Food Pharmaceuticals

In Woody Allen's Sleeper, the perpetually disgruntled New York comedian plays a man who has been frozen away by scientists and thawed out again, a number of years later. The world has become a very different place. The scientists who have defrosted Allen inform him that it is now common knowledge that hot fudge sundaes and ice cream milkshakes are good for one's health. While medical researchers have not yet reversed their judgments of such desserts, many have indicated that a number of the foods we already enjoy eating may have significant therapeutic effects. While it is not surprising that foods that contain oft-praised ingredients like bran and fiber contribute to our health, the suggestion that such previously hedonistic items as wine and beer may prolong life have caused quite a stir. Add garlic and fish, two other potential food pharmaceuticals, and one has a delectable meal reminiscent of the French or Italian riviera, not a hospital gurney.

The idea that those with health concerns may be able to follow a healthy and enjoyable diet is extremely seductive. Well aware of current widespread health concerns, the mass media was quick to tout a diet of these tasty treatments. As is so often the case with scientific understanding, details were lost in the transition from research article to mass media article. In turn, the public is poorly informed about the critical issue of healthy eating. This article is intended to look beyond the simplistic and misleading headlines and set the record straight. Do these foods in fact have healing powers? What do these food actually do to our bodies? Should we change our diets in response to these findings?

Bad news

For a number of reasons, scientific and medical discoveries are rarely reported effectively to the mass audience. For one, science has its own jargon-filled language. When the results of a study are presented to an audience not versed in scientific discourse, critical elements frequently get lost in the translation. It is also important to recognize that the public is interested in absolute declarations while science is filled with exceptions and qualifications. In an article for USA Today entitled "When it comes to scientists, believe the caveats", science writer Ann Finkbeiner argues that the problem is one of poor communication:

Scientists usually talk in caveats: "We have fairly good evidence," they'll say. "The case is suggestive." Occasionally sloppy science writers and iniquitous editors cut these caveats as wimpy or quote caveats only as complaints by competing scientists. The rest of us ignore caveats and think the scientists are holding out; we like the bottom line. (Finkbeiner, "When it comes to scientists, believe the caveats USA Today, 13A)

The French paradox

In 1992, attention was first paid to the potential connection between wine and cardiovascular well-being. In June of that year, Jacques Caen, Professor of Medicine and Director of the Blood Vessel Institute at the Lariboisi re Hospital in Paris, delivered a lecture which proposed that moderate consumption of wine can significantly reduce the risk of cardiovascular disease, (Stockley, Wine and Cardiovascular Disease). The studies Caen spoke about were inspired by the remarkable fact that despite a diet notoriously high in saturated fats, with cheese, pastries, and rich food preparations, the French population has a lower rate of mortality due to coronary heart disease than any country in the western world. In fact, the rate of cardiovascular disease in France is 36 percent while the rate in the United States is at 75 percent, (Stockley). This perplexing situation caught a great deal of attention and became known appropriately as "The French paradox". Noting that France also had one of the highest rates of alcohol intake in the world, scientists began to look for a causal relationship alcohol intake and the relative infrequency of coronary heart disease. A series of studies were conducted in order to determine the cause of the French paradox. In a research paper published in the esteemed medical journal Lancet, French scientists Renaud and de Lorgeril reported the results of an epidemiological study which provided an explanation for the French paradox. Their research showed that moderate alcohol consumption decreases one's chances of developing coronary heart disease by at least 40 percent, (Renaud & de Lorgeril, Lancet, 1523-6). A number of research groups, conducting similar studies, independently concluded that alcohol effects on the cardiovascular system could be responsible, at least in part, for the perplexing health of the French heart.

