Doctor, doctor, shall I diet?

That’s not the question we’re likely to ask our doctor whose job is to prescribe expensive medicine, not food, to make us well. So can you blame some people for thinking that only 90 percent of what we eat goes to our bodies while the other 10 percent goes to our doctors?

The good news is there are now more doctors who are becoming more and more concerned about nutrition as they are about medication.

"Proper medical care should include advice about the right foods to eat to help you prevent illness as well as to cure it," says Isadore Rosenfeld, M.D. in his totally absorbing book Doctor What Should I Eat? (537 pages, available at Goodwill Bookstore). "There should be no contest or confrontation between diet and medication; it is not a matter of either/or. "Traditional" doctors don’t pay enough attention to the importance of your diet. Yet almost every major medical condition you can think of is either caused or affected in some way by what you eat. Ulcers, kidney or liver malfunction, heart disease, anemia, asthma, diabetes – you name it – for these and other conditions the right diet can help, and the wrong one can hurt."

Here are some things you’ve always wanted to know but were probably too sick to ask your doctor:

Vitamin C is commonly believed to be an effective treatment for the common cold. To C is to believe – or just how effective is vitamin C?

Dr. Rosenfeld: I have reviewed major research reports concerning the effect of vitamin C on the common cold published in the last 20 years. There are a few that claim it can shorten the duration and severity of symptoms, but for every such positive report, there are 20 that conclude it is ineffective. So I compromise by telling my patients to get extra vitamin C – from food. If you have a cold, drink lots of citrus fruit juice (orange or grapefruit), which naturally contains about 15 milligrams of vitamin C per ounce, but is often fortified with extra amounts. Remember that vitamin C is easily destroyed by cooking and leaches out into cooking water, so you’re better off eating your fruit and vegetables raw. Yellow peppers and papaya also have an abundance of vitamin C.

To paraphrase Shakespeare, farting is such sweet sorrow. What foods should we avoid so we don’t fart or pass gas too often?

Most burps and belches originate in the stomach and are due to swallowed air, excessive amounts of carbonated beverages drunk too quickly, or baking soda or other liquid "indigestion" medications. Normal people like you and me fart (the word is considered to be in such bad taste it’s not even in the spell check on the Microsoft program) an average of 13 times a day, but someone with a gas-forming problem may do it as often as 20 times an hour – you read that right, 20 times an hour!

Gas in the bowel is produced by normal bacteria in the gut, acting on undigested food. As you might expect, the worst offenders are high-fiber foods, since insoluble fiber is indigestible. Virtually every kind of pea and bean – soy, navy, lima, kidney, or dried – is especially bad that way. Their designation, "the musical fruit" (except that they’re legumes, not fruits), is well deserved. But don’t let that stop you from eating them as their benefits far outweigh this inconvenience. You can "de-gas" most legumes to some extent by soaking them for several hours and then discarding the soaking water (but doing so leaches out some of their nutrients). Other potential gas formers are cabbage, peppers, any uncooked starch, broccoli, cauliflower, brussels sprouts, radishes, cucumbers, raisins, garlic, onions, and foods that are eaten extremely hot or cold.

Are specialized sports drinks really necessary? Are they better than plain water?

If you work out for less than an hour at a time, all you need is water and/or fruit juice. But if you’re really into it and exercising steadily and strenuously for two or more hours, you do require the additional carbohydrates, sodium and potassium present in such products as Gatorade, Power Ade, First Ade, etc. Despite all the advertising hype, however, these products are pretty much all alike, so pick the one with the taste you prefer. If you are diabetic, pay attention to the sugar in these drinks; some people with high blood pressure need to watch their salt intake, too, and these drinks have plenty. In both cases, check with your doctor about how much is safe for you to drink and when.

This may sound like a hard question, but what should (or shouldn’t) we eat to help prevent the formation of gallstones and reduce the frequency of their attacks?

The gallbladder is a small, pear-shaped sac on the undersurface of the right side of the liver. It contains a bitter, yellow-green liquid produced by the liver called bile, that aids in the digestion of fats. A diet rich in vegetables and fruit is believed to protect against gallstones because the soluble fiber they contain interacts with bile to leave it less prone to stone formation. Eating too much fat and refined sugar, as well as high cholesterol level in the blood, predisposes one to gallstones. Most doctors tell their patients with gallstones to follow a very-low-fat or fat-free diet so as not to induce active gallbladder contractions. That means no whole milk and no whole milk products such as cheese, whole-milk yogurt, and cream, as well as butter, eggs, or fatty meats. If the cruciferous vegetables (broccoli, cauliflower, cabbage, and brussels sprouts) or other fruits or vegetables give you gas, as they do many people with (and without) gallstones, you’ll need to avoid them, too. There should be no visible fat in whatever you eat, and you should remove all the skin from poultry. The only fat you should use is monounsaturated olive or canola oil, and even then, no more than 1 tablespoon a day, carefully measured. Take a multivitamin that contains fat-soluble group (A, D, E, and K).

