UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION

NUTRITION PERSPECTIVES

Volume 24, No. 5
Sep/Oct 1999

TABLE OF CONTENTS
The AICR Proposes Radical Changes in The US Dietary Guidelines
Has Folic Acid Fortification Reduced Folic Acid Deficiency?
The FDA Approves New Health Claim for Soy Protein and Coronary Heart Disease
New Screening Methods to Test for Iron Deficiency?
Food Safety: When to Toss It?
Safe Food Storage Recommendations
Is Your Diet Making You Lose More Than Just Weight?
Iron-Supplemented Formula May Diminish Developmental Delay
Prescription for Your Heart: Relax!
Dietary Trans Fatty Acids and Serum Lipids
Drinking Among Pregnant and Nonpregnant Women
Ways to Increase Your Antioxidant Intake

Book Reviews:
Sugar Busters!
Eat Right 4 Your Type
Dr. Atkins' New Diet Revolution
The Zone
Upcoming Conference:
The Community-Campus Partnerships For Health Annual Conference
Resources:
Final Report on Dietary Reference Intakes for Calcium, Phosphorus,
Magnesium, Vitamin D, and Fluoride
School Gardens Require Planning and Money to Successfully Grow
Subscription for NUTRITION PERSPECTIVES


Sheri Zidenberg-Cherr, PhD, Editor
University of California
Department of Nutrition
One Shields Ave.
Davis, CA 95616

NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Julie Schneider, 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, University of California, Department of Nutrition, One Shields Ave., Davis, CA 95616-5270. Phone (530) 752-3387; Fax (530) 752-8905.

THE AICR PROPOSES RADICAL CHANGES IN THE US DIETARY GUIDELINES
The American Institute for Cancer Research (AICR) is proposing a sharp shift in the way Americans think about a healthy diet. In comments submitted to the US Dietary Guidelines Advisory Committee, the Institute called for shifting emphasis away from reducing intake of fat to increasing intake of vegetables and fruits.

"We are proposing that the guidelines reshape the American diet in a positive manner. Vegetables and fruits, along with other plant-based foods, should be moved to the center of the plate at breakfast, lunch, and dinner," says the AICR President Marilyn Gentry.

The US law requires that the Dietary Guidelines Advisory Committee issue a report revising the guidelines before the end of the year 2000. The guidelines have great influence on public education and government food programs.
According to the AICR's comments, the heavy emphasis placed on reduction of fat consumption in the current guidelines has encouraged some Americans to switch from red meat to poultry and from meat, milk, and egg-based products to processed products that may be low in fat, but are still high in calories. This focus may have contributed in part to the high level of obesity in the country. More than half of all Americans are now considered overweight. It has not led to greater consumption of vegetables, fruit, grains, and beans, which are both low in fat and rich in nutrients.

The AICR comments to the advisory committee say, "Eliminating a small amount of fat has been excessively advocated instead of making more serious efforts to choose the right types of foods in the first place. Minimally adjusting the existing poor diet 1) has little or no supporting data, 2) diverts attention away from the benefits of diets rich in fruits and vegetables, and 3) causes great confusion among the public."

A diet high in vegetables and fruits, say the comments, provides a wide variety of nutrients and non-nutrient substances known to reduce risk of many chronic illnesses. Deriving most fat from plant sources is unlikely to create health problems. Protein obtained from a variety of grains and legumes will satisfy protein needs.

"The end result we seek is not eliminating foods of animal origin, but the movement toward a predominantly plant-based diet. The US Dietary Guidelines should lead to new proportions of food in the American diet," says Ms. Gentry.
The four revisions of the Dietary Guidelines recommended by AICR are stated below:
1. Give first priority to plant-based foods;
2. Emphasize variety and minimal processing;
3. Emphasize consumption of whole foods and caution against use of nutrient supplements as a primary strategy for disease prevention.
4. In place of a recommendation on fat, caution against use of excessive added fat, salt, and sugar.
Adapted from: AICR Science News 13, September 1999.

HAS FOLIC ACID FORTIFICATION REDUCED FOLIC ACID DEFICIENCY?
The fortification of grain products with folic acid has been associated with a substantial reduction in folic acid deficiency. Researchers from Tufts University in Boston used data from two studies to determine folic acid concentrations among nearly 1,100 subjects who were mostly white, middle-aged residents of a Boston suburb. The subjects were divided into two groups. One was a study group of 350 people who had taken part in a research project after fortification of grain products had begun (experimental). The other group consisted of 756 people who were participants in another study prior to fortification (control). The researchers found that folic acid deficiency had decreased among the experimental group from 22 percent to 1.7 percent, and that serum levels of folic acid increased. The control group showed no changes in folate concentrations. In 1996, The Food and Drug Administration ordered all enriched grain products to be fortified with folic acid to reduce the incidence of birth defects among newborns. Most manufacturers had complied with the rule by mid-1997.
Reference:
1. Jacques PF, Selhub J, Bostom AG, Wilson PW, et al. The effect of folic acid fortification on plasma folate and total homocysteine concentrations. New Eng J Med 340(19): 1449-54., May 13, 1999
Adapted from: Community Nutrition Institute, Nutrition Week 29(18), May 14, 1999.

THE FDA APPROVES NEW HEALTH CLAIM FOR SOY PROTEIN AND CORONARY HEART DISEASE
On October 26, 1999, the FDA authorized use of health claims about the role of soy protein in reducing the risk of coronary heart disease (CHD) on labeling of foods containing soy protein. This final rule is based on the FDA's conclusion that foods containing soy protein included in a diet low in saturated fat and cholesterol may reduce the risk of CHD by lowering blood cholesterol levels.

