Chapter 11

Question 1

A disorder that impairs or disrupts normal body or organ functioning, and often produces characteristics signs and symptoms.

Answer 1

disease

Question 2

One class of disease caused by specific pathogens.

Answer 2

infectious diseases

Question 4

Against infectious diseases, the body’s best defenses are its own natural immunity and preventive measures provided by public health services known as what 2 things?

Answer 4

vaccines and sanitation

Question 5

Today’s predominant diseases are chronic diseases known as what (3)?

Answer 5

Chronic Diseases:
1.) Heart disease
2.) Cancer
7.) Diabetes

Question 6

Degenerative conditions or illnesses that progress slowly, are long in duration, and lack immediate cures. Limit functioning, productivity, and the quality and length of life.

Answer 6

Chronic Diseases

Question 7

In the United States today, more than 100 million people suffer some form of disease of the heart and blood vessels, collectively known as this. It’s a disease of the heart and/or blood vessels. Examples include: hypertension, coronary heart disease, and stroke. This disease claims the lives of more than 650,000 people each year in the United States and has been the leading cause of death in this country for decades. Represents a number of diseases rolled into one.

Answer 7

cardiovascular disease (CVD)

Question 8

Hardening of the arteries that is a major underlying cause of most forms of CVD, including hypertension. It’s an arterial disease characterized by deposits known as plaques along the inner walls of the arteries. Begins with damage to cells lining the arteries, caused by factors such as high blood LDL cholesterol, hypertension, diabetes, toxins from cigarette smoking, obesity, and certain viral and bacterial infections.

Answer 8

Atherosclerosis

Question 9

Worsens atherosclerosis. It is high blood pressure. PRIMARY cause of stroke.

Answer 9

hypertension

Question 10

What is the most prevalent (widespread) forms of CVD? Afflicting more than 100 million US adults, and its incidence has been rising steadily.

Answer 10

Chronic hypertension

Question 11

The ballooning out of an artery wall at a point that is weakened by deterioration.

Answer 11

Aneurysm

Question 12

A chronic, progressive disease characterized by obstructive blood flow in the coronary arteries. The coronary arteries are those that feed the heart muscle itself.

Answer 12

coronary heart disease

Question 13

A clot that travels through the circulatory system.

Answer 13

embolus

Question 14

The event in which an embolus lodges in an artery and suddenly cuts off the blood supply to a part of the body. Also thrombosis.

Answer 14

embolism

Question 15

Deposits of fat on the inner surfaces of arteries, an early stage in the formation of plaques.

Answer 15

fatty streaks

Question 16

foamy-looking cells formed during plaque formation: develop from white blood cells that, while clearing fat from plaques, become engorged with it.

Answer 16

foam cells

Question 17

sudden, unexpected cessation of the heartbeat, respiration, and consciousness, usually caused by a clot lodging in a coronary artery (thrombosis). If not quickly reversed, this is followed by death.

Answer 17

heart attack

Question 18

uncontrollable bleeding

Answer 18

hemorrhage

Question 19

any disease or disorder that affects the peripheral arteries, those that carry blood to the body’s organs other the heart.

Answer 19

peripheral artery disease

Question 20

mounds of lipid material mixed with smooth muscle cells and calcium that develop in the artery walls in atherosclerosis.

Answer 20

plaques

Question 21

The shutting off of the blood flow to a part of the brain by a thrombus, an embolus, or the bursting of a blood vessel.

Answer 21

stroke

Question 22

the event in which a thrombus grows large enough to close off a blood vessel and gradually cuts off the blood supply to a part of the body.

Answer 22

thrombosis

Question 23

a stationary blood clot in the circulatory system.

Answer 23

thrombus

Question 24

How damage involving Atherosclerosis forms over the years:

Answer 24

1.) Develop fatty streaks, especially at branch points
2.) Enlargement and hardening of these fat deposits to become plaques
3.) Narrowing and hardening of the arteries
4.) Inflammation, which produces abundant free radicals

Question 25

Atherosclerosis Plaque Development:
Inflammation leads to many more events. The immune system responds by sending white blood cells to the site to try to repair the damage. Particles of LDL cholesterol become trapped in the blood vessel walls, and these become oxidized by abundant free radicals produced during inflammation. White blood cells flood the scene to scavenge and remove the oxidized LDLs, and as they become engorged with oxidized LDL, they take on a foamy appearance (hence the name foam cells). Then these foam cells become triggers of oxidation and inflammation that attract more scavengers to the scene. The smooth muscle cells of the arterial walls proliferate in an attempt to heal the damage, but they, too, may become trapped in the plaques. Some plaques become covered with fibrous coatings; some are hardened by calcium deposits. Ultimately, many inner artery walls are virtually covered with rigid, disfiguring plaques.

