The Preservation of Health

The Preservation of Health:

Managing Carbohydrate Intake for Life

Mark A. Falco, D.M.D.

DORRANCE PUBLISHING CO., INC.

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Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

1. An Episode of a Family Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
2. A History of Sugar Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
3. Sugar Rush . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
4. Sugar Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
5. The Good and the Bad of Sugar . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
6. Nutrient Void . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
7. Hunger and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
8. Tooth Decay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
9. Gum Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
10. Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
11. Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
12. Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
13. Carbohydrates and Coronary Artery Disease . . . . . . . . . . . . . . . . . .112
14. Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
15. Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
16 Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
17. Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
18. The Everyday Preservation of Life . . . . . . . . . . . . . . . . . . . . . . . . .144
19. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177

Acknowledgments

I am grateful to the illustrious work of pioneers in human oral nutrition.
Melvin E. Page, D.D.S. and Weston A. Price, D.D.S. were two dedicated
men whose extraordinary work with nutrition continue to form the basis for
diagnoses today.

My heartwarming thanks goes to the tremendous guidance and profes-

sionalism exemplified by the wonderful people that have supported this book.
I greatly appreciate the expertise displayed by Michael J. Glade, Ph.D.,
F.A.C.N., C.N.S. in assisting me with the improvement of the delivery of my
information. My special thanks to James P. Costello, D.D.S. for heightening
my awareness and allowing me to ‘just do it.’ I thank Jeff Baird, D.O. for his
contribution in putting the book’s message into practice. Significant thanks
must be bestowed upon Nancy Appleton, Ph.D. for her cultivating enthusi-
asm and remarkable breadth of knowledge in helping me to structure my
information.

To my family and friends, who have always been there for me, and to my

dog that believes I must always be right.

INTRODUCTION

Is a low carbohydrate intake the answer to healthier living? Many experts have
written substantial amounts of information on the benefits of a low carbohy-
drate intake to encourage and maintain weight loss. Others have written
about the ailments that a high sugar intake have caused on health. Dentists
have been telling us to reduce sweets for years. Since the ubiquitous addition
of fluoride into our oral hygiene regiment and the placement of dental
sealants on cavity-prone teeth, tooth decay has shown some evidence of
decrease in the youthful population receiving these treatments. Yet, half of
our youth do not benefit as much as they should from better oral health care.
What’s more, as most of our mature population has established a greater
longevity of teeth retention, an even greater incidence of new tooth decay has
surfaced. This decay is attacking the surfaces of tooth roots.

Is a low carbohydrate intake the answer to healthier living? Most of the

beverages I drank as a child were sweetened. I had a sweet tooth in my youth.
I also had many cavities filled. Suddenly I developed severe asthma at age
four. Most of my activities became limited. When an asthma attack came
upon me, it was as if there wasn’t any air left in the room for me to suck into
my lungs. I was constantly sick and oftentimes had to remain home from
school to recover. As with most asthmatics, my body was able to adapt to the
illness. I developed less and less severe attacks over time. As I reached adult-
hood, I had very little dependency on my life-saving inhalers. I began to live
what I thought to be a normal life. But by the age of 43, I was diagnosed with
a 90 per cent blockage in one of my coronary arteries. Although it was opened
during catheterization, it eventually failed me and I required a heart bypass
operation. It took six months to feel sensations at the wound sites on my skin
again. It took another six months to regain the muscle strength I had been
accustomed to. My doctors told me that I was not considered to be a high risk
for heart disease. My blood pressure was normal. My cholesterol was slightly
elevated. My weight was above normal by only five pounds. I had always been
active. I had no diabetes and no family history of heart disease. I went on a
low-fat diet after the surgery anyway because that is what you’re supposed to
do when heart disease hits you. I took a cholesterol-lowering drug. But after

vii

18 months of this type of diet, my triglycerides were still elevated above nor-
mal. This elevation was considered an increased risk for another blockage. A
normal life was robbed from me as a child due to asthma. Was a normal life
going to be robbed from me as a middle-aged man due to heart disease this
time? I wanted to prevent this from happening again. Once was enough.

Is a low-carbohydrate intake the answer to healthier living? The convinc-

ing arguments for answering this question were discovered after an exhaust-
ing search for the reasons I had experienced the illnesses that nearly short-
ened my life twice. At a first look, it might be easy for someone to consider
this to be a bit trifling. After all, how can the food we normally love to eat be
responsible for harming us? Carbohydrates are necessary for our survival.
Carbohydrates are also poorly understood. It’s taken a lifetime to understand
that this is not at all trifling. In order to dismiss the doubts about this, I want-
ed to present a history of the arguments, the facts behind the arguments, the
connections to various disciplines and simple instructions to correctly identi-
fy and enjoy the foods we ought to be eating in the right combinations to pre-
serve our health as optimally as we can. These lessons are not a substitute for
your own health care provider’s advice on how you may need to plan your
own diet. You must consult with your health care provider before altering any
prescribed diet or nutrition plan for your or any member of your family that
is described within this book. The lessons you learn from the pages of this
book are to make you a better consumer and make you more knowledgeable
in the choices of foods you must select to eat every day. The mysteries behind
carbohydrate consumption need to be revealed. Tooth cavities happen to be
one of the early revelations behind the carbohydrate consumption mystery.
You body has many more startling mysteries to reveal.

Mark A. Falco, D.M.D.

viii

An Episode of a Family Health Crisis

Alex awakens Monday morning, starts breakfast, sweetens his coffee with two
teaspoons of table sugar and drinks eight ounces of orange juice from con-
centrate. He eats a bowl of frosted corn flakes and consumes two slices of
toasted white bread with jelly. Then, he drinks a second cup of coffee sweet-
ened with two more teaspoons of table sugar. His watch tells him that it’s time
to run off to work. He pushes himself away from the kitchen table taking one
last gulp from his coffee cup as he loads his dishes into the dishwasher. He
scrambles about the house in search of his two children, Amy and Dylan.
Finding Amy first, he picks her up and plants a big kiss on her cheek. In the
arms of her father, Amy giggles from the squeezing of her ribs and the
momentary attention she receives. Amy is just six years old, but she already
has missed ten days of school this year because of either colds or the flu.
Today is her first day back to school after her most recent bout with a cold.

Alex hears Dylan singing in his bedroom. He gently places Amy down

beside him and quickly moves into Dylan’s bedroom. He finds Dylan smiling
and singing to a couple of his action-figure soldiers. Alex grabs Dylan from
beneath his armpits and hoists him toward the ceiling, shaking him into a
burst of laughter. He kisses Dylan on his forehead and drops him onto his bed
where he returns to his amusement with the soldiers. Dylan is three years old.
He has had episodes of wheezing, coughing, and breathing difficulties over
the last year that have appeared to worsen in the last month.

Alex locates Jill, his wife of seven years. He embraces her with a strong

hug and a quick kiss. Jill works for an advertising agency. She travels a little
bit more than she would like to, but her hours are flexible enough to allow her
to attend to her children as she sees fit. After meetings with two clients today,
Jill will pick up Dylan from the day care center and take him to his doctor to
discuss the results of some tests that were done on Dylan several days ago.

Without wasting another second, Alex grabs his briefcase, picks up his

keys and darts out the door to the garage and into his car. He has a fifteen-
minute drive to his office, a telecommunications firm in which he is the

vice-president of the commercial marketing division. He has worked for this
company for five years and has held his present position for the last two of
those years.

At work, someone was kind enough to bring in a box of chocolate-glazed

donuts. Alex eats one with another cup of sweetened coffee. He’s very fired up
today and is able to get all of his morning business activities done in time to
get out for a bite of lunch. At a nearby restaurant, he orders a cheeseburger
on a white roll with lots of catsup and macaroni salad on the side. He washes
this down with two glasses of cola and returns to work.

One of his co-workers has been given a surprise birthday bash and every-

one gets to eat a slice of vanilla-iced layer cake. Of course, Alex needs a cola
to wash it down. By four o’clock he’s anxious to leave work for home because
he’s worked hard all day and he’s now tired. Jill phones Alex to tell him that
Dylan’s symptoms have now been confirmed for a diagnosis of asthma. He’ll
need to be on various medications and restrictions above what he’s already
been given. Things we can’t see such as dust mites and pollen according to his
doctor have probably triggered the symptoms. Alex is somewhat relieved that
Dylan can be helped but he’s concerned about Dylan’s growth and develop-
ment. He’ll need answers to that from Dylan’s doctor.

Exhausted from his day, Alex is ready to relax to a good meal and he’s anx-

ious to see his kids. With his workday complete, he leaves behind a tidy desk,
takes the elevator to the parking lot and enters his car for the return drive
home. Alex is so tired that he starts dozing behind the wheel of his car on his
way home. He’s experienced this behavior before on several different occa-
sions. He’s reasoned that it’s been due to his abundant workload. Once home
he greets all of his kids who strive for his attention. But, he’s too tired and irri-
table to enjoy their company.

He finally sits down for a dinner of green salad and bottled French dress-

ing, creamy fettuccine alfredo with a sirloin steak and steak sauce, glazed car-
rots and two dinner rolls. A glass of fruit juice washes everything down. All of
the kids ask for dessert and so everyone gets a dish of Rocky Road ice cream
with chocolate syrup. Alex plays with the kids some, and then relaxes to watch
television with a glass of wine. He and Jill talk incessantly about Dylan’s
health. Jill casually mentions that she had been concerned that maybe she
wasn’t getting enough exercise because her joints had been getting stiff late-
ly. She questioned that maybe her health was somewhat poor. She didn’t want
any poor condition of health on her part to affect the care she needed to give
to Dylan. Alex falls asleep during Jill’s exposition.

Next morning he wakes up exhausted and starts his day all over again.

The only change to his previous day’s routine is to visit with two doctors
beginning with his physician at three o’clock that afternoon for a check-up.
He’s asked how he’s been doing by the physician. Alex reports that he’s been

Mark A. Falco, D.M.D.

more worried and stressed lately and that’s causing him to be moody and have
altered sleep habits. His physician says he’s going through the same thing. He
suggests taking more time off to get away from it all, but that he recommends
a medication known as Xanax because it’s great for calming stressed nerves. He
orders some blood tests taken, mentions that his blood pressure is slightly above
normal due to his worries, but otherwise states that everything else checks out
fine. Alex leaves deciding that he might give the Xanax a trial period.

His next appointment is for a check-up at the dentist who tells him that

his gums are swelling and suggests taking X-rays. The X-rays show that he’s
losing bone around his teeth. The dentist reminds him to brush and floss bet-
ter and also recommends a scraping of the roots and gums of his teeth to stop
the bone loss and shrink the gum tissue. He sets up another appointment to
start this work.

One week later, Alex receives a call at work from his physician to say his

blood cholesterol level is too high and that it must be treated with some med-
ication. He wonders why his cholesterol would be elevated. He thinks he may
have been eating too much red meat. Now he has to be on medication. He
asks himself, how much fat has he been eating? He’s always trimmed the fat
off of his steaks. Soon after that call, Jill phones Alex to tell him that Dylan
had to be taken home to rest because of an emergency breathing spasm at the
day care center. Luckily, the medication he had with him saved him from
another trip to the hospital emergency room. It wasn’t until Alex returned
home from work that day that he told Jill that he has to have his cholesterol
level treated by his doctor because he’s at risk of acquiring heart disease. Jill
took this moment to tell Alex that she has been dealing with constant joint
pain that has forced her to be on a lot of anti-inflammatory medication to
relieve it. A scan that her doctor had performed recently also showed that
she’s at high risk for developing osteoporosis. Now, she needs calcium sup-
plementation on top of that.

Before retiring for the evening, Alex and Jill checked on Dylan in his

room. He was already asleep. He looked comfortable. The nebulizer was still
operating by his bed. They also checked on Amy. She, too, was asleep. Her
nose sounded a bit clogged and it has started running again. Alex and Jill both
looked at each other with the exact same question on their minds, why are we
getting sicker instead of healthier? The response was silence.

Have you or anyone you’ve known experienced days like these? Do you

consider this routine? Do you think it’s normal? Although the focus of this
family has centered on illness, the most overlooked and most damaging
change to health comes from what is eaten in the diet. Buried in this family’s
melancholic episode is Alex’s food intake for a typical Monday. I could have
chosen any of the family members to highlight his or her diet, but I needed
only one to substantiate the following component breakdown of a common

The Preservation of Health

diet. Alex was a good choice to demonstrate that diet and now we’ll review
what he consumed. The described daily intake of food for Alex that Monday
had a high content of sugar; one and one-half pounds worth of sugar as both
simple and complex carbohydrates. This is more than Alex’s daily protein and
fat intake combined. Do you agree that the daily consumption of carbohy-
drate for Alex was one and one-half pounds? Without even considering calo-
ries at the moment, the total number of grams of carbohydrates adds up to
700 for Alex. When converted to pounds, 700 grams is approximately one and
one-half pounds.

The total number of carbohydrate calories for a 2000 calorie-a-day diet is

300 grams if 60 per cent of the calories are to come from carbohydrates. For a
2500 calorie-a-day diet, it’s 375 grams. Alex consumed 700 grams, about twice
the recommended amount. If he were expected to be on a 2500 calorie-a-day
diet, he would have exceeded that by 300 calories, not including his daily intake
of protein and fat. His daily carbohydrate intake alone was 2800 calories.

Let’s be generous. Let’s say Alex had an extremely abnormal carbohydrate

intake on this day. Instead of one and one-half pounds of carbohydrate intake,
we’ll say he averages more like one pound of carbohydrate intake a day. Some
days may be more and some days may be less but his average over a year is
one pound a day. That equates to 365 pounds a year. Is that good? Most
experts believe that at the uppermost limits, we consume 150 pounds of sim-
ple carbohydrates a year each. What amount of Alex’s one and one-half
pounds of carbohydrates are simple carbohydrates (or simple sugars)? If we
separate out the simple sugars from the complex sugars, the simple sugars
account for 425 of the 700 grams or about 14 ounces out of a total of 24
ounces. That’s about 85 teaspoons of sugar.

Let’s still be more generous. Let’s say our friend averages less than 14

ounces of simple sugars a day. Let’s say he normally consumes 10 ounces a day
on an average in a year. This means that in a year’s time, he would consume
about 225 pounds of simple sugars in his diet. This amount is still 75 pounds
higher than the uppermost limit the experts agree we individually consume in
a year in our nation!

So what’s all the fuss about, anyway? All sugars are carbohydrates.

Carbohydrates are needed in our diet. Why the concern? The best way to
answer this question is by examining several issues. We can ask ourselves if
Alex is showing any early signs of sickness. Is what he is experiencing just a
consequence of aging? Is he improving his life or is he on a downward spiral?
Why is his sugar intake so high? Is this normal over a year’s time? How about
a lifetime? Should he be alarmed? Should you be alarmed? What about his
family’s illnesses? What about your family’s illnesses?

What does sugar have to do with all of this aging stuff anyway? By exam-

ining the issues, we can develop a better understanding of what can trigger

Mark A. Falco, D.M.D.

illnesses. We can also determine why the processed and refined sugar that we
normally consume in our diet is not a healthy product at all. From this infor-
mation, we can begin to learn the patterns that developed the problems for
Alex, Jill, Amy, and Dylan. We can also begin to correct these problems in a
much more natural way without a myriad of medications. Ultimately, each
person from infancy to old age can be taught to manage his or her diet intake
to further improve his or her lifestyle. The end result? Your family’s health
would be restored once again.

The Preservation of Health

A History of Sugar Consumption

Tracing the Pathway

Everyone’s first contact with sugar is from the first days of infancy either from
breast milk or baby formula. The reason for this immediate contact with
sugar as a nutrient is for the production of fuel for the body’s cells. Sugar, in
the form of simple and complex carbohydrates, is needed to sustain life.
Without carbohydrates, the body’s store of fuel dries up. Carbohydrates are
analogous to gasoline as fuel to drive an automobile. In conjunction with oxy-
gen and other additives, gasoline helps to make the automobile run more effi-
ciently by being burned up to produce the energy to fuel it. In the same way
carbohydrates along with oxygen, water, and other additives such as vitamins
and minerals, help to make the body run more efficiently by being burned up
to produce the energy to fuel the cells in the brain, heart, muscle, digestive
system and so on.

Not only does sugar consumption keep the engines burning fuel in our

body’s cells, nature has cleverly given us a rewarding signal for our taste buds to
appreciate the importance of carbohydrates by imparting a sweet taste to these
sugars. From a juicy bite of a ripened peach to the crispy crunch of a red pep-
per, nature has provided us a way to enjoy carbohydrates in our food supply.

All green plants create sugar from sunlight, air, and water. Different

species of plants create different types of sugars and in different amounts.
Sucrose, a combination of two simple sugars, glucose and fructose, is consid-
ered to be one of the sweetest of the sugars found high in abundance in sugar
maple, sugar beets, and cane sugar.

There is nothing new about the significance of sucrose in our society.

Sugar cane syrup was being processed hundreds of years before the birth of
Christ in southern Asia. Although the imported amounts were small, the peri-
od of the Crusades in Europe led many sweeps into Asia by merchant traders
to bring this high-priced commodity back to Europe. With demand outstrip-
ping supply, European countries made huge investments in the establishment

of more appropriate and abundant growing regions for sugar cane, which
could be stored in large quantities aboard ships providing an alternative to
more expensive and slower land routes or threats of attacks from Asian inhab-
itants. These investments led Europeans to the Western coast of Africa where
they were able to use the inhabitants on massive slave plantations to chop
down huge amounts of sugar cane during harvest. Often times this was done
without the slaves ever leaving the fields for weeks.

As the success of the discovery of the New World launched more invest-

ments in imperial commerce in the sixteenth century, the soil and climate of
the West Indies created further races by European countries to compete for
domination of the sugar commerce. Numerous African slaves packed in like
sardines with very little food and water to share were sent over on ships to
plant and harvest new sugar cane plantations in the Caribbean and surround-
ing areas. The growing popularity of coffee, chocolate, and tea, made sugar
cane the number one European import from the New World by surpassing
tobacco imports at the beginning of the eighteenth century. The continuing
influx of African slaves to the West Indies, begun around 1500, continued to
roll on for nearly four hundred years.

The extraordinary success of sugar revenue created wealthy people and

wealthy nations. It also created political leverage against other countries
through taxes such as the heavy taxation of the American colonies that were
unable to grow sugar but needed to import it. This form of taxation was one
of the major contributions to the establishment of the Freedom Fighters and
the eventual revolt that led to the American Revolution. A similar form of tax-
ation penalty exists today by our own United States that prevents foreign
countries from having the ability to sell sugar to our country for less than the
price of American grown sugar even though foreign grown sugar is sold on
the world market for far less.

The annexation of Hawaii as the fiftieth state was driven by the need to

protect the Hawaiian sugar plantations from foreign intervention. American
refineries were home to Cuban exports of sugar cane until the Cuban revolu-
tion, which grew out of resentment toward Americans for their massive con-
trol over sugar cane revenue, put an end to this practice. Recognizing the
importance of sugar on the American economy and for economic control of
the western hemisphere, the U. S. government provided all means possible to
create an environment for sugar cane planting in the inhospitable Everglades
region of southern Florida to be run by exiled Cuban sugar industrialists.
This effort was fostered quickly in order to regain control of an extraordinary
commercial trade market that helped support the U. S. government. Sugar
cane from Hawaii, Louisiana, Texas, and the sugar beet growth in the
Midwest were not considered to have been able to produce enough sugar to
sustain economic growth and pure dominance of this important commodity

The Preservation of Health

in the western hemisphere. The U. S. government’s efforts to protect the
sugar growers and the economy, bolstered by the economic embargo of Cuba,
helped to produce a successful transition of sugar supply and income to the
American people.

The Joy of the Sprawling Suburbs

This protection and support of sugar became fuel for many American indus-
tries during the economic boom covering the Sixties. After WWII, the Fifties
saw a major movement toward more rapid family growth. Homes were being
built in places that were formerly farmlands. Larger supermarkets sprang up
to replace the fresh foods of the smaller market stands and grocery shops with
a broader supply of canned, bottled, and packaged foods. Households in every
region of the country had a new access to baking supplies and home-cooked
meals without the use of home-delivered perishable dairy products. Stoves
and freezers were appliances that no housewife was to be without. School
cafeterias became the source of childhood lunches. Television increased con-
sumers’ awareness of beverages such as frozen orange juice, bottled soda pop,
and fruit-flavored powdered mixes. Store shelves packed more and more
ready-to-eat foods including candy bars, cup cakes, potato chips, and pretzels.
Huge markets for sweetened cereals aimed at children grew rapidly as did
other quick breakfast foods that made waffle and pancake preparation idiot-
proof. Coffee consumption skyrocketed. More ice cream filled those freezers
that housewives clamored for. More cookies and cakes were coming out of
household ovens en masse than ever before. Quick preparation frozen TV
dinners became the rage. Every one of these aforementioned products need-
ed sugar to remain tasty and to insure consumers would return for more of
these same products. Instead of simply blossoming, the market for sugar
exploded. No product and no consumer could escape this provision. Sugar
was in everything and everywhere. It was a successful gamble by the U. S.
government to protect and support it. Not even the federal government or
the sugar growers could have predicted this type of success. We can attribute
this rapid rise of sugar consumption to American consumers demand for
refined, canned, dried, packaged, bottled, and frozen foods which pervades
our selection of food choices every day.

This continuous growth for the need of consumers to have sweetened

foods in their diet caused industries to create even more sources of sugar. The
corn industry had finally developed a way to produce corn syrup relatively
cheaply and market it to food industries as a less expensive sweetener for
foods than cane sugar. By the early Seventies, corn syrup had made its way

Mark A. Falco, D.M.D.

into processed foods and soft drinks. The market for sweetened foods con-
tinued. Advertising increasingly targeted children. Research demonstrated
that people, especially children, craved sweetened foods. It was obvious that
to market sweetened foods to kids it wouldn’t take much effort at all.
Competition for market share became the driving force behind food process-
ing executives’ efforts to attract and maintain young consumers. Thus, the
constant media wars between the likes of Coca-Cola and Pepsi, Kellogg’s and
General Mills, and Nabisco and Keebler, dominated the airwaves. The turf
for market share was homes inhabited by children.

What’s Up with Sugar?

Aside from our preference for sweetened foods, why has sugar dominated the
food market to such an extent? It is conveniently cheap and effective. There
are three important aspects of the convenience of sugar usage, whether it is as
sucrose, corn syrup, or dextrose (obtained from corn), which have helped to
establish its inexorable presence in today’s food supply.

1. Refined syrups and sugars can be stored for long periods and they are

not subject to spoilage. In fact, they can help to retard growth of some
microorganisms. A can of soda can stay on a shelf for months without
the loss of taste. A sweetened fruit beverage can be kept in a refriger-
ator for weeks without a change in quality. Can you say the same thing
about milk? How about fresh orange juice? Refined sugars and syrups
can be frozen, heated, and mixed at room temperatures without a
change of properties. Therefore, sugar can be added to any processed
food, even from a sugar bowl, without harming the taste of any food.
A frozen dinner when cooked will not lose its content of sugar. A bot-
tled sauce poured over a baking roast will not lose its flavor. A packet
of sugar added to iced tea or hot coffee would still be sweet. Catsup,
mayonnaise, salad dressing, peanut butter, pickles, ice cream and
bread will still hold their sweetness. Long-term storage is not a deter-
rent to sugar consumption.

2. Sugar is cheap. Any food product containing lots of sugar or corn

syrup is of relatively low cost by weight and by calories compared to
other flavoring products. Everyone wants to eat well, but most times
food selections are based on price or taste. Usually the lower the
price, the higher the sugar content. Unfortunately, this leads to
improper food purchases that are not based on nutrient or caloric

The Preservation of Health

value. It also has led to purchase choices of sweetened food products
over natural foods.

3. Sugar gives foods texture. It helps to impart bulk to baking products.

It creates a smoothness to foods and beverages without any negative
aftertaste. Sugar helps to brown microwaveable foods and make them
more colorful. Sugar can also disguise the presence of fats in food.
Ever try eating a really plain donut without any sugar glaze? Which
feels smoother? Ever eat a plain bagel? It’s smoother than a very plain
donut, right? Well, a bagel has lots more sugar in it. A lot of tomatoes
go into a jar of tomato sauce. What keeps the sauce from tasting too
acidic after long storage? Yes, it’s sugar to the rescue. What keeps
canned foods so palatable? That’s right. It’s added sugar.

These three reasons have given the boost to an industry-wide acceptance

of sugar. This is why it can be found in practically every processed food.

The Refining Process

Refined sugars are manufactured in a way that allows them to retain the prop-
erties they were intended for; long-term storage, affordability, texture, and, of
course, sweetness. After harvest, the cane is transported to sugar mills near
the cane fields. The mills separate the sugar from the plant by first washing
and cutting the cane stalks. The juice from this is pressed out of the shredded
pulp and clarified by adding lime milk and carbon dioxide to extract out the
wax, fats, and gums. The remaining clarified sucrose solution is subjected to
multiple vacuum stages to remove water to allow the solution to be boiled at
low temperatures to become syrup. In the process of crystallization, a pulver-
ized seed of sugar is introduced to the solution under vacuum that creates the
formation of crystals that are then spun and dried yielding a golden raw sugar
that is about 97% sucrose. Molasses, the remaining raw syrup from the
extraction process coats the crystals. Any remaining nutrients from this
extraction process are to be found in the molasses. The raw sugar that is left
contains some impurities and is not stable enough for storage. From the mill,
the raw sugar is transported to a sugar refinery to complete the processing for
human consumption. At the refinery, the sugar is coated with a warm syrup of
water and sugar to loosen the molasses. This is spun down to separate the
molasses from the crystals which are then washed, dissolved, clarified, or fil-
tered to remove the molasses and any other impurities. The sugar is now a
gold colored liquid. Filters remove the color. Evaporation of water creates

Mark A. Falco, D.M.D.

thicker syrup. This syrup is placed under vacuum and seeded with fine sugar
crystals to create perfect sugar crystals. This is spun down to separate out any
remaining syrup. The crystals are then washed in hot water. These crystals are
placed into large dryers to remove virtually all of their moisture content. The
crystals are then passed over screens to separate the various sizes as specified
by industrial customers.

Sugar beets contain slightly more sucrose than sugar cane and are found

throughout the Midwest. The harvest of sugar beets is seasonal and so the fac-
tories do not operate year-round as do sugar mills. At the factories, sugar
beets are washed and sliced into thin strips that enter a diffuser to extract the
juice. As with sugar cane, lime milk and carbon dioxide are involved in this
process. The remaining juice is filtered leaving a golden light brown colored
juice that is boiled under vacuum to create a thick juice. Another filtration is
done and the juice is again returned to boiling under vacuum to form crystals.
This is spun down and washed with hot water to create the sugar crystals.
These crystals are then dried and passed over screens to separate the crystal
sizes for their customers.

Corn syrup is a sugar mixture produced from cornstarch after the starch

slurry has been heated under pressure with acids and enzymes. After several
different refining processes involving steeping, separation, grinding, and pro-
cessing, the final product is corn syrup, high-fructose corn syrup, maltodex-
trin, or dextrose. No vitamin or mineral content can be found at all in any
corn syrup product. Aside from the addition of a monosaccharide named fruc-
tose and a disaccharide named maltose, which are to be discussed in a later
chapter, the monosaccharide known as glucose is the only product of corn-
starch conversion to corn syrup. This conversion product is not sucrose. It is,
instead, glucose. Why would I repeat that statement twice? There is a very
significant differentiation that you will need to remember about these simple
types of sugars that will be addressed in detail a little later on.

Corn syrup has taken a dramatic foothold in the food industry as a sweet-

ener of choice, but not necessarily as a replacement for sucrose as a food
ingredient sweetener. In many products, sucrose as sugar and glucose as corn
syrup are ingredients contained within the same product. In the United
States, the baking industry uses more than one-half of the dextrose and about
ten percent of all the corn syrup produced. The advantage of corn syrup over
sucrose for food manufacturers is that corn syrup does not crystallize when
heated. This makes it more convenient to use in jams, jellies, baked goods,
candies, and soft drinks. The cost of using corn syrup by the food industry
also happens to be less than the cost of using sucrose. Corn syrup comprises
about 90 percent of all sweetened products today.

Where does flour fit into the refining process? Where does it come from?

To answer this best, let’s first identify the three classifications of nutrients for

The Preservation of Health

our bodies aside from water. They are carbohydrates, fats, and proteins. What
is flour? Flour is a carbohydrate, too. Actually, it is a complex carbohydrate.
A complex carbohydrate has a long chain of individual sugars connected
together much longer than the simpler glucose molecule. You will learn the
importance of this in chapters 4 and 5. A complex carbohydrate is also known
as a polysaccharide because of its multiple monosaccharide structure. This
type of sugar can be found in starchy vegetables such as potatoes, but it is
readily found in abundance in whole grains such as wheat, oats, and barley
which can also be processed for long-term storage just like sugar.

A whole grain such as wheat has three parts called the germ, the

endosperm (the bulk), and the bran. Most of the carbohydrates are in the
endosperm. Most of the vitamins and minerals are in the germ. Most of the
fiber is in the bran. In grain refineries, the whole grain is milled to strip away
the germ and bran in order for the remaining bulk to be further processed and
subsequently packaged for the food industry without turning rancid. This
milled product may be bleached, further refined, and separated to be used as
flour or to be packaged for use in pasta, cereal, or other baked goods. As with
sugar, the refined flour is in a condition whereby storage, spoilage, texture,
and cost have not and will not play a role in its restriction from industrial or
consumer use. However, just as sugar and corn syrup, flour has lost virtually
all of its vitamin and mineral content.

An Addiction?

Our consumption of refined sugars and syrups has increased by thirty per-
cent since 1970. No other food ingredients have found their way into more
foods so consistently and increasingly than the refined sugars and syrups.
These products continually make their way into our foods because of our
wide acceptance of prepared meals and our craving for sweet tasting sub-
stances. Our present sugar consumption is now accepted as an addiction.
The dictionary defines addiction as the surrender of oneself to a habitual or
compulsive desire for something. But sugar addiction is not an affliction of a
few people. It is also not just an addiction afflicting obese people only. Sugar
addiction is afflicting our entire population from infancy to old age. This fact
truly situates sugar consumption as a most serious affliction of pandemic
proportions.

Mark A. Falco, D.M.D.

The Dominating Presence of Sugar

•

Sugar satisfies a desire for a sweet taste

•

Sugar is conveniently stored

•

Sugar is cheap

•

Sugar gives texture to food

•

Sugar is addictive

The Preservation of Health

Sugar Rush

The Importance of Glucose

Is there anything good about sugar? Actually, we know that sugar (in the form
of glucose) is a vital component of our bodies. Next to oxygen and water, glu-
cose is the most vital ingredient to facilitate energy production in the body.
Without glucose, our cells would not put forth enough energy to sustain
function beyond several minutes. Glucose provides the energy for the cells to
perform their functions. The majority of glucose is obtained from the break-
down of carbohydrates from our diet. Although all cells of the body require
glucose, the brain and blood cells need the steadiest diet of glucose to perform
all of their functions efficiently and correctly. Other body cells can suffer
through a temporary loss of glucose by converting fats and proteins to glu-
cose in resting states when needed, but the brain and blood cells make little
attempt to make this same conversion. The reason for this is that the body
behaves as a machine by using up stores of glucose rapidly as if they were low-
octane gasolines functioning in high gear. The cells continue to burn the glu-
cose swiftly and efficiently for constant energy. When fats and protein are
used for conversion to glucose, this immediacy and efficiency is slightly com-
promised. Instead of the machine functioning in high gear with low-octane
gasoline, it downshifts to a lower gear pumping out more costly high-octane
gasoline to move forward more smoothly and steadily. The brain cannot
afford to function this way on a regular basis and so it relies primarily on the
glucose which comes from carbohydrates to run as low-octane gasoline in
high gear never intending to increase its run at the expense of more nutrients
(high-octane gasoline). Energy is not wasted in this process.

In order to obtain a constant supply of glucose for the brain, a regulated

amount of glucose concentration must be flowing in the bloodstream at all
times. The blood constantly bathes the brain with oxygen and nutrients,
including glucose. This is the best means of keeping a steady supply of glu-
cose available for entry into brain cells. The body’s hormones help to insure
a constant supply of glucose to the body cells especially the brain by normally

regulating sugar or glucose levels in the blood. In summation, the body
derives glucose from the breakdown of carbohydrates and this glucose is
transported throughout the body via the bloodstream to be used as fuel.

If we need glucose to carry on the maintenance of life, how do we know

if we’re getting enough? Hormones, which are substances secreted by partic-
ular glands into the bloodstream that influence the activities of other distant
cells, help to regulate our body’s response to the amount of glucose entering
our bloodstream after a meal. Most hormones are synthesized from amino
acids derived from protein or from steroids derived from cholesterol. (Some
hormones are derived from fatty acids). Some of the hormones that are
important to blood-glucose levels are cortisol, epinephrine, norepinephrine,
insulin, and glucagon. Thyroxin, growth hormone, and the sex hormones
have also been shown to exert some influence on blood-glucose levels as well.

Cortisol

Cortisol belongs to the main group of hormones known as stress hormones
because their release is increased dramatically during physical or emotional
stress. As cortisol pours into the bloodstream during episodes of stress, its
action is on liver cells that convert fats, proteins, and stored glucose (known
as glycogen) into glucose for additional release into the bloodstream. Again,
this helps to prevent interruption in the supply of fuel the brain needs from
the circulating glucose in the blood.

Cortisol’s action is to promote normal function of other body tissues by

helping to regulate blood-glucose levels during either external environment
changes or during fasting or starvation. Its heightened secretion occurs only
under stress. Cortisol acts like a two-way light bulb. It displays a minimal
amount of light normally, but it can immediately switch into a greater lumi-
nescence when more juice stimulates it.

Cortisol is manufactured in the adrenal cortex, an outer layer of the adre-

nal gland located above the kidney. Adrenal glands are paired, just as the kid-
neys are. They are physiologically known as endocrine glands. Endocrine
glands are glands that produce hormones. The adrenal glands themselves are
controlled by other regulatory mechanisms that reside within the brain.
Cortisol and its counterpart, cortisone, exhibit anti-inflammatory properties
on body tissues. Their properties are simulated by cortisone or prednisone
injections given by doctors for their patients suffering from rheumatoid
arthritis or allergies. However, excessive levels of these natural or man-made
hormones over long periods of time can contribute to unwanted conditions
such as bone loss and a depressed immune system. Another unwanted condition

The Preservation of Health

of cortisol during stress is its ability to scramble our appetite control mecha-
nism causing us to make poor food choices when we’re hungry. Its greatest
effect on appetite is its association with serotonin, a significant messenger in
the brain.

Continually excessive release of cortisol will reduce the brain’s ability to

utilize glucose effectively. This creates two problems. First, it forces a person
to eat increased amounts of sugar to try to offset this reduction. Secondly,
free-radical damage occurs to brain cells as the cortisol exposure over time
becomes toxic. This can interfere with memory and learning ability and can
also increase anxiety. Elevated chronic levels of cortisol have also been asso-
ciated with depression and weight gain.

Pancreatic Hormones

The hormones insulin and glucagon help to direct the flow of glucose into or
away from the bloodstream. The pancreas, a mixed endocrine organ located
behind the stomach, synthesizes these hormones and secretes them into the
bloodstream. Insulin has the action of removing glucose from the blood-
stream and pushing it into cells for storage as glycogen or fat in the liver,
skeletal muscle, or fat tissue known as adipose tissue.

Glucagon is secreted to counteract the effects of insulin. Its primary

target is the liver where it activates cells to release glucose from stored glyco-
gen. The released glucose then enters the bloodstream. The balancing oper-
ation of insulin and glucagon is a classic example for what is known as a neg-
ative feedback mechanism. This simply means that as the level of one prod-
uct, in this case it is glucose, is too high, the counteracting agent, in this case
it is the hormone insulin, is released to lower it. This also operates effective-
ly when the opposite is true. When blood-glucose is low, glucagon is released
to stimulate glucose entry into the blood. Insulin is identified as a ‘hypo-
glycemic agent’ meaning it removes excess glucose from the blood. Glucagon
is a ‘hyperglycemic agent’ meaning it increases glucose levels in the blood-
stream when they’re low.

The normal blood-glucose level is approximately 85 milligrams of glu-

cose to 100 milliliters of blood. That is equivalent to around two teaspoons
of sugar for the entire blood volume. Levels above 90 milligrams of glucose
in the blood, which occur right after the glucose in a meal is absorbed into
the blood, cause the secretion of insulin. The insulin looks for places to
move the glucose away from the bloodstream to bring the level back under
90 milligrams again. This can sometimes take several hours. Glucagon on
the other hand is released to raise the blood glucose level when it falls below

Mark A. Falco, D.M.D.

90 milligrams between meals. It acts by finding places where available glucose
can be released into the bloodstream. Insulin and glucagon constantly work
to create a blood-glucose balance during post digestion and fasting states.

As stated earlier, the brain needs its constant supply of glucose causing

insulin and glucagon to act in response to food ingestion or food fasting by
keeping the blood-glucose level in an optimum range. If the glucose level
increases above 165 milligrams of glucose per 100 milliliters of blood, the
excess glucose spills into the urine. This is one of the classic signs for detect-
ing diabetes. Diabetics for one reason or another have an inability to release
enough insulin to move the glucose out of the blood or their cells have
become resistant to insulin. When glucose is properly removed from the
blood it will be transported immediately into muscle cells, connective tissue
cells, or white blood cells, or it will be used up by the brain, liver, or kidneys.
If it isn’t needed immediately, it is transported to the liver or skeletal muscle
for storage as glycogen or it is transported to adipose tissue for storage as
triglycerides with the aid of insulin.

The presence of amino acids, the smallest component of proteins that

body cells can utilize, and to a lesser extent the presence of fatty acids, the
smallest components of fat that body cells can utilize, after ingestion from a
meal will also increase levels of insulin. Insulin secretion will also promote
protein synthesis and fat storage.

Brain chemicals

Epinephrine and norepinephrine are hormones secreted by the interior por-
tion of the adrenal glands known as the adrenal medulla. Levels of arousal and
anxiety are influenced partly by both of these hormones. Both are manufac-
tured from an amino acid called tyrosine. These hormones target the cells of
what is known as the sympathetic nervous system, a division of the autonom-
ic nervous system that mobilizes the body during extreme situations.
Oftentimes the effects of these hormones produce the ‘fight or flight’
response to stimuli by swinging a person into a state of fear, rage, or height-
ened activity. Both hormones act in the same way by increasing blood-glucose
levels and constricting most vascular blood vessels. Epinephrine will also
increase the heart rate. Their actions are similar to cortisol in that they are
released during stressful situations, however, their response to a situation are
as brief bursts during an emergency while cortisol’s effect is much longer last-
ing. These emergency releases of epinephrine and norepinephrine are desir-
able for raising blood-glucose levels quickly in order to give the body power-
ful energy to mobilize into a quicker action. The liver, skeletal muscles, and

The Preservation of Health

adipose tissue are acted upon to mobilize the conversion of sugars, amino
acids, and triglycerides into glucose immediately during these emergencies.

Norepinephrine also functions as a neurotransmitter. A neurotransmitter

is a substance that allows one nerve to communicate a message to another
nerve. A neurotransmitter can also be described as a brain messenger. The
action of a neurotransmitter is to regulate a bodily state or activity such as
sleep, hunger, anger, joy, memory, or mobility. Norepinephrine is a neuro-
transmitter that is present in many parts of the brain. It is known as the ‘feel-
ing good’ brain messenger. Its release will influence the selection of more
sweets for ingestion increasing the appetite for this food. Norepinephrine is
important for memory, storage, and retrieval. If you feel as though you’ve for-
gotten where you have placed something only several weeks ago, you may
have encountered a momentary loss of norepinephrine transmission in the
brain. It has been shown that exercise boosts norepinephrine levels and con-
tributes to better alertness. When norepinephrine levels are low, depression,
irritability, and moodiness are triggered. High levels of norepinephrine, how-
ever, can cause mania or even violence. High levels are most likely an over-
powering response to the perception of a heightened danger.

