Sunday, August 29, 2010

Go to Health: Unwanted Pregnancy & Ella, the new emergency contraceptive

Have you noticed that sex scenes in movies almost never include any discussion of whether the woman is using the pill or an IUD, and whether the man has a condom? Stopping to talk about AIDS doesn’t happen either. Film producers are getting better about cigarettes, but apparently condoms are too risqué. There is even controversy about requiring actors in pornographic movies to be protected by condom use. Our inability to get real about sex and to make protection available translates into our high rate of unintended pregnancies. It is not surprising that the US has a higher rate of unintended pregnancy than other developed countries. In France, about one third of pregnancies are unintended. In the US our rate is close to 50%; married and unmarried women are included in this number. Of the 800,00 pregnancies in teenagers per year, over 80% are reported as unintended. One third end in abortion. Teens who become mothers are less likely to finish high school or find decent jobs, and more likely to live in poverty.

The most rational plan for sexually active females and males is to talk about contraception ahead of time and use highly effective methods such as the pill, the IUD and condoms. Teenagers need to rehearse the way they will handle such talks, as they are not easy at first. Since sexual desire often overtakes rational thinking, a ‘plan B’ is needed to prevent unintended pregnancy. It’s called emergency contraception, and the foremost pill on the market is called ‘Plan B’!

Plan B One-Step contains levonorgestrel, a progesterone-type hormone that is used in many birth control pills. It prevents pregnancy primarily by stopping ovulation (the maturation and release of eggs from the ovaries) or by preventing fertilization of the egg if ovulation has already occurred. Plan B One-Step also alters the lining of the uterus, making it less receptive to a fertilized egg. Plan B One-Step is available without prescription to women and men 17 and older; it consists of a single pill that should be taken as soon as possible after unprotected intercourse, or if the condom breaks or pills have not been taken regularly. (Men don’t take Plan B,, but can buy it for their partners.) Girls younger than 17 can get Plan B One-Step with a doctor’s prescription. Women who have been raped should ask for Plan B One-Step in the emergency room. Plan B One-Step can be used up to 5 days after sex but loses some of its effectiveness after 3 days. Other emergency contraceptive pills on the market are Plan B and Next Choice. These both contain two pills, with instructions to take them 12 hours apart. However, studies have shown that both pills can be taken together.

Ella: In mid August, 2010, the FDA approved a new emergency contraceptive that has been used in 22 European countries since October 2009 and is said to be considerably more effective than Plan B. Ella works by preventing ovulation – the release of an egg from the woman’s ovaries, and probably also by changing the uterine lining to make it less receptive. It is similar in chemical configuration to RU 486, and thus has aroused opposition from groups who oppose abortion. Studies have shown Ella to be more effective that Plan B, and useful for up to 5 days after sex. Ella should be available by prescription by October or November of 2010. The approval of Ella by the FDA has been seen as evidence of a shift in the influence of political ideology at the FDA. Approval of Plan B, on and then off prescription, was very slow and controversial, while the approval of Ella was faster and unanimous. Ella and Plan B should not be used if the woman is already pregnant, or breastfeeding.

The Copper T IUD is the most effective way to prevent pregnancy after unprotected sex, It can be inserted within 5 days after sex and is said to be 99% effective in preventing pregnancy. It can remain in place for 10 years, This method is not the best birth control for women who may be at risk for sexually transmitted diseases, as infections in the pelvic organs can occur with IUDs. However, for monogamous couples, the IUD is an excellent choice.

Final Thoughts: If you are reading this column and it doesn’t apply to you, pass on the information to a young person who may need it.

If anyone can explain to me why film-makers find it impossible to include the question of contraception in sex scenes, please leave me a message and let me know. Films have enormous influence on our consciousness, and could do a lot of good by being honest on this subject. The scenes could be made as funny or poignant as real life.

Sadja Greenwood, MD, MPH Past issues on this blog

Sunday, August 15, 2010

Go to Health: Ghrelin and Leptin – the hunger hormones

There are many influences that govern what, when and how much we eat. Clearly our family of origin, habits and thinking play a big role in this, and so do the temptations of sweet, salty and rich foods in every store and restaurant. Most of us probably want to get in touch with our body’s signals that tell us when and how much to eat. Several hormones are constantly playing an unseen and important role in this. Ghrelin (the word comes from “ghre" in Proto-Indo-European languages meaning “grow") is made in the stomach and pancreas; it stimulates hunger. To pronounce this word, make ghrel rhyme with dwell, then add an ‘in’. Leptin (derived from the Greek word ‘leptos’ meaning thin) is formed mainly in fat tissue and inhibits

Ghrelin levels increase before meals and when blood sugar is low. Ghrelin stimulates hunger. The hormone circulates in the blood and affects areas of the brain that cause an increase in growth hormone and the dopamine reward area. The pleasurable aspects of food (and alcohol) are reinforced. Ghrelin has also been found to reinforce learning and memory (think of a hungry animal looking for clues to find food). Short sleep duration is associated with increased levels of ghrelin, increased hunger and obesity – so getting enough sleep is important to maintaining a normal weight.