Coronary heart disease, one of the most common and serious forms of cardiovascular disease, is a major public health concern because it causes more deaths in the US than any other disease. Risk factors for CHD include high total cholesterol levels and high levels of low density lipoprotein (LDL) cholesterol.

This new health claim is based on evidence that including soy protein in a diet low in saturated fat and cholesterol may also help to reduce the risk of CHD. Recent clinical trials have shown that consumption of soy protein compared to other proteins such as those from milk or meat, can lower total and LDL-cholesterol levels.

Foods that may be eligible for the health claim include soy beverages, tofu, tempeh, soy-based meat alternatives, and possibly some baked goods. Foods that carry the claim must also meet the requirements for low fat, low saturated fat, and low cholesterol content except the foods made with the whole soybean may also qualify for the health claim if they contain no fat in addition to that present in the whole soybean.

Scientific studies show that 25 grams of soy protein daily in the diet is needed to show a significant cholesterol lowering effect. In order to qualify for this health claim, a food must contain at least 6.25 grams of soy protein per serving, the amount that is one-fourth of the effective level of 25 grams per day. Because soy protein can be added to a variety of foods, it is possible for consumers to eat foods containing soy protein at all three meals and for snacks. An example of a health claim about the relationship between diet and the reduce risk of heart disease is:

"Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of (name of food) provides ____ grams of soy protein."
This new health claim rule responds to a petition submitted to the FDA by Protein Technologies International. This rule is based on the proposed rule that was published in the Federal Register on November 10, 1998, and comments received by the FDA.
Use of the claim in food labeling is authorized immediately.
Adapted from: Press Release, FDA Talk Paper T99-48, October 20, 1999.

NEW SCREENING METHODS TO TEST FOR IRON DEFICIENCY?
Iron deficiency anemia, and perhaps non-anemic iron deficiency, may lead to permanent impairment of mental and motor development in children. Determining the best screening method to detect iron deficiency is therefore important. The reticulocyte hemoglobin content (CHr) may be the answer.

In a recent study, researchers obtained blood samples from 210 young children (mean age, 2.9 years) whose pediatricians ordered routine complete blood cell counts and plasma lead levels. The following tests for iron deficiency were performed: CHr, serum iron concentrations, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin content, red blood cell volume distribution width, erythrocyte zinc protoporphyrin, ferritin, transferrin saturation, and transferrin receptor.

Using a transferrin saturation cutoff value of less than 20 percent, 43 (20.5 percent) of the children were found to be iron deficient. Twenty-four (56 percent) of these 43 children were also anemic, using a hemoglobin cutoff of less than 110 g/l. CHr and hemoglobin levels were the only significant predictors of iron deficiency, and CHr was the only significant multivariate predictor of iron deficiency anemia. A lowered CHr was the only significant multivariate predictor of iron deficiency anemia. A lowered CHr was significantly associated with abnormalities in all other tests except ferritin.
These results need to be confirmed in a larger, unselected population. CHr, which can be measured on an automated hematology analyzer, may be a better, less expensive, and fast way to detect iron deficiency.
References:
1. Brugnara C, Zurakowski D, DiCanzio J, Boyd T, et al. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA 218(23): 2225-30, June 16, 1999.
2. Cohen AR. Choosing the best strategy to prevent childhood iron deficiency. JAMA 281(23), June 16, 1999.
Source: Dershewitz RA. Journal Watch 19 (14), July 15, 1999.

FOOD SAFETY: WHEN TO TOSS IT?
For food that is safe and delicious to eat, proper storage is important. But no matter how well you package something, at some point it's got to go. How can you tell how long it's safe to hold onto something? In the following chart you'll find a listing of recommendations for storing various foods. It's important to note that some recommendations are safety-based, while others are for maintaining best food taste.

Foods like oils, herbs, and flour simply lose flavor quality if they are stored for too long. If the recommended storage time for one of these foods has elapsed, but it smells fine, it will not have as good a flavor as when it was fresh but is still safe to eat, according to food processors.

Foods like eggs, milk products, meat, chicken, seafood, and tofu, however, are subject to bacterial contamination. Eating these foods after they have spoiled could result in food-borne illnesses.

Dates printed on many food products can help you decide what stays and what goes. The following information can help you understand what they mean:
¨ "Sell by" date tells the store how long to display the product for sale. Don't buy something after this date, but if you already have it at home, it may be safe for a few more days (see table).
¨ "Use by" or "Best if used by" date is the last date recommended for use of the product at peak quality. It is not a safety-related date.
¨ "Expiration" date means don't use the product after this date.

SAFE FOOD STORAGE RECOMMENDATIONS
GRAINS
FOOD SHELF REFRIGERATOR FREEZER COMMENTS
Flour, white 6-12 months unopened6-8 months opened
Flour, whole wheat 1-2 months unopened 6-8 months opened Bring to room temperature before baking for proper leavening.

DAIRY
FOOD SHELF REFRIGERATOR FREEZER COMMENTS
Cheese, hard 6 months unopened 6 months Wrap well after opening.
Cheese, soft Up to 4 weeks opened 6 months Wrap well after opening
Milk Up to a few days after "sell by date"
Yogurt Up to a few days after "sell by date" Throw out if you see mold. Clear liquid on top is whey - stir in.

