Sunday, September 15, 2019

Many Drugs have Dangerous Interactions with Alcohol – Be Aware

Information in this column is based on a newsletter called Worst Pills, Best Pills.  I suggest subscribing to this newsletter (800-289-3787) if you or members of your family take over-the- counter or prescription drugs. You do not need medical knowledge to understand the content of this newsletter, and it can be lifesaving.  

Research from the National Institute on Alcohol Abuse and Alcoholism has shown that many people, especially those over 65, may be incurring a risk by using alcohol when taking prescription drugs.  Alcohol, itself a drug, becomes more intoxicating if the drug taken will block the stomach’s ability to metabolize alcohol.  This is true of commonly used drugs for treating gastrointestinal ulcers such as ranitidine (Zantac and Tagamet), and also true for the smoking cessation drug Chantix.  

People combining alcohol and sedatives, including benzodiazepines (such as Valium or Ativan) and sleeping pills of all kinds, can experience increased sedation, impaired breathing, and be more likely to fall or have serious accidents.  Respiratory arrest can occur.  

Alcohol can impair the metabolism of drugs, resulting in risk of drug overdose.  This could happen with the drug warfarin (Coumadin), used as a blood thinner, and could result in an increased risk of bleeding. Conversely, long term heavy drinking could increase the metabolism of warfarin and increase the risk of blood clots. It is clear that people on warfarin should not drink heavily and be aware of their levels of the blood thinner.

Alcohol can interact with antibiotics, anti-fungal drugs, antidepressants, antihistamines, diabetes drugs, opioids, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen (Advil and Aleve), and Tylenol.  

People who are used to having a glass of wine with dinner may not experience problems with medications. However, heavier drinking can cause serious problems.  Therefore, the following advice is very important: check with your pharmacist and your health care provider before using alcohol with any prescription or over-the-counter drug. Read the warning labels on the bottle or package.  If it says not to drink alcohol – don’t drink it! 

Sadja Greenwood, MD, MPH

Monday, September 9, 2019

Sunday, September 8, 2019

What YOU can do about Global Warming

Speak up – to your friends, neighbors and elected officials. Tell California officials you are proud of their policies on fuel economy standards. A pushback is coming immediately from the Trump administration.  Stay tuned.

Follow Swedish teenager Greta Lundberg as she mobilizes youth to fight climate change. They want to inhabit a livable world.  She is currently at the U.N. in NYC.  I have her on Google Alert, so I can read about her every day.  

What would happen if everybody in the United States cut back on driving?It turns out that even driving just 10 percent less — if everyone did it — would have a big impact on greenhouse gas emissions. That’s because Americans drive trillions of miles every year, helping to make transportation the biggest contributor to United States greenhouse gas emissions. In 2017, light-duty vehicles in the United States (including cars, S.U.V.s, pickups and most of the vehicles used for everyday life) produced 1,098 million metric tons of carbon dioxide equivalents.  That’s about one fifth of the country's total emissions footprint. A 10 percent cut, therefore, would be roughly 110 million metric tons of carbon dioxide, or the same as taking about 28 coal-fired power plants offline for a year.  While not easy, that target is realistic for most people, said Tony Dutzik, a senior policy analyst at the Frontier Group, a nonprofit research organization. Walk, bike or take public transit when possible. Car-pool, and work from home when you can. Emissions from a full bus or train are vastly lower than a car.  Fly less – take a train or bus instead.  

Weatherize your dwelling – make sure to seal drafts and have good insulation.  There may be federal tax breaks for some of this.  Invest in energy efficient appliances – look for the Energy Star label on them.  Find power plug-in devices that are rarely used and turn them off – I found two immediately in my apartment.  

It takes energy to heat your water and make it clean.  Take shorter showers, turn off the tap when you brush your teeth, wash your clothes in cold water. 75 to 90% of the energy used by your washing machine goes to warming the water.   Set a timer to run your dishwasher at night, to save on electricity, gas and water costs.  If you have time, dry your clothes on a bamboo clothes drying rack.  