Once plaques have formed, a spasm of an artery wall or a surge in blood pressure can tear the surface of a plaque, causing it to rupture. Then the body responds to the damage as to an injury—by clotting the blood.

Question 26

Atherosclerosis Blood Clot Formation:
Clots form and dissolve in the blood all the time, and when the processes are balanced, the clots do no harm. Blood clots are a normal and necessary response to injuries that bleed: they shut down blood flow and begin the healing process. In atherosclerosis, though, the balance is disturbed and clots form faster than they dissolve. Arterial damage, plaques in the arteries, and inflammation all favor the formation of blood clots.

Abnormal blood clotting can trigger life-threatening events. For example, a clot, once formed, may remain attached to a plaque in an artery and grow until it shuts off the blood supply to the surrounding tissue. The tissue starves, slowly dies, and is replaced by nonfunctional scar tissue. Such a stationery clot is called a thrombus, and the tissue death it causes is thrombosis. A clot can also break loose, becoming an embolus, and circulate in the bloodstream until it reaches an artery too narrow to allow its passage. Now called an embolism, the clot remains stuck there, and because the episode happens suddenly, the surrounding tissues die quickly. In either situation, once an artery is blocked, it may swell and its walls grow thin, so that it balloons out, becomes weak, and may burst (aneurysm). Once a blood vessel has burst, blood leaks rapidly from it (hemorrhage) and again, depending on the location, this may be disabling or fatal.
When the words cerebral (brain) or coronary (heart) modify the terms just introduced, they describe life-threatening events in the brain or heart. For example, such an event in the brain is called a stroke, and such an event in the heart is a heart attack.

Question 27

Atherosclerosis Raises Blood Pressure:
Plaques in arteries also promote and aggravate hypertension (high blood pressure). Normally, arteries expand with each heartbeat, accommodating the pulses of blood that flow through them, but arteries hardened and narrowed by plaques cannot expand, so the blood pressure rises. High blood pressure then becomes a symptom of atherosclerosis. Hardened arteries also fail to let the blood flow freely through the kidneys, which respond as if the blood pressure is low: they release hormones that stimulate the body to retain sodium and water. This, of course, enlarges blood volume and makes the blood pressure still higher in a vicious cycle.

Question 28

High Blood Pressure Accelerates Atherosclerosis:
High blood pressure also worsens atherosclerosis. High pressure damages the artery walls, making fatalities more likely. And because plaques are most likely to form at damage sites, atherosclerosis progresses most rapidly at those sites. Thus, the manifestation of each chronic disease precipitates and aggravates the other.

Question 29

Learn:
Atherosclerosis progresses rapidly in people with diabetes, blocking blood vessels and obstructing circulation. For an individual with diabetes, the risk of a future heart attack is roughly equal to that of a person without diabetes who has already had a heart attack.

Question 30

Carry cholesterol away from the body’s cells to the liver to be assigned to other uses or disposed of. Also carry proteins that inhibit inflammation, plaque accumulation, and lipid oxidation–all, valuable services to the body. Thus, low levels of this can contribute to the development of atherosclerosis.

Answer 30

HDL

Question 31

Triglyceride transporters. When these are high it promotes atherosclerosis. These high blood triglyceride levels are associated with a sedentary lifestyle, overweight and obesity (especially abdominal obesity), and type 2 diabetes.

Answer 31

(VLDLs) - LDLs

Question 32

The five member set of symptoms—high fasting blood glucose, central obesity, hypertension, low blood HDL, and high blood triglycerides—any three of which greatly increase a person’s risk of developing CVD. Also called insulin resistance syndrome. This syndrome underlies several chronic diseases and notably increases the risks of CVD and type 2 diabetes. Central obesity and insulin resistance are thought to be the primary factors in its development. Involves inflammation and elevates the risk of blood clotting.

