Great Smokies Medical Center of Asheville

Archive for the ‘Diet/Nutrition’ Category

Prescription Drugs Cause Nutrient Depletion

Sunday, September 11th, 2005

Many side effects of prescription drugs may not be direct effects of the drug per se, but due instead to nutrient depletion caused by taking the drug over time. Some common classes of drugs are listed below. Refer to Drug-Induced Nutrient Depletion Handbook, by Pelton, et al. for more comprehensive information.

Antacids: calcium, magnesium, copper, iron, phosphate, zinc, potassium
Antibiotics, in general: all B vitamins, vitamin C, vitamin K, probiotics
Aspirin: folic acid, vitamin C, iron, amino acids/protein
Beta blockers: Coenzyme Q10
Birth control pills: vitamin B2, vitamin B6, vitamin B12, folic acid, vitamin C, magnesium, zinc
Cardiac glycosides (Lanoxin and Digoxin): Calcium and magnesium
Cholesterol Lowering Drugs: Coenzyme Q10
Corticosteroids (Prednisone): vitamin D, calcium, selenium, zinc, potassium
Gout medications: vitamin B12, vitamin A, potassium, sodium
H2 receptor agonists (Tagamet and Zantac): folic acid, vitamin B12, vitamin D, calcium, iron, zinc
NSAIDs (Advil, Motrin, ibuprofen, etc.): folic acid
Loop diuretics: (Lasix and Bumex): vitamin B1, vitamin B6, magnesium, zinc, potassium
Potassium supplements: Vitamin B12
Proton pump inhibitors (Losec and Nexium): vitamin B12
Sulfa drugs: folic acid
Sulfonylureas (including the diabetic medications: Orinase, Glucotrol, Diabinase, Micronase, Glynase): vitamin B1, coenzyme Q10
Tetracyclines: vitamin B6, vitamin B12, probiotics, calcium, magnesium, zinc

Dietary Soy Intake Linked to Nutrient Deficiencies

Sunday, September 11th, 2005

Soy is recommended by healthcare providers for its ability to modulate the metabolism of estrogen in both sexes, and is commonly used in soy-based infant formulas.

Soy, once touted as a perfect, inexpensive protein source, has worked its way into the American diet in a big way and has done so with the blessings of many healthcare providers and nutritionists. Soy is now found in non-traditional, convenience foods such as bread, pasta, veggie burgers, soy milk, soy cheese, soy ice cream, roasted “nuts”, hot dogs, sausages, high protein energy bars, and powdered nutritional beverage mixes.

Advocates of eating soy products say that millions of Asians can’t be wrong, claiming Asians have eaten large amounts of soy for centuries. In Asia, soy is traditionally eaten in small amounts as a condiment in the forms of slowly fermented miso and tempeh. (The increased Asian consumption of fish is more likely related to their lower occurrence of heart disease and some cancers.)

When it comes to soy, the American tendency to believe that if a little is good, then more is better, could be putting the health of some soy consumers at risk.

So what’s the problem? Nutritionists are concerned about organic acids in soybeans called phytates blocking the absorption of calcium, magnesium, iron and zinc, and soy’s trypsin inhibitors blocking the absorption of protein. This reduced nutrient uptake is thought to be responsible for the short stature of the Asian population. Phytates and trypsin inhibitors are particularly high in non-fermented soy products, such as texturized vegetable protein (TVP) in soy burgers and convenience foods.

Soy is among the top six most allergenic foods (corn, egg, milk, soy, wheat and yeast) and, unless otherwise stated on the label, soy can be assumed to be genetically modified (GMO). Genetically modified soy results in sterility when fed to Monarch butterflies. Because humans have longer life spans than butterflies, the effects of GMO soy on people are difficult to study and are thus unknown at this time.

More studies are needed to define the impact of a diet excessively rich in convenience soy foods. In the meantime, we advise eating organic, non-GMO soy such as miso, tempeh, traditional tofu, and natto in moderation to both prevent nutrient deficiencies from phytates and trypsin inhibitors and to prevent unwanted estrogen modulation. We don’t recommend the use of soy-based infant formulas due to the unknown effect of estrogen modulation on infants.