Before we tip back our glasses and drown ourselves in drink, though, it is necessary to put these findings in perspective. The romantic notion that wine holds great healing powers must be considered alongside the significant negative effects of alcohol consumption. When used in excess, alcohol causes numerous health problems including increased levels of fat in the blood stream, higher blood pressure and can lead to heart failure and stroke, (American Heart Association Web Site). Immoderate intake can also lead to alcoholism, a disease with negative social and physiological effects that are likely to outweigh any benefits that accompany alcohol consumption. Creina Stockley of the Australian Wine Research Institute poses the critical question: "is it appropriate to endorse the regular, moderate consumption of wine when immoderate alcohol intake can lead to other causes of mortality?" (Stockley) The American Heart Association suggests that such an endorsement is inappropriate and it does not advocate alcohol consumption for health purposes. While most people inspired by research findings do not plan to over-indulge, alcohol is psychologically addictive and problematic consumption is likely to ensue for certain, predisposed individuals.

The French are known for their wine consumption. Here in America, we stereotypically consume more beer. A number of studies have looked at the cardioprotective effects of wine versus alternative alcoholic beverages and found that all libations do in fact have beneficial effects. This seemed like cause for celebration and the media responded with simplistic, catchy headlines like "Drink to your health," ("Drink to your health", Men's Health, p. 33). It turns out, though, that it is not that simple. Such simplistic declarations are potentially dangerous. In this country, alcohol is one of the primary causes of death, be it slowly through liver damage or quickly through vehicle accidents caused by intoxicated drivers. Nearly 60 percent of traffic fatalities in this country are alcohol related (Microsoft Bookshelf 1996-97). While it is refreshing to hear that the popular pastime might also have positive, healing effects, the problems associated with alcohol should not be ignored. In order to make wise, healthy decisions about our own intake of alcohol, it is important to look past the headlines and critically examine the recent studies on the effects of wine and alcohol.

The Silent Killer

In order to comprehend the methods and results of many of the studies which look at the cardiovascular effects of the beverages we drink and the foods we eat, we must first become familiar with the condition we aim to prevent: coronary heart disease (CHD). CHD is the largest single killer in the western world and is responsible for half of the deaths each year. While the immediate cause of death is usually a heart attack or stroke, such events are the eventual result of progressive CHD. CHD is known as the 'silent killer' because the disease begins to have damaging effects on the arteries long before any symptoms arise. A heart attack occurs when a blood clot forms in an artery that leads to the heart, causing inadequate supply of blood to the heart and body. Prolonged blockage leads to muscle damage and cell death. A stroke occurs when a blood clot forms in an artery in the brain and prevents blood from supplying oxygen and other nutrients to brain cells. Insufficient blood supply causes cell death in the area of the brain supplied by the artery in question.

For many of us, it is not necessary to be particularly concerned about developing CHD. This is an important point that is often overlooked or purposely avoided by the mass media, thus contributing to public misunderstanding. Health stories are common in the media today because they tap into and help preserve the individual's fear of illness. If a reporter or columnist were to announce at the beginning of his story that the following material only concerned a certain 'at risk' segment of the population, he would lose much of his audience. It is not in the media's best interest to do so and, therefore, such declarations are rarely made. In truth, CHD develops primarily in those individuals who are either genetically predisposed to the disease or who engage in high-risk behaviors such as smoking, inactivity, and consumption of a diet high in saturated fats. These genetic and behavioral factors work in combination to make one susceptible to CHD. If you come from a family in which heart attacks and strokes are rare and you lead a healthy lifestyle, cardioprotective foods should not be a great concern.

For those of you who are predisposed in one way or another, food pharmaceuticals may be worth your attention. To understand the effects of these foods, some explanation of CHD is necessary. CHD is a condition which makes it easier for a life threatening artery blockage to occur. Healthy arteries have smooth internal cell linings and diameter wide enough for ample blood flow. In CHD, arteries become rough, hard and constricted Atherosclerosis is a form of CHD and is responsible for a large percentage of the blockages which lead to heart attacks and strokes. Atherosclerosis occurs when plaques begin to form at sites where endothelial cells have incurred damage. Plaque accumulations cause the arteries to become more narrow and cause the artery walls to harden. Once plaque has accumulated, blood platelets adhere to plaque formations in atherosclerotic arteries as they flow by. Platelets perform a critical healing function when there is internal or external bleeding. When they bind to plaque formations, however, they initiate the formation of a dangerous blood clot or thrombus which further blocks blood flow through the artery. A thrombus, in turn, can sometimes totally block an artery, causing a heart attack. When a piece of a thrombus breaks off it becomes an embolus. An embolus will be transported in the blood until it becomes lodged in a vessel of smaller diameter where it can cause a dangerous blockage known as an embolism. When an embolism occurs in an artery in the brain a stroke occurs. (Purves, Orians & Heller, Life: The Science of Biology, 966-973).

