ABSTRACTS

VANCOUVER, CANADA. Several studies have shown that an extract of the Chinese herbal remedy Tripterygium wilfordii (TW) is effective in the treatment of severe rheumatoid arthritis. Unfortunately, side effects are frequent when the herb is administered orally. A team of Canadian and Chinese researchers has now evaluated the effectiveness of topical application of TW to affected areas. Sixty-one patients with rheumatoid arthritis were randomized to apply either a TW tincture or a placebo tincture to painful/swollen joints 5-6 times per day. At the end of six weeks patients in the TW group had substantially fewer swollen joints, less morning stiffness, improved grip strength, and both patients and physician noticed a remarkable overall improvement in the TW group. Patients in the TW group were 8 times more likely to experience at least a 20% improvement than were the placebo group patients.

The researchers conclude that their trial supports the efficacy of TW in the treatment of rheumatoid arthritis, but caution that a larger trial is needed before the efficacy of topical application can be judged.
Cibere, Jolanda, et al. A randomized double blind, placebo controlled trial of topical Tripterygium wilfordii in rheumatoid arthritis: reanalysis using logistic regression analysis. Journal of Rheumatology, Vol. 30, March 2003, pp. 465-67

KUOPIO, FINLAND. Atherosclerosis is a disease of the arteries in which fatty, often calcified deposits develop on the inside of the arterial wall (intima) and eventually cause blockages that lead to cardiovascular disease (angina, heart attack and stroke). The progression of atherosclerosis can be followed by measurement of the thickness of the intima with ultrasonography.

Finnish researchers reported about 3 years ago that supplementing with a combination of vitamin C and vitamin E markedly reduced the increase in intima thickness. The researchers now report the results of a further 3 years of follow-up. The study involved 440 men and women between the ages of 45 and 69 years. All participants had cholesterol levels at or above 5.0 mmol/L (193 mg/dL) and both smokers and non- smokers were included. The participants were randomized into two groups – one receiving 136 IU of natural vitamin E (d-alpha-tocopherol) and 250 mg of slow-release vitamin C (ascorbic acid) twice daily with meals, the other receiving placebos.

The researchers observed an average annual increase in intima thickness of 0.014 mm in the placebo group as compared to 0.010 mm in the supplement group corresponding to a substantial 25% treatment benefit. Further analysis showed that the benefit was limited to male participants. Here the treatment benefit was 37% as compared to an insignificant 14% among women. The benefit of supplementation was greatest among participants with low baseline levels of vitamin C and among those with existing plaques in the carotid artery. Plasma levels of vitamin E and vitamin C increased by 57% and 38% respectively over the 6 years of supplementation.

The researchers emphasize that vitamins C and E must be taken together as vitamin C is needed for regeneration of vitamin E. It would also appear that it may be crucial to use natural vitamin E (d-alpha- tocopherol) rather than synthetic (dl-alpha-tocopherol) in order to achieve the desired effect. They point out that the treatment effect among participants who had carotid plaques at baseline was more than 50%. This is comparable to the effect of the most effective cholesterol-lowering drugs (statins), but with no adverse effects and at a much lower cost. Researchers at the UC Davis Medical Center suggest that the optimum regimen may well be 600-800 IU/day of natural vitamin E plus 500 mg/day of vitamin C.
Salonen, Riitta M., et al. Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression. Circulation, Vol. 107, February 25, 2003, pp. 947-53
Jialal, I. and Devaraj, S. Antioxidants and atherosclerosis: Don't throw out the baby with the bath water. Circulation, Vol. 107, February 25, 2003, pp. 926-28 (editorial)

TEL AVIV, ISRAEL. A team of American, Austrian and Israeli researchers has found that heart disease patients tend to have lower intracellular magnesium levels than do healthy people. Their study involved 187 patients (151 men and 36 women) who had undergone coronary bypass surgery or angioplasty or had suffered a heart attack. The patients were randomized to receive 365 mg of elemental magnesium (in the form of citrate) daily or a placebo for six months. The average intracellular magnesium level (analyzed in scraping from under the tongue) in the entire group was 33.5 mEq/L, which is well below the normal level of 37.9 mEq/L. About 75% of participants in the US and Israel were found to be magnesium deficient.

