UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION

NUTRITION PERSPECTIVES

Volume 27, No. 2
March/April 2002

TABLE OF CONTENTS PAGE

Is Saint John's Wort a Safe and Effective Antidepressant?
HHS, American Diabetes Association Renew Campaign to Help People with Diabetes Know their Cardiovascular Risks
Preventing Diabetes by Lifestyle Modification vs. Drug Therapy
Homocysteine, Risk Factor for Alzheimer's Disease?
AHA Advises Caution on High-Protein Diets
Making Fast Food Healthful
Nutrition and the Cancer Survivor
Folic Acid and Parkinson Disease
Plate Waste In Schools
Fish, Omega-3 Fatty Acid Intake and Cardiovascular Risk In Women
FDA Issues Kava Warning

Resources:
New Resource Available from the International Food Information Council (IFIC) Foundation!!

Websites
Expanded Calcium Web Site for Kids
The National Center for Home Food Preservation Announces their New Web Site!

Book Review:
The Natural Medicines Comprehensive Database: Book Version

Subscription for NUTRITION PERSPECTIVES

Sheri Zidenberg-Cherr, PhD, Editor
Department of Nutrition
University of California
Davis, CA 95616

NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, and staff. It is designed to provide research-based information on ongoing nutrition and food-related programs. It is published bimonthly (six times annually) as a service of the University of California Cooperative Extension and the United States Department of Agriculture. Subscription to NUTRITION PERSPECTIVES is available from UC Cooperative Extension, Department of Nutrition, University of California, Davis, California. Cost is ten dollars ($10.00) for a one-year subscription. Subscriptions and questions or comments on articles may be addressed to: NUTRITION PERSPECTIVES, Department of Nutrition, University of California, Davis, CA 95616-5270. Phone (530) 752-3387; FAX, (530) 752-8905.

IS SAINT JOHN'S WORT A SAFE AND EFFECTIVE ANTIDEPRESSANT?

In recent years, a significant amount of public interest in alternative medicines has focused on the use of St. John's wort as an antidepressant. Consumers may be attracted to this product because it is available over-the-counter and is perceived as "safe" or "natural" [1]. St. John's wort is one of the most extensively studied herbal medications available. Research has examined its efficacy in comparison to conventional antidepressants, safety, mechanism of action, and product purity. This is discussed in greater detail below.

What is St. John's wort?

St. John's wort, also known by the Latin name Hypericum perforatum, is a plant with bright yellow-orange flowers. Both leaves and flowers may be incorporated into medicinal preparations. Commercially available preparations of St. John's wort include tablet, capsule, tea, and tincture [2].

Is St. John's wort an effective antidepressant?

Clinical trials of St. John's wort usually compare it to placebo (sugar pill) or to a tricyclic antidepressant. Tricyclic antidepressants (TCAs) are synthetic antidepressants often used to treat mild to moderate depression. A few clinical trials have compared St. John's wort to selective serotonin reuptake inhibitors (SSRIs), another type of antidepressant.

For treatment of mild to moderate depression:
Studies of patients experiencing mild to moderate clinical depression have generally concluded that, for these patients, St. John's wort is more effective than placebo, and that it is as effective as low doses of TCAs (3, 4, 5, 6,7). Additionally, studies have found that St. John's wort produces fewer side effects than TCAs, which may result in increased patient compliance.

For treatment of major depression:
In addition to the large number of studies investigating mild or moderate depression, a few studies have examined the efficacy of St. John's wort in major depression [8]. These studies have not found significant treatment effects, and Shelton and colleagues have therefore concluded that patients with major depression do not benefit from St. John's wort. Synthetic antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are significantly more effective than St. John's wort for the treatment of major depression.

How does St. John's wort work?

The antidepressant mechanism of St. John's wort is not well understood. Hyperforin and hypericin are two compounds contained in this herb that are thought to have pharmacological activity. Several compounds in St. John's wort may be acting synergistically to produce the drug's effects, with no single compound being solely responsible for antidepressant activity [9]. The antidepressant effect is thought to result from selective inhibition of serotonin, dopamine and norepinephrine reuptake in the central nervous system [10].

Does St. John's wort produce side effects?

When used as a monotherapy, the reported incidence of side effects for St. John's wort is lower than for synthetic antidepressants. In clinical trials, mild side effects have included nausea, rash, fatigue, restlessness, constipation or diarrhea, allergic reactions of the skin, and tiredness [4, 5]. Potentially serious side effects of St. John's wort include photosensitivity, which is rare, and induction of manic symptoms in predisposed patients [10].

Is it safe to combine St. John's wort with other medications?

When combined with other medications, St. John's wort can pose serious health concerns. This is because it increases the rate of metabolism of several types of synthetic drugs. Plasma levels of a variety of drugs can be decreased as a result. A partial list of affected medications is given in the following table.

Drugs Affected by St. John's wort (SJW)

Patients who are stabilized on treatment regimes that combine St. John's wort with other medications should not discontinue their St. John's wort without medical supervision, as this could cause dangerous changes in the pharmacokinetics of their other medications [13]. In addition, since St. John's wort affects a variety of enzymes and transporters involved in drug metabolism, the drugs whose metabolism could potentially be changed by St. John's wort extends far beyond those listed in the table. Patients should consult a knowledgeable physician before combining St. John's wort with any other medications.

Are St. John's wort products quality-controlled?

