Airway Genetics and Ambient Combustion Aerosol

Multiple Chemical Sensitivity: 2021 Consensus Criteria Part III

Multiple Chemical Sensitivity: 2021 Consensus Criteria

Baseline, Diagnosis, Patient Rights, Etiology

Part III Baseline: Nutrition and Exercise

Expertise from the most Prestigious Academic, Medical, and Government Research Facilities

Outline

I. Baseline GSAA, ACA, SRPE 1-8

II. Diagnosis, Patient Rights, Etiology 9-14

III. Baseline: Nutrition and Exercise 15-31

A. SJF, LE 15-20

B. Whole Food Nutrition 21-31

IV. Baseline: Nutrition and Exercise 32-38

C. Suboptimal Actors 32

D. Maintaining Bone Density 33-37

E. Preventing Atherosclerosis 38

Outline Expanded IIIA,B, IVC,D,E

III. Baseline: Nutrition and Exercise

A. SJF, LE 15-20

15. Impaired Capillary Circulation

16. Dietary Fat: Cancer

17. Cordain 2005

18. GSAA, ACA, SRPE, SJF, LE

19. Specified Junk Food (SJF) Defined

20. Prevention and Reversal

B. Whole Food Nutrition 21-31

21. Gram/Calorie Conversion

22. Fructose Lipogenesis

23. Hemoglobin: Iron Absorption

24. Protein: GSH Synthesis

25. Digestion: Wheat, Rye, Barley

26. Viscous Fiber: Villus Flattening

27. Nutrients in Matrix

28. N-6 and N-3 EFA

29. Vitamin C: 200-300 mg?

30. Nutrigram

31. Vegigram

IVC. Suboptimal Actors 32

IVD. Maintaining Bone Density 33-37

33. Acid Base Balance

34. Calcium: Adequate Not Excessive

35. Salt: A Small Amount

36. Vitamin D: 1000 iu Soft Gel - Safe Upper Limit?

37. Summary: Bone Health, Postmenopause

IVE. Preventing Atherosclerosis 38

III. Baseline: Nutrition and Exercise

A. SJF, LE 15-20

15. Impaired Capillary Circulation

Contempt opposes good: the world of love and appreciation.

Tradition - ice cream and cake to added ingredients - oil, fat, sugar, refined flour, excess salt: consequences. SJF (specified junk food) causes immediate adversity and inability, gradual development of atherosclerosis: plaque free at birth to artery narrowing calcified lesions - and a long list of degenerative disease misleadingly ascribed to aging.

Run a mountain straight up, but add dietary fat and oil can't for 72 hours - neck pulsates - stop and walk. The chylomicrons from added dietary fat have impaired fine capillary circulation. Its obviously horrible. It was shown (Friedman 1965) - both a cream and vegetable oil drink block capillary circulation. And it took 72 hours in Swank 1961 for tissue suffocation to wear off.

16. Dietary Fat: Cancer

Fatty acid quantity, distribution, and composition of adipose and muscle tissue reflects dietary fat (Andersson 2002) - and can be reduced, redistributed, and recomposed (Soriguer 2003) by whole food 80/8/12 carb/fat/protein % of calories. Adipose fat deposition has implications not only for cardiovascular disease, obesity, type 2 diabetes, and kidney failure; but also breast, intestinal, and prostate cancer - specified junk food (SJF) the principal cause. On contrast, 80/8/12 the risk is near zero.

American Cancer Society predicted 2021 cancer:

women breast 281,550 new cases - 43,600 deaths; digestive 147,000 - 71,140; men prostate 248,530 - 34,130; digestive 191,090 - 98,140. Combined total 868,170 new cases - 243,010 deaths in one year - largely due to nutrition.

Carroll K.K. and Khor H.T. Dietary fat in relation to tumorigenesis. Prog Biochem Pharmacol 10:308-53 1975. Dietary fat grams average daily per person; deaths year per 100,000 total of breast, intestinal, prostate cancer:

UK 144 grams/49 deaths, Canada 144/50, USA 150/49, Netherlands 155/49, New Zealand 158/49

Thailand 25 grams/2 deaths, Phillipines 30/7, El Salvador 40/5, Japan 42/9, Taiwan 44/8, Ceylon 46/4

17. CORDAIN 2005:

68% of total daily energy: alcohol 1.4%, vegetable oils 17.6, refined sugar 18.6, refined grains 20.4, dairy products 10.6%

much from cookies, cake, bakery foods, breakfast cereals, bagels, rolls, muffins, crackers, chips, snack foods, pizza, soft drinks, candy, ice cream, condiments, and salad dressings.

resulting in: overweight or obese 65%, over 240mg/dl cholesterol 37 million, cardiovascular disease 64 million, hypertension 50 million, type 2 diabetes 11 million, cancer 25% of deaths - one third due to nutrition.