Amphetamines act on the neurotransmitter norepinephrine by increasing

more availability of it for a much longer period of time. Cocaine acts on nor-
epinephrine by prolonging its transmission between nerve cells. Both drugs
contribute to increased pleasure of the mind. Psychiatrists, on the other hand,
use tricyclic antidepressants such as amitryptaline (Elavil) and imipramine
(Tofranil) to calm moods or increase concentration by addressing norepi-
nephrine and serotonin levels. Monamine oxidase inhibitors (MAOIs) are also
prescribed to maintain better behavioral balance by regulating norepineph-
rine, serotonin, and dopamine levels in the brain. Dopamine is a neurotrans-
mitter also made from tyrosine. It is closely related to norepinephrine, but
unlike norepinephrine, dopamine depresses appetite instead of increasing it.
Its effect on pleasure and mood is similar to norepinephrine.

In much the same way, amphetamines and cocaine act on dopamine as

well by increasing the euphoric mood associated with these drugs.
Cocaine addiction is the result of the need to replace the effect on recep-
tors in the brain that have lost the normal amounts of norepinephrine and
dopamine dried up from drug overuse. Neuroleptics such as fluphemazine
(Prolixin), haloperidol, (Haldol), and chlorpromazine (Thorazine) are
prescribed to affect dopamine levels to balance a patient’s perception of
reality. The anti-obesity drugs fenfluramine/phentermine (Fen/phen) and
dexfenfluramine (Redux) act by reducing levels of norepinephrine in the
blood. This created the problem whereby dangerously low blood pressure
and even cardiac arrest occurred in patients who had been taking the
drugs for some time.

Mark A. Falco, D.M.D.

The neurotransmitters norepinephrine and dopamine are produced and

maintained when a good protein meal is eaten more consistently. Another
neurotransmitter, serotonin briefly mentioned earlier, is produced and main-
tained when a good carbohydrate meal is eaten on a steady basis. Serotonin is
synthesized from an amino acid known as tryptophan. Serotonin has been
shown to control moods including aggression, induce sleep, inhibit pain, and
influence the intake of carbohydrate-rich foods. Even though tryptophan is
derived from protein, as is tyrosine, these two amino acids compete with each
other for entry into the brain based on blood-glucose levels. If your food
intake is comprised of high protein levels, tyrosine will increase its entry into
brain cells. When your craving is for sweets, tryptophan is preferred for
uptake by brain cells. A high-protein, low carbohydrate meal lowers serotonin
levels. A high-carbohydrate, low-protein meal raises serotonin levels. In the
presence of large amounts of blood-glucose, the amino acid tryptophan is
given the green light by insulin to cross the blood-brain barrier exclusive of
other amino acids just to be converted to more serotonin. Within an hour,
stress and anxiety are relieved. Alternatively, a high-protein, low-carbohy-
drate diet reduces levels of tryptophan and serotonin in the brain. For this
reason, an adequate, but not excessive, carbohydrate intake is important for
normal brain activity.

Interestingly, studies have linked caffeine to increased levels of trypto-

phan in the brain, but lower serotonin levels overall. It could be that levels of
melatonin, a neurotransmitter derived from serotonin, may be accelerated in
response preventing the normal recycling of serotonin. Nicotine from tobac-
co also affects serotonin levels by stimulating their release. Smokers attempt-
ing to quit experience symptoms of withdrawal that make them turn to an
increase in the intake of sweets to regain the more familiar levels of serotonin
that they had during the period of smoking the tobacco product.

Regular exercise raises serotonin levels contributing to improved mood.

Excess levels of serotonin create a calming effect and also induce sleep.
Increasingly high levels are conducive to shyness, obsessive compulsion, fear-
fulness, and a lack of self-confidence. Extremely low levels of serotonin have
been linked to suicide, depression, violence, and alcoholism. Its easily seen
how this one brain chemical can have so much influence on someone’s behav-
ior by closely linking pain and pleasure with small changes in the amount of
this chemical’s presence in the brain.

Cortisol will lower serotonin levels. This would mean that chronic stress

contributes to a reduction in serotonin levels and altered moods. Excessive
alcohol intake lowers tryptophan levels. This impairs serotonin production
and leads to depressive states. Initial intake of alcohol even when repeated
creates an early rise in serotonin, but it steadily begins to fall with continued
imbibement. This initial rise in serotonin is the reason that affected alcoholics

The Preservation of Health

need to take those first drinks again and again. Cocaine reduces serotonin lev-
els by squeezing it out with more and more cocaine use as its longer-lasting
replacement. The rave drug Ecstasy acts by causing a flood of release of sero-
tonin from nerve receptors and prolonging its presence at the risk of damaging
nerve endings. Even premenstrual syndrome is now considered to be a form of
depression tied to plunging serotonin levels during the menstrual cycle.

Melatonin released by the pineal gland, an endocrine gland within the

middle of the brain, attains the highest levels at night and the lowest levels
during the daylight in normal conditions. This is because melatonin regulates
the state of wakefulness and sleep. Exposure to light lowers melatonin levels
and raises serotonin levels. The reverse holds true as well. Melatonin levels
are higher and serotonin levels are lower during sleep. Serotonin levels are
lower and melatonin levels are higher during the shorter daylight hours of
winter. Melatonin release is also related to carbohydrate intake. Levels of
melatonin happen to decrease with age. It’s important to note that melatonin
is made from serotonin. The two chemicals complement one another.

Neurotransmitters nicknamed the natural opiates, beta-endorphins and

enkephalins, are long-chained amino acids that exert a euphoric effect on
receptors in the brain. They naturally inhibit perception of pain. Narcotics
such as heroin and morphine act in the same way on the same receptors in the
brain. The heightened sensation of joy and peacefulness experienced during
and after intense exercise or competition by an athlete are attributed to beta-
endorphins. Beta-endorphins do not affect regular eating habits, but they do
turn on a desire for sweets because sweets help to raise levels of beta-endor-
phins in the brain. The mere touch of sugar on the tongue produces an imme-
diate endorphin rush. Do you wonder why taking a sweetened drink from a
baby bottle calms babies? You can owe it to the endorphin rush. The body’s
intake of sugar creates an intense endorphin rush followed by a slower-acting
release of serotonin. Both substances calm mood and satisfy hunger.

If a consumed meal of sugar comes from complex carbohydrates (starch-

es), but not sweets, levels of serotonin will still become elevated. However, no
endorphin rush will occur as a result. Does that sadden you? You can get an
endorphin rush from a fruit drink or cake icing, but not from rice or green
beans. Which might a teenager choose?

Effects of the Sugar Habit

Today, psychiatrists look for altered brain chemical concentrations
(neurotransmitter imbalances) in order to diagnose mental disturbances.
They treat their patients with drugs that can only perform temporary fixes

Mark A. Falco, D.M.D.

and that always compromise their patients’ lifestyle. Is it possible that altered
brain chemical concentrations not attributed to genetic damage can be
acquired from repetitive high sugar consumption? There may be a strong
possibility.

Carbohydrate-rich foods have the source of the instant glucose we need

to raise levels of norepinephrine, serotonin, and another amino acid derived
neurotransmitter called gamma-aminobutyric acid (GABA). Most studies
have focused on serotonin levels. When serotonin stores in the brain are low
between meals, mood swings develop. Restlessness ensues and a voracious
appetite for carbohydrates is turned on to raise serotonin levels. Why are car-
bohydrates craved above all else? Remember the amino acid tryptophan? An
influx of glucose into the bloodstream allows more circulating tryptophan to
enter the brain to be converted to more serotonin. Presto! The mood swing
returns back to normal. The desire for cakes, doughnuts, and pastries substi-
tuting for more nutritious foods is a result of crashing serotonin levels. Some
people are more serotonin-sensitive or more carbohydrate-sensitive than oth-
ers and this, too, can influence the desire for sweets on a greater scale.
Serotonin levels remain normal only when excess sugar intake is minimized.

After enough carbohydrates are consumed, the switch for carbohydrate

craving is turned off. This involves the pancreatic hormones and regulatory
mechanisms within the brain. After about an hour, the agitated mood is
calmed. Depending on the total carbohydrate intake, excess serotonin may
induce sleep enabling more melatonin to be released to prolong the use of the
tryptophan that has entered the brain cells. This is why a high-carbohydrate
meal can make you sleepy if the excess carbohydrates are not used up in a
form of activity or exercise. As mentioned earlier, whatever is not used up
immediately needs to be stored elsewhere in the body because the body does-
n’t like parting with glucose unless it’s going to be used up for energy.

Every year 30,000 people in the United States commit suicide.

Researchers say that lack of enough serotonin contributes in large part to
these suicides. Suicide is the third leading cause of death among youths.
Mood-altering drugs now defined as serotonin reuptake inhibitors (SSRIs)
are prescribed frequently. They act to prolong the presence of serotonin in
the brain by having it remain much longer before returning for a recycling
within the nerve cells. SSRI drugs include fluoxetine (Prozac), sertraline
(Zoloft), paroxetine (Paxil), and fluvoxamine maleate (Luvox). They are used
to treat serotonin imbalances resulting in bulimia, obsessive-compulsive dis-
orders, depression, and anxiety disorders. Other anti-psychotics such as
risperidone (Risperdal), clozapine (Clozaril), and olanzapine (Zyprexa) are
used to regulate both serotonin and dopamine levels. Changing serotonin and
dopamine levels cause hyperactivity in children. Methylphenidate HCL
(Ritalin), a drug used to treat attention deficit hyperactivity disorder (ADHD)

The Preservation of Health

affecting about 5 per cent of children between the ages of 4 and 14, acts upon
serotonin and dopamine receptors in the brain.

Could it be possible that the body’s regulation of glucose has been altered

or damaged in a mentally unstable individual? Could this have occurred
before symptoms of a mental disorder was diagnosed? Could the mentally dis-
abled be more sensitive to the damages associated with high sugar intake?
Could stress in children be magnified much more than has been previously
realized? Are we giving our stressed youth the proper guidance toward the
improvement of their lives? In my opinion, a high sugar intake contributes
heavily to poor mental health. A poll of recent doctors found that almost 75
per cent of them had written a prescription for an antidepressant to patients
under the age of 18. The drug fluoxetine (Prozac) is now prescribed to chil-
dren under age 16 about 350,000 times a year! Are drugs the answer? Stop the
excess sugar consumption first.

Studies have proven that bad experiences in childhood induce stress that

affects genes by practically reprogramming them to respond to conditions
differently and sometimes abnormally. Abusive situations, feelings of aban-
donment, trauma, and fear create long-standing emotional anxieties that can
often go undetected because they are repressed. Reprogramming of condi-
tions that can influence something as unexpectedly terrifying as receiving an
injection for placement of a dental filling can affect behavior patterns for a
lifetime. The underlying stresses that have shaped behavior eventually wear
down a person resulting in emotional or social problems, violence, depend-
ency, or disease.

It is a well-established fact that impaired mental function occurs from

nutrient deficiencies. A lot of the nutrients required by the body are utilized
in the manufacture of the neurotransmitters, hormones, and enzymes we need
every day. If the mechanisms of brain chemical formation and release, blood-
glucose balance, and glucose utilization become compromised due to inap-
propriate replacement levels of the nutrients involved in these mechanisms,
the body tissues begin a slow death, become altered, or experience both alter-
ation and death. Increases in the frequency of allergies, mental illnesses, obe-
sity, heart ailments, vascular diseases, bone and joint diseases, tooth decay and
gum disease, and cancer all point to breakdowns in body tissues. Many of
these tissues have lost the right balance of nourishment.

Children and teenagers are more vulnerable to the effects of stress and

nutrient deficiencies. Growth and development, cognitive function, and
immunity are compromised in these important years when proper nutrients
are not consumed. A diet high in sugar, especially sweets, leads to depression
of white blood cell activity. White blood cells are needed to ward off or
destroy infectious substances that enter the body. Since hormones are acti-
vated in response to stress, it is a clear indication that sugar begins its damage

Mark A. Falco, D.M.D.

on the body early in life possibly involving infancy if parents unknowingly
feed infant formulas, drinks, or foods with refined sugars or corn syrups to
them.

Since recent studies confirm that teenagers are normally getting 20 per

cent of their calories from added sugars, averaging about 30 teaspoons of
added refined sugar a day, it is not a coincidence that teenagers have varied
mood behaviors and uncontrollable urges. Only two teaspoons of glucose
need to be circulating in the blood at any one time. How are those 30 tea-
spoons of sugar plus the remainder of a daily load of natural carbohydrates
consumed, stored and burned up in those same teenagers? If the sugars are
not burned up through exercise, they may contribute to weight gain. Are the
right balances of nutrients available to assist in the processing of this much
glucose to completion? Absolutely not!

We know quite well that serotonin, norepinephrine, and GABA are the

brain chemicals that cause us to crave sweets. We know also that the effects of
caffeine, tobacco, alcohol, heroin, morphine, cocaine, amphetamines,
fIuoxetine, sertraline, and alprazolam (Xanax), which affects GABA concen-
tration, influence the behavior of these chemicals in the brain. Why are we
not, then, regulating the amount of refined sugar that is added to food prod-
ucts? If you think that’s a silly question, please think again. Caffeine is a
known stimulant. Tobacco and alcohol are government regulated (age restric-
tions are enforced and extreme levels are a health risk). Psychiatric medica-
tions are dispensed only by qualified doctors and are subject to dispensing
restrictions. Illegal drugs are just that—illegal. Sugar influences the same
exact brain chemicals that each of the aforementioned substances influence.
Do you not think that sugar is addicting? It is. All of the other substances men-
tioned have been proven to lead to addiction. Can excess sugar consumption
lead to altered moods, disease, and dependency? The other substances have
been shown to alter mood, cause disease, develop dependency, and even lead
to crime. All for what purpose? Answer: To satisfy the feeling that these prod-
ucts have on the brain. If we haven’t been increasingly exposing the children
in our society to increased amounts of addicting sugars, we may not have seen
such a paralleling increase in the use of tobacco, alcohol, or drugs even before
our youth have reached 21 years of age. Children and teenagers remain the
most easily affected and most easily altered by the effects of these substances
on the brain.

Stresses in family life and poor eating habits contribute to reduced stores

of neurotransmitters in the brain. The craving for more and further lasting
substances that stimulate the chemical receptors in the brain can trigger a
young person to react in different ways by altering his or her mood, con-
tributing to a disease, developing a dependency, or even leading to crime.

The Preservation of Health

Hormones Affecting Blood-Glucose Levels

•

Cortisol

•

Epinephrine

•

Insulin

•

Glucagon

•

Thyroxin

•

Growth hormone

•

Sex hormones

Causes of Low Serotonin Levels

•

Excess sugar intake

•

Stress

•

Increased alcohol consumption

•

High protein intake

•

Illegal drugs

Mark A. Falco, D.M.D.

Sugar Shock

Complex Carbohydrate Journey

What happens to sugar as soon as we eat it? If it’s so important, the body will
produce energy from it immediately, right? The answer to the second ques-
tion will be addressed in chapter 5. The answer to the first question is best
explained by dividing it into two parts: what happens to complex carbohy-
drates and what happens to simple carbohydrates as soon as we eat them?

First, we’ll discuss the breakdown of complex carbohydrates (whole

grains, brown rice, and starchy vegetables). In the mouth, the complex carbo-
hydrates are acted upon by digestive organs including the teeth and tongue
for mastication (chewing), starch-digesting enzymes known as salivary amy-
lases, and other digestive enzymes primarily residing in the saliva. The saliva
also contains low levels of the B vitamins, vitamin C, and vitamin K to help
assist in the proper utilization of these sugars. The teeth are important
because they are meant to grind up the fiber of the grains and vegetables to
release the carbohydrates from the cells. Plants also have another type of car-
bohydrate as fiber called cellulose in their cell walls of which humans don’t
use as nutrients but act, instead, to aid in the movement of digested foods
through the intestine. Therefore, our teeth are needed to cut through the
plant cell walls to enable appropriate digestion of the starches.

In a neutral to slightly acidic environment, salivary amylase begins to break

down the long-chain complex carbohydrates known as polysaccharides into
smaller chains. This is done by the addition of water molecules. The smaller
carbohydrate chains are then swallowed following mastication and continue to
be digested by salivary amylase as they reach the stomach. Once in the stom-
ach, the salivary amylase is inactivated by the higher acidity of the stomach.

From the stomach, the remaining small and long-chain polysaccha-

rides are further acted upon by pancreatic amylase that is secreted into the

duodenal portion of the small intestine. Enzymes within the cell membranes
of the duodenum will further breakdown the fragmented polysaccharides into
the monosaccharides glucose, fructose and galactose, simple carbohydrates
also known as simple sugars as they pass through the small intestine. The
fragmented complex carbohydrates are slowly and systematically broken
down to monosaccharides for distribution into the bloodstream. Insulin lev-
els can stay in better control this way. Digestion and absorption of complex
carbohydrates continues uniformly and without straining insulin secretion.
The amount of surface area provided by the intestinal cell membranes due to
their microscopic finger-like projections is about the size of a tennis court.
This is where the absorption of simple sugars occurs into the bloodstream.
The stomach, however, has very little ability to absorb any nutrients.

In the bloodstream, almost all of the circulating simple sugar is exclusive-

ly glucose. Fructose needs to pay a visit to the liver in order to be converted
to glucose. Therefore, the metabolism of fructose is much slower than for
glucose. Glucose from galactose is derived from the milk sugar lactose. It, too,
converts slowly to glucose. Refined grains are absorbed much more rapidly
into the bloodstream than whole grains because the carbohydrate complexes
in refined grains have been previously split apart during the refining process.

Glycogen and Triglyceride Storage

Excess glucose that is not used immediately is converted in the liver for stor-
age as glycogen. When large amounts of glucose are to be absorbed for stor-
age by cells in the body, larger amounts of the hormone insulin, formed from
amino acids, are secreted by the pancreas, increasing to ten times or more the
rate of glucose transport into cells. The amount and rate of insulin secretion
is dependent on the body’s regulation of the blood glucose level. Insulin is also
important in converting excess stored glucose into fatty acids in the liver
which is then transported to tissues and deposited as fat. After all, the liver can
only store so much glucose under normal conditions. In the liver, fatty acids
are used to synthesize triglycerides, a stored fat. In the blood, the triglycerides
are released as lipoproteins, which are the transport vehicles for lipids (fats) in
the bloodstream to tissues.

The energy that is stored up in triglycerides is about 65 times greater than

the amount of energy stored up in glycogen. This means that a lot more calo-
ries can be burned up in cellular activities by converting triglycerides back into
energy than when glycogen is converted back into energy .The reason for this
is a simple one. The body prefers to use triglycerides in massive doses for ener-
gy when it needs it. Glycogen is composed of linked glucose molecules that get

Mark A. Falco, D.M.D.

stored mostly in the liver and skeletal muscle. When the glycogen is needed
to convert back to glucose, the hormone glucagon activates this conversion to
raise blood-glucose levels and, separately, the hormone epinephrine activates
this conversion to produce an emergency action. Triglycerides are synthe-
sized mainly from carbohydrates in the liver when the glycogen stores have
become saturated. The glucose is converted to fatty acid. Several fatty acid
chains grow in size until they can couple with glycerol, an oil derived from fat,
to form a triglyceride molecule. The triglycerides are moved out of the liver,
bound to very low-density lipoproteins, and transported to adipose tissue.
When triglycerides are needed for conversion to glucose, an entirely differ-
ent mechanism occurs. Only the glycerol portion of the triglyceride molecule
can be converted to glucose again. The fatty acid portions originally formed
from glucose conversion cannot be returned as glucose. The fatty acids will
be used for energy, but not as glucose. Insulin, cortisol, epinephrine, and nor-
epinephrine are the major hormones that activate the conversion of triglyc-
erides. Glucose is used constantly for energy by the brain, red blood cells, and
white blood cells. The brain prefers glucose exclusively. The liver, cardiac
cells of the heart, and resting skeletal muscles prefer to use the fatty acids as
their primary energy source. When necessary almost all of the amino acids in
the body can be separated from protein and be converted into glucose.
Cortisol activates the separation of the amino acids and distributes them into
the bloodstream under chronically stressed conditions when blood-glucose
levels require it.

Most triglycerides are stored in fat (adipose tissue) and connective tissue.

Connective tissue is an abundant primary body tissue that helps support, insu-
late, and protect other structures and organs. Blood is considered to be a con-
nective tissue that is involved in transport. There are two reasons why triglyc-
erides are the main storage source for energy. First, they can be deposited in
greater numbers throughout the body than glycogen can. Although the fatty
acids are constantly turned over for use, triglycerides help to weather the
stormy times when proper food may not be readily available or readily eaten.
Secondly, strenuous exercise or muscle activity needs an available energy
source that doesn’t compromise the working efficiency of other important,
cells and organs. Active skeletal muscle will use up glycogen rapidly.
Therefore, the mechanism known as lipolysis (hydrolyzing lipids into fatty
acids and glycerol from triglycerides for energy conversion) is the production
of choice for greater endurance. The reason that athletes ingest a high-car-
bohydrate meal before a vigorous activity is to take advantage of available glu-
cose in the blood sparing the stores of glycogen. Meals high in dietary fats do
not behave similarly because they empty very slowly from the stomach unlike
carbohydrates. Fats are processed differently leading to further delay before
they are eventually released into the bloodstream for energy use.

The Preservation of Health

Insulin inhibits the conversion of amino acids into glucose, and so, helps

to retain protein (and more insulin). But, it also helps to actively transport
amino acids into the cells to help form more proteins. In the presence of
amino acid ingestion from the breakdown of digested proteins, a minimal
amount of insulin is released. When glucose and amino acids together
become available for digestion, insulin is produced in even greater amounts
than with glucose alone.

Simple Carbohydrate Journey

For simple sugars and other sugars (table sugar, corn syrup, honey, maple
syrup, fruits, malt, and milk) the mechanism of breakdown changes slightly.
Mastication can begin the digestion of fruits and grains, but has very little
impact on the digestion of liquids, syrups, jellies, puddings, sweets and other
snacks. Salivary amylase is basically ineffective with disaccharides that are pri-
marily sucrose (table or confectioner’s sugar), lactose (milk sugar), or maltose
(malt) because they are only one fragmentation away from absorption into the
blood in the small intestine as monosaccharides. However, harmful bacteria
living in the mouth will adapt and can overwhelm the good bacteria because
the harmful bacteria can feed on monosaccharides and disaccharides much
more easily than on the complex carbohydrates. Yeast love the simple carbo-
hydrates, too. Constant intake of simple carbohydrates allows harmful bacte-
ria to further multiply and continually acidify the mouth.

Once in the small intestine, there are few fragments of remaining simple

carbohydrates and, of course, no fragmented polysaccharides. So, the small
intestine starts transporting the monosaccharides (glucose and galactose) into
the bloodstream in droves, no longer slowly and systematically. Fructose is
the exception. It is transported in an orderly way. The overwhelming influx of
rising blood sugar as glucose and, to a smaller extent, galactose forces a rapid
and heightened secretion of insulin. The pancreas no longer has hours to deal
with this; it has minutes. Blood glucose levels must return to normal as quick-
ly as possible. This can still take hours. Due to this rapid influx of glucose and
subsequent response, it has become imperative for our bodies to endure a
rapid decrease in blood glucose as well. And why not? The insulin is very
effectively removing the glucose from the blood. So much so that it can
remove too much and needs the assistance of glucagon to raise blood glucose
levels by targeting the liver and fat tissue to release stored glucose.

Epinephrine will also cause fats and amino acids to produce glucose when

there is a shortage of glucose in the blood. Cortisol, growth hormone, and
thyroxin will behave similarly. The essential difference with simple carbohy-

Mark A. Falco, D.M.D.

drates and refined grains over complex carbohydrates is that the simple car-
bohydrates and refined grains, when consumed routinely and consistently,
constantly overwhelm the normal circuitry of the body’s systems and, as we
shall see, contribute to often permanent changes and a predisposition to var-
ious diseases.

Nutritious and Fiber-rich Carbohydrates

•

Whole grains

•

Legumes

•

Root vegetables

•

Green vegetables

•

Yellow vegetables

•

Whole fruits

Poorly Nutritious and Fiber-deficient Carbohydrates

•

White flour

•

Sugars and syrups

•

Processed fruit juices

•

White baked goods

•

White starches

•

Jams, jellies, and preserves

•

Sauces, spreads, and dressings

•

Beer and wine

The Preservation of Health

The Good and the Bad of Sugar

Complex Carbohydrate Foods

The recommended daily allowance (RDA) of carbohydrates by the USDA is
60% of the total calories taken in. That equates to 1200 calories on a 2000
calorie-a-day diet. That equates to 1500 calories of a 2500 calorie-a-day diet.
More would be necessary for those individuals who exercise regularly. I
believe the RDA level is slightly high. Does it still matter, though, if the
intake is mostly simple carbohydrates and not complex carbohydrates? In the
last one hundred years, we’ve seen a direct correlation in the rise of adult-
onset diabetes, coronary artery disease, and asthma alongside an increased
intake of simple carbohydrates. Some experts say there’s even been an
increase in mental sickness to correlate with this as well. Two hundred years
ago, a person consumed eight pounds of sugar as simple carbohydrates in an
entire year. Today, as I have mentioned earlier, it’s around 150 pounds a year.
This correlation with disease is not just speculation. We’ll examine more facts
about this later.

What foods in our diet are full of complex carbohydrates? In their

natural states, whole grains (wheat, barley, etc.), starchy vegetables and brown
rice are good foods, right? Let’s examine these closer starting with whole
grains. A whole grain such as wheat has three parts, the germ, the endosperm
(the bulk), and the bran. Most of the carbohydrates are in the endosperm.
Most of the vitamins and minerals are in the germ. During milling, the grain
is stripped of the germ and bran so it can be packaged without turning ran-
cid. What’s left is a carbohydrate meal without the nutrients necessary to
become directly involved in the energy the body needs to work the carbohy-
drate into fuel. In addition, the grain is then bleached, molded, refined and
then packaged into a familiar form as bread, pasta, or cereal. All three of these
products have lost their original nutrients. Even though government regula-
tions demand that certain nutrients are returned to a good portion of these
products after processing, it is rarely in the most productive proportions.

Whole grains lose their B vitamins, vitamin E, protein, unsaturated fats, and
minerals when they are milled and refined. Brown rice and wild rice have
most of their nutrients intact. White rice has lost its B vitamin content and
some of its protein, calcium, phosphorus, and iron.

The loss of B vitamins has a very significant impact on glucose metabolism

because many of the processes that convert glucose to energy require these
same vitamins. Without B vitamins in our diet regularly, symptoms of depres-
sion, memory loss, fatigue, fear, heart ailments, skin abnormalities, and muscle
weakness develop. Continual function without the B vitamins can ultimately
result in death. These symptoms prompted the federal government to enforce
the addition of vitamin B1, vitamin B2, vitamin B3, folic acid and the mineral
iron to all refined grain products. The word ‘enriched’ is used to signify this
addition in all refined grain products. With the loss of vitamin E from com-
plex carbohydrates, we can’t help to prevent the body’s formation of harmful
free radicals that cause tissue breakdown. With the loss of protein and unsatu-
rated fats, we reduce the body’s ability to utilize these nutrients for various cel-
lular functions. Minerals needed for glucose metabolism such as magnesium,
chromium, manganese, and zinc are lost in the milling of flour, too.

Even though some vitamins are added back to milled flours prior to

consumption, refined sugars have no vitamins added back to them at all. Corn
syrups have no vitamins to start with. Yet, both refined sugar and corn syrup
have loads of sucrose, glucose, and/or fructose. If a teenager averages 150
grams of simple carbohydrates a day, excluding fruit and grain, he or she still
needs to find the vitamins and minerals that assist in the burning, storage, or
conversion of the 600 calories provided by these sugars. The teenager would
have to jog steadily for one full hour to burn up the 600 calories. For Alex,
our friend from the first chapter of this book, he needed to find enough vita-
mins and minerals not provided by the simple carbohydrates he consumed
that one Monday to help with the placement of the 1700 calories he took in.
To restate the loss of vitamins that coincide with sugar intake into a question,
if the consumption of an average 20% of added sugar intake is part of our diet,
where are the beneficial amounts of vitamins and minerals to jumpstart sugar
metabolism coming from? They are lost substantially from our body stores
without adequate and equal replacement in poor diets.

Vegetables are a primary source of complex carbohydrates because they

are mostly carbohydrate, fiber, and water. Raw vegetables have the most
vitamins and nutrients retained in them. Isn’t it interesting to note that all
of the complex carbohydrates are found along with soluble fiber and cellu-
lose, that indigestible fiber that helps to cleanse the intestinal tract? Except,
of course, when the carbohydrates are milled and refined. Most of the fiber
is lost here, too.

The Preservation of Health

Fiber

Is the lost fiber from milled flour, refined sugar, and corn syrup all that bad?
The fiber content of Americans is roughly half what it normally should be.
Colon cancer has been on the increase since the beginning of the twentieth
century. It has already been proven that a high-fiber diet can lower choles-
terol and may reduce the risk of colon cancer. Newer studies now show that
soluble fiber (mostly pectin and gums found in fruit, vegetables, and oat bran)
will actually lower blood-glucose levels during a meal sparing the work of
insulin. The reason this occurs is because the soluble fibers slow the rate of
absorption of sugars from the intestine minimizing an all-out rapid increase
in blood-glucose concentrations. Nature certainly has a reason to provide
fiber alongside carbohydrates in plants.

Colonic bacteria normally found in the intestine derive their energy from

soluble fiber. The bacteria assist in the body’s intake of fatty acids, which also
create energy for our use. They also help in proper stool formation.

Simple Carbohydrate Food

What foods in our diet are rich in the simple carbohydrates? These are main-
ly sugar cane and beets (sucrose), malt (maltose), milk (lactose), and fruit
(fructose). Fructose is the only one that can be classified as a simple sugar
(monosaccharide). Honey and maple sugar are also simple carbohydrates.
Next to milk products, sucrose is the most widely distributed sugar. It is your
table sugar. Table sugar has also been through processing and refining which
removes all of its natural nutrients including calcium, phosphorus, potassium,
and many B vitamins. This is done, of course, to allow for the most stable
sweetness for packaging and storage. This sugar is found everywhere in pack-
aged and processed foods and baked goods as sugar or sucrose. Raw honey
and raw maple syrup have most of their vitamins and minerals if they haven’t
been heated or modified. Malt grains are also modified losing their vitamins
and minerals through the refining process as well. Lactose loses its vitamins
through the pasteurization and packaging process for milk products.

Cornstarch is also processed into a sugary product known as corn syrup

that is also hydrolyzed and isomerized into a fructose/glucose mixture known
as high-fructose corn syrup. The product is 80 percent fructose and 20 per-
cent glucose. Here you have another simple carbohydrate, corn syrup, sweet
to taste, but void of any vitamins or minerals whatsoever. Where do you find
lots of corn syrup in products? You’ll find it everywhere. It’s in soft drinks
such as soda and fruit juice, condiments such as catsup, mayonnaise, pickles,

Mark A. Falco, D.M.D.

jelly, and coffee whiteners, baked products like bread, bagels, and pizza, pan-
cake syrup and salad dressings, and many frozen foods and desserts. Baby
food, beer, and meat products like ham and sausage contain corn syrup.
Cheese spreads, chocolate, and sauces have corn syrup in them. Corn syrup
sugars can be found disguised in flavorings and sweet wine as well. Besides
corn syrup and high-fructose corn syrup, processed cornstarch can also be
manufactured to yield dextrose, maltodextrin, and corn syrup solids, which
are all sugars, found in various foods.

Fructose is found in its original form in fruit. Fructose is also added as a

sweetener in other products separated from the original fruit. But here, once
again, a large portion of the nutrients has disappeared. In fresh fruit, the sim-
ple carbohydrate fructose can be found with all of its nutrients beneath the skin
along with the fiber. Very importantly, even though it is a simple sugar like glu-
cose and galactose, the fructose in whole fruit does not actively enter the
bloodstream after ingestion as glucose and galactose do. Instead, the fructose
is separated out and stored for the most part being converted to glucose when
needed at a later time. Insulin is actively involved in this transport to storage.
High-fructose corn syrup products cause rapid spikes in insulin levels, howev-
er, when they are rapidly absorbed into the bloodstream from the intestine.

Canned and dried fruits have lost a lot of nutrients. In fact, canned fruits

may have added sugar and/or corn syrup with no nutritional value, just a lot
more calories which have to be either burned up or stored. As a liquid, fresh-
squeezed juices are the best for nutrients. Juice concentrates have the least.
Again, some juices also have added non-nutritive sugars. Keep in mind that all
of these juices have been separated from their fibers partially or completely.

Sugar Comparisons

Which is more nutritious, soda pop or fruit juice? Fruit juice has a better
chance of having a little more vitamins and minerals. Soda pop has only phos-
phorus with no vitamins. Sweetened fruit drinks or those labeled cocktails,
punches, sparklers, blends, or beverages do not have 100% fruit juice in them
and, so, may have a lot more calories without adequate vitamins and miner-
als. Which has more sugar or corn syrup, soda pop or fruit juice? It actually
is fruit juice, but not by much. Even 100% fruit juice will have as much or
more sugar than soda pop. Another ingredient that may be added to soda pop
is caffeine, which enhances the impact of sugar in the brain without the cor-
responding vitamins. Cola drinks average 40 grams of sugar in a 12-ounce
glass. That’s 8 teaspoons of sugar. Would you put 8 teaspoons of sugar in 12
ounces of coffee? It may be time for us to insist that soft drinks and fruit

The Preservation of Health

drinks be fortified with enough vitamins and minerals to properly utilize all
of the glucose that these drinks pour into our bloodstreams. How many colas
or power drinks is your child drinking in a day? Fruit juice can have over 50
grams of sugar in a 12-ounce glass. There may not be enough vitamins in that
glass. Choose beverages lowest in sugar content.

How many cookies does your child like to eat in a day? If he likes to eat

five chocolate cookies with cream filling, he’s eaten as much sugar as one can
of cola. Fortunately he’s also eaten over two grams of protein as well, but this
amount is small and not balanced in required amino acids. Do you like
doughnuts? Just two medium-size frosted doughnuts contain the same
amount of sugar as 12 ounces of fruit juice. The protein content is 5 grams
for these two doughnuts and there is over 20 grams of fat. The combination
of sugars and saturated fats can lead to a health crisis with continuous con-
sumption. One cup of chocolate ice cream has the same amount of sugar as
a 12-ounce cola. What’s your favorite candy bar? The amount of sugar in one
candy bar varies not only by the added sugar used, but also by the weight of
the candy bar or package. About two-thirds of the weight of the candy bar is
sugar. Chewy and fruity candy will have more sugar. Nutty and crunchy
candy will have less sugar.

Most morning meals start with a bowl of cereal. Do you normally have

one cup of cereal or two cups? One cup of cereal can have as little as 5 grams
to as much as 90 grams per cup of total carbohydrate. Where’s the difference?
Cereals like Post’s Shredded Wheat, Quaker Oats’ Puffed Rice, General
Mills’ Total, and Kellogg’s Special K have the least amount of sugars and the
least amount of fat. Cereals with more sugar may have a small amount of fat,
too. Granolas, nut-cereal blends, and fruit and nut-cereal blends have more
sugar, fiber, and fat in one cup, but they also have more weight per volume
than the ‘puffed’ cereals. Choose cereals and other grains with the lowest
amount of sugar per serving.

Would you prefer two frozen waffles and four tablespoons of pancake

syrup? This is equivalent to 8 ounces of fruit juice. Of course, there’s some
better nourishment in those cereals and breads that make up for the sugars
in them, right? This may not be true at all. Some essential amino acids such
as lysine are not present in breads and cereal. Refined flours that go into
the formation of these products have very little fiber and many of the vita-
mins and minerals need to be added. It is much worse if table sugar, pan-
cake syrup, or jelly is added onto the breakfast food. Where, then, is the
added glucose going to wind up in the body? It’s going to be stored in your
fat cells!

Mark A. Falco, D.M.D.

Three Standard Criteria for Sugar Consumption

Are quality foods any less nutritious if sugar is in them? The answer is no if
guidelines for limits of sugar consumption in foods is adhered to. Quality
foods may have natural or added sugar. The ability to easily recognize the
amount of sugar content in food to establish its significance on health is
desired. Diets that are designed to substantially reduce carbohydrate intake
are good for people suffering from weight problems or serious disorders and
require medical supervision. A simpler system of diet control based on sugar
intake needs to be nutritionally sound, does not require medical supervision
except in states of ill health, and can easily be used to maintain a desired
weight. The following criteria help to make the distinction between good
quality and poor quality foods based on daily sugar content.

1. Natural or added sugar should account for 10% or less of the calories

from the food product. This will be called the 10% rule. Fresh raw or
cooked fruits or vegetables can have 100% of their calories derived
from carbohydrates. If the fruit or vegetable is prepared in a dish con-
taining other carbohydrates (grains, sweetened dairy products, or
recipe-sweetened fruits and vegetables) the 10% rule applies to the
final product. All sweetened beverages apply to this rule as well.

2. The fiber content should account for 10% or slightly more of the

total carbohydrate content. Do not consider fiber content less than
8% for a meal rich in carbohydrates. Beverages cannot be considered
in this context. The fiber from whole grains is best.

3. Enough B vitamins and minerals should be in the food product to

mobilize the glucose efficiently once it enters the bloodstream.
The total carbohydrate content is always labeled in food for purchase.

Total carbohydrate includes all sugars (simple carbohydrates), all complex

carbohydrates, and fiber. Total fiber content in fresh fruits and vegetables
range between 20% and 50% of the total carbohydrate content. The RDA of
fiber is considered to be a little over 8%. This is too low in my opinion. The
RDA for total carbohydrate intake is 60%. This is too high in my opinion.
The average person can be healthy and live without weight fluctuations by
gaining less than 50% of his or her calories from carbohydrates. Total caloric
intake must parallel your lifestyle. Most slightly active people require 2000 to
2500 calories a day. In any weight program, the proper amount of exercise is
conducive to the amount of glucose your body is using up. Table 1 provides
information on sugar, fiber, total carbohydrate, calories, and vitamin and min-

The Preservation of Health

eral levels of several common foods. Let’s present a few comparisons of these
foods to see how they match the criteria. Each gram of sugar contains 4 calo-
ries. One teaspoon of sugar equals five grams. All of the numbers obtained
will be rounded to a whole or a half number.

One-half cup of frozen broccoli in cheese sauce has 3 grams of sugar, 2

grams of fiber, a total of 7 grams of carbohydrates, and a total of 70 calories.
The total sugars in this food add up to 17% of the total calories (3 grams x
4 calories = 12 calories. To get a percentage, 12 x 100 / 70 = 17.14%). Total
fiber content is about 28.5% of the total carbohydrate content. Most of the
B vitamins (about 10% of the RDA) are within this food. In fact, broccoli has
a high amount of folic acid and a substantial amount of manganese, a miner-
al, as well. It meets the first criterion for quality foods by containing 100%
of the total calories from sugar in a vegetable source along with another
product, the unsweetened cheese, added in. It meets the second criterion by
having fiber content no less than 10% of the total carbohydrate content. It
meets the third criterion because there’s a good amount of the B vitamins
and minerals. This food is exceptional. The calories are low, too, consider-
ing the available cheese sauce.

Why don’t we look at the beef and bean burrito? It has 5 grams of sugar,

4 grams of fiber, a total of 45 grams of carbohydrates, and a total of 310 calo-
ries. The total sugar adds up to 6.5%. This is a partial vegetable food source
because there are other food sources of carbohydrates in it. The 10% rule
applies here. Fiber content is 9% of the total carbohydrate content thanks to
the beans. A good amount of B vitamins and magnesium are present due to
the beans and the enriched flour. The fiber content is not optimum at 9%.
Less than that is not sufficient for normal carbohydrate flow through the
intestine. Based on all the evidence, this is a quality food for carbohydrate
content. Watch the calories!

