Monday, November 5, 2018

The Benefits of Garlic

A study from the University of Saskatchewan and UCLA on garlic and heart disease was published in the Journal of Nutritionin 2016.  It was a review of thousands of studies on animal and humans evaluating garlic’s effects and safety. The authors looked at the medical literature on garlic supplements and their effects on high blood pressure, cholesterol,, C-reactive protein (an indicator of inflammation) and coronary artery calcium, as well as available data on side effects..  Only double blind, randomized, controlled trials were included.  In other words, this was a very careful study.. What was found was that garlic supplementation reduced blood pressure by 7-16 mm Hg systolic and 5-9 mm diastolic. It reduced total cholesterol by varying amounts: 7.4 to 29.8 mg/dl in various studies.  The most consistent benefits were shown in studies that used aged garlic extracts.  Although garlic is generally safe, rare adverse reactions were documented.   The authors concluded that garlic supplementation has the potential for cardiovascular protection based on risk factor reduction.  

The take home message from this, and other studies on garlic, is that it is a powerful vegetable we should include in cooking and also as a supplement if needed.  It is a member of the allium family of vegetables including onions, leeks, shallots and chives, all of which are healthy and flavorful. To prepare garlic in your cooking – select a few cloves, peel them and crush or chop them.  Let the garlic then rest for at least 10 minutes before cooking, - this triggers an enzyme reaction that boosts the healthy properties of garlic.  Cooking the garlic for a shorter time will enhance its effectiveness.  You can also add raw garlic to hummus, salads and soups. The most well-known aged garlic extract is Kyolic, but there are several others on the market.  

Sadja Greenwood, MD, MPH   past columns on this blog   leave me a message or a question