Abbreviations

GSAA: Genetically Susceptible Acquired Alteration

ACA: Ambient Combustion Aerosol

SRPE: Subjectively Recognized Personal Exposure

SJF: Specified Junk Food

LE: Lack of Weight Bearing (Walk, Run) Exercise

Kcal: calories

18. GSAA, ACA, SRPE, SJF, LE

Western baseline conditions are influenced by cumulative GSAA, continuous ACA, prior and ongoing SRPE, SJF dietary habits, and LE.

Environmental illness - MCS included - and comorbidity having SJF and LE big factors, are degenerative diseases which develop over time. Disability is not normal to healthy aging - instead a combination of GSAA, ACA, SRPE, SJF, and LE.

MERCK 1999 pg 2503: "...disease rather than normal aging is the prime determinant of functional loss in old age...Many decrements reportedly caused by aging are often attributable to lifestyle, behavior, diet, or environment which can be modified..."

19. Specified Junk Food (SJF) Defined

Cholesterol intake over 100 mg/day; added fats and oils beyond naturally occurring in vegetables, fruit, and grain - except nuts, seeds, olives, avocados, and soybeans are too high in oil - raising the fat calorie percentage above 10% - and with sugar, refined grain, and excessive salt (sodium beyond 1500 mg/day) - comprise specified junk food (SJF) - in agreement with Pritikin 1990, 1979.

Dietary fat: 98% triacylglycerides made up of one glycerol esterified with 3 fatty acid molecules; the vast majority consume a diet more than 10% calories in fat - animal origin fatty acids are mostly saturated - and from plant foods - often called oils - with few exceptions, unsaturated fatty acids dominate. Fats and oils over 10% of calories are harmful.

20. Prevention and Reversal

Most commercial bread is 17% of calories fat - plus sweeteners - and it gets worse add some mayo, then potato chips, an Oreo, ice cream, and the oily granola bar - the result is caloric density nutrient deficiency, chronic anoxia - rising lipids (blood fats - chylomicrons, VLDL, LDL - carry triglycerides and cholesterol) - sludging blood components, impairing fine capillary flow, nutrient and oxygen delivery obstructed - building arterial plaque deposits - a catastrophic 70% blockage sometimes achieved (Delgado-Lista 2008, Friedman 1965, Williams 1957, Kuo 1955), better 80-8-12 carbohydrate, fat, protein % of calories - fine capillary delivery is restored in 72 hours (Swank 1961), arterial plaque is cleared in 1-2 years (Ornish 1998). And work towards a minimum 6 miles a day (2 hours) walking and running - referred to as weight bearing exercises for good health - including strong joints and bones. Exercise does not correct dietary indiscretion, and caution, pain may occur anywhere from foot strike - repetitive stress from the always unnatural interposition, adjust shoe or insole (replace, rotate, upside down, backwards, cut out, alter) - memory foam may conform better. If not a complete meal, 12-24 ounces vegetables and quart or more water before going a long distance may be helpful.

MERCK 1999 pg 449: "...Normal joints have a low coefficient of friction and do not wear out with typical overuse and trauma...cartilage health and function depend on compression and release of weight bearing and use; ie compression pumps fluid from the cartilage into the joint space and into capillaries and venules, whereas release allows the cartilage to re-expand, hyperhydrate, and absorb necessary nutrients..."

Diseases caused by SJF, LE include angina, arthritis, atherosclerosis, coronary artery disease (CAD), coronary heart disease (CHD), cancer, diverticulitis, gallstones, gout, hypertension, irritable bowel syndrome, kidney disease, metabolic syndrome, non alcoholic fatty liver disease (NAFLD), obesity, osteoporosis, and type 2 diabetes.

Unrefined whole food (Malik 2007, Slavin 2003) less than 10% calories in fat, cholesterol intake under 100 mg/day - supports total blood cholesterol under 160 ng/dl - nearly impossible to develop atherosclerosis (Ornish 1998, Pritikin 1990, 1979).

MERCK 1999 pg 1659-60: "...the average US diet contains 37% of total calories in fat. The American Heart Association recommends the proportion be reduced to 20%, yet a reduction to less than 10% may be needed to have a major effect on CAD risk..."

