Dr. R. L. Wysong
February 1990
.Nutritional Metaphysics
    I've found my study of nutrition to be extraordinarily exciting.  Although I began it as simply a branch of my interest in health care in general, I’ve found it to be much more.  Our attitude toward what  we eat is formed from a wide host of factors  including tradition, peer pressure, conscience and morality (certain Hindus won't eat meat, others only eat milk and vegetables, we don't eat other people, dogs or horses, but others do), also there is taste, perceived health or spiritual benefits and.. a little bit of science and a whole lot of marketeering.
    As far back in history as we can go we find much ado about what should or should not be eaten and the consequences might  result.  Holy books such as the  Bible, Koran and Bahgavagita   talk about clean  and unclean foods, specific ways to  butcher and what   is  proscribed verses what brings one  closer to Nirvana.
    The point is that nutrition is not simply an addition of nutrients defined by a  lab somewhere or how to make the most flavorful casserole..  It is these but it is much more.  It reflects   our attitudes, our moras, our sensitivities our conscience.
    Thus the biochemistry of food and physiology  can tell us much about the physical consequences of diet but don't address the other aspects of food, the emotional--spiritual, if you will--meaning of eating which perhaps means more to health than all the chemicals  combined.
    Nutrition is not physical, it is metaphysical. Our attitude about  what we eat and when and why is perhaps more important than what we eat.
    I've got a topic on vegetarianism which addresses  this and makes some of these points  more evident which I hope to get to you next month.  But until then think about how much more eating is than just physically or sensorally what we put in our mouths.
Lamenting the Foods of Old
    This  doesn't mean we don't care how things taste or what we believe the physical merit of the food is.
    Most  of us can lament days gone by when foods simply tasted better than some of the plastic in skins we find in the produce counter today. Erma  Bomback, the  noted nutritionist recently wrote:
    The slightest mention of the “good old days” (30 years prior to wherever you are now) triggers stories of “juicy white corn on the cob with butter dripping off your elbow” … “sweet strawberries as big as your fist”... and those wonderful tender fryers that tasted like real chicken.
    Food today is like a highway under construction: You travel your own risk. Add some oat take out the salt, lower the fat, compress the nutrients, inject for longevity, corral the calories, remove the seeds, alter the color, and slap a label on to let people know what it is supposed to be. Dispensing food is matter of keeping it alive long enough to execute it. It’s down right inhumane.
Exercising Fat Away
    Although it seems obvious that exercise could reduce body fat stores since exercise requires calories and body fat has calories, it is less clear what kind of exercise most efficiently reduces that innertube around the belt line or the saddle bags on the thighs.
    It’s the traditional recommendation in weight reducing programs that dieters embark on a low-intensity exercise regimen based on the assumption that there is more lipid oxidized during low-intensity exercise than that during vigorous effort.  This concept has been promoted in Astrand’s Textbook of Work Physiology.
    This view, however, must now be modified by evidence that post exercise adaptations are perhaps more important than the way fuel is burnt during the course of exercise.  It has been found that vigorous enforced exercise suppresses appetite and increases the resting metabolic rate.   Taking both of these factors into consideration, it’s now believed that more intense and vigorous exercise periods are much more effective than the more comfortable relaxed versions which are very easy to accept but don’t work as well.
    This reminds me of my recent visit to a health spa where a variety of exercise equipment was assembled around the perimeter of the room.  As I was busy moving about the room stressing all of the machines to their maximum, putting the pins into the bottom of the plate stacks, and taking my breaks performing poses in front of the mirror, I noticed a person who came into the room dressed in beautiful work-out attire, but noticeably overweight.  She had brought a friend and they sat down in the middle of the room and did a few leisurely stretches and then proceeded to move onto the machines.  They worked out using machines that were side-by-side so they could continue their conversations and I noticed that part of their conversation revolved around a dieting center that they both attended.   But what I noticed more than anything was the intensity, or lack of it, I should say, in their work out.  I noticed it partly because they interfered with my ability to try to work through a program with some degree of vigor since they particularly liked the machines that allowed them to sit or recline and then they would put the pins in the last amount of weight possible and leisurely move a leg over a course of about 5 minutes through endless reps which stressed them little more than a leisurely walk.  Perhaps this is what they had been taught in their dieting class or perhaps they were simply lazy and content with the facade of exercise rather than attempting its reality.
    Successful weight trainers and athletes understand certain basic principles such as nothing in, nothing out and no pain, no gain.  It also makes sense that a more intense, vigorous exercise is going to be more helpful to the body and restore it to its more natural lean form since, as we have mentioned before, the body becomes its function.  It adapts to that which it is called upon to do.   If the body is required to perform leisurely, it is going to look leisurely and flaccid - kind of like a soft staffed recliner.  If the body is required to be athletic, it is going to look athletic.  Pretty simple concept.
