Sunday, December 18, 2011

The Role of Spices in Cancer Prevention

In their recent lecture at Commonweal, The Cancer-Fighting Kitchen, Dr Jeanne Wallace and chef Rebecca Katz talked about foods and spices that have special relevance in cancer prevention. Wallace spoke about the ability of diet and lifestyle changes to modulate gene expression, changing the probability of getting a disease and also surviving after a diagnosis. She described Nuclear Factor Kappa B (NF-kB) as a master switch for genes involved in tumor growth and invasion. NF-kB is a protein complex that controls DNA transcription, and regulates various steps in cancer cell growth. NF-kB also controls many genes involved in inflammation. While drug companies are researching new medicines to inhibit NF-kB, herbs and dietary plants have been found to inhibit NF-kB activation.

Wallace showed a slide of spices that inhibit NF-kB, and here is the list: anise, basil, black pepper, caraway, cardamom, chili pepper, cinnamon, clove, coriander, cumin, fennel, fenugreek, flaxseed, garlic, ginger, Holy basil, lemongrass, licorice, mint, mustard seed, nutmeg, oregano, parsley, rosemary, saffron, tamarind, turmeric. Note that spices in this list are used in many ethnic foods. Each one has unexpected properties as well as distinctive tastes. I will write about many of them in future articles; today I want to focus on cinnamon, clove and nutmeg, as these are so commonly used in the winter holidays - for baking, mulled wine, chai, spiced apple juice and eggnog.

Cinnamon: In addition to NF-kB inhibition, cinnamon has been shown to control blood sugar in people with type 2 Diabetes. Subjects using ¼ to ½ teaspoon daily were found to lower their fasting blood sugar, their hemoglobin A1C as well as their triglycerides and LDL cholesterol. Blood sugar spikes after a meal were lessened. Healthy people without diabetes had showed improvement in their glucose tolerance tests after daily cinnamon intake. Cinnamon has also been found to inhibit vaginal yeast infections and the bacterium Helicobacter pylori infection in the stomach.

Cloves: In addition to NF-kB inhibition, cloves have a long history as pain relievers in dentistry. Oil of clove is a mild topical anesthetic, and also has anti-inflammatory and antibacterial properties in the mouth for teeth and gums. Eugenol, the scientific name for oil of clove, is used in India for stopping the growth of H. pylori in the stomach. Cloves are used in Ayurvedic medicine, Chinese medicine and western herbalism. They can increase hydrochloric acid in the stomach, and improve intestinal action,. Cloves should be use sparingly, as the taste is strong, and high doses can be toxic to the liver. Following a tried and true recipe should yield good results

Nutmeg: In addition to NF-kB inhibition, nutmeg has been used by herbalists as a brain stimulant, and for its ability to kill rotaviruses, a common cause of diarrhea. Used in very large quantities, nutmeg can cause intoxication and hallucinations. This use in dangerous, but will not occur with the amounts used in everyday cooking. Some cooks use nutmeg in savory dishes as well as sweet ones, such as bean soups, stews, and vegetable casseroles.

Before closing, I wish all readers a good holiday season, with an emphasis on seasoning, and a suggestion that you look at the book Healing Spices, by B.B. Aggarwal, a prominent cancer researcher at the University of Texas M.D.Anderson Cancer Center . One of his sayings is: Put more spice in your life, to prolong your life.
Sadja Greenwood, M.D. past issues on this blog

Sunday, November 20, 2011

Inflammation - What to do About it

We are all familiar with acute inflammation: you cut yourself with a knife and it hurts, the area around the cut gets red, warm and swollen, and the process takes a few days to heal. Bacteria entered the wound, and your body’s immune system went into gear to send more blood with white blood cells to prevent infection, which caused the swelling, redness and tenderness. (Sometimes you need antibiotics and/or a tetanus booster as well.)

Chronic inflammation is another story – and many of us have it without awareness. It has been called ‘a slow burn’ that is detected by a rise in inflammatory markers – proteins produced by the immune system. High –sensitivity C reactive protein is such a protein, and your doctor or nurse-practitioner can order this test if needed. Obesity is a major cause of inflammation, along with gum disease, untreated infections with bacteria, parasites or viruses, smoking., and other factors.

Chronic inflammation is associated with coronary heart disease, by helping to build the plaque that narrows arteries and can lead to a heart attack. When the person is overweight and has high blood pressure, high blood sugar, and high triglycerides, the risk is greater.

Chronic inflammation has also been associated with a number of cancers, including stomach, colon, lung, esophagus, cervix and liver. The evidence that regular aspirin use reduces the risk of colon cancer is believed to be related to aspirin’s anti-inflammatory effects.

Inflammation has also been linked to Alzheimer’s disease – a Harvard study of people in their 70’s and 80’s showed that people with high levels of inflammatory markers were twice as likely to be diagnosed with Alzheimer’s than those with lower levels. Inflammation has also been linked to declining muscle strength with aging.

What helps prevent inflammation? Weight loss is the big factor here – along with regular, moderate exercise that will assist in weight loss. In a recent seminar at Commonweal (The New School at Commonweal, Bolinas, California) Dr. Jeanne Wallace and the chef, Rebecca Katz, discussed the foods that can reduce inflammation. I have my additions in italics.

*Increase your intake of fruits and vegetables to 8 servings a day. Have leafy green vegetables and cruciferous vegetables regularly (cabbage, broccoli, cauliflower, kale and many more). Eat pumpkin, butternut squash, yams and carrots.

*Eat cold-water fish, grass-fed animal foods, omega-3 eggs, walnuts, hemp, chia and flaxseed meal. I advise adding fish-oil capsules as a supplement. Read the label to make sure it is molecularly distilled to avoid mercury.

*Avoid foods with sugar and refined flours. This is a hard one for many people. Learn to treat yourself with dried or fresh fruit, and satisfy your between meal hunger with nuts, raw vegetables or an apple..

*Use spices liberally, especially curry, ginger, garlic, parsley and hot peppers.

*Use olive oil for cooking and salads.

*Eat dark chocolate -in moderation because of the sugar. I advise using fair-trade unsweetened cocoa powder, in hot chocolate sweetened with xylitol or stevia. Mash a banana and add some nut butter and cocoa powder for a sugar-free treat.

*Eat berries – blueberries, cherries, raspberries. These can be found frozen when their season is over.

*Eat legumes – lentils, peas, beans, dried beans. A Spanish study showed that obese men and women told to cut calories and eat four servings a week of legumes lost weight and lowered their C Reactive Protein levels, even after adjustment for the weight loss.

Since many of us have chronic inflammation without knowing it, and since it is related to such devastating problems as heart disease, cancer, Alzheimer’s and muscle loss, it is time to start paying attention to this condition. You can find all the slides of the talk by Wallace and Katz on line at The New School Commonweal, November 3rd, 2011, The Cancer-Fighting Kitchen. I plan to write more about their seminar in future columns.

Happy holidays to all. I suggest snacking on raw vegetables and nuts and avoiding that extremely hungry feeling followed by that overstuffed feeling. Remember what the Japanese say Hara hachi bu – eat until 80% full.
Sadja Greenwood MD – back issues on this blog

Sunday, October 30, 2011

Update on Coffee, Vitamin D, and your Brain

Coffee – Mood - MRSA! A recent Harvard study showed that over a 10 year study period, women who drank 2-4 cups of coffee a day had a 15-20% lower risk of depression than women drinking one cup a day or less. The researchers suggested that consistent use of caffeine may have long term effects on the brain, binding to receptors for brain chemicals associated with mood elevation.

A new study from the Medical University of South Carolina showed that hot tea or coffee may give a 50% reduction in the likelihood of carrying MRSA (methicillin- resistant Staphylococcus aureus) inside the nose. About 1.4% of over 5000 people tested carried MRSA in their noses.. MRSA can cause serious problems when the bacteria come in contact with an open skin wound, and in people with weakened immune systems. Compounds in hot tea and coffee seem to have volatile antimicrobial compounds that reach the nose in vapor form. Cold coffee and tea do not have this effect. More research is needed here, but the news is hopeful!

Vitamin D: Take your Vitamin D supplements with food – a study from the Cleveland Clinic showed that this fat soluble vitamin is better absorbed with the largest meal of the day, which is likely to contain the most fat.. New studies show that newborns low in Vitamin D are at higher risk of lung infections, breast cancer patients low in D may have more aggressive tumors, and people with low D levels are at higher risk of developing diabetes. If possible, have a blood test for 25-hydroxyvitamin D, and aim for a level of 40ng/ml or higher. As winter is coming, sun exposure will not boost your level at our latitude. Most people can safely supplement with 1000 IU of D daily, or more if deficient. .

