversial advice on how to eat.

Nobody thought that the glycemic index issue was dead: insulin and the other hormones involved in fat and carbohydrate metabolism are powerful and have multiple roles in the body.

A study published in the Archives of Internal Medicine in July, helps further refine our understanding about glycemic index. High carbohydrate foods with a low glycemic index are the best way to reduce your risk of cardiovascular disease. The problem is that you want to avoid sudden surges in glucose after you eat a meal. What normally happens is that those surges are accompanied by sudden rises in triglycerides and insulin. The three together can cause all kinds of mischief to the insides of your blood vessels. High protein and low glycemic index diets will help with weight, but it’s only the combinations of high carbohydrates with low glycemic index that reduces the risk of vascular disease.

My redoubtable Web Mistress, Carol Kirshner, has found a most useful resource at the University of Sydney, that you can use to help guide your food choices.

This is such a useful resource that we are going to attach it to our blogs and websites.

However, it’s essential that we don’t get seduced by the idea that high carbohydrate/low glycemic index eating is the solution to all of our ills.

We still need to follow the basic principles of a balanced diet:

1. It is important for you to maintain your energy balance, between input and output
2. Calories do count
3. What you include in your diet is as important as what you exclude: we are designed to consume not just rice and lettuce, but an array of other nutrients
4. Make only moderate dietary changes at any time: making big dietary changes can be a violent attack on your body and your mind
5. Avoid the “trans-fatty acids”
6. Try to consume some Mercury-free omega-3 fatty acids every single day
7. Eat fewer simple carbohydrates
8. Use weight management and exercise strategies that enhance your overall health and well-being
9. Take more exercise: even small amounts can have a big effect.
10. Make it a goal to gradually reduction your overall intake of cereals

Banquo’s Ghost

“Chess is the game which reflects most honor on human wit.” -- Voltaire (a.k.a. François-Marie Arouet, French Writer and Philosopher,  1694-1778)

For anyone with even a passing interest in chess, a re-unification match for the World Championship is currently taking place in Elista, the capital city of Kalmykia, a small region of the Russian Federation that is Europe’s only Buddhist country. Though I’m sure that some would quibble about whether it should be in Europe or Asia.

The beginning of the match between two of the world’s top Grandmasters - the aggressive Bulgarian gambler Veselin Topalov and the conservative Russian, Vladimir Kramnik - has led to and 2-0 score in favor of the Russian.

So why am I mentioning this is a blog dedicated to Personal Growth, Healing and Wellness? Because the current one-sided score line has a lot to do with each of these topics. This match is not just about chess playing ability: it is also about psychological and emotional strength, character and resilience.

There was a time when chess masters were unfit, often over-weight and the majority smoked. When I first started playing in tournaments in England, it was quite normal to have ashtrays beside most of the boards.

Oh how things have changed!

Now the players prepare physically, psychologically and some even spiritually with prayer and meditation:

1. Very few players smoke, not just because of long-term health risk, but because the deleterious effects of lowered oxygen levels on cognition outweigh the short-term improvement in attention caused by nicotine.
2. Aerobic exercise is essential to ensure that the brain is perfused with oxygen, and if you are physically unfit you cannot expect to survive a number of games that may each last for five or six hours.
3. Strength training is also essential to overall fitness and physical and the maintenance of psychological resilience. Topalov is going to need that now.
4. Posture is extremely important. According to Chinese and Ayurvedic physicians and chiropractors, bad posture results in a restriction in the flow of Qi, Prana, or blood. Whether or not you believe in the flow of Qi in the body, it is easy to demonstrate that bad posture has bad effects on cognition.
5. Flexibility is also an essential part of physical wellness that affects you psychologically as well as physically. Daily stretching should be part of everyone’s life.
6. Relaxation and meditation: one or other or both are essential tools for maintaining your balance while under stress, and for building resilience.
   
7. Diet: a carefully balanced nutritious diet rich in omega-3 fatty acids (without any added mercury!) and fiber is essential for optimum mental functioning.
8. Fluid intake: the current recommendations are for a healthy person to drink between 80 and 120 fluid ounces of pure water each day.
9. Avoid alcohol: A former World Champion – Alexander Alekhine – lost his title after turning up drunk on a number of occasions during a match to defend his title.

Looking at the pictures from the match, in both games Topalov looked intense and Kramnik far more relaxed. It could have been an illusion: I would need to be in proximity to be sure. In the first game Topalov took a needless risk in a dead level position. In the second, he had an absolutely won game. I’m no grandmaster, but even I spotted a win in three moves. How could he have failed to find it and then lost?

What is the explanation? Chess players have to play a certain number of moves in a specified time, so not only are they playing their opponent, they are also playing against the clock. The biggest prize in the game is on the line, for which both players have been preparing since childhood. And there are hundreds of thousands of people who are watching and analyzing their every move.

