Disease Proof : Disease Proof : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

Ear infection, or otitis media, is the most common medical problem for children in the United States, and is the most common reason for prescribing antibiotics for infants and children. The typical doctor does not take care to avoid the overuse of these potentially dangerous drugs, and he does not champion nutritional excellence to prevent future infections.

When Stephanie Rogers, a typical seven-year-old girl, became my patient, her parents handed me a printout from the local pharmacy documenting the filling of 67 rounds of antibiotics at the cost of $1,643.80 by the ripe age of seven. Once the pediatric group started prescribing the antibiotics for minor complaints of fever and cough, it escalated to ear infections, sinus infections, and finally visits to the ear specialist by the age of four. She received 15 separate prescriptions of antibiotics when she was five years old. The first year she was my patient, the entire family changed its diet style. Stephanie went along for the ride and did fine. I did use an antibiotic once for her that next winter, when she had a persistent high fever and a red painful eardrum; however, that was the last time an antibiotic prescription was necessary. Luckily, Stephanie has been free of antibiotics ever since.

An international study following more than 3,000 children treated by general practitioners in nine countries showed that antibiotics did not improve the rate of recovery from ear infections. But nearly 98 percent of U.S. physicians in the survey prescribed antimicrobials routinely, the biggest percentage of all countries surveyed.

As a result of accumulating evidence documenting the dangers of antibiotics and their overuse, new guidelines for treating ear infections in children were just released from a joint effort of the American Academy of Family Physicians and the American Academy of Pediatrics. These guidelines represent a major shift in policy and thinking by physician leadership. The guidelines encourage doctors to initially manage the pain and not prescribe antibiotics for children with ear infections and to defer antibiotic use for the sicker children who are not improving two or three days later. I hope doctors will heed this message.

The story of Stephanie Rogers (not her real name) is from the book Disease-Proof Your Child.

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Tomorrow evening PBS will launch a major television series about global health.

They have already launched a comprensive "Rx for Survival" website, which has lots of interesting information, essays, maps, statistics, and other fodder for discussion.

The site emphasizes infectious diseases in developing nations. One of the non-infectious diseases that is shown to be leading killer the world over, including in the world's most modern countries, is malnutrition.

As the site explains, that is not the same as starvation, and in some cases it's quite the opposite:

Malnutrition (from the French mal, meaning "bad") doesn't just mean lack of food. It might surprise some to learn that it refers to obesity, too. In addition, malnutrition describes a lack of micronutrients, including a range of vitamins and minerals.

One of the most powerful micronutrients for child survival is vitamin A. Found naturally in carrots and green and yellow vegetables, or supplied in vitamin capsules or liquid drops taken orally, vitamin A can improve children's health by preventing deaths caused by diarrheal dehydration and measles, dry eye, and nightblindness. Severe deficiencies of vitamin A can ultimately result in total blindness. Vitamin A supplement pills or drops administered twice a year in Africa were able to avert approximately 400,000 cases of childhood blindness per year. Worldwide, it's estimated that the supplements are boosting children's immune systems and saving up to a million lives a year among children at risk of infectious disease.

Pregnant women also benefit from vitamin A supplements, which help reduce maternal mortality dramatically. In a study done in Nepal, maternal mortality rates dropped by more than one-third when women took vitamin A supplements during their pregnancies. It was famously said by nutritionist EV McCollum, who identified vitamin A in 1913, that "Green leafy vegetables are unbottled medicine."

Ingesting vitamin A or beta-carotene in isolation—from supplements, instead of from food—may interfere with the absorption of other crucially important carotenoids, such as lutein and lycopene, thus potentially increasing cancer risk.

The precursor to vitamin A, beta-carotene once was regarded as a safe and beneficial antioxidant and even recommended as an anti-cancer vitamin, but it has recently been shown to increase the risk of certain cancers when administered as an isolated supplement. Scientists now suspect that problems may result when beta-carotene is ingested without other carotenoids that would have been present had it been ingested from real food. Beta-carotene is only one of about 500 carotenoids that exist. Beta-carotene supplements are poor substitutes for the broad assortment of carotenoid compounds found in plants.

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The New York Times has a big story in today's business section about a candy bar from Mars that is dressed up with some supplements to allegedly be something we should all eat two of every day to keep our hearts healthy.

I'm not a scientist (or a doctor--as you'll see at the top of the post, this is Henry writing, not Dr. Fuhrman), but I'm just betting that if this product went head to head with something low-tech like apples in long-term trials, the apples would win hands down.

Or, to put it another way, if your primary concern is defeating heart disease, it's hard to imagine what kind of research you'd do to end up with a candy bar, a product that is famously comprised of dairy fat and refined sugar. On the other hand, if your primary concern is selling chocolate bars...

A blog called "Jeff's blog" has some funny perspective on the new product, which is called "CocoaVia."

"Heart disease is the No. 1 killer in the world, and chocolate is the No. 1 favorite ingredient in the world," said Jim Cass, Mars's vice president of marketing. "When you put those two giant macro trends together, we know this is a big idea."