Signs and Symptoms of Specific Nutrient Deficiencies

Sunday, September 11th, 2005

The following nutrient deficiencies are related to the listed signs and symptoms:

Fat-soluble Vitamins
Vitamin A: Increased susceptibility to cancer, acne, night blindness and other eye problems; impaired maintenance, repair, and healing of skin and mucus membranes; impaired bone and teeth formation; accelerated aging
Vitamin D: (Rickets) Bone loss (osteoporosis); low blood calcium; osteomalacia (pain in ribs, spine, pelvis, legs, muscle weakness, brittle bones); retarded growth; muscle weakness, impaired tooth development; rickets in children
Vitamin E: Susceptibility to cancer and heart disease; anemia; lethargy; apathy; inability to concentrate; muscle weakness; decreased sexual performance
Vitamin K: Impaired blood clotting

Water-soluble Vitamins
Vitamin B1 (Thiamine): (Beriberi) Impairment of gastric acid production, blood formation, circulation, and starch metabolism; gastrointestinal, neurological, and heart muscle tone problems, learning and growth; low energy
Vitamin B2 (Riboflavin): Impaired metabolism of carbohydrates, fats and proteins; impaired cell growth and production of antibodies; tired eyes; cataracts; sores and cracks in corners of the mouth; decreased iron and pyridoxine levels
Vitamin B3 (Niacin): (Pellagra) The three D’s: dermatitis, dementia and diarrhea; circulatory problems; heart disease
Vitamin B5 (Pantothenic Acid): headache, listlessness, fatigue, insomnia, intestinal disturbances, and numbness and tingling of hands and feet
Vitamin B6 (Pyridoxine): Fatigue; carpal tunnel syndrome; water retention; irritability; increased premenstrual stress; allergies; asthma; weakened immune system; heart disease
Vitamin B12 (Hydroxycobalomin): Anemia; improper digestion and metabolism of foods; nerve damage; fatigue; uneven gait; infertility; memory loss; cataracts
Folic Acid: Fatigue, anemia, weakness and low energy; problems with clotting and bruising; birth defects; cervical dysplasia; elevated homocysteine level (a risk factor in heart disease)
Vitamin C (Ascorbic Acid): Weakened immune system; increased susceptibility to cancer; impaired wound healing; gum disease; damage to nerves, eyes and vascular system; bruising

Minerals
Calcium: Osteoporosis; muscle cramps; joint aches; increased cholesterol levels; nervousness; heart rhythm irregularities; skin disorders; brittle nails; rheumatoid arthritis; tooth decay; sleep disturbances; numbness in arms and/or legs; rickets
Magnesium: Muscle weakness and twitching (spasm); depression; dizziness; high blood pressure; heart disease and cardiac arrhythmias; asthma; menstrual cramps
Phosphorus: Mineral imbalance, especially calcium and magnesium; impaired bone and teeth formation; kidney function; heart muscle contraction problems
Potassium: Heart irregularities; increased blood pressure; muscle twitches; weakness; fluid imbalances

Trace Minerals
Chromium: Poor glucose/insulin control.
Copper: Fatigue; impaired wound healing; osteoporosis; altered sense of taste
Iodine: Lethargy, constipation, dry skin
Iron: Anemia; fatigue; weakness and low energy; clotting and bruising problems
Selenium: Increased susceptibility to cancers of liver, skin, breast and colon; stroke; heart muscle disorders; immune system deficiencies; allergy
Sodium: Fluid and electrolyte imbalance, weakness and fatigue
Vanadium: Poor glucose/insulin regulation.
Zinc: Impaired wound healing; weakened immune system; impaired sense of smell and taste.

Nutrient Deficiencies Can Result in Serious Health Problems

Sunday, September 11th, 2005

A tragic reminder of the consequences of nutrient deficiencies occurred in November 2003, when the deaths of three Israeli infants were linked to the use of a Kosher soy-based infant formula manufactured in Germany that was sold as Remedia. Fourteen more infants were treated for problems associated with using the infant formula. Remedia was not commercially marketed in the United States, though some may have been imported via mail order. Laboratory analysis revealed that the formula did not contain any Vitamin B1, thiamin, even though the label stated it did. Thiamine deficiency results in a condition known as beriberi which causes a variety of cardiac and neurological problems and, if untreated, death.

While a dramatic example of the effects of nutrient deficiencies, it brings to mind the more subtle but very significant roles that chronic nutrient deficiencies can cause throughout a lifetime.

Nutrient deficiencies can be caused by food supply problems from homelessness, poverty, and isolation, in addition to some psychiatric disorders, including anorexia, bulimia, paranoia, and depression. Mechanical problems such as ill-fitting dentures and poor dental health also contribute to nutrient deficiency, as can laxative abuse and lack of sunshine. Side effects of prescription drugs include their ability to deplete essential nutrients, as does consumption of alcohol and a diet rich in soy. Even when an adequate diet is eaten, nutrients may not be absorbed due to inadequate production of hydrochloric acid or digestive enzymes, and inflammatory bowel disease.

That being said, the number one cause of nutrient deficiencies in the United States is eating processed and junk food, fast food, food high in sugar, and “bad” fat. We don’t need box cutters to undermine our nation. We’ve got spoons and forks!

Nutrient deficiencies usually don’t directly result in death, but more often undermine health in ways not easily apparent. The afflicted person does not feel or function well and is often clueless as to why. A physician trained in nutritional medicine can be alerted to clinical signs and symptoms that suggest nutrient deficiency. When deficiencies are treated and the body’s functions are supported, some prescription drug use can be decreased or even prevented altogether.

