Food for Life: How the New Four Food Groups Can Save Your Life (23 page)

Many doctors tell arthritis patients that dietary changes will not help them. Unfortunately, this conclusion is based on older research with diets that included dairy products, oil, poultry or meat.
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It is clear that, at least for some people, a healthier menu is the answer to arthritis.

Gout is a form of arthritis that usually starts in the big toe. Severe pain ensues, often requiring hospital treatment. Tests show abnormally large amounts of a chemical called
uric acid
in the blood, and if the doctor draws a sample of fluid from the inflamed joint, uric acid will be found there as well. For some reason, men develop gout much more commonly than do women.

Some patients have attacks in joints other than the big toe, and as time goes on, more joints may become involved. Uric acid can also lead to kidney damage and kidney stones, and deposits in the skin, particularly in the ear, forearm, elbow, or Achilles’ tendon. If these deposits break open, as they sometimes do, out comes a chalky or pasty material made largely of uric acid crystals.

The word
gout
comes from the Latin word
gutta
, which means a “drop,” because in ancient times the disease had been thought to be caused by drops of mythological “morbid humors.”

Patients improve with medication in the hospital. But the key to prevention of gout lies in changing the diet. Although some cases are due to inborn deficiencies of certain enzymes, the cause most often is the Western diet. Uric acid is a breakdown product released from diets loaded with animal products.

The New Four Food Groups are an ideal prescription for preventing gout. It takes time for uric acid levels to change, so if you are currently being treated for gout or high uric acid levels, do not stop your medication during the dietary transition, and do so only under the guidance of your physician. Dietary transitions are times of particular vulnerability for people with a tendency toward gout.

Multiple sclerosis is a disease of the nervous system in which episodes of weakness or sensory symptoms come and go. The disease strikes young adults, usually between the ages of twenty and thirty-five. Early symptoms may be quite vague: fatigue, difficulty sleeping, or nervousness. Later on, visual blurring and other sensory symptoms occur, and the extremities become weak. At first, these symptoms usually resolve on their own. As time goes on, however, the symptoms become chronic, and eventually the individual may become incapacitated and ultimately die. A hot bath or any other source of heat can make the symptoms much worse. The disease was unknown until the early 1800s, and, like rheumatoid arthritis, may well be an affliction of modern times.

Until recently, there was little hope for MS patients. Medical treatments were not much help, and diet was the last thing anyone thought about. But one doctor has changed that. Dr. Roy Laver Swank’s studies of MS began in 1948 in Montreal. The young doctor noticed that MS follows a pattern like that of typical diet-related diseases. It is rare in Asia, but relatively common in North America and Western Europe. In Montreal, the disease was considerably rarer among poorer residents, whether French- or English-speaking, than among wealthier citizens. He looked within other countries
and found that MS rates were high where saturated fat intake was high and rare where fat intake was low. On the other hand, polyunsaturated oils seemed not to increase the risk.

Swank hypothesized that, in the presence of a genetic predisposition, fat may cause the clumping of platelets and blood cells, leading to sludging of blood in the capillaries to the brain. These microscopic clumps damage the capillary’s capacity to be selective in what goes into the brain and what does not. Toxic products enter the brain, leading to damage and scarring of the brain cells and nerves. He spent a considerable amount of time proving various aspects of his theory and published over two dozen research articles in major journals.

Swank developed a diet that cut down on saturated fat. The dietary changes he recommended were modest compared to those necessary to reverse heart disease or prevent cancer. He limited saturated fat intake to no more than 15 grams (three teaspoons) per day. This meant no red meat at all for the first year, and only small amounts thereafter. Fatty dairy products and other sources of saturated fats were to be eliminated as well. He felt that, unlike saturated fats, polyunsaturated oils might actually be helpful, so he recommended from 20 to 50 grams of oil per day. He published his recommendations in
The Multiple Sclerosis Diet Book
.
⁹

Dr. Swank tested his findings in Montreal and later in Portland in more than 2,000 patients, and followed these patients for anywhere from one to four decades. The results are impressive. The dietary treatment was most effective when begun early. For those who started the dietary treatment in the early stages of the disease, 95 percent either remained unchanged or actually improved during the next twenty years. Those who started the dietary changes later in the course of their disease did less well. After thirty-six years, only 30 percent of patients who did not go on the diet were still alive, compared to 79 percent of those who followed the diet.

Later, the suggestion to boost polyunsaturated oil was relaxed, as many patients did very well when they reduced both saturated and unsaturated fats.

Although Dr. Swank’s research was published in major journals,
¹⁰
it still tends to be ignored by most physicians, perhaps because of their general discomfort with dietary treatments. Research, however, has been very supportive.

About a year ago, after I finished a lecture in Portland, a man in the audience came up to introduce himself. “I thought you might like to see
what one of Dr. Swank’s patients looks like,” he said. He had been diagnosed with multiple sclerosis three decades earlier and, unlike the patients I had seen decline during my medical training, this man did not seem to have lost any ground at all. He did not claim to know why the diet worked, but he was not about to stop what might have saved his life.

My father specialized in the treatment of diabetes. He told me how, during his training at Boston’s Joslin Clinic, a competing institution received a research grant for $25,000, an enormous amount of money at the time. Dr. Joslin, who was then a prestigious diabetologist, responded: “Gentlemen, we don’t need a $25,000 grant. What we need is a good idea.” Dr. Joslin would have been delighted with the extraordinarily good ideas that have helped diabetics in recent years.

Diabetes is, in essence, starvation. The cells of the body are starving for their normal food, which is a simple sugar called glucose. Normally, the cells use this sugar to run their microscopic machinery. The problem in diabetes is that sugar has trouble passing from the bloodstream into the cells where it can be used. It must be escorted into the muscle, liver, and fat cells by a hormone called insulin, which can be thought of as a key that opens a door in the cell membrane for glucose to enter. When insulin is absent or not working properly, glucose simply waits in the bloodstream, unable to enter the cells.

