THAT’S THE WAY THE COOKIE CRUMBLES (2 page)

“Gee! You scientists — one day you say this, the next day you say that,” exclaimed the apparently frustrated lady as she approached me after a public lecture. “I remember having you as a prof twenty years ago, and you maintained that anyone who had a balanced diet did not have to worry about taking vitamin supplements. Now here you are suggesting that we take a multivitamin and that there may be value in some other supplements as well. Can’t you guys make up your minds?”

Well, frankly, no. At least not completely. Science rarely gives us conclusive answers. It is an ongoing process that attempts to remain in step with the latest research. That’s why changes in recommendations made to the public should come as no surprise. Indeed, I think I would be more concerned if I were saying the same things today as I did twenty years ago, because it would indicate that we had made no progress in our understanding of nutrition. Also, I would suggest that a time span of twenty years is not exactly “one day this, the next day that.” During this period, for example, we have firmly established the role of the B vitamins in preventing the buildup of homocysteine in the blood, and we have recognized the potential value of an increased intake of vitamin D. In general, we have come to understand more fully that some vitamins may do more than just prevent nutritional deficiency diseases. At worst, as I’ve often said, a multivitamin may just make for more expensive urine. At best, it may result in significant health benefits.

That’s the argument I was giving to my former student when another gentleman joined the discussion. He took issue with what he perceived to be my enthusiasm for vitamin supplements (although I hardly think that suggesting a multivitamin qualifies me as a supplement pusher) and informed me that he had just given up his vitamin E pills because he did not want to “die of a heart attack.” I was a little taken aback by this, because vitamin E has been associated with protection against heart disease. So what was this guy talking about? He had “proof” of the dangers of vitamin E, he said, and he proceeded to pull a neatly folded newspaper article out of his pocket. “Vitamin E Debunked as Heart Healthy,” the headline screamed.

Now it all began to click. A study published in
The New England Journal of Medicine
had garnered a great deal of media attention because it suggested that taking a mixture of antioxidants reduced the effectiveness of a cholesterol-lowering medication. It was an interesting study, to be sure, but it certainly did not show that vitamin E supplements are dangerous, as many newspaper accounts inferred.

One of the most commonly prescribed classes of drugs for reducing LDL cholesterol, the so-called “bad cholesterol,” is the statins. LDL causes deposits to form in arteries and triggers heart attacks. This happens when the cholesterol that has been deposited undergoes a chemical reaction and becomes oxidized cholesterol, the most dangerous form. By contrast, HDL, or high density lipoprotein, scavenges cholesterol from the blood and prevents its deposition. That’s why it is referred to as “good cholesterol.” HDL can be increased by taking high doses of niacin, one of the B vitamins. There is also some evidence that antioxidants such as vitamin C, vitamin E, beta-carotene, and selenium can reduce the oxidation of LDL and therefore reduce the risk of heart disease. A logical question to ask, therefore, is what would happen if someone at risk for heart disease took a statin drug, plus niacin, plus antioxidants? Would the beneficial effects be combined and the risk reduced accordingly?

This is just what researchers at the National Institutes of Health decided to find out. So they enrolled 160 subjects with existing heart disease in a study. Forty patients were given Zocor — one of the most popular of the statin drugs — together with niacin, while forty others took the same drugs plus vitamins C, E, beta-carotene, and selenium. Another group of forty took only the antioxidants, and a fourth group was given a placebo. The results were surprising. As expected, Zocor and niacin reduced LDL, raised HDL, and lowered the risk of heart attack. But when researchers incorporated the antioxidants into the mix, they noted a smaller increase in HDL and a slight increase in artery blockages. The groups taking only the antioxidants or a placebo had the most cardiac complications.

What are we to make of this? The basic conclusion is that the mix of antioxidants blunted the benefits of the combined statin-niacin therapy. We don’t know which antioxidant was responsible. Vitamin E may not even have played a role at all. And this study doesn’t give us information about what happens when only a statin is taken together with antioxidants, a situation that is far more common than combined statin-niacin therapy. Finally, we must remember that all the participants in this trial already had heart disease, so we can draw no conclusions at all about the possible effectiveness of antioxidants in preventing the disease in the first place. Certainly, the data do not justify headlines about antioxidants increasing the risk of heart disease.

