4 questions | Applied Sciences homework help

1. “A recall of a harmful product guarantees that all such harmful products will be immediately and completely removed from the marketplace.” A product recall of a dietary supplement is voluntary; and while many manufacturers do their best, a recall does not necessarily remove all harmful products.

Don’t Make These Questionable Assumptions about Dietary Supplements and Herbs74 Part Three Nutrition and Fitness214 popular herbal products Table 11-5 Cat’s claw. Although cat’s claw appears to have potential for treating certain viral and inflammatory diseases, more clinical research is needed to determine its effectiveness and long-term safety. Echinacea. Test-tube evidence suggests that echinacea stimulates immune processes, but it has not been proven useful by well-designed human studies.75 Echinacea should not be taken by people with an autoimmune disease (such as type 1 diabetes, rheumatoid arthritis, or multiple sclerosis) or a disease that causes immune suppression. Quality control is also problematic. Ephedra. Products containing ephedrine alkaloids have been marketed as weight-loss aids and athletic enhancers. Although some products of this type may have slight posi- tive effects, they have also been associated with death, heart attacks, stroke, seizure, and serious psychiatric illness in young adults.76 The FDA has banned their sale as dietary supplements and is battling in court to enforce the ban. Garlic. Allicin, a component of garlic, has been shown to inhibit the production of cholesterol by the liver. Popu- lation studies have found an association between lower cholesterol levels and increased intake of garlic, onions, and related vegetables. However, most well-designed clini- cal trials have not found a cholesterol-lowering benefit for garlic supplements, and its anticoagulation property may undesirably enhance that of other blood-thinners. Ginkgo. Ginkgo biloba contains compounds that can in- crease blood flow to the brain. However, there is no evidence that ginkgo products can cure or prevent Alzheimer’s disease or generally improve mental function.77 A recent study found that ginkgo extract did no better than a placebo in prevent- ing mental decline among adults ages 72 to 96 with normal cognition or mild cognitive impairment. The study involved more than 3000 people who, for about 6 years, were tested twice a year for memory, attention, language, and several other abilities.78 Ginkgo’s anticoagulation property may undesirably enhance that of other blood-thinners. Ginseng. Ginseng may help improve sleep, appetite, and work efficiency. However, it can raise blood pressure, and many ginseng products contain little or none of the active ingredient. Goldenseal. Goldenseal is claimed to have laxative, anti- inflammatory, and anti-hemorrhagic properties. It has many adverse effects, and its use is not supported by adequate research. Green tea. Epidemiologic and animal studies suggest that green tea may help prevent atherosclerosis. However, clinical trials are needed to accurately assess its usefulness. Kava. Small studies suggest that kava may be useful for treat- ing anxiety, stress, and restlessness. However, chronic, heavy use can cause adverse effects. In 2002, the FDA warned consumers that kava products can cause severe liver injury.79 Milk thistle. Studies suggest that milk-thistle extract may have a useful role in treating various liver diseases. However, most of the supporting research has not been well-designed and the best-designed studies have not demonstrated benefit.80 Saw palmetto. Saw palmetto is widely believed to relieve symptoms of benign enlargement of the prostate gland. A survey of Consumer Reports81 readers found that about half improved, compared to about 75% of prescription drug users. However, a 2009 Cochrane review82 of 30 trials concluded that saw palmetto has little or no efficacy over placebo. This conclusion differed from that of previous Cochrane reviews because two recent high-quality clinical trials showed no benefit. St. John’s wort. St. John’s wort is widely promoted as an antidepressant. However, the two most important studies found no benefit against moderate or severe depression.83,84 Moreover, researchers who tested 54 commercial St John’s wort products purchased in Canada and the United States found only two products with a total hypericin content (hypericin plus pseudohy- pericin) within 10% of the amount stated on the label. (These sub- stances are thought to reflect product potency.) The percentage of the label claim varied from 0% to 108% for capsule products, 31% to 80% for tablet products, and total hypericin content of tinctures also varied widely. On average, most products tested contained half of the labeled amount of hypericin.85 St. John’s wort should not be combined with standard antidepressants or used by women who are pregnant or are breastfeeding. Valerian. Valerian appears to exert mild sedative-hypnotic