Monday, October 29, 2018

The Cerebellum – Surprising New Findings

The cerebellum is located on the underside of the brain and has been thought to be limited to controlling movement. It has been treated like an afterthought by researchers studying higher brain functions. However, researchers at Washington University School of Medicine in St. Louis say overlooking the cerebellum is a mistake. Their findings, published Oct. 25, 2018 in Neuron, suggest that the cerebellum has a hand in every aspect of higher brain functions -- not just movement, but attention, thinking, planning and decision-making.
"The biggest surprise to me was the discovery that 80 percent of the cerebellum is devoted to the smart stuff," said senior author Nico Dosenbach, MD, PhD, an assistant professor of neurology, occupational therapy and of pediatrics. "Everyone thought the cerebellum was about movement. If your cerebellum is damaged, you can't move smoothly -- your hand jerks around when you try to reach for something. Our research strongly suggests that just as the cerebellum serves as a quality check on movement, it also checks your thoughts as well -- smoothing them out, correcting them, perfecting things."
Dosenbach is a founding member of the Midnight Scan Club, a group of Washington University neuroscientists who have taken turns in an MRI scanner late at night, scanning their own brains for hours to generate a massive amount of high-quality data for their research. A previous analysis of Midnight Scan Club data showed that a kind of brain scan called functional connectivity MRI can reliably detect fundamental differences in how individual brains are wired.
Postdoctoral researcher and first author Scott Marek, PhD, decided to apply a similar analysis to the cerebellum. In the better-known cerebral cortex -- the crumpled outer layer of the brain -- wiring maps have been drawn that connect distant areas into networks that govern vision, attention, language and movement. But nobody knew how the cerebellum is organized in individuals, partly because a quirk of MRI technology means that data obtained from the underside of the brain tend to be low quality. In the Midnight Scan Club dataset, however, Marek had access to more than 10 hours of scans on each of 10 people, enough to take a serious look at the cerebellum.
Using the cortex's networks as a template, Marek could identify the networks in the cerebellum. Notably, the sensory networks are missing -- vision, hearing and touch -- and only 20 percent of the cerebellum is devoted to movement, roughly the same amount as in the cerebral cortex. The remaining 80 percent is occupied by networks involved in higher-order cognition: the attention network; the default network, which has to do with daydreaming, recalling memories and just idly thinking; and two networks that oversee executive functions such as decision-making and planning.
"The executive function networks are way overrepresented in the cerebellum," Marek said. "Our whole understanding of the cerebellum needs to shift away from it being involved in motor control to it being more involved in general control of higher-level cognition."
The researchers measured the timing of brain activity and found that the cerebellum was consistently the last step in neurologic circuits. Signals were received through sensory systems and processed in intermediate networks in the cerebral cortex before being sent to the cerebellum. There, the researchers surmise, the signals undergo final quality checks before the output is sent back to the cerebral cortex for implementation.
"If you think of an assembly line, the cerebellum is the person at the end who inspects the car and says, 'This one is good; we'll sell it,' or 'This one has a dent; we have to go back and repair it,'" Dosenbach said. "It's where all your thoughts and actions get refined and quality controlled."
People with damage to their cerebellum are known to become uncoordinated, with an unsteady gait, slurred speech and difficulty with fine motor tasks such as eating. The cerebellum also is quite sensitive to alcohol, which is one of the reasons why people who have had too many drinks stumble around. But the new data may help explain why someone who is inebriated also shows poor judgment. Just as a person staggers drunkenly because his or her compromised cerebellum is unable to perform the customary quality checks on motor function, alcohol-fueled bad decisions might also reflect a breakdown of quality control over executive functions.
Marek also performed individualized network analyses on the 10 people in the data set. He found that while brain functions are arranged in roughly the same pattern in everyone's cerebellum, there is enough individual variation to distinguish brain scans performed on any two participants. The researchers are now investigating whether such individual differences in cerebellar networks correlate with intelligence, behavior, personality traits such as adaptability, or psychiatric conditions., Dosenbach said: There are four times as many neurons in the cerebellum as in the cerebral cortex, so if you're leaving out the cerebellum, you've already shot yourself in the foot before you started. The promise of imaging the whole human brain at once is to understand how it all works together. You can't see how the whole circuit works together when you're missing a major piece of it."
This article comes from an October 25th post from the website Science Daily. Materials provided are from the Washington University School of Medicine
The take -home message from these findings are - treat your brain with great care!  Avoid head injuries in sports; don’t let your kids play tackle football. Headers in soccer can also be dangerous.  Treat alcohol and other drugs with caution.  Do some exercise – it stimulates the production of new brain cells.  Getting adequate sleep helps the brain, as do self-calming practices such as meditation. Eating a plant based diet low in salt will prevent obesity and high blood pressure, which will favor brain health. Your brain makes you, you.  Have a lot of respect for yourself, as well as others!
Sadja Greenwood, MD, MPH   leave me a message





Monday, October 15, 2018

The Health Risks of Alcohol

On August 24, 2018, the Lancet published a paper based on a study from the University of Washington,concluding that there is no safe level of drinking alcohol. The Lancet is a renowned English and international medical journal.  The study shows that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12 percent of deaths in males between the ages of 15 and 49.

"The health risks associated with alcohol are massive," said Dr. Emmanuela Gakidou of the Institute for Health Metrics and Evaluation at the University of Washington and the senior author of the study. "Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss." Gakidou is a professor of health metrics sciences at the UW School of Medicine, and of global health at the UW School of Public Health.
The study does not distinguish between beer, wine, and hard liquor due to a lack of evidence when estimating the disease burden, Gakidou said. However, researchers used data on all alcohol-related deaths generally and related health outcomes to determine their conclusions.
Alcohol use patterns vary widely by country and by sex, the average consumption per drinker, and the attributable disease burden. Globally, more than 2 billion people were current drinkers in 2016; 63% were male.  Alcohol use was less in countries with large numbers of Muslims, as Islam forbids and discourages drinking.  
The study looked at deaths and overall poor health attributable to alcohol for 23 health outcomes, such as communicable and non-communicable diseases and injuries, including:
  • Cardiovascular diseases: atrial fibrillation and flutter, hemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy;
  • Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal;
  • Other non-communicable diseases: cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders;
  • Communicable diseases: lower respiratory infections and tuberculosis;
  • Intentional injuries: interpersonal violence and self-harm;
  • Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries; and
  • Transportation-related injuries.
"We now understand that alcohol is one of the major causes of death in the world today," said Lancet Editor Richard Horton. " We need to act urgently to prevent these millions of deaths. The myth that one or two drinks a day are good for you is just that -- a myth. This study shatters that myth."
The take home message from this study is complicated.  Companies providing beer, wine and hard liquor are enormously large and powerful, permeating the world of sports, dining and agriculture. Cutting down on alcohol use means resisting pressures from many directions – advertising, friends, social events, and habits.  If you want to abstain, and can go 3-4 days without alcohol, you are probably not seriously addicted and can make the shift. You may decide to have a single drink on special occasions, such as your birthday, but be sober at other events.   If you have been a regular drinker and have great difficulty abstaining a day or two, you should see your doctor to discuss the possible use of temporary drugs to help you through the transition to sobriety.  In either case, you should start going to AA meetings, both for help and to meet other non-drinkers.  You will get a sponsor who will help your transition.  Don’t worry if you don’t believe in a God – the group itself, or nature, can function as your higher power.  
Sadja Greenwood, MD, MPH    back issues on this blog






