"NEWSTART" Lifestyle Program: A Survey of the Results

By Milton G. Crane, M.D. and Barbara G. Crane, R.D. of Weimar Institute

1. Purpose of the Review:

To evaluate the effect of the NEWSTART health conditioning program of a total vegetarian diet of unrefined foods and other components of the program in patients with hypertension, diabetes, coronary heart disease, and other disease conditions that could possibly be related to faulty lifestyle.

Two basic questions will be answered from our experience. First, is such a program of simple total vegetarian diet of unrefined foods, exercise, and additional factors effective in certain chronic degenerative diseases? Do group sessions of health education motivate the patients to change their lifestyle to an effective lifestyle?

The results of patients who give the history of hypertensive will be examined in depth because the blood pressure is a readily accessible objective sign for follow-up. With it, we can determine what percentage of patients could have control of their blood pressure to below 140/90 both with and without the usual antihypertensive medications.

2. Basic Aspects of the Health Education Programs:

The programs were designed to introduce the patients to the basic modifications they should make in their lifestyle for optimum health, to teach them how to apply them rightly, and to persuade them to remain on them permanently. The same principles were used for both the outpatient and inpatient programs. These differed in that the outpatient programs met as group sessions once a week for eight to nine weeks with the patients living at home, whereas the inpatients were fed and housed for the group sessions for either 25-, or later, 18-day periods.

1. Dietary pattern was a total vegetarian diet of unrefined foods that included: whole fruit, vegetables, whole grains, legumes, green leafy vegetables, mild herbs, and tubers, high-fat seeds. The patients ate cafeteria-type dining room. A nuts, olives, avocados, and all their meals in a central menu slip, showing the calories per serving, was routinely filled out by the patients.

Two levels of naturally occurring fat were served. The "Therapeutic" was a low-fat (10-15% of calories), no cholesterol, high fiber total vegetarian diet with careful exclusion of the nuts, olives, avocados, and high fat seeds as well as of all the refined foods. The nuts, olives, and avocados were excluded from the diet in patients. with coronary heart disease (CHD), most hypertensives, arthritics,diabetics, and in the obese until their weight was optimal for their height. Alternatively, at the discretion of the physician, the patients were prescribed a "Preventive" type diet that allowed the natural high-fat foods such as nuts, olives, avocados, and high-fat seeds. Calories were restricted for those who were overweight to about 600 to 800 calories per day. Salt was restricted on the therapeutic diet for hypertensives, but permitted ad lib t6 the food of the normotensives.

Suggested daily fare:

A citrus fruit,
An additional fruit,
Two or three whole grains,
A legume,
High available-calcium greens,
A yellow and a green vegetable.

Foods that were excluded:

Meat, fish, and fowl,
Eggs and all milk products,
oil, margarine, and shortening,
Sugar, syrup, and starch,
Meat substitutes, gluten or soy protein,
Degerminated corn, white flour, white rice.
Peanut products because of some undesirable features.

Supplemental elements of the program included:

2. Conditioning exercises designed to increase endurance was prescribed for the patient.

3. Simple hydrotherapy treatments. (Inpatients only)

4. Adequate water, sunshine, and rest.

5. Exclusion of coffee, tea, tobacco, alcohol, and other harmful agents. Medications that were not needed for specific medical problems were discontinued.

6. Spiritual counseling, for those who desired it.

7. The health education program included lectures, cooking demonstrations, exercise supervision, and twice weekly consultations with a physician (once weekly for outpatient programs).

3. Results of Program in Hypertensives:

A. Outpatient Program for Hypertensives: While at LLU, one investigator (MGC), collaborating with Dr. Hans Diehl, began to evaluate group sessions to aid hypertensives. The degree of control of B.P. that could be achieved by the help of three-hour group education sessions once a week (8 weeks) was compared with that B.P. control obtained in the same patient by the same physician with the usual one-to-one office consultation approach.

Thirty-five hypertensive patients of one of us (MCC) were invited to attend group sessions for health education. All were patients who, for two to four years, had been advised and instructed by the physician during return office visits at intervals of every two to three months on how to change their diet to a total vegetarian type. The usual array of antihypertensive medications were utilized as needed to control the blood pressure (with minimal side effects), to below 140/90. Twenty-five of 29 who enrolled, attended all eight of the three-hour sessions (once a week for eight weeks). Four missed one or two sessions.