Good cholesterol?

It is widely understood that high cholesterol levels can lead to a heart attack or stroke and, as a result, many individuals avoid foods with a lot of cholesterol. Until recently, the mass media has been irresponsible in its dealings with cholesterol by neglecting to inform the public that there are, in fact, desirable forms of cholesterol called high density lipoproteins (HDLs). HDLs transport cholesterol and fats through the blook to the liver where they is made into bile and secreted from the body. In this way, HDLs reduce the accumulation of fatty deposits on artery walls and help prevent atherosclerosis. Because these 'lipid transporters' take cholesterol and fat out of the blood and render it harmless, HDLs have come to be known as "good" cholesterol. Low density lipoproteins (LDLs), however, perform the opposite task. These particles carry cholesterol through the blood and deposit lipids on artery walls, thereby facilitating the formation of fatty deposits likely to form blockages. For obvious reasons, LDLs have come to be known as "bad" cholesterol. (Raloff, "More on those 'really bad' LDLs", Science News On-line).

From veins to vineyards

Now that the basics of CHD and cholesterol are clear, it is possible to look at the original research which sought an explanation for the French paradox. In 1992, While French scientists Renaud and de Lorgeril confirmed that moderate alcohol consumption decreases one's chances of developing CHD by at least 40 percent, the exact mechanism by which this effect occurs remained somewhat elusive, (Renaud et al.) Originally, scientists were convinced that a lipoprotein interaction was responsible for alcohol's cardioprotective effects. Numerous studies suggested that alcohol increases HDL ("good" cholesterol) levels in the blood while it decreases LDL ("bad" cholesterol) levels. This effect, researchers believed, was responsible for the French paradox. Studies conducted by Renaud and de Lorgeril, however, found that blood concentrations of HDLs were no higher in the French population than in the populations of other countries, (Renaud & de Lorgeril). While this evidence did not discredit the ample evidence for a beneficial alcohol-lipoprotein interaction, it suggested that there must be other factors involved. Scientists continued to search for an solution to this difficult puzzle.

Medical researchers soon concluded that alcohol exerts cardioprotective effects through multiple mechanisms. One primary mechanism involves the effects of alcohol on platelet aggregation. Threatening blockages occur when platelets clump or stick together. A clump of platelets can form a thrombus which hinder or prevent blood flow and results in a heart attack or stroke, (Purves, Orians & Heller, 967). Within several hours of ingestion, alcohol seems to significantly inhibit the ability of platelets to bind together to form dangerous thrombi and may therefore have a short term cardioprotective effect. Investigations by Renaud and de Lorgeril showed that platelet reactivity is lower in France than in Scotland, suggesting that alcohol's hindrance of platelet aggregation is the best available explanation for the French paradox, Renaud & de Lorgeril).

Drink up?

The discovery of alcohol's cardioprotective nature raises a number of important questions regarding consumption. Certain members of the media have been quick to unabashedly promote alcohol consumption. Take Mort Hochstein's dangerously simplistic title for an article that appeared in the Ale Street News: "It's Official, Beer's Good For You" (Hochstein, "It's Official, Beer's Good For You", Ale Street News Online.) Many physicians and medical professionals, on the other hand, have been tentative with their recommendations due to their awareness of the risks associated with immoderate consumption. In addition, a variety of sources promote different levels of consumption and consequently send a confusing message to the public. All research on alcohol's beneficial effects has dealt with what has been termed 'moderate' consumption. There is little agreement, however, on the definition of 'moderate'. Some view moderate consumption as two ounces of pure alcohol or two 8 ounce glasses of wine per day. Others suggest three ounces or three glasses of wine. The American Heart Association (AHA), an authority on heart-related health concerns, recommends that individuals limit their consumption to one ounce of alcohol or one glass of wine (AHA Web Site.) These differences are critical. While some alcohol seems to be beneficial, too much is certainly harmful. For this reason, the media and other sources of medical information must arrive at some consistent recommendation for alcohol consumption. Until then, consumers must be careful and conservative with their decisions regarding alcohol consumption. While precise intake remains a point of contention, researchers generally agree that alcohol, to a certain extent, has beneficial effects when consumed in moderate amounts (Renaud et al., Goldberg et al., Sharpe et al.)