At the end of the six months the magnesium level in the supplemented group had increased to an average of 35.5 mEq/L versus 32.6 in the placebo group. The participants were given a complete medical examination, including a treadmill test at the beginning and end of the study. Patients in the magnesium- supplemented group increased their exercise duration by 14% over the six months while no change was observed in the placebo group. Instances of exercise-induced chest pain also decreased substantially in the magnesium group. Only 8% of the magnesium-supplemented patients experienced pain at the end of the six months versus 21% in the placebo group.

The researchers conclude that coronary artery disease may be associated with a magnesium deficiency and that magnesium supplementation is an inexpensive and safe method of improving the quality of life for heart disease patients.
Shechter, Michael, et al. Effects of oral magnesium therapy on exercise tolerance, exercise-induced chest pain, and quality of life in patients with coronary artery disease. American Journal of Cardiology, Vol. 91, March 1, 2003, pp. 517-21

CLAYTON, VICTORIA, AUSTRALIA. Several studies have shown that glucosamine sulfate and chondroitin sulfate administered orally are effective in reducing pain associated with osteoarthritis of the knee. Glucosamine, however, is subject to degradation in the liver and is also taken up by non-joint tissue. The amount actually reaching the affected knee joint is thus only a small percentage of the original oral dose. Chondroitin sulfate is known to be poorly absorbed from the gastrointestinal tract. In order to overcome these problems researchers at Monash University have evaluated a proprietary cream designed to be applied topically directly to the affected area. The cream contains 30 mg/gram of glucosamine sulfate, 50 mg/gram of chondroitin sulfate, 140 mg/gram of shark cartilage (a source of chondroitin sulfate), 32 mg/gram of camphor, and 9 mg/gram of peppermint oil in a water-soluble cream.

The randomized, double blind, placebo controlled trial of the cream involved 59 men and women diagnosed with osteoarthritis of the knee. Thirty of the participants were given the proprietary cream to apply to the affected area as needed while the remaining 29 were given a placebo cream. All participants evaluated their pain daily on a visual analog scale running from 0 to 100 mm. Baseline pain score was 62 mm. The pain score began decreasing on day one in the active cream group and after 8 weeks had dropped to 28 mm as compared to 46 mm in the placebo group. The participants applied the cream 2-3 times every day. The researchers estimate that the cream delivered about 60-120 mg of glucosamine sulfate and 156-300 chondroitin sulfate directly to the affected area. They conclude that topical application of the cream is a safe and effective way of treating pain associated with osteoarthritis of the knee.
Cohen, Marc, et al. A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. Journal of Rheumatology, Vol. 30, March 2003, pp. 523-28

BOSTON, MASSACHUSETTS. Alzheimer's disease (AD) is a rapidly growing health problem in Europe and North America. The prevalence of AD is now 3% in persons aged 65 years rising to almost 50% in those over 85 years. The current cost to the economy of AD is estimated to be over $100 billion per year and is exceeded only by the cost of heart disease and cancer. AD is characterized by neuronal degeneration and the presence of neurofibrillary tangles and senile plaques in the brain. There is now considerable evidence that inflammation and oxidative stress are crucial elements in the development of AD.

Vitamin E is highly effective in combating both oxidative stress and inflammation. A recent study carried out in the Netherlands found that people with a high intake of vitamin E from food (more than 15.5 mg/day) were 43% less likely to develop AD than were people with a low intake. Supplementing with vitamin E, on the other hand, did not decrease the risk of developing AD. Another study concluded that a high dietary intake of vitamin C and vitamin E was associated with a reduced risk of AD, especially among smokers.

Vitamin E is not only a powerful antioxidant, but is also involved in cellular signaling and transcriptional regulation and has been shown to inhibit key events in inflammation. These latter properties, however, would appear to be exhibited only by natural but not by synthetic vitamin E.
Martin, Antonio. Antioxidant vitamins E and C and risk of Alzheimer's disease. Nutrition Reviews, Vol. 61, February 2003, pp. 69-79
Editor's comment: The failure of vitamin E supplements to prevent AD could be due to either or both of two factors:

• synthetic rather than natural vitamin E was used in the trials;
• it is gamma-tocopherol (the form of vitamin E found in most foods) that is beneficial and not alpha- tocopherol (the form of vitamin E found in most supplements).

CHARLOTTE, NORTH CAROLINA. Common infectious illnesses such as upper respiratory tract infections (bronchitis, common cold), lower respiratory tract infections (pneumonia), influenza, gastrointestinal infection (stomach flu), and urinary tract infections account for a significant number of sick days and absenteeism. Researchers at the North Carolina School of Medicine now report that taking a daily multivitamin pill (with minerals) may significantly improve an individual's resistance to infection. Their study involved 130 adults who were randomized to take a common, commercially available multivitamin pill or a placebo daily for 1 year.

