By Anne S. Lewis

NOVEMBER 16, 1998:  My theory is that people tend to break down into two groups: those who think what you eat matters and those who don't. The body as high-performance engine that peaks on premium-grade fuel, or one that rocks along just as well on regular ... or Diet Coke. But sometimes even the Diet Coke drinkers get the what-ifs. According to recent surveys and first-hand experience, those in the former camp who believe in the power of food and seek nutritional advice will look long and hard for someone in the medical profession who knows much about nutrition. Enter James Heffley, Ph.D., clinical nutrition counselor. He's the one I ring up -- and send all my friends to, and to whom an increasing number of physicians are now referring patients -- when something is out of whack and nothing else has been able to fix it, or simply when a nutritional take on what's going on seems to be in order.

Heffley has a doctorate in biochemistry from U.T. and did nutritional research with the late Roger J. Williams, Ph.D., at UT's Clayton Foundation Biochemical Institute. He's been in private practice offering nutritional counseling for 25 years -- people from all over the country come for consultations in person or by telephone -- and yet he still makes time to serve as editor, since 1992, of the Journal of Applied Nutrition and promptly return the phone call of a mother with a baby in distress. Heffley's office, with its warm, supportive staff, could be one of the last of its kind: a health-care provider where the first question asked is not, "And how will you be paying for these services?"

The theory underlying Heffley's approach is that we're all unique in terms of our nutritional needs, and that most of us come up short somewhere on the nutrient scale, which means we're operating at less than optimal capacity. Whether it's an unrelenting low-grade fatigue, an annoying susceptibility to any bug that happens to be making the rounds, or some major system break-down, there may be a nutritional solution to the problem. Heffley does a nutritional work-up on each client -- detailed questionnaires, interviews, and laboratory tests -- in an attempt to isolate the problem and then, with a regime of dietary changes and supplements, to solve it.

James Heffley, Ph.D. photograph by Anne S. Lewis

Austin Chronicle: A lot of us are kind of dizzy from the Ping-Pong game of "take this vitamin ... no, don't take that vitamin" that we see in the press. Last year, with Page One pageantry, The New York Times ran Jane Brody's essentially skeptical romp through the current field of vitamin research. That article relies on the premise that if you eat a good diet you don't need supplements.

Jim Heffley: That's a tremendous "if." At the University of Texas, Dr. Don Davis had to cut rat chow 70% with starch to approximate the nutritional quality of the American diet. So we are living and reproducing and living to 70+ years on about 30% of what we might receive if we improved our diet and used modest supplements. The body is capable of a lot of accommodation to an imperfect diet, but the more imperfect your diet, the more it taxes your nutritional resources and reduces your ability to function.

Even the best diet can be improved upon. The average American diet will support a person through their 70s; an excellent diet, alone, will often support a person up through their 90s. With a truly superior diet, I don't see any reason that people could not live into the 100s. A lot of geriatric specialists are saying that's an entirely accomplishable age.

AC: So what would that truly superior diet look like?

JH: It would rely mostly on unrefined foods and include judicious supplements, those tailored for you. I've always preached individuality; so the best diet and supplement pro-gram has to be individualized.

AC: If you were to try to get what you need from food alone, can you be certain of the nutrient content of foods?

JH: There are variations in nutritional contents of produce, but there are bigger variations in our requirements as our circumstances change. In 1976, I put together a computer program analyzing peoples' diets for 60 items; I used it maybe 100 times, because there were small variations in peoples' diets in terms of what they supplied but enormous variations in terms of what they needed, especially in different circumstances. Dietary intake was a poor predictor of need. What you need depends upon your genetics and your current situation. The nutrients supplied by the foods are certainly important and are the basis of a healthy nutrient intake, but when looking for things that change the way you feel and the way you function, dietary deficiency may not be the overriding cause for the way you feel. If you require 150 micrograms of selenium a day -- and your food only provides 40-50 micrograms per day, increasing your dietary intake to 60-70 mcgs a day won't make or break the way you feel. You would have a difficult time getting 150 mcg of selenium per day from your food, even by very selective food choices. You could take a selenium supplement -- which is what most people end up doing.

We have developed into a pill-taking society. The amount of home gardening and cooking that you would have to do to get the nutrients that you need is more than most people are willing to do. We would have to return to a hunter-gatherer society. I'm afraid that the time has passed when we could truly obtain all of our nutrients from our food -- things are just not the way they were long ago. Our soil has been depleted of many trace minerals; the time lag between harvesting and consumption is too long, or preservation methods are required which necessarily reduce food quality. We can do the best we are able, but we are now probably dependent on supplements in order to get close to the ideal situation. We may never even get as close as 95% to perfect.

AC: The way I understand your approach is someone comes in and describes the problems they're having. You elicit a lot of information from them and then, essentially, reverse-engineer the problem by asking what it is that this person's body needs to be doing but is not and what nutrients would jump start that process?