St. John's wort is classified as a dietary supplement under the Dietary Health Education and Supplement Act of 1994. Supplements are not subject to the same regulatory procedures as conventional drugs [18]. Since St. John's wort products are prepared from extracts of plant matter, the dose of active compounds present in each preparation is uncertain. Thus, the potency of St. John's wort supplements varies significantly from manufacturer to manufacturer and between batches prepared by the same manufacturer [9].

Summary:

In general, clinical trials have found that St. John's wort is an effective antidepressant for persons experiencing mild to moderate depression, with an efficacy similar to tricyclic antidepressants and significantly greater than placebo. However, St. John's wort has been found ineffective for those suffering from major depression. St. John's wort has fewer side effects than tricyclic antidepressants, which may improve patient compliance with this antidepressant regimen. The most serious safety concerns related to the use of St. John's wort are (1) its ability to modify the metabolism of other medications and (2) the fact that the levels of active compounds in St. John's wort products are not standardized, which makes accurate dosing difficult.

References:
1. Wagner PJ, et al. Taking the Edge Off. Why Patients Choose St. John's wort. The Journal of Family Practice;1999; 48(8); pp. 615-19.
2. Greeson J, Sanford B, and Monti D. St. John's wort (Hypericum perforatum): a review of the current pharmacological, toxicological, and clinical literature. Psychopharmacology,;2001; 153; pp. 402-414.
3. Kim H, Stretzler J, and Goebert D.St. John's wort for depression: a meta-analysis of well-defined clinical trials. Journal of Nervous Mental Disorders; 1999; 187; pp. 532-538.
4. Gaster B and Holroyd J. St. John's wort for depression: a systematic review. Archives of Internal Medicine; 2000; 160; pp. 152-156.
5. Kasper S. Hypericum perforatum - a Review of Clinical Studies. Pharmacopsychiatry; 2001;34 Suppl1; pp. S51-S55.
6. Linde K and Mulrow CD. St John's wort for depression. Cochrane Database Syst Rev; 2000; CD000448.
7. Stevinson C, and Ernst E. Hypericum for depression. An update of the clinical evidence. European Neuropsychopharmacology; 1999; 9; pp. 501-5.
8. Shelton RC, et al. Effectiveness of St. John's wort in Major Depression: A Randomized Controlled Trial. Journal of the American Medical Association; 2001; 285(15); pp. 1978-1986.
9. Wurglics M, et al. Batch-to-batch reproducibility of St. John's wort preparations. Pharmacopsychiatry; 2001; 34 Suppl1; pp. S152-S156.
10. Ernst E.. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Annals of Internal Medicine; 2002; 136; pp. 42-53.
11. Ernst E.. Second thoughts about safety of St. John's wort. The Lancet; 1999; 345; pp. 2014-5.
12. Maurer A., Johne A, and Bauer S. Interaction of St. John's wort extract with phenprocoumon. European Journal of Clinical Pharmacology;1999; 55; p. A22 (abstr).
13. Wheatley D. Safety of St. John's wort (Hypericum perforatum). (Letter). The Lancet; 2000; 355; pp. 575-576.
14. Yue QY, Bergquist C, and Gerden B. Safety of St. John's wort (Hypericum perforatum). (Letter). The Lancet; 2000; 355; pp. 576-577.
15. Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The Lancet; 2000; 355;pp. 547-8.
16. Ruschitzka F, et al. Acute heart transplant rejection due to St. John's wort. The Lancet; 2000; 355; pp. 548-9.
17. Martin TG. Serotonin syndrome. Annals of Emergency Medicine; 1996; 28; pp. 520-526.
18. Kaczka K. From herbal prozac to Mark McGwire's tonic: how the Dietary Supplement, Health and Education Act changed the regulatory landscape for health products. Journal of Contemporary Health Law and Policy; 2000; 16; pp. 463-99.

Source: Erin Digitale, PhD Candidate; Department of Nutrition, University of California at Davis.

HHS, AMERICAN DIABETES ASSOCIATION RENEW CAMPAIGN TO HELP PEOPLE WITH DIABETES KNOW THEIR CARDIOVASCULAR RISKS

As the American Diabetes Association (ADA) released a new poll showing that people with diabetes often know too little about their greatest health risks, Department of Health and Human Services (HHS) Secretary Tommy G. Thompson recently renewed HHS' commitment to help those affected by the disease take steps to minimize their risks for heart disease and stroke.

"This ADA survey reinforces the need to help people with diabetes understand their increased risk for heart disease and stroke - and what they can do to reduce those risks," Secretary Thompson said. "Not only controlling blood sugar, but also controlling blood pressure and cholesterol, is important to prevent heart disease and stroke in those who have diabetes."

The ADA-commissioned survey, released by ADA President Christopher D. Saudek, MD, polled more than 2,000 people diagnosed with diabetes. Even though heart disease and stroke are the leading causes of death among people with diabetes, the poll found that two out of three people with diabetes did not consider cardiovascular disease to be a significant risk.

Most knew more about disabilities associated with diabetes, such as blindness and amputation, than they did about cardiovascular complications that are often fatal. Many knew little about steps that they can take to reduce their cardiovascular risks, such as taking aspirin or prescription medications, lowering their cholesterol and quitting smoking.

"It is very alarming to learn that 68 percent of people with diabetes are unaware of the link between diabetes, and heart disease and stroke," Saudek said. "Consequently, they are unlikely to be doing what they need to save their lives."

To promote a comprehensive approach to diabetes care, HHS' National Diabetes Education Program has developed the "ABCs of Diabetes" campaign. The A stands for the A1c or hemoglobin A1c test, which measures average blood glucose (sugar) over the previous 3 months, B is for blood pressure, and C is for cholesterol.