        Textbook of Work Physiology, by P. O. Astrid and K. Rodale, 1978, McGraw Hill.
        The American Journal of Clinical Nutrition, February 1990;51;2:153.
Oat bran’s falls
    Put oat bran on your label and you’re guaranteed commercial success.  At least that is the way it would appear over the last year since about everything from breakfast cereals to candy bars has oat bran plastered on the label.  This commercial response was to studies over the past 25 years demonstrating the effect of soluble dietary fibers, which are fairly high in oat bran, lowering serum cholesterol levels. 
    Now a new study reported in the New England Journal of Medicine suggests hat oat bran may not be directly capable of the wonders previously imagined, but that its affect on cholesterol was likely more related to decreased fatty foods consumption than to a direct action of oat bran on cholesterol.   In other words, if a person eats a couple of big bowls of oatmeal in the morning, they simply don’t have the room for bacon and eggs, and thus serum cholesterol levels fall.  This was a well-designed, double blind, cross over trial and indeed raises serious doubts about the specific action of oat bran.
    It is interesting to watch the repercussions of this through the food processing industry.  Several articles have appeared expressing the embarrassment of having bandwagoned this supposed healthy marketing ploy.
    This, however, does not mean that the fibers associated with natural foods are without their health-enhancing aspects.   Some forms of water soluble fibers, particularly those found in gels and gums such as guar, consistently lower serum cholesterol levels.  The insoluble fibers such as found in wheat bran are believed to have no effect.  The mechanism by which fibers are believed to decrease cholesterol levels in the serum is by binding the sterols in the bile and thus not permitting their enterohepatic circulation back into the serum but rather encouraging their exit via the feces.
    Fiber is a part of the archetypal dietary pattern and thus can be expected to exert health effects.  Graham, in the late 1800’s, argued the merits of  unrefined flours as well as sleeping on a hard mattress and cold showers.  (Graham crackers were named after him.)   From there, the doctors Burkitt and Trowell found that the high fiber intake of Africans was related to their low incidence of a variety of degenerative diseases common in Western society.  Burkitt, incidentally has a lymphoma named after him, Burkitt’s Lymphoma, which is a type B cell heoplasm, and Trowel is the first to describe kwashiorkor as an infant malnutrition disease.  They advanced the fiber hypothesis and from their time until now, those aware of arguments on behalf of fiber have understood its value.   Burkitt, in fact, argued that you could rate the health of a population inversely proportional to the volume of stool they produced.
    But as various studies attempt to demonstrate the pharmacological value of certain isolated nutrients such as the components of fiber including pectin, beta-glucan, gums and so forth, controversy will arise because of not only study design but because nutrition is a matrix not an addition.   For example, psyllium seed which is a source of high levels of soluble fiber is able to produce a lowering of low-density lipoprotein levels.  But other studies have shown, for example, that feeding patients nine bran muffins a day had no effect on plasma lipid levels in either normal subjects or hypercholesterolemic patients.
    Evidence remains quite convincing, however, that dietary fiber, particularly as a part of whole natural foods, can have many health-enhancing and preventive effects.  Its value just in decreasing constipation, diverticulitis, hemorrhoids, large bowel cancer, hiatal hernia, appendicitis, diabetes, heart disease and hypertension is enough to warrant its continued incorporation into the diet.
    So this one study on the effect of oat bran on cholesterol is not a coup de gras, although those anxious to pooh-pooh the natural nutrition movement would like it to be.  It is simply one piece of information which belongs with a thousand others.  The thousand other plus this piece of information all add up to one summary conclusion that health is better served by a diet of fresh, whole, natural foods.
        Dietary Fibre, Fibre-depleted Foods and Disease, by H. Trowell, D. Burkitt and K. Heaton, eds., 1985:433, Academic Press.
        The New England Journal of Medicine, January 18, 1990;322;3:147.
Colonic implanted flora
    A case report in Lancet of an individual who had severe ulcerative colitis for seven years demonstrated that colon micro flora had been severely altered.  The patient had been refractory to standard management of the disease including steroids, sulfas and alpha-tocopherylquinone which reduces bacterial oxidation of bile acids. 
    Physicians decided to reinoculate the colon of this patient by using the flora from a disease-free donor.   First they sterilized the bowel of the patient and then introduced the microbes from the donor by way of large volume retention enemas.  Somehow a poop transplant doesn’t seem real high tech, but nevertheless the patient has now been free of symptoms for six months for the first time in 11 years without any medication.