DRI 2006 pg 143: "...Because all tissues are capable of synthesizing enough cholesterol to meet their metabolic and structural needs, there is no evidence for a biological requirement for cholesterol...Much evidence indicates a positive linear trend between cholesterol intake and LDL cholesterol concentration, and therefore increased risk of CHD (coronary heart disease)...It is recommended that people maintain their dietary cholesterol intake as low as possible, while consuming a diet nutritionally adequate in all required nutrients..."

IB. Whole Food Nutrition 21-31

21. Gram/Calorie Conversion

Round numbers fat 9 kcal(calories)/gram, carbohydrate and protein 4 kcal/gram. A label 2 grams carb, fat, protein each is 24/52/24% of calories carb/fat/protein. 2% low fat milk is 30% of calories fat because the other 98% by weight includes carb, protein, and water.

More precisely kcal/gram carb, fat, protein: grains 3.4/8.4/3.3; veg 3.6/8.4/2.6; fruit 3.6/8.4/3.4; nuts, legumes 4.1/8.4/3.9; meat, fish 4.0/9.0/4.3; milk 3.4/8.8/4.3

22. Fructose Lipogenesis

There are potential difficulties in replacing SJF: multiple units of glucose (not sweet tasting) - preferred fuel blood sugar - make up the starch of whole grain, metabolized with insulin release and a temporary rise in blood glucose and triglycerides; on contrast glucose as a simple sugar and fructose (recognized by its sweetness) - or in combination as sucrose, such as in white table sugar, sweetened beverages, and fruit juice - even at low to moderate consumption are shown to impair glucose and lipid metabolism, increase inflammation - and fructose intake is an independent predictor of a proatherogenic increase of smaller LDL particles (Aeberli 2011, 2007).

Excessive fructose (10% of US calories, 20% among America's youth), high fat, and refined grain of SJF - action on bacterial flora, even if not in a weight gain situation may result in alteration or bloom of bacteria, lower scores on tight junction protein measures, impacts on intestinal wall integrity, increase in microbrial translocation (MT) from the gastrointestinal tract to the liver - endotoxemia - high plasma endotoxin concentrations (inflammatory cell wall components of gram negative bacteria) involving soluble CD-14 LPS (lipopolysaccharide endotoxin) receptors and LPS binding protein (LBP-1), large elevations in c-reactive protein and liver enzymes: alanine transferase, alkaline phosphatase, and y-glutamyl transpeptidase; LPS overwhelming local and innate immune mechanisms reaching kupffer (liver macrophages) and non immune liver cells producing periportal inflammatory infiltrates - liver damage - which if accompanied by extra calories leads to Hepatic Steatosis (HS) - today's epidemic of nonalcoholic fatty liver disease (NAFLD) afflicting nearly 1/3 of the US population - fructose participation in lipogenesis, unlike glucose, not involving insulin - fructose 90% uptake by the liver promoting insulin resistance adversely affecting glucose metabolism disposing to the development of type 2 diabetes and cardiovascular disease (Kavanagh 2013, Hellerstein 2012).

Fructose - small amounts okay in nutritious vegetables such as kale, brussels sprouts, cauliflower; but high in fructose low in nutrients, fruit becomes the junk food of a good diet; not bad as SJF, fruit now and then better than starving in a pinch; fructose is 75% of calories apple, 50% grape and orange, 25% of calories bananas.

23. Hemoglobin: Iron Absorption

Meat factor iron absorption enhancement (MF) fish, beef, pork, poultry; closely but not fully understood, cysteine-containing peptides reduce and chelate iron (Hurrell 2010) and sulfated glycoammoglycom carbohydrates in fish muscle tissue enhance iron absorption from phytic acid iron complexes (Navas Carraterro 2008): at least 50-200% more absorption of plant food non heme iron (Hurrell 2010, Navas Carraterro 2008, Gilooly 1983, Hallberg 1979). Exclusion of meat factor for 25 days, hemoglobin borderline anemic 10.5-11 mg/dl (13-18 normal range): fatigue, weakness, chronic sniffles; reversed quickly by reinclusion of MF: 4-7 ounces average daily fish consumed with whole grain rice (phytate containing plant food) and vegetables, continuous 24/7 bacterial enzyme large intestinal digestion, nutrient absorption: iron, calcium, folate (Aufreiter 2009), lignans (Rodriguez-Garcia 2019), short chain fatty acids, electrolytes, water; made possible by whole foods of proper fiber composition.

Spinach is high in iron absorption inhibiting polyphenols (Hurrell 2010, Gilooly 1983).