effects, but most supportive studies have been methodologi- cally flawed. A U.S. Pharmacopeia expert panel has concluded that there is not enough evidence to support its use for treating insomnia.86 century its use as a medicine was abandoned, but it became popular as a syrup for soft drinks. Although a few plant extracts have been used in modern medical practice, most have been replaced by products that are safer or more effective or have fewer unpleasant side effects. For example, reserpine, found naturally in snakeroot (rauwolfia), was one of the earli- est effective remedies against high blood pressure and was used extensively during the 1950s and 1960s until better synthetic drugs were developed. Curare, used to paralyze muscles during surgical procedures, has been replaced by synthetic derivatives. Powdered willow bark, discovered during ancient times to relieve pain, has evolved into today’s aspirin. Foxglove leaves contain digitalis, a drug used to treat heart failure and abnormal heart rhythms. However, the use of dried leaves has given Chapter Eleven Nutrition Fads, Fallacies, and Scams 215 way to extracts and synthetic drugs whose dosages are precisely controlled. Today, Americans spend billions of dollars per year for herbal capsules and tablets, bulk herbs, and herbal teas used for supposed medicinal qualities. Most are purchased over-the-counter, but some are prescribed by practitioners. Many herbs contain hundreds or even thousands of chemicals that have not been completely cataloged. While some may ultimately prove useful as therapeutic agents, others could well prove toxic. Most herbal products sold in the United States are not standardized, which means that determining the exact amounts of their ingredients can be difficult or impos- sible. Moreover, many herbal practitioners are not quali- fied to make appropriate diagnoses or to determine how herbs compare to proven drugs. Many herbal products are marketed as “dietary supplements,” even though they have little or no nutri- tional value. No legal standards exist for their processing, harvesting, or packaging. In many cases, particularly for products with expensive raw ingredients, contents and potency are not accurately disclosed on the label. Many products marketed as herbs contain no useful ingredients, and some even lack the principal ingredient for which people buy them. Some manufacturers are trying to develop industrywide quality-assurance standards, but possible solutions are a long way off. Herbs in their natural state can vary greatly from batch to batch and often contain chemicals that cause side effects but provide no benefit. Surveys conducted in the United States have found that the ingredients and doses of various products vary considerably from brand to brand and even between lots of the same product.88 For example, researchers at the University of Arkansas tested 20 “supplement” products containing ephedra (ma huang) and found that half the products exhibited discrepancies of 20% or more between the label claim and the actual content, and one product contained no Quality oF sources oF iNFormatioN about herbs aNd other Natural products Table 11-6 Recommended Sources Natural Medicines Comprehensive Da- tabase (www.naturaldatabase.com) AboutHerbs (www.mskcc.org/mskcc/ html/11570.cfm) ConsumerLab.com (www.consumerlab.com) The Natural Pharmacist (consumerlab.com/tnp.asp) NIH Office of Dietary Supplements (ods.od.nih.gov) Review of Natural Products www.factsandcomparisons.com Herbal Medicines, 3rd Edition87 Nonrecommended Sources AltCareDex System HealthNotes Herbal Safety (University of Texas) Natural Standard Commission E Report PDR for Herbal Medicines, 3rd Edition Comments More than 1000 entries about herbs and dietary supplements. Thoroughly researched and referenced; frequently updated. Best information source on side effects and interac- tions with drugs and other products. Costs $92/year for online access or book, or $132/year for both. More than 300 entries about herbs, dietary supplements, and “alternative” cancer treat- ments. “Professional” and consumer versions are provided, but most of the profession- al information is readily understandable by laypersons. Less detailed than the Natural Medicines database, but quite reliable. Free. Tests whether popular products contain the amounts of ingredients listed on their label and provides information about their usefulness. Some information is free; other infor- mation requires a nominal subscription or temporary access fee. Covers several hundred substances plus many “complementary and alternative treat- ments.” Very scholarly but not updated since 2003. Available free of charge to ConsumerLab subscribers and other sites that license it. (Use Google to find them.) Provides more than 60 comprehensive Dietary Supplement Fact Sheets. Covers more than 350 products. Available as book (6th edition, 2010), printed newsletter, and online database. Some libraries provide free online