Tuesday, November 21, 2017

Mushrooms and Your Well-being

Mushrooms are in the news.  They may contain unusually high amounts of two antioxidants that could help to fight aging and increase health, according to research done at Penn State University.  Penn State has a Center for Plant and Mushroom Products for Health. The antioxidants are ergothioneine and glutathione..  When we use food to produce energy, we produce ‘oxidative stress’ as free radicals are formed.  These free radicals are oxygen atoms with unpaired electrons that can cause damage to cells throughout the body.  Antioxidants such as ergothioneine and  glutathione can reduce this damage. 

The amounts of these compounds vary greatly between mushroom species. Porcini mushrooms contain the highest amounts.  White button mushrooms have less, but still higher amounts than most other foods.  Cooking mushrooms does not significantly affect the antioxidants.  Countries that have more of these antioxidants in their diet, such as France and Italy, have lower incidents of neurodegenerative diseases like Parkinson’s and Alzheimer’s.  This could be merely correlation and not causation, but is something to be noted.  About 5 white button mushrooms per day would give an amount of antioxidants that could be helpful, according to Penn State researchers.  Mushrooms are also good sources of vitamin D and B vitamins.

There is controversy about the safety of eating raw mushrooms, because of tough cells walls and a possible toxin that disappear with cooking .  I suggest cooking first.    The cooking techniques that preserve most of the benefits of mushrooms include microwaving and grilling.  However you use them, mushrooms greatly enhance the flavor of your food.

Many people buy dried porcini mushrooms in bulk, or use mushroom powder to sprinkle on their food.  Be exceedingly careful to check the species of mushroom you may collect in the wild after a rain.  Many species are poisonous, deadly poisonous.  Consult a book and an expert.

Sadja Greenwood, MD, MPH

Champiñones y tu bienestar 

Los hongos están en las noticias. Pueden contener cantidades inusualmente altas de dos antioxidantes que podrían ayudar a combatir el envejecimiento y aumentar la salud, según una investigación realizada en la Universidad Estatal de Pensilvania. Penn State tiene un Centro de productos de hongos y plantas para la salud. Los antioxidantes son ergotioneina y glutatión. Cuando usamos alimentos para producir energía, producimos "estrés oxidativo" cuando se forman radicales libres. Estos radicales libres son átomos de oxígeno con electrones desapareados que pueden causar daño a las células en todo el cuerpo. Antioxidantes como la ergotioneína y el glutatión pueden reducir este daño.

 Las cantidades de estos compuestos varían mucho entre las especies de hongos. Los hongos Porcini contienen las cantidades más altas. Los champiñones blancos tienen menos, pero aún cantidades más altas que la mayoría de los otros alimentos. Cocinar setas no afecta significativamente los antioxidantes. Los países que tienen más de estos antioxidantes en su dieta, como Francia e Italia, tienen menores incidentes de enfermedades neurodegenerativas como el Parkinson y el Alzheimer. Esto podría ser simplemente una correlación y no una causalidad, pero es algo que debe tenerse en cuenta. Alrededor de 5 setas de botón blanco por día daría una cantidad de antioxidantes que podrían ser útiles, de acuerdo con los investigadores de Penn State. Los hongos también son buenas fuentes de vitamina D y vitamina B. 

Existe controversia sobre la seguridad de comer champiñones crudos, debido a las paredes resistentes de las células y una posible toxina que desaparecen con la cocción. Sugiero cocinar primero. Las técnicas de cocción que conservan la mayoría de los beneficios de los hongos incluyen el microondas y la parrilla. Sin importar cómo los use, los champiñones mejoran en gran medida el sabor de su comida.  Muchas personas compran setas porcini secas a granel, o usan polvo de setas para rociar sobre sus alimentos. Sea extremadamente cuidadoso para controlar las especies de hongos que puede recolectar en la naturaleza después de una lluvia. Muchas especies son venenosas, mortales venenosas. Consulte un libro y un experto.
Sadja Greenwood, MD. MPH













Talking to Your Children About Sex


Last week I wrote a column about Nurx, an app or website that helps women order birth control or ‘morning after’ pills by mail. Women can order these drugs by using the app, answering a series of health questions, providing basic demographic information, and having their information reviewed by a physician.  They then choose their pills of choice, either birth control (pills or a vaginal ring) or emergency contraception (Plan B or Ella) after unprotected sex.  The doctor reviews their information, writes a prescription and the drug is delivered to the patient’s home or local pharmacy.  The service is available to women over the age of 12.