Each weekly group session consisted of a brief consultation with the physician where the weight, resting blood pressure and pulse, and clinical condition of the patient were assessed. The medication was adjusted as needed to keep the blood pressure below 140/90. They, then, attended three one-hour lecture or discussion periods by the health educator, the physician, and/or a dietitian.

They were instructed in home preparation of a "Therapeutic" low fat (10-15% of calories), no cholesterol, high-fiber total vegetarian diet with careful exclusion of refined foods.

Since multiple antihypertensives were used in some patients and since each hypertensive drug differed in the milligram dose needed to achieve optimal blood pressure control, a "drug potency rating" (DPR) was estimated for each drug. For each drug utilized the maximum milligram amount of that drug that customarily would be used to control the hypertension was arbitrarily assigned a value of "4." Thus, by summation of the DPR of all the antihypertensives that the patients took regularly, the relative need for medication could be assessed, and a crude estimate could be obtained for comparison of the total antihypertensive effect of all the drugs could be made in the patients.

Results: Certain clinical characteristics and average results of the patients are presented in the tables and figures below.

1. The patients responded enthusiastically to the group sessions, and nearly all attended all the sessions. These data indicate that very few patients grasp and put into practice the major changes that are necessary to be made in their lifestyle to help them with their health by just the one-to-one usual physician's office consultation. Many more will comply to the spartan diet if it is presented properly by the right team of health educators and if they find that it is effective. It takes about two weeks for the majority of the patients to have enough change in their taste buds so that they relish the new fare.

2. This study demonstrated that a three-hour once-a-week session for eight weeks is effective in the majority of patients. Only four of the 28 patients exhibited weight, in serum cholesterol, and little, if any, change in benefit of control of blood pressure, the major parameters useful to test compliance. The beneficial response of the blood pressure to the program was evident in the group as a whole by the third session.

In retrospect, from this and later experience in outpatient programs, we believe that the medication could have been cut back in the responsive patients as early as the second and third session with a more dramatic decline in the "Drug Potency Rating."

3. Calculations made on these patients indicated that if all 28 of them continued as they were on the program, they would save $4,030. per year in their drug medical bill, based upon the cost of their medication. Follow-up one year later indicated that at least half of them were on the program with continued benefit.

Table 1.

Clinical Characteristics of the 28 Hypertensive Patients in the 8-Week LLU Outpatient Session
		Hypertensive	28
M/Fe Ratio	18/10	Obese (20% + over ideal)	26
Age (yrs.)	63 (44-77)	Degenerative Arthritis	14
Ht. (in.)	67 (54-73)	Diabetes Mellitus	11
		Coronary Heart Disease	8

Table 2.

Results of 28 Hypertensives from Eight Weeks of Training
OBSERVATIONS	BEFORE	AFTER 8 WEEKS
Weight (lbs.)	190 ±45	184 ±42
B. P. (on med. if needed)	155/86	130/70
Relative Need for Med.	4.7 ±3.4	2.5 ±2.8
No. off B.P. Medicine	3 of 28	6 of 28
Serum Cholesterol mg%	244	206
Fasting Blood Sugar mg%	122	108
Insulin Dose *		50% less
*Amount needed to control FBS below 120 mg%

Figure 1.

Changes in Pressure and in Drug Potency Rating in LLU Outpatient Study.

B. Part I - Hypertensives on 25-Day Inpatient Programs: Patients in this part of the study were those with hypertension as a main presenting problem who enrolled in the Weimar Institute NEWSTART 25-day conditioning program in the 1982-1985 period. They gave a past history of having resting pressures of 160 or more systolic or 95 or more diastolic on repeat examination by their local physician. Ninety percent were on antihypertensive medication on entry with varying degrees of control.

They lived in motel type housing and ate essentially all their meals in the central cafeteria. Nearly all of them were advised to eat a "therapeutic" type diet and to avoid the foods that had salt added to the food.

Routine work-up of the patient included a complete history and physical. A treadmill stress test and a chemistry panel were done at the beginning and again after two weeks on the program.

Antihypertensive medications were tapered off or discontinued as the blood pressure dropped to 140/90 or below to test effectiveness of the NEWSTART program. Blood pressure was measured by the same examining physician under the same conditions of position after at least five minutes of sitting.