Monday, October 8, 2018

Are Sugar-Free Chemicals Affecting Your Gut?

According to a new paper by researchers at Ben-Gurion University in Israel and Nanyang Technological University in Singapore, FDA-approved artificial sweeteners and sport supplements were found to be toxic to digestive gut microbes. The  study looked at the relative toxicity of six artificial sweeteners (aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k) and 10 sport supplements containing these artificial sweeteners. The bacteria found in the digestive system became toxic when exposed to concentrations of only one mg./ml. of the artificial sweeteners.  The researchers modified  bioluminescent E. coli bacteria, which luminesce when they detect toxicants and act as a sensing model representative of the complex microbial system,.  They stated: "This is further evidence that consumption of artificial sweeteners adversely affects gut microbial activity which can cause a wide range of health issues."
Artificial sweeteners are used in countless food products and soft drinks with reduced sugar content. Many people consume this added ingredient without their knowledge. Moreover, artificial sweeteners have been identified as emerging environmental pollutants, and can be found in drinking and surface water, and groundwater aquifers. According to the researchers - "The results of this study might help in understanding the relative toxicity of artificial sweeteners and the potential of negative effects on the gut microbial community as well as the environment. Furthermore, the tested bioluminescent bacterial panel can potentially be used for detecting artificial sweeteners in the environment.”
Diet Coke, Diet Pepsi, Sprite Zero and other sports drinks contain aspartame and acesulfame potassium as artificial sweeteners, along with other ingredients for flavoring. Splenda is sucralose.  
As you are aware, your gut microbes play a large role in your digestive health, your weight and the strength of your immune system.  They thrive on a diet with lots of fiber from vegetables and fruits.  This recent study, published in the journal Molecules, can be toxic to these important bacteria.  
What are your alternatives for a thirst-quenching drink that will not harm your gut and allow you to avoid sugar?  Slice an organic orange, other fruit or cucumber into a glass bottle of water and sip from it during the day.  Add mint and other herbs.  Drink plain coffee and a variety of teas, Sweeten with small amounts of stevia (this plant derived sweetener may not be safe for the kidneys with excessive use, but is considered safe as ordinarily used.)  Yacon syrup, derived from a plant grown in the Andes, is another recently popular sweetener.  It has not been extensively studied, but should probably be used sparingly.  The syrup can cause abdominal pains, nausea, bloating and diarrhea when taken in doses greater than two teaspoons a day.  You can retrain your taste buds to prefer unsweetened foods.  If you order or make a fruit smoothie, use a permanent straw – not a disposable plastic one.  Try a few raisins and nuts for a treat.  

Let’s celebrate Indigenous Peoples Day.  

Sadja Greenwood, MD. MPH



Monday, September 24, 2018

The Exercise Paradox – Are We Designed to Sit on the Couch?

