Alcohol & Drugs

 

 

Devastating Problems.

Among the serious problems facing our country today are the ones that come from the use of the legal drugs, tobacco and alcohol, and illegal drugs, especially methamphetamine. The question comes up, can anything be done about it? As I ponder this question I am reminded of a poem that appeared in my college newspaper when I was a student. Although the poem was not about drugs it is given here to make a point.

Since terms will be used that some younger readers may not understand, the term “consumption” is a word that was used in past times for T.B.(tuberculosis), which can cause frequent coughing in its later stages. So here is the poem:

T.B or not T.B, that is the question.

Consumption be done about it?

Of cough, of cough.

Yes, I think something can be done about these problems. But first an appropriate question would be, “Why do people start using these things?” For some people there may be a single cause. For others there could be several causes.

Since alcoholism is one of the major problems let’s look at it first. In August 1972 in the Journal of the American Dietetic Association there appeared an important article entitled, “Influence of nutrients on intake of alcohol-Free-choice consumption by rats fed human diets.” (1). For at least 30 years prior to the appearance of this article numerous studies had been done primarily on rats or mice demonstrating that when animals were fed diets deficient in certain nutrients and they were allowed to choose freely between water or alcohol they showed a preference for alcohol. The August 1972 article was the first one in which animals, rats in this case, were fed human diets to see what fluid they preferred.

For brevity in this write-up the August 1972 study will be summarized. For full details it will be necessary to read the attached paper. Suffice it to say that basically the rats were started on two different diets after they were placed in cages where they could drink freely of either water or alcohol. One group

was fed a well balanced diet, hereafter called the control human diet, which consisted of fruits, grains, legumes, nuts, milk, cottonseed oil ,and a small amount of sugar. Another group of rats were started on a teen-age or basal diet which was as follows: breakfast-2 glazed doughnuts, mid-morning snack-1 sweet roll, noon-meal -1 hot dog, 1 c.carbonated beverage, 1/6 apple pie, mid-afternoon snack-1 sweet roll, evening meal-3 oz.meatballs with 4 oz. Spaghetti, 3 slices garlic bread, ½ c.green beans, ¾ c tossed salad, 1 piece chocolate cake, evening snack-1 candy bar, 3 filled cookies. The ones on the control human diet drank very little alcohol.. The teen-age or basal diet was then varied with the addition of spice, coffee, decaffeinated coffee. The group on the basal diet began to consume alcohol such that they were drinking five times as much alcohol as the ones on the control human diet. The addition of spices to the teen-age diet made very little difference in alcohol consumption. However when coffee was added the alcohol intake skyrocketed to 13 times as much.

On a weight basis if a 154 pound man drank as much alcohol as the rats on the basal diet with coffee and spices he would be drinking over a quart of 100- proof whiskey a day. (2)

This study raises a number of issues which need to be addressed:

A. Has anyone replicated or duplicated this study? Replication is an important concept in scientific circles. To have someone replicate a study and get similar results gives greater credence to the study. Unfortunately a careful perusal of PubMed which gives access to the National Library of Medicine and the National Institutes of Health with journals from all over the world for the past 50 years showed no other studies using human diets in rats. However this study was quoted in the British Journal of Addiction.(3) as well as in The American Journal of Addictions.(See #30)

The fact that the 1972 article was quoted gives stature to the study and indicates that it was considered a valid study.

Although the human diet study has not been replicated there have been two other studies on rats since 1972 reinforcing the concept that caffeine when fed to malnourished rats caused them to drink substantial amounts of alcohol.(4 & 5) And in a study reported in 2000 it was shown that even with an adequate diet when rats were injected with caffeine intraperitonally (in the abdomen) they drank alcohol. The injection of normal saline did not produce a desire for alcohol. (6)

B. Just because rats acted this way is there any reason to think that humans would? Unfortunately no human studies have been done. It would be very helpful if they had. It appears there are two reasons for this. #1.A large percentage of studies are funded by pharmaceutical companies. Since a study of this type would not produce any drug to sell it is highly unlikely they would put money into it. #2.It would be considerably more difficult to do this kind of study in humans. An adequate study would probably cost several hundred thousand dollars. Perhaps a foundation or the government would be willing to fund one.

