Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health

Contents

Title Page

Contents

Copyright

Preface to the New Edition

Introduction

Preventative Maintenance

What Should I Eat?

Answers to Common Questions About Diet and Health

What Will You Have to Drink?

Air and Breath

A Guide to Exercise for People Who Hate the Whole Idea of It

Relaxation, Rest, and Sleep

Habits

Connections

Specific Prevention: Outwitting the Killers

How Not to Get a Heart Attack

How Not to Get a Stroke

How Not to Get Cancer

How to Protect Your Immune System

Basic Natural Treatments

Simple Measures

Vitamins and Supplements

The Herbal Medicine Chest

A Treasury of Home Remedies for Common Ailments

Appendix A: Finding Practitioners

Appendix B: Finding Supplies

Appendix C: Sample Recipes

Acknowledgments

Index

About the Author

Connect with HMH

Footnotes

Copyright © 1995, 1998, 2004 by Andrew Weil, M.D.

ALL RIGHTS RESERVED

For information about permission to reproduce selections from this book, write to [email protected] or to Permissions, Houghton Mifflin Harcourt Publishing Company, 3 Park Avenue, 19th Floor, New York, New York 10016.

hmhbooks.com

The Library of Congress has cataloged the print edition as follows:

Weil, Andrew.

Natural health, natural medicine : the complete guide to wellness and self-care for optimum health / Andrew Weil.—Rev. ed.

p. cm.

Includes bibliographical references and index.

ISBN 0-618-47903-1

1. Health. 2. Nutrition. 3. Naturopathy. 4. Medicine, Popular.

1. Title.

RA776.W417 2004

613—dc22 2004057683

eISBN 978-0-547-52767-3

v7.0321

THIS BOOK IS NOT INTENDED TO BE A TOTAL REPLACEMENT FOR STANDARD (ALLOPATHIC) MEDICINE, WHICH HAS ITS PLACE IN THE DIAGNOSIS AND TREATMENT OF DISEASE. ANY UNUSUAL, PERSISTENT, OR SEVERE SYMPTOMS SHOULD BE EVALUATED BY A PHYSICIAN. THE NATURAL TREATMENTS SUGGESTED HERE, ALTHOUGH GENERALLY SAFER THAN PHARMACEUTICAL DRUGS, CAN AFFECT DIFFERENT PEOPLE DIFFERENTLY, OCCASIONALLY PRODUCING ADVERSE REACTIONS. IF A CONDITION FAILS TO RESPOND TO THESE TREATMENTS, YOU SHOULD CONSULT A PHYSICIAN TO SEE ABOUT ANOTHER COURSE OF ACTION. THE AUTHORS AND PUBLISHER DISCLAIM RESPONSIBILITY FOR ANY ADVERSE EFFECTS RESULTING DIRECTLY OR INDIRECTLY FROM INFORMATION CONTAINED IN THIS BOOK.

Preface to the New Edition

IN THE YEARS since this book first appeared, countless readers have told me that it has become their bible, kept at hand and referred to constantly. The Bible is supposed to contain revealed, unchanging truth, but ideas about health and treatment are in constant flux, and what appears to be self-evident today is often questioned tomorrow or even rejected as false. This normal evolution of medical conceptions commonly puts people off, especially since the rate of change has accelerated in the present information age. First they tell us olive oil is no good, then they say it’s good. Probably next year it will be no good again. When I had my first baby, the pediatricians said that the way to reduce the risk of crib death was never to let the baby sleep on his back. Now they say always put babies to sleep on their backs.

I wrote Natural Health, Natural Medicine to cut through the confusion and provide a basic collection of strategies and methods to maintain optimum health and treat common ailments. In order to keep this book current and consistent with the latest research findings, I find it necessary to revise it at regular intervals. This new edition is completely revised and updated, with new treatments for more conditions. All the information is consistent with the best scientific evidence currently available. But please remember that it, too, will need to be updated with the passage of time. Please consult my website (www.drweil.com) to keep informed about research developments as well as to learn about treatments and conditions not covered in these pages.