Young girls can use the app without parental knowledge, in situations when they feel they cannot talk with their parents about sex, either because of strict religious views or strong parental discomfort with the subject.  Here are some books that could help parents and children talk about sexual feelings and actions.   These books are recommended by The School Library Journal, a national monthly magazine with articles and reviews for school librarians, and public librarians who work with young people.   The books include Sex is a Funny word, which is filled with cartoons and is for younger kids, and Doing it Right: Making Smart, Safe and Satisfying Choices about Sex, which is for high school girls and boys.  These books, and others on the recommended list, reassure readers that developmental differences are quite normal.  They account for differences in gender, family makeup, and sexuality. Often the best way to a difficult topic is through fiction, and this is certainly the case with teen romance and sex.  The School Library Journal suggests:
·       The Fault In Our Stars, by John Green
·       Graceling, by Kristin Cashore
·       Finding Audrey, by Sophie Kinsella
·       *Aristotle and Dante Discover the Secrets of the Universe, by Benjamin Alire Sáenz
·       Love and First Sight, by Josh Sundquist
·       Goodbye, Stranger, by Rebecca Stead
·       Marcello In the Read World, by Francisco X. Stork
·       The Absolutely True Diary of a Part-Time Indian, by Sherman Alexie
·       Stargirl, by Jerry Spinelli
·       *Lily and Dunkin, by Donna Gephart
·       Fangirl, by Rainbow Rowell
·       *Tell Me Again How a Crush Should Feel, by Sara Farizan
Although issues of romance and love -- and teen angst! -- are universal and often transcend sexuality, books with an * will be of particular interest to LGBTQ readers.
Sadja Greenwood, MD, MPH



Nurx – the ‘Uber for Birth Control”


There’s an app for birth control and ‘morning after’ pills, called Nurx.  Women can order these drugs by using the app, answering a series of health questions, providing basic demographic information, and having their information reviewed by a physician.  They then choose their pills of choice, either birth control (pills or a vaginal ring) or emergency contraception (Plan B or Ella) after unprotected sex.  The doctor reviews their information, writes a prescription and the drug is delivered to the patient’s home or local pharmacy.  The service is available to women over the age of 12.

 Needless to say, Nurx has run into controversy, because  ‘morning after’ pills are considered abortion-causing drugs by people in Right to Life groups.  They believe that life begins at fertilization of the woman’s egg, even before it has implanted in the uterine wall.  This view is out of step with science , according to Susan Wood, an associate professor of health policy at George Washington University. She says that a fertilized egg is not the same as a pregnancy or the same as a person.  Half of all fertilized eggs never implant in the uterus, and a woman is not pregnant until the egg is implanted and stabilized.  Moreover, there is some evidence that emergency contraceptives may prevent the sperm from fertilizing the egg in the first place.  Dr. Jessica Knox, medical director for Nurx, says that by vetting patients’ information , and asking follow-up questions if needed, the company is going above and beyond the usual prescription of these drugs.  Nurx is available in California (and 15 other states, including Texas) and accepts Medicaid for payment, as well as other forms of insurance.  Nurx will also prescribe Truvada, a medicine for people who are HIV-negative, to reduce the risk of contracting HIV.  People using Truvada should also practice safe sex by always using a condom.
Controversy has also surrounded the prescription of birth control to girls 12 and older without parental consent.  Obviously it is important for parents to talk to their children, boys and girls, about sex and birth control early, as appropriate.  But in cases where there has been no communication about sex, many birth control centers have considered minors to be ‘emancipated’ and have provided birth control to prevent pregnancy at a young age. 
Sadja Greenwood, MD, MPH