Exclusion of the meat factor group, such as fish, also reduces skeletal muscle carnitine transport capacity - muscle carnitine availability is rate limiting for fat oxidation and carbohydrate flux during exercise. Reinclusion of fish restored total carnitine (TC) - normal in 6 months (Stephens 2011).

Ramon 2009 - mercury aside - found worse birth outcomes result from other contaminants mostly in fatty fish - with lean fish producing better birth outcomes than diets without fish - though blood cord mercury was higher among all consuming fish.

Lowest tuna mercury levels are of most commercial canned light (skipjack) from the Indian and Pacific Oceans (Sunderland 2007); canned white (albacore) has nearly 3 fold the mercury of light (skipjack and yellowfin, with skipjack the least); and fresh tuna from the Atlantic have 2-5 times higher levels depending on the variety. Cod and haddock are lean with mercury levels close to light tuna (FDA 2010).

Canned yellowfin and tongol, somewhat oily, are not low in fat as skipjack.

Mercury amalgam has a strong association with exascerbation of MCS (Pigatto 2013). However, it is not clear whether exposure from fish containing relatively low amounts of mercury has a net adverse effect, especially considering nutritional disadvantages of not including fish.

Low in fat and cholesterol, lean fish may be preferred over meat or poultry - keeping cholesterol intake under 100 mg/day. Beef, pork, and poultry have cysteine and methionine amounts similar to that of fish - pork and poultry are low in B-12 (USDA).

Per 3.5oz mcg B-12 Cholesterol (mg)

light tuna canned/water 2.9 40

beef round separable lean 1.5 77

pork all .7 84

turkey breast .39 83

chicken " .34 85

24. Protein: GSH Synthesis

GSTM1 and GSTT1, objects of the Deluca and Schnakenberg studies, concern the activation of Phase II enzymes known as GSH-S-transferases (GST) which catalyze the reaction of glutathione (GSH) with electrophiles - a broad class of xenobiotic and endogenous compounds - including environmental toxins and reactive oxygen species. (Block 2011, Manfredi 2009, Hayes 2005, Wu 2004, Griffith 1999).

Deletion of GSTM1, GSTT1, or both at the same time found to occur in approx 50, 20, and 10% of the population respectively; perhaps compensatory concerning GSTM1 - Block 2011 reported upregulation of vitamin C; but with both deletions bigger changes: malendialdehyde lower; serum iron, total cholesterol, and LDL higher; however, risk associations with specific diseases termed modest (Block 2011) - consistent with a broader genetic picture rather than a single candidate gene, followed by GSAA from ACA, SRPE, SJF, and LE.

In a condition such as MCS; GSH depletion may be inevitable (Deluca 2010) either by excess utilization in spontaneous or GST catalyzed reactions or by suppression of synthesis such as with high levels of NO production (Lu 2009, Oslund 2008, Darmaun 2005, Wu 2004, Canals 2003, Griffith 1999, Sterner-Kock 1999, Tanabe 1996).

A reduced antioxidant capacity and increased susceptibility to oxidative stress may occur if protein intake is low (Humayan 2007, Jackson 2004), though increasing protein will not cure MCS.

Glutathione (y-glutamyl-cysteinyl-glycine; GSH) is synthesized from amino acids glutamate, cysteine, and glycine by the sequential action of y-glutamylcysteine synthetase (y-GCS) and GSH synthetase (Wu 2004, Griffith 1999).

Adequate dietary protein - including provision of the precurser amino acids glutamate, glycine, and especially the sulfur containing amino acids cysteine and methionine - is critical for the maximization of GSH synthesis (Sekhar 2011, Lu 2009, Jackson 2004, Lyons 2000, Bella 1999, Jahoor 1995, Grimble 1992). Cysteine is considered a semi-essential amino acid because it can also be derived from methionine - an essential amino acid (Griffith 1999a).

Sekhar 2011 reported that by supplementing elderly volunteers with glycine and approx 1000 mg cysteine in the form of n-acetylcysteine per 150 lb body weight (.81 mmol kg-1 d-1), GSH levels improved and oxidant concentrations - isoprostanes and lipid peroxides - expected elevated in MCS (Deluca 2010, Terlecky 2006, Kennedy 2005) - were decreased.

The 1000mg/150 lb body weight n-acetylcysteine supplementation of Sekhar 2011 is nearly the combined total of cysteine (273mg) and methionine (755mg) in 3 1/2 oz 100% light tuna in water (no added soy). The elderly often consume less protein than those younger and recent research using the indicator amino acid method holds that the RDA/DRI for protein has been 30% underestimated (Elango 2011, Humayan 2007, Jackson 2004).

