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FAQs: Nutrition

Why can't my husband, who is 50 pounds overweight, lose weight from being on a low-fat, no sugar diet? He exercises about ten hours a week, has one of those liquid weight-loss shakes for breakfast, and drinks juices and black decaf coffee instead of sodas during the day. He eats sensibly at other meals, too.

I'm 44 years old. I have heart problems. I weigh 340 lbs and I'm 5'10". I've tried to lose weight by regular means but I can't. I asked my doctor how and I was told to lose weight or use some type of medication to help me lose weight. But he won't give me anything for it or even suggest what I should do. I have been considering seeking another doctor out who will help me. It just appears to me that my current doctor is over-booked. Help!!
--DW

You've both put your finger on a very, very difficult problem. Everyone who is overweight knows that they should lose weight in order to protect their good health. They know it; their families know it; their doctors rant and rave about the risks; hundreds of studies laboriously document the toll taken by obesity. And everywhere they turn, they are confronted with the latest diet techniques, a blizzard of low-fat foods, the marvelous benefits of exercise, and the idealized and idolized lithe bodies of young men and women who clearly have it much more together than they do. Dieters by the millions try, and try again, using every trick they can find.

Let's skip the many reasons why obesity is such a problem, and look at the bottom line: Very few overweight people successfully lose weight and keep it off. Nothing works. And no amount of wishful thinking, advertising gimmicks, or expensive diet promotions can prove otherwise.

Again, forget about the causes of obesity. Let's assume that thyroid problems, adrenal gland problems, and other weight disorders have been excluded -- as they usually are. Let's forget about the genetics of obesity. In the end, the only way to lose weight is to take in fewer calories than you burn. It's as simple, and as hard, as that. You must eat less than what you burn. You may think you are not eating much (research shows that obese people often underestimate how much they eat), or that your portions are small, or that you used to be able to eat like this without gaining weight. Maybe it seems impossible that such small portions could result in obesity. Well, maybe these are all true, but in the end it doesn't matter. If you were to stop eating altogether, you would loose a tremendous amount of weight and die of starvation. It's crude, but somewhere between the diet that keeps you obese, and starvation, is a middle ground that has the potential to afford reasonable weight loss. Your goal is to find it, and get there.

Now the highly touted drugs "fen-phen" (Redux) are selling like candy. Already some experts are concluding that about 50 percent of the prescriptions are being inappropriately prescribed. Former Surgeon General Koop has just released new guidelines for the treatment of obesity (I've yet to see them published) that stratifies patients according to their risk of complications from obesity. These medications are recommended for those who are at high risk. The drugs may, in fact, facilitate long-term weight loss, better than anything tried before, but it has never been used in studies for longer than a couple of years, and the long-term risks and benefits remain unknown.

My advice: Be tough, committed, and persistent. Find that middle ground that will allow a very gradual loss of weight over months and years. Most likely this means you will have to change your lifestyle (what you eat, how you eat, where you eat, why you eat). If you are very obese, Redux may be helpful, but be sure you understand the risks of taking these pills.

-- R. Jandl, 11/23/96, Category: nutrition

Can you please tell me the benefits and risks of the new drug DHEA?
-- MF

DHEA is a natural hormone that is being marketed as a food supplement with claims that it improves memory, lessens obesity, and reverses the effects of aging. Peak levels may be found in the blood stream at about 20 years of age.

Do the claims for its effects have any basis in fact? Well, it's hard to say, since there has been very little research done to test the claims. Two very small trials suggest that an enhanced sense of physical and psychological well-being may be achieved among middle aged and older people compared to taking a placebo. But these studies did not address whether it improved memory or changed any of the signs of aging.

One interesting study suggests that patients with systemic lupus (an autoimmune disease often causing sun sensitivity and arthritis in young women) improved while taking DHEA. However, one study is rarely sufficient to recommend a drug. More controlled studies involving lupus and other diseases affecting the immune system would certainly be welcome.