I recognize that people are still confused about natural therapies. In fact, one complaint I hear frequently is that the experience of walking into a health food store today is totally bewildering. What is one to make of all those products, all those claims and counterclaims? Even if you just want to buy some vitamin C, the task is not simple. Do you want buffered C, Ester-C, C with bioflavonoids? This book can help you become an informed consumer of health products and a wary shopper.

At the same time, I am gratified to see how much of the material in Natural Health, Natural Medicine remains timely and accurate, supported now by even more evidence. And I am delighted that more and more physicians are beginning to seek instruction in subjects they did not learn in medical school and becoming knowledgeable about the natural therapies that are now so popular with patients. The Program in Integrative Medicine that I direct at the University of Arizona is now in its tenth year (www.integrativemedicine.arizona.edu) and has graduated over 120 physicians, the beginning of a new generation of practitioners who understand the importance of natural healing and the need for thoughtful combinations of conventional and alternative medicine. More practitioners of this kind will be available in the near future, especially since medical schools are finally moving in the right direction. A Consortium of Academic Health Centers for Integrative Medicine now has twenty-five member schools, a fifth of the nation’s medical schools (www.imconsortium.org).

In the meantime, the responsibility for achieving and maintaining optimum health remains with you. You are the one who has to get the best information about designing a healthy lifestyle and then implement it. You need to know how to treat common ailments with safe, natural methods on your own and not get involved with professional health care unless there is a clear need to do so. I wrote this book to help you. I have made a great effort to keep it up-to-date. And I will be pleased if this new edition helps more people take greater responsibility for their own well-being.

Vail, Arizona

February 2004

Introduction

THIS BOOK is a complete guide to preventive health maintenance; it also includes suggestions for treating many common ailments on your own with methods that are safe, natural, effective, and not as expensive as standard medical treatments. If you are unfamiliar with the concept of preventive maintenance, I can summarize it for you in a few words: timely and appropriate investment of energy in your well-being will save a great deal of trouble, pain, and money down the road. Many people understand the value of preventive maintenance in caring for their cars. They get regular oil changes and tune-ups, and they pay attention when a warning light comes on. It is strange that more of us do not apply the same concept to our bodies, which are infinitely more valuable.

The most common reason for neglecting preventive maintenance used to be lack of information. Today it is often too much information, especially from the Internet and the media, much of it contradictory and a good deal of it wrong. I have always felt that the main work of doctors should be to educate, to give people the trustworthy information they need to keep themselves healthy most of the time. Prevention of disease should be primary, treatment secondary. One of my main motivations in writing this book is to help you avoid the need for treatment.

In addition to teaching medical students, residents, physicians, and other health professionals, I have for some years practiced natural and preventive medicine in Tucson, Arizona, always encouraging well people to come in for preventive health checks and advice about diet, exercise, and stress reduction. I am in a rapidly growing minority of physicians who practice this way and am busily training others to do so.

Mainstream medicine continues to be the same as it has been, but more so: more expensive, more reliant on technology, more focused on the physical body to the exclusion of mind and spirit. One trend of recent years has been the appearance of health maintenance organizations (HMOs) that offer prepaid medical care. As corporations interested in making a profit, HMOs want their staff doctors to see as many patients as possible during their time on duty, with the result that doctors have less time than ever to spend with patients. They cannot take detailed histories or get to know the people they treat. For their part, patients seem to feel that since they have paid in advance for care, they might as well take full advantage of it. They come in for every headache, sore throat, twinge, and pain, giving up more and more responsibility for their own well-being. It is discouraging to see in HMOs thick medical charts on men and women in their twenties and thirties. Most of these patients have no sense of their own health and their own power to affect it for good or ill. They also do not know how much better off they would be if they took care of common ailments on their own.

Blind faith in professional medicine is not healthy. In my book Health and Healing, I explained the limitations and dangers of regular (allopathic) medicine and reviewed several kinds of alternative or complementary medicine. I urge you to read that book, both to inform yourself about the strengths and weaknesses of these systems and to get a sense of the philosophy of health and treatment that is the foundation of this book.