Answer 32

metabolic syndrome

Question 33

Preventative Measures against CVD:

Answer 33

1.) Study Yourself: assess present health conditions, learn medical history and face lifestyle habits that are harming your health.
2.) Take Action especially if you already have disease/disorder to seek medical help and evaluate lifestyle choices
3.) Lose Weight if Overweight to improve blood pressure (hypertension), blood lipid and glucose response reducing CVD risk and diabetes
4.) Physical Activity: develop coronary arteries and nourish heart muscle, healthy body composition, raises HDLs, improves insulin response, quells inflammatory stimuli, and lowers blood pressure, LDLs, blood triglycerides, and blood glucose. Hormonal balance.
5.) Control Alcohol and Smoking

Question 34

Risk evaluation plays an important role in CVD intervention. The AHA, together with the American College of Cardiology, sets assessment standards for evaluating a person’s risk of developing CVD:

Answer 34

For adults who are 20 to 39 years of age, assessment of cardiovascular risk factors every 4 to 6 years is recommended. For adults who are 40 to 75 years of age, clinicians should routinely assess cardiovascular risk factors. If the risk is high, treatment guidelines define when physicians should prescribe cholesterol-lowering medications.

Question 35

The Centers for Disease Control and Prevention lists 5 major symptoms of a heart attack:

Answer 35

Pain or discomfort in the jaw, neck, or back

Feeling weak, light-headed, or faint

Chest pain or discomfort

Pain or discomfort in arms or shoulders

Shortness of breath

Importantly, women may or may not experience classic symptoms such as chest discomfort. Women are more likely to experience unusual fatigue, dizziness or weakness, nausea, and breaking out in a cold sweat.

Question 36

What organization estimates that a significant reduction in sodium intake could reduce by half the number of people requiring medication for hypertension and greatly reduce CVD mortalityMost authorities recommend that everyone, even those with normal blood pressure, restrict sodium intakes, not to exceed the DRI Chronic Disease Risk Reduction Level of 2,300 milligrams of sodium per day. Individuals with hypertension are advised to further limit sodium intake to 1,500 milligrams of sodium per day.

Answer 36

The World Health Organization (WHO)

Question 37

This mineral may help regulate blood pressure. The well-known relationship between sodium intake and hypertension may be modulated, in part, by this. Some research suggests that the benefits of reduced dietary sodium may be enhanced with greater intakes of this. Optimal blood pressure is most often observed when the diet is both low in sodium and high in this. Therefore, eating plans often recommended to prevent and treat hypertension, such as the DASH diet, emphasize this rich in fruits and vegetables while keeping sodium intake in check.

Answer 37

Potassium

Question 38

What is the richest food source of DHA and EPA, eicosanoid products of an omega-3 fatty acid, which oppose blood clots and support heart health? A diet that includes two fatty fish meals per week, as the AHA recommends, may therefore help to protect against blood clotting better than a diet that lacks fish. For people with heart disease, even more fatty fish than this is recommended, and a physician may prescribe fish oil supplements. However, as is true for most nutrients, too much is as bad as too little—DHA in large amounts may promote blood clots, so supplements should be taken only with a physician’s approval.

Answer 38

fish oil

Question 39

What are among the first in the body to be impaired by nutrient deficiencies or toxicities? When deprived of essential nutrients, these critical immune components dwindle in size and number, leaving the body vulnerable to infections.

Answer 39

immune tissues and cells

Question 40

Metabolic diseases characterized by elevated blood glucose arising from insufficient or ineffective insulin, or both.

Answer 40

Diabetes

Question 41

A condition in which the blood glucose concentration is above normal, but not high enough to be diagnosed as diabetes; a major risk factor for diabetes and cardiovascular diseases.

Answer 41

prediabetes

Question 42

Autoimmune disorder. A person’s own immune cells mistakenly attack and destroy the insulin-producing cells of the pancreas. The less common type of diabetes in which the pancreas produces little or no insulin. Accounts for 5-10% of all cases. It usually sets in during childhood or adolescence but it can begin at any age, even late in life. Although this is far less common, many adolescents and children under 20 have this and its becoming more widespread.

Answer 42

Type 1 diabetes

Question 43

The more common type of diabetes in which the body’s cells fail to respond to insulin. Although it appears later in life, it has been on the rise among children and adolescents, following current trends in obesity among US youth. There is an inadequate response of the body’s cells to the hormone insulin—that is, insulin resistance.