What side-effects might there be? DHEA is a precursor to the body's manufacture of androgens ("male hormones") and estrogens ("female hormones"). In women, androgenic side-effects have been reported after taking DHEA. These include increased facial hair, acne and a deepening of the voice. These side-effects may not be reversible even after DHEA is stopped. Also of potential concern is the effect of DHEA on the growth of cancer cells. Androgens are known to stimulate the growth of prostate cancer. A man with known (or as yet undetected) prostate cancer could therefore theoretically suffer from more aggressive cancer growth. Similarly in women, known (or undetected) breast cancer could be stimulated by the potential estrogenic effects of DHEA.

On the balance, as enticing as the claims for DHEA are, it is hard to recommend its use outside of a research protocol. Since it is not being marketed as a drug, the FDA has no oversight of its manufacture or use. (Currently, the FDA does not approve of its use for any purpose.) Meanwhile, it would be best to listen to the claims with a skeptical ear until we have more information.

-- R. Jandl, 10/16/96, Category: nutrition

Which is better for weight loss, fenfluramine or Redux? I only want to lose about 20 lb. Sitting in front of the computer doesn't help, and I already eat fat free or low fat.
--RY

A lot of excitement has been generated by the publicity surrounding a drug called Redux. The generic name is dexfenfluramine, a derivative of a previously known weight loss drug called fenfluramine. Redux is said to be more effective, has fewer side-effects, and is the only medication approved by the FDA for the long-term treatment of obesity.

How does it work? Redux will increase levels of a neurotransmitter called seratonin. (This is the same chemical that is thought to mediate the effects of anti-depressant drugs such as Prozac.) This change is associated with diminished appetite.

Does it really work? For most people, yes. Compared to diet alone, about two-thirds to three-quarters of the people who use Redux will lose more weight. How much more varies from study to study, but may be up to twice as much. We're talking numbers in the range of 11 lb. by diet alone, versus 22 lb. by diet plus the drug. However, when the drug is stopped, virtually all of the weight loss is gained right back, and no study has been conducted using the medication for longer than one year. You therefore must continue to take it long-term in order to sustain its effectiveness, and there is no indication that continuing the drug will help you to keep losing more and more weight. The drug company is targeting their efforts on those whose body-mass index is greater than 30 (or 27 if you already have certain other diseases). This index is derived from measurements of height and weight, which, to give you an idea, for a 5 ft 6 in person would be 186 lb.

Are there side-effects? The most common ones include fatigue, drowsiness, dry mouth, dizziness and diarrhea. Of course no one knows if there are any long-term side-effects. There have been recent reports of an association between fenfluramine and dexfenfluramine with something called pulmonary hypertension. This is a problem whereby the blood vessels of the lungs are constricted, elevating the blood pressure within the lungs (but not elsewhere in the body), resulting in an inability to absorb sufficient oxygen from the air. There have also been experiments in mice and monkeys showing toxicity to neurons (nerve cells in the brain) on these medications. Although worrisome, it is not clear whether the same toxicity will be seen in humans.

I also like to view obesity in a larger perspective. Reams of data exist showing the health risks associated with obesity, ranging from heart disease to diabetes and cancer. We also know that all efforts to combat obesity have essentially failed. It is rare for an individual to lose a substantial amount of weight and actually keep it off. In order to effectively prevent these other diseases we are going to have to figure out a better way of treating or preventing obesity.

The usual explanation of obesity is that it results from a complex interaction of genetic factors, learned behaviors, and environmental influences. It has also been suggested that for many people the drive to over-eat is a misplaced effort to "be filled up" with something else. Something vital to a sense of wholeness or contentedness, or even a lack of fulfillment in life that is on a deeper, more spiritual level. Or, perhaps, it is just boredom, or a reward for a hard day at work. Unfortunately, too much food often becomes not enough as the deeper desires are still not being met. And just to make us really crazy, we decide to make extreme thinness the cultural icon of beauty and success.

Having dispensed with all that, what should we do? Do we grab the Redux and pass it around? Personally, I have too many reservations. I discourage my patients from taking it because it makes me feel uncomfortable. I worry about long-term toxicity; I think about the cost and wonder who should pay; I wonder if the relatively small amount of weight lost will actually translate into better health (that is still completely unknown); and I fear that the use of drugs to treat what for some people is a social, cultural or emotional problem merely serves to increase the heavily slanted efforts of modern healthcare to treat every problem with drugs.