JH: Correct. It's a functional approach. If there's something that's hindering a particular activity or biochemical transformation, I want to see if there is a way to make the right thing happen. Sometimes it's a problem that nutrition cannot solve, or at least that I don't know how to solve. But sometimes, even for problems with genetic roots, there are modifiable circumstances in our environment that will affect which genes are expressed or not. Nutrition not only influences our metabolic processes, it impinges on how messages to cells are delivered. There is potential in nutrition to influence our most basic body functions and not just to keep away deficiency diseases.

AC: What percentage of physiological problems can nutrition help?

JH: Almost everything. If nothing else, improved nutrition can help support the body in a stressful situation. Under any sort of stress, there are certain nutrients, such as Vitamin C that you need more of. Or, it may go beyond that: Nutrition may influence the actual expression of your genes, i.e. which particular genes work and which are turned off. An example: If you are deficient in Vitamin B6, the body simply manufactures less of many of the enzymes that utilize B6. Since enzymes control the speed at which chemical reactions progress, the result of a B6 deficiency, for instance, can be reduced production of brain neurotransmitters. If you are taking in enough of the vitamin, then the body will make as much of these enzymes as is necessary. This is all under genetic control, so the body makes some adjustments in genetic expression on the basis of the nutrition you provide it.

AC: Why with all of the studies that have been done on vitamins is there not more consensus?

JH: One of the biggest problems is that the traditional dietitians and conventional physicians tend to view each vitamin as the magic bullet that will work all by itself. Physicians, in particular, tend to take this approach because they're trained to look at a disease in terms of: Here's the disease, here's the prescription for it. For a nutritionist, there are 60 or so nutrients to consider and they work as a team. You don't expect one nutrient to do everything, even when it happens to be the primary deficiency -- it needs other nutrients to function. For example, in order to make Vitamin B6 do its job, there has to be riboflavin (Vitamin B2) and probably magnesium also in the system.

This kind of research is just now becoming popular. Very recently, there was a study published that showed that adding zinc to a children's vitamin doubled its benefits in protecting against infection. This kind of study makes more sense than just giving this one nutrient in isolation to kids and asking, okay, how good is it? It might not be any good at all in that context because some of the other things that it needs to perform that function are not present. Most deficiencies do not happen as single nutrient deficiencies. In the real world, if one nutrient is low, a dozen others are at least marginal, if not low. So this teamwork concept is so crucial to learning how a nutrient works, because you can't assume that it will work at all if it is used all by itself.

AC: So was this a problem in that infamous Finnish beta-carotene study, a few years ago, which had everyone tossing their bottles of beta-carotene out of fear that it could cause cancer?

JH: That's an excellent example, because beta-carotene, while it is an antioxidant itself, needs other antioxidants to maintain its own integrity. There are several antioxidants which, when used all by themselves or used in an environment that doesn't support their antioxidant function, can actually turn around and bite you -- make things worse. In that Finnish study, Finland happens to be a part of the world with very low soil selenium, leading to a wide-spread deficiency in the population. This is important because selenium-containing enzymes help the body re-generate its best homemade antioxidant -- glutathione. Without enough selenium, beta-carotene was deprived of an essential member of its team, resulting in increased cancer incidence. Plus, the study was conducted on longtime smokers -- that's a real late start in the ball game. When the Vitamin A and carotenoids work as anti-cancer nutrients, they tend to work at the front end of the process rather than the later stages.

AC: The Times article also quotes researchers who contend that free radicals -- the presumptive bad guys, the antioxidants' targets-- can actually be good guys in some contexts and hence it may not be a good idea to employ gunslingers like Vitamin C and folic acid to eradicate them.

JH: That's true. Everything has a use if it's used at the right time and in the right amount. Our immune system uses free radicals in its fight against viral or bacterial invaders, and our mitochondria produce energy using free radicals in the electron transport process. However, we still need antioxidants such as Vitamin C to protect normal molecules from free radical damage. Many nutrients can provoke problems if too much is taken, but thankfully, most have a safety factor of five or 10 times the RDA, sometimes much more than that.

AC: What is your response to the conclusion of that recent study in the journal Nature, which asserted that Vitamin C supplements could be harmful?

JH: There were several flaws in the study. For instance, it lacked a proper description of the subjects and it didn't distinguish between damaged DNA still present in the gene and free (but damaged) DNA. The major conclusion of the article, that Vitamin C can become a pro-oxidant in certain circumstances, has been known for several years and so that is not news. The media picked up on the finding that oxidation of one nucleic acid (the most sensitive one) was increased when Vitamin C was used. The media did not say much about a second nucleic acid which was actually protected from damage and that three other nucleic acids were not checked for damage. Basically, the findings did not match the magnitude of the outcry.

AC: So how can the average consumer, without professional consultation, know how to self-treat?