Take a good look at the cereal bar, a fruit and grain food. It has 12 grams

of sugar, 1 gram of fiber, a total of 26 grams of carbohydrates, and 135 calo-
ries. Total sugars are 35.5% of the total calories. Total fiber content is 4% of
the total carbohydrate content. The vitamin and mineral content is good
because it is enriched with B vitamins and zinc. The cereal bar fails in the first
and second criteria, but is able to satisfy the third criterion. This product is
not a quality food. Its value may be best as an energy boost when part of a pre-
athletic meal. Watch the fat content!

Look at the chicken parmesan-frozen entrée. It has 3 grams of sugar, 2

grams of fiber, a total of 18 grams of carbohydrates, and a total of 260 calo-
ries. It has 4.5% of its calories derived from sugar. Its fiber content is 11% of
the carbohydrate content. The vitamin and mineral content is adequate. This
is a quality carbohydrate food.

Mark A. Falco, D.M.D.

Table 1. All measurements are grams except where noted.

product

amount

sugar

fiber total carb total calories B vit/min

baby food

4 oz.

good

(vegetable-beef)

frozen broccoli
in cheese sauce

1/2 cup

excellent

chicken-
flavored rice

1/2 cup mix

240 mix

very good

canned
minestrone soup 1 cup

120

very good

beef and bean
burrito

5 oz.

310

good

frozen entrée
chicken teriyaki

12 oz.

340

good

frozen cheese
ravioli dinner

13 oz.

330

good

pasta
uncooked

4 oz.

410

good

frozen buttermilk
waffle

2 oz.

190

good

frosted toaster
pastry

210

fair

cereal
bar

135

good

corn
flakes

1 cup

100

very good

sugar-frosted
corn flakes

3/4 cup

120

good

chicken parmesan
frozen entrée

6 oz.

260

very good

frozen entrée
macaroni/cheese 8 oz.

270

fair

The Preservation of Health

product

amount

sugar

fiber total carb total calories B vit/min

potatoes au gratin
packaged

2/3 cup mix

100 mix

fair

macaroni/cheese
dinner package

2-1/2 oz. Dry 7

260

fair

alfredo noodles
packaged

2/3 cup mix

260

good

baked beans,
canned

1/2 cup

150

fair

corn dog

220

fair

frozen extra
cheese pizza

5 oz.

360

fair

deli ham

3 slices

fair

plain bagel

3-1/2 oz.

280

fair

white bread

2 slices

120

good

stone ground whole
wheat bread

2 slices

160

very good

tater tots

3-1/2 oz.

200

fair

peach yogurt
fat free

8 oz.

120

fair

peanut butter

2 tbspn.

140

very good

orange juice

8 oz.

110

good

2% milk

1 cup

130

fair

fruit drink
blend

8 oz.

120

fair

100%
grape juice

8 oz.

170

fair

power drink

8 oz.

poor

cola
soda pop

12 oz.

160

poor

Mark A. Falco, D.M.D.

product

amount

sugar

fiber total carb total calories B vit/min

frozen strawberry
cheesecake

1 slice

320

fair

chocolate cream-
filled cupcake

1 ﬂ oz.

180

fair

frozen lemon
meringue pie

4 oz.

360

poor

glazed doughnut 1

250

fair

chocolate cookie
sandwich n’ cream 3

130

fair

chocolate chip
cookie

160

fair

vanilla
ice cream light

1/2 cup

130

poor

double
cheeseburger

600

fair

soft taco

210

fair

6-inch turkey sub
whole wheat

290

good

spaghetti with
meat sauce

1 cup

600

fair

bread ‘n’ butter
pickles

poor

fat-free red wine
vinaigrette
dressing

2 tblspn.

poor

fat-free
mayonnaise

1 tblspn.

poor

bottled ketchup

1 tblspn.

poor

jarred
spaghetti sauce

1/2 cup

fair

barbecue sauce

2 tblspn.

poor

The Preservation of Health

product

amount

sugar

fiber total carb total calories B vit/min

pancake syrup

1/4 cup

210

poor

grape jelly

1 tblspn.

poor

salsa, mild

2 tblspn.

fair

frozen candied
sweet potato

5 oz.

300

fair

table sugar

1 packet

poor

coffee latte
with skim milk

13 oz.

poor

lager beer

10 oz.

poor

fresh orange

excellent

fresh banana

105

excellent

fresh strawberry

1 cup

excellent

fresh apple

excellent

fresh pineapple

1 cup

excellent

fresh cantaloupe

1 cup

excellent

fresh lettuce

1/2 cups

very good

fresh tomato

1.5

5.5

excellent

frozen corn
niblets

2/3 cup

excellent

frozen cut
green beans

3/4 cup

excellent

frozen cut
broccoli

2/3 cup

excellent

frozen baby
carrots

1/2 cup

excellent

frozen
sweet peas

2/3 cup

excellent

Mark A. Falco, D.M.D.

product

amount

sugar

fiber total carb total calories B vit/min

fresh green
pepper

excellent

fresh onion

1 tblspn.

trace 1

excellent

baked potato
with skin1

220

excellen

sliced mushrooms 1/2 cup

trace 1.5

very good

celery stalk

trace 1.5

very good

Examine the bagel. It has 7 grams of sugar, 2 grams of fiber, 56 grams of

total carbohydrates, and 280 total calories. Total sugar content is 10% of the
total calories. Its fiber content is 3.5% of the total carbohydrate content. It’s
vitamin enriched because of the refined flour used. The preference is to have
the sugar content at or less than 10%. The fiber content is much too low. The
vitamins are barely adequate. This food fails one of the required criteria for a
quality carbohydrate food and should be eaten sparingly. It is best eaten with
more protein, which would lower the percentage of sugar to the total calories.

Look at one more, the chocolate chip cookie. The cookie has 10 grams of

sugar, 1 gram of fiber, 21 grams of carbohydrates, and 160 calories. Sugar
calories add up to 25%. Very little fiber is present. Tiny amounts of vitamins
come from the enriched flour. This food fails the first two criteria and is inad-
equate to meet the third criterion. This is a poor quality food for carbohy-
drate calories.

Spend some time examining the other food sources in the list of Table 1

to determine how the three criteria for quality carbohydrate food can influ-
ence your food choices. Then perform your own study of the various foods
you like to eat the same way that we did them in this exercise. Please make a
note to yourself to count everything because as you can see by the list of
common foods, many of the dressings and condiments are added sweeteners
that fail the criteria. Don’t turn a quality food choice into a poor one because
of the addition of more sweeteners. Make sure the amounts added up togeth-
er still create a good balance by meeting all of the criteria. If you’re not sure
about vitamin and mineral content, the following guides may help. Fresh is
best because very little alteration of vitamin and mineral content will occur.
Ripe is best because the maximum available vitamin and mineral content
exists only at that time. Frozen is the next best choice. Raw is the best way
to eat most of the carbohydrate foods except grains. Cooked is good
although some vitamins are lost. Soup retains the most vitamin and minerals
of the cooked foods. Processed juices lose some vitamins and minerals prior

The Preservation of Health

to packaging. It’s best to have fresh juices. All milled grains are enriched, but
some B vitamins and minerals may still be missing. Approximately 10% of
some of the B vitamins are added back to about every 25 grams of carbohy-
drate. Most importantly, read all labels. This becomes significant when you
learn from your investigations that many of the same products you’re very
familiar with have much different levels of sugar and carbohydrate content in
them. For example, one-half cup of spaghetti sauce can vary as much as 10
grams of sugar from one set of ingredients and one manufacturer to another.
Also be aware that certain products such as cookies may be measured in dif-
ferent amounts based on the manufacturer’s definition of what constitutes one
serving. Three cookies may not equal the same weight as one cookie even
though they may be listed each as one serving. Note also the total servings
from the product. A package of spaghetti lists eight servings in a sixteen-
ounce box. A sixteen-ounce power drink has two servings. If you’re going to
have more than the package listing of one serving, be sure you’ve totaled up
your carbohydrate amounts accurately.

Meal Comparisons

Where do beverages fit in? If you’re drinking other than water, the last item
that you need to be counting for sugar content and calories should be bever-
ages. The best way to score this is to create your own schedule of food intake
for breakfast, lunch, and dinner, or however you plan the number of meals
you eat daily. After you’re satisfied with the sugar content, fiber content, car-
bohydrate content, and calories of your daily meal totals, then go back to see
if beverages other than water have room in your diet. Always keep in mind, of
course, that physical exercise not only influences your daily calorie level, it
will influence your daily carbohydrate and fluid intake as well. Let’s find out
how this all works by looking at Table 2.

The first diet schedule meets the first criterion for sugar calories at all

three meals and the nectarine snacks. The breakfast contains 7 grams of sugar
equal to 28 calories. The total meal is 280 calories. The total sugar is exactly
10% of the total calories. This is the acceptable upper limit. Fiber content is
15% of the total carbohydrate content. This is good. The B vitamin and min-
eral content is excellent. All the criteria are fulfilled for this meal. What would
happen if 8 ounces of orange juice were added to this breakfast? There would
be 22 more grams of sugar, the equivalent of 88 more calories, along with 26
more grams of carbohydrates and only a little more fiber. This produces a
failure in the requirements of both the second and first criteria. If the orange
juice were to be required as a beverage, then an added protein, fat and fiber

Mark A. Falco, D.M.D.

source would be needed to offset the balance of added calories and added
sugar. The total daily caloric intake would need adjustment to maintain the
overall caloric balance as well. The lunch for the first diet schedule looks
healthy. Total sugar content is 4.5 grams or 18 calories. Total calories equal
208. This provides fewer than 10% sugar content which is great. The fiber
content is 3 grams and the total carbohydrate content is 29 grams. Fiber rep-
resents just over 10% of the total carbohydrate amount. This is good. The B
vitamin and mineral content is good because of the vegetables.

Dinner consists of 12 grams of sugar or 48 calories, 1157 total calories, 8.5

grams of fiber, and 79.5 grams of carbohydrate. Sugar content is 4.1%. Fiber
content is over 10% of the carbohydrate content. There is a very good source
of vitamins and minerals due to the chicken, rice, and vegetables. Finally, a
snack of two nectarines can be eaten and still satisfy all of the criteria. In addi-
tion, the total calories for the day add up to 1785. The carbohydrates con-
sumed equal 193 grams or 772 calories. The amount of carbohydrate calories
for this day is over 43% of the total calories taken in for the day. There would
still be 215 calories remaining to meet the required daily goal if this were a
2000 calorie-a-day diet. Carbohydrates can still be consumed depending on
your diet requirements as long as they meet the three criteria safely.

The second diet schedule consists of a breakfast of eggs, sausage, muffin,

and a slice of honeydew. The sugar content of this meal is more than the first
breakfast diet reviewed. Note also that the total number of calories is twice as
much as the first breakfast diet. Sugar calories make up a little over 8% of the
total calories of the second breakfast since 48 of the 574 calories are sugar.
Fiber content is 5 grams of the 40.5-gram carbohydrate amount or just over
12% of the total carbohydrates. The B vitamin and mineral content is very
good for most all of the foods. Three criteria are satisfied in this meal.

The Preservation of Health

Table 2. All measurements are in grams except where noted.

product

amount

sugar

fiber total carb total calories B vit/min

breakfast
wholegrain oats
cereal, plain2 cups

220

very good

soy milk

2 ozs.

3.5

32.5

good

fresh
strawberries

1/2 cup

27.5

excellent

lunch
fat-free balsamic
vinaigrette

2 tblspns.

poor

Italian salad

4 ozs.

2.5

good

microwave-baked
potato w/butter

168

good

dinner
roasted chicken
breast w/herbs

8 ozs.

400

excellent

frozen peas
and carrots

1 cup

4.5

13.5

excellent

brown rice dry
seasoned

1/2 cup

150

very good

dinner roll

136

good

blush Chablis
wine

8 ozs.

176

fair

Swiss cheese

2 ozs.

220

poor

snack
fresh nectarine

140

excellent

total meal
breakfast

52.5

280

very good

lunch

4.5

208

good

dinner

8.5

79.5

1157

very good

snack

140

excellent

day total

47.5

25.5

193

1785

product

amount

sugar

fiber total carb total calories B vit/min

breakfast
scrambled eggs

200

good

browned
sausage links

200

good

whole wheat
Eng. muffin w/but1

130

good

fresh honeydew

1 wedge

11.5

excellent

lunch
double
cheeseburger

600

fair

raw carrot

excellent

dinner
fat-free honey
Dijon dressing

2 tblspn.

poor

French salad w/
1/2 tomato

4 ozs.

very good

baked
lasagna

2.5x2.5 in.

375

good

soft garlic
breadsticks

280

good

snack
green seedless
grapes

1 cup

excellent

total meal
breakfast

40.5

574

very good

lunch

626

very good

dinner

738

good

snack

excellent

total

158.5

1996

product

amount

sugar

fiber total carb total calories B vit/min

breakfast
whole wheat
pancakes/mix

1/2 cup

260

very good

light pancake
syrup

1/4 cup

230

poor

fresh banana

105

excellent

walnut pieces

1/4 cup

190

very good

lunch
plain turkey sand.
w/lettuce/tomato 1

350

excellent

baked sweet
potato

136

excellent

dinner
lean T-bone
steak, broiled

6 ozs.

520

excellent

cooked
broccoli

1/2 cup

excellent

scalloped
potatoes pkg.

1/2 cup

280

good

chocolate chip
ice cream

1/2 cup

150

poor

total meal
breakfast

114

785

good

lunch

486

excellent

dinner

975

very good

total

249

2246

The second lunch diet is heavier than the first lunch diet by possessing

three times as many calories due to its saturated fat content. The sugar con-
tent is 4.5%. The fiber amounts to 8.9%. This is low, but tolerable when the
amount of sugar is low. There is some balance of B vitamins and minerals. Do
you see how one raw carrot helped to save this meal from not meeting the
requirements of the three criteria? The fiber content would have been too
low without the carrot. My complaint, however, is that 50% of the double
cheeseburger is made up of fat. That’s too much.

The dinner is moderate at 738 calories. Sugars equal over 4% of the

calories. The fiber is just over 10%. The B vitamin and mineral content is sat-
isfactory. All of the criteria are satisfied.

A snack of grapes rounds out the daily food intake. Total calories add up

to 1996. The total carbohydrates equal 634 calories or 32% of the total daily
meal consumption. On a 2000 calorie-a-day diet, this diet is complete with no
room for sweetened beverages.

The third diet schedule has a greater carbohydrate total. Breakfast

contains a lot of sugar calories and a lot of total calories. The sugar is equiv-
alent to 27% of the total calories consumed. This is totally unacceptable.
What may look like a very healthy meal is destroyed by relatively too much
sugar. Removing the banana and its sugar won’t help. The banana would be
digested better if it were away from this meal. You could remove the syrup,
but the pancakes would not be as tasty without the added sugar. The fiber
content of this meal is below 9%. This is tolerable on occasion, but it is not
tolerable when the sugar content is above 10% of the carbohydrate content as
is the case with this meal. The content of vitamins and minerals are good
when the banana and walnuts are included and just fair when they are not
included. This meal should be enhanced with protein and fiber to become a
higher caloric meal or their needs to be an immediate active use of most of
the glucose created from this meal for proper metabolism.

Lunch looks like it has some appeal. The sugar content of the turkey

sandwich and baked sweet potato is 56 calories of the 486 total calories.
That’s 11.5% worth of sugar! Don’t add on any other dressings! The addition
of two slices of soy cheese to the sandwich would add 80 calories without
adding much additional sugar. That would bring the total sugar content to
near 9.5%, which is acceptable. The fiber content amounts to 8.9% of the
total amount of carbohydrates. You can boost the amount of fiber by replac-
ing the white bread with a higher fiber bran-based bread or whole grain
bread. This would raise the fiber content to about 10 grams increasing the
amount of total fiber to near 13% of the total carbohydrate content. The
turkey, vegetables, and enriched bread give the vitamin and mineral content
an excellent rating. Just a few adjustments to the food content can easily make
or break a meal as seen in this example of a lunch meal. What seemed to be a

The Preservation of Health

healthy lunch actually failed to meet the first two criteria until alternatives
were chosen to make the meal work correctly.

The total calories presented by the dinner selection are 975. There are 92

sugar calories. The sugar amounts to 9.5% of the total calories even with one-
half cup of ice cream added for dessert. The fiber is over 12%. The steak and
broccoli help to make the vitamin and mineral content excellent.
The total for all three meals adds up to 2246 calories. This may be appropri-
ate for someone on a 2500 calorie-a-day diet. The total of 44% carbohydrates
as the percentage of total calories is appropriate. [The goal for total daily car-
bohydrate consumption is 50% or less for normal daily activity]. The total
calories from sugar are almost 16% of the total calorie content of the third
meal example. This is poor. The total calories from sugar are about 10.6% of
the total calorie content of the first daily meal schedule, but this includes two
nectarines. This amount would fall to around 7.8% if we chose to eat only one
nectarine. The total calories from sugar are about 7.8% of the total calorie
content for the second daily meal example also. Keeping the total calories
from sugar at 10% or less daily is your goal even when including raw fruits or
vegetables as snacks. Incidentally, these meals and the above criteria for car-
bohydrate intake will still meet the daily requirement for the fruits and veg-
etables. If one meal of the three daily meals is to contain the highest sugar
intake, it should be breakfast. The reason will be explained in chapter 10. To
determine total teaspoons of sugar, take the total day’s sugar amounts in
grams and divide by 5.

About 70-90% of fruit is carbohydrate when water is excluded. Although

this may seem extreme for those wishing to lower their sugar intake, nature
intended this food to be eaten. Since large portions of the sugars in fruit are
fructose, there is little havoc played on the body’s hormonal system to man-
age them when a small amount is consumed. There is also an existing source
of fiber to slow digestion, a balance of vitamins and minerals to aid in metab-
olism, and a complementary source of antioxidants and enzymes to make
everything hum better similar to your car having been given a service check.
It is foolish to cut out fruits or even vegetables completely. It is not sensible
to add any more sweeteners to fruit as is done so often. Sensible eating of
fruits should be done with an already low sugar content meal or should sim-
ply be eaten alone. Vegetables should complement a high protein meal or
should also be eaten alone if eaten raw. The benefits will outweigh the sugar
content. It is the additional sugars, the sweetened beverages, and the flavor-
ings that cause fruits and vegetables to be given a bad rap. If you’re not sure
how much fruits and vegetables you should be eating in a day, do the mathe-
matics previously described. That is, divide the total day’s calories from sugar
by the total day’s overall calories. The score should still be 10% or less. If it
is above this number, then rework your diet program to exclude any excess

Mark A. Falco, D.M.D.

syrups, sweetened baked foods, refined grains or beverages. If this is not
enough, then you can choose to reduce a grain, fruit, or vegetable to get this
number under 10%.

Beverages

What can you drink with all of these meals as a beverage that won’t add sugar
or calories when you’re calorie restricted? The answer is simply water and
more water. One-half gallon of water a day is normally adequate. Do not sub-
stitute too many sweetened beverages, juices, alcoholic beverages, and coffee
for the water because sweetened beverages and juices will concentrate the
sugars in your body and upset the three criteria balance and the alcohol and
coffee will remove the water from your body including the vitamins and min-
erals. Unsweetened herbal teas and water slightly flavored with fresh-
squeezed fruit are permitted without adding any perceptible sugars or calo-
ries. Diet drinks are to be used sparingly. Milk and soymilk are satisfactory
when the amounts are kept to a minimum and they continue to meet the daily
criteria. Fresh juices are okay in very small amounts if you continue to meas-
ure your sugar intake properly. Fresh fruits and vegetables with their fiber are
better. It is absolutely necessary to choose your meals first and then decide
upon which beverages your meals can be taken with.

Energy Boosts

The question that remains is what can you do when you need more energy
and more calories than normal? For more energy to be used immediately, call
upon sugar unless you’re a diabetic. Fruits foremost followed by juices and
power drinks have a ready source of sugar that can be burned off immediate-
ly or replenish glycogen stores and aid in the maintenance of body fluids.
Extra water to complement the excess calories created by the sugar would be
advisable to drink alongside these other beverages. Water is needed continu-
ously to break down the body’s stored glucose back into usable glucose.

If you need more calories than normal because of extreme exercise, you

must first produce a diet of 50% or less of total carbohydrates based on your
total daily caloric intake, then, jump to as much as 85% of your excess calo-
ries as carbohydrates, preferably complex carbohydrates, based on your
activity level not ignoring the rules for the three criteria for the excess calories!
In other words, if you’re a normal 35 year-old male consuming 2500 calories
per day for regular maintenance, you must follow the formula for the three

The Preservation of Health

criteria as usual. Your daily carbohydrate total must be 50% or less. In prepa-
ration for vigorous training or extreme exercise, you’ll need to exceed the
2500 calorie-a-day total. The calorie requirement for certain activities can be
determined from the Basal Metabolic Rate (BMR). It is the amount of ener-
gy required by the body at rest in a post-absorptive state. If it’s 500 extra calo-
ries you need to burn off on top of the normal 2500 calories you need, the 500
calories can be obtained from mostly simple and complex carbohydrates. Up
to 75-85% of excess carbohydrates are permissible and do not need adherence
to the 10% rule if the calories from sugar are to be used up immediately. For
energy storage, complex carbohydrates are your best source for obtaining a
short-term source for your stored glucose. For energy required during vigor-
ous activity, glucose, but not high-fructose corn syrup, in water with essential
vitamins and minerals is the best source. More information on this is covered
in chapter 10. Always remember that a balance of fat and protein are still
required for body maintenance. Glucose will give you energy, but protein will
give you strength and endurance. An adequate intake of protein is an essen-
tial part of athletic training. The mineral potassium needs to be replenished
in your body as well due to the loss of it during prolonged exercise.

Natural sweeteners

One of the reasons the corn industry converts corn syrup (pure glucose) to
high-fructose corn syrup (fructose and glucose) is to minimize the racing and
crashing effects of a rapid influx of glucose into the brain. An overwhelming
rush of glucose into the brain affects serotonin levels raising them immedi-
ately and enhancing mood activity. After the spike in serotonin, there is a
rapid decline in these levels leading to drowsiness. Fructose does not affect
serotonin levels because it is not moved from the bloodstream directly into
the brain. It is normally converted to glycogen in the liver and subsequently
used when it is needed at a later time. Fructose, however, can release large
amounts of insulin when it is consumed without fiber. This form, found in
corn syrup, can be more harmful to the body than sucrose.

Natural sweeteners are a good alternative substitute for sugar and corn

syrup in home recipes because they contain several types of carbohydrates to
balance body metabolism better and they contain more of their original vita-
mins and minerals in them. Organic food products sold in health food stores
and grocery chains contain natural sweeteners.

Mark A. Falco, D.M.D.

The Basal Metabolic Rate (BMR)

For a healthy adult, the BMR formula is 10(calories) x ideal body weight

(lbs.) = calories for BMR.

To do this, multiply voluntary muscle activity at the following rates:

Sedentary rate = 30%
Light rate = 50%
Moderate rate = 75%
Very active rate = 100%

It is the voluntary activity rate that allows increased levels of carbohy-

drates to fit into a nutrient program.

For example:
An ideal weight for a 5’4” woman would be 120 lbs.
Using the BMR formula:
10 (calories) x 120 (lbs.) = 1200 calories needed for her daily BMR.
One day a week, she has no voluntary muscle activity. Her voluntary activ-

ity rate is, therefore, 30% based on her level of activity, which is sedentary.

1200 BMR calories x .30 = 400 calories.
She needs an additional 400 calories to enjoy her day without muscle activity.
1200 BMR calories + 400 additional calories = 1600 calories.
Her normal level of activity for that one day requires her to take in 1600

calories with no additional carbohydrate requirements needed above 50%.

Another day during the week, she manages a moderate 1-1/2 hour work-

out at the gym.

Her voluntary activity rate is, therefore, 75% based on the moderate rate.
1200 BMR calories x .75 = 900 calories.
She needs an additional 500 calories for this activity above her sedentary

level of activity.

900 calories (moderate) - 400 calories (sedentary) = 500 calories.
Instead of 1600 calories, she requires 2100 calories. It is only this extra

500 calories, not all 900 calories, which can be satisfied with increased carbo-
hydrate intake above the 50% level if it is going to be used up on the day of
her workout.

How to Reduce Sugar

•

Choose beverages lowest in sugar content.

•

Choose whole grains with the lowest amount of sugar per serving.

•

Follow the ‘three standard criteria for sugar consumption’
1. No more than 10% of the calories in your daily diet should come

from all sources of sugar.

2. Fiber content should be near 10% of your total carbohydrate

calories

The Preservation of Health

3. Adequate requirement for B vitamins, vitamin C, and minerals

should be maintained in your diet

•

Discuss sugar reduction with your health care practitioner to ensure
proper nutrient balance.

Mark A. Falco, D.M.D.

Nutrient Void

Micronutrients

Vitamins and minerals are essential to life. Next to the major nutrients, water,
carbohydrates, fats, and proteins, vitamins and minerals are necessary for life
functions in very small quantities. Because they are needed in small amounts
they are often called micronutrients.

Vitamins are chemicals that act as catalysts in the creation of other

substances that utilize energy in the body. They don’t run the body’s machin-
ery, but they make it run smoother and more efficiently. Because they act as
catalysts in certain reactions, they are given biological definitions as enzymes
or coenzymes. An enzyme accelerates a necessary cellular reaction to com-
pletion. For instance, if you had two halves of a broken plate and needed to
make the plate whole, glue would be added to bond the two halves together.
Enzymes and coenzymes act like the glue. They make the completion of the
whole possible. There are two kinds of vitamins, water-soluble and fat-solu-
ble. The water-soluble vitamins, B complexes and vitamin C, are more direct-
ly related to the utilization of carbohydrates than the fat-soluble vitamins, A,
D, E, and K. Although most of the discussion of vitamins in this chapter will
be focusing on the water-soluble vitamins, this in no way should be viewed as
a diminished need for the fat-soluble vitamins in proper nourishment. They
are equally important, but in different capacities. Water-soluble vitamins are
depleted within several days of storage in the body, which means their
requirements need constant replenishment every day.

Minerals are substances found normally in the soils of the earth. Any plant

or animal does not produce them, but they are absorbed from the ground into
plant cells and subsequently incorporated into animal cells. Incorporation of
these minerals into the food chain is directly related to the conditions of the
soil and water that are nourishing the growth of the organisms in their respec-
tive environments. Minerals also act as coenzymes aiding the completion of
cellular reactions. Most minerals are stored in the body particularly in bone

and muscle tissue. Macrominerals are needed in large amounts and include
calcium, magnesium, phosphorus, sodium potassium, and chloride.
Microminerals are needed in much smaller amounts and include potassium,
zinc, manganese, copper, chromium, iodine, selenium, iron, and molybde-
num. This chapter will concentrate on the minerals directly responsible for
sugar metabolism which, again, is not intended to diminish the role of the
other minerals needed in other cellular functions.

The role of amino acids, the building blocks of protein, is also explored

to bridge the relationship between the simple sugars, micronutrients, amino
acids, and balanced nutrition. A break in this linkage leads to diminished
activity, illness, or disease. Some explanation of the role of accessory nutrients
in sugar metabolism will be touched upon as well. Accessory nutrients have
not been described as vitamins or nutrients, but have demonstrated very sig-
nificant therapeutic effects.

Thiamine (Vitamin B1)

Thiamine is actively involved in the metabolism of sugar into energy in the
body. It helps to accelerate this conversion. Glycogen cannot be converted to
glucose without the presence of thiamine. Magnesium, manganese and cer-
tain proteins combine with thiamine to catalyze the conversion of glycogen to
glucose. Thiamine is important in the formation of nucleic acids, the basis for
the DNA genes, and in nerve impulse transmission because it mimics acetyl-
choline, a neurotransmitter involved in memory. Abnormal stiffening of col-
lagen and elastin is prevented by thiamine because it helps to keep these con-
nective tissues flexible. It also assists in the conversion of fatty acids to steroid
hormones such as cortisol and progesterone.

An increased sugar intake adds to the burden of glucose storage which

impacts on the availability of thiamine. Increased carbohydrate consumption
increases the demand for this vitamin. Thiamine is naturally present in sugar
cane and sugar beets to aid in the processing of glucose by the body. It is miss-
ing from processed sugar, polished rice, and milled grains. Half of this vita-
min can be found temporarily stored within muscles where they can readily
be used to help generate energy. Tobacco, alcohol, coffee, and black tea con-
sumption reduce the absorption of thiamine reducing its effectiveness in car-
bohydrate utilization and in nerve impulse transmission. Impairment of learn-
ing, memory, and muscle and nerve function occurs in thiamine deficiencies.
A dry scalp is an indication of a possible deficiency. The demand for thiamine
increases in heightened muscular activity, stress, infection, fever, overactive
thyroid, pregnancy, lactation, and surgical or burn recovery.

Mark A. Falco, D.M.D.

Thiamine loses its availability in cooking preparations containing too

much water, high cooking temperatures, or a prolonged exposure to heat.
Baking soda will neutralize its effectiveness as will live yeast, carbonates, cit-
rates, sulfites, and nitrites. The average adult RDA (Recommended Daily
Allowance) is 1.2 milligrams with 0.5 milligrams of thiamine required for
every 1000 calories needed in the diet.

Thiamine Content of Selected Foods per 3-oz. Serving Above the RDA

Brewer’s yeast

Rice bran

Wheat germ

Sunflower seeds

Thiamine Content of Selected Foods per 3-oz. Serving at or Near the RDA

Peanuts

Soybeans

Pine nuts

Thiamine Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Brazil nuts

Pecans

Beans, pinto and red

Peas

Sesame seeds

Dried figs

Wheat branOats
Pistachio nuts

Beef

Pork

Enriched white flour

Whole wheat flour

Wild rice

Lima beans, dry

Riboflavin (Vitamin B2)

Riboflavin is the most unpleasant tasting of all the vitamins. It is, however,
very important in energy production for the body through actions involving
oxygen by influencing the oxidation and synthesis of amino acids, fatty acids,
and glucose. Riboflavin assists thiamine in the utilization of sugar. It, too, is
required in additional amounts with an increase in sugar consumption. It is
found in every body cell.

This vitamin helps to generate glutathione, a potent antioxidant, and aids

in the production of antibodies. It helps to activate another B vitamin, pyri-
doxine. Along with folic acid, it helps to detoxify a cellular by-product called
methotrexate. Riboflavin is also known to preserve the integrity of the nerv-
ous system, skin, mucous membrane linings, and eyes. Deficiencies result in
slow learning, diminished problem-solving skills, photophobia (eye sensitivi-
ty to light), cracking, scaling, and itching of crevicular areas of the skin, and
esophageal cancer. Cataracts may also develop. Deficiencies are more pro-
nounced with individuals living primarily on carbohydrates. The body will

The Preservation of Health

break down its own proteins for energy if too little protein exists in the diet.
This causes an abnormal loss of riboflavin because it is normally bound to
some of these proteins in the bloodstream. Extra amounts are required in
women taking oral contraceptives or estrogen and for those living on
processed foods. Increased amounts of riboflavin are needed following surgi-
cal treatments.

Riboflavin is inactivated by light, but not by cooking. Baking soda

destroys it. Tobacco and alcohol decrease its absorption. The adult RDA for
riboflavin is 1.7 milligrams. Intake should reflect 0.6 milligrams for every
1000 calories eaten.

Riboflavin Content of Selected Foods per 3-oz. Serving Above the RDA

Brewer’s yeast

Liver

Riboflavin Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Almonds

Wheat germ

Wild rice

Mustard greens

Brown rice

Cheese

Mushrooms

Chicken

Niacin (Vitamin B3)

Niacin functions as a coenzyme in over fifty chemical reactions involving
energy production from carbohydrate metabolism, fatty acid synthesis, and
amino acid conversions. There are two active forms, nicotinic acid and niaci-
namide. Each of these forms is equal in potency with behavior in the body as
the only difference between them. Niacin is a major constituent of glucose
tolerance factor, which is responsible for the regulation of blood sugar involv-
ing insulin. Sex and adrenal hormones are manufactured using niacin, as are
red blood cells. Niacin is responsible for antioxidant mechanisms and detox-
ification reactions. The nicotinic acid form creates a harmless reddening of
the skin known as the ‘niacin flush’ that occurs from the release of histamine
from body cells when excess amounts are taken. This is the form used to
reduce cholesterol and triglyceride levels. The skin and digestive tract are
kept healthy with niacin. The maintenance of the nervous system and the
brain are also accomplished through the use of niacin in the prevention of
fatigue and irritability.

A deficiency of niacin can be caused by a deficiency of the amino acid

tryptophan because niacin is also made from tryptophan when enough of the
required proteins are in the diet. Vitamins B1, B2, B6, C, and iron are all
needed for tryptophan conversion to niacin. Niacin is obtained pure from

Mark A. Falco, D.M.D.

foods in the diet as well. Foods low in tryptophan are usually low in niacin,
however. Excess sugar consumption and stress increase the body’s need for
niacin. Illness, tissue injury, and increased exercise require more niacin.
Deficiency symptoms affect the skin, digestive tract, and the nervous system
resulting in weakness, fatigue, anorexia, skin eruptions, indigestion, tender
gums, bad breath, irritability, headaches, anxiety, and depression.

Niacin is very stable, however, the milling and processing of grains

removes near 90% of this vitamin. It dissolves easily in water and, therefore,
can be lost if the water is discarded. About 50% of the niacin comes from the
conversion of tryptophan in our livers. The adult RDA of niacin is 19 mil-
ligrams or 6.6 milligrams for every 1000 calories taken in. Tobacco decreases
its absorption.

Niacin Content of Selected Foods per 3-oz. Serving Above the RDA

Brewer’s yeast

Niacin Content of Selected Foods per 3-oz. Serving at or Near the RDA

Liver

Peanuts

Rice branWheat bran

Niacin Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

SalmonTun

Swordfish

Turkey breast

Halibut

Veal

Wild rice

Pork

Sunflower seeds

Sesame seeds

Passionfruit

Avocado

Pantothenic Acid (Vitamin B5)

Pantothenic acid is converted to coenzyme A in the body. Coenzyme A is a
high-energy compound involved in carbohydrate metabolism, fatty acid
metabolism, and the production of glucose from glycogen. It is important in
the synthesis of neurotransmitters such as acetylcholine and in the synthesis
of hormones, cholesterol, bile, and hemoglobin. Pantothenic acid is nick-
named ‘the anti-stress’ vitamin because of its requirement in nerve impulse
transmission and adrenal hormone production. In addition, this vitamin has
been shown to be valuable in memory and long-term planning. It works
together with carnitine, an amino acid, and coenzyme Q10, an accessory
nutrient, in fatty acid transport and utilization.

A deficiency of pantothenic acid results in fatigue, numbness in the extrem-

ities, poor muscle coordination, anxiety, and depression due to compromised

The Preservation of Health

fat and glucose metabolism. Deficiencies decrease the immune response caus-
ing less antibody production, loss of protection against harmful bacteria, and
generally depress the body from defending against new foreign substances.

Much of the pantothenic acid is lost during the milling of flour, but it is

not one of the ‘enriched’ ingredients returned back to the flour after process-
ing. Tobacco decreases its absorption. Cooking may cause the loss of up to
30% of its value during prolonged heating. A slight acid such as vinegar or a
slight alkali such as baking soda easily destroys it. It is one of the few vitamins
whereby human intestinal bacteria can also produce it. The adult RDA is esti-
mated to be 4-7 milligrams or an average of 5.5 milligrams per day.

Pantothenic Acid Content of Selected Foods per 3-oz. Serving Above the RDA

Brewer’s yeast

Liver

Pantothenic Acid Content of Selected Foods per 3-oz. Serving at or Near the RDA

CornEgg yolk
Soybeans

Sunflower seeds

Pantothenic Acid Content of Selected Foods per 3-oz. Serving at or Greater than 1/3
the RDA

Peas

Peanuts

Eggs

Mushrooms

Blue cheese

Broccoli

Lentils

Lobster

Wheat germ

Pecans

Oatmeal

Cashews

Apricot nectar

Chickpeas

Avocado

Brown rice

Pyridoxine (Vitamin B6)

Pyridoxine converts to a coenzyme that is essential for over sixty enzymatic
reactions involving amino acid and fatty acid metabolism. It helps to convert
amino acids for the production of neurotransmitters such as serotonin. It
helps the skin, linings of the membranes, red blood cells, and cells of the
immune system to multiply faster. Proper growth and maintenance of body
structures and body functions rely on pyridoxine. Riboflavin assists in the
conversion of pyridoxine to its active form. Tryptophan is converted into
niacin with the aid of pyridoxine.

An accumulation of homocysteine, a damaging byproduct of the amino

acid methionine, occurs with a pyridoxine deficiency. Magnesium plays an
essential role in the activation of pyridoxine. A deficiency of magnesium will

Mark A. Falco, D.M.D.

result in a deficiency of pyridoxine. Depression, glucose intolerance, anemia,
impaired nerve function, seborrhea, and cracking of the lips are indicative of
pyridoxine deficiency.

Drugs such as hydralazine and dopamine, yellow food coloring dyes, oral

contraceptives, alcohol, and excessive protein intake inactivate pyridoxine in
the body. Tobacco decreases its absorption. It is relatively stable, but up to
25% potency may be lost during cooking. Milled flour loses its pyridoxine
and is not replaced by enrichment. Increased amounts are needed during
pregnancy. Human intestinal bacteria manufacture a small amount of this
vitamin. The adult RDA is 2 milligrams or 1.5 milligrams for every 100 grams
of protein.

Pyridoxine Content of Selected Foods per 3-oz. Serving Above the RDA

Brewer’s yeast

Pyridoxine Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Sunflower seeds

Wheat germ

Wheat branSalmon
Soybeans

Brown rice

Liver

Walnuts

Hazelnuts

Shrimp

Whole wheat flour

Avocado

Peas

Lentils

Chickpeas

Banana

Choline

Choline is a vitamin that helps to manufacture acetylcholine. It also helps to
metabolize fats. It is important as a major component of cell membranes in
the form of lecithin. Choline assists in the conservation of folic acid and the
amino acid carnitine. It can be manufactured from the amino acids methion-
ine and serine when necessary. Human intestinal bacteria will manufacture it.
Choline has the ability of directly entering the brain from the bloodstream in
order to produce acetylcholine preventing memory loss development. It
works together in cell membrane development and fat transportation with
another B vitamin known as inositol.

Fat accumulation in the liver and liver dysfunction develop with a severe

deficiency. It is sensitive to water and can be destroyed by cooking and food
processing. High amounts of nicotinic acid supplementation deplete the avail-
ability of choline and require supplementation of choline as well. Sulfa drugs,
alcohol, and estrogen will destroy choline. No RDA has been established for

The Preservation of Health

choline, but doses of 50 to 500 milligrams per day are considered adequate.
Athletes may require more.

Choline Content of Selected Foods per 3-oz. Serving Equal to the Requirement

Liver

Beef

Ham

Pork

Lamb

Eggs

Peanuts

Peanut butter

Soybeans

Lentils

Peas

Chickpeas

Bean sprouts

Coffee

Biotin

Biotin is similar to a B vitamin. It helps to produce and utilize carbohydrates,
fats and amino acids. Other B vitamins, coenzyme Q10 and carnitine work
together with biotin in the metabolism of these nutrients. Human intestinal
bacteria manufacture it.

Fatigue, muscle pains, nausea, loss of appetite, hair loss, baldness, and

depression result from deficiencies, but these are rare. Consumption of large
amounts of raw eggs leads to a deficiency. Dry skin, lethargy, muscle weak-
ness, increased cholesterol, and impaired fat metabolism can occur with a
deficiency as well. Antibiotics decrease levels of biotin in the body. Tobacco
decreases its absorption. There is no RDA for biotin. Estimations are for no
more than 300 micrograms per day as adequate for adults.