Junk food eaters beware: Before you improve your diet, be aware that if too many people decide to eat a nutritionally sound diet, disease incidence would decrease and our health care system could collapse due to fewer people seeking healthcare.

Two Trials on Low Fat vs. Low Carbohydrate Diets

Monday, August 22nd, 2005

by John L. Wilson, Jr., M.D.

Physicians are often asked about the safety and effectiveness of Low-Carbohydrate diets. The two camps of Low Carbohydrate and Low Fat diets have little common ground on which to stand and seem to be locked in continual debate. Two trials have been done which may help shed some light on this ongoing controversy.

Preliminary results from a 3-center (University of Pennsylvania, University of Colorado, Washington University) trial compared a low carbohydrate (LC) diet with a higher carbohydrate low-fat (LF) plan that restricted daily caloric intake to 1200-1500 calories for women and 1500-1800 calories for men. The study included 63 obese males and females. After 12 weeks, 12 % of the LC study subjects had dropped out, while 30% of the LF diet dropped out. The results are as follows:

Lo Carb Low Fat
Weight -8.5 lbs -3.7 lbs
Triglycrids -21.7% -0%
Total Chol +2.2% -8.2%
HDL Chol. +11.5% +0%
LDL Chol +6.6% -11-1%

Subjects in the LC group lost over two times as much weight as the LF group. The increase in Total Cholesterol in the LC group is insignificant, while its decrease in the LF group is significant. The LC group increased their HDL or “good cholesterol” significantly by 11.5%, while it remained unchanged in the LF group. Both the LC group’s increase of LDL or “bad cholesterol” and the LF group’s LDL decrease are significant. The researchers concluded that the LC diet produced favorable effects on weight, HDL cholesterol, and triglycerides, whereas the LF diet was associated with more favorable effects on Total Cholesterol and LDL cholesterol.

A similar trial from Duke University studied 120 obese males and females. The LC group lost significantly more weight, an average of 13.3 lbs. compared with 8.6 lbs. with the LF group. The LC group lost proportionately more fat mass and gained more lean body mass compared to the LF group. Both groups showed decreases in triglycerides, with the LF group also showing a significant decrease in Total Cholesterol of13.5 mg/dl. The LC group again showed significant beneficial increases in HDL.

In evaluating these results, one should be aware of a 1999 Harvard analysis of data from the well-known Framingham Heart Study. It determined that by far the best predictors of a future heart attack were a high Cardiac Risk Ratio (Total Cholesterol divided by the HDL) and an elevated blood test for coronary artery inflammation, hsCRP. The hsCRP was not measured in these trials, but the benefits of the HDL increases reported with a LC diet cannot be overstated when assessing risk of heart disease. Also, it should be stated that the relationship between elevated Total Cholesterol and heart disease risk has come under scrutiny by researchers and physicians in recent years.

In assessing the effectiveness of LC diets in my practice, I find they often result in significant decreases in Total Cholesterol and LDL, in addition to the increases in HDL, decreases in triglycerides, decreased fat mass, increased lean body mass, and weight loss reported here. These differences are likely due to additional recommendations of avoidance of harmful fats such as margarine, deep fried foods, and commercial solvent-extracted oils, combined with supplementation of essential fatty acids, avoidance of sugar, and emphasis on vegetable intake. Longer-term studies are needed to further evaluate these two diverse dietary approaches.

Risks and Benefits of Chronic Vegetarian Diet

Monday, August 22nd, 2005

Nutrients that are at risk for depletion in long term vegetarian diets are iron, Vitamin D, Vitamin B12, selenium, zinc, taurine and Omega 3 oils (due to heavier use of the Omega 6 soy and corn oils in vegetarian diets). Females who had been on a vegetarian diet for greater than 6 years had the most severe depletion of Vitamin B12. The beneficial antioxidant vitamins beta-carotene, vitamins E and C and folic acid levels however are significantly higher in a vegetarian diet that is vegetable (not grain) based.

It is difficult to generalize about vegetarian diets as some are high in quality with a large variety of vegetables, high quality oils and adequate protein sources, while others are mainly composed of wheat, corn and high in sugar and low in vegetables. After all, Pepsi, potato chips and M&M’s is technically a vegetarian diet. It is prudent to recognize that a high quality vegetarian diet is more involved than simply not eating meat and is more likely the result of planning, study, and time spent in the kitchen. Essential Fatty Acid (EFA) testing at GSMC however is finding more depletion of Omega 6 oils occurring in vegetarians, likely due to the fact that the Omega 3 (flax oil) supplementation is practiced because of the coverage it gets in the media. Vegetarian diets can lead to nutrient deficiencies (selenium and essential fatty acids specifically) that may increase cancer risk. It seems wise to consider vitamin, mineral and fatty acid supplementation if you are vegetarian, unless you consistently eat a high quality vegetarian diet with adequate protein and essential fatty acids from nuts and seeds and their oils. Given enough time, nutrient deficiencies contribute to chronic illness.