...I can just imagine the boardroom meeting that launched this. 12 suits sitting around looking at different charts. Too bad they didn't try to make a hybrid-SUV with chocolate steering wheels.

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• The CDC has released new diabetes numbers, and they're shocking. About 7% of the US is now thought to have the disease. Here's one story about the effect diet can have on diabetes.
• "To promote vaccine use, many in the public health community have overstated the risk of flu-related death and the effectiveness of the vaccine in preventing it." A Washington Post editorial by these people.
• A discussion of how much exercise children should get every day.
• Study: 20mg/day of iron supplements for pregnant women can have a statistically significant negative impact on the behavior of children.
• A Canadian couple is attempting to live on food from sources within 100 miles of their British Columbia home. The first step was some unplanned weight loss.

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Dr. Fuhrman's recommendations to families to avoid flu, including avian flu, stirred some interesting comments--especially the idea that those with the healthiest immune systems may be less protected from avian flu than those with average immune systems. Dr. Fuhrman responds:

Clearly, the concept that powerful and competent host defenses are enabled by nutritional excellence is not merely my opinion; rather it is the reality of human physiology supported by hundreds of scientific studies.

And because I have written books on nutrition to teach applied nutritional excellence does not make my viewpoints any more or less substantiated. However, keep in mind my books contain hundreds of references for all my points and likewise my opinions expressed here are not off the cuff but reflect a lifetime of devoted study to these issues.

The idea that a person eating a nutrient-rich diet is just as likely to develop and suffer the dangerous consequences from an influenza virus as a cheese burgers and soda eating American is simply wrong. Moe importantly such opinions are dangerous as they may lead to tragic outcomes for those mistaking authority for knowledge.

Let's review just a few articles from the scientific literature that further support this concept that nutritional.excellence can offer protection from viral attacks. I will show the reference and post some explanatory comments below each reference.

1. Bendich A. Antioxidant nutrients and immune functions--introduction Adv Exp Med Biol 1990;262:1-12
This short introduction encompasses only a small portion of the literature linking free radical production and consequent effects on immune functions. The role of essential dietary components in modulating these effects is an area of intense and expanding investigation. Each of the nutrients examined in the chapters has distinct functions to support immuno-competency, but in this volume they concentrate on their shared capacity to act as antioxidants

2. Fawzi W. Nutritional factors and vertical transmission of HIV-1. Epidemiology and potential mechanisms. Ann N Y Acad Sci 2000 Nov;918:99-114
This article shows that the transmission of the AIDS virus is significantly reduced and even made improbable when the host's nutrition is excellent.

3. Beck MA; Levander OA Dietary oxidative stress and the potentiation of viral infection. Annu Rev Nutr 1998;18:93-116. Beck MA Antioxidants and viral infections: host immune response and viral pathogenicity. J Am Coll Nutr 2001 Oct;20(5 Suppl):384S-388S; discussion 396S-397S. Beck MA; Levander OA; Handy J Selenium deficiency and viral infection. J Nutr 2003 May;133(5 Suppl 1):1463S-7S. Rayman MP; The argument for increasing selenium intake Proc Nutr Soc 2002 May;61(2):203-15
These articles above review the literature and studies showing nutritional deficiencies lead to more serious infections. They contain the interesting science that describes how a diet low in anti-oxidents and phytochemicals can enable genetic sequences in the pathogen to alter allowing more serious outcome. Oxidative stress is implicated in the pathogenesis of several viral infections, including hepatitis, influenza, and AIDS. Dietary oxidative stress due to either various nutritional deficiencies such as selenium or vitamin E increases cardiac damage in mice infected with a myocarditic strain of coxsackievirus B3. Poor diet allows a normally benign (i.e., amyocarditic) coxsackievirus B3 to convert to virulence and cause heart damage. These findings were then documented to occur in humans too. It was found that cardiomyapathy as well as viral induced neuropathy have a dual etiology involving a nutritional deficiency along with a enterovirus that now can create a serious outcome, not permitted in a more nutritionally adequate host. More recently research has shown that the influenza virus also exhibits increased virulence in a nutritional deficient host allowing multiple changes in the viral genome. Interestingly, the influenza virus causes more serious lung pathology and HIV infection progresses more rapidly to AIDS in the micronutrient poor host. Although it has been known for many years that poor nutrition can affect host response to infection, the finding that host nutrition affects the genetic sequence of a pathogen is an important field of future investigations.

4. Levander OA. Nutrition and newly emerging viral diseases: an overview. J Nutr 1997 May;127(5 Suppl):948S-950S. Amati L; Cirimele D; Pugliese V; Covelli V; Resta F; Jirillo E Nutrition and immunity: laboratory and clinical aspects. Curr Pharm Des 2003;9(24):1924-31 Irshad M; Chaudhuri PS Oxidant-antioxidant system: role and significance in human body. Indian J Exp Biol 2002 Nov;40(11):1233-9
Malnutrition has long been associated with increased susceptibility to infectious disease due to an impaired immune response. Now more data has emerged to substantiate the view that oxidants, anti-oxidants and nutritional factors have dramatic positive effect on host recovery, response, resistance and also to protect the virus from mutating into a more dangerous forms. When discussing interactions of nutrition and infection, nutritionists have traditionally considered only the effects of diet on the host. Recent data, however, indicate that host nutrition can influence the genetic make-up of the pathogen and thereby alter its virulence. These symposiums and articles were designed to alert the community of nutritional scientists to this discovery and possible implications for the improvement is public health.