At the end of the year 73% of the members of the placebo group reported having experienced one or more infections during the previous 12 months. Only 43% of the supplemented group had experienced infections. Infection-related absenteeism was also higher in the placebo group at 57% versus 21% in the supplement group. The differences were almost exclusively found in the subgroup of participants with type 2 diabetes. Here 93% of placebo takers reported an infection versus only 17% in the supplement group. This is likely due to the fact that many of the diabetic participants suffered from vitamin deficiencies at the beginning of the trial.

The researchers conclude that supplementation with a multivitamin may be highly beneficial for diabetics, particularly those with a nutrient-deficient diet. They also urge larger trials to conclusively determine the benefits of vitamin supplementation in the general population.
Barringer, Thomas A., et al. Effect of a multivitamin and mineral supplement on infection and quality of life. Annals of Internal Medicine, Vol. 138, March 4, 2003, pp. 365-71
Fawzi, Wafaie and Stampfer, Meir J. A role for multivitamins in infection? Annals of Internal Medicine, Vol. 138, March 4, 2003, pp. 365-71

BALTIMORE, MARYLAND. There is growing evidence that certain micronutrients, more specifically antioxidants, may help prevent some forms of cancer. Selenium, for example, has been found highly effective in preventing prostate cancer. Researchers at the Johns Hopkins School of Public Health now report that gamma-tocopherol, the form of vitamin E found in most foods, is also effective in preventing prostate cancer. Their study involved over 20,000 male residents of Washington County, Maryland who had donated blood in 1974 and 1989. A total of 324 men had developed prostate cancer by 1996. These men were each matched with two healthy controls in regard to age, race, and date of blood donation. Comparing the blood levels of micronutrients in cases and controls found no significant differences in concentrations of alpha-carotene, beta-carotene, total carotene, beta-cryptoxanthin, lutein, lycopene, retinol, and ascorbic acid (vitamin C). There was, however, a difference in gamma-tocopherol levels between cases and controls with controls having significantly lower levels. For the men who donated blood in 1989 it was observed that men with the highest gamma-tocopherol levels had an almost 5 times lower incidence of prostate cancer than did those with the lowest levels. There was also some evidence that higher circulating levels of retinyl palmitate (formed from vitamin A and stored in the liver) were protective against prostate cancer. The researchers conclude that gamma-tocopherol may help protect against prostate cancer, but note that lycopene did not appear to have any protective effect.
Huang, Han-Yao, et al. Prospective study of antioxidant micronutrients in the blood and the risk of developing prostate cancer. American Journal of Epidemiology, Vol. 157, February 15, 2003, pp. 335- 44

SOUTHAMPTON, UNITED KINGDOM. Atherosclerosis increases the risk of stroke and heart attack because part of the atherosclerotic buildup (plaque) on the inner wall of arteries may dislodge and block smaller arteries in the brain and heart respectively and thus cut off the vital supply of oxygenated blood. Depending on its tendency to break loose from the artery wall plaque is classified as either stable or unstable with the stable form being the least likely to cause problems.

Researchers at the University of Southampton have just completed a clinical trial to see if fish oil supplementation would improve plaque stability and thus help prevent heart attack and stroke. Their study involved 162 patients who were awaiting carotid endarterectomy (an operation involving the removal of atherosclerotic deposits from the carotid artery feeding the brain). The patients were randomly allocated to receive a placebo, fish oil (omega-3 polyunsaturated fatty acid) or sunflower oil (omega-6 polyunsaturated fatty acid) daily from the time they entered the study until the endarterectomy during which atherosclerotic plaque was removed for analysis. The placebo capsules contained an 80:20 blend of palm and soybean oils (a composition which closely matches that of the average UK diet); the sunflower oil capsules contained 1 gram of sunflower oil plus 1 mg of vitamin E (alpha-tocopherol); the fish oil capsules contained 1 gram of fish oil and 1 mg of vitamin E. The participants took 6 capsules daily providing a total to 3.6 grams linoleic acid (in the sunflower oil capsules) or 850 mg EPA (eicosapentaenoic acid) + 500 mg of DHA (docosahexaenoic acid) in the fish oil capsules.