In short, allopathic medicine is very good at managing trauma, acute bacterial infections, medical and surgical emergencies, and other crises. It is very bad at managing viral infections, chronic degenerative disease, allergy and autoimmunity, many of the serious kinds of cancer, mental illness, functional illness (disturbances of function in the absence of major physical or chemical changes), and all those conditions in which the mind plays an active role in creating susceptibility to disease. It is not wise to go to an allopathic doctor with a disease that allopathic medicine cannot treat. It is also not wise to go to other sorts of practitioners with diseases that allopathic medicine can treat very well. For more detail on these points, please read Health and Healing.

I want you to know at the outset that I expect a lot of you as a reader. I expect you to want to be more responsible for your own health and wellness and more independent of professional medicine. I expect you to be willing to experiment and to make changes in your lifestyle. I expect that you will use good judgment and common sense in evaluating the information you receive on health care and in deciding when a problem is outside your limits of competence and should be taken to a doctor.

For example: if you develop fevers, night sweats, and enlarged lymph nodes, you should not ignore those symptoms or waste time trying to get help from alternative practitioners. You should go directly to an allopathic physician for a complete physical exam and blood tests. I would give the same advice to anyone who developed any alarming, dramatic, or persistent symptoms that might indicate infection, malignancy, or malfunction of a vital organ. The greatest failure you can make in trying to be your own doctor or in trying to rely on natural treatments is to miss the diagnosis of a condition that is fully and easily curable by standard allopathic medicine.

People often ask me, How can I find a good doctor? I have no simple answer to that question except to give you what I think are qualities you should look for when you shop around. First, a doctor should show interest in you as a person as well as a medical case. He or she should take the time to ask questions about you and answer your questions fully. My experience is that a thorough history is the best diagnostic instrument available; slighting it is bad medicine. One of the most common complaints I hear from patients who have had unsatisfactory experiences with allopathic medicine is that practitioners do not take the time to address their concerns and questions.

Next, a doctor should be a good teacher. You should emerge from a visit to your doctor better equipped to deal with problems in the future, with more knowledge and tools to help you practice preventive maintenance and wise self-care. The most effective way to teach is by example. A good doctor embodies and exemplifies good health. I could not tell patients to improve their diets, start exercising, learn to breathe correctly, and meditate if I were not committed to those actions myself. In shopping for a physician to use in time of need, look for one who will inspire you to work at preventive maintenance by his or her own way of being.

I often teach physicians not to hesitate to say, I don’t know when they don’t. To me that statement is a positive sign in a doctor. Yet another is openness to new ideas and willingness to try out new concepts and procedures. Ask prospective doctors what they think of vitamins, herbal remedies, acupuncture, manipulation, hypnotherapy. Are they willing to consider and learn, or do they dismiss everything unfamiliar as quackery?

Most difficult, I’m afraid, is finding a doctor whose philosophy of health and treatment is consistent with that presented here and in Health and Healing. A main point of this philosophy is that healing is the birthright of every human being. It does not have to be put into people or imposed on them from without but, rather, gently encouraged. Do not stay in treatment with doctors who discount the possibility of healing or who make you feel that you are incapable of experiencing it. Also, your physician should adhere to the famous injunction of Hippocrates: First, do no harm! All too often today doctors ignore that prescription and jump right in with drastic treatments before giving the body’s own healing systems a chance. Awareness of and reverence for the healing power of nature—another principle of Hippocrates—has been a constant theme of my own research and practice, one that I will try to convey to you in these pages.

Finally, look for doctors who have certificates of training in integrative medicine from recognized academic institutions and who are willing to be your partners in health care and treatment.

You can use this book in several ways. Part I gives you basic information about designing a healthy lifestyle. Read it through, try the suggestions, and see how you respond to them. You do not have to make all the changes at once. Go at your own pace, and do not stick with any regimen that does not give you results after a reasonable trial.

Part II gives you very specific advice about reducing your risks of getting the diseases that kill most people prematurely in our society. As you will discover, heart attacks, strokes, and cancer are not simply the results of bad heredity and bad luck. They are often diseases of lifestyle, and lifestyle can be changed. Some of the recommendations will be easy to follow, others hard. You can decide for yourself how many of them you need to implement, based on your own sense of risk.