Really, the only appropriate conclusion we can draw from this study is that anyone who has been prescribed both a statin and niacin is probably better off not taking any antioxidants. But there is absolutely nothing in the study to suggest that antioxidants, and vitamin E in particular, are dangerous to the general population. Any contention about vitamin E causing heart attacks is totally unjustified. True, the study does hint that the benefits of antioxidant supplements have probably been overstated. We’ll see. No one can be certain about what further research will show. But of one thing, I am sure. If I’m around in twenty years to talk about this stuff, I won’t be saying the same things as I’m saying now. That’s the way science works. And do I have a better chance of being around if I take antioxidants? I guess that depends on which study I read.

It was an experience I never thought I would have. I had read about it, I had seen pictures of it. Now here I was, sitting in Dr. John Harvey Kellogg’s patented vibrating chair, happily vvvibrrraaatinggg away. I was visiting the little museum in Battle Creek, Michigan, dedicated to the exploits of the good doctor, whose flaky ideas about health had captured America’s imagination in the late 1800s.

Kellogg was infatuated with the human colon. He believed that virtually all ailments could be traced to “autointoxication” through substances produced by the “putrefying” bacteria inhabiting the colon. The key to health, he maintained, is a clean colon. His cereal flakes served as “little internal brooms” that helped sweep out the colon’s contents, especially if these were loosened by the activity of the vibrating chair. I didn’t note any such effect. Neither did I notice any stimulation of the internal organs after galloping on Dr. Kellogg’s famous mechanical horse. But I did spy something while riding that horse. A curious glass and metal device sat unceremoniously in a corner, barely eliciting a glance from other museum visitors. I recognized it right away. It was Kellogg’s enema machine.

Dr. John Harvey Kellogg administered and received more enemas than anyone in history. His electric enema appliance pumped fifteen gallons of water through the colon in just one minute. But that was not the end of the cleansing process. Next came the yogurt flush. Made with the amicable bacterium
Lactobacillus bulgaricus
, the yogurt would “drive out the disease-forming bacteria that had been implanted by the putrefactive action of flesh foods.” “Balance your intestinal flora,” Kellogg maintained, “and you’ll live as long as the rugged mountain men of Bulgaria!” And, according to Elie Metchnikoff, the Russian bacteriologist whose research triggered Kellogg’s yogurt compulsion, that was pretty long.

Metchnikoff had caused quite a sensation with his theory that the longevity of Bulgarians was due to the copious amounts of yogurt they ate. He even had a theory to explain how this happened. The good bugs, which Metchnikoff named in honor of the Bulgarians, overwhelmed the bad bugs in the gut that caused disease. Yogurt was elevated to the rank of a wonder food, in spite of the fact that Metchnikoff had no real evidence for his theory, or indeed for his notion that Bulgarians experienced remarkable longevity.

Metchnikoff was awarded a Nobel Prize in 1908 (for work unrelated to yogurt), and that helped enshrine the yogurt mystique and make the food a “health” staple in the Balkans and in Russia. Indeed, when the former Soviet Union began its manned space flight program, it established a microbiology laboratory at the Baikonur Cosmodrome to study the cosmonauts’ gut bacteria. The concern was that the stresses of space travel might change the balance of these bacteria and cause some nasty symptoms. A spacecraft is certainly no place to be struck by diarrhea!

The researchers experimented with giving the cosmonauts yogurt before their missions. They must have been satisfied with the results, because the practice became routine, as did the collection of bacteria samples from the spacemen’s saliva and guts after they returned to Earth. The researchers cultured these samples and used them to make yogurt with the hope that, having withstood the stresses of space travel, these bacteria would create a healthier product. They probably didn’t, but they did help the struggling Russian space program raise funds. A commercial variety of yogurt made with bacteria cultured from cosmonaut emissions is still being touted as a health food.

