CHICAGO—Americans have easier access to greater quantities of food at lower prices than any other people in history. Yet many are malnourished, said Steven C. Masley, at the annual scientific assembly of the American Academy of Family Physicians.
It isn’t the bloated-bellied, twig-limbed malnutrition seen where famine prevails (though this, too, exists in some impoverished corners of our country). It’s the multiple nutrient deficiencies that derange and dysregulate physiology, producing obesity, heart disease, inflammation, cancer and other chronic problems.
“We certainly don’t lack calories, but about 80% of people are nutrient-deficient when we do lab testing,” said Dr. Masley, a family physician and nutritionist in St. Petersburg, Fla. Many peoples’ diets are built on calorie-dense, nutritionally void processed foods, refined carbs, animal proteins and hydrogenated fats.
Federal statistics from 2000 indicate that back then, only 10% of all Americans ate well. “That’s about right, based on what I’m seeing in my practice,” said Dr. Masley, who directs the Masley Optimal Health Center. Most peoples’ diets are (nutritionally) inadequate; a lot are just terrible. We’re going to have the 2001–2006 report soon, and it actually looks worse.”
Deadly Duo: Corn Syrup & Hydrogenated Fats
To make matters worse, many peoples’ diets are rich in things guaranteed to make them sick. One is corn syrup. “It’s the most common sweetener we use in America, and it has huge impact on obesity. It bypasses normal metabolism and insulin pathways for regulating energy, and it results in high triglyceride levels. So when you see high TGLs in your patients, think, ‘Corn Syrup!'”
The other partner in the deadly dietary duo is hydrogenated fat, also plentiful in the American foodstream. “I call it embalming fluid, because that’s how it works in our bodies,” said Dr. Masley. “It’s like injecting plastic into our arteries. It decreases insulin sensitivity, plays havoc with metabolism, and worsens lipid profiles by raising LDL and lowering HDL.” (For more on healthy versus unhealthy fats, visit www.holisticprimarycare.net and read Well-Oiled: A Guide to Healthy Dietary Fats.)
Encourage patients to cut out corn syrup and hydrogenated fats as much as possible. But it is equally important to look at what’s missing from their diets. Dr. Masley reviewed the most common nutrient deficiencies, and offered practical steps you can share with your patients to make improvements.
The Fiber Void
“If I only had one thing to track, it wouldn’t be calories or fat. It would be fiber. It’s the No. 1 nutritional deficiency that impacts health. Fiber intake is very, very low in this country,” said Dr. Masley, who strongly recommends having patients complete a questionnaire that, among other things, identifies daily fiber intake.
Dietary fiber falls into two classes: insoluble, which is good for GI function, and soluble, which can lower cholesterol and blood sugar. As a rough goal, patients should get between 30–50 grams total fiber per day, with half of that being soluble fiber. Most Americans are not even close.
Many people, especially older people concerned about bowel regularity, take supplemental fiber, but this is almost exclusively insoluble fiber. “It’s good that they’re getting that, but they’re not doing much to lower their cholesterol or blood sugar unless they’re also getting the soluble fiber as well,” Dr. Masley said.
Whole, fiber-rich plant foods are the key. Fruit, vegetables, nuts, beans, and whole grains, especially oats, are the best sources of both soluble and insoluble fiber, to say nothing of all the other nutrients they contain.
Long-Chain Fatty Acids
Dr. Masley believes increasing intake of omega-3 fatty acids is more important even than cutting saturated fat. Almost everyone benefits from taking omega-3s.
Often touted for cardiovascular health, omega-3s are good for all tissues. “If fish were made of butter fat and swam in cold water, they would be so stiff they would sink to bottom. They need to be made out of flexible fats. Those double bonds in omega-3s make these fats very flexible. When we eat those fats, our tissues become fluid. It’s the opposite of trans fats, which make our tissues stiff and hard.”
The documented benefits of omega-3s are myriad: they enhance endothelial nitric oxide synthase leading to vasodilation and lower blood pressure; they inhibit ICAM and VCAM markers of endothelial dysfunction and plaque formation; they decrease inflammatory cytokine production; they decrease platelet aggregation reducing the risk of thrombosis; and they improve insulin sensitivity via PPAR gamma.
Brain function definitely benefits from increasing omega-3s. “Remember that the brain is 40% docosahexaenoic acid (DHA) by weight. The best predictor of not getting Alzheimer’s disease is daily activity. The second biggest is omega-3 level. Adding omega-3s decreases in inflammation in the brain. You also increase insulin sensitivity, so you have less glycoprotein interactions,” Dr. Masley said.