Part III gives you tools in the form of natural treatments you can use yourself. Here I want you to experiment in earnest. Keep notes on your experiences. See if you can make these simple measures, dietary supplements, and herbs work for you as they do for me and my patients.

Finally, Part IV gives detailed recommendations for the treatment of a large number of common ailments. I have not included in this list the kinds of medical disasters that ought to be dealt with by allopaths. Instead I have concentrated on the problems that people bring to me most frequently and that respond well to gentle, natural therapy and lifestyle modification. In these cases strong allopathic drugs and surgery should be used only as last resorts, after simple measures fail. This section is a reference work to consult in time of need, or you can browse or read it through all at once. You will find that much of the advice here echoes the general themes of earlier parts of the book. Following Part IV, in Appendixes A and B, I give the names and addresses of organizations and companies that can provide you with referrals to nonallopathic practitioners and with recommended materials.

Our ideas about how to maintain health and prevent disease change as we acquire more knowledge and experience. When you read the section on fats in Chapter 1, you will see examples of such a change. Not long ago we thought that olive oil was not good for the heart and that safflower oil was a healthy fat. Today we think very differently. The information in this book is the best available at the moment, consistent with the findings of scientific research, with clinical experience, and with my own personal experience. Doubtless we have more to learn, and doubtless we will change our minds on some issues that now seem so clear. For this reason I urge you again to be willing to experiment and to trust your own experience. You are ultimately the one responsible for your health. I have given you the best directions I know to help you on your journey to wellness. I leave it to you to put them into action and modify them according to your individual needs, guided by the experience you acquire.

Part I

Preventative Maintenance

1

What Should I Eat?

WHAT SHOULD I EAT? This simple question has no simple answer. Many people will try to persuade you that they know the right way to eat, but so much of the information is contradictory that the more theories you listen to, the more confused you will be. I have read convincing arguments against every category of food you can name: fats, carbohydrates, meat, fish, poultry, milk, cheese, butter, fruit, vegetables, vegetable oils, wheat, eggs, bread, yeast, sugar, spices, and so on. If all these arguments were valid, we would starve in the midst of plenty, our minds finding endless reasons to avoid everything our bodies craved.

I enjoy seeing how the rules of different dietary systems conflict totally. In yoga philosophy, foods are grouped in three categories, from highest (expressing the quality of balance) to lowest (expressing the quality of inertia). Fresh yogurt and white rice are in the top group; brown rice is at the bottom. In macrobiotics, a dietary system invented in Japan, brown rice is the best thing you can eat, milk products and white rice among the worst.

What should I eat? The first guideline I can give you is that there is no one right way. A particular diet may be right for you at this stage of your life, but it may not be right for me, and it may not be right for you a year from now. We are all different physically and biochemically, with different and changing dietary needs. Do not believe anyone who tells you he has discovered the one right way to eat. For any dietary system you name, I will show you examples of terrifically healthy people who violate all its rules. I read an interview recently with a Russian woman who had reached the age of 106 and was still vigorous. Her answer to the usual question about the secret of her success was I never eat vegetables.

Some authorities say that human beings are meant to be vegetarians, others that we must eat animal products to be healthy. The fact is that human beings are omnivores, designed not only to survive but to do well on an astonishingly wide range of foods. Behind most of the rigid diets promoted in popular books and health food pamphlets is a most unhealthy assumption: that our bodies are inefficient and unresourceful, easily upset unless we consume exactly the right foods or combinations of foods. When you buy into these assumptions, you are underselling your body’s natural resilience and capacity for adaptation. Do not accept this harmful belief.

Also do not believe anyone who tells you that all illness results from poor diet or that dietary change can cure any illness. It’s not so. Diet is one factor shaping health—an important factor, but not the only one. Diet has the distinction of being the only major determinant of health that is completely under your control. You have the final say over what does and does not go into your mouth and stomach. You cannot always control the other determinants of health, such as the quality of the air you breathe, the noise you are subjected to, or the emotional climate of your surroundings, but you can control what you eat. It is a shame to squander such a good opportunity to influence your health.