Nurx - el 'Uber para control de la natalidad' 
Hay una aplicación para píldoras anticonceptivas y 'mañana después', llamada Nurx. Las mujeres pueden ordenar estos medicamentos usando la aplicación, respondiendo una serie de preguntas de salud, proporcionando información demográfica básica y haciendo que su información sea revisada por un médico. Luego eligen las píldoras de su elección, ya sea anticonceptivos (píldoras o un anillo vaginal) o anticoncepción de emergencia (Plan B o Ella) después de tener relaciones sexuales sin protección. El médico revisa su información, escribe una receta y el medicamento se entrega en el hogar del paciente o en la farmacia local. El servicio está disponible para mujeres mayores de 12 años.   Huelga decir que Nurx ha tenido controversia, porque las píldoras de "la mañana después" son consideradas drogas que causan el aborto por personas en los grupos Right to Life. Creen que la vida comienza con la fertilización del óvulo de la mujer, incluso antes de que se haya implantado en la pared uterina. Esta visión está fuera de sintonía con la ciencia, según Susan Wood, profesora asociada de política de salud en la Universidad George Washington. Ella dice que un óvulo fertilizado no es lo mismo que un embarazo o lo mismo que una persona. La mitad de los óvulos fecundados nunca se implantan en el útero, y una mujer no está embarazada hasta que el óvulo se implanta y se estabiliza. Además, existe cierta evidencia de que los anticonceptivos de emergencia pueden evitar que los espermatozoides fecundan el óvulo en primer lugar. La Dra. Jessica Knox, directora médica de Nurx, dice que al examinar la información de los pacientes y hacer preguntas de seguimiento si es necesario, la compañía va más allá de la prescripción habitual de estos medicamentos. Nurx está disponible en California (y en otros 15 estados, incluido Texas) y acepta Medicaid para el pago, así como otras formas de seguro. Nurx también recetará Truvada, un medicamento para personas que son VIH-negativas, para reducir el riesgo de contraer el VIH. Las personas que usan Truvada también deben practicar sexo seguro utilizando siempre un condón.  La controversia también ha rodeado la prescripción de control de la natalidad a las niñas de 12 años o más sin el consentimiento de los padres. Obviamente, es importante que los padres hablen con sus hijos, niños y niñas, sobre el sexo y el control de la natalidad temprano, según corresponda. Pero en los casos donde no ha habido comunicación sobre el sexo, muchos centros de control de la natalidad han considerado a los menores como 'emancipados' y han proporcionado anticonceptivos para prevenir el embarazo a una edad temprana.  Sadja Greenwood, MD


Wednesday, October 25, 2017

Nudge



Here’s a surprising story from the San Diego International Airport.  For 10 non-consecutive days, signs were posted at the bottom of a set of stairs and escalators urging people to take the stairs.  The signs read: ‘Please reserve the escalator for those who need it’, or ‘Don’t lose time, lose weight. Use the Stairs’, or ‘Don’t waste Time, trim your Waistline. Use the Stairs’, or ‘You’ll get more stares if you use the stairs’, or ‘If you want to feel younger, act younger. Step it up! Use the stairs.’  On alternating days there were no signs posted. 

Researchers from the San Diego State University counted how many people took the stairs versus the escalator on days with and without the signs, and also interviewed people atop the stairs about their health and level of physical activity.  The research was headed by John Bellettiere, at UC San Diego, who is working on ways to help people sit less and move more.   On days when one of the signs was present, about twice as many people took the stairs compared to a no-sign day.  An important finding was that people who never exercised also used the stairs. People used the stairs even if they were in a rush and carrying luggage.  Bellettiere concluded that having even a small amount of exercise early in the day may lead to getting more later.  When people see others taking the stairs they are more likely to do so themselves, creating a ripple effect. 

