Nutrition

Sandra Goodman

A considerable body of nutrition and epidemiological research, ongoing for decades, internationally, has been focused upon determining the potentially therapeutic and preventive effects of various dietary components - fruits, vegetables, red meat, fat, antioxidant vitamins - upon the major diseases afflicting the majority of "developed" populations - cancer, heart disease and ageing. Amongst this burgeoning research literature are included a large number of clinical trial studies of many types - randomised, single and double-blinded and placebo-controlled and crossover - researching the effect of single or multiple dietary or nutritional components in the treatment of disease.

However, despite the huge amounts of research funding evidently dedicated to nutritional research in health and disease, and the large teams internationally of expert scientific and medical personnel responsible for conducting and publishing the above-mentioned research, the compelling results of the past few decades' nutrition research would appear to be a hugely well-guarded secret, known mainly to those scientists and researchers who read the scientific literature.

From reading the above selected assortment from the published nutritional literature, one would expect that physicians would be exploring or offering their patients nutritional treatment options, sometimes in conjunction with other standard treatments for many of the most common ailments - allergies, asthma, arthritis, heart disease, even cancer. However, despite the existence within the medical professional of a branch called "Nutritional Medicine", nutrition appears to be a subject of which the majority of physicians admit to a glaring ignorance.

Why there exists this incredible vacuum around the huge evidence of nutritional research is beyond the understanding of the author. The research is published in journals for the entire world community to read. Yet, nutrition is apparently totally missing from the curriculum of the majority of medical schools, so that the extent of nutritional knowledge gleaned by the general physician is generally confined to arguably out-moded notions of what constitutes a "balanced diet" and recommended daily allowances (RDAs) of certain vitamins, below which levels deficiency diseases such as beri beri and scurvy occur. Considering that health-promoting nutrition is such a basic and fundamental requirement for good health, and that every person must eat to remain alive, the omission of this most universal medical tool from the physician's armament of knowledge and experience is a tragic opportunity wasted.

Furthermore, nutritional approaches to illnesses such as cancer, heart disease, diabetes or cystic fibrosis are rarely mentioned in the written or broadcast media. Numerous television programmes which have been devoted to illnesses such as cancer have overflowed with advice about lifestyle, stress reduction, even massage, but regarding treatment, nutrition is hardly ever mentioned - usually only the mandatory approved treatments - surgery, radiotherapy or chemotherapy. Any mention of nutritional approaches to cancer is often framed in a derogatory manner, assuming "quack" or even cultic bizarre practices.

Various dietary regimes which appear to be successful for some cancer sufferers, including vegetarian, raw food, fruit, macrobiotic, or the Gerson regime are marginalised and defamed, and practitioners daring to suggest a dietary approach may be subjected to criminal litigation or even be struck off the medical registers. It is astonishing that hard evidence demonstrating that low blood levels of vitamins A, C, E and carotene are related to high overall cancer mortality is rarely broadcast, nor that risk of premenopausal breast cancer is more than halved in women whose diet is high in vegetables and fruits, or that two-thirds of all colorectal cancer cases in Italy can be attributed to 5 dietary risk factors - low beta-carotene and vitamin C intake, red meat consumption, seasoning fat intake and increased daily meal frequency.

The situation with respect to cardiovascular diseases - heart attack, stroke, hypertension - is similarly dominated by medical, surgical and pharmacological approaches. There is much discussion and reporting of cholesterol-lowering drugs, ACE inhibitors, aspirin and triple-bypass surgical techniques, whereas the significant effects of dietary and lifestyle changes in cardiovascular disease are so often placed on the periphery or omitted altogether. Non-invasive techniques such as EDTA chelation (the intravenous infusion of a combination of antioxidant and antiatherogenic nutrients) which has been successfully performed for decades, are rarely mentioned, let alone on offer by the majority of physicians.

It must be remembered that what is published today in the research literature regarding the positive therapeutic effects of antioxidants, essential fatty acids and coenzyme Q10 is frequently the results of decades of intensive research. Twenty-five years ago, eating a diet high in organically grown fruits and vegetables, pulses and taking vitamins was considered by society-at-large to be an aberrant or fringe life-style. Today, the recommendations of major national and international health organisations and governments espouse exactly such practices!

