Nutrition Confusions - A Search for Evidence

by Jon Bjornstad

Senior Thesis submitted to Anthony Fink, Ph.D.
for the Comprehensive Requirement in Biology

June 1984

Do as little as possible to your food between the ground and the tummy.
- Scott Nearing, 1976

Table of Contents

Introduction  

The book, Are You Confused?, by Paavo Airola, was published in 1971. In it the author holds a kind of debate with himself about many important and controversial issues relating to food and health. Nutrition is a confusing subject. When I first saw the title of the book in 1976, I said to myself, “Yes, I am confused.” In the forward to the government publication, Dietary Goals for the United States, Senator George McGovern wrote:
The primary purpose of this report is to point out that the eating patterns of this century represent as critical a public health concern as any now before us.

We must acknowledge and recognize that the public is confused about what to eat to maximize health.

Are You Confused? changed not only my diet but my life as well. It began the series of changes that resulted in my returning to school to study biology and chemistry in preparation for entrance to graduate school in nutrition. It seems appropriate to satisfy the comprehensive requirement for my B.A. in biology by writing a Senior Essay on a topic related to nutrition.

Paavo Airola has a Ph. D. in biochemistry and an N.D. - a degree in naturopathy. The style of Are You Confused? (abbreviated hence AYC) reflects his education. It is a very persuasive combination of scientific evidence, common sense, and natural wisdom. The book is not a scientific treatise that proves everything it says. Dr. Airola wrote: (AYC pg. 13)

Because of space limitations and the desire to make this a short and easily read book, the presentation in this work is free from the usual references. I could have easily filled 25 pages or more with various references to substantiate every claim made. Those readers who are impressed by such voluminous references I advise to read my other works, which are richly documented, ... They contain the documented sources of scientific references for most of the claims presented in this book.
His other works are not richly documented.

The aim of this essay is to search for “scientific” evidence for the following questions about nutrition that were presented in AYC:

These 7 were chosen for no good reason. AYC has a controversial statement on almost every page!

Each section will have 4 parts:

I hasten to say that my search for evidence was not complete or exhaustive. I simply present what I found given the limited time and resources I had. The main sources I used were the standard reference work, Modern Nutrition in Health and Disease, and the journal articles listed in Cumulative Index Medicus from 1974 to the present.

Before treating the 7 controversial topics in nutrition I thought it relevant to discuss “certainty”. How sure can we be? Since absolute truth is rarely, if ever, possible, how sure should we be before making a conclusion?

ReferencesShow

Airola, P. O. (1971) Are You Confused? Health Plus Publishers, Phoenix Arizona

Airola, P. O. (1968) There is a Cure for Arthritis Parker Publishing Company, Inc., West Nyack, NY

Goodhart, R. S. and Shils, M. B. (1973) Modern Nutrition in Health and Disease, 5th edition, Lei and Feibiger, London

U.S. Senate Select Committee on Nutrition and Human Needs (1977) Dietary Goals for the United States 1st edition

Certainty  

Airola Said

From AYC pg 21:
Medicine and nutrition are not exact sciences. Medicine is an art more than a science. When any given drug, vitamin, or food brings about a different reaction in each individual, you can not talk about exact science. Scholastic dogmatism in the area of human nutrition, scientifically rigid adherence to a principle or tenet, without taking the varied and changeable human element into consideration, can only result in pseudo-science and confusion.

Evidence

Even with the best science (uninfluenced by commercial motives and personal prejudice) there is a limit to the “surety” of our knowledge.

McMullin (1981) has some important comments about this:

... since it is inappropriate to demand certainty of a properly scientific claim, an assertion that is expressly hypothetical in character must not, on these grounds alone, be treated as though it were somehow lacking in proper scientific status.

... since commercial interests are always deeply involved in patterns of food consumption, spokesman for the threatened interests will inevitably remind us that the supposed hazard has not really been proved. The implication is that a proof, an incontrovertible theoretical account of the processes involved, can properly be demanded of anyone who would seek to use science for the guidance of action. This is wrong, of course, but it can be very persuasive.

McMullin ends by quoting Aristotle:
It is the mark of an educated person to look for precision in each class of things just so far as the nature of the subject permits.
When the U.S. government published the “Dietary Guidelines” the issue of certainty in nutritional science was raised. Harper (1981) quotes C. T. Foreman, the Assistant Secretary of Agriculture:
We could have awaited unanimity, instead of accepting consensus [before publishing the guidelines]. We could also have waited for the millenium to dawn, for the cows to come home, and for the moon to be made of green cheese.
In “Dietary Goals”, the respected Dr D. M. Hegsted, professor of nutrition at Harvard, said:
There will undoubtably be many people who will say that we have not proven our point; we have not demonstrated that the dietary modifications we recommend will yield the dividends expected. We would point out to these people that the diet we eat today was not planned or developed for any particular purpose. It is a happenstance related to our affluence, the productivity of our farmers, and the activities of our food industry. The question to be asked, therefore, is not why should we change our diet, but why not?

Conclusions

All of these quotations speak very eloquently.

Even if scientists did all agree and could prove that a certain element of diet were harmful or beneficial, most people would still simply eat what they want. The healthfulness of a certain food item is usually the last thing considered. Custom, habit, social pressure, and psychological needs are very powerful influences.

There are many people, however, who are curious and are willing to change. For them, science and government have an obligation to provide the best available knowledge, certain or not.

