A Fresh Look at Gasoline Prices
Surging gasoline prices would have to go still higher — perhaps up to about $5 a gallon — to repeat the economic turmoil sparked by high prices in the 1970s and early 1980s, according to an analysis by one petroleum expert.
Michael Economides, a professor at the University of Houston, cites a more energy efficient economy. “When prices go up they don’t have the same impact as they did in the 1970s,” he says. Simply looking at the inflation-adjusted cost of gasoline — a common measure used to judge the impact of higher gasoline prices compared with the impact of previous surges — leaves out important measures that have bearing on how much Americans are willing to pay for it, he says.
U.S. gasoline prices have risen since the end of 2003 amid strong global demand for crude oil, political disruptions in key oil-producing regions and refinery constraints. The average price for a gallon of regular gasoline this week is $2.91 a gallon, up about 78 cents from a year ago.
Some retailers with less affluent clientele, including Wal-Mart Stores Inc. and Dollar General Corp., have expressed concerns that shoppers may curtail their activity because of prices at the pump. Auto makers General Motors Corp. and Ford Motor Co. have seen sales of some of their most-profitable but least fuel-efficient models slide, hurting their bottom line.
Still, economic growth has continued apace, with other shoppers apparently taking up the slack and other auto makers reporting healthy sales. Gasoline demand in March was 9.1 million barrels a day, up 1.5% from last year. Many transportation companies have said they are able to pass on rising fuel costs with little economic effect.
Mr. Economides said improving fuel economy is one reason. A gallon of gas takes drivers farther than it did 30 years ago, though fuel-efficiency has flattened in recent years. “Our economy has also become more efficient, requiring a lot less energy to generate a dollar of wealth,” he says.
In 1975, for example, the ratio of gasoline consumed to the size of the GDP was nearly twice what it is today. Mr. Economides says this needs to be factored into the gasoline-price adjustments. Normalizing the price of gasoline in this way, he says, “shows the real ‘feel’ of gasoline costs. They are way lower than anything before 1985.”
Nutrient Is Linked to Healthy Babies
Graphic: Which foods are high in choline?
Scientists who study fetal development are abuzz over a nutrient most people have never heard about. Choline, pronounced KO-leen, is a vitamin B-like compound found in high quantities in eggs, beef and chicken liver, wheat germ and soybeans. The latest studies suggest that in pregnancy it plays a critical role in brain development, and may even lower the risk of neural-tube defects such as spina bifida, in the same way that folic acid does.
In 1998, the Institute of Medicine, part of the National Academy of Sciences, deemed choline an essential nutrient, meaning that humans must obtain most of what they need from diet in order to stay healthy. The Food and Drug Administration permits food manufacturers to use “Good source” or “Excellent source” labeling on their products if they contain specified minimum amounts.
But choline has yet to find its way onto the public’s radar screen.
Low Visibility Is a Hurdle
“From a marketing standpoint it has been a slow go, mainly because of the lack of customer awareness of what choline is,” says Roger Lantz, a sales director at the Solae Co., which produces soy-based ingredients for food makers, including Rumford Naturals Cornbread & Muffin mix, one of the few items on store shelves that touts choline on its label.
Generally speaking, except for women who are pregnant or breastfeeding, choline deficiency is rare, because the nutrient is present in many basic protein foods. Women, more than men, can produce a significant amount of it in their livers. But during pregnancy, the demand becomes too great to be met by what the body can make on its own.
“During pregnancy, enormous quantities of choline are pumped across the placenta. It’s 15 times more concentrated in the fetus than it is in the mother,” says Steven Zeisel, who runs the nutrition department at the University of North Carolina in Chapel Hill and is recognized as an expert on choline.
This drawdown in the mother persists into breastfeeding, he says, evident from the high levels of choline in breast milk. It is the reason why the FDA requires that all infant formulas contain the nutrient, which generally isn’t included in prenatal vitamins.
Dr. Zeisel worries most about the choline intake of pregnant vegans and those he dubs “pastatarians.” “If you’ve cut out eggs, milk and meat you should carefully think about whether or not you’re getting enough overall choline,” he says.