C. Humans are not the same as rats. Of course!. However over the last 100+ years there have been many studies done on rats probably consuming hundreds of thousands, possibly millions of rats, in large part because there has been found to be significant correlations between what happens in rats and human. If this were not so they wouldn’t be doing these studies. In regards to the importance of rat studies ( and animal studies in general) James D. Lane, Ph.D, a caffeine researcher at Duke University stated, “Animal studies are important for the advancement of knowledge in medical science even though we realize that results in rats don’t always apply to people for a variety of reasons.” (7)

D. The coffee that was given to the rats was equivalent to 18 cups a day. Depending on how it was brewed and what type of coffee it was, the total daily caffeine intake for the rats could have ranged from 1,278 mg to 3,960 mg. Not very many people drink that much coffee daily. Another factor to consider is that rats and mice metabolize caffeine at a significantly faster greater rate than humans. (8) So the 18 cups of coffee a day may not be so far off the mark. How important is the use of caffeine in getting people to drink alcohol? Although there have been limited studies looking at a smaller intake of caffeine there are some interesting findings when it comes to dealing with alcoholics.

For instance, at the Betty Ford Center which is probably one of the best known addiction treatment centers in the U.S. a phone call on 4-10-07 revealed they do not allow people who are taking the 30 day treatment program for alcohol addiction any caffeinated beverages. The person who was contacted at the Betty Ford Center stated that caffeine is a drug thus implying that it was not helpful for alcoholics to use during treatment. The Lakeside-Milam Recovery Centers located in the Seattle area is the largest private addiction treatment center on the west coast according to the medical director, Terry Rogers, MD. They treat 4500 patients a year. They do not allow caffeinated beverages for recovering alcoholics.(9). Nor does the Holistic Addiction Center in south Florida. Narconon in Tennessee does not forbid the use of caffeine.

Neil Nedley, MD in his well researched and documented book, “Proof Positive-How to Reliably Combat Disease and Achieve Optimum Health through Nutrition and Lifestyle” has this to say about caffeine,

“Caffeine has far-reaching effects on the brain….Caffeine’s widespread influence focuses primarily on its ability to affect the level of two transmitters (neurotransmitters): acetylcholine and adenosine…a third neurotransmitter called dopamine also rises when you drink a caffeine beverage.” (10). Another researcher made this comment on the effects of caffeine on the mouse brain, “Chronic ingestion of caffeine causes a significant increase in levels of A1-adenosine, nicotinic and muscarinic receptors, serotenergic receptors, GABAA receptors and L-type calcium channels in cerebral cortical membranes.” (11)

 

In the “Good Food for a Sober Life-A Diet and Nutrition Book for Recovering Alcholics-and Those Who Love Them” are these statements, “It is not uncommon to see recovering alcoholics put away 30 to 50 cups of coffee a day using this substance in the same addictive fashion as they use alcohol.” (12)

There are two major types of coffee, Arabica and Robusta. In a standard 150 ml (5 oz) cup the content of caffeine from Arabica could be 71-120 mg per cup and from 131-220 mg in Robusta. The daily caffeine consumption in the U.S. for regular caffeine consumers is 170-300 mgm. Other sources of caffeine are tea, cocoa beverages, candy bars, and soft drinks. (13) In doses of 100-200 mg caffeine can increase alertness, relieve drowsiness, and improve thinking. At doses of 250-700 mg per day caffeine can cause anxiety, insomnia, nervousness, and hypertension. (14) Two cups of Robusta coffee per day could give one 440 mg of caffeine.

The medical literature makes it clear that the response to caffeine can be quite varied. In two separate studies in which people with known panic attack disorder (PD) were given caffeine a certain percentage experienced a panic attack. In one study when 23 patients with PD were on two occasions 3-7 days apart given 200 and 400 mg of caffeine, respectively in coffee form, 33% experienced a panic attack.(15) In a second study 83 PD patients who were given oral caffeine-480 mg within 1 week interval, 45.8% had a panic attack.(16). In May 2007 a study reported from South Korea showed worrisome results. But before describing the study which showed the activity of long term use of caffeine on the hippocampus, a description of the hippocampus is in order. The hippocampus is located deep in the brain as a ridge in the floor of the right and left ventricles. It has a central role in memory processes. In the abstract of the study it was pointed out that caffeine is a psycho stimulant which is widely used around the world. Whereas the short term effects are pretty well known the long term effects are not well defined. The South Koreans found that long term use of low dose caffeine slowed hippocampus-dependent learning and impaired long-term memory. What is of deeper concern is that caffeine consumption for 4 weeks significantly reduced the development of the hippocampus or neurogenesis. (17) The fact that the vertebrate (this includes humans) brain continues to produce neurons throughout life (18) makes the South Korean study even more troubling This is certainly a provocative study and raises a question as to whether caffeine is as innocuous as has been claimed. Hopefully other researchers will replicate this test and clarify this issue.