Earlier estimates of adult protein requirement at 55 grams/day include 2000-3000 mg cysteine and methionine. An improved intake of 80-100 provide 3200-4200, similar to the 1000 mg supplement difference in the Sekhar study.

3.5 oz tuna rather than a supplement increases total protein (25 grams), adds 3 mcg B-12 (Hermann 2008) which exceeds the RDA and approaches the optimal 4-7 mcg suggested by Vakur Bor 2010, provides non heme iron absorption enhancement (Hurrell 2010, Navas Carraterro 2008), may prevent loss of skeletal muscle carnitine transport capacity as may occur in vegetarians (Stephens 2011), is a source of iodine (presence in plant foods varies with soil), and may contain a modest amount of preformed EPA and DHA omega-3 fatty acids after processing and drain losses.

Brown rice has nearly the methionine, but lower in cysteine compared to wheat; however the greater fiber and digestion resistant starch of whole wheat limits its consumption due to excess bulk, so that prepared breads typically consumed - not 100% whole wheat - with added fats, oil, and sweetener - have little more cysteine per calorie than rice.

25. Digestion: Wheat, Rye, Barley

Celiac disease - intolerance of wheat, barley, and rye - occurs in about 1% of the population (McGough 2005).

Whole wheat as principle calorie source results in too much fiber and digestion resistant starch (RS) reaching the large intestine, excessive 7-10% of the total carbohydrate, compared to 1-3% comfort of whole grain rice (Groff 1990).

Clearance of a full stomach takes 4 hours by small increments of chyme, 1-5 ml twice per minute released to the small intestine; 90 minutes later - remaining fiber, RS, and undigested sugars enter the large intestine in a fluid. Active and vegetable colored, optimal substrate provides nourishment and hydration nearly to elimination 36-45 hours total (Olson 1995, Groff 1990); a long playing nutrient and electrolyte pool: bacterial enzyme digestion releases short chain fatty acids acetate, proprionate, butyrate - small quantity but absorbable stabilizing energy (Priebe 2010).

Gentle buffer - large particles of highly fibrous vegetable matter require 100 minute contractions during interdigestive periods to break down and clear the stomach.

26. Viscous Fiber: Villus Flattening

Despite other unhealthful aspects, the finger-like villi of the newborn remain so in adults consuming traditional Western diets which do not emphasize unrefined plant foods (Owen 1977, Baker 1963).

Studying small intestinal biopsies of South India adults, Baker 1963 found villi were no longer finger-like as present in human fetuses - but instead leaf-like with changes maximal at the duodenum and upper jejunum and contrasting with Western man where similar distortions in villus structure had only been associated with pathological states.

Cook 1969, in biopsy of African jejunal mucosa found villus structure both leaf shaped with normal d-Xylose absorption (grade 2) and leaf shaped coalescing to form short ridges with abnormal d-Xylose absorption (grade 3).

Owen 1977 compared biopsies of San Francisco vegetarians with those on American mixed diets and reported vegetarians showed fusion of the tips, branching, and broadening - but not shortening of the villi - with more plasma cells in the lamina propria and lymphocytes in the villus epithelium compared to the mixed diet group.

Pectin has been associated with cell swelling, loss of microvilli, and hemorrhage on the surface of the jejunum. In addition, 7 subjects fed a diet with 20 grams of apple pectin for 4 weeks not only had delayed gastric emptying during that period but also were found to take twice as long to empty the stomach of a pectin free meal following a 16 hour overnight fast (Schwartz 1982).

Tasman-Jones 1978 confirmed villus alteration in rats and implicated pectin as a likely culprit; number of villi in the jejunal and ilead small intestine:

fiber free 1769 and 3174

fiber free + cellulose 1789 and 3467

fiber free + pectin 1548 and 2802

It appears cellulose, hemicellulose, and lignins (fiber distinct from phytoestrogen lignans) of brown rice and careful selective quantity of vegetables may prevent broadening and loss of villi (Tasman-Jones 1986, 1978).

In summary, Africans whose diets predominate in plant foods and vegetarians studied in San Francisco have a broadening of the villus structure with a reduced number of villi (Owen 1977, Cook 1969) thought to be caused by viscous fiber, especially pectin (Tasman-Jones 1986, 1978, Baker 1963); therefore, rather than the preferred hydrating, slowly 30-80% fermented cellulose, hemicellulose, and nearly non-fermentable lignins; thick cell walls of rice bran have high lignification; instead a high proportion of plant foods predominating in rapidly 90-100% fermenting, viscous soluble fiber such as pectin may result in small intestinal villus broadening, reduced number of villi, loss of absorptive surface, suboptimal colonic (large intestinal) fermentation, digestive discomfort, and irregularity (Priebe 2010, Cummings 1987, Paulini 1987, Tasman-Jones 1986, 1978, Schwartz 1982, Owen 1977, Chako 1969, Cook 1969).