access. Book contains 152 thoroughly referenced and highly reliable herbal monographs. These four databases offer huge amounts of research-based information without suffi- cient interpretation to provide practical advice. Some presentations are not sufficiently critical. Natural Standard, which is fee-based, is the most comprehensive. The others are free. Both books are comprehensive but rely too much on anecdotal evidence. The herbal PDR contains bizarre recommendations for homeopathic products. Part Three Nutrition and Fitness216 ephedra alkaloids. The products were marketed as “energy boosters” and/or “thermogenic” diet aids, even though no published clinical trials substantiated that they are safe or effective for these purposes. The researchers also noted that hundreds of such products were marketed and that their number exceeded that of conventional pre- scription and nonprescription ephedra products, which are FDA-approved as decongestants.89 To make a rational decision about an herbal product, it would be necessary to know what it contains, whether it is safe, and whether it has been demonstrated to be as good or better than pharmaceutical products available for the same purpose. For most herbal ingredients this information is incomplete or unavailable. “Popularity” is not a reliable sign of effective- ness. In 1999, Consumer Reports81 asked its readers in the United States and Canada to rate the standard and “complementary” therapies they had used most often for the two most serious or bothersome medical condi- tions they had encountered during the previous 2 years. Prescription drugs scored significantly better than herbs for each of the reported problems where both were used. Table 11-6 rates several of the best-known sources of information about herbs and other natural products. Dr. Harriet Hall observed that only about 5% of the substances listed in the 2007 Natural Medicines Com- prehensive Database90 were rated effective and most of these were either vitamins, minerals, or substances that were also ingredients in standard drugs. Establishing that a substance is clinically effective does not ensure that products containing the substance will be appropriately formulated. An evaluation of herbal products from 20 retail stores in and around Minneapolis concluded that only 43% of 880 products were labeled with the ingredients and dosage that had been used in published studies of the ingredients. The chosen herbs were echinacea, St. John’s wort, ginkgo biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian. The actual ingredients were not measured, but the survey indicated that many manufacturers failed to formulate their products to cor- respond with available research data.91 ConsumerLab.com, which has tested over 2600 products since 1999, reported in 2010 that 19% of the vitamins and minerals, 22% of the other supplements, and 47% of the herbals failed their evaluations. The most common reason for the failure was too little or none of the main ingredient. The other problems included too much active ingredient; the wrong ingredient; potentially dangerous or illegal ingredients; contamination with heavy metals, pesticides, or pathogens; “spiking” with unexpected ingredients; poor disintegration (which af- fects absorption); and misleading or incomplete product information. Even when a botanical product contains ingredients that are potentially effective, it may not be practical to use. Garlic, for example, has been demonstrated to lower cholesterol. However, prescription drugs are more potent for this purpose, and garlic has anticoagulant properties. No data are available to indicate the risk of combin- ing garlic with other widely used products (vitamin E, ginkgo, fish oil, and aspirin) that can interfere with blood clotting. The entry of drug companies into the herbal market- place may result in standardization of dosage for some products, and recent public and professional interest in herbs is likely to stimulate more research. However, with safe and effective medicines available, treatment with herbs rarely makes sense, and many of the conditions for which herbs are recommended are not suitable for self-treatment. The National Council Against Health Fraud92 rec- ommended that the FDA establish a special category of over-the-counter drugs called “Traditional Herbal Remedies.” These could then be marketed with less- than-standard proof of effectiveness if: (a) reasonable evidence exists that they are safe and effective; (b) labels identify the name and quantity of each active ingredient; (c) indications are restricted to nonserious, self-limiting conditions; (d) labels contain adequate directions for use, including a warning about inappropriate self-treatment; and (e) adverse reactions are reported. Herbal teas may have a single ingredient or may be blends of as many as 20 different kinds of leaves, seeds, and flowers. The Medical Letter93 has identified the following as potentially troublesome: buckthorn