Fiber Facts

Monday, August 22nd, 2005

Dietary fiber has become very easy to avoid by those who eat the Standard American Diet (SAD). Processing and refining of foods to satisfy a penchant for “lighter” foods has nearly stripped dietary fiber right out of existence, unless one consciously attempts to include it in their diet It is estimated that the dietary fiber intake of average persons in industrialized Western nations is one fifth of what it was 100 years ago. Researchers now know that this reduced level of fiber in diets is a major contributor to breast cancer, diabetes, high blood pressure, elevated cholesterol levels, constipation, diarrhea, arthritis, diverticulosis, hemorrhoids, irritable bowel syndrome, obesity, heart disease, colon cancer, cancers in general, and virtually any chronic degenerative disease known to man.

Technically, fiber is a carbohydrate, though the body is unable to digest fiber, as digestive enzymes, acids and alkali cannot break it down. All fiber is of plant origin–animal products have no fiber. There are two types of fiber–insoluble (sometimes called crude) and soluble.

Insoluble fiber includes cellulose and lignins–material which provides structural support for plants. This material is rough and coarse. Insoluble fiber is found in wheat bran, celery, whole grains and legumes. It serves to create a larger stool mass which can be moved along the intestinal tract with ease, whereas the smaller volume of pasty stool resulting from a diet low in fiber can take a week to move through the digestive tract, allowing toxic unnatural situations to develop in the intestinal tract. Soluble fiber includes pectin (a mucilaginous carbohydrates)-fibers still unaffected by digestive juices, yet they are soluble in water. As one might expect, this type of fiber is softer than insoluble fiber. This fiber is plentiful in legumes, psyllium husks, flax seeds, grapes, prunes, carrots, seaweed, most vegetables and fruits, especially apples. It attracts water to the stool mass, making the stool bulky and soft, thus aiding in reducing intestinal transit time. The fiber contained in vegetables, and not the fiber in whole grains, is now thought to be responsible for lowering colon cancer occurrence.

Could Vitamin C be Dangerous?

Monday, August 22nd, 2005

An article was published recently announcing the results of an in vitro study (one done in a laboratory test tube) suggesting that vitamin C damaged cellular DNA, that genetic messenger of our cells. The report recommended caution in taking vitamin C as a supplement.

The clinical supplementation of vitamin C has a long history, starting in the 1795 when limes were rationed to sailors to prevent scurvy, the clinical condition characterized by weak blood vessels resulting in symptoms such as spongy gums and easy bruising that results from the deficiency of vitamin C. Dr. Linus Pauling, history’s only unshared winner of 2 Nobel Prizes, first promoted use of vitamin C to shorten the duration of a common cold. He also recognized the role of vitamin C in the prevention of cardiovascular disease and cancer, mostly through its ability to combat the effects of free radicals in our bodies. Free radicals are dangerous molecules that are the major causes of the “rusting” of our cells, leading to cellular dysfunction and ultimately death. Vitamin C is the major water-soluble extracellular anti-oxidant in our bodies. Vitamin C aids in the production of collagen, the main constituent of the connective fibers that cement our cells together. Collagen is found in virtually every tissue including blood vessels, mucus membranes, tendons, ligaments, bone, teeth, cartilage, etc.

The easy bleeding of scurvy is thought to be the first step in the development of some cases of fatty deposition in arteries, because the bad fat Lp(a) will act like a thumb in a dike and plug the microscopic holes in arteries caused by scurvy. You won’t bleed to death, but you may develop heart disease as a price to pay for ignoring the underlying cause (scurvy). Treatments for this situation include vitamin C to treat scurvy and N-acetyl cysteine to reduce Lp(a) levels. It is interesting that animals in the wild do not have heart disease, likely because they do not shop in grocery stores, but instead eat fresh living foods that provide them adequate amounts of vitamin C.

Vitamin C activates our immune system by causing a 50-fold increase in phagocytosis, the activity by which our white blood cells kill germs. Due to the lack of an enzyme, guinea pigs, gorillas, fruit bats, and humans are the only carnivorous members of the Animal Kingdom that have lost their ability to manufacture vitamin C internally. If your dog cut its paw and developed an infection, it would manufacture around 10,000 mg of vitamin C per day to fight the infection. Fido can, you can’t.