    Although this is a case of one and of course is not controlled, it does fit with previous information we have discussed about the potential beneficial effects of the universe of microbial life existing within the GI tract, namely over 100 trillion cells.  Altering this universe from its normal is understandably linked with potential disease.  Probiotic microbial therapy will increasingly be demonstrated as a resourceful therapeutic tool.  
        The Lancet, January 21, 1989:164.
Cerebrospinal Fluid In Canned Milk
    Infants with post-hemorrhagic hydrocephalus often require frequent removal of spinal fluid by lumbar punctures.   This is continued usually until a permanent device can be implanted that normally will shunt cerebrospinal fluid form the brain ventricles into the atrium of the heart.   Until the infant is to an age where this shunt can be safely implanted, lumbar punctures must be performed and the resultant loss in albumin and sodium can require monitoring of these losses and parenteral replacement.  This continual manipulation is not without its dangers including a small but definite risk of viral infection with the infusion of albumin.
    Two doctors in England reasoned that if the cerebrospinal fluid could be shunted to the circulation without the ill effect, then it could also be given orally.  With great resistance from the hospital staff they were permitted to give the cerebrospinal fluid to an infant mixed with formula if a significant number of doctors would imbibe the fluid first.  The self-sacrificing spirit is still in some physicians and they did consume the cerebrospinal fluid reporting that it tasted similar to salt water.  But even though this trial with one patient worked and that albumin levels and hyponatremia were controlled by mixing the cerebrospinal fluid with formula, further implementation was prevented because of the disgust of some of the staff who felt it was a form of cannibalism. 
    It is interesting how our tastes and judgements have become so conditioned.  We feed infants commercial processed concoctions extracted from soybeans, transplant feces from one patient to another - as in the last topic, but are repulsed by a simple practice such as feeding cerebrospinal fluid orally mixed with the milk.
    Taken to its logical conclusion, there may come a time when foods will all seem disgusting if they are not prepackaged.
        The Lancet, August 19, 1989:447.
Zinc Toxicity
    For many years now the role of zinc in enhancing health has been investigated and promoted.  It is an essential mineral nutrient believed to be important by some estimate in more than 100 different enzymatic reactions.
    Not only is zinc a part of most multi-vitamin/mineral supplements, but it is a part of specialized formulas such as zinc-vitamin C throat lozenges and fortification in various foods.  In medical practices as well, zinc has been used for treating sickle cell anemia and non-responsive celiac disease.
    It is easy to become impressed with the health effects of a natural nutrient and view its singular usage as directly related to fostering health.  If a study shows certain levels of zinc prevent or ameliorate upper respiratory disease, then it seems easy to conclude that one should take zinc.  Free radical pathology perhaps lies as a root cause to many, if not all, diseases and since super oxide dismutase is a free radical scavenger and requires zinc as a cofactor, then certainly it would seem zinc supplementation would be beneficial.   On and one the reasoning could go convincing one that zinc supplementation is not only beneficial, but certainly natural and likely very safe.
     But everything is dose related.  Oxygen, certainly an essential nutrient, can kill if given in sufficient concentration as can water or any other singular element.  Zinc has its limits too.   An interesting review article in the recent American Journal of Clinical Nutrition demonstrated that this is indeed the case.  Although the RDA of zinc is 15 milligrams per day, it is not unusual for this level to be exceeded by 10, 20 and even 30 fold with some supplementation programs.   As zinc increases, it had reciprocal effects on other nutrients, particularly iron and copper.
    Decreases in these minerals can result in immune dysfunction and can adversely affect lipoprotein ratios.  Thus the very effect we could be attempting to achieve with zinc, could be negated by the secondary effects of isolated supplementation.
    It’s believed that zinc increases the synthesis of metallothionein which binds to copper and prevents its absorption through the enterocyte into the circulation.  On the other hand, zinc is believed to compete for ligands which iron requires for transport across the enterocyte.   The end effect, however, is that increased zinc can mean decreased copper and iron.
    This is not to suggest that zinc supplementation in certain instances may not be highly beneficial, but it must be done with the understanding that zinc does not work in isolation and there are upper limits that may vary with each individual’s biochemistry.
    The principal we have repeatedly emphasized in the Review, that nothing acts in isolation, is again demonstrated here.  Attempting to increase certain nutrient levels by selection of natural foods which are high in these nutrients or by consuming supplements which are naturally balanced is the safer method for achieving optimal health rather than succumbing to single nutrient manias which seem to change almost weekly.
        The American Journal of Clinical Nutrition, February, 1990;2;51:225.