27. Nutrients in Matrix

In choosing plant foods having known essential nutrients - thousands of desirable phytochemicals are likely present including brown rice and brassica vegetable phytoestrogens, flavonols, and glucosinolates (Frankenfeld 2008, Prior 2003, Drewnowski 2000).

Phytoestrogen lignans including matairesinol (MAT), secoisolariciresinol (SECO), and their glycosides - are transformed by large intestinal bacteria to the mammalian lignans: enterolactones and enterodiols (Rodriguez-Garcia 2019, Wang 2002, Tham 1998).

The Recommended Daily Allowance (RDA 1989) and Dietary Reference Intakes (DRI 2006) are met and exceeded for C, B2, folate, A, E, K, calcium, potassium, and 18.3 N-3 linolenic essential fatty acid (EFA) from 28-40 oz/day nutritious vegetables (kale, collard greens, brussels sprouts, cauliflower) - and magnesium, phosphorous, iron, zinc, selenium, B-1, niacin, B-6, pantothenic acid, and 18.2 N-6 linoleic EFA mostly from brown rice.

Collard greens and kale most pleasant; broccoli florets, brussels sprouts, cauliflower third, fourth, fifth: increase osmotic load, nutrients incomplete, not good stand alone consecutive days, and broccoli stalks may be harsh or irregular.

Parboiled "minute" brown rice is unsafe - antioxidants are lost and form altered in processing.

SLAVIN 2003: "...Whole grains are composed of germ, bran, and endosperm. In contrast, refined grains lack both the germ and bran, which are removed during processing and results in the loss of fiber, vitamins, minerals, lignans, phenolic compounds, and phytochemicals..."

Thiamine (B-1) is essential to maximize erythrocyte transketolase activity involved in the metabolism of carbohydrate and branched chain amino acids. Water soluble, 9-18 day half life, adult human holds 30 mg, intakes above 5 mg at one time are much unabsorbed and rapidly excreted in the urine (DRI 2006). B-1 requirement is in ratio to caloric intake (especially carbohydrate) - deficiency symptoms occur less than .12 mg/1000 kcal, .3-.6 is suboptimal, between .6 and 1.1 mg/1000 kcal reaches maximum transketolase activity (RDA 1989). Brown rice, abundant in carbohydrate: .95 mg/1000 kcal B-1 closely matches human requirements. Orange juice 2 mg, grape .6 mg, apple juice is almost acutely deficient .2 mg/1000 kcal (USDA). The RDA (DRI 2006) set low at 1.2 mg/day regardless of activity level, total carbohydrate calories; does mention that more B-1 may be needed for increased energy expenditure, consistent with brown rice 2000 kcal = 1.9 mg/day.

28. N-6 and N-3 EFA

N-6 18.2 linoleic and N-3 18.3 linolenic are the dietary essential fatty acids (EFA) - losses noted in MCS patients (Deluca 2010). N-6 can be formed into arachidonic acid. N-3 serves as precursor for synthesis of the omega 3 fatty acids - eicosapentaenoic (EPA) and docosohexaenoic DHA (DRI 2006).

Concentrated vegetable oils present an excess of N-6, enriching lipoproteins and cell membranes creating a pro-oxidant state, and often disproportion beyond the recommended ratio between 5 and 10 to 1 N-6/N-3. Competing for the same desaturase enzymes - too high a ratio may inhibit N-3 synthesis to DHA while too low may limit desaturation of N-6 to arachidonic (DRI 2006).
Adequate N-3 and formation of omega 3 EPA and DHA is associated with prevention of arrhythmias, reducing atherosclerosis, decrease in platelet aggregation and plasma triacylglycerol concentration, a slight increase in HDL, modulation of endothelial function, and decreasing inflammatory eicosanoids (DRI 2006).
Excessive intake of omega 3 EPA and DHA - such as supplements - may result in prolonged bleeding time (DRI 2006).
Adequate intake is estimated 8-16 grams N-6 and 1-1.6 grams N-3, less than 1/2 ounce and a few drops - within the ratio of 5 and 10 to 1 N-6/N-3. Naturally dispersed in whole grain matrix of antioxidants leaving no oily residue - water only clean up possible - brown rice provides a safe level of N-6 and some N-3, brassica vegetables bring more N-3 to the right ratio. Most other vegetables, except dried beans and spinach, contain little N-3. The inclusion of fish may add preformed omega 3 (USDA, DRI 2006).