bark, burdock root, catnip, chamomile, devil’s claw root, ginseng, horsetail, hydrangea, Indian tobacco, jimson- weed, juniper berries, licorice root, lobelia, mistletoe, nutmeg, pokeweed (especially the root), sassafras root bark, senna leaves, shave grass, and wormwood. A 1993 FDA report94 stated that chaparral, comfrey, germander, jin bu huan, lobelia, ma huang, willow bark, and yohimbe have been associated with illness or injury. Consumer Reports95 includes bitter orange, chaparral, kava, skull- cap, and snakewood in its “Dirty Dozen” list of supple- ment and herbal products to avoid. Pennyroyal, taken with the hope of inducing menstruation or an abortion, has caused serious toxicity and death.96 Many traditional Chinese and ayurvedic medicinal herbs have been found to be contaminated with heavy metals or other toxic substances.97 Chapter Eleven Nutrition Fads, Fallacies, and Scams 217 Nutrition-related fads and myths have existed throughout the ages. It has been alleged that foods can sustain or interfere with general health and that many foods can cause or cure various illnesses. Although the science of nutrition offers the potential to curb faddism, the parallel development of mass communication has enabled faddists to reach vast audiences of unsuspecting people. Food faddism’s basic premise, traceable to ancient times, is that diet is the primary factor in health, disease, intellect, behavior, and mortality. Many cultures have believed that “we are what we eat.” The ancient doctrine of correspondences held that “like is like” or that “like produces like.” Thus eating a tiger’s heart would produce courage, and eating its genitals would enhance virility. The ancient Egyptians believed that all diseases were caused by what people ate and that dietary regimens were curative. They preserved corpses so that a winged creature could recognize them and carry their soul to the sun god for eternal circulation in the heavens. Believing that the anus was the center for disease and decay, the Egyptians were also preoccupied with enemas, drenches (drinking large quantities of water), and bowel movements to cleanse the colon. The Greeks ate grasshoppers for liver disorders and believed that fevers were helped by eating seven bugs from the skin of a bear. The Romans thought lettuce cleansed the senses, garlic gave physical strength, and truffles increased sexual potency. They also believed that good health came only with sacrifice, discomfort, self-discipline, and dour at- titudes—concepts still common among faddists. “Modern” food faddism began with the preaching of Syl- vester Graham (1794–1851), who mixed religion with a zeal for the natural, “uncomplicated” life. Graham was ordained as a Presbyterian minister in 1826 but was influenced by Philadelphia’s Bible Christian Church. He practiced home- opathy and lectured on temperance, cholera, fresh air, bathing, and sexual restraint. He was one of the first American “health reformers” to reach large audiences. His initial focus on the evils of alcohol soon expanded to other health concerns. “The simpler, plainer, and more natural the food,” he said, “the more healthy, vigorous, and long-lived will be the body.” Among the prohibited foods were salt and other condiments (these and sexual excesses caused insanity), cooked vegetables (against God’s law), and chicken pies (caused cholera). Graham’s most vigorous attacks were against “unnatu- ral” substances such as meat, white-flour products, and water consumed at mealtimes. He also claimed that people did not bathe enough and needed external applications of cold water at least weekly. Partly because of his advocacy, Saturday night baths and setting-up exercises before open windows became common practices. Although Graham died at the early age of 57, the cracker that bears his name is still with us. James Caleb Jackson (1811–1895) was a farmer before he became a physician by apprenticeship. His health had failed due to heart and kidney trouble and dyspepsia. He attributed his recovery to drinking 30 to 40 glasses of water daily. In 1858 he opened a sanitarium to provide “water cures” both internally and externally. At this facility women were encour- aged to wear bloomers (the standard reformist dress) instead of a corset. They were also relieved of their false hair; fed fruits, Graham crackers, and bread; and urged to take naps and walks. Jackson also advocated phrenology and vegetarianism. To supplement the Graham crackers, he prepared broken bits of rock-hard baked wheat with water, which he called Granula. He also marketed a cereal coffee called So Mo and several other items. These may have been the first prominent “health foods” sold in the United States.98 John Harvey Kellogg (1852–1943) reportedly ate his way through medical school on a diet of apples and Graham crackers. He belonged to a Seventh-day Adventist group that had founded a religious colony and health sanitarium at Battle Creek, Michigan. He and his brother Will