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First remove the sugar and have a glass of wine
- Nicholas D Moore (23 January 2004)
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Promises in Nutrition
- Ned Hoke (23 January 2004)
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EAT, DRINK, AND BE HAPPY
- BM Hegde (25 January 2004)
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Polypill or food?
- AK. Al-Sheikhli. (26 January 2004)
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Exaggeration, indifference or both?
- Vikas Dhikav (27 January 2004)
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Nicholas D Moore, Professor of clinical pharmacology Université Victor Segalen, 33076 Bordeaux
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Dear Sir, The health consequences of dietary habits have indeed been the focus of much debate over the past years. The present one concerns a specific coenzyme, but of course this is but a small part of the overall effects of nutrition, which are globally quantitative (as in overeating, or starvation) or selectively quantitative (as in excess sugar in processed foods leading to obesity, or in possible benefits of semistarvation protein-poor (or is it rich?) diets). The qualitative aspects are also important: folic acid (cited here), polyunsaturated or mono-unsaturated fatty acid, omega-3), anti- oxidants, expecially polyphenols in wine or armagnac (1) (I can't resist self-citation...), vitamins, minerals could all be added to highly modified "healthier" food. Why not have the supplements included directly in the foodstuff by genetically modified organisms in a sort of organic polypill (2) (polyfood?). But don't let the leaves hide the forest Maybe we should first, before adding anything more to our food, which results mainly in increased prices and more profits for "premium enriched food" for the predominantly US food industry, ask them to remove all the sugar that is added, and that results in the disastrous obesity epidemic in the US, now extending to most of Europe. Removing sodas which are essentially sugared water and whose main purpose or result is to create or magnify sweet-taste craving in children would also be a good idea. And of course for consenting adults a glass of wine (red or white if oak- barrel matured) or armagnac with the cheese (3) (on buttered bread or crackers) brings all sorts of useful nutrients, vitamins, anti-oxidants, folic acid, etc, in addition to the relaxing feeling of gustative pleasure which can only lead to a longer, happier life (4). Bon appétit Nicholas Moore references 1. Umar A, Boisseau M, Segur MC, Begaud B, Moore N. Effect of age of Armagnac extract and duration of treatment on antithrombotic effects in a rat thrombosis model. Thromb Res 2003;111(3):185-9. 2. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. Bmj 2003;326(7404):1419. 3. Tunstall-Pedoe H. Autres pays, autres moeurs. Bmj 1988;297(6663): 1559-60. 4. Evans AE, Ruidavets JB, McCrum EE, Cambou JP, McClean R, Douste- Blazy P, et al. Autres pays, autres coeurs? Dietary patterns, risk factors and ischaemic heart disease in Belfast and Toulouse. Qjm 1995;88(7): 469-77. Competing interests: O actually like good food (and wine) |
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Ned Hoke, Ecological Medicine Western USA
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Professor Moore's poignant response appropiately makes more whole and real the issues. The unrelenting damages sewn into modern behaviors are so far more important than most any public misapperception about the value of one additive or other that the commercial consequences are a bland matter in contrast. Non-learned physicians of nutritional clinical relevance will swing endlessly to and fro amidst perceived state of the art claims authorized by the academy and cling to science reports that live quite poorly in the real world. Nutrition isn't simply a matter of another form of drug therapy where isolated biologic responses can be initiated or limited and these additive discussions appear to imagine often consequences, either to the good or bad, proven or unproven about clinical outcomes when the actual health issues are truly elsewhere. Stuck in the drug model of thought the public will never hear enough about nutrition they can truly use and the physician teachers will never be satisfied with their outcomes given they don't know what they actually are talking about. Stop the extremes of sugar and have a glass of wine is indeed the best part of this article so far. <end> Competing interests: None declared |
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BM Hegde, Retired Vice Chancellor Mangalore, India
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“I speak the truth, not so much as I would, but as much as I dare; and I dare a little more, as I grow older.” Michel de Montaigne. While it is impossible to say that a particular food is good for a particular individual, one could reasonably argue that, for most healthy people, the following guidelines would be good enough. I must hasten to add that all scientific findings are true until proven otherwise. No man, however great or learned, could write the last word on anything. Everything is dynamic and changing. Man’s wisdom is only a small fraction of the secrets that Nature keeps close to its bosom. In the case of foods it is all the more complicated. Most of our modern reductionist research gives us only a key hole view of the reality, while the ancient wisdom of the Vedas (Ayurveda) is longitudinal research of observations and is, therefore, more reliable. The following data are given from all those sources. There are three kinds of foods- thamasic, satvik and rajas. In short, the type, the variety, as also the contents are different in the three types. In addition, the seasons of the year and the ambient temperature, the phases of the moon and humidity have a lot to do with what one eats and how comfortable one feels. To give a quick example, let us take the strong spices in Indian diet. While