"People with diabetes know how important it is to control their blood glucose, but too little attention is paid to the role of cholesterol and blood pressure," said Allen M. Spiegel, MD, director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH). "Research shows that this new approach, aggressively treating these three risk factors, can save lives."

As part of the "ABCs of Diabetes" campaign, the National Diabetes Education Program and the ADA offer a free brochure for people with diabetes with essential information about managing their health and a wallet card to help them track their ABC numbers. These materials are available free to the public through HHS at 1-800-438-5383 or http://www.ndep.nih.gov and through the ADA at 1-800-DIABETES (1-800-342-2383) or http://www.diabetes.org/makethelink.

In August 2001, HHS released results from the Diabetes Prevention Program, a major clinical trial involving more than 3,000 people, that showed millions of overweight Americans at high risk for developing type 2 diabetes, can delay and possibly prevent the disease with relatively moderate diet and exercise. Those results show that prevention efforts can greatly reduce the impact of diabetes.

Diabetes affects 16 million people in the United States and costs the nation about $100 billion each year. It is the main cause of kidney failure and new onset blindness in adults and a major cause of heart disease, limb amputation and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases. Most common in adults over age 40, type 2 diabetes affects 8 percent of the U.S. population age 20 and older. It is strongly associated with obesity (more than 80 percent of people with type 2 diabetes are overweight), inactivity, family history of diabetes, and racial or ethnic background. The prevalence of Type 2 diabetes has tripled in the last 30 years, and much of the increase is due to the dramatic upsurge in obesity.

The HHS' National Diabetes Education Program is jointly sponsored by NIH and the Centers for Disease Control and Prevention (CDC) and 200 public and private partners.

Source: HHS Press Release; February 19, 2002.

PREVENTING DIABETES BY LIFESTYLE MODIFICATION VS. DRUG THERAPY

Results from several studies show that diet and exercise can reduce the incidence of type 2 diabetes in certain populations. In this multi-center US trial, 3234 adults at high risk for diabetes were randomized to 3 intervention groups: standard lifestyle recommendations plus metformin (850 mg twice daily); standard lifestyle recommendations plus placebo; or intensive lifestyle modification (goal, at least 7 percent weight reduction and 150 minutes of exercise weekly) (1).

Enrollment criteria included body-mass index (BMI) of 24 or higher, fasting plasma glucose of 95 mg/dL to 125 mg/dL, and plasma glucose of 140 mg/dL to 199 mg/dL 2 hours after oral glucose load. Mean baseline BMI was 34. During an average follow-up of 2.8 years, incidence of newly diagnosed diabetes was significantly lower in the intensive lifestyle intervention group (4.8 vs. 7.8 vs. 11.0 cases per 100 person-years). This pattern of response was similar among men and women and among all ethnic and racial groups. The rate of gastrointestinal symptoms was significantly higher in the metformin group than in the other 2 groups.

Intensive lifestyle intervention prevented diabetes more effectively than did metformin, which in turn was more effective than placebo alone. The results underscore the tangible benefits of weight reduction and exercise, but the lifestyle intervention in this trial was labor-intensive: each person in that group received a 16-lesson educational intervention, which was taught one-to-one by specially trained case managers.

Reference:
1. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med; Vol.346; February 7, 2002; pp. 349-403.

Source: Journal Watch; 22(6); March 15, 2002; p. 48.

HOMOCYSTEINE, RISK FACTOR FOR ALZHEIMER'S DISEASE?

Results of recent studies suggest that patients with cardiovascular risk factors have in increased incidence of Alzheimer's disease (AD). This observation raises the question of whether plasma homocysteine, a recently identified cardiovascular risk factor, also might be a risk factor for dementia and AD (1).

Boston researchers identified 1092 participants (mean age, 77) from the Framingham Heart Study who were free from dementia; plasma homocysteine levels were determined at baseline. During a median follow-up of 8 years, 111 subjects were diagnosed with dementia (of whom 83 were diagnosed with AD). Risks for any dementia and for AD increased with increasing homocysteine levels for example, subjects with homocysteine levels higher than 14 µM had about a 2-fold increase in risk for any dementia or AD, compared with subjects who had lower homocysteine levels. Analyses were adjusted for age and other potentially confounding variables.

These findings raise the intriguing possibility that a potentially modifiable risk factor, hyperhomocysteinemia, promotes the development or progression of Alzheimer's disease. The next logical question is to determine weather some cases of AD could e prevented by dietary supplementation with b vitamins or folate, which reduce plasma levels of homocysteine. On caveat is that nearly all subjects in this study were white.

Reference:
1. Seshadri S, Beiser A, Selhub J, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med; Vol. 346; February 14,2002; pp. 476-83.

Source: Journal Watch; 22(7); April 1, 2002; p. 56-7.

AHA ADVISES CAUTION ON HIGH-PROTEIN DIETS

In recent years, the debate over high-protein diet has been the stuff of talk shows and popular magazine articles. Meanwhile, an American Heart Association (AHA) committee has released an advisory cautioning against this "new" strategy for weight loss.

First, the AHA Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism notes that high-protein diets have been around in some form or another since the 1960s. Second, the committee, in its Statement for Healthcare Professionals, says these diets are not recommended "because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs." The diets put people at risk for a variety of ills, from compromised vitamin and mineral intake to possible cardiac, renal, bone, and liver problems, the committee says (1).