It is difficult to increase omega-3s from land-based plant sources alone. “Plants produce medium chain fatty acids, which have different benefits, different issues. Flax, soy, some nuts, green leafies are all good. They lower LDL and CV events. But they don’t have same power or same evidence base as fish oils.”
Most people should get 1 gram of mixed DHA and EPA per day for general health. That means 2–3 servings cold-water fish per week. One to two grams daily will reduce arrhythmias, normalize metabolic syndrome, and minimize Alzheimer’s risk. People with high TGL need 3–4 grams daily, as do those with chronic inflammatory conditions or arthritis. That’s harder to obtain with diet alone (unless someone really likes fish). These patients almost always need supplements.
Urge patients to choose fish oil supplements carefully. While most are, thankfully, mercury free, a lot of the fish oil sold in the US is rancid, leading to the nasty fish burps that deter many from taking fish oils. “Fish oil should smell and taste pleasant and fresh. Ninety percent of the fish oil sold in the US is illegal for sale in Europe because it is rancid,” Dr. Masley said.
“There are some very good brands, and you can ask for their lipid peroxide levels. But the best way to test them is to just stick a needle in the capsules, and just smell or taste the oil.” Dr. Masley cited Nordic Naturals, Metagenics, and Designs for Health among the highest-quality brands, though there are others. At all costs, steer patients away from discount brands that sound like a bargain … it’s a bargain that they’ll be belching up for days!
Be aware that as you go above 2 grams per day, fish oils significantly reduce platelet aggregation. This is good for reducing CV events, but it can lead to increased bruising and bleeding, especially in people on coumadin/warfarin. “I’m very hesitant to give more than 2 g per day, without first discussing the risks & the benefits. As a general rule, people should probably stop taking their fish oils at least 1–2 weeks before surgery.”
D-ficiency
Vitamin D has had a lot of attention lately as researchers debate the connection between vitamin D and cancer risk. Overall, it seems that risk of breast, prostate and colon cancer is inversely related to vitamin D level; the higher your D, the lower your risk. Autoimmune diseases like Crohn’s and Multiple Sclerosis also appear to be linked with low vitamin D. This adds to what’s already known about this hormone-like vitamin in bone health. (See related articles from the current issue on our website, www.holisticprimarycare.net: D, C and CVD: New Studies Correlate Deficiencies With Cardiovascular Risk and Can Vitamin D & Calcium Reduce Diabetes Risk?)
Most Americans are vitamin D-deficient. Blame indoor sedentary lifestyles, and the increased use of sunscreens. And we can’t ignore latitude. “You make it from the sun, so if you live north of the Atlanta-to-San Francisco line, you are only really making it 6 months out of the year. You need to build up stores, and we don’t do that anymore because of sunblocks that prevent the UV from getting through the skin. Most people need to get it from a supplement,” said Dr. Masley.
Most multivitamins contain between 200–500 international units. At 200, you protect against rickets, but that’s all. Absence of rickets is not the same as optimal health, and the cold truth is that rickets is actually on the rise in some parts of the country, particularly in poor Black communities in Northern cities.
To prevent cancer and autoimmune problems, people need between 800–1,000 IU per day. Those with osteoporosis or osteopenia will need more, as will people with MS or poorly controlled autoimmune disease. “It is reasonable to do vitamin D testing, look at the 25-hydroxy-vitamin D levels, and consider recommending up to 1,000 IU/day,” said Dr. Masley.
Food sources include fortified milk, which contains around 150 IU; yogurt, which has around 50 IU per serving, and fish oils, which typically contain between 50–150 IU per gram. Given the small amounts in food, it is difficult for most people to get high levels from diet alone; sunshine and supplementation are necessary.
Vitamin D is generally safe, with serious toxicities only emerging at doses of 10,000 to 20,000 IU per day. A relatively small number of people—roughly 2–3% of the population—will have toxicities at 3,000 IU. Dr. Masley said he seldom goes above the 3,000 IU range unless there’s a compelling reason. “If a patient really has a significant health issue such as rickets, advanced osteoporosis, autoimmune diseases, multiple sclerosis, that would be a reason to consider high-dose supplementation.”
Read Part 2 of Dr. Masley’s approach to common nutritional deficiencies in the upcoming Summer 2008 edition of Holistic Primary Care, or visit our website, www.holisticprimarycare.net, and read it now!
