Monday, July 3, 2017

Osteoporosis and Yogurt

A recent study from Trinity College in Dublin, Ireland is the largest observational study to date of bone measurements in older men and women and dairy intake.  After taking into account traditional risk factors for bone strength or frailty, the researchers found that increased yogurt intake was associated with higher hip bone density and a significantly reduced risk of osteoporosis in older Irish men and women. 
The study analyzed a wide ranged of factors that could contribute to bone strength or weakness, such as BMI, kidney function, physical activity or inactivity, servings of milk or cheese, calcium and vitamin D supplements, smoking, and alcohol use. After adjusting for these factors, total hip and femoral neck bone density in women were 3.1 – 3.9% higher among those with the highest yogurt intakes compared to the lowest.  In men, the biomarker of bone breakdown was 9.5% lower in those with the highest yogurt intakes compared to the lowest – showing reduced bone turnover.  Vitamin D supplements were also associated with significantly reduced risk in both men and women.
Lead author of the study and research fellow at the Centre for Medical Gerontology, Trinity, Dr Eamon Laird said: "Yogurt is a rich source of different bone promoting nutrients and thus our findings in some ways are not surprising. The data suggest that improving yogurt intakes could be a strategy for maintaining bone health but it needs verification through future research as it is observational."
Dr Miriam Casey, senior investigator of this study and Consultant Physician at St James's Hospital Dublin said: "The results demonstrate a significant association of bone health and frailty with a relatively simple and cheap food product. What is now needed is verification of these observations from randomized controlled trials as we still don't understand the exact mechanisms which could be due to the benefits of micro-biota or the macro and micro nutrient composition of the yogurt."
The study included 1,057 women and 763 men who underwent a bone-mineral-density (BMD) assessment and 2,624 women and 1,290 men who had their physical function measured. Yogurt consumption information was obtained from a questionnaire and categorized as never, 2-3 times per week and more than one serving per day.
The Irish study did not look at the type of yogurt eaten, and whether it was sweetened or unsweetened.  However, it is wise to consider the fat and sugar content of the yogurt you eat if you are planning to increase your intake.  A study done by Kaiser Permanente researchers suggests that women with breast cancer should avoid high-fat dairy foods, which may contain more estrogen from the cows’ milk fat.  Avoiding too much sugar in your diet, a smart move for all of us, may mean that you find ways to enjoy plain yogurt with fruit, or eat it as they do in India, with spicy lentils (dal).
Previous studies on milk intake and osteoporosis have shown mixed results in terms of fractures and bone density.  One study showed benefits from both milk and yogurt in the diet.  This is the first large study to show that yogurt may be more beneficial than other dairy products.
Sadja Greenwood,  MD, MPH

The Benefits of Mind-Body Interventions – Take a deep breath and read!

Mind-body interventions (MBIs) such as mindfulness, yoga, Tai Chi, Qigong, the relaxation response, and breath regulation were studied by researchers in Coventry University in England and Radboud University in the Netherlands.  They looked at published studies that examined changes in gene expression in MBIs  and explored how these changes are related to health.  They found and analyzed 18 relevant studies ,  including 848 participants, publishing their findings in Frontiers in Immunology, June, 2017.  

Overall, the studies indicated that MBI practices are associated with a pattern in the molecular changes that happen in the body, and how these changes may benefit our mental and physical health.  Research on stress and inflammation has looked at nuclear factor kappa B (NF-kB), which is produced when stress activates the sympathetic nervous system (fright/flight/fight).  NF-kB translates stress into inflammation.  Lower activity of NF-kB  suggests reduced inflammation. 

While acute inflammation is a short-lived adaptive response that enables the immune system to fight injury or infections, chronic inflammation is maladaptive because it persists when there is no actual threat to the body.  According to the study, it is associated with increased risk for some types of cancer, neurodegenerative diseases, asthma, arthritis, cardiovascular diseases, and psychiatric disorders such as depression and posttraumatic stress. 

The study found that people who practice MBIs have been found to have a decrease in the production of pro-inflammatory gene expression.  The authors caution that the studies they looked at did not have control groups and measured the MBI interventions for varying amounts of time.  More exacting research is needed. 