We all know that exercise is good for the body and brain, and yet we are becoming less active as work has become more sedentary.  If getting out for a walk, or taking a trip to the gym seems difficult, researchers at the University of British Columbia say that the problem is real, and it’s happening inside your brain. Research findings, published recently in the journal Neuropsycologia, say that we may be designed to prefer lying on the couch.  Matthieu Boisgontier, lead author of the paper, wrote “Conserving energy has been essential for human’s survival, as it allowed us to be more efficient in searching for food and shelter, competing for sexual partners, and avoiding predators. The failure of public policies to counteract the pandemic of physical inactivity may be due to brain processes that have been developed and reinforced across evolution.”
In their study, the researchers had young adults sit in front of a computer. They flashed sequential images of stick figures that depicted either physical activity such as running, biking and swimming, or inactivity, such as sitting or lying down. Subjects were told to move their markers as quickly as possible toward the pictures of physical activity and away from the pictures of inactivity.  Subsequently, the order was reversed.  Electrodes were recording their brain activity.  While participants were faster at moving towards the active pictures and away from the lazy pictures, brain results showed that this required their brains to work harder.  Avoidance of physical inactivity comes as a cost – namely increased involvement of brain resources.  Boisgontier said “These results show that our brain is innately attracted to sedentary behaviors.”   Researchers asked whether people’s brains can be retrained, adding that knowing what is happening is an important first step.  
I found this paper to be astounding.  What are its take-home messages?  I think it’s important to knowthat the lure of the chair, the hammock and the bed is innate and powerful.  If we want to stay strong and feel well, we have to find ways to balance resting and moving.  We are all aware that physical activity, including walking, is beneficial for the brain, bones, muscles, heart and most body organs.  It helps with weight control and diabetes prevention. Therefore, we have to plan to get movement into our lives. Do more work in your garden, or home.  Join a class, or a team. Take Pilates, dance classes, Qigong or Tai Chi. Form a group with friends to walk, talk and visit the gym. If you are a solitary person, you can find good exercise classes of all kinds on line.   Set an alarm to get you up from the chair hourly during the day.  We humans are endlessly inventive.  Knowledge is powerful.  Let’s go for it!
Sadja Greenwood  MD, MPH


Monday, September 17, 2018

Plastic Pollution – What Can You Do?

First comes knowledge.  When I read that a friend, Laurie Riley, was not buying any plastic goods or anything wrapped in plastic, I was galvanized. People are changing from despair into action!  Several long conversations with Laurie have taught me what an individual, and better yet, a group, can do.  Here goes, with many thanks to Laurie.  

China is no longer accepting our plastic waste for recycling.  Huge amounts are piling up at recycling centers, and much of it is going into landfills or just sitting with no place to go. These centers will not be able to accept the mounds we are creating, and side effects will be toxic to the environment.  Remember the saying – Reduce, Reuse, Recycle?  We must Reduce and Reuse starting now. Recycling has become a very difficult predicament.

 Pollution of the oceans is an enormous problem. Over 5 trillion pieces of plastic currently litter the ocean,, accumulating in in 5 huge ‘gyres” throughout every ocean.  The biggest one is between Hawaii and California; the large and tiny pieces of plastic therein are killing fish, ocean mammals, birds and even plankton.  

Enter Boyon Slat, a young Dutch inventor, entrepreneur and Aerospace Engineering student dropout who founded the company - The Ocean Cleanup. He is 24.  He has developed and built a floating device that has sailed through the Golden Gate heading for the gyre.  Slat estimates that they will deploy 60 of these free-floating barriers in the ocean by 2020.   They hope to remove 50% of the Great Pacific Garbage Patch in 5 years. The free-floating barriers are made to withstand harsh weather conditions and constant wear and tear.  After two decades they hope to have collected 90% of the trash in the patch. The Ocean Cleanup has raised $35 million so far in crowd funding, with generous donations from Marc Benioff  of Salesforce and Peter Thiel of  Paypal.  