Changing your eating habits in order to improve your life can be a way to activate the body’s healing system. It is difficult to give up familiar foods and try new ones. To do so requires committing mental energy toward the goal of improved health. I have seen a number of cures of serious illnesses in people who decided to go on long-term fasts, macrobiotic diets, yoga vegetarian diets, and other regimens. My interpretation of these cases, consistent with the theory I presented in Health and Healing, is that part of the reason for success is the mental shift represented by the decision to follow a demanding nutritional program. That mental shift may be more important than the specifics of a program. I usually ask my patients to make changes in diet as one way of increasing their chances of natural healing. I never use dietary adjustment as the only means of treatment.

Be critical of the advice of professional nutritionists and dietitians. Nutritional science is still developing. Research on food and diet is much distorted by cultural biases and values, and the researchers are seldom able to see these distortions. As an example of a cultural bias, consider the different reactions you would have to eating a lobster tail or a plate offered grasshoppers. The biological reality of the two organisms is similar, but most people in our culture consider one delicious, the other revolting. There is no agreement from culture to culture on the answer to the most basic question of all: what is food, what is not? Food and eating have enormous symbolic importance, and that is why we surround them with taboos and rituals. Different dietary preferences divide nations, religions, and sometimes families. Trying to find truthful information in this area is as easy as dancing through a minefield.

Nutritional science gave us the Basic Four food groups, the concept responsible for much of our unhealthy obsession with protein (more on this in a moment). It also gave us the Food Pyramid, guaranteed to produce obesity in many people. In the past, registered dietitians have been witting or unwitting tools of the food industry, since the information they dispensed often came from industry rather than from disinterested sources. If you are tempted to follow their recommendations, remember that dietitians have also been the people responsible for the food served in schools and hospitals. (I recognize that enlightened dietitians are often powerless to make changes in institutional menus because they are controlled by food service contractors.)

Having given all these warnings, I will now offer you nine basic suggestions about how to design a healthy diet.

1. Eat with Your Senses, Not with Your Intellect

Your senses of taste and smell are excellent guides to what is good for you. Trust them. Practice developing these senses and paying attention to them. If you eat what you think is good for you even if you don’t like it, you are not listening to the wisdom of your body. Eating foods you don’t like that someone else says are good for you is even further off base. Above all, the food you eat should appeal to your senses and agree with your body. Eating is one of life’s great pleasures, and I assure you that a healthy diet does not require any sacrifice of enjoyment, even if you give up foods you now like.

2. Eat with Full Attention and with Gusto

Your digestive system mirrors your state of mind, which is why so many digestive disorders are stress-related. If you eat while angry, anxious, or distracted, your body will not process food well, no matter how good the food. If you always eat while listening to the news on television or while discussing business, you are not giving the act of eating the attention it deserves. How your body handles what you eat may be more important than what foods you eat. You will digest food most efficiently if you eat with full attention and full enjoyment of the experience. (I applaud the efforts of the Slow Food Movement to encourage this kind of eating; visit their website at www.slowfood.com.)

Once, when Saint Theresa of Avila (1515–1582) visited a monastery, the abbot served her a special dinner with a main dish of roasted partridges instead of the usual plain fare. To the astonishment of her host, Saint Theresa tore into the meal with abandon. The abbot admonished her, saying he thought it unseemly for a woman whose life was devoted to prayer to show such enthusiasm for the pleasures of the table. Saint Theresa replied, When it’s prayer time, pray! When it’s partridge time, partridge!

3. Eat a Widely Varied Diet

By varying what you eat, you protect your health in two ways. First, you ensure that you get all the nutrients you need. If you eat the same foods day after day, you are more likely to shortchange yourself of needed vitamins, minerals, or other elements. We probably do not yet know all of the nutritional factors required for optimal health. Only fifty years ago did we discover the need for zinc, for example. You don’t have to memorize the government’s recommended daily allowances of carbohydrate, fat, protein, and vitamins—just go for variety.