Alzheimer’s Disease: An epidemiologic study from UCSF looked at data involving hundreds of thousands of participants from many countries. In the US, the biggest modifiable risk factors for dementia are – in descending order - physical inactivity, depression, smoking, mid-life hypertension, midlife obesity, low education and diabetes. These risk factors are associated with up to 54% of Alzheimer’s cases in the US. Researchers said that this data suggests that simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a big impact on preventing dementia. They caution that their conclusions are based on the assumption that there is a causal connection between each risk factor and Alzheimer’s, which is being investigated in various laboratories. Another study from the Neuroscience Center at the School of Medicine at Louisiana State University showed that DHA – a component of fish oil – is concentrated in the nervous system and plays a key role in vision, neuroprotection, successful aging and memory. It is anti-inflammatory and as such may help with pain, heart disease and many other ailments. DHA is believed to lower the risk of Alzheimer’s, macular degeneration in the eye, Parkinson’s disease and other brain disorders. Both DHA and EPA (a related omega-3 fatty acid) are found in coldwater fatty fish and fish oil, and both are essential for brain function. If you are not familiar with the benefits of fish oil, here’s a good website at the University of Maryland:

That’s it for this week – in summary – coffee can be really helpful as well as enjoyable in amounts that do not interfere with sleep; take your Vitamin D with a meal containing fat, and prevent dementia with a daily walk, not smoking, and taking fish oil.
Sadja Greenwood, MD, MPH

Sunday, September 25, 2011

News about Coffee

Positive news about caffeine and coffee is on the rise! Annia Galano, a Cuban chemist, recently published a paper suggesting that coffee is one of the richest sources of healthful antioxidants in the average person’s diet. It scavenges free radicals that can have damaging effects on the body. Here is a summary of recent research.

Cognitive decline: A study by French neuropsychologist Karen Ritchie found that women over age 65 who drank over three cups of coffee a day showed less cognitive decline over 4 years than those drinking one cup or less. No such relationship was found for men in this study. A study in mice at the University of South Florida found that caffeinated coffee increases a growth factor called GCSF (granulocyte colony stimulating factor) . GCSF improves memory performance in Alzheimer’s mice, acting to remove harmful beta-amyloid protein that initiates the disease. GCSF also creates new brain connections and increases the birth of new neurons. Decaf coffee and caffeine alone did not give this protection.

Heart disease: While coffee may increase blood pressure in certain people, it can also increase blood vessel elasticity. If your blood pressure is high, it is important to assess the effects of coffee with a home blood pressure cuff and a talk with your doctor. Researchers in the Netherlands found that people drinking 2-4 ups of coffee daily had a 20% lower risk of heart disease, and a slightly reduced risk of death from heart disease and all other causes.

Reduced stroke risk: A study from Sweden’s Karolinska Institute found that women who drank one or more cups of coffee a day had a 22% lower risk of stroke – both the kind from arterial blockage and from bleeding in the brain. Men were not included in this study, as the population of 35,000 women were in a mammography study.

Breast cancer risk: Another Swedish study showed that drinking coffee specifically reduces the risk of estrogen-receptor negative breast cancer. There has been speculation that the boiled coffee used by Swedes has more beneficial compounds against cancer than the filtered coffee preferred in this country, but this remains an unproven question. Boiled coffee can increase cholesterol levels.

Prostate cancer risk: A recent study from Harvard School of Public Health of 48,000 male health professionals showed that men who drink coffee (regular or decaf) had a lower risk of developing a lethal form of prostate cancer. Men consuming 6 or more cups daily had a 20% lower risk of developing any form of prostate cancer. They had a 60% lower risk of developing lethal prostate cancer. Drinking 1-3 cups daily was associated with a 30% lower risk of lethal prostate cancer. Additional studies of the mechanisms involved are underway.

Diabetes risk: Past studies have suggested that regular coffee drinking may reduce the risk of type 2 diabetes. At the University of Nagoya in Japan, lab mice commonly used to study diabetes were fed either water or coffee. Coffee consumption prevented the development of high blood sugar and improved insulin sensitivity. There were also beneficial changes in inflammation and fatty liver. Caffeine was felt to be the anti-diabetic compound. However, another recent study from Duke University found that in humans, caffeine can increase insulin resistance in people without diabetes , and produce an exaggerated blood glucose spike in diabetics after they eat carbohydrates. More research needed here.

Gout: A Harvard study of male health professionals looked at 46,000 men over age 40 with no history of gout. After controlling for risk factors for gout, they found that men who drank 4-5 cups of coffee daily had a 40% lower risk of gout, and those drinking 6 or more cups had a 59% lower risk. Decaf coffee showed a more modest lower risk. Tea drinking had no effect on gout, and factors other than caffeine were believed responsible for the benefit.

Coffee makes most users feel energetic, and for many people it is a great pleasure. However, the caffeine in coffee can be a big problem for people with irregular heart rhythms, insomniacs and children. These recent studies should help to clarify what to do with this amazing beverage. Consult your body and your medical history; use it wisely.
Sadja Greenwood, MD, MPH back issues on this blog

Saturday, September 17, 2011

Go to Health: News about Walnuts & Cranberries

Walnuts – Breast and Prostate Cancer:
Dr Elaine Hardman, at Marshall University School of Medicine in West Virginia, has been investigating diet and cancer for years. She noted that walnuts contain multiple ingredients that slow cancer growth, including omega-3 fatty acids, antioxidants, and phytosterols (healthy compounds in plants that are similar to cholesterol, and reduce cholesterol in humans). Hardman worked with mice that are genetically likely to develop breast cancer at high rates. She studied mice given walnuts during pregnancy through weaning, and then the pups were fed a walnut supplemented diet. These mice developed breast cancer at less than half the rate of a group on a typical lab-mouse diet. Additionally, the number of tumors and their sizes were smaller. Gene analysis showed that those on the walnut diet had different expression of genes associated with the breast cancers in mice and humans. The amount of walnuts fed to the rats would correspond to about 2 oz. daily in humans. One cup of walnut halves is about 3 1/2 ounces. Hardman also found that increases in omega-3 fatty acids did not fully account for the anti-cancer effect, and that tumor growth decreased when dietary vitamin E increased. Dietary vitamin E is found in nuts, sunflower seeds, spinach and other leafy vegetables, and many natural foods.

Dr. Paul Davis at UC Davis has studied the benefits of walnuts in mice genetically programmed to develop prostate cancer. When he compared 8 week pups given added walnuts to control pups given added soy oil, those in the walnut group had cancers 30-40% smaller. They also had reductions in several proteins that may increase cancer growth, including insulinlike growth factor-1. Davis said the amount of walnuts humans should eat to correspond to the mouse diet was about 2.4 ounces daily.

Walnuts also contribute to heart health, by decreasing LDL cholesterol, lowering the risk of clotting, and decreasing inflammation. Numerous studies have shown that they do not cause weight gain, but rather make people less hungry for other high-fat, sugary foods.

Cranberries- Blood vessel flexibility and infection prevention:
Researchers at Boston and Tufts Universities recently reported that people with heart disease (coronary artery disease) showed a decrease in the stiffness of the aorta after drinking double-strength cranberry juice. Blood vessel dilation and blood flow to the arms also improved, but in an uncontrolled pilot study. Subjects drank 16 ounces of a cranberry drink that was 54% cranberry juice daily. Authors of the study point out that the flavonoids in plant foods have multiple benefits. Flavonoids are plant pigments that that have anti-inflammatory, anti-microbial and anti-cancer activities. In the case of cranberries, the heart benefits are added to known anti-bacterial benefits. A recent study that looked at daily cranberry pills compared to antibiotics to prevent bladder infections in women. Those taking the antibiotic (Bactrim) had the fewest bladder infections, although the cranberry pills were also effective. However, women taking the antibiotic developed resistance to Bactrim and other antibiotics. Cranberries are believed to be helpful by preventing bacteria from sticking to the walls of the bladder and urethra and multiplying.

Rather than taking cranberry pills, it is probably better to drink the whole juice on a daily basis, for heart health (if you have narrowed arteries), or to prevent frequent bladder infections. Note – people on Coumadin should not drink cranberry juice without talking to their doctor – it can increase the risk of bleeding. For all other interested people, I suggest looking for an unsweetened cranberry concentrate, which you can usually find in health food stores. Mix it with water, add a little apple juice for sweetener or put it in your shake. Some people love its sour taste. Fall is coming, and whole cranberries will be in the market soon!
Sadja Greenwood, MD MPH back issues on this blog

Wednesday, August 31, 2011

Go to Health: the link between fiber, overweight and cancer

You may be confused, and skeptical, about the importance of a high fiber diet. The connection between dietary fiber and a reduced risk of colon cancer has been disputed because of conflicting studies and differing measurements of dietary fiber. However, according to the American Institute for Cancer Research (AICR – a non-profit that fosters research on diet and cancer), a diet high in whole grains, fruits, legumes and vegetables is valuable to reduce both overweight and several cancers. AICR looked at over 7,000 studies worldwide, finding evidence that whole grains in the diet do lower the risk of colorectal cancer. In a large prospective cohort study, subjects who ate the most whole grains had a 20% lower risk of colorectal cancer than those who ate the least.

As readers know – whole grains include minimally processed wheat, spelt (an ancient variety of wheat) oats, rye, corn, barley, millet, quinoa and amaranth. When buying these grains as bread, crackers or pasta, it is important to read the label, and make sure that your product does not contain a deceptive sprinkle of whole grain but is 100% what you are looking for - the whole grain.

Foods high in fiber are relatively low in energy density; they contribute to a feeling of fullness and reduce the risk of overweight. Here is another way that whole grains prevent disease. Overweight is related to an increased risk of several cancers, including colon, uterine, breast (in women post menopause), esophagus, pancreas, gall bladder, liver, and kidney.