-- R.Jandl, 9/9/96, Category: nutrition

Why is it I get terrible leg cramps at night, unless I eat foods with potassium that amounts to 2500 mg a day? No one else I've talked to has this problem. If I eat too little potassium I also get heart palpitations. Is there something seriously wrong with me?
--PW

Leg cramps are a problem for many people. Typically, they awake suddenly in the middle of the night with a severe "charlie-horse." Often the only way to get rid of them is to jump out of bed and stand firmly on the foot. This serves to stretch the calf muscle and overcome the spasm. What does this have to do with potassium? Usually very little. Although a low blood potassium can indeed cause muscle cramps (as well as heart problems) true potassium deficiency is relatively rare. It's a good question to ask, however, since it is important that it not be overlooked.

An exception to this rule is seen in people who are using diuretics. Diuretics are medicines that help your kidneys loose excess water from the body. As a consequence of its mode of action excess potassium is often lost as well. This is why people who take diuretics are usually advised to eat extra fresh fruit such as bananas which are high in potassium.

Now if you were to take everyone who complained of nighttime leg cramps and test their blood for potassium (excluding diuretic users) you would find that almost everyone would have a normal potassium level. So what causes the cramps? Actually it is not known. Most people with leg cramps that occur at rest do not have any reason for it that can be identified.

You might ask whether or not the taking of extra potassium by someone whose blood level was normal might be helpful. To my knowledge it is not. In fact, I am not aware of any remedy that is terribly effective. It used to be thought that taking quinine sulfate would help prevent the cramps. However, studies have shown that it doesn't work any better than a placebo.

In terms of the effects of potassium on the heart, that is a much trickier question. It is also not one to fool around with as both high and low potassium levels may cause serious heart problems such as rhythm disturbances and weakness of the heart muscle. It would be a good idea to have your heart palpitations checked out if you haven't already.

-- R. Jandl, 8/14/96, Category: nutrition

What foods can't you eat if you have diabetes?

There is both a simple and a complicated answer to your question. The simple one is based on understanding that diabetes is a disease wherein the body cannot handle sugar ("glucose") normally. In a normal person the blood glucose is kept within a narrow range of say from 70 to 120 -- no matter what you eat. But in a diabetic, depending on the severity of the diabetes, what exactly is eaten, and how the individual's body responds, the glucose might rise well into the three or four hundreds. So the simple answer is that diabetics should not eat sweets. That means candies, cakes, pies, jams, table sugar, anything with high concentrations of concentrated sweets (artificial sweeteners are fine).

Part two of the simple answer is that in addition to watching the sweets, the total calorie intake per day is also critical. That's because being overweight or gaining weight will tend to make a diabetic's blood sugar go up. Conversely, losing weight just by restricting the total number of calories can have a dramatic effect on blood sugar control. By losing weight and not eating sweets, some diabetics are able to avoid taking any medications at all.

So what's the complicated answer? That has to do with the percentage of the diet that is devoted to complex carbohydrates such as pasta and bread, and limiting the total fat intake. For most diabetics, the percentage of calories that come from carbohydrates ought to be in the 50 to 60% range. For many people that will mean lowering the amount of fats eaten in order to keep the total calorie intake reasonable. And that's where the emphasis needs to be. Interestingly, once ingested, carbohydrates are broken down into their building blocks. Those building blocks are --guess what -- sugars. Now it turns out that maintaining good blood sugar control has a lot more to do with the size of meal portions than what specifically is eaten. So if a diabetic is able to understand and follow the portions recommended in their meal plans, then it doesn't make any difference whether they eat a candy bar or a loaf of bread. Of course they'd get about two bites of their candy bar as opposed to a much larger amount of bread. And they will loose the nutritional value found in foods that are not so sweet. But that's the trade-off, and it does at least allow for a little more flexibility in the diet.

Other important factors in maintaining good blood sugar control have to do with maintaining day to day regularity in the meal plan, spacing the meals throughout the day (not just eating one or two meals a day), and using exercise as a means of burning off calories and lowering blood sugar. If you are interested, check out the Diabetes and Diet chapter of the University of Massachusetts Medical Center's Diabetes Healing Handook. for lots more information on diabetes and the diet.