The duration of supplementation varied between 7 and 189 days with the median being 42 days. Upon analysis of the removed plaque the researchers found that the supplemented fish oil (EPA and DHA) had been readily incorporated into the plaques and had resulted in favourable changes. Plaque from fish oil treated patients tended to have thick fibrous caps and no signs of inflammation indicating more stability. Plaques from the control and sunflower oil groups, on the other hand, tended to have thin fibrous caps and signs of inflammation indicating less stability. The number of macrophages (large scavenger cells) in the plaque of fish oil treated patients was also significantly less than the number observed in the control and sunflower oil groups.

The researchers conclude that the increased plaque stability observed in the fish oil treated patients could explain the reduction in fatal and non-fatal heart attacks and strokes associated with an increased intake of fish oils.
Thies, Frank, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. The Lancet, Vol. 361, February 8, 2003, pp. 477-85

ROCHESTER, MINNESOTA. Rheumatoid arthritis (RA) involves a persistent inflammation of the synovium of the joints eventually leading to destruction of the surrounding bone and cartilage. There is evidence that free radical attacks (oxidative stress) and the presence of pro-inflammatory cytokines are the major culprits and three American universities have just completed a study to determine if antioxidants in the diet or supplements could reduce the risk of RA by combating oxidative stress and inflammation. Their study involved 29,368 middle-aged women who were enrolled in 1986 at which time their diet and supplement usage was ascertained. The women were followed until the end of 1997 at which time 192 cases of RA had been definitely confirmed. The average age at onset was 68 years, range = 57-79 years.

Analysis of diet and supplement intake revealed a strong inverse correlation with dietary intake of the carotenoid, beta-cryptoxanthin. Women with an intake of more than 87 micrograms/day had a 41% lower incidence of RA than did women with an intake of less than 40 micrograms/day. Citrus fruits, particularly oranges are good sources of beta-cryptoxanthin. Zinc supplementation with more than 15 mg/day conferred a statistically significant 61% reduction in RA risk while copper supplementation exhibited a trend for a significant risk reduction. Oddly enough, a high zinc consumption through the diet was associated with a trend towards a greater risk for RA perhaps indicating that zinc-rich food sources tend to contain compounds which increase the risk of RA. Consumption of cruciferous vegetables also showed a protective trend with 3 or more monthly servings of broccoli reducing risk by 35% as compared to consumption of less than 2 servings per month.

The researchers conclude that a high intake of beta-cryptoxanthin and supplemental zinc may materially reduce the risk of developing rheumatoid arthritis.
Cerhan, James R., et al. Antioxidant micronutrients and risk of rheumatoid arthritis in a cohort of older women. American Journal of Epidemiology, Vol. 157, February 15, 2003, pp. 345-54

CAMBRIDGE, MASSACHUSETTS. Tryptophan and tyrosine are two important amino acids involved in the synthesis of serotonin and catecholamines (epinephrine and norepinephrine) respectively. Tryptophan must pass through the blood-brain barrier in order to be converted to serotonin. The blood-brain barrier's capacity for transporting amino acids is limited so tryptophan must compete with other large neutral amino acids (tyrosine, phenylalanine, leucine, isoleucine, valine and methionine) for access to the brain. This makes the ratio of tryptophan to the other amino acids (LNAAs) crucial in determining how much tryptophan will eventually be converted to serotonin. A similar situation exists for tyrosine.

Researchers at the Massachusetts Institute of Technology recently carried out a small trial to see if the composition of breakfast would influence the tryptophan:LNAA and tyrosine:LNAA ratios. Their experiment involved 8 healthy, young volunteers who consumed a carbohydrate-rich breakfast (69.9 grams of carbohydrates and 5.2 grams of protein) and a protein-rich breakfast (15.4 grams of carbohydrates and 46.8 grams of protein) 3 to 7 days apart. The researchers found that the carbohydrate-rich breakfast increased tryptophan:LNAA ratio by approximately 10% (not statistically significant) over baseline while the protein-rich breakfast decreased the ratio by about 30% (statistically significant). Similarly, while the carbohydrate-rich breakfast increased the tyrosine:LNAA ratio by a non-significant 5%, the protein-rich breakfast decreased it by a significant 20%. The total average difference in tryptophan:LNAA ratio between the carbohydrate-rich breakfast and the protein-rich one was 54% (28% for the tyrosine:LNAA ratio).