Leptin is a hormone secreted mainly from fat cells – receptors are found in brain areas known to be important in regulating hunger, body temperature and energy expenditure. When an animal gains weight and has larger amounts of body fat, leptin levels rise. Normally, hunger and food intake go down, and body temperature rises. Leptin counteracts the effects of anandamide, a neurotransmitter that stimulates eating and binds to the same receptors as THC in marijuana. Anandamide makes food pleasurable, as does marijuana, while leptin signals the brain that the body has had enough to eat. A recent study in rats showed that animals fed a diet high in fructose became resistant to leptin, and gained more weight than animals on a diet with similar calories but without fructose. This study gives a clue to the rise of obesity in the US. It’s fine to eat fruit, but avoid sweetened drinks, especially if they contain fructose.

The ‘Appestat’ The regulation of appetite has been the subject of much recent research, primarily because of the marked increase in weight gain in our population. The hypothalamus in the brain is the main regulatory organ for appetite; it is influenced by ghrelin, leptin and many other hormones and neurotransmitters. Research indicates that it takes time for the brain to register a feeling of fullness after eating, possibly up to 20 minutes. People who eat rapidly, or are distracted by watching television, may eat more than they need, by ignoring and not waiting for the body’s signals of fullness. Foods that contain more water, fiber and/or protein have the greatest ability to promote feelings of fullness. Most vegetables, fruits and beans or animal foods fall into this category. Whole grain pasta, bread and cereal contain more fiber than foods with refined flour foods, and are 50% more filling. However, choosing healthy food when you are hungry, and confronted with foods like chocolate cake or cheeseburgers, takes considerable resolve! Carrying some nuts, fruit or dried fruit in your backpack or purse can help.

Self-knowledge There are many valuable ways to stay in touch with your body – meditation, conscious relaxation, mindful breathing, and slow walking, come to mind. Slow and conscious eating can also be a great help in staying in touch with your body’s need for the right amount of healthy food.
Sadja Greenwood, MD, MPH – back issues on this blog

Sunday, August 8, 2010

Go to Health: Almonds, Peanuts, and PlumpyNut

Almonds are a delicious food, and one considered heart-healthy - because of studies showing that they decrease blood sugar and insulin response after a meal, and also lower damage to ingested protein as it is metabolized. Researchers at the University of Toronto followed this study with a look at ‘the portfolio diet’, in which subjects with elevated cholesterol followed an eating plan containing many heart-healthy foods: oatmeal, beans, olive oil, soy products, fibrous vegetables and a daily ounce of almonds (20-24 almonds). LDL cholesterol decreased by 29.6% in 4 weeks, compared to a 33.3% decrease on lovastatin. The ‘portfolio’ concept was to combine many known heart-healthy foods. Researchers called almonds a ‘mini-portfolio’ because they contain several components stressed in the eating plan - vegetable proteins, fiber, and plant sterols (structural components in cell membranes that lower cholesterol in humans). Almonds also are a good source of vitamin E, magnesium, heart-healthy monounsaturated fat, protein and calcium. Adding a daily ration of almonds to a weight loss diet is helpful, as their fat content can prevent overeating. Following salmonella outbreaks from raw almonds in 2001 and 2004, the USDA has mandated that all almonds be pasteurized to reduce bacterial contamination. This move has been very distressing to the raw food community. Some unpasteurized almonds can still be found, labeled as such. Other people prefer the taste of roasted almonds, and are not concerned by the ruling.

Peanuts are believed to have been domesticated about 7000 years ago in Peru; they are members of the bean family and grow underground. The Portuguese took them to China in the 1600s and to Africa in the 1800s; they became important in the diet of both areas. Besides being high in protein (25% by weight), peanuts have numerous health benefits. In 2003, the FDA allowed the following health claim: scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, including peanuts as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. (1.5 ounces of most nuts is about 1/3 cup.) Peanuts contain as much antioxidant capacity as blackberries and strawberries, and are richer in anti-oxidants than carrots or beets. Certain of their antioxidants are increased by roasting. They are also a good source of resveratrol, a compound in some plants that is studied for its anti-aging effects and protection against heart disease and cancers. Resveratrol is known to be present in grapes and concentrated in red wine – for non-drinkers, peanuts are a good alternative. For dieters, and people dealing with diabetes, a 2002 study from the Harvard School of Public Health found that women who ate 5 or more 1 ounce servings of peanuts or other nuts per week reduced their risk of type 2 diabetes by almost 30%. A similar finding was found among women eating 5 tablespoons of peanut butter per week.

Peanut allergy can be serious; it affects .6 to 1% of the US population, but is much less common in developing countries – possibly due to different ways of processing the nut. Peanuts can be contaminated with a mold called aflatoxin that can be carcinogenic; processing peanuts at high temperatures makes this contamination unlikely in the US.

PlumpyNut is a high protein, high energy peanut based paste that also contains vegetable oil, powdered milk, sugar, vitamins and minerals. It was specially formulated by a French nutritionist in the 1990s for use in famine conditions in Africa, where it has been lifesaving for emaciated children. It comes in a foil-wrapped bar which the child can use to feed herself or himself. You can see the remarkable results of PlumpyNut feeding on the 60 Minutes program of Oct 21st, 2007, narrated by Anderson Cooper. Recently there has been serious controversy about the patent on PlumpyNut held by the French company that makes it. Regardless of this problem, PlumpyNut is distributed by Doctors Without Borders and other relief organizations, which are worthy of our support.
Sadja Greenwood, MD, MPH Back issues on this blog