An important question remains unanswered: do the cardioprotective effects of alcohol make it appropriate to promote regular, moderate consumption of alcohol when excessive consumption can lead to illness and death in so many other ways? Through its conservative recommendations, AHA seems to suggest that such an endorsement of alcohol is not appropriate, given the situation. The AHA emphasizes the damaging effects of alcohol: its ability to raise blood pressure; cause heart failure, rhythmic disturbances, and stroke; and contribute to the development of cancer and diseases of the liver, pancreas and nervous system. The AHA recognizes that there is evidence that moderate use of alcohol is linked with higher HDL levels, but fails to promote its consumption. If you choose to consume alcohol, the AHA recommends that you limit your consumption to one drink per day, (AHA Web Site).

Red or white?

Is it still a matter of taste? To complicate an already hefty set of studies, there has been additional controversy over the importance of wine color to cardiovascular effect. Initial claims held that only red wine was truly cardioprotective. Consequently, many are still convinced that certain ingredients unique to red wine are solely responsible for the beneficial effects of wine consumption. Studies involving wine color, however, have shown that all forms of alcoholic beverages help stave off CHD. Some evidence has been found, though, that flavonoids in red wine, may enhance the beneficial effects of HDLs and diminish the negative effects of LDLs making red wine a better choice than white wine, beer, or spirits (Goldberg et al., Clinica Chimica Acta, 183-93). The AHA holds that the advantages of red wine are controversial and require further study. Until more is known, perhaps you should listen to your taste buds, (AHA Web Site)

A fish story

Researchers have payed particular attention to fish oil component omega-3 (or n-3) fatty acids, a form of polyunsaturated fat that is chemically different from the omega-6 acids found in most vegetable oils. Studies suggest that these fish-specific acids lower blood levels of tryglicerides and LDLs. The effects of these acids on those elements of the blood more closely associated with CHD, however, are not yet understood. Researchers have determined that n-3 fatty acids do not lower LDL levels in the blood, (Ascherio et al., The New England Journal of Medicine, 978). On the other hand, it is known that fish oils interfere with the ability of blood to form clots, an effect than can be useful for lowering one's risk of CHD, but can also be harmful because clotting ordinarily allows the body to mend itself. Thus, fish oil taken in large dose capsules can lead to excessive bleeding, (AHA Web Site). Fish oil, like alcohol, can be beneficial or harmful, depending on the amount consumed. While the public is generally aware of the risks associated with alcohol, few recognize that too much fish oil may be harmful. For this reason, it is important to educate and inform the public about these complicated issues rather than feed them persuasive, one-sided headlines.

Tails from a Tanzanian fishing village

A study published in the reputable medical journal Lancet in 1996 examined the relationship between fish intake and CHD risk in Bantu villagers in Tanzania. The study looked at a Bantu group living on the shores of Lake Nyasa which consumed a significant amount of freshwater fish and compared it to another Bantu group living in a nearby vegetarian village. The researchers found that the fish-consuming villagers had fewer cases of hypertension, lower blood pressure, and lower total cholesterol and lipoprotein levels than the vegetarian villagers. These results suggest that fish intake may contribute significantly to cardioprotection and prevention of CHD, (Pauletto et al., Lancet, 784).

One fish? Two fish?