The second reason to vary your diet is that it is the best way to avoid eating too much of anything that is not good for you. There are surprisingly many toxins in the food we eat, both natural and man-made. Celery, basil, the common cultivated white mushrooms (Agaricus bisporus), chickpeas, and many other vegetables contain natural toxins; most, but not all, are destroyed by the heat of cooking, which is a strong argument against raw food diets. (You will find more information on this subject at the end of this chapter.) Alfalfa sprouts, so loved by raw food enthusiasts, contain a natural toxin called canavanine, which is definitely not good for you. Peanuts and peanut butter are usually contaminated with traces of aflatoxin, a very potent natural carcinogen found in a mold that grows on peanuts and other seeds. Does that mean you should exclude peanut butter from your diet? No, but again, you would be better off not eating it all the time or in large quantities.

In addition to the natural toxins are all the unnatural ones, such as pesticides, fungicides, hormones, antibiotics, PCBs, and others too numerous to list, that are added to the food we buy. These substances are a serious problem in my view, with strong political and economic components. I will give you advice on how to minimize your consumption of dangerous additives in the next chapter. For now, let me just repeat that the best general safeguard against taking in unhealthy doses of dietary toxins, natural or not, is to select the foods you eat from a widely varied menu rather than concentrating on a few items.

4. Eat Fresh Foods

Dried, canned, frozen, and prepared foods are more and more prominent in modern diets. Many of these foods contain too much fat, salt, sugar, and unhealthy additives, and rarely do they taste as good as fresh foods. If this has not been your experience, please work further to develop your sense perceptions. If you pay attention to the appearance, taste, and smell of what you eat, your senses will lead you away from packaged foods toward fresh ones.

5. Eat Less Rather Than More

Research shows that animals fed somewhat less than the recommended daily allowance of calories live longer and have fewer diseases than those put on standard diets or allowed to eat as much as they want. It may be that the recommended daily allowances of nutrients are too high, that eating these amounts creates a state of chronic overnutrition that stresses our bodies. In fact, some scientists now talk about undernutrition as a way of promoting health and longevity. Of course, it is easy to say we should eat less rather than more, but it is hard to put into practice. Eating, as I have noted, serves functions other than simply supplying the body with nutrients. It is a symbolic act, a social function, and a source of pleasure.

Our bodies evolved through long periods of scarcity, when food was simply not easily available or not available at all times of year. The surviving fittest—our ancestors—were those individuals who best developed the ability to seek out food and put it to maximal use. That genetic heritage can be a liability in a world where food is ever present, in unprecedented quantity and variety. It is no wonder that obesity is such a common problem, no wonder that we are obsessed with dieting and weight reduction, no wonder that the concept of undernutrition is unpopular. Nonetheless, the research findings are clear: less is better than more, and it is worth trying to apply this lesson as best we can. One possibility is to eat smaller meals more frequently. Another is to fast occasionally (see pp. 223–25). Another is to learn how to reduce the calorie content of dishes we like.

6. Learn to Appreciate Simple Foods

Much contemporary cooking, particularly in restaurants, is designed to excite the senses more than to provide good nourishment. As much as anyone else, I like to try novel dishes and strong flavors, but I think there is a risk in losing the ability to delight in utterly simple food, simply prepared. Can you take pleasure in an ear of sweet corn, just picked, lightly cooked, and eaten plain without butter or salt? How about a perfect garden tomato, sliced and served as is? Or a crisp green salad with a little olive oil and fresh lemon juice, a warm slice of homemade bread with nothing on it, or a plate of lightly stir-fried fresh vegetables over a mound of rice? Or a slice of really fresh wild salmon, grilled, and served only with lemon wedges? Or a section of perfectly ripe melon? If you cannot imagine eating corn and bread without butter, salad and tomatoes without gobs of creamy dressing, a stir-fry without a spicy sauce, salmon without butter or hollandaise sauce, melon without prosciutto or ice cream, I suggest you try learning to appreciate the pure tastes of these and other plain foods.

I am not urging you to live on gruel and water. You can still have Mexican and Italian and Szechuan food, if it is made from healthy ingredients. My concern is that if sensory novelty is the main appeal of food, you will move in dietary directions that are not necessarily best for your health. Learn to enjoy simple foods prepared quickly and properly without fancy adornments.