Eat less meat – there are large energy and water costs in producing meat and cleaning animal refuse.  Eat vegetable protein such as nuts, and organic soy.  Combined with wholegrains, you will get a complete protein. Consider drinking nut milk instead of milk and cream.  Follow the Monterey Bay Aquarium Guide for advice on sustainable seafood.  

Buy LED lightbulbs – they use 90% less power than incandescent bulbs and are much longer lasting. They will cost you more up-front but save money and power.  

Find a way to plant trees in your community – either on your property if feasible, or possibly through a local school where the children participate.  Contact the Arbor Day Foundation to find suitable trees for your area.  
Keep at it!   Sadja Greenwood, MD, MPH


Monday, August 26, 2019

Eggs – Good or Bad For You?

Data for these reports come from the Tufts University Friedman School of Nutrition Science and Policy.  I consider their publications to be extremely well researched.

Eggs: the protein in eggs provides all the essential amino acids your body needs as well as essential nutrients such as biotin, selenium, vitamins B12, A and D, iodine, potassium and phosphorus.  Egg yolks are high in lutein and zeaxanthin that may help to protect against age-related macular degeneration.

The controversy about eggs comes from the cholesterol in the yolk.  Too much LDL cholesterol in the blood can lead to a build-up of plaque in the arteries, increasing the risk for heart attack and stroke. Recent research has shown that for most people dietary cholesterol is not significantly related to LDL cholesterol in the body.  Saturated fat in the diet is more of a problem. 

Studies published in the last year have shown data on both sides of the subject of eggs in the diet.  Here is a prudent way to look at it.  If you have diabetes, have had a heart attack or are at high risk for heart disease, talk to your doctor about avoiding eggs altogether.  Enjoy an egg white omelet.  Get tested for diabetes if you are overweight or obese – many people have diabetes without knowing it.  

If you are not in the high risk category, eat eggs in moderation.  The American Heart Association suggests no more than one egg a day. Avoid unhealthy sides with your egg, such as bacon, ham, sausage, white bread or other refined grains, or fried white potatoes.  Eat eggs with vegetables, beans and whole grains instead. Store eggs in the refrigerator. Cook them until the yolk is firm to decrease the risk of salmonella infection.
Saturated fat is found in butter, lard, cheese, meats, chicken with the skin, and many baked good such as doughnuts, piecrusts, frozen pizza and cookies.   Fast food restaurants use trans-fats for frying because the oil can be used over and over again. Avoid when possible. Read the label on processed foods and margarine to look for partially hydrogenated oil. Avoid it.  Coconut oil is a saturated fat that many people enjoy because of its distinctive taste.  According the Dr. Walter Willett of the Harvard School of Public Health – “for now, I’d use coconut oil sparingly.  Most of the research so far has consisted of short-term studies to examine its effect on cholesterol levels.  We really don’t know how coconut oil affects heart disease.  And I don’t think coconut oil is as healthful as vegetable oils like olive oil and soybean oil, which are mainly unsaturated fat and therefore both lower LDL and increase HDL.  Coconut oil’s special HDL boosting effect may make it ‘less bad’ than the high saturated fat content would indicate, but it’s still probably not the best choice among the many available oils to reduce the risk of heart disease.”
Sadja Greenwood, MD, MPH


Sunday, August 18, 2019

Breath Meditation – A Way to Relieve Stress

This entry is based on an article in

Psychological stress is bad for your health, increasing the risk of heart disease and cancer.  Stress can bring memory problems and bodily aches and pains.  Reducing stress helps sleep and may bring down blood pressure.  Focusing attention on breathing can help to make you relaxed, and is a gateway to ‘mindfulness’ – which means that you accept what comes in life, and its challenges.  Dr. Ronald Siegel, an assistant professor of psychology at Harvard Medical School, has written a book on meditation and mindfulness – The Mindfulness Solution: Everyday practices for everyday problems

Find a comfortable place with minimal distractions – sit, stand or walk.  Many people find sitting the most helpful.  Repeat a sound, phrase or movement – allowing thoughts to come and go as you focus on repetition.  You can silently count inhalations and exhalations, going from one to four for example, or silently say ‘in and out’ to yourself, or say peace/love, or here/now as you breathe.