Obviously it is important that we humans throughout the world reduce the millions of tons of plastic that we discard yearly. Scouring the beaches for waste is a good approach.  Changing our buying habits is also necessary.  Take note of the plastic bags you now have, and reuse them over and over. Don’t take new ones; use your own cloth bag to go shopping.  Try to avoid packaged foods, which almost always come in plastic. Make cloth baggies to use when you buy in bulk. Never accept a plastic straw for your drinks; you can find reusable ones in many places, including at the store cited below. Compost your food waste – it’s easy to do and you will be rewarded with great soil for your garden.  Jennie Pfeiffer is a ‘master composter’ so you can give her a call for suggestions. 

For a store that has a great many products made without plastics, including tooth brushes, straws, deodorants, cosmetics and lots of kitchen ware, visit packagefreeshop.com.  They are based in New York, but have plastic-free shipping. Shipping is free for orders over $50.  Look over their selections – it may work for you.  The founder of this store is Lauren Singer, who has a blog called Trash is for Tossers, and has put all the trash she has produced in the past five years into a 16oz mason jar!

You can follow the ocean cleanup progress at theoceancleanup.com.  You can read the definitive book on living without plastic by Beth Terry – Plastic Free – How I Kicked the Plastic Habit and How You Can Too.  Again – many thanks to Laurie Riley and to all of you who are working for a cleaner environment.  

Sadja Greenwood, MD, MPH  back issues on this blog

 


Monday, September 10, 2018

The Amazing History of the Condom – and Why it is Important Today

Drawings from ancient Egypt show men with sheaths over the penis; the purpose of this – whether ritual or sexual – is not known. The material used was probably linen. Evidence dating back to the 14thcentury suggests that upper classes in Asia used ‘glans condoms’ that covered the tip of the penis, and could be dislodged during use.  The Chinese made theirs from oiled silk paper or lamb intestine, and the Japanese made theirs from harder materials such as tortoise shell (!). 

In the late 15thcentury, a well-documented outbreak of syphilis occurred among French troops; the disease spread across Europe, and then into Asia.  Syphilis was more serious than it is today, covering the body with pustules and leading to death in a few months.  To the rescue came an Italian anatomist , Gabriele Fallopio, who invented a device made of linen sheaths soaked in a chemical solution and then dried.  The cloths were held on with a ribbon. Fallopio as an anatomist is famous for his description of the woman’s fallopian tubes.  He performed an experiment, recruiting 1100 men to use his device.  Epidemiologists today say that 1000 subjects are necessary to get a representative sample.  This happened in the 1490’s and is amazing.  We do not know the length of his experiment.  He reported that none of his subjects became infected with syphilis.

The first documented use of the word ‘condom’ is thought to have occurred in 1666 when the English Birth Rate Commission reported a drop in birth rates and attributed it to condoms.  Condom usage was rising in this era.  They were made of animal bladder or intestine, or of linen soaked in chemicals.  Condoms were available to buy in pubs, markets, barber shops and from chemists, but due to expense their use was usually confined to the middle and upper classes.  In the 1700s Casanova is thought to have been a frequent user of condoms for protection against syphilis.  His memoirs make reference to this, as does a picture of him with several attractive young women as he blows a condom like a balloon. 

In the 19thcentury birth control advocates began to promote condom use to less affluent people – advocates in England included Jeremy Bentham and in the U.S. Robert Dale Owen.  Assertive and popular women and men traveled and lectured around the country teaching about physiology and sexual matters.  They often sold condoms after their lectures.  Moralists and some medical professionals condemned this practice as spreading abortion and prostitution.  However, in 1861 a condom advertisement appeared in the New York Times, 10 years after the paper was founded.   
The rubber vulcanization process was invented by Charles Goodyearand patented in 1844.[7] The first rubber condom was produced in 1855,[8] and in a few years several major rubber companies were mass-producing rubber condoms. A main advantage of these condoms was their reusability, making them a more economical choice in the long term.  However, skin condoms were initially cheaper and offered better sensitivity.  By the end of the 19th century "rubber" had become a euphemism for condoms in countries around the world.
 In 1919, due to high rates of sexually transmitted disease (STDs) in World War 1, the search was on for better protection.  Frederick Killian in Ohio invented a latex condom which was thinner and easier to use than rubber.  The latex used in condoms is a natural compound  from rubber that is not vulcanized.  Condom making increased, leading to mass production. In the 1920’s quality control of condoms was pursued.  In the 1950’s a reservoir tip and lubricant was added to collect semen and reduce leakage.  A lubricant was added to reduce friction.  In the 1980s the AIDS epidemic increased condom use worldwide.  In 1994 polyurethane condoms were introduced to reduce allergies to latex.  And so the refinement and improvement of condoms goes on.  The female condom is available in the U.S. and many other countries – its effectiveness against STDs has not been thoroughly studied. Its use is somewhat awkward and cannot be hidden from a partner.