However, the researchers were encouraged by the results they found.  Lead investigator Ivana Buric from the Brain, Belief and Behavior Lab at Coventry University said “Millions of People around the world already enjoy the health benefits of mind-body interventions like yoga or meditation, but what they perhaps don’t realize is that these benefits begin at a molecular level and can change the way our genetic code goes about its business.  These activities are leaving what we call a molecular signature in our cells, which reverses the effect that stress or anxiety would have on our body by changing how our genes are expressed. Put simply, MBIs cause the brain to steer our DNA processes along a path that improves our wellbeing.  More needs to be done to understand these effects in greater depth, for example how they compare with other healthy interventions like exercise or nutrition.  But this is an important foundation to build on to help future researchers explore the benefits of increasingly poplar mind-body activities.”

Here is West Marin we are fortunate to have great classes in yoga, Tai Chi, Qigong and meditation.  I have found a computer class called Mindfulness Daily with Jack Kornfield and Tara Brach from Soundstrue, which is helping me.   There’s something for everyone. 

Sadja Greenwood, MD, MPH

All About Olive Oil and Your Brain

Researchers from the Lewis Katz School of Medicine at Temple University (Philadelphia) have identified a specific ingredient in extra-virgin olive oil (EVOO) that protects against cognitive decline.  In a study published online in the Annals of Clinical and Translational Neurology, June 21st, 2017, researchers found that  EVOO protects memory and learning ability by reducing the formation of classic markers of Alzheimer’s disease in the brain – amyloid-beta plaques and neurofibrillary tangles.  The Temple team, led by Dr.Practico, identified the mechanisms by which EVOO is effective: “We found that olive oil reduces brain inflammation but most importantly activates a process known as autophagy.” Autophagy is the process by which cells break down and clear out intracellular debris and toxins, such as amyloid plaques and tau tangles.

"Brain cells from mice fed diets enriched with extra-virgin olive oil had higher levels of autophagy and reduced levels of amyloid plaques and phosphorylated tau," Dr. Praticò said. Phosphorylated tau is responsible for neurofibrillary tangles, which are suspected of contributing to the nerve cell dysfunction in the brain that is responsible for Alzheimer's memory symptoms.

Previous studies have suggested that the widespread use of extra-virgin olive oil in the diets of people living in the Mediterranean areas is largely responsible for the many health benefits linked to the Mediterranean diet. "The thinking is that extra-virgin olive oil is better than fruits and vegetables alone, and as a monounsaturated vegetable fat it is healthier than saturated animal fats," according to Dr. Praticò.

The Mediterranean diet, as you probably know, consists of primarily plant-based foods such as vegetables and fruits, whole grains, legumes and nuts.  Butter is replaced by olive oil.  Herbs and spices flavor foods, so that less salt is used.  Red meat is limited to no more than a few times a month, while fish and poultry are eaten at least twice a week.  Red wine is used in moderation if desired (not to exceed one glass for women, two for men).  In previous studies, this diet has been associated with a decrease in high blood pressure, heart attack and stroke, and intestinal polyps. 

In order to investigate the relationship between extra-virgin olive oil and dementia, Dr. Praticò and colleagues used a well-established Alzheimer's disease mouse model. Known as a triple transgenic model, the animals develop three key characteristics of the disease: memory impairment, amyloid plagues, and neurofibrillary tangles. The researchers divided the animals into two groups, one that received a chow diet enriched with extra-virgin olive oil and one that received the regular chow diet without it. The olive oil was introduced into the diet when the mice were six months old, before symptoms of Alzheimer's disease begin to emerge in the animal model.

In overall appearance, there was no difference between the two groups of animals. However, at age 9 months and 12 months, mice on the extra virgin olive oil-enriched diet performed significantly better on tests designed to evaluate working memory, spatial memory, and learning abilities. Studies of brain tissue from both groups of mice revealed dramatic differences in nerve cell appearance and function.

"One thing that stood out immediately was synaptic integrity," Dr. Praticò said. The integrity of the connections between neurons, known as synapses, were preserved in animals on the extra-virgin olive oil diet. In addition, compared to mice on a regular diet, brain cells from animals in the olive oil group showed a dramatic increase in nerve cell autophagy activation, which was ultimately responsible for the reduction in levels of amyloid plaques and phosphorylated tau.