When derived of anti-oxidant nutrients viral infections can cause serious even fatal diseases, that don't occur when deficiency is not present. Immunity when optimized can ward off infection and when infected is more likely to have harmless outcome. It is well known that inappropriate nutrient intake accounts for the maintenance of the immunological equilibrium, in humans and animals. Vitamins, elements, lipids, proteins. phytonutrients, and nucleic acids play an important role in the regulation of cellular and humoral immune responses since single or multiple deficits of these food components have been shown to cause immune abnormalities.

5. Reid AH; Taubenberger JK; Fanning TG. The 1918 Spanish influenza: integrating history and biology. Microbes Infect 2001 Jan;3(1):81-7. Afkhami A Compromised constitutions: the Iranian experience with the 1918 influenza pandemic. Bull Hist Med 2003 Summer;77(2):367-92
The global demographic impact of the 1918-19 influenza pandemic continues to fascinate researchers and scholars. These papers examine the social and demographic effects of this outbreak on society, through a comprehensive investigation of the modes of transmission and propagation, mortality rates, and other distinctive features of various regions, and reveals the importance of taking a country's unique settings into account. For example, Iran was one of the regions hit hardest by the pandemic, with mortality rates significantly higher than in most regions of the world. Contrary to the prevailing notion that the 1918 influenza targeted the young and healthy, this paper suggests that famine, opium, malaria, and anemia were fundamentally responsible for the high mortality in Iran. Clearly those with compromised immunity suffered the most damage.

The touted concept that the pandemic flu of 1918 target the "young and healthy" is not quite accurate. First of all, like today the diet in Western Europe in those days was largely meat, bread, potato, lard, butter and cheese with minimal fresh produce. The so-called, "young and healthy" back then, like today could not be used as an example of those eating a diet to assure nutritional adequacy. The diets of yore were grossly deficient. Today most industrialized nations eat less than five percent of total calories from fresh produce: fruit, vegetables, seeds, nuts and beans. In spite of the fact that we have new science pointing to the impressive disease protection against heart disease, strokes, dementia, cancer and yes, serous infections, our society still consumes a diet assuring nutritional compromise and tragic medical outcomes..

Those of you naysayers who would like to stay on your chicken and pasta "low fat diet" or your cheeseburger and cokes with your heads buried deeply in the French fries, I say that is your prerogative. As for me, I will use and apply the science of today that shows the protection offered by cruciferous vegetables, raw vegetables and fruits, nuts and seeds and beans to give myself, my family and my patients the greatest potential to live a live a long, healthy life. This is not alternative medicine, it is good medicine.

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Tamiflu is going for record-high prices on auction sites. The news media is following the spread of Avian flu among poultry across Asia and into Europe and Africa. The great pandemics of the past---with millions dead---are being cited day in and day out, and it seems that there is nothing we can do to prevent another one in the months and years to come.

Fear is spreading faster than the flu itself. People are frantic, running to get themselves and their children vaccinated out of fear they or their loved ones will die from this viral illness that may spread rapidly throughout the world.

The panic is on.

Almost every year flu season seems to bring with it extraordinary anxiety and fear, especially among parents of young children. This year is perhaps even worse, as the media is full of reports of a deadly H5N1 Avian influenza (or "bird flu") bug, which in theory could mutate to be transmissible from human to human.

Through all the fog of media and worry, let's not lose our bearing and make rash decisions. The important news is that most Americans can and should take six steps to reduce the likelihood of getting an infectious disease like the flu, which are explained below.

First, some background:

Nutrition and Infection
The most effective artillery we have to protect ourselves against the potential damaging effects of influenza and other infectious disease is nutritional excellence. Micronutrients---meaning vitamins, minerals, and phytochemicals---fuel various clever host defense mechanisms, including:

• phagocytosis (surrounding and eating viruses) by macrophages and neutrophils
• cell-mediated protection by T cells
• natural killer cells
• antibody production by B cells

It has also been demonstrated that when diets are low in consumption of green and yellow vegetables, (rich in carotenoids) viral illnesses take a more serious form.

Multiple micronutrients including lutein, lycopene, folic acid, bioflavoinoids, riboflavin, zinc, selenium, and many others have immunomodulating functions. That means they influence the susceptibility of a host to infectious diseases and the course and outcome of such diseases. These micronutrients also possess antioxidant functions that not only up-regulate immune function of the host, but also alter the genome of the microbes that can result in more prolonged and serious infection, particularly in viruses. Viruses are able to assume a more virulent form and new more severe infections are more likely to emerge when nutritional deficiencies are present in the host. A healthy immune system adequately armed with a symphonic assortment of plant-derived phytochemicals inhibits DNA variation in the virus that could allow it to better evade host defenses.