they feel good during the cold months, especially in the heavy rainy season in India, they are not that pleasant during very hot summer months. Human body’s need for heat generation also changes with seasons. It is; therefore, better to eat fewer spices during summer months. Timing of food: It is good to eat many times, at least, four to five times day, small amounts of food rather than eat one, two, or three large meals. Multiple small feeds keep the metabolism under a steady state without large fluctuations in blood sugar levels. In addition, people who want to watch their weight would also be helped by the absence of hunger if one takes multiple meals. The long intervals between infrequent meals make dieting difficult because of hunger. Another great advantage is that a large meal directly strains the heart by forcing it to work almost 2.5 times its normal. Hearty meal is derived from this scientific fact. Large meals could be quite dangerous in the elderly, whose blood pressure could drop after a heavy meal when they get up from the dining table, resulting occasionally in a major stroke or a heart attack! Small frequent pleasing meals should be the bija mantra. Heavy exertion after a large meal could be dangerous at any age. What to eat? It is not what you eat that kills you, but it is what eats you that kills you--your destructive emotions of anger, hatred, jealousy, depression and hostility. This has now been proven even by the modern medical methods. That said, I must hasten to add that man is what he eats. Your moods, your enthusiasm to work hard, as also your capacity to work hard depend on the healthy foods that you consume. Everything that one eats and drinks gives one the calories for work and, for the younger ones, the calories they need for growth as well. Pregnant mothers need special diets. It is only in old age that one needs very little food for sustenance. Common man need not worry about balancing the calories. Body sends out signals whether one should eat or not. Simple rule to follow would be to eat very, very little or little when not hungry. Eat only when you feel like eating. Drink when you are thirsty but do have a minimum quantity of water daily. It is difficult to say how much water one has to take daily, although the rough guide could be about 30 ml/Kg. body weight. Please remember that one could get waterlogged if one drinks too much water even though the normal kidneys could balance the water levels in the body. Occasionally, people could have low sodium levels because of too much water. Once again, the body is the best guide. You feel thirsty when you need water and feel uncomfortable if you had too much and might even feel dizzy. How to eat? If one is eating three large meals, the breakfast must be the largest, as the whole day’s energy needs should be met. Lunch and dinner must be smaller and the last the smallest of all. One should have, at least, three (four) helpings of fresh fruit in between. Keep the total food intake under control to see that you neither gain nor lose weight, if you are normal weight. If one were over weight, the simple formula would be to cut the intake by half and walk daily for one hour to lose around 350 calories daily. If one is underweight, one should try and see how he/she could improve on that by adjusting the calories. Those who are ill and are under medical care should follow their doctor’s advice strictly. Should one take vitamins and minerals daily? Never! They are dangerous in the long run. They are OK for a short while, if you are ill. It is a very bad habit to ape the American dining table with a centre spread of vitamin and aspirin tablets. If you are healthy, taking even baby aspirin for the imaginary prevention of heart attacks is fraught with danger! Any drug, including aspirin, if taken for no good reason, could result in higher deaths in the long run, vitamins included. How does one know that he/she is healthy? If one could sleep well, has good appetite, good bowel motion, is full of enthusiasm to work hard and keeps the mind filled with universal compassion, one can’t but be healthy. Any sign of disease, any symptom for that matter, must immediately be brought to the doctor’s attention without delay, since disease is only an accident and life teems with ills. Studies done on large cohort of women, comparing extra intake of fruits and vegetables vis-à-vis added vitamins and minerals daily, have clearly shown that the extra fresh fruit and vegetable eating group had significantly less cancers and heart attacks in the following five years. Is it healthy to have a small amount of alcohol daily? This is one of the many myths in our noble profession of medicine. There is no unequivocal scientific evidence to show that small amounts of alcohol, whichever class it belongs to, do any good to human health, although we do not know, for certain, that in small amounts alcohol harms human health! If one understands statistics in medical research, one quickly realises how easy it is to draw any conclusion that one wants from the available data, seeing what you want to see, by either "sharp shooting"-emptying all the bullets on to the wall and then drawing the target in a convenient area-and/or "data dredging". Epidemiology is a good science when applied to acute contagious diseases and is a miserable failure in trying to predict the unpredictable outcome of chronic degenerative diseases. One of the leading American epidemiologists, Steven Milloy, in his well written book, Science without Sense, gives a graphic description of how epidemiologists could produce epidemics of such diseases in society by injecting fear into the common man’s psyche. Are diary products good for health? For an infant, and many children for as long as they get, mother’s milk is the best food. After the child weans off from breast milk, the child loses the milk-digesting enzyme. Milk from any other animal only supplies foreign protein that is antigenic. Except pure ghee (clarified butter) having only caprionic and butyric acids, which is free of animal