A study from Tufts University showed that the distribution of body fat varied with whole and refined grain intake. Subjects with the highest intake of whole grains had the lowest amount of deep abdominal fat – known as visceral adipose tissue. Around our waists and in our buttocks and thighs, fat lies under our skins, which we can feel by pinching ourselves gently. This fat poses less of a problem in normal-weight people. However, visceral fat lies inside the abdominal cavity, packed in between the stomach, liver, intestines and kidneys. This visceral fat has been shown to be a risk factor for insulin resistance, type 2 diabetes, cardiovascular disease and a shorter life. Visceral fat is associated with chronic inflammation in the body, and higher insulin levels – both linked to an increased risk of cancer. It is also linked to higher total and LDL cholesterol, and lower HDL (good) cholesterol.

Obviously, fat in the diet is essential – for the absorption of vitamins A, D, E and K from foods, for essential fatty acids like omega-3s, for taste, satiety and maintenance of stored energy reserves. Healthy fat intake is good, but having excess amounts of visceral fat is dangerous.

Here’s advice from Harvard Medical School on how to reduce visceral fat.
*Regular moderate intensity physical exercise – 30 to 60 minutes a day. This would include brisk walking, biking, and gym workouts. Check with your MD or NP before beginning a program if you have not been active.
*Reduce portion size and emphasize whole grains and lean protein over white flour, rich desserts, sugary food and drinks, and alcohol.

It’s that simple – in theory at least – and such a program will work. Many people welcome the help of a program such as Weight Watchers or Overeaters Anonymous to get started and keep going.

Marion Nestle, a professor in the Department of Nutrition at New York University and the author of many books on food and food policy, has a daily blog which you may enjoy: She has short, humorous and cogent posts on the latest in food science, how to eat, and how to improve our food system.
Sadja Greenwood, MD, MPH – back issues on this blog

Saturday, August 13, 2011

Go to Health: Garlic

Garlic has been used by humans for over 4000 years; it originated as a wild plant in Central Asia and spread all over the world. It has been found in the tombs of Egyptian pharaohs dating back to 3200 B.C.E. Garlic is a rich source of organosulfur compounds, which are thought to be responsible for its aroma and flavor as well as its potential health benefits. Garlic has been found to inhibit bacteria, viruses and some types of fungus in the laboratory, but this has not been reliably shown in humans. Nevertheless, garlic supplements are among the best selling in the US today; I will try to explain the evidence behind its popularity as an herbal medicine. Its use in enhancing the flavor of food must be experienced: “and there was a cut of some roast…which was borne on Pegasus-wings of garlic beyond mundane speculation” C.S. Forester.

Heart Disease: Many randomized controlled trials have looked at the effect of garlic and garlic supplements on people with elevated cholesterol, LDL cholesterol and triglycerides. Some trials showed an improvement in 3 months, but no lasting effects by 6 months. However, most studies have shown that garlic supplements significantly decrease platelet clumping, which is a first step in the formation of blood clots. Because of this effect, people on blood thinners should talk to their doctors before taking garlic supplements. There is no solid evidence so far that garlic supplements reduce blood pressure or prevent the progression of plaque in the arteries, leading to heart attack or stroke. However, some studies do show benefits in these areas, and research continues.

Cancer of the stomach and colon: Studies from China, other Asian countries and Europe show that people eating raw or cooked garlic have a lower rate of cancers of the stomach, colon and rectum. However, the amount of garlic eaten, either raw or cooked, and the variable amount of vegetables also eaten made it difficult to be precise about rates of reduction, which were 30 to 50%. Aged garlic extract in high doses was also found to decrease the number of precancerous polyps in the colon. These are important benefits.

Effects of cooking: the organosulfur compounds that give garlic its beneficial effects can be inactivated by heat. The protective effects of garlic can be partially conserved by crushing or chopping garlic and letting it stand for 10 minutes before cooking. Powdered or dehydrated garlic is made from garlic cloves dried at low temperatures to prevent inactivation; the dried garlic is pulverized and made into tablets. The beneficial compounds vary greatly among commercial products – enteric coated tablets that pass the USP ‘allicin release test’ are likely to be the best. Garlic supplements are also made from fluid extracts, garlic oil and aged garlic extracts. In my opinion, the most beneficial way to use garlic for health and pleasure is to eat it raw in salad and cooked in many dishes. Follow the 10 minute rule for cooking – crush or chop garlic and let it stand for 10 minutes before cooking, to preserve its benefits.

Adverse Effects: Some people report gastrointestinal symptoms after eating garlic, some have allergic responses such as asthma, and some have skin rashes. Occasional cases of serious bleeding have been reported. However, these reactions are rare. For most of us, garlic is a strong, or subtle, delight.
There are many miracles in the world to be celebrated and, for me, garlic is the most deserving. Leo Buscaglia (the love doctor)
Sadja Greenwood, MD, MPH

Friday, July 29, 2011

Saving Health Care by taxing junk food?

IHOP Bacon ‘N Beef Cheeseburger has 1,250 calories, plus 620 for onion rings. The Cheesecake Factory Farmhouse Cheeseburger has 1,530 calories, 1900 with fries. A PB&C milkshake at Cold Stone has 2010 calories; it contains peanut butter, chocolate ice cream and milk, with 68 grams of saturated fat and 153 grams of sugar. Since the new health-care law mandates calorie count information on menus, starting in 2011, will this make a difference? Most fast-food chains now offer lower calorie choices – whether this is helping people make wiser choices is not yet clear.

As readers know, the ‘standard American diet’ (SAD) of fast food laden with sugar, fat and salt, is causing an epidemic of obesity, with resultant high rates of diabetes and its many complications. Mark Bittman, a well known food writer and New York Times columnist, analyzes the impact of taxing junk food on our health and health care costs in the July 24th edition of the NYTimes. His premise is that the food industry is interested in profits, not the public health, and that the federal government should establish a bold, national fix. Much of this column is based on Bittman’s ideas. I should add that I agree with him.

The Rudd Center for Food Policy and Obesity at Yale says that taxes become a significant force in changing buying habits for soda at about a penny an ounce. The average American consumes 44.7 gallons of sweetened sodas a year, and another 17 gallons of non-carbonated sweetened drinks. With a 20% tax in the price of sugary drinks, there would be an estimated 20% decrease in consumption, resulting in the prevention of obesity of 1,500,000 Americans (over 10 years) and 400,000 fewer cases of diabetes, saving about $30 billion dollars in health care costs. The money gained in taxes could be used to subsidize the purchase of staple foods like vegetables, whole grains, dried legumes and fruit. This is an essential part of the plan: making healthy foods available and affordable, bringing grocery stores into ‘food deserts’, teaching children and adults how to shop and cook, and supporting farmers markets and community gardens.

Soda taxes have been proposed in Philadelphia, San Francisco, and New York. France and Hungary are also proposing a tax on junk food, while Brazil is subsidizing produce for the poor in its ‘Zero Hunger ‘ program. The idea is gaining ground.

Currently, instead of taxing junk food, we are paying – with tax dollars - to support corn farmers whose corn is made into high-fructose corn syrup – used to sweeten soda! So far, efforts to change what Americans eat through education and persuasion have failed, partly due to the 4 billion spent annually on advertising by the fast-food industry. Bittman says that 86% of food ads seen by children are for foods high in sugar, fat and sodium. The percentage of obese children has tripled in the last 30 years, and of obese adults has more than doubled.

Efforts to tax certain foods will be opposed by those decrying the ’nanny -state’. However, we are faced with a health crisis with serious budgetary implications. Public health regulations have been very successful in other areas.
We now tax cigarettes over $2 per pack – a combination of state and federal excise taxes – and the US smoking rate has fallen from 40% to 20%. Although over 400,000 people still die each year from tobacco, the toll was twice as high before taxation. We have government mandates for seat belts and children’s safety car seats in most states, which are estimated to save over 15,000 lives each year. Government regulation of drinking water and food safety, driving speeds, and building codes have saved countless lives and reduced health care costs.

Here in West Marin we are tremendously lucky to have organic farmers, farmers’ markets and healthy produce. We also have great tasting water. We should all thank our farmers, eat more produce and drink fewer calories, whether it’s soda, sweetened bottled tea, or beer. OK, beer drinkers, I said less, not none! And – support a tax on sweetened soda if it comes around, as it will reduce your health care costs.
Sadja Greenwood, MD, MPH back issues on this blog

Saturday, July 2, 2011

Turmeric - an ancient spice with exciting modern research

Turmeric has been gathered and cultivated in India for over 2500 years, used as an orange dye, a medicinal plant and a spice in curry. Today there is renewed interest in turmeric and its main ingredient curcumin for their potential activity against cancer, Alzheimer’s disease, arthritis and many other health problems.