Is everything published in an accepted, refereed scientific journal true? Even a cursory glance a the history of science will force one to answer, “Of course not!” How, then, is one to recognize truth? How to recognize “bad science”? These are hard questions, far beyond the scope of this little essay. I will simply note two fallacious tendencies that I felt as I was searching through those innumerable references:

ReferencesShow

Harper, A. E. (1981) “Human Nutrition - Its Scientific Basis” Nutrition in the 1980's: Constraints on our Knowledge Alan R. Liss, Inc., New York, pgs. 15-28

McMullin, E. (1981) “Certainty: The Elusive Goal” Ibid pgs. 3-14

U.S. Senate Select Committee on Nutrition and Human Needs (1977) Dietary Goals for the United States 1st edition

What are the consequences of eating too much protein?  

Airola Said

From AYC pg 31:
... too much protein in your diet can cause: A good rule to follow in regard to protein is: enough but not too much.
In his book on hypoglycemia (pg 78), Airola said:
We are so brainwashed by two decades of protein oriented propaganda that although we readily accept the fact that too much fat is harmful (although fat is vital in human nutrition), that too much carbohydrate is harmful (although carbohydrates certainly are important), and that too much of anything is not good, we have an almost allergic resistance to the mere suggestion that too much protein, also, can be harmful.

Evidence

I didn't find very much about this. Some references were unavailable. Many of the references in Airola's book on hypoglycemia were in a foreign language.

In Modern Nutrition in Health and Disease the authors first state these facts (pgs. 57-58):

Giving examples of Arctic explorers who lived for years mainly on meat, they conclude that “normal adults seem able to tolerate a protein intake far above actual requirements”. Infants and children, they say, do not do well on diets containing large amounts of protein. Citing a reference I was unable to get (Albanese and Orto 1963), they describe the “protein overload effect”:
Consumption of protein over and above the usual levels, namely 15% of the total caloric intake, can lead to increased water requirements and increased levels of end products of protein metabolism in the bloodstream. ... Excessive ingestion of protein may lead to fluid imbalances.
Apparently at one time it was thought that excessive protein intake would lead to hypertension, febrile disease, and kidney or liver disease. The authors (in Modern Nutrition) point out, though, that “these ideas have been abandoned”. They continue to say:
On the other hand, this should not be regarded as an indication for feeding excessive amounts of protein. There is no wisdom in prolonged feeding of diets containing more protein than 20% of the total caloric intake.

Conclusions

With so little evidence to draw on, I can't conclude very much.

Airola listed 8 consequences of excessive protein. The first 3 related to toxic residues seemed to be supported. The last 3 about various disease processes would appear to be pretty flimsy.

High levels of protein in the diet would probably imply a high level of fat and a low level of fiber and carbohydrate. This shifted balance could lead to various diseases that would not be attributable to the high level of protein alone.

ReferencesShow

Airola, P. O. (1977) Hypoglycemia: A Better Approach Health Plus Publishers, Phoenix, Arizona

Albanese, A. A. and Orto, L. A. (1963) Newer Methods in Nutritional Biochemistry Academic Press, New York, pgs. 1-112

Goodhart, R. S. and Shils, M. E. (1973) Modern Nutrition in Health and Disease, 5th edition, Lei and Feibiger, London

After heavy sweating do we need to replace the salt that was lost?  

Airola Said

From AYC pg 191:
To say that your body loses salt, which it needs, with sweat, is to display total ignorance of the body's inherent wisdom. The truth is, in fact, exactly the opposite: your body uses perspiration as a welcome opportunity to get rid of the undesirable, toxic salt from its tissues. To replace this salt, after your body has succeeded in excreting it with perspiration is to do your body a great disservice. ...

Your body does not need salt to perspire; it can perspire without it. I haven't used any salt to speak of for twenty-five years. I exercise and work very hard, run several miles each day, use a sauna once or twice a week - and sweat profusely. Often I spend several months in tropical heat and perspire gallons of water each day. My perspiration has no salty taste, and I have never experienced symptoms of salt deficiency. On occasions when I consumed salt unknowingly, however, I could taste it the next day in my perspiration.

Evidence

I found 4 papers and 2 books related to this topic but none directly addressed the question.

The mechanism of sweating was explained in the paper by Dobson and Sato (1972). In the eccrine sweat gland there is the Na-K-ATPase which pumps sodium into the intercellular canaliculus. The resulting osmotic gradient induces a water flow (sweat) across the cell from the extracellular fluid to restore osmotic equilibrium. This implies that the sodium content of the plasma and sweat will be equal. This model is confirmed by the fact that oubain, a specific inhibitor of Na-K-ATPase inhibits sweating completely.

Cage et. al. (1970) studied the effects of ingestion of large amounts of water on the sweat rate and sweat composition. Drinking 3 liters of water greatly increased the sweat rate but had no independent direct effect on the concentration of sodium in the sweat. Increasing amounts of water did increase the sodium concentration but no more that would be expected through increasing the sweat rate by increasing the temperature.

Allan and Wilson (1971) found that sweat sodium concentration increases with sweat rate and decreases with heat acclimatization. To explain the latter they discuss the fact that sodium is reabsorbed from sweat as it passes down the sweat duct. This reabsorption has a maximal rate which is increased by heat acclimatization.