were probably the first to make $1 million from food faddism. Under John’s leadership, the Battle Creek Sanitarium attracted hordes of wealthy clients whose intestines he “detoxified” with enemas and high-fiber diets. His 1217-page book, Rational Hydro- therapy, recommended a “water cure” for virtually every ailment. While trying to develop a dried bread product upon which his clients could exercise their teeth without breaking them, Kellogg hit upon the idea of a wheat flake. By 1899 the flakes had evolved into a cereal-based company that soon had many competitors. One was Charles W. Post, a former Kel- logg patient, who ground up wheat and barley loaves, called his new product “grape nuts,” and marketed it as a cure for appendicitis, malaria, consumption (tuberculosis), and loose teeth. Their enterprises were the roots of two of today’s giant cereal producers: the Kellogg Company and the Post Division of General Foods. Bernarr Macfadden (1868–1955) was the first faddist to use mass-media techniques to amass a fortune (see Chapter 14). He taught that medical care (which he steadfastly avoided) should be rejected in favor of “natural” methods. D.C. Jarvis, M.D. (1881–1966), wrote that body alkalinity was the principal threat to American health and that honey and apple cider were the antidotes. False claims in his book—which is still widely sold—were the basis for an FDA seizure of a product called Honegar. Gayelord Hauser (1895–1984) promised to add years to people’s life with five wonder foods: skim milk, brewer’s yeast, wheat germ, yogurt, and blackstrap molasses. He lec- tured frequently and was a partner in a company that marketed products bearing his name. Hauser wrote a syndicated news- paper column and more than a dozen books reported to have sold close to 50 million copies here and abroad. One book, Look Younger, Live Longer, led the bestseller list in 1951. That same year, the FDA seized copies of the book, claiming they were being used to promote sales of blackstrap molasses as a cure-all. The court readily agreed that the molasses was misbranded by many false claims in the book. Continued on page 218 Historical Perspective Some Roots of Today’s Food Faddism Part Three Nutrition and Fitness218 Historical Perspective Some Roots of Today’s Food Faddism—Cont’d. Adolphus Hohensee (1901–1967) began his training in nutrition with a job as a soda jerk. After dabbling in real estate (with time in jail for mail fraud) and the field of transportation (during which time he was arrested for passing bad checks), Hohensee resumed his education. In 1943 he acquired an Honorary Degree of Doctor of Medicine from a nonaccredited school and followed this with Doctor of Naturopathy degrees from two schools that he did not attend. In 1946 he acquired a chiropractic license in the state of Nevada. A master showman, Hohensee could lecture for hours about the terrible American diet that would stagnate the blood, corrode blood vessels, erode the kidneys, and clog the intes- tines. He said that most people had intestinal worms, which, fortunately, could be cured by his special cleansing. He prom- ised a long life to those who consumed his wonder products. Repeated prosecution by the FDA made him more cautious about selling his products during lectures, but his promotion of the gamut of food myths sent his audiences flocking to nearby health-food stores whose shelves just happened to be well-stocked with his product line. In 1955, reporters caught Hohensee eating a meal of forbidden foods after one of his lectures. In 1962 he began serving an 18-month prison term for selling honey with false claims. But neither of these setbacks dampened his enthusiasm or that of his loyal followers. Lelord Kordel (1908–2001), author of about 20 books, recommended high-protein foods, lecithin (“the miracle nutri- ent”), and high-dosage vitamin and mineral supplements for everyone. He began marketing supplements in 1941. In 1946 he was convicted of misbranding and was fined $4000. One product in the case was Gotu Kola, an herbal tablet said to restore youth and “produce erect posture, sharp eyes, velvety skin, limbs of splendid proportions, deep chests, firm bodies, gracefully curved hips, flat abdomens” and even “pleasing laughter.” Thirteen other products were falsely claimed to be effective against heart disease, liver troubles, tuberculosis, impotence, and various other problems. Kordel had a brush with the FTC in 1957 and two more with the FDA in 1961. In 1963, when he was president of Detroit Vital Foods, Inc., products shipped by the company were found to be misbranded because they were accompanied by Kordel publications that falsely claimed that nutritional products could treat practically all diseases. After the appeals process ended in 1971, Kordel was fined $10,000 and served 1 year in prison. Catalogs from Vital Foods, Inc., described him as “America’s leading vitamin and diet expert” and claimed that he had never been ill. During the 