PROTEIN
FOOD SHELF REFRIGERATOR FREEZER COMMENTS
Bacon,Smoked sausage 5-7 days 1 month
Chicken, fresh 1 week Uncooked 9 monthsCooked 4-6 months
Eggs 1-2 days3-4 days after cooking Freeze egg whites only, 12 months Toss eggs with even slight crack in shell.
Fish, fresh 1-2 days3-4 days after cooking Lean types 6 monthsFatty types 2-3 monthsShellfish 3-6 monthsCooked fish 4-6 months
Fish or Chicken, canned 2-5 years unopened 2-3 days after opening Transfer to glass or plastic dish after opening.
Lunch meat, store sliced 2-5 days 1-2 months
Lunch meat, sealed in package 2 weeks unopened3-5 days opened 1-2 months
Meat(beef, pork, lamb) 3-5 days chops steaks1-2 days ground3-4 days cooked meat 4-12 months chops, steaks3-4 months ground2-3 months cooked meat May be frozen up to 2 weeks in store wrap.If freezing for longer, use extra wrapping.
Nuts 1 year sealed can2-3 months opened 4-6 months 9-12 months First loses flavor, later becomes rancid.
Tofu Untl expiration date unopened1 week opened Up to 5 months (some texture change will occur) Change water each day after opening.

OTHER
FOOD SHELF REFRIGERATOR FREEZER COMMENTS
Oil, olive, canola, or vegetable 1 year unopened4-8 months opened A sharp smell means flavor quality is off, but still safe to use.
Oil, walnut, peanut, or other nuts 6 month unopened 4 months opened
Spices and herbs, dried 2-4 years whole spices6 months to 3 years ground spices1-2 years unopened herbs1 year opened herbs red pepper, chili powder, paprika after opening due to possible insect infestation Store in cool dark cabinet or drawer.Don't shake over steaming pot, steam will enter jar.
Source: American Institute for Cancer Research Newsletter 65, Fall 1999.

IS YOUR DIET MAKING YOU LOSE MORE THAN JUST WEIGHT?
At least 50 percent of American women consume weight-reduction diets at some time in their lives, and most women participate in some type of physical activity to lose weight. Although a healthy diet and exercise are key elements to living a healthy lifestyle, new research shows that women who want to lose a few pounds need to plan their weight loss programs carefully to avoid long-term problems like osteoporosis.

A recent study found that a lifestyle intervention program utilizing a low-fat diet combined with moderate exercise resulted not only in the desired weight loss but also in loss of critical bone mineral density at the hips and lumbar spine (1). Women who participated in the weight-reduction program lost an average of 7 pounds during the 18-month study period; however, these women also lost two times more bone mineral density than women who did not modify their diets or exercise patterns.
According to lead author of the study, Loran M. Salamone, PhD, of the University of Pittsburgh Graduate School of Public Health, "Women need to evaluate the risks and benefits of their weight-reduction program. Dieting without adequate amounts of exercise can have potentially detrimental effects on bone mineral density and can increase the risk of developing osteoporosis. The ideal program is one that achieves weight loss while maintaining skeletal integrity."

In this study, women in the intervention group maintained calcium intake at or above the recommended dietary allowance by consuming low-fat milk, cheese, or yogurt, or by taking calcium supplements. However, there are many other factors involved in the formation and degeneration of bone mineral density. The women who increase their physical activity to a "high" level (defined as more than 17,472 kcal/week) had significantly less bone loss over the short term. The long-term effects of weight reduction on bone loss are currently under investigation.

This media release is provided by The American Society for Nutritional Sciences and The American Society of Clinical Nutrition Joint Public Information Committee (PIC) to provide current information on nutrition-related research.
Reference:
1. Salamone LM, Cauley JA, Black DM, Simkin-Silverman L, et al. Effect of a lifestyle intervention on bone mineral density in premenopausal women: A randomized trial. Amer J Clin Nutr 70(1): 97-103, Jul 1999.
Adapted from: Press Release ASCN/ASNS, June 18, 1999.

IRON-SUPPLEMENTED FORMULA MAY DIMINISH DEVELOPMENTAL DELAY
An estimated 10 percent of children in developed countries and 50 percent of children in developing countries have iron deficiency, which has been linked to developmental delays. In a randomized trial, investigators studied the effect of a milk-based formula containing iron on infant development on 100 inner-city British infants (aged 5.7 to 8.6 months) already drinking unmodified cow's milk (1). Infants received either the formula or cow's milk until 18 months old and were followed until 24 months old.

At 18 months, 2 percent of the formula group were anemic, compared with 33 percent of the cow's-milk group. At 18 months, both groups had similar overall declines from baseline on a developmental scale, but at 24 months, the decline was significantly less in the formula group than in the cow's milk group. The formula group scored better on all five subscales (locomotor, personal and social, hearing and speech, eye and hand coordination, and manipulation and precision) and significantly better in personal and social development.

This study, reported in the Brithish Medical Journal, supports the idea that preventing iron deficiency in high-risk infants is worthwhile and feasible. An accompanying commentary, however, cites mixed results of earlier studies and stops short of calling these results conclusive (2).
References:
1. Williams J, Wolff A, Daly A, MacDonald A, et al. Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: Randomized study. BMJ 318(7185): 693-7, March 13, 1999.
2. Logan S. Commentary: Iron deficiency and developmental deficit- The jury is still out. BMJ 318: 697-8, March 13, 1999.
Adapted from: Journal Watch 19(9), May 1, 1999.