In considering whether caffeine is really harmful an extensive review of journal articles and abstracts reveal a mixed bag. In several studies on experimental animals, which have already been mentioned, it was found that caffeine does indeed alter the level of a number of neurotransmitters in the brain. In some cases it appears these activities may be helpful but in others harmful. Some journal articles state that caffeine is completely harmless and non-addictive. However when it comes to the psychiatric literature a different picture is painted. Some of this picture has already been given in the preceding paragraph.

Here are more things from the psychiatric literature, “Caffeine can cause or worsen psychiatric symptoms but also has the potential to interact with many psychiatric medications.” (19). Although caffeine has been widely accepted for use in society it can be harmful both psychologically and physically, particularly for people with mental illness.(20) From the Department of Pharmacology and Psychiatry at the University of Extramadura Medical School in Spain it is reported that caffeine is enormously popular and that its use is thought to be safe and that although long term caffeine use may be disregarded as a medical problem it has many features usually associated with drug abuse such as withdrawal symptoms. Its most serious central nervous system effects can be seizures and delirium. It can cause modest increases in heart rate and even severe cardiac arrhymthia. (21) Admittedly these serious side effects are rare.

“Reduction of cerebral blood flow (blood to the brain) has been shown in multiple studies.” (22) Only one of those studies is cited here. It is uncertain how or serious this finding is. However, a number of authors express concern over what could happen as a result of the decreased blood flow to the brain. Maybe the report from the South Korean authors shows what can happen to the brain. On a personal note, I don’t want anything to decrease the blood flow to my brain.


A number of human studies have shown a correlation between the use of caffeine and the consumption of alcohol. “Coffee and alcohol consumption are also associated , especially when either substance is used heavily.” (23). For smokers, and non-smokers, a majority of individuals who reported drinking more alcohol also reported drinking more coffee.(24)

Other papers that deal specifically with the relationship in humans between the use of caffeine and alcoholism deserve mention here. In one which dealt with alcoholics in Israel “relationships between alcohol and caffeinated beverages were observed.” (25). In the second one it was found that “caffeine dependence and a family history of alcoholism are associated with continued use of caffeine during pregnancy.” In this study 50% of the women with a lifetime diagnosis of caffeine dependence and a family history of alcoholism continued to use more than 300 mg of caffeine per day.(26). This amount, incidentally, is far less than was contained in the 18 cup/day equivalence fed to the rats.

My primary purpose in writing this paper was to describe measures that could be used to keep people from being addicted to alcohol, and addicted to meth. It was not to describe the dangers of caffeine. However, in view of the crucial role caffeine played in causing rats to drink alcohol, and in view of all the things that was learned in researching the effects of caffeine it seemed compelling to add that information to this paper.

From a personal standpoint I have only drank a half cup of coffee, perhaps two or three cups of tea, and perhaps 3 bottles of caffeinated pop in my lifetime. When I think that caffeine affects a number of neurotransmitters in my brain and may cause a loss of memory or lack of development of the hippocampus I think I can continue to do well without it.

E. There are elements that need discussion in regards to the teen-age diet. In my opinion, far too many people, not just teen-agers, are eating diets that are too high in refined sugar, white flour, and fats and are lacking in several crucial nutrients. In the rat study just the teen-age diet alone was enough to increase the alcohol intake five fold. A classic example of the lack of nutrients would be found in showing what is lacking in the nutrients of white, all purpose, enriched, bleached flour as compared to the nutrients in whole grain wheat flour. White flour has 78% less fiber, 56% less calcium, 85% less magnesium, 74% less potassium, 77% less zinc, 82% less manganese, 53 % less selenium, 57% less pantothenic acid, 87% less vitamin B6, 63% less copper, and 93 % less vitamin E (alpha tocopherol).This information was obtained on 3-18-07 from the USDA website which is given in reference 27.

All of the substances given in the list above except fiber, calcium, and magnesium play a critical role in neutralizing the effect of free radicals or oxidants. Several powerful oxidants are produced by the body’s metabolism and can produce a variety of tissue damages throughout the whole body. The antioxidants act as scavengers of free radicals.