1950s and early 1960s government agencies carried out more than 200 successful actions against misbrand- ing. Several prominent faddists were sentenced to prison, and the courts ruled that any false message given in the context of a sale could be considered part of a product’s labeling. The budding health-food industry soon reorganized to get around the law. Most supplement manufacturers stopped labeling their products as effective against specific diseases. Industry emphasis shifted somewhat from “miracle” drugs to “nutrition insurance,” an approach that tends to attract little regulatory attention. “Specialization” developed whereby most publicists have no direct financial tie to the sale of specific products. This enables their claims to be protected by the doctrines of freedom of speech and freedom of the press.7 The leading publicists have included Adelle Davis (1904–1974), Carl- ton Fredericks (1910–1987), and Robert C. Atkins, M.D. (1930–2003). Davis was the first “authority” among modern food faddists who had any formal professional background. She was trained in dietetics and nutrition at the University of California at Berkeley, and received a Master of Science degree in biochemistry from the University of Southern Cali- fornia School of Medicine. Her four main books sold a total of 10 million copies: Let’s Eat Right to Keep Fit, Let’s Get Well, Let’s Cook It Right, and Let’s Have Healthy Children. She criticized the American diet as excessively high in salt; loaded with refined sugar; and contaminated by pesticides, growth hormones, and preservatives. She claimed modern food processing destroys vital nutrients. She proposed that people eat organic fruits and vegetables, whole wheat bread, wheat germ, vitamin supplements, certified raw milk, fresh stone-ground whole-grain bread or cereal, and other “health food” products. Although Davis often cited references to back what she said, investigators found that many of them did not actually support her claims. Moreover, she was sued successfully by parents of two children who were seriously harmed by her advice.99 Fredericks was described on some of his book jackets as “America’s foremost nutritionist.” He considered himself an expert and gave copious advice in books and articles for health-food publications. However, he had virtually no nutrition or health science training. He graduated from the University of Alabama in 1931 with a major in English and a minor in political science. In 1937 he began writing adver- tising copy for a vitamin company. He also gave sales talks, adopting the title of “nutrition educator.” In 1945, after investigators found that he had been diag- nosing patients and prescribing vitamins for their illnesses, Fredericks pleaded guilty to practicing medicine without a license and paid a small fine. He then obtained a master’s de- gree in education and a Ph.D. in communications at New York University. His doctoral thesis was based on the responses of listeners to his radio programs. For 30 years, beginning in 1957, he hosted “Design for Living,” a daily show on radio station WOR in New York City. Atkins, who practiced in New York City, claimed that “nutrition has been useful in just about every condition I have treated. . . . And there are probably herbal answers for every condition for which there is a pharmacological answer.” He was one of the first physicians to use the term “complementary medicine.” He considered Fredericks to have been his men- tor and took over Fredericks’ radio program after his death.7 Atkins advocated a low-carbohydrate (high-fat) diet that is still widely used today (see Chapter 12). Chapter Eleven Nutrition Fads, Fallacies, and Scams 219 macrobiotic diets Macrobiotics is a quasireligious philosophical system founded by the late George Ohsawa. (Macrobiotic means “way of long life.”) The system advocates a vegetar- ian diet in which foods of animal origin are used as condiments rather than as full-fledged menu items. The optimal diet is achieved by balancing “yin” and “yang” foods. Ohsawa outlined a 10-stage “Zen” macrobiotic diet in which each stage is progressively more restrictive. The diet was alleged to enable individuals to overcome all forms of illness, which Ohsawa said were due to excesses in diet. Current proponents espouse a diet that is less re- strictive but still can be nutritionally inadequate. They recommend whole grains (50% to 60% of each meal), vegetables (25% to 30% of each meal), whole beans or soybean-based products (5% to 10% of daily food), nuts and seeds (small amounts as snacks), miso soup, herbal teas, and small amounts of white meat or seafood once or twice a week. The leading American proponent has been Michio Kushi, a former student of Ohsawa, who founded the Kushi Institute in Becket, Massachusetts. Institute pub- lications recommend chewing food at least 50 times per mouthful (or until it becomes liquid), not wearing syn- thetic or woolen clothing next to the skin, avoiding long hot