Answer 43

Type 2 diabetes

Question 44

In infants and children, destruction is rapid; in adults, it is slow. Eventually, the damaged pancreas no longer produces enough insulin to control blood glucose adequately. Then, after each meal, glucose concentration builds up in the blood, while body tissues are simultaneously starving for glucose, a life-threatening situation. The person must receive insulin from an external source to assist the tissues in taking up the glucose they need from the bloodstream.

Insulin is a protein, and if it were taken orally, the digestive tract would digest it. Insulin must therefore be taken as daily injections, inhaled in powder form, or pumped from an insulin pump that delivers it through a tiny tube implanted under the skin. Some insulin pumps also monitor blood glucose and report its levels throughout the day. Fast-acting and long-lasting forms of insulin allow more flexibility in managing meals and treatments, but users must still plan ahead to balance blood insulin and glucose consumption.

Answer 44

Type 1 Diabetes

Question 45

How Does Type 2 Diabetes Develop?
In type 2 diabetes, the body’s cells are deprived of some or all of the glucose energy they need, even as both glucose and insulin build up in the blood. The glucose that is circulating in the blood would normally enter cells freely with the help of insulin from the pancreas, but now the cells are failing to respond to it.

When the muscle, fat, and other cells become insulin resistant and fail to take up glucose from the blood, the blood glucose concentration rises. The pancreas responds by producing more and more insulin, but to no avail. Eventually, the overtaxed cells of the pancreas begin to fail and reduce their insulin output, while blood glucose soars farther out of control. Chronically elevated blood glucose taxes the kidneys with the task of excreting the excess (this produces the familiar diabetes symptom of sugar in the urine) and alters metabolism in virtually every cell of the body. Some cells convert excess glucose to toxic alcohols. In other cells, glucose becomes attached to working protein molecules, rendering them nonfunctional. When blood glucose is high and the cells are starved for energy, a triad of telltale symptoms appears:

Intense hunger, although there is plenty of glucose in the blood, the cells are starved for energy

Frequent urination, because the kidneys are filtering excess sugar out of the blood and having to draw water from the body to excrete it

Intense thirst, because the frequent urination brings about dehydration

Recognizing these symptoms and seeking medical help as soon as possible can often help to minimize the consequences of untreated diabetes.

Question 46

Diseases of Large Blood Vessels?
Atherosclerosis tends to develop early, progress rapidly, and become severe in people with diabetes. The interrelationships among insulin resistance, obesity, hypertension, and atherosclerosis help explain why the most common causes of death in people with long-term diabetes are heart attacks and strokes.

This close relationship between the CVD and diabetes is reflected in their risk factors. When you study the CVD risk factors listed in Table 11-3 (p. 402), it’s easy to spot their overlap with these three risk factors for type 2 diabetes:

Advancing age. Diabetes testing should begin at age 45 for everyone.

Family history (heredity). Having a close relative with type 2 diabetes increases the risk.

Overweight and obesity. Most, but not all, people with type 2 diabetes are overweight, and obesity can foster insulin resistance.

In addition, race and ethnicity affect diabetes risk: Black Americans, Hispanic Americans, certain Asian Americans, Native Americans, and Pacific Islanders all have increased risks for type 2 diabetes.

Question 47

Impaired Kidney, Eye, and Nerve Function:
In diabetes, the structures of the blood vessels and nerves become damaged, leading to diminished blood circulation and nerve function. Poor circulation leads to dry skin and a tendency to develop slow-healing injuries and infections. Critical organs become inefficient and begin to fail all over the body. Reduced blood flow to the kidneys damages them, often making it necessary to cleanse the blood outside of the body by means of kidney dialysis or, in late stages, to undergo kidney transplant. Poor circulation to the eyes impairs vision and can lead to blindness. Diabetes is the leading cause of both kidney failure and blindness in adults in the United States. Poor circulation at the extremities makes the peripheral nerves insensitive to the pain that would otherwise signal injury or infection, so injuries and infections of the feet and hands go undetected. These events can lead to death of tissue (gangrene), necessitating amputation of the affected limbs (most often the feet).

Question 48

Diagnosis of Diabetes can be made using any of several tests including this test that measures the current blood glucose concentration in a person who has not ingested any caloric foods or beverages for at least 8 hours; it can detect both prediabetes and diabetes. A clinician draws a patient’s blood after at least 8 hours of fasting and measures the glucose concentration. A healthy person’s blood glucose will fall within the normal range, but in a person with prediabetes it may still be high from the meal eaten the night before.