In addition to these things being left out there are the phytochemicals. For those who may not know, phytochemicals are substances that are found only in plants. There are some 5,000 ones that have been identified and they are known to have antioxidant properties.In general there are far less of these chemicals in white flour than in whole wheat flour.(27)

A grain of wheat is composed of endosperm, bran, and germ. When white flour is produced it comes from the endosperm. Phytochemicals are largely found in the bran/germ layer In one study it was found that there is up to 87 times (that is 8,700%) as much of a certain phytochemical in whole wheat flour as in white flour. (28) We now know that these phytochemicals play an important role in the body’s health although no one seems to know just how important a role they play.

Although the enriched flour has more thiamin and riboflavin it has a little less niacin and less than half of the pantothenic acid of whole wheat flour. These are all B vitamins. It is also, as we have seen above, much lower in a number of minerals. The teen-age diet is a high sugar diet. In order to process sugar the B complex vitamins and certain minerals need to be present. When one considers that most of the doughnuts, pies, cakes, cookies, bread, crackers, various types of pasta , and very likely fry bread are made from white flour those people who are eating that way are going around chronically malnourished and don’t even realize it. That may be part of the reason why folks feel the need to have a cup or two of coffee to get going in the morning.

F. What about the spices? The addition of spices to the teen-age diet did not increase alcohol consumption that much. So their role is not that important. Some of the spices that are listed are now known to have positive health effects. In the rat study no effort was made to determine the effect of individual spices.

At this point it will be instructive to consider what happened at the Central Alternative High School in Appleton, WI. In 1997 significant changes were made in available foods and beverages. The soft drink and junk food machines were removed. In the cafeteria burgers, fries, and burritos were eliminated. In their places were salads, meats prepared with old fashioned recipes, and whole grain breads, fresh fruits, and vegetables. The only liquid provided was water. There were no caffeinated beverages. The results were amazing. Great changes were seen in behavior and academic performance.(29)

Lets summarize what we now know:

1. Alcohol and meth addiction can both be devastating to the individual, their families, and innocent victims.

2. A teen-age diet is nutritionally inadequate. People who habitually follow that diet are chronically malnourished and must have subclinical deficiencies of several essential elements unless they are taking an adequate vitamin-mineral supplement. However most vitamin-mineral supplements only contain one or two phytochemicals

3. In a school setting where junk foods and caffeinated beverages were removed and students were fed nutritionally adequate diets there was marked improvement in behavior and scholastic performance.

4. In one study rats that were fed a teen-age diet with alcohol and coffee had a marked increase in alcohol consumption. Several other rat studies have shown that when rats were given caffeine they consumed substantial amounts of alcohol

5. Although for many people caffeinated beverages appear harmless there is a subset of individuals who can have problems from them.

6. Some centers in the U.S. that specialize in addiction treatments such as the Betty Ford Center do not permit caffeinated beverages, especially for recovering alcoholics.

7. A number of human studies have shown a correlation between caffeine consumption and the drinking of alcohol. None of those studies specifically showed or stated that use of caffeine had been proven to lead to drinking.

As we consider this issue this quote seems appropriate, “Caffeine appears to have few medical effects but can have adverse behavioral effects.” (30)

 

In view of what we know let’s move on to probable concepts. Although we do not have solid proof that a teen-age diet with coffee and spices induces alcoholism in humans the evidence strongly points in that direction. In my opinion there is a real likelihood that the same type of diet leads people to try methamphetamines. When Dr. Terry Rogers, who has been previously mentioned was queried about his opinion he stated that in regards to alcoholism a poor diet could be a contributing factor. In regards to meth addiction he stated, “There is no question about it.” In an article already cited which was a collaborative study from these three respected institutions-Virginia Commonwealth University, Johns Hopkins University, and University of California-it was caffeine-dependent women with a family history of alcoholism who “may be at greater risk for abuse of or dependence on other drugs.” (such as meth-my comment). (31)

Although anecdotal evidence is not considered as valuable as properly conducted studies it is not without value. The following anecdote is considered worthwhile because it was unsolicited, it came from a medical professional, and was told to a medical professional:

About 2 months ago I was telling a nurse at the San Juan Regional Medical Center about the rats, caffeine, and alcohol study. She volunteered the information that a few years back she was basically eating a teen -age diet and from time to time she felt the need to drink a glass of beer. Then about 1 ½ years ago, partly because of a young daughter, she decided to switch to a well balanced diet. Her desire for alcohol went away.

To return to the question, “consumption be done about it” I believe that there needs to be wide spread dissemination of this information. Given the devastating nature of those addictions, the huge costs arising from them, and the fact that the dietary changes would be relatively easy to achieve and much less expensive than going to a treatment center it would seem to be a no-brainer to encourage people to change their eating habits. There would no doubt be other health benefits that would accrue from such a change.