Although they may not hurt most healthy people in the short run, there are no long-term studies to support their safety, the committee says.
The diets are popular because of initial high weight loss and a freedom to eat quantities of high-protein foods not typically allowed in traditional diets. Yet followers generally consume higher levels of total fat, saturated fat, and cholesterol because they are eating animal proteins. The initial drop in weight is brought on by fluid loss caused by consuming fewer carbohydrates and calories as well as ketosis-induced appetite suppression.

The committee states: "High-protein, high-fat diets induce metabolic ketosis and are initially attractive because they may induce quick weight loss. This initial weight loss, however, may be attributed in part to the diuretic effect from low carbohydrate intake and its effects on sodium and water loss, glycogen depletion, and ketosis. As the diet is sustained, loss of appetite associated with ketosis leads to lower total caloric intake." In addition, any positive outcomes for blood lipids and insulin resistance are caused by weight loss, not by change in diet.

The statement also says the amount of protein intake called for in these diets is higher than people require and can pose significant health risks. The animal proteins usually consumed can raise LDL cholesterol levels, and that problem is exacerbated because the very foods that help lower cholesterol, high-carbohydrate, high-fiber plant foods, are allowed only sparingly. Similarly, this change in balance can raise blood pressure, increase sodium intake, raise uric acid levels, and increase urinary calcium loss. Low carbohydrate intake also may make exercise difficult.

In evaluating these diets, the committee notes the importance of following AHA Dietary Guidelines and using primary prevention strategies for coronary heart disease:

1. Total protein intake should not be excessive (average 50-100 g/d) and should be reasonably proportional (~15 percent of kilocalories per day) to carbohydrate (~55 percent of kilocalories per day) and fat (~30 percent of kilocalories per day) intake.

2. Carbohydrates should not be omitted or severely restricted. A minimum of 100 g of carbohydrates per day is recommended to ensure overall nutritional adequacy through the provision of a variety of healthful foods.

3. Selected protein foods should not contribute excess total fat, saturated fat, or cholesterol.

4. The diet should be safely implemented over the long term, i.e., it should provide adequate nutrients and support dietary compliance with a healthful eating plan to prevent increases in disease risk.

Reference:
1. St Jeor ST, Howard BV, Prewitt TE, et al. Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 04(15); October 9, 2001; pp.11869-74.
Source: Nutrition & the M.D.; 28(2); February 2002; pp. 7-8.

MAKING FAST FOOD HEALTHFUL

"Healthful fast food" may sound like an oxymoron, but fast food restaurants catering to the health-conscious are popping up around the country. Witness Healthy Bites Grills and Evos restaurants in Florida, which dish up items like bean soup and salmon burgers; the Topz chain in southern California, which serves air-baked fries; and Heart Wise Express in Chicago, which wraps its burritos in whole-wheat tortillas.

But can this fast food provide the same comfort quotient as the "regular" kind? Yes. Tasters around the country were asked to check out these chains for us, and all came back with favorable reviews. One taster dispatched to Topz said she'd rather eat there than Burger King or Jack in the Box. Someone reporting for a group of six at Healthy Bites said "there wasn't one person out of all of us who didn't like what they ate." And during a recent busy lunch hour when their taste testers visited Chicago's Heart Wise Express, more people were buying the veggie burger with roasted potato wedges than opting for free ice cream at a nearby sundae giveaway.

These places truly deliver on nutrition, too. An All American Champion burger at Evos delivers 445 calories and just 2.5 grams of saturated fat, considerable less than the 590 calories and 11 grams of saturated fat in a McDonald's Big Mac (even though the Evos item outweighs the Big Mac by a third). And a Heart Wise Express Chicken Sandwich has 420 calories and 1 gram of saturated fat. Compare that to a chicken sandwich at Burger King, which is about two-thirds the size but has some 50 percent more calories (660), along with 8 grams of saturated fat.

With just a few outlets scattered in just a few states, the good taste and nutrition profile of the new chains probably won't cause the Golden Arches to fall anytime soon. But it is possible to pick up healthful fare at the usual fast food outlets. Check out the table, below.
Healthy Picks at the Fast Food Chains

Each of the meals listed below contains fewer than 600 calories and no more than 7 grams of saturated fat, and includes some form of vegetable. Unfortunately, had a sodium limit been set, this list might not have existed. In several cases, a single meal comes close to the recommended maximum of 2,400 milligrams a day.

Fast Food Chain Calories Saturated Fat (grams) Sodium (milligrams)

Arby's
Grilled Chicken Caesar Market Fresh Salad with BBQ Vinaigrette Dressing 370 5 1,580
Arby-Q Roast Beef Sandwich, Side Salad with Reduced-Calorie Buttermilk Ranch Dressing 450 4 2,300

KFC
Honey BBQ Flavored Sandwich, Corn on the Cob 460 2 580
Popcorn Chicken (small), Corn on the Cob 512 6 630

McDonald's
Chicken McNuggets (4 pc) with Honey Mustard Sauce, Garden McSalad Shaker with Fat-Free Herb Vinaigrette 375 6 825
Hamburger, Garden McSalad Shaker with Fat-Free Herb Vinaigrette 415 7 970

Pizza Hut
Hand Tossed Pizza (2 medium slices Veggie Lover's or Chicken Supreme), Side Salad with Low-Cal Dressing 477-497 6-7 1,316-1,456
Thin Crispy Pizza (2 medium slices Veggie Lover's or Chicken Supreme, Ham), Side Salad with Low-Cal Dressing 380-440 6-7 1,196-1,396