Bran cereal obstruction
    The fiber craze is not without its dangers.  Anytime an isolated nutrient is focused on by the medical community, the public and the food processing industry, it is not without its potential problems including:  1) the focusing on an isolated nutrient may result in imbalance of other nutrients or excess toxicity; 2) focusing on a single ingredient misses the main point of the discovery, namely the need for bran is a statement for the value of whole natural food products not for consuming isolated fibers other than in certain specific instances.
    The report in the recent Journal of the American Medical Association described a case of a physician recommending that a patient consume a large bowl of bran cereal, which amounted to about 20 grams per day of fiber.  After about 10 days of eating the cereal, the patient developed abdominal pain, nausea, vomiting and fever.  an obstruction was diagnosed and an enterotomy was necessary in order to remove a mass of fiber that had lodged in the ileum.  
    Emphasis should be placed upon people changing their diets to incorporate increasing levels of fresh fruits and vegetables and if dietary fiber supplements are taken, they should be slowly increased over a period of several weeks.  This should prevent the sort of difficulty experienced in this report.
    Other potential contraindications for consuming isolated fiber would be for those individuals who have undergone abdominal surgery which may result in bowel restriction from scarring which in turn may serve as a point of accumulation.  Individuals who may have various forms of atony such as sometimes is found in diabetics with gastroparesis whereby the intestinal tract is not capable of propelling the bulk as a normal intestinal tract should , are also at increased risk from fiber supplement consumption. 
        The Journal of the American Medical Association, February 9, 1990;263;6:813.
Death Statistics
    An interesting summary of United States deaths due to nine chronic diseases was recently reported in the Journal of the American Medical Association.  The nine diseases included stroke, coronary heart disease, diabetes, chronic obstructive pulmonary disease, lung cancer, female breast cancer, cervical cancer, colorectal cancer and cirrhosis, which in total amounted to 52% of all deaths in 1986.
    One can look at such data and form all sorts of conclusions and attribute causes and relationships which may or may not exist.  It was found that a higher age adjusted mortality occurred in those states east of the Mississippi compared to those west of it.  Some might argue by looking at the chart that the more industrialized states seemed to suffer the greatest mortality and there may be a link there.   I would tend to agree that there is a link, but the exact relationship is not known for sure since there are so many confounding factors possible.
    The state with the lowest mortality rate was Hawaii and the state with the highest mortality rate was Michigan - gulp.
In another review of years of potential life lost before ages 65 and 85, an assessment is made of mortality which occurs before a particular age.
    In 1988, unintentional injuries was the leading cause of years of potential life lost (YPLL) followed by cancer, heart disease, suicide, homicide and congenital anomalies.
    In YPLL before age 85, heart disease was the number one killer followed by cancer, unintentional injuries, suicide, homicide and cerebral vascular disease.
    Increases in YPLL have been attributed to AIDS, suicide, diabetes, pneumonia and congenital anomalies.
    In any case, it is clear that there are plenty of areas to address in attempting to increase the health of our nation.   Some interesting comparisons unrelated to the reports noted here in the journal are that your relative risk of being murdered during your lifetime is one in ten thousand, your risk of being killed in a car accident is one in five thousand, your risk of dying of heart disease is approximately one in two. 
        The Journal of the American Medical Association, February 9, 1990;263;6:800.
Fat Moms Can Induce Children’s Cancer
    Although body fat has been positively associated with the risk of reproductive system cancers, women who switch to low fat diets have not yet been shown to alter their risk significantly for such cancers.
    Feeding studies in mice may give a clue to why this is so.  In East Lansing, it has been observed that the offspring of fatter mice developed higher rates of neoplasia. The exact mechanism is not known but it may be due to abnormal development of the fetal hypothalamus which might lead to it releasing hormones later in life which induce cancer.   Other possibilities include the possible background radiation, so-to-speak, of free radicals which are likely higher in mothers carrying high levels of body fat.
    The exact mechanism however, is not important but what is of interest is the fall out which can occur from our individual actions. We tend to think that what we do effects primarily us.  Now we are finding with more broad prospectives being forced upon us by  ecological  crises and   chronic degenerative disease that how we act now may not only effect our future but that of our offspring as well.
        Journal of the National Cancer Institute January 1990.
        Science News January 6, 1990, page 5
Stars and The Environment
    In an unlikely find in a television viewing guide called TV Entertainment, we ran across on encouraging article about Hollywood stars who are getting involved in environmental concerns.  The article says, Hollywood is green again -- not with envy or greed this time, but with a tidal wave of concern for our troubled environment. The article asks, "whatever happened to the days when the only people who cared were a few granola-munching, baby-seal-protecting, back-to-nature zealots?" And the answer? 1989 happened: the filthy year we saw medical waste begin to wash up on beaches; garbage barges wandering the seas looking for places to dump their waste; and of course the tragic Exxon Valdez. All of this was just enough to finally alarm people all over the world about the environment, and luckily Normal Lear and other Hollywood personalities began to care enough to push for the inclusion of environmental themes in films and TV. The snowball effect took over and now, since celebrities are beginning to rally to support the environment, it seems it has even become fashionable to care.