7. Eat a Balanced Diet

We’ve all been told so many times to eat a balanced diet that we don’t want to hear it anymore, but just what is a balanced diet? A balanced meal is supposed to provide the proper proportions of the three basic categories of nutrients: carbohydrates, fats, and proteins. You need to know what these nutrients are and how the body uses them if you are to make intelligent choices of food. Let me explain what I know about nutrients.

Carbohydrates

Carbohydrates are the most basic foodstuffs, relatively simple compounds of carbon, hydrogen, and oxygen. Plants make them from carbon dioxide, water, and the energy of the sun. The simplest carbohydrates are familiar sugars: glucose (grape sugar or blood sugar), fructose (fruit sugar), dextrose (corn sugar), and sucrose (table sugar, from sugar cane and beets). Starches are complex carbohydrates, larger molecules made up of units of simple sugars linked in chains. Plants make the simplest sugars by photosynthesis, then convert them into other sugars and starches as storage foods.

When we eat carbohydrates, our bodies metabolize or burn them, releasing their stored energy and breaking them down again to water and carbon dioxide. For both plants and animals, carbohydrates are high-quality fuels, since it takes relatively little work to dismantle these compounds and release their energy. Because the end products of carbohydrate metabolism are carbon dioxide and water, these are clean-burning fuels as well as efficient ones.

Sugar is instant energy for us, and, as the first form of bound solar energy made by plants, it is also the foundation of the body’s energy economy. All other foods are converted into glucose for distribution to our tissues and cells. Many of our cells prefer to run on glucose, and some, such as the highly specialized nerve cells of the brain, can run only on glucose; they have sacrificed the metabolic equipment needed to burn starch, fat, and protein.

Starch is almost instant energy. To release the energy from starch molecules, plants and animals convert them back to glucose. Sugars have not always been as readily available as they are today, but starches have been mainstays of our diets at least since the invention of agriculture. Indeed, they are the staples of most cultures; rice, wheat, corn, beans, potatoes and other starchy roots and tubers, bread, pasta, and so on are the satisfying peasant foods that give comfort as well as nourishment.

In the late twentieth century carbohydrates acquired a bad name, and this trend has continued. Sugar is maligned in all quarters, accused of causing a long list of ailments from tooth decay to depression, and bread, pasta, and potatoes are prime suspects as causes of the obesity epidemic in North America. Low-carbohydrate diets are now immensely popular, with low-carbohydrate restaurants appearing to cater to people on them. Even convenience stores and fast food outlets are advertising low-carb options. Many people think of all starches and all forms of sugar as low-quality, fattening foods, and many health practitioners tell them that refined sugar and flour provide nothing more than empty calories. The fact that carbohydrates are so inexpensive relative to fats and proteins seems to lend credence to these notions.

Until recently, nutritionists divided carbohydrates into simple and complex and advised eating less of the former and more of the latter. Simple carbohydrates are sugars, complex ones starches. This turns out to be useless advice based on an obsolete understanding of how carbohydrates are digested. What counts is how quickly the body can turn a carbohydrate food into blood sugar. The speed of this conversion can be measured and quantified as the glycemic index (GI) on a scale from o to 100, with the GI of glucose—no digestion required—set at 100. The higher the GI of a carbohydrate food, the greater the impact on blood sugar and the greater the requirement on the pancreas to secrete insulin to allow blood sugar to enter cells to be metabolized.

Many people—perhaps more than 50 percent of the population—are genetically programmed to develop insulin resistance with the repeated stress of a diet high in high-GI carbohydrate foods. Insulin resistance in turn produces a metabolic syndrome marked by weight gain (especially in the abdomen), high blood pressure, elevated levels of blood fats, and, in extreme cases, type 2 diabetes. The reason these genes are so common is that they were an evolutionary advantage in the distant past when food was scarce; they enable people to take maximum advantage of caloric energy when it is available. They are decidedly disadvantageous when food is abundant all the time, especially quick-digesting carbohydrates.