The recommended daily allowance (RDA) of vitamin C is currently 60 mg/day. This represents the minimum dose of vitamin C that will prevent scurvy, and has nothing to do with optimal health. Since needs for vitamin C increase greatly with stressors including infection, smoking, or chemical exposures, it is reasonable to assume that deficiencies can exist at doses much higher than 60 mg/day. I recommend taking vitamin C to bowel tolerance (the amount of vitamin C that an individual can take without causing diarrhea) which is usually from 500 to 8,000 mg per day in divided doses, and possibly more in times of stress or illness.

It is common for scientists and practitioners alike to find that results that occur in test tubes often do not occur in the real lives of people outside the laboratory. The test tube just isn’t a good model to approximate the wisdom and complexity of a human body. Vitamin C has in fact proven safe and effective during years of clinical use.

Calcium In Health and Disease, including Dietary Sources

Monday, August 22nd, 2005

By Connie Wilson, RN

Calcium is the most abundant mineral in the body. The average adult has between two and three pounds of calcium in their body, and 99% of that calcium is bound in bones and teeth. The remaining 1% of the total body calcium is in the soft tissues and fluids of the body where it helps to regulate critical biochemical processes of the body, such as heart rate and rhythm. Most of that 1% of calcium is extracellular or outside of the cell, not intracellular or inside the cell.

When calcium moves to the inside of a cell, that cell will dysfunction or often die. The medical term for this cellular death is calciphylaxis. Thus calcium influx into a cell plays a role in many illnesses, including hardening of the arteries, senility, osteoporosis, blood clotting abnormalities, heart arrhythmias, seizures, elevated blood pressure, muscle cramping, etc. The influx of calcium into cells that is associated with many degenerative diseases of aging has resulted in the development of a class of drugs called calcium channel blockers. The holistic medical approach to calcium influx recognizes magnesium as the preferred calcium channel blocker. Magnesium is usually well tolerated (excessive magnesium can cause loose stools), and is inexpensive, as it cannot be patented.

You can think of bones as similar to a bank savings account for calcium. We will make calcium withdrawals from that bony bank account to normalize blood calcium levels if needed. Calcium is a very alkaline mineral, and metabolic and medical conditions associated with acidosis (almost all chronic illnesses) will require a withdrawal of calcium from the bone to correct acidosis. Drinking dark cola beverages with their high phosphoric acid content is an example of a dietary habit that pulls calcium out of bones. The body will deplete its bony bank account to maintain homeostasis . . . a wise choice, as excessive acidosis that is uncorrected can cause death. You can see it is difficult to talk about calcium without talking about osteoporosis.

The absorption of calcium depends on adequate hydrochloric acid production, as calcium, like all minerals, goes into solution in the presence of an acid. Like all body secretions, hydrochloric acid production decreases with aging, which in turn decreases the uptake of dietary calcium and all minerals. A post-menopausal woman only absorbs about 7% of dietary calcium. Thus calcium-based antacids, which are in an alkaline base to counter excessive acid, despite advertising claims, do not provide a bio-available source of calcium and do not address calcium dietary supplementation needs. Simply supplementing calcium is not an effective way to address complex situations such as osteoporosis. Nature gives us calcium in the context of whole foods that contain other vitamins and trace minerals (including boron, phosphorous, selenium, Vitamin D, magnesium, etc.), which work synergistically to promote balance and homeostasis. While some nutritional supplements have trace minerals incorporated into their formulas, they will likely never be an equal to the designs nature has provided in whole foods. Yet, they may be worthwhile for a person unwilling or unable to improve their diet. Note the all the “greens and beans” on the list. Eat your vegetables, exercise consistently in moderation, and use natural hormone replacement therapies if you want to maintain or improve bone density.

Some lifestyle factors decrease the absorption of calcium, including:

* Lack of exercise or immobility
* Lack of sun exposure
* Alcohol consumption
* Coffee consumption
* Sugar consumption
* Chronic intake of antacids that contain aluminum
* High intake of foods that contain phytates and oxalates (spinach, rhubarb, chard, beet greens, soy, and whole wheat) known to bind to calcium and thus reduce uptake of minerals

Many people are intolerant of dairy products or otherwise choose not to eat them for a variety of reasons including allergy, lactose intolerance, presence of bovine growth hormone, etc., and need to depend on other calcium sources. Dairy products have been heavily advertised as an excellent source of calcium and they in fact are rich in calcium, though much of it is fortified. Advertising is seldom a good source of unbiased scientifically based information. Only about 32% of calcium in diary products is assimilated, compared to about 40-65% assimilation of the calcium from vegetable sources. The National Dairy Council funded a study which ended up yielding results suggesting that the more milk women drank, the more bone loss they experienced. [Am J Clin Nutrition 1985; 41:254]

Dietary calcium intake is not a predictor of bone density, so over concern about calcium intake is not particularly useful. Height, weight, vegetable intake, and regular exercise are predictors of bone density. The Harvard Nurses’ Health Study of 77,761 women, aged 34 to 59 followed for 12 years, found that those who drank three or more glasses of milk per day had no reduction in the risk of hip or arm fractures compared to those who drank little or no milk, even after adjustment for weight, menopausal status, smoking, and alcohol use. In fact, the fracture rates were slightly, but significantly, higher for those who consumed this much milk, compared to those who drank little or no milk. [Am J Publ Health 1997;87:992-7.]