What is the take-home message of this long and rather amazing history of the condom? Be aware that rates of syphilis, gonorrhea and chlamydia have climbed rapidly for the 4thconsecutive year in the U.S. according to the Centers for Disease Control.  Antibiotics are in danger of becoming resistant.  If not treated early, STD’s can lead to serious illness.  Hepatitis B and HIV can also be a danger to people of any age who have sex with new partners. Talk honestly with your health care provider and protect yourself.  Human ingenuity is impressive.  Use yours!!
Sadja Greenwood MD,MPH  










Monday, August 20, 2018

A New Contraceptive and HarvestPlus

The U.S. Food and Drug Administration has approved a new contraceptive for women developed by the Population Council.  Annovera; (segesterone acetate and ethinyl estradiol vaginal system) is a combined hormonal contraceptive for women of reproductive age and is the first vaginal ring contraceptive that can be used for an entire year. It is a reusable donut-shaped (ring), non-biodegradable, flexible vaginal system that is placed in the vagina for three weeks followed by one week out of the vagina, at which time women may experience a period (a withdrawal bleed). This schedule is repeated every four weeks for one year (thirteen 28-day menstrual cycles).  It is not felt during sex.  It does not prevent sexually transmitted diseases.  
Annovera is washed and stored in a compact case for the seven days not in use. It does not require refrigeration prior to dispensing and can withstand storage temperatures up to 30°C (86°F).  This new contraceptive is considered suitable for women who do not always remember to take the pill regularly, or who used the previously available contraceptive ring that had to be replaced every month. Women in developing countries may find this method convenient, as they are often unable to find other contraceptives on a regular basis.  The Population Council plans to make it available in Latin America, Asia and Africa as well as in the US.   It will be released in 2019.
The efficacy and safety of Annovera were studied in three, open label clinical trials with healthy women ranging from 18 to 40 years of age. Based on the results, about two to four women out of 100 women may get pregnant during the first year they use Annovera.
All hormonal contraception carries serious risks. Annovera carries a boxed warning relating to cigarette smoking and serious cardiovascular events. Women over 35 who smoke should not use Annovera. Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptive use.

HarvestPlus is an international organization that uses ‘biofortification’ to make plants more nutritious. Its work is in Asia, Africa and Latin America. It uses conventional plant breeding rather than genetic modification, and focuses on three crucial micronutrients that are most limited in the diets of the poor—vitamin A, zinc, and iron, breeding these into key staple crops. Harvest Plus screens thousands of different types of crop seeds stored in seed banks that have naturally higher amounts of iron, zinc, and vitamin A. They use these more nutritious seeds to breed new crop varieties with higher micronutrient content that are also high yielding and have other traits farmers want. Together with farmers, they test these new varieties in the target region. The national government then officially releases the best-performing varieties of micronutrient-rich crops for farming communities to grow, eat, and sell in local markets.

Iron deficiency during childhood and adolescence impairs mental development and learning capacity. In adults, it reduces the ability to do physical labor. Severe anemia increases the risk of women dying in childbirth. Five hundred million women aged 15 to 49, at the peak of their productive years, are anemic due to iron deficiency. This condition reduces their productivity, decreases their economic potential, and affects their reproductive health outcomes.