Recently, the issue of a "healthy diet" has now been given more prominence, largely in light of evidence placing the UK almost at the top of the mortality from heart disease league tables. Elevated mortality from heart disease in the UK and Scotland especially have been linked with a high-fat, low fibre diet and a conspicuous lack of fresh fruit and vegetables.

The proportion of overweight or obese adults is approaching 50%, due mainly to consumption of high-fat and protein, low fibre diets and sedentary lifestyle. These trends, taken together, add up to a lethal cocktail of ill-health, disease and suffering into the next millenium, unnecessary in that the prescription for most healthy adults to reverse these trends, relies upon saliently simple nutritional practices of consuming a diet replete with fresh fruits and vegetables, whole grains, restraining alcohol overconsumption, taking moderate exercise and managing stress. This is not to say that adoption of the above measures will prevent or cure all cancers and heart disease, as clearly they are multi-factorial in nature, but the published nutritional research clearly points the way to better health and the prevention of much disease in the general population.

Moreover, campaigns for the implementation of a more healthy diet appear to run into snags at many levels - from attacks in the media about the "food police", and sarcastic sniping at food scares - to protests from the food industry over reports that nutrients such as sugar may be detrimental to health. Popular food programmes on television attack, ridicule and over-emphasise the dangers of taking nutritional supplements, while cooked with large quantities of fat and sugar, and the obligatory gustatory tasting of wines. People's reluctance to adopt healthier dietary and lifestyle practices is also a major impediment to achieving better health.

However, the disastrous events over the past decade which have posed serious dangers to public health - salmonella, listeria, BSE and CJD and the development of super-resistant bacteria - which have their origins in intensive agricultural and livestock handling techniques, have struck deep into the public psyche, and will hopefully, be a powerful ally in enabling the implementation of better (organic) farming, dietary and nutritional habits.

Dr Sandra Goodman is the publisher and editor of 'Positive Health' magazine. Publications: 'Nutrition and Cancer: State of the Art' (1995), 'Cancer and Nutrition - the Positive Scientific Evidence' (1994), 'Vitamin C - the Master Nutrient' (1991), 'Germanium - the Health and Life Enhancer' (1988).

General Clinical Nutrition References

***Stewart Alan (Dr) and Davies Stephen (Dr). (1987). Nutritional Medicine: The drug-free guide to better family health. Pan Books. ISBN: 0-3302-8833-4.
This is my personal favourite nutritional bible. A superb compendium of information about all the nutritional elements, as well as their application to illnesses. Extremely well-referenced and with extensive case studies, recommended dosages, and instructions for elimination diets.

***Werbach Melvyn. 1990. Nutritional Influences on Illness: A Sourcebook of Clinical Research. Keats Publishing. ISBN 0 8798 3531 1.
Melvyn Werbach, MD is one of the world's leading nutritional scientists. An indispensable reference (504 pages). Contains summaries regarding the scientific evidence for the major supplements, chapters regarding laboratory methods of nutritional evaluation, nutrient bio-availability and interactions, as well as thousands of clinical studies.

***Murray, Michael, ND. 1996. Encyclopedia of Nutritional Supplements: The Essential Guide for Improving Your Health Naturally. Prima Pub. ISBN 0-7615-0410-9.
Michael Murray is a leading naturopathic physician in the US. An indispensable reference book (576 pages); each chapter describes vitamins, minerals, essential fatty acids, nutrients, and recommended supplements to take for health conditions including cancer, arthritis, depression, allergies and heart disease. Extensively referenced.

***Barnard, Neal, MD. 1999. Foods that Fight Pain: Revolutionary New Strategies for Maximum Pain Relief. Bantam Books. ISBN: 0-5538-1237-8.(460 pages)
Dr Neal Barnard discusses the fundamental causes of, and nutritional approaches to, circulatory conditions such as back and chest pain, inflammatory conditions including migraine and other headaches, arthritis, stomachache and other digestive problems including ulcers, Crohn's, ulcerative colitis and diverticulitis, fibromyalgia, hormone-related conditions including menstrual pain, breast and cancer pain, and metabolic and immune conditions such as carpal tunnel syndrome, diabetes, herpes and shingles, kidney stones and urinary infections. Topics include food sensitivities, infections, how plaque (and clearing it) can be implicated in back pain, how oestrogen dominance can contribute to menstrual pain and how eating oestrogen "calming" foods such as starflower oil, and phytoestrogens such as found in vegetarian diets can alleviate pain. He also goes into considerable detail about the benefits of using Natural Progesterone transdermal cream (Progest) for treating menstrual pain and endometriosis. There are about 100 pages of recipes prepared by Jennifer Raymond, herself a sufferer of joint stiffness, who developed delicious recipes for a wide variety of dishes. The book is extensively referenced with hundreds of published scientific research articles and also provided are contact details for organisations and a recommended reading list. This book is required reading both for nutritional practitioners as well as for sufferers of pain.