Supplementation of calcium is often recommended because:

* many people have difficulty in eating high quality diets consistently,
* there is a rising prevalence of bone thinning (osteoporosis) in an increasingly aging population,
* calcium supplementation is relatively inexpensive, and
* there is a mistaken notion that supplemented calcium somehow ends up strengthening bones (it doesn’t).

The average recommended daily intake of calcium for U.S. adults, male or female, after age 50 is approximately 1200 mg per day. That need can be increased by the existence of pre-existing risk factors for calcium depletion. It is interesting that many cultures that eat vegetable-based native diets get much less calcium than that, yet they have significantly less osteoporosis, as their lifestyles do not have as many calcium-depleting risk factors such as smoking, excess sodium intake, excess alcohol intake, high soda intake, and sedentary lifestyles.

Excess intake of calcium may cause high blood pressure, kidney stones, heartburn, aches and pains, heart arrhythmias, and may contribute to heart failure and constipation.

To help assure adequate dietary calcium intake, we recommend eating three servings per day from the following non-dairy calcium rich foods, combined with moderate exercise (walking is excellent) and avoidance of sodas, excess alcohol, and tobacco use.

* Sardines (3 ounces) 371 mg
* Collards (1 cup boiled) 358 mg
* Blackstrap molasses (2 Tbsp) 342 mg
* Turnip greens (1 cup boiled) 249 mg
* Canned salmon (3 ounces) 181 mg
* Okra (1 cup cooked) 176 mg
* Sesame seeds (2 Tbsp) 160 mg
* Bok choy (1 cup cooked) 158 mg
* Mustard greens (1 cup boiled) 150 mg
* Figs (5 dried) 135 mg
* Navy beans (1 cup boiled) 128 mg
* Tahini (2 Tbsp) 128 mg
* Great northern beans (1 cup boiled) 121 mg
* Black beans (1 cup boiled) 103 mg
* Broccoli (1 cup boiled) 94 mg
* Kale (1 cup boiled) 94 mg
* Almond butter (2 Tbsp) 86 mg
* Butternut squash (1 cup boiled) 84 mg
* Pinto beans (1 cup boiled) 82 mg
* Chick peas (1 cup boiled) 80 mg

Elimination/Challenge Diagnostic Diet

Monday, August 22nd, 2005

Read this information in its entirety before starting your elimination/challenge diagnostic diet.

CAUTION: Never do elimination/challenge testing on a food to which you have known or suspected life-threatening (anaphylactic) reactions. Persons with potentially life threatening conditions such as severe depression, severe asthma, seizures, extremely high blood pressure, heart arrhythmias or other symptoms of a severe nature are not candidates for this at-home method of testing without medical supervision. The symptoms provoked on this diet may be more severe and dramatic than those experienced on an everyday chronic basis.

There is a very accurate, revealing, and inexpensive method of determining what, if any, foods may be contributing to your health problems. This method, called elimination/ challenge testing, can be carried out in your own home.

This method is suitable for infants, children, and adults. School aged children do pose some special problems due to possible food swapping, shared treats, an inability to determine exactly what is in school cafeteria food, and general lack of parental control over their diet. School vacations may be the best time to test school aged children. You will then be able to monitor your child’s diet and help your child cope with what may be strong cravings for the foods that are eliminated from their diet. This craving may lead to sneaking of foods, and eating even small amounts of the food being tested can invalidate the results of the food challenge test. Women who experience numerous symptoms prior to or during their menstrual cycle should not use that time of the month as their time for doing this diagnostic dietary testing. The pre-existence of numerous symptoms and the hormonal influences make the results of testing difficult to interpret, at best.

It may be understandably difficult to buy into avoidance of foods based on seemingly abstract results of numbers on a laboratory report, especially if they have no apparent relevance in the everyday life of the person. Such blood testing gives clues to what foods are problematic, but the elimination/challenge diagnostic diet goes one step further by informing the person what specific impact a particular food has on their health. Persons who have positive reactions to food allergy testing by either skin testing or blood testing at the Medical Center may need to verify that a particular food is a cause of their symptoms by using the food elimination/challenge diagnostic diet. If done properly, this method is as accurate and probably more revealing than the food testing by any other method. The American Academy of Environmental Medicine calls it the gold standard of food allergy diagnosis.

The disadvantages of the elimination/challenge method are: 1) It requires more effort of the patient, 2) it requires more time to get results, 3) its usefulness requires strict adherence to the techniques described below, and 4) as with all methods of food allergy testing, a false negative reaction can occur to foods if they have not been eaten for a long time.