PRESCRIPTION FOR YOUR HEART: RELAX!
Mental stress is known to induce heart problems in at-risk individuals, but why? Recent research published in suggests that prolonged mental stress - such as job-related stress - causes higher levels of lipids and lipoproteins in the blood (1).
Previous studies have measured lipid levels in the blood after an overnight fast; however, this study focuses on lipid levels during the postprandial period (immediately following a meal). Study participants consumed a meal that was 16 percent protein, 34 percent fat, and 50 percent carbohydrate, composed of bread, butter, ham, or cheese, apple marmalade, and cottage cheese. Following the meal, individuals in the test group were subjected to a computerized reaction-response test for 10 minutes, every half-hour, for 5 hours, imitating the real-life stress many people experience at work. Control subjects ate the same meal, but did not participate in the test. Blood samples were drawn prior to the meal and every hour for seven hours. Results showed that, throughout the study period, individuals subjected to prolonged mental stress had significantly higher levels of fats in the blood than "stress-free" control subjects.

According to Jean Dallongeville, PhD, senior author of the study, "Our study shows that mental stress increases the levels of atherogenic lipoproteins and decreases the rate at which fats are cleared from the blood after a meal. The longer fats reside in the body, the greater the risk of cardiovascular consequences."

While eating healthy and exercising regularly are imperative to good health, this research provides clinical evidence that avoiding or alleviating mental stress might also play an important role in reducing the risk of heart disease.
This media release is provided by The American Society for Nutritional Sciences and The American Society for Clinical Nutrition, Joint Public Information Committee (PIC) to provide current information on nutrition-related research. This information should not be construed as medical advice. If you have a medical concern, consult your doctor.
Reference:
1. Le Fur C, Romon M, Lebel P, Devos P, et al. Influence of mental stress and circadian cycle on postprandial lipemia. Amer J Clin Nutr 70(2): 213-20, Aug 1999.
Adapted from: Press Release ASCN/ASNS, July 28, 1999.

DIETARY TRANS FATTY ACIDS AND SERUM LIPIDS
Trans fatty acids are formed when vegetable oils are partially hydrogenated to produce solid fats. A recent study examined the effects of varying amounts of dietary trans fatty acids on serum lipid levels in 36 subjects over age 50. Participants' mean baseline values were: cholesterol, 245 mg/dl; LDL, 167 mg/dl; HDL, 48 mg/dl.

All subjects consumed a series of six diets, each given for 35 days and providing 30 percent of calories from fat. Five of the diets had progressively higher trans fatty acid content (contributed by soybean oil, semiliquid margarine, soft margarine, shortening, or stick margarine); butter, which is low in trans fatty acids but high in saturated fat, provided most of the fat in the sixth diet.

The mean serum LDL cholesterol increased as the trans fatty acid content of the diet increased (from 154 mg/dl with soybean oil to 168 mg/dl with stick margarine) and was highest with butter (177 mg/dl). Mean HDL cholesterol was similar across the five oil/margarine diets (42 to 43 mg/dl) and slightly higher with the butter diet (45 mg/dl)

Although the highest LDL levels occurred with the butter diet, the more solid vegetable oil products, with their higher trans fatty acid content, yielded higher LDL levels than their liquid counterparts. Because trans fatty acid intake is associated with coronary disease in some epidemiologic studies, an accompanying article (2) urges the food industry to reduce the trans fatty acid content of prepared foods.
References:
1. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. New Eng J Med, 340(25): 1933-40, June 24, 1999.
2. Scherio A, Katan MB, Zock PL, Stampfer MJ, et al. Trans fatty acids and coronary heart disease. New Eng J Med, 340(25):1994-8, June 24, 1999.
Source: Brett AS. Journal Watch 19(14), July 15, 1999

DRINKING AMONG PREGNANT AND NONPREGNANT WOMEN
The prevalence of binge drinking among pregnant women increased from 0.7 percent in 1991 to 2.9 precent in 1995, according to a survey of US women ages 18 to 44. Researchers analyzed data collected by the Centers for Disease Control and Prevention in a telephone survey of 4,611 pregnant women and 99,312 non-pregnant women in 46 states (1).
Results showed:
¨ 13.7 percent of pregnant women and 52.8 percent of nonpregnant women said they drank alcohol in the month before the survey;
¨ 1.9 percent of pregnant women and 11.6 percent of nonpregnant women reported consuming five or more drinks per occasion (binge drinking) during the study period;
¨ the prevalence of binge drinking among nonpregnant women remained about the same form 1991 to 1995;
¨ among pregnant women, binge drinking was correlated with being single, being employed, or being a smoker; and
¨ among nonpregnant women, binge drinking was correlated with being 30 years of age or younger, a non-black race, a college level education, being single, being employed or a student, or being a smoker.
The increase in binge drinking among pregnant women suggests it is becoming a more prevalent pattern of alcohol use among that group. In addition, pregnant women may not believe binge drinking is as risky to their fetus as frequent or daily drinking.
Reference:
1. Ebrahim SH, Diekman ST, Floyd RL, Decoufle P. Comparison of binge drinking among pregnant and nonpregnant women, United States, 1991-1995. Am J of Obstetrics and Gynecology 180(1): 1-7, January 1999.
Adapted from: AAP News 15(5), May 1999.

WAYS TO INCREASE YOUR ANTIOXIDANT INTAKE
It seems that antioxidant nutrients - vitamin C, vitamin E, beta carotene, and selenium - are always in the news. Numerous studies are being conducted on their health-promoting characteristics, especially for cancer protection. So what is the best way to get antioxidants? From food, especially fruits and vegetables. Following are a few suggestions for increasing the antioxidants in your diet.