-- R. Jandl,8/14/96, Category: nutrition

I have suffered all my life from being overweight. I now weight 294 lbs. I also suffer from emotional problems (which I can't really get into here because it would take too long). Can you tell me how to stop myself from eating every time something goes wrong? I eat when I am unhappy, moody, angry, etc. Never because I am hungry! Any advice for me? Please help.

Obesity is such a difficult problem. Anyone who has ever tried to lose weight knows what a struggle it is. However, you have made one very important observation -- the connection between your emotions and your diet. This is a connection of critical importance to many obese people.

It is interesting to listen to people -- especially those who are obese -- describe their diet and eating behaviors. There are few places in medicine where t he discordance between what people think they are doing, and what they are really doing, is so readily apparent. Many who are obese do not understand how the small amount of food they eat could cause them to be obese. And they become stuck right there. It just doesn't make sense.

Fortunately, it seems you recognize how it is you became obese. What can we say about someone who over-eats whenever they experience emotions such as anger, boredom, frustration, or fear? This is an area of enormous complexity and many uncertainties, but I would like to offer a few observations.

First, our culture places an extreme and perhaps unprecedented value on food. We are surrounded with readily available fresh, filling, rich, and delicious foods wherever we go. We not only eat at mealtimes, but we eat when we drive, while we work, while watching TV, after sex, and as we walk down the street. There are few experiences in life that wouldn't be enhanced, we are to believe, by eating something delicious.

Second, it seems clear that eating can serve as a way of quieting disturbing emotions. Food diverts one's attention from the troubling feeling or emotion at hand. The act of eating occupies one's attention long enough (it is hoped) to forget about the bad feelings, and to feel soothed by the sensory pleasure of eating. Certain foods may actually have biological effects on the brain to bring about a state of calmness.

So, there are many factors that can lead to a habit of eating in response to stress or disturbing emotions. Rapidly, this response becomes deeply ingrained, and subconscious. Before a compulsive over-eater even recognizes that they are feeling any of these emotions, they are often half way through a bag of cookies.

For most people, the way back to a balanced lifestyle, and to control of one's diet, requires gaining a greater awareness of the emotional and psychological factors underlying compulsive eating. This is hard, often painful work. It requires great courage and determination. A therapist may be able to help; support groups may help; and the help and support of family members will make it easier. Try eating slowly and mindfully. Never eat standing up or on the fly. Always sit down. Avoid all distractions except socializing. Try not reading, watching TV, or doing anything other than eating during your meals. Concentrate on your meal. Prepare it with care. Eat slowly, mindfully, and enjoy every bite. Begin to hear your body when your stomach is telling you that you are getting full. Stop then. Eat well during meals and only during meals. Use the rest of the time to live your life free of food.

There are many resources on the web that offer information, advice and support for sufferers of eating disorders. Here are a few places to start:

Something's Fishy Eating Disorder Site (more serious than the name suggests!) is about shared awareness, including information on signs and symptoms of eating disorders, recent research, self-help techniques and personal stories.

Doctor Barton Blinder is an eating disorders specialist whose page is devoted to the latest research/advances on the psychiatric approach to eating disorders.

Serotonin and Eating Disorders "recognizes that obesity is not a failure of will or behavior, nor is it a disorder of body weight regulation. It is a chronic medical condition." Recent research and possible treatments.

Usenet - alt.support.eating-disord is a ready-made community for the discussion of eating disorders.

-- R. Jandl,7/24/96, Category: nutrition

I've noticed that my fingernails have been getting shorter over the last few years. I don't trim them down to the quick or bite them. I remember my pediatrician long ago noticing white spots on my nails and telling me to take zinc supplements - could there be a nutritional factor? I'm a 29 year old male, reasonably good health (although I could drink a little less beer!). My nailbeds (the pinkish part) are only about 2/3 as long as they used to be -- what can I do?