Social science research has shown that there are many ways we can be ‘nudged’ into acting in ways that may be positive, or negative, for our well being.  Some utility companies get people to conserve power by sending out comparison notices, telling people how their use compares to others in the area who are using less.  This is a carefully designed strategy encouraging people to use less energy, and it has been successful.  If we believe other people are doing the right thing, we will want to do so also. The approach originates from the sociological concept of social norms, which holds that group members will respond to appropriate – or inappropriate  - values and behaviors held by others in their group.  The recent  Nobel Prize winner in Economics, Richard Thaler, wrote about these ideas in a book with Harvard lawyer Cass Sunstein – titled Nudge.  They consider their concepts to be from neither left nor right on many hot button issues, since a nudge does not restrict freedom of choice.

Be on the lookout for ways you are being subtly nudged by the culture around you.  Candy at the checkout counter at Safeway.  Signs urging you to walk up the stairs.  Wait a minute – that’s a good one.  Think of ways you can nudge yourself in a beneficial direction to exercise more.  Form a walking group; tell your friends what you plan to do; pay money to join a gym; write signs in your house that will inspire you to move, eat healthy food, or reach out to friends. 
Sadja Greenwood, MD, MPH  back issues on this blog




Monday, October 2, 2017

Your Microbiome has Circadian Rhythms

We humans have internal clocks; we experience daily changes in our energy, mood, appetite  and sleepiness based on time of day, light and dark, temperature and sleep patterns. These changes are known as circadian rhythms. Microbes in our gut, the so-called ‘microbiome’, have also been found to have circadian rhythms. Our gut bacteria make small rhythmical movements throughout the day and night. In so doing they impact our physiology and affect tissues far away from the gut, such as the liver.  Gene expression in the liver can change in tandem with the microbiome’s rhythm changes, resulting in variations in important liver functions, such as drug metabolism and detoxification. 

The new findings in a paper from the Weizmann Institute of Science in Israel, published 12/1/16 in the journal Cell, show that our circadian rhythms are deeply dependent on the oscillations of the gut microbes. Some of our daily rhythms are maintained but others are disrupted.  Previous work by the authors of this study, Eran Elinay and Eran Segal, showed that disrupting feeding times and sleep-wake patterns in mice induced changes in the gut microbiome.  Understanding more about this relationship could eventually help to find ways to intervene in obesity and it’s related metabolic problems, which are more common when circadian rhythms are disrupted due to shift work or jet lag.  Also, since most drugs, from Tylenol to chemotherapy, are metabolized by the liver, a better understanding of gut/liver rhythms could affect how and when medications are taken or given. According to Eran Segal “What we learned from this study is that there’s a very tight interconnectivity between the microbiome and the host.  We should think of it as one supraorganism that can’t be separated.  We have to fully integrate our thinking with regard to any substance we consume.” 
A take-home lesson from this study is that we should become more aware of our daily patterns of eating and sleeping, and try to keep them as regular as possible.  Eating during the day and letting the gut rest at night is desirable.  Also, remember that your gut microbiome thrives on the fiber found in vegetables and fruits. Think of yourself as a ‘supraorganism.’ !
Sadja Greenwood, MD, MPH  back issues on this blog



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Monday, September 18, 2017

Lower Your Risk of Colorectal Cancer

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A new report from the American Institute for Cancer Research finds evidence that physical activity and eating whole grains lowers the risk of cancer of the colon and rectum, while processed meats increase the risk.   Edward Giovannucci, professor of nutrition and epidemiology at the Harvard School of Public Health, wrote “Colorectal cancer is one of the most common cancers, yet this report demonstrates there is a lot people can do to dramatically lower their risk.”  The new report evaluated scientific research worldwide, analyzing 99 studies that included data on 29 million people, of whom over a quarter million had colorectal cancer.  Risk factors included consuming hot dogs, bacon and other processed meats regularly, eating high amounts of red meat such as beef or pork, being overweight or obese, and consuming two or more daily alcoholic drinks, such as wine or beer.  On the other hand, eating about three servings of whole grains daily, such as brown rice, whole wheat or rye bread, quinoa (actually a seed, but good source of fiber) and other non-refined grains will lower the risk of colorectal cancer.  A higher risk was observed with low intakes of non-starchy vegetables intakes.  Lower risks were seen with fish and foods containing vitamin C, such as oranges, strawberries and spinach. According to Alice Bender, Director of Nutrition Programs for the American Institute of Cancer Research, “Replacing some of your refined grains with whole grains and eating mostly plant foods, such as fruits, vegetables and beans, will give you a diet packed with cancer protective compounds and help you manage your weight, which is so important to lower risk.” 