¨ Go for the greens. Kale and spinach are two top vegetables when it comes to antioxidant content. Also, try collards, Swiss chard, mustard, and other greens.
¨ "Crucifers" offer loads of antioxidants, so fill up on Brussels sprouts, broccoli, cauliflower, and cabbages.
¨ Orange-colored produce is a list-leader for carotenoid content. Enjoy sweet potatoes, cantaloupe, carrots, winter squash, pumpkin, and apricots.
¨ Red-colored produce is rich in antioxidants too. Choose strawberries, raspberries, plums, tomatoes, red grapes, red peppers, and cherries.
¨ Citrus fruit, such as orange, grapefruit, lemon, and lime, offers loads of the antioxidant vitamin C.
¨ Small snacks can pack a big antioxidant punch. Snack on prunes, raisins, blueberries, blackberries, and kiwi fruit.

The best way to make sure you're getting cancer-fighting antioxidants is to eat a variety of vegetables and fruits every day!
Source: Polk M. American Institute for Cancer Research Newsletter 65, Fall 1999.
There are several diet books that have become popular among consumers and some members of the medical community. Below are summaries of selected diet books recently reviewed by internationally recognized nutrition experts.

BOOK REVIEW: SUGAR BUSTERS!
By H. Leighton Steward; Morrison C. Bethea, MD; Sam S. Andrews, MD; Luis A. Balart, MD. New York: Ballantine Books, The Ballantine Publishing Group. 1998.

This second edition of Sugar Busters! was written for the public by three physicians and one CEO of a Fortune 500 company (1). The guidelines proposed by the authors are based on the glycemic index.
Premises:
Based on the glycemic index of certain foods, the authors suggest that they be eliminated from the diet. The approach uses only the glycemic index of foods to determine which foods to eat and when to eat them.
The basic physiology of digestion is explained in terms easily understood by the layman. However, the authors overstress the role of carbohydrate intake and of insulin in fat storage. Even the normal increase in insulin seen postprandially is implicated by the authors in excessive fat storage. The authors propose that eating only foods with low glycemic index will help minimize the insulin-fat storage process and prevent weight gain.

Sugar consumption is presented as the main culprit for the increased incidence of Type II diabetes and obesity. Other risk factors for obesity such as fat intake are downplayed. The authors claim that it is not the fat that is eaten that causes problems, but the fat that is created when excess sugar is consumed and converted into fat.

Protein intake recommendations - at least one gram of protein per kilogram of body weight - are slightly higher than the RDA of 0.8 gm protein/kg. Protein intake is promoted because it causes an imperceptible increase in blood glucose and, therefore, little insulin stimulation and fat storage.

Limitations and Concerns:
The majority of the recommendations are not harmful and follow generally accepted guidelines for a low-fat, high-fiber diet. Unrefined sugars, whole unprocessed grains, vegetables, fruits, lean meat, fiber, and fats are recommended. Portion control is also stressed. Menus are provided for the diet as well as assistance in planning meals and recipes.

Certain nutritious foods are eliminated, including potatoes, all corn products, carrots, beets, white rice and white bread, all refined sugar, and any food product made with refined sugar. Balanced meals are not always advocated. Fruits are to be eaten separately from other foods, but the authors give no rationale for this recommendation. Most starches are considered harmful, and it is recommended they not be eaten alone or in combination with other foods. Beverages should be consumed in small portions with meals to avoid "washing" food down, which may lead to less than adequate chewing, and because excess fluids are claimed to dilute the digestive juices. There is no physiologic basis for this practice.

While the diet principles advocated in the Sugar Busters! diet may not harm most individuals, diabetics and those with
cardiac risk factors should exercise prudence. Diabetic readers should be cautioned to discuss the diet with their physician prior to beginning. The authors stress that insulin and/or oral hypoglycemic medication needs will decrease if they follow the Sugar Busters! diet. Diabetics will likely be better served working with health professionals to establish a diet plan, with priority given to the individual's metabolic and clinical goals.
Reference:
1. Steward HL, Bethea MC, Andrews SS, and Balart LA. Sugar Busters! New York: Ballantine Books, The Ballantine Publishing Group. 1998.
Source: Blackburn GL and He YH. Nutrition & the MD 25(6), June 1999.

BOOK REVIEW: EAT RIGHT 4 YOUR TYPE
By Dr. Peter J. D'Adamo. New York: GP Putnam's Sons. 1996.
The premise behind this book is that your blood type determines your susceptibility to illness, which foods you should eat, and how you should exercise. The author uses blood type to determine right or wrong food choices (1).
The essence of the purported blood type connection rests in these observations:
¨ Your blood type - O, A, B or AB - is a genetic fingerprint that identifies who you are and can serve as a guide to living healthier.
¨ Individual characteristics related to blood type are claimed to be useful as a guidepost for eating and living healthier, naturally reaching your ideal weight, and slowing the aging process.
¨ The key to the significance of blood type is ascribed to evolution: type O is stated to be the oldest; type A evolved with agrarian society; type B emerged as humans migrated north into colder, harsher climates; and type AB is discussed as a modern adaptation, a result of the intermingling of disparate groups.
¨ By learning the principles of blood type difference, the reader is led to tailor his or her optimal diet, pinpointing the foods that may lead to illness, weight gain, and chronic disease.
¨ A food that may be harmful (agglutinate) to the cells of one blood type is said to be beneficial to the cells of another.
¨ Lectins, abundant and diverse molecules found in foods, have agglutinating properties that affect blood. The key is to avoid the lectins that agglutinate your particular cells, determined by blood type. The author has tested common foods for blood type reactions, using both clinical and laboratory methods.
¨ The author developed four blood type diets identifying 16 food groups for each diet, divided into three categories: highly beneficial is a food that acts like a medicine; neutral is a food that acts like a food; and avoid is a food that acts like a poison. Other elements of the Blood Type Plan include: meal planning, a weight loss factor, a supplement advisory, a stress/exercise profile, and a personality question.
Each blood type has reactions to certain food lectins, which can:
¨ Inflame the digestive tract lining;
¨ Interfere with the digestive process, causing bloating;
¨ Slow down the rate of food metabolism;
¨ Compromise the production of insulin; and
¨ Upset the hormonal balance, causing water retention and thyroid disorders.
Type O: The Hunter
Characteristics: Meat-eater, hardy digestive tract, overactive immune system, responds best to stress with intense physical activity, requires an efficient metabolism to stay lean and energetic. The belief is that the type O digestive tracts have not adapted to eating grains and dairy products because these foods did not become staples of the human diet until later in the course of evolution. Some foods to avoid: Pickled foods, coffee, tea, soda, whole wheat, coconut, melons, dairy products, and pork.