While the appeal of yogurt cultured from cosmonaut poop may be limited, the notion of introducing beneficial bacteria into the gut is receiving widespread attention from scientists. Research into “probiotics” is mushrooming. Simply put, a probiotic is any preparation that contains specific microorganisms in sufficient numbers to alter the microbial flora in a host and exert beneficial health effects. There is increasing evidence that yogurt, if made with the right bacteria, falls into this category. Traditionally, yogurt has been made with
Lactobacillus bulgaricus
and
Streptococcus thermophilus
, which are acid sensitive and do not make it through the stomach to the colon in sufficient numbers. But acidophilus and bifido bacteria do. And they really do squeeze out disease-causing bacteria, such as
Clostridium difficile
, often responsible for diarrhea.

Very good scientific evidence now exists for treating diarrhea with probiotics, including the type associated with antibiotic use. Antibiotics can destroy some of the gut’s beneficial bacteria, the kind that keep troublesome microbes in check.
Clostridium difficile
can seize the opportunity, multiply, and cause severe diarrhea. In rare cases, such diarrhea resists all treatments. Well, maybe not all. Dr. Lawrence Brandt, a gastroenterologist at Montefiore Medical Center in New York, has come up with a novel, though admittedly unconventional, approach. In one highly publicized case, he mixed stool samples from a patient’s husband in saline water and deposited little chunks of this matter every ten centimeters along the woman’s colon. This “fecal colonoscopy” resulted in the almost immediate resolution of symptoms, in all likelihood due to the restoration of a healthy balance of microflora in the gut. Doesn’t sound particularly appealing, but protracted diarrhea is no pleasure either. Science sometimes moves forward in unusual ways.

In children, diarrhea is most often caused by a rotavirus infection. Studies have shown that treatment with an oral hydration solution containing
Lactobacillus GG
significantly shortens the duration of the problem. Yet that may be just the starting point for probiotic benefits. There is tantalizing evidence for cancer prevention and immune system enhancement. Some probiotics can destroy cancer-causing agents in the gut, and at least one excellent study has shown that the risk of eczema in babies can be reduced if they are given
Lactobacillus GG
. Chances are that this will work for some allergies as well. Particularly noteworthy is the fact that in over 150 studies of probiotics, no adverse effects have been noted.

Now the vexing question is to determine which probiotic bacteria are the most beneficial.
Lactobacillus GG
(modestly named by its discoverers, Sherwood Gorbach and Barry Goldin) looks very promising. It performs well against diarrhea, shows anticancer effects in animals, and in some cases has even relieved the symptoms of ulcerative colitis. So has VSL#3, a research mix of eight bacterial species. Bio-K+ is a commercially available product that in clinical studies has been shown to deliver the goods to the colon — namely, viable organisms in sufficient numbers. Still, there are products out there that claim to contain a host of beneficial bacteria but in fact do not. Let the buyer beware!

And what about plain old yogurt? If it is to be of any benefit, it has to have live cultures of acidophilus or bifido bacteria — preferably both. Check the label. Isn’t it fascinating that the eccentric Dr. Kellogg may have been on the right track after all with his ideas about introducing beneficial bacteria into the colon? I’m taking his advice. I eat low-fat yogurt regularly. But as far as the enema machine goes, I’m just happy to have seen it in the museum.

I don’t think I would want to take nutritional advice from Professor Wonder. He seems to get things muddled. But maybe that’s because he’s not a real professor — he just plays one on TV. The good prof is the television spokesperson for the makers of that spongy, tasteless, presliced loaf that adorns many an American dinner table: Wonder Bread. Since many other breads vie for the same market, the people who make Wonder Bread have taken a shot at pulling ahead of the competition by enriching their product with calcium.

We all know how important an adequate calcium intake is for proper bone formation. Certainly, the dairy industry won’t let us forget it. But when the makers of Wonder Bread added calcium to their recipe, the amount was too small to make a substantial contribution to a person’s daily intake, at least as far as warding off osteoporosis goes. Perhaps this is why Professor Wonder decided to push the envelope a little and make the claim, “As a good source of calcium, Wonder Bread helps children’s minds work better and helps their memory.” Sounds good. There was just one little problem: he lacked scientific evidence to back up his claim. The public didn’t question the professor’s nutritional expertise, but the U.S. Federal Trade Commission did. It charged that the makers of Wonder Bread had made unsubstantiated health claims and violated federal law. The company agreed to refrain from making further claims unless they could be backed up by scientific evidence.