The most common cancers in the U.S, today are breast, lung, prostate and colorectal.  Factors that reduce the risk of colorectal cancer, as suggested in this column, are also helpful in lowering the risk of breast, lung and prostate cancers.  Maximize your intake of vegetables and fruits, go for varied colors, think fiber, keep your blood sugar low and even, and get yourself, and your dog, out for a walk.    Next week – I’ll report on how the bacteria in your gut – your microbiome,  show subtle movements throughout the 24 hour cycle and influence your metabolism.  If possible, keep a steady sleep schedule in tune with nature’s light and dark.  
Sadja Greenwood, MD, MPH  search this website for back issues 

  
  
 Baje su riesgo de cáncer colorrectal
Un nuevo informe del Instituto Americano para la Investigación del Cáncer encuentra pruebas de que la actividad física y comer granos enteros reduce el riesgo de cáncer de colon y recto, mientras que las carnes procesadas aumentan el riesgo. Edward Giovannucci,
profesor de nutrición y epidemiología de la Escuela de Salud Pública de Harvard, escribió que "el cáncer colorrectal es uno de los cánceres más comunes, pero este informe demuestra que hay mucha gente que puede hacer para reducir drásticamente su riesgo". la investigación científica en todo el mundo, analizando 99 estudios que incluían datos sobre 29 millones de personas, de las cuales más de un cuarto de millones tenían cáncer colorrectal. Los factores de riesgo incluyen el consumo de perritos calientes, tocino y otras carnes procesadas regularmente, comiendo grandes cantidades de carne roja como la carne de res o de cerdo, el sobrepeso u obesidad, y el consumo de dos o más bebidas alcohólicas diarias, como el vino o la cerveza. Por otro lado, el consumo de tres porciones de granos enteros al día, como el arroz integral, el trigo integral o el pan de centeno, la quinua (en realidad una semilla, pero buena fuente de fibra) y otros granos no refinados reducirá el riesgo de cáncer colorrectal . Se observó un riesgo mayor con la ingesta baja de ingestas de hortalizas no almidonadas. Menores riesgos se observaron con los pescados y los alimentos que contienen la vitamina C, tales como naranjas, fresas y espinaca. Según Alice Bender, Directora de Programas de Nutrición del Instituto Americano de Investigación del Cáncer, "Reemplazar algunos de sus granos refinados con granos enteros y comer principalmente alimentos vegetales, como frutas, verduras y frijoles, le dará una dieta llena de proteínas protectoras del cáncer compuestos y ayudarle a manejar su peso, que es tan importante para reducir el riesgo ". 

Los cánceres más comunes en los Estados Unidos son el de mama, pulmón, próstata y colorrectal. Los factores que reducen el riesgo de cáncer colorrectal, como se sugiere en esta columna, también son útiles para reducir el riesgo de cánceres de mama, pulmón y próstata. Maximice su consumo de verduras y frutas, opte por colores variados, piense en fibra, mantenga su nivel de azúcar en la sangre bajo e incluso, y consiga que usted y su perro salgan a pasear.  La próxima semana - voy a informar sobre cómo las bacterias en su intestino - su microbioma, mostrar movimientos sutiles a lo largo del ciclo de 24 horas e influir en su metabolismo. Si es posible, mantenga un horario de sueño estable en sintonía con la luz y la oscuridad de la naturaleza.
 Sadja Greenwood, MD sadjascolumns.blogspot.com para los números anteriores 
  