If the previous two papers were somewhat confusing, that by Ohara et. al. (1974) was more so. These physiologists put people through the strangest things and measure everything they can. Then they try to relate everything to everything! The title of the paper looked promising but I couldn't make heads or tails out of their conclusions.

Of the two books, The Hunger for Salt gave the most relevant information. By devoting several hundred pages to it the authors reminded me of the role that habit and taste play in how much salt people prefer in their food. The minimal need for sodium is about 1 gram a day or less. That people use it in great excess of this implies that there are many other factors to consider beyond physiology. The book quotes Lapicquez:

The explanation of the use of salt is that it should be considered as a condiment and not a food. It is a substance agreeable and at the same time useful because of its action on the senses but not a substance necessary for the continued supplementation of the body.
The symptoms of sodium deficiency include: Two other things I gleaned from this book were the concepts of sodium balance and sodium status. One is in sodium balance if the amount of sodium ingested is balanced by the amount excreted (in urine, feces, or sweat). This equilibrium is maintained in northern Japan where the intake is 500-600 mmole/day and also in Brazil where the Yanomamo Indians consume 2-10 mmole per day. These two populations are both in sodium balance but have a greatly different sodium status. In certain individuals and under certain conditions of sodium overload the body cannot excrete all the sodium that was ingested. When the plasma concentration of sodium reaches a certain point the body takes steps to reduce it by increasing the blood volume and eventually the blood pressure. The alternative is to store the excess sodium in the tissues. To do so it must first be diluted sufficiently with water and this leads to edema. This is a simplistic explanation of complex physiological events but it should suffice.

Conclusions

Airola was wrong when he said that “we don't need sodium to perspire”. Sweating depends on the action of the enzyme Na-K-ATPase. We do need sodium to perspire and this can usually be supplied by the sodium in foods without added salt.

Salt is not “lost” when we perspire unless one also considers that water is lost when we urinate. That's how the body works! We should trust its wisdom.

Sodium is reabsorbed by the sweat glands so that there is a recycling effect.

Since plasma and sweat have the same sodium concentration one can conclude that sweating would have a more efficient cooling effect if the sodium concentration were as low as possible. For each mole of sodium pumped out, more water would be excreted thus giving more cooling power.

The story that Dr. Airola told about his perspiration tasting salty after unknowingly consuming salt is pretty convincing. It merely shows that his sodium status was very low and that on consuming excess salt he excreted it (through sweating). His urine would probably have tasted salty too!

A final point: what is excessive sweating? When the body is put under abnormal heat stresses and the sweating response is insufficient to cool the body, then one could probably say that the excreted salt would need to be “replaced” - the body was pushed beyond it limit. Rather than regularly taking salt tablets it would be wiser to avoid the extreme stresses in the first place.

ReferencesShow

Allan, J. R. and Wilson, C. G. (1971) “Influence of acclimatization on sweat sodium concentration” Journal of Applied Physiology 30(5): 708-712

Cage, G. W., Wolfe, S. M., Thompson, B. H. and Gordon, R. S. Jr. (1970) “Effects of water intake on composition of thermal sweat in normal human volunteers” Journal of Applied Physiology 29(15): 687-690

Denton, D. (1982) The Hunger for Salt Springer-Verlag, London

Dobson, R. L. and Sato, K. (1972) “The secretion of salt and water by the ecrine sweat gland” Archives of Dermatology 105:366-370

Fitzsimons, J. T. (1970) The Physiology of Thirst and Sodium Appetite Cambridge University Press, Cambridge

Ohara, K., Sato, H. and Takaba, S. (1974) “Correlative relationships of response patterns between body temperature, sweat rate, and sodium concentration in sweat during heat exposure in man” Japanese Journal of Physiology 24:19-34

How harmful are heated fats and oils?  

Airola Said

From AYC pg 97:
... besides altering the odor and flavor in oils and foods, the products of oxidation which cause rancidity are detrimental to health:

Evidence

A very recent review by Bruce Ames in Science (1983) and the responses that it generated show that the issue of rancid fats is still very much alive. Ames said,
... the amount of ingested oxidized fat my be appreciable. Unsaturated fatty acids and cholesterol in fat are easily oxidize, particularly during cooking. The lipid peroxidation chain reaction (rancidity) yields a variety of mutagens, promoters, and carcinogens. ... The colon and digestive tract are exposed to a variety of fat-derived carcinogens.
In response to Ames, Hunter (1984) stated:
There are no direct estimates of the amount of oxidized fat ingested by humans, and it is well recognized that the unpalatable nature of rancid fats precludes their ingestion in significant quantities.
Ames (1984) rebutted:
Appreciable amounts of lipid oxidation products may be found in palatable food. For example, Tsai et. al. have found significant amounts of cholesterol expoxide in commercial dried eggs, ... each averaging about 20 ppm although some samples reached 8 times this.

Even a small amount of oxidation which could be found commonly in cooking oil in restaurants and in fat would represent a level of 1200 ppm.

Hunter cited a study in which
animals consuming used frying fats as the sole source of fat in the diet throughout their life-span thrived as well as control animals consuming the same fat that had not been subjected to frying conditions.
It should be noted that Hunter is employed by the Institute of Shortening and Edible Oils.