Flu Facts
About 10 percent of US residents get influenza each year. About 100,000 are hospitalized and 36,000 Americans die each year from the complications of the flu.

The symptoms of the flu include:

• High fever.


• Headache.


• Extreme fatigue.


• Muscle aches.


• Cough, sore throat, nasal congestion are also common.


• Gastro-intestinal symptoms, such a nausea, vomiting and diarrhea is more common in children.


• Severe headaches and muscle aches are what usually differentiate the flu from other viral illnesses and colds.

The good news is that, if you are generally healthy, and eat a healthy diet and get a high percentage of your calories from fruits, vegetables, seeds, and nuts, then you need not panic. The flu is not a dangerous disease in healthy individuals. In spite of the fear that the Avian Flu is an exceptionally virulent strain, with about half of those humans infected having died, it still stands little chance against a truly healthy immune system.

Fifty percent of Americans die of heart attacks and strokes too, but that does not mean those deaths were not 100 percent avoidable with excellent nutrition. About 35 percent of all Americans die of cancer, but those deaths were also largely the result of nutritional folly. When we eat a nutrient-poor diet, diseases flourish. With nutritional excellence our body becomes a miraculous disease-resistant organism. Flu is no exception.

A More Virulent Strain: Bird Flu
The H5N1 bird flu, at the time of this writing, does not transmit easily from birds to humans. Despite the fact that it is now very common in birds in parts of the world, the virus has infected few more than 100 humans. As the WHO points out: "this is a small number compared with the huge number of birds affected and the numerous associated opportunities for human exposure, especially in areas where backyard flocks are common. It is not presently understood why some people, and not others, become infected following similar exposures." Actually only a very small percentage of people in contact with this virus has become infected. At this point it seems most likely that this strain of flu will not become highly endemic.

The concern is that these kinds of flu viruses constantly mutate. It is entirely possible that at some point this virus that is virulent (powerfully contagious and harmful) to birds will develop into a form that will spread efficiently from human to human. In that scenario, it could do a lot of damage.

According to the Centers for Disease Control, the symptoms of bird flu in humans "have ranged from typical flu-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications."

So how can we determine which individuals will catch this potentially deadly enemy and in which individuals it will develop life-threatening complications? The answer is that the same three basic factors determine the contagious potential of any flu:

• The size of the inoculum (how large the number of virons in the exposure)


• The virulence of the microbe (how well designed the virus is to evade host defenses)


• The resistance of the host. How effective is the immune system of the host at preventing viral replication.

If this virulent form of the flu does appear in our region we are not without protection. We have control over the size of the exposure, because we can avoid hand to mouth and hand to nasal contact and we can wash our hands after touching people and birds.

Now, once you have contracted the disease, only "the resistance of the host" is important because it is the critical factor that governs the extent of damage. It is this host resistance that plays a major role in infection and we can improve our resistance to make ourselves almost disease-proof. So no matter what kind of flu you are trying to prevent, there are six key steps we should all take to strengthen our immune systems and minimize the impact of the flu.

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Research suggests a little less meat on the plate could mean less bulk on your frame. In a study, women who consumed few or no animal products were less likely to be overweight or obese than self-identified meat eaters.

In their American Journal of Clinical Nutrition article, researchers PK Newby, Katherine L Tucker and Alicja Wolk conclude:

Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.

Make fresh fruit, vegetables, whole grains, and legumes your diet staples. For a protein fix, opt for low- or non-fat dairy, skinless chicken, nuts, or fish to control saturated fat.

Plant-based diets consisting of fruits, vegetables, legumes, and whole grains are high in fiber and nutrients and low in fat and calories, all of which may help you lose weight. This study suggests that people who classify themselves as vegetarian, semivegetarian, or vegan are much less likely to be overweight or obese than meat eaters.

However, you don't need to go completely meatless if that doesn't suit your lifestyle. Just choose appropriate portion sizes and low-fat cooking methods. A serving of meat is equal to three ounces, about the size of a deck of playing cards. If you eat red meat, limit consumption to no more than one serving per week. Also, limit intake of meats high in saturated fat, such as bacon, sausage, and fatty cuts of beef.

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As we have discussed before, The China Study is a long-term epidemiological study that teaches us a lot about which foods inspire long-term health. It was completed by studying different groups all over China, who make sense to study because they have different diets but similar genetics.

According to a Xinhua news article (via Eastday) studying young people in Beijing today would reveal an unhealthy trend:

A survey shows that about 80 percent of Beijing middle and primary school students are fond of foreign snacks, 43.6 percent of them go to McDonald's, KFC or other foreign fast food eateries every month, and 6.1 percent go every week or every day.

The smokers all around us now are also people of outstanding character. They have a great deal of determination and strength. The courage that they show in the face of unforeseen events—a courage that many nonsmokers are unable to muster—is unforgettable.

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Laura Landro is an assistant managing editor of The Wall Street Journal, who wrote a well-reviewed book about her own struggle with breast cancer.