Biotin Content of Selected Foods per 3-oz. Serving at or Near the Requirement

Brewer’s yeast

Soybeans

Liver

Biotin Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
Requirement

Butter

Rice

Split peas

Sunflower seeds

Walnuts

Peanuts

Tuna

Red grapefruit

Watermelon

Turnip greens

Mark A. Falco, D.M.D.

Folic Acid

Folic acid is necessary for the synthesis of RNA and DNA enabling cell divi-
sion to proceed properly. This is important for all living cells in the body with
the most frequent use involving the most rapidly reproducing cells such as the
bone marrow cells, which produce the red blood cells. Folic acid is needed
during the rapid cell turnover of the digestive tract and the uterine lining also.
The presence of niacin and vitamin C are needed to convert folic acid to its
active form. Vitamin B12 acts to regenerate the used active form of folic acid
for repeated use in RNA and DNA synthesis. Folic acid, vitamin B6, and vita-
min B12 act to remove homocysteine during the conversion of methionine to
cysteine. Folic acid is also important in the critical development of the nerv-
ous system of the fetus. It stimulates serotonin production in the brain.
Derivatives of folic acid are actually composed of another B vitamin known as
para-aminobenzoic acid (PABA) and an amino acid called glutamic acid.
PABA stimulates intestinal bacteria to make folic acid, which in turn helps in
the manufacture of pantothenic acid.

A deficiency of folic acid results in mental symptoms such as fatigue, apa-

thy, depression, forgetfulness, irritability, and paranoia. Anemia, sore gums,
weight loss, and diarrhea develop as well. Pregnancy requires more folic acid.
Increased amounts are needed during stress, illness, and alcohol consumption.
The intake of high amounts of vitamin C also requires a higher intake of folic
acid. Analgesics, antibiotics, anti-convulsants, cortisone drugs, and oral con-
traceptives decrease its effect. Tobacco decreases its absorption.

Folic acid is extremely sensitive. Over 90% of folic acid in the form of

folate may be lost from vegetables during cooking, more so if the cooking
water is discarded. Besides heat, folic acid is sensitive to any light, any type of
heating, and acidity. It can even be lost from long-term storage at room tem-
perature. Its potency is also lessened in any food processing or preparation. It
is one of the ‘enriched’ vitamins added back to flour after processing. The
average adult RDA for folic acid is 200 micrograms per day. The average dur-
ing pregnancy is 400 micrograms per day.

Folic Acid Content of Selected Foods per 3-oz. Serving Greater than the RDA

Brewer’s Yeast

Black eye peas

Soybeans

Chickpeas

Wheat germ

Beans

Lentils

Liver

Folic Acid Content of Selected Foods per 3-oz. Serving at or Near the RDA

Split peas

Wheat

Broccoli

Brussels sprouts

The Preservation of Health

Folic Acid Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Sprouts

Peas

Asparagus

Sunflower seeds

Collard greens

Spinach

Eggs

Avocado

Raisins

Walnuts

Cobalamin (Vitamin B12)

Cobalamin is needed to metabolize carbohydrates, fats, and proteins. It acts
along with folic acid in the synthesis of RNA and DNA and the stimulation
of growth. It is the only vitamin composed of a mineral, namely, cobalt. It
helps to produce choline and methionine. It metabolizes homocysteine,
which aids in the regeneration of the active form of folic acid. Through the
metabolism of methionine and homocysteine, cobalamin contributes in the
development of myelin, which sheathes and protects nerve fibers. Cobalamin,
iron, folic acid, copper, protein, vitamin B6, and vitamin C are all essential for
the formation of red blood cells. Cobalamin also assists in the formation of
the amino acid leucine. It also influences melatonin secretion.

Cobalamin is not found in plants. It is found in animals only and normal-

ly it is consumed because the gut bacteria of these animals produce it. Human
intestinal bacteria manufacture cobalamin in the colon, but it is considered to
be unavailable for absorption. Stomach acid aids in the absorption of ingest-
ed cobalamin in the intestine. Impaired nerve function such as numbness
occurs during deficiencies. Mental confusion, auditory disorders, visual disor-
ders, and a red tongue are indicative of a deficiency. Since both folic acid and
cobalamin work together in many functions, supplementation for only one of
these vitamins may still mask a deficieny in the other. Antibiotics, alcohol,
tobacco, and long-term use of nitrous oxide (laughing gas) act to reduce the
levels of cobalamin. It is stable to heat, but not stable in heated acid or alkali
solutions. Light can partially destroy it. The stores of cobalamin in the body
can remain a very long time for such a small amount necessary for proper
function. The adult RDA is 3 micrograms.

Cobalamin Content of Selected Foods per 3-oz. Serving Greater than the RDA

Liver

Clams

Sardines

Oysters

Flounder

Mackerel

Snapper

Herring

Mark A. Falco, D.M.D.

Cobalamin Content of Selected Foods per 3-oz. Serving at or Near the RDA

Trout

Salmon

Tuna

Beef

Cobalamin Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Eggs

Lamb

Cheese

Liverwurst

Lobster

Bass

Halibut

Sausage

Ascorbic Acid (Vitamin C)

Ascorbic acid is not manufactured in humans as it is in other animals. It
must come entirely from our diet. It functions to produce collagen, an
important protein in cartilage, tendon, and connective tissue construction,
along with two amino acids, proline and lysine. Ascorbic acid is important
in wound repair, healthy gum tissue, immune function, cortisol production,
and in the production of carnitine. It is transported into cells with the aid
of insulin. The conversion of dopamine to norepinephrine in the adrenal
gland is accomplished by the addition of ascorbic acid. It assists the conver-
sion of folic acid into its active form and, as an antioxidant; it helps prevent
the oxidation of vitamin A and vitamin E. Iron from non-meat sources is
absorbed well in the presence of ascorbic acid. Copper absorption is less-
ened in its presence.

Deficiencies of ascorbic acid cause fatigue, bleeding gums, easy bruising,

swollen joints, more frequent infections, slow wound repair, and irritability.
White blood cells possess large amounts of this vitamin, which relates to their
efficiency in attacking and engulfing bacteria. Seniors, pregnant women,
stressed individuals, burn victims, ill patients, alcoholics, and athletes all
require more ascorbic acid.

Sulfa drugs, tetracycline, aspirin, oral anti-coagulants, and oral contra-

ceptives decrease the effectiveness of ascorbic acid. Large amounts of ascor-
bic acid can break down alcohol in the body. Tobacco decreases its absorption.
It is very unstable in light and air. Drying, cooking, and long storage reduce
the levels of ascorbic acid, also. Fruits and vegetables picked before they have
ripened will also have diminished levels of ascorbic acid. The actions of ascor-
bic acid are enhanced by the carotenes and flavonoids present in the food
sources they are contained in. The adult RDA is 60 milligrams. It is 100 mil-
ligrams for smokers.

The Preservation of Health

Ascorbic Acid Content of Selected Foods per 3-oz. Serving Greater than the RDA

Acerola

Rose hips

Red chili peppers

Black currants

Red sweet peppers

Guava

Collard greens

Turnip greens

Green sweet peppers

Brussels sprouts

Broccoli

Spinach

Mustard greens

Cauliflower

Ascorbic Acid Content of Selected Foods per 3-oz. Serving at or Near the RDA

Red cabbage

Strawberries

Papaya

Orange juice

Ascorbic Acid Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
RDA

Orange

Grapefruit juice

Grapefruit

Turnips

Mango

Asparagus

Liver

Cantaloupe

Tangerine

Oysters

Lima beans

Peas

Soybeans

Radishes

Potatoes

Tomatoes

Calcium

Calcium is the most abundant mineral in the body. Yet, the body cannot pro-
duce it. It helps to build and maintain bones and teeth. Vitamin D helps reg-
ulate its absorption. Calcium is closely involved with muscle contraction, neu-
rotransmitter release, heartbeat regulation, and blood clotting. It interacts
with vitamin D, vitamin K and magnesium. Blood calcium levels are regulat-
ed by vitamin D, parathyroid hormone, and calcitonin. Its absorption
decreases with age.

High protein diets, high sugar intake, high phosphorus intake, and caf-

feine will accelerate its loss. Calcium contained within high phosphorus
foods forms calcium phosphate, which is not absorbed by the body. Spinach
and rhubarb contain an acid that inhibits its absorption as well. Decreased
levels of calcium result in osteomalacia or osteoporosis and periodontal dis-
ease. Tea and coffee decrease its absorption. The adult RDA is established at
1200 milligrams.

Mark A. Falco, D.M.D.

Calcium Content of Selected Foods per 3-oz. Serving at or Greater than the RDA

Seaweed

Kelp

Sesame seeds

Parmesan cheese

Calcium Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Swiss cheese

Cheddar cheese

Carob

Sardines

Collard greens

Turnip greens

Magnesium

Fifty percent or more of magnesium stores in the body are found in bone. It
is important for healthy teeth and bones. Magnesium is required for about
300 enzymatic functions within the body including the management of vita-
min D. Its most important function is in regulating muscle relaxation. It
essentially blocks calcium entry into heart muscle cells and vascular cells aid-
ing in lower blood pressure and a more efficient heart rate.

The highest concentrations of magnesium in other tissues are in the

brain, heart, liver, and kidney where the most metabolic activity is. It func-
tions in these tissues to convert glycogen to glucose and it plays a major role
in the action of insulin. It has been shown to be valuable in regulating blood-
glucose levels. Pyridoxine is essential for allowing magnesium to enter into
body cells.

Stress can deplete magnesium. Severe deficiencies occur in alcoholics,

diabetics, kidney damage, or chronic diarrhea. Muscle contraction, tremors,
confusion, fatigue, irritability, weakness, heart disturbances, and a predisposi-
tion to stress can all result from a deficiency. Low magnesium levels are asso-
ciated with low blood levels of calcium and potassium. Diuretics can increase
the loss of magnesium. Fat-soluble vitamins, oral contraceptives, and tetracy-
cline can decrease its absorption. A high calcium intake or a high amount of
vitamin D fortified dairy products reduces the absorption of magnesium. A
magnesium deficiency is strongly implicated in premenstrual syndrome.

The average adult RDA for magnesium is 400 milligrams. Athletes require

more. Many nutritionists believe 6 milligrams for every 2.2 pounds of body
weight is more accurate for a daily intake. One survey determined that about
72% of adult Americans are not getting the daily requirement for magnesium.

Magnesium Content of Selected Foods per 3-oz. Serving at or Greater than the RDA

Kelp

Wheat bran

Wheat germ

Blackstrap molasses

The Preservation of Health

Magnesium Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
RDA

Sunflower seeds

Almonds

Cashews

Shrimp

Carp

Herring

Mackerel

Soybeans

Halibut

Ocean perch

Peanuts

Snapper

Scallops

Swordfish

Haddock

Lobster

SalmonFloun

der

Snails

Pistachio nuts

Crab

Oatmeal

Oysters

Hazelnuts

Brown rice

Wheat grain

Phosphorus

Phosphorus is an important ingredient in bone formation. It is important in
the utilization of fats, proteins, and carbohydrates and helps the body to gen-
erate energy. Vitamin D aids in its absorption into the bloodstream. Many B
vitamins are not effective unless combined with phosphorus. The accepted bal-
ance for phosphorus intake is a 1 to 1 ratio with calcium intake from all food
sources. However, amounts found in every day foods such as carbonated soft
drinks, milk, and dairy products tip the scales toward a higher intake of phos-
phorus than is necessary. Too much phosphorus will lead to a loss of calcium
and form calcium deposits in soft tissue. About 85% of the phosphorus in the
body is located in bone where it is the second largest component of bone com-
position. Parathyroid hormone and calcitonin regulate its blood levels in
opposition to calcium. Phosphorus deficiencies are relatively uncommon.

Niacin and riboflavin cannot be digested without phosphorus. The aver-

age adult RDA is 700 milligrams. Doses above 3 grams per day may be toxic.

Phosphorus Content of Selected Foods per 3-oz. Serving at or Greater than the RDA

Pumpkin seeds

Sunflower seeds

Processed cheese food

Phosphorus Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
RDA

Sardines

Soybeans

Almonds

Liver

Mark A. Falco, D.M.D.

Cheddar cheese

Peanuts

Peas

Scallops

Tuna

Flounder

Barley

Chicken

Rice

Veal

Turkey

Lamb

Eggs

Pork

Zinc

Zinc is important in a lot of enzymatic reactions and in the actions of hor-
mones including insulin. It is also involved in the synthesis of DNA and RNA.
It is stored primarily in muscle, but is highly concentrated in red and white
blood cells. The presence of zinc supports proper immune function, decreas-
es wound-healing time, and maintains vision, taste, and smell. Zinc has antivi-
ral and antioxidant properties.

Zinc is one of the essential minerals lost in the milling of flour. Copper

competes with it for absorption. The levels of zinc fall during stress or infec-
tions. Marginal deficiencies are the most common especially for pregnant or
lactating women. Increased susceptibility to infection, poor wound healing,
decreased sense of taste and smell, acne, and eczema result from a deficiency.
A low sperm count, decreased night vision, mouth ulcers, a white coating on
the tongue, and halitosis can also develop from a deficiency. High amounts of
zinc decrease the absorption of copper and iron. Oral contraceptives decrease
its blood levels. Tetracycline is poorly absorbed in its presence in the gas-
trointestinal tract. Alcohol and coffee decrease its availability.

The average adult RDA for zinc is now less than 15 milligrams. Pregnant

and nursing women require more. Most diets are consistently low in the lev-
els of available zinc. Phytic acid in whole grains can block absorption of zinc
into the bloodstream. Dairy products and high calcium foods also interfere
with its absorption.

Zinc Content of Selected Foods per 3-oz. Serving Greater than the RDA

Oysters

Herring

Zinc Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Wheat germ

Turkey

Brewer’s yeast

Sesame seeds

Maple syrup

Soybeans

Sunflower seeds

Pumpkin seeds

Lamb

Ginger root

The Preservation of Health

ChickenCocoa
BaconPecan

Chromium

Chromium is a trace mineral that works closely with insulin to facilitate the
uptake of glucose into the cells of the body. It is an essential part of glucose
tolerance factor (GTF), which gives it importance in carbohydrate metabo-
lism. GTF is made up of a chromium molecule, two niacin molecules, and the
amino acids, glycine, cysteine, and glutamic acid. Insulin function is enhanced
by GTF. Chromium also activates enzymes involved in metabolizing glucose
and synthesizing proteins.

Milled grains producing flour lose 40% of the chromium. Sugar cane

refinement results in over 90% loss of chromium. Reduced absorption occurs
through aging, refined diets, and lack of exercise. A deficiency causes elevated
levels of insulin and blood sugar, which may be a factor in adult-onset diabetes.
Up to 50% of the American population may be deficient in chromium. Low
levels in soil contribute to this deficiency. Milk and other high-phosphorus
foods bind to chromium in the gastrointestinal tract preventing absorption.

A carbohydrate-rich diet requires more chromium to help utilize the glu-

cose generated. The adult RDA is not estimated. Safe ranges are recom-
mended to be 50-200 micrograms. Bodybuilders and individuals trying to
lower blood cholesterol require more.

Chromium Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
Range

Brewer’s yeast

Liver

Whole wheat bread

Wheat bran

Rye bread

Potatoes

Wheat germ

Green peppers

Copper

Copper is important for the formation of hemoglobin, which carries the oxy-
gen we need in the red blood cells. It is involved in the metabolism of cells for
producing energy. It works with vitamin C in the formation of collagen. It is
essential in the formation of superoxide dismutase, a potent antioxidant. It
also functions in some amino acid conversions, nervous system function, thy-
roid function, histamine control, and hair and skin color.

Mark A. Falco, D.M.D.

A deficiency is found commonly along with iron deficiency. Fatigue, pale-

ness, skin sores, and edema can appear. Slowed growth, hair loss, anorexia,
diarrhea, and dermatitis can also occur. High levels of zinc or increased zinc
intake can cause copper deficiency, reducing red blood cell function and
decreasing oxygen delivery. In addition, poor collagen formation, reduced
thyroid function, weakened immunity, cardiovascular disease, and poor nerve
conductivity can be associated with a deficiency.

Fiber, vitamin C, and zinc can interfere with copper absorption. Oral con-

traceptives increase copper levels. The RDA for copper in adults is 2 mil-
ligrams per day.

Copper Content of Selected Foods per 3-oz. Serving at or Greater than the RDA

Crab

Oysters

Liver

Mushrooms

Wheat germ

Mussels

Lobster

Molasses

Copper Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the RDA

Honey

Hazelnuts

Brazil nuts

Walnuts

Spinach

Salmon

Cashews

Oats

Peanuts

Lentils

Barley

Almonds

Manganese

Manganese is involved with a number of enzymes that control blood-glucose
levels and energy metabolism. It is a component of a very powerful antioxi-
dant known as superoxide dismutase. It is also important in proper thyroid
hormone function.

The milling of grains removes nearly 75% of the manganese. A deficien-

cy in manganese results in impaired growth, skeletal abnormalities, infertili-
ty, and defects in carbohydrate, fat, and protein metabolism. There is no RDA
for manganese, but 2.5 to 5 milligrams is considered safe.

Manganese Content of Selected Foods per 3-oz. Serving Greater than the Range

Avocado

Seaweed

Manganese Content of Selected Foods per 3-oz. Serving at or Near the Range

Ginger

Buckwheat

Oatmeal

Barley

The Preservation of Health

Hazelnuts

Pecans

Brazil nuts

Sunflower seeds

Manganese Content of Selected Foods per 3-oz. Serving at or Greater than 1/3 the
Range

Whole wheat flour

Almonds

Peas

Watercress

Peanuts

Rice

Coconut

Spinach

Amino Acids

Several of the amino acids have a working relationship with the vitamins and
minerals previously discussed. A few help in carbohydrate metabolism. Others
are converted to different compounds necessary for energy metabolism.

Glutamic acid gives rise to GABA, the inhibitory neurotransmitter, along

with the help of pyridoxine and manganese, and is required for the synthesis of
folic acid. It is the only amino acid metabolized in the brain. It detoxifies ammo-
nia by converting to glutamine. It is a member of GTF. Supplementation with
L-glutamine has been shown to reduce the cravings for alcohol and the crav-
ings for sugar and carbohydrates. It is synthesized from other amino acids,
arginine and ornithine (bodybuilders’ supplements) and proline. Arginine is
involved in insulin production. Glutamic acid is found in abundance in ani-
mal and vegetable proteins. Monosodium glutamate is a single salt of glu-
tamic acid. Arginine is present in most proteins, particularly nuts, grains,
and chocolate.

Alanine can be converted to glucose in the liver or muscles for energy when

needed. It is an important part of human muscle tissue. It also functions as an
inhibitory neurotransmitter in the brain and it helps to stimulate lymphocyte
production. Alanine metabolizes tryptophan and pyridoxine. It is easily found
in beef, pork, turkey, cheese, wheat germ, oats, yogurt, and avocadoes.

Glycine is one of the few amino acids that enhance glycogen storage. It

helps to calm the brain. It can be converted from choline and from the amino
acids threonine and serine. Glycine is needed for the production of hemoglo-
bin, collagen and glutathione. By converting to creatine, it helps to manufac-
ture RNA and DNA.

Lysine is concentrated primarily in muscle tissue, but it helps in the

absorption of calcium from the gastrointestinal tract, bone growth, and col-
lagen formation. It utilizes vitamin C to assist its conversion and incorpora-
tion into collagen. Its metabolism in the liver depends on vitamins B2, B3,
B6, and C and on iron and glutamic acid. Lysine helps to form the amino

Mark A. Falco, D.M.D.

acid carnitine. It is found in abundance in fish, meats and dairy products. It is
in higher amounts in wheat germ, fruits, and vegetables than most other
amino acids.

Phenylalanine can cross the blood-brain barrier to affect brain chemistry.

It can form thyroid hormones, norepinephrine, epinephrine, dopamine, and
tyramine by way of its conversion to tyrosine. It is important for memory,
alertness, and learning. The metabolism of phenylalanine requires pyridox-
ine, niacin, ascorbic acid, copper, and iron, as does the metabolism of tyro-
sine. Tyrosine is additionally supportive of the metabolism of melanin, estro-
gen, and endorphins and is known to be the ‘antidepressant’ amino acid. Once
formed, tyrosine cannot be converted back to phenylalanine. Aspartame is
made from the combination of phenylalanine and aspartic acid. Phenylalanine
is found in high levels in meats and milk products with lower levels found in
wheat germ and oats.

Taurine is important for metabolism especially in the brain. Taurine helps

to generate nerve impulses by assisting in the entry and removal of potassium,
sodium, calcium, and magnesium from cells. Zinc supports this effect.
Taurine is in highest amounts in the brain and heart tissue. Newborns can’t
produce it, but adults can produce it from cysteine with the aid of pyridoxine.
Fish and meats are the best sources.

Cysteine is formed from homocysteine, which is formed from methionine.

Cysteine can form the powerful antioxidant glutathione with the aid of
glutamic acid and glycine. It is found along with methionine in egg yolks, red
peppers, garlic, onions, broccoli, and Brussels sprouts. Methionine is the least
abundant amino acid present in foods. Its concentrations are the lowest of all
the amino acids, but the best amounts may be found in dairy products, eggs,
fish, and meats. It acts as choline and inositol do by preventing excess fat build-
up in the body. Methionine helps prevent fatigue and reduces histamine release.

Carnitine converts fatty acids into energy for muscular activity and is,

therefore, most abundant in the skeletal muscles and the heart muscles. It is
important in triglyceride reduction and fat oxidation. Ascorbic acid, niacin,
pyridoxine, iron, methionine, and lysine are essential for the synthesis of car-
nitine by the body in the liver and kidneys when it is required. Red meats and
dairy products contain the highest amounts. Athletes report greater
endurance with carnitine supplementation.

Tryptophan is needed to make niacin and serotonin. Pyridoxine, ascorbic

acid, folic acid, and magnesium are needed to metabolize it and create its
availability for use in the brain. Tyrosine and phenylalanine compete with it
for absorption into the brain. Many depressed individuals demonstrate low
levels of tryptophan. Dietary intake of tryptophan is low. High amounts are
not found in any foods. It is the lowest essential amino acid found in corn,
grain, and legumes. The best sources are fish and meats.

The Preservation of Health

Accessory Nutrients

Coenzyme Ql0 is an essential component of the cell machinery that produces
energy. It is involved in the manufacture of the elements necessary to produce
energy. A deficiency can lead to heart failure. Coenzyme Q10 works along-
side carnitine and vitamin E as an antioxidant. Low amounts exist in peri-
odontal disease. It is found in all plant and animal food.

Lipoic acid has a necessary role in the formation of the elements needed

to produce energy. It is an effective antioxidant. It is involved in the conver-
sion of carbohydrates to energy in a process utilizing thiamine and niacin.
Lipoic acid is one of the precursors for the antioxidant glutathione. Liver and
yeast are food sources that possess the most amounts of lipoic acid.

Bioflavonoids, or flavonoids as they are sometimes called, are pigments

responsible for the colors of fruits. They have anti-inflammatory, anti-viral, anti-
histaminic, anticarcinogenic, and antioxidative properties. Proanthocyanidins
are flavonoids found in plants and red wine that possess a profound effect on
collagen metabolism and integrity. They are the most potent antioxidants
known. Quercitin has anti-inflammatory activity by preventing histamine
release. It also aids in the prevention of cataracts by inhibiting the formation
of sorbitol from glucose. Quercitin is the most effective flavonoid exhibiting
antiviral activity. Green tea polyphenols are potent antioxidants and are used
in the prevention of cancers.

There are many citrus bioflavonoids that help reduce capillary fragility

after bruising and help improve varicose veins. Bioflavonoids are found in the
inner lining of the skin of fruits. They are in abundance in black currants,
black raspberries, cranberries, blueberries, and red grapes. Green tea, sage,
and red wine also have an abundance of flavonoids.

Several more vitamins, other minerals and amino acids, and essential fatty

acids all help to make up the rest of the nutrients for our bodies to function
properly. Only the most notable for the purposes of this book have been
addressed. Although most of the food contents listed relate to the RDA, opti-
mum daily allowances have not been listed. Individuals suffering from defi-
ciencies, diseases, and illnesses need optimum requirements. Optimum
requirements are also necessary for those individuals experiencing heightened
exercise activity or stress. A discussion with your health care practitioner is
best to determine if supplementation of micronutrients is best for your situa-
tion. It is clear, however, that a lack of balance in metabolizing nutrients is a
direct reflection on the amount of excess glucose the body must absorb. Only
the right balance of nutrients and micronutrients can restore the correct lev-
els the body needs to regain and retain health. The following chapters will
concentrate on specific impairments to normal function created by excess
glucose and the subsequent loss of metabolic balance. The information has

Mark A. Falco, D.M.D.

been garnered from various supportive research. Their references are listed in
the back of the book.

Vitamins and Minerals Important for Carbohydrate Metabolism

•

Thiamine (vitamine B1)

•

Riboflavin (vitamin B2)

•

Niacin (vitamin B3)

•

Pantothenic acid (vitamin B5)

•

Pyridoxine (vitamine B6)

•

Cobalamin (vitamin B12)

•

Folic acid

•

Choline

•

Biotin

•

Ascorbic acid (vitamin C)

•

Calcium

•

Magnesium

•

Phosphorus

•

Zinc

•

Chromium

•

Copper

•

Manganese

The Preservation of Health

Hunger and Obesity

Hunger symptoms

What triggers hunger? The mechanisms that trigger hunger are multifaceted
and relate to the presence of certain levels of glucose, amino acids, and fatty acids
in the blood. A release of hormones into the blood, stimulation of the hypothal-
amus, contractions of the gut, body temperature, micronutrient requirement,
and eating habits also precipitate hunger. Hunger can predominate when imbal-
ances in body chemistry or body physiology resulting in adverse conditions
affects the hormonal metabolism of nutrients. Short-term and long-term hunger
sensations act chemically different from each other as well.

An individual eating three meals a day is susceptible to short-term hunger

for glucose and some amino acids and is equally susceptible to long-term
hunger for other amino acids and fatty acids. The two types of hunger over-
lap each other at times, which can make it difficult for someone to appropri-
ately satisfy the particular hunger for that moment. In many instances, the
satisfaction of hunger occurs by eating the most immediately available food
or, because of its endorphin elevation, the richest simple carbohydrate food.
This oftentimes will satisfy the short-term hunger, but may not help to satis-
fy the long-term hunger. Repetition of this cycle over and over can create a
long-term deficiency in available micronutrients, which further disturbs the
metabolism of amino acids and fatty acids. This eventually disrupts the
metabolism of glucose when the hunger is repeatedly satisfied by excess sim-
ple carbohydrates.

The process of creating immediate energy comes mostly from the reac-

tions of glycogen breaking down to glucose or triglycerides breaking down to
fatty acids. The formation of glycogen and triglycerides as stored energy
requires glucose and fatty acids. Energy is required in the form of calories for
these conversions. In a natural and normal supply of carbohydrates obtained
from plant and animal foods, the nutrients and enzymes needed to assist in
reactions are already in the food supply. Our bodies need only minimal sup-

plies from the stored nutrients in our cells to help in these conversions.
However, when the amount of sugar, as in sucrose or corn syrup, to be burned
as calories for conversion requires all of its micronutrients from stored sup-
plies in the body, a rapid depletion of micronutrients from many of our cells
occurs. The body becomes starved to return these micronutrients back to
their normal stored levels. Our bodies recognize that they’re missing and they
ask us to replenish them. How? By signaling hunger. For some of us, the stim-
ulation to replenish these micronutrients leads to overeating.

The Triggers

Studies done by the Wurtman’s at the Massachusetts Institute of Technology
indicated that carbohydrate ‘snacking’ increased the availability of serotonin in
the brain. This had a profound effect on mood in individuals that were not
considered to be carbohydrate ‘snackers’. Even more astounding were the
effects on the carbohydrate craving ‘snackers’ who felt less depressed after eat-
ing the carbohydrate-rich foods. Since insulin secretion at a high-carbohydrate
meal diminishes the levels of amino acids in competition with tryptophan for
entry into the brain, serotonin activity determines the choice of food con-
sumption at a meal and may be somewhat defective in carbohydrate cravers.

The defect that carbohydrate-craving individuals suffer from is related to

the amount of insulin released at a meal containing carbohydrates. If carbo-
hydrate consumption is high throughout the day, an overabundance of insulin
is released into the bloodstream without being lowered. This event causes
serotonin levels to be too low and prevents the satisfaction that serotonin
release has in relieving hunger. The amount of insulin released is always
dependent upon the amount of glucose entering the blood at anyone time. If
the absorption of glucose is low or slow, insulin release is more easily con-
trolled and the level of serotonin is more easily maintained.

There are several other factors that turn on and turn off hunger of which

we know very little about at this time. Endorphins, norepinephrine, and corti-
sol are a few of the chemical neurotransmitters already discussed that play
major roles in the regulation of carbohydrate consumption. Neuropeptide Y
(NPY) is a neurotransmitter released by the hypothalamus when blood-glu-
cose levels are low that helps to turn on a person’s desire for consumption of a
carbohydrate-rich meal. It assists in jump-starting our mornings. NPY is also
released when a chronically stressed individual releases cortisol into the blood.
The cortisol release triggers a higher productive state within body cells that
uses up larger doses of glucose and depletes glycogen stores. Glucose replen-
ishment within the body becomes more urgent under these circumstances.

The Preservation of Health

Adequate serotonin levels reduce the release of these neurotransmitters under
normal conditions in short-term situations. The hormone leptin regulates the
action of NPY in long-term situations.

The craving for sweets may be highest among stressed individuals due to

the increased need for tryptophan in reducing the risk of depression. Subjects
were divided into high-stress prone and low-stress prone categories. Both
groups were given a carbohydrate-rich, protein-poor diet and a carbohydrate-
poor, protein-rich diet. All subjects except the carbohydrate-rich, protein-poor
diet subjects demonstrated changes in cortisol levels and in moods under exper-
imental stress. However, the high-stress prone subjects showed significant ele-
vations when they were on a carbohydrate-poor, protein-rich diet. High-stress
prone individuals are more likely to have increased episodes of lower blood-glu-
cose levels, a condition known as hypoglycemia. Hypoglycemia can have
mood-altering effects on the brain due to lower levels of the neurotransmitters
resulting from the reduced presence of amino acids and glucose. This may ulti-
mately lead to depressive states or schizophrenia. Depression can also involve
mood disorders in premenstrual syndromes and seasonal affective disorders.

A study by the Fernstrom’s, psychiatrists at the University of Pittsburgh

School of Medicine in 1995, demonstrated in rats that tryptophan concentra-
tions and the synthesis of serotonin respond to sequential ingestion of meals
if a three-hour interval between meals is established. Tryptophan levels would
not rise again two hours after an ingested meal regardless if the meal consist-
ed of carbohydrates or protein. Tryptophan levels would rise after a carbohy-
drate meal, but not again unless the meal was separated from the first meal by
at least three hours. This could very well represent our need for increased
serotonin levels to be satisfied only if a reasonable separation between meals
is obtained. This satisfies the blood-glucose levels and the symptoms of
hunger. In another study performed at the McGill University in Quebec,
Canada, it was found that rats didn’t produce serotonin as efficiently on a
fructose-fed diet as they did on a glucose-fed diet, although insulin secre-
tion increased during the fructose feeding. Glucose is obviously the most
important nutrient for the brain’s activity and, as this study indicated, very
important for serotonin production. The trouble occurs when carbohydrate
consumption is too heavy resulting in increased insulin levels and wild fluc-
tuations in serotonin levels. Avoid carbohydrate ‘snacking.’

Fat Accumulation Facts

An increased intake of food without a similar increase in the expenditure of
energy results in increased body weight. For each 9.3 calories of excess energy

Mark A. Falco, D.M.D.

secured in the form of carbohydrates, protein, or fat, one gram is stored as fat.
It is reasonable to reduce the amount of fat intake as nutritionists suggest, but
it is equally important to reduce the amount of total simple carbohydrate
intake as well. Excess carbohydrate intake without an equal expenditure of
energy will cause the carbohydrates to be converted to fat. Over a long peri-
od of time, this leads to obesity. The energy input of calories must be less than
the energy output of calories for an obese individual to lose weight. Weight
maintenance is dependent upon sugar, fiber and total carbohydrate intake in
proportion with calorie-burning activities. Muscular activity is the single
most important means of energy expenditure by the body and remains key to
weight maintenance from the toddler years to old age.

The national Body Mass Index (BMI) is used as a guideline to determine

obesity. Multiplying your body weight in pounds by 703, then dividing this
number by your height in inches squared determines the BMI. A BMI over
25 indicates an overweight person. A BMI over 30 indicates obesity. It is now
recognized that more than 55 per cent of American adults are overweight
according to a report in 1998 by the National Institutes of Health. A 1999
poll by On Health.com had nearly 8500 respondents of which 65 per cent
considered themselves to be overweight. Another survey showed us that
Californian men were 60 per cent overweight and Californian women were
45 per cent overweight in 1999. Sugar intake has increased dramatically in the
last thirty years with the most consumption reported by pre-schoolers and
early elementary level age groups. This early consumption of a high carbo-
hydrate diet involving primarily refined sugars predisposes many of these
young children to an early development of fat cell growth and a lifetime of
uncontrollable weight problems. A year 2000 survey of 2800 people conduct-
ed for the International Bottled Water Association found that nearly one-
third of the participants didn’t know that giving a child water instead of juice
or soft drinks could help prevent childhood obesity. The U. S. population is
getting too fat!

Only about 24 per cent of the American population sits down to eat three

meals a day. The increase in the shortened preparation of foods, quick meals,
fast foods, and snack foods lacking acceptable nutrition content contribute to
an increased load of refined sugars in the diet leading to obesity.

It has been shown through a study conducted in 1994 at Indiana University

that obese individuals obtain most of their sugar intake from added refined
sugars compared to lean individuals. In addition, fiber intake for the obese
individuals was substantially lower than the lean individuals. A high intake of
refined sugar forces the body to deplete stores of micronutrients quicker caus-
ing the percentages of daily vitamin and mineral contents to be lowered. The
effects of this are not readily seen early on in development. As a high carbo-
hydrate diet continues to predominate over a considerable period of time, the

The Preservation of Health

body’s adaptation to more glucose is either used up with increased activity or
bottled up with increased fat storage.

In multiethnic neighborhoods of Montreal, Canada, Louise Johnson-

Down and others surveyed 498 children aged 9-12 years in 1997. They found
that dietary fat intake was higher in children from single-parent families and
nearly 40 per cent of the children were overweight. It may be true that it is
more difficult for children to achieve balanced nutrition in single-parent
households. Quick meals, unsupervised meals, and poorer eating habits can
greatly influence the level of balanced nutrition in any child.

In yet another study of 12-19 year-old Navajo inhabitants in Arizona in

1997 by David S. Freedman and others, it was learned that almost 40 per cent
of the participants were overweight. Higher levels of fats, glucose, and
triglycerides prevailed when compared to other age groups. Obviously, the
diet of the Navajo population is poor in nutritional value. Increased risk for
disease predominates in their society.

The Contribution of Insulin

As long as insulin levels continue to remain elevated after carbohydrate
consumption, glycogen and triglycerides cannot be utilized because the excess
glucose in the blood needs to be redirected into cells first. If an individual is
extremely active, this does not present a problem short-term. If the individual is
relatively inactive, obesity results long-term. Remember this, it’s not the amount
of calories you add on that causes obesity, it’s the amount of energy you expend
that is less than the energy you consume in proportion to your sugar intake, fiber
intake, and total carbohydrate intake that leads to weight gain. Fat consumption
regulates satiety with our meals. The fact that we have been told to eat less fat
actually causes us to eat more carbohydrates that do not help us to control satiety.

Increased levels of insulin have been designated as the main culprit in the

deposition of fats into normal cells. Regulation of appropriate levels of insulin
during and after meals is the chief impetus behind many of the diet experts’
programs for weight loss. If the energy you consume is not equal to the ener-
gy you expend, insulin is probably overworking. If you expect to maintain a
normal weight, you are required to do three things. First, you must follow the
nutrition guide for the ‘three criteria’ listed in Chapter 5. Second, you must
lessen the rebound effect of insulin as indicated by the diet experts. Only they
have the ability to help you to manage individual weight loss effectively. Their
plan may have to override the ‘three criteria’ in serious conditions. Lastly, you
must get plenty of exercise. Your intake of added sugars must be curtailed to
benefit from all three of these conditions.

Mark A. Falco, D.M.D.

The minerals chromium, magnesium, zinc, and manganese necessary for

glucose and fatty acid storage are used up when insulin secretion is above nor-
mal. The amino acids, glutamic acid, glycine, and cysteine involved in the glu-
cose tolerance factor are diminished during an overwhelming release of
insulin. Carnitine is continuously inhibited by insulin in converting triglyc-
erides back into fatty acids. All of these and other nutrients and micronutri-
ents behave as a team. As in the game of baseball, if one hits the ball, anoth-
er one must catch it. To do this effectively, a good bat and a good glove are
needed. Insulin behaves as the catcher, needing to store the ball, or store the
energy. Glucagon behaves as the batter, needing to power the ball, or release
the energy. The micronutrients behave like the bat and the glove. They make
the reactions stop and go correctly. When an imbalance in micronutrient
uptake exists, the energy isn’t transformed completely. A crack in the bat or a
tear in the glove changes the outcome of the baseball game.

Body Mass Index (BMI)

The formula for BMI is 703 x weight (lbs.)/height squared (inches).
Example:

Man
Weight: 225 lbs.
Height: 72 inches
703 x 225/72 (squared) = 158,175/5184 = 30.5

A BMI over 30 indicates obesity.

Example:

Woman
Weight: 145 lbs.
Height: 62 inches
703 x 145/62 (squared) = 101,935/3844 = 26.5

A BMI over 25 indicates overweight.

Maintenance of Normal Weight (BMI of 25 or less)

•

Follow the ‘three standard criteria for sugar consumption’

•

Exercise regularly

•

Seek professional help for appropriate diet if weight loss is desired

The Preservation of Health

Tooth Decay

High Sugar Intake

Prior to 12,000 B. C., evidence of tooth decay (caries) from remaining skulls
was non-existent. Between 12,000 B.C. and 3000 B. C., caries became evident
in skulls of older persons isolated to areas of severe tooth wear from grinding.
In addition, the root areas of teeth indicated some caries frequency. There
was no tooth decay noticed in the children. Eskimos that have lived in villages
away from modern civilizations in the twentieth century experienced tooth
decay in about one-tenth of one percent of the population. Isolated village
children of Rhodesian, Samoan, Maori, and Bedouin descent who were intro-
duced to European foods and subsequently ate them for most of their lives
had fifty per cent of their teeth possessing cavities. Prior to the introduction
of European foods, the village rate was less than one per cent.

A 1984 report on 405 English adolescents discovered that the boys had an

average daily intake of 85 grams (17 teaspoons) of added sugar while the girls
averaged 78 grams (15 1/2 teaspoons) of added sugar intake. Confectionery,
table sugar, and soft drinks accounted for 71 per cent of their added sugar
intake. Finnish children were reviewed for dietary patterns and caries in 1979.
A higher intake of refined sugars correlated with a higher incidence of caries.
It was also found that the high-caries group had less iron, thiamine, and
ascorbic acid, in their diet. Germans consuming large amounts of sucrose
were found to have lowered nutrient and micronutrient intake compared with
those consuming moderate amounts of sucrose. A recommendation for a
maximum 10 per cent daily intake of sugar for energy was suggested in 1998
to offset this trend. This supported an analysis conducted by the Federal
University of Goias in Brazil between 1961 and 1991 of 36 countries showing
an 84.5 per cent recommendation that extrinsic sugars such as sucrose had to
be reduced in the diet to a maximum level of 10 per cent of the total calorie
intake to prevent dental caries and obesity. The ‘three criteria’ meet these
requirements safely. An excess amount of sugar in the diet does cause caries
and contributes to greater health risks.