Type A: The Cultivator
Characteristics: The first vegetarian, reaps what he sows, sensitive digestive tract, tolerant immune system, adapts well to settled dietary and environmental conditions, responds best to stress with calming action, requires an agrarian diet to stay lean and productive. Some foods to avoid: Meat, whole milk, peppers, cantaloupe, and ketchup.
Type B: The Nomad
Characteristics: Balanced and strong immune system, tolerant digestive system, most flexible dietary choices, dairy eater, responds best to stress with creativity, requires a balance between physical and mental activity to stay lean and sharp. Some foods to avoid: Corn, buckwheat, lentils, peanuts, chicken, wheat, rye, and tomatoes.
Type AB: The Enigma
Characteristics: Modern merging of A and B, chameleon's response to changing environmental and dietary conditions, sensitive digestive tract, overly tolerant immune system, responds best to stress spiritually, with physical verve and creative energy, an evolutionary mystery. Some foods to avoid: Red meat, kidney and lima beans, smoked and cured meats, corn, wheat, and banana.
The choices of food in each food group are not very common and may be difficult to find, ie Essene or Ezekial bread is recommended for all four diets. It should be noted, however, that even if the recommended food choices listed by the author were more common, it would not make the dietary recommendations more appropriate. The book contains some menus and recipes that were developed by a nutritionist. Menus are atypical of common food choices and would be difficult to follow without recipes (ie kifta, tabbouleh, tofu sardine fritters).
The type Os are told to avoid whole wheat products, grains, and pasta, which would result in a diet low in B vitamins. The author recommends a B-complex vitamin supplement due to a sluggish metabolism, not because the diet is deficient in these vitamins. For the diets without dairy products, there is a cautionary statement that there is an additional need for calcium. In most cases, diets deficient in nutrients address the need to supplement them with appropriate vitamins and minerals.
Where's the Proof?
The author, a naturopathic doctor, creates an interesting story. However, any physiological relationship between blood type and digestion is never discussed other than the evolution of the digestive tract from early man, the hunter who had type O blood.
Based on this evolution concept, the author argues that type Os tolerate meat well but not much else. The next type, type A, became agrarian by adjusting to vegetables, grains, and fruit.
Supposedly, the metabolism of the blood type genetically remembers its origins, and those with the blood type tolerate the original foods without reacting (immunologically speaking) or having adverse reactions to foods not known by their ancestors.
There are many such specious arguments presented with these theories. The agglutinating or clumping - the attacking of a food item by cells - is supported only by a hit-or-miss kind of science. Although the author lists some references regarding blood types and lectins, the lack of scientific data on the relationship between blood types and food-related or other health problems should be a reason for profound skepticism on the part of the reader.
Reference:
1. D'Adamo PJ. Eat Right 4 Your Type. New York: GP Putnam's Sons. 1996.
Source: Blackburn GL and He YH. Nutrition & the MD 25(6), June 1999.

BOOK REVIEW: DR. ATKINS' NEW DIET REVOLUTION
By Atkins. New York: Avon Books. 1992.
"Imagine losing weight with a diet that lets you have bacon and eggs for breakfast, heavy cream in your coffee, plenty of meat, and even salad with dressing for lunch and dinner." - Dr. Atkins' Diet Revolution, 1972 (2).
Major Messages
1. Obesity exists primarily because of metabolic imbalances, not overeating. This metabolic defect can be circumvented by restricting carbohydrate intake. Following this diet, weight is lost without substantially lowering caloric intake.
2. The goals of the diet are achieving weight loss and reducing major health problems.
The Atkin's Diet Basics
The diet is divided into four phases:
1. Induction (14 days): to correct unbalanced metabolism; unlimited fat and protein are allowed, but daily carbohydrate intake is restricted to 20 grams (about three cups of salad vegetables).
2. Ongoing weight loss: Carbohydrate can be increased to 40 to 60 grams per day.
3. Pre-Maintenance phase: Can deviate with carbohydrate-containing foods one to two times per week.
4. Maintenance: 40 to 60 grams of carbohydrate, to the Induction phase if weight is gained.
Scientific Premises Promoted and their Limitations
1. Metabolic imbalance causes most overweight. According to Dr. Atkins overweight people usually have a disturbed carbohydrate metabolism. They produce too much insulin that lowers blood sugar and makes them hungry. Proteins and fats have satiety value, carbohydrates actually provoke hunger. Overeating is not as psychological in origin as it is said to be. The over-weight overeat merely because their own metabolic abnormality makes them feel excessive hunger.
Limitations of the above premise: There is no solid evidence that high insulin levels make you fat, even if a very high-carbohydrate, very low-fat diet raises insulin levels. Many studies show that if they decrease calories, people lose weight, and it does not matter if the fat or carbohydrate is reduced. Populations that eat vegetarian diets tend to be leaner, not fatter, than other groups and have lower rates of heart disease, cancer, and stroke.
2. On this diet, "benign dietary ketosis" is a state to be desired. This is the difference between this diet and other low-carbohydrate diets, which allow enough carbohydrate to prevent ketosis. Only with drastically reduced carbohydrate intake are the benefits of carbohydrate restriction seen, including a sense of well being, and the loss of hunger and of pounds and inches. Urine test sticks are recommended to measure the degree of ketosis/lipolysis. As carbohydrate is added back very gradually, the body is kept as a fat-burning engine. Calories are sneaked out of the body every day in the form of ketones and a host of other incompletely broken down molecules derived from fat.