Do your meditation at the same time every day, starting with 10 minutes in the morning and evening and working up to 20 minutes or more as it becomes easier.  Mindfulness came from Buddhism originally but is shared by many spiritual traditions and religions.  It means focusing on the present moment and accepting it without judgment.  Embrace life as it is. Much stress comes from fighting reality.

In summary: sit with your spine erect in a comfortable position.
Focus on your breath - it doesn’t matter if it’s long or short.
Allow your thoughts to come and go, returning your attention to your breath.

Get the book by Dr. Siegel mentioned above, or find a meditation site such as Insight Timer. 

Stay tuned for exciting new treatments for the Ebola Virus in Africa and drug resistant tuberculosis in the U.S. and throughout the world.  

Mindfulness does not mean that you abdicate working against injustice and the many problems in the world. It means that you accept your personal stressful situation for a short time every day to achieve a sense of well-being. 

Sadja Greenwood, MD, MPH

Sunday, August 4, 2019

Water Safety, Kale, Abortion Pills Should be Everywhere

Water Safety
Drowning is the leading cause of injury death in children ages 1-4 and the third leading cause of unintentional injury deaths in children and adolescents ages 5-19.  In 2017 1000 children in the US were killed by drowning. The American Academy of Pediatrics says that parents must supervise their children constantly, require and model life jacket use, enroll children in swimming classes, keep barriers in place around pools, and know CPR. 
When playing in or near a pool or at the beach, stay in the water with your child and give him/her 100% of your attention.  Ignore your phone - but keep it charged and within reach in case of emergency,  Know the address of where you are swimming.  
Install a 4 sided fence around any pool of water, with a self-latching gate. Make kids buddy up - explain that each kid is responsible for knowing where the buddy is at all times.  Teach your child these water rules - no running, no diving in the shallow end of a pool, no pushing someone in, no pulling another kid under the water, no swimming without adult supervision, ever.  Never leave a child under 4 alone in a bathtub at home or near a bath that is filling.  Keep the toilet cover down and keep the bathroom door closed.

Kale has joined the ranks of 'the dirty dozen' by the Environmental Working Group!  This is probably because it has become so popular as a health food that producers must use herbicides to grow enough.  Be sure to buy organic kale, or grow your own.  

Abortion Pills Should be Everywhere by Farhad Manjoo, in the New York Times Sunday Review, August 4th.  In this article, Manjoo explains that it is possible to order the two pills that can result in a 'medical abortion' if taken within the first 10 weeks of pregnancy.  He was able to obtain the requisite pills on-line multiple times, for $200-300. This method has been shown to be about 97% effective, and much safer than childbirth. It will result in earlier and safer abortions. Manjoo expects that despite the current political efforts to make abortion illegal or difficult to obtain, ordering on-line will be unstoppable. Be sure to read his article on-line or at the library.
Sadja Greenwood, MD, MPH

Sunday, July 28, 2019

Sustainable Eating

This article is based on a special report from the Tufts University Health and Nutrition Letter, August 2019.
There is a dietary pattern that can help you and the earth – by promoting sustainable agriculture. Sustainable agriculture refers to ways of growing food and raising animals that conserve natural resources and have minimal impact on the environment.  Sustainable eating means choosing foods that are good for our bodies and the environment.  

The United Nations Sustainable Development Goals state that we must change the way we produce food to increase productivity and sustainability while also improving human health. Raising cattle has the biggest impact on the planet of any single human activity. It produces 15% of the world’s greenhouse gases and uses 1/3 of the world’s fresh water.  Decreasing beef consumption is an important way toward a more environmentally friendly use of resources.  