Results: The results of the 102 "live-in" patients (see Tables 3 and 4 and Figures 2 and 3) followed a similar pattern to that of the outpatients. In this closely controlled environment of the "live-in" program, the blood pressure began to respond, if it was going to, after four to six days on the program. In fact, some patients developed orthostatic hypotension if the medication was not cut back by then. Since they were under closer supervision, the medications could be cut back more rapidly. In general, the patients in this study were on a lower dose of medication than those in the LLU outpatient program. The changes in blood pressure were essentially the same for both men and women.

Follow-up data indicates that just over sixty percent of these patients remained on the program at home for two years or more sufficiently well to maintain their clinical advantage.

Table 3.

Clinical Characteristics of the 102 Patients of the Weimar 25-Day "Live-in" Program.
		Hypertensive	102
M/Fe Ratio	46/56	Obese (20+ % over ideal)	79
Age (years)	63 (29-82)	Coronary Heart Disease	48
		Diabetes Mellitus	33
		Degenerative Arthritis	28

Table 4.

Results in the 102 Hypertensive Patients from Three Weeks of the "Live-in" Program
OBSERVATIONS	START	AFTER 3 WEEKS
Weight (Lbs.)	195 ±52	184 ±48
B.P. (on meds. if needed)	147/82	129/74
Relative Need for Meds.	2.4 ±2.4	0.5 ±1.4
No. off B.P. Medicines	18	76
Serum Cholesterol Men	228 ±63	176 ±41*
(Mg.%) Women	245 ±59	213 ±6l*
Serum Triglyceride Men	263 ±228	144 ±73*
(Mg.%) Women	245 ±156	174 ±93*
*Results after 2 weeks on program.

FIGURE 2.

Changes in Pressure and Drug Potency Rating with Live-In Program.

Figure 3.

Number of Patients with Elevated Blood Pressure and the Number Who Were off Medication at the Start and During the Program.

C. Hypertensives 18 Days in Outpatient Program: In 1987 it was decided to shorten the NEWSTART live-in program by one week, but otherwise keep the program the same. The same basic set of physician lectures would be given as in the 25 day period. Preliminary evidence indicated that the same percentage drop in cholesterol and triglyceride values occurred on the "preventive" diet as on the lower fat "therapeutic" diet. it should be noted that a modest amount of salt was allowed in the cooking and on the table for those on the preventive diet, but not on the therapeutic diet. The following is a presentation of an evaluation of the data of the hypertensive patients.

The comparison of data with the above 18-day sessions can be obtained by from the data of the second week of the 25-day sessions. The main difference in technique was that essentially all of the 102 patients in the 25-day sessions were followed by one physician (MGC), whereas these 105 patients were cared for by the various staff physicians present. The cascade of events with these patients in the 18-day sessions is outlined in Figure 4. Observations can be made from these data as follows:

1. Twenty-four (23%) of the patients entered the program with a pressure of 138/88 or below, all of which were on antihypertensive medication. The medication was discontinued in 7 of the 10 patients and drastically reduced in the remaining three on the therapeutic diet. Yet they all remained normotensive. The medication was discontinued in 10 of the 14 on the preventive diet, and the medications were reduced comparably in the other four. Twelve remained normotensive, but two of them became mildly hypertensive.

2. Of the 81 who were 140/90 or above on entry into the NEWSTART program, one-third (21) were not taking medication in spite of pressures as high as 198/100. Roughly half of those on medication and 2/3 of those off medication were placed on the preventive type diet. The average initial pressure and Drug Potency Rating were slightly, but not significantly higher, for those on the therapeutic diet (166 +18 / 89 +12) versus those on the preventive diet (161 +19 / 89 +9). The D.P.R. values were 1.6 +1.4 and 1.3 +1.5 for the two groups respectively. A higher percentage 55.3% versus 43.5% (N.S.) became normotensive on the therapeutic diet in comparison with those on the preventive diet. Yet the percentage of patients who at the end were off medication was nearly the same 54.3% of those on the therapeutic diet versus 60.9% on the preventive diet. The average D.P.R. value for the 35 on the therapeutic had declined from 1.6 to 0.8, whereas the value for the 46 on the preventive diet had declined from 1.3 to 0.5.