proteins, all other diary products obviously can not be that good for human health. Vegetable protein, especially from germinating seeds gives the best protein. Ghee is very good food but remember that it is fat! Total fat intake in a healthy adult should not exceed 20% of total calories. Fat in food is vital for human life, but the quality and quantity do matter a lot. Anything deep fried in fat is bad as the fat then gets hydroxylated and becomes dangerous to blood vessel health. Cocoanut oil, when fresh, is another very good fat for human use. It prevents cancers and protects the heart and keeps it healthy. Rancid cocoanut oil is dangerous as the fatty acids in cocoanut oil get converted into the deadly trans-fatty acids, normally found in many other preserved oils, sold in the market as healthy food! Cocoanut oil does not contain cholesterol. No vegetarian food can have cholesterol in it. The latter comes from animal cell wall. We try and confuse people saying that cocoanut oil is saturated fat and gets converted into bad blood fat. Truth, however, is that the saturated fat in fresh cocoanut oil is mostly medium chain and not long chain. Lauric acid, found only in cocoanut oil, is the best fatty acid for humans. New data has reinforced the truth that unsaturated fats, heavily advertised and sold in the market, are, in fact, the villains in the drama. Simple truth is that any food heavily advertised should be bad for health. Anything good does not need advertisement. Cocoanut oil has stood the test of time. In addition, as a bonus, it is a good germ killer. Is Non-Vegetarian food bad for health? Man is basically a vegetarian, physiologically but, meat, as such, may not be poison. It is definitely not as good as vegetarian food. Once cooked, the amino acids in raw meat fuse, losing what little good there was. Large studies have shown that even the fish myth is an invention. The fishy meal story of fish protecting against vessel diseases is commercial bait. Fish, however, is a good and cheap source of protein for the coastal people. Vegetarian diet is satvic, in addition. A diet based mainly on fruits and vegetables, and is otherwise balanced, is the best choice for good health and energy. The darker the outer colour of the ripe fruit, the better it is for health. If people doubt the capacity of pure vegetarian diet to give enough strength, they should think of fighting with an elephant to verify the truth. Meat, in addition, contains added hormones and anti-biotics in its edible avatar. Are preserved Junk foods good for health? This is a bad habit that we have inherited from others and is bound to bring new epidemics of dangerous degenerative diseases in its wake. Any food that is preserved is bad for health. The main preservative is common salt. This is man’s enemy numero uno. The other preservatives in those foods are equally bad. Most of them also contain heavy doses of fat and sugar that are not good in the long run. The sugar equivalents in some of the preserved foods and drinks are dangerous to the liver. Some of those get converted into formic acid in the body, damaging the liver. Conclusions: Eat what you want to eat in moderation, not bothering to worry about the contents as long you do not over indulge in food. Try to be happy when you eat. For routine use follow the tips given above. Worrying each time you hit the dining table could kill faster than the food on the table. None of the above suggestions would make you immortal. If you follow sensible food habits you could expect to be healthy and active as long as you live. Once in a blue moon even poison might not be that bad after all. “Three things are good in little measure and evil in large: yeast, salt and hesitation.” …..The Talmud. Competing interests: None declared |
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AK. Al-Sheikhli., Psychiatrist,Medical Centre. 2Manor Court Avenue,Nuneaton CV11 5HX,UK.
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Dear Editor, It was interesting to read, let food be thy medicine by Smith (BMJ 2004;328:0-g). My comment, 1.It will be interesting to know whether the author prefers the polypill (1),food,or both? 2.I wonder whether folic acid is also present in large amounts in fish, as some articles also suggest that fish as diet is of benefit for the depressed,..etc, Thanking you
AK.Al-Sheikhli, References, 1.Smith R,Polypill may be availble in two years. BMJ 2003;327:0-g. Competing interests: None declared |
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Vikas Dhikav, Resident All India Institute of Medical Sciences, New Delhi-110029, INDIA
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Dear Editor, Richard Smith has been brilliant in expressing, in rather concrete terms what he always wants to; the statement "let medicine be thy food and food be thy medicine" seems to be a mix of both. While several prophylactic and therapeutic benefits of folic acid are well known to all of us and upcoming usages seem exciting; it would be "too much" to say that its let this medicine be food. Why do always make "too-much" of the medicines available all around? Someone rightly said sometime ago, "The best physician is the one who knows that worthlessness of most medicines". Therefore, we at some point of time start propagating the unconventional or the unorthodox ways and means of health care for benefits of masses; especially the underprivileged. Several inexpensive techniques such as meditation, regular exercise and yoga have been shown to have countless health benefits; yet they are yet to meet the response they deserve. Are we too, "medicine savvy?" or we don’t want to look beyond medicines? Do we seem to forget that majority of the world population still does not have the reach even to the most essential drugs? Do we see the sea change in the prevailing situation in the near future? And are we convinced that only the drugs are the answer to everything? I guess, all of us know the answer. Competing interests: None declared |
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