baths or showers (unless you have been consuming too much salt or animal food), having large green plants in your house to enrich the oxygen content of the air, and singing a happy song every day. Kushi100 claims that macrobiotic eating can help prevent cancer and many other diseases. He also presents case histories of people whose cancers have supposedly disappeared after they adopted the macrobiotic diet. Dwyer101 counters that there is no scientific evidence of benefit, and that the diet itself can cause cancer patients to undergo serious weight loss. Raso,102 who attended a macrobiotic seminar for professionals, reported that astrologic conditions, weather conditions, and a long list of other bizarre factors were said to be relevant to diagnosing patients. Lindner103 had a private consultation at the Institute as part of an assignment for American Health magazine. After examining Lindner’s face, the practitioner stated that Lindner’s kidneys were weak, he was slightly hypoglycemic, and his heart was enlarged because he ate too much fruit. He was also told that de- posits of fat and mucus were starting to build up on his intestines. In 2001, Kushi’s wife and colleague, Aveline, died of cervical cancer. According to an Associated Press obituary, she underwent standard radiation treatment when the cancer was discovered. When the cancer spread to her bones and she was told that no standard treatment was available, she relied on acupuncture and “Eastern” methods.104 dubious diagNostic tests Nutrition consultants, chiropractors, and small numbers of other licensed practitioners use a wide variety of tests as a basis for recommending supplements. The most widely used include hair analysis, “muscle-testing,” live-cell analysis, electrodermal testing, and a nutritional panel offered by a laboratory in Texas. Hair analysis is performed by obtaining a sample of hair, usually from the back of the neck, and sending it to a laboratory for analysis. The customer and the referring source usually receive a computerized printout that sup- posedly indicates deficiencies or excesses of minerals. Some also report supposed deficiencies of vitamins. The test usually costs from $60 to $135. Medical authorities agree that hair analysis is not ap- propriate for assessing the body’s nutritional state. It has limited usefulness as a screening procedure for detecting toxic levels of lead or other heavy metals. Hair analysis cannot diagnose vitamin deficiency because normally there are no vitamins in hair except at the root (below the skin surface). Nor can it identify mineral deficien- cies because the lower limits of “normal” have not been scientifically established. Moreover, the mineral compo- sition of hair can be affected by a person’s age, natural hair color, and rate of hair growth, as well as the use of hair dyes, bleaches, and shampoos.105 When 52 hair samples from two healthy teenagers were sent under assumed names to 13 commercial hair analysis laboratories, the reported levels of minerals varied considerably between identical samples sent to the same lab and from lab to lab. The labs also disagreed about what was “normal” or “usual” for many of the minerals. Most reports contained computerized inter- pretations that were voluminous, bizarre, and potentially frightening to patients. Six labs recommended food supplements, but the types and amounts varied widely from report to report. One report diagnosed 23 “possible or probable conditions,” including atherosclerosis and kidney failure, and recommended 56 supplement doses per day. Literature from most of the labs suggested falsely that their reports were useful against a wide va- riety of diseases and supposed nutrient imbalances.106 In 1985 the FTC secured a court order forbidding one laboratory from advertising to the public that hair min- eral analysis could be used as a basis for recommending supplements. For about 10 years, this order discouraged Part Three Nutrition and Fitness220 other companies from advertising directly to consumers. However, many Web sites are now marketing the test. In 1999, researchers from the California Department of Health107 located nine laboratories and sent identical samples to six of them. The reported mineral levels, the alleged significance of the findings, and the recommen- dations made in the reports differed widely from one to another. The researchers concluded that the procedure was still unreliable and recommended that government agencies act vigorously to protect consumers. Muscle-testing is part of a pseudoscientific system of diagnosis and treatment called applied kinesiology (AK). AK is based on the notion that every organ dysfunction is accompanied by a specific muscle weakness, which enables diseases to be diagnosed through muscle-testing procedures. Its practitioners, most of whom are chiro- practors, also claim that nutritional deficiencies, aller- gies, and other adverse reactions to food substances can be identified by placing