I know from personal experience that it can be hard enough to be interviewed on a television show being watched by millions of people, where any false statement would haunt me forever. Imagine having a battle of wits with one of the finest chess players in the world in the knowledge that every move will be analyzed for the next century, and computers are already analyzing every permutation of every move that the two players have made.

The stress on the players is unbelievable. Both have prepared for it, but it is also a matter of who has prepared best: that is a mixture of temperament and training. Just today I read an article talking about ways of avoiding stress. This is silly: stress is part of life and it can provide the motor in motivation. The trick is how we learn to respond to stress.

There is also another stressor that has only been felt by world championship contenders on two or three previous occasions. This match is being played in the shadow of the retirement of Garry Kasparov, who, in the opinion of most people, is the strongest player who ever lived, with the possible exception of Bobby Fischer. The difference is that Bobby became World Champion all by himself, with little help and by inventing a new approach to chess. It is a great tragedy that his life has apparently been blighted by mental illness, and that he has played only a few recorded games in the last 34 years.

By contrast, Garry was the strongest player in the world for twenty years, and in the opinion of most experts would probably still beat both of the current contenders. So whoever wins wants to prove himself a worthy champion. Garry’s specter remains like the ghost of Banquo in the Scottish play.

The final essential is that both players have to detach from the results of the first two games. Kramnik will obviously have his tail up now, but he is too smart and too experienced to give in to complacency. Topalov has to completely forget about the first two games and focus on what lies ahead: I’m sure that he has someone on his team working on simple techniques to stop the past from populating his psychological present.

Whatever lies ahead for these two men in the next few weeks, we shall see that chess is a microcosm of life in general.

“What is needed, rather than running away or controlling or suppressing or any other resistance, is understanding fear; that means, watch it, learn about it, come directly into contact with it. We are to learn about fear, not how to escape from it.” --Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)

Acids and Alkalis

Have you seen those books and advertisements about supplements that are supposed to “alkalinize” your body and therefore avoid the effects of nasty acids? Many have frightening titles, like “Alkalinize or Die.” Some time ago I read a whole bunch of these books while I was trying to help two people with interstitial cystitis. This is a nasty problem, and I had failed to help with conventional medicine, naturopathy, acupuncture or homeopathy. One of the many books that I read claimed that altering the acidity of the urine would cure the problem. It did not.

The basis for these claims that we need to alkalinize our bodies comes primarily from three sets of observations:

1. That manipulating the external environment of cells in culture and isolated organs can have dramatic effects on the activity and life expectancy of these cells and organs
2. That some of the products of exercise or metabolism are acidic, and so need to be buffered or expelled from the body
3. A great many anecdotes about people benefiting from following an “alkalinization” protocol of some sort.

That all sounds good, but it is a big jump to go from cells in culture and perfused organs to whole human beings. Or to base medical advice on anecdotes ALONE.

There is also another origin for some of these ideas, and they derive from the work of Edgar Cayce and some oriental healing traditions: I have enormous respect for both.

I'm a card-carrying biochemist and metabolic physician, so some things about acid/base balance I know well.

Our blood is maintained at a pH of 7.42, and even the tiniest shift can cause major health and psychological problems. So there are sophisticated systems for keeping things in balance. Most of the popular books fail to mention much about the easiest way to change pH, and that is by changing your rate of breathing!

We show people how to do that every day in clinical practice. And when doing electrical recordings of the brain – electroencephalograms - hyperventilation is a good way of inducing some types of abnormal electrical activity.

We know a great deal about how changes in the pH of the blood can impact behavior and many physiological approaches. I’ve worked with hundreds if not thousands of people with disturbances in the acid/base balance of their bodies. Usually as a result of diabetes that was out control, but also scores of other illnesses. Many of them rare but educational.

The populist writers then often talk about excess acid being a stressor. So we don’t want to have acid in our systems because it depletes the alkaline buffers that are supposed to keep things in balance. An interesting idea, but one that can quickly be shown to be deeply flawed. It’s easy for a biochemist to calculate the amounts of acid in single cells, organs and the whole body. We’ve done it thousands of times when treating people with medical conditions like diabetic ketoacidosis and lactic acidosis.

Sadly some of the writers of popular books and articles on acids and alkalis have clearly not studied the literature in any detail.

There have also been some examples of what we call the “Trudeau effect:” vague comments about studies that are supposed to have been completed, but which, if they have been read at all, have never been analyzed by the writer. And often odd statements from books and from research are taken out of context and cited as the Gospel truth. There’s a legal loophole that Trudeau and some others get away with saying things about health that are not supported by any data.