At the University of Texas MD Anderson Cancer Center, Dr. Bharat Aggarwal is studying curcumin. Aggarwal, a biochemist and molecular biologist, considers turmeric to offer great promise for health. He says that the combined rate of the four most common cancers in the United States—lung, prostate, breast, and colon—is much lower in India, where turmeric (in curry) is a staple in the diet. Aggarwal is studying the ability of curcumin to shut down nuclear factor kappa B (NF-kB), which is involved in the regulation of inflammation and many other processes. By blocking the activity of this ‘master switch’, curcumin appears to interfere with the cancer process at an early point, impeding multiple routes of growth: reducing the inflammatory response, inhibiting the proliferation of tumor cells, inducing their self-destruction, and discouraging the growth of blood vessels feeding tumors. These effects can shrink tumors and inhibit metastasis. Also, shutting down NF-kB can enable chemotherapy drugs to destroy cancer cells more effectively. Research on curcumin and various cancer types is still preliminary, and laboratory based; there have been few human trials. It would be unwise to stop cancer chemotherapy to take curcumin, however some oncologists are interested in curcumin as a supplement. People under treatment for cancer should confer with their oncologist, as curcumin may alter the efficacy of chemotherapy drugs. A detailed discussion of curcumin used in cancer can be found at Dr. Aggarwal’s website

Alzheimer’s Disease: Based on the finding that there is 4 times less Alzheimer’s disease in India than in the US (turmeric is used as a daily spice in Indian curries), researchers at UCLA are studying the ability of synthetic curcumin and Vitamin D to clear the amyloid plaques found in the brains of people with Alzheimer’s. Laboratory experiments have shown that blood cells called macrophages are able to destroy amyloid plaque when incubated with Vitamin D and a form of synthetic curcumin. Studies using Vitamin D and curcumin in human patients are underway at UCLA, USC and various universities in India. At present, there is no recommended dose of curcumin for treatment or prevention.

Since curcumin is anti-inflammatory, it is being tried in the treatment of rheumatoid arthritis, with trials at UCLA. Osteoarthritis may also be helped, according to a trial at Western Ontario and McMaster Universities, where researchers used a mixture of curcumin and soy phospholipids, called Meriva. At the University of Arizona, there is a study on curcumin’s ability to prevent bone loss in mid-life women.

Inflammatory Bowel Disease: Both Crohn’s Disease and ulcerative colitis can result in abdominal pain, diarrhea, weight loss and fatigue, and often strike children or young adults. At the U. of Arizona there are studies showing that daily curcumin pills were able to decrease intestinal damage and cut the number of relapses by 50%. The researchers stressed that curcumin should not replace standard therapies.

Cautions: Curcumin is safe, but should not be used in pregnancy or in people with gall bladder disease because it stimulates bile secretion and gallbladder contractions. Most people, however, can try curcumin supplements, which are better absorbed if combined with pepperine (black pepper). If you look at the recent book by Dr. Aggarwal, Healing Spices, you will find more information on turmeric as well as ways to make your own curries.
Sadja Greenwood MD, MPH –back issues on this blog

Sunday, June 5, 2011

HarvestPlus and the world food crisis

Rising temperatures, droughts and floods are causing agronomists and country leaders great concern. Food staples, such as wheat, corn, rice, and soybeans may not be reliably harvested in the amounts needed for a growing world population. Climate change is considered a significant reason for the problems with crops.

Micronutrients: Beyond rising prices for staple grains, poor people in developing countries are affected by a lack of essential micronutrients in the diet. The World Health Organization has identified iron, zinc and vitamin A as the most limiting elements. Lack of these in a diet of rice or cassava can lead to blindness, stunting and susceptibility to infectious disease. More than 2 billion people in developing countries may have ’hidden hunger’ for essential micronutrients, as they subsist on staple foods (maize, wheat and rice) but have little access to fruits, vegetables, and protein foods. Lack of vitamin A causes about half a million children to go blind every year. Zinc deficiency impairs brain and motor functions; shortage of iron causes anemia and weakness, and affects half the women of childbearing age in some poor countries. A supplement program to provide these nutrients is not affordable or feasible. Policymakers are now asking whether farming could do more to improve nutrition.

HarvestPlus, funded by the Bill and Melinda Gates Foundation and other donors, is working to reduce hidden hunger and provide micronutrients to people directly through the familiar, staple foods they eat. At this point they are using mainly conventional breeding techniques, rather than genetic engineering, to select plants high in iron, zinc and the carotenes that become vitamin A in the body. Their work on developing ’biofortified’ crops is done in collaboration with more than 200 agricultural and nutrition scientists around the world. Biofortification programs are active in China, India, Bangladesh, Latin America and Africa. They are working on cowpeas (a drought tolerant, warm-weather legume, well adapted to drier regions of the tropics), other beans, rice, corn, pearl millet, wheat, sweet potatoes, and cassava. Once biofortified crops are developed, they can be distributed and grown by farmers, year after year, by seed saving.

The traditional sweet potatoes used in Africa and Latin America are light in color and lacking in the needed carotenes that will become vitamin A in the body. Biofortified sweet potatoes, orange in color, have been bred and used in Uganda and Mozambique. Getting people to accept a different looking food item takes planning and education, and is becoming successful. Pearl millet high in zinc and iron will be introduced in India in 2012. Wheat high in zinc will be introduced in India and Pakistan in 2013. Beans high in iron will be tried in Ruanda, cassava high in provitamin A in Nigeria and maize high in provitamin A in Zambia.

World Population: There were 3 billion of us in 1960, and close to 7 billion at present. Food production rose during those years, so that people in developed countries had plenty to eat. In poor countries there could have been adequate calories if distribution had been improved. In many cases, however, crops for export to rich countries used land at the expense of food for the local poor.

In recent years the impact of climate change has raised fears of increasing food scarcity. Crops that can grow despite rising temperatures, drought, and flooding are needed. Arable land is potentially in short supply due to development. We are facing difficult times on this earth, and many are wondering what to do about the challenges. Here are some suggestions:

*Get involved in food politics in the US. See Marion Nestle’s blog, Food Politics, and Healthy Food Action, which will work to improve the 2012 farm bill.

*Support your local food bank.

*Support family planning nationally and internationally, by contributing to Planned Parenthood, the International Planned Parenthood Federation, or other family planning organizations

*Support HarvestPlus. The Gates Foundation can’t do it all!

Sadja Greenwood, MD, MPH back issues on this blog

Monday, May 30, 2011

Beets and Green Vegetables Relax Your Arteries

A recent conference on Nutrition and Health, sponsored by the University of Arizona, contained many useful ideas for everyday life. The problems with sugar, in last week’s column, were on the menu. Here is another topic.

Beets and Greens: These foods contain nitrates, which used to be considered harmful because of serious health problems when infants drank contaminated well water. However, it was found that the main problem was fecal bacteria in the wells, rather than excess nitrates. In the 1970’s, researchers found that dietary nitrates (NO3) are converted into nitric oxide (NO), in the presence of L-arginine (an amino acid) and oxygen. NO is an important ‘signaling molecule’ in the body, diffusing rapidly – as it is a gas – across cell membranes. It causes relaxation of the smooth muscles that line blood vessels, resulting in lower blood pressure and increased blood flow. Nitroglycerine works to lessen the pain of angina (chest pain resulting from lack of oxygen for the heart muscle) by its conversion to NO. Viagra works to simulate penile erection by the release of NO. The production of NO is elevated in people living in high altitudes, which helps them get more oxygen by dilation of the blood vessels in their lungs. NO transmits messages between nerve cells and is associated with memory, learning, sleeping, feeling pain, and depression.

Researchers at Wake Forest University studied volunteers over age 70 given a diet containing beet juice and high nitrate vegetables. The subjects were found to have increased blood flow to their brains, potentially helping to avoid dementia. Studies on beet juice, at the University of Exeter, found it enables people to exercise up to 16% longer. The amount of nitrate in studies on athletes was the equivalent of what is found in 2-3 red beets or a plate of spinach. Other vegetables high in nitrates are kale, lettuce, parsley, cabbage, celery, radishes and turnips.

People with high blood pressure may be interested to know that the DASH Diet (Dietary Approach to Stop Hypertension) may owe at least some of its effectiveness to an emphasis on green leafy vegetables. For those who want quick results without cooking, beet juice is available on line. Mix it with soda water or plain water, and start with a little at a time. A few people don’t feel well after drinking beet juice.

The Dash Diet This diet, which has been shown to be effective in lowering blood pressure, can work surprisingly well within two weeks. DASH is described on line at the WebMD site and also in the book – The DASH Diet Action Plan – based on the National Institutes of Health Research. This book has great reviews, and should be read by anyone who is serious about reducing blood pressure and possibly getting off of blood pressure medications. Of course, it is important to talk to your doctor about changing your medicines. For those who want to start the eating plan right away, here it is. Eat more vegetables, fruits and low or non-fat dairy foods. Eat less red meat, processed meat, sweets and foods high in fat. Eat more whole grains, fish, and poultry. Read labels carefully, and avoid foods high in salt. For snacks, try unsalted popcorn (avoid the buckets in movies!), unsalted nuts of all kinds, raisins, and low or non-fat yogurt. Don’t forget that the nitric oxide (NO) in green vegetables and beets will rapidly go to work for you, by relaxing your arteries, increasing blood flow, and lowering your blood pressure. And, of course, there’s moving the body, which is also good for you, your arteries and your blood pressure. See you on the trails!
Sadja Greenwood, MD, MPH

Tuesday, May 17, 2011

Go to Health: “Fructose is alcohol without the buzz”

So says Dr. Robert Lustig, Professor of Pediatric Endocrinology and director of the children’s obesity program at UCSF. His talk – Sugar: The Bitter Truth – has been watched over a million times on Youtube; I will try to summarize his points in this column.