The researchers conclude that the composition of breakfast, or any meal for that matter, can result in substantial differences in plasma tryptophan ratio and thus probably in brain tryptophan concentration and serotonin synthesis. The meal composition also affects tyrosine ratio and may affect the synthesis of catecholamines. The researchers also noticed that while insulin concentrations rose sharply after the carbohydrate-rich meal there was very little, if any, increase after the protein-rich meal.
Wurtman, Richard J., et al. Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. American Journal of Clinical Nutrition, Vol. 77, January 2003, pp. 128-32

NEWSBRIEFS

Cancer rates expected to double in next 17 years
The World Health Organization (WHO) estimates that about 10 million new cases of cancer are diagnosed every year on a worldwide basis. This figure is expected to rise to 20 million by the year 2020. Smoking and unhealthy lifestyles are the main causes of cancer and it is estimated that smoking alone has been responsible for about 100 million deaths during the 20th century. Developing countries have only half the cancer rates as compared to the world as a whole. This is due to a later onset of the smoking epidemic and a generally healthier diet and lifestyle than that found in more affluent countries.
British Medical Journal, April 5, 2003

Baycol compensation?
The German pharmaceutical giant, Bayer, is facing over 8000 claims for compensation from the fiasco involving its cholesterol-lowering statin drug cerivastatin (Baycol). The drug was withdrawn in August 2001 after having been linked to at least 100 deaths from rhabdomylosis (an often fatal muscle disease). The first lawsuit came to trial in Corpus Christi, Texas in early March 2003. Prior to the trial Bayer had sent a letter to 2000 local residents reminding then that it contributes about $185 million to the economy of the state of Texas in payroll, taxes and support of local groups. The judge in the case commented that the sending of the letter was "outlandish". If Bayer is found guilty it may face bankruptcy.
The Lancet, Vol. 361, March 8, 2003, p. 793

Nutrition bars may interfere with warfarin therapy
Warfarin prevents blood clots by interfering with the synthesis of vitamin K-dependent coagulation factors. Vitamin K, in turn, inhibits the effect of warfarin thus necessitating the use of higher doses of the drug in order to attain adequate anti-coagulation effect. Researchers at the University of Iowa have found that many common nutrition and sports bars contain vitamin K in amounts high enough to interfere with warfarin action. A Luna bar, for example, contains 60 micrograms of vitamin K or about half the amount found in ½ cup of broccoli. Other bars such as Viactiv soft calcium chews, Balance and Clif bars also contain significant amounts of vitamin K as does Boost and Ensure nutritional supplements. The researchers recommend that physicians inform their warfarin-using patients about these sources of vitamin K as they can significantly affect INR values.
Annals of Pharmacotherapy, Vol. 37, February 2003, p. 302

New painkiller based on Botox
Botulinum toxin or Botox is the most potent neurotoxin known to man and is highly effective in preventing muscles from contracting; however, it has no effect in blocking the nerves that transmit pain because it only binds to muscle cells. Keith Foster and his research team at the Centre for Applied Microbiology and Research near Salisbury in the UK reasoned that, if they could find a compound which would seek out and bind to the surface of pain neurons, and combined this with Botox then the result should be a very potent painkiller. Their search led them to the Mediterranean coral tree, Erythrina cristagalli. Protein from the coral tree binds only to pain neurons and not to any other cells. Combining the coral tree protein and Botox did indeed produce a very powerful painkiller without affecting other senses such as touch. The painkiller performed as well as morphine in experiments on laboratory mice and was still working 9 days after injection whereas morphine would have worn off in 4 hours. Human trials are planned for the near future.
New Scientist, April 19, 2003, p. 14

Broccoli fights cancer
Broccoli contains a class of chemicals called sulphoraphanes. Some sulphoraphanes inhibit the oxidizing enzymes that damage DNA and thus help protect against cancer. The sulphoraphanes are released when broccoli is chewed. Dr. Nathan Matusheski of the University of Illinois has studied broccoli extensively and has found that in the common supermarket variety only 20% of the sulphoraphanes have anti-carcinogenic effects. However, by heating the broccoli to 60 degrees C the proportion of cancer-fighting sulphoraphanes increased to 80%. Dr. Matusheski points out that cooking broccoli in the conventional way does not improve its value as a cancer-fighting agent as the enzyme, which releases the sulphoraphanes in the first place, is also destroyed in the cooking.
New Scientist, April 5, 2003, p. 25