Answer 48

fasting plasma glucose test

Question 49

This can detect diabetes. Test a blood test that measures the percentage of hemoglobin (a blood protein) with glucose molecules attached to it. The test reflects how well blood glucose has been controlled over the past few months and can aid in diagnosing type 2 diabetes. Nonfasting test. a blood indicator reveals how well blood glucose has been controlled over the past few months. A registered dietitian nutritionist, a Certified Diabetes Educator, or a physician can help those with prediabetes or diabetes learn to manage their conditions.

Answer 49

A1C Test

Question 50

Learn:
A common misconception is that people with diabetes need only to omit sugary foods, but as far as blood glucose is concerned, the amount of carbohydrate matters more than its source. (Most carbohydrates become glucose during digestion and metabolism.) Sugar recommendations for people with diabetes are similar to those for the general population, which suggests limiting foods and beverages with added sugars. Of course, sugars and sugary foods must be counted as part of the daily carbohydrate allowance.

Question 51

Diet Recommendations for diabetes:
Effective medical nutrition therapy can help stabilize blood glucose, control blood lipids, achieve and maintain healthy body weight, and normalize blood pressure in people with diabetes. For an individualized approach, a person’s cultural pattern and preferences should be honored; and factors such as insulin use, other medication use, and blood pressure must be accommodated. Anyone with diabetes should pay strict attention to the Dietary Guidelines for Americans, particularly concerning intakes of nutrient-dense foods, sodium, saturated fats, and added sugars.

A wide variety of meal plans can meet these recommendations. People at risk for diabetes can do no better than to begin following these recommendations long before symptoms appear.

In conclusion, among the previous recommendations, research shows that these three lifestyle elements most consistently and dramatically reduce people’s risks of developing diabetes:

Achieving and maintaining a healthy body weight.

Adopting and maintaining a dietary pattern of regularly timed, healthy meals that are moderate in calories, low in saturated fat, and high in vegetables, legumes, fruit, low-fat or fat-free dairy products, fish, poultry, and whole grains.

Engaging in a program of regular physical activity.

Question 52

A group of diseases characterized by the uncontrolled growth and spread of abnormal cells. Unfortunately, given current trends, overweight and obesity may overtake smoking as the leading risk factor for this.

Answer 52

Cancer

Question 53

Cancer arises in the genetic material inside a person’s cells. The process, known as this, usually proceeds slowly and continues for several decades. It’s the process of cancer development It often begins when a cell’s genetic material sustains damage from a carcinogen such as radiation, a free radical, or another cancer-causing chemical. Damage from these insults occurs every day, but cells can often deflect or promptly repair it. If the damage is not repaired and the cell becomes unable to faithfully replicate its genetic material, it dies by way of a sort of cellular suicide, thereby preventing its progeny from inheriting faulty genes.

Answer 53

carcinogenesis

Question 54

Occasionally, a damaged cell doesn’t die off but continues to live and becomes unable to halt its own reproduction. In a healthy, well-nourished person, the immune system steps in to destroy such cells. If, however, the immune system falters, the damaged cell reproduces uncontrollably and the result is a mass of abnormal tissue—known as this.

Answer 54

tumor

Question 55

Life-threatening cancer begins with an event called this. An event, probably occurring in a cell’s genetic material, caused by radiation or by a chemical carcinogen, that can give rise to cancer.

Answer 55

initiation

Question 56

Following initiation, these, such as hormones or environmental factors, stimulate tumor growth. Factors such as certain hormones or environmental factors that do not initiate cancer but speed up its development once initiation has taken place.

Answer 56

promoters

Question 57

Following this, promoters, such as hormones or environmental factors, stimulate tumor growth. Then the tumor overwhelms the healthy tissue in which it developed, or exports its cells through the bloodstream to other parts of the body to initiate other tumors known as this.

Answer 57

metastasis

Question 58

Factors Affecting Cancers:

Answer 58

• Age
• Family History
• Chronic Inflammation
• Diet
• Weakened Immunity
• Infections
• Obesity and Estrogen
• Alcohol and Smoking
• Carcinogens in Red and Processed Meats
• Cooking Methods
• Irons
• Fried Foods

Question 59

Weakened Immunity?
The immune system can identify and fight cancer cells just as it fights allergens, toxins, and other foreign invaders. However, when immunity is weak, due to nutrient deficiencies, medical procedures, hormone treatments, or other influences, the body becomes defenseless against cancer development.