The obesity epidemic in the US has been growing steadily since the public was told in the 1980s to decrease fats in their diet. The introduction of low-fat processed foods, laden with sugars for palatability, and devoid of fiber, laid the groundwork for our weight gain. Roughly half of teenage boys drink more than two six-packs of soft drinks every week. Today, one in 50 adults is severely obese (with a BMI of 40 or higher) and 34% of us are obese (BMI 30 or higher). The share of obese children has tripled in that time, to 17%. This is more than double the percentages of 30 years ago. Someone whose height is 5’6” is obese at 186 pounds; a 6’ person is obese at 221 pounds.

Understanding sucrose, glucose, fructose and starch: Sucrose is derived from sugar cane and sugar beets. It is 50% glucose and 50% fructose. High fructose corn syrup is 55% fructose and 45% glucose. From the point of view of the liver, they are about the same – neither is good for us. The fructose in whole fruit is fine, because it is encased in fiber, which slows its absorption. Whole fruits also have many beneficial compounds for health. Starch is a complex carbohydrate, made up of joined glucose molecules, used by many plants for energy storage. Our digestion easily breaks down most starch to glucose.

Glucose digestion: When we eat plants, from cabbage to potatoes, we break down their starch to glucose; this travels in the bloodstream to all our body cells for energy use. About a quarter of the glucose goes to the liver, where it makes glycogen – a useful and necessary storage compound for energy. A small amount is translated into fat.

Fructose digestion: When we eat or drink sugar (sucrose) or high fructose corn syrup (HFCS), the 50% or 55% that is fructose goes to the liver, as only the liver can metabolize it. This is in contrast to glucose, used by all our body’s cells. Some fructose is broken down into uric acid and excreted by the kidneys. Uric acid increases the risk of gout, and also elevates blood pressure. Much of it is metabolized to fat, leading to a problem called non-alcoholic fatty liver – rarely if ever seen before the recent sugar craze. Some of it goes into the blood stream as triglycerides, which become fat. As triglycerides rise, and body fat increases, cells become resistant to insulin. Insulin, produced by the pancreas, causes cells in the liver, muscle and fat to take up glucose from the blood, for energy production and storage. When blood glucose rises, due to the cells’ insulin resistance, diabetes results. A diet high in fructose also is associated with ‘leptin resistance’ – the body does not respond to the hormone called leptin that cuts off appetite. The eater keeps on eating.

Alcohol digestion: Alcohol is fermented sugar. When it enters the liver, it is digested in a way that is similar to fructose, resulting in high blood pressure, fat deposition in the liver (ultimately cirrhosis) and increased triglycerides in the bloodstream. Alcohol also leads to obesity (beer belly), insulin resistance and possible addiction. A small amount of alcohol, especially as red wine, is heart-healthy (1 five ounce glass for women, 2 for men). However, even small amounts of alcohol raise women’s risk for breast cancer.

What to do!
Here is the formula that Dr. Lustig gives to the families with children in his obesity clinic: He says it works – they lose weight – if they can follow it and stay off of soda.
1.Only drink water or plain milk
2.Eat carbohydrates with their natural fiber.
3.Wait 20 minutes before seconds.
4.Buy screen time minute for minute with physical activity. Screen time includes TV, DVDs, computer games, et al.
Look at 2 in this table. This would mean avoiding all foods made with sugar – cakes, cookies, pies, candy, ice cream, jam, syrup, the works. These foods were occasional treats one hundred years ago, and now they are everywhere, and often cheaper than real food. It also means eating whole grain pasta, 100% whole grain bread, and brown rice. Even Dr Lustig admits to an occasional dessert, and lets his kids eat ice cream on Sunday (according to another Youtube video). However, he still labels sugar a ‘toxin’ and would like FDA regulation. Others are calling for a tax on high-sugar soft drinks, which would decrease use and help pay for health care reform. Stay tuned for a discussion of this proposal. In the meantime – opt for water, unsweetened coffee and tea, and an orange for dessert!
Sadja Greenwood, MD, MPH back issues on this blog

Sunday, May 8, 2011

Go to Health – Cinnamon

This common and amazing spice was first grown in Ceylon (Sri Lanka) and was imported to Egypt, the Mediterranean world and Europe as early as 2000 BCE. Spices like cinnamon, that we take for granted, were great luxuries in times past; they were used for flavoring, to prevent food spoilage, and for treating many ailments. Cinnamon was found to inhibit bacterial growth in stored food, which was very useful before the days of refrigeration.

Blood Sugar lowering: Currently, the interest in cinnamon centers on its role in lowering blood sugar. A study in normal subjects from the University of Lund in Sweden showed that adding cinnamon to a meal significantly lowered blood sugar an hour later, and also delayed stomach emptying. A study from the Beltsville Human Nutrition Research Center (US Department of Agriculture) on men and women with type 2 diabetes showed that cinnamon (given as 1, 3, or 6 grams daily in capsules) significantly reduced fasting blood sugar, LDL cholesterol, total cholesterol, and triglycerides. This is important, as people with type 2 diabetes have an increased risk of heart disease and stroke. The results from 1 gram of cinnamon were effective, and this amounts to about 1/5th teaspoon per day. Cinnamon had a sustained effect on levels of blood sugars and fats, even if not consumed every day. The authors of this study note that a number of other herbs have been reported to yield blood-sugar lowering effects in patients with diabetes: bitter melon, Gymnema (see below), Korean ginseng, onions, garlic, and flaxseed meal. The authors write that cinnamon may work by increasing glucose uptake by cells and activating the synthesis of glycogen ( a normal storage compound for glucose). Also, cinnamon is believed to stimulate cell receptors for insulin.

Gymnema sylvestris is an herb from India where it has been used to treat diabetes since before modern medicine. It curbs sugar cravings, and may also stimulate insulin secretion. It is available in the U.S. (online and in some natural food stores) as a supplement. Not enough is known about its side effects and dosage levels, so people who use it should work with their health-care practitioner. It should not be used in pregnancy or at the time of any surgery.

Polycystic Ovary Syndrome is a disorder associated with infertility in women, who also have multiple cysts on their ovaries, elevated glucose, weight problems, excess body hair and menstrual irregularities. A study was published in 2007 from Columbia University showing that oral cinnamon (1 gram daily) improved their glucose levels. More studies are underway using cinnamon for this condition.

Brain chemistry: A professor of psychology at Ohio Northern University found that students scored higher on attention, memory and visual-motor response speed when smelling cinnamon or chewing cinnamon-flavored gum.

How much is enough? There is concern that a substance called coumarin in cinnamon may be toxic to the liver in certain sensitive individuals. Liver damage is reversible if cinnamon is stopped. Since the genetics of this potential problem is not worked out, it is prudent to use cinnamon as a spice rather than in large doses. People with diabetes should talk to their doctors or nurse practitioners about using 1/5th teaspoon a day on oatmeal, baked apples or other foods, in case their need for medications decrease. Other people can continue to use cinnamon sensibly on favorite dishes and enjoy the wonderful flavor of this spice.

I have enjoyed reading Healing Spices by Bharat B. Aggarwal as a takeoff for this column on cinnamon. Aggarwal is a molecular biologist and cancer researcher at the M.D. Anderson Cancer Center of the University of Texas in Houston. Look for a wonderful collection of spices at the Bolinas People’s Store, or at most natural food stores. Leave me a comment, or a question!
Sadja Greenwood, MD, MPH back issues on this blog.

Monday, May 2, 2011

Phthalates – what are they & how to avoid them

Phthalates are a class of chemicals added to plastics to increase their flexibility and durability. About a billion pounds per year are produced worldwide. They are found in the enteric coating of pills and supplements, in adhesives and glues, personal care products, medical devices, detergents, paints, printing inks, shower curtains, vinyl upholstery, car interiors and many other plastic products. They easily diffuse into the environment as plastics age. We all have phthalates in our bodies – from our diet, skin exposure (from personal care products) general environmental contamination and inhalation. Cheese, butter and meats are a source of phthalates in food, in part from plastic packaging.

Shana Swan at the University of Rochester School of Medicine has studied the exposure of pregnant women to phthalates. She has written that most findings concern male children, where she found a correlation between a shortened distance between the anus and penis, and a smaller penis size with higher concentration of phthalates in the mother’s urine during pregnancy. These measurements may indicate an anti-androgen effect of phthalates, which was also found in some experimental animals. Swan writes that sensitive biomarkers to assay human phthalate exposure have been available for a short time (10-11years), so that the long term effects may not yet be known. The necessary epidemiological studies are expensive and slow, so that animal studies and small human studies will be necessary. Results from these are controversial. Some recent studies have found correlations between low sperm counts and phthalate levels in men. . Studies on early puberty in girls have not reliably shown a correlation with phthalates at this point.

Studies on phthalate levels in pregnant women and their babies/children have been done in several universities. Women exposed to phthalates and pesticides in the workplace are more likely to take six or more months to conceive and to have lower birth-weight babies, according to a recent study at Erasmus Medical College in Rotterdam. Researchers at Mt Sinai (NYC), Cornell and the US Centers for Disease Control found that higher prenatal exposure to phthalates was connected to disruptive and problem behaviors in children ages 4-9. Behaviors included aggressiveness, and ADHD.