It is absolutely not true that simple carbohydrates are worse and complex carbohydrates better for carbohydrate-sensitive people. Common table sugar, sucrose, has a relatively low GI, whereas a puffed rice cake is right at the top of the scale. In general, refined and processed carbohydrates, especially products made from flour—chips, crackers, pastries, and the like—are high on the GI scale. Low-GI carbs include beans, sweet potatoes, winter squashes, and whole or cracked grains, as opposed to pulverized ones. A good resource for learning where carbohydrate foods fall on the GI scale is the website www.glycemicindex.com.

Carbohydrates can, indeed, be fattening, especially if you ignore the glycemic index, eat them with a lot of fat, and are not active enough to burn off their calories. A box of linguini I just bought asks and answers a question: Pasta . . . Why the Fattening Image? Where do you find satisfying eating without blowing your calorie budget? In pasta! That’s right. Far from being fattening, pasta scores a moderate 210 calories per serving and has virtually no fat at all. In fact, pasta has a moderately high GI, especially if you cook it softer than the al dente stage favored by Italians. One inch below this blurb is a recipe for Pasta with Four Cheeses, calling for the pound of linguini in the box plus 6 tablespoons of butter, 3⅓ cups of half-and-half, and a pound of high-fat cheeses. Most of us have learned to like these starch-fat combinations. We put butter in and on our bread, butter and sour cream on potatoes, butter, cream, and oil on pasta, and so on. These dishes are very caloric as well as high on the GI scale and will certainly increase your weight if you eat them immoderately.

If you are an active person, and if you learn to prefer low-GI carbs without a lot of added fat, you can eat these foods in moderation without problems, even if you are carbohydrate-sensitive. Starch calories are easily burned through aerobic exercise. Low-and moderate-GI carbohydrates ought to be a major part of the diet, accounting for 50 to 60 percent of total calories consumed. (Sample recipes begin on page 402.)

Refined carbohydrates, like white flour and polished rice, may have the same calorie count as whole-wheat flour and brown rice, but some of the grain’s constituents have been lost: the bran, which is an important source of fiber, and the germ or embryo, which has vitamins and other nutrients. I like various kinds of brown rice, and I also like good white rice (like basmati rice from India or Texas, arborio rice from Italy, and Japanese-style steamed rice). I much prefer whole-grain breads to those made from white flour. I eat ordinary pasta occasionally and some whole-wheat pasta. (The best kinds come from Japan and Italy.)

The main difference between sugar and starch is that the body tends to burn sugar immediately and may be unable to store its energy. Starches do not create this difficulty. The body easily stores starch calories, turning them into sugar when needed. Many people report problems from eating foods high in sugar. A common experience is a quick rush of energy followed later by a crash into lethargy and depression. Some people just feel the crash, saying sweets make them logy and sleepy. Others say that mood swings disappear when they stop eating sugar. Some parents are convinced that sugar makes their young children hyperactive, that behavior and attention problems are much less severe if sugar is restricted or removed.

Of course, everybody is different. Some of us can handle sugar, and some cannot. In those who cannot, the problem may be a mild version of what happens with alcohol. Alcohol is a drug (discussed in Chapter 7, Habits) that is also a food. The body metabolizes alcohol as a carbohydrate but burns it immediately, releasing a flood of caloric energy into the system. Charlie Poole (1891–1931), a legendary banjo player, songwriter, and whiskey drinker from North Carolina, used to call his drug of choice heavy sugar; he died of complications from alcoholism at the age of thirty-nine. It is fashionable today to talk about addiction to sweets, and some people would like me to call sugar a drug rather than a food. I prefer to call sugar a food that may have druglike effects in some individuals. Addiction to sugar does not look different from addiction to food in general, but I certainly agree that sugar is a powerful source of pleasure.

Aside from its effects on metabolism and energy cycles, sugar is certainly bad for our teeth. It is a favorite food of the bacteria that cause dental caries. Some forms of sugar are worse than others in this regard, honey being particularly bad because of its stickiness, chocolate being surprisingly benign because substances in it disrupt the glue that bacteria make to adhere to enamel. Diets high in sugar may also predispose some people, especially women, to yeast infections, may aggravate some kinds of arthritis and asthma, and may raise the level of blood fats (triglycerides).