Subway
Low Fat 6" Sub (Veggie Delite, Turkey Breast, Turkey Breast and Ham, Ham, Roast Beef, Subway Club, or Roast Chicken Breast) 200-311 0.5-1.5 500-1,260
6" Subway Classic (Tuna, Seafood and Crab, Cold Cut Trio, Subway Melt, or Steak and Cheese) 362-419 4.5-7 1,180-1,690

Taco Bell
Soft Steak or Chicken Taco, Pinto Beans (no Cheese) 340 5-5.5 1,075-1,185
Fiesta Chicken Burrito or Bean Burrito, Mexican Rice 560 7 1,750-1,830

Wendy's
Baked Potato topped with Small Chili 520 2.5 825
Grilled Chicken Sandwich, Side Salad with Fat-Free Dressing 390 2 1,040

Adapted from: Tufts University Health & Nutrition Letter; 19(8); October 2001; p.8.

NUTRITION AND THE CANCER SURVIVOR

In America alone, an estimated 8.5 million cancer survivors are leading vital, cancer-free lives. There is a new brochure out by the American Institute for Cancer Research (AICR) that will help patients and clients understand how the diet-cancer connection relates to the growing population of cancer survivors. By making some healthy changes to their diets, survivors may be able to help their bodies fend off both recurrence and secondary cancers.

This brochure offers a variety of information for the cancer survivor such as:

· Discussing AICR's Diet and Health Guidelines from the unique perspective of survivors;
· Answering questions common among survivors on topics such as supplements, specialized diets, and soy;
· Showing how to make sense of confusing and contradicting health claims; and
· Providing a list of additional resources.

Evaluating Nutrition Information

Many cancer survivors are highly motivated about issues. They read widely, ask informed questions, and are eager to make healthy changes. Survivor research, however, is still in its early stages. Dependable, science-based advice can be hard to come by.

Many uninformed or even unscrupulous individuals are rushing to fill the gap between what science knows and what cancer survivors want to know. That's why you need to stay alert. News reports can cause confusion by overstating the results of research. Makers of pills, powders, and other products may attempt to exploit survivors' desire for information by touting unverified, and unverifiable, health claims. With the advent of the Internet, baseless rumors about diet and cancer can spread around the world in minutes.

Separating fact from fiction is all-important. Here are some things to keep in mind the next time you come across something that sounds too good to be true.

Read closely
Science progresses in a slow and careful fashion. That's why products that use words like "breakthrough" and "miracle" and even "discovery" should send up red flags in your mind. Another warning sign is reliance on anecdotal evidence ("testimonials" or "case histories") rather than published scientific data.

Get the whole story
Reports about science that appear on television or radio are too short to include many important details. Look to magazines or newspapers from more complete information, including where the report was published, who paid for it, how big it was, and (especially) how it relates to previous research in the same field. Remember to rely on scientific consensus, not simply a single study.

Promises, promises
Be skeptical of easy answers. It's human nature to look for quick fixes, or "magic bullets" that solve health problems. But cancer is a complex disease, with no single cause or cure. The human body is composed of many intricate systems that work together. Even the foods we eat contain hundreds, perhaps thousands, of protective components. The most healthful strategy will always be one that addresses the overall diet, not single foods or supplements.

Go to a reputable source
These days, everyone's got something to say about nutrition and health. Survivors are barraged with ideas for staying healthy from television, the Internet, magazines, and word-of-mouth. Things can easily get confusing. Before trying any new strategy for yourself, tell your doctor about it. Health professionals work hard to keep up with new developments, and their years of training and experience come in handy. Your doctor can be a helpful resource in your efforts to remain cancer-free, but only if he or she is kept informed. There are some practical reasons for this: certain herbal supplements, for example, can interact with other medications you may be taking with potentially dangerous results.

Maintaining a healthy skepticism is perhaps the most useful thing to do. That doesn't mean you have to spend the rest of your life in a research library, cross-checking each and every scientific study that comes along. Luckily, you've already got the most important thing you'll need: common sense. Because if something sounds too good to be true, it probably is.

Common Questions

Supplements

Although we have the largest food supply in the world, many Americans are still lured by dietary supplements. Cancer survivors are no less attracted to these products, and marketing efforts may even target them.

There is much controversy concerning the use of supplements, especially antioxidants. Some research shows that large doses of nutrients from supplements can actually protect the cancer cell from being destroyed. Of course, other studies show the opposite. The majority of research, however, indicates that protective nutrients in food are far superior to pills.

Get your nutrients by eating a wide variety of plant-based foods, including at least five servings per day of vegetables and fruits. Supplements should never replace conventional food in the diet.

There may be certain times, however, when you are not able to eat a nutritionally adequate diet. In this case, a standard 100 percent RDA multi-vitamin can offer some advantages.

Phytochemical supplements

The discovery of phytochemicals, protective substances in plant foods, is relatively new in cancer research. Each phytochemical seems to have a unique role in cancer protection, such as detoxifying carcinogens, protecting body cells from damage, or affecting hormones that can influence the development of cancer.
Scientists have identified hundreds of phytochemicals in foods, and they believe there are thousands more. That is one reason why phytochemical supplements cannot be a substitute for whole fruits and vegetables.