What you can do
Lowering exposure to phthalates is prudent, and especially important if you are pregnant or care for children. Body-care products containing phthalates are a source of exposure for infants. Read the ingredients whenever you buy a product: avoid personal care products (hair products, nail polish, deodorants, perfumes, lotions, etc) with DBP, DEP, BzBP. Be aware that the term ‘fragrance’ can mean that phthalates are present. This may mean a serious change in your use of body-care products and cosmetics. You can find safer cosmetics of all kinds at the website of the Environmental Working Group:

DEHP is used in PVC plastics. DMP is in insect repellents. Choose plastics with the recycling code 1,2 or 5. Codes 3, 6 and 7 may contain bisphenol A or phthalates. Parents should not buy soft plastic PVC toys for children. California has a law – signed by Governor Schwarzenegger – that bans products containing more than 0.1% phthalates from toys as well as baby bottles and other items that children can put in their mouths.

Something positive!
After reading about the widespread nature of phthalates in our environment, as well as bisphenol A, you are probably ready for some better news. Dr. B.B. Aggarwal, a cancer researcher at the University of Texas MD Anderson Cancer Center, has written a new book called Healing Spices in which he brings together ancient traditional medicine and modern medical research to show how herbs and spices can promote healing and health. I will report on his findings in subsequent columns. In the meantime, know that he has a chapter on cocoa and chocolate, and is also a strong proponent of turmeric. See his website – Curcumin – The Indian Solid Gold, and prepare to be surprised at the science on the actions of curcumin against cancer and other diseases. Curcumin is the active agent in turmeric. Make some curry for dinner!
Sadja Greenwood, MD, MPH – back issues on this blog

Friday, April 22, 2011

Go to Health: More on Brassica Vegetables aka Cruciferous

This genus of plants contains more plants for human consumption than any other. You can think of them as roots: radishes, rutabaga, turnips, daikon, as stems: kohlrabi, as leaves: cabbage, kale, collards, bok choy, Brussels sprouts, arugula, cress, as flowers: cauliflower, broccoli, and as seeds: mustard seed and oil producing rapeseed (canola). Wasabi is also a brassica.

There are numerous beneficial compounds in these plants. Besides vitamins, carotenes and fiber, they contain nutrients with anti-cancer properties – the most promising one being sulforaphane.

Plants in the genus brassica produce sulforaphane (SGS) to defend against insect predators. Researchers at Johns Hopkins found that SGS is especially high in broccoli sprouts. SGS is an ‘indirect antioxidant’ that eliminates many types of free radicals before they can harm cells, and cycles over and over again, triggering a long lasting process. It stimulates other natural antioxidants, such as glutathione, the body’s most abundant antioxidant. Studies from the University of Michigan found that SGS, from broccoli, inhibits breast cancer stem cells in mice and cell cultures, and prevents new tumors from growing. Studies are also ongoing on protection against ovarian and prostate cancer. There is preliminary work on the ability of SGS to protect against skin cancer, ulcer-producing bacteria in the stomach (helicobacter pylori) and inflammation of blood vessels in the heart.
The researchers at Johns Hopkins have established a company that sells regular or decaf green or black tea with SGS – it is available from the Baltimore Coffee and Tea Company at 800-823-1408. You can also make home-grown broccoli sprouts – organic broccoli seed for sprouting is available by calling 800-695-2241. If you want some help in making broccoli sprouts at home, watch “how to grow broccoli sprouts with your homemade sprouter” on You Tube. The best way to prepare regular broccoli to maximize SGS is to steam it lightly for 3-4 minutes- until it is tough-tender.

There is a downside to brassica vegetables – eaten in high amounts they can interfere with the formation of thyroid hormone, and induce goiter formation. So – include them in your diet, especially if you are a cancer survivor, but eat a lot of other vegetables and fruits as well.

Dietary spices – These include onions, garlic, ginger, cloves, cinnamon, cardamom, mint, all Indian curry ingredients, all Italian herbs etc. These and other spices/herbs have been studied at MD Anderson Cancer Center at the University of Texas for their many roles in preventing cancer. There is interesting science here. Include them in your diet every day. I will be writing more details about these ‘nutraceuticals’.

Sadja Greenwood, MD, MPH see back issues on this blog

Friday, April 1, 2011

Bisphenol A (BPA): What you should know

BPA is one of the most commonly manufactured chemicals in the world. It is a component of polycarbonate plastic and is found in a wide range of common materials and food packaging. It has been known for many years that BPA has estrogenic properties; its effects on the reproductive systems of animals -fish, amphibians and mammals - have raised concern for humans. The chemical has been called an endocrine disrupter, which can mimic the body’s own hormones and lead to negative health effects. Animal studies (those unfortunate mice and rats) have suggested effects of BPA on the brain, breast, prostate, thyroid, obesity, sexual behavior et al. Some studies suggest an increased risk for breast and prostate cancer. Newborns and children may be specially affected by environmental BPA levels, due to their reduced capacity to eliminate the substance and their higher daily exposure, adjusted for weight. A study from Rockefeller University on primates in 2008 showed that even at relatively low exposure levels, BPA abolishes the ability of spinal synapses to respond to estrogen, which may play a critical role in cognition and mood. An English study published in the JAMA (University of Exeter - 2008) showed that higher levels of BPA in the urine of US adults correlated with cardiovascular disease, diabetes and abnormal liver enzyme levels. A study carried out by the Division of Research at Kaiser in Oakland showed that male workers in China with high occupational exposure to BPA had a significantly higher risk of lowered sexual desire, erectile dysfunction and difficulty ejaculating. This study is obviously important to men, and a motivator for youth to avoid exposure as much as possible. I have cited only a few examples of research on BPA that suggest negative health effects on humans and animals. While studies abound, our response in the US has been painfully slow.

Canada announced its intent to ban the import and sale of polycarbonate baby bottles containing BPA in 2008. Walmart announced soon thereafter that it would stop selling food containers, water and baby bottles, sippy cups and pacifiers containing BPA at its Canadian stores. In 2010, Canada declared BPA to be a toxic substance and is proceeding to decrease its use overall. European countries have been slower to act. But the European Union executive commission plans to stop the manufacturing of polycarbonate baby bottles containing BPA by June, 2011. Minnesota, Chicago, Connecticut, Massachusetts and Maine have taken steps to ban products containing BPA from baby food containers and other products. However, in 2009, California’s EPA unanimously voted against placing BPA on the state’s list of chemicals that are believed to cause reproductive harm.

What you can do
1) Shop wisely: BPA is found in the internal coating of food and beverage metal cans to protect the food from the metal. Choose fresh or frozen foods over canned whenever possible. Eden Organic has eliminated the use of BPA in their canned and packaged food, and Muir Glen organic tomato products will be BPA free this year. These products are available at natural food markets.
2) In your kitchen: If you feed your baby from a bottle, use glass, and avoid plastic pacifiers and cups. Don’t microwave food in plastic containers, and store leftovers in glass or ceramic containers. Carry extra water in a stainless steel or glass bottle. Nalgene is now selling plastic water bottles made of copolyester , with non-BPA materials. Hikers will want to have a light-weight water bottle, but more research may be needed on the long term safety of these new materials.
3) Go to the website of and sign their petition asking President Obama to eliminate the use of potentially cancer-causing chemicals in our environment, including BPA
4) Ask our assemblymember, Jared Huffman, to work on banning BPA containing products in California. Mention the 2009 California EPA vote when you call or write. Huffman is an environmentalist – 479-4920. Contact Governor Jerry Brown while you are at it: 916-445-2841. Go citizens!
Sadja Greenwood MD, MPH back issues on this blog

Thursday, March 17, 2011

Go to Health: The 2012 Farm Bill: What you can do

Every five years, Congress writes a Farm Bill that establishes our nation’s food and agricultural policies. The 2012 Farm Bill will cost approximately 300 billion. It’s largest slice, the Nutrition Title, governs foods bought by those on food stamp assistance. Currently, farm policy has driven down the price of commodities such as corn and soybeans, resulting in lower prices for high fructose corn syrup and soybean oils. Our consumption of unhealthy foods made with these substances has increased. At the same time we have grown and eaten fewer vegetables and fruits; their production has not been subsidized, and their prices have increased over the years.

Many organizations interested in local food production, water and soil quality, and the health of our population are working on changing the way we support farmers. A prestigious group of nutrition experts, including Walter Willett of the Harvard School of Public Health, Marion Nestle at New York University and Andrew Weil, have written a charter for a healthy farm bill, which concerned citizens are urged to sign. The charter calls for a new food system that is:
*healthy – accounting for health impacts on farmers, workers in food industries, and eaters
*sustainable – protecting natural resources and biodiversity
*resilient – overcoming challenges of climate change, pest resistance, and problems with expensive water and energy
*fair – providing fair access to affordable and healthy food, and fair conditions for farmers, workers, and eaters
*economically balanced – providing economic opportunity across the nation’s states, for a diverse range of farmers and workers , from local to global in scale
*transparent – farmers, workers and eaters should be able to participate in decision making on food production distribution, marketing, and disposal.