**Passwater Richard, Ph.D. 1995. The New Supernutrition. Pocket Books. ISBN: 0-6717-0071-5.
Richard Passwater is a world leader in research about vitamins, minerals and trace elements. In this book (337 pages) he provides programmes of "supernutrition" to prevent effects of ageing, protect against illnesses such as diabetes, cancer, heart disease, arthritis and osteoporosis. He also discusses newer supplements including pycnogenol, coenzyme Q-10, quercetin and many more.

Cancer

***World Cancer Research Fund (WCRF) in association with American Institute for Cancer Research (1997). Food, nutrition and the prevention of cancer: a global perspective. World Cancer Research Fund. ISBN: 1-8995-3305-2,
105 Park Street, London W1Y 3FB. Tel: 0171 343 4200; Fax: 0171 343 4201. This epic tome, probably the best collection of scientific evidence ever assembled into one text, is some 700 pages long, and cites more than 3,000 references, regarding the following topics:

1. patterns of diet and cancer;
2. diet and the cancer process, including the genetic and molecular processes of cancer initiation, promotion and progression;
3. the types of scientific evidence published;
4. 18 distinct types of cancer and how they are affected by food and nutrition;
5. dietary constituents, i.e. carbohydrates, energy factors, fats, proteins, alcohol, vitamins, minerals;
6. foods and drinks, i.e. grains, vegetables and fruits, pulses, nuts and seeds, meat, poultry, fish, eggs, milk, coffee, tea and other drinks;
7. food preparation, including contaminants, additives, processes such as curing, salting and other cooking methods.

The evidence is graphically illustrated with charts, colour drawings, and tables listing, in great detail, the scientific literature from which the text is drawn.

Some 15 distinguished international scientists assembled this massive amount of evidence which, in short, concluded the following with regard to cancer prevention:

1. That 30%-40% of all cancers, representing the prevention of some 3-4 million cancer case each year, could be prevented using appropriate diet, physical activity and maintaining proper body weight;
2. That diets with substantial and varied amounts of fruits and vegetables could prevent 20% or greater of all cancer cases;
3. That if alcohol consumption were maintained within recommended limits, up to 20% of aerodigestive tract, colon, rectal and breast cancer cases could be prevented;
4. That appropriate diet could prevent most stomach cancers and that colon and rectal cancers are mainly preventable by diet, physical activity and appropriate body weight.

***Olivier Suzannah. 1999. The Breast Cancer Prevention and Recovery Diet. Michael Joseph. ISBN: 0-7181-4395-7.
This book is set to become an all-time indispensable reference book, not only for cancer, but for nutrition in general. Large, (433 pages), extensively referenced, and with case studies, recipes and menus, as well as a large list of organisations, Suzannah Olivier has produced an exceptionally useful book. Herself and breast cancer survivor of 10 years, Suzannah Olivier brings together a huge amount of information about all aspects of nutrition, particularly regarding the environmental and hormonal components modulated by many of the pesticides, hormones, xenobiotics and antibiotics used in modern agriculture.

**Goodman Sandra, Ph.D. 1995; 1998. Nutrition and Cancer: State of the Art. Positive Health Publications Ltd. ISBN: 0-9533-5180-7.
This book is drawn from the 5000-record database established by this reviewer in 1993 for the Bristol Cancer Help Centre. 143 pages, the book provides extensive references to the scientific literature regarding published articles regarding prevention and treatment of cancer by nutritional elements, including vitamins, minerals, essential fatty acids and dietary regimes. The text of the book is also published on Positive Health's extensive internet site - www.positivehealth.com. From the home page, select Articles, then Cancer.