Many allergies are obvious to the sufferer. Pollen, dust, and danders often produce allergic symptoms immediately and seldom is the sufferer left in the dark as to what is causing their symptoms. The basis of the effectiveness of the elimination/challenge diagnostic diet is the fact that most food allergy is hidden or masked because most symptoms of food allergy are delayed in onset. This means you can eat a food Monday and not react to it until Tuesday or Wednesday. If you frequently eat a food to which you have a hidden allergy, for example wheat (toast for breakfast, a sandwich for lunch, and pasta for dinner), you can end up with chronic symptoms and be genuinely clueless as to the cause. The techniques outlined here can unmask the previously hidden reaction, exposing the true cause and effect relationship one has with a particular food.

The elimination/challenge diagnostic diet consists of five days of strict avoidance of the foods you intend to test, and then systematic reintroduction of foods one at a time in the method described in detail below in steps 1-10.

1) Choose a start time when it will be easiest for you to have a restricted diet-Thanksgiving Day dinner with family may be the wrong time. As you may experience withdrawal symptoms such as irritability, cravings, headaches, etc., coordinate the timing of your diet with your work schedule and other expectations on you or your child.

2) Purchase a spiral bound notebook to use to keep a written record of symptoms, not forgetting ones that are so chronic that you have almost accepted them as “normal”. These include such symptoms as spaciness, headache, stiff neck, throat clearing, shortness of breath, coughing, fatigue, aches and pains, depression, weakness, increased sleep need, fluid retention, irritability, urinary tract symptoms, skin rashes, etc. Write down when you feel well, also. Keep this diary after you are finished with your testing-food allergies can persist over a lifetime, and that information could prove invaluable later in life. Be as observant as a crime scene investigator, and work from the premise that everything is caused by something, even when the cause isn’t apparent. This mindset will help your efforts pay off in better health for you. The opposite belief has led to many medical conditions being described as having “no known cause”. It is common for all of us to infer emotional causation especially for behavioral problems in children or mood disorders in adults. Open your mind to the possibility that these symptoms may have physical triggers. If your child goes from playing quietly to “climbing the walls”, being irritable, or needing an unscheduled nap, that is a symptom. Write it down and the patterns of symptoms will become your “crime scene investigation” notes to review later. If the child being tested is old enough to understand, set this testing up as an experiment in which he/she can play an active part.

3) Decide, with your physician if need be, which foods are to be tested. Exposure to these foods is required in the days prior to the elimination phase, so be sure to include this food in moderate amounts daily prior to starting the elimination of it from your diet. For people who have not already manipulated their diet, this simply means eating as they usually do.

4) Plan ahead now to have foods on hand to eat that you are not eliminating during the elimination phase. These are typically less commonly eaten foods that are not usually eaten on a daily basis. It only makes sense to also eliminate all foods with sugar, preservatives, artificial colors, and flavors that can themselves cause symptoms. Read labels! You will more likely avoid accidentally eating some form of the food being eliminated by eating food prepared at home. Cook with fresh unprocessed ingredients. Labeling of processed foods, though improved in recent years can, legally, omit foods of the label that are actually in the prepared food. And labels can be vague-for instance “vegetable oil” may be corn, soy, peanut, safflower, coconut, palm, or sunflower in origin.

5) During the elimination phase, eliminate all sources of the food(s) to be tested for five days. It is more efficient to eliminate a group of five or so foods all at the same time, although you need to test the foods individually during the challenge phase. Do not fast for the five days. Fasting creates a stress that you don’t need during this time. You may feel worse the first one to three days of going without a habitually eaten food due to occurrence of withdrawal symptoms. If you or your child feels worse during the elimination phase, you can try using the Vitamin C and Alka Seltzer Gold as described at the end of this paper for symptomatic relief, but do not take either on the morning of your challenge meal. If you make a mistake and eat the food to be tested during this five-day elimination period, you will need to restart the five-day elimination phase again. Continue to record all foods eaten and symptoms experienced. If your or your child’s target organ for allergic reactions is their brain, you may need to stop and remember that being angry or impatient with yourself or anyone else for having a “brain allergy” makes as much sense as being angry with arthritic symptoms of someone who has their joints as their target organ. There is just a different target organ involved. It needs to be said here that most often five days of elimination is adequate to unmask food allergy. Much less often, however, up to two weeks of elimination will be required to rid the body of the effects of the food in question. This seems to be more apt to be true with pediatric behavior disorders, depression in adults, sinusitis, and arthritis. If you do feel you are not “cleared” of the effects of the foods being eliminated in five days, you cannot go wrong by continuing the elimination phase for a few days longer, up to two weeks at the most.