Infections?
Certain viral, bacterial, and parasitic infections present risks of particular kinds of cancer. (To give just one example, infection with human papilloma virus carries a risk of cervical cancer.) In many cases, the mode of action seems to be that these infections weaken the immune system’s cancer-fighting ability.

Obesity and Estrogen
Obesity is clearly a risk factor for cancers, especially those of the colon, endometrium, pancreas, kidney, esophagus, and breast (in postmenopausal women). These cancers originate differently depending on the organ. For example, in the case of breast cancer in postmenopausal women, the hormone estrogen is involved: women with obesity have more circulating estrogen than women who are lean do, because adipose tissue converts other hormones into estrogen and then releases it into the blood. In women of healthy weight, blood estrogen drops dramatically beyond menopause, but in obesity, fat tissue continues to produce estrogen beyond menopause, extending the exposure and increasing the breast cancer risk.

Carcinogens in Red and Processed Meats
Population studies spanning the globe for more than 30 years consistently report that diets high in red meat and processed meat increase the risk of colon cancer. Processed meats are listed among human carcinogens by the WHO. They contain additives, nitrites or nitrates, which contribute a pink color and deter bacterial growth in meats. In the digestive tract, nitrites and nitrates form other nitrogen-containing compounds that may be carcinogenic.

Cooking Methods
Cooking meats at high temperatures (frying, broiling) causes amino acids and creatine in the meats to combine and form carcinogens. Grilling meat, fish, or other foods—even vegetables—over a direct flame causes fat and added oils to splash on the fire and then vaporize, creating other carcinogens that rise and stick to the food. Smoking foods has the same effect. Eating these foods, or even well-browned meats cooked to the crispy, well-done stage, introduces carcinogens into the digestive system. A steady diet of foods containing these toxins can overwhelm defenses and increase cancer risk.

Iron
Iron, both from the diet and from body stores, is under study for links with promotion of colon cancer. How iron may promote cancer is not known, but iron is suspected because it is a powerful oxidizing agent that can damage DNA. A high-meat diet generously supplies iron and also correlates with colon cancer risks.

A Note about Environmental Carcinogens?
Environmental factors also present risks of cancer. Overexposure to the sun, especially without the use of sunscreen or protective clothing, incurs a risk of skin cancer. Exposure to radiation, as when a nuclear accident occurs, poses a cancer risk; and there are many other such cases. These are beyond this book’s scope.

Question 60

Cancer Prevention:
- First, a Note of Reassurance about Carcinogens in Foods
Many people want to avoid all foods that contain carcinogens. This is impossible, though, because all foods, even the purest wild and natural foods, contain carcinogens together with thousands of other chemicals and nutrients needed by the body. The body easily detoxifies the minute amounts of carcinogens that occur in common foods and fear is not warranted. Feel free to enjoy your coffee, toast, and coffee cake.

Some people also fear that food additives are carcinogenic. In this realm, too, fear is not warranted. Additives are held to strict standards in the United States. No additive approved for U.S. use causes cancer when used appropriately in food. Food contaminants may, however, enter foods by accident and may prove to be powerful carcinogens or be converted to carcinogens as the body breaks them down. Most contaminants are monitored in the U.S. food supply, and ordinarily they are present, if at all, in amounts much lower than would pose risks to consumers.

A key to evaluating the safety of foods is to note how frequently you eat them. Small quantities of a carcinogen in any food may add up to large quantities if you eat that food every day. Nutritionists encourage their clients to eat a “balanced and varied diet,” and that is the place to begin to craft a cancer-prevention strategy.

• Eat a Balanced and Varied Diet
• Fiber-Rich Foods:
  Many studies show that as people increase their dietary fiber intakes, their risks for colon cancer decline. Possible mechanisms of this protective effect include binding, diluting, and speeding removal of potential carcinogens from the digestive tract. If a meat-rich, calorie-dense diet is implicated in cancer causation, and if a vegetable-rich, whole grain-rich diet is associated with prevention, then wouldn’t vegetarians have a lower incidence of these cancers? They do.
• Whole Foods and Phytochemicals:
  ime and again in this book, but it bears repeating: whole foods, not single nutrients, are most influential in cancer prevention. Fruits and vegetables, for example, contain a wide variety of nutrients and phytochemicals that may reduce oxidative damage to cell structures, including DNA, the material of genes. In addition, some phytochemicals are thought to act as anticarcinogens, promoting the buildup of the body’s arsenal of carcinogen-destroying enzymes. Figure 11-10 displays cruciferous vegetables—broccoli, brussels sprouts, cabbage, cauliflower, collard greens, turnips, and the like which contain a variety of potentially protective phytochemicals. Research suggests that some of these phytochemicals may exert their protective effect by way of epigenetic actions (a topic of Controversy 13, p. 512). Also, of course, whole, plant-based foods are rich in fibers, whose cancer-opposing virtues have already been mentioned.