Food and Diet

**Van Straten Michael. 1999. The Healthy Food Directory. Newleaf, an imprint of Gill & MacMillan Ltd. ISBN: 0-7171-2881-4.
Michael van Straten has assembled an excellent compendium (225 pages) of every sort of food, with each section covering an individual food group, including various diets (Mediterranean, vegetarianism, macrobiotic, food combining, exclusion and convalescent); fruit; vegetables; nuts, seeds and pulses; meat, fish and shellfish; starchy foods; dairy foods and eggs; herbs, spices, vinegars and fats; sweet foods and drinks; and vitamins and minerals. There is an extremely useful chapter about the properties of fats and oils, including short essays about the different types of fats, including saturated, polyunsaturated, mono-unsaturated, essential fatty acids and trans fats, as well as entries about cholesterol, butter, margarine, vegetable and olive oils.

**Wills Judith. 1998. The Food Bible. The Ultimate Guide to all that's Good and Bad in the Food We Eat. Quadrille Publishing Limited. ISBN: 1-8999-8897-1.
This is a coffee-table format, large book (320 pages) which covers a multitude of subjects regarding food, including food and a balanced diet, food as medicine, food for stages of life and food for weight control. There is considerable information about various diets, herbs, detoxification regimes, as well as numerous charts. There is a very good section about phyto-nutrients and which foods contain them. Very professionally produced, with many colour illustrations. More for the general reader than the academic, yet packed with information.

Fats

***Erasmus Udo. 1986, 1993. Fats that Heal, Fats that Kill. Alive Books. ISBN: 0-9204-7040-8.
This book is in a category of its own, and is the definitive guide to everything concerning fats, oils, essential fatty acids, omega-3 and omega-6 fatty acids. It is exceptionally well-referenced, has a very useful section of abbreviations, extensive glossary (needed to handle the biochemistry essential to this book. A must-own book for the serious researcher and nutritionist.

Women's Health

***Mills, Dian Shepperson, MA and Vernon Michael, Ph.D. Endometriosis: A Key to Healing through Nutrition. 1999. Element Books. ISBN: 1-8620-4300-0.
Dr Vernon, reproductive physiologist and scientific director at Woman's Hospital of Baton Rouge, Louisiana and Dian Mills, nutritionist and Trustee, National Endometriosis Society, have produced an invaluable, authoritative book (370 pages) which discusses this painful conditions said to affect 10% of women today, and provides extremely useful information regarding the role of nutrition in the condition and as a treatment for the pain and inflammation associated with endometriosis. There is an excellent discussion of natural and environmental oestrogens, the role of fibre and probiotics in their excretion and nutritional support for endometriosis and infertility. There is an excellent glossary, a comprehensive list of scientific references, as well as addresses and useful organisations. Again, a definitive book in its field.

***Stewart Maryon. 1998. The Phyto Factor. Vermillion, an imprint of Ebury Press, Random House. ISBN: 0-0918-1607-6.
Maryon Stewart has produced a definitive text book (288 pages) regarding phytochemicals. She describes the abundant family of phytochemicals, discusses how phytoestrogens, including soy and the multitude of foods containing them, can be applied to help with managing symptoms associated with menstrual problems, the menopause, cancer, osteoporosis, diabetes and heart disease. There are extensive recipes, menu plans, and excellent reference sections, including scientific references, nutritional content of foods and useful addresses.

Sports Nutrition

**Colgan Michael, Ph.D. 1993. Optimum Sports Nutrition: Your Competitive Edge. A Complete Nutrition Guide for Optimizing Athletic Performance. Advance Research Press. ISBN: 0-9624-8404-0.
There are some 67 pages of references to the scientific literature in Dr Colgan's large book (562 pages), filled with everything nutritional to do with sports and athletics. Despite the author's very chatty style, he is a world leader in the field, and the biochemistry and physiology shows through, with chapters about fats, carbohydrates, proteins, vitamins, minerals, antioxidants, as well as other nutrients such as carnitine, caffeine, chromium. There is a large section on drugs, including steroids, human growth hormone and erythropoietin, among others.

Further Resources

*** Positive Health (1994-present). Monthly serious publication specialising in authoritative information regarding all aspects of complementary medicine and also extracting research relating to complementary approaches to all illnesses, including cancer and nutrition. All articles and research updates, as well as Nutrition and Cancer: State of the Art published on Positive Health's internet site - www.positivehealth.com .