In general, the nails of well-nourished individuals grow faster than those of undernourished individuals, but it appears that there are no specific foods, minerals, or vitamins that will accelerate nail growth. Zinc deficiency may be diagnosed by analyzing fingernail (or hair) samples, but it appears that zinc supplements will not by itself speed nail growth. Perhaps the best advice is to make sure your diet is a good one, drawing on all the major food groups (grains, dairy, fruits, vegetables, meat, etc.).
-- R. Jandl, 12/10/95; Category: Nutrition

In the response to a question posed about vitamins, I read, 'Vitamin A itself, which can become toxic over time if consumed in excessive amounts'... How much time, and what is an excessive amount? I'm currently taking Vitamin A (under a physician's advice) in doses of ~20,000 IU a day, as part of a treatment for some stubborn warts; is this likely to become a problem?
-- MS

Vitamin A intake and toxicity are dependent on a variety of factors. These include body weight, the sources of Vitamin A, amount eaten, absorption from the intestines, age, and health status, so it is difficult to provide you with a 'pat' answer. Toxic levels can accumulate over time. One guideline for determining excessive levels of Vitamin A is to limit intake to <2,000 IU/kg/day -- or in the case of a woman who weighed 120 lbs, an intake of less than about 100,000 IU per day would be considered non-toxic. An important exception would be women who may be pregnant, in which case she would be advised not to take more than 8,000 IU of Vitamin A daily from all sources.

You are currently taking about 400 percent of the RDA for Vitamin A which according to the guidelines mentioned above should be safe. It would seem that you would not have to worry too much about cumulative toxicity, but this is definitely a question to pose to your doctor as well.
-- L. Hill Einbinder, 11/29/95; Category: Nutrition

I am trying to lose a few pounds, and have been overcome with cravings for different types of foods. What can I do to decrease these cravings, and stay on track of eating a healthy diet?

Everyone has cravings for certain foods every once in awhile-- it is a normal human behavior that can be triggered by a variety of factors. Sometimes cravings are due to the body's physiologic need for a particular nutrient. For example, pregnant women who are suffering from iron deficiency anemia have been known to crave ice chips --and even detergent, or dirt! There is a theory that the reason why some women crave chocolate during certain times of their menstrual period is due to the brain's biochemical desire for a particular compound found in chocolate. However, it is unusual for a food craving to be fostered by a physiologic need.

Most cravings are triggered by environmental cues. Studies have shown that television commercials displaying food, provide very strong cues for us to eat. And according to some studies, women who are dieting appear to be particularly prone to responding to TV commercials by eating! Also, many times we do not eat due to hunger, but rather in response to other psychological factors. Cravings for food can be the response to other stresses in our lives that need to be addressed.

The current recommendation for those trying to lose weight is to satisfy those cravings by planning for them. A lower calorie substitute may satisfy some cravings. For example, a serving of sugar-free, fat-free chocolate pudding may be a satisfying substitute for a chocolate candy bar for those craving chocolate. If you know that no alternative will satisfy your craving, plan a reasonable portion of that food into your diet. For example, if you know that you must have chocolate, plan to have that piece of chocolate but in a reasonable amount.

Try not to fall into the dieter's 'cascade' of feeling guilty about 'blowing' your diet having relented to a craving for an 'undietetic food'-- followed by consuming vast quantities of that food since the diet has been 'ruined' for the day anyway -- followed by firm intentions to begin the diet again soon. A 'diet' is a life-long pattern of eating habits that cannot be changed in a day!

-- L. Hill Einbinder, 11/7/95

In various health stores I have seen numerous "fat burning" tablets on the market for sale. Is there any truth to their claims, and if so, how do they work and in what context should they be taken?

In general, if something sounds too good to be true, it probably is. Although there is promising scientific research exploring the genetic causes of obesity, and in the development of 'fat substitutes' for use in prepared foods, there are no 'fat burning' tablets available on the market that have been proven in the scientific literature to fulfill the advertised claims of quick and easy weight loss by simply consuming a pill without regard to exercise or dietary habits.

-- L. Hill Einbinder, 11/7/95

I am a collge student and I was wondering what vitamins I should be taking for someone in my age group, 18-25. I am female and have a reasonably healthy diet. I am confused about the benefits of vitamins -- do they work, which ones do I need, etc.,

It is important to know that currently, the government has little regulatory control over the vitamin industry. Some points to consider for all ages when purchasing a vitamin supplement follow:

Cost: A thirty day supply can range from $2 to $20 or more, but price is not an indication of quality.

Bioavailability: The longer it takes a supplement to break down during digestion, the less likely that the vitamins and minerals will have a chance to enter the bloodstream and be used by the body. Unfortunately, bioavailability information is rarely found on a vitamin supplement label.