We conclude that 51 of the 105 (23 on the therapeutic diet and 28 on the preventive diet) who entered the program, were normotensive without antihypertensive medication by the sixteenth day on the program. This is essentially the same as that observed by the second week of the 25-day session. We would conclude, further, that the preventive type diet, with its modest amount of salt, is very nearly as effect as the therapeutic diet in which no salt is added.

Previously, we have observed that about half the patients who come down on the therapeutic diet with salt restriction have a have a return of the blood pressure into the hypertensive range with the daily use of half a teaspoon of salt.

Figure 4.

Total "Known" Hypertensives

4. Results in Other Disease Conditions:

1. Diabetes: Two items bear consideration. First, the data of the entire group year by year indicates that 30% of the adult onset diabetics (AODM) and 10% of juvenile type (IDDM) can be controlled without insulin with a morning fasting blood sugar below 120 mg% within a 25-day session. And, further, the remainder of the patients, those who still need insulin or oral hypoglycemic agents require half as much to control the fasting blood sugar in the 100 to 140 mg% range. This is illustrated in the figures to follow of 21 patient with diabetic neuropathy.

Perhaps the greatest advantage that the NEWSTART diet has to offer the diabetic is in the control of the pain of diabetic neuropathy. The following is a summary of our findings in this condition.

a. The results are shown in table 5 below.

b. All but four patients had complete relief of their distressing sharp, burning pain. Numbness persisted, but most patients had a symptomatic increase in the ability to sense touch.

C. All but three had a significant drop in weight. The average drop in weight during the three weeks was 11.4 lbs which was the same as that for the usual overweight patient on this program. Relief of the neuropathy pain did not seem to be related to weight loss.

d. Seven of 21 patients no longer required insulin or hypoglycemic drugs to keep their FBS below 140 mg%. Those who continued to need insulin or drugs to control blood glucose, required only 25 to 75% (ave. 51%) as much to achieve the same or improved control of FBS two weeks after starting the program in comparison with their needs on entry.

e. Thirty-two percent of the patients had less than 10% drop in triglyceride, and 53% had less than a 10% drop in cholesterol in two weeks on the program. Diabetic patients are twice as likely to show resistance to drop in these parameters on the program than do nondiabetic patients.

f. The mechanism whereby symptomatic relief occurs is not clear. This deserves further study.

Table 5.

Regression of Diabetic Neuropathy (D.N.) with Total Vegetarian Diet
Pt.	Age & Sex	Known D.M. (yrs)	Known D.N. (yrs)	Percent Over Ideal Wt.	Wt. Loss (lbs.)	Days Until Pain Free	Glucose mg % Basal/Day-14	Insulin or Oral Meds. Basal/Day-25	Triglycerides mg % Basal/Day-14	Cholesterol mg % Basal/Day-14
SL	45F	15	3	+82	-16	partial	263 / 129	95 / 40	238 / 183	202 / 191
JB*	5OF	15	0.5	+57	-8	7	313 / 141	C250 / 0	738 / 267	328 / 211
KM*	58F	10	3	+65	-11	10	171 /128	C500 /16	523 /271	285 /297
LM*	58F	8	3	+145	-16	10	113 /135	T1000 /15	207 /218	236 / 253
IF*	62F	10	10	+71	-6	slight	132 / 129	G15 / G10	367 /313	240 / 243
VR*	63F	20	8	+50	-10	4	255 / 113	65 / 35	544 / 390	216 / 243
GS	63F	8	2	+31	-10	5	86 / 108	30 / 0	302 / 270	338 / 215
RB*	65F	14	4	+112	-9	14	348 / 124	120 / 90	308 / 140	241 / 152
OV*	67F	5	1	+60	-19	5	153 / 118	0 / 0	216 / 133	200 / 167
RB*	70F		5	+47	-12	10	115 / 88	0 / 0	78 / 86	164 / 145
GC	70F	13	0.5	+46	-11	9	113 / 107	C125 / 0	378 / 346	286 / 281
MG*	73F	15	0.7	+46	-8	12	151 / 138	30 / 20	180 / 137	224 / 200
EH*	73F	11	0.5	+14	-2	15	83 / 139	C500/C250	161 / 189	224 / 201
IW*	78F	20	1	+45	-14	15	111 / 111	50 / 30	260 / 138	239 / 202
RM*	57M	6	2	+31	-8	slight	112 / 177	C250 / 10	327 / 265	272 / 248
KR	60M	20	10	0	0	8	148 / ND	50 / 24	184 / ND	219 / ND
WG*	62M	5	4	+83	-21	12	273 / 92	74 / 20	127 / 95	202 / 146
SR*	64M	4	4	+44	0	8	215 / ND	0 / 0	256 / ND	190 / ND
RB*	64M	20	2	+54	-16	partial	126 / 92	210 / 75	485 / 308	241 / 220
PW	71M	10	4	+48	-16	15	142 / 137	72 / 30	234 / 214	156 / 138
WH	74M	11	5	+24	-13	16	115 / 86	50 / 0	369 / 172	326 / 234
*Hypertensive as well as diabetic (DM)							Medication: Unspecified = units/day of Insulin
Glucose, etc., after 12 hour overnight fast							C = ong./day chlorpropamide, T = mg./day tolbutanide, G = tog./day glyburide