To understand the rancidity reaction I looked at the very extensive review by Artman (1969). He begins his 80 page review like so:

The central question to which this review is directed is this: “Are fats that have been heated in cooking harmful to people who consume them?” The weight of available evidence answers this question with a strong 'No' But since direct experimentation relative to this question is impossible, investigators have used many different, indirect approaches and have come up with quite disparate results, conclusions, and implications.
Rancidity occurs via these steps. Exposure to air causes antioxidants to be consumed and free radicals (R) are formed. Light and the presence of transition metals accelerates this process.

The kinetics and mechanism of these reactions has been well studied. The length of the induction period is shortened by and the rate of oxidation is increased by: increases in temperature, irradiation, increasing surface to volume ratio, and increasing unsaturation of the fatty acids. Once the hydroperoxides have been formed, a host of other secondary oxidation products ensue.

Artman goes on to cite an endless number of studies of feeding heated and oxidized fats and oils to rats. The results of the studies varied widely as did the kind of lipid used and the degree to which it was abused. It's hard to conclude anything. Ames (1984) simply said,

Rodent feeding studies with oxidized fat have not yielded definitive results.
4 recent papers were found related to this topic. McMurray and Rice (1981) state that it is important
... to ensure that unsaturated fatty acids are used correctly. Molecular damage resulting from peroxidative pathways can result in alteration in lipids (membranes), proteins (enzyme activity) and nucleic acids. This gives considerable potential for both short and long term pathogenic processes. Thus, where the consumption of unsaturated fatty acids occurs and especially where their use is actively encouraged, care must be exercised to ensure that tissue peroxidation is not an extremely unpleasant sequel. Vitamin E and selenium dietary intake levels must be adequate to ensure that this is not the case.
Alexander (1977) fed rats a variety of oxidized fats and did histopathological evaluation of the heart, liver, and kidney tissues. He observed cellular damage including pyknosis, vacuolization of the cytoplasm, and mitotic aberrations. He concludes:
It is obvious that the thermally oxidized fats were more damaging to the organs of the rats than the fresh fats.
Chang et. al. (1977) did a survey of fats actually used in commercial frying operations. They also did an extensive fractionation and identification of the volatile decomposition products of 4 fats and found a total of 211 different compounds! They conclude:
There is no doubt that overused or highly abused frying oil contains oxidized and polymerized materials which are harmful to human health. ... A quick, simple, and dependable test must be deveoped to allow those who conduct deep fat frying to determine the point at which a batch of frying oil must be discarded.
Billek (1979) analyzed the effects of heated sunflower oil on rats and estimated the point at which such oil would be harmful to humans.

Conclusions

If I had only read the review by Artman I would have thought that Airola was exaggerating the harmful effects of rancid oils. Artman's review was 15 years ago and the question is still being actively debated and studied. It seems wise to exercise caution.

Airola recommends using only sesame and olive oil as these have special factors to retard rancidity. He describes a kind of “water frying” where oil is put on top of a sheet of boiling water and this used to saute until the water is gone. This prevents the oil from being heated over 100° C. For baking purposes he recommends butter over oil. These practices are simple to follow. In the words of former president, Jimmy Carter,

Why not the best?

ReferencesShow

Alexander, J. C. (1977) “Biological effects due to changes in fats during heating” Journal of the American Oil Chemists' Society 55:711-717

Ames, B. N. (1983) “Dietary carcinogens and anti-carcinogens: Oxygen radicals and degenerative disease” Science 221:1256-1264 Ames, B. N. (1984) Letter to editor Science 224:759-760

Artman, N. R. (1969) “The chemical and biological properties of heated and oxidized fats” Advances in Lipid Research Academic Press, New York pgs. 245-330

Billek, G. (1979) “Heated oils - chemistry and nutritional aspects” Nutrition and Metabolism 24 (supplement 1):200-210

Chang, S. S., Peterson, R. J. and Chi-Tang, H. (1978) “Chemical reactions involved in the deep fat frying of foods” Journal of the Americal Oil Chemists' Society 55:718-727

Hunter, E. J. (1984) Letter to the editor Science 224:659-660

How harmful is the substance solanine that develops in potatoes exposed to light?  

Airola Said

In The Airola Diet and Cookbook (pg 35), but not in AYC, Airola describes the many virtues of potatoes and goes on to say:
Watch out for solanine, a highly toxic chemical which develops in potatoes when they are exposed to light. ... Solanine can be present in harmful quantities long before the development of a detectable tell-tale green color. ... Solanine is located in the skin, under the skin, and also in the “eyes” of the potato.

Evidence

Ames (1983) mentioned solanine in his paper and pointed to the exhaustive review of solanine by Jadhav et. al. (1981). This study is 80 pages long with 250 references! I was really blown away by the magnitude of the research into this one topic. Most people don't know anything about solanine. From this review I will extract 5 things - the structure of solanine, its distribution in the plant, conditions which encourage its development, its toxicity, and its physiological purpose.

Solanine is only one of many glycoalkaloids found in potatoes. Alpha solanine is the major one and has this structure:

Solanine is present in most tissues of the plant. In the tubers it is concentrated in the peels and sprouts and around the eyes. The concentration is arranged in a descending gradient from the outside inward. Little or none is found in the pith and only small amounts in the intermediate region.

Solanine can form when potatoes are exposed to light. Such exposure also induces “greening” that indicates that chlorophyll has formed. The formation of chlorophyll parallels that of solanine but it actually independent from it. In different cultivars solanine content can range from 1.8 to 25mg/100g of fresh tissue. One study found a cultivar, Katahdin, which, although greening the least, contained the maximum amount of glycoalkaloids (88mg/100g of peel). Solanine content can be affected by soil, climate, environment, maturity, storage temperature, and physical stresses.