    Some of the names that are dropped and what they're doing include: Tom Cruise whose particular cause is the Amazonian rain forest, and who has consented to be the voice of “Captain Planet”, a new TV cartoon hero fighting environmental enemies; Meryl Streep has been working against pesticides in food products for some time; Ted Danson, who began the American Oceans Campaign with a quarter million dollars of his own money; then began lobbying Congress to clean up the waters; and even Sylvester Stallone who, according to this article, has been thinking about turning Rambo into a one-man environmental army since he is quoted as saying, “That's the only real war going on.” Others getting involved are Bette Midler and Paul Simon, who with other music world well-knowns are producing a recycling video called “Yakkety Yak  (Take it Back).”
    Television has also joined in: The series My Two Dads included an episode about the teenage daughter learning about oil spills when her parents are arrested for protesting one; Murphy Brown included a recent episode with a bet about two weeks of environmentally correct living; CBS plans to introduce a series next fall called The Elite, about a Mission Impossible sort of team of environmental champions.
    It is so encouraging to see this type of article in a television viewing guide. A decade ago no one even wanted to be bothered; even five years ago few cared. This means the message is getting out there, it means the people viewing at night may begin to pick up the message and from there it all begins. Education is the beginning, and the people the public idolizes are in such a privileged position. As Cheers star Ted Danson says, he can now talk about something besides himself in an interview, and since the public and the media want to give such a spotlight to Hollywood stars, they can at least use their moment in the sun to have something worthwhile to talk about, and to make a real contribution.
    The article even includes a chart entitled "Five Ways YOU Can Help Save the Planet:" which I have enlarged and hung here in our office where everyone can't help but see it. The first: Recycling paper, glass aluminum and plastic; Secondly, writing to your senator or representative to encourage the support of environmental legislation; Thirdly, using environmentally sound products such as unbleached paper products recycled paper, and cloth diapers, since Americans use 18 billion disposable diapers each year, enough to reach the moon and back seven times); Fourth, staying away from products not recyclable and reusable such as cups, plates and fast food containers, overly packaged products, and products made from endangered or exploited species such as ivory, furs, reptile skin, tortoise shells, and so forth; and lastly, stop using the car so much since emissions from cars driven in the U.S. alone account for 50 percent of the greenhouse effect --instead walk, car-pool, use public transportation, or ride a bike.
    Finally the article recommends a book entitled. 50 Simple Things You Can Do to Save the Earth,  available through the Wysong Library.
Questionable Cervical Smears
    Cervical cancer is a dreaded disease which can leave children motherless. It seems logical that if early detection of this disease could be made then treatment could be performed early to prevent progression.
    Although cervical cancer is indeed a disease to be avoided, it is not as prevalent as one might think it is, judging by the number of screening tests performed.  Most practitioners during a lifetime in practice will likely see no more than one or two cases of terminal cervical cancer.   This, balanced against thousands of patients normally seen by a practitioner, shows the disease in its more dire form to be far less prevalent than supposed.
    Although about 10% of women having cervical papanicolaou smear tests show abnormalities, very few of these would ever progress to cancer.
    McCormick, in a recent issue of the British journal Lancet, indicates that this test, although performed millions of times every year, has never been shown by controlled trial to change mortality or morbidity at all.  Additionally, it has been argued that the test itself is quite unreliable.   There are problems of interpretation, often the endocervix is not included and other critical areas may be missed.  There may also be problems with fixation.   The end result is that there is low specificity and sensitivity resulting in a large number of false positives and some false negatives.  There is also the risk of cross infection due to adequate sterilization of specula.
    Actual dangers of the smear include the effects on the patient in terms of anxiety and distress from false positives. Colposcopy and biopsy can result in hemorrhage, infection, stenosis of the cervix and potential unnecessary hysterectomy.  Additionally, women who have false tests are often regarded as promiscuous so their character as well as their cervix is smeared.
    In studies where isolated groups have undergone intensive screening and other groups have not, there has been no greater incidence of carcinoma of the cervix in the unscreened group than in the screened group. Thus this may be a test begun with the best of intentions that may have more morbidity and mortality associated with it than with the disease it is designed to prevent.
    The test seems a logical approach.  Watching patients succumb to cervical cancer is strong motivation for early diagnosis and treatment.  There is the “if only” motivation that leaves who have lost a patient determined to design methods to prevent further losses.   This “if only” guilt trip takes a tremendous toll on practitioners.   Most practitioners would admit privately that there are few cases they lose that they do not feel that something somehow could have been done at sometime to prevent the disease. This feeling that something can always be done to creates a tremendous amount of pressure and guilt and stimulates the production of various technologies for early diagnosis through screening.