In her column today, she addresses something lots of people are worried about these days: cold and flu season. She cites good research in recommending lots of fruits and vegetables, limiting saturated fat, avoiding processed and junk foods, exercising, and maintaining a normal weight.

As cold-and-flu season arrives, so do the pitches for products that claim to increase the body's natural immunity and ward off infection. And with alarming reports about avian flu and a threatened global pandemic, it may be tempting to load up on mega doses of vitamins, minerals and herbal supplements as an added precaution.

But as scientists delve more deeply into how the immune system works, they are finding evidence that it is the complex interaction of nutrients in food that helps the body build its defenses against disease and infection, in part by controlling some types of inflammation that can weaken the immune system. Single nutrients and cocktails of nutrients consumed alone can't provide the same benefit, they warn, and large doses of some supplements such as selenium, zinc, vitamin A, vitamin B6 and vitamin E may even harm and suppress the immune response.

The best defense against influenza is getting vaccinated as soon as possible -- and the most important way to prevent the spread of colds is frequent hand washing. But experts say that following the most basic tenets of good nutrition -- consuming a balanced diet rich in fruits and vegetables and low in saturated fats, and eliminating highly processed and junk foods -- can actually help ward off illness.

"There is lot people can do with proper nutrition to improve their chances of warding off the flu or making the disease less pathogenic," or harmful, says Simin Nikbin Meydani, director of the nutritional immunology laboratory at Tufts University's Jean Mayer USDA Human Nutrition Research Center on Aging.

Exercise and maintaining a normal weight are equally important, Dr. Meydani adds, because obesity can also impair immune function and make people more susceptible to many types of infections. Tufts researchers have shown that moderate caloric restriction in humans appears to be beneficial for immunity.

For instance, in Disease-Proof Your Child he discusses phytochemicals, which are a recently discovered class of more than 12,000 nutrients that are the subject of a lot of new research. Phytonutrients do all sorts of good things, from detoxifying certain harmful compounds, deactivating free radicals, and enabling DNA-repair mechanisms. From the book:

We cannot acquire a sufficient amount and diversity of phytochemicals in supplements; we must get them from real food, especially because many of them have not been discovered yet. When we pass up eating fruits and vegetables, we are turning our backs on a host of nutrients that can keep us from developing disease.

In case you needed another reason to eat your broccoli... (And what if you don't like broccoli? There are plenty of good, healthy recipes in his books, and right here on DiseaseProof.)

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Here is a fun letter Dr. Fuhrman recently received from Janine Kroner--the mother of one of his patients.

Dr. Fuhrman,

I thought you might like to hear a cute story related to your vegetable soup and your carb advice you gave me for our son, who is our track star.

Back in May when you started treating our daughter, our son decided to apply proper eating toward his track program. He eats your vegetable soup, or what our kids have now renamed the "Green" soup, everyday. Well he had an amazing spring track season and we would jokingly say it was the green soup with a chuckle. His track friends/teammates found out about it and decided they wanted the soup. It is now cross country season and two of his teammates asked to come for dinner the night before yesterday's meet and have Green soup, sweet potatoes, and pasta. So the three boys ate us out of house and home, hoping the Green soup would work its magic. Well, yesterday the boys had their first meet and won. It was not even close. Not only did they win, but their times were great. When they recovered from the run, they came over to me all excited and said it was the soup. They have now decided they would like to have Green soup parties instead of pasta parties before big meets. Two other moms came to me and asked for the recipe. I found it all pretty entertaining, but hey who knows maybe we're on to something.

Actually, all three of these young men are amazing athletes who have trained hard for months and I do think they would have done well yesterday without the soup, but if it gets them to eat right let there be soup!

Very best,

Janine Kroner

Here is the version of Dr. Fuhrman's soup recipe that Janine uses:

Kale and Collards
Swiss Chard
Broccoli rabe
3 stalks leeks
Broccoli sprouts
Mushrooms diced
3 carrots, diced
3 parsnips, diced
4 zucchini
Spit peas 1/2 cup
Lentils 1/2 cup
Adzuki beans 1/2 cup
3 onions
celery juice 10 oz.
carrot juice 20 oz.
30 oz water
Vogue - Vegebase 2 tablespoons (Whole Foods will have this)

-Fill large pot with water, juices, and two tablespoons of VegeBase.
-Put peeled onions, unpeeled zucchinis, carefully cleaned leeks and beans in large pot, and simmer until zucchinis, leeks & onions are soft enough to blend or food process.
-While waiting for veggies to soften in pot, blend or food process all other ingredients until smooth. (I use half of the bunches of greens.)
-You will need a big bowl to put them in while waiting for zucchini, onions, and leeks to soften for food processing.
-When zucchini, onions and leeks are soft, blend or food process them.
-Put everything in the pot and simmer on low for 1.5 hours.

Making Green soup takes some time--but if you have a really big pot you can cook two weeks' worth at once. If you can't find or are missing an ingredient or two it really will not matter.

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As we have discussed previously, many studies point to a link between diet and cancer. Studies that consider long-term diets, and the diets of the very young, suggest particularly strong ties. Studies in which middle-aged people have made modest dietary changes for only a few years have had mixed results (which can create confusion and be discouraging for those who are interested in eating the healthiest diet possible).