Choline helps regulate the transport of nutrients into and out of cells. It also forms acetylcholine, a neurotransmitter involved in learning and memory functions. According to Dr. Zeisel, who published findings this year in the Journal of Neurochemistry, choline also seems to regulate the division of stem cells that go on to form the memory areas of a baby’s brain by turning off the expression of certain genes in DNA. If there isn’t enough choline, those genes are expressed and the stem cells stop dividing.
Animal Studies Play Role
Until now, the majority of the science linking prenatal choline intake to brain function has come from animal studies at Duke University in Durham, N.C. Researchers there have shown that giving extra choline to a pregnant rat during a key window of development permanently changes the way the brains of its offspring are organized and function.
For example, those offspring performed 30% better on tasks relating to memory and attention than control animals that were not given prenatal choline supplements.
In a study published this year in the Journal of Neurophysiology, Duke researchers showed that the neurons in the offsprings’ brains were bigger and could make more neural connections.
“The amazing part of these studies is that the effects lasted the animal’s entire life, even though it never received any more extra choline except for that one six-day period in the womb,” says Dr. Zeisel. This summer, Dr. Zeisel began a study to see if the same outcome will happen with pregnant women and their babies when they get extra choline.
The detriment of not having enough choline in the diet was the subject of a paper in last month’s issue of the American Journal of Epidemiology. The authors — led by Gary Shaw, a research director of the California Birth Defects Monitoring Program — based their study on the medical records of California women who were pregnant in the late 1980s and early 1990s.
‘Sizable Risk Reduction’
Dr. Shaw selected a group of 864 women — 424 whose pregnancies resulted in babies or fetuses with neuraltube defects, and 440 who delivered normal babies. In the months that followed delivery, all of the women took part in an eating-habits survey. They were asked to complete a detailed food questionnaire in which they listed the frequency and portion size of the foods, including vitamin supplements, they had eaten in the months before and around the time of conception. From this, Dr. Shaw and his colleagues then were able to calculate each woman’s estimated daily choline intake using a database that lists the choline content of common foods, published by Dr. Zeisel’s group last year.
The researchers found that women whose daily choline intake was greater than 498 mg had about half the risk of delivering a baby with a neural-tube defect, compared with expectant mothers whose choline intake was 290 mg or less.
“That’s a sizable risk reduction,” says Dr. Shaw. Most startling is that this reduction occurred independently of intake of folic acid, a nutrient found in leafy greens that’s now added to staples such as bread because it’s been proven to reduce birth defects.
“Many of us have been targeting folic acid as the way to prevent birth defects, and this has certainly worked,” Dr. Shaw says. “But issues remain as to why it doesn’t work in everyone. How do we prevent birth defects in women who take folic acid? … We started thinking about other exposures. Choline and its metabolite, betaine, are good candidates because they play similar biochemical roles to folic acid.”
Experts aren’t ready to recommend supplementing a normal diet with choline.
“Right now, we don’t know if there are any benefits of women taking extra choline. Without knowing what the benefits are, any potential risks are not worth it,” says Dr. Zeisel. For now, the advice is simply to consume choline-rich foods.
Originally published in the Wall Street Journal
Catch-Up Care Is Essential for Foreign Adoptees
Last month, the Centers for Disease Control and Prevention temporarily suspended adoption processing from an orphanage in China’s Hunan Province, after determining that it was the source of nine measles cases in recently adopted children.
This was the second time since 1997 that the agency suspended adoptions from abroad. The previous, which occurred in February 2001, also pertained to a measles outbreak and also originated in a Chinese orphanage.
Both cases represented very little threat to the public’s health, since most Americans are immune to measles, the CDC said. The agency has found only one secondary case of measles so far–in an unvaccinated college student who had close contact with one of the infected children. In the 2001 outbreak, four of the 14 measles cases occurred in unvaccinated U.S.-born individuals. So the events, while not worrisome, do highlight the need for new adoptive parents to be tuned in to a range of health issues that can arise with foreign-born children. Parents need to be ready to play catch-up on vaccinations, and make sure they select a pediatrician who knows how to recognize childhood diseases that are becoming less familiar to doctors in the States.