Numerous animal and human studies have verified a powerful correlation

between refined sugar and caries. Why has consumption of refined sugars
been on the increase in spite of this health risk? I suppose the best answer to
this question is to draw an analogy of the runaway train. Now that sugar
demand and sugar consumption have built up a head of steam, no one person
or group can stand in its way to slow it down in spite of being run over by it.
It would take another equally powerful train coming from the opposite direc-
tion to stop it cold. I don’t see that ever happening. Instead we’ve developed
and promoted toothbrushes, toothpaste, fluoridation, mouth rinses, bacteri-
cidal agents, sealants, and dental cleanings to substitute for caries control. In
fact, work on vaccines and bacteria that eat oral bacteria continue to be
researched. As a dentist myself, I do appreciate the great efforts many of my
colleagues have made to decrease the incidence of caries in the last quarter of
the century. My focus, however, remains on better management of the sources
that decrease the risk of caries naturally and, other than a genetic flaw, reduce
the onset of further disease. Brushing and rinsing your mouth, although nec-
essary, may mask altered states of health. Pay close attention to the appear-
ances and sensations your mouth displays.

There are very few reviews in the literature on the management of diet

and nutritional intake as it relates to dental caries. Research in the United
States is lacking in this area. One of the few studies cited had verified a strong
caries-diet relationship, but recommended no guidelines because the
researchers felt if they had done so, they may have induced the public to con-
sume more fat to make up for the reduction in carbohydrate calories they
qualified. The study may have been beneficial, but the conclusions were all
wrong. A Russian survey in 1993 boldly stated that the least caries developed
in the families studied when 30 grams (6 teaspoons) or less of sugar were part
of their daily calorie intake. This is specific. They didn’t just recommend low-
ering the intake; they specifically set a reasonable limit.

Many researchers, presumably funded by others, look for that miracle

drug, that prodigious product, or that superseding substance that can be mar-
keted to the masses. A lot more people would benefit from the knowledge and
disease prevention that researchers can bring to the table if nutritional bio-
chemistry in interactive states were highlighted more. For instance, nursing
bottle caries is a well-known dental condition that occurs to an infant’s teeth
when he or she suckles from a baby bottle full of a sweetened juice as the baby
dozes off to sleep with this bottle day after day. The infant’s teeth are com-
pletely broken down in this acidic environment, which often leads to prema-
ture removal of the carious teeth. What’s less known is that continuous con-
sumption of the refined sugar, non-fiber containing fructose, or corn syrup in
this sweetened juice can also cause a malabsorption of carbohydrates and
other nutrients that can develop into bowel problems and allergies.

The Preservation of Health

Eleven per cent of preschoolers consume 12 ounces or more a day of fruit

juice, which is excessive. Fruit juice is not and cannot be a replacement for the
recommended daily servings of fruits and vegetables. And fruit juice does not
fit into the three criteria for balanced nutrition. Excessive consumption of
fruit juice can affect physical and mental development and cause obesity.
Excess consumption of fruit juice lessens the consumption of milk, which is
still the major source of calcium for youngsters in the diet. So here we have a
greater amount of information for the parent of the infant who is now much
more able to adjust to a more preventive and nutrition oriented lifestyle based
on more thorough interrelated information than simply not allowing the
infant to retain the baby bottle during sleep.

Structural Compositions in the Mouth

The saliva in the mouth is useful for lubrication, detergent cleansing, destruc-
tion of pathogenic bacteria, and enzymatic actions. Buffering the fluid in the
mouth is important in maintaining a good mineral balance between the teeth
and the rest of the mouth. The saliva contains a bicarbonate buffer to regu-
late the pH (acidity) of the mouth. Thiamine, riboflavin, niacin, pyridoxine,
pantothenic acid, biotin, folic acid, cyanocobolamin, ascorbic acid, and vita-
min K can be found in normal saliva. These are the very vitamins that are
associated with carbohydrate metabolism and structural protein formation.

The formation of tartar (dental calculus) on teeth is due to a mineral

imbalance at the site of deposit partially related to the presence of acid-pro-
ducing bacteria at the same site. Calcium phosphate is the main ingredient of
calculus above the gum line. Magnesium phosphate is the main ingredient of
calculus below the gum line. The small organic component of calculus is
mainly carbohydrates and proteins. There are several theories as to why cal-
culus forms on teeth, but the principal effect is similar to any other fluid-ion
exchange within the body. Calcium phosphate precipitation occurs on teeth
as it does in any other calcification process in soft tissue anywhere within the
body. These precipitates can contribute to gallstones, kidney stones, arte-
riosclerosis, connective tissue nodes, and osteoporosis. An increased alkalini-
ty of saliva precipitates calcium phosphate. Magnesium phosphate precipita-
tion is related to bone loss around the tooth socket.

When a calcium and phosphate deficiency exists in the body, excessive

bone and tooth resorption occurs. When a phosphate deficiency alone occurs,
there is disturbed jaw growth and tooth eruption, and malocclusion (mis-
aligned teeth). A calcium deficiency in youngsters causes osteoporosis, a pro-
tein deficiency especially tryptophan, and connective tissue degeneration. A

Mark A. Falco, D.M.D.

magnesium deficiency decreases bone formation, causes connective tissue
hyperplasia (ballooning), and results in the loosening of teeth. A balance of
each of these minerals is essential to healthy teeth and bones.

The teeth are structurally made of enamel, dentin, and cementum.

Enamel is the hardest tissue in the body covering the outermost part of the
tooth above the gum line. It consists of greater than 95 per cent calcium phos-
phate. Dental caries aids the acid demineralization of the calcium phosphate
structure of enamel.

Dentin is a connective tissue underneath the enamel that protects and

hydrates the pulpal tissue of the tooth housing the nerves, lymphatic vessels,
and blood vessels. It is composed of 70 per cent calcium phosphate. Dental
caries reduces the magnesium and affects protein levels including the reduc-
tion of arginine. The cementum is the material that makes up the entire solid
part of the root of the tooth. It, too, is a connective tissue structure. It has a
calcium phosphate level of about 50 per cent. It functions as an exchange of
nutrients and micronutrients between the tooth and the surrounding blood
vessels, tissue, and bone.

The Role of Bacteria

Several studies have shown that certain oral lactobacilli and oral streptococci
are subdued resident oral bacteria that proliferate in the presence of frequent
sugar consumption. The availability of easily digestible simple carbohydrate
food void of fiber and micronutrients coupled with the presence of an oral
acidic environment up to thirty minutes after a single intake of this food or
drink help these harmful bacteria and others to multiply swiftly. The immune
response of the saliva is overloaded and the tissue permeability of nutrients is
altered. An acidic environment precipitates serum calcium and interferes with
the protein formation of cellular structures. An alkaline environment revers-
es this process, but ultimately precipitates serum phosphorus. Alkaline foods
such as nuts and cheeses can reduce the acidity of the oral fluids caused by
ingested sugar and resulting in enamel demineralization and bacterial over-
growth. As teeth age and tissue breakdown continues, the roots of teeth
become the chief location for bacterial digestion of teeth. This form of decay
is known as root caries.

Melvin Page was an early pioneer in dental research with calcium-phos-

phorus balance in the blood. His work established an extraordinary level of
dental care that treated body chemistry to alleviate the problems of dental dis-
ease in the first half of the twentieth century. By balancing the blood levels of
calcium and phosphorus to a 10 to 4 ratio, balancing blood levels of glucose

The Preservation of Health

to 100 milligrams per 100 milliliters, and by eliminating refined sugars from
the diet, he was not only able to eliminate dental caries, but he succeeded in
reducing the effects of connective tissue diseases such as arthritis. Most
researchers today still focus only on how to manage the bacteria that form the
decay without addressing the diet or related degenerative imbalances con-
ducive to the growth of the harmful bacteria in the mouth.

Systemic Changes with Caries Risks

Tooth decay has been shown to increase when certain systemic diseases start
to develop. A study by the Department of Cardiology at the University of
Goteborg in Sweden found that patients with Crohn’s disease, an inflamma-
tory condition of the gut, had a higher incidence of caries than the normal
population. Malabsorption of nutrients in an imperfect gut can affect blood
serum levels of glucose, calcium, bile salts, and amino acids among others.
Arthritic involvement is frequent. This may be one of the strongest indicators
relating caries risk to a systemic disorder especially involving the absorption
of nutrients.

A study in Finland of 1354 people aged 45 to 64 years investigated the

association between missing teeth caused by oral infections and ischemic
heart disease. The evidence pointed to a causal relationship between the two.
Denture wearers are not immune, therefore, to systemic diseases involving
carious teeth. In fact, the implausible loss of teeth had been a clear signal of
accelerating disease throughout the body. I have seen many senior denture
wearers in dental practice and many of them carry around a long list of med-
ications usually to control their blood pressure and heart disease. They are
also more prone to infections. I have also seen many seniors who have
retained most all of their teeth caries-free and they average the least amount
of medication of all seniors combined.

Stopping Dental Decay

•

Brush and rinse your mouth 2-3 times daily

•

Follow the ‘three standard criteria for sugar consumption’

•

Consume a small amount of nuts or natural cheese after meals or as
snacks

•

Do not feed infants or children sweetened beverages or refined car-
bohydrate snacks

•

Drink unsweetened teas

•

Discuss the benefits and risks of fluoridation with your health care
practitioner

Mark A. Falco, D.M.D.

Gum Disease

The Mechanism of Gum Disease

Gum disease affects greater than 80 per cent of the population. It can begin
as an early inflammation of gum tissue known as gingivitis and progress over
a longer period of time to advanced periodontitis, a disease of the gum, tooth
root, and surrounding bone resulting in abscesses and tooth loss. Worsening
gum disease, clinically known as periodontitis, is the chief cause of tooth loss
in the population over age 40.

The primary protein component of the gum (gingiva) is collagen as it is

with teeth and bone. Collagen is a dense connective tissue that is compacted
into fibrous bundles to provide rigidity for tissue and to withstand compres-
sive and tensile forces. In gingivitis and periodontal disease, the matrix of col-
lagen undergoes a breakdown. Plasma cells and white blood cells invade the
tissue in response to the offending organisms or foreign substances causing
more vascular flow and collagen destruction, which results in gingival
swelling and bleeding. As the disease migrates toward the bone, new tissue
formation attempts to replace the destroyed tissue in the previously invaded
area. This can appear as though the gingival inflammation has improved
when, instead, the invasion has penetrated into deeper tissue not readily visi-
ble but causing more damage. Both the root surface and the bone become
damaged with the accompanying loss of collagen fibers from both. This
results in gingival recession, tooth sensitivity, caries, tooth mobility and
migration, and even pain.

Many studies have focused on oral microorganisms of various types that

have been implicated in the etiology of gingivitis and periodontitis while sali-
vary antibodies have been shown to maintain consistent levels during bacter-
ial invasion of the gingiva. But most bacteria implicated in the development
of gingivitis and periodontitis are not foreign residents to the oral cavity. In a
healthy mouth, their numbers are small. It is only when the environment
changes, or when the entry of an abnormal substance is introduced, that the
amount and type of bacteria present are shifted away from normal balance.

For example, leaving your house with a thick overcoat and an umbrella in a
driving rainstorm and returning home without wearing the overcoat or car-
rying the umbrella because the sun is shining and warming your body is a
response to the change in the weather. In the oral environment, acidity and
neutrality behave like the entry of sugar and the absence of sugar. The envi-
ronment is different for each and the response by bacteria is different for each
just as it is for you when the weather changes.

If this type of change is evident just through observation, what else may

be happening on a microscopic or cellular level in the body? Collagen makes
up the primary organic component of all the connective tissue in the body
from soft supportive tissue to ligaments and tendons, and from cartilage to
bone and teeth. Calcium, phosphorus, and magnesium are the primary inor-
ganic components of all the connective tissue in the body. If the introduction
of sugar can trigger a damaging response in the mouth, would it be hard to
believe that similar changes can trigger damaging responses within the rest of
the body? It just may take years to finally observe the changes and, as is usu-
ally the case, some discomfort or pain forces you to get medical attention and
a degenerative disease is diagnosed.

Diet and Periodontal Health

Is diet involved in gum disease, or is it just poor plaque control? A German
article published in 1984 proved that gingivitis developed more rapidly in
subjects on a carbohydrate-enriched diet with greater amounts of refined
sugar than a carbohydrate-reduced diet. In addition, more complex and
destructive microorganisms quickly accompanied the formation of dental
plaque in the carbohydrate-enriched diet, but developed more slowly in the
carbohydrate-reduced diet. In 1989, an article was published in Japanese on
the relationship of dietary habits to gingivitis, dental calculus deposit, and
dental plaque in 16 high school students of both sexes. It was discovered that
the intake of calcium, iron, vegetables, and vitamins A and B2 were insuffi-
cient in the boys. The boys also had more irregular eating habits than the
girls. Gingivitis was found to be more severe when inadequate nutrition and
irregular dietary habits prevailed. All of this evidence points to the effective
destruction of gingival tissue by added sugar and the subsequent depletion of
micronutrients by added sugar in the diet.

A demonstrative study published by Drs. A. D. Sidi and F. P. Ashley in the

Journal of Periodontology in 1984 on 21 male dental students over two three-
week periods demonstrated that significantly higher gingival inflammation
upon dental examination existed for the student group given a high-sugar diet

Mark A. Falco, D.M.D.

although plaque levels remained the same for both the high-sugar diet group
and the low-sugar diet group. The conclusion was that frequent high-sugar
intake directly increased gingival inflammation resulting in gingivitis. It wasn’t
the bacteria. This conformed to the work done by Drs. Jalil, Cornick, and
Waite in 1983 that showed that increased dietary sucrose frequency resulted
in an increase in gingival inflammation accompanied by an enhancement of
plaque deposition. The diet determined the tissue response and the environ-
ment, and this determined the bacterial growth. Can the explanation get any
simpler than this?

Does the environment of the mouth make a difference in the develop-

ment of disease? The previous chapter mentioned that an acidic environment
led to the demineralization of enamel that enabled certain harmful bacteria to
thrive. What about the type of dental plaque growth? In 1988, an experiment
on 11 dental students at Hebrew University in Israel proved there was a link.
The pH (acidity) of the plaque measured significantly more acidic after a pre-
vious high-sugar diet than it did after a previous low-sugar diet. Certain
opportunistic microorganisms will thrive in a more acidic environment and
plaque deposition on teeth becomes their new home. A different study found
that plaque pH varied at different times after a sugary meal between a smooth
tooth surface and a surface between adjacent teeth associated with salivary
mechanisms and dietary patterns. Dental plaque deposition occurs wherever
its survival is best and whenever its host ignores its development.

From chapter 6 it was learned that collagen was formed from the amino

acids proline and lysine with the help of vitamin C and glycine, along with
manganese and copper. Collagen is found everywhere within the body. What
can imperil collagen formation? Sugar? How can that happen? William Dufty
in his book Sugar Blues describes the rations of rum and sugar that the British
Royal Navy consumed centuries ago and the sugared condensed milk that the
U. S. Army consumed a little over a century ago that led to a disease known
as scurvy, which resulted in tens of thousands of deaths. Scurvy is a result of
defective collagen formation throughout the entire body’s connective tissue
including teeth and bones. Blood capillaries become fragile resulting in hem-
orrhaging. Wounds won’t heal, bones fracture, and muscle cells fragment.
The gingival tissue swells and bleeds. When no other protein and micronu-
trients are available except pure sugar, the body can’t sustain itself and death
ensues. Can a slight loss in vitamin C result in a collagen deficiency of gingi-
val tissue? One study by Drs. P. J. Leggott and others in 1986 on 11 young,
healthy men provided controlled periods of ascorbic acid depletion and sup-
plementation. Gingival inflammation was found to be directly related to the
ascorbic acid status. It did not influence levels of plaque accumulation. A fol-
low-up study on 150 subjects in Finland confirmed that gingival inflammation
averaged higher in subjects with low serum levels of ascorbic acid compared

The Preservation of Health

with subjects possessing normal serum levels. Ascorbic acid is also a vital com-
ponent of white blood cells. Reduced amounts of it influence the effectiveness
of an immune response, which can result in an increased risk of infections.

If sugar intake can be observed to have caused gingival inflammation in

the mouth, then it can be suspected that collagen destruction has also
occurred since it is known through histological examinations that collagen
breakdown occurs during an inflammatory process. Collagen stability is
impaired. The same collagen that is designed to protect and support the body
structures is thwarted. The responsible criminal is sugar.

If ascorbic acid is used up, collagen regeneration cannot continue

normally. When any of the amino acids involved in collagen formation is defi-
cient, collagen regeneration cannot continue. A deficiency of this type is rare.
A deficiency in manganese or copper, however, can slightly impair collagen
formation since both play a small role in its development.

How does sugar break apart collagen? The answer is still elusive, but inten-

sive studies on a process known as glycation in diabetics may shed some light.
Glycation is the process whereby glucose uncharacteristically binds to or cross-
links with protein molecules. If oxidation reactions occur within this process,
the newly formed structure is irreversibly altered. Collagen is affected heavily
by glycation. Antioxidants such as ascorbic acid and sulfhydryl groups such as
those contained within glutathione and methionine inhibit the oxidation. A
study conducted by the Academic Center for Dentistry in Amsterdam, the
Netherlands, correlated this same glycation reaction between carbohydrate and
protein as the reason for carious lesions to turn brown in teeth.

The cross links formed by glycation of collagen decreases the flexibility

and permeability of the tissues. In a matter of tremendous concern, prema-
ture aging is the consequence of glycation and glycoxidation (oxidation reac-
tions associated with glycation). Reduced formation of new collagen con-
tributes to the aging process.

So far the studies observed to date point to increased blood-glucose

levels or hyperglycemic conditions often found in diabetics as the precipitat-
ing event in glycation. The research is astounding and remains ongoing, but
overall, any increased concentration of blood-glucose at any time, whether
diabetic or not, requires deposition of the glucose into body cells for storage
or immediate use. A diabetic person has an increased risk of periodontal
inflammation, osteoporosis, renal disease, obesity, neuropathy, and cardiovas-
cular disease due to uncontrollable excessive blood sugar. Non-diabetics can
experience these same conditions although they may not be considered at risk
to acquire these diseases unless other factors are present. I believe excess
sugar consumption is the greatest risk factor for many conditions.

When the glucose in the blood exceeds normal levels, insulin races to

remove it. In a compromised metabolic state or in a state of sugar overload,

Mark A. Falco, D.M.D.

glucose can aberrantly become deposited in vascular walls, soft tissue and
bone where collagen is present. The sugar, therefore, affects collagen forma-
tion. It can be surmised that a frequent high-sugar intake by healthy individ-
uals contributes to a similar glycation process within the gingiva resulting in
gingival inflammation. Ascorbic acid is an antioxidant and a vital component
to the formation of collagen. Its temporary absence cannot prevent the oxida-
tive process of glycation from occurring. Stated once more, as the environ-
ment changes so does the response to it. The tissue integrity is impaired and
it is this event that allows the harmful bacteria, or virus for that matter, to set
up a presence. This impairment can ultimately affect, or infect, the DNA,
which expresses the information for tissue growth.

The Benefits of Folic Acid and Calcium on Gingival Health

Folic acid has been shown to improve gingival health especially during preg-
nancy. Why? One of the many benefits of folic acid is its ability to increase
cell turnover through the synthesis of RNA and DNA. Since gingival tissue
normally experiences a rapid turnover, the addition of more folic acid helps to
accelerate this turnover and improve upon an inflammatory condition.

Calcium is important for reducing the loss of bone, the mobility of teeth, and

the inflammation associated with gingival hemorrhaging. A reduction in the cal-
cium to phosphorus ratio accelerates bone loss. A balance of calcium, phospho-
rus, and magnesium in the blood are needed to prevent bone loss. Fluctuating
blood-sugar levels upset this balance and contribute to the bone loss.

B vitamins, zinc, and coenzyme Q10 are important for tissue health and

tissue maintenance.

Associated Distant Sites of Concern

Periodontal disease is associated with coronary heart disease. For each greater
category loss of gingival attachment at the root of the tooth, an increased risk
of coronary artery disease has been associated with it as verified by data com-
piled by Dr. S. T. Arbes and others on more than 5500 people at the University
of North Carolina School of Dentistry. The Cancer Bureau of Canada found
a significant association between periodontal disease and the risk of fatal coro-
nary heart disease. It has already been known for some time that diabetics have
an increased risk of developing cardiovascular disease, renal disease, and asso-
ciated periodontitis. Even adolescents with juvenile diabetes have an increased
severity of gingivitis compared to healthier adolescents of the same age.

The Preservation of Health

Drugs that aid in the dilatation of coronary arteries known as calcium-

channel blockers have a side effect, which causes an overgrowth or hyperpla-
sia of the gingiva. The reason for this is unclear, but I don’t think it would be
hard to believe that high sugar consumption plays a role.

Bacteria involved in the progression of periodontitis can also be intro-

duced into the bloodstream from the diseased gingiva. It seems to be that
the bacteria encounter blood platelets in the bloodstream causing them to
clump or aggregate. An accumulation of these clumps may cause coronary
thrombosis (coronary artery blood clots) and signs of myocardial infarction
(heart failure).

An association exists between alveolar bone loss (bone loss around teeth)

and density changes in osteoporotic women. Drs. Payne and Reinhardt at the
University of Nebraska College of Dentistry have worked extensively to
determine that osteoporosis and estrogen deficiency are risk factors for alve-
olar bone loss in postmenopausal women with a history of periodontitis.

Infections due to periodontitis have been indicated in the increased risk

of preterm birth. The American Academy of Periodontology states that
women with periodontal disease may be up to seven times more likely to
deliver a preterm low weight baby.

Recent evidence also suggests a role for the oral cavity in respiratory

infections. Bacteria involved in periodontitis can be aspirated into the lungs
to cause aspiration pneumonia. Poor oral hygiene and alveolar bone loss have
been connected to chronic obstructive pulmonary disease.

Tobacco smoking has a detrimental effect on periodontal health. Even

smokers with excellent hygiene lose more alveolar bone than non-smokers.
Tobacco pulls oxygen away from tissues and creates an altered tissue environ-
ment. Smoking is considered to be a major risk factor in periodontal disease.

Psychological stress has also been shown to be a significant risk factor for

periodontal inflammation although at present the reason is not clear. I would
not hesitate to blame poor eating habits and a high-sugar intake. At the
University of Dusseldorf in Germany, medical students were examined for
gingival bleeding four weeks prior to final examinations and on the last day of
examinations. Severe deterioration in gingival health was observed more fre-
quently in the students taking examinations than in controls. Other forms of
stress will cause similar results.

It can readily be seen that complications of the oral cavity are interrelat-

ed with other processes occurring throughout the body. Often, the earliest
signs of systemic disease can be identified upon examination of the mouth.
No abnormality should be taken lightly. If the teeth or the gums exhibit
inflammatory or infectious disorders, it is apparent that other areas within the
body have been slightly to severely afflicted as well. A high level and frequent
intake of added sugar is very likely to be involved.

Mark A. Falco, D.M.D.

Symptoms of Periodontal Disease

•

Bad breath

•

Bad taste

•

Bleeding gums

•

Reddened gums

•

Receding gums

•

Sensitive teeth

•

Gum swelling

•

Loose teeth

•

Shifting teeth

•

Tooth or gum pain

Steps to Lower Periodontal Disease Risk

•

Eliminate or reduce added sugars

•

Follow the ‘three standard criteria for sugar consumption’

•

Read all bottle, can, and package labels for sugar content

•

Brush and cleanse your mouth 2-3 times daily

•

Visit dentist and dental hygienist every 3-6 months to detect and
address gum problems

The Preservation of Health

10.

Fatigue

Perception of Reality

In chapter 1, I described Alex’s drive home from a tiresome day at work. Alex
nearly dozed off to sleep while he was driving. He attributed it to exhaustion.
Was it? How many times have you seemed to have suddenly slowed down,
tired out, become socially withdrawn, or momentarily fell asleep in the mid-
dle of a conversation, or while reading a good book, or watching a television
program? Was your body just tired or was it something else that abruptly
halted your body’s ability to comprehend events? Let’s see. The number one
energy source for the brain is glucose, right? What happens to the brain with-
out glucose? It can’t operate, of course. The brain needs glucose constantly,
just like oxygen, so it will divert glucose from other areas of the body or con-
vert it from other nutrients in order to sustain itself if it’s lacking.

Now what would happen if the brain repeatedly gets fooled into thinking

there is too little glucose to carry on the normal activities of the brain? The
perception of reality changes. Reality? Shouldn’t the answer be hunger or
fainting or some other manifestation of an identifiable disease? Well, the
answer is all of the above, but the perception or the sensation of events sur-
rounding the brain is still temporarily altered. Now you’re probably thinking
that my own perceptions of hunger and fainting must be altered if I think
these manifestations are not based on reality. After you’ve had your chuckle,
and I don’t think it’s unfounded at this point, let me get more serious with
you. Hunger is an explainable symptom. When you’re hungry, that’s a real
symptom. When you faint or black out, these are real symptoms of something
in the body that had to be turned off quickly. This event is definitely real and
sometimes it creates an emergency situation. The body’s perception of what
is happening begins with a change in the reality of the situation. Hunger is
the mildest form of an altered situation. Fainting is the extreme form of an
altered situation. This is not to say that when hunger or fainting transpires
that these situations are not real to us. These are real experiences. What I am
saying is that the brain can be fooled sometimes into perceiving dramatic

changes are occurring even though they may be subtle. The body then pro-
ceeds to react as it has been instructed to do over time from one generation
to the next, from one century to the next. The response can vary from hunger
to fainting with each presentation of events commanding a different kind of
reaction. In most instances, only mild fluctuations in perception occur
because the perception is ephemeral. Normally, we don’t even recognize it
when it happens. We may doze off behind the wheel of a car, catch ourselves
daydreaming about a comforting scene, forget our own phone number, ask
for a statement to be repeated, or we may see something for a split second that
others may not see. Yes, the brain can be fooled. It is undoubtedly fooled by
alcohol, drugs, perversion and even starvation or thirst. Why? Because the
receptors for the neurotransmitters in the brain get their wires crossed some-
how. The reality of any given situation is, therefore, changed.

If the availability of glucose for the brain is deprived temporarily under nor-

mal conditions, a chain of events ensues. Hunger strikes. Neurotransmitters
signal the body to hunt for carbohydrates. Cortisol and other hormones are
released to dump glucose into the bloodstream from glycogen stores and from
fats and proteins if more glucose is needed to briefly handle the deficit. You eat
a well-balanced meal and everything returns to normal with the help of insulin.

What if the replenishing meal consisted of excess refined sugar in place of

the complex carbohydrate foods containing small amounts of simple sugars?
Does the brain still get satisfied? Yes it does, but this is where the brain
becomes fooled. Suddenly glucose pours into the bloodstream as if a faucet
attached to a water hose was opened up all the way. The brain gets its share
of glucose anyway, but the body scrambles to remove the excess as quickly as
possible. If it’s not through exercise, then the cells of the body get prepared
for glucose entry with the aid of insulin. But this entry of glucose into cells
requires a rapid and extensive release of insulin. When the high-carbohydrate
meal is finished, the faucet is abruptly turned off. The pancreas was not
designed to do the same thing with insulin. As the blood-glucose level drops
to a certain level, mechanisms in the body signal the pancreas to turn off the
insulin. However, the blood-glucose level continues to drop in spite of the
release of glucagon to restore the blood-glucose level to normal. Now
glucagon has to be released rapidly and extensively to bring the glucose back
out of the cells. The adrenal glands and other glands see this as a stressful sit-
uation that causes the release of cortisol, epinephrine and other hormones to
rectify the blood-glucose imbalance. The same glucose that went into the
body for storage now returns to the bloodstream. Once the body recognizes
this vicious cycle it begins to make changes that it expects to be within toler-
able limits for the next meal.

At the next meal, the carbohydrate intake changes again. It is worse.

Twenty-four ounces of cola are drunk with the meal, which is finished off with

The Preservation of Health

two dishes of ice cream. The body wasn’t ready for that onslaught and so the
hormones overcompensate. The brain’s perception of the situation gets
fooled again. Only this time, based on the habit from the previous meal, more
glucose has to redeposit itself elsewhere. This takes much more energy and
much more of the available micronutrients are needed to accomplish this task.
The brain starts to feel the effects of minor fluctuating levels of glucose.
Mood becomes altered. Anger at something that hadn’t normally been irri-
tating begins to surface. Fatigue sets in. Serotonin and norepinephrine levels
begin to swing between left and right. Of course, a momentary drop in glu-
cose after a meal starts the hunger process all over again.

At the very next meal, very little sugar is eaten. Protein is eaten in greater

quantities. The body senses the next wave of glucose and the insulin is
released to compensate as usual. Only this time, the glucose entry into the
bloodstream is less frequent and in a lesser amount. By the time the blood-
glucose balance has returned to normal from this event, more cortisol has
been released. Way too much insulin for the day has been secreted, and the
blood-glucose has momentarily plummeted below normal due to the incon-
sistent eating habits. Possibly, a late-night sugary snack is eaten leading to
greater blood-glucose fluctuations and continuous insulin release.

The drop in blood-glucose is a signal for the body to rest and we do so

by falling asleep. Thinking it needs to preserve energy fools the brain again.
It then seeks rest. If the level of blood-glucose drops significantly during the
day, even from high levels, the body senses fatigue and wants to rest. Some
people are more sensitive to these blood-glucose fluctuations than others
are. This sudden drop in the blood-glucose level is known in the medical
community as reactive hypoglycemia. Only established medicine doesn’t
recognize reactive hypoglycemia as a challenging or threatening condition
unless you’re a diabetic. Some members of the medical profession haven’t
accepted it as even a symptom because tests to screen it may show normal
blood-glucose levels while the brain reacts as though it is sugar-starved. If
it can’t be measured, it is declared non-existent. The symptoms are attrib-
uted to psychological disturbances instead. Individuals experiencing the
symptoms of fatigue, listlessness, memory loss, and even depression are
diagnosed as psychologically impaired. It’s an unfortunate coincidental fact
that the perceptions of these patients’ experiences by their brains have been
fooled twice, not just by their own hand, but by the hand of the medical
community as well.

Mark A. Falco, D.M.D.

Reactive Hypoglycemia

A German study in 1983 found that a high meal frequency with smaller
amounts eaten during meals stimulates the synthesis of more serotonin, which
seemed to reduce fatigue. Serotonin needs tryptophan to be manufactured.
Tryptophan can only be delivered to the brain when a high-protein meal has
not been eaten. Carbohydrates must be a significant part of the meal for sero-
tonin production to take place. Serotonin soothes moods and aids concentra-
tion. Sleep is induced as the levels increase.

A Russian article published in 1994 on artificially induced hypoglycemia

led to heightened signs of mental fatigue and markedly altered intellectual
activities. Too little serotonin contributes to irritability and a loss of concen-
tration. When blood-glucose levels fall, tryptophan has reduced entry into
the brain. Constant and heavy sugar intake contributes to repeated blood-glu-
cose declines and an inability to produce enough serotonin.

It has been known for some time that glutamine in the brain, formed from

glutamic acid, is derived from GABA. Glutamine’s presence in the brain reduces
the cravings for alcohol and carbohydrates. Research done by Madl and Royer
at Colorado State University found that hypoglycemia produces a large loss of
glutamic acid in the brain and reduces the levels of GABA in neuron receptors.
This finding may be significant for evidence linking hypoglycemia to altered
mood changes and possible permanent damage in the brain.

In cases of reactive hypoglycemia, too much insulin is released when this

condition becomes chronic resulting in impaired insulin production.
Symptoms of diabetes can develop. Excess glucose can become glycated in tis-
sues (see Chapter 9). Under these conditions, oxidative processes in the body
begin to increase, which can eventually damage the neurotransmitters and
other protein structures.

Much of the credit for discovering hypoglycemia goes to Seale Harris. He

was able to control the symptoms with diet alone. Reactive hypoglycemia, as
opposed to organic hypoglycemia, is caused by an excess release of insulin
when the blood-glucose levels are apparently normal. Meal content and meal
interval dependency are apparently the two factors that evoke increased
insulin release. Through conditioning alone, the pancreas overproduces
insulin to avoid the embarrassment that stress from excess glucose entry into
the body creates. A condition known as insulin resistance contributes to this
overproduction. Insulin receptors on active cells within the body do not rec-
ognize small increases in insulin levels in the bloodstream. This delay in
recognition causes a significant drop in blood-glucose that causes the hypo-
glycemia. The body appears to be functioning normally when examined by
doctors since a maintained elevation in blood-glucose is considered abnormal,
but the normal to periodically subnormal level that returns back to a normal

The Preservation of Health

blood-glucose level is not considered abnormal. To maintain the best blood-
glucose balance, consume a diet that prevents wild fluctuations in this bal-
ance. The ‘three criteria’ can help guide you.

Meals and Moods

Is it certain that our diet can affect our mood? The Institute of Food Research
in the United Kingdom prepared low-fat/high-carbohydrate, medium-
fat/medium-carbohydrate, and high-fat/low-carbohydrate lunches for 18 sub-
jects on 3 separate days. The subjects rated themselves as more drowsy, inde-
cisive, and less cheerful after the low-fat/high-carbohydrate and high-fat/low-
carbohydrate lunches. Cognitive deficiency was also impaired when the car-
bohydrate or fat level was high. A follow-up to this study was done on 16 sub-
jects with breakfast meals. Mood was shown to have improved and less fatigue
occurred following the low-fat/high-carbohydrate breakfast. The findings
also showed that a deviation from a habitual meal composition produced a
decline in mood. The two studies reflect a significant effect on mood in
regard to the type of meals eaten and the time of day they are eaten. The
breakfast meal indicated the highest need for an increased carbohydrate
intake to improve overall mood and energy when compared to the lunch. The
need for increased serotonin in the brain through a high-carbohydrate break-
fast improved mood, but this wasn’t the case for lunch. Why not?

Unfortunately, we don’t know what the subjects had for breakfast when

they were involved in the lunch experiment. We do know from both studies
that the protein content was extremely low for each of the meals. Why would
a high-carbohydrate meal improve mood after breakfast, but not after lunch?
Part of the answer may lie in a study conducted by the Department of Brain
and Cognitive Science at the Massachusetts Institute of Technology in 1989.
Subjects were separately given both high-protein and high-carbohydrate
breakfasts and high-protein and high-carbohydrate dinners. It was found that
the high-protein meal consumed at breakfast induced more fatigue and
drowsiness than the high-carbohydrate meal at breakfast. This was reversed
at the evening meal where it was found that the high-carbohydrate meal
induced more fatigue than the high-protein meal.

The question is then asked, why does a high-protein meal eaten in the

evening create less fatigue the following morning while a high-carbohydrate
meal eaten in the morning creates less fatigue during the day? Once again we
can look to a study done on diabetics. At the University Hospital in Basel,
Switzerland, eight subjects were fixed on a continuous infusion of insulin and
given two different evening meals consisting of a low-protein/high-fat meal
and a high-protein/low-fat meal. Carbohydrate content of each meal was

Mark A. Falco, D.M.D.

maintained at 35 percent. The blood-glucose levels were measured and found
to be higher in the early morning hours after the high-protein meal. Two of
the subjects developed hypoglycemia after the low-protein meal.

Insulin is secreted during every meal when the blood-glucose levels rise.

More is secreted during a high-carbohydrate intake and during a mix of protein
and carbohydrate intake. Since the protein is needed for construction within the
body, it is most efficiently used while the body is resting. Carbohydrates, on the
other hand, are most efficiently used immediately for energy and brain func-
tion, which precludes their optimum usage prior to retirement in the evening.
This high-carbohydrate meal can drive the body’s glucose levels more toward
subnormal levels during rest as the insulin continues to perform its work.
This stresses the body especially if the person is already stressed. This is when
fat stores begin to increase. Cortisol release occurs in response to any stress,
which leads to greater ranges in blood-glucose levels. It can be seen here that
food content and meal intervals do indeed influence mood.

Why would a high-protein dinner equate to an improved morning mood

if carbohydrates were equal to or less than the protein concentration? We do
know that insulin secretion is heightened during a mixed carbohydrate-pro-
tein meal. Norepinephrine and dopamine levels need to be replenished and
protein structures need to be formed during sleep. We also know that
increased serotonin levels will induce sleep. The best time for the body to
utilize protein is during rest. If, however, circulating blood-glucose levels
remain more constant during sleep after a high-protein ingested meal, then
it becomes very apparent that a high-carbohydrate ingested meal as the last
meal before resting plays havoc on the body at night creating hypoglycemic
episodes. This can lead to fatigue upon awakening in the morning. If you
awaken in the morning fatigued after a decent sleep time, you’ve probably
been through a hypoglycemic state. The greater amounts of glucose circu-
lating in the blood prevent the necessary amino acids from entering the brain
in the evening where they can be used to form proteins and neurotransmit-
ters. Insulin will help to promote protein synthesis. Excessive or diminished
levels of glucose in the blood must be rebalanced before proteins can effec-
tively be utilized.

Ten subjects in the Queen’s Medical Centre in Nottingham, England

were assessed for wellness, cerebral function, and physical fatigue after an
exercise test and a mechanically induced mild nocturnal hypoglycemic state.
The subjects were more fatigued after the hypoglycemic night than the nor-
mal night. They also had their sense of well being affected, but not their cere-
bral function, the morning after the hypoglycemic state. This is further proof
to a relationship between food, eating habits, and fatigue.

The Preservation of Health

Athletic Requirements

What would happen if your body needed the extra energy from carbohydrates
but couldn’t get it? What if you were an athlete conditioned to a higher car-
bohydrate intake prior to a strenuous exercise or competition? Faculty at
Auburn University in Alabama followed seven competitive female cyclists in
1991 for one week each. For the experiment, the cyclists lived on low-carbo-
hydrate, moderate-carbohydrate, and high-carbohydrate diets. Each cyclist
completed a Profile of Mood States questionnaire. The low-carbohydrate diet
indicated greater tension, depression, anger, and less vigor than the other
diets. Athletes are more prone to hypoglycemic conditions because they rely
on substantial sources of glucose that must be transported through the blood-
stream to various muscle sites. If the glucose is insufficient or inadequately
oxidized from carbohydrates, mood changes and fatigue develop.

Carbohydrate feeding during or prior to exercise delays fatigue by 30-60

minutes by maintaining blood-glucose concentration and regulating the rate
of carbohydrate conversion to glucose. Dr. S. C. Dennis and others at the
Sports Sciences Institute of South Africa believe that endurance athletes need
to ingest carbohydrates during exercise at a rate of 100 milliliters every 10
minutes of a 3-5 gram per 100 milliliter carbohydrate solution for the first
hour and increasing that to 10 grams per 100 milliliters afterwards to match
the ingested carbohydrate pre-load. I continue to recommend B and C vita-
min supplementation at the same time as well. The athletic drink Propel pro-
duced by the Gatorade Company attempts to balance this quite nicely.

Mental States

Is the perception of reality altered during a hypoglycemic state? Is the mind
being fooled into an experience that normally doesn’t exist? Glucose depriva-
tion definitely causes hypoglycemia. Involuntary changes in nerve transmis-
sion due to hypoglycemia produce tremors, palpitations, anxiety, sweat,
hunger, and paresthesias. The brain responds to hypoglycemia by developing
confusion, a sensation of warmth, fatigue or weakness, severe cognitive fail-
ure, a seizure, or a coma.

A study conducted at the Pitie-Salpetriere Hospital in Paris, France in

1994 on suspected fasting hypoglycemics found the patients to have a nor-
mal glucose tolerance test (a test for diabetes). However, serum insulin lev-
els were higher and heart rates and systolic blood pressures were much high-
er after glucose administration when compared to the controls. After the
administration of glucose, the patients had increased emotional stress with

Mark A. Falco, D.M.D.

several hypoglycemic symptoms. These events indicate the presence of
insulin resistance. Since their blood-glucose levels were considered normal,
their brains were considered emotionally stressed. Unfortunately, this is a
recurring diagnosis by most of the medical community.