Levels of Evidence
An important concept is what we refer to as levels of evidence. In the past it was often thought that the only kind of evidence to be of any value in clinical decision making had to have been obtained by randomized controlled trials. Yet we all know from experience that there are other types of evidence. A teacher or a colleague may have recommended a course of action based on experience or observation, and this can provide valuable guidance. We now recognize four types of clinical evidence:

1. Case reports
2. Case series and uncontrolled observational studies
3. Retrospective database analyses
4. Controlled analytic studies, including randomized clinical trials

You will see from this is that even single case reports go into the mix. Numbers one and two and used not as proof, but as ways to generate testable hypotheses.

If you tell me that you have slept better since you started an alkalinization regimen, I’ll see if what you are doing can be applied to others (that’s a pragmatic study), and also whether there could be an explanation for your report (that will need an analytic or mechanistic study).

When we review evidence or perform meta-analyses we give each type of evidence a rating. Controlled studies are given a higher rating than case reports, because the evidence can be generalized to many individual patients. A further refinement is to factor in the source of the study. So research by a pharmaceutical company or a manufacturer of an herbal supplement tends to get a lower rating than an independent study.

Recently someone did indeed tell me that she had slept better since following a special diet. When we looked carefully at the protocol that she was following, it was probably not the alkalinization, but the hops in the diet.

There are many, many claims of health benefits from various diets. The benefits may be genuine, but we need to be very cautious about attributing the success of a diet or any other form of treatment to just one factor.

There is no question that some illnesses, for instance peptic ulcers or gastro-esophageal reflux disease can be made worse by eating an acid diet, and having acid urine can sometimes be very irritating to the bladder.

But the evidence for the benefits of alkalinizing of the whole body – even if it were possible to do it - just does not exist.

You also need to be aware of a potential consequence of "alkalinizing diets:" they can dramatically alter the absorption of some herbs, medicines and supplements.

So what should you do?

1. The key to any diet is balance: it would be a mistake to be on a diet consisting of just one thing. Experts are always very wary of health claims based on one juice, herb or supplement. Your body is not designed that way: you need a mixture of different fruits and vegetables. When someone tells us that the key to healing is a berry that can only be found in a hidden valley in the Himalayas, we have to ask, “How could that have happened?” How could it be that we evolved or were created with a key ingredient missing?
2. Avoid drinking carbonated drinks. The old story about a can of Pepsi Cola being a good way to remove oil from your driveway is true. In high school we did the experiment of taking a small nail and leaving it in a sealed container with some carbonated soda. The nail had largely dissolved inside a week.
3. Keep up your intake of pure water. The current recommendations vary depending upon the time of year and where you live. In the Southern United States, during the summer time, it is currently recommended that you should drink 120 fluid ounces of pure water each day. I personally prefer pure spring water or distilled water. But also bear in mind that if you choose not to drink fluoridated water, that your chance of dental cavities increases. You can get around that problem by applying fluoride directly to your teeth and then rinsing it out. Ask you health care provider about that.
4. Listen to you body: you should avoid anything that feels irritant, causes indigestion, diarrhea or urinary symptoms
5. Use you intuition: the answers are within you. One of the most valuable uses of your intuition is not to help you pick lottery numbers, but to help you make wise decisions about your body, your relationships and your subtle systems. I have already written a little about some techniques for listening to and amplifying your intuition, and I shall soon be writing and recording a lot more about those essential topics.

Restless Legs Syndrome and Integrated Medicine

In the last entry we looked at RLS: what it is, and some of the conventional approaches to treating it. I now want to spend a moment talking about some of the other approaches that we have tried. For most of these there is very little evidence, so we use them in conjunction with conventional medicine.

If you want to try any of them, discuss them with your health care provider, so that he or she can guide you toward the best ways of putting treatments together.

1. Diet: A low sugar diet helps some people, and it is always worth keeping a food diary for a week to see if there’s any association between something that you’ve eaten and a worsening of your symptoms.
2. If you like juicing, there have been a number of anecdotal reports of the use of carrot, celery and spinach juices helping some people. (I am writing this while we are still in the middle of the spinach/E. coli scare, so leave this one out until the FDA has given us the all clear.
3. There have been publications about the use of vitamins E and B and folic acid in RLS. Vitamin E can cause a GI upset in some people and if used in too high a dose (above 800IU/day) may elevate blood pressure; folic acid has to be used with caution in people on anticonvulsants. If you try these options, bear in mind that no supplement is likely to work unless it is taken for at least a month.
4. Acupuncture sometimes helps: there are three acupuncture points in the legs that come up in the prescription: Urinary bladder 57, Spleen 6 and Stomach 36.
5. Homeopathic remedies have been reported to help, and I’ve had some success. The precise remedy always depends on the precise characteristics of the individual, but the most common ones have been Rhus Toxicodendron, Causticum, Tarentula Hispanica and Zincum Metallicum. If you live in a place in which there are good homeopaths available for consultation, it’s another option.
6. Several herbal remedies have been reported to help: Passion Flower, Cimicifuga, Valerian, Black Cohosh and Piper Methysticum. Just remember that some of the herbs sold in health food stores don’t contain what they should, and Valerian and Black Cohosh have recently been associated with liver toxicity in some people.
7. Here is an old trick from China: take a one inch piece of fresh ginger root and grate it into a bowl of warm water. Then soak your feet in the water for about ten minutes. I’ve never seen that one work myself, by some people whom I respect have.

