Fruits and Vegetables

Fruits and Vegetables

G. Douglas Andersen, DC, DACBSP, CCN

Volume 13, number 25, 12/4/95, page 24
Vegetarians may have low levels of vitamin B12, trace minerals help calcium build bones, and vitamin B12 and folic acid reduce osteoarthritis pain.

You are probably tired of hearing how you and your patients should eat more fruits and vegetables. However, Americans are not getting the message. Only 20 percent of the population consumes five servings per day, and this percentage is much higher than I have seen in other studies.1

In a study of adult-onset diabetic patients (average age 64 years) who suffered from systemic distal polyneuropathy, the patients were placed on a low-fat, vegetarian diet (no animal products and no more than 15 percent fat). Eighty percent had a complete resolution of polyneuropathic pain along with weight loss, decrease in triglycerides of 23 percent, and a decrease in cholesterol of 15 percent after only two weeks on the diet. Half of the patients also were able to reduce the amount of insulin they needed. In a follow-up study, the patients who maintained the diet continued to be free of neuropathy. This study really drives home how important fruits and vegetables are for patients who are sick.2

Fruits and vegetables also protect against stroke with the incidence of stroke decreasing as the amount of servings of fruits and vegetables increases. In a recent study it was found that people who consumed over eight servings of fruits and vegetables a day had a significantly lower risk of stroke (30 percent) than those who ate the recommended five servings. In turn, people who ate five servings a day of fruits and vegetables had 40 percent fewer strokes than people who ate from zero to two servings.3

Those of you who have patients who are strict vegetarians should be aware of possible B12 deficiency. Signs and symptoms include symmetrical paresthesias in the toes, feet, hands, and fingers. Patients will typically complain of tingling, burning, numbness, stiffness, and weakness, along with tight, band-like sensations that can involve other extremity joints including the knees, ankles, wrists, and elbows. Symptoms can manifest as memory loss, mood swings, and paranoia.

In a recent study, 47 of 78 adult vegetarians had low vitamin B12 levels. Furthermore, when people change from a lacto-ovo vegetarian diet to a vegan diet, their B12 levels dropped another 35 percent. Finally, when they gave oral B12 supplements (150 mcg) to the patients, those who chewed their vitamin B12 had higher serum levels than those who swallowed their vitamin B12.4 I do not know what brand of B12 was used in this study. I do know that many of the companies that service our industry have oral B12 that is highly absorbable whether it is swallowed, given sublingually, or chewed.

Preventing Bone Loss

There was a double-blind, placebo-controlled, two-year study on 59 postmenopausal women. They were divided into four groups and given either (1) placebo, (2) 15 mg of zinc, 5 mg of manganese, and 2.5 mg of copper, (3) 1000 mg of elemental calcium, or (4) 1000 mg of calcium plus the trace minerals zinc, manganese, and copper. Bone loss was calculated at L2 and L4. At the end of the study the placebo group had a 3.53 percent loss of bone density. The trace mineral group had a 1.89 percent loss of bone density. The calcium group had a 1.25 percent loss of bone density.5 The calcium and trace mineral group had a 1.48 percent GAIN in bone density. This is very impressive by itself and even more impressive when one considers that patients did not receive any magnesium, boron, vitamin D, or other "bone friendly" nutrients. Supplementation can make a difference in preventing slowing or reducing bone loss. It is never too late to start. If you have a choice, I recommend women begin a bone-building program in their early teenage years.

Circadian Calcium

In a very interesting study, when women were given 1,000 mg of calcium citrate at bedtime or in the morning, it was found that supplementation altered the circadian increase in parathyroid hormone.6 Parathyroid hormone increases bone resorption. By taking calcium at bedtime, bone resorption was reduced.

It will be interesting to see if this finding can be reproduced. In the meantime, what we do know is that calcium anytime is better than no calcium, and calcium with minerals is healthier than calcium alone.

Osteoarthritis and B Vitamins

Twenty-six patients with osteoarthritis for at least five years under the care of rheumatologists were given either lactose or folic acid and vitamin B12. All the groups used acetaminophen for pain control. But, only the group who took B12 (20 mcg) with folic acid (6.4 gm or 6400 mcg) reported a reduction in the number of tender joints with increased grip strength equivalent to what nonsteroidal anti-inflammatories produced without NSAID side effects. We have all learned that folic acid and B12 work well together. It is amazing that such a small amount of B12 could make such a big difference, especially when the amount of folic acid given was significant. I wonder what would have happened if vitamin B6 would have been added to this mixture. Finally, anyone who reads this column or keeps up with nutrition at all realizes that there are many ways to nutritionally help patients with arthritis. Those of you who ignore the nutritional component of arthritis management are doing yourselves and your patients a disservice.7 Note: patients were taking acetaminophen in this study and this substance can build up and cause liver problems. The antidote for acetaminophen poisoning is N-acetylcysteine, which can be purchased from many of the nutrition companies that supply our industry, or in some health food stores.

References
1. Serdula, M. Fruit and vegetable intake among adults in 16 states: Results of a brief telephone survey. American Journal of Public Health. February 1995. 85(2):236-239.

2. Crane & Sample. Regression of diabetic neuropathy and total vegetarian (vegan) diets. Journal of Nutritional Medicine. 1994. 4:431-436.

3. Gillman. A protective effect of fruits and vegetables on the development of stroke in men. JAMA. April 12, 1995. 273(14):1113-1117.

4. Crane. Vitamin B12 studies in total vegetarians. Journal of Nutritional Medicine. 1994. 4:419-430.

5. Strause & Saltman. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. Journal of Nutrition. 1994. 124:1060-1064.

6. Blumsohn et al. The effect of calcium supplementation on the circadian rhythm of bone resorption. Journal of Clinical Endocrinology and Metabolism. 1994. 79(3), 730-735.

7. Flynn et al. The effect of folate and cobalamin on osteoarthritic hands. Journal of the American College of Nutrition. 1994. 13(4), 351-356.

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