Zinc is involved in more body functions than any other mineral. Its role includes acting as a necessary component of more than 200 enzyme systems, normal growth and development, the maintenance of body tissues, sexual function, vision, and the immune system. Zinc is essential for survival, and zinc deficiency has serious consequences for health, particularly during childhood when zinc requirements are increased. In addition, zinc deficiency also causes stunting. Randomized controlled trials showed that zinc supplementation can reduce the severity of morbidity from a number of common childhood infections, including diarrhea, pneumonia, and possibly malaria, by one-third. 

Vitamin A is essential for good vision and cell differentiation. Deficiency results in growth retardation, damage to mucous membrane tracts, reproductive disorders, eye damage—and ultimately blindness. Children with vitamin A deficiency are often deficient in multiple micronutrients and are likely to be anemic, have impaired growth, and be at increased risk of severe morbidity from common childhood infections such as diarrheal diseases and measles. Pregnant women with vitamin A deficiency may be at increased risk of mortality.

Today, biofortified crops, including vitamin A orange sweet potato, iron beans, iron pearl millet, vitamin A yellow cassava, vitamin A orange maize, zinc rice, and zinc wheat, have been grown in more than 40 counties in Asia, Africa and Latin America. Crop improvement continues to develop varieties with higher levels of vitamins and minerals that are adapted to a wide range of agro-ecological conditions, and ensuring that the best germplasm for climate-adaptive and consumer-preferred traits continues to be used in breeding biofortified crops.

The take home message from this column is: despite the suffering in our world due to climate change and political chaos, efforts to improve situations of poverty are underway. As far as iron, zinc and Vitamin A are concerned – do not start to take these micronutrients as supplements, get them from your healthy diet and possibly a multi vitamin/mineral pill – not more! Talk to your health-care provider.

HarvestPlus is supported by several sources: the UK Government, the Bill & Melinda Gates Foundation, the US government’s Feed the Future Initiative, the European Commission and donors to the CGIAR Research Program on Agriculture for Nutrition and Health. HarvestPlus is also supported by the John D. and Catherine T. MacArthur Foundation.

Sadja Greenwood MD, MPH   Sub

Wednesday, August 15, 2018

Legumes Lower Blood Sugar, Diet to Reduce Breast Cancer Risk, Work Related Email after Hours

Legumes Reduce Blood Sugar Levels: Researchers at the University of Guelph (Ontario, Canada) have found that adding legumes to your diet can significantly reduce blood sugar levels.  They experimented with swapping out half a portion of white rice or white potatoes with green or red lentils.  Replacing the half portion of rice with lentils reduced blood glucose levels by 20%. Replacing a half portion of potatoes with lentils reduced blood glucose levels by 35%, compared to the levels found when lentils were not used.  Details of the study were recently published in the Journal of Nutrition.  Lentils can slow digestion and slow the release of glucose into the bloodstream from the starch of white rice or potatoes.  Other legumes with similar properties include beans of all kinds, garbanzo beans, soy beans and peas.  These legumes are nitrogen-fixing, thereby improving soil fertility.  

A Diet to Ward off Breast Cancer:  Results from the Nurses Health Study have indicated that women who had five and a half servings of fruits and vegetables daily, compared to those who had less than two and a half servings, had an 11 percent lower breast cancer risk.  A serving is about one cup.  The effect was especially significant with the most aggressive types of breast cancer. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, kale, and cabbage) were especially strongly associated with reduced risk, as were yellow and orange vegetables such as carrots, winter squash, yams and sweet potatoes.  This study has recently been published in the International Journal of Cancer.

