Chapter 8: Nutrition


1. Neel J. Thrifty Gene Theory. 1962.
2. Conn C, Silverman H, (eds) What Counts: The Complete Harper’s Index, Henry Holt & Co., New York. 1991.
Food addiction in animals: Teegarden SI, Bale TL. Decreases in dietary preference produce increased emotionality and risk for dietary relapse. Biol Psychiatry 2007;61:1021-9.
3. Okinawa Studies:
4. Obesity – Special Report. The Economist. December 15, 2012. pp. 3-16.
Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med 2007;357:370-9.
5. Conn C, Silverman H, (eds) What Counts: The Complete Harper’s Index, Henry Holt & Co., New York. 1991.
6. Obesity – Special Report. The Economist. December 15, 2012. pp. 3-16.
7. Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6:97-106.
8. Anderson RE. The spread of the childhood obesity epidemic. CMAJ 2000;163(11):1461-2.
Miller J, Rosenbloom A, Silverstein J. Childhood obesity. Journal of Clinical Endocrinology and Metabolism 2004;)4211-218.
Kelsall D. How schools teach our children to be fat. CMAJ 2015;187(6):387.
Summerbell C, Brown T. Childhood obesity: the guideline for primary care should form part of a whole-system approach. CMAJ 2015;187(6):389-90.
9. Barry GA. Complications of obesity. Ann Intern Med 1985;103;1052-1062.
Bjorntorp P. Abdominal obesity and the development of non-insulin-dependent diabetes mellitus. Diabetes Metab Rev 1988;4:615-622.
10. Obesity – Special Report. The Economist. December 15, 2012. pp. 3-16.
Payne D. U.S. Obesity rates climb. Southern states fare poorest again in study. Reported in: The Medical Post. October 2007. Pp. 21.
11. In Western Europe and the USA, 0.5% of the population becomes obese each year. In China and Brazil, 1.0%. In Mexico and S. Korea, 2.5% (ca. late 1990s). In India 33% of women are malnourished, 12% obese, even within the same household. India – obesity in same household. ? GR
12. (Health Canada. Canadian Guidelines for Body Weight Classification in Adults. Ottawa: Minister of Public Works and Government Services Canada, 2003).
13. Zhu S. Waist circumference is a better gauge of morbidity risk than BMI. Am J Clin Nutr 2002;October.
Obesity – Special Report. The Economist. December 15, 2012. pp. 3-16.
Despres J-P. Cardiology Update: Focus on waist circumference, not BMI, expert says. Reported in: The Medical Post. November 2007. Pp.17.
14. 60 Minutes, May 4,2014, — Dr. Kawa 90+ study:
15. Weindruch R., Caloric Restriction and Aging. Scientific American 1996;274(1):46-52.
16. Okinawa Studies:
Fontana L, Meyer TE, Klein S, Holloszy JO. Long term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans. PNAS 2004;101(17):6659-63.
17. Andersen LF, Jacobs JR. DR, Carlsen MH, Blumhoff R. Consumption of coffee is associated with reduced risk of death attributed to inflammatory and cardiovascular diseases in the Iowa Women’s Health Study. Am J Clin Nutr 2006;83(5):1039-1046.
Hartley TR, Sung BH, Pincomb GA, et al. Hypertension risk status and effect of caffeine on blood pressure. Hypertension 2000;36:137-141.
18. van Dam RM, Hu FB, Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review. JAMA 2005;294(1):97-104. doi:10.1001/jama.294.1.97.
Andersen LF, Jacobs JR. DR, Carlsen MH, Blumhoff R. Consumption of coffee is associated with reduced risk of death attributed to inflammatory and cardiovascular diseases in the Iowa Women’s Health Study. Am J Clin Nutr 2006;83(5):1039-1046.
Ming Ding, Bhupathiraju SN, Satija A, et al. Long-term coffee consumption and risk of cardiovascular disease. A systematic review and dose-response meta-analysis of prospective cohort studies. Circulation 2014;129:643-659.
