The Health Consequences of the American Diet, Part 2
This two-part interview is a sneak peek at Dr. Tieraona Low Dog’s book on the state of the American diet. Every physician will want to get a head start on using Dr. Low Dog’s advice in their daily practice.
Kimberly Lord Stewart: It seems our culture has lost some of what could be best thought of as old-fashioned common sense, and, in some cases, we are too risk averse. What examples do you see where we may have gone too far?
Dr. Tieraona Low Dog: Because of legitimate concerns for skin cancers, we have warned people about the dangers of excessive sun exposure. It is almost impossible to find a facial moisturizer that doesn’t contain an SPF of 15 or higher. Many public schools, at least in the Southwest, require parents to provide and teachers to apply sunscreen before recess. Slathering these lotions on skin may have reduced skin cancers but it is also a fact that many contain chemical ingredients that have been shown to have endocrine-disrupting properties. But even leaving that aside, the unintended consequence has been a reduced absorption of vitamin D. Exposure of our skin to sunlight is the way our body is supposed to maintain its stores of this powerful nutrient, as it is hard to get in our diet. Our work has also changed with many of us no longer toiling in the fields but spending much of our day indoors. The Endocrine Society recommends that our 25(OH)D level be at or higher than 30ng/mL (75 nmol/L) and yet the CDC reports that 66 million Americans have levels less than 20ng/mL. To be clear, we need vitamin D for far more than healthy bones. It is vitally important for cardiovascular, immune and respiratory health, as well.
KLS: You have long been an advocate for taking a multivitamin-mineral. With all the negative press and controversy, has your position changed?
TLD: Absolutely not, if anything, I believe the vast amount of evidence shows that many people in the United States (and other countries) do not get enough of the critical nutrients they need for vitality and health. Should you be able to get all the nutrients you need in your diet? Yes, with the possible exception of vitamin D. But the American diet would have to look a lot different from what it currently looks like. I think it’s a dangerous message to continue to tell the general public not to worry; they’re getting everything they need in their diet. That’s crazy! And it shows just how out-of-touch clinicians are when it comes to understanding essential nutrients.
Studies from the Centers for Disease Control show that more than 30 million people are deficient in vitamin B6. That’s more than all the people living in the entire state of Texas. Vitamin B6 is critical for many processes in the body, including the production of the neurotransmitters gamma-aminobutyric acid (GABA), which calms and quiets the nervous system; as well as serotonin, norepinephrine, and dopamine, which affect mood, pleasure, appetite, movement, concentration, digestion and more.
It is also required for the manufacture of melatonin, which not only maintains our sleep-wake cycle but also tightens the lower esophageal sphincter and shuts down stomach acid at night, preventing reflux and heartburn. Why are so many deficient? Probably a variety of reasons but one for sure: inflammation. As inflammation in the body rises, B6 levels plummet. This may be just one more reason why so many Americans are increasingly feeling depressed, fatigued, anxious, having insomnia, heartburn and difficulty concentrating.
As mentioned above more than 66 million Americans have insufficient levels of vitamin D and roughly a 1/3 of those have very low levels, which can lead to osteomalacia. Osteomalacia can cause a deep aching pain in the lower back, hips and thighs. The muscles become weaker and the bones more likely to break. Do you know how many older people describe these symptoms? How common it is for a 72-year-old to think that this is just a normal part of getting old? As our skin thins with age, it becomes more difficult to synthesize vitamin D, and many elders spend more time indoors. It’s not uncommon for them to be taking 1000 IU of vitamin D3 every day and still have a level of 9 ng/mL. It will take 6000 IU per day or 50,000 IU per week for 8-12 weeks, or even longer, to get their levels up to 30 ng/mL. And yet, we still argue about testing vitamin D levels.
We check cholesterol and blood sugar, we monitor thyroid. Why? Because it is only through a laboratory test that we can ascertain risk. You can’t tell by just looking at someone if their HDL is low or their fasting insulin is elevated. With all the evidence we now have for health benefits of vitamin D, it seems irresponsible NOT to check a level in someone who lives in more northern latitudes, spends much time indoors, is obese, has dark skin, etc.
I won’t go into detail in this interview but suffice it to say that there are also many medications that can deplete the body of essential nutrients. And there are few clinicians monitoring for these nutrient depletions. With more and more Americans becoming insulin resistant due to diet and lack of physical activity, and more and more Americans complaining of heartburn and reflux, we are going to see a tidal wave of B12 deficiency from the combination of metformin and PPIs that they will all be taking. When they develop diabetes, we’ll add a statin, in accordance to our new guidelines, and then an ACE inhibitor. Over the years, they will develop neuropathy and as a result we’ll throw in some Lyrica. The statins will cause their CoQ10 levels to decline, increasing fatigue and making their muscles weak, further decreasing physical activity. The PPI and ACE inhibitor will cause their magnesium levels to fall but, their cells will be starving before anyone realizes since few clinicians ever test RBC magnesium.
The low magnesium will worsen their diabetes, which will cause a further loss of magnesium, as well as thiamine. They will have more muscle cramping, their blood pressure will start to creep up, the bones and muscles weaken. Their memory and cognition and mood decline as B12 levels continue to drop. The CBC fails to show a megaloblastic anemia, so no one believes B12 is an issue, so it is never checked. Waiting for megaloblastic anemia to occur is kind of like insisting jaundice be present, before ordering a liver test. And many will be told that this is all just part of getting old.
So do I believe that many people would benefit from a basic multivitamin-mineral? Yes based upon their age, gender, lifestyle, life stage (pregnant, breastfeeding) and medication usage. I’m not a fan of “mega-dose” multivitamins. If you need a high level of a particular nutrient, you should take it separately, but you should take it with a full complement of other nutrients, as they are interconnected. For instance, most people know that iron absorption is enhanced with vitamin C. But riboflavin is also needed for the absorption and utilization of iron; a nutrient many teen girls are low in. Copper is needed to take iron to the bone marrow, and Vitamin A helps it partner with hemoglobin. This is why if you take an iron supplement, it makes sense to also take a basic multi.
About Tieraona Low Dog, MD
Tieraona Low Dog, M.D.’s exploration of natural medicine began more than 35 years ago as she studied midwifery, herbal medicine; massage therapy and martial arts before earning her medical degree from the University of New Mexico School of Medicine. An internationally recognized expert in the fields of integrative medicine, dietary supplements and women’s health, Dr. Low Dog was appointed by President Bill Clinton to the White House Commission on Complementary and Alternative Medicine Policy, served as the elected Chair of the US Pharmacopeia Dietary Supplements and Botanicals Expert Information Panel, and was appointed to the Scientific Advisory Council for the National Center for Complementary and Alternative Medicine.
She has been an invited speaker to more than 550 scientific/medical conferences, published 40 peer-reviewed articles, written 22 chapters for medical textbooks, and has authored five books, including three National Geographic books, Fortify Your Life, Healthy at Home and Life is Your Best Medicine. She has appeared on CNN, ABC’s 20/20, and is a frequent guest on the Dr. Oz show and NPR’s The People’s Pharmacy. She currently serves as the Fellowship Director for the Academy of Integrative Health and Medicine.