“Remember, doctors here are seeing [these children] in the context of middle-class America-cleaned up, dressed nicely,” says pediatrician Deborah Borchers. “So diseases prevalent in the developing world, where these children are coming from, don’t immediately spring to their minds.” Dr. Borchers is a member of the American Academy of Pediatrics’ Committee on Early Childhood, Adoption and Dependent Care. She also has three girls adopted from China. Not until she began adopting 10 years ago did she realize how ill-prepared many of her colleagues were to adequately screen children from abroad.
“Physicians need to think ‘outside of the box’ when it comes to evaluating these children with what seems like routine illnesses,” she says. With regard to the latest measles cases, for example, Dr. Borchers and another expert said they had heard through “the doctor rumor mill” that at least one of the children was initially misdiagnosed as having coxsackie virus, which can also give symptoms of fever and rash.
The CDC couldn’t confirm the claim. “However, it isn’t surprising, because doctors in the U.S. don’t see that many measles cases anymore,” said Dr. Marty Cetron, deputy director of the agency’s Division of Quarantine and Global Migration, which has been investigating the current cases. Measles is one of the most infectious diseases in the world, but the U.S. sees fewer than 100 measles cases per year on average, mostly imported from other countries.
U.S. Americans adopted 21,616 foreign children in 2003, mostly from China and Russia, according to the State Department. The CDC reports that infectious diseases have been found in up to 60% of children adopted from abroad-depending on the country of origin-and many infections can show no symptoms.
Mary Staat, who directs the International Adoption Center in Cincinnati, says it’s worth it to require parents to show proof they’ve had their children evaluated for infectious diseases, although that’s currently not required. “Tuberculosis is a prime example, because it is so prevalent in many host countries, is a silent infection in children and can only be detected by doing screens,” she says. The American Academy of Pediatrics advises pediatricians to screen and if necessary, immunize, internationally adopted children against the vaccine-preventable diseases specified by immigration law, and to screen them for HIV, tuberculosis, intestinal parasites and hepatitis C.
“There is no regulation from the U.S. side that governs how these kids are cared for in their countries of origins, and the parents may have to play catch up,” says Margaret Hostetter, who founded Yale University’s International Adoption Clinic. “Parents should be accepting of the environment from which the child comes and recognize there may be infectious diseases in that environment we may not have here,” she says.
A U.S. law passed in 1996 requires all immigrants applying for a permanent visa to show proof of immunity to a slew of vaccine-preventable diseases, such as measles, mumps, polio and hepatitis B. International adoption groups and health experts succeeded in amending the law to exempt adopted children under 11 years of age, arguing the requirement placed an unnecessary burden on the children and lengthened what is already a heavily bureaucratic and emotionally exhausting experience for the prospective parents.
“We couldn’t guarantee the vaccine records from most host countries were reliable,” says Dr. Borchers. Studies conducted in the last few decades often showed discrepancies between what was recorded on children’s immunization records and what actually showed up in post-adoption blood screens, she says. Follow-up investigation found that even well-intentioned vaccination programs had been rendered ineffective because health officials had improperly stored the vaccines or administered them at the wrong dosage or at the wrong time in the child’s life.
The CDC hasn’t determined yet if the children who came down with the measles had health records that indicated they had been vaccinated against the disease in China. In the case of the 2001 outbreak, the 10 orphans involved were not vaccinated prior to adoption.
In addition to following through on screening and vaccinations, parents of newly adopted children should cocoon for a few weeks after arrival, as difficult as that is when it’s time to show off the newest member of the family, experts say. It’s especially important in those initial weeks to minimize contact between the child and family members or friends who may be have compromised immune systems.
“It’s in the best interest of these children, from both an emotional and health point of view to have a fairly low key, reserved life for a few weeks after they arrive,” says Dr. Jerri Ann Jenista, a pediatrician who specializes in international adoptions. During this time, parents can observe the infant or toddler for any signs of sickness. “Last year, because of SARS it was easy,” she says. “We told all families to go home, lock the doors and not leave the house for a while. So we know it can be done when there’s a major impetus.”