Jahdev et. al. tell several stories about the toxicity of solanine. The most recent one was in 1979 in England where 78 school children were served (accidentally, of course) potatoes containing 33m/100g of glycoalkaloids. 17 required hospitalization some for nearly a week. Jahdev comments,

The episode serves as a reminder that in spite of the usual care taken to provide a toxicity-free meal, incidences of poisoning from potatoes high in alkaloid content was possible, even in modern times.
Ames states that >20mg/100g of glycoalkaloids is a toxic level for man. Solanine is toxic because of it anticholinesterase activity and possible teratogenicity.

Potatoes develop solanine because it gives the plant disease and insect resistance. Ames (1984) concludes:

Plants have been devising nasty chemicals to kill of insects and animals throughout all of evolution. There is not reason to think nature is any more benign than man.

Conclusions

Airola is right. Potatoes can be a dangerous food if they aren't stored properly. He doesn't suggest eliminating them from the diet but his advice to be aware seems wise.

My mother always peels potatoes before she cooks them. I thought this wrong because of the loss of vitamins and minerals from the skin. In view of the higher concentration of solanine in the peel I now see that this wasn't so dumb after all. The advice she was following from The Joy of Cooking may have been an example of “natural wisdom”.

To the objections of those who say that the small amount of solanine in potatoes cannot have much effect, I quote Ovid:

Add little to little and there will be a big pile.

ReferencesShow

Airola, P. O. (1981) The Airola Diet and Cookbook Health Plus Publishers, Phoenix, Arizona

Ames, B. N. (1983) “Dietary carcinogens and anti-carcinogens” Science 221:1256-1264

Ames, B. N. (1984) Letter to editor Science 224:668-669, 759-760

Jahdav, S. J., Sharma, R. P. and Salunkha, D. K. (1981) “Naturally occurring toxic alkaloids in foods” CRC Critical Reviews in Toxicology 9:21-99

What are the consequences of the pasteurization and homogenization of milk?  

Airola Said

From AYC pg 84:
... today's milk is unfit for human consumptiom. ... It is contaminated with antibiotics used to combat disease in cows., DDT and other pesticides, herbicides, and detergents used in the washing of milk machines.

Pasteurization of milk was originated to protect the consumer from disease-causing bacteria that may be transmitted with milk. But pasteurization also destroys the nutritive value of the milk. It kills not only the harmful bacteria, but also all the beneficial enzymes and the beneficial bacteria present in milk. It destroys some of the vitamins. It changes the chemical structure of the protein and renders it, and the minerals, less digestible and assimilable. ...

Only the highest quality, uncontaminated, raw milk from healthy animals can be considered as a healthful addition to your diet.

Evidence

I found 3 kinds of evidence:
  1. The large book by Webb et. al. (1974) which tells everything one ever wanted to know about milk.
  2. Papers about the immunological properties of raw and unpasteurized milk.
  3. I called the Alta-Dena dairy in Southern California and asked them to send me some information. Their propoganda was informative but it's hard to know if it is trustworthy. They cited scientific studies by Wulzen and Bahr; Annand, J. C.; and Oster, Kurt A. but gave no specific references.

In discussing homogenization, Webb et. al. (1974) say (pg. 572):

The normal characteristics of milk are profoundly altered by the homogenization process. Although these effects are most obvious in the characteristics of the lipid phase, subtle but significant changes in the characterisics of the plasma protein are affected which seem to contribute materially to the overall characteristics of homogenized milk. In many aspects, homogenized milk represents a denatured form of its non-homogenized counterpart.
They summarize the changes induced by homogenization (pg 574):
As a consequence of the increased dispersion of the lipid phase and its resurfaced, interfacial boundary, many interesting and profound changes in the characteristics of milk result from homogenization. Homogenized milk is whiter in appearance, bland in flavor, less heat stable and more sensitive to light-induced deterioration, less susceptible to copper-induced oxidative changes, and has greater foaming capacity and lower curd tension than non-homogenized milk. Above all, the lipid phase in properly homogenized milk exists as a stabilized emulsion.
The purpose of the pasteurization of milk is to protect it from pathogenic bacterial contamination. What does pasteurization actually mean? Webb describes a range of treatments:

61.8° Cfor 30 minutes
71.8° Cfor 15 seconds
87.8° Cfor 20-40 seconds
93.4° Cfor 3 seconds
149.5° Cfor 1 second
As the heating becomes more intense the milk will have a longer and longer “shelf life”. Associated with this heat treatment are many effects on other substances in the milk. Webb did not summarize these effects but I have gathered them from various chapters. The losses of vitamins are approximately: thiamine 5%, biotin 10%, folacin 12%, B12 4-10%, C 20%, and the others very little.

Heat treatment is known to cause reduction of both the total soluble and ionic calcium. Under pasteurization conditions, the reduction is slight, but significant losses of soluble calcium and phosphorous occur above 76° C. ...

The influence of heat on the natural state of milk protein is substantial. ...

Minimum pasteurization processes do not materially alter the physical behavior of the lipid phase.