Table 6.

Follow-Up Data of Diabetics with Neuropathy on Total Vegetarian Diet
Pt.	Age & Sex	Known D.M. (yrs)	Known D.N. (yrs)	Days Until Pain Free	Months of Follow-Up	Status of D.N.	Degrees of Compliance Diet / Exercise
SL	45F	15	3	partial	36	better	++++	+
JB*	5OF	15	0.5	7	40	same for 6 mo.	+++	++
KM*	58F	10	3	10	46	better	++	+
LM*	58F	8	3	10	45	no follow-up	no follow-up	no follow-up
IF*	62F	10	10	slight	32	same	+++	+
VR*	63F	20	8	4	34	better	+++	+++
GS	63F	8	2	5	39	deceased	deceased	deceased
RB*	65F	14	4	14	42	better	+++	+
OV*	67F	5	1	5	12	better	++	+
RB*	70F		5	10	34	better	+++	+
GC	70F	13	0.5	9	34	better	++++	++++
MG*	73F	15	0.7	12	30	better	+++	+++
EH*	73F	11	0.5	15	14	same	++++	0
IW*	78F	20	1	15	17	better	+++	+
RM*	57M	6	2	slight	48	same	++	+
KR	60M	20	10	8	28
WG*	62M	5	4	12	41	same	+	+
SR*	64M	4	4	8	28	better	++++	++
RB*	64M	20	2	partial	26	better	+	++
PW	71M	10	4	15	36	deceased	deceased	deceased
WH	74M	11	5	16	44	no follow-up	no follow-up	no follow-up
*Hypertensive as well as diabetic (DM)					Rating of Relative Compliance to Vegetarian Diet & Exercise Program at Home:
Relative Change in Neuropathy Pain Since Attending 25-Day Vegan Program: Same = same as at the end of the program Better = improved further after going home					0 = not on program + = on program only somewhat ++ = on program 50-50 +++ = on program in nearly every item ++++ = on program as advised

Results of Demographic and Lipids Assessment for 1988:
The data of the 1988 sessions is quite similar to that of 1982 that was reviewed in detail at an earlier date. Certain demographic characteristics are as follows:

Sex and Age:				Age
	Sex	No	Range	Median	Mean
	Male	75	10-84	59	57
	Female	191	17-86	62	60

Observe that the female/male ratio is 2.5 (versus 1.8 in 1982-5). In this discussion sample sizes will vary from graph to graph because of some missing data.

Weight Status: (5 non-response) Data compared with ideal weight
	Male	Female	Total
Underweight (10% or more)			7%
Optimal weight			21%
Overweight (10% to 19%)	11%	13%	12%
Obese (20% or more)	61%	58%	60%

Changes in Cholesterol and Triglyceride over the two-week period were dramatic and highly significant (p.001). Figures 5 and 6 illustrate these changes relative to initial value. We observe for both graphs that the larger the initial value the greater the percentage loss in lipids. Notice that the percentage figures given on the graph represent a decrease in cholesterol or triglyceride value.

HDL cholesterol exhibits a different pattern than either cholesterol or triglyceride as shown by Figure 7. Since in this figure there are percentage increases as well as decreases, negative signs have been introduced to indicate a decrease. We see, then, that whereas at lower levels of HDL there is a modest increase in value (the direction we desire), at higher levels there is a decrease.