How much fish is enough? As with alcohol, it is important to consider cardioprotective effects in terms of amounts in question. In 1995, a surprising paper was published by Ascherio and colleagues at the Harvard School of Public Health in The New England Journal of Medicine. The paper documented a large scale study which followed 45,000 male health professionals who were free of known cardiovascular disease. The study looked specifically at fish intake and health outcome of subjects over a six year period. In opposition to previous findings, the study found no association between greater fish intake and decreased risk of CHD. The Harvard research team did find that the risk of CHD was about 25 percent lower for men who ate at least some fish than for those who ate none at all (Ascherio et al.) While eating fish may be good for the heart, any beneficial effect is obtained in one or two servings of fish per week - this is not an instance in which more is better. For this reason, the AHA currently recommends eating fish regularly but does not recommend the use of fish oil capsules which administer n-3 fatty acids in much larger amounts than are naturally present in food.

Ward off more than vampires

A bottle of wine and a nice piece of fish are a start, but what meal is complete without a dose of the stinky herb. Like alcohol and fish, Western scientists have recently accredited garlic with cardioprotection as well as a variety of other beneficial effects. For non-westerners, though, this declaration comes as no surprise. For centuries, garlic has been considered a versatile and indispensable remedy by a variety of cultures. An ancient Indian proverb suggests that garlic is "as good as ten mothers" for its healing and strengthening effects, (Belsinger & Dille, The Garlic Book, 8). Recent studies have shown, more specifically, that the natural composition of garlic gives the favorite flavoring cardioprotective, anti-thrombotic, and anti-cancer effects when tested on human subjects. Additional studies have shown that garlic may also help bolster the immune system by promoting natural killer immune cell production. Perhaps it's worth having bad breath after meals.

Cloves and cardioprotection

Garlic's cardioprotective effects are quite similar to those of wine, though it seems to be a less potent elixir. According to a study conducted by Dr. Yu-Yan Yeh at Penn State's College of Health and Human Development, men who consumed 9 deodorized garlic capsules daily for a period of 5 months showed a 7 percent reduction in blood cholesterol levels. Furthermore, LDL or "bad" cholesterol levels were 12 percent lower for individuals taking garlic capsules than for individuals taking placebos. HDL or "good" cholesterol levels did not change for those individuals taking garlic capsules, (Turner, Penn State Department of Public Information Online.) Scientists remain ignorant of the mechanism by which garlic bestows its therapeutic effects on LDL levels and, with over 70 natural constituents, it could be some time before the "active" ingredient is determined. The drop in LDL levels in response to garlic intake is significantly less pronounced than the drop in response to alcohol. Garlic-lovers need not worry, though, as the risks associated with heavy garlic consumption pale in comparison to those of alcohol.

Like alcohol, garlic also has anti-thrombotic effects. That is, it helps prevent blood from clotting and, consequently, forming a life-threatening blockage in the heart or brain. Garlic's anti-thrombotic nature has been studied extensively but is still not well understood. Researchers have found that two constituents of garlic, allicin and adenosine, have strong anti-thrombotic effects in vitro. These constituents, however, are rapidly metabolized by the human body. Therefore, these constituents are not likely to be responsible for garlic's physiological effects. Attention is now being paid certain enzyme inhibitors present in garlic which may give garlic its clot-preventing abilities. Researchers know that garlic can help prevent dangerous clots, they just aren't sure how.

Cloves and cancer

Along with heart attacks, strokes, and vampires, garlic may also be useful for keeping cancer away. In a study conducted at the Illinois Institute of Technology, Dr. Richard Moon and a team of researchers looked specifically at the effects, on hamsters, of a specific compound found in garlic. The hamsters were given doses of the compound, diallyl disulphide, and consequently exposed to a carcinogenic substance. The incidence of cancer in those hamsters whose diets contained the compound found in garlic was lower than the incidence of cancer in a control group exposed to the carcinogen by between 14 and 19 percent. These results are exciting as they represent one of the first links found between a natural compound and cancer-preventive effects. Further research may lead to the production of an anti-cancer drug, (Irwin, New Scientist, 23.)

Garlic seems to have numerous confirmed and unconfirmed therapeutic effects, but there is still a great deal to be learned about the mysterious bulb. Scientists, for example, are unsure if cooking decreases any of garlic's beneficial effects or if garlic capsules are as effective as fresh cloves. Studies are in progress worldwide to develop effective and odorless garlic preparations. Until then, keep the breath mints close at hand.