What about gout – what should (or shouldn’t) we eat to avoid it?

Gout is essentially a man’s disease; only 10 percent of cases occur in women, and rarely before menopause. It is the most common form of arthritis and is due to a metabolic problem – the way the body handles, produces, and gets rid of urates (crystal-forming substances in which certain foods are rich). Uric acid is one form of urate. Thus, you must be careful about what you eat and drink, keep away from foods that raise your uric acid level. The worst culprits are virtually every animal organ such as liver, kidney, brain, heart, and pancreas (sweetbreads); goose; seafood and shellfish like mackerel, anchovies, herring, sardines, scallops, mussels, and roe (caviar); bouillon, gravy; and supplements of brewer’s and baker’s yeast (the amounts of yeast present in other prepared foods or used in baking are too small to cause gout). The following contain less uric acid, and whether or not they will bring on an attack in your case is something you’ll have to learn from experience: other fish, poultry meat, asparagus, dried beans, lentils, mushrooms, dried peas, and spinach.

Drinking any form of alcohol decreases the amount of uric acid you excrete, so too much of any kind can precipitate an attack. Red wines or "heavy" ones such as Madeira and port are the worst offenders.

Instead of foods rich in uric acid, focus on complex carbohydrates such as pasta, rice, potatoes, fruits and vegetables; go easy on fat (20 to 25 percent of total calories); and eat protein in moderation (20 percent of your total caloric intake). Drink plenty of fluids to increase the normal urinary secretion of uric acid.

Now, how do you avoid becoming a member of the hemorrhoid club?

Hemorrhoids are dilated rectal veins that have clotted and become inflamed. Any of the following makes you eligible for membership in the hemorrhoid club: chronic constipation, recurring diarrhea, continual stress, having several babies, frequently lifting heavy objects, sitting around a lot, or standing for long hours at a stretch. The best way to prevent hemorrhoids is to eat enough fiber and drink plenty of water (a minimum of 2 quarts daily to prevent the impaction of stool that sometimes occurs when large amounts of fiber are consumed).

Specifically, your high-fiber diet should consist of at least 1/4 or 1/2 cup of wheat bran or other whole-grain cereals every day. Switch from white to whole-grain bread. Include at least six servings of fruit and vegetables daily, especially those whose skins you can eat (apples and vegetables). Other rich sources of fiber are prunes, dates, figs, and various beans (like lima and lentils).

Is it true that aluminum causes Alzheimer’s disease?

This aluminum theory has been around for some 30 years. Looking under the microscope at brain tissue from one who had died with Alzheimer’s (characterized by progressive memory loss and mental deterioration), doctors saw tangled-up nerve fibers which, when stained with special dyes, contain abnormal amounts of aluminum. Some neurologists think that this aluminum has something to do with the development of the disease while other neurologists disagree and say that the aluminum is simply a contaminant that’s sucked in by tissue that was previously damaged by another disease process and is not, in fact, a cause of Alzheimer’s.

But several doctors I know are decreasing their own exposure to aluminum – just in case. Of course, that’s easier said than done, because aluminum is everywhere – in our food, soil, and in the very air we breathe. You are exposed to aluminum when you drink regular, nonherbal tea, swallow an antacid for your ulcer, take a buffered aspirin for your headache, use a nondairy creamer, eat pickles or processed cheeses, or bake your cakes and cookies with baking powder to make them rise. And whenever you coat your underarm with a roll-on, cream or spray deodorant, some aluminum enters your body (if Alzheimer’s bothers you more than body odor, buy aluminum-free deodorants at health food stores). Natural aluminum cookware is yet another source of aluminum – it is shed easily when acidic or salty foods, like tomatoes, oil, beans, flour, and grains, are cooked.

Until drugs that would reverse or prevent Alzheimer’s are invented, avoiding large amounts of aluminum, where practical, certainly can’t hurt.

Salamat po, Dr. Rosenfeld!