6) Many people with allergies do not feel well when they wake up. If this describes you, you should postpone the eating of your test meal until your morning symptoms clear. On the morning of the day your challenge phase starts, eat only the chosen food being tested in its purest form in 2-4 times the quantity normally eaten at a meal. If you are testing wheat, eat cream of wheat cereal or whole organic wheat berries cooked in water (not milk) instead of using bread as your test meal. Bread contains yeast, vegetable oils, and many ingredients in addition to wheat. Use a glass of plain cow’s milk to test cow’s milk. To test chocolate, use a bar of unsweetened baking chocolate, not your favorite chocolate bar that contains maybe a dozen other ingredients. To test corn, fresh corn on the cob (no butter), or freshly dry popped popcorn is acceptable. If possible, eat organic foods for your test meal and you will rule out any adverse reaction to traces of pesticides that themselves are capable of provoking symptoms. Eat the purest form of the food you can obtain.

7) After eating your test meal, observe yourself for two hours for any changes, not forgetting to observe for changes in mood such as becoming irritable or feelings of hopelessness. Keep in mind that someone else may be more objective in observing you than you are. Eat no other foods during this time. You may drink water. If, after the first two hours of observation you notice no change or a vague change that you are not certain of, repeat your test meal and observe yourself for an additional hour. If no changes are noted by the end of this hour, resume your normal elimination diet, add the single food being tested back into the diet in normal quantities, and continue observing for symptoms for 24-48 hours for a possible delayed reaction. Remember unlike dust or pollen, most food allergies are delayed, making their detection challenging. Continue to record your responses in your food diary. If you have no reaction after 48 hours, consider the food to be non-reactive. For unknown reasons, reactions can occur to the food challenge, which are distinct, but different from those caused by that food when it is eaten on a daily basis. For example, a potato challenge meal could make you extremely sleepy, but in everyday eating may cause joint pain. Any symptoms, familiar to you or not, indicate a positive reaction.

8) Continue testing each of the foods you have eliminated in the same systematic way described above, one at a time. You should clear the reactions, if any, to the prior food test before testing another food. (See recommendations below for clearing an adverse reaction to food.) You may be able to test two foods in the same day, or you may only be able to do one every two days, depending on your reactions.

9) At this time, your physician may determine, based on your reactions, if you need to eliminate the reactive foods or rotate them on a schedule, usually every four days. Generally speaking, elimination or avoidance of foods that caused more problematic symptoms is required, and four-day rotation of less reactive foods is advised. Some food allergies are fixed, meaning that no matter how long you avoid or rotate them, you will always react. Other food allergies are concomitant and will react seasonally with some apparent synergistic or cross-reactivity, often associated with pollen exposure. Most food allergies however, are dose and frequency related, and after a period of time of avoidance or rotation, you may find a frequency and dose of eating that food that you can tolerate. If you resume the same dose and frequency of eating it as you did prior to the testing, you can expect previously experienced symptoms to return.

10) If you experience symptoms from eating your challenge test food, the crime scene investigator in you may wish to observe your reactions to see what unfolds. However, if you are certain that you have had a reaction to a food or are quite uncomfortable with your symptoms, there are some actions you can take to decrease the amount of time you feel uncomfortable.

Some people will get loose stools from Vitamin C at very low doses and others not at all. Or you could take bicarbonate salts in the form of BiCarb Formula capsules (available from the Medical Center) or Alka Seltzer Gold (the aspirin free variety) with a large glass of water. Separate doses of Vitamin C and Alka Seltzer Gold by 30 minutes. Alternately you could use Milk of Magnesia or Magnesium sulfate (Epsom salts) to hasten the elimination of the offending food from your body. Contact your physician anytime you have persistent symptoms that concern you.

Recommended Vitamin C dosing:
Children 25-50 pounds
1000-2000 mg daily in divided doses of 250 mg*

Persons 50-100 pounds
2000-4000 mg daily in divided doses of 500 mg*

Persons 100-150 pounds
4000-6000 mg daily in divided doses of 1000 mg*

Persons greater than 150 pounds
4000-16,000 mg daily in divided doses of 2,000-4,000 mg*

Recommended Alka Seltzer Gold Dosing:
Children 25-50 pounds
? effervescent tabs up to twice a day

Persons 50-100 pounds
1 effervescent tab up to twice a day

Persons greater than 100 pounds
2 effervescent tabs up to twice a day

Recommended BiCarb Formula dosing:
Persons 50-100 pounds
1 capsule up to three times daily

Person greater than 100 pounds
2 capsules up to three times daily

* Vitamin C may cause diarrhea in some individuals. Dose it to your individual tolerance. Stop taking Vitamin C if diarrhea develops and reduce your dosage to a tolerated dose upon resuming it. Vitamin C is a water-soluble vitamin and is more effective if take in 3-6 doses a day and not just one dose.

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