Regarding risk ratio (cholesterol/HDL), Figure 8, there is a non-significant increase at values less than 5. But for those with elevated risk (RR 5) there is a significant decrease (p.001) in risk ratio over the two-week period.

We have observed regularly over the years that women have a smaller decline in serum triglyceride and cholesterol than do men with the two to three weeks on the program. About 38% of the women and 9% of the men of comparable ages had a less than 10% drop in cholesterol in those with a cholesterol:HDL risk ratio of 5 or greater. The 1988 data indicates a similar trend, but needs further study.

Figure 5.

Changes in Cholesterol (Day-14) Related to Initial Range

Figure 6.

Changes in Triglyceride (Day-14) Related to Initial Range

Figure 7.

Changes in HDL Cholesterol (Day-14) Related to Initial Range

Figure 8.

Changes in Risk Ratio (Day-14) Related to Initial Range

Cholesterol was contrasted for men and women (not shown). Initial cholesterol values were similar for men and women, but men manifested a greater percentage change in cholesterol than women. similar pattern was observed for triglycerides.

In general, men showed less of an increase in HDL cholesterol to an acceptable level than did women on the program. We observed similar situation for men and women relative to the risk ratio.

We have initiated a study of men and women whose cholesterol, risk ratio, and triglyceride in the serum who exhibit resistant to reduction to acceptable levels. Preliminary data indicates that the use of certain food supplements can assist the program in correcting this problem.

6. General Results:

Obesity: Obesity was a major problem as indicated above. On the NEWSTART program the patients regularly lost weight remarkably free of hunger symptoms. We observed the following changes.

Relative Weight	No.	Average Wt. Change
Obese	153	-8.1 ± 6.2 lbs
Overweight	30	-3.3 ± 2.6 lbs
Optimal weight	54	-2.0 ± 3.2 lbs
Underweight	16	-1.1 ± 1.1 lbs

Coronary Heart Disease: From 40 to 50% of our patients have coronary heart disease by history of typical angina, previous anglographic findings, positive treadmill, and/or coronary bypass surgery. Over half of them have clear-cut relief of symptoms of angina on the program. The relief of symptoms became most evident about the tenth day with a greater ability to walk without distress.

A follow-up survey is in progress to evaluate the long-range benefits. Two examples indicative of regression of CHD are presented below. The first patient, D.C., was a 62-year-old manufacturer who had 2-3 mm. depression of the S-T segment of his EKG after three minutes of the (Bruce) treadmill exercise test. The patient has stayed on the diet and exercise program faithfully, even on his various hunting safaris. After six weeks on the program, he could go nine minutes of the Bruce treadmill before having S-T depression of 2-3 mm. After one year lie could go twelve minutes before that degree of suppression of the S-T segment; and after two years, he could go 12 minutes of Bruce protocol without S-T segment before he reached a pulse of 150 (the 85% of allowable heart rate). On his own volition he returned to his hobby of hunting. His first trip was at the high altitude of 12,000 to 13,000 ft in Tibet. The following years he took similar excursions at like altitude in Nepal and the Andes, all without anginal chest discomfort. (See Fig. 9).

Patient M.H. was a 61-year-old Seventh-day Adventist whose serum cholesterol had been found over the years to range from 130 to 160 mg%. After developing anginal-type chest pain during a hike, he consulted a cardiologist who found severe CHD by anglography and with evidence of ischemic areas in the left ventricle by thallium heart scan. He chose the plan of a change in lifestyle instead of the recommended coronary bypass surgery. His initial cholesterol was 120 mg% with a Cholesterol/RDL risk ratio of 5.2 because of an HDL of 23 mg%. His risk ratio remained elevated at 4.8 after two weeks on the program. Following the addition of Chromium GTF and niacin food supplements, his cholesterol dropped to 92, his HDL increased to 60, and his risk ratio dropped to 1.5. After about eight months he had a repeat thallium heart scan which revealed no evidence of ischemia of the heart. (See Fig. 10).

Degenerative Joint Disease: Within 18 days, over half of the patients with symptomatic involvement of the back, hips, or knees (a major problem in our patients), have improvement or entire relief of pain. The joint deformity still remains. This condition needs more prolonged correction of the life style before sufficient restoration of circulation can occur from the arterio-atherosclerosis and allow repair of the joint, if such is possible. Those who have the best clinical results state that the occasional use of a "little" sugar or oil interferes with relief of their symptoms.