Monday, August 14, 2017

Walnuts - an Update

Readers are probably aware that we have trillions of bacteria in our intestinal tract, which can protect us from infection if they are the beneficial kind.  These helpful bacteria are nourished by a diet high in plant fiber, such as vegetables, whole grains and fruit. Research from Louisiana State University School of Medicine has found that eating walnuts can change the makeup of bacteria in the gut in a beneficial way. The findings are published this year in The Journal of Nutritional Biochemistry.  “Walnuts have been called a ‘superfood’ because they are rich in the omega-3 fatty acid, alpha-linoleic acid and fiber, and they contain one of the highest concentrations of antioxidants” writes Dr. Lauri Bylerly, the chief author on the paper.  “Now an additional superfood benefit of walnuts may be their beneficial changes to the gut microbiota.”
The research team worked with rodents, adding walnuts to the diet of one group but not the other.  They measured the types and numbers of bacteria in the descending colon in both groups.  “We found that walnuts in the diet increased the diversity of bacteria in the gut, and other non-related studies have associated less bacterial diversity with obesity and other diseases like inflammatory bowel disease.  Walnuts increased several bacteria, like Lactobacillus, typically associated with probiotics suggesting walnuts may act as a prebiotic.”   Probiotics are foods containing beneficial bacteria, such as yogurt,, kefir, and fermented foods such as sauerkraut, and kimchi.  Readers may know that prebiotics are foods that promote the numbers of beneficial bacteria – such as garlic, onions, leeks, dandelion greens, asparagus, bananas and now – walnuts.  “Researchers are finding that greater bacterial diversity may be associated with better health outcomes.”  In previous studies, eating walnuts has been associated with reduced cardiovascular disease risk, slower tumor growth in animals and improved brain health.
This research was supported by the American Institute for Cancer Research and the California Walnut Commission.  The American Institute for Cancer Research is a non-profit organization that funds research to help people prevent and survive cancer.  The California Walnut Commission is funded by mandatory assessments of growers.  It represents growers and handlers of California walnuts and conducts health research.
Sadja Greenwood, MD, MPH   past columns on this blog

Nueces (walnuts) - una actualización
 Los lectores son probablemente conscientes de que tenemos trillones de bacterias en nuestro tracto intestinal, que puede protegernos de la infección si son benéficas. Estas bacterias útiles se alimentan de una dieta rica en fibra vegetal, como verduras, granos enteros y frutas. Investigación de la Escuela de Medicina de Louisiana State University ha encontrado que comer nueces (walnuts) puede cambiar el maquillaje de las bacterias en el intestino de una manera beneficiosa. Los resultados se publican este año en The Journal of Nutritional Bioquímica. "Walnuts se han llamado un" superfood "porque son ricas en el ácido graso omega-3, el ácido alfa-linoleico y la fibra, y contienen una de las concentraciones más altas de antioxidantes" escribe el Dr. Lauri Bylerly, el autor principal en el papel. "Ahora un beneficio suplementario adicional de walnuts puede ser sus cambios beneficiosos para la microbiota intestinal". El equipo de investigación trabajó con roedores, añadiendo walnuts a la dieta de un grupo, pero no al otro. Medían los tipos y números de bacterias en el colon descendente en ambos grupos. "Encontramos que walnuts en la dieta aumentaron la diversidad de bacterias en el intestino, y otros estudios no relacionados han asociado menos diversidad bacteriana con la obesidad y otras enfermedades como la enfermedad inflamatoria intestinal. Los probióticos son alimentos que contienen bacterias beneficiosas, como yogur, kéfir y alimentos fermentados como el chucrut y el kimchi. Los lectores pueden saber que los prebióticos son alimentos que promueven el número de bacterias beneficiosas, como el ajo, las cebollas, los puerros, los verdes de diente de león, los espárragos, los plátanos y ahora las nueces. "En los estudios anteriores, comer walnuts se ha asociado con la reducción del riesgo de enfermedades cardiovasculares, el crecimiento del tumor más lento en los animales y la mejora de la salud del cerebro.
 Esta investigación fue apoyada por el Instituto Americano para la Investigación del Cáncer y la California Walnut Commission. El Instituto Americano de Investigación del Cáncer es una organización sin fines de lucro que financia la investigación para ayudar a las personas a prevenir y sobrevivir al cáncer. La California Walnut Commission es financiada por evaluaciones obligatorias de los productores. Representa a los productores y manipuladores de las nueces de California y realiza investigación en salud.

Sadja Greenwood, MD, MPH   past columns on this blog