Each individual vegetable and fruit has its own profile of phytochemicals. Thus, the substances in broccoli are different from those found in cherries or leeks or zucchini. Each time you eat a tossed salad with a large variety of vegetables, such as spinach leaves, cucumbers, grated carrots, cauliflower, chopped green onions, red cabbage, and tomato wedges, you are eating an arsenal of cancer protection. So pass on the pills and fill your plate with healthful plant-based foods.

Soy

Experts currently caution against large amounts of soy for women who have, have had, or are at risk for estrogen receptor-positive breast cancer. Eating a few servings of soy foods per week, however, does not appear to be a problem. Some researchers suggest that women who do not already eat soy on a regular basis should not do so solely for the purpose of breast cancer prevention.

Also, it is not wise at this time to use large amounts of soy powders. Although we know soy protein may help to control cholesterol levels, we do not know all the effects of supplemental amounts of isoflavones on cancer. There is just not enough research data available to make recommendations. Since this issue is largely unresolved, it is wise to discuss soy with your physician.

Vegetarian diets

A vegetarian diet is often considered a healthier alternative to what many cancer survivors ate before their diagnosis. Studies have shown that diets high in vegetables, fruits, whole grains, beans, nuts, and seeds, and lower in meats, are cancer protective.

There is no evidence, however, that a vegetarian diet provides any more protection than a mostly plant-based diet with small amounts of meat. If you choose a vegetarian meal plan, be sure to eat a variety of foods, including many different vegetables and fruits, whole grains and protein alternatives to meat (such as beans, eggs, tofu, or small amounts of cheese).

Macrobiotic diets

There is no clear evidence that a macrobiotic diet can cure or prevent disease. This diet is based on a few types of grains, with lesser amounts of specific vegetables, seaweed, beans, and miso soup. Nutrients and calories may be quite limited. And since the diet is also limited in food choices, it should include a complete multivitamin that contains vitamin B12.

Since a macrobiotic diet is not based on a large variety of plant-based foods and has not been found to be cancer protective, special care should be taken to obtain the nutrients needed for optimal health.

A Final Word

Many questions remain about the best diet for cancer survivors. Scientists across the country are working to find answers, and many more researchers will join this quest in the years to come.

In the meantime, existing science shows that a diet high in vegetables, fruits, whole grains, and beans, along with regular physical activity, can increase the body's ability to resist cancer. Since this type of lifestyle also helps protect against serious illnesses like heart disease, stroke, and Type 2 diabetes, making the changes recommended in the AICR brochure can only enhance your health, and most importantly, add pleasure to your life.

Additional Resources

216 West Jackson Boulevard
Chicago, IL 60606-6995
Consumer Nutrition Hotline: 1-800-366-1655
www.eatright.org

If you feel the need for individual nutrition counseling, call ADA's Consumer Nutrition Hotline from 9:00 AM to 4:00 PM Central Time, Monday through Friday. You will receive a referral to a registered dietitian (RD) in your area.

1759 R Street, NW
Washington, DC 20009
1-800-843-8112 or 1-202-328-7744
www.aicr.org

Contact AICR for practical, reliable information on healthy eating for lower cancer risk.

· AICR Newsletter: This free, quarterly publication provides tips on eating well, exercise, great-tasting recipes, and the latest information on nutrition and cancer research.
· Educational brochures: AICR brochures cover a variety of topics, such as Moving Towards a Plant-based Diet, No Time to Cook, and Healthy Eating Away from Home. Single copies are free. Call or write for a publications catalog or visit AICR online.
· Nutrition Hotline: Dial 1-800-843-8114 and leave any questions you may have about diet, health, cooking, cancer, and more. A registered dietitian will return your call and discuss our questions free of charge. The hotline is available 9:00 AM to 5:00 PM Eastern Time, Monday through Friday.

Adapted from: Nutrition and the Cancer Survivor Brochure, AICR; 2001; pp. 11-17.

FOLIC ACID AND PARKINSON DISEASE

Folic acid deficiency could increase the risk for Parkinson disease, according to research from the National Institute on Aging (NIA) (1). In the study, mice fed folate-deficient diets developed severe Parkinson-like symptoms, which the scientists traced to elevated levels of homocysteine in the brain. They suspect that this excess amino acid damages DNA in the substantia nigra, a brain structure rich with dopamine cells. In mice fed adequate amounts of folic acid, however, dopamine neurons repaired intentionally damaged DNA, counteracting the effects of excess homocysteine.

"It is clear that a deficiency of this vitamin increases toxin-induced damage in the mouse brain," said Mark Mattson, PhD, chief of the NIA's laboratory of neurosciences.

People with Parkinson disease often have low levels of folic acid, but it remains unclear whether this results from the disease process or simple malnourishment. The FDA requires food manufacturers to add folic acid to breads and other processed grain products; the vitamin is naturally abundant in dark green vegetables, citrus fruits, and whole wheat bread.

Reference:
1. Duan W, Ladenheim B, Cutler RG, Kruman II, Cadet JL, Mattson MP. Dietary folate deficiency and elevated homocysteine levels endanger dopaminergic neurons in models of Parkinson's disease. J Neurochem; 80(1); January 2002; pp.101-10.

Source: JAMA; 287(14); April 10, 2002; p.1763.

PLATE WASTE IN SCHOOLS

About 12 percent of calories from food served in the National School Lunch Program go uneaten, a practice known as plate wastereported the USDA's Economic Research Service. Possible causes of plate waste include times meals ore served, student food preferences, and availability of competitive foods. Solutions include rescheduling lunch hours, improving food quality, and allowing students to have some choice in their lunch. Go to www.ers.usda.gov/puplications/efan02009/efan02009.pdf to read the report.