    Unfortunately such efforts are not weighed in the balance of benefit vs. harm. We have addressed this in previous reviews, that many diagnostic tests performed with the noblest of motives usually the potential for creating harm as well as benefit.  Who, for example, can measure the harm – considering the new link ups being discovered between the psyche and the immune system – to a young person being told she has a positive smear test and that she may be developing cancer of the cervix.  This in itself must be considered potentially pathological let alone all of the other secondary problems which can result from invasive diagnostic tests themselves.
    But reason loses out to emotion. Because this is a terrible disease – and something must be done – to suggest that the screening procedure is the worship of the false god is, as McCormick argues, likely to put such a proponent under the label of heretic, chauvinist, or more politely nihilist.  Now with several million tests being performed yearly, there is a gigantic industry surrounding the procedure, vested interests are at stake because it is generally believed that diagnostic tests create no harm and are potentially useful, they continue undaunted.  However, a new awareness must come where such diagnostic tests must be measured by some reliable controlled method to determine whether they are indeed able to create more benefit than harm.
        J. S.McCormick, “Cervical smears: A Questionable Practice?” Lancet, July 22, 1989, pg. 207-9.
        J. A. Quiles, et al., “Colposcopic assessment of the accuracy of cervical cytology screening,” British Medical Journal, 1988; 296:1099
        L. Villard, “Cervical Cancer Deaths in Young Women,” Lancet, 1989;1377.
Vitamins and Cervical Cancer
    The incidence of cervical dysplasia as determined by pap smears is on the rise.  In the previous review we talked about the questionable nature of cervical screening procedures and perhaps the unnecessary trauma it subjects many women to in terms of the trauma they must endure for treatment and psychological effects of being told that they have some stage of cervical cancer.   These are issues still left unresolved but not the subject of the present topic.
    A recent gynecological journal reported that low tissue concentrations, low serum levels and low intake of vitamin A, beta-carotene, vitamin C or folic acid are associated with an increased prevalence of cervical neoplasia. 
Carcinogenesis is a complicated phenomenon involving both exogenous and intrinsic factors including genetics. Cancer progresses through stages of initiation, promotion and on to uncontrolled neoplasia and metastasis.
    The exact mechanism by which nutrients may affect the development of carcinogenesis or its regression are subject to broad debate.  However, it is believed that the antioxidant vitamins, A and its precursor beta-carotene, and C may stop initiation factors which are related to free radical pathology.  Folic acid is believed, on the other hand, to perhaps effect hormonal stimulation of the target tissue as well as effect enzymes which are important for cellular mitosis.
    I mentioned before that I am high on the antioxidant vitamins and this is yet another reason to suggest their value.   Vitamin C is present in most fresh fruits and vegetables and beta-carotene, a vitamin A precursor, is particularly available in the deeply colored fruits and vegetables, those which are dark green, dark orange and red in particular.  Folic acid is also found in a variety of vegetables and fruits but is highly susceptible to degradation in processing with over 95% of it lost.  Preformed vitamin A is found in meat and organ products as is folic acid.
    The value of antioxidant nutrients is increasingly being emphasized in the scientific literature.  If we remember that each time we eat a meal that is stripped of its nutrients or devitalized in some way by processing that we put out body into nutrient debt, since the body’s reserves will be called upon to process these devitalized nutrients, we can see the logic of shifting our diet more to fresh, whole, natural products and possibly incorporating rational doses of antioxidant supplements to act as insurance against indiscretions which are so easy in our busy convenience world.
        Am. J. Obstet. Gynecol., 1984;148:309-312.
        Am. J. Clin. Nutr., 1983;37:32-333.
        Arch. Gynecol. Obstet., 1989;246:1-13.
Smelling Mates
    Odor has long been known to be linked to mate selection.  Pheromones and other odiferous chemicals play an integral part in the perpetuation of most species.  We intuitively know the importance as evidenced by the multi-million dollar perfume, talc, spray, puff and cologne industry.  
    Study of the way mice select mates has revealed that genetic variation creates odor differences that make difference I mate selection.  Mice will normally select a mate that is genetically different than them even if the variation is only one out of thousands of genes.
    This is an extremely interesting mechanism which may explain the natural tendency of organisms to outbreed which helps maintain and perhaps even increase genetic health.  Such subtleties and intricacies seem incredible even at our simple understanding of things.  This should create humility and the wisdom to work within the natural order of things recognizing that there are likely interconnections far beyond our understanding which could be easily disrupted by simply intruding and manipulating as though we understood it all. 