Expiration dating: Expiration dates are set by the manufacturer, and do not have to be based on laboratory tests like pharmaceutical products do.

Vitamins and minerals together: Nutrients work best together, so it is recommended that you select a supplement that includes both vitamins and minerals, although some mineral do not have an established Recommended Dietary Allowance (RDA). Products with excessive (> 100-150% USRDA) or limited amounts of one or another nutrient, could create imbalances.

Calcium: Generally, the calcium content of vitamin/mineral supplements is small because calcium increases the bulk of the supplement to the point that it would be too big to swallow. In order to get the USRDA for this mineral, you would need to take an additional separate calcium supplement.

Iron: It is not necessary to buy products containing >100% USRDA for iron unless you have iron deficiency anemia.

Vitamin A: Vitamin A comes in two forms: Vitamin A itself, which can become toxic over time if consumed in excessive amounts, or beta carotene, a Vitamin A precursor which is converted to Vitamin A in the body and is considered safer. Unfortunately, most vitamin supplement labels list Vitamin A as 'Vitamin A and beta carotene' together without a percentage breakdown.

Non-essential ingredients: Supplements often contain ingredients that have never been shown to be essential in humans. Some of these ingredients include: PABA, lecithin, inositol, bee pollen, hesperidin complex, among others.

"Natural" ingredients: The body can't differentiate between a vitamin made in a lab or the same vitamin extracted from nature.

Vitamin 'Stress formulas': The only type of stress that can increase your nutrient requirements is the physiologic stress brought on by a severe illness or injury, not mental stress.

Childproof caps: "From 1983-1990, iron tablets alone were responsible for more deaths due to accidental overdose of pills in children under the age of three than any other medication."

Source: Tufts University Diet and Nutrition Newsletter : A Nine Point Guide to Choosing the Right Supplement

-- L. Hill Einbinder, 11/7/95

I'm following a cardiac rehab program that includes a 24-gram daily fat limit. I'm generally below 10 grams. I'll sometimes splurge to 20, but almost never more, and rarely any saturated or trans-saturated fats. I also exercise rigorously every day and have lost about 25 pounds in the last year, now down to 135, about my ideal weight. I'm 50 years old. Recently, I read an article that said it's dangerous to include less than 25 percent calories from fat in one's diet. Do you agree? Thanx much.
-- RB

Congratulations on successfully changing your diet and exercise habits to support a healthy lifestyle!! What you have accomplished is commendable!

In regard to your concern regarding the potential for limiting fat intake too much, the short response is -- it is not a concern. There is no danger to most people in maintaining a low fat intake as long as they are able to maintain their ideal body weight and do not have any other serious medical problems.

Recommendations by most mainstream medical groups such as the American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) recommend less than 30 percent fat intake for the prevention of atherosclerotic plaques ("hardening of the arteries"). Even the American Academy of Pediarics recommends limiting fat intake to 30% of total calories for healthy children over the age of two.

Some preventive health experts such as Dr. Dean Ornish, author of several books and papers advocating a preventive medicine response to heart disease, has published studies documenting the reduction of plaque formation with a program which includes dramatically lower fat intakes (< 10% fat intake.) Since you are in a cardiac rehab program and are young, the more stringent recommendations -- if you are able to comply with them -- and if your physician agrees, may make sense.

There are many large populations (continental Africa and China) which have traditionally consumed very low fat diets for centuries-- as low as 10 grams daily-- which do not exhibit any detrimental effects. In fact, populations with very low fat diets have extremely low incidences of heart disease.

There are many researchers and clinicians who hesitate to recommend very low fat diets because they believe the restriction on the American lifestyle is too severe to be considered a viable adjunct to medical treatment. It appears you have made that transition successfully!