Limitations of the above premise: Ketosis may initially make dieting easier due to rapid water loss, but ketones in the urine and breath account for up to only 100 calories per day. Ketosis can also cause slight nausea, and light-headedness and fatigue, especially in those who remain physically active. It may also exacerbate existing medical problems such as gout and kidney disease. Pregnant women should avoid the diet because chronic ketosis in the mother could adversely affect the fetus.

3. The calorie - and fat - counting approach has failed. Just eating less and counting calories are traps that keep people fat. Americans are getting fatter even though we have cut back on fat intake. Calories do count, but a low-calorie diet is a second-best diet. As long as the dieter does not take in carbohydrate, he or she can eat any amount of "fattening" food and will not put on fat. On a high-protein, ketogenic diet, virtually no lean tissue is lost, only adipose tissue. It is not that calories don't count, it is just that you can sneak them out of your body, unused, or dissipated as heat.
Limitations of the above premise: There is no evidence that the diet circumvents the "first law of thermodynamics." Total calories consumed in the diet and expended by physical activity do count. Americans are getting heavier because we are eating more in total calories and exercising less. In fact, food intake surveys show that although the percentage of fat calories has been reduced, the total fat intake in grams of fat a day has remained essentially the same over the past decades. If we compare ourselves to other countries with leaner populations, our diets still have a higher proportion of fat.
4. The one predisposing common factor in many diseases is carbohydrate intolerance. The over-weight person, the diabetic, the hypoglycemic, and the heart-attack prone all have one thing in common: something is very wrong with the way their bodies handle sugar and other carbohydrates. We are the victims of "sugar addiction."
Limitations of the above premise: No long-term follow-up studies are available to show this is a safe and effective weight-loss program; missing as well are the results for the 20-plus years since Atkins first published the Diet Revolution. A diet relatively high in fat is thought to increase the risk of heart disease and some cancers. In addition, excreting potassium and sodium along with the ketones may risk disruption of heart rhythms. An increase in blood uric acid, and can exacerbate gout. A loss of calcium in the urine may raise the risk of osteoporosis. The Atkins diet is contrary to what the American Heart Association recommends for the prevention of heart disease and what other groups recommend overall for the prevention of other diseases.
5. Vitamin/mineral supplements are recommended. Vitamin and mineral supplements are recommended, and even double the dose would present virtually no risk of overdosing. Special nutritional supplements or "neutraceuticals" are also recommended for constipation, sugar craving, hunger, fluid retention, fatigue, nervousness, and insomnia as well as for health problems, including hypoglycemia, diabetes, hypercholesterolemia and hypertriglyceridemia, hypertension, coronary heart disease, and arthritis.

Limitations of the above premise: Although vitamin and mineral supplementation may be warranted for individuals following diet plans, several of the levels in the Atkins diet are higher than recommended.

Counseling Tips
The conclusion of the classic 1973 review of the Atkins Diet Revolution by the American Medical Association Council on Foods and Nutrition is still applicable: "No scientific evidence exists to suggest that the low-carbohydrate, ketogenic diet has a metabolic advantage over more conventional diets for weight reduction" (3).

The Atkins diet is also contrary to the emerging scientific evidence that consuming a diet rich in plant foods, grains, beans, and fruits and vegetables is one of the best ways to prevent many chronic diseases, including heart disease and cancer.
References:
1. Atkins RC. Atkins' New Diet Revolution. New York: Avon Books. 1992.
2. Atkins RC. Atkins' Diet Revolution; The High Calorie Way to Stay Thin Forever. Recipes and menus by Fran Gare and Helen Monica. New York: D. McKay Co. 1972
3. JAMA, 1973; 224(10): 1415.
Source: Blackburn GL and He YH. Nutrition & the MD 25(6), June 1999.