There is a definite distinction between the function of glucose in body

metabolism and the function of glucose in cognitive function, mood, and per-
ception. Yet, few of us elect to work on the less glamorous research of glucose
on brain function relegating the usefulness of glucose primarily to energy
production and overall survival. Reactive hypoglycemia is considered to be a
perceived mental state of a normal physical state that is by all means elusive
to medical practitioners. Aside from the diagnostic measurements obtained
from hypoglycemic conditions due to diabetes or other endocrine diseases or
cancers, reactive hypoglycemia is not considered to be measurably significant.
The role of food intake, eating habits, and stress on the development of reac-
tive hypoglycemia is scarcely reviewed. In reactive hypoglycemia, the brain is
periodically fooled into thinking it has less glucose available. Oxidation of
brain proteins ensues. Tryptophan entry gets tripped up. Sugar overload has
a price to pay. Mouth changes are the second warning sign. Brain activity
alteration is the first warning sign although most of us continue to ignore the
fears, the fatigue, the mood swings, the loss of self-esteem, and stress as early
warning signs for a blood-glucose imbalance.

Steps That May Help Avoid Hypoglycemia

•

Follow the ‘three standard criteria for sugar consumption’

•

Eat whole grain foods instead of refined grains

•

Lunch and dinner should contain equal to or less sugar than breakfast

•

No carbohydrate snacks, especially at bedtime

•

Eat meals at intervals that prevent hunger

•

Visit your health care practitioner to determine your blood-glucose
levels

The Preservation of Health

11.

Depression

Dietary Factors

It has been estimated that 25 per cent of all American women and 12 per cent
of all American men experience episodes of depression during their lifetimes.
Seasonal Affective Disorders (SADs) suffered by men and women and pre-
menstrual syndromes suffered by women can compound the bouts of depres-
sion and often lead to increased carbohydrate snacking to improve mood.
Kathleen Des Maisons describes in her book Potatoes Not Prozac how sugar-
sensitive people (people with a weakness for sugar-based foods) find it more
difficult to overcome their depression because of consistently low serotonin
and low beta-endorphin levels in the brain due to the ingestion of high
amounts of sugar.

Caffeine may add to depressive states because it can lower serotonin

levels as well possibly by preventing tryptophan conversion. Consumption of
alcohol will also lower tryptophan levels dramatically after some time has
passed from the intake of the first drink.

Vitamin deficiencies are highly prevalent within the population of

depressed individuals. Most research has centered on niacin, folic acid, thi-
amine, and pyridoxine levels, all of which are found to be low in depressed
individuals. The minerals magnesium and zinc have also been found to be too
low in depressed individuals. These vitamins and minerals are important in
carbohydrate metabolism when a sufficient supply of them is in the diet. Men
and women without a regular exercise program have been shown to have a
higher incidence of depression. Exercise increases carbohydrate metabolism.
There are even convincing connections between asthmatics and depression
and osteoporosis and depression.

100

The Influence of Sugar

How does an intake of sugar influence depression? As has been presented

in chapters 3 and 10, serotonin in the brain is derived from tryptophan, which
responds to the presence of glucose. When too much glucose is present in the
bloodstream, a rapid increase in serotonin production occurs followed by a
sudden fall in serotonin production shortly afterwards as the high blood-glu-
cose levels drop precipitously due to insulin. When the function of nerve cell
receptors (neurons) or the availability of serotonin is impaired, altered mood
and depression result. The reason that we know about this effect of serotonin
is because efficacious antidepressants also are able to increase serotonin levels.

An English experiment in 1997 enrolled 15 women suffering from recur-

rent episodes of major depression. Each was given a tryptophan-free drink
mixture and all were subsequently measured for symptoms of depression.
Ten of the 15 women experienced temporary significant depressive symp-
toms. The effect of this study was reinforced by another English study in
2000 that concluded that extreme dieting lowered tryptophan levels in
women and contributed to impaired serotonin formation in women with a
history of depression. Women who constantly diet are susceptible to low lev-
els of tryptophan.

In the newborn, tryptophan is essential to mature and develop neural

regulations of food intake, satiety, and sleep patterns. This necessary level of
tryptophan is optimal in human breast milk. Commercial infant formulas have
been determined to contain lesser amounts of tryptophan in their formulas.

If tryptophan can improve serotonin levels, it can improve mood when it’s

available. Sucrose can improve serotonin levels temporarily. Since insulin reg-
ulates the influx of glucose into cells from sugars such as sucrose, a high level
of glucose is rapidly depleted when it is pulled out of the bloodstream by the
insulin. This event causes an immediate loss of available tryptophan to the
brain. This, then, activates more serotonin receptors in the brain, which had
just enjoyed a steady stream of tryptophan. The receptors starve for more
tryptophan similar to newborn chicks hungry to be fed food from their moth-
er. In other words, the receptors and the chemistry surrounding them cause a
person to turn on to more sweets forcing an oftentimes-uncontrollable behav-
ior to satisfy the appetite of the serotonin receptors in the brain. Have you
ever exchanged your lunch with someone at school or stolen a food item from
a convenience store as a child? Do you think it was the satisfaction of having
the added sugar as your driving force toward this behavior?

Still not convinced that sugar has that much power over our brains?

Sucrose has been linked to calming and pain reducing effects similar to an
opioid analgesic. Faculty at Marmara University in Istanbul, Turkey per-
formed one of several studies done on the impact of a refined carbohydrate

The Preservation of Health

101

on behavior in 1999. Newborn infants were given a solution of water, human
milk, or sucrose prior to being given a heel prick with a blood sample taken.
Crying time and recovery time from the heel prick were the shortest, and
heart rate was the lowest in the infants previously given the sucrose solution.
Unquestionably, a newborn infant doesn’t develop a food preference based on
taste alone. Neurological and behavioral influences must be driven by the
immediate response to the increased blood sugar.

The Effect of beta-Endorphins

With such a strong effect on mood and pain tolerance indicated by the pres-
ence of large amounts of sugar entering the body and glucose entering the
bloodstream, what brain receptors are being stimulated to reduce depression?
For that answer, we must look again to the beta-endorphins originally intro-
duced in chapter 3. A 1987 study by D. Giugliano and others in Italy demon-
strated that a beta-endorphin infusion into the bloodstream of obese subjects
increased the response of insulin that wasn’t seen in lean subjects. This indi-
cated that an alternate mechanism was contributing to the increased release
of insulin in obese subjects. Increased levels of beta-endorphin, which had
normally correlated with an increased intake of sugar for the obese subjects,
had programmed the pancreatic cells to release high amounts of insulin in
response to an increased blood-glucose level. The glucagon level had risen as
well. The beta-endorphin level was influencing the release of insulin in the
obese subjects as glucose levels increased in the bloodstream.

A follow-up to this study on normal subjects showed that higher beta-

endorphin levels in the blood inhibited insulin release during a single glucose
infusion. These levels also inhibited glucose suppression of glucagon levels
and augmented the glucagon response to arginine. Arginine is involved in
insulin production. When the blood-glucose was stable, a single beta-endor-
phin infusion caused an immediate and noticeable increase in the blood-
insulin levels. This data strongly points toward the beta-endorphin levels in
the blood as a major factor in determining glucose transport, ultimately to
influence the level of euphoria.

A 1992 study by Ableitner and Schulz in Germany found that the opioid

effects of beta-endorphins produced increases in glucose utilization of the lim-
bic regions of the brain with the highest increase in the hippocampus. The lim-
bic region of the brain is centralized within the brain. Many serotonin and nor-
epinephrine secreting nerve fibers project into the limbic region. This region of
the brain determines what is perceived as pleasant and what is perceived as
unpleasant. The hippocampus is involved in decision-making processes based

Mark A. Falco, D.M.D.

102

on the pleasant or unpleasant information it receives. This decision determines
the type of emotional behavior displayed from passivity to rage. The hip-
pocampus also plays a role in long-term memory. Beta-endorphins have been
shown to influence memory through an interaction with GABA neural mecha-
nisms as well. Beta-endorphins are the naturally produced opioids of our bod-
ies. Their stimulation increases the use of glucose in our brains. The effect of
beta-endorphins on glucose utilization continues to astound.

Giugliano and his colleagues continued their research on catecholamines

(hormones produced by the adrenal medulla) such as epinephrine in addition
to beta-endorphins. Both are released under stressful conditions. They found
that infusion of epinephrine in obese subjects led to increased blood-glucose
levels and glucagon concentrations. Insulin levels remained low until the infu-
sion ceased. The beta-endorphin infusion elevated the blood glucose, insulin,
and glucagon levels as noted earlier. When both hormones were infused
together, blood-glucose levels more than doubled from normal amounts.
Minor changes were seen with the infusion of these hormones in lean sub-
jects, but none proved as dramatic as those seen with the obese subjects.
There is no doubt from the information obtained from this study that stress
has a huge influence on glucose levels through the release of beta-endorphins
and epinephrine. Snacking on carbohydrates is expressed by many individuals
in order to improve mood. This relief is short-lived as blood-glucose levels
begin to fall rapidly and the process repeats itself. Eliminate ‘carbohydrate
snacking” when not exercising vigorously.

A Look at Tyrosine

Although a relationship between sugar intake and overweight people has been
established for depression, what can cause the development of depression in
normal weight people? Tyrosine is one of the amino acids needed to manu-
facture the catecholamines epinephrine and norepinephrine. It is one of the
five amino acids that compete with tryptophan for entry across the blood-
brain barrier. Tyrosine and its precursor, phenylalanine, have both been
implicated in anxiety disorders when their amounts have become depleted.
The Department of Psychiatry at McGill University in Montreal, Canada
performed research on these two amino acids by providing a mixture for
healthy women void of them both before and after a psychological challenge.
There was an increased vulnerability to lowered mood and less energy fol-
lowing the challenge.

Studies by Vrije University in the Netherlands and the Uniformed

Services University of the Health Sciences in Bethesda, Maryland support the

The Preservation of Health

103

administration of tyrosine to reduce the effects of stress and fatigue, and to
sustain working memory during multitasking performances. Although hard
evidence linking depression and diet is lacking, some knowledge of the work-
ing relationship between the nutrients that cross the blood-brain barrier, the
availability of neurotransmitters, and the uptake by neural receptors in the
brain is necessary to understand why the brain of an individual can lapse into
depression. More answers will need to be forthcoming.

The Comfort of Sugar

As described in chapter 3, many antidepressants are effective because they tar-
get the same receptors in the brain the neurotransmitters are supposed to tar-
get. Think again about the newborn infants’ response to a sucrose solution. It
made the infants tolerate pain better in the study. The sugar calmed them
down almost immediately.

Do you know a teenager who has resorted to obtaining an illegal drug in

order to get high? Do you believe that teenager is tolerating physical or psy-
chological pain better while on that high? Do you know an adult who must
have one alcoholic drink after another in order to ‘feel better’? Do you know
a person who has become hooked on a pain medication because of some
severe discomfort? You can look at every one of these individuals, from child-
hood to adulthood, and you will find two things in common with all of them.
First, they all suffer from an addiction. Secondly, their sugar intake is higher
than average. In fact, their diet, even with a little protein, is predominantly
sugar. Check it out for yourself.

Sugar is eaten to calm the feelings of irritability or depression over and

over again. A disruption in the flow and amount of glucose in the blood
occurs. Neural receptors become teased and may eventually become dam-
aged. Weight gain, fatigue, and altered moods are telltale signs of increased
sugar intake. Depression follows these three occurrences. This is not seen
with a well-balanced lower carbohydrate intake.

Sugar is no different than any other drug. When the comforting feelings

are gone, more sugar and eventually alternative treatments and devices are
sought to satisfy the desires. But the damage has already begun. And it just
gets worse and worse as more sugar continues to enter into our daily food
choices and we continue to consume it.

Mark A. Falco, D.M.D.

104

Activities to Lower the Risk of Depression

•

Follow the ‘three standard criteria for sugar consumption’

•

Limit caffeine consumption

•

Limit alcohol consumption

•

Avoid drug addiction

•

Avoid high-carbohydrate foods and snacks

•

Exercise regularly

•

Consult with your health care practitioner about adequate protein
intake and any episodes of mood pattern changes

The Preservation of Health

105

12.

Osteoporosis

A Blood Chemistry Imbalance

Osteoporosis normally affects the middle aged and elderly. However, the
process of osteoporosis develops much earlier. Most people identify this dis-
ease with a lack of calcium. Actually, it is the imbalanced body chemistry that
causes the calcium to drift away from bones and not the lack of calcium that
causes osteoporosis.

Let’s suppose you were an electrically charged atom of calcium that had

just entered the small intestine. The electrical charge you carry means you
must find an oppositely charged receptor or membrane to hook up with. You
may encounter an electrically charged atom of phosphorus, bind to it, and
wave bye-bye to the body as you wind up being excreted from the bowel. This
is where most of the calcium goes. But, if you’re timing is good, a vitamin D
compound through the regulation of parathyroid hormone opens the doors
of the intestinal cell membranes to you where you are transported to join with
other atoms like yourself in the blood. You are then grouped with others to
be bound to proteins in the blood or you are given a signal to join others that
are diffusing through capillary membranes where you are directed to muscle,
heart, the nervous system, or bone. If you and others like you begin to num-
ber too many, you may find yourself leaving by way of the kidneys. You may
temporarily take up residence in bone as a calcium salt if another hormone,
calcitonin, has its say. Parathyroid hormone may call you back into the blood-
stream at any time, however.

Electrically charged atoms are known as ions. As with all ions in the body,

a perfect balance between coupling and uncoupling of oppositely charged
atoms is mediated by cellular necessity. An imbalance toward one ion can be
harmful to body tissues creating either toxins or an inability to function prop-
erly. The body has a number of back-up systems to manage this balance even
under extreme circumstances if normal hormonal regulations are stressed.
But, these systems are for emergencies only. They are not meant to be chron-
ic replacements for normal everyday mechanisms.

106

The thyroid gland, which manufactures calcitonin, and the parathyroid

glands, which manufacture parathyroid hormone, monitor the level of calci-
um in the blood. Each gland releases its particular hormone to establish a nor-
mal blood level as the pancreatic hormones do with glucose. Aside from
definitive organic diseases such as hyperparathyroidism or Cushing’s disease,
bone loss still seems to occur in normally healthy individuals. What factors
can trigger this accelerated bone loss?

Hormonal Activity

Osteoporosis involves the loss of minerals in bone including calcium and loss
of the protein matrix of bone. The effects of estrogen deficiency in menopausal
women have been attributed to bone loss in the mouth as well as the rest of the
body because normal estrogen levels have been proven to stimulate bone cell
growth. Although some experts admit estrogen therapy has its drawbacks,
bone maintenance is one of the reasons for its supplementation in women.

Parathyroid hormone and calcitonin may be used along with estrogen

therapy in order to retain bone calcium in post-menopausal women.
Parathyroid hormone increases serum or blood calcium. Calcitonin increases
bone calcium.

Several other hormones have been shown to influence bone activity.

Glucocorticoids such as cortisol and cortisone, when administered over a
prolonged period of time in experimental studies, have been shown to cause
protein loss, osteoporosis, elevated total cholesterol levels, and carbohydrate
intolerance. Cortisol is one of the glucose-influencing hormones that is
released by the adrenal glands during prolonged stress. Stress seems to be a
significant factor in disrupting body chemistry including the development of
osteoporosis.

Several European studies have shown success in treating the side effects

of prolonged glucocorticoid administration with growth hormone. Growth
hormone has been shown to normalize glucose levels, lower cholesterol, and
improve protein retention.

Mineral Deficiencies

Deficiencies of zinc and magnesium have been implicated in bone loss and
osteoporosis as they have been in rheumatoid arthritis. When either of these
two minerals are lacking in the diet, bone formation slows and more bone loss
occurs. A diet high in refined sugars has been determined to be a leading

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107

cause of zinc and magnesium deficiencies in our population. A magnesium
deficiency has been known to impair parathyroid secretion leading to
increased bone fragility. The intake of calcium needs to be at a one to one
ratio with magnesium in order to optimize the absorption of calcium into the
body. Magnesium also needs to be present to enhance the effects of vitamin
D, which helps the body to absorb calcium.

Nitric Oxide, Arginine, and Glutamic Acid

Nitric oxide is a gaseous molecule formed in the body in response to an asso-
ciated inflammatory condition. Nitric oxide is the active ingredient in nitro-
glycerin. Nitric oxide synthesis is enhanced by the anti-impotence drug
Viagra, which increases vasodilatation (blood vessel lumen widening) during
erections. When nitric oxide levels are high, breakdown of bone is inhibited.
When the concentrations are too low, the presence of inflammation induces
the breakdown of bone. These events are dose dependent. For instance, nitric
oxide levels way above normal do not have this same effect. K. E. Armour and
others at the Aberdeen Medical School in the United Kingdom suggest that
low levels of nitric oxide and its enzyme activator, nitric oxide synthase, are
associated with osteoporosis.

The only amino acid found to be metabolized in the brain that aids in the

normal termination of neurotransmitter release is glutamate (glutamic acid).
It has been traced to signaling the activity of bone forming and bone resorb-
ing cells according to A. J. Patton and others at the University of York in the
United Kingdom. D. J. Mason and others at the University of Bristol in the
United Kingdom identified the glutamate transporter that is involved in gene
expression for the formation of bone.

Glutamic acid is part of the Glucose Tolerance Factor. It is essential to the

support of insulin synthesis. It returns released neurotransmitters back to the
neurons. It helps to detoxify ammonia build-up in the body. It reduces the
cravings for carbohydrates and alcohol. The availability of sugar in the blood
is involved in all of these mechanisms. Therefore, sugar has a tremendous
impact on the utilization of glutamic acid.

The amino acids arginine (which can also be converted to glutamate) and

lysine have been associated with healing bone fractures by increasing intes-
tinal calcium absorption, collagen formation, insulin and growth hormone
secretion, and bone formation. Arginine has also been shown to stimulate
nitric oxide synthesis, which may help to prevent bone loss. By improving the
intestinal absorption of calcium, arginine and lysine increase bone density and
bone formation. Nitric oxide levels may normalize by reducing sugar intake.

Mark A. Falco, D.M.D.

108

Advanced Glycation End-Products (AGEs)

Japanese studies on the effects of glycation of body proteins has been investi-
gated in bone as well as in the brain and other soft tissues. These glycation
formations of sugar-bound protein are known in the late stages of formation
as advanced glycation end-products (AGEs). AGEs are crosslinked sugar and
protein molecules on collagen, which irreparably harm the collagen. Studies
by the Nagoya University School of Medicine and the Tokai University
School of Medicine verify the involvement of AGEs by effectively demon-
strating their enhancement of bone resorption (bone breakdown). Another
study done by the Osaka City University Medical School reported that high
levels of glucose impair the function of bone-forming cells in diabetic
patients. Katayama, Celic and others reported in an Australian study that an
accelerated accumulation of AGE collagen in bone tissue exists in diabetes.
AGEs are implicated in the failure of cellular proteins to perform normal
functions. All of this research further points to the evidence that excess glu-
cose in the body has a debilitating effect on numerous metabolic functions
including bone formation and bone removal.

Exercise

There is evidence that regular exercise lowers the risk of osteoporosis. An
investigation by Tom Lloyd at the Pennsylvania State University College of
Medicine found that any form of physical exercise improved bone density in
teenage women without increasing calcium intake. This statistic changes
when too much sugar is in the teenage diet, however. Grace Wyshak at
Harvard Medical School discovered in a study on 460 girls in the ninth and
tenth grades that those who drank lots of soft drinks were three times as like-
ly to develop bone fractures as other teenagers. Physically active girls that
drank lots of soft drinks containing lots of sugar and phosphorus were five
times as likely to develop bone fractures as teenagers. The impact of excess
glucose on bone is expressed even in youth.

Lactose Intolerance and Microbial Dietary Supplements

With the importance of the intake of calcium from the intestine as an aid in
the prevention of osteoporosis, factors that prevent normal calcium intake
should be avoided. Approximately 30 per cent of the adult U.S. population
that are lactose intolerant (unable to digest the sugar lactose from dairy

The Preservation of Health

109

products) may have a reduced ability for getting enough calcium from their
diet. In her popular book, Lick the Sugar Habit, Nancy Appleton describes the
ability of high sugar consumption to upset the phosphorus level in the blood
resulting in protein loss through cell membranes. This effect contributes to
the inability of calcium to be absorbed into the body. Phosphorus and calci-
um need to be in balance in the bloodstream. Structural protein loss creates a
deficit in the ability to form new bone.

Probiotics are widely used to prepare fermented dairy products. They are

microbial dietary supplements by which some nutritionists express their bene-
fits in immune enhancement and lactose intolerance by helping to repopulate
the human intestine with the essential bacteria needed for normal digestion.

Prebiotics are insoluble fibers that act as a food supply for normal intes-

tinal bacteria by stimulating their growth and, therefore, contributing to the
formation of important micronutrients and more effective absorption of
nutrients into the body. Some have claimed the importance of prebiotics in
reducing the risk of osteoporosis.

A high sugar intake lacking considerable fiber upsets the rate and type of

absorption of nutrients through the intestinal wall and alters the population
of normal bacteria. Both probiotics and prebiotics may be important in calci-
um absorption and in normalizing intestinal problems.

Other Concerns for Osteoporosis in Women

The National Institutes of Health has found a link between depression and
osteoporosis because depression releases the hormones that can weaken bone,
especially with the release of cortisol. Depressed women have been shown to
have 15 per cent more bone loss than healthy women with their chances of
hip fracture increased to 40 per cent.

One and-a-half million American women suffer from hip fractures every

year due to osteoporosis, which affects more than 23 million Americans.
Undergoing a bone mineral density testing, as alluded to by Jill, Alex’s wife,
in chapter 1, is crucial to determining an early diagnosis. Osteoporosis may
be a silent disease. There may be no aches, pain, or discomfort as warning
signs. Yet, a proper diet and a low sugar intake can be a good preventative.

Steps That May Reduce the Risk of Osteoporosis

•

Follow the ‘three standard criteria for sugar consumption’

•

Eat whole grain foods

Mark A. Falco, D.M.D.

110

•

Eliminate all soft drinks

•

Reduce alcohol consumption

•

Exercise regularly

•

Obtain up to 1 hour of sunlight per day

•

Balance calcium level intake from foods with a similar intake from
foods containing magnesium

•

Discuss probiotic and prebiotic supplementation with your health
care practitioner

•

Seek bone density screening

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111

13.

Carbohydrates and Coronary Artery Disease

Lipoproteins and Triglycerides

Triglycerides are vital to body metabolism. They function to provide ener-
gy for all body cells except brain cells. When released from stored fat,
triglycerides separate into fatty acids and glycerol. The glycerol is reused
but the fatty acids are bound to transport proteins in the bloodstream to
form free fatty acids (FFAs ) that are used by cells for energy throughout the
body. The amino acid carnitine is one of the carriers for FFA entry into
body cells.

The turnover rate for free fatty acids is extremely rapid, being replaced by

new free fatty acids every two to three minutes. The transport proteins also
have the ability to cluster more free fatty acids onto their receptors when
more fatty acids are needed quickly throughout the body.

Lipoproteins are formed almost entirely in the liver. Their principal

function is to transport lipids throughout the body. Other than the chy-
lomicrons, which act only to carry triglycerides absorbed through the cell
membranes of the intestines into the lymph, lipoproteins consist of very low
density lipoproteins (VLDLs), which contain high concentrations of
triglycerides and moderate concentrations of both phospholipids and cho-
lesterol; low density lipoproteins (LDLs), which contain very little triglyc-
eride but a very high percentage of cholesterol; and high density lipopro-
teins (HDLs), which contain about 50 per cent protein with smaller
amounts of lipids (fats).

If the VLDLs are high, more triglycerides are being synthesized by the

liver because either too much glucose is available or not enough insulin is
available or both. This is why excess carbohydrates in the diet lead to excess
triglycerides and elevated VLDLs. After the triglycerides have been unloaded
in fat tissue, the VLDLs are converted to LDLs containing high amounts of
cholesterol, which are then transported to other tissues for use in cell mem-
brane formation or hormone synthesis. Excess LDLs in the blood are a risk
for cholesterol deposition in the walls of arteries.

112

The HDLs transport excess or discarded LDL remnants of cholesterol

back to the liver for degradation and excretion into the bile. Excess HDLs
reduce the risk of cholesterol deposition in the walls of arteries.

Much of the carbohydrate that is transported to the liver after a meal is

converted to triglyceride. Only about 400 grams of carbohydrates can be
stored as glycogen in muscles and the liver for use as instant energy at anyone
time. However, large amounts of carbohydrates entering the body are con-
verted to triglycerides to be stored as fat in excess of the amount of carbohy-
drate stored as glycogen. An average built person can store almost 150 times
as much energy in the form of fat as he or she can in the form of carbohydrate.

An interesting phenomenon occurs with the formation of free fatty acids

when excess glucose is available. They are synthesized more rapidly than they
are degraded because one of the normal metabolic pathways of glucose for-
mation produces fatty acids. Unfortunately, the newly synthesized FFAs can’t
be utilized effectively for cellular energy if the individual is not burning up the
calories available from them efficiently. This leads to excess fatty acids with
the ensuing excess formation of triglycerides.

One of the pathways for glucose metabolism produces a precursor for the

glycerol portion of triglyceride known as alpha-glycerophosphate. The excess
alpha-glycerophosphate combines with the excess fatty acids to form more
triglycerides. Excess glucose needing to be cleared from the bloodstream, not
utilized to any greater extent by other body cells, and not required for glyco-
gen storage, ends up producing more triglycerides. This produces more fat.
If excess protein is taken into the body through diet, it too can lead to
increased fat storage. Oddly enough, increased fat intake into the body,
although it can lead to increased fat storage, does not lead to increasing cir-
culating triglycerides in the bloodstream if the carbohydrate intake is low.

All along we’ve been told to decrease fat intake to lower the levels of

triglycerides and cholesterol under the assumption that fats deliver the high-
est amount of calories and that cholesterol and triglycerides are found pre-
dominantly within fats for consumption. But the Eskimos of Canada and the
Aborigines of the Australian outback eat low amounts of carbohydrates and
increased levels of fats and they don’t suffer from coronary artery disease.
Western society dieticians advise substituting carbohydrates for fats to replace
the calories. But we have to eat 2 1/4 times as many grams of carbohydrate to
get the same amount of calories from the missing fat. This excess carbohy-
drate intake actually increases the amount of circulating triglycerides and
cholesterol rather than decreases it. How is that possible?

When a diet or a snack high in carbohydrates is eaten, glucose levels in the

bloodstream begin to rise. Insulin is released to move the glucose out of the
bloodstream and into other tissues for usage or storage. Insulin also promotes
the storage of triglycerides as fat. While insulin levels in the bloodstream are

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113

elevated, fat cannot be broken down as readily. If a person is insulin resistant,
insulin levels are abnormally higher and blood cholesterol levels are elevated.
Insulin resistance is a condition caused by a diminished response to circulat-
ing insulin by the insulin receptors located on active cells within the body.
More insulin is needed to perform at the level the normal insulin amounts
should have been able to perform at. A longer presence of blood insulin
means less fat breakdown and an accumulation of more triglycerides.

It is no mystery that the liver and to some extent intestinal cells will

produce cholesterol in the absence of cholesterol from the diet. Cholesterol
is needed to produce bile, sex hormones, skin and cell membrane integrity,
and vitamin D. Dietary soluble fiber helps to reduce the absorption of cho-
lesterol through the intestines. Intestinal bacteria, producing a compound
that lessens cholesterol synthesis after its absorption into the bloodstream,
will digest the indigestible fiber consumed by humans. A low carbohydrate
diet and adequate fiber intake help to lessen the build-up of cholesterol and
triglycerides in the bloodstream. These facts cannot be disputed.

The hormones norepinephrine, epinephrine, and cortisol increase the

release of fatty acids from fat cells. This can occur during exercise, or during
stress. When fat is being broken down for use as energy during starvation,
exercise, or chronic stress, free fatty acids are returned to the liver for rede-
posit as triglycerides and then degraded. In some way, a mechanism or mech-
anisms develop whereby the lipoproteins formed by the liver engage more
triglyceride and cholesterol when entering the bloodstream. Some of the
research that has been gathered from all over the world on coronary artery
disease follows. The newest answers to the unusual accumulations of choles-
terol and other degradations in the arteries are addressed. The formation of
coronary artery disease is dependent upon changes in the arterial walls that
are created by damage from free radicals, cholesterol and calcium deposition,
and blood platelet aggregation known as blood clot formation. The connect-
ing mechanism in all of these abnormalities seems to be glucose.

Hyperinsulinemia

Insulin resistance may be a factor in cholesterol synthesis. During hyperinsu-
linemia (acute excess insulin in the bloodstream), cholesterol synthesis nor-
mally decreases. However, R. P. Naoumova and others at the Hammersmith
Hospital in London demonstrated that non-insulin dependent diabetes mel-
litus (NIDDM) subjects have a less marked cholesterol synthesis decrease.
NIDDM individuals develop insulin resistance because of their disease. A
good percentage of the population may have insulin-resistant episodes that

Mark A. Falco, D.M.D.

114

have not developed into a confirmed diabetic condition. Many overweight
individuals display insulin resistance. Insulin resistance seems to be responsi-
ble for delaying the decrease of cholesterol synthesis.

Hyperinsulinemia in healthy people has also been shown to suppress

VLDL production according to G. F. Lewis and others at the University of
Toronto Department of Medicine. But elevated free fatty acid levels in the
blood during hyperinsulinemia will stimulate VLDL production. This atten-
uates the suppressive effect of insulin on VLDL production. This would be in
agreement with the observations that excess glucose causes a more rapid syn-
thesis of free fatty acids and, subsequently, more triglyceride development. If
the level of insulin due to insulin resistance does not rapidly balance the level
of blood glucose, more VLDL triglycerides will form.

Increased serum (blood) insulin and triglycerides and decreased HDL con-

centrations are primary risk factors in the development of coronary artery
disease. Hyperinsulinemia and hypertriglyceridemia (excess triglycerides in the
blood) have a strong relationship to one another. The HDL, in comparison, has
an opposing relationship to insulin and VLDL triglyceride levels. Sustained high
insulin levels and triglycerides decrease HDL levels in the blood. HDLs are the
good lipoproteins. They are the scavengers of excess or oxidized cholesterol.
Heart disease risk is assessed by the ratio of total cholesterol to HDL. To deter-
mine this, the total cholesterol number (in mg/dl) is divided by the HDL num-
ber. Both are obtained from a lipid profile in a blood sample. The ratio should
be 4 or less. A higher number increases the risk of heart disease. Since the job of
HDL is to return the cholesterol back to the liver, an insufficient amount
returned will stimulate the liver to manufacture more cholesterol because cho-
lesterol has vital functions in several mechanisms of cell metabolism.

Non-diabetics are at primary risk for coronary artery disease as much as

diabetics if elevated serum insulin levels exist. Weight becomes a secondary
factor.

Calcium

There is some evidence that the absorption of more calcium through the
intestines reduces the absorption of cholesterol through the intestines. It
would stand to postulate, then, that any food or drug that lessens calcium
absorption would increase cholesterol absorption. High protein diets, high
sugar intake, high phosphorus intake, and caffeine decrease calcium absorp-
tion. Vitamin D, Vitamin K, and magnesium improve calcium absorption.

Calcium salt deposits occur in damaged or inflamed areas within the

body. Calcium ions are important in blood clot formation. In an experiment

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115

performed by Kurgan, Gertz, and Wajnberg in 1983, rabbit carotid arteries were
given a calcium salt to induce spasm. [Calcium ions drawn into muscle cells will
cause muscle contraction under normal muscle-stimulating events]. Vessel fold-
ing and membrane damage occurred to the arteries almost immediately. Calcium
continued to precipitate and deposit deep within the arterial lining followed by
white blood cell migration and proliferation at the damaged sites. It has been
found that the calcification of arterial walls is similar in composition to fully
formed bone and bone marrow. A glycoprotein called osteopontin is involved in
this mineralization process as it is in normal bone formation according to
research performed by the Mayo Clinic in Minnesota. The calcification of arte-
rial walls is a tenuous attempt to repair damaged membranes.

Normal contractions of the smooth muscle in arterial walls occur to aid

in the flow of blood into tissues. Normal relaxation of the smooth muscle
occurs to balance the rate of flow in between heartbeats. Insulin has been
demonstrated to inhibit the smooth muscle contraction of arterial linings.
According to Han, Ouchi, Karake, and Orimo at the University of Tokyo, this
occurs because insulin causes the release of nitric oxide from arterial mem-
branes, which decreases the calcium ion level involved in contraction of the
smooth muscle in the arterial wall.

Other studies have presented evidence that nitric oxide and AGEs (see

Chapter 12) are elevated in response to the resistance of calcium entry in vas-
cular and heart smooth muscles. This resistance lowers the ability of further
contractions in an already restricted or damaged heart or artery to allow for
more blood flow. This mechanism contributes to elevated blood pressures
because the arteries cannot easily relax between heartbeats. Calcium and fat
deposition have created greater constrictions. In addition, the channel within
the artery is kept open as wide as possible for continued blood flow even
though it is compromised from damage within its own lining.

Glycation in Arterial Walls

Glycation of LDLs is increased in diabetic persons. Oxidized glycation, or
glycoxidation (see chapter 9), alters protein structures irreversibly. If LDL
becomes unrecognized or damaged due to glycation, it accumulates heavily
causing certain types of white blood cells called monocytes to devour the
LDLs resulting in foam cell formation. Foam cells are aggregates of mono-
cytes filled with lipids that can form sheets and ultimately be deposited in
body tissues.

Platelet aggregation is stimulated by this glycation. This same process can

impair VLDLs and HDLs. If HDLs are impaired, they can no longer return

Mark A. Falco, D.M.D.

116

cholesterol back to the liver. Binding of vascular structural proteins and further
oxidative reactions can damage the walls of arteries. The lipoproteins affected
by glycation and glycoxidation have been shown to induce prostaglandin pro-
duction according to a 1996 Australian study. Prostaglandins are important in
vascular smooth muscle contraction, blood clotting, increasing inflammation,
and causing fever among other things not related to the blood vessels.
Increased prostaglandin production is stressful to the body.

Nitric oxide dilates blood vessels in the presence of low oxygen. When

oxygen levels are increased as can occur with increasing glycation, the dilata-
tion of blood vessels by nitric oxide is inhibited. The decreased activity of
nitric oxide results in an inability to control monocyte adhesion to the blood
vessel walls due to tearing or some other damage from free radicals.

A 1999 study at the Kanazawa University School of Medicine demon-

strated that vascular calcification was influenced by AGEs on the acceleration
of cells that differentiate into bone-forming cells. Artery wall damage seems
to be accelerated by AGEs caused by oxidative stress. Oxidative stress is
caused by an excess build-up of the by-products from cellular energy conver-
sion of oxygen. These by-products are known as free radicals. In the presence
of excess free radicals, AGEs cause the most damage within the arteries.
Glycation occurs because of glucose excess. This excess results in more free
radical formation with more arterial damage as a result.

Effects of Glucose on Arteries

How does glucose contribute to vascular damage? Hyperglycemia (excess
glucose in the blood) contributes to oxidative stress. Ceriello, dello Russo,
Amstad, and Cerutti at the University of Udine in Italy cultured endothelial
cells (cells from the outer lining of blood vessels in contact with the blood-
stream) in high-glucose conditions. The endothelial cells displayed high con-
centrations of antioxidant enzymes, which act to dispose of free radicals. The
presence of these antioxidants suggests that glucose was able to produce
oxidative stress in these cells.

Glycation of elastin, an elastic connective tissue protein found partly in

arterial walls, causes the stiffening of the arterial wall in atherosclerosis (hard-
ening artery disease). Incubation of an animal thoracic aorta in a high-glucose
concentration developed glycated linkages with the lysine portions of the
elastin in a study conducted by C. P. Winlove and others at the Imperial
College of Science, Technology, and Medicine in the United Kingdom.

Furthermore, high-glucose concentrations have been shown to reduce

the influx of calcium into smooth muscle promoting relaxation. Glycation is

The Preservation of Health

117

an apparent suspect in altering the calcium channel within the smooth mus-
cle cells of arterial walls.

These studies support the increasing evidence that glucose, by way of gly-

cation, affects the vascular wall. High insulin levels, usually a result of higher
glucose levels, affects the vascular wall, also. The oxidative stress from excess
glucose inhibits nitric oxide formation, impairs lipoprotein receptors, precip-
itates calcium in the bloodstream at the site of glycation on the vessel wall,
causes platelet aggregation, and allows monocytes to engulf the lipoproteins.
Is there still reason not to be concerned about the role of sugar in developing
heart or coronary artery disease?

Arginine Effectiveness

As mentioned earlier, reduced nitric oxide activity results in greater adhesion
of monocytes to the vessel wall. The monocytes respond to the excess oxi-
dized cholesterol at the vessel wall by engulfing the cholesterol and turning
into foam cells. Arginine initiates an enzyme known as nitric oxide synthase
to form nitric oxide. Supplementation with L-arginine has been shown to
increase nitric oxide activity and inhibit the monocyte adhesion in a study
performed by G. Theilmeier and others at the Stanford University School of
Medicine in California in 1997. It is suggested that the oxidative stress is less-
ened when nitric oxide levels increase.

The Department of Cardiology at the Royal Prince Alfred Hospital in

Sydney, Australia gave ten men with coronary artery disease 7 grams of L-
arginine three times a day for three days. Their evaluation determined that
endothelium-dependent dilatation of the arteries was improved. The use of
L-arginine may be dose-dependent. When proper dosage is maintained, L-
arginine can be an effective protector of heart muscle according to a 1999
study done at the Heart Institute for Children in Oak Lawn, Illinois.

Since hypertension is partly a result of endothelium thickening and

constriction of the vascular channel, nitric oxide shrinks the endothelium and
widens the vascular channel. A 2000 study at the University Medical School
in Rouen, France found that L-arginine supplementation reduced monocyte
adhesion in hypertensive rats suggesting that nitric oxide reduction con-
tributed to the hypertension.

Glycated LDLs have been shown to reduce nitric oxide synthesis by

inhibiting the uptake of L-arginine in a study done at the University of Graz
in Austria in 1999. The benefit of L-arginine supplementation may be mini-
mal if the catalytic products of glycation, excess glucose and insulin resistance,
are not addressed.

Mark A. Falco, D.M.D.

118

Diet and Coronary Artery Disease

Differences in the amount and kind of ingested carbohydrate can modify
the response by glucose and insulin. Both glucose and insulin levels
decrease when the total calories given as carbohydrates are decreased. This
effect has a concomitant decrease in the triglyceride levels. Diets eaten by
the Australian Aborigines are low in fat, extremely low in carbohydrate and
high in protein. Their insulin response is low and their triglyceride levels
are very low.

Coulston, Liu, and Reaven performed a study on 11 healthy volunteers in

1983. Ten days of a 40 per cent and 10 days of a 60 per cent carbohydrate diet
were assessed for triglyceride levels, insulin levels, and HDL levels. The 60
per cent diet showed significant elevations in triglycerides, significant deficits
in HDLs, and insulin remained elevated. A follow-up study on ten patients
with hypertriglyceridemia showed similar results.

A study published by Ullrich, Peters, and Albrink actually showed

that a high-fat diet decreased serum triglyceride levels more than a high-
protein diet. Other authors have disputed this. But, a study done at the
University of Texas Southwestern Medical Center in Dallas involved 10
patients with NIDDM receiving insulin therapy. Again it was learned that
a high-monounsaturated fat diet, when compared to a high-carbohydrate
diet, produced lower glucose levels and reduced insulin requirements, and
lowered triglyceride levels and raised HDL levels. A follow-up study on 42
non-insulin dependent diabetes mellitus (NIDDM) individuals gave simi-
lar results. A recent conclusion by researchers in the Republic of China
claimed that a high-carbohydrate intake was responsible for hypertriglyc-
eridemia in their country. A similar statement is warranted in all of west-
ern society.