19. Scottish Health Survey:
Dr. Sarah Jarvis:
Cornelis MC, et al. 2006. Reported in: Jenkins D. Coffee and the heart – It’s all about genes. Parkhurst Exchange 2006;November:19.
Yesil A, Yilmaz Y. Aliment Pharmacol Ther 2013;38(9):1038-44. Coffee consumption may modulate risk of metabolic syndrome and non-alcoholic fatty liver.
Heliovaara M, Aho K, Knekt P, et al. Coffee consumption, rheumatoid factor and the risk of rheumatoid arthritis, Ann Rheum Dis, 2000;59:631-635.
James JE. Critical review of dietary caffeine and blood pressure: a relationship that should be taken more seriously. Psychosomatic Medicine 2004;66:63-71.
Lopez-Garcia E, Rodriguez-Artalejo F, Rexrode KM, et al. Coffee consumption and risk of stroke in women. Circulation 2009;119:1116-23.
20. A recent study from Harvard School of Public Health showed that people who drink a cup of coffee six or more times a day may reduce their risk of diabetes by more than 50%.20 – GR
21. During the Nurse’s Health Study cohort involving 84,276 women from 1980 to 1998, coffee consumption was documented every 2-4 years through validated questionnaires. The researchers found an inverse relationship; the more coffee consumed the lower the incidence of diabetes. GR
Salazar-Martinez E, Willett WC, Ascherio A, Manson JE, Leitzmann MF, Stampfer MJ, Hu FB. Coffee consumption and risk for type 2 diabetes mellitus. Ann Intern Med 2004 Jan 6;140(1):1-8. Summary for patients in: Ann Intern Med 2004 Jan 6;140(1):I17.
22. The Health Professional Study of 41,934 men, aged 40-75 were followed with food frequency surveys and asked to report diabetes diagnosis between 1986 and 1998. Results were similar to that of the Nurse’s Health Study. GR
23. Reported in: Cristafaro A. In praise of tea – Popular beverage packs a powerful antioxidant punch. Parkhurst Exchange 2005;April:113.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea–a review. J Am Coll Nutr 2006 Apr;25(2):79-99.
Biali S. Green tea: the best beverage on earth? The Medical Post 2008;August:21.
24. Reported in: Cristafaro A. In praise of tea – Popular beverage packs a powerful antioxidant punch. Parkhurst Exchange 2005;April:113.
25. Basu A, Lucas EA. Mechanism and effects of green tea on cardiovascular health. Nutrition Reviews 2007;65(8):361-375.
Cheng TO. All teas are not created equal: the Chinese green tea and cardiovascular health. Int J Cardiol 2006 Apr 14;108(3):301-8. Epub 2005 Jun 22.
Peters U, et al. Does tea affect cardiovascular disease? Am J Epidemiol 2001;154:495-503.
26. Schmidt A, Hammann F, Wolnerhanssen B, et al. Green tea extract enhances parieto-frontal connectivity during working memory processing. Psychopharmacology 2014 March 19. [Epub ahead of print]
27. Okello EJ, Leylabi R, McDougall GJ. Inhibition of acetylcholinesterase by green and white tea and their simulated intestinal metabolites. Food Funct 2012;3(6):651-61.
Okello EJ, McDougall GJ, Kumar S, Seal CJ. In vitro protective effects of colon-available extract of Camellia sinensis (tea) against hydrogen peroxide and beta-amyloid (Aβ((1-42))) induced cytotoxicity in differentiated PC12 cells. Phytomedicine 2011;18(8-9):691-6.
Okello EJ, Savelev SU, Perry EK. In vitro anti-beta-secretase and dual anti-cholinesterase activities of Camellia sinensis L. (tea) relevant to treatment of dementia. Phytother Res 2004;18(8):624-7.