The two papers on the immunological properties of milk view the matter from opposite sides. Pahud (1981) show that antibodies in milk confer a certain antibiotic protective effect against pathogenic E. Coli. These antibodies would be altered and inactivated by pasteurization. Kilshaw et. al. (1982) found that pasteurization “reduces the immunological sensitizing capacity of cow's milk protein” - in other words, makes it less allergenic.

The propoganda from Alta-Dena emphasized that the sanitary standards they follow are much stricter than those dairies producing pasteurized milk. They did not say that their milk was freer of toxic contaminants such as antibiotics, pesticides, or detergents.

Conclusions

Alta-Dena dairies (also Millers in Sebastopol) show that it is possible to mass produce raw milk for a price that is not significantly higher than “normal” milk.

Milk is changed drastically by homogenization and pasteurization.

Is homogenization performed solely to preven the separation of the lipids? Is it done purely for aesthetics? Wouldn't it be better to simply invert the milk container before pouring? Milk scientists will probably say that the effects of homogenization is innocuous. Why should we trust them when the alternative is so simple?

I think Airola is right in this case. The evidence supports him. If the price difference between “normal” milk and raw certified milk is not too much, it's clear, raw milk is better.

ReferencesShow

Kilshaw, P.J.; Heppell, M. J.; and Ford, J. E. (1982) “Effects of heat treatment of cow's milk and whey on the nutritional quality and antigenic properties” Archives of Disease in Childhood 57:842-847

Pahud, J. J.; Hilperd, H.; Schwartz, K.; Amster, H.; and Smiley, M. (1981) “Bovine milk antibodies in the treatment of enteric infection and their ability to eliminate virulent factors from pathogenic E. Coli” Advances in Experimental Biology and Medicine 137:591-598

Webb, B. H.; Johnson, A. H.; and Alford, J. A. (1974) Fundamentals of Dairy Chemistry 2nd edition, The AVI Publishing Company, Wesport, Connecticut.

Does juice fasting and a lacto-vegetarian diet help arthritis?  

Airola Said

Airola wrote a whole book entitled, There IS a Cure for Arthritis (1968), on how arthritis is treated with juice fasting and a lacto-vegetarian diet in numerous clinics in Europe. He did not claim it was an instant cure nor an easy one but did make one aware that there was indeed some promise in that direction.

Evidence

The paper by Skoldstam et. al. (1979) caught my eye as I was flipping through the Index Medicus. The research was done because of the increasing interest in Sweden about the effects of juice fasting and lacto-vegetarian diet. The orthodox medical community was moved to action by the “faddist health farms”.

Skoldstam et. al. tried to imitate the practice of the “health farms” - this included fasting for 7 to 10 days using juices, teas, and a vegetable bouillon followed by a lacto-vegetarian diet for 9 weeks. Prior to fasting a purgative of castor oil was given and during fasting water enemas were used twice daily. This is very different from the orthodox drug therapy!

The results were interesting but not conclusive:

... fasting brings temporary improvement to patients with rheumatoid arthritis. The most striking effect was the feeling of reduced pain and stiffness reported by most patients; an impression which was strengthened by the significant reduction in average drug intake by the fasting group.

... In only one patient did improvement persist after 9 weeks of the diet.

... The beneficial effecs of fasting for 10 days are not long lasting, and would seem to be an insignificant gain with regard to the chronic character of RA.

... We believe our findings are of interest, but that they need to be confirmed by further investigation.`

An aside: do all journal articles end with the refrain, “further investigation is needed”?

Conclusions

The results of the study weren't too convincing. Airola would probably say that the fasting and diet would need to be continued over a longer period for the lasting effects to be gained. In his book (pg. 92) he describes one woman who achieved a complete and lasting cure of her “incurable” arthritis but only after 2 years of periodic fasting and diet and various treatments. He emphasized that “it takes time”.

As I scanned through the Index Medicus I noticed that foreign countries do a different “style” of research. I saw that research on fasting was mainly done in Germany and Russia but no where else. Interesting. To what extent do scientists learn from each other? How much interest is there in what other nations are doing? Is there a certain provincialism even in science?

Dr. Airola is an international citizen. He was born in Finland, educated in Sweden, England, and Russia, is a Canadian citizen, lives in Phoenix, and works in Mexico.

The study by Skoldstam et. al. was supported by a grant from the Swedish National Association Against Rheumatism. Would the corresponding organization in the U.S. have supported such a study?

ReferencesShow

Airola, P. O. (1983) There IS a Cure for Arthritis Parker Publishing Company, Inc., West Nyack, NY

Skoldstam, L.; Larsson, L. and Lindstrom, F. D. (1979) “Effects of fasting and lacto-vegetarian diet on rheumatoid arthritis” Scandinavian Journal of Rheumatology 8:249-255

Are vegetarians healthier?  

Airola Said

In AYC pg 34-35:
Some popular health writers will tell you that meat eaters are healthier than vegetarians. Haven't they ever met Seventh-Day Adventists? There are a million of them, mostly living right here in the United States. Seventh-Day Adventists supply grand scale scientific evidence supporting the low-animal protein diet.

A recent study conducted by several medical doctors, show that Seventh-Day Adventists, who do not eat meat for religious reasons, have:

... The above is an extraordinarily remarkable scientific study made by reputable medical men and reported in the Journal of the American Medical Association which shows that a large group of people, who live in the United States under seemingly the same conditions as the rest of us, but do not eat meat, have such superior health compared to the rest of Americans!
He goes on to give many examples of healthy vegetarian or near-vegetarian cultures around the world.
There is no better way than the empirical way to prove any nutritional theory. If one can put the theory into practive and see what results if has produced through the centuries, even milleniums, of actual application - then it is worth more than bookshelves of scientific reasoning and laboratory proofs.

Evidence

It was easy to find studies on vegetarians. I will briefly indicate the main findings from the 16 papers I chose.

The first one (Lemon and Walden 1966) is the one quoted by Airola in the excerpt above. It is a study about respiratory system disease and its relation to smoking. It makes no mention of diet. It is a remarkable study and speaks well for the Seventh-Day Adventist (SDA) lifestyle but one can't draw any conclusion about vegetarianism.

Phillips observes that

... cancer mortality rates in SDAs are 50 to 70% of general population rates for most cancer sites that are unrelated to smoking and drinking.
He studied the existing data and suggested that “the apparent reduced risk of cancer death in all Adventists may be due to selective factors related to who chooses to become and remain a SDA.” He studies colon cancer specifically, however, and concluded that the “lacto-vegetarianian diet may protect against colon cancer.”

Armstrong et. al. (1977) studies blood pressure in SDAs. He noted a significant difference between the SDAs (128/76) and the control group (139/84) and made an extensive discussion of what factors could be responsible. SDAs differed from the control group in many ways other than their diet.

Goldberg et. al. (1976) studies the fecal microflora of SDAs and a control group and found no statistically significant differences.

Kinlen et. al. (1983) did a proportionate study of cancer mortality among members of a vegetarian society in England. This type of study will only show what vegetarians are likely to die of, not whether they are healthier. The only major disease group to show a reduced proportion of deaths was respiratory disease which is consistent with the evidence that vegetarians smoke less than the average.

Rouse et. al. (1983a, b) studied blood pressure on a vegetarian diet. This was a well designed study. It seems best to simply quote the abstract in full:

59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a control group, which ate an omnivorous diet for 14 weeks, or to one of two experimental groups, whose members ate an omnivorous diet for the first 2 weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental periods. Mean systolic and diastolic blood pressures did not change in the control group but fell significantly in both experimental groups during the vegetarian diet and rose significantly in the experimental group which reverted to the omnivorous diet. Adjustment of the blood-pressure changes for age, obesity, heart rate, weight change, and blood pressure before dietary change indicated a diet-related fall of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the nutrient(s) causing these blood-pressure changes are unknown, the effects were apparently not mediated by changes in sodium or potassium intake.
Dwyer et. al. (1980b) studies the intelligence of vegetarian children and found that they had mental ages over a year beyond their cronological age (61.6 vs 49.1 months). They comment:
No matter what type of diet they eat, educated parents are likely to have bright children, provided that basic nutrient needs are met. Therefore, it is unlikely that the omnivores and beef-eaters of the world would need to worry that this particular aspect of their life styles is doing violence to their children's I.Q.
Dywer et. al. (1978, 1980a) studied vegetarian preschool children and found them to be shorter, lighter, and leaner than their “normal” counterparts.

Graves et. al. (1980) studied bone mineral mass in vegetarian and omnivore women aged 30-60. They compared their results with a similar study of women aged 60-90 and concluded that:

A lacto-vegetarian diet may be beneficial in extended protective health care in terms of defense against, or control of, bone mineral loss in the later years of a woman's life.
Harland and Peterson (1978) examined the nutritional status of a community of Trappist monks and found nothing remarkable except that they needed a little nutrition education.

Began and Brown (1980) studied “new” vegetarians. They found that they were “extremely lean” and that their nutritional status was acceptable with respect to most nutrients.

Register and Sonnenberg (1973) review the literature on vegetarianism and conclude that “a well planned vegetarian diet (with or without milk or eggs) can easily supply sufficient amounts of all known nutrients.” This was established 30 years ago by Hardinge and Stare (1954) and I find it curious that it is still being written about. On obtaining sufficient protein they quote Hegsted:

It is difficult to obtain a mixed vegetable diet which will produce an appreciable loss of body protein without resorting to high levels of sugar, jams, jellies, and other essentially protein-free foods.
This sounds like something Airola said in AYC (pg 33):
It is virtually impossible to not get enough protein in your diet provided you have enough to eat of natural, unrefined foods. The proponents of a high protein meat diet often refer to the big-bellied, starved African children as an example of protein deficiency. These children suffer from protein deficiency not because they eat a protein-deficienct diet, but because they are starving.
In 1980 the American Dietetic Association issued a “position paper” on the vegetarian approach to eating. It is a very good review of the types of vegetarians, the sufficiency of well planned diets, and the times when more attention needs to be given to the diet (pregnancy, lactation, childhood). Two quotes from this paper:
Many omnivore diets fail for one reason or another to provide nutrient intakes which are likely to result in satisfactory nutrient status. Any evaluation of vegetarian diets must be made within this overall perspective.

The ADA recognizes that a growing body of scientific evidence supports a positive relationship between the consumption of a plant-based dietary and the prevention of certain diseases. It is recognized that this relationship has been established, in the main, from animal experimentation and epidemiologic studies. The ADA encourages scientifically controlled, long-term, prospective follow-up studies which should provide more conclusive evidence.

Conclusions

All of these studies agree that a well-planned vegetarian diet is possible - that people can choose to follow such a diet and remain healthy. Many of the studies indicate that the diet may be associated with lower incidence of certain diseases - heart disease, cancer, obesity, osteoporosis, dental caries, etc. As is usual in such relationships, there are doubts about exactly what factors are involved - it may not be the vegetarian diet per se but the lower overall fat or increased fiber.

Airola was right but he could have been more accurate in his quoting of the JAMA study of Seventh-Day Adventists.

ReferencesShow

American Dietetic Association (1980) “Position paper on the vegetarian approach to eating” Journal of the American Dietetic Association 77:61-69

Armstrong, B.; Van Merwyk, A.J.; and Coates, H. (1977) “Blood pressure in Seventh Day Adventist vegetarians” American Journal of Epidemiology 105(5):444-449

Bergan, J. G. and Brown, P. T. (1980) “Nutritional status of 'new' vegetarians” JADA 76:151-155

Burch, P. R. J. (1983) Letter to editor Lancet September 24:743

Dwyer, J. T.; Palombo, R.; Thorne, H.; Valadian, I.; and Reed, R. B. (1978) “Preschoolers on alternate life-style diets” JADA 72:264-270

Dwyer, J. T.; Andrew E. M.; Valadian, I.; and Reed, R. B. (1980a) “Size, obesity, and leanness in vegetarian preschool children” JADA 77:434-439

Dwyer, J. T.; Miller, L. G.; Arduino, N. I.; Andrew, E. M.; Dietz, W. H.; Reed, J.; and Reed, H. B. C. Jr. (1980b) “Mental Age and I.Q. of predominantly vegetarian school children” JADA 76:142-147

Freeland-Graves, J. H.; Bodzy, P. W.; and Eppright, M. A. (1980) “Zinc status of vegetarians” JADA 77:655-661

Goldberg, M. J.; Smith, J. W.; and Nichols, R. L. (1976) “Comparison of the fecal microflora of Seventh Day Adventists with individuals consuming a general diet” Annals of Surgery 186(1):97-100

Hardinge, M. G. and Stare, F. J. (1954) “Nutritional studies of vegetarians” American Journal of Clinical Nutrition 2:73-94

Harland, B. F. and Patterson, M. (1978) “Nutritional status of lacto-ovo-vegetarian Trappist monks” JADA 72:259-264

Kinlen, L. J.; Hermon, C.; and Smith, R. G. (1983) “A proportionate study of cancer mortality among members of a vegetarian society” British Journal of Cancer 48:355-361

Lemon, F. R. and Walden, R. T. (1966) “Death from respiratory system disease among Seventh Day Adventist men” Journal of the American Medical Association 198(2):117-126

Marsh, A G., Sanchez, T. V.; Mickelson, O.; Keiser, J.; and Mayor, G. (1980) “Cortical bone density of adult lacto-vegetarian and omnivorous women” JADA 76:148-151

Phillips, R. L. (1975) “Role of life-style and dietary habits in risk of cancer among Seventh Day Adventists” Cancer Research 35:3513-3522

Register, U. D. and Sonnenberg, L. M. (1973) “The vegetarian diet” JADA 62:253-261

Rouse, I. L.; Beilin, L. J.; Armstrong, B. K.; and Vandogen, R. (1983a) “Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects” Lancet January 1:5-8

Rouse, I. L.; Beilin, L. J.; Mahoney, D. P.; Margetts, B. M.; Armstrong, B. K.; and Vandogen, R. (1983b) Letter to the editor Lancet September 24:742-743

Summary  

I chose 7 controversial topics in nutrition from the book Are You Confused?, by Paavo Airola, and did a literature search to see if these statements could be scientifically justified.

In general I found that, yes, there was some scientific justification for all of them. None of the issues has been decided absolutely nor will everyone agree on the importance of the findings.

Dr. Airola did exaggerate and make some statements that were beyond what reason might allow. He was very uncompromising and insisted on the best. At the same time he urged moderation, common sense, and always discouraged fanaticism. I am reminded of something Beethoven once said, (paraphrased):

Will I ever be able to exaggerate enough?
Often one needs to exaggerate to make one's point, to move people to action, to disturb inertia.

In May 1983 Paavo Airola died at the age of 65 of a cerebrovascular stroke.

In May 1984 I was denied admission to graduate school in nutrition at Berkeley.

The life or death of a single man should never alter the course of science. Throughout his career Dr. Airola said, “Do not follow my teaching because I say so. Follow them because they are true.”

Upon inquiring about the reason for my rejection, Berkeley said:

There were 90 applicants for 15 openings. You were definitely one of the top candidates. We felt that you did not have sufficient experience in a biochemistry lab. ... You should try to get some more lab experience, take a few more courses in nutrition, and certainly reapply.
For a final word on the role of science in the inexact field of nutrition I quote Shakespeare, King Henry IV:
I can call spirits from the vasty deep.
Why so can I, or so can any man;
But will they come when you do call for them?

Evaluation by Professor Anthony L. Fink  

Jon chose seven controversial questions concerning nutrition, based on a book by Airola. He carried out literature research on the seven topics to determine the current state of knowledge on these subjects. He also prefaced his comments with a short philosophical note regarding the question of “certainty”, especially in the context of nutrition and health. Jon did a good job in tracking down articles relating to his chosen topics, and wrote a very readable paper, outlining, among other things, the difficulty in many cases of arriving at a consensus answer. Overall he did a very nice job.

Anthony L. Fink 6/20/84