In May, however, a study was released showing that women who had been treated for breast cancer decreased their likelihood of a recurrence with a modest reduction of fat intake. In a a question-and-answer session describing his study, Rowan Chlebowski of Harbor-UCLA Medical Center explains that the research involved more than 2,400 women as part of the Women's Intervention Nutrition Study.

After an average of five years, 9.8 percent of the women on the low-fat diet had a recurrence of cancer. Meanwhile, 12.4 percent of the women on a standard diet had recurrences. That's a 24 percent reduction. Impressively, women with cancers that were not sensitive to estrogen--and who therefore are not candidates for drugs like tamoxifen--had their risk fall even more, by about 42%.

The only dietary adjustment these women made was to eat an average of 33.3 grams of fat per day, compared to the "average diet" which contained 51.3 grams of fat. That is a very modest dietary adjustment.

In his books, Dr. Fuhrman describes a diet that is low in fat, but otherwise very different from the diet these women were following. Dr. Fuhrman's recommendations for cancer patients include fresh squeezed vegetable juices, blended salads, and his cruciferous vegetable containing soups. His menus are designed to contain optimal levels of phytonutrients as they occur in nature. Phytonutrients have been shown in scientific studies to boost the immune system's ability to defend itself against a cancer and actually enable the body to stop the growth of cancer cells. His results with many cancer patients have been dramatic, and make clear that the marginal benefits of reducing fat intake is only the beginning of what diet can do to ward off cancer.

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This spring, Dr. Fuhrman was interviewed by Marshall Glickman of Green Living Journal. The conversation gives an overview of the unique equation that underlies Dr. Fuhrman's approach (health = nutrition/calories), touches on the social challenges of healthy eating, and concludes with some meaningful news for those concerned about heart disease. With Mr. Glickman's permission, here is some of their conversation:

Thanks so much for the chance to ask you some questions, and especially for the huge amount of hours you've put into research. It seems hard to disagree with the formula Health = Nutrients/Calories. Can you flesh out your approach a bit, with a quick summary of what you advocate in Eat to Live?
Sure. There are a few points that together make the H = N/C approach unique. One is the concept of nutrient density; that is, as you start to meet the body's nutrient needs, it desires less food. This mean we're not going to crave food as much or want to eat as often.

Another is that when you eat foods that have toxic properties or that aren't healthy for you, they create addictive withdrawal symptoms once you stop eating them. Since those addictive withdrawal symptoms are relieved by frequent eating, they drive people to eat more frequently than is necessary. For example, if you stop drinking coffee, you get headaches. You can get rid of the headaches by breaking the caffeine habit or by drinking more coffee. Likewise, a diet that contains processed foods and trans fats, lots of saturated fats and plenty of salt is relatively toxic, and when you stop eating for a few hours, you start to feel lousy. Weakness, achiness, abdominal spasms, and headaches are not symptoms of true hunger. Like thirst, true hunger is felt in the throat, not the stomach. So the point is, in order to stop the addictive drives and perverted cravings that lead to compromised health and our current obesity epidemic, we must restore nutritional excellence. This puts people back in touch with the amount of calories they actually need. Dieting doesn't work because you are always fighting your addictive sensations.

Restoring nutritional excellence not only improves health, drops weight, and lowers cholesterol, once the perverted food cravings and addictions are gone, you can make appropriate connections between the body's natural signals--directing you to the right amount of calories needed to maintain an ideal weight. Otherwise, dieting becomes a guessing game of how much food to eat, measuring of calories, walking around starving all the time, and fighting against the natural drive to eat.

The third point is taste. As you start to eat more healthfully in a nutrient-dense diet, your taste adjusts itself so that you actually get more pleasure from eating, not less. That's why I say this is a knowledge-based system. You need to know that giving up some of your favorite, unhealthy foods requires only a temporary loss, but after a while you'll actually like this way of eating as much or more than your old way. When you're eating food that tastes good and aren't restricted on the quantity, you don't feel deprived.

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Patricia Reaney writes for Reuters about a new study showing quick growth among the very young can lead to obesity.

Big babies and infants who gain weight very quickly early in life have a higher risk of suffering from obesity.

A review of 24 studies published online by the British Medical Journal on Friday showed that size early in life has a life-long impact.

"In the majority of studies the infants who were heaviest or those with the highest body mass index (BMI), and those who gained weight more rapidly in the first two years of life were more at risk of obesity," Dr Janis Baird, of the University of Southampton, in southern England, told Reuters.

"This was true for obesity in childhood, adolescence and adulthood."

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If you're someone who prefers listening to reading, and you're wondering what Dr. Fuhrman is all about, here's a little sample: about a five-minute-long interview he did upon the arrival of his book Eat to Live.

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These people are really into mushrooms.

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Every parent wants their child to enjoy the benefits of excellent nutrition.

Many parents have good ideas about which foods their children would ideally eat.

Yet somehow it seems very few parents actually succeed in getting their children to eat a healthy diet.