Nicole T. Blackstone, PhD, an assistant professor at the Friedman School of Nutrition and Policy, analyzed the three diets recommended by the Dietary Guidelines for Americans – the Healthy US-style, Mediterranean and vegetarian dietary patterns.  Her results, published in The Lancet Planetary Health, showed that the US-style diet was tops in land use and CO2 emissions, because it includes the largest amount of red meat consumption.  The Mediterranean diet was highest in water pollution, mainly because of water use in Spain to produce olive oil.  (Data on the Mediterranean diet came from Spain).  A vegetarian eating pattern had the lowest impact on all sectors – CO2 emissions, water depletion, land use, pollution of fresh water, oceans and the air.  This does not mean that all conscientious eaters must become completely vegetarian, but that we should all make gradual changes in that direction.  

In January of 2019 a body of experts published a report entitled Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.  They aimed to use the latest scientific evidence to develop a “planetary health diet” that is both health promoting and environmentally sustainable.  Their proposed pattern is largely plant based but optionally includes modest amounts of fish, meat and dairy foods.  Worldwide, adhering to this diet would mean doubling per-person intake of  fruits, vegetables, legumes and nuts while cutting consumption of red meat and sugars at least in half.   According to Nicole T. Blackstone these recommendations would mean eating no more than the equivalent of 3 ounces of red meat per week, which is about the size of a deck of cards.  Currently the average American eats 5 to 6 times that much..  This would be a big shift. Such changes can be made gradually.

 Regardless of what we eat, cutting down on food waste is of great importance.  U.S. consumers throw away nearly one pound of food per day.  All that food in landfills produce greenhouse gases.  Planning meals ahead, storing food properly, and using frozen fruits and vegetables are ways to save food and money.  Find someone who composts and give your food waste to him/her. For many of my readers in West Marin, these changes will not be difficult.  Please write me a note on this blog if you have questions.  Subscribe to the Tufts Health and Nutrition Letter if you want a great source of reliable information monthly – 800-274-7581
Sadja Greenwood MD, MPH

Sunday, July 14, 2019

What's in Your Nail Polish? Berries and Brain Function

What's in Your Nail Polish?
This article is taken from the July,2019 Wellness Letter of the University of California, Berkeley.  Nail polish contains plasticizers to make it flexible and chip resistant, but also endocrine disruptors that may adversely affect reproductive health, fetal development and thyroid function.  There has been an effort in recent years to ban ingredients of known risk, but the substitute ingredients may be just as toxic. Nail polish is clearly an occupational hazard for salon workers.  For you, dear reader, go to the Environmental Working Group’s Skin Deep Cosmetic Database to look for guidance for choosing safer nail polish.  Alternatively, you could decide to give up nail polish and find other ways to decorate your toes and fingers.  At the present state of knowledge, this may be the wise thing to do. 

Berries and Brain Function
Blueberries have attracted a good deal of scientific attention for their ability to help the brain, but strawberries, raspberries, blackberries, and cranberries contain similar pigment compounds called anthocyanins, which give berries their red, purple and blue colors.  Anthocyanins can cross the blood-brain barrier to become localized in areas of the brain related to learning and memory.  Anthocyanins decrease the vulnerability to the oxidative stress that occurs with aging.  They reduce inflammation and may increase neuronal signaling.  In the Nurses’ Health Study, an analysis of 16,000 women over 70 suggests how berries might affect aging brains. The women were tested for memory and other cognitive functions every 2 years and completed dietary questionnaires every 4 years.  Those who consumed two or more half –cup servings of strawberries or blueberries per  week had a slower mental decline over time of up to 2 ½ years of delayed aging. Previous studies conducted at Tufts University found that blueberries improved short-term memory, navigational skills, balance, coordination and reaction time.  Berries retain their healthy qualities even when dried or frozen. You can enjoy them year round.
This article is taken from the journal Environmental Nutrition, a newsletter of food, nutrition and health. This newsletter is highly recommended by your writer, Greenwood.  Here’s another addendum from Greenwood:  Strawberries should be purchased in organic form whenever possible, as they are treated with about 20 pesticides, and are on the ‘dirty dozen’ list of the Environmental Working Group.  
Sadja Greenwood, MD, MPH

Sunday, June 23, 2019

Do Not Open or Crush Tablets or Capsules Without Checking with Your Doctor or Pharmacist!

Information in this column comes from Public Citizen’s newsletter:  Worst Pills, Best Pills News. 