"This is an exciting finding for us," explained Dr. Praticò. "Thanks to the autophagy activation, memory and synaptic integrity were preserved, and the pathological effects in animals otherwise destined to develop Alzheimer's disease were significantly reduced. This is a very important discovery, since we suspect that a reduction in autophagy marks the beginning of Alzheimer's disease."

Dr. Praticò and colleagues plan next to investigate the effects of introducing extra-virgin olive oil into the diet of the same mice at 12 months of age, when they have already developed plaques and tangles. "Usually when a patient sees a doctor for suspected symptoms of dementia, the disease is already present," Dr. Praticò added. "We want to know whether olive oil added at a later time point in the diet can stop or reverse the disease."

Sadja Greenwood, MD, MPH

Sunday, May 21, 2017

Antibiotics in Poultry; Q Tips and Ear Injuries; Ways to Cook Rhubarb with Minimal Sweeteners

Antibiotics in Poultry
Here’s the latest from Marion Nestle, a former Professor in the Department of Nutrition, Food Studies, and Public Health at New York University, She is currently a Professor of Sociology at NYU and Visiting Professor of Nutritional Sciences at Cornell.  She writes a weekly column called Food Politics.

The International Poultry Council (IPC) will soon issue a statement advising the poultry industry to
  • Stop using antibiotics critical to human medicine to promote livestock growth and prevent disease,
  • Only use these drugs when prescribed by a veterinarian for treatment of disease,
  • Be transparent about the amount of antibiotics it uses and why.
The poultry industry routinely uses antibiotics in feed and water despite major efforts to stop this practice.
Government agencies concerned about increasing resistance to animal antibiotics have long wanted their use stopped or managed appropriately.
  • The FDA’s policy is to do what the IPC is now advising.
  • The CDC has long complained that widespread misuse of antibiotics promotes the growth of antibiotic-resistant bacteria.
  • The Union of Concerned Scientists has an excellent background paper on the topic.
  • Consumers Union also has an excellent position paper.
Trying to stop misuse of animal antibiotics has a long history. The animal agriculture industry has fought all attempts to curtain antibiotic use.
The following is an addition to Dr. Nestle’s writing.  You should know that the only way to be sure that antibiotics were not used on the eggs that become organic chickens is to find the words “no antibiotics” in addition to the organic label. 
Q Tips and Ear Injuries
According to a new study from the Nationwide Children’s Hospital in Columbus, Ohio, almost three dozen children end up in U.S. hospital emergency departments every day thanks to injuries that result from using cotton-tipped swabs to clean their ears. The injuries can range from minor to severe – about 30% of children were found to have something stuck in their ears, 25% were diagnosed with broken eardrums, and another 23% had injuries to the tissues of the ear canal. Bleeding and pain were common problems. These injuries happened at home, mainly to children under the age of 8.  "It highlights the misconception that adults and children need to clean the ear canal in the home setting," said senior author Dr. Kris Jatana, a pediatric ear, nose and throat surgeon. "While cotton-tipped applicators may seem harmless, there are certainly a lot of potential risks to using them to clean the ears”.  The number of emergency room visits for ear injuries in children has decreased somewhat in recent years, but the problem remains.
Recipes for cooking Rhubarb with Minimal Sweeteners
Last week I wrote a short article on the history of rhubarb’s travel from China to the west, and the plant’s medicinal properties.  You can find it on this blog.  I promised to publish any recipes from readers on ways to prepare rhubarb with minimal sweeteners.  Here are the replies (including mine). 
Vickisa -Take rhubarb stocks about eight and cut off the leaves and the bottoms and wash them and then cut them up into small chunks, add strawberries or cut up half or whatever you like put a little bit of vanilla in there and some maple syrup to taste or maple sugar to taste cook it down till it's a little bit soft but not smushed
Put it with yogurt and cottage cheese. I like Nancy's or Wallabies. You can add cereal; you can add some chocolate sauce; you can eat it on toast; you can eat it with cheese; you could just eat it anytime you want .

Sadja – cut rhubarb stalks into small pieces, add plenty of raisins and a cinnamon stick, cover with water and cook until the rhubarb pieces are soft.  Add honey and/or maple syrup to taste while the mixture is hot.   I found I could use less honey or maple syrup this way – previously I cooked the rhubarb in honey and used a lot more to keep the mixture moist.  The raisins add their own sweetness, and taste good in the final compote.