You can sign the Charter for a Healthy Farm Bill by going to the website of There will undoubtedly be more discussion and controversy than ever before as the new farm bill is debated and written. Energized and informed people (you are probably one of these!) confront a system that has given rise to overproduction of foods for animal feed and underproduction of healthy vegetables and fruits, and a national health crisis. This column will continue to discuss the new Farm Bill in coming months.

While you are at the website for, you can also sign a petition asking President Obama to set the course for a new cancer prevention strategy, by eliminating the use of potentially cancer-causing chemicals in our food and environment, such as Bisphenol-A (BPA) and Dioxin.

BPA is a compound used to make polycarbonate plastics and epoxy resins.. BPA is known as an ‘endocrine disrupter’ because of its estrogenic properties and possible effects on fetuses and young children. It has been found in the internal coating of food and beverage metal cans to protect the food from direct contact with metal. It is also found in polycarbonate bottles. Eden Foods has eliminated the use of BPA in their canned and packaged foods, and Muir Glen organic tomato products will be BPA free this year. You can find foods from Eden and Muir Glen at many natural food stores.

Dioxins are chemicals that enter the atmosphere as by-products of the bleaching of paper pulp, chemical and pesticide manufacture, and burning of trash. The defoliant Agent Orange, used by the US in the Vietnam war, contained dioxin. Stay tuned for a more complete discussion of BPA, Dioxin and other chemicals in my forthcoming columns. You will be pleased to know that Bolinas citizen Sharyle Patton, working at the Biomonitoring Resource Center and the Collaborative on Health and the Environment at Commonweal, is a world expert on the chemicals in our environment and their effects on our bodies. Her research is having an important impact on policy in many countries.
Sadja Greenwood, MD back issues on this blog

Monday, February 21, 2011

Go to Health: Strategies that work for weight loss

Researchers at Brown Medical School and the University of Colorado have established the National Weight Control Registry to follow people who have successfully lost 30 pounds or more and have kept it off for long periods of time. These people’s approaches are diverse and inspiring. Given the obesity epidemic among adults and children in the US, with an associated rise in diabetes and health care costs, the subject is important for all of us. Here are some salient findings from people who joined the registry:
*Weight losses range from 30 to 300 pounds.
*Duration of successful loss: 1-66 yrs.
*Some lost weight rapidly, others very slowly – over as many as 14 years.
*55% lost weight with the help of a program or support group.
*98% modified their food intake
*94% increased physical activity, most frequently by walking.
*78% eat breakfast every day
*75% weigh themselves at least once a week
*62% watch less than 10 hours of TV per week
*90% exercise about 1 hour a day

Mayo Clinic on Weight Loss: Here are some ideas from the Mayo Clinic Diet Book, which is sensible and pays attention to motivation as well as food and exercise. Permanent weight loss takes time and effort, and is a lifelong commitment. Address the other stresses in your life, so that you can focus on changing your habits. Find your inner motivation – looking better, or getting healthier. Pick people to support you in positive ways. Set realistic goals, such as losing 1-2 pounds a week, or walking at least 30 minutes a day. Enjoy healthier food – fruits, vegetables, whole grains, olive oil, nut butters, low-fat dairy products. Cut back on sugars, and limit meat consumption. Stay physically active. Work out a way to gradually change the habits and attitudes that have sabotaged your past efforts.

Childhood Obesity: 20% of children are now overweight or obese, mainly due to lack of physical activity and unhealthy eating patterns. Michelle Obama has put forth an action plan – “Let’s Move” to solve the problem of childhood obesity within a generation. Her plan includes getting parents more informed about nutrition and exercise, improving the quality of food in schools, making healthy foods more accessible in poor neighborhoods, and focusing on physical education. The American Academy of Pediatrics recommends that children under 2 not watch any TV, and those older than 2 watch no more than 1-2 hours a day of quality programming. Children who consistently watch more TV and computer screens – including computer games - are more likely to be overweight. Here are some other tips for parents to keep their children healthy and slim: don’t drink soda, and don’t have it at home. Keep kid-friendly snacks in the house: fruit, nuts, low fat yogurt, nut butters, whole grain bread and pre-cut vegetables. Avoid storing cakes, chips, full-fat cheese, white crackers and most lunch-meats. Make healthier versions of favorite recipes, like cookies and pizza. Be active together – get everyone out for a bike ride or hike. Don’t make it about losing weight; make it about being healthy. Be a good example!

Sleep: getting too little sleep adds to weight gain in children and adults. The relationship in children is strongest, and may be related to disrupted levels of the hormones – gherlin and leptin – that regulate hunger. Sleep deficits also elevate levels of cortisol from the adrenal glands, raising blood sugar levels. Catching up on lost sleep on weekends is not as effective as maintaining a consistent pattern of sleep. If you are working on weight control, regular and adequate sleep will help you.

Some Extra Exercise Ideas: Get a pedometer in order to measure your steps every day, and slowly increase your walking. I recommend a Digi-walker SW - 200, available on-line. Put bricks under your desk, so that the top is at elbow height. You then have a standing desk – used by Benjamin Franklin and Thomas Jefferson among other enlightenment thinkers. Standing will increase your strength as you work on your computer, or pay bills, or write your poems. Put a stationary bike or other exercise equipment in front of your television, and pedal as you watch your favorite programs. You can easily get to that hour a day recommended by the people who successfully lost weight. Get an exercise pal – who could be a dog.
Sadja Greenwood, MD, MPH back issues on this blog

Wednesday, February 9, 2011

Updates on Brains, Vitamin D and Green Vegetables

Your brain on weights: You’ve probably heard that running, brisk walking and other aerobics increase blood flow to the brain and may be linked to the creation of new brain cells. Recent research shows that weight training may do the same. Rats with weights tied to their tails (!) who climbed ladders, or rats on loaded running wheels, packed on muscle mass and had higher levels of ‘brain derived neurotropic factor’, which is thought to spark the growth of new brain cells. Older women who lifted weights did better on tests of cognitive functioning than women in toning classes. Teresa Liu-Ambrose at the University of British Columbia speculates that resistance training, by strengthening the heart, improves blood flow to the brain, which is associated with better cognition.

Confusion on Vitamin D: A recent report from the Institute of Medicine (IOM) recommended that adults get 600 IUs of Vitamin D daily, and those over 71 get 800. They said that most people get this amount from foods (fatty fish and fortified milk) and sun exposure, and do not need supplements. These recommendations were contrary to the more widespread view in recent years that considered the importance of Vitamin D for bone health and other benefits, including protection against certain cancers and auto-immune diseases. Beth Dawson-Hughes, a vitamin D researcher at Tufts University, criticized the IOM recommendations as insufficient for the following groups:
*people with little sun exposure, including winter residents at higher latitudes, shut-ins, those who use sunscreen, those with dark skin (absorbs less D).
*osteoporosis patients
*obese people – it is thought that vitamin D is deposited in body fat and is less available from skin or dietary sources.
*people with gastrointestinal disorders that affect absorption.

Dawson-Hughes, as well as other vitamin D researchers, said that a laboratory level of 30 ng/mL (rather than the 20 ng suggested by the IOM) is good insurance, and is difficult to achieve by diet alone. Most adults need 1000 to 2000IU daily in supplement form, depending on their blood levels.

More benefits of Green Vegetables
Nitrate (NO-3) is found in vegetables such as red beets and spinach, and has been considered either without nutritional value or potentially toxic. Researchers at the Karolinska Institute in Sweden have found, however, that dietary nitrate is transformed by friendly bacteria in the mouth into nitric oxide (NO) – an important molecule in our bodies. NO helps blood vessels relax, lowering blood pressure and promoting more blood flow. It also makes the mitochondria that power our cells perform more efficiently. A high intake of vegetables and fruits has been found to protect against diabetes and heart disease. Boosting the nitrate to NO pathway may be one mechanism by which vegetables exert their protective effect. Readers may recall that dark chocolate also results in NO production in the body. But – try leafy greens first! And – think twice about using a strong mouthwash – we need oral bacteria for the system to work.
Sadja Greenwood, MD back issues on this blog. Leave a message or question.

Friday, January 28, 2011

Pesticide & herbicide residues in food - what to do

According to the Environmental Working Group, people can greatly reduce their exposure to pesticides by avoiding the most contaminated fruits and vegetables and eating the cleanest ones. Eating organic produce avoids these problems, but is usually more expensive. Even if you generally rely on organic food, you may eat conventionally grown foods in take-out or in restaurants. Here is the 2010 list of foods with highest pesticide residues, based on testing by the US Department of Agriculture and the FDA. The list reflects measurable pesticide residues after a food is washed and peeled.
The Dirty Dozen:
*Celery – with no protective skin it is hard to wash off the 64 pesticides found in residues on this vegetable.
*Peaches – conventional orchards use multiple sprays - 62 pesticides have been found on peaches.
*Strawberries – 59 pesticides found. If you buy out of season, they may come from countries with less regulation of pesticide use.
*Apples – 42 pesticides found. Peeling an apple removes many beneficial nutrients, and still there is residue.
*Blueberries – 52 pesticides found. This fruit is new on the list in 2010, possibly due to it popularity and intensive cultivation.
*Nectarines – 33 pesticides found.
*Bell peppers – 49 pesticides found.
*Spinach – 48 pesticides found.
*Kale – generally considered resistant to pests, but high pesticide residues were found in 2010. (Note – it is easy to grow your own organic kale almost year round in our climate.)
*Cherries – 42 pesticides found. Cherries grown in US had more pesticide residue than imported.
*Potatoes – 37 pesticides found.
*Grapes – only imported grapes made the ‘dirty dozen ‘ list in 2010. Wine can also harbor many pesticides.
Salad greens, carrots, and pears have been on the ‘dirty dozen’ list in recent years; when possible, look for organic varieties.