Once again, degree of consumption must be considered. The effects found by recent studies deal with garlic intake on the order of 8 fresh cloves per day or an equivalent amount in concentrated capsules. The romantic notion of continuing to eat the food we enjoy and know that we are doing good for our bodies begins to break down at this point. Such a high intake of garlic would require a great deal of effort or relocation to Italy. In order to acquire the same cardioprotective effects as demonstrated in scientific studies, one must inevitably turn to pills or capsules which lack the appeal of true food pharmaceuticals. Research on garlic, as well as fish oil and alcohol, is now focusing on the development of safe and effective drugs that will administer the natural chemicals of these foods at concentrated levels. Until then, a Mediterranean meal may be the best bet.

Becoming a savvy consumer of food and media

You are now familiar with the original research which led to the slew of headlines proclaiming the great health benefits of wine, fish and garlic. With this knowledge, it should be possible to make wise decisions regarding your own intake of these foods. The process of becoming a savvy consumer of food and media does not stop here. Research on this topic continues and, in order to continue to make the best dietary choices, it is necessary to stay current. Read the literature yourself or find a reliable source of research summaries such as Science News or Scientific American. Mass media is a useful resource for brief updates on the basic findings of medical research. It is, however, important to look, listen, and read critically. Consult other sources for the details which are so often omitted from mass media reports. There is certainly a great deal of healing potential in our natural world and people have thought so for ages. In the Apocrypha of the Old Testament, it is said that: "the Lord hath created medicines out of the earth: and he that is wise will not abhor them" (Apocrypha, Ecclesiasticus 38:4-5). We are only now beginning to understand and appreciate the mechanisms by which this healing occurs. I urge you to stay tuned.

Glossary of Medical and Scientific Terms:

atherosclerosis: Disease related to CHD in which the arteries become hard and heart failure becomes more likely. Atherosclerosis has both genetic and behavioral causes.

bile: A brownish-yellow or greenish-yellow fluid that is secreted by the liver and helps in the emulsification, digestion, and absorption of fats.

blood platelets: Minuscule cell fragments which function to seal leaks in blood vessels via clotting.

coronary heart disease (CHD): An often fatal disease in which the walls of the arteries become thick, hard and rough. Such arteries become blocked more easily, leading to heart attack or stroke.

diallyl disulphide: The component of garlic which is responsible for its strong, lasting aroma and thought to possibly be responsible for some of its beneficial effects.

embolism: A blockage in a vessel created by a lodged embolus which prevents blood flow causes the cells fed by that vessel to die. When an embolism occurs in the brain it is known as a stroke.

embolus: A piece of a thrombus which breaks off and is transported by the blood to a thinner vessel where it may become lodged. A lodged embolus can block flow, resulting in an embolism.

flavonoid: A plant substance found in wine, particularly red, which is thought to possibly have cardioprotective effects on its consumer.

high density lipoproteins: Particles which are thought to remove lipids, cholesterol and fats, from tissue and transport it to the liver where it is made into bile and secreted from the body. HDLs reduce the accumulation of fatty deposits on artery walls and helps prevent atherosclerosis. HDLs are therefore known as the "good" cholesterol.

in vitro: In an artificial, often laboratory, environment.

Low density lipoproteins: Particles which carry cholesterol through the blood and deposit lipids on artery walls, thereby facilitating the formation of fatty deposits likely to form blockages. LDLs have come to be known as the "bad" cholesterol.

omega-3 / n-3 fatty acids: A group of fatty acids which lower blood levels of LDLs. These fatty acids are particularly prevalent in fish oil.

plaque: Fatty deposits which form on arteries in areas where damage has occured. These deposits contribute to the hardening and constriction of the arteries that occurs in CHD.

platelet aggregation: The accumulation of blood platelets in a clump as part of the clotting process, a necessary process the body uses to mend itself. These clumps can consequently form life-threatening blockages.

thrombus: A blood clot which forms in an artery, restricting or entirely blocking blood flow through that artery.

trygliceride: A compound which is the chief constituent of both fats and oils. High trygliceride levels increase one's chances of heart disease related fatality.

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