How can you get your kids to eat well? With four children of his own, and hundreds he has successfully treated with excellent diet, Dr. Fuhrman has a wealth of experience and plenty of tricks.

Dr. Fuhrman gives parents techniques they can use to end "the food wars," and encourage children to joyfully consume things like kale, tomatoes, and carrots. (It happens. Really.)

This DiseaseProof.com podcast is about twenty minutes long, and you can listen directly on the web or by downloading to your portable media player.

Listen to an mp3 of Dr. Fuhrman on Getting Children to Eat Well.

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Eureka! Some good news about the health of Americans. The website of the magazine Cooking Light offers these numbers:

The new USDA guidelines recommend we eat between five and 13 servings of fruit and vegetables a day, and we're starting to hear the message. The average American consumed roughly 332 pounds of fresh produce in 2004, up from 287 pounds in 1990. Plus, with the growth of America's farmers' markets, the introduction of Consumer Supported Agriculture, where community members buy produce from local farmers each month, and home delivery from many supermarkets, opportunities for Americans to have fresh produce abound.

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One of the most impassioned speeches about childhood nutrition that I've seen anywhere is this letter that Christopher Kimball had published recently in the Boston Globe. Christopher Kimball is the founder and editor of the magazine Cook's Illustrated, and the host of the TV show America's Test Kitchen.

It's worth clicking to read the whole letter, but here's an excerpt.

Stop feeding my kids the offal from the bottom of the processed food barrel: turkey loaf, chicken nuggets, processed macaroni and cheese, high fructose corn syrup, palm oil, preservatives, artificial flavors and colors, and whatever surplus foodstuffs the USDA happens to have on hand that week.

One of America's greatest shortcomings is the triumph of commerce over culture even when it affects the health and well-being of the next generation. For the most part, public schools have abdicated their sacred role as guardians of our children's minds and bodies and have succumbed to the lure of either budgetary pressures (one large school district in Colorado signed a $10 million pouring rights deal with Coca Cola) or simple convenience.

Boston's Mayor Thomas Menino is the self-proclaimed education mayor. Our nation's first lady is a former teacher and advocate for better schools. We've all heard speeches galore about the quality (or lack thereof) of public school education. Yet our kids are nothing more than a gigantic captive market for our nation's fast-food industry and dumping ground for low-quality USDA surplus.

One day, mothers and fathers across America are going to wake up, throw open the window, and yell, ''We're mad, and we're not going to take it anymore!" Like Hercules, we are going to clean the stables of the corporate profiteers, the bureaucrats, and the number-crunching nutritionists and demand that school lunches be put back on the front burner.

How about that day being tomorrow?

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Have you noticed? In the last few years, there has been more attention than ever on feeding children healthy foods. Consider all these different groups:

• Celebrity Chef Jamie Oliver's campaign is credited with having a profound effect on the British Government's decision to ban junk food from schools.
• In an official proclamation declaring National School Lunch Week, President Bush declared that "by helping our children make healthy choices not only about food but also about their overall well-being, we can reduce the rates of childhood obesity and diabetes and help prevent heart disease, stroke, and other diseases later in life. Nutritious meals can also improve students' concentration and help them succeed in school." And don't forget these related federal programs.
• A coalition of food suppliers has launched a campaign called Eat Smart Grow Strong.
• Stonyfield Farm is leading a grassroots effort to get children to eat healthier food.
• The Center for Science in the Public Interest has a massive, multifaceted campaign designed to help citizens improve nutrition for young people.
• As we'll seein the next post, Cooks Illustrated founder and editor Christopher Kimball, who is also the host of TV's America's Test Kitchen, is on the case too.

That is just the tip of the iceberg. There are similar public and private programs at regional and local levels across the country and around the globe.

Of course, all of these programs have their strengths and weaknesses. One thing to keep in mind: in programs sponsored by food manufacturers, drug companies, or those with a financial, political, or social motive, the potential is there for the science to be clouded in favor of such views. But the one really good thing is that every one of these programs promotes the idea that children should be getting a greater percentage of their calories from healthy foods like fresh vegetables and fruit. Who can argue with that?

The approach Dr. Fuhrman describes in Disease-Proof Your Child takes the generally accepted bandwagon a step further and surveys the science of disease-causation in an impartial way--so that parents who are looking to protect the health of their children can know exactly what they need to do with scientific integrity. The book has precise recommendations to help protect children against later life cancers and most other diseases. The fact that childhood food choices are the major factor governing tragic illnesses later in life has a silver lining: now parents (not doctors and drug companies) have the power to prevent disease.

As Dr. Fuhrman points out, "research scientists have been forced to accept the idea that the causes of cancer are usually set into motion more than 50 years before diagnosis. Our big artillery in the war on cancer is truly in our kitchen; but we must start feeding our kids right to unleash the big guns."

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The current issue of the British medical journal The Lancet has a series of articles on "the neglected epidemic" of chronic disease. One of the central premises of Dr. Fuhrman's work is that many of the most prevelant deadly diseases are preventable with healthy lifestyle choices like stopping smoking, exercising, and eating the healthiest foods. A Lancet article called "Preventing chronic diseases: how many lives can we save?" (by Kathleen Strong, Colin Mathers, Stephen Leeder, and Robert Beaglehole) addresses the entrenched resistance to this approach.