From this disarmingly simple beginning, diabetes leads to many problems. Sugar builds up in the blood and ends up being excreted in the urine. Excessive urination leads to thirst and dehydration, along with weight loss and weakness. In serious and untreated cases, the disease progresses to labored breathing and coma.

Over the long run, the results of diabetes can be deadly. Diabetics can develop aggressive atherosclerosis, leading to heart attacks and strokes. The poor circulation to the legs, combined with trouble combating infections, means that a simple foot sore can progress to gangrene and amputation. There can even be damage to the tiny blood vessels in the retina, leading to blindness, and in the blood vessels of the kidney, leading to kidney failure.

The technical name for the disease is diabetes mellitus. (
Mellitus
is a Latin
word meaning “honey-sweet,” referring to the sugar content of the urine.) There are two different types of the disease. In childhood, if the pancreas is somehow damaged so that insulin cannot be produced, the result is insulin-dependent diabetes, which means that the affected individual will need insulin injections for the rest of his or her life. This form of diabetes is sometimes called childhood-onset diabetes or Type I diabetes. It usually starts before the age of forty.

In the second, and much more common, form of diabetes, the problem is not a lack of insulin but simply that the insulin does not work effectively. This form of the disease is called non-insulin-dependent diabetes (or adult-onset or Type II). It typically occurs in overweight adults over the age of forty, and is usually treated with dietary changes and oral medications, although insulin injections are sometimes used.

Diabetes is not rare. About 7 million Americans have it, and the prevalence is higher in African-Americans, Hispanics, and Native Americans. Because diabetics frequently need medical treatment and lose time from work, the costs of medical care and lost productivity are enormous-over $20 billion annually.
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The combination of the New Four Food Group menu and regular physical activity has a powerful effect on diabetes. In a study of a low-fat, starch-based diet and regular exercise in patients with non-insulin-dependent diabetes, researchers found that twenty-one of twenty-three patients on oral medications and thirteen of seventeen patients on insulin were able to get off their medication in less than four weeks. At two- and three-year follow-up, most diabetics treated with this regimen retained their gains.
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Although non-insulin-dependent diabetics often find that the disease disappears with diet and exercise, people with insulin-dependent diabetes will need insulin injections regardless of the diet they follow. However, dietary changes are usually helpful in managing the disease and in minimizing complications. Diabetic treatments should always be individualized. The information in this book should be coordinated with the treatment prescribed by a physician for your own needs.

The cornerstone of the diet is, first, to keep fats and oils to a minimum because they interfere with insulin. When I was a medical student, we did not appreciate the importance of this. We thought sugar was all there was
to it. It is true that diabetics tend to develop high blood sugar levels in response to sugary foods. We used to chase our patients around the hospital to make sure they never bought candy in the gift shop, because we did not want their blood sugar to rise. But all the while, the high-fat foods on the hospital trays were a much bigger problem because fats interfere with the action of insulin. Researchers have taken samples of cells from individuals on various diets and found that when patients are on low-fat, starch-based diets, insulin is able to bind to the cells more effectively.
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This can also be seen in the reduced amounts of insulin that such patients require.

Although doctors used to believe that diabetics should steer clear of carbohydrates, we now know that just the opposite is true. Complex carbohydrates and fiber should be increased to allow a more gradual release of sugars into the blood. Many scientific studies
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20
have shown that blood sugar levels are under better control on diets that are high in fiber and carbohydrate and low in fat.

The specific type of carbohydrate may make a difference. For example, beans seem to cause little rise in blood sugar levels, while the soluble fiber in fruits, vegetables, and legumes helps reduce blood sugar.
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A very low fat, high complex-carbohydrate diet also encourages weight loss, which improves insulin’s action. Weight loss alone can make noninsulin-dependent diabetes disappear. A healthier diet may also reduce the complications of the disease. Researchers at the National Institutes of Health compared diabetic patients with eye damage to patients without it, and found that those who had not developed the characteristic retinal damage had consumed more carbohydrate and fiber, and less protein.
²⁴

A no-cholesterol, low-fat diet gives the diabetic the best defense against the risks of arterial damage. This diet is also modest in protein, so it helps preserve kidney function, as we saw in
Chapter 1
.

The diet currently recommended by the American Diabetes Association could stand considerable improvement. The cornerstone of the ADA diet is a set of exchange lists, which divide foods into six categories: milk, fruit, vegetables, starch and bread, meat, and fat. The foods within each group have a similar nutritional makeup, and the lists help the patient maintain fairly constant levels of fat, protein, and carbohydrate intake day after day. The main problem with the diet is that it is much too high in fat, cholesterol, and protein, and too low in complex carbohydrates. Up to 30 percent of the calories in the ADA diet come from fat.
²⁵
This is too high, with the result being more insulin resistance than would occur on a lower-fat diet. And
given diabetics’ tendency toward aggressive damage to the heart, blood vessels, and kidneys, high-fat, high-protein foods are the last thing they need. The difference between the New Four Food Groups and the exchange lists is that the New Four Food Groups delete the milk, meat, and fat categories; encourage more generous amounts of grains, vegetables, and fruits; and add the legume group, yielding a much more powerful regimen.

Physical activity is also very important. Exercising muscles have a voracious appetite for sugar. They pull it out of the blood, even with very little insulin present. For this reason diabetics do well to maintain a regular program of aerobic physical activity. Caution is advised, however; a sudden increase in exercise can lower blood sugar too rapidly, and insulin doses will need to be adjusted by your doctor.