A study entitled :Killing me Softly…electronic communications monitoring and employee and spouse well-beinghas shown that when employers expect workers to monitor their work related emails during non-work hours, the result is a problem for the employees and their families.  William Becker, a Virginia Tech associate professor of management in the Pamplin College of Business, wrote that "The competing demands of work and nonwork lives present a dilemma for employees, which triggers feelings of anxiety and endangers work and personal lives."  Their study shows that employees do not need to spend actual time on work in their off-hours to experience the harmful effects. The mere expectations of availability increase strain for employees and their significant others -- even when employees do not engage in actual work during nonwork time. "The insidious impact of 'always on' organizational culture is often unaccounted for or disguised as a benefit -- increased convenience, for example, or higher autonomy and control over work-life boundaries," Becker said. "Our research exposes the reality: 'flexible work boundaries' often turn into 'work without boundaries,' compromising an employee's and their family's health and well-being."   Prospective employees should be told clearly whether or not email availability in off-hours is expected, so they can decide on the suitability of the job.  Employers should establish boundaries on when they expect off-hour work to be done, and how it will be compensated.  
There are several take-home messages from this paper that apply to all of us.  The digital world of screens and phones has taken over most of our lives, even when work demands are not the issue. It is wonderful and amazing to have the knowledge of the world, past and present, in your pocket.   However, making time for talking face to face, reading or writing a book, doing art and playing music are still important ways of being human.  Gardening, walking, hiking and running outdoors, playing sports and watching the sky – name your favorite and leave your screen behind for a while.  But – you might want to turn it on to listen to – Killing me Softly with his Song – its haunting.  

Sadja Greenwood MD, MPH  


















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Monday, July 30, 2018

Listen to Your Daily Rhythms

The body has been found to have many time clocks – one governing the sleep-wake cycle in response to light and dark, and others in most of our body organs.  These daily (circadian) rhythms are coordinated by the brain’s hypothalamus –which links the nervous system to the endocrine system  via the pituitary gland.  The pancreas secretes insulin during the day and slows down at night, meaning that blood sugar levels are better controlled in the morning than evening. The gut has a clock that controls nutrient absorption, and removal of waste.  The microbiome –the trillions of bacteria in our digestive tract – also have a daily rhythm.  

Dr. Satchin Panda of the Salk Institute is an expert on circadian rhythms research.  He has just published a book on this subject – The Circadian Code - Lose Weight, Supercharge Your Energy and Transform Your Health from Morning to Midnight. He has studied genetically identical mice and divided them into two groups.  One group could eat a diet of high fat, high sugar foods around the clock. The other group ate the same foods in a daily 8 hour window.  Calories were similar for both groups.  Those who ate around the clock became fat and sick, while those who ate in a time restricted fashion were protected from obesity, fatty liver and metabolic disease. 

Courtney Peterson at the University of Alabama at Birmingham has also studied this subject and published several papers on her findings.  She took a group of prediabetic men, and had them eat their meals in a 12  hour window for five weeks.  In the next phase, these men were fed the same meals in a six hour window beginning each morning.  They were eating enough calories to maintain their weight, to see whether time restricted eating had health benefits unrelated to weight loss.  The men on the time restricted program had lower insulin, reduced levels of oxidative stress, less nighttime hunger, and significantly lower blood pressure – their systolic pressure dropped by roughly 11 points and their diastolic by 10 points.  These are very significant results.

In other papers Dr. Peterson and colleagues have reviewed evidence that the circadian system plays a pervasive role in regulating glucose, insulin, lipid levels, appetite and energy metabolism in humans. Eating at the wrong times – late in the day – disrupts the circadian system and adversely affects metabolic health.  Chronobiology is important in preventing and treating type 2 diabetes, obesity and high blood fats (hyperlipidemia).

The take home message from these findings is that eating early in the day will synchronize with your sleep-wake cycle and bring you many health benefits.  If you are never hungry for breakfast,  start by having a very small supper around 5 pm, and you will be hungrier in the morning.  Have a healthy breakfast after waking, and aim for a 10 hour time for eating .  As you get used to this new schedule, you can restrict your time further, depending on what results you are aiming for. You may worry that such a schedule will be a problem for your social life, and if you frequently meet friends for dinner and drinks in the evening, this is true.  Perhaps you can socialize around lunch on the weekends, or break your schedule occasionally to be with friends, but eat lightly at dinner so you can return to your new way in the morning. 
 I suspect that the Marin County library system will purchase copies of Dr. Panda’s book – remember that they bought over 50 copies of Michael Pollan’s   How to Change Your Mind. Stop by the library to find out.  

Sadja Greenwood, MD, MPH