29. Vitamin C 200-300 mg from Plant Foods

Known for role as antioxidant: including scavenging reactive oxidants in respiratory mucosa, and diminished lipid peroxidation as measured by urinary isoprostane excretion (DRI 2006); most vitamin C is in cells, with a lesser plasma concentration (Padayatty 2003, RDA 1989, Garry 1987, Moser 1987, Kallner 1979). Cells saturate before plasma at intakes between 100 and 200 mg daily with nearly the maximum 2000-3000 mg body store achieved at approx 200 mg/day, though plasma concentrations rise slightly as intakes increase to over 1000 mg/day.

Intakes of 60-100 mg/day result in nearly one half the body store (1500 mg), which at full deprivation may fall into the scorbutic range in 30 days; overt symptoms of scurvy occurring at under 10 mg/day with stores below 300 mg. Low but non-scorbutic plasma vitamin C concentrations may produce fatigue.

90% of 30 mg and less than half a 1250 mg dose is absorbed. At daily intakes of less than 100 mg metabolic byproducts, mostly oxalate, are excreted. At intakes over 200 mg much vitamin C spills into the urine as the originally composed ascorbic acid. Observing the minimal rise in plasma concentration at intakes over 200 mg/day and no change in the marker of oxidative stress (plasma T bars - thio barbituric acid - reactive substances), Rousseau 2004 concluded the optimal bioavailability of vitamin C seems to be reached at 200 mg/day, higher amounts apparently conferring no additional value with increased energy expenditure.

The DRI has been set at 60-90 mg/day, which not reaching maximum saturation, may seem low. 200-300 mg may be best: fully saturating the cells which comprise most of the store while not resulting in large amounts of ascorbic acid or its metabolites in the urine and feces, reducing risk of undesirable side effects that may occur at higher intakes (Rautiainen 2010, Gomez-Cabrera 2008, DRI 2006).

30. Nutrigram (Cg, K)

RDA - recommended dietary allowance, R2500 - brown rice 2500 kcal, Cg 16 - collard greens 16 oz, K16 - kale 16 oz, TF6 - light tuna in water/ salt 6 oz

Adapted from USDA SR28 composition data

Macronutrients grams kcal(calories)

R2500 Cg 16 K16 TF6 Total Total % of kcal

carb 517 24 25 - 566x4 2264 79 (gram/calorie conversion rounded)

fat 20 2 2 1 25x9 225 8

protein 47 10 8 36 101x4 404 13

fiber 40 15 9 - 64

Kcal 2436 154 150 153 2893

Micronutrients

Rice Most RDA Total R2500 Cg16 K16 TF6

mg iron 10 23 9 5 7 2

magnesium 350 1182 966 91 80 45

phosphorous 800 2406 1866 137 125 278

zinc 15 17 14 1 1 1

copper 1.5-3.0 3.2 2.2 .2 .7 .1

manganese 2.0-5.0 13 9 2 2 .02

mcg selenium 70 347 205 2 4 136

mg B1 1.5 2.5 2.1 .2 .2 .05

niacin 19 60 33 3 2 22

pantothenic acid 5 6.5 5 1 .2 .3

B6 2.0 5.0 3.2 .6 .6 .6

18.2 N-6 linoleic 5-10 to 1 7.7 6.9 .4 .4 .01

ratio over N-3, 7.7 (N-6) 1.2 (N-3 below) is 6 to 1 ratio

Veg Most RDA Total R2500 Cg 16 K16 TF6

mg calcium 800 1338 225 685 410 18

sodium less than 1500 491 13 73 105 300

better under 1000

potassium 2000-4700 3381 966 960 1050 405

(78 per 100 Kcal)

C 200 280 - 100 180 -

B2 1.3 1.5 .6 .5 .3 .12

mcg folate 200 580 90 424 59 7

mcg rae A 1000 5051 - 1851 3105 95

mg E 10 11.3 3.3 4 4 -

mcg K 120 5752 13 2006 3737 -

18.3 N-3 linolenic 1.1-1.6 1.2 .30 .49 .47 -

much of N-3 is converted to omega 3 (EPA and DHA)

preformed omega 3 may be lower than below due to drain losses:

N-3 EPA .095 .095

N-3 DHA .388 .388

mcg B-12 2.4 (RDA) 5.1 5.1

4-7 Vakur Bor 2010

Parboiled "minute" brown rice is unsafe - antioxidants lost and form altered in processing.