JH: If you're healthy and don't have anything seriously wrong, there are some good, inexpensive multi-vitamin and mineral preparations that will do you some good -- especially if your body is only hitting on four cylinders out of eight, these can get you up to six cylinders.

With rare exceptions -- for instance, there are people who cannot tolerate the amount of Vitamin C in a multi-vitamin -- the benefits of a multi-vitamin will outweigh the disadvantages in taking such a supplement. And, if you don't find benefits from it, you can just stop taking it. A person probably should not megadose without some professional help or at least doing some research on their own. Most people don't need megadoses. Most do quite well on a multi-vitamin that contains two to five times the RDA of nutrients.

People should be aware that the benefits from a supplement program or a change in diet are most noticeable in the most deficient people. When you are running at only 20-40% of potential, maybe nothing more than leaving sugar out of your diet could make a whale of a difference in the way you feel. But, as you do better with your nutrient intake, it seems to require more effort to see improvement. When performing at 90% of your potential, to get that extra 1% might take a doubling of your efforts. All along the line, there are questions to be asked in terms of how much is it costing me to get this much better; is it worth it in terms of how much home cooking you are willing to do or how many pills you're willing to swallow. For some, it's worth it; for others, not. For some, it's life-saving. Without any risk, a person can always change their diet to exclude refined foods and get some benefit.

AC: What are some of the most common complaints that people bring to your office?

JH: For the entire 25 years that I have been counseling, inordinate fatigue is by far the most common complaint. Because there are so many nutrient deficiencies which include this symptom, I need to gather further information on what else is bothering, or not bothering, a client so I can make some educated guesses about which nutrients are most likely deficient. I try to recommend a program which allows an evaluation of the effects of each nutrient so in the end we know which nutrients to keep and which can be left off. The process requires several months of observation, but given the high cost of testing for nutrient deficiency, it still seems the best method.

AC: For what kinds of problems do you get the most physician referrals?

JH: That is a tough question, because although I receive many more physician referrals now than 10 years ago, it certainly represents the minority of clients. I would guess that referral of cancer patients is most frequent, but anything from autism to interstitial cystitis has come through.

AC: You work with a number of clients who are undergoing chemotherapy; how can nutritional therapy help them?

JH: Chemotherapy is a terrific stress, literally, a controlled poisoning. I would want to make sure the "stress nutrients" are supplied. Plus, certain chemotherapy agents have side effects which can be controlled through nutrient supplementation, without decreasing the effectiveness of the agent. We have known for years that Vitamin E prevents the heart damage common to Adriamycin(TM) chemotherapy, and recently learned that Coenzyme Q-10 is also protective. N-Acetyl cysteine is another nutrient which will generally reduce side effects of several types of chemotherapeutic agents without negating their effects.

AC: You've said that there is more sophisticated nutritional research going on today than 10 years ago and more interest and money to do the research which the vitamin manufacturers are sponsoring. Which vitamins promised more than they delivered?

JH: DHEA, held out as an anti-aging "steriod," didn't pan out mainly because of a low risk- benefit ratio. Melatonin didn't do for most people everything that it was claimed it could, though safety was not an issue there. Those hotly promoted "ancient seabed" liquid minerals were certainly oversold.

AC: What are some of the more promising vitamin -- or nutritional studies -- working their way through the research journals?

JH: Lipoic acid will get more attention in the next few years as a unique antioxidant which operates in both the fat-soluble and water-soluble portions of the body. Acetyl-L-carnitine has a lot of potential for improving brain function, better than plain L-carnitine, in that it gets into the brain more easily. L-glutamine is an amino acid with a bright future in normalizing gut function. There are dozens of bioflavanoids which, once we separate them out, may have remarkable uses as anti-inflammatory agents or as enzyme modulators.

AC: Given all of the confusing nutritional information that the public is bombarded with, what do you consider to be the most erroneous health assumptions that we operate under? In 10 years, where do you think we will be on the spectrum of nutritional thought?

JH: The idea that nutrients only prevent "deficiency diseases" is perhaps our worst assumption. Vitamin C deficiency produces more problems than bleeding gums. Then there's the erroneous notion that "if it worked for me, it'll work for you" -- a belief held too often by those newly interested in nutrition. We are simply too different from one another, especially here in America, for one-size-fits-all nutrition. To be satisfied with a life span of "three score and 10" years is to underrate the capability of the human body. We should expect 110-130 productive years, and with only a few years of dependency, rather than 10-15 non-productive years.

With the ascent of "outcome-based medical intervention," the future role of nutrition as both prevention and therapy will certainly increase. In short, nutritional intervention works, and as we become more sophisticated in both evaluation and therapy, I anticipate tremendous gains in our nation's health. As we realize the interrelations between the gut and the immune system, the gut and the brain, the brain and the immune system, and so on, we will be able to minister to the whole person in a way that provides exponentially increased benefits over medical specialization. The future could hardly be brighter.

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