28. Kao YH, Chang HH, Lee MJ, Chen CL. Tea, obesity, and diabetes. Mol Nutr Food Res 2006 Feb;50(2):188-210.
Wolfram S, Wang Y, Thielecke F. Anti-obesity effects of green tea: from bedside to bench. Mol Nutr Food Res 2006 Feb;50(2):176-87.
A Taiwanese study found a correlation between steady long term tea consumption and low body fat but it is not known whether tea really causes fat loss. GR.
29. Bruinsma K, Taren DL. Chocolate: food or drug? J Am Diet Assoc 1999;99(10):1249-56.
Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menstrual cycle, suggesting a hormonal link and confirming the assumed gender-specific nature of chocolate cravings. GR
30. Milne C. For hypertensives, a dietary change that’s easy to swallow. Eating chocolate found to lower blood pressure. The Medical Post 2007;Sep18:25.
Schieszer J. Cocoa flavanols may boost vascular function. The Medical Post 2010;Aug3:33.
Flammer AJ, Hermann F, Sudano I, et al. Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation 2007;116:2376-2382.
Engler MB, Engler MM. The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutrition reviews 2006;64(3):109-118.
In an Italian study, participants who ate 3.5 ounces of dark chocolate daily for 15 days had a 12 mmHg decrease in systolic blood pressure and a 9 mmHg drop in diastolic blood pressure compared to those who ate white chocolate. GR.
31. Morice AH. Developing antitussives the clinician’s pipeline-what do we need? Thorac Dis 2014 Oct;6(Suppl 7):S735-8. doi: 10.3978/j.issn.2072-1439.2014.08.40.
32. Schroeter H, Heiss C, Balzer J, Kleinbongard P, Keen CL, Hollenberg NK, Sies H, Kwik-Uribe C, Schmitz HH, Kelm M. (-)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc Natl Acad Sci USA 2006;103(4):1024-9. Epub 2006 Jan 17.
Mink P, Scafford CG, Barraj LM, et al. Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. Jr Am J Clin Nutr 2007;85(3):895-909.
High blood pressure develops in those who move to the mainland and start drinking commercial cocoa. GR
33. Grant D. ‘Super chocolate’ in the works. The Medical Post 2007;Sep18:25.
33.1. Won Lee K, Jun Kim Y, Joo Lee H, Yonh Lee C. Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine. J Agric Food Chem 2003;51:7292-95.
34. Hines LM, Stampfer MJ, Ma J, et al. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption in myocardial infarction. N Engl J Med 2001;344(8):549. Studies show that about five out of six Caucasians of European ancestry seem to benefit from moderate alcohol consumption. They can certainly tolerate higher amounts than the other people. GR
35. Zakhari S, Goldberg DM, Wolkoff I, Werner M, Rehm J, Room R, Babor TF. Publicizing the benefits and risks of moderate alcohol consumption. Annals RCPSC 1999;32(4):235-9.
Hines LM, Stampfer MJ, Ma J, et al. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption in myocardial infarction. N Engl J Med 2001;344(8):549.
Lamon-Fava S. High-density lipoproteins: effects of alcohol, estrogen and phytoestrogens. Nutrition reviews 2002;60(1):1-7.
Lacoste L, Hung J, Lam JYT. Acute and delayed antithrombotic effects of alcohol in humans. Am J Cardiol 2001;87:82-5.
36. Hedstrom AK, Hillert J, Olsson T, Alfredsson L. Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk. JAMA Neurology. Published online January 6, 2014.
37. Copenhagen Study: Type of Alcohol Consumed and Mortality. Annals of Internal Medicine 2000;133(6):415.
38. At low levels it is not harmful, it may even give you a little benefit.” The international team was led by researchers from University of Victoria and the University of California. It analyzed 54 studies conducted from 1974 to 2004 linking how much people drink with risk of premature death from all causes, including heart disease. Researchers investigated an earlier claim that many studies about the link between moderate drinking and heart disease made a critical error. Those studies included as abstainers people who had reduced or quit drinking because of chronic illnesses, declining health, frailty, drug use or disability. When abstainers were compared with moderate drinkers, the imbibers came out slightly healthier. However, seven studies that compared moderate drinkers to long-term abstainers found no difference in risk of death.