Organic Foods –If you don’t want to eat foods on the ‘dirty dozen’ list, and are able to pay more for organic varieties, what are the benefits? Organic agriculture is better for the environment, avoiding the problems of monoculture. The ocean, rivers and lakes are not contaminated with chemicals and high nitrogen fertilizers that promote the rapid growth of algae, reduce oxygen levels and create ‘dead zones’ in oceans and lakes. The soil is treated with healthier fertilizers and crops are rotated to enrich nitrogen retention. You will probably benefit from greater amounts of beneficial plant compounds that the plant makes to fight off insects, fungi, viruses and bacteria. Farm workers are not exposed to dangerous chemicals, which have resulted in high pesticide blood levels and serious health problems. You and your family will also have lower levels of pesticides and herbicides in your body. The role of such chemicals in disease promotion is under study, and is controversial. With a rapidly growing population the world needs more food, and its production probably requires a mix of industrial and organic agriculture.
This leads us to the question of choosing safer, ‘cleaner’ conventional foods:

The Clean 15: These foods have fewer pesticide residues. They should be washed, and peeled if applicable:
onions, avocados, sweet corn, pineapple, mango, asparagus (fewer pests/diseases ergo fewer chemicals used), sweet peas, kiwis, cabbage, eggplant, papaya, watermelon, broccoli, tomato (used to be on the ‘dirty dozen ‘ list, but is no more), sweet potato.

Note that the grains and beans used as fill-up foods by most of humanity are not on this list. Unless they are grown organically, they also have chemical residues. Corn and soybeans are increasingly genetically modified to be ‘Roundup ready’ , with a potential problem with ‘super-weeds’ needing more Roundup (glyphosate ) spray. What will happen to super-weeds and the results of increased use of Roundup is yet to be known.

Global food prices have currently reached a record high, because of food shortages. This has recently caused riots in several North African and Middle Eastern countries. At such a time, it may seem elitist to be concerned with chemical residues in food. However, the problems of industrial agriculture, climate change (droughts and floods impeding food production) and population growth are interrelated. These and other crises facing humanity are daunting. Among the many proposed solutions are several that seem extremely important to this writer: limiting population growth with voluntary and accessible family planning, the spread of regional and sustainable food systems, and working to diminish global warming. Think globally, act locally
Sadja Greenwood MD, MPH Back issues on this blog

Thursday, January 13, 2011

Walk, Dance and Eat Your Way Through 2011!

Walking one & 1/4 miles daily, or 9 miles a week, can protect the grey matter of your brain. This was the finding of a study at the University of Pittsburg which looked at older adults over a 13 year time span. Those who walked 9 miles a week had half the risk of cognitive impairment of more sedentary subjects. You know the other benefits of walking – weight control, reduced risk of high blood pressure, heart disease and diabetes, reduced risk of falls and fractures, and mood improvement . There are also studies showing a lower risk for cancers of the breast, uterus, colon and prostate with physical activity. Here are some strategies to make regular walking a part of your life.
*get a pedometer – I suggest the Digiwalker SW-200, available from Amazon for $22.50 or from Step into Health. Get it with a strap that secures it to your pants. This simplest pedometer only measures steps – for most people a walk of 3200 steps would be one & 1/4 miles. Some people wear a pedometer all day long, and work up to 10,000 steps a day, which is the amount popularized in Japan by research showing better health at that level of activity. If you get a digiwalker, a booklet on the 10,000 step philosophy will come along with it. It’s a great motivator. You’ll be surprised at the number of steps you take in the house and yard, and you may find you want to take more trips to the compost pile.
*find a walking partner – a person or a dog who will motivate you to keep going. If you like to talk and socialize, choose a compatible person – if you want to tune into your own rhythms, try a dog. It could be your neighbor’s dog.
*dance at home to your favorite upbeat music on rainy days. You can get endless amounts on Pandora radio (on your computer or smart phone). I favor Cajun and Zydeco to keep me moving. Don’t wait for a dance partner – go free form. For ballroom dancing, Cenize Rodriguez and Don Jolley run great classes at the Stinson Beach Community Center, and Carol Friedman teaches at the Dance Palace. You can go to these classes with or without a partner. They are fun! If you don’t live in West Marin, find a class through the yellow pages or a community college.
*For the arms and spirit – try conductorcise. Maestro David Dworkin leads classes of older people , standing or seated, through the exercise of conducting classical music. Watch him at and put on your favorite symphony. Using the upper body this way is invigorating, and moving to the music is thrilling.

Eat for Your Brain A French study showed that older people who took good care of their brains had a lower risk of developing dementia. Taking care of the brain meant avoiding diabetes and depression, and eating lots of fruits and vegetables. Here is a list of fruits and vegetables with the highest antioxidant values. Prunes, which lead the list have the greatest ORAC value (oxygen radical absorbance capacity): prunes, raisins, blueberries, blackberries, kale, strawberries, spinach, raspberries, Brussels sprouts, plums, broccoli, beets, oranges, red bell peppers. Many other vegetables and fruits not on this list are also valuable sources of antioxidants and other nutrients. We are so lucky to have great organic produce at the Bolinas People’s store and our local farm stands.

Update on citrus peel After my column last week on the benefits of hesperidin in citrus fruit and peel, a friend told me that her daughter had become violently nauseated after putting a whole orange in a blender drink, and had to go to the ER with intractable vomiting. This will not happen to you when you make or eat marmalade, but avoid too much peel in blender drinks.
Sadja Greenwood, MD, MPH Back issues on this blog

Monday, January 3, 2011

What’s new in school food, food safety, arsenic, and hesperidin

An important bill on child nutrition was signed by President Obama in December. It gives schools extra money for meeting nutrition standards for breakfast and lunch, requires the USDA to develop new meal/snack patterns based on current science, allocates funds for school gardens and farm to school programs, enables the USDA to establish national nutrition standards for all food sold on school grounds (including vending machines), funds state and local organizations that promote healthy eating and fitness, funds projects to research and end child hunger and child obesity, promotes breastfeeding, and helps foster children get free meals. While food in our local Stinson-Bolinas schools is already healthy, and even organic, this bill bodes well for the rest of the country. Nutrition activists, parents and students will need to be vigilant in insisting that changes take place rapidly. $8 billion will be available over 10 years. Possibly Stinson-Bolinas schools could benefit from the farm to school programs.

The Food Safety Modernization Act was also signed by Obama in late December. This bill gives the FDA power to directly issue a food recall – previously a company could stall because the recall was voluntary. Companies must develop plans to prevent contamination, share them with the FDA, and show the FDA how effectively they carry out their plans. Any whistleblower in a company will be protected when providing information to the FDA. Inspection of foreign food facilities must happen more frequently. There is a long lead time for important provisions to go into effect, and the ability of the FDA to enforce the law will depend on funding. This funding could well be cut by the next congress. However, major industry groups are in favor of the bill because of the harm that recalls can do to sales. Stay tuned.

Arsenic in poultry and pig feed: A compound called roxarsone, containing arsenic, is routinely added to feed for poultry and hogs to control intestinal parasites and thereby promote growth. There have been a few media stories on this practice, including a recent one about two children in Utah who developed arsenic poisoning by eating eggs from their backyard chickens. Some large poultry producers, including Perdue Farms and Foster Farms, have stated that they do not use arsenic (however they may well use other antibiotics in their feed). Arsenic is a poison, and also a carcinogen. Until there is more action on roxarsone, I advise readers to buy organically raised poultry, and to feed backyard chickens organic feed. Also, be careful about the use of chicken manure in your garden, unless you are sure about the source. I find it disgraceful that the media and the FDA have paid so little attention to the widespread use of arsenic in our food supply. Vast amounts of chicken manure from confined animal feeding operations are spread on fields throughout the US, endangering workers and the public. Roxarsone is banned in the European Union.

Some good news – Hesperidin: When I watched a friend eat a whole organic Meyer lemon, peel and all, I felt she might be on to something. A recent study looked at the effects of orange juice on blood pressure, and found that both o.j. and a compound called hesperidin found in citrus fruits and peel lower diastolic pressure. The juice and hesperidin both resulted in dilation of blood vessels, compared to a placebo. Hesperidin, also found in green vegetables, is an anti-oxidant, anti-inflammatory agent with some effect in lowering cholesterol. You can get more hesperidin by making your own marmalade - cut oranges, tangerines or lemons into small pieces with the skin, soften them by boiling in a little water, then add honey or maple syrup and cook until your favorite consistency. Yum.
Sadja Greenwood, MD, MPH back issues on this blog