Originally published in the Wall Street Journal
In the Hunt for Cheaper Drugs, Bulk Buying Is Good–Usually
Graphic: Purchasing decision tree for drugs
It pays to shop around, even when it comes to prescription drugs.
With ever-rising costs of co-payments and cutbacks in insurance coverage, an increasing number of Americans — and not just the 41 million who are uninsured — are facing sticker shock on medicines. The trick is learning how to become a savvier shopper without jeopardizing quality or consistency.
Personal Journal looked at several strategies for saving money and found some surprises.
While going with generics is cheaper than taking a brand-name drug, we were surprised how much variation there can be with the prices for generic drugs, depending on where you bought them.
We also learned not to make assumptions. Canadian Internet pharmacies, which can offer substantial savings on brand-name drugs, sometimes don’t offer any savings at all on generics.
Chain drugstores, meanwhile, aren’t always cheaper than independent Main Street pharmacies.
Take, for example, the generic form of antidepressant Prozac, known as fluoxetine. In our search, prices ranged from as high as $2 a pill at various chain and independent pharmacies in the greater New York City area, to as low as 15 cents a pill at Costco. The Costco price — available through its Web shop or in its actual warehouseclubs — was lower than some co-payments under company-sponsored insurance plans.
Online Comparison Shopping
Internet pharmacies can seem intimidating for those who aren’t regular Web shoppers, but the potential savings can be worth the trouble of getting familiar with cyberspace. It is easier and more convenient to do comparison shopping online rather than calling around to pharmacies.
Important drug information — instructions, side effects and potentially dangerous interactions with other drugs — is generally just a mouse click away. Most of the major Internet pharmacies, such as drugstore.com, also have a pharmacist available 24 hours a day to answer questions over the phone. Ordering online also means that medications will be delivered to your door.
As with all online pharmacies, processing and shipping can take as long as three weeks, so buying medications online that are needed immediately, such as antibiotics, isn’t practical.
Shopping at Canadian online pharmacies has become a popular way for people in the U.S. — especially the elderly — to reduce their drug costs. Because of Canadian price controls and the weak Canadian dollar, you can generally save between 50% and 70% on brand-name drugs. But for generics we found that the savings weren’t as great, and in some cases U.S. online pharmacies had lower prices than those north of the border.
Shopping in Canada may also become more difficult because some of the major drug makers are trying to shut down cross-border sales. In January, GlaxoSmithKline PLC stopped shipping its drugs, including the antidepressant Paxil, to Canadian pharmacies until they stop filling U.S. prescriptions. (In the U.S., only drug manufacturers are permitted to import drugs, although the Food and Drug Administration generally allows individuals to import small amounts for personal use and hasn’t clamped down on Internet shipments.)
Buying in Bulk
Internet purchases and buying in bulk — say, getting a threemonth-supply at a time — often go hand in hand. As the graphic shows, bulk purchases are generally economical, but that isn’t always the case. There are also other considerations beyond the cost per pill. For example, your doctor needs to write a multimonth prescription.
This isn’t always possible with some drugs — such as bloodpressure and thyroid medications — because your doctor may have to tweak the dosage until it is right for you. Also, if you are on a fixed income, buying in bulk may not be financially feasible no matter how great the savings.
Your doctor should be your first stop in your bargain hunt, because he or she may have a stash of free samples that could be a big help even if only for a week or two.
Both doctors and pharmacists also will know if a generic version exists for a particular drug. Such versions of brand-name drugs by far the biggest overall money saver.
Doctors and pharmacists can suggest a cheaper branded alternative made by a rival drug maker when appropriate. Cholesterol drugs, for instance, can range from $100 a month for Pfizer Inc.’s Lipitor to less than $50 for Novartis AG’s Lescol.
Splitting Pills
Pharmacists, in addition, can tell you whether it is possible to buy a higher dosage and save money by splitting the tablet, though that tactic requires some familiarity between druggist and customer. “If I felt that certain of my customers are capable, I would suggest they split tablets,” says Tony Welder, a pharmacist in Bismarck, N.D.