        Science News, January 6, 1990;86:#3:13.
The Healing Touch
    A recent book by Norman Autton devotes itself to the underused capabilities of touch in caring and healing in medicine.   Autton brings out how that normally when patients are touched it is through the medium of cold instrumentation or with the caregiver concerning themselves only with what they feel by the touch.  Thus, touch in medicine is not really touch, it is termed palpation or the art of diagnosing through tactle manipulation.
    But as Autton argues, touch for the benefit of the patient is an impressive therapeutic maneuver in its own right.   Particularly is this true for newborn babies, as we have discussed, also in obstetrics, in the care of the very ill and of course in care of the dying.
    Nurses are often held in high regard by patients likely as a direct result of their touching and caring as a direct response to the needs of the patient.  Few of us cannot recall being ill as a child and feeling the loving touch of a parent.  A hand on our forehead, a swipe of the cheek, a hug, plus caring and concerned words.
    It is likely that a caring touch serves a basic need in the patient of feeling important and loved and perhaps there is something that passes between two living entities electromagnetically or otherwise by means yet still far from understood that are important to health and healing.
    So practitioners, reach out and touch, not palpate someone.
        Touch and Exploration, by Normal Autton, 1989, Longman and Todd.
        Lancet, July 22, 1989:193.
Falling in Love
    Let's take a look at love This is primarily on my mind because my oldest daughter is entering into engagement and making marriage plans,  There have been some bumps in the road -- for many of you this is a familiar story as you watch your children enter adulthood and face some adult realities. But love is a tough pursuit.  No love is a real threat to our mental health and happiness, our emotional well-being -- without it our overall health suffers.   The Road Less Traveled, a bestseller for four years, written by Scott Peck, a practicing psychiatrist, looks at some behaviors that are definitely not love, but which are disguised as love, and offers suggestions for healthy love and emotional well-being.
    The primary problem with love is differentiating between loving a person and falling in love, or what some have called mature and immature love, or the natural progression of love, and so forth. Dr. Peck says that of all the misconceptions about love, the most powerful and pevasive is the belief that “falling in love” is love, or at least one of the manifestations of love. This is a potent misconception, because falling in love is invariably temporary. No matter whom we fall in love with, sooner or later if the relationship continues will fall out of love. The only way to stay in love with someone is to have the relationship aborted, then we can remain in love and hold this person as our ideal for a lifetime. This is reccommended only if you are very into pain or we can go the route of Romeo and Juliet.   They stayed in love. This is not to say we always stop loving the person with whom we fell in love, but rather that the feeling of ecstatic lovingness which characterizes falling in love always posses. As Peck says, “The honeymoon always ends. The bloom of romance always fades.” Reality intrudes upon the couple who have fallen in love, and the fantastic unity they have felt sooner or later is lost in response to the problems of daily living. At this point, as each of them in their own hearts cam to the sorrowful realization that they are not completely in unity, are not one with this beloved person, and that the beloved has and will continue to have their own desires, tastes, prejudices, preferences, feelings and timing different from the other's; it is at this point that they can either begin to dissolve the ties of their relationship or to initiate the work of real loving. This includes acting lovingly toward your mate even when you don't feel loving. This involves a lot of work   and much commitment, which would account for the large percentage of foiled relationships and emotionally unhealthy people.
    As Peck says, this “romantic love” is something of a myth which has its origins in our favorite childhood fairy tales, wherein the prince and princess, once united, live happily ever after. Actually, he says, and I quote: “falling in love is a stereotypic response of human beings to a configuration of internal sexual drives and external sexual stimuli, which serves to increase the probability of sexual pairing and bonding so as to enhance the survival of the species. Or to put it in another, rather crass way, falling in love is a trick that our genes pull on our otherwise perceptive mind to hoodwink or trap us into marriage.” He also concludes that without this trick, this illusion, “many of us who are married today would hove retreated in wholehearted terror from the realism of the marriage vows.”
    Permit me to read on entire passage, if you will, and for any of you who are married, are going to be married, or have ever been married, or even maintained a long-term relationship, this may be helpful as reassurance that you're not alone, and that may be reason enough to include this material. Sometimes our mental health is best served not by therapy or even deep introspection, but just by knowing that we're all in it together, that we're not alone.