Derzko C. “Not exercising, drinking three alcoholic beverages a day, or gaining 20 lbs. or being more than 20 lbs. overweight raises your risk of breast cancer 2 – 3 times as much as 10 years of being on HRT.” said by Dr. Christine Derzko, Director of the midlife menopause program at St. Michael’s Hospital in Toronto, quoted in “Healthy Woman”, Feb. March 2001.
Oslin D, Atkinson RM, Smith DM, Hendrie H. Alcohol Related Dementia: Proposed Clinical Criteria. Int J Geriat Psychiatry 13: 203-212, 1998.
39. Rehm J, Mathers C, Popova S, et al. Alcohol and Global Health 1: Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009;373:2223-33.
Alcohol and Global Health 2: Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet 2009;373:2234-46.
Alcohol and Global Health 3: Reducing harm from alcohol: call to action. Lancet 2007;373:2247-57.
Reuters. Study claims too many Americans hit the bottle. Viet Nam News. February 26, 2013. Pp. 22. (
Alcohol pricing. Mulled whines. Economist 2013;4098(8867):99-100.
Ruitenberg A, van Swieten JC, Witteman JCM, et al. Alcohol consumption and risk of dementia: the Rotterdam study. Lancet 2002;359:281-6.
40. Fuhrman J. Eat to Live. Little, Brown and Company. New York. 2003. (Health value = nutrients/calories).
41. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 2007;334:885-8.
A study showed that a low salt diet reduced blood pressure in those with normal blood pressure by an average of 7.1 mmHg and in those with high blood pressure by 11.5 mmHg. That was a randomized prospective study for 30 days involving 412 people. The researchers concluded that long-lasting dietary changes are most important.41 GR
42. Murray-Kolb LE, Beard JL. Iron treatment normalizes cognitive functioning in young women. Am J Clin Nutr 2007(Mar);85(3):778-87.
Mazza J. Ed. (2002) Manual of Clinical Hematology (Third Edition). Lippincott Williams & Wilkins. Philadelphia.USA.Pp.20.
Murray-Kolb LE. Iron status and neuropsychological consequences in women of reproductive age: what do we know and where are we headed? J Nutr 2011(Apr);141(4):747S-755S.
43. Mustapha RA, Ogundahunsi GA, Ibrahim A. Effect of cooking utensils on iron content of four staple foods in Nigeria. Journal of Research in National Development 2010(June);9(1):1-6.
44. Gale CR, Ashurst HE, Powers HJ, Martyn CN. Antioxidant vitamin status and carotid atherosclerosis in the elderly. Am J Clin Nutr 2001 Sep;74(3):402-8.
Gale CR, Martyn CN, Cooper C. Cognitive impairment and mortality in a cohort of elderly people. BMJ 1996 Mar 9;312(7031):608-11.
Gale CR, Martyn CN, Winter PD, Cooper C. Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people. BMJ 1995 Jun 17;310(6994):1563-6.
Padayatty SJ, Levine M. New insights into the physiology and pharmacology of vitamin C. CMAJ 2001;164(3):353-355.
45. Ivanov V, Ivanova S, Roomi MW, Kalinovsky T, Niedzwiecki A, Rath M. Extracellular matrix-mediated control of aortic smooth muscle cell growth and migration by a combination of ascorbic acid, lysine, proline, and catechins. J Cardiovasc Pharmacol November 2007;50(5):541–7.
Ivanov V, Roomi MW, Kalinovsky T, Niedzwiecki A, Rath M. Anti-atherogenic effects of a mixture of ascorbic acid, lysine, proline, arginine, cysteine, and green tea phenolics in human aortic smooth muscle cells. J Cardiovasc Pharmacol March 2007;49(3):140–5.