Some tablets, like antidepressant Zoloft, made by Pfizer, can be split fairly easily because they’re already indented with a dividing line. Thesavings can be tremendous. In the case of Zoloft, 30 tablets of a 50-milligram dose costs $69.99 at drugstore.com, while the same number of 100-milligram Zoloft tablets costs $70.99. Cut the larger dose in half, and you have a 50% savings.
Of course, not all tablets can or should be split, Mr. Welder warns. Some are too hard or have special coatings, and some drugs, especially heart medications, have critical dosages that shouldn’t be tampered with. There is also the worry that perhaps an elderly patient may not do it properly.
Another warning: Don’t sacrifice consistency of care to cut costs on prescription drugs, no matter how great the savings. Pharmacists and doctors need to know all of the medicines you are taking, and tracking can get complicated when making purchases from multiple sources.
“A la carte shopping for your drugs is a bad idea” because that makes it hard for a pharmacist to guard against dangerous drug interactions, says Todd Andrews, a representative for drugstore chain CVS Corp.
Originally published in the Wall Street Journal.
Have A (Pig) Heart
In January the team that helped clone Dolly the sheep revealed another distortion in nature: five genetically modified cloned pigs.
PPL Therapeutics is betting that hearts and other organs from pigs can be transplanted into humans. About the same time, another group at the University of Missouri reported a similar cloning of swine.
About 16 Americans die every day waiting for a transplant donor. Scientists believe pigs are the most likely candidates for xenotransplantation because their organs are biologically similar to those of humans. The biggest obstacle has been rejection by the human immune system. In the new piglet clones, a gene that codes for a sugar on the surface of cells has been turned off.
“Blocking production of this sugar has been the Holy Grail of xenotransplantation, because the molecule causes a hyperacute rejection within the first two or three minutes of putting a pig organ or cell into a human or primate,” said PPL spokesperson David Ayares.
Knocking out one gene, however, doesn’t mean the body will accept a new organ. “We need to have strategies for T-cell-mediated, or chronic, rejection,” Ayares said, which usually occurs within a few days after transplantation. That will involve adding human genes to the DNA of a pig clone so its organs will look more familiar to a human immune system.
And researchers still have to worry about pig viruses that could be transplanted into humans along with the organs. PPL intends to begin trials in primates in the next six to 12 months.
Published in Discover’s Year in Science 2002
Maya Up Against a Wall
Wiliam Saturno’s search was shaping up to be a disaster. What should have been a five-hour trip had become a three-day journey through the rain forest.
His hired guides had drastically underestimated how much time it would take to reach their destination. Now the food and water were gone. The situation looked downright scary. Then Saturno and his befuddled crew stumbled onto the ruins of an early Mayan ceremonial site in northeastern Guatemala.
The site, San Bartolo, had been previously unknown to archaeologists, though not unknown to looters, who had dug numerous tunnels around a central plaza complex. Saturno didn’t see any of the carved stone monuments he was looking for, so he decided to duck into one of the tunnels. There he happened upon a phenomenon far more extraordinary than any statue: the oldest intact mural of any early Mayan society. Superbly detailed and richly colored, the mural was exceptionally preserved. “I started laughing at the sheer improbability of the situation,” recalls Saturno, a researcher at Harvard’s Peabody Museum of Archaeology and Ethnology. He announced the find in March.
The entire site is a treasure, but its crown jewel is the 1,900-year-old mural. The panel covers about four feet, but only the 10 percent that was uncovered by looters is visible. “We know so little about Mayan wall painting for this time period that we exponentially expand our data set with every inch we analyze,” Saturno says. Prior to this discovery, only a few fragments from murals dating from the early Maya (400 B.C. to A.D. 250) had been found. From the mural’s exquisite craftsmanship, Saturno and his colleagues deduce that it must have been painted by a group of artists trained for the task and supported by the state or by members of the court who had sufficient wealth to commission such a work.
The mural has also yielded news about ancient Mayan legends and religion.“We now know,” says Saturno, “that mythology that was important in the16th century was equally important in the first century,” which establishes a degree of cultural continuity. The pivotal figure in the one scene that has been uncovered so far is the corn god attended by two women, apparently goddesses, and a young male, probably the god’s son.