-- L. Hill Einbinder, 10/26/95

What is the maximum dosage recommended when taking melatonin? Also, are there any adverse side effects of long-term usage?
-- DS

Melatonin, a hormone produced by the pineal gland in the brain, has generated a lot of press recently for its many effects on such diverse topics as circadian rhythmicity, sleep cycles, sexual function, cancer cell growth, and depression. For example, it has been used as a way of resetting sleep cycles when changing time zones, or changing work shifts, to try and help the body adjust more rapidly. And in the elderly, where difficulty sleeping and low melatonin levels co-exist, some evidence suggests that melatonin supplements improve sleep. One recent study related to sleep induction found that 0.3 mg taken any time between 6pm and 9pm shortened the time to sleep onset. However, insufficient research has been done to recommend using melatonin for any of these purposes on a regular basis. The long-term effects are not sufficiently known, and when it comes to manipulating your own neuroendocrine system one should be cautious. In spite of the promise of some of these initial reports, remember that the world is filled with reports of the latest elixir curing all sorts of ailments. Patience, and a little skepticism regarding the most appropriate use of such breakthrough's, often pay off in the long run.

-- L. Hill Einbinder, R. Jandl, 10/19/95

I gained the "freshman 15" last year and I have been trying to lose it ever since. A friend of mine said that chromium picolinate would help, but I do not know how much to take. What is the recommended dosage, and does it really work?

Chromium is a trace element that works with insulin to help your body's cells absorb glucose, and is the biologically active component of "glucose tolerance factor" (GTF). Chromium has been shown in some studies to improve "glucose tolerance"-- the ability to metabolize sugars normally -- in some people with adult onset diabetes.

There is no RDA (Recommended Daily Allowance) for chromium. Therefore, it is difficult to quote an appropriate "dosage" to you. One study determined that 10-20 micrograms per day was a safe and adequate amount for humans, but it is difficult to make recommendations on the basis of one study. Good food sources of chromium include: brewer's yeast, meats, cheeses, and whole grains.

There are no studies which have demonstrated any effect of chromium picolinate on weight loss in humans. However, chromium may possibly provide some benefit to people with diabetes who consume a diet low in chromium.The best weight loss regimen as always, includes exercise and a healthy low fat diet.

-- L. Hill Einbinder, 10/14/95

Should everyone take antioxidants?

Antioxidants are substances which are considered to be responsible for reducing the by-products of oxygen metabolism in the body -- or, stated more simply, retarding the aging process. Vitamin C, Vitamin E, Beta carotene (a source of Vitamin A), Vitamin A itself, and the trace mineral, selenium, appear to have antioxidant -- 'free radical scavenging' -- properties, along with other dietary compounds.

Studies have demonstrated associations between populations that have dietary intakes high in varying antioxidants with a variety of desirable outcomes -- including reduced risk of heart disease, certain cancers, cataracts, and an enhanced immunity. With so much potential benefit, should we indeed, all be consuming supplemental antioxidants?

Researchers will provide varying responses on this matter. Despite the promising research in this area, results are still preliminary. It is not clear if the antioxidant is acting alone or in conjunction with a combination of compounds found in various fruits and vegetables. In addition, scientists are not sure to what degree antioxidants enhance health and longevity apart from some other very important factors such as exercise, maintaining ideal body weight, and consuming a diet low in fat.

Of course excessive amounts of anything can be hazardous to your health-- including antioxidants. Supplemental doses of Vitamin A and the trace mineral, selenium, in particular, could become toxic if high doses are consistently consumed.

In short, everyone should indulge in foods containing high amounts of antioxidants!

Some lesser known, tasty sources of antioxidants are listed below.

Sources of Vitamin A/beta carotene, Amount, IUís, RDA (5000 IUís), %

Sources of Vitamin C, Amount, mgs, RDA( 60 mg), %

Sources of Vitamin E, Amount, mgs, RDA( 8-10 mg), %

Reference: Pennington and Church, Food Values of Portions of Commonly Used, 14th edition; Recommended Daily Dietary Allowances- Food and Nutrition Board, National Academy of Sciences

-- L. Hill Einbinder

My friends are always drinking this ginseng tea for energy. Is there anything to this? If so how does it work?

Ginseng has been touted as an 'energy food' for some time. However, there is no scientific evidence to support this attribute. Ginseng in large quantities has been documented as causing insomnia, hypertension, and gastrointestinal problems. If your friends enjoy drinking ginseng tea, and believe it 'energizes' them, it is probably not harmful, but is unlikely to provide them with any measurable energy boost.

Reference: The Mount Sinai School of Medicine Complete Book of Nutrition, 1990.

-- L. Hill Einbinder

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