BOOK REVIEW: THE ZONE
By Barry Sears and Bill Lawren. New York: Harper Collins Publishers. 1995.
This book is designed to appeal to a sophisticated reader with discussions of concepts such as hormonal balance, insulin-glucagon axis, and actions of good and bad eicosanoids and their control over the body's hormonal system (1).
Premise:
The major theme of the book is rather simple: carbohydrates are bad because they raise your blood glucose level and cause the release of insulin, resulting in obesity. Much of the material in the book explains this concept and attempts to convince the reader how wonderful it is to be in "The Zone." The book is intended to be a dietary road map to five outcomes: permanent weight loss; resetting your genetic code; disease prevention; maximum physical performance; and enhanced mental productivity.
"'The Zone' is a real metabolic state that can be reached by everyone, and maintained indefinitely on a lifelong basis." It is intended to represent optimal health, not just wellness. The only way you can reach "The Zone" is through eating the proper food. Food should be treated as a drug; it must be eaten in a controlled fashion and in the correct proportions, according to Sears and Lawren.
The authors indicate that the American public has dramatically cut back on the amount of fat consumed, yet the country has experienced an epidemic rise in obesity. They state that for the past 15 years the "reigning dietary wisdom promoted by government nutrition boards, scientific panels, and private practitioners has encouraged diets that are low in fat, low in protein, and high in carbohydrates." Yet people are eating less fat and getting fatter. The authors' conclusion is that a high-carbohydrate, low-fat diet is dangerous to your health.
The key to losing fat, according to the authors, involves reaching "The Zone." You need to follow a Zone-favorable diet and maintain that diet in order to keep you there for the rest of your life. A Zone-favorable diet restricts:
¨ High-density, high-glycemic carbohydrates such as grains, breads, pasta, rice, and other starches;
¨ Protein sources rich in arachidonic acid including egg yolks, fatty red meat, and organ meats.
However, none of these foods is absolutely forbidden, but may be used in moderation. Zone-favorable recipes are provided in the book.
Limitations and Concerns:
Many concepts and disease treatments are based on anecdotal information, including treatment of cardiomyopathy, diabetes, hypertension, arthritis, depression, and alcoholism. The authors felt they have proved this diet to be statistically significantly better for athletes in a study of a "large enough group" of nine patients and no control group. This is an example of "studies" described in the book that have not been peer-reviewed or published in scientific journals; the authors lead the reader to believe that the studies are scientifically valid.
In summary, the major claims are not supported by scientific literature. Americans are fatter not because they are eating less fat, but because they are eating more total calories and exercising less. Carbohydrates consumed at the usual dietary percentage of energy intake do not cause obesity, but calories do count. Readers should be aware that the Zone-favorable diet promotes weight loss, not because of the omission of carbohydrate but because it is a low-calorie diet. Like other diets that provide complicated rules for adherence and are not based on a balanced diet in combination with moderate exercise, it is ultimately doomed to failure. There is no magic panacea to weight loss; a calorie is still basically a calorie, and there must be a long-term deficit between calories eaten and calories burned if the weight-loss battle is to be won.
Reference:
1. Sears B, Lawren B. The Zone: A Dietary Road Map. 1st ed. New York : Regan Books.1995.
Source: Blackburn GL and He YH. Nutrition & the MD 25(6), June 1999.

CONFERENCE:

THE COMMUNITY-CAMPUS PARTNERSHIPS FOR HEALTH ANNUAL CONFERENCE
The Community-Campus Partnerships for Health (CCPH) 4th Annual Conference is scheduled for April 29 to May 2, 2000 in Washington DC.
More than 500 community and campus leaders will convene for four days of skill-building sessions, policy briefings, and community site visits. The conference - "From Community-Campus Partnerships to Capitol Hill: A
Policy Agenda for Health in the 21st Century" - aims to broaden and deepen participants' understanding of the policies, processes, and structures that affect community-campus partnerships, civic responsibility, and the overall
health of communities. The Federal Corporation for National Service provided support for the conference.
Among the major themes to be discussed are:
¨ Making the case for service-learning in health professions education
¨ Community-based teaching, research and service as scholarship
¨ Promoting cross-sector collaborations that improve the health and well-being of communities
¨ Financing community-based and interdisciplinary health professions education
¨ Community-campus partnerships for community and economic development
¨ Engaging communities as partners in research
¨ Improving health access and outcomes in minority populations
¨ Student leadership and activism
¨ Skills needed for advocacy
The conference registration materials will be out in January. To be added to the mailing list, please email ccph@itsa.ucsf.edu. For information on conference cosponsorship and exhibit opportunities, please email sarena@u.washington.edu. For information on CCPH membership, please email ccph@itsa.ucsf.edu or call (415) 476-7081.

RESOURCES:

FINAL REPORT ON DIETARY REFERENCE INTAKES FOR CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE
The first in the Food and Nutrition Board's Dietary Reference Intakes (DRI) series which will replace the Recommended Dietary Allowances, has been published. Copies can be ordered from the NAS website at www.nap.edu or by mail at National Academy Press, 2101 Constitution Avenue, North West, Lockbox 285, Washington, DC 20055. The specific website for the book "Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride" is http://books.nap.edu/catalog/5776.html .

SCHOOL GARDENS REQUIRE PLANNING AND MONEY TO SUCCESSFULLY GROW
Pull out the shovels - it's time to start digging. California State Superintendent of Schools Delaine Eastin set a goal in 1996 for "a garden in every school" by the year 2000. That means this fall it's high time to get growing! Before the dirt starts flying, however, take time to plan and to raise necessary funds.
For help with planning, start by contacting the Nutrition Services Division of the State's Department of Education (916) 322-4792. If offers free of charge to California teachers "A Garden In Every School," a must-have comprehensive packet of school gardening how-to's. Contents include information about gardens and nutrition; suggestions for books, resources, and supplies; listings of pertinent websites; a vermicomposting guide; garden publication addresses; Food Guide Pyramid poster; and guidelines for financial assistance.

That's an important detail, because money doesn't grow on trees - not even on school garden varieties. Yet it's as essential an ingredient in a garden's productivity as are seeds, water, soil, and fertilizer. Beyond local fundraising and site monies, funding can be obtained on a limited basis through several agencies.
Adapted from: California Foundation for Agriculture in the Classroom Cream of the Crop 13(1), Autumn, 1999.

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