substances in the mouth or using glass vials that the patient holds. “Good” substances will make specific muscles stronger, whereas “bad” sub- stances will cause specific weaknesses. “Treatment” may include special diets, food supplements, acupressure, and spinal manipulation. Applied kinesiology should be distinguished from kinesiology (biomechanics), which is the scientific study of movement. The concepts of AK do not conform to scientific facts about the causes of disease. Controlled studies have found no difference between the results with test substances and with pla- cebos.108 Differences from one test to another may be due to suggestibility, variations in the amount of force or leverage involved, and/or muscle fatigue. Live-cell analysis is carried out by placing a drop of blood from the patient’s fingertip on a microscope slide under a glass coverslip to slow down the process of drying out. The slide is then viewed with a dark-field microscope to which a television monitor has been at- tached. Both practitioner and patient can see the blood cells, which appear as dark bodies outlined in white. The practitioner may also make a videotape for himself and the patient. Proponents of live-cell analysis claim that it is useful for diagnosing vitamin and mineral deficiencies, enzyme deficiencies, tendencies toward allergic reac- tions, liver weakness, and many other health problems. Dark-field microscopy is a valid scientific tool in which special lighting is used to examine specimens of cells and tissues. Connecting a television monitor to a microscope for diagnostic purposes is also a legitimate practice. However, experts believe that live-cell analysis is useless in diagnosing most of the conditions that its practitioners claim to detect. Lowell,109 who observed several practitioners, noted that they failed to clean their microscope slides carefully between patients, which meant that dirt seen under the microscope would be misinterpreted as blood components. He also noted that one practitioner reported blood cell patterns that resulted from his microscope being out of focus. Cell changes also occur as the preparation begins to dry out. For several years, Infinity2, a multilevel company headquartered in Mesa, Arizona, marketed live-cell analysis through chiropractors, naturopaths, and “nu- tritional consultants.” In 1995 Dr. Barrett was tested by two Infinity2 distributors at a chiropractic convention. One diagnosed a mild B12 deficiency and “maldigestion” that could weaken the immune system and cause fatigue. The other said Barrett’s blood cells showed evidence of “liver toxicity,” “bacterial infection,” and “free radical damage.” The recommended “treatment” was enzyme pills, which Infinity2 marketed with claims that “en- zyme deficiency” is widespread among Americans. The company also maintained a telephone line for recording testimonials that were typed and “kept on file for future reference.” Electrodermal testing, which is discussed in Chapter 8, is done by connecting the patient to a device that sup- posedly measures “imbalances” in the flow of “electro- magnetic energy” and recommends dietary supplements, herbal products, and/or homeopathic products to correct the alleged imbalances. SpectraCell Laboratories of Houston, Texas, claims that its Comprehensive Nutritional Profile precisely measures an individual’s nutrient status more precisely than is done by standard tests. It further claims that the majority of Americans have nutrient deficiencies and that “intracellular nutrient deficiencies” even occur in over 50% of Americans who take multivitamins. The test is performed by placing lymphocytes (a type of white blood cell) from the patient’s blood into petri dishes containing various concentrations of nutrients. A growth stimulant is added and, a few days later, technicians identify the dishes in which “greatest cell growth” takes place, which supposedly points to a deficiency. Properly performed lymphocyte cultures have a legitimate role in medical practice, but they are not appropriate for general screening or for diagnosing “nutrient deficiencies” in the manner SpectraCell uses. The late Victor Herbert, M.D., J.D.,7 who helped develop the use of lymphocyte cultures for nutrition-related evaluations, stated that the test merely measures the amounts of nutrients stored in the lymphocytes at the time of the test and not whether the body has a shortage. He considered the test a gim- mick used to promote the sale of supplements. Chapter Eleven Nutrition Fads, Fallacies, and Scams 221 “Nutrient Deficiency” Questionnaires Some nutrition consultants and retailers use comput- ers to help them decide what to recommend. The tests usually involve completion of a dietary history and/or a questionnaire about symptoms that supposedly signify deficiency. Computer analysis of diet is a valuable tool that reputable nutritionists may find useful when appro- priate compu

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