46. National Institutes of Health. Office of Dietary Supplements.
47. Vannier S. Low Vitamin C Linked to Intracerebral Hemorrhage. 66th Annual Meeting of the American Academy of Neurology. April 26-May 2, 2014 Abstract 3101. Reported in Medscape Medical News May 1, 2014.
48. Song J, Park J, Kim JH, Choi JY, et al. Dehydroascorbic Acid Attenuates Ischemic Brain Edema and Neurotoxicity in Cerebral Ischemia: An in vivo Study. Exp Neurobiol 2015 Mar;24(1):41-54.
Cisternas P, Silva-Alvarez C, Martínez F, et al. The oxidized form of vitamin C, dehydroascorbic acid, regulates neuronal energy metabolism. J Neurochem 2014 May;129(4):663-71.
Harrison FE, May JM. Vitamin C function in the brain: vital role of the ascorbate transporter SVCT2. Free Radic Biol Med 2009 Mar15;46(6):719-30.
49. Moore HMT, Zammit S, Lingford-Hughes A, et al. Cannabis use and the risk of psychotic or affective mental health outcomes: a systematic review. Lancet 2007;370:319-28.
Filbey F, Aslan S, Calhoun V, et al. Long-term effects of marijuana use on the brain. Proceedings of the National Academy of Sciences 2014;November 10:(Epub ahead of print).
49.1 Some forms of cannabis have anti-convulsant effects: Accessed on July 21, 2015.
50. Buka I, Koranteng S. Lead Poisoning. Even low levels in children are unsafe. Parkhurst Exchange 2006;November:90-93.
51. Dawson EB, Evans DR, Harris WA, Teter MC, McGanity WJ. The effect of ascorbic acid supplementation on the blood lead levels of smokers. J Am Coll Nutr 1999 Apr;18(2):166-70.
52. It has been estimated that about 40% of people with tinnitus (ringing in the ears), are suffering from nitrate toxicity(52ef).
53. Mozaffarian D, Rimm EB. Fish intake, contaminants and human health: Evaluating the risks and benefits. JAMA 2006;296(15):1885-99.
Hites RA, Foran JA, Carpenter DO, et al. Global Assessment of Organic Contaminants in Farmed Salmon. Science 2004;303(5655):226-29. DOI: 10.1126/science.1091447
54. The recommended dietary allowance (RDA) was developed during World War II by Lydia J. Roberts, Hazel Stiebeling, and Helen S. Mitchell, all part of a committee established by the United States National Academy of Sciences in order to investigate issues of nutrition that might “affect national defense” ( The committee was renamed the Food and Nutrition Board in 1941.
55. Optimal Daily Allowance (ODA) is not a fixed value like the RDA but a calculated value arrived at by taking into consideration a person’s age, gender, activity level, stress level, health status and BMI.
56. Van Way CW, Ireton-Jones C. Nutrition Secrets, 2nd Edition. Hanley & Belfus, Philadelphia. 2004. 6. Is a change in lean body mass a normal part of the aging process? Pp.51.
57. Scarmeats N, Stern Y, Mayeux R, et al. Mediterranean diet, Alzheimer disease and vascular mediation. Arch Neurol 2006;63:1709-1717.
58. Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008;108:287-331.
59. Lead investigator: Oyebode O, et al. BBC. April 1, 2014.
60. Spiller G, Health Research Studies Centre, Los Altos, CA, 2002 Oxygen Radical Absorbing Capacity (ORAC) Study.
61. Nurk E, Drevon CA, Refsum H, et al. Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study. Am J Clin Nutr 2007;86:1470-8.
Daiello LA, Gongvatana A, Dunsiger S, et al. Alzheimer’s Disease Neuroimaging Initiative. Association of fish oil supplement use with preservation of brain volume and cognitive function. Alzheimers Dement 2014;Jun 18. [Epub ahead of print].