    Peck says, “This myth of romantic love is a dreadful lie. Perhaps it is a necessary lie in that it ensures the survival of the species by its encouragement and seeming validation of the failing-in-love experience that traps us into marriage. But as a psychiatrist I weep in my heart almost daily for the ghastly confusion and suffering that this myth fosters. Millions of people waste vast amounts of energy desperately and futilely attempting to make the reality of their lives conform to the unreality of the myth. Mrs. A. subjugates herself absurdly to her husband out of a feeling of guilt. “I didn't really love my husband when we married,” she says. “I pretended I did. I guess I tricked him into it, so have no right to complain about him, and I owe it to him to do whatever he wants.” Mr. B. laments: “I regret I didn't marry Miss C. I think we could have had a good marriage. But I didn't feel head over heels in love with her, so I assumed she couldn't be the right person for me.” Mrs. D., married for two years, becomes severely depressed without apparent cause, and enters therapy stating: “I don't know what's wrong. I've got everything I need, including a perfect marriage.” Only months later can she accept the fact that she has fallen out of love with her husband but that this does not mean that she made a horrible mistake. Mr. E., also married two years, begins to suffer intense headaches in the evening and can't believe they are psychosomatic. "My home life is fine. I love my wife as much as the day I married her. She's everything I ever wanted,” he says. But his headaches don't leave him until a year later when he is able to admit, “She bugs the hell out of me the way she is always wanting, wanting, wanting things without regard to my salary,” and then is able to confront her with her extravagance. Mr. and Mrs. F. acknowledge to each other that they have fallen out of love and then proceed to make each other miserable by mutual rampant infidelity as they each search for the one “true love,” not realizing that their very acknowledgement could mark the beginning of the work of their marriage instead of its end. Even when couples have acknowledged that the honeymoon is over, that they are no longer romantically in love with each other and are still able to be committed to their relationship, they still cling to the myth and attempt to conform their lives to it. “Even thought we have fallen out of love, if we act by sheer willpower as if we still were in love, then maybe romantic love will return to our lives,” their thinking goes.” So, love is not the romantic love myth.
    Next Peck looks at passive/dependent personalities and how they “love”, the childlike way in which they really simply want to be adored or cherished by someone -- sometimes anyone.
    This destructive love behavior is every bit as harmful to us as destructive physical behaviors -eating the wrong foods, living the wrong lifestyle. The diagnosis uses the word “passive” In conjunction with the word “dependent” because these individuals concern themselves with what others can do for them to the exclusion of what they themselves can do. It is as if it does not matter whom they are dependent upon as long as there is just someone. It does not matter what their identity is as long as there is someone to give it to them. Consequently their relationships, although seemingly dramatic in their intensity, are actually extremely shallow. Peck says that once, in working with a group of five single patients, all passive/dependents, he asked them to speak of their goals in terms of what life situations they wanted to find themselves in within five years. Each of them replied, in one way or another, that their goal was that they wanted to be married to someone who really cared for them. Not one mentioned a challenging career, being creative, making a contribution to society, or being in a position where he or she could love, or even have children! Thus we see that the notion of effort was not even involved in their daydreams; they envisioned only an effortless, passive state of receiving love and care. Peck says that in his work he has to tell many patients: "If being loved is your goal, you will fail to achieve it. The only way to be assured of being loved is to be a person worthy of love, and you cannot be a person worthy of love when your primary goal in life is to passively be loved.” When you think of it love is how others make you feel about yourself, it is not a feeling divorced from all other forces.  Thus, it implies mutual active participation, each making the other feel good about themselves.
    Further, if a person's motive in doing things for others is to cement the attachment of the others to them so as to assure their own care and receipt of love, this also is an unhealthy love. In marriage and in most long-term relationships, there is normally a differentiation of the roles of the two; a traditional or efficient division of labor between the two. Even today, the woman usually does the cooking, housecleaning and shopping and cares for the children -- assuming she isn't employed full time, that is; while the man usually maintains employment, handles the finances, mows the lawn and makes repairs. Healthy couples, Peck says, instinctively will switch roles from time to time. The man may cook a meal now and then, spend one day a week with the children so their mother can get away, clean the house to surprise his wife; the woman may get a part-time job, mow the lawn on her husband's birthday, or take over the bill paying for a year. The healthy couple may often think of this role switching as a kind of play that odds spice and variety to the relationship. It is this, but Peck says perhaps more importantly, even if it is done unconsciously, it is a process that diminishes their mutual dependence. Each spouse is training for survival in the event of the loss of the other, and this a healthy love position to be able to maintain. A healthy marriage or relationship should be LESS of a trap for each person, not more of a trap. The conclusion drawn here seems to be that love is definitely not dependency.
    Well, again, I'm not sure what the real point of this segment is, except that love certainly dominates much of our emotions, our mental health and, like all aspects of health we need to learn as much as possible and through knowledge perhaps safeguard and spare ourselves. Unfortunately, trying to teach young adults these things can be almost as frustrating as dealing with our own love lives and the emotional stability or instability which results.