At Stanford University in California in 1997, a study on 10 healthy post-

menopausal women found that triglyceride levels and insulin levels to be
higher with a 60 per cent carbohydrate diet when compared to a 40 per cent
carbohydrate diet, confirming the earlier studies by Coulston, Liu, and
Reaven. If a low carbohydrate and higher monounsaturated fat diet reduces
triglyceride, glucose, and insulin levels in normal, diabetic, and post-
menopausal people, why aren’t we eating more diets like this? You can pack-
age and sell the sugar easily. But fats are not tasty, are not as easily packaged,
and have been given faulty press. Some experts still believe that too much fat,
monounsaturated or not, is still not healthy.

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119

Vitamin and Mineral Support and Exercise

Niacin has been shown to be the most safe and most desirable vitamin to
lower cholesterol when in high doses and under the supervision of a physi-
cian. Besides niacin, pyridoxine and folic acid levels were found to be highest
in people with the lowest risk of heart disease. Some experts believe that low
levels of these vitamins and vitamin B12 allow methionine to produce toxic
levels of homocysteine, which contributes to artery damage. Proper levels of
these vitamins prevent this accumulation.

Vitamin E supplementation has been shown to increase nitric oxide

synthase activity leading to lower blood pressure due to vitamin E’s antioxi-
dant effect. Vitamin C supplementation has been shown to reduce triglyc-
eride levels and to work effectively as an antioxidant protecting nitric oxide
from inactivation by free radicals.

A 1981 study determined that high levels of vitamin C supplementation

could make dietary copper relatively unavailable for regulating cholesterol
metabolism. Copper supplementation would also be necessary, but must be in
a 1 to 15 ratio with zinc because of the competition of copper and zinc for
similar binding sites.

Caffeine and norepinephrine cause a calcium exchange in smooth muscle

resulting in contractions of the muscle. Magnesium inhibits the muscle con-
traction by relaxing the muscle instead. In magnesium deficiency, smooth
muscle relaxation of the arteries can be inhibited leading to coronary spasm.
Caffeine can greatly augment smooth muscle contraction in the arteries.
Another factor, stress, can potentiate magnesium deficiency. Magnesium has
a strong association with blood pressure. Adequate levels need to be main-
tained in the body at all times.

Fiber, especially water-soluble fiber found in fruits, vegetables, oat bran,

and pectin bind to cholesterol in the intestines allowing for it to be excreted.
Pectin has been shown to lower serum and liver cholesterol by regulating 3-
hydroxy-3-methylglutaryl-CoA reductase (HMG-CoA reductase) activity,
which increases liver synthesis of cholesterol as the serum cholesterol level
falls. This provides good balance. HMG-CoA reductase enzyme is inhibited
by the statin medications to prevent the synthesis of cholesterol.

Exercise can keep the endothelium of blood vessels in shape according to

Stefano Taddei of the University of Pisa in Italy. Elderly people who do not
exercise have higher levels of free radicals in the blood. Nitric oxide is inhib-
ited by these free radicals preventing proper relaxation of the blood vessels
and contributing to fatty plaque formation in the vessel walls.

Blood pressure has been shown to decline when exercise accompanies

weight management. This regiment also causes blood-glucose and insulin lev-
els to decline improving glucose metabolism and insulin resistance. James

Mark A. Falco, D.M.D.

120

Blumenthal at Duke University in North Carolina headed up the study that
determined combined exercise and weight management improved hypertension.

Death Rates

Death rates from heart disease among men with cholesterol levels above 240
mg/dl are 2 to 3.6 times higher compared to men whose cholesterol levels
were below 200 mg/dl. At 280 mg/dl, the death rate is 8 to 12 times higher.

It is essential for everyone to have testing for cholesterol, triglycerides,

serum insulin, and glucose tolerance starting at age 40 or earlier if there is a
family history of heart disease regardless if you have normal blood pressure,
and maintain an ideal weight. The symptoms of faulty glucose metabolism
and insulin sensitivity are not clearly distinguished until a disease has been
finally diagnosed.

One million Americans die from cardiovascular disease every year. Early

prevention through improved knowledge and assertive action can start saving
many more lives and can begin to reduce this death rate.

Factors That May Reduce the Risk of Cardiovascular Disease

•

Follow the ‘three standard criteria for sugar consumption’

•

Eat whole grains, more vegetables, and fruit

•

Avoid fried foods and limit saturated fats

•

Exercise regularly

•

Substitute more cold-water fish for animal protein sources

•

Avoid high-protein consumption

•

Avoid soft drinks

•

Limit caffeine

•

Eat foods high in calcium, magnesium, and vitamin D

•

Eat food high in the antioxidants such as vitamin C and vitamin E

•

Consult with your health care practitioner about testing for choles-
terol, triglycerides, serum insulin, and glucose tolerance by age 40 or
earlier if there is a family history of cardiovascular disease

•

Consult with your health care practitioner to determine if the foods
that you eat or other factors may also increase your risk for cardio-
vascular disease

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121

14.

Asthma

Effects of Asthmatic Attacks

Over fifteen million people are affected by asthma in the United States. Five
thousand of them die every year due to asthma. It impacts almost 10 per cent
of children less than five years of age. By 2020, it is projected that asthma will
have affected 1 in every 14 people. In 1995 alone, asthma was the chief rea-
son for school absenteeism with 10 million missed school days.

Asthma is an inflammatory illness of the lungs demonstrated by mild to

severe breathing difficulties caused by constriction and swelling of the airways
within the lungs known as bronchioles. Mucous secretions during the inflam-
matory episodes plug up portions of the bronchioles preventing normal air
exchange. Wheezing, coughing, increased respiratory rate, chest tightness,
and breathing difficulties accompany asthma attacks. Various stimuli have
been shown to trigger asthma attacks including food and environmental aller-
gies, bacteria, viruses, and stress.

As in arteries, the bronchioles also are lined with smooth muscle.

Receptors known as beta 2-adrenergic receptors located on the smooth mus-
cles respond to stimuli to relax the smooth muscles, opposite to cardiovascular
smooth muscle, which is stimulated to constrict smooth muscles. Epinephrine
stimulates these receptors and, so, it is recognized as a beta 2-adrenergic ago-
nist. Both epinephrine and norepinephrine relax the bronchioles.

Corticosteroids such as cortisol are secreted naturally by the adrenal

glands to control inflammation. Short-term cortisol secretion contributes to
elevated glucose levels in the bloodstream as it would when synthetic corti-
costeroid drugs are administered for treatment. Long-term cortisol secretion
results in adrenal suppression, a suppressed immune system, osteoporosis,
peptic ulcers, and acts to retard growth.

Absorption of undigested food proteins into the bloodstream may create

allergic immune responses and lead to asthma. Loss of proper nutrient absorp-
tion through the intestine can be enhanced by an excessive and massive intake
of simple carbohydrates lacking fiber. Alterations in the ionic absorption

122

process or damage in intestinal membranes will rapidly force absorption of
glucose and other incompletely digested proteins uncharacteristic with this
rate of absorption.

Asthma can be split into two major categories, stress-induced asthma and

allergy-induced asthma. Exercise-induced asthma is a form of stress-induced
asthma. If your child runs around quite a bit, and then begins to wheeze and
has difficulty catching his breath, he or she may be diagnosed with asthma
generated from exercise. Tests will always reveal an allergy to something that
exacerbates the asthma, but allergy may be the result not the cause. No one
is exactly sure why exercise triggers the inflammatory stages of asthma,
although many mechanisms of cellular changes in the lungs have been
explored. You may recall the episode of asthma in Dylan from chapter one.
Oddly enough, Dylan will never express hyperglycemia while he is an asth-
matic. Once again, glucose steps in as a significant factor in the development
of a disease. The reasons for a non-expression for hyperglycemia will be
examined a little later.

At other times, rest may generate asthmatic episodes. A child may arise

from his or her sleep wheezing and gasping for air. As far as I know, sleep is
not a form of exercise. Nor is it likely a pollen-induced reaction, although
exposure to pollens can result in asthma attacks. Nighttime is not character-
ized by any activity that increases pollen count levels above daytime levels.

Beta-Adrenergic Blockades

Insulin secretion in asthmatics significantly reduces the blood-glucose con-
centrations. Asthmatics as a group suffer more from episodes of hypo-
glycemia. In fact, the incidence is so high that it is absolutely rare for an
asthmatic to suffer from diabetes at the same time. It seems as though both
conditions are on the opposite ends of the spectrum. Researchers are still
confused by this relationship.

The effects of glucagon have been studied in asthmatics for several years.

Glucagon, the hormone that enables more glucose to re-enter the blood-
stream, has a selective bronchodilator (opens the bronchioles) effect that
allows for better breathing in asthmatic patients. Sherman, Lazar, and
Eichacher at the Albert Einstein College of Medicine in Bronx, New York
studied the effect of glucagon on eight patients with asthma that produced
this result. If asthmatics are more sensitive to hypoglycemic episodes from
insulin, then an increased secretion of glucagon may be an absolute necessity
in restoring blood-glucose levels to relax the bronchioles. Unfortunately for
asthmatics, this mechanism may sometimes be impaired. Ahonen, Sovijarvi,
and Muittari determined that glucagon release by asthmatics is a defense

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123

mechanism against exercise-induced constriction of the bronchioles when
they saw a significant increase in serum glucagon levels almost immediately
after exercise. Glucagon is the body’s natural bronchodilator.

Glucagon is a beta-agonist. It will act to dilate bronchioles when released

into the bloodstream, as does epinephrine. It also acts on beta-receptors in
the liver to breakdown glycogen and protein into glucose. The question is
raised as to why asthmatics need more glucagon than normal individuals to
attain normal blood-glucose levels. Karnik, Gumaa, Guindi, and Fenech at
Kuwait University administered intravenous glucagon to asthmatic patients
and healthy individuals. The asthmatics demonstrated lesser increases in both
glucose and insulin than the control group. They suggested that a partial
beta-blockade mechanism existed in asthmatics meaning that receptors for
glucagon in the liver and the lungs may be only partially operational. Lee,
Busse, and Reed discovered that beta-adrenergic stimulation was reduced in
asthmatics when they studied human lymphocytes in 1977.

Blood-glucose levels are observed to be low after epinephrine is adminis-

tered to asthmatics. Epinephrine normally increases blood-glucose levels.
This further supports the presence of a partial beta-blockade. Beta-adrener-
gic stimulation normally enhances both glucagon and insulin secretion and
activates liver cells to breakdown glycogen into glucose. It would appear that
receptors for glucagon are diminished, impaired, or simply outnumbered by
other events in asthmatics. With any of these events being true, many of the
complications suffered from asthma may be in a direct relationship to
glucagon resistance, opposite to the insulin resistance seen in diabetics.

Decreasing Effects of Cortisol

During sleep, blood-glucose levels drop to the lowest point between the
hours of 3 a.m. and 5 a.m. Nocturnal asthma correlates with hypoglycemia
during these hours. M. Fujitaka and others at the Hiroshima University
School of Medicine in Japan found that cortisol levels in asthmatics during
attacks at these hours had a greater increase when compared with asthmatic
attacks in the afternoon. Fujitaka and Nomura further identified that the
adrenocortical hormones such as cortisol increased in proportion to the asth-
ma attack but subsequently decreased with time. These patterns are typical
for asthmatics, but not for healthy subjects. It is suspected that decreasing
cortisol levels over time might lead to more persistent asthmatic attacks. The
asthmatic person is stressed during an asthmatic attack, which releases corti-
sol. But the effect of cortisol diminishes over time to the attack. This can be
attributed to glucocorticoid (cortisol) impairment, deficiency, or exhaustion.

Mark A. Falco, D.M.D.

124

Increased incidents of colds and infections in children with asthma may be a
result of a poorer response by cortisol to the stress of foreign invasion into
the body.

At the Tongji Medical University in the Republic of China, Liu, Niu, and

Hu found that the glucocorticoid receptors on white blood cells such as
neutrophils were significantly lower in asthmatics than in healthy subjects.
Instead of impairment in glucocorticoid metabolism, they theorized that the
decreased number of glucocorticoid receptors in asthmatics contributed to
repeated asthma attacks. This may explain why the white blood cell count can
increase greatly in asthmatics. More white blood cells mean more glucocorti-
coid receptors for asthmatics. White blood cells act to absorb the cortisol for
degradation at the affected site of inflammation.

Superoxides

The respiratory burst is a phenomenon whereby white blood cells, namely
neutrophils, actively metabolize oxygen to produce germ-killing substances
that are penetrated inside the cell membranes of the offending bacteria to kill
them. Neutrophils in asthmatics have heightened respiratory bursts and
greater superoxide production, a free radical. To meet the demands for ener-
gy by the neutrophils, more glucose is required by the neutrophils.

If more glucose is required by the neutrophils, more glucose needs to be

released into the bloodstream. If this process is diminished because of a delay
or shortening of glucagon metabolic activity, other hormones such as epineph-
rine and cortisol are called upon to activate receptors that raise blood-glucose
levels. But their effects may still be minimal, therefore, neutrophils begin to
adapt to alternative energy sources. This will be discussed in a moment.

The neutrophils of asthmatics in both acute and remission phases demon-

strate greater superoxide production than normal healthy controls. Research
by Lin, Tan, and Candlish at the National University of Singapore supported
a study that indicated this difference between superoxide production in asth-
matics and non-asthmatics. They believe that glucose levels play a role in
determining the amount of superoxide production, which impacts on airway
inflammation in asthmatics. Increased glucose levels are needed for rapid use
by neutrophils. This generates more rapid production of superoxides.

Excessive superoxide production in asthmatics results in increasing

airway obstruction and inflammation. Superoxide is a generated free radical.
Most recently, research by S. Furukawa and others at the University of Tokyo
have found that glutamine can also be used by neutrophils in the absence of
glucose for energy with a smaller generation of free radicals. This alternative

The Preservation of Health

125

energy source may actually aid in lessening the severity of asthma attacks pos-
sibly by reducing the production of superoxides and sparing greater hormon-
al release. Epinephrine has been shown to partially inhibit glutamine utiliza-
tion by neutrophils according to C. Garcia and others at the University of Sao
Paulo in Brazil. Besides blood-glucose level elevation exhibited by epineph-
rine in the bloodstream, this hormone also inhibits superoxide production by
neutrophils. Garcia postulated that glutamine metabolism by neutrophils is
actually a protective mechanism against the inhibitory effect of epinephrine
on superoxide production.

In asthmatics, however, the availability of glucose is diminished for

neutrophils. It may be theorized that glutamine is substituted in far greater
amounts than may be realized in place of glucose as a form of energy in asth-
matics. As a consequence, superoxide production increases anyway, but more
likely in lesser amounts.

Nitric Oxide in Expired Air

Nitric oxide has been found to be present in greater quantities in the expired
air of asthmatics than in normal subjects. Some researchers believe that nitric
oxide is a natural response by the body to prevent viral replication. Arginine-
generated nitric oxide release may actually be a protective element in exacer-
bations of asthma according to H. W. deGouw and his colleagues at the
Leiden University Medical Centre in the Netherlands. Nitric oxide inhibits
the inflammatory products of monocytes in asthmatics at the cellular level.

Jarjour and Calhoun from the University of Wisconsin Medical School

in Madison investigated 56 patients with asthma. They compared forced
expiratory vital capacity (a forceful high volume expiration of air capacity in
the lungs) with controls. Their findings revealed that increased generation of
superoxide by neutrophils worsened airway obstruction in asthmatics. It
would seem that nitric oxide synthesis correlates with inflammatory condi-
tions to remove the free radicals. Supporting this, M. J. Thomassen and oth-
ers at the Cleveland Clinic in Ohio believe that a feedback loop mechanism
with nitric oxide starts with an allergen that stimulates inflammatory chem-
icals as part of the immune response, which in turn stimulates nitric oxide
production. Nitric oxide synthesis then acts to reduce the levels of superox-
ide. This lessens the efforts of cortisol and continues to allow neutrophils to
utilize glutamine without an unwanted excess of superoxide building up in
the tissues.

Mark A. Falco, D.M.D.

126

Norepinephrine

Norepinephrine release relaxes the bronchioles. Norepinephrine is related to
dopamine. Both norepinephrine and dopamine are ‘feeling good’ neurotrans-
mitters. Dopamine levels in the brain are lower in asthmatics at night when
compared to healthy individuals. Both neurotransmitters are made from tyro-
sine. An impaired norepinephrine response is suspected in asthmatics. The
consequences are not immediately known, but withdrawal, depression, mem-
ory retrieval problems, and a craving for sweets are found in subjects with low
dopamine and norepinephrine levels.

Norepinephrine secretion may hinder the receptors for cortisol and epi-

nephrine during asthmatic episodes. Asthmatic symptoms coincide with
increased levels of norepinephrine, epinephrine, dopamine, serotonin, and
cortisol in the blood vasculature. Cortisol influences the release of epineph-
rine. Both are beta agonists. Norepinephrine is an antagonist to these two
hormones. Scanlon and Chang at the Georgetown University School of
Medicine in Washington, DC studied 47 pediatric patients for symptoms of
asthma based on the detection for inhibition of norepinephrine release in the
hypothalamus on corticotropin releasing hormone, which affects cortisol
release. Their study revealed that norepinephrine levels were higher in the
asthmatics than in controls. This increase counteracted the beta agonists’
ability to relieve the symptoms resulting from bronchial constriction.

Nutrition in Asthmatics

A 1995 evaluation of 77,866 women by the Channing Laboratory in Boston,
Massachusetts on the relationship of antioxidants and asthma found that vita-
min E had a protective effect against asthma. Antioxidant levels of vitamins A,
C, and E are lower in asthmatics during remission of an asthmatic attack as
determined by a 2000 study at the Hacettepe University Faculty of Medicine
in Ankara, Turkey.

Deficiencies of vitamins A, B, C, and E, zinc, selenium, methionine,

cysteine, and arginine reduce antiviral immune functions paving the way for
chronic viral infections, obesity, atherosclerosis, allergies, and cancer as
defined by a 1999 study by J. E. Sprietsma in the Netherlands. Magnesium
has been shown to attenuate the neutrophil respiratory burst in asthmatics in
a 1996 study at the University of Colorado Health Sciences in Denver by
Cairns and Kraft. Magnesium salt absorbed from the Dead Sea in Israel has
reduced inflammation and increased vasodilatation in the lungs of asthmatics.
Magnesium also increases nitric oxide synthesis.

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127

An experiment led by P. J. Collipp on 76 asthmatic children for five

months noted significant improvement in their asthma following a 200 mil-
ligram daily dose of pyridoxine. Niacin has also been shown to reduce hista-
mine release. Histamine, an inflammatory agent, is released by blood to tis-
sue migrating protective cells known as mast cells to make the blood capillar-
ies leak fluid, white blood cells, and proteins into the affected tissues.
Histamine release is heightened in asthma and in allergies.

Emphasis on a good diet is stressed in asthmatic patients since food aller-

gies to sugar, wheat, ice, soda pop, fried food, nuts, oranges, milk, chocolate,
and eggs have all been implicated in asthma attacks. In a 1980 study, 322 chil-
dren under one year of age with respiratory allergies were given a six-week
diet of hypoallergenic foods consisting of meat-base formula, beef, carrots,
broccoli, and apricots. Ninety one per cent showed significant improvement
of respiratory symptoms and subsequent food challenges resulted in repro-
duction of symptoms in fifty one per cent. Food sensitivity reduced dramati-
cally over time.

This research emphasized that a proper diet without refined foods or

additives can do much better in reducing allergic symptoms most likely
because blood-glucose and serum hormone levels would be in better balance.
Once again, we find refined sugar and flours as major contributors to a cas-
cade of events from vitamin and mineral insufficiency to allergies. In many
cases, it would appear that a better diet would help to correct the imbalances
as well as the symptoms. This kind of approach may go a long way for asth-
matics, too.

Natural Choices That May Reduce Asthmatic Episodes

•

Follow the ‘three standard criteria for sugar consumption’

•

Eat whole grain foods and no refined grain foods

•

Increase consumption of tolerable foods high in antioxidants, vitamin
C, and B vitamins

•

Increase intake of tolerable foods high in magnesium

•

Avoid foods that are known to exacerbate the asthma

•

Avoid mouth breathing while at rest to reduce the risk of airway irri-
tation from pollutants or oral bacteria

•

Consult with your health care practitioner about increasing the
amount of vegetable and/or animal protein

•

Discuss with your health care practitioner about cardiovascular exer-
cises that can strengthen the immune system

•

Consider changes that help to avoid stressful situations

Mark A. Falco, D.M.D.

128

15.

Diabetes

Insulin Resistance

Diabetes mellitus is the direct result of excess sugar consumption. There is
very little historical evidence in civilizations prior to the nineteenth centu-
ry of the ‘downward escaping honey’ as early physicians coined the descrip-
tion for diabetes mellitus. It had previously been diagnosed only in the well
to do. Once refined sugar factories grew in Europe in the eighteenth cen-
tury, the consumption of sugar rose dramatically, and so did the number of
diabetic cases.

The most common form of diabetes, adult-onset diabetes, or NIDDM

(non-insulin dependent diabetes), may start out as an increased secretion of
insulin to remove an excess intake of sugar and carbohydrate from the blood.
This makes the pancreas work feverishly to produce a lot more insulin lead-
ing to hypoglycemia following glucose removal. Insulin resistance ensues. A
lot more insulin is required to remove the same amount of glucose. After long
periods of this activity, either receptors for insulin in body tissues become
defective, or the pancreatic cells become exhausted and cannot keep up with
the production of insulin. In either case, after many years of this strain on the
pancreas, sugar spills into the urine confirming a diagnosis for diabetes.

Any amount of sugar that can’t be stored as glycogen in the body due to

insulin insufficiency causes available sugar to be stored as fat. Obesity starts
to develop. In diabetics, however, these fats cannot all be stored in adipose tis-
sue, again, because of an insufficient activity of insulin to assist in the storage
process. In early stages, the excess fats, instead, deposit in the arteries and
increase blood pressure, contribute to atherosclerosis, elevate cholesterol, and
increase obesity. In later stages, impaired kidney filtration, cataracts or other
eye vessel complications, and gangrene can result in uncontrolled situations.

Excess sugar consumption can result in the glycation of proteins, render-

ing the proteins unusable with an inability to replicate more tissue. If a lot of
proteins cannot be readily broken down to amino acids, hormones such as
insulin cannot be readily synthesized. This effect can diminish the ability of

129

the pancreas to manufacture enough insulin. Couple this with a lower level of
insulin receptors throughout the body and you can see why an amount of glu-
cose absorbed into the body that has a high glycemic index is not tolerable to
a diabetic. Carbohydrates are indexed into their relative rate of absorption
into the bloodstream from the intestines when compared to the rate of
absorption of glucose. The more rapid the carbohydrate is absorbed, the
quicker the insulin becomes elevated. Carbohydrate foods with a high
glycemic index are foods that are absorbed very quickly and evoke a rapid rise
in blood-glucose. These foods do not benefit the diabetic.

Control of insulin for NIDDM is the reduction of carbohydrates. Fever

and infection in a diabetic changes the insulin requirement. First of all, these
states create an increase in glucagon concentration in order to release more
glucose into the bloodstream from body cells. This creates a greater source of
energy for proliferating white blood cells. Insulin release coincides with a rise
in the blood-glucose level. In insulin resistant individuals, especially diabetics,
the level of glucose in the blood rises to levels of hyperglycemia because it is
slower to clear. As more glucose is needed to fight the infection, more glyc-
erol from triglycerides and more costly amino acids are converted to glucose.
Release of growth hormone, cortisol, and epinephrine will contribute to the
rising glucose levels. Diabetics are always in danger of becoming hyper-
glycemic in a state of fever or infection.

Glucagon behaves as a general in an early assemblage of support troops,

rallying and mobilizing them to engage in selected tasks to provide the best
modes of action for its troops. Release of glucose from glycogen is one task.
Another, the assembly of amino acids into glucose by glucagon is assisted by
the hormone cortisol, which moves proteins out of body tissues to be deliv-
ered to the liver for the conversion. Growth hormone, along with cortisol,
over stimulates the secretion of insulin by effectively raising blood-glucose
levels. Over stimulation of the pancreas by these hormones results in insuffi-
cient insulin production or insulin resistance due to an overwhelming num-
ber of glucagon receptors over insulin receptors, or possibly, an inadequate
number of available insulin receptors.

The Amino Acid Stimulation

An increased intake of amino acids such as alanine, glutamine, and arginine
stimulate glucagon secretion after a meal. This is a result of increased insulin
secretion, which acts to move the amino acids into cells to build proteins.
Excess glucagon causes the release of these amino acids to be converted back
into glucose in the liver. How important can an amino acid like glutamine be

Mark A. Falco, D.M.D.

130

to a diabetic? Li, Nussbaum, and others at the University of Cincinnati
Medical Center in Ohio found that L-glutamine supplementation increased
glucagon levels in laboratory rats, normalized insulin levels, and reduced fatty
deposit accumulations in the livers even in the presence of a 25 per cent dex-
trose (sugar) solution. Glutamine, as you may recall, also has the ability to
stop the cravings for sugar. If for no other apparent reason, L-glutamine sup-
plementation may be a benefit to diabetics who need to reduce their refined
sugar intake.

Elevated glucose levels have been shown to increase insulin secretion.

This occurs through a calcium ion channel pathway in the cell membranes of
the pancreatic cells. Arginine has also been shown to induce insulin secretion
through an increase in the calcium concentration in these cells. HMG-CoA
reductase inhibitors, prescribed for at-risk patients to lower cholesterol, act
on slowing the cellular metabolism of cholesterol. Most of these inhibitors
have been shown to also inhibit the pancreatic cell response to glucose at this
calcium channel level including the blockage of arginine in the channel
sequence according to Yada, Nakata, Shiraishi, and Kakei at the Kagoshima
University School of Medicine in Japan. These cholesterol inhibitors may
affect the insulin response to elevated blood-glucose.

Neurotransmitter Influences

Arginine and lysine can be used to synthesize glutamic acid. The body absorbs
glutamine from food protein. Glutamine is the only amino acid that easily
passes the blood-brain barrier independent of blood-glucose or amino acid
levels. It is the major amino acid circulating in the blood and cerebrospinal
fluid. Glutamic acid is produced from glutamine in the brain fluids. Glutamic
acid, with the help of pyridoxine, will form the neurotransmitter GABA. X.
H. Gu and others at the Kyoto University Faculty of Medicine in Japan inves-
tigated the role of GABA on insulin secretion in rat pancreatic cells. They
found that GABA caused a dose-dependent inhibition of arginine-induced
insulin secretion in the presence of glucose. GABA also inhibited the increase
in the calcium channel pathway.

Increasing consumption of carbohydrates increase brain levels of GABA

as well as norepinephrine and serotonin. Could it be possible that GABA and
other neurotransmitters have a mediating effect on blood-glucose levels by
creating or increasing insulin resistance? In a study published in 1984,
Steffens, Damsma, van der-Gugten, and Luiten chemically stimulated both
the lateral and ventromedial hypothalamic areas of the brain in laboratory
rats. The hypothalamus is the center for endocrine functions and emotional

The Preservation of Health

131

behavior. The ventromedial hypothalamic region controls satiety and neu-
roendocrine function. The lateral hypothalamic region controls thirst and
hunger. The researchers infused norepinephrine into the regions of the
hypothalamus directly and intravenously. Blood sample results indicated
that the infusion of norepinephrine into the lateral region increased serum
insulin. Infusion of norepinephrine into the ventromedial region increased
both serum insulin and blood-glucose. Intravenous administration of nor-
epinephrine did not alter blood-glucose or serum insulin levels. Shimazu,
Noma, and Saito, took this work further by infusing norepinephrine into
the ventromedial regions and lateral regions for up to 20 weeks in labora-
tory rats. Serum insulin levels elevated markedly, but they didn’t notice sim-
ilar increases in blood-glucose. More astonishingly, they found norepineph-
rine stimulation of the ventromedial region, the center for satiety, devel-
oped massive obesity in the rats and an incessant ability toward eating.
Clearly, the elevations in serum insulin were mediated by the level of nor-
epinephrine in the ventromedial hypothalamus resulting in insulin resist-
ance and a greater appetite.

Liang, Luo, and Cincotta at the Ergo Science Laboratory in Charlestown,

Massachusetts infused norepinephrine and/or serotonin into the ventromedi-
al hypothalamus of hamsters for five weeks and then examined insulin release
from the pancreatic cells. They observed that the combination of increased
serotonin and norepinephrine infusion into the ventromedial region pro-
duced marked glucose-induced insulin release. Their research has given
impetus to the recognition of hyperinsulinemia as a feedback mechanism in
the ventromedial hypothalamus through norepinephrine activity in the per-
petuation of insulin resistance and obesity. Since we know that excess carbo-
hydrate contributes to several disorders, with the most thoroughly studied
being diabetes, and we know that carbohydrate craving is mediated by sever-
al neurotransmitters, the role of neurotransmitters in insulin resistance
requires further study.

Oxidative Processes

Arginine-produced nitric oxide has been frequently mentioned for its role in
reducing free radicals released by cellular degradation. A team of researchers
headed by N. Matsuura at the University of Shizuoka in Shizuoka-City, Japan
studied the involvement of nitric oxide in the regulation of insulin secretion
from pancreatic cells. By using a nitric oxide synthase inhibitor to prevent
arginine-derived nitric oxide production, they discovered that increased cal-
cium channel ion levels were partially inhibited in the presence of glucose.

Mark A. Falco, D.M.D.

132

These findings indicated that not just arginine, but the production of nitric
oxide from arginine stimulated the pancreatic cells to induce insulin secretion
in the presence of glucose.

Collagen formation, important for tissue repair and wound healing, is

reduced in diabetics. The low amount of available insulin during hyper-
glycemia is a major contributing factor in the reduction of collagen formation.
Glycoxidation processes in body tissues may be the most damaging factor.

M. X. Fu and others at the University of South Carolina in Columbia,

South Carolina studied the effects of glycation, the cross-linking of sugar and
protein, in collagen. Oxidation of glucose forms glycoxidation products, which
were found by Fu to be reversed by antioxidants. Unfortunately for diabetics,
collagen glycation can continue if elevated glucose levels persist. This eventu-
ally creates kidney malfunction, eye damage, and cardiovascular complication.
It is the task of researchers to test and develop glycation inhibitors to offset the
most damaging effects of glycation seen in diabetes and ageing. However, nor-
malizing blood-glucose levels and providing adequate antioxidant supplemen-
tation are two tasks that can easily be accomplished now by every person who
has any concern for their overall health. A diabetic must eliminate refined sug-
ars and be given a proper diet to sustain health.

Dietary Factors

Increased release of epinephrine and cortisol contribute to increased blood-
glucose levels, protein breakdown, and aid in the loss of magnesium and some
chromium stores. Loss of magnesium reduces tissue sensitivity to insulin and
contributes to insulin resistance. Loss of chromium impacts on the glucose
tolerance factor necessary for the regulation of carbohydrate metabolism for
enhancing insulin function.

Foods high in simple sugars, carbohydrates that are rapidly absorbed into

the bloodstream after a meal, and a low fiber intake increase the risk of
NIDDM. Corn syrups and refined flour are included in these categories.
Most fruits, vegetables, and high-fiber whole grains have a protective effect.
They lower blood-glucose levels on average and reduce cholesterol and
triglyceride concentrations.

A team of researchers at the Columbia University College of Physicians

and Surgeons in New York found a class of transport proteins for fats known
as heparin sulfate proteoglycans (HSPGs) that do not work as well in a hyper-
glycemic environment. In diabetic mice, their study found that less HSPGs
were formed causing less fat to be cleared and more heart disease risk. Further
studies on these proteins are continuing.

The Preservation of Health

133

About 16 million Americans have diabetes of which 90 per cent are in the

form of NIDDM. Smokers have been shown to have an increased risk in the
development of diabetes although other risk factors seem to contribute such
as sugar consumption, alcohol consumption, a low exercise level, and a fami-
ly history of diabetes. A moderate level of alcohol, dry red wine in particular,
is important for lowering the risk of heart disease, but this will add more glu-
cose to the bloodstream. Diabetics need to avoid all alcohol.

Simple Ways to Lower the Risk of Diabetes

•

Follow the ‘three standard criteria for sugar consumption’, but elimi-
nate all refined sugar if a borderline diabetic

•

Eat whole grain foods and whole vegetables

•

Avoid consumption of too many high-glycemic foods that are too rap-
idly absorbed into your bloodstream, but eliminate all high-glycemic
foods if a borderline diabetic

•

Increase intake of foods high in antioxidants or consider antioxidant
supplementation

•

Increase food intake higher in chromium and magnesium sources

•

Snack on nuts instead of other high carbohydrate foods

•

Exercise regularly

•

Test for glucose tolerance by age 40 or younger if there is a family his-
tory of diabetes

•

Reduce alcohol consumption, but eliminate alcohol consumption if a
borderline diabetic

Mark A. Falco, D.M.D.

134

16.

Stress

The Endocrine Glands

What produces stress? We can look at a lot of activities within our homes, our
jobs, and our interactions with others that cause stress in our lives. The stress
I wish to examine here is metabolic stress, or the stress on the body’s interac-
tive cellular system. Metabolic stress can develop from infections from bacte-
ria or viruses, radiation, extreme cold, extreme heat, wounds, burns, allergies,
overexertion, trauma, and pain. Metabolic stress can also occur due to nutri-
ent inadequacies or excesses, hormonal imbalances, oxidative stresses, toxins,
and emotional challenges. Chronic metabolic stress is believed to contribute
to aging, depression, recurrent illnesses, hypercholesteremia, and cancer.
Metabolic stress is the stress imposed on normal functioning cell and tissue
activity, which impacts on whole body function and behavior.

The main target of stress on the body resides with the endocrine glands

since they function to maintain balance or homeostasis for the body. These
glands, which produce most all of the body’s hormones, are affected the great-
est metabolically by any stressful condition. The immediate response to stress
is to release hormones such as epinephrine and cortisol to produce an eleva-
tion in the blood-glucose levels and a release of glycogen. Insulin secretion
increases. A change in nutrient activity in the cells of the body develops.

The most prevalent metabolic stressor is sugar. Sugar directly attenuates

the body’s immune system and subjects children to a host of infections and
allergies. Amy, the young girl introduced in chapter 1 demonstrated many of
the symptoms of repeated respiratory infections. Heavy sugar consumption
adversely affects the white blood cells, the very cells the body utilizes to ward
off infections. Elevated blood-glucose levels cause much more insulin release
and hypoglycemic episodes. Chronic cortisol release eventually leads to
fatigue and poor concentration. The bottom line? Substantially reduce your
sugar intake.

A study at Yale University in New Haven, Connecticut in 1994 and 1999

found that men and women with high waist-to-hip ratios (a measure for

135

insulin resistance and obesity) exposed to laboratory challenges had greater
cortisol elevations than normal waist-to-hip ratio men and women. This ele-
vation correlated with higher mood reactivity in the women. Cortisol release
is associated with an increased stress challenge. A continuous presence of
stress raises insulin levels constantly, eventually contributing to insulin resist-
ance. Insulin resistance has been found to be common in many obese persons.
As this study determined, obesity and mood reactivity are common with
hypoglycemia and insulin resistance.

Glucocorticoids such as cortisol will rise to prevent hypoglycemia as a

response to descending blood-glucose levels in an attempt to return these lev-
els back to normal quickly. But in stressful situations, cortisol elevations can
occur during hyperglycemia as well. C. Kirschbaum and his colleagues at the
University of Trier in Germany examined the effects of short-term fasting
and subsequent glucose administration on cortisol response to a psychologi-
cal stress test after one hour. The glucose load did not affect the cortisol level,
but the psychological stress induced a large cortisol response. Controls given
tap water in place of the glucose load did not respond to the psychological
stress with elevated cortisol levels. An increased sugar intake is metabolically
stressing to normal cellular activity. This triggers a greater rise in cortisol
release from the adrenal glands when a cognitive stress task is introduced.

Does an increase in blood-glucose always occur with stressful situations?

Studies on diabetics may give us the answer. Goetsch, Wiebe, Veltum, and
VanDorsten at West Virginia University examined six adults with NIDDM
for blood-glucose levels after a laboratory mathematical test and then during
12 days of home monitoring of stressful events. Diet and activity were con-
trolled so as not to influence the outcome. Blood-glucose levels increased
during the mathematical test when compared to resting conditions. Home
monitoring data paralleled the laboratory findings; blood-glucose levels were
greater on high stress days compared to low stress days.

In ten NIDDM patients, a mental stress test was performed at Danderyd

Hospital in Stockholm, Sweden. Insulin sensitivity was measured by infusing
insulin and glucose. The stress test evoked significant responses by epineph-
rine, cortisol, and growth hormone. Blood-glucose levels were significantly
higher when measured several hours after the insulin-glucose infusion on the
stress day compared to the control day. This effect verified a state of insulin
resistance in the NIDDM patients induced by mental stress and excess hor-
mone release.

Although hyperglycemia may be associated with stress in diabetics, can

non-diabetics get hyperglycemia following a stressful episode as well? A.
Esposito-Del Puente and others at the National Institutes of Health in
Phoenix, Arizona studied several Pima Indians with normal blood-glucose
levels. Sixty per cent of the Pima Indian population eventually develops

Mark A. Falco, D.M.D.

136

NIDDM. Only 5 per cent of Caucasians develop it. A mathematical stress test
was given to each person two hours after a standard breakfast. Blood-glucose
measurements showed that glucose had continued to fall one hour after the
meal and continued to fall following the stress test in all but one of the
Caucasians. However, in 10 out of the 13 Pima Indians in the study, the
blood-glucose levels rose during and following the stress test. This study
demonstrates that a predisposition to diabetes may begin with chronic
episodes of stress that continually elevate blood-glucose levels leading to
insulin resistance and finally diabetes. Therefore, non-diabetics, who may be
prone to getting diabetes, can increase their risk from constant mental stress.

The Neurotransmitter Connection

Neurotransmitters respond to stress in different ways. In a 2000 study at the
University of Ioannina Medical School in Greece, brain norepinephrine,
dopamine, and serotonin levels were measured in rats and mice under stress.
Each species exhibited different responses to neurotransmitter levels, but
overall, norepinephrine levels and serotonin levels were decreased in response
to the stress. These are two of the strongest hormones for influencing carbo-
hydrate intake.

We know that serotonin levels decrease under stress. If serotonin levels

were to be increased, can this improve the ability for someone to better cope
with stress? Markus and his colleagues at the TNO Nutrition and Food
Research Institute in Zeist, the Netherlands seem to think so. They tested
alpha-lactalbumin, a whey protein with a high tryptophan content, on 29
stress vulnerable subjects and 29 relatively stress free subjects. They found
that this diet decreased the cortisol level and reduced depression in the stress
vulnerable group that had been given a stressful task. It must be remembered
that insulin has the ability to move amino acids from the bloodstream into the
cells after a meal. But in the presence of carbohydrates, tryptophan is select-
ed over other competing amino acids such as tyrosine and glutamic acid for
entry into the brain.

A carbohydrate rich/protein poor diet and a protein rich/carbohydrate

poor diet were fed separately to 22 high-stress prone subjects and 21 low-stress
subjects aged 19 to 26 in 1999 at Utrecht University in the Netherlands.
Following the meal, the subjects were given a memory performance task. The
researchers felt that serotonin function in stress-prone subjects would increase
from the available tryptophan in a high-carbohydrate diet. Their speculation
was confirmed by the study, but interestingly, it was found to be true only in
controlled laboratory stress conditions, not uncontrollable laboratory stress.

The Preservation of Health

137

The implications of this are intriguing. When subjects can limit their stress,
the increased carbohydrate intake can satisfy them. When the stress was not
self-limiting, the increased carbohydrate intake did not correlate well with
increased serotonin levels. The reason for this loss in serotonin may be due to
an increasing release of cortisol, which acts to continually reduce serotonin
levels over time in stressful conditions. Cortisol competes with the insulin for
glucose and protein availability.

Balance

Metabolic stress studies require more thorough examination. When microor-
ganisms or viruses invade the body, metabolic stress can spark many changes
within the body, sometimes lasting a lifetime. The secret to resisting most
bacterial or viral invasions lies in proper nutrition.