Of course, Wonder Bread is not the only manufacturer looking to cross the line between selling a food and selling a “nutraceutical.” Simply put, a nutraceutical is a food or beverage that provides some health benefit beyond simple nutrition. The addition of iodine to salt, iron to cereal, and folic acid to flour are common examples of processes that were introduced to improve the health of consumers. A nutraceutical does not necessarily have to be a product of modern technology. Yogurt, for example, fits the bill. The live bifido and acidophilus bacteria present in many varieties may have beneficial effects. As we saw in the last chapter, these bacteria may elbow out some of the disease-causing microbes that invade the colon. They can be effective against certain types of diarrhea and may also help with bowel disorders such as Crohn’s disease and irritable bowel syndrome. Furthermore, these bacteria may give a boost to the immune system and even reduce the risk of allergies if given to children at an early age. There is some question, however, about whether the helpful bacteria can survive the journey from the mouth, through the stomach and the small intestine, all the way to the colon. There may be another way to address the problem. A nutraceutical way.

I suspect that some people would raise an eyebrow if they encountered terms such as “fructooligosaccharides (FOS),” “lactulose,” or “inulin” on a food label. These substances may not sound too appetizing, and you may not want to eat them, but the good bacteria in your large intestine find them to be tasty morsels indeed. As far as our bodies are concerned, these complex carbohydrates are just “fiber,” meaning that we do not digest them as food. Our small intestines are not equipped with the enzymes they need to break down these carbohydrate polymers into smaller molecules that can be absorbed into the bloodstream. They therefore pass through the stomach and small intestine unchanged, and they collect in the colon. Here they help make up the bulk of the stool, and, more importantly, they foster the growth of beneficial bacteria and limit the multiplication of harmful ones. We refer to substances that stimulate the growth of specific bacteria in the colon as “prebiotics,” and they are at the forefront of nutritional research. That’s because the potential benefits include the prevention of abnormal cell proliferation (which can lead to cancer), improved mineral absorption, and even reduced blood cholesterol.

In Japan, numerous foods fortified with fructooligosaccharides and inulin are already on the market, and the trend is coming our way. Where do these chemicals come from? They occur naturally in onions, garlic, and bananas, but not to an extent that would have a significant effect on colonic bacterial populations. We need a daily dose of at least four grams of prebiotics to have any hope of benefit, but double that amount is preferable. Just about the only way we can achieve such an intake is by adding fructooligosaccharides or inulin to processed foods. The most common source of the chemicals is chicory root, from which they can be readily extracted.

One plant that does contain a significant amount of inulin is the Jerusalem artichoke. The explorer Samuel de Champlain learned about this tuber from the North American Indians and introduced it to Europe. Actually, it is not an artichoke, and it has nothing to do with Jerusalem. The plant is a member of the sunflower family and is sometimes called a “sunchoke.” But it seems that to Champlain it tasted like an artichoke, and the term stuck. Why Jerusalem? The Italians dubbed the new plant from America “girasole” — meaning “turning to the sun.” Somehow this got corrupted to “Jerusalem.”

In Europe and Japan, manufacturers add Jerusalem artichoke flour to foods to improve their health potential. It’s kind of hard to find Jerusalem artichoke here, but I’m trying. Apparently, you can shred or slice the tubers into a salad or stir-fry.

There may be a downside. At least there is if we listen to John Goodyear, a British farmer who commented, in the 1860s, “In my judgment, which ever way they be drest and eaten, they stir up and cause a filthie loathsome stinking winde with the bodie, thereby causing the belly to be much pained and tormented, and are more fit for swine than for men.” He may have been right about the wind, but he was surely wrong about the Jerusalem artichoke being unfit for human consumption. Indeed, I wouldn’t be surprised if someday soon we hear Professor Wonder touting the benefits of Jerusalem artichoke flour, which he has added to Wonder Bread. He may even say something about improved calcium absorption. And you know what? The FTC would not object, because scientific evidence would back him up.