Go to Health: Evolution: Snuggle or Struggle?


Writing in the July 2012 issue of Scientific American, Martin Novak outlined the ways in which cooperation has operated to shape evolution. Novak is a professor of biology and mathematics at Harvard; he has looked at evolution in species from amoebas to zebras, and has found that cooperation, and selfless behavior, is a pervasive phenomenon. The view that competition, for resources, mates, prestige, and leadership has been the most important factor explaining survival is challenged by this view.






Novak looked at numerous species to illustrate his views, and identified 5 mechanisms for the evolution of cooperation.


1.Vampire bats will share their blood meal with one who lost out on a given day; bats remember who helped them and later return the favor. Novak calls this direct reciprocity.


2. Neighbors, or friends in a social network, tend to help one another, so in a population with groups of cooperators, clusters develop that can prevail in competition with those who don’t cooperate. Novak calls this ‘spacial selection’.


3. Kin selection occurs when individuals make sacrifices for their relatives, who share their genes, still fostering the spread of these genes. J.B.S. Haldane, who first mentioned kin selection, wrote “I will jump in the river to save 2 brothers, or 8 cousins.”


4. Individuals may help another member of his (her) species based on the needy individual’s reputation. When the helper is in need, s/he may become the beneficiary of more help, having been seen to be generous. Novak calls this ‘indirect reciprocity’., and feels it is especially important in humans.


5. Finally individuals may perform selfless acts for the greater good of the group, as opposed to a single member. This is known as ‘group selection’. Lionesses within a pride will suckle each other’s young. Ants work together and sacrifice themselves to serve their colony. In his book The Descent of Man Darwin wrote that “a tribe including many members who….were always ready to aid one another, and to sacrifice themselves for the common good, would be victorious over most other tribes, and this would be natural selection”.






Novak writes that cooperation has been a driving force in the evolution of life from the beginning, and that it has been particularly useful for humans because of our language. We can share information about each other – from our family members to strangers anywhere on earth. We are intensely interested in who does what to whom, and why. Reputation plays a major role in our decisions of how to position ourselves in the social network around us, what to do, what to support, what to buy.






Researchers looking at the need for cooperation to reduce climate change have found that people are more altruistic when they receive authoritative information about climate research, and they act more generously when allowed to make their contributions publicly rather than anonymously – when their reputation is on the line. When people receive a gas bill that compares their own consumption with the average household gas consumption in their neighborhood and that of the most efficient homes, they lower their consumption. How’s that for the interplay of competition and cooperation?






Our political parties both embrace concepts of individual struggle and cooperative unity, with Republicans leaning more toward individualism and competition, and Democrats more toward mutual help and cooperation. The balance is constantly shifting. In my home town, Bolinas, it seems that cooperation has been on the upswing for years. I am stunned by the work that people do locally for public good. We have the food programs at the Community Center, and at Mesa Park, Food for Families, the new Saturday lunch at St. Aidan’s Church, the free showers at Sam’s House, the free book store, and the immense amount of volunteer work to put on programs at the Community Center. Volunteer work for other local non-profits is outstanding – everyone I know is involved in one or another. Novak sums up his article with the following: “My work indicates that instead of opposing competition, cooperation has operated alongside it from the get-go to shape the evolution of life on earth, from the first cells to Homos Sapiens. Life is therefore not just a struggle for survival, - it is also, one might say, a snuggle for survival.”


Sadja Greenwood – back issues on this blog -->

Reduce your blood pressure with what?

Chocolate: Recent studies have shown that compounds in cocoa, called flavanols, reduce blood pressure via the formation of nitric oxide (NO) in the body.  NO is a signaling molecule in the body, which causes blood vessels to relax and open wider.  The people living on San Blas Island off Central America drink cocoa every day, as their main beverage, and have normal blood pressure regardless of age. Cocoa or chocolate has more protective flavanols if it has not been ‘Dutch processed’, so read labels carefully, and buy unsweetened cocoa powder (not Dutch-processed) or a dark chocolate bar with 70% cacao content.  You can sweeten the cocoa powder with xylitol, and do a favor to your teeth.  (Xylitol is a sweetener derived from plants that prevents bacteria from sticking to the teeth.) A recent report from the University of L’Aquila in Italy showed that elderly people with mild cognitive impairment showed improvement with cocoa flavanols, as well as reductions in their blood pressure.

Beets and beet juice:  numerous recent studies have shown that drinking beet juice lowers blood pressure and improves athletic performance.  The nitrates in beets (also found in leafy green vegetables) are translated into nitric oxide in the body.  Blood vessels widen, allowing for more blood flow.  In addition, beet juice reduces the amount of oxygen needed by muscles during activity.  For example, test subjects used less oxygen while walking, reducing the effort it took to walk by 12%.  This could be helpful for the elderly, and those recovering from heart and lung problems.  When competitive male cyclists were given beet juice before a timed trial, they were able to improve their racing times by 3%. Since in the world of elite sports a 3% improvement is big, athletes are turning to beet juice, as well as tart cherry juice, with enthusiasm.  Beet juice and freeze-dried beet juice powder are widely available on the Internet – although fairly costly. 

Celery and celery seed:  these foods have a long history in Indian Ayurvedic medicine to treat fluid retention, arthritis, gout and other problems. Chinese medicine also recommends celery to treat high blood pressure.  A substance called phthalide in celery acts as a diuretic, and apparently causes an equal loss of both sodium and potassium, which is helpful in maintaining sodium-potassium balance in the blood.  It also works by relaxing smooth muscles lining blood vessel walls.  A study done at the University of Chicago in the 1990s showed that a celery extract given to laboratory rats lowered their blood pressure 12-14%. In humans, a comparable daily ‘dose’ of celery would be about 4 stalks.  There are numerous individual reports of people using celery for blood pressure, but no further studies on this question.  Perhaps this is because it is hard to get funding for natural substances.   Celery seed, used as a spice, comes from a different plant related to edible celery.  Like celery, it acts as a diuretic, promoting loss of excess fluid in the body.  It is also used as an anti-inflammatory food. Chefs suggest that you add celery seeds to soups, tomato dishes, salads and eggs.   Light toasting brings out a sweet flavor. 

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If you take medicines to bring down your blood pressure, don’t stop them.  Chocolate, beet juice and celery may help, but should be factored in gradually.  Daily exercise and the DASH Diet are also essential.  Talk to your doctor about your plans!

Sadja Greenwood, MD    back issues on this blog

HPV – Who Knew All it Could Do?

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HPV – the Human Papilloma Virus – has been known for years to be the main cause of cervical cancer in women. There are over 40 types of HPV that are transmitted by direct skin to skin contact during vaginal, anal and oral sex, and most do not cause disease.  However, infection with certain viral types,  mainly but not exclusively  HPV 16 and 18, can cause cervical cancer if not treated. This is why the Pap test is so important for women who are or have been sexually active, with men or with women.  The Pap test is a procedure in which cells are scraped from the cervix and looked at under a microscope. The Pap test can detect abnormal cells before they become cancerous, and early treatment in the doctor’s office can get rid of the problem. However, some women don’t know about the need for regular pelvic exams, or can’t afford them. There were 4,200 deaths from cervical cancer in the US last year.  Cervical cancer is a very serious problem in developing countries which cannot afford to do Pap screening. 

Some subtypes of HPV can also cause cancers of the vulva, penis, anus and the mouth and throat.  Sexually transmitted HPV type 16 causes about 85% of anal cancers according to the National Cancer Institute. The risk for anal cancer is much higher in gay and bisexual men than heterosexual men.  Women who have anal sex are also at greater risk.

Condoms, which help to prevent pregnancy and HIVAIDS, can prevent HPV infection by about 70% if used every time.  Skin to skin transmission can still occur outside of the condom.  Still  - condom use is important with new partners.   The good news is that most HPV infections are cleared by the immune system in a few years and never cause a problem.  However, some people don’t clear the virus, and their infections remain. 

In recent years there has been an increase of cancers of the throat and base of the tongue, caused by HPV 16.  Previously known risk factors for throat cancer included smoking and alcohol, but throat cancers are now seen in younger people who don’t smoke or abuse alcohol. Throat cancers from HPV are more commonly seen in men, but women are also affected.  Oral sex is considered to be a major predisposing factor.  The increase in throat cancer is considered serious, because it can be hard to detect early.

Since most people do have genital and oral sex, how can we view this threat and deal with it?  Prevention and early detection are vitally important.  This would include:

*consistent condom use with new partners, even with oral sex.  This may seem unlikely, especially for teenagers trying to do the right thing to avoid pregnancy.  However, they should be informed about the problem.

*Make sure your children get the HPV vaccine, Gardasil or Cervarix – given in 3 shots over 6 months.  Both are effective in preventing infections that cause cervical cancer.  Gardasil is believed to prevent more HPV types, those that cause cancer of the anus, vulva and vagina.  HPV vaccination is recommended by the Centers for Disease Control for 11 and 12 year old girls, and girls and women age 13 through 26 who have not been vaccinated.  Gardasil has been found to be safe and effective for males age 9-26.  Vaccinating a boy with Gardasil will help his partners, and also help him to prevent oral cancer.  The cost of the vaccine is about $130 per dose - $390 for the series.  Most health insurance plans cover the cost, and the Vaccines for Children program may be able to help.

*Pap tests are still important for women, even if vaccinated, because the vaccines do not prevent about 30% of HPV types that can cause cervical cancer.

*Being in a faithful relationship with one partner, limiting the number of sex partners, and choosing a partner with few prior sex partners can be helpful.   However, it is not always possible to know if a partner or oneself is currently infected with HPV. 

*Early detection of cervical, vaginal, vulvar and anal cancer can be done by regular medical examinations, self exams, and alertness to anything that feels like a persistent sore or abnormal growth. 

*Early detection of cancers of the mouth and throat can be done by regular visits to the dentist and dental hygienist, who should look for abnormalities in the mouth and throat, including hidden areas at the back of the tongue.   Everyone should be aware of symptoms such as a persistent sore throat or mouth sore, a feeling of a mass in the throat, a lump in the neck, or difficulty swallowing.  

Check it out!

* Keep your immune system strong by getting enough sleep, exercising moderately, eating healthy food (lots of vegetables!), and avoiding tobacco, dangerous drugs, and excess alcohol.

Our venerable sage Ben Franklin told us:  An ounce of prevention is worth a pound of cure.  Let’s follow his advice. 

Sadja Greenwood, M.D., MPH  back issues on this blog

Arsenic in Rice?

Arsenic is a chemical element found in water, soil and air. For this reason, it is inevitably found in some foods. Human activities have added arsenic to the environment, through burning coal, oil, gasoline and wood, and through the use of arsenic compounds in pesticides, herbicides and wood preservatives. The Food and Drug Administration (FDA) monitors foods in our diet; it has analyzed arsenic levels in rice for 20 years, and has not found evidence of change in arsenic levels. However, researchers are now better able to measure whether existing levels represent more or less toxic forms of the element. It plans to complete its analysis of about 1,200 rice products (rice milk, rice cakes, infant cereal, etc) by the end of the year, and to issue guidelines.

Meanwhile, Consumer Reports, published by Consumers Union, has stated that its tests of more than 60 samples of rice and rice products found inorganic arsenic, a probable human carcinogen, in most samples. Earlier this year, they had found worrisome levels of arsenic in apple and grape juices, and called on the FDA to set limits for arsenic in these juices. They are now asking the FDA to set limits for arsenic in rice.

Consumer Reports’ study found:
*White rice grown in Arkansas, Missouri, Louisiana and Texas had higher arsenic levels than samples from California, India, and Thailand.
*Brown rice had higher levels than white rice, comparing rice from within a tested brand.
*Infant rice cereals and drink products contained worrisome levels of arsenic.
*Groups who rely on rice as a staple, such as some Asians and Hispanics, were found to have higher arsenic levels.

Rice grown in Texas, Louisiana and other gulf coast states have high levels of arsenic because of cotton growing in times past. Arsenic pesticides were used to control the boll weevil. California rice, and Asian rice have considerably lower levels.

Consumer Reports advises that children under 5 not be given rice drinks daily. Similar advice has been given in the United Kingdom.

Consumer Reports has asked the FDA to ban the feeding of arsenic containing drugs to animals (used for growth promotion and disease prevention). The manure of these animals contains arsenic, which can be used to fertilize food crops. It also asked for a phase out of arsenic containing pesticides.

Philip Landrigan, an epidemiologist, author and pediatrician at New York’s Mt. Sinai School of Medicine, suggests that pregnant women and babies avoid rice, or use only small amounts of California rice, or switch to other grains, such as oats or barley.

Arsenic has been implicated as a cause of skin cancer (non-melanoma), and is also related to cancers of the liver, lung, kidney and bladder. The evidence for this comes from studies in Taiwan, where well water contains high amounts of arsenic. The same is true in Bangladesh – tube wells drilled to protect the population from bacterial diarrheal disease have been found to have high levels of arsenic. This is a very serious situation in parts of India as well. Current remedial efforts include digging very deep wells, where water may have lower arsenic levels.

What can you do about arsenic in food and water? There is virtually no arsenic in Bolinas water. Call your local water department to find levels if you live elsewhere. Avoid apple and grape juice unless it is organic – even then, it’s better to eat the whole fruit. Avoid chicken, unless it is organic. Eat California rice, but don’t make it your everyday staple. Try almond milk if you usually drink rice milk. If you are avoiding gluten, try millet as a rice substitute. Millet should be rinsed first, and cooks in 20 minutes. You can make it very tasty by cooking it with onions, garlic, chopped nuts, and spices. When cooking, I always think of chef Rebecca Katz’ suggestion: FASS. F stands for a bit of fat, such as olive oil. A stands for acid – meaning a little something sour, like a squeeze of lemon. S stands for sweet – a drop of maple syrup, or pomegranate juice, or some frozen corn. S stands for salty – a pinch of salt. Put this in every dish, and you’ll love the result!

Sadja Greenwood, MD, MPH see more on this blog

What Are the Benefits of Organic Food?

A recent study from Stanford University looked at 17 studies comparing people who ate organic or conventional diets, and 223 studies comparing the bacterial, fungal or pesticide contamination of such foods. There were no long-term studies of health outcomes between the two diets in their analysis. The studies showed no consistent differences in the vitamin content of organic products, although there were higher levels of omega-3 fatty acids in organic milk. The study did find that organic produce had a 30% lower risk of pesticide contamination, but the pesticide levels in all food generally fell within the allowable safety limits. They found that children on organic diets had lower levels of pesticide residues in their urine, and organic chicken and pork reduced exposure to antibiotic resistant bacteria, but the clinical significance of all these findings were found to be unclear.

Many people have been confused by these findings from Stanford. Is organic food worth the extra money? Charles Benbrook, a professor at Washington State University’s Center for Sustaining Agriculture and Natural Resources, wrote a compelling answer in the October issue of Nutrition Action Healthletter. Benbrook has worked for the National Academy of Sciences, and consults for The Organic Center. He says that 60% of studies do show a higher nutrient content in organic foods, especially when the comparison is between fruits and vegetable grown in similar locations. The Stanford study did not consistently make such comparisons.

A recent study of tomatoes in Spain showed that organic tomatoes had twice the antioxidant levels as conventional tomatoes. There are two reasons for this. Organic plants have to fend off a range of insects, so they develop more defensive compounds that also keep us healthy. Conventional crops are produced with large amounts of nitrogen fertilizer, which drives up yields and fruit or leaf size, but dilutes the levels of vitamins, minerals and antioxidants.

Contaminants that cause food poisoning can grow more readily in conventional fields, because of extra nitrogen, and the lesser microbial diversity due to pesticide use. In organic fields there is more microbial biodiversity, so pathogens may not last as long or become as numerous.

Organic foods may not be pesticide free, because of traces blown in from conventional fields. However, pesticide levels are markedly lower. Benbrook has devised a scoring system, the Dietary Risk Index (DRI) that measures the number of different pesticide residues and their levels. Looking at organic versus conventional strawberries, blueberries, apples, grapes, nectarines, peaches and pears grown in the US, the DRI was 3 for organics, versus 24 for conventional fruits. Imported conventional fruits from Chile and Argentina have much higher DRIs than those grown in the US, because of more stringent regulations of pesticide use in the US.

According to Professor Benbrook, there is compelling evidence that low level exposure to organophosphate insecticides in food are contributing to neurologic and developmental problems in children, such as lowered IQ. Lead exposure was found to be most harmful in a Harvard study, followed by organophosphate pesticides and methylmercury. The most compelling evidence of harm comes from the insecticide chlorpyrifos, which has been banned by the EPA for home use, but is still permitted in agriculture. Its level in pregnant farmworkers correlated with lower IQs in their children. When researchers at Emory University in Atlanta gave children organic fruits and vegetables, chlorpyrifos levels fell to almost undetectable levels in their urine in 5 days. Chlorpyrifos is made by Dow Chemical. A coalition of farmworker and advocacy groups filed a lawsuit against the EPA in 2007 seeking to ban the use of chlorpyrifos; the suit is still pending.

Professor Benbrook thinks that the most important dietary change we can make is to eat more fruits and vegetables, and less bad fat, added sugar and processed food. I’m going to add – eat with the seasons, so that you avoid imported produce with its higher levels of pesticides. The second most important is – of course - to eat organic produce and organic grains. If you can afford it, this is your most important step.

Subscribe to the Nutrition Action Healthletter if you want to keep up with the science of nutrition in an easy, readable format. It’s easy to find the address on-line, and 10 issues cost only $10!

Finally – let always give thanks to our local organic farmers, and to the Bolinas People’s store with its daily array of luscious, healthy food!

Sadja Greenwood MD back issues at on this blog

Olive Oil - What are its advantages?

New studies show some surprising benefits for olive oil, including a possible protective effect on bone. Spanish research, to be published in the October issue of the Journal of Clinical Endocrinology and Metabolism, shows that consumption of a Mediterranean diet enriched with olive oil is associated with increased serum osteocalcin and other bone formation markers. Osteocalcin is produced by bone cells called osteoblasts, and is used as a marker for bone formation. Prior to this study, it had been noted that the incidence of osteoporosis in Europe was lower in the Mediterranean basin. All subjects in this study were instructed to eat a Mediterranean diet, rich in fruits and vegetables, lean protein from fish, poultry, and beans, and whole grains instead of white flour bread and pasta. Olive oil was their added fat.

Another Spanish study in 2010 showed that the phenolic compounds in extra virgin olive oil change how genes function. Phenols are chemical compounds found in plants that have many unique properties. In conjunction with a Mediterranean diet, genes related to atherosclerosis were down regulated, and there was a positive impact on oxidation of fats and DNA, insulin resistance, inflammation, carcinogenesis and tumor suppression. Atherosclerosis is a disorder that occurs when fat, cholesterol and other substances build up in the walls of arteries and form hard structures called plaques. This diminishes blood flow and can lead to heart attack and stroke.

Breast cancer risk may also be modified by virgin olive oil. Spanish scientists at the University of Barcelona decoded the signals within breast tumor cells activated by olive oil, concluding that benefits include decrease in activity of an oncogene, and stimulation of tumor cell death. An oncogene is a gene that has the potential to cause cancer, if activated by mutations in another gene or certain environmental factors. Olive oil also showed ability to prevent DNA damage. Corn oil and some other vegetable oils high in polyunsaturated fatty acids, can increase the aggressiveness of cancers.

Virgin olive oil is oil produced by crushing olives mechanically, with no chemical treatment. It has an acidity of less than 1.5%. Extra virgin olive oil comes from virgin olive oil and is lower in acidity (less than 0.8%) and is judged to have the best taste. Virgin olive oils contain the highest levels of phenolic compounds and anti-oxidants that have been linked with better health.

Using olive oil or canola oil on your salads will give you the best absorption of carotenes from colorful vegetables, according to a new study from Purdue University. Low fat and non-fat salad dressings resulted in minimal carotene absorption. Carotenes are pigments that occur in vegetables and fruits and have multiple healthy properties. Avocado is another healthy fat that enhances carotene absorption. If you do use canola oil, make sure that it is organic. Otherwise you will be using genetically modified canola that may be high in pesticides and herbicides, as ‘superweeds’ and resistant insects have evolved to make the application of Roundup less effective. More spraying is necessary.

Your vote in support of Proposition 37 in November will help to ensure that genetically modified food products are labeled in California. This is a huge issue for food companies, who have raised millions against the proposition. Stay tuned, and read the arguments on your ballot carefully.

Sadja Greenwood, MD, MPH back issues on this blog

Dr. Oz on Longevity

Who is Dr. Oz? Mehmet Oz is a cardiac surgeon from Columbia University who has become a popular author and energetic television promoter for getting fit, losing weight and staying healthy. His books, co-authored with Michael Roizen, include You: The Owner’s Manual, and You: On a Diet; they explain the workings of the body and its organs clearly and simply. Dr. Oz’s television program (weekdays at 4, channel 2)) shows a charismatic doc in surgical scrubs promoting a great variety of techniques for staying fit and losing weight, along with numerous products to help you on your way. He is fun to watch. Here are his 10 simple habits that could help you live to 100, with my comments tacked on.

1. Add red foods to your diet. Oz suggests red cabbage, as cruciferous vegetables help to protect against cancer, and beet juice, with nitrates that relax blood vessels. I will add that beets are a great food because the nitrates in beets, also found in green leafy vegetables, are a source of nitric oxide in the body, which dilates blood vessels, improves blood flow, and lowers blood pressure. Other red foods are tomatoes and watermelon, high in the beneficial antioxidant lycopene, and red wine and red grapes, with resveratrol. Resveratrol is currently under study as a substance with anti-inflammatory properties and cardiovascular benefits. It is also found in peanuts and chocolate. I think it is wiser to get resveratrol in foods than in supplements.

2. Black tea – have a cup daily to boost your survival after a heart attack. I will add that research from The Netherlands showed that drinking 3-6 cups of tea daily was associated with a 45% reduced risk of death from heart disease.

3.Dial one phone number from memory every day. Oz advises using your memory rather than relying on your devices. I will add that there are many ways to exercise your memory, including memorizing new words, school work, a new language, poems, music and songs. Work on this while you walk or work out, and just before sleep at night.

4. Use the first stall in a public restroom to prevent getting sick. Oz says the first stall is used less often, as people want more privacy, and it contains the lowest bacteria counts. I’ll add that washing your hands is also very important. Taking a daily probiotic is vital to amp up your immune system (the majority of your immune tissue lines your gut). Vitamin D also helps to prevent respiratory illness.

5. Take two steps at a time when you climb stairs. If you can’t do that, try walking up the stairs twice. I’ll add that keeping your legs strong is important for balance as well as for walking and other sports. If you don’t have stairs at home, you can get step-up blocks or risers at a sporting goods store or on the internet. Resistance training at home or in a gym is really important.

6. Stretch after a hot shower to prevent pain – stretching is best when muscles are warm; stretching improves posture and prevents muscle soreness. Oz suggests raising your arms, bending forward to the right slowly, and then to the left. I would add that that any other standing stretching exercise you like can also be helpful.

7. Hold your breath: take a deep breath, hold for 10 seconds, and then slowly exhale through pursed lips. I think this is a wonderful daily practice, not only for singers and wind instrument players but for all of us who breathe. Yoga classes emphasize many kinds of breathing, to stimulate and relax the body.

8. Do the Reverse Warrior Pose: For this exercise, I suggest you watch Yoga Reverse Warrior Pose by Jennifer Kostel on YouTube. Her presentation is simple and not extreme. Do it on both sides. It promotes balance, flexibility and strength.

9.Chew your food 20 times – slowing down your eating will increase your enjoyment of food, and help to prevent diabetes. If this is hard, put down your fork between bites. I have found the chewing practice to be extremely helpful in preventing reflux pain at midnight. By extra chewing, you start the digestive process (with digestive enzymes in saliva) and make less grinding work for your stomach. It can empty faster. I’m a convert.

10. Cut your cravings in half to cut calories. When confronted with ‘must have’ chips or cookies, Dr. Oz wants you to ‘halve them’. Put the second half away and out of sight. My thinking is that this works well for some people, but others with food addictions need to have the tempting foods out of the house. Don’t shop when you are hungry, and don’t buy foods you will binge on.

Dr. Oz is a television wonder, on a nationwide mission to get us slimmer and more fit. I know it’s daytime TV, but watch him if you have a chance.

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

Lists for Longevity

Back to school, Labor day: is it time to make lists and get organized? Here are ten suggestions from the August issue of Tufts University Health and Nutrition Letter. Next week I’ll report on Dr Oz’s 10 simple habits that could help you live to 100.
1. Combining moderate regular exercise and mentally stimulating activities can help protect your memory as you age, according to a Mayo Clinic study.
2. Raisins, a handful eaten 3 times a day, can reduce blood pressure significantly in mildly hypertensive people according to study from the Louisville Metabolic and Atherosclerosis Research Center. This may be because raisins are high in potassium, and also in fiber and healthful anti-oxidants. There are opposing views on whether raisins promote or prevent tooth decay, so keep flossing.
3. Your waist to hip ratio can predict you risk of sudden cardiac death. Best measurements are under 0.82 for women and 0.92 for men. Use a tape measure.
4. Regular jogging, at a slow to average pace, increases longevity, according to the Copenhagen City Heart Study. (Be sure to check with your doctor before starting to jog, if you don’t do so currently).
5. Fiber may help to protect against heart disease and stroke, according to a Swedish study.
6.Switching from white rice to brown rice could reduce your risk of diabetes, according to a Harvard study. This is especially important for Asians if they eat a lot of white rice.
7. Skip sugar sweetened beverages to reduce your risk of heart attack, according to the Nurses’ Health Study and the Health Professionals study. No increased risk was found for diet sodas.
8. Eating a Mediterranean diet, already linked to a lower risk of chronic diseases, leads to a better health-related quality of life, according to Spanish research. This diet is high in vegetables, fruit, fish or poultry, whole grains, nuts and olive oil, with small amounts of low fat milk as yogurt. There is new evidence that olive oil may strengthen bones. The diet avoids red meat and dairy fat. Get a book on this way of eating – The New Mediterranean Diet Cookbook by Nancy Harmon Jenkins and Marion Nestle is a winner.
9. Low-fat dairy may lead to fewer strokes, according to a Swedish Study.
10. Any physical activity: formal exercise, gardening, housework and walking may lower the risk of Alzheimers’s disease, according to a study of older adults at Rush University.

These studies in the Tufts newsletter are a good reminder of what you already know about healthy living.

Here are my additional suggestions for people who watch television, home movies and sit at a desk for work. Invest in a minicycle or pedal exerciser. These small devices use no electricity and can fit under your desk or in a corner for storage. They keep your legs moving with mild but continuous exercise while you sit. On a table, they are also used to exercise the arms and shoulders. The Sunny health and fitness minicycle is about $57 and is available from Amazon and Overstock. You can also look at the Carex Pedal exerciser (lighter and about $45) and the Pedlar Pro #316 (about $34). Alternatively, consider a standing desk. Prolonged sitting (at work, in the car, watching TV) is not good for the metabolism. Several recent studies show that prolonged sitting increases mortality. You may be able to raise your desk on a sturdy brick pile until the desk-top is at elbow height, but if it is not stable, make or buy a standing desk. It takes a few tries to get used to a standing desk, but it is worth the effort in terms of leg strength and endurance. Finally, you can invest in a trek desk, which enables you to walk slowly on a treadmill while working on the computer, reading or thinking. There are manual treadmills that do not require electricity.

There’s a famous t-shirt that says “If it’s physical, it’s therapy.”

Sadja Greenwood MD, MPH back issues on this blog
Leave me a message, or a question, if you like. I'll answer, for sure.

More Good News About Exercise and Coffee

We all know that it’s good to get moving, but why? Will walking and other forms of exercise do more than help us stay trim? Here’s a study from Japan, in the British Medical Journal, that shows an association between time spent walking, life expectancy and lifetime expenditure for medical care. Researchers from Japanese medical schools followed 28,000 men and women aged 40-79, and divided them into those who walked an hour or more a day, and those who walked less than an hour. The more active group had a significantly longer life expectancy and lower lifetime medical expenditure. They concluded that increased longevity resulting from a healthier lifestyle does not necessarily translate into an increased amount of medical costs throughout life.

Health care costs are important in Japan, as here, because the country has a universal health care insurance system. People without insurance can join a national insurance program administered by local governments. People can select doctors or facilities of their choice, and cannot be denied coverage. Sounds familiar? This system is similar to the Affordable Care Act being implemented in the US.

A similar study from The University of Texas was recently published the journal Circulation. The authors studied 63,000 men and women over 0-10 years, 10 to 20 years, and beyond 20 years. Their fitness was based on age and sex -adjusted treadmill times, as found at the Cooper Center. High fitness was associated with lesser mortality from all causes and from cardiovascular causes.

A recent article in the Journal of the National Cancer Institute reviewed the effects of physical activity on people with cancer. Edward Giovannucci of the Harvard School of Public Health, made the following comments in his review of the article. Survival after cancer, although it may be dependent on the destructive behavior of the tumor, is also related to the general health of the patient. Health is often enhanced by activity. In addition, physical activity can have a direct effect on the cancer by altering various hormones, including insulin, insulinlike growth factor 1, estrogen and adiponectin (a protein involved in regulating blood sugar and fatty acid breakdown). These factors can promote or inhibit cell growth; insulin is a possible growth promoter for cancer, and exercise results in lower insulin levels. Observational studies of breast cancer (17 studies) and colon cancer (6 studies) suggest that physically active people have better cancer-specific and all-cause survival. Despite problems in comparing types of breast and colon cancer, and the presence or absence of metastases, the studies look promising. Few other leads have shown as much promise in extending the lives of cancer survivors, and activity can also improve the quality life of survivors. Giovannucci concludes that physical activity should be a standard part of cancer care.

More good news about coffee: In a new study from the National Institutes of Health, coffee drinkers who did not smoke were less likely to die in the next 14 years from a wide variety of illnesses. Total mortality was less in coffee drinkers, but deaths from cancer did not show this trend. Men showed an increasing benefit from coffee for up to 5 cups a day, and women who drank 2 cups a day showed a mortality benefit. Decaf coffee was also helpful.

If coffee helps you get out for a walk, a jog, a game of tennis or a swim, go for all of it! Now that it’s foggy and cool in West Marin, it’s great time to get started and keep it up.

Sadja Greenwood, MD back issues at
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Eve Ensler and The Vagina Monologues

She is one of the most energetic revolutionaries in the world today, with her ambition to end violence against women and girls, everywhere. Eve Ensler has launched a global movement known as V-Day, to end rape, battery, incest, female genital mutilation and sex slavery. She has set up a community in the Democratic Republic of the Congo, called the City of Joy, to help Congolese women who have been raped. Classes in literacy, self-defense, communication, political action and mental and physical healing were held in the first year. A terrible history of widespread and violent rape had made such a center important in the Congo.

Through V-Day campaigns, volunteers and college students in this country put on benefit performances of Ensler’s plays, including The Vagina Monologues. They hold teach-ins and workshops for men, to raise awareness and funds for grassroots anti-violence groups. V-Day has produced a documentary film, Until the Violence Stops; this72 minute documentary is available from Netflicks. It shows women from Harlem, Ukiah, Pine Ridge Reservation to the Philippines and Kenya, revealing their experiences of abuse and genital mutilation, and what they are doing to improve their situations. A five minute trailer for this film can be seen on You Tube.

Funds raised by V-Day support local and national organizations worldwide, including Egypt, Iraq and Afghanistan. The V-Day movement exists in 140 countries from Europe to Asia, Africa, the Americas, and the Caribbean.

In June, 2012, Michigan State Representative Lisa Brown was banned from speaking during a debate on a bill putting new restrictions on abortion providers, because she had used the word ‘vagina’ in her remarks. As a result, four days later a special and rousing performance of The Vagina Monologues was staged on the steps of the state capital, before a crowd of 5000. Eve Ensler was on hand. You can watch the action on You Tube – Vagina Monologues at Michigan’s Capitol Steps.

The Vagina Monologues was written in 1996 and first performed in Greenwich Village, New York City. It has been translated into 48 languages and performed in over 140 countries. Clearly it has been a powerful opening for women to talk about their sexual selves, their joy, their anger and their liberation from prudery and restrictive customs. Ensler has written numerous other plays, including “I am an Emotional Creature: The Secret Life of Girls Around the World.” This play was recently staged at the Berkeley Repertory Theater. It features a cast of 6 young women who talk, sing, and dance their way through a script that covers cliques, popularity, sex, sexual slavery, genital mutilation, slave labor in a Barbie Doll factory and more. The brilliant cast has now gone to New York City.

Here’s the big news of this column. The Vagina Monologues is coming to Marin, and specifically to Bolinas! It will play at the Bolinas Community Center on Saturday, September 22nd at 7:30 pm. It will be staged at the San Geronimo Cultural Center on September 15th, and at Toby’s in Point Reyes on Friday September 21st. This play (which I have seen several times) is different at each staging as the cast and venue changes. It is much more than a ladies’ night out; men and couples will also get a lot out of it, including humor, sadness, surprise, and a powerful understanding of the human condition.
Sadja Greenwood, MD, MPH: back issues on this blog. Leave me a note, and I'll answer you pronto. Pura Vida

The Affordable Care Act - what it means to you

In a dramatic and unexpected move , Supreme Court Chief Justice John Roberts sided with liberal justices Stephen Breyer, Ruth Bader Ginsberg, Elena Kagan and Sonia Sotomayor to allow most of President Obama’s health care law, the Affordable Care Act, to remain intact. Here are the essential features that may be of interest.

The “mandate” that everyone will need to buy insurance by 2014 was the most controversial part of the new law. The justices decided that it will remain under the taxing power of the government. Anyone who refuses to buy insurance will be taxed $95 in the first year, and subsequently more, until the tax reaches $695 or 2.5 percent of income, whichever is more. However, there will be federal subsidies for people who cannot afford insurance. Many uninsured people with pre-existing conditions will be eligible for insurance and will probably sign up quickly. If a substantial fraction of healthy young people also sign up, insurance companies will be able to even out costs and charge less.

Those politically opposed to the act will advise the public not to purchase insurance, which could result in higher premiums for those who do. This dynamic has already started, and it will greatly influence how the new law will work. Here’s a way for healthy young people to think about insurance: Their likelihood of having a heart attack and other chronic disease is low, so they can probably save money by just paying the tax. However, should they have a serious accident or develop an unexpected illness, they might receive expensive emergency hospital care, be ineligible for some important forms of treatment, and be burdened by large debts while recovering. Getting health insurance will avoid these problems. It is a smart and prudent option.

New money is being offered to states to help enroll people with limited finances into Medicaid programs. If a state turns down the new funding from the act, it can still keep its current federal Medicaid funds. Republican governors may want to turn down the new funds; however, hospitals and care providers are going to pressure them to accept the greatly expanded funding in order to have more of their patients insured.

California will benefit from the new funding for Medicaid — currently we have 7 million uninsured people, a number expected to fall by more than half by 2016 due to the new funds. There will be a substantial increase in the number of people insured by Medi-Cal, and county and University of California hospitals are working to improve their delivery of care. California plans to enroll more low-income seniors and people with disabilities into managed care. These plans must have a sufficient number of providers and be geographically near the patients. As this occurs, California and other states will face challenges in finding enough primary care providers to care for more insured people.

Coverage of children under 26 in their parents’ insurance policies is already in force and is very popular. Starting in 2014, people with pre-existing conditions will be able to buy insurance. Insurance companies will not be able to charge the sick more than the healthy, nor can they charge women more than men. Free wellness checkups will be part of all plans. Insurance companies will have to spend at least 80 percent of their revenue on medical care, which may limit their administrative costs and high executive salaries.

By January 1, 2014, states will be required to have new marketplaces, called exchanges, in which individuals and small businesses can examine a variety of competing plans, their costs and their policies, before purchasing them. States must begin talking to a federal hub that is being created to help determine who is eligible for subsidies. Within 10 days after the November election, states are supposed to report to the federal government on their readiness to set up the exchanges, and must get them ready in 2013. If a state does not comply, residents can access a federal “fallback” exchange. To get a subsidy, you must buy your insurance through an exchange.

Readers may be happy to know that California is a leader in working toward having an exchange ready by late 2013.

The Affordable Care Act is a start on the path towards healthcare for everyone. It is not as efficient as an expansion of Medicare for all, which would be like a single payer plan. It is extremely controversial, so we can expect a lot of political fallout in coming months. Republicans vow to overturn the ACA if they return to power. However, it is a great accomplishment of the Obama administration in the current political climate. Here’s one more compelling reason to vote in November.
Sadja Greenwood, MD, MPH

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Beneficial Bacteria in your Body

Microbiologists are excited about recent studies showing that the bacteria in our guts, throat, genital organs and on our skin can have newly discovered beneficial roles in health. We have some 500 different strains of bacteria in our intestinal tract; the average healthy adult carries about 5 pounds of them. From the mouth to the colon, they help us break down and digest our food and allow for its absorption. They also synthesize a range of vitamins, from the B group to vitamin K.

About 70% of our immune system resides in the lining of the gut; signals from good bacteria influence immune cell development and susceptibility to infections and inflammatory diseases. Researchers at the University of Pennsylvania have shown that when mice are treated with antibiotics to reduce numbers of beneficial bacteria, they have an impaired antiviral immune response and delayed clearance of systemic viruses or influenza in the airways. The researchers concluded that signals from beneficial bacteria stimulate immune cells in a way that is optimal for antiviral immunity.. This may be a way that good gut bacteria reduce your susceptibility to colds and flu.

The same researchers also looked at allergic lung inflammation, similar to asthma in humans, and found that mice given antibiotics had higher levels of basophils in their white blood cells, and elevated seum IgE – seen in allergic disease. Researchers at the University of British Columbia found that mice treated with the antibiotic vancomycin reduced the diversity of microbes in the gut and increased the susceptibility of the animals to experimentally induced asthma. They conclude that normal bacterial populations can positively influence the response to allergens in the environment, making inflammation and asthma less likely. The bacterial multitudes in our bodies may have functions never before appreciated.

Antibiotics are life-saving drugs in many situations, including streptococcal throat infections (that can lead to heart valve damage), bacterial meningitis, bacterial pneumonia, urinary tract infections, et al. The purport of this column is not to criticize their use when needed, but to underline the importance of beneficial bacteria in the gut.

Research on the ‘microbiome’ is a hot topic currently, with exciting implications for human health. Microbiome is defined as the totality of microbes in the body (bacteria, viruses and fungi), their genetic elements and environmental interactions. What you can do right now to keep your microbiome in good shape is to feed your helpful intestinal bacteria the right food. Sugary foods that are low in fiber allow the ‘bad’ microbes to thrive. Avoid them. Certain foods are known as ‘prebiotics’ can help our beneficial bacteria. Examples are whole grains, oats, bananas, garlic & onions, artichokes and asparagus. In addition, many people take a ‘probiotic’ supplement that contains beneficial bacteria, and also eat fermented foods such as yogurt, kefir, and sauerkraut. Make sure the yogurt you buy contains living cultures, and avoid ones that are sweetened – it’s better to add fruit yourself. You can buy probiotic capsules at many grocery stores. Look in the refrigerated section and keep the capsules refrigerated at home to preserve the life of the bacteria therein.

If you take antibiotics for a bacterial infection, it’s a good idea to take a probiotic to restore your beneficial bacteria. This may help to prevent serious diarrhea after antibiotic use, which can occur when bad bacteria such as Clostridium difficile take over. Wait at least 2 hours after taking the antibiotic, so it can be absorbed into your bloodstream, before taking the probiotic. If you have asthma, a probiotic supplement might help – talk to you doctor about this.

Sadja Greenwood, MD, MPH - back issues on this blog. Write me a comment, and I'll answer you.

GMO labeling, the Farm Bill, & anti-cancer herbs and spices

In November we will be voting on a referendum in California requiring that all genetically engineered foods be labeled. If it passes, California will be the first state to require such labeling on packaging. Citizens in Europe, Japan and other countries (almost 50 in all) have access to such knowledge. This is an historic occasion for voters – you should know that companies such as Dow and Monsanto will put up a strong campaign against the referendum, and may sue the state if it passes, as they threatened to do in Vermont, where a legislative bill for labeling did not make it out of committee.

The referendum is important because ‘superweeds’ have developed in response to the herbicide ‘Roundup’ (glyphosate). The result has been heavier spraying of the Roundup Ready corn and soybeans that have been genetically modified to withstand such spraying. About 90% of soybeans and 70% of corn and cotton grown in the US are Roundup Ready crops. Additionally, Dow Chemical has asked for USDA approval of a type of corn that can withstand spraying by 2,4D (a defoliant similar to 2,4T used in Agent Orange in Vietnam war days). Many large-scale farmers in the Midwest approve of Dow’s new crops, saying that resistant weeds have become a crisis and without new chemical approaches, farmers would have to plow more and thereby increase soil erosion. On the other hand, Sweden, Norway and Denmark have banned the use of 2,4D, because of toxicity to workers (central nervous system symptoms, dermatitis, possible long term effects on the children of women exposed in pregnancy, and possible increase in lymphomas). Farmers who do not use GMO crops fear genetic drift from the altered plants’ pollen, and also drift of the herbicides used.

This is clearly a complicated question, and we will hear a great deal about it in the run-up to the November election. Here is another reason to exercise your right to vote!

Th US Senate is currently considering the 2012 Farm Bill. Senator Kirsten Gillibrand (D- NY) is opposing a $4.5 billion cut from food stamps, which will then be opposed in the House of Representatives where a majority of Republicans have said they want deep cuts in food stamps. In addition, she wants to help markets that sell fresh produce in areas where it is not available, and encourage the creation of insurance for specialty crops such as apples and onions. To take action on Gillibrand’s amendment that would restore cuts from nutrition programs and redirect $500 million to healthy food programs, you can call Lynn Woolsey (415-507-9554), Senator Boxer (415-403-0100) and Senator Feinstein (415-393-0707). Senators Bernie Sanders (D-Vermont) and Barbara Boxer ( D-California) have introduced an amendment requiring GMO foods to be labeled nationwide. Call Senator Boxer about this as well, if you agree with such labeling.

I have just returned from a nutrition conference put on by the Center for Mind-Body Medicine. One of the speakers on cancer was Jeanne Wallace, who also spoke here at Commonweal last year with chef Rebecca Katz. Wallace listed the top 10 foods to block angiogenesis – the growth of new blood vessels that encourage cancer growth. They are:
*Spices – especially curry, ginger, garlic, parsley
*Berries – all types
*Green tea
*Parsley, peppermint, thyme
*Curry - turmeric, coriander, cumin
*Garlic
*Brazil nuts – for the selenium
*Cold-water fish/ Grass fed meat - for the omega-3 fatty acids
*Traditional soy foods - edamame, tempeh, tofu, plain soy milk
*Peanuts (boiled), red grapes/wine - resveratrol

I will write more about this conference in future columns. In the meantime, if you eat, be a food activist!
Sadja Greenwood, MD, MPH

Update on calcium

Recent reports of an increased risk of heart attack in people taking calcium supplements have been very confusing. For years we have been told to take calcium pills to supplement dietary sources of this mineral. Here’s the evidence so far. Calcium is critical for building and maintaining strong bones and teeth; it also plays a role in muscle contraction, nerve transmission, blood clotting and blood vessel flexibility.

A recent study in the Archives of Internal Medicine looked at 39,000 older women in the Iowa Women’s Health Study, and found a small decreased risk of death among women taking calcium supplements. This contrasts with two studies from the University of Auckland (British Medical Journal, 2010 and 2011) which looked at the U.S. Women’s Health Initiative and found that calcium supplements, with and without vitamin D, modestly increased the risk of a heart attack. The data are difficult to interpret, and more studies and further analysis is needed. A Canadian journal said “if 100 patients take calcium supplements, less than 1 will have a fracture prevented, and less than 1 will develop a heart attack
or stroke.” A small increased risk of kidney stones has also been shown in people taking supplemental calcium, but not with dietary calcium.

The Institute of Medicine concluded in 2010 that adults should get 1000 mg a day of calcium, and post-menopausal women should get 1200 mg. An adequate calcium intake is especially important in pregnancy and breast feeding. Girls ages 9 – 18 often do not get enough calcium in their diets due to a preference for sodas, fake foods and dieting. Supplements of calcium, magnesium and vitamin D as chewable tablets may be beneficial for them, as this is a critical time for bone building.

I conclude that it is vitally important to get enough calcium from our diets, and to use supplemental vitamin D if needed to raise levels of D to 30 ng/ml or higher. Good dietary sources of calcium include low fat milk products (think unsweetened yogurt and cottage cheese and nonfat or 1% milk), green vegetables (especially broccoli, collards, kale & bok choy), almonds, Brazil nuts, sunflower seeds, sesame seeds and dried beans. Calcium fortified soy milk and orange juice can help vegans get enough calcium. Some tofu is high in calcium; read labels to be sure. People with osteoporosis should talk to their doctor or nurse practitioner about the risks and benefits of supplemental calcium.

Studies of men have suggested that a high intake of calcium from dairy products may increase the risk of prostate cancer, but the evidence for this is inconsistent. Men can consider getting a maximum of dietary calcium from non-dairy sources of the mineral.

A 2006 study from the University of Pennsylvania showed that use of proton pump inhibitors (Nexium, Prilosec, Prevacid and others ) to reduce acid reflux is associated with an increased risk of hip fracture in people over 50, probably due to decreased calcium absorption and other mechanisms. Long-term use of these medicines increases the risk. Short term use is often indicated, but many people stay on these anti-reflux drugs for years. These medicines can also increase the risk of pneumonia, vitamin B12 deficiency and low magnesium levels. There are other ways of dealing with acid reflux, including weight loss, avoiding trigger foods and high fat meals, eating frequent small meals, and sleeping in a Lazy-Boy chair or with a wedge pillow if the problem comes on at night.

Here in West Marin are blessed to have local organic dairies that produce wonderful yogurt. Yea for farmers’ markets with their abundance of calcium rich vegetables

Sadja Greenwood, MD, MPH back issues on this blog
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The Ethics of Eating Meat

The Ethicist, Ariel Kaminer, writing in the New York Times Sunday magazine, recently proposed a contest to readers – make an ethical case for eating meat. Thousands of people sent in essays. Five judges, who included Mark Bittman, Peter Singer and Michael Pollan, narrowed the entries down to six finalists, whose main ideas are summarized below. (Readers noted that all these judges were white men; many readers wanted nutrition professor Marion Nestle of New York University to be among them.). New York Times readers then voted on the essays.

*Her Australian father taught her to love hunting and a high meat diet. When her father developed gout, colon cancer, heart problems and stroke, the writer became aware of the ethical problems of killing animals, and took a 40 year hiatus from meat eating. She now looks forward to eating meat again without worrying about health, cruelty to animals or environmental degradation. She thinks that meat will soon be available, grown from cow, chicken, pig and fish cells in laboratories – without manure lagoons or contamination with dangerous bacteria. This essay received the most votes, but it turned out that the writer was a member of People for the Ethical Treatment of Animals (PETA) and had used their mailing list to garner votes. The essay was disqualified from winning under these circumstances.

*The writer is a young woman farmer who says that small scale farming requires the use of animals to clear cropland – goats and chickens – and to nourish the soil with their manure. Animal husbandry teaches her about the natural order of life and death. When you eat eggs or drink milk, you should know that the male roosters or bulls must be culled from the herd, and either eaten or wasted. The eating of animals is part of a balanced system of food production that is regenerative. Without farm animals, food production would require more use of fossil fuels in the forms of fertilizers and chemicals. This is why eating animals is ethical.

*The writer is a vegetarian who returned to meat eating. He feels that animals are raised and killed in cruel conditions, animals receive grain that should be given to hungry people, pasture land leads to deforestation, and eating meat is killing a sentient being. However, in some climates, such as dry grasslands, eating animals is a better choice than trying to grow vegetable sources of protein. Eating meat is ethical if you realize that all life is solar energy stored in an impermanent form, if you choose ethically raised vegetables, grains or meat, and if you give thanks. This was the winning essay.

*The writer is a farmer who became a lacto-vegetarian at age 7 because of love for animals. When s/he became a farmer s/he realized that bone and blood meal, fish emulsion and domestic animals were an integral part of vegetable farming. Animals are essential in a balanced food system. It is not ethical to eat animals raised in industrial-scaled confinement operations. There is an ethical option, even responsibility, to eat animals raised in a sustainable farm system and slaughtered with compassion.

*The writer discusses many moral choices we make, such as spending money on ourselves rather than charities, and having children rather than adopting them. We may choose to feed our family meat because of lack of time or knowledge on how to prepare vegetable protein. We need to rank the reasons for various moral decisions, realizing that the moral world is complex and the quest for any one good thing may require the sacrifice of others. We should attempt to tread more lightly on the earth, and realize that eating meat can be both ethical and tragic.

*The writer feels that it is morally permissible to kill and eat animals, if their basic needs are met in their lives, and their killing is painless. However, the killing of animals for food can be harmful to people, because most of us love animals and are upset by the idea that they are slaughtered for us. We learn to put this idea out of our heads, but it continues to affect us. The author felt a considerable freedom and lightness by giving up meat. As feeling creatures, there is a powerful self-interested reason to not eat meat.

I find these essays to be compelling. As a skeptic, I think the essay on ‘in vitro meat’ to have an element of science fiction, at least for feeding the world’s growing population, or being available in the near future. However, the Dutch have been working on this for years. Scientists at Maastricht University plan to produce sausage and hamburger in 2012. It is probable that animal growth factors and antibiotics will be necessary in the production process, which could lead to serious health concerns.

Here in West Marin, we are fortunate to have many organic farmers who raise animals in a careful way to help with the farming and provide meat, eggs and milk. There is a slowly growing awareness throughout the country of the brutality of factory farming of animals, and its unhealthy consequences for the environment. McDonalds and Target ended their relationship with a company that produced eggs in a factory farm with horrendous conditions for the animals, after an underground video went viral. We all need to eat animal products with great respect, and support our local farmers.
Sadja Greenwood, MD, MPH

Sleeping Pills - the downside

The most popular prescription drugs for insomnia these days are Ambien, Lunesta and Sonata. Many people also use pills called benzodiazepines, such as Valium, Restoril, Ativan, and Xanax. While effective, such pills have side effects and can be habit forming if used continuously. Sleep apnea can become worse with these powerful sleeping pills. In some people, Ambien is associated with sleepwalking, and eating when asleep without conscious awareness. