End of Illness': Hidden Health Cues in Hair, Nails, Feet?

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End of Illness': Hidden Health Cues in Hair, Nails, Feet?

By KIM CAROLLO (@kimcarollo)

Jan. 16, 2012

 

ABCNEWS.com

 

Can seemingly trivial details such as the length of your fingers and whether you wear high heels actually be important clues about your risk for serious medical conditions?

According to Dr. David Agus, author of the new book "The End of Illness," finger length and shoe type are two potentially important pieces of information people can use to unlock their body's secret code. By learning to interpret the body's signals, Agus says people can prolong their health and live their lives free of illness.

"The end of illness is closer than you might think," Agus, also a professor of medicine at the University of Southern California Keck School of Medicine, wrote in the introduction to his book. But to achieve that, he continued, people must look at their bodies in a whole new way.

"Medicine today is, 'I treat the individual condition. Your joint hurts, I'll give you something to help the joints.' But I want to figure out why. What in your system allowed that joint to hurt. And I want to change the whole system in a different direction," Agus told ABC News.

In the book, Agus offers much medical advice he believes people should carefully consider, and there are many recommendations on gathering information that may never have seemed important before, such as the color of the fingernails. While patients should not consider these indicators definitive indicators of illness, he said taking note of them may help patients and their doctors determine next steps in terms of diagnostic tests.
"All these tickers, I want all that data put together before you go to your doctor," he said.

Some of the tips, he says, may seem contrary to what the medical establishment has long recommended, but are important because they show how every part of the body plays a role in maintaining good health. For example, he talks about what it could mean if unpolished nails are a certain color or if people notice they are losing hair near their ankles.

Not all agree that these indicators are always relevant. Doctors in preventive medicine who were not involved in writing Agus' book say while some of the advice he offers is thought-provoking, current scientific evidence suggests these risk factors may not be issues upon which people should necessarily focus.

Still, Agus, who has garnered numerous accolades and is widely know as a cutting-edge figure in medicine, said these seemingly minor signs may offer clues to overall health. On the following pages are some of Agus' hidden health indicators he said people need to be aware of, and how medical experts weigh in.
 

Hidden Health Indicators

Getty Images

 

Agus says finger length is an indicator for risk of certain diseases.

Finger Length

"If you're a woman, and, for example, you look at your ring finger and index finger, there's data," Agus told ABC News. "And this is a real published study showing that if your ring finger is bigger than your index finger, you're almost twice as likely to get osteoarthritis."

In the book, Agus cited a 2008 study in the journal Arthritis & Rheumatism that found an association between longer ring fingers and higher testosterone exposure in the womb, which lowers the levels of estrogen, a hormone critical to bone development.

In men, Agus wrote that the pattern is reversed -- if the index finger is longer than the ring finger, the risk of developing prostate cancer drops by a third.

The issue of finger length has been a subject of study in the past. A sub-study of the very large and well-known Framingham Heart Study did find a difference in finger length among women with osteoarthritis, and researchers said that arthritis could account for the length discrepancy.

Some experts say that this means a person already has osteoarthritis, not that a person is going to get it. Dr. Sharon Bergquist, assistant professor of medicine at the Emory University School of Medicine in Atlanta, said there have been a number of studies that found a link between finger length and the condition, but the data do not suggest having a longer index finger causes osteoarthritis.
"Even if there is an association, what does it imply from a preventive standpoint, because you can't change the length of your fingers," she said.

But she added that if there are well-established factors present for osteoarthritis, such as being older, being a woman, being sedentary and having other conditions such as gout, an underactive thyroid or diabetes, people can make lifestyle changes such as building up muscle and maintaining proper posture that can prevent the disease from happening in the first place.
 

Nails Although nails often get attention only as part of a beauty regimen, Agus said they can hold vital health clues.

"Discolored nails can signal certain conditions, from a simple infection to diabetes," he wrote. "If your nails have a yellowish hue to them, it's time for a diabetes check."
Previous research has found diabetes can cause yellowish nails, possibly due to diabetics' inability to properly break down sugar. Thus, the finding of yellowed nails could be a clue that testing for diabetes is in order.

But those with yellow nails must bear in mind that this does not necessarily mean they have diabetes.

"I know many people with diabetes that have normal-colored nails, and people with yellowish nails that don't have diabetes," said Dr. Robert Schwartz, chair of the Department of Family Medicine and Community Health at the University of Miami's Miller School of Medicine.

Nails can become yellow because of other conditions, such as lung disease or heart disease, which cause a lack of circulation to the extremities, fungal infections and age. As people age, the nails can get thicker and grow slower, leading to a susceptibilitiy to fungal infections. Many smokers also have yellowed nails.

Agus also notes a lack of the white crescent normally present above the cuticle can signal a problem with low iron levels.

Iconica/Getty Images

 

Loss of hair around the ankles may indicate a circulatory problem in men, Agus says.

 

Hair

Hair is another part of the body that can harbor hidden health signs. Graying and baldness can certainly indicate aging, but what about finding hair where it's never been before, or losing hair in previously unnoticed places?
"Have you lost hair around your ankles? This could be a sign of a circulatory problem, especially noticeable in men," Agus wrote.

Circulatory problems can indeed cause men and women to lose hair around their feet and lower legs. But those concerned about unusual hair loss should also be aware that it could also be due to something else.

"In men, most of the time they're wearing very tight socks that can cause hair loss," Scwartz said.

According to the National Institutes of Health, excessive hair growth, known as hirsutism, can indicate a medical issue, but it often has no cause at all and can be hereditary.

But it can also be a result of a hormonal imbalance. Women, Agus said, often start growing hair on their face or arms, which could mean hormonal changes.

Polycystic ovary syndrome, caused by multiple cysts in the ovaries that lead to an excess of male hormones, is one cause. Cushing's syndrome, characterized by an excess of cortisol that causes a sex hormone imbalance, is another possible cause. Obesity, tumors and certain medications can also cause hirsutism.

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Wearing high heels can cause chronic inflammation, which in turn leads to heart problems, Agus says.

 

Shoes

Women who favor high heels have probably noticed how much their feet and legs hurt after a long day of wearing them, but Agus says the risk to women is much greater than aching feet.

"Aching feet means inflammation. Inflammation in the long term is bad for heart disease, for cancer, for neural degenerative diseases. We want to prevent inflammation," Agus said, calling heels and platform pumps "hidden, sneaky sources of chronic inflammation."

The idea that uncomfortable shoes could lead to problems beyond strained muscles and joints is a controversial one.
"Chronic inflammation can affect the heart. It can lead to an increase of C-reactive protein that is associated with heart disease, but this isn't necessarily caused by wearing high heels," said Schwartz.

"High heels definitely pose more of an issue with the musculosketal system," said Bergquist.

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Sitting for long periods may be just as unhealthy as smoking, Agus writes.

 

Sitting

According to Agus, too much sitting can be just as unhealthy as smoking.

"Researchers at the American Cancer Society released a study published in 2010 in the American Journal of Epidemiology that pretty much said sitting down for extended periods poses a health risk as 'insidious' as smoking or overexposure to the sun," Agus wrote.

He cited one study that found women who reported sitting for more than six hours a day outside of work were 37 percent more likely to die than those who sat less than three hours a day. Other research, he added, has linked sitting to obesity, type 2 diabetes, cardiovascular disease and an unhealthy diet.

It's not so much the sitting, he explained, it's the physiological processes sitting causes that are the big culprits.

Even if people exercise once a day, sitting too much can cause increased blood sugar, higher blood pressure and higher triglyceride levels, all linked to cardiovascular disease, obesity and other chronic problems.

And the negative health impacts of sitting is a topic on which many health experts agree.

"The lack of physical activity is the root cause of many diseases," said Bergquist. "It's important to be active and continually move."

The End of Illness: Personal Health Inventory Questionnaire

The following Personal Health Inventory Questionnaire is adapted from The End of Illness by Dr. David B. Agus. Find out more about The End of Illness at the ABC News special section.
***
This questionnaire was originally designed to help you prepare for a checkup with your doctor, giving you clues to discuss during your visit. However, while piecing this book together, I realized that the same questionnaire should be filled out before even reading the book, which will help you to know yourself better before embarking on this adventure. I also know that you want to be told what to do as soon as possible, and even though you'll find lots of "health rules" to consider throughout this book, many of which will be called out at the ends of chapters, at least the following questions will equip you with concepts to think about as you read further and incorporate my advice into your life. This questionnaire is also downloadable online at www.The End of Illness.com/questionnaire, where you'll find a version that you can respond to directly on the page to print for your records and/or take to your doctor.

Overall feeling: How do you feel? It's arguably the most important question to ask of yourself. You might feel great today, but how about yesterday? When do you have your low moments? Is there a pattern? Is it hard for you to get out of bed in the morning?

Energy levels: How would you rank your energy level on a scale of 1 to 10? How has it changed in the last year?

Schedule: How regular is your schedule of when you eat, exercise, and sleep? Is every day the same or different?
Breathing: Anything abnormal to report? Do you hear or feel rattles when you breathe? Does it hurt to breathe deeply? Do you cough when you take a deep breath?

Answer these questions when you are at rest and after exercise.

Exercise tolerance: How much can you comfortably tolerate? How does this amount of physical activity compare with how you felt and how hard you moved your body last year? Does anything hurt or feel funny when you move or exercise?

Walking: Are you walking the same way you always have? Do you lean to one side and never did before? Do you hunch over more? Is it hard to walk fully upright?

Sensations: Anything unusual or out of the ordinary to report in any part of your body? For example, how is your sense of smell? Is it as strong as ever? Weak?

Skin: When you scan your skin for any strange marks, growths, or bumps while naked in front of the mirror, do you find anything? Has anything changed since the last time you examined your skin? Do your socks leave indentation marks on your ankles/legs? (If so, this could indicate that your heart isn't working properly and fluid is getting stagnant in areas, increasing your risk for a blood clot.)

Hair: Has your hair changed at all in terms of thickness, texture, growth/loss, and so on? Have you lost hair around your ankles? This could be a sign of a circulatory problem, especially noticeable in men. Conversely, do you have hair growing in odd places, such as your arms and face? This could signal hormonal changes, especially in women.

Nails: These dead tissues can actually tell you a lot. Have they changed in appearance or color lately? Discolored nails can signal certain conditions, from a simple infection to diabetes. If your nails have a yellowish hue to them, it's time for a diabetes check. Nails can also indicate iron levels. Look for a whitish crescent C at the base of your nails, which indicates good iron levels.

Fingers: Do your joints ache after using them? If you're a woman, is your ring finger longer than your index finger? If so, you may be twice as likely to suffer from osteoarthritis. That's according to a 2008 study in the journal Arthritis & Rheumatism, which discovered this odd connection and hypothesized that longer ring fingers are linked to higher levels of testosterone exposure in the womb. Higher prenatal levels of testosterone lower the concentration of estrogen, which is critical to bone development. If you're a man whose index finger is longer than your ring finger, your risk of prostate cancer drops by a third.

Joints: Do they hurt? More in the morning when you get up, or after a long day? What makes the aching joints better?

Appetite: Is it the same as it used to be? Stronger? Weaker? Do you have serious cravings? If so, for what?

Breasts: If you're a woman, do you see or feel any lumps, bumps, or dimples when you perform a breast exam?
 
Digestion: Any feelings of discomfort to report? Do you have to use any over-the-counter medications for your digestion/stomach on a regular basis (e.g., Tums, Pepto-Bismol, Tagamet, Zantac, Prevacid, laxatives, and the like)? If you have symptoms, are they better or worse after eating a meal? Do you experience an intolerance, sensitivity, or allergy to certain foods?

Headaches: Do you experience headaches regularly? Migraines? Do you know the triggers for such headaches? Do you find yourself taking over-the-counter painkillers consistently (e.g., Advil, Aleve, Tylenol, Excedrin, aspirin, and the like)?

Allergies: Do you have any? Have your allergies changed over the years? How so?

Sleep: Do you sleep well? Do you resort to sleep aids on occasion? Do you wake up feeling rested most of the time? How consistent are your bedtimes and wake times? Does your bed partner say that you snore? (Sleep apnea, which is often characterized by snoring, is incredibly common today and is a known risk factor for a heart attack. Luckily, sleep apnea can be treated pretty successfully.)

Pain: Is there any area where you feel discomfort or pain?

Passing colds and flus: Do you get sick a lot? How many fevers have you had this past year? When you get sick, does it seem to take you longer than your friends or family members to get better? Did you get a flu shot this year?

Mood: How stable is your mood? Do you have feelings of depression?

Hormonal cycle: If you're a woman, is your cycle regular? Are you in perimenopause or menopause?

Previous diagnoses: What have you previously been diagnosed with? Is there anything that you deal with chronically?

Stress level: On a scale of 1 to 10, how bad is it? Is it chronic or just once in a while? Does the stress affect your lifestyle? If your stress is work-related, do you love or hate your job? (Turns out that if you love your job despite the stress, you're much better off than if you hate your job and it causes you stress!)

Weight: Are you happy with it? Have you tried to change it? What happened when you did? Do you have a paunch that you cannot get rid of?

Medications (prescription and nonprescription): What do you take, for what conditions, and for how long have you been taking them? This includes all vitamins, supplements, additives, and occasional medications (such as a few Tylenol or Advil for a headache).

Health-care prevention: Are you up-to-date with things like routine exams/wellness checkups, vaccines, screenings (e.g., Pap smear, colonoscopy, etc.), and blood tests? Do you know what foods you're supposed to be eating given your underlying disease risk factors?

Overall satisfaction: If you had to rank how you felt about yourself in general, on a scale of 1 to 10, what would your number be? What kind of report card would you give yourself? What do you want to change in your life?

Scientists Cry Fowl Over the FDA's Regulatory Failure

Published on Friday, April 27, 2012 by the Guardian/UK

Scientists Cry Fowl Over the FDA's Regulatory Failure

Overuse of antibiotics in factory farming kills thousands every year, yet the industry is force-feeding chickens pharmaceuticals

by Richard Schiffman

 

In 2005, the antibiotic fluoroquinolone was banned by the FDA for use in poultry production. The reason for the ban was an alarming increase in antibiotic-resistant campylobacter bacteria in the meat of chickens and turkeys – "superbugs", which can lead to a lethal form of meningitis that our current antibiotics are no longer effective against.
 
 

We create hellish conditions for our livestock, then we drug them to keep them numb. Then we drug them again to wake them from their pharmaceutical stupor. Then we drug them to grow faster. Then we drug them so their flesh will look healthier. Then we drug them to withstand the disease epidemics that our overcrowding has created. Then, of course, we drug ourselves every time we take a bite of factory-farmed poultry.Antibiotic-resistant infections kill tens of thousands of people every year, more than die of AIDS, according to the Infectious Diseases Society of America. This problem is on the rise because antibiotics are recklessly overused, especially in the commercial livestock industry, where 80% of all antibiotics manufactured in the US end up.

Fluoroquinolone used to be fed to chickens primarily to stimulate their growth. But why did the banned substance show up recently in eight of 12 samples of "feather meal", the ground-down plumage leftover from commercial poultry production?

This was just one of the mysteries uncovered in a study conducted jointly by the Johns Hopkins Center for a Livable Future and Arizona State University. The research, published last month in the journal Environmental Science & Technology, uncovered a whole slew of other drugs in the feather meal that the scientists had not expected to find there.

Traces of the arsenic compound Roxarsone, for example, were present in almost all of the samples. Farms administer arsenic to chickens to turn their flesh just the right shade of pink that consumers find attractive. Yet, in June 2011, the FDA gave Pfizer 30 days to discontinue selling Roxarsone, a proven carcinogen. So why is it still showing up in our chickens?

Other substances that the scientists found include acetaminophen, the active ingredient in Tylenol, Benadryl, an antihistamine, even Prozac, an antidepressant. Farms feed chickens these mood-altering drugs to reduce their anxiety. Chickens are anxious because they are bred on overcrowded and filthy factory farms. Stressed-out birds develop meat that is tough and unpalatable, so they need to be sedated. Yet, chickens on tranquilizers sleep all the time and do not eat enough. So they are given high doses of caffeine (which was also found in the feather meal) to keep them awake at night to feed and fatten up.
So, here is the deal. We create hellish conditions for our livestock, then we drug them to keep them numb. Then we drug them again to wake them from their pharmaceutical stupor. Then we drug them to grow faster. Then we drug them so their flesh will look healthier. Then we drug them to withstand the disease epidemics that our overcrowding has created.

Then, of course, we drug ourselves every time we take a bite of factory-farmed poultry.

"We were kind of floored," Keeve E Nachman, a co-author of the study told the New York Times. "It's unbelievable what we found." While Nachman says that the levels of arsenic and the witches' brew of other drugs and chemicals in the chicken samples may not be high enough to harm humans, he is not betting his own health on it.

"I've been studying food-animal production for some time," the researcher said, "and the more I study, the more I'm drawn to organic. We buy organic [in my family]."

"So, here is the deal. We create hellish conditions for our livestock, then we drug them to keep them numb. Then we drug them again to wake them from their pharmaceutical stupor. Then we drug them to grow faster. Then we drug them so their flesh will look healthier. Then we drug them to withstand the disease epidemics that our overcrowding has created... Then, of course, we drug ourselves every time we take a bite of factory-farmed poultry."Organic chickens are bred without artificial growth hormones and antibiotics. They are fed organically grown vegetable foods rather than the ground-up animal products – bones, feathers, blood, excrement, fishmeal and diseased animal parts – which their conventionally grown brethren receive. They are also raised free-range with plenty of space, sunlight and opportunities for exercise to keep them healthy. A 2001 study conducted at the University of Perugia found that chickens produced this way actually taste better than conventionally bred birds.

Yet, organic poultry is a lot more expensive to raise. While the market is growing steadily for organic birds, it still comprises less than 1% of the poultry sold in the US today (pdf). So, food scientists argue that the standards for conventional chickens and turkeys need to be strengthened.

"We strongly believe that the FDA should monitor what drugs are going into animal feed," Keeve Nachman urged, adding that, based on what the researchers discovered, they had little confidence that the animal food production industry could be left to regulate itself.

Earlier this month, the FDA announced what looked at first glance like sweeping new guidelines on the use of antibiotics in livestock. The new rules, however, are strictly "voluntary", and, while they do recommend restricting the use of antibiotics to stimulate growth, they would still allow them to be prescribed by a veterinarian for animals that are "either sick or at risk of getting a specific illness".

Critics contend that the words "at risk of getting a specific illness" provide factory poultry farms a loophole big enough to drive a truck through. Margaret Mellon, senior scientist at the Union of Concerned Scientists, said in a press statement:

"The outlined process appears to give the companies the opportunity to relabel drugs currently slated for growth promotion for disease prevention instead. Such relabeling could allow them to sell the exact same drugs in the very same amounts."

Public interest groups like the Union of Concerned Scientists say the time has come for the FDA to stop proposing half-measures and demonstrate that it is serious about preventing a looming public health disaster. It needs to ban dangerous antibiotic use in the raising of livestock, and to conduct rigorous on-site inspections to insure that the ban is enforced.

© 2012 The Guardian/UK

 

Richard Schiffman is the author of two books and a former journalist whose work has appeared in, amongst other outlets, the New York Times and on a variety of National Public Radio shows including Morning Edition and All Things Considered.

America's Mad Cow Crisis

Published on Thursday, April 26, 2012 by Common Dreams

America's Mad Cow Crisis

by John Stauber

 

Americans might remember that when the first mad cow was confirmed in the United States in December, 2003, it was major news.  The United States Department of Agriculture (USDA) and the Food and Drug Administration (FDA) had been petitioned for years by lawyers from farm and consumer groups I worked with to stop the cannibal feeding practices that transmit this horrible, always fatal, human and animal dementia.  When the first cow was found in Washington state, the government said it would stop such feeding, and the media went away.  But once the cameras were off and the reporters were gone nothing substantial changed.

 

In the United States, dairy calves are still taken from their mothers and fed the blood and fat of dead cattle.  This is no doubt a way to infect them with the mad cow disease that has now been incubating here for decades, spread through such animal feeding practices.  No one knows how the latest dairy cow was infected, the fourth confirmed in the United States.  Maybe it was nursed on cow's blood.  Perhaps it was fed feed containing cattle fat with traces of cattle protein.  Or perhaps there is a mad cow disease in pigs in the United States, which simply has not been found yet, because pigs are not tested for it at all, even though pigs are fed both pig and cattle byproducts, and then the blood, fat and other waste parts of these pigs are fed to cattle.

All these U.S. cattle feeding methods are long banned and illegal in other countries that suffered through but eventually dealt properly with mad cow disease.  Here, rather than stopping the transmission of the disease by stopping the cannibal feeding, mad cow is simply covered up with inadequate testing and very adequate public relations.  US cattle are still fed mammalian blood, fat and protein, risking human deaths and threatening the long term safety of human blood products, simply to provide the U.S. livestock industry with a cheap protein source and a cheap way to get rid of dead animal waste.Docile, eating what they are fed, trusting the rancher all the way to the slaughterhouse.  Is that just the cows, or is it us too?

I began researching this issue around 1989, long before the disease was confirmed to have jumped from cattle to the people eating them, as announced by the British government in 1996.  In 1997 I co-authored Mad Cow USA, warning that the disease was likely already here and spreading, since the animal cannibalism that caused its outbreak in Britain and spread it to other countries was actually more widespread in the United States than anywhere.

Some years ago responsible U.S. beef companies wanted to test their animals for mad cow disease and label their beef as being disease free, but they were forbidden under penalty of law from doing so.  Only the USDA can test for mad cows in America.    In 2004 and 2005, after two additional mad cows were discovered in Texas and Alabama, the United Sates government declared that obviously mad cow wasn't much of a problem and gutted it's anemic testing program.  Today only about 40,000 cattle a year are tested, out of tens of millions slaughtered.  It's amazing that the California cow was even detected given this pathetic testing program that seems well designed to hide rather than find mad cows. 

The prevention of mad cow disease is relatively  simple.  If your country has it, test each animal before it goes to slaughter to keep the diseased animals out of the food chain.  Cheap, accurate and easy tests are now available in other countries but illegal here.  Testing cattle both identifies the true extent of the disease, and keeps infected animals from being eaten in your sausage or hamburger.  In this manner countries like Britain, Germany, France and Japan have controlled their problem through testing and a strict ban on cannibal feed.

Once mad cow disease moves into the human population of a country, all bets are off as to what could happen next.  It's a very slow disease, it develops invisibly over decades in someone who has been infected, and it is always fatal.  We'll know a lot more in fifty years, but the future looks worrisome.  In Britain people are dying from mad cow disease, people who never consumed infected meat.  They used medical products containing human blood, and that blood was infected because it was from infected people.  There is no test to identify infectious prions, the causal agent, in blood.

Almost none of this information appeared in news stories about the California mad cow.  Instead the headlines and the talking heads fed us the line that the United States fixed this problem long ago, and the fact that only 4 mad cows have been detected so far is proof of our success.   Oprah Winfrey once tried via her talk show to warn about this, way back in 1996,  but Texas cattlemen dragged her and her guest Howard Lyman into court and she had to spend many millions of dollars defending herself from the supposed crime of slandering meat.

Oprah won her case, which was probably unfortunate for the rest of us because had she been convicted the ensuing appeals court trial might have gotten enough attention to wake up Americans to the truth.  Instead Oprah learned her lesson - shut up and you won't get sued.   Other media learned too that if the government and industry can silence Oprah, they can muzzle anyone. (One of the 4 confirmed U.S. mad cows was later found in Texas, appropriately enough.)

There are a handful of dedicated activists such as Howard Lyman who have been sounding the alarm on this.  They include the ecologist Dr. Michael Hansen of Consumers Union and Dr. Michael Greger, a physician.  Terry S. Singeltary Sr., whose mom died of a version of the human form of mad cow disease, has been a relentless, unpaid activist on this issue.

Despite their dedicated work,  there is no indication that anything is going to change here in America.  The U.S. government refuses to implement the feed ban and the animal testing necessary.   It doesn't matter if the President is named Clinton, Bush or Obama because their bureaucrats in the USDA and FDA stay the course and keep the cover up going.  Docile, eating what they are fed, trusting the rancher all the way to the slaughterhouse.  Is that just the cows, or is it us too?

John Stauber founded the non-profit, non-partisan Center for Media & Democracy and its newsmagazine PR Watch in 1993 in Madison, Wisconsin. Prior to his retirement from CMD in 2009, Stauber co-authored six books for them including the 2003 New York Times bestseller Weapons of Mass Deception: The Uses of Propaganda in Bush's War on Iraq. He continues now as an independent investigative writer, public speaker and democracy advocate whose leadership on controversial public issues began in high school when he organized to end the U.S. war in Vietnam and for the first Earth Day. He has begun or worked with many non-profit public interest groups.

CBS News.com

HealthWatch

April 1, 2012 7:07 PM 

Is sugar toxic?

 

 (CBS)

Watch the Episode »

Dr. Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer.

Web Extras

• Is sugar toxic?
• Sugar and kids: The toxic truth
• Calories: not all created equal
• More »

(CBS News) If you are what you eat, then what does it mean that the average American consumes 130 pounds of sugar a year? Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. Some physicians go so far as to call sugar a toxin.

---

The following script is from "Sugar" which aired on April 1, 2012. Dr. Sanjay Gupta is the correspondent. Denise Schrier Cetta and Sumi Aggarwal, producers.
The chances are good that sugar is a bigger part of your daily diet than you may realize which is why our story tonight is so important. New research coming out of some of America's most respected institutions is starting to find that sugar, the way many people are eating it today, is a toxin and could be a driving force behind some of this country's leading killers, including heart disease.

60 Minutes Overtime

Sugar and kids: The toxic truth »

As a result of these findings, an anti-sugar campaign has sprung up, led by Dr. Robert Lustig, a California endocrinologist, who believes the consumption of added sugars has plunged America into a public health crisis.
Dr. Sanjay Gupta: Is sugar toxic?
Dr. Robert Lustig: I believe it is.
Dr. Sanjay Gupta: Do you ever worry that that's-- it just sounds a little bit over the top?
Dr. Robert Lustig: Sure. All the time. But it's the truth.
Dr. Robert Lustig is a pediatric endocrinologist at the University of California, San Francisco and a pioneer in what is becoming a war against sugar.
Motivated by his own patients -- too many sick and obese children - Dr. Lustig has concluded that sugar, more than any other substance, is to blame.
Dr. Sanjay Gupta: What are all these various diseases that you say are linked to sugar?
Dr. Robert Lustig: Obesity, type II diabetes, hypertension, and heart disease itself.
Lustig says the American lifestyle is killing us.
Dr. Sanjay Gupta: And most of it you say is preventable?
Dr. Robert Lustig: Seventy-five percent of it is preventable.
While Dr. Lustig has published a dozen scientific articles on the evils of sugar, it was his lecture on YouTube, called "Sugar: The Bitter Truth," that brought his message to the masses.
[YouTube Video: I'm standing here today to recruit you in the war against bad food.]
By "bad food" Dr. Lustig means the obvious things such as table sugar, honey, syrup, sugary drinks and desserts, but also just about every processed food you can imagine, where sugar is often hidden: yogurts and sauces, bread, and even peanut butter. And what about the man-made, often vilified sweetener, high fructose corn syrup?
Dr. Sanjay Gupta: Is it worse than just table sugar?
Dr. Robert Lustig: No. 'Cause it's the exact same. They are basically equivalent. The problem is they're both bad. They're both equally toxic.
Since the 1970s, sugar consumption has gone down nearly 40 percent, but high fructose corn syrup has more than made up the difference. Dr. Lustig says they are both toxic because they both contain fructose -- that's what makes them sweet and irresistible.
Dr. Robert Lustig: We love it. We go out of our way to find it. I think one of the reasons evolutionarily is because there is no food stuff on the planet that has fructose that is poisonous to you. It is all good. So when you taste something that's sweet, it's an evolutionary Darwinian signal that this is a safe food.
Dr. Sanjay Gupta: We were born this way?
Dr. Robert Lustig: We were born this way.
Central to Dr. Lustig's theory is that we used to get our fructose mostly in small amounts of fruit -- which came loaded with fiber that slows absorption and consumption -- after all, who can eat 10 oranges at a time? But as sugar and high fructose corn syrup became cheaper to refine and produce, we started gorging on them. Americans now consume 130 pounds per person a year -- that's a third of a pound every day.
Dr. Lustig believes those sweeteners are helping fuel an increase in the most deadly disease in America: heart disease. For years, he's been a controversial voice.
[Kimber Stanhope: Here is our oral isotope...]
But now, studies done by Kimber Stanhope, a nutritional biologist at the University of California, Davis are starting to back him up. She's in the middle of a groundbreaking, five-year study which has already shown strong evidence linking excess high fructose corn syrup consumption to an increase in risk factors for heart disease and stroke. That suggests calories from added sugars are different than calories from other foods.
Dr. Sanjay Gupta: The mantra that you hear from most nutritionists is that a calorie is a calorie is a calorie.
Kimber Stanhope: And I think the results of the study showed clearly that is not true.
Stanhope's conclusions weren't easy to come by. Nutrition studies are expensive and difficult. Stanhope has paid groups of research subjects to live in this hospital wing for weeks at a time, under a sort of 24-hour lockdown. They undergo scans and blood tests - every calorie they ingest, meticulously weighed and prepared.
Kimber Stanhope: They're never out of our sight. So we do know that they are consuming exactly what we need them to consume.
Dr. Sanjay Gupta: And they're not sneaking any candy bars on the side.
Kimber Stanhope: Yeah, right, exactly.
For the first few days, participants eat a diet low in added sugars, so baseline blood levels can be measured.
[Research assistant: So remember you guys have to finish all of your Kool-Aid. ]
Then, 25 percent of their calories are replaced with sweetened drinks and Stanhope's team starts drawing blood every 30 minutes around the clock. And those blood samples? They revealed something disturbing.
Dr. Sanjay Gupta: And what are you starting to see?
Kimber Stanhope: We found that the subjects who consumed high fructose corn syrup had increased blood levels of LDL cholesterol and other risk factors for cardiovascular disease.
Dr. Sanjay Gupta: How quickly did these changes occur?
Kimber Stanhope: Within two weeks.
Kimber Stanhope's study suggests that when a person consumes too much sweet stuff, the liver gets overloaded with fructose and converts some of it into fat. Some of that fat ends up in the bloodstream and helps generate a dangerous kind of cholesterol called small dense LDL. These particles are known to lodge in blood vessels, form plaque and are associated with heart attacksDr. Sanjay Gupta: Did it surprise you when you first got these results back?
Kimber Stanhope: I would have to say I was surprised because when I saw our data, I started drinking and eating a whole lot less sugar. I would say our data surprised me.
So imagine, for these healthy young people, drinking a sweetened drink might be just as bad for their hearts as the fatty cheeseburgers we've all been warned about since the 1970s. That's when a government commission mandated that we lower fat consumption to try and reduce heart disease.
Dr. Sanjay Gupta: So with the best of intentions, they say, "Time to reduce fat in the American diet?"
Dr. Robert Lustig: Exactly. And we did. And guess what? Heart disease, metabolic syndrome, diabetes and death are skyrocketing.
Dr. Lustig believes that's primarily because we replaced a lot of that fat with added sugars.
Dr. Robert Lustig: Take the fat out of food, it tastes like cardboard. And the food industry knew that. So they replaced it with sugar.
Dr. Sanjay Gupta: This idea that sugar increases this particularly bad LDL, the small dense particles that are associated with heart disease. Do most doctors-- do they know this?
Dr. Robert Lustig: No, they do not know this. This is new.
And it turns out, sugar has become a major focus in cancer research too. Lewis Cantley, is looking at the connection.
Dr. Sanjay Gupta: If you limit your sugar you decrease your chances of developing cancer?
Lewis Cantley: Absolutely.
Cantley, a Harvard professor and the head of the Beth Israel Deaconess Cancer Center, says when we eat or drink sugar, it causes a sudden spike in the hormone insulin, which can serve as a catalyst to fuel certain types of cancers.
Lewis Cantley: What we're beginning to learn is that insulin can cause adverse effects in the various tissues. And of particular concern is cancer.
Why? Nearly a third of some common cancers -- including breast and colon cancers -- have something called insulin receptors on their surface. Insulin binds to these receptors and signals the tumor to start consuming glucose.
Lewis Cantley: This is your body...
Every cell in our body needs glucose to survive. But the trouble is, these cancer cells also use it to grow.
Lewis Cantley: So if you happen to have the tumor that has insulin receptors on it then it will get stimulated to take up the glucose that's in the bloodstream rather than go into fat or muscle, the glucose goes into the tumor. And the tumor uses it to grow.
Dr. Sanjay Gupta: So you've just seen that tumor turn blue which is essentially reflective of glucose going into it.
Lewis Cantley: That's right.
Dr. Sanjay Gupta: So these cancers, much in the same way that muscle will say, "Hey, I'd like some of that glucose, the fat says, "I would like some of that glucose," the cancers have learned how to do this themselves as well?
Lewis Cantley: Yes. So they have evolved the ability to hijack that flow of glucose that's going by in the bloodstream into the tumor itself.
Lewis Cantley's research team is working on developing drugs that will cut off the glucose supply to cancer cells and keep them from growing. But until there's a breakthrough, Cantley's advice? Don't eat sugar. And if you must, keep it to a minimum.
Lewis Cantley: In fact-- I-- you know, I live my life that way. I rarely eat sugar.
Dr. Sanjay Gupta: When you see a sugary drink or if I were to offer you one, what-- with all that you know, what's going through your mind?
Lewis Cantley: I probably would turn it down and get a glass of water.
But for most of us, that's easier said than done...
Eric Stice: It turns out sugar is much more addictive than I think we had sort of realized early on.
Eric Stice, a neuroscientist at the Oregon Research Institute, is using functional MRI scanners to learn how our brains respond to sweetness.
Eric Stice: Sugar activates our brain in a special way. That's very reminiscent of, you know, drugs like cocaine.
That's right. Cocaine.
Dr. Sanjay Gupta: Let's give it a shot...
I climbed into the MRI scanner to see how my brain would respond. That's a straw that's been rigged to deliver a tiny sip of soda into my mouth.
Eric Stice: Stay as still as you can, ok?
Just as it hit my tongue, the scanner detected increased blood rushing to certain regions of my brain. In these images, the yellow areas show that my reward region is responding to the sweet taste. Dopamine - a chemical that controls the brain's pleasure center - is being released, just as it would in response to drugs or alcohol.

Dr. Sanjay Gupta: So dopamine is released. That sort of makes me feel good. I'm experiencing some pleasure from having this Coke.
Eric Stice: Right, that euphoric effect.
Dr. Sanjay Gupta: So far be it for people to realize this 'cause sugar is everywhere, but you're saying this is one of the most addictive substances possibly that we have?
Eric Stice: It certainly is very good at firing the reward regions in our brain.
Eric Stice says by scanning hundreds of volunteers, he's learned that people who frequently drink sodas or eat ice cream or other sweet foods may be building up a tolerance, much like drug users do. As strange as it sounds, that means the more you eat, the less you feel the reward. The result: you eat more than ever.
Eric Stice: If you overeat these on a regular basis it causes changes in the brain that basically it blunts your reward region response to the food, so then you eat more and more to achieve the same satisfaction you felt originally.
With all this new science emerging, we wanted to hear from the sugar industry, so we visited Jim Simon, who's on the board of the Sugar Association, at a sugar cane farm in Louisiana.
Dr. Sanjay Gupta: Would it surprise you that almost every scientist that we talked to in researching this story told us they are eliminating all added sugars. They're getting rid of it because they're concerned about the health impacts.
Jim Simon: To say that the American consuming public is going to completely omit, eliminate, sweeteners out of their diet I don't think gets us there.
Simon cautions that eliminating sugar wrongly vilifies one food, rather than working towards the long-term solution of reducing calories and exercising.
Dr. Sanjay Gupta: You know, a lot of people, Jim, are saying that sugar is different. That it is bad for your heart and is causing a lot of the problems we're talking about. It is addictive and in some cases might even fuel cancers. What would you - I mean you've looked at this. You must have looked at some of these studies. What do you say about that?
Jim Simon: The science is not completely clear here.
Dr. Sanjay Gupta: But some of that's, but some of these studies exist. I mean, what is a consumer, what are they to make of all that?
Jim Simon: Well, I would say to them, that they've got to approach, their diet in balance.
Dr. Robert Lustig agrees -- we need a balanced diet -- but his idea of balance is a drastic reduction in sugar consumption. To that end he co-authored an American Heart Association report recommending men should consume no more than 150 calories of added sugars a day. And women, just 100 calories. That's less than the amount in just one can of soda.
Dr. Robert Lustig: Ultimately this is a public health crisis. And when it's a public health crisis, you have to do big things and you have to do them across the board. Tobacco and alcohol are perfect examples. We have made a conscious choice that we're not going to get rid of them, but we are going to limit their consumption. I think sugar belongs in this exact same wastebasket.

Need More Magnesium? 10 Signs to Watch For

Symptoms of poor magnesium intake can include muscle cramps, facial tics, poor sleep, and chronic pain. It pays to ensure that you get adequate magnesium before signs of deficiency occur.

But how can you know whether you’re getting enough?

According to population studies of average magnesium intake, there’s a good chance that you’re not.

Less than 30% of U.S. adults consume the Recommended Daily Allowance (RDA) of magnesium. And nearly 20% get only half of the magnesium they need daily to remain healthy.^{1 2 3}

Estimated U.S. Intake of Magnesium Recommended Daily Allowance

Do I get enough magnesium?

One method of assessing your magnesium status is to simply contact your health care provider and request detailed magnesium testing. Yet magnesium assessment is typically done using blood serum testing, and these tests can be misleading. Only 1% of magnesium in the body is actually found in blood, and only .3% is found in blood serum, so clinical blood serum testing may not successfully identify magnesium deficiency.

What to do?

Fortunately, it’s possible to get a sense of where your intake may lie simply by asking yourself a few questions about your lifestyle, and watching for certain signs and signals of low magnesium levels.

Learn how to read your signs below, and find out what you can do to ensure magnesium balance and good health. If you answer yes to any of the following questions, you may be at risk for low magnesium intake.

1. Do you drink carbonated beverages on a regular basis?

Most dark colored sodas contain phosphates. These substances actually bind with magnesium inside the digestive tract, rendering it unavailable to the body. So even if you are eating a balanced diet, by drinking soda with your meals you are flushing magnesium out of your system.^{4 5 6}

The average consumption of carbonated beverages today is more than ten times what it was in 1940.⁷ This skyrocketing increase is responsible for both reduced magnesium and calcium availability in the body.^{8 9}

2. Do you regularly eat pastries, cakes, desserts, candies or other sweet foods?

Refined sugar is not only a zero magnesium product but it also causes the body to excrete magnesium through the kidneys. The process of producing refined sugar from sugar cane removes molasses, stripping the magnesium content entirely.

And sugar does not simply serve to reduce magnesium levels. Sweet foods are known by nutritionists as “anti-nutrients”. Anti-nutrients like sweets are foods that replace whole nutritious foods in the diet, yet actually consume nutrients when digested, resulting in a net loss. Because all foods require vitamins and minerals to be consumed in order to power the process of digestion, it’s important to choose foods that “put back” vital nutrients, and then some.

The more sweet foods and processed baked goods you have in your diet, the more likely you are deficient in magnesium and other vital nutrients.

3. Do you experience a lot of stress in your life, or have you recently had a major medical procedure such as surgery?

Both physical and emotional stress can be a cause of magnesium deficiency.

Stress can be a cause of magnesium deficiency, and a lack of magnesium tends to magnify the stress reaction, worsening the problem. In studies, adrenaline and cortisol, byproducts of the “fight or flight” reaction associated with stress and anxiety, were associated with decreased magnesium.⁴

Because stressful conditions require more magnesium use by the body, all such conditions may lead to deficiency, including both psychological and physical forms of stress such as surgery, burns, and chronic disease.

4. Do you drink coffee, tea, or other caffeinated drinks daily?

Magnesium levels are controlled in the body in large part by the kidneys, which filter and excrete excess magnesium and other minerals. But caffeine causes the kidneys to release extra magnesium regardless of body status.

If you drink caffeinated beverages such as coffee, tea and soda regularly, your risk for magnesium deficiency is increased.

5. Do you take a diuretic, heart medication, asthma medication, birth control pills or estrogen replacement therapy?

The effects of certain drugs have been shown to reduce magnesium levels in the body by increasing magnesium loss through excretion by the kidneys.

See also:

• For a complete list of the specific drugs which can affect magnesium levels, read our article, Causes of a Lack of Magnesium.

6. Do you drink more than seven alcoholic beverages per week?

The effect of alcohol on magnesium levels is similar to the effect of diuretics: it lowers magnesium available to the cells by increasing the excretion of magnesium by the kidneys. In studies, clinical magnesium deficiency was found in 30% of alcoholics.¹⁰

Increased alcohol intake also contributes to decreased efficiency of the digestive system, as well as Vitamin D deficiency, both of which can contribute to low magnesium levels.¹¹

7. Do you take calcium supplements without magnesium or calcium supplements with magnesium in less than a 1:1 ratio?

Studies have shown that when magnesium intake is low, calcium supplementation may reduce magnesium absorption and retention.^{12 13 14} And, whereas calcium supplementation can have negative effects on magnesium levels, magnesium supplementation actually improves the body’s use of calcium.⁷

Though many reports suggest taking calcium to magnesium in a 2:1 ratio, this figure is largely arbitrary. The ideal ratio for any individual will vary depending on current conditions as well as risk factors for deficiency.

However, several researchers now support a 1:1 calcium to magnesium ratio for improved bone support and reduced risk of disease. This is due not only to the increased evidence pointing to widespread magnesium deficiency, but also concerns over the risk of arterial calcification when low magnesium stores are coupled with high calcium intake.

According to noted magnesium researcher Mildred Seelig:

The body tends to retain calcium when in a magnesium-deficient state. Extra calcium intake at such a time could cause an abnormal rise of calcium levels inside the cells, including the cells of the heart and blood vessels… Given the delicate balance necessary between calcium and magnesium in the cells, it is best to be sure magnesium is adequate if you are taking calcium supplements.”⁸

8. Do you experience any of the following:

• Anxiety?
• Times of hyperactivity?
• Difficulty getting to sleep?
• Difficulty staying asleep?

The above symptoms may be neurological signs of magnesium deficiency. Adequate magnesium is necessary for nerve conduction and is also associated with electrolyte imbalances that affect the nervous system. Low magnesium is also associated with personality changes and sometimes depression.

Read more:

• For a complete list of the signs of magnesium deficiency, read our article, Symptoms of Low Magnesium.

9. Do you experience any of the following:

• Painful muscle spasms?
• Muscle cramping?
• Fibromyalgia?
• Facial tics?
• Eye twitches, or involuntary eye movements?

Neuromuscular symptoms such as these are among the classic signs of a potential magnesium deficit.

Without magnesium, our muscles would be in a constant state of contraction.

Magnesium is a required element of muscle relaxation, and without it our muscles would be in a constant state of contraction. Calcium, on the other hand, signals muscles to contract. As noted in the book The Magnesium Factor, the two minerals are “two sides of a physiological coin; they have actions that oppose one another, yet they function as a team.”⁸

Chvostek’s Sign and Trousseau’s Sign are both clinical tests for involuntary muscle movements, and both may indicate either calcium or magnesium deficiency, or both. In fact, magnesium deficiency may actually appear as calcium deficiency in testing, and one of the first recommendations upon receiving low calcium test results is magnesium supplementation.

Read more:

• For a complete list of the conditions associated with magnesium deficiency, read our article, Symptoms of Low Magnesium.
• To learn more about the role of magnesium in muscle function, see How Magnesium Functions in the Body.

10. Did you answer yes to any of the above questions and are also age 55 or older?

Older adults are particularly vulnerable to low magnesium status. It has been shown that aging, stress and disease all contribute to increasing magnesium needs, yet most older adults actually take in less magnesium from food sources than when they were younger.

In addition, magnesium metabolism may be less efficient as we grow older, as changes the GI tract and kidneys contribute to older adults absorbing less and retaining less magnesium.¹⁵

If you are above 55 and also showing lifestyle signs or symptoms related to low magnesium, it’s particularly important that you work to improve your magnesium intake. When body stores of magnesium run low, risks of overt hypomagnesaemia (magnesium deficiency) increase significantly.

How can you know for certain if you have a deficiency?

Magnesium’s impact is so crucial and far reaching that symptoms of its absence reverberate throughout the body’s systems. This makes signs of its absence hard to pin down with absolute precision, even for cutting edge researchers. Doctors Pilar Aranda and Elena Planells noted this difficulty in their report at the International Magnesium Symposium of 2007:

The clinical manifestations of magnesium deficiency are difficult to define because depletion of this cation is associated with considerable abnormalities in the metabolism of many elements and enzymes. If prolonged, insufficient magnesium intake may be responsible for symptoms attributed to other causes, or whose causes are unknown.”

Among researchers, magnesium deficiency is known as the silent epidemic of our times, and it is widely acknowledged that definitive testing for deficiency remains elusive. Judy Driskell, Professor, Nutrition and Health Sciences at the University of Nebraska, refers to this “invisible deficiency” as chronic latent magnesium deficiency, and explains:

Normal serum and plasma magnesium concentrations have been found in individuals with low magnesium in [red blood cells] and tissues. Yet efforts to find an indicator of subclinical magnesium status have not yielded a cost-effective one that has been well validated.”¹⁶

Yet while the identification of magnesium deficiency may be unclear, its importance is undeniable.

Magnesium activates over 300 enzyme reactions in the body, translating to thousands of biochemical reactions happening on a constant basis daily. Magnesium is crucial to nerve transmission, muscle contraction, blood coagulation, energy production, nutrient metabolism and bone and cell formation.

Considering these varied and all-encompassing effects, not to mention the cascading effect magnesium levels have on other important minerals such as calcium and potassium, one thing is clear – long term low magnesium intake is something to be avoided.

What can you do to increase magnesium intake?

The Magnesium Miracle, by Carolyn Dean, M.D. N.D.

The longer your intake remains low, the more likelihood your bodily stores will be diminished, leaving you exposed to some of the more troubling side effects of long term deficiency. According to Dr. Carolyn Dean, M.D., N.D., and expert on magnesium therapy, adequate magnesium can improve heart health, prevent stroke and obesity, and improve mood and memory.

If you answered no to all of the above questions, you may be able to rely on high food sources of magnesium, like those described in our article on Magnesium in the Diet.

Yet for many people, especially those with diseases and symptoms associated with low magnesium, active magnesium supplementation may be a crucial element of returning to good health.

In her book, The Magnesium Miracle, Dr. Dean notes that achieving adequate magnesium through foods is notoriously difficult, stating:

I’m convinced that to get enough magnesium today, you need to take supplements.”⁴

Transdermal magnesium does not have the side effects of oral supplements.

One of the most effective ways to improve your magnesium levels is to combine a healthy diet with transdermal magnesium.

Many of the factors which contribute to low magnesium stores are caused by inefficiencies of the GI tract. By delivering magnesium through the skin directly to the cells, topical magnesium products bypass many of the problems associated with low magnesium absorption.

In older adults, reduced gastric acid levels in the digestive system may be a factor in reduced mineral availability. Hydrochloric acid supplements may be combined with magnesium to combat this dilemma; however a simpler and less expensive option is the use of magnesium chloride supplements. Magnesium chloride has been proven to have a high bioavailability, while simultaneously providing the chloride necessary for healthy digestion and vitamin and mineral absorption.

Magnesium researcher Mildred Seelig has called magnesium “the silent guardian of our hearts and arteries” and “necessary for life”. And Dr. Carolyn Dean calls it “the missing link to total health”.

If you haven’t heard much about magnesium and its importance to good health, now is the time to learn. And if it’s something you’ve always meant to look into, now is the time to take action!

What’s Next?

Magnesium through the skin? Yes! Learn about topical magnesium products.

Why can’t you get enough magnesium through foods? Get the good news and the bad news.

Watch health experts’ video interviews — powerful commentary on the why and how of magnesium.

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References:

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2. Pao EM, Mickle SJ. Problem nutrients in the United States. Food Technology. 1981:35:58-79. [↵]
3. King DE, Mainous AG 3^rd, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. Journal Of The American College Of Nutrition. 2005 Jun;24(3):166-71. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed November 6, 2009. [↵]
4. Dean C. The Magnesium Miracle. New York: Ballantine Books; 2007. [↵] [↵] [↵]
5. Weiss GH, Sluss PM, Linke CA. Changes in urinary magnesium, citrate and oxalate levels due to cola consumption. Urology 1992;39:331-3. [↵]
6. Brink E. J., Beynen A. C., Dekker P. R., Beresteijn E.C.H., Meer R. Interaction of calcium and phosphate decreases ileal magnesium solubility and apparent magnesium absorption. The Journal of Nutrition. 1992; 122:580-586 [↵]
7. Vartanian L, Schwartz, M, Brownell, K. Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis. American Journal of Public Health. 2007;97(4):667-675. [↵] [↵]
8. Seelig M, Rosanoff A. The Magnesium Factor. New York: Avery Books; 2003. [↵] [↵] [↵]
9. Heaney RP, Rafferty K. Carbonated beverages and urinary calcium excretion. American Journal of Clinical Nutrition. 2001; 74:343–347. [↵]
10. Irwin R, Rippe J. Irwin and Rippe’s Intensive Care Medicine. Philadelphia: Lippincott, Williams and Wilkins; 2008. [↵]
11. Shane SR, Flink EB. Magnesium deficiency in alcohol addiction and withdrawal. Magnesium and trace elements. 1991-1992;10(2-4):263-8. [↵]
12. Wester PO. Magnesium. American Journal of Clinical Nutrition. 1987; 45:1305-12. [↵]
13. Norman DA, Fordtran JS, Brinkley U, et al. Jejunal and ileal adaptation to alterations in dietary calcium. The Journal of Clinical Investigation. 1981 ;67: 1599-603. [↵]
14. Seelig MS. The requirement of magnesium by the normal adult: Summary and analysis of published data. American Journal of Clinical Nutrition. 1964;14:342-90. [↵]
15. Bernstein A, Luggen AS. Nutrition for the Older Adult. Sudbury, MA: Jones and Bartlett Publishers; 2010. [↵]
16. Driskell J. Nutrition and Exercise Concerns of Middle Age. Boca