Source: Nutrition Week; XXXII(6); March 25, 2002; p. 7.

FISH, OMEGA-3 FATTY ACID INTAKE AND CARDIOVASCULAR RISK IN WOMEN

Current dietary guidelines recommend fish consumption twice weekly for the prevention of coronary heart disease (CHD). The association between consumption of fish and long-chain omega-3 fatty acids and reduced risk of CHD has been documented primarily in men. In a recent analysis of data from the Nurses' Health Study, a prospective cohort study of women aged 34 to 59 years, at baseline, Hu and colleagues found that higher consumption of fish and omega-3 fatty acids was associated with a significantly lower risk of incident DHD events (CHD deaths and nonfatal myocardial infarction) during 16 years of follow-up (1).

Reference:
1. Hu FB, Bronner L, Walther C, et al. Fish and Omega-3 Fatty Acid Intake and Risk of Coronary Heart Disease in Women. JAMA; 287(14); April 10, 2002; pp.1815-1821.

Source: JAMA; 287(14); April 10, 2002; p.1763.

FDA ISSUES KAVA WARNING

The FDA issued a consumer advisory about dietary supplements containing kava, saying it may be associated with severe liver injury. The supplements, which are taken for relaxation and sleeplessness, have been linked to 25 reports of adverse reactions in other countries; in the United States, the FDA received a report of one woman who needed a liver transplant after taking the supplement. The FDA is recommending that people who have liver disease or liver problems talk to their doctors before taking kava.

Go to www.cfsan.fda.gov/~addskava.html for more information.

Source: Nutrition Week; XXXII(7); April 8, 2002; p. 7.

RESOURCES:

NEW RESOURCE AVAILABLE FROM THE INTERNATIONAL FOOD INFORMATION COUNCIL (IFIC) FOUNDATION!!

The body of consumer research indicates a distinct disconnect in communication between health professionals and consumers. Consumers seem to think they should make healthful decisions concerning food and nutrition and want to, but don't have the understanding and tools necessary to permanently incorporate changes into their lifestyles.

In response, the International Food Information Council (IFIC) designed a "New Nutrition Conversation with Consumers," an innovative program that provides tools for health professionals to develop and deliver consumer-tested nutrition messages and tips. This program is founded on the principle that it is more effective to talk with consumers about food and nutrition than at them. A New Nutrition Conversation is truly about giving consumers the opportunity to tell the health professional what resonates with them and which messages they find "doable". After all, isn't that the whole point, doing it?

A Web site has been developed for this express purpose. Log on to www.newconversation.org where you will find all the tools you need to get started!

All of the consumer research is summarized and links are provided to full-reports in Adobe Acrobat Portable Document Format (pdf) files. You can walk through the marketing model step-by-step and view message development guidelines, all designed to aid you in developing your own consumer-tested messages and tips!
There are case studies to "bring it all home" and a tip bank where you and your colleagues can share your own tips with each other. Visit, submit your tips, and check back. The TOP-10-TIPS are posted every month so you can learn from your contemporaries and look for your own tip in print! Also available is full access to interactive presentation materials. You can order a video demonstrating how real people view food and nutrition and how they react to consumer-tested messages. This video provides the health professional with tremendous insight into reaching their audience with actionable nutrition advice. A New Nutrition Conversation with Consumers Microsoft PowerPoint presentation and a highlighted preview of the "person-on-the-street" video can be downloaded right from the site. And, after your visit, please let IFIC know what you think! If this article has stressed nothing else, it is that audience feedback (whether it be health professionals, consumers, or otherwise) is essential to the success and effectiveness of any communications tool!

Source: IFIC Press Release; March 17, 2002.

WEBSITES:

EXPANDED CALCIUM WEB SITE FOR KIDS

The National Institute of Child Health and Human Development (NICHD), sponsors of the Milk Matters calcium education campaign, is expanding its Web site (www.nichd.nih.gov/milkmatters) to appeal directly to children and their parents about the importance of calcium. The information is available in English and Spanish.
Besides featuring a variety of publications and resources, the site soon will include games and other interactive content for kids. According to the US Department of Agriculture, only 13.5 percent of girls and 36.3 percent of boys ages 12 to 19 in the United States get the recommended daily amount of calcium. Because 90 percent of adult bone mass is established by the end of this age range, NICHD reports that the nation's youth stand in the midst of a calcium crisis.

At the January 2002 Calcium Summit II, representatives from national health and nutrition organizations, including the Academy of Pediatrics, met to develop and agenda for actions on the nation's calcium crisis.

Source: AAP News; 20(2); February 2002; p. 79.

THE NATIONAL CENTER FOR HOME FOOD PRESERVATION ANNOUNCES THEIR NEW WEB SITE!

The National Center for Home Food Preservation, a CSREES-USDA funded project based at the University of Georgia, is pleased to announce the opening of their website. Please visit at http://www.homefoodpreservation.com. The site is for science-based information on home food preservation for Extension educators, other educators and home food preservers. In addition, we want to represent the breadth of expertise within the entire Cooperative Extension System. The site is still a work in progress, but you will hopefully find something useful already. The links to other state Extension sites are far from finished, but there are some in place for you to see how they are listing other states' information and links.

Please visit the site, look around at the types of information going into each link, and send back your comments about the site. There is a survey form online, at the following location: http://www.arches.uga.edu/~bnummer/website-survey.htm and we'd really like it if you could take the time to fill that out. However, if you prefer to just submit general comments, there is also an "Info Request" form on the website that can be used for comments and questions at any time, or you can email: bnummer@uga.edu>bnummer@uga.edu.