Barbara MacDonald  also sent in a recipe for a rhubarb cake from Jane Brody’s Good Food Book .  I can’t format it correctly for this column; leave me a message if you want to see it and I will send it to you.

Sadja Greenwood MD,MPH  


Tuesday, May 9, 2017

Rhubarb – Its History and Uses

The Chinese were using rhubarb as a medicinal plant for thousands of years before its introduction to Europe.  It was found to be valuable because of its laxative properties.  The rhubarb root was also considered to have anti-cancer properties.  This article will be discussing the properties of the rhubarb stems, and not the root, which is not used in the west and little has been published about its safety.
Rhubarb was imported into Europe along the silk road, beginning in the 7th or 8th century; Later it started arriving via maritime routes or overland through Russia.  It was expensive in medieval Europe, more so than cinnamon, opium and saffron, Nevertheless it was poplar because of its laxative and purgative properties. Apothecaries in medieval times preferred the plants that came from Russia – Siberian rhubarb. 
In the United States, medicinal and culinary rhubarb was grown in the early 1700s.  Jefferson planted it at Monticello, and is quoted as saying that the leaves are excellent as spinach.  In this he was greatly mistaken – rhubarb leaves are extremely toxic, high in oxalic acid, and should never be eaten or given to animals. Put them in your compost.  I hope Jefferson did not encourage his slaves to eat them.People who have had urinary stones containing oxalic acid, calcium oxalate stones, should drink lots of water and avoid too much food high in oxalate, such as rhubarb, beets, okra, spinach, Swiss chard, nuts, tea,and chocolate.
On the positive side, rhubarb is high in vitamin K, which supports healthy bone growth and brain functioning.  It contains lutein, beneficial for the eyes, calcium, and many other vitamins and minerals.
Researchers are interested in substances in rhubarb that kill human leukemia cells and slow the growth of lung cancer cells in mouse models. 
Rhubarb is sour – cooks need to add sweetening to make it palatable for most people.  You can cook it with raisins and cinnamon, and add a bit of sugar or honey at the end to taste.  There are some good recipes on the web for rhubarb chutney.  If any readers have a good rhubarb recipe low in sugar, please leave me a message on this blog, and I will publish it next week. 
Sadja Greenwood MD, MPH  


Saturday, May 6, 2017

Diet Sodas – the Bad News

About one in three Americans drink a can of sweetened soda every day, which is – as you already know – a bad habit leading to weight gain and diabetes.  Many people have switched to diet soda, hoping to avoid these outcomes but still enjoy the taste of a sweet, cold, fizzy can of Coke, Pepsi. Mountain Dew, or Dr. Pepper.  You may be immune to pressure to buy these drinks, but they are ubiquitous and their marketing is pushed at teens and young adults. 
Research suggests that excess sugar, especially the fructose in sugary drinks, may damage the brain.  Data from the Framingham Heart Study found that frequent users of sugary beverages are more likely to have poorer memory, smaller overall brain volume, and a smaller hippocampus – an area of the brain important for leaning and memory.
A follow-up study found that people who drank a diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not.  The researchers took age, smoking, diet quality and other factors into account, but acknowledged that they could not completely control for preexisting conditions like diabetes, which is a known risk factor for dementia.  They concluded tat it was somewhat surprising that diet soda consumption led to these outcomes.  While previous studies have linked diet soda intake with stroke risk, the link with dementia was not previously known. The studies did not differentiate between types of artificial sweeteners.  Scientists have put forth various hypotheses about how artificial sweeteners may cause harm, from transforming gut bacteria to altering the brain’s perception of ‘sweet’, but they conclude that more work is needed to figure out the underlying mechanisms.
  Sudha Seshadri, professor of neurology at Boston University School of Medicine, and senior author on the papers, wrote “these studies are not the be-all and end-all, but it looks like there is not very much of an upside to having sugary drinks, and substituting the sugar with artificial sweeteners doesn’t seem to help.  Maybe good old fashioned water is something we need to get used to.
The following is Greenwood  writing: You could also try unsweetened iced coffee or tea, or plain sparkling water with a slice of lemon or orange.  Plain carbonated water does not adversely affect your bones or teeth, and may improve swallowing problems in some people.
Sadja Greenwood, MD  back issues at