31. Vegigram Mini (Max Fwd V)

Score 5-1 best to worst - quantity to meet RDA (Vakur Bor 2010, DRI 2006, Rousseau 2004, RDA 1989, [DRI, RDA: Food & Nutrition Board, Institute of Medicine, National Academies]):

5 - 1 lb (16oz), 4 - 1 lb + 1 lb score 2 or more, 3 - 2 lbs or 1 + 1 score 3 or more, 2 - 1 lb + 1 lb score 4 or 5, 1 - 1 lb + 1 lb score 5

Score - digestive column, 10-1 best to worst, transit time usually 36-42 hours

10 - good; 9, 8 - increased osmotic load, looser; 7 - may be somewhat harsh; 6 - discomfort or cramping; 5 - unpleasant or suboptimal fiber; 4 - coating, bloating; 3, 2, 1 - discomfort or cramping

Calcium, Sodium, Potassium, C, B2, Folate, A, E, K, 18.3 N-3 Linolenic

Score 5-1 Score 10-1

3.5 oz Ca So Po C B2 Fo A E K N-3 Digestive

Collard greens (Cg) 5 3 4 3 5 5 5 5 5 3 10

Kale (K) 4 3 4 5 4 1 5 2 5 3 10

Turnip greens (Tg) 5 3 3 4 4 5 5 5 5 3 7

Brussels sprouts (Br) 2 2 4 5 5 5 2 2 4 3 8

Cauliflower (C) 2 3 2 4 4 4 1 1 1 3 8

Spinach (Sp) 5 5 4 2 5 5 5 5 5 5 5

Broccoli florets Bf) 3 3 4 5 5 4 3 4 4 3 5

Broccoli (B) 3 3 2 4 4 4 2 4 4 2 5,6

Cabbage (Cab) 3 1 1 4 2 3 1 1 1 4 6

Green Beans (Gb) 3 1 2 2 5 1 1 1 3 2 5

Sweet potatoes (Swp) 3 4 5 3 5 1 1 2 1 1 5

Carrots (Cr) 2 5 3 1 1 2 5 3 2 1 6

Potatoes (Po) 1 1 5 2 1 1 1 1 1 1 5

Turnips (T) 2 4 2 1 1 1 1 1 1 3 5

Tomatoes (Tm) 1 1 3 2 1 1 2 2 2 1 6

Green Peppers (Gp) 1 1 2 5 1 1 1 1 2 1 ?

Zucchini (Sz) 1 1 4 2 4 2 2 1 1 2 ?

Cucumbers (Cu) 1 1 1 1 1 1 1 1 2 1 ?

Celery (Ce) 3 5 4 1 3 3 1 1 3 1 ?

Pumpkin (Pk) 2 1 3 1 2 1 5 3 3 1 4

Winter squash (Ws) 2 1 3 1 1 2 5 5 1 1 4?

Corn (CN) 1 1 3 1 3 3 1 1 1 1 4

Cilantro (Ci) 4 4 5 3 5 4 5 5 5 1 3

Ca So Po C B2 Fo A E K N-3 Digestive

Parsley (P) 5 5 5 5 5 5 4 2 5 1 2

Head lettuce (HL) 1 1 1 1 1 2 1 1 1 2 2

Leaf lettuce (LL) 2 3 3 2 4 3 4 1 4 2 3

Mustard greens (Mg) 5 3 1 3 2 5 4 4 5 1 1

Fruit - excessive fructose and low in nutrients, juices result in osmotic load and wash out, and bananas have most fiber and digestion resistant starch (RS) - but suboptimal.

Banana (Ba) 1 1 4 1 3 1 1 1 1 1 5

Cantaloupe (Ca) 1 2 4 4 1 2 3 1 1 2 8,5

Apple sauce (As) 1 1 2 1 1 1 1 1 1 1 8,5

Grape juice (Gj) 1 1 2 1 2 1 1 1 1 1 8

Apple juice (Aj) 1 1 2 1 1 1 1 1 1 1 8

Orange juice (Oj) 1 1 3 4 1 4 1 1 1 1 8,3

MCS Etiology CAR References A-H

MCS Etiology: CAR References I-Q

MCS Etiology: CAR References R-Z

MCS 2021: CAR Nutrition References

I. Baseline GSAA, ACA, SRPE 1-8

II. Diagnosis, Patient Rights, Etiology 9-14