I also think it important not to neglect the psychological aspects of this problem, and sometimes some psychotherapy can be a helpful adjunct.

Finally, ask yourself what the RLS is trying to teach you.

These are all options that have been tried and have helped some people. If you are not having success from conventional medicine alone, or if you don’t care for conventional medicine, then discuss these options with a professional, use your intuition, and let us know if you have success.

Prostate Cancer, Shift Work and Vitamin D

One out of six American men will develop prostate cancer and more than a third of them will experience a recurrence after undergoing treatment, putting them at high risk to die of the disease.

A study from Japan in this month’s issue of the American Journal of Epidemiology, reports prospective research that examined the association between shift work and the risk of prostate cancer incidence among 14,052 working men. Compared with day workers, people who worked rotating shifts were significantly at risk for prostate cancer whereas fixed-night work was associated with a small and non-significant increase in risk. This report is the first to reveal a significant relation between rotating-shift work and prostate cancer. Previous research has found that shift work may be linked to an increased risk of breast and colon cancer.

It’s important not to jump off the deep end: we are long way from saying that sleep disturbance is linked to prostate cancer. But it is another piece of evidence suggesting a link between environmental factors and genes, since there are a number of genes that may increase a man’s risk for prostate cancer.

However, there have now been several reports that disturbances in normal body rhythms might be linked to some cancers and this report adds to that evidence. It has never been shown that the actual sleep disturbance itself is responsible for the slight increase in risk seen in these studies. It could also be that people with abnormal sleep patterns are more likely to be doing something else, for instance smoking or eating junk food that would interfere with sleep and increase people’s cancer risk.

But here’s something to think about: shift workers have been found to have reduced secretion of the sleep-inducing hormone melatonin. Melatonin has also been shown in some studies to have some potential anti-cancer effects. The studies are controversial and certainly not conclusive, despite what one or two melatonin manufacturers may say. But something that is true is that reduced secretion of melatonin has been linked to increased production of sex hormones, which play a role in regulating prostate tissues. Under normal circumstances, secretion of the hormone is low during daytime, increases soon after the onset of darkness, peaks in the middle of the night, and gradually falls until morning. In shift workers the melatonin cycle becomes disrupted.

There has been some recent evidence that maintaining adequate levels of vitamin D may reduce a man’s risk of prostate cancer.

Another study, this time on pancreatic cancer and led by Northwestern University in Illinois has indicated that taking the US Recommended Daily Allowance (RDA) of vitamin D (400 IU/day) reduces the risk of pancreatic cancer by 43%. It is published in this month’s issue of Cancer Epidemiology Biomarkers & Prevention. This does not mean that we should start taking vitamin D supplements to reduce our cancer risk. But it ties in with research indicating that some exposure to sunlight might actually reduce the risk of some cancers. But all things in moderation: malignant melanoma and basal cell carcinoma of the skin have been increasing with increased exposure to sunlight.

Curry and Cognition

During a visit to Singapore a couple of years ago, I heard about some interesting research that's just been published in the American Journal of Epidemiology.

The authors did something fairly simple. They took a group of 1,010 people with no evidence of dementia aged 60-93 years, and correlated their consumption of curry with their cognitive performance. Studies like this are not easy: what if more intelligent people like eating curry to begin with? What if sick people can't get out to the local curry house? And so on.

But the researchers did this all very carefully: they took into account all the known sociodemographic, health, and behavioral determinants of performance on a simple cognitive test. So they controlled for many of the other factors that can accelerate cognitive decline, like depression, smoking, drinking alcohol, high blood pressure, glucose and lipids.

The result was that people who occasionally or often ate curry had significantly better cognitive function than people who "never, or rarely" ate curry.

Is there any logic to this?

Well in fact there is. Curcumin, from the curry spice, turmeric, has been shown to possess potent antioxidant and antiinflammatory properties and to reduce beta-amyloid and plaque burden in experimental studies. There have been serious suggestions about using active constituents of tumeric to try and prevent the development of Alzheimer's disease.

This research is all very encouraging. The amount of curcumin used in the experimental studies is similar to the amount ingested by having a couple of curries a week, and now the epidemiological study from Singapore suggest that those couple of curries may have a clinically measurable effect.  That's not to say that eating curry three times a day is going to be even better.

All things in moderation: too much curry can play havoc with your digestive processes.

And your relationships....