Cooking:
Consumers can take these steps to minimize carcinogen formation during cooking:

Marinate meats before cooking, and roast or bake them in the oven.

When grilling, line the grill with foil, or wrap the food in foil.

Take care not to burn foods.

In addition, limit intakes of crispy, browned French fries and chips and other well-browned foods.

Question 61

Absorption of Drugs and Nutrients:
The business executive described earlier felt the effects of chemical incompatibility. Acids from the tomato juice, coffee, and colas she drank before chewing the nicotine gum kept the nicotine from being absorbed into the bloodstream through the lining of her mouth as intended, and so did not quell her craving. Instead, it traveled to her stomach and caused nausea.

Similarly, dairy products or calcium-fortified juices interfere with the absorption of certain antibiotics. Drug label instructions, such as “Take on an empty stomach” or “Do not combine with dairy products,” help avert most such interactions.

Certain drugs can also interfere with the small intestine’s absorption of minerals. This interaction explains the experience of the tired 14-year-old. Her overuse of antacids neutralized her stomach’s normal acidity, on which iron absorption depends. The medicine bound tightly to the iron molecules, forming an insoluble, unabsorbable complex. Her iron stores already bordered on deficiency, as iron stores for young girls typically do, so her misuse of antacids pushed her over the edge into iron-deficiency anemia.

Chronic laxative use can also lead to malnutrition. Laxatives can carry nutrients through the intestines so rapidly that vitamins in the tract have no time to be absorbed. Mineral oil, a laxative the body cannot absorb, can rob a person of important fat-soluble vitamins and potentially beneficial phytochemicals by dissolving them and carrying them out in the feces.

Question 62

Metabolic Interactions:
The teacher who landed in the emergency room was taking an antidepressant medicine, one of the monoamine oxidase inhibitors (MAOI). At the party, he suffered a dangerous chemical interaction between the medicine and the compound tyramine in his cheese and wine. Tyramine is produced during the fermenting process in cheese and wine manufacturing. Table C11-2 lists some foods high in tyramine.

Table C11-2 Some Foods High in Tyramin
Aged cheeses

Aged meats

Alcoholic beverages (beer, wine)

Anchovies

Caviar

Fava beans

Fermented foods (sauerkraut, sausages)

Feta cheese

Lima beans

Mushrooms

Pickled fish or meat

Prepared soy foods (miso, tempeh, tofu)

Smoked fish or meat

Soy sauce

Yeast extract (Marmite); yeast supplements

The MAOI medication works by depressing the activity of enzymes that destroy the brain neurotransmitter dopamine. With less enzyme activity, more dopamine is left, and depression lifts. As a side effect, the drug also depresses enzymes in the liver that destroy tyramine. Ordinarily, the man’s liver would have quickly destroyed the tyramine from the cheese and wine, but due to the MAOI medication, tyramine built up and caused the potentially fatal reaction.

Phytochemicals in foods, spices, and herbal supplements also affect drug metabolism. A chemical constituent of grapefruit juice suppresses an enzyme responsible for breaking down many kinds of medical drugs. With less drug breakdown, doses build up to toxic levels in the body. A person who drinks either grapefruit or cranberry juice and also takes the blood-thinning drug warfarin may exhibit delayed blood clotting with dangerously prolonged bleeding times.

Question 63

Learn about Coffee:
Regarding moderate caffeine intakes, research is limited, but it mostly refutes any causative links between daily caffeine and cancer, cardiovascular disease, or birth defects. In fact, observational research suggests that consuming caffeine or coffee, including decaffeinated coffee, may reduce the risk of type 2 diabetes. Such correlations cannot establish cause, however. It may be that people who choose coffee over sugar-sweetened soft drinks take in fewer calories and weigh less, and that it is these factors that reduce diabetes risk. More research is needed to clarify these associations.