It is recognized that the dietary changes and information dissemination would only be one arrow in the quiver that would be used to prevent addictive behaviors.The old saying, “an ounce of prevention is worth a pound of cure” seems applicable to this issue. How much better it would be to keep people from starting the use of these addictive substances. It is better to light a candle than to curse the darkness.

It seems important to add that no one thinks that everyone who drinks coffee is going to become an alcoholic or meth addict. But it is felt that this information will be of definite value to a subset of individuals.

As a final note this quote seems appropriate, “It is well known that certain vitamin B deficiencies will lead to irritability, confusion, persecution complex, emotional instability or an inability to adjust to conflict situations. Is it possible that diet factors like coffee, tea, strong spices, etc, may act synergistically with a poor quality, though popular diet to exceed man’s nutritionally-lowered mental and emotional threshold, thus triggering him to turn to alcohol (and/or meth and other drugs-my comments) as an anesthetic or a poor solution to the increasing and apparently insurmountable problems facing him in this complex age?” (32)

References:

1.Register, U.D., et al. J.Am Dietet. A. 61:159,1972

2. Register, U.D. This quote was taken from an article published in a non-medical journal for which no title is available.

3.Norton, V.P.Br J Addict Alcohol Other Drugs 72: 205,1977

4.Gilbert, R.M. J Stud Alcohol 37: 11, 1976

5.Gilbert, R.M. J Stud Alcohol

6. Kunin, D Alcohol 21:271, 2000

7.Email of 6-18-2007 from James D.Lane, Ph.D, caffeine researcher at Duke University

8.Phone conversation with Dr. Lane.

9.Phone conversation with Terry Rogers, MD on April 7,2007

10. Nedley, N Proof Positive Neil Nedley, Ardmore, OK 1998

11. Shi D Cell Mol Neurobiol 19: 719, 1999

12.Mumey, J Good Food for a Sober Life Contemporary Books, Inc. Chicago, IL 1987

13. www.emedicine.com/neuro/topic666.htm

14. www.medterms.com/script/main/art.asp?articlekey=11068

15. Masdrakis, V.G. Depress Anxiety, 2007 (Epub ahead of print)

16.Nardi, A. Human Psychopharmacol. 2007 (Epub ahead of print)

17.Han, M. Biochem.Biophys Res Commun 356:976, 2007

18. Shors, T.J. Nature 410: 372, 2001

19. Broderick, P. J Okla State Med Assoc 98:380, 2005

20. Simmons, D.H, Arch Psychiatr Nurs 10: 116,1996

21..Carrillo, J.A Clin Pharmacokinet 39:127, 2000

22. Blaha, M.J. J Clin Neurosci 14: 464, 2007

23. Swan, G Journal of Substance Abuse 8:19, 1996

24. Carmody, T.P. Health Psychology 4: 323m 1985

25. Amit,Z. Eur. Addict Res 10:22, 2004

26. Svikis, D.S. Am J Psychiatry 162: 12 2005

27. http://riley.nal.usda.gov/NDL/cgi-bin/list-nut_edit.pl

28. Adom, K.K. J Agric Food Chem 53: 2297, 2005

29. www.feingold.org/PF/wisconsin1.html

30. Hughes, JR The American Journal on Addictions 5: 49, 1996

31. See #26

32. See #2

 

Donald E.Casebolt, MD

505-598-5235

Vege27doc@peoplepc.com

Other adverse effects of caffeine

While doing the literature search for the paper Devastating Problems it was learned that there are other health problems related to the use of caffeine besides causing experimental animals and some people to desire alcohol. It seems to this writer that people who are concerned about health would want to know about these other side effects. Let’s see what those side effects are.

1. A premature newborn with caffeine withdrawal. A premature newborn was proven to have caffeine withdrawal after chronic maternal drinking of mate-a caffeine containing drink popular in some Spanish speaking countries. (1) One can only wonder how often this might occur without anyone even suspecting it.

2. Osteoporosis. “Women with caffeine with intakes greater than 300 mgm/day had higher bone loss and women with vitamin D receptor (VRR) variant, tt were at a greater risk for this deleterious effect of caffeine.” (2) (3) To put this in more understandable language, women who drank more than approximately 2 cups of coffee per day lost more bone (greater chance for osteoporosis) and if they genetically had an abnormal vitamin D receptor their chance of getting osteoporosis was even higher.