Reduction in sugar intake urged by WHO
The World Health Organization and the UN Food and Agriculture Organization have just released a report, Diet, Nutrition and the Prevention of Chronic Disease, which recommends that no more than 10% of daily calories should come from added sugar. The report claims that the refined sugars in soft drinks, cookies, etc. are emerging as a contributor to obesity and a major aggravator of diabetes. These sugars have also been implicated in syndrome X, which impairs the body's ability to handle sugar and is the forerunner of obesity and diabetes. The US Sugar Association, not too surprisingly, sharply disagrees with the WHO report and claims that a daily sugar intake of up to 25% of calories is quite OK. The Association now threatens to use its lobbying clout to get the US Congress to cut off the country's $406 million annual contribution to the WHO.
New Scientist, May 3, 2003, p. 12-13, 23

RESEARCH REPORT

BOOK REVIEW

The Paleo Diet
Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat
Loren Cordain, Ph.D.
John Wiley & Sons, New York, 2002
(hardcover or paperback)

Loren Cordain is a professor in the Health and Exercise Science Department of Colorado State University, is a respected expert on the early human diet, and has published significant original research in this area.

The thesis of "The Paleo Diet" is that we have essentially the genetic make-up and metabolism of our Stone Age ancestors, and that the human genome has changed less than 0.02% in the last 40,000 years. The Stone Age or Paleolithic era actually covers the period from the first appearance of stone tools, about two million years ago, up to the end of the last Ice Age about 15,000 years ago. Homo sapiens are thought to have arrived on the scene in Africa about 100,000 years ago in the so-called Upper Paleolithic period. It is now reasonably well established that when Homo sapiens migrated out of Africa to Europe, Asia, and beyond, replacing earlier Homo species, they were still hunter-gatherer tribes, a situation that prevailed for thirty to forty thousand years prior to the advent of raising, grinding and storing grains and raising animals for food (see for example "The Seven Daughters of Eve", by Bryan Skyes, W. W. Norton, 2001, for a fascinating and up-to-date discussion by an Oxford genetics professor of the use of female mitochondrial DNA in this context). Basic to Cordain's argument is the belief that the rate of mutation would not have allowed humans to adapt to the profound changes brought about in diet that came with the advent of agriculture and animal husbandry, which occurred about 10,000 years ago. Thus it is argued that modern man should still eat a diet based on the balance of nutrients in the diet of our Stone Age ancestors, i.e. based on our genetic blueprint, a diet which for example included nuts, seeds, roots, leaves, fruit, honey (rarely!), lean meat and fish. Thus the Paleo philosophy requires avoiding many of the diet changes that started about 10,000 years ago. Further rapid and profound changes have occurred in the last century with the development of the modern food and drink industry.

Cordain develops this thesis early in the book and then moves rapidly to apply its basic principles. In Part One he develops arguments for the proper balance of fat, protein and carbohydrate, and the types of each that are consistent with the Paleo Diet. The ground rules are simple: eat only lean meats, fish and other seafood, fruits and non starchy vegetables, and avoid cereals, legumes, dairy products and processed foods. Finally he discusses how, in his opinion, our modern diet went wrong and how his approach corrects the problem. He also discusses the optimum balance of omega-3 vs. omega-6 essential fatty acids.

Part Two, titled "Losing Weight and Preventing and Healing Disease," includes a discussion of Syndrome X (also called the "Metabolic Syndrome") which he calls "The Civilization Disease" and attributes the syndrome, as have a growing number of nutritional scientists, to our modern Western diet with its emphasis on refined grains and sugars, which results in problems with glucose and insulin control, obesity, diabetes, heart disease etc. At the end of Part Two the author elaborates at some length on the proposed connection between the modern Western diet and a variety of diseases and health problems. An example is the relationship between celiac disease and cereal grains. Another is lactose intolerance. The remainder of the book provides detailed information on applying the principles of the Paleo Diet with a discussion of what to eat and what to avoid, meal plans, recipes, and the general principles of "Living the Paleo Diet."

This book is an important addition to the modern diet literature, and its theme is related to the debate regarding high vs. low carbohydrate diets, although the author's criticism of low-carb "fad diets" seems at variance with recent research results as well as most modern versions of this type of diet. Some readers may consider his restrictions too severe, and may find some of his beliefs debatable (e.g. "saturated fats are mostly bad"), but the general principles seem definitely worthy of serious consideration. "The Paleo Diet" is highly recommended reading for anyone trying to adjust their diet to optimize health.

Reviewed by William R. Ware, Ph.D.