Cite this article: Alan R. Jacobs. Fish Oil Slows Cognitive Decline, With Caveats. Medscape. Oct 09, 2014. Fish oils slows AD process in those who do not already have dementia.
Bhatnagar D, Durrington PN. Omega-3 fatty acids: their role in the prevention and treatment of atherosclerosis related risk factors and complications. Int J Clin Pract 2003;57(4):305-314.
Covington MB, Omega-3 fatty acids. Am Fam Physician 2004;70:133-40.
Morris MC, Evans DA, Bienias JL, et al. Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease. Arch Neurol 2003;60:940-946.
GR – A prospective study was conducted from 1993 through 2000, of a stratified random sample from a geographically defined community. Participants were followed up for an average of 3.9 years for the development of AD. A total of 815 residents, aged 65 to 94 years, who were initially unaffected by AD completed a dietary questionnaire on average 2.3 years before clinical evaluation of existing AD. Result: Consumption of the n-3-polyunsaturated fatty acids and fish was associated with reduced risk of incident AD in this large prospective study(61.
62. Koppal T, Drake J, Yatin S, et al. Peroxynitrite-induced alterations in synaptosomal membrane proteins: insight into oxidative stress in Alzheimer’s disease. J Neurochem 1999;72:310-317.
Carrie I, Clement M, de Javel D, Frances H, Bourne JM. Phospholipid supplementation reverses behavioral and biochemical alterations induced by n-3 polyunsaturated fatty acid deficiency in mice. J Lipid Res 2000;41:473-480.
Carrie I, Clement M, de Javel D, Frances H, Bourre JM. Specific phospholipids fatty acid composition of brain regions in mice: effects of n-3 polyunsaturated fatty acid deficiency and phospholipid supplementation. J Lipid Res 2000;41:465-472.
Chalon S, Dellon-Vancassel S, Belzung C, et al. Dietary fish oil affects monoaminergic neurotransmission and behavior in rats. J Nutr 1998;128:2512-2519.
Connor WE, Neuringer M, Lin DS. Dietary effects on brain fatty acid composition: the reversibility of n-3 fatty acid deficiency and turnover of docosahexaenoic acid in the brain, erythrocytes, and plasma of rhesus monkeys. J Lipid Res 1990;31:237-247.
63. Conquer JA, Tierney MC, Zecevic J, Bettger WJ, Fisher RH. Fatty acid analysis of blood plasma of patients with Alzheimer’s disease, other types of dementia, and cognitive impairment. Lipids 2000;35:1305-1312.
64. Gu Y, Nieves JW, Stern Y, et al. Food combination and Alzheimer disease risk. Arch Neurol 2010;67(6):699-706.
Scarmeas N. Washington Heights/Hamilton Heights Aging Project (WHICAP) Neurology 2012;May 2. Cite: Omega-3-rich diet may protect against Alzheimer’s disease. Medscape, May 4, 2012.
Also see: Alzheimer Dement 2011;7:S296-S297 and Arch Neurol 2006;October.
Chowdhury R, Stevens S, Gorman D, et al. Association between fish consumption, long chain omeg-3 fatty acids and risk of cerebrovascular disease: systematic review and meta-analysis. BMJ 2012;345:e6698 doi:10.1136/bmj.e6698.
GR – Other studies found that fish consumption was inversely associated with risk of incident AD.64
65. Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;Jul 23;290(4):502-10.
Anderson JW. Diet first, then medication for hypercholesterolemia. JAMA 2003;Jul 23;290(4):531-3.
Djousse L, Arnett DK, Coon H, et al. Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung and Blood Institute Family Heart Study. Am J Clin Nutr 2004;79:213-7.
66. Mancini GBJ, Baker S, Bergeron J, et al. Diagnosis, prevention and management of statin adverse effects and intolerance: proceedings of a Canadian Working Group Conference. Canadian Journal of Cardiology 2011;27:635-662.

Reviewed on July 30, 2015