Beans, greens, & tangerines.

Have you noticed that hospitals are expanding, pharmacies are popping up everywhere, and grocery stores are dedicating more and more shelf space to over-the-counter medications? An explanation for this, of course, is the aging baby boomer population and, as statistics indicate, we are living much longer lives than our recent ancestors. It sounds convincing enough, but many health practitioners aren't buying this as the whole story. These practitioners are leading a new movement in medicine, wanting their patients to experience a higher quality of life while a growing body of research is providing evidence that simple lifestyle choices are essential for optimal health. On your next visit to your doctor, don't be surprised if you walk out with a prescription in hand that reads: "Eat more beans, greens, and tangerines."

A dietary prescription like this is essentially what participants of the Duke University Diet & Fitness Center, a residential weight-loss program, can expect to hear. Not only will this be effective for losing weight, many will need to reduce or eliminate their medications, often within the first week because blood pressure levels plummet with a lifestyle practice that includes regular exercise, lower stress, and a diet moderate in sodium and rich in fruits and vegetables. Observations like these spurred researchers to design a study to answer the question: Just how effective can diet be---without weight loss, exercise, or stress reduction-at lowering blood pressure? The results of the landmark DASH (Dietary Approaches to Stopping Hypertension) study (l), published in the New England Journal of Medicine in 1997, were impressive: Individuals with mild to moderate hypertension could reduce blood pressure as effectively as if they were on medications by eating a diet with higher levels of fruits, vegetables, beans, and nuts. These findings were truly noteworthy for physicians that agree that the DASH diet, with a moderate reduction in salt intake (3,000 milligrams sodium), can be an enjoyable, Mediterranean-style diet. For more information, visit the website: www.nhlbi.nih.gov/health/public/heart/hbp/dash/

Studies confirm that it's harder to eat healthier when stuck on the convenience merry-go-round that includes sugary snacks and caffeinated drinks. While many of us believe that we are eating well enough, practitioners say they are seeing disease symptoms indicating the contrary. Dr. Russel Sher, founder of the Asheville Center for Health Excellence, says that many of his patients have a subclinical [not yet producing clinical symptoms] folate deficiency that contributes to poor health including depression, mood disorders, and over time, an increased cancer risk. Folate, which is found abundantly in beans, greens, and orange juice, is known to help prevent birth defects-but cancer? Noted Berkeley researcher Bruce Ames has studied the association for years and says that folate deficiency causes chromosomal breaks, a precursor to cancer. (2) It is estimated that ten percent of all Americans are folate-deficient, (3) while surveys show that thirty percent of the elderly population is not meeting the daily recommendation of 400 micrograms. (4) It stands to reason that with a lower intake of fruits, vegetables, beans, nuts, and whole-grains than our grandparents, nutritional deficiencies, even subtle ones, are bound to surface over time.

Liz Lipski, Ph.D, CCN, author of Digestive Wellness, says that many of the patients she sees in her practice are likely magnesium deficient, a problem she says can contribute to type 2 diabetes, headaches, cramping, and more. Magnesium, which is found most abundantly in whole grains, nuts, beans, and greens, is a cofactor in several enzymes critical for carbohydrate metabolism. A recent survey found that black women derive only 55 percent of the daily requirement of 320 milligrams from their diet and white women only 69 percent. (5) Scientists are finding that those who consume more dietary magnesium have less bone loss at the hip (6) and a significantly lower risk of diabetes, particularly for overweight women. (7)

And it's more than just folate and magnesium. Practitioners routinely see patients with low intakes of calcium, zinc, chromium, selenium, omega 3s, and other essential nutrients and are recommending dietary change as the remedy. While multiple vitamins are still advisable, the consensus is that they are not enough: a "one-a-day" is designed to supplement the diet. The best way to get these nutrients is through food.

It's common today to hear doctors advising us to eat more fish, but what if they told us to start ordering bean burritos with guacamole, hold the cheese? A quick glance at the diet of the world's inhabitants is telling: Americans don't eat many beans. A staple food for those living in Africa, the Middle East, India, Mexico, and Mediterranean countries, the average American eats a mere seven pounds each year (contrast this with 34 pounds for Americans of Mexican descent). Recently, headlines announced that beans are a source of potent flavonoids and have surpassed blueberries as the top antioxidant food. Beans, in addition to magnesium find folate, are an excellent source of fiber, a nutrient linked to lower heart disease, cancer, diabetes, and obesity risk.

At about the same time that Americans replaced beans with burgers, the dark, curly-leaved greens became just garnish adorning the salad bar. More and more practitioners today are recommending the regular consumption of collards, kale, spinach, broccoli, chard, and other leafy greens. There are many good reasons for this, including the fact that green leafies help improve blood sugar metabolism independent of fiber (8) and provide an array of nutrients including calcium, magnesium, vitamin K, vitamin C, and folate that are important for maintaining bone density. Greens happen to be the most concentrated source of vitamin K, a nutrient that activates osteocalcin and other bone proteins. In one study, those consuming at least 109 micrograms of vitamin K each day (the amount in one-half cup of spinach) had a significantly lower risk of hip fracture (9) (see Table 1).

Dr. Sher believes, "the media and various commercial interest groups have influenced the public perception that the solution to our disease symptoms are substances that manage symptoms rather than address root causes of illness." What effect could dietary change have if we took it seriously? The researchers that conducted the DASH diet estimate that if Americans made the switch to the DASH diet, our healthcare costs would be reduced by more than $40 billion annually. Hippocrates, the father of modern medicine, is often quoted as having said, "Let thy food be thy medicine and thy medicine be thy food." Rumor has it he loved beans, greens, and tangerines.

(1) Appel D, Moore TJ, Obarzanek E, et at. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336(16):1117-1124.

(2) Blount BC, et al. Folate deficiency causes uracil misincorporation into human DNA and chromosome breakage: implications fur cancer and neuronal damage. Proc Nail Acad Sci USA. 1997;94(7):3290-3295.

(3) Senti FR, Pilch SM. Analysis of folate data from the second National Health and Nutrition Examination Survey (NHANES II). J Hurt. 1985;115(11):1398-1402.

(4) Selhub J, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA. 1993;270(22):2693-2698.

(5) Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr. 2003;133(g):2879-2882.

(6) Tucker KL, et al. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727-736.

(7) Song Y, et al. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004;27(1):59-65.

(8) Sargeant LA, et al. Fruit and vegetable intake and population glycosylated haemoglobin levels: the EPIC-Norfolk Study. Eur J Clin Nutr. 2001 May; 55(5):342-8.

(9) Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr. 1999;69(1):74-79.

(10) US Department of Agriculture, Agricultural Research Service. Nutrient Database for Standard Reference, Release 17 (2004). Available at: http://www.nal.usda.gov/fnic/foodcomp/

Greg Hottinger, MPH, RD, is the nutritionist for the Duke University Center for Integrative Medicine and author of The Best Natural Foods on the Market Today: A Yuppie's Guide to Hippie Food (www.bestnaturalfoods.com). He is a regular contributor to New Life Journal.

Nutrient Content of Green, Leafy Vegetables (10)

Food (1 cup cooked)      Calcium     Vitamin K     Folate
                            (mg)         (mcg)      (mcg)

Collards                     266           836        177
Spinach *                    245           889        263
Turnip greens                197           529        170
Kale                          94          1062         17
Broccoli                      62           220        168
Mustard greens               104           419        102
Cabbage                       47            73         30
Lettuce (green), raw          20            97         21

* Calcium absorption from spinach is low (5%) due to
high oxalic acid content.