The site is just the beginning. More information will be added as it is properly reviewed, updated, or researched. Your suggestions are welcome. Please forward this post to others in your organization who may have interest.

Source: NCHFP Press Release; April 16, 2002.

WEBSITES ON OBESITY AND RELATED TOPICS

American Obesity Association:
www.obesity.org

Calorie Control Council:
www.caloriecontrol.org

Centers for Obesity Research and Education:
www.uchsc.edu/core/

International Association for the Study of Obesity:
www.iasolorg

International Obesity Task Force:
www.iotf.org

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)-Weight Control & Loss:
www.niddk.nih.gov/health/nutrit/nutrit.htm

National Task Force on Prevention and Treatment of Obesity:
www.niiddk.nih.gov/fund/divisions/DDN/obesitytaskforce.htm

NHLBI Obesity Education Initiative:
www.nhlbi.nih.gov/about/oei/index.htm

NIDDK/NIH Clinical Nutrition and Obesity Research Centers:
www.niddk.nih.gov/health/nutrit/cnruon.htm

North American Association for the Study of Obesity:
www.naaso.org

Partnership for Healthy Weight Management:
www.consumer.gov/weightloss

Weight Control Information Network:
www.niddk.nih.gov/health/nutrit/pubs/statobes.htm

And for a different perspective:

National Association to Advance Fat Acceptance:
www.naafa.org

Source: Nutrition & the M.D.; 28(2); February 2002; p. 8.

BOOK REVIEW:

THE NATURAL MEDICINES COMPREHENSIVE DATABASE: BOOK VERSION

This superb book subjects 964 natural medicines to current standards of scientific scrutiny. The editors' strict, evidence-based grading system allows them to rate the performance of such remedies for their various indications. Only 46 are considered effective and 72 likely effective. Efficacy is supported by at least two randomized, prospective, controlled, adequately large human studies that give positive results for clinically relevant end-points plus publication in an established refereed journal. The rest of the medicines descend a therapeutic hierarchy: 333 possibly effective, 46 possibly ineffective, 61 likely ineffective, 6 ineffective, and 538 unclassifiable owing to insufficient reliable data (some medicines are given different effectiveness ratings for different indications).

Regarding safety, the editors could objectively rank only 147 natural ingredients as likely safe. Based on the route of administration, the remainder are classified as possibly safe (292), possibly unsafe (118), likely unsafe (131), unsafe (45), and unclassifiable (262).
Overall, the collection indicates that only 15 percent of natural medicine products have been proven safe and only 11 percent effective or likely effective for the indications for which they are being used.

The clinically relevant problems associated with phytopharmaceuticals are instructively grouped into (1) interactions between herbs/supplements (e.g., the potentially fatal combination of guarana and ephedra), and (2) interactions with drugs (e.g., capsicum may exacerbate the cough associated with angiotensin converting enzyme inhibitors; ginkgo can increase blood pressure when used with thiazide diuretics), and (3) interactions with food (wheat bran, for instance, inhibits calcium absorption). St John's wort lowers digoxin levels by about 25 percent and, within three days of first appearance in the primary literature, new information was posted, namely that St John's wort can interact with cyclosporine, resulting in acute heart transplant rejection and can lower levels of indinavir and possibly other HIV antiretrovirals.

Another clinical curve ball that natural medicines can throw concerns their interaction with lab tests. They can either produce true elevations of serum values (in aminotransferase by coenzyme Q10, in creatinine by creatine, in bilirubin and amylase by lemon grass) or foster misinterpretation of lab results by interference with certain assay methods. Vitamin C, for example, can bring about false elevations in serum aspartate aminotransferase and bilirubin, false decreases in serum lactate dehydrogenase and glucose, and false-negative urine acetaminophen levels and stool guaiac results. By harvesting such information and documenting reports of allergic and other adverse reactions (like the inhibition of oocyte fertilization and alteration of sperm DNA by St John's wort), this book engenders an appropriate respect for natural medicines. As with prescription drugs, the indiscriminate use of natural remedies can cause harm.

The Natural Medicines Comprehensive Database Web page, available at http://www.naturaldatabase.com, is easily navigated and permits subscribers to ask the panel of experts such questions as which specific formulations of Ginkgo biloba were actually used in the clinical trials that established its efficacy for Alzheimer disease and receive a prompt reply. One can also access constantly updated data. Since the December 1999 printed version, for instance, the efficacy of ipriflavone for postmenopausal osteoporosis has been upgraded to likely effective based on six more references. In addition, as new products become popular, they are added to the Web version, e.g., vinpocetine, glossy privet, deanol, Andrographis paniculata, and no doubt others by the time this review is printed. Because it is probably important that readers know what is not known, whenever available reliable information is insufficient, the authors successfully avoid the flawed explanations found in less authoritative books

Even when an herb is ineffective, knowing why people use it can be helpful. Thus the monograph on goldenseal discloses that it is promoted to mask the results of lab tests for illicit drug use. With such knowledge, physicians can ask insightful questions. Finally, if a patient asks whether a particular drug will induce nutrient depletion, a handy table has been carefully constructed to address this often overblown concern in a rational way. Natural Medicines Comprehensive Database is highly recommended for all physicians, pharmacists, and others interested in the responsible use of natural medicines sold in North American.
Source: [Online source] http://www.naturaldatabase.com; 2002.

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