Some patients find it difficult or impossible to swallow large tablets or capsules.  This is especially true of the elderly, people with Parkinson’s disease or dementia, and young children.  To cope with this problem, patients may crush or chew tablets, or open capsules and sprinkle the resulting powder or fragments onto food or into liquids.  A review article from Prescrire International in 2014 warned that for many medicines this may have very serious results.  Drug companies combine their medicines so that they will be released at a specific rate and in specific locations in the digestive tract, such as the stomach or small intestine. Crushing, opening or chewing the medication can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach, or intestines.  

Drugs that have a low margin of safety for overdosing include digoxin (Lanoxin) and blood thinners.  Serious injuries including death can occur with tampering with these drugs.   A drug such as Prilosec, frequently given for gastroesophageal reflux (so called heartburn) and/or ulcers can be made ineffective by crushing or chewing the tablet, allowing the stomach acid to inactivate the Prilosec and rendering the drug ineffective.  Prilosec and related drugs are available over the counter.  The label advises consumers to swallow the medicine whole.  Many people ignore these warnings.  Do not be one of them!  You should never crush a tablet, open a capsule or chew one without checking first with the prescribing health care provider or the dispensing pharmacist.  There may be a smaller tablet or capsule of the same drug, or another drug that you can swallow, or that can be safely crushed or opened before ingesting.  
Sadja Greenwood  MD, MPH

Sunday, June 9, 2019

Magnificent Trees Should Not Go Down the Drain

 This article is taken from a report by the Natural Resources Defense Council, (NRDC).

Below the Arctic Circle, the largest intact old growth forest rings the globe.  Canada’s share of this boreal forest is vast.  It is a dense mix of spruce and fir trees mixed with aspen and birch, with peat bogs and verdant wetlands. More than 3 billion birds migrate there to breed – whooping cranes, the great gray owl, and a majority of North American songbirds.  Year-round residents include the Canada lynx, moose, pine marten and woodland caribou, as well as more than 600 communities of indigenous people who have relied on the forest’s bounty for millennia.  

Canada’s boreal forest is being leveled at an alarming rate – a million acres a year.  The oil and gas industries have added to the destruction, but the greatest threat is from logging, driven in large part by the rapacious demand in the U.S., the destination of more than 3/4ths of all boreal wood products.  The wood ends up as lumber, packaging and throwaway tissue products like paper towels and toilet tissue.  No major brand of toilet paper, facial tissue or paper towels, such as Procter & Gamble, Kimberly-Clark or Georgia-Pacific contains any recycled content. A recent paper by Shelley Vinyard at the NRDC, entitled The Issue with Tissue: How Americans are Flushing Forests Down the Toilet was followed by a call to action targeting Procter & Gamble, maker of Charmin. the top selling brand of  toilet paper in the U.S.  More than 80,000 NRDC members and online activists wrote to the Procter & Gamble’s CEO.  

The NRDC has evaluated several brands of paper products that are sustainable: Green Forest, 365 Bath Tissue, Natural Value, Earth First, Seventh Generation, and Trader Joe’s Bath Tissue.  Note that 365 Sustainably Soft and Trader Joe’s Super Soft Bath Tissue do not make the grade as sustainable.  

Another critical threat to the forest’s survival is the extraction of tar sands oil, which levels the forest and transforms the denuded earth into an industrial area of strip mines and toxic tailings pits.  The NRDC and its allies have fought to stop three quarters of the dozen tar sands pipelines the industry proposed, and continue to fight the Keystone XL pipeline. 

Worldwide, boreal forests store more carbon per hectare than any other forest biome, making them one of the best natural defenses against climate change.  Mandy Gull, deputy grand chief of the Cree Nation, says: As Indigenous peoples in the boreal forest, we live on the food from our land.  The forest is our supermarket, with aisles of berries and meats and fish.  My hope is that, once people know that their choice of tissue will determine whether food will be there for us tomorrow, they will help protect our homelands by switching to recycled and responsibly sourced products.

For the full report from the NRDC, including a buyer’s guide to tissue products, go to : Sadja Greenwood, MD, MPH