Another more insidious myth about the chronic disease burden is that we can do nothing to prevent these conditions because they are caused by unhealthy behaviours that people choose to have. The reality could hardly be more different. Human behaviour is shaped by many factors, including environment and economic pressures, which with increasingly urbanised populations in low-income and middle-income countries may result in poor diet choices and limited physical activity. Fortunately, many of these diseases are amenable to successful intervention.

The experience of high-income countries clearly shows what can be achieved with sustained interventions. Death rates from heart disease have fallen by up to 70% in the past three decades in Australia, Canada, Japan, the UK, and the USA. Between 1970 and 2000, 14 million deaths due to cardiovascular disease were averted in the USA alone. During the same period, the numbers of deaths averted in Japan and the UK were 8 million and 3 million, respectively. These data correspond to a reduction in chronic disease death rates of 1-3% per year over a 30-year period. Estimates of the joint effects of the leading chronic disease risk factors (tobacco use, raised blood pressure, and poor diet) indicate that more than 30% of the burden of chronic diseases and more than 50% of deaths from chronic disease are attributable to a relatively small number of modifiable risks.

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This is a bit from left field, but the Rand Corporation--a non-profit think tank in California--did a study that looked at factors contributing to high body mass index scores in children. They looked at things like proximity to fast food restaurants. The research found one of the most important factors was the price of fruits and vegetables:

Lower real prices for vegetables and fruits were found to predict a significantly lower gain in BMI between kindergarten and third grade; half of that effect was found between kindergarten and first grade. Lower meat prices had the opposite effect, although this effect was generally smaller in magnitude and was insignificant for BMI gain over 3 years.

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Shaoni Bhattacharya of the NewScientist.com news service passes along news of a major new report of the World Health Organization, which says chronic diseases like heart disease, cancer, and diabetes are causing far more deaths around the globe than all other causes combined.

By the end of 2005, twice as many people will have died from chronic diseases as from all infectious diseases, starvation and pregnancy and birth complications combined, international experts have warned.

The "neglected epidemic" of chronic disease will take 35 million lives in 2005, out of the total 58 million who will die globally. And contrary to popular belief, most of the deaths - 80% - from chronic conditions such as heart disease, diabetes and cancer will be in low to middle-income countries.

The two factors behind this epidemic are smoking and obesity, says Richard Horton, editor of The Lancet, in a commentary accompanying four studies published on Wednesday. "These risks and the diseases they engender are not the exclusive preserve of rich nations."

If action is taken now, 36 million lives could be saved by 2015, says a major World Health Organization (WHO) report on chronic diseases also published on Wednesday.

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Of course, there are a million reasons to feed children healthy food in schools. Inspiring better behavior and academic performance, preventing diseases like obesity, teaching healthy habits...

Author, former school kitchen administrator, and Food and Society Policy Fellow Ann Cooper adds another reason: money. In an article from 2004, Cooper cites USDA statistics in coming up with this assessment:

It costs approximately $6,000 to feed a child lunch during the entire tenure of their K-12 education, and it costs our health care system and our taxes approximately $175,000 per adult, for illnesses related to poor childhood nutrition.

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According to this Reuters story, researchers had two groups of women. One group was instructed to eat a low-carbohydrate diet. The other was intructed to eat a diet free of animal products including, meat, eggs, and milk. Even though the vegan group had no portion restrictions, they ended up losing significantly more weight.

Researchers found that of 64 postmenopausal, overweight women, those assigned to follow a low-fat vegan diet for 14 weeks lost an average of 13 pounds, compared with a weight loss of about 8 pounds among women who followed a standard low-cholesterol diet.

The weight loss came despite the fact that the women were given no limits on their portion sizes or daily calories -- and despite the fact that the vegan diet boosted their carbohydrate intake.

CORRECTION: In the first paragraph, I should have said low-cholesterol. My mistake, and thanks for the comment catching it. (The confusion came from the the line saying the vegan diet "boosted their carbohydrate intake.")

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Red meat has been linked to heart disease and cancer in a number of studies. Most of that research has focused on saturated fat and toxins that arise from cooking.

A new study from the University of San Diego School of Medicine, published in the Proceedings of the National Academy of Sciences, investigates another theory: that a cell-surface molecular sugar called N-glycolylneuraminic acid (Neu5Gc), which exists in fairly high levels in milk and red meat, might build up in human tissue and inspire disease. This is from a UCSD press release on the study:

The study's senior author, Ajit Varki, M.D., UCSD professor of medicine and cellular and molecular medicine, and co-director of the UCSD Glycobiology Research and Training Center, said that although it is unlikely that the ingestion of Neu5Gc alone would be primarily responsible for any specific disease, "it is conceivable that gradual Neu5Gc incorporation into the cells of the body over a lifetime, with subsequent binding of the circulating antibodies against Neu5Gc (the immune response), could contribute to the inflammatory processes involved in various diseases."

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