According to Karl Taube, an anthropologist at the University of California at Riverside,whom Saturno recently invited to help interpret the mural, the scene establishes the importance of maize inMayan culture even at this early date. The kneeling woman is reminiscent of the later classic Mayan wind god, and the other woman seems to be shadowed by a rain cloud. Taubes speculates that painters created a metaphor of wind and rain assisting the growth of maize.
Saturno expects more surprises: “They represent a watershed moment in the study of early Mayan civilization, perhaps holding clues to its very origins.”
Published in Discover’s Year in Science 2002
Copycat
In February scientists at Texas A&M reported cloning the first house pet: a gray tabby named CC. Researchers created CC in partnership with a biotech firm called Genetics Savings & Clone, which plans to offer cloning services to pet owners within a year.
After CC’s birth, the company received hundreds of calls, both for and against, says spokesperson Ben Carlson. “A lot of people alarmed about cloning believe cloning pets is really the most slippery slope toward cloning humans.”
After many attempts, CC was created by coaxing the nucleus of a cell from a calico cat into an enucleated egg; an electrical spark prompted the hybrid to divide, and the resulting embryo
was then transferred into a surrogate mother. The team performed 188 nuclear transfers to produce 87 cloned embryos. Eight of the embryos were implanted in surrogate mothers, and
one led to a live birth. The group has tried to clone dogs, but canine reproductive physiology has proved to be complex.
CC’s appearance shows that clones are not exact copies. With her gray fur, CC doesn’t even look like the calico cat that donated her genes. Coat color is determined by a poorly understood
process that randomly inactivates certain genes in the cells of a developing embryo. The process of gene inactivation is thought to be a phenomenon of all mammals, including humans.
Genetic Savings & Clone warns that pet owners may be expecting more than cloning can deliver. Carlson says: “We have gone to great pains to emphasize that a clone is a brand new animal,
without any of the memories of the old one. It’s not going to be a reincarnation of Fluffy.”
Published in Discover’s Year in Science 2002
Eating Is Believing
Patients suffering from Crohn’s disease say diet can help their pain. But doctors ask: Show us the proof
After suffering from stomach cramps and diarrhea for almost two years, Rachel Turet says a diet has solved her health problems. Now her biggest problem has been convincing doctors it works.
Ms. Turet, a 55-year-old from Deer Park, N.Y., suffers from inflammatory bowel disease, or IBD, a debilitating condition that robs the body of its ability to efficiently absorb nutrients. An estimated one million to two million Americans have IBD, which can cause chronic stomach cramps, diarrhea and intestinal bleeding. The two most common forms are ulcerative colitis — where the large intestine becomes inflamed — and Crohn’s disease — where inflamed tissue can be found anywhere in the digestive tract.
IBD shouldn’t be confused with irritable bowel syndrome (IBS), which is a more common but much less serious condition that produces neither inflammation nor intestinal bleeding. In addition, people with IBS often can manage their symptoms by changing their diet and reducing their stress level.
There is no cure for Crohn’s disease, though. And the only way to cure ulcerative colitis is to remove the patient’s colon. Conventional therapy for either form of IBD calls for either taking steroids, immunosuppressive drugs or “maintenance” drugs such as sulfasalazine. But steroids can lead to osteoporosis, and some of the other drug treatments can cause severe headaches and vomiting.
Seeking an Alternative
Ms. Turet and hundreds of other patients now claim that a controversial, carbohydrate-limiting diet offers the best hope for IBD patients: the “specific carbohydrate diet,” or SCD. “The diet gave me my life back,” says Ms. Turet.
But many gastroenterologists are skeptical. Though there haven’t been studies on this particular diet, the Crohn’s and Colitis Foundation of America, an advocacy group for IBD patients, maintains that research has shown that diet doesn’t affect the disease. “Would I go on record and say this diet is not effective? I certainly would not,” says William Sandborn, a gastroenterologist at the Mayo Clinic in Rochester, Minn., and chairman of the foundation’s committee on clinical research. “But there is no rigorous scientific evidence to show it or any other diet works.”
Patients and alternative-medicine researchers have long battled skepticism that diet can treat a variety of illnesses including AIDS, cancer and epilepsy. The failure of the IBD diet to gain widespread acceptance within the medical community is a lesson in the grim financial reality of medical research. Doctors don’t accept treatments that aren’t validated by controlled studies, and drug companies, which fund most medical research, pay to study pills, not diets.
And so the main source of news and discussion about SCD is the Internet, where patients swap information and personal experiences at the currently two dozen Web sites in seven languages dedicated to the diet. Since 1996, Ms. Turet has run an electronic mailing list, where dieters exchange e-mails describing their experiences and offering recipes and support. Newcomers can subscribe to the free service at www.uclbs.org/longislandlistserve.htm3 The list has about 800 subscribers and generates 100 e-mails a day.
A Mother’s Determination
The diet was first brought to light as an answer to IBD symptoms by Elaine Gottschall, an 81-year-old Ontario resident whose daughter has had IBD since she was four. Ms. Gottschall wrote and published “Breaking the Vicious Cycle: Intestinal Health Through Diet,” which she says has sold three million copies.
Although doctors don’t know what causes IBD, Ms. Gottschall, who has a master’s in nutrition and biochemistry, theorizes that people with IBD can’t fully break down complex chains of carbohydrates. Instead, these partially broken chains accumulate in the lower intestinal tract and spur growth of bacteria and yeast there. This creates toxic conditions that damage the cells lining the intestine and trigger an inflammatory response by the body’s immune system, she says.
So the diet excludes most complex carbohydrates, such as processed sugars, grains and legumes. Even the slightest bit of these carbohydrates can cause symptoms to flare up. What it does include is homemade yogurt and most kinds of meat, fruits and vegetables.
Going on the diet sounds easier than it is, though. Strict adherence to the diet is challenging and often inconvenient, requiring a significant change in lifestyle for the patient and family members.
Some patients say the results are worth it. When Seth Barrows, 28, tried his first bowl of the homemade yogurt, he said he experienced relief as never before in his 11 years of having Crohn’s disease. “So then I ate all the yogurt I had and made another batch, and then another. I would drink it warm, not even wait for it to cool down,” he says.
But many gastroenterologists are still waiting for proof the diet works. Although the CCFA spends $7 million annually on research, it currently has no plans to study the diet, says spokesman Bruce Sands, a gastroenterologist at Boston’s Massachusetts General Hospital.
Studying the diet would be “devilishly difficult,” Dr. Sands says, because it would be tough to monitor patients’ compliance. Also, no one has yet submitted a “worthy proposal” to the foundation, he says.
Skeptics say some of the diet’s success may be due to the placebo effect, where patients’ hope that a treatment will work spurs them to feel better even when the treatment is a fake. For instance, studies involving medication have shown that the placebo effect can be as high as 50% in IBD patients. What’s more, doctors say, some patients can naturally go into remission for years.
‘A Major Change’
But even without conclusive scientific evidence, some physicians, saying they have seen the diet work, are starting to prescribe it. Manhattan physician and nutritionist Ronald Hoffman, who says he has treated hundreds of IBD patients, says about 70% have responded well to the diet, and about 30% have improved so much they can substantially reduce their medications.
Dr. Hoffman, who wrote the foreword to the second printing of Ms. Gottschall’s book, says the diet doesn’t always work, in part because the disease is too advanced in some patients. He says a major cause for failure stems from patients’ inability to rigorously follow the diet. “The diet is inconvenient, and represents a major, life-impacting change,” he says.
Stuart Ditchek, a New York University associate professor of pediatrics who treats about 25 IBD patients, says that in his experience, 85% of his patients who strictly followed the diet improved. He says many doubting doctors are starting to come around to the idea of the diet, and are now at least willing to consider it. “What you find now is that some doctors will say… ‘I’m not sure if it works but you can try it,’” says Dr. Ditchek. “To me that’s a victory.”
Originally published in the Wall Street Journal.
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