Other Ailments Benefitted: Statistical studies are under way to evaluate the long-range benefit in patients with rheumatoid arthritis, multiple sclerosis, allergic states, and peripheral vascular disease. In rheumatoid arthritis we can say that over half of the patients have dramatic improvement in the joint pain to the extent of being free of the need for pain medication by the seventh to fourteenth day of the program. Patients with allergic conditions are helped by avoidance of all foods which contain milk or egg products, avoidance of anything which may contain mold or yeast residue, and by avoidance of certain foods determined by history, such as grains, which are known offenders. Fat restriction has been shown by other investigators to be beneficial in helping relieve multiple sclerosis. Preliminary evidence on the few patients that we are familiar with indicates that M.S. there are two components that need to be addressed simultaneously, the refined foods such as sugar and oil, and a food dyscrasia factor.

8. Concluding Remarks:

Precautions with the Diet: As with all diets, a proper selection of foods is needed to obtain a balanced intake of all the known minerals, vitamins, protein, fatty acids, and trace elements. All of our daily needs, with the possible exception of vitamin B₁₂ and iodine, can be supplied from a daily menu of a citrus fruit; green leafy vegetables; a yellow vegetable such as carrots or yellow squash; a legume like beans, peas, lentils, or garbanzos; and two or three whole grains. Mustard greens, radish greens, turnip greens, collards, broccoli, or kale are the best sources of calcium and magnesium. Spinach, chard, and beet tops have calcium, it is bound with oxalate.

When a person becomes a total vegetarian, he should remember special needs to insure proper nutrition. Most of these factors are known; they merely should be noted and implemented. Civilized methods of food processing and improper farming can upset nutrition.

Vitamin B₁₂: Vitamin B₁₂ is made by bacteria, yeasts, or molds; but not by plants or animals. By necessity we must wash and thoroughly cleanse our produce before eating it. We refrigerate the leftovers, and thoroughly sterilize our eating utensils. It is now known that B₁₂ must be combined with a food or saliva factor in the mouth, so that it can be exchanged in the first portion of the duodenum for intrinsic factor (from the stomach), and then it is available for absorption by the last six or eight feet of the small bowel. A weekly dose of 100 to 500 mcg of B₁₂, chewed with the food is advisable.

Iodine: When persons go on a total vegetarian diet, they need to realize that produce as grown in most localities may be deficient in iodine. Unless they routinely use iodized salt, they may not get sufficient iodine. Patients who are advised to restrict salt are particularly at risk in this regard. They should take one or two kelp pills daily or obtain iodine by other means.

Vitamin D: Americans are used to vitamin D supplemented milk and other foods. Sufficient sunshine should be obtained regularly, or if that is not possible artificial sunshine or vitamin D supplements should be taken regularly when sunshine is not available because of location, fog, smog, etc.

Calcium and Magnesium: The best total vegetarian available source of these minerals is found in the low oxalate green leafy vegetables.

Protein: Adequate protein is available in the vegetarian kingdom. It would seem wise to combine a couple of grains, a legume, and green leafy vegetables as a regular daily fare. The usual American diet is too high in protein and thus causes a drain on the calcium stores unless a very high calcium intake is maintained.

The "Gas" Problem: the amount of intestinal gas can be controlled by consideration of a few guidelines.

1. Chew the food thoroughly, - 30 to 50 chews/mouthful
2. Avoid fruit and vegetables at the same meal
3. Avoid the known "gas former" foods such as beans, cabbage, etc., until ways are found to prepare them to prevent distress
4. Cut back on the total calories and total volume of the meal
5. Allow a few weeks or months for the intestinal flora to change
6. Most people pass flatus up to 15 times a day.

Figure 9

Figure 10

Patient M.H. has a positive Thallium scan on March 3, 1987, and a negative Thallium scan on November 25, 1987. Note the prompt rise in HDL and a further decline of total cholesterol with chromium GTF and niacin. Patient on therapeutic diet and exercise program faithfully.

Copyright © 1995-2002 Milton G. Crane, M.D. and Barbara G. Crane, R.D., Weimar Institute, Weimar, CA 95736. All rights Reserved.