We have already seen how sugar in excess can alter the metabolism with-

in the body, reducing immunity and opening the floodgates to invasions into
the teeth, gums, bone, internal organs, arteries, and lungs. A lower carbohy-
drate diet and a proper nutrient balance will provide a lot more health bene-
fits over a lifetime than the typical American diet of today. In fact, that life-
time will not only increase in years, it will reduce dependency on medications
and artificial or modified food substitutes.

Methods for Lowering Metabolic Stress

•

Follow the ‘three standard criteria for sugar consumption’

•

Eliminate all refined sugar if you are at risk of acquiring diabetes,
heart disease, lung disorders, or allergies

•

Eat whole grain foods and plenty of vegetables

•

Reduce or eliminate alcohol consumption

•

Exercise regularly

•

Get appropriate rest and plan to fill your life with more friendly
humor and enjoyment among the company of others

Mark A. Falco, D.M.D.

138

17.

Aging

Free Radicals

Every one of us follows a path from birth to death. What happens in between
is referred to as aging. Researchers and dreamers have pursued substances or
sought to define mechanisms that would slow the aging process. The lack of
proper nutrition, the exposure to toxins, the reduction in hormone produc-
tion, and genetic vulnerability all contribute to the aging process. The most
widely accepted ongoing contributor to the aging process rests with the free
radicals. These are the same free radicals that cause the tissue degeneration
and diseases the previous chapters have described.

What do we really know about free radicals? To summarize, free radicals

are molecules with unpaired electrons circulating throughout the body. The
unpaired electron portion generates a negative electrical charge, which, by its
own nature, must ‘pair up’ with a positively charged molecule to become neu-
tralized and stabilized. This new molecule can then be utilized or discarded
from the body in a normal fashion. Oxygen is needed by the body to aid in
the metabolic processes of storing or releasing energy for all bodily functions.
This normal process of burning oxygen (oxidation) results in unpaired elec-
tron by-products known as free radicals. This occurs not only as a result of
normal physiological processes, but also under duress from other elements
such as pollutants, chemicals, drugs, and radiation. Free radicals that contain
oxygen are known as reactive oxygen species (ROS). The body is built to
remove these free radicals by neutralizing and stabilizing them naturally.
Antioxidants, which include vitamin E, vitamin C, beta-carotene (a derivative
of vitamin A), selenium, zinc, bioflavonoids, melatonin, methionine, glu-
tathione (formed from glutamine), haptoglobin, and superoxide dismutase
take care of neutralizing these free radicals. Aerobic exercise and weightlift-
ing have also been shown to reduce the formation of free radicals.

When the body is overly stressed, additional toxins, pollutants, or a poor

diet create more free radicals than the body can dispose of. A chain reaction
of free radical damage to tissue cells that are most vulnerable occurs, which

139

can amplify over a person’s lifetime and accelerate disease processes. This can
occur because the free radicals are determined to find a partner that will sta-
bilize their structures. If these partners cannot be found within fractions of a
second, they steal them from weaker stabilized structures beginning with
molecules within the cell membranes. This action destabilizes the cell mem-
brane, which results in a host of new free radical formations as each mem-
brane molecule is disrupted. The most vulnerable cell membrane molecules
to break apart are the phospholipids, cholesterol, and free fatty acids that con-
tribute to triglyceride formation. Ruptured cells release many of these fats
back into the bloodstream. These are the same triglycerides and cholesterol
that are picked up by lipoproteins circulating within the bloodstream. This
activity elevates the cholesterol and triglyceride levels in the blood.

Eicosanoids

Essential fatty acids (EFAs) are fatty acids that only come from the diet.
EFAs, of which linoleic acid is the primary source, help to manufacture cell
membranes, prostaglandins, and eicosanoids (cellular-derived short-lived
hormones). There are two kinds of eicosanoids, both of which are important
for regulating metabolic activity. Of these two types, the ‘good’ eicosanoids
are important for increasing the life of normal cells. It is the linoleic acid
found in olive oil, light sesame oil, and sunflower oil that benefit the body’s
production of eicosanoids, not the corn, soybean, or canola oils containing
alpha-linoleic acid, which can interfere with the normal production of the
‘good’ eicosanoids.

For the production of eicosanoids to proceed, an enzyme known as delta

6 desaturase must be working properly. Alpha-linoleic acids, trans-fatty acids
(found in partially hydrogenated foods), and a high carbohydrate diet inter-
fere with the ability of delta 6 desaturase to work properly. Sugar also blocks
the release of linoleic acid (the ‘good’ EFA) from tissue storage areas. Excess
carbohydrate, therefore, disrupts linoleic acid production in two different
ways. A high carbohydrate diet ultimately slows down the ‘good’ eicosanoid
production, which shortens normal cell life. This activity accelerates aging.

Glycation Damage

Free radical damage has been implicated in diabetes, Alzheimer’s disease,
osteoporosis, arthritis, immune system disorders, heart disease, and cancer.
Excess sugar consumption contributes to the formation of free radicals.

Mark A. Falco, D.M.D.

140

Excess sugar consumption will further contribute to the aging process
through one more major deleterious change, the formation of advanced gly-
cation end products (AGEs). This formation is an irreversible process con-
tributing to the aging of living tissue. The browning of foods, especially when
sugars are present, is a glycation reaction. When fruits or vegetables are baked
or fried, their surfaces can turn brown. This is from glycation. Boiling and
steaming do not normally produce this effect on fruits or vegetables.

First described in chapter 9, glycation is a non-enzymatic reaction of

glucose or other sugars with the amino acids in proteins to form compounds
such as cetoamine or fructosamine. This occurs everywhere in the body from
the hemoglobin in blood to nucleic acids, the building blocks of DNA. In fact,
the glycation of hemoglobin forms hemoglobin Alc, which is now measured
in a blood test to determine the amount of sugar that has bound to hemoglo-
bin on an average within a 90-day period. In other words, this blood meas-
urement reflects the number of hyperglycemic episodes experienced over this
period of time by an individual. This is an important tool for determining dia-
betes risk.

White, Swartz, and Swartz performed an experiment on diabetes-prone

mice in which they gave the mice a 5% glucose solution as their only source
of liquid over a 10-week period. Controls were supplied with tap water. Both
groups were allowed to feed themselves, as they required it. The researchers
examined mice pancreatic cells for any changes. They discovered that the
constant consumption of a glucose solution produced premature aging of the
pancreatic cells, a condition previously observed in diabetics. None of the
controls displayed this change. They suspected that the sugar intake con-
tributed to the precipitation of overt diabetes.

Complications of diabetes include dysfunction of the retinal capillaries of

the eyes, kidney tissue, and the cardiovascular system. Hyperglycemia, as seen
in diabetics, accelerates these changes. It is the modification of the collagen
in these tissues by glycation that results in the observed complications.
Glycation of the proteins in collagen creates cross-links that decrease tissue
flexibility and permeability, and reduce cell turnover.

The glycation of the aorta, the main artery exiting the heart that distrib-

utes oxygenated blood to the rest of the body, was found to increase with
advancing age according to Oimomi and others at the Kobe University
School of Medicine in Japan. They measured the content of furosine
through a fructose-lysine (sugar bound to protein) hydrolysis reaction. This
content indicated the amount of the fructose-lysine combination in the
aorta. The aorta has an extremely large amount of collagen in its vascular
wall whereby its lysine component can form glycation cross-links under
stressed conditions. A significant positive correlation between the level of
furosine and the degree of atherosclerosis was demonstrated over time. In

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141

the test subjects, individuals with diabetes expressed greater levels of furosine
than in the normal subjects. This experiment proved that glycation and ath-
erosclerosis had a close association that was enhanced in diabetics. Could this
same association be demonstrated in non-diabetics?

In 1995, a study conducted at Fukuoka University in Japan focused on 38

subjects without diabetes from age 42 to 82. By sampling collagen tissue from
the aortas with an enzyme specific for collagen solubility, they found that an
age-related decrease in the solubility of collagen was evident. The only expla-
nation for this result was theorized to be from increased AGEs, which render
collagen insoluble to this particular enzyme in non-diabetics. An association
between glycation and atherosclerosis was evident.

A Diet of Sugar

AGE formation is accelerated during hyperglycemia. The combination of
excess sugar and tissue proteins create an environment conducive for AGE
formation. If insulin resistance is present, AGE formation can be accelerated
even more. All sugars in excess contribute to tissue damage and lead to pre-
mature aging. Abandon your grip on sugar, please!

Fructose can be more damaging than glucose in the formation of AGEs.

B. Levi and M. J. Werman studied the separate effects of fructose, glucose,
and sucrose-fed rats given a commercial diet and free access to water. After
one year, they evaluated blood-sugar levels, cholesterol, fructosamine, glycat-
ed hemoglobin levels, and urine lipid peroxidation products (oxidized fat
products). They discovered that the fructose-fed rats had significant eleva-
tions in all of these substances when compared to glucose and sucrose. They
also analyzed the amount of insoluble collagen and found it to be significant-
ly higher in the fructose-fed rats, a discovery first noted by Oimomi and his
colleagues in 1989.

A similar fructose solution fed to these rats that we consume every day is

high-fructose corn syrup, a product found in everything from beverages to
desserts. Do not fear the fructose from naturally ripened raw fruits. They
contain a lot of fiber, nutrients, enzymes, and antioxidants to control the small
amount of fructose ingested from eating a serving of raw fruit. The fructose
in fruits is still a very important sugar for the body as is glucose. But its excess
is less tolerated than glucose. The danger of fructose comes from the modi-
fied products that are slipped into packaged food products to improve taste
and solubility, which increase fructose consumption, usually in the form of
high-fructose corn syrup, way beyond our physiological limits. High-fructose
corn-syrup products are highly damaging. Don’t be fooled by their taste.

Mark A. Falco, D.M.D.

142

All sugars in all forms are damaging when they are ingested in excess.

What the above study showed was that a similar amount of pure fructose
when compared to either glucose or sucrose, can be even more damaging than
any of the other two alone.

Researchers led by J. A. Joseph at the U. S. Department of Agriculture

Human Nutrition Center on Aging at Tufts University in Boston studied the
effects of antioxidant extracts for 8 months beginning with 6-month old rats
to determine their relationship in the aging and age-related nerve degenera-
tion diseases. They found that spinach extract; followed by strawberry extract
and vitamin E had the most protective benefits on age-induced neural deficits.

Magnesium depletion due to inadequate nutrition has been implicated in

the aging process and Alzheimer’s disease. Sugar consumption increases the
magnesium deficit. Copper deficiency can also be linked to sugar excess
resulting in accelerated glycation and eventually AGEs. The difference
between early glycation and AGEs is that AGEs have more of their free sugar
ends attached to more free-end protein sites on the same protein molecule
making them utterly useless.

With proper nutrition and a balanced diet lower in carbohydrates, the

effects of aging including wrinkles, fatigue, and disease can be dramatically
reduced. This formula works best when it is started in childhood. Infancy
through the teenage years, the years of rapid body growth and development,
are the most critical for reducing the effects of premature aging later in life.

Reducing the Aging Effects of Free Radicals

•

Follow the ‘three standard criteria for sugar consumption’

•

Significantly reduce or eliminate high-fructose corn syrup products

•

Eat whole grains, vegetables, and fruits

•

Eat less processed animal protein or eliminate it if other sources of
protein adequately fill your nutritional requirements

•

Consider antioxidant supplementation

•

Eat foods higher in magnesium and copper

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143

18.

The Everyday Preservation of Life

The Basis of Health

The truth is people are living longer. The decrease in infant deaths and the
advancements in medicine over the past century have contributed to an aging
population that grows faster every year. Some researchers predict that the
human body can last an average of 125 years as the benefits of gene therapy
discoveries continue to increase.

We may be living longer, but are we living any healthier? The average

man today is only 2 1/2 years older than the average man was in the year 1900
when you factor out child mortality rates. Gene recognition for a predisposi-
tion to disease will be found in virtually all of us. But something still needs to
turn the disruptive gene on. Invasion by bacteria, viruses, pollutants, toxins,
and metabolic stress will disrupt gene combinations and signal the start of a
gene-linked disease process. You are what you eat as the old saying so aptly
states. Most medicines and surgeries are utilized to relieve the symptoms
caused by diseases in certain locales within the body. These procedures help
us to live longer, but do not help us to live healthier.

Each one of us can still control the harmful effects that poor nutrition

plays in our lives every day. Mood, depression, aggression, stress, infections,
tooth decay, gum disease, fatigue, obesity, diabetes, asthma, osteoporosis,
coronary artery disease, and premature aging are all connected to excessive
sugar consumption. One product. One vital nutrient, important for the func-
tion of life, that contributes greatly to the advancement of disease when it is
out of balance. Wake up and smell the sweet air. From high-fructose corn
syrup to table sugar; from French fries to pizza; from white bread to pasta;
from microwaveable foods to condiments; from soft drinks to fruit juices; the
ingredients cry out excess, excess, excess!

A recent news story about a five-year old boy that developed scurvy due

to a deficiency in vitamin C is shocking. This young boy lived on only Pop-
Tarts, pizza, biscuits, and water for five months. His circumstances were
unfortunate because he had little chance to eat well-balanced meals. Yet, his

144

diet was truly high in carbohydrates with very little protein and no vitamin
supplements. How many other children may be only marginally as severe as
this child’s nutrition intake was, but are able to avoid the severity only by acci-
dent? Eventually the bones, the tissues, and the mind may slowly break down.

Dr. J. Stang and her colleagues at the University of Minnesota studied four

hundred teenagers for diet habits. More than one-third had less vitamin A, B6,
C, E, and folic acid, and less calcium, iron, and zinc than the RDA. They also
learned that one-third of the teenagers were taking vitamin supplements, but
they tended to be the ones who had been eating well to start with.

Almost 5 million youths age 6 to 17 are overweight or obese. The

American Dietetic Association says 15 per cent of children are overweight.
According to the U. S. Department of Agriculture, only 2 per cent of youth
meet all the recommendations for the food guide pyramid while 16 per cent
do not meet any of the recommendations. School cafeterias for these age
groups continue to serve high-fat and high-sugar foods and do not meet many
of the standards necessary for good nutrition.

The U. S. Department of Agriculture stops short of recommending that

no more than 10 per cent of calories come from sugar. I not only agree with
this percentage, I completely support it across the board, from all sources that
include simple carbohydrates as stated in the ‘three criteria’ first described in
chapter 5. The more sugar a child eats, the less available nutritious foods he
or she will consume, and the less healthy he or she will become. Anyone who
says that a child should develop his own choices by eating only the foods he
or she wants to is absolutely ignorant of the effects that will occur as the child
grows. The imbalance in body chemistry is exacerbated by sugar. Make no
mistake about this.

Because the effects of sugar on behavior and diseases are so prevalent now,

many more nutrition experts who want to take action to alert the public are
hearing the warnings. In the last 25 years, the consumption of soft drinks has
doubled. Even though new surveys may show soft drink consumption is
declining, the switch to power drinks or fruit beverages only means that
sweetened beverage consumption is rising overall.

A recent study published by Dr. Leslie Lytle and her colleagues at the

University of Minnesota determined that the food choices of young adoles-
cents become increasingly unhealthy, as they grow older. Vegetable con-
sumption dropped from 60 per cent in the third grade to 42 per cent in the
eighth grade. Almost 66 per cent had a quarter cup of fruit in third grade, but
that amount fell to 37 per cent by the eighth grade. The researchers called for
better nutrition education in the elementary and middle school years, as well
as social and physical environments that support and facilitate healthy eating
among teens.

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145

The Five Steps Toward Influencing Your Child’s Better Health

How can we change the social and physical environments among teens to cre-
ate healthier food choices for them? Milk consumption had decreased by 36
per cent in teens in a thirty-year period. French fries, pizza, and macaroni and
cheese (high-carbohydrate foods) have steadily risen in consumption. How do
we teach our youth the benefits of a low-carbohydrate, higher-fiber diet rich
in vitamins and minerals?

The first issue to address is to tone down the RDA and the American

Heart Association’s recommendation for a 55-65 per cent of daily calories
from carbohydrates. This level is too high. A 45 to 49 per cent maximum is
appropriate for a person with normal activity. Although the American Heart
Association’s recommendation for 25-30 grams of fiber daily is satisfactory for
normally active people, the higher recommendation for carbohydrate calories
comes from the belief that excess weight is directly related to excess fat calo-
ries. Reducing fat calories by reducing fat intake will help weight loss short-
term, not long-term. It is the excess carbohydrates that slowly begin to devel-
op fat deposits in blood vessels from early age.

When the activity level of a child increases to a moderate level or a stren-

uous level, this is the only time that the carbohydrate level should move high-
er, and only then, after the ‘three criteria’ for the normal activity level with
the appropriate calorie levels are satisfied. Carbohydrates are for increased
energy for body tissues. Proteins need to be consumed in balance to continu-
ally develop and repair body tissues. For teenagers, a thorough education in
balancing carbohydrates is key. Although progress can be made toward creat-
ing a healthier lifestyle for their future, old habits will be hard to disrupt.
Much of the change and support has to be accepted and exemplified by the
parents. The best opportunities reside with young children.

The first step in providing children with a chance to influence better

health is to not provide them with excess sugar as infants. Be careful what you
give them to drink and be careful about what they start to taste. Consult with
your child’s pediatrician before modifying any nutrient or caloric consump-
tion to ensure your child is in good health. There are guidelines for dietary
intakes for infants and young children much different than guidelines for
adults. Never begin any diet plan for your child’s growing years until a health
care practitioner has determined your child’s health status.

The second step is to modify your family’s carbohydrate intake at home

long before the child grows up enough to learn the type of eating habits you
have. Follow the simple formula for the ‘three criteria’. If you succeed at
adjusting your nutrient intake, so will your child.

The third step in the process is to teach your children early in their rapid

learning years the value of nutrition and the value of selective food choices

Mark A. Falco, D.M.D.

146

based on their bodies’ needs. This will include your staunch ability in making
other members of your family, friends and sitters aware of when and where
snacks including candies and beverages should be taken. You know they’ll be
offered. You can’t prevent everything at every moment from being ingested
by your child, but the ultimate test still lies with you, the parent. Denying
access to the food is not the answer, either. Sugar is everywhere and it will
always be everywhere. What you must teach your children without fail is that
they need to learn to recognize, rate, and react.

Teach them to recognize an alternate food choice may be offered to them,

especially if it is between meals. Remind them that this is normal. Teach them
to rate the food choice. If it is other than a raw fruit or vegetable, it could be
a sugary food. If it is sweet to taste, it is definitely a sugary food. Teach them
to react. This response is important. They must know if they can immediate-
ly burn off the energy from the food or beverage they will have eaten by
increasing their activity (not to sit in front of a television set or video game
and attempt to remain quiet). If possible, a good fiber source, vitamin and
mineral enrichment, and water should be made available to them to better
utilize the excess sugar and balance the hormone levels during their increased
activity. Maintain your desire to feed them meals based on the ‘three criteria’.
Do not allow them to overeat on the carbohydrates as snacks or in place of
skipped meals. This will result in failure if it continues unchecked.

For a young girl playing soccer or a young boy playing baseball, the

requirements for more energy are important, as is the amount of protein
necessary to stimulate more growth. Carbohydrates consumed during a peri-
od of non-activity will stimulate hormones to act to the detriment of the
body. Protein consumption will have a more positive stimulus on growth
during low levels of activity. More carbohydrates should be recognized as a
stimulus for more energy, nothing more. When the energy isn’t needed, the
excess sugar will play havoc on the body’s metabolism if consumed. This is
why increased carbohydrate levels should only be attained when a direct rela-
tionship to increased energy needs are to occur. When you instill this in your
children first, they will understand the difference between sugar use and
sugar abuse.

This brings us to the fourth step in the process. As your child reaches

adolescence and becomes more active in sports, dance, or other physical activ-
ities, he or she will be old enough to modify his nutrient intake based on activ-
ity level. The focus and concentration between academics and athletics will be
better and social interaction will be much more positive.

The fifth step in the process is for when your child has become a teenag-

er. He or she will have a strong mind and a strong body. Your child will share
that same process of carbohydrate intake with those younger. That strength
will be carried into adulthood and passed on to the next generation.

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147

Will these five steps bring the right results each and every time? There

are those that will argue that a poor environment, broken families, trauma,
bad influences, and heredity will still prevent children from becoming
healthier. But these are only based on historical statistics. The importance in
the contribution to the development of a healthy population of youths rests
on values. If health is valued in the home, if the ‘three criteria’ are followed,
and if the ‘five steps’ are adhered to, everyone will be much better off.
Diseases won’t disappear, but many can be significantly reduced in the earli-
er years of life.

The most dangerous element invading our society is the one that we can

taste every single day, and it’s not in the air, or in the water. It’s in the foods
we eat every day. High-fructose corn syrup, followed by refined grains,
sucrose, dextrose, and corn syrup are the most dangerous elements entering
our bodies collectively because they are consumed in excess. Over a lifetime,
this excess creates enough damage to our metabolisms that we have become a
nation, and for that matter a world, of walking diseases, constantly receiving
medication and operations, and avoiding appropriate exercise. All the while
we’ve increased our carbohydrate intake to dangerous levels, which got us
into the state of walking diseases to begin with.

It would take several more generations before resistance to the damage

caused by sugar can begin to surface in our genes. We may not be the same
type of society by that time. You owe it to yourselves, to your children, and to
your children’s families to create stronger, healthier generations now. Not all
of us react to sugar excess in the same way. Yet, all of us can reduce sugar
excess in the same way. Use the ‘three criteria’ and take the ‘five steps’ to bet-
ter your health. Don’t add to the walking disease pool.

The Five Steps Toward Better Health

•

Do not provide infants with excess sugar

•

Follow the ‘three standard criteria for sugar consumption’ for the
entire family—special diets for children age 2 and under need to be
addressed with your health care practitioner

•

No carbohydrate snacking during periods of low activity

•

Teach the value of nutrition to children at home

•

Teach the value of your children’s nutrition to other family members,
friends, sitters, and teachers

•

Have adolescents modify their carbohydrate intake based on their
activity level

•

Allow teenagers the ability to educate younger family members and
school-age children about the benefits of good nutrition

Mark A. Falco, D.M.D.

148

Evaluating Unknown Nutrients with Your Child

•

Recognize the food choice

•

Rate the food choice as sweet or not sweet

•

React to expected consumption of sweetened food by increasing activ-
ity, consuming more water, and eating other foods higher in B vita-
mins, vitamin C, and other minerals

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149

19.

Conclusion

The impact of sugar on health is real. Though the ubiquitous source of this
food in natural foods has never been dangerous to us. Without a doubt, we
know sugar and all other carbohydrates are essential to life. But as our society
continues to evolve and mature so does our zeal for convenient and desirable
foods and beverages. Sugar has a way of satisfying both our readily convenient
acceptance of food and our desire for tasty foods. This unabated transition of
sugar into our food supply has removed the natural riches of natural carbohy-
drate foods and replaced them with excessive amounts of sugars substituting
falsely as nourishing carbohydrates. This overwhelming change has manifest-
ed itself greatly in our children’s food sources. As sweetened cereals, snack
cakes, sweet drinks, chips and candies become more prevalent as tasty inex-
pensive foods for children to feed on, fruits, vegetables, and whole grain foods
are slowly squeezed out of their diets creating metabolic imbalances. These
metabolic imbalances are formed early in childhood leading to recurrent ill-
nesses. By the teenage years, behaviors become uncontrolled and mental func-
tions are reduced. By the middle-age years, physical ailments and stress are
more pronounced. By the senior years, a host of medications must be taken to
counteract symptoms and conditions in a desperate hope to force the body to
regain its balance unsuccessfully in many instances because of the experience
of side effects to the medications. The quality of life has been lessened.

It is true that excess sugar is not the cause of all diseases. But, excess sugar

does cause many of the health problems we experience today. It is a contribu-
tor, during chronic consumption, to the body’s inability to correct and repair
itself properly and this leads to metabolic stress, which slowly weakens the
mind and the body. This weakening allows host viruses, bacteria, and even
genetic flaws to overpower the body circuitry, and thus, disease states develop.
For some people this overpowering occurs early in life. For others it may not
demonstrate itself until later in life. The subsequent disease emergence may be
totally dependent upon the available body circuitry of each individual to defuse
the onslaught of excess sugar. It is not the natural existence of carbohydrates

150

in the food chain that is dangerous to us. It is the refining of carbohydrates in
the food chain that is most dangerous to us. If it is allowed to continue with-
out interruption, our society will have many more difficulties in minimizing
or eradicating diseases, even with identified genetic markers for disease made
available to us.

Managing carbohydrate intake for life is one of the first conditions that

needs to be met in order to preserve a healthier life. It is also the first condi-
tion that must be met in order to augment the advent of gene recognition for
diseases. A stronger mind and a stronger body will minimize the factors that
can turn on genetic links to various diseases. The ‘three criteria’ and the ‘five
steps’ in managing carbohydrate intake were designed to be the first steps in
building that stronger mind and that stronger body.

The consumer needs guidance in managing levels of carbohydrate intake

beyond the scope of the benefits suggested in this book. The dental and med-
ical communities need to embrace the concept of carbohydrate management
in controlling the disease process. Dentists should take the helm in redefin-
ing this new way to control disease. Dentists are the first to observe a devel-
oping disease process when they look into the mouths of both children and
adults. Actually, dentists see the manifestations of disease every day often-
times before a medical condition is diagnosed elsewhere in the body. Dentists
must be both better diagnosticians and better educators in identifying disease
processes. Though dentists do an excellent job of saving diseased teeth and
gums, they can do even more by recognizing that the diseases of tooth decay
and gum disease are definitive markers for metabolic imbalances that are hap-
pening all throughout the body. The role of dental professionals functioning
in a greater capacity to improve upon the lives of individuals, beyond what can
be restored in the mouth, will further contribute to the advancement of over-
all health. The importance of relationships with dental professionals will grow
tremendously. The cooperation with physicians will be further enhanced. And
the strength of the health community will be such that greater advancements
and greater needs will be quid pro quo. This ultimately will improve upon the
cost of health care as health will be addressed early on in life and spread out
more judiciously throughout life. This will reduce the sudden spiraling cost
of health care in later years on an individual because an ounce of prevention
still remains a pound of cure especially when it relates to dollars.
Furthermore, research and development will have greater freedom to
improve without the restraints that regulations or insurance coverage have
now because programs of prevention will supersede programs of illness. We
will have more information with which we can be given guidance through.
Health is preserved. Health care costs are lessened. Workers stay employed.
Health service industries will continue to grow. Everyone wins. That’s the
quintessential preservation of life.

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151

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Chapter 7

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Fernstrom, M. H., Fernstrom, J.D., Brain tryptophan and serotonin synthe-

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Freedman. D. S., et al., Obesity, levels of lipids and glucose, and smoking

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Halford, J. C., Blundell J. E., Separate systems for serotonin and leptin in

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Johnson-Down, L., et al., High prevalence of obesity in low income and mul-

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Lieberman, H. R., Wurtman, J. J., Chew, B., Changes in mood after carbo-

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Miller, W. C., et al., Dietary fat, sugar, and fiber predict body fat content. J

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Thibault, L., Dietary carbohydrates: effects on self-selection, plasma glucose

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Wurtman, J. J., The involvement of brain serotonin in excessive carbohydrate

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Wurtman, R. J., Wurtman, J. J., Carbohydrate craving, obesity and brain

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Wurtman, R. J., Wurtman, J. J., Do carbohydrates affect food intake via neu-

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Chapter 8

Crossner, C. G., Variation in human oral lactobacilli following a change in

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152

Freire, M. do C., Cannon, G., Sheiham, A., [An analysis of the recommenda-

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Mark A. Falco, D.M.D.

176

Index

Ableitner, A., 102
Academic Center for Dentistry, 88
advanced glycation end-products, 109,

115-117, 142-143
also see glycation

Ahonen, A., 123
Allbrink, M., 119
American Academy of

Periodontology, 90

American Dietetic Association, 145
American Heart Association, 146
Amstad, P., 117
antioxidants, 56, 63, 67, 69, 71-72,

88-89, 117, 120, 127, 133, 142

Appleton, Nancy, 110
Arbes, S. T., 89
arginine, 70, 83, 126, 127

and nitric oxide, 108, 118, 132
role of, 103, 131

Armour, K. E., 108
Ashley, F. P., 86
Auburn University, 98

beta-endorphins, 20, 71, 74, 75, 100,

102-103

biotin, 60, 82
blood-glucose, 16-17, 19, 32, 83-84,

102-103, 119, 124, 125-126, 132,
133, 135-137
after a meal, 26-29, 75-76, 96-97
diabetes and, 129-130
glycation and , 88-89
hypoglycemia and, 93-94, 95-96

Blumenthal, James, 120-121

body mass index, 77
Busse, W., 124

Cairns, C., 127
calcium, 31, 32, 54, 65, 67, 70, 71, 86,

89, 100, 114, 115-116, 117-118,
120, 131, 145
function of, 64-65
in the mouth, 82-83
osteoporosis and, 106-111
phosphorus and, 66, 89, 110

Calhoun, W., 126
Cancer Bureau of Canada, 89
Candlish, J., 125
carbohydrates, 77, 100, 129-130, 133,

138, 140, 150-151
craving and, 21, 74-76, 95, 132
complex, 12, 25-26, 28-29, 30-31
daily totals of, 35-50
meals and, 19, 21, 27, 96-97, 119,
137-138
simple, 28-29, 30, 32-33
storage and, 112-114
tastes and, 5, 12
also see sugar

Celic S., 109
Ceriello, A., 117
Cerrutti, P., 117
Chang, S., 127
Channing Laboratory, 127
cholesterol, 15, 32, 53, 56, 107, 112-

114, 115, 116-117, 120, 131, 133,
140, 142

choline, 59-60, 62, 71

177

chromium, 31, 54, 68, 79, 133
Cincotta, A., 132
collagen, 54, 63, 68, 70, 72, 85-88

glycation and, 88-89, 133, 140-142,
143

Collip, P. J., 128
Columbia University, 133
copper, 54, 62, 63, 67, 68-69, 71, 87,

88, 120

corn syrup, 9, 11, 23, 28, 31, 32, 33, 50,

81, 133, 148, 151
also see high-fructose corn syrup

Cornick, D., 87
cortisol, 17, 28, 75-76, 93, 114, 133

ascorbic acid and, 63
asthma and, 122, 124-125, 127
bone and, 107, 110
role of, 15-16, 130
serotonin and, 19
in stress, 27, 97, 135-138

Coulston, A., 119

Danderyd Hospital, 136
Damsma, G., 131
deGouw, H. W., 126
dello Russo, P., 117
Dennis, S. C., 98
DesMaisons, Kathleen, 100
Dufty, William, 87

Eichacher, P., 123
eicosanoids, 140
epinephrine, 71, 93, 103, 114, 124, 130,

133, 136
in asthma, 122, 125-126
function of, 17-18, 27, 28

Esposito-Del Puente, A., 136

Federal University of Goias, 80
Fenech, F., 124
Fernstrom, M. and J., 76
fiber, 12, 25, 32, 33, 35-50, 69, 77, 110,

114, 120, 122, 133, 142

five steps toward influencing your

child’s better health, 146-149

free radicals, 16, 31, 114, 117, 120, 125,

126, 132
definition of , 139-140

Freedman, David S., 78
fructose, 26, 28, 32,-33, 50, 81, 142-

143

Fu, M. X., 133
Fujitaka, M., 124
Fukuoka University, 142
Furukawa, S., 125

gamma-amino butyric acid (GABA), 21,

23, 70, 95, 103, 131

Garcia, C., 126
Gertz, S., 116
glucagon, 28, 79, 93, 102

in asthma, 123-124, 125
role of, 16-17, 130

glucose, 31, 32, 34, 50, 54, 55, 57, 65,

92-93, 98-99, 101, 112, 113, 118,
123, 125-126, 131, 132-133, 136,
142-143
in bloodstream, 14, 23
importance of, 15, 17, 25-29
meals and, 75-76, 78, 94, 97
also see sugar

glutamic acid (glutamate), 61, 68, 70,

71, 79, 108, 131, 137
GABA and, 95
sugar and, 108

glutamine, 70, 95, 130-131, 139

as glucose substitute, 125-126

glycation, 88, 109, 116-118, 129, 133,

140-142
also see advanced glycation

end-products

glycogen, 70, 75, 113, 124, 129, 130,

135
definition of , 16-17
energy formation, 26-27
micronutrients with, 54, 57, 65

Goetsch, V., 136
grains, 12, 26, 28-29, 30-31, 32, 49, 57,

Mark A. Falco, D.M.D.

178

133, 146, 148

Gu, X. H., 131
Guigliano, D., 102
Guindi, R., 124
Gumaa, K., 124

Hacettepe University, 127
Han, S., 116
Harris, Seale, 95
Heart Institute for Children, 118
Hebrew University, 87
high-fructose corn syrup, 32, 33, 50,

142, 144, 148, 151
also see corn syrup

hormones, 15-22, 56, 57, 93, 112, 130,

135-137, 140

Hu, D., 125
hypoglycemia, 96-99, 123, 124, 129,

135-136
definition and cause of, 76, 95

Indiana University, 77
Institute of Food Research, 96
International Bottled Water

Association, 77

insulin, 26, 27, 28, 33, 50, 56, 63, 65,

75-76, 78-79, 87, 88, 93-94, 97, 99,
101, 102-103, 113-115, 116, 119,
120, 123-124, 142
arginine and, 70, 118
chromium and, 68
cortisol and stress in, 135, 138
diabetes and , 129-130, 131-132,
133
function of, 16-17
glutamic acid and, 108
magnesium and, 65
with meals, 75-76, 78-79, 93-94,
95-99
triglycerides and, 113-114

Jalil, R., 87
Jarjour, N., 126
Johnson-Down, Louise, 78

Joseph, J.A., 143

Kakei, M., 131
Kanazawa School of Medicine, 117
Karake, H., 116
Karnik, A., 124
Katayama, Y., 109
Kirschbaum, C., 136
Kraft, M., 127
Kurgan, A., 116

Lazar, E., 123
Lee, T., 124
Leggott, P. J., 87
Levi, B., 142
Lewis, G. F., 115
Li, S., 131
Liang, Y., 132
Lin, X., 125
lipoproteins, 26, 112-113, 115

HDL, 112-114, 115, 119
LDL, 112-113
VLDL, 27, 112-113, 115

Liu, G., 119
Liu, H., 125
Lloyd, Tom, 109
Luiten, P., 131
Luo, S., 132
Lytle, Leslie, 145

McGill University, 76, 103
Madl, J., 95
magnesium, 31, 36, 71, 79, 82-83, 86,

89, 133
asthmatics and, 127
calcium and, 64
function of, 65
role with glycogen, 54
pyridoxine and, 58

manganese, 31, 36, 54, 69-70, 87, 88
Markus C., 137
Marmara University, 101
Mason, D. J., 108
Massachusetts Institute

The Preservation of Health

179

of Technology, 96

Matsuura, N., 132
Mayo clinic, 116
minerals, 30-50, 53-54, 64-70, 77, 107-

108
sources, 11, 31

Muittari, A., 123

Nagoya University

School of Medicine, 109

Nakata, M., 131
Naoumova, R. P., 114
National Institutes of Health, 77, 110,

136

neurotransmitters, 18-23, 58, 70,

75-76, 93, 95, 97, 127, 131-132,
137-138
definition of, 18

nitric oxide, 120, 132-133

arteries and, 117-118
asthma and, 126-127
bone and, 108

Niu, R., 125
Noma, M., 132
Nomura, S., 124
norepinephrine, 17-21, 23, 27, 75, 94,

97, 114, 132, 137
adrenals and, 17
ascorbic acid and, 63
the brain and, 21
bronchioles and, 122, 127
tyrosine and, 71, 103

Nussbaum, M., 131

Oimomi, M., 141, 142
OnHealth.com, 77
Orimo, H., 116
Osaka City University

Medical School, 109

Ouchi, Y., 116

Page, Melvin, 83-84
Patton, A. J., 108
Payne, J., 90

Peters, P., 119
phosphorus, 31, 32, 54, 68, 82-83, 86

calcium and, 64, 89, 110
function of, 66
soft drinks with, 33, 109

Pitie-Salpetriere Hospital, 98
Propel, 98

Queen’s Medical Centre, 97

Reaven, G., 119
Reed, C., 124
Reinhardt, R., 90
Republic of China, 119
Royal Prince Alfred Hospital, 118
Royer, S., 95

Saito, M., 132
Scanlon, R., 127
Schulz, R., 102
serotonin, 19-21, 23, 58, 94, 95-97,

101-102, 137-138
in the brain, 18, 50, 131
folic acid and, 61
melatonin and, 20-21
tryptophan and, 19-21, 71, 75-76

Sherman, M., 123
Shimazu T., 132
Shiraishi, T., 131
Sidi, A. D., 86
Sovijarvi, A., 123
Sprietsma, J. E., 127
Stanford University, 118, 119
Stang, J., 145
Steffens, A., 131
sucrose, 6-13, 28, 31, 32, 69, 80, 87,

101-102, 104, 142, 148
also see sugar

sugar, 6-13, 22-23, 28, 30-52, 80-82,

86-89, 101-102, 107-110, 129-136,
141-148, 150
effect on WBC’s, 22
first contact with, 6
product of, 10-12

Mark A. Falco, D.M.D.

180

refining process, 10-12
supply of, 6-10

Swartz, F. and A., 141

Taddei, Stefano, 120
Tan, W., 125
Theilmeier, G., 118
Thomassen, M. J., 126
three standard criteria for

sugar consumption, 35

Tokai University

School of Medicine, 109

triglycerides, 18, 56, 71, 78-79, 115,

119, 130, 133, 140
activity of, 26-27
lipoproteins and, 112-114

tryptophan, 70-71, 95, 99, 137

with meals, 76, 137
mood and, 100-101
niacin and, 56-57, 58, 71
pyridoxine and, 58, 70, 71
serotonin and, 19, 21

tyrosine, 17, 71, 127, 137

mood and, 103-104

Ullrich, I., 119
University of Dusseldorf, 90
University of Goteborg, 84
University of Graz, 118
University of the Health Sciences, 103
University Hospital in Basel, 96
University of Ioannina

Medical School, 137

University Medical School

in Rouen, 118

University of Texas Southwestern

Medical Center, 119

U.S. Department of Agriculture, 145
Utrecht Unviersity, 137

Van der Gugten, J., 131
Van Dorsten, B., 136
Veltum, L., 136
Viagra, 108

vitamins, 11, 30-50, 54-64, 77, 100,

120, 145
ascorbic acid (vitamin C), 25, 53,
56, 61, 62, 63-64, 68-69, 70, 71,
80, 82, 87-88, 120, 127, 139,
144-145
B vitamins, 25, 30-49, 53, 59, 61,
66, 70-71, 89, 127
cobalamin (vitamin B12), 61, 62-
63, 82, 120
folic acid, 31, 36, 55, 59, 61-62, 63,
70, 71, 82, 89, 100, 120, 145
niacin (vitamin B3), 31, 56-57, 58,
61, 66, 68, 70, 71, 82, 100, 120,
128
pantothenic acid (vitamin B5), 57-
58, 61, 82
pyridoxine (vitamin B6), 55, 56,
58-59, 62, 65, 70, 71, 82, 100, 120,
128, 131, 145
riboflavin (vitamin B2), 31, 55-56,
58, 66, 70, 82, 86
thiamine (vitamin B1), 31, 54-55,
56, 72, 80, 82, 100

Vrije University, 103

Waite, I., 87
Wajnberg, R., 116
Werman, M. J., 142
White, J., 141
Wiebe, D., 136
Winlove, C. P., 117
Wurtman, R. and J., 75
Wyshak, Grace, 109

Yada, T. , 131
Yale University, 135

zinc, 36, 54, 67-68, 71, 79, 89, 100,

107-108, 127, 139, 145
copper and, 69, 120
function of, 67

The Preservation of Health

181

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