3. Insomnia. Some people have problems with insomnia and some don’t. It has been learned that this is due to a difference in genes. (4)

4. Overweight. A Cleveland, Ohio study demonstrated that overweight adolescents were

“ significantly associated with male gender, increased caffeine intake, and short sleep duration.” (5)

5. Poor iron absorption. “A cup of coffee reduced iron absorption from a hamburger meal by 39%”

(6) (7). This could be a significant problem for people with anemia.

6. Ovarian cancer. In the case of ovarian cancer “regular coffee drinkers were at significantly increased risk compared with women who did not drink coffee.” (8) This risk was nearly double.

7. Can cause non-fatal MI (myocardial infarction or heart attack). It is now known that genetically speaking there are people who metabolize caffeine rapidly and others slowly. Note this study result,

“Intake of coffee was associated with risk of non-fatal MI only among individuals with slow caffeine metabolism.” (9)

8. Increase in impulsivity or sensation seeking. There has been found to be a relationship between certain personality traits, impulsivity or sensation seeking, and caffeine consumption. (10)

9.Tremors. Caffeine can cause or worsen tremors. The severity may be based upon the amount of caffeine consumed. (11) “Caffeine has a detrimental effect on microsurgical ability” because it can cause a fine tremor according to a small study done in England. (12).

10. Dependence on caffeine in teenagers. Of thirty six adolescents who consumed caffeine daily 77.8% described withdrawal symptoms after cessation or reduction of caffeine intake. (13).

11. Cardiovascular and neuroendocrine activations at work and at home. Caffeine has significant hemodynamic effects (changes in ambulatory blood pressure and heart rate) and caused a 32% increase in urinary excretion of epinephrine (adrenaline) during the workday and the evening.(14)

12. Adverse effects in diabetics.

A. Differences in methodology. Although there have been recent studies suggesting that coffee drinking significantly reduced the risk of getting type 2 diabetes these studies have been “based on

correlational observations, not controlled, experimental studies.” (15)

B. Adverse effect on prediabetics. Controlled experimental studies “suggest that caffeine consumption promotes the development of type 2 diabetes” in people who have pre-diabetes.

(16)

C. Impairs the management of type 2 diabetes. A Canadian study on obese men with type 2 diabetes showed that when they were given caffeine 1 hour before an oral glucose tolerance test the serum insulin, proinsulin, C-peptide, and blood sugar all increased. This suggested that caffeine impaired the management of diabetes in men with type 2 diabetes. (17).

D.Elevates the two hour postprandial (after a meal) blood sugar and insulin. When 250 mgm of caffeine was given before a meal to type 2 diabetics and tests were drawn 2 hours after the meal the blood sugar was 28% higher and the insulin level was 19% higher than when a placebo was given before the meal.(18)

13. Colon cancer. The findings as far as the effects of caffeine on colon cancer are equivocal.

14. Lung Cancer. In a 2005 study reported by the Roswell Park Cancer Institute these findings were reported: “elevated lung cancer risk was observed for participants who consumed 2-3 cups of regular coffee daily…..In contrast, decaffeinated coffee was associated with decreased lung cancer risk.(19)

References

1. Martin, I Ther Drug Monit 29:127, 2007

2.Rapuri, PB J Steroid Biochem Mol Biol 103:368, 2007

3. Hallstrom, H Osteoporosis Int 17:1055, 2006

4. Retey, JV Clin Pharmacol Ther 81:692, 2007

5.Seican, A Sleep Breath. (Epub ahead of print) 2007

6. Morck, TA Am J Clin Nutr 37:416, 1983

7. Hurrell, RF Br J Nutr 81:289, 1999

8.. Goodman, MT Nutr Cancer 46:23, 2003

9.. Cornelis, MC JAMA 295: 1135, 2006

10. Gurpegui, M Prog. Neuropsychopharmacol Biol Psychiatry 31: 997, 2007

11. www.emedicine.com/neuro/topic666.htm

12. Urso-Baiarda, F. Microsurgery 27:84, 2007

13. Bernstein, GA Drug Alcohol Depend 66:1, 2002

14. Lane, JD Psychosom Med 64:595, 2002

15. Lane, JD Family Practice News April 17, 2007, p.18

16. Ibid.

17. Robinson, LE J Nutr 134: 2528, 2004

18. Lane, JD Endocr Pract 2007-May-June

19. Baker, JA Nutr Cancer 52:15,2005

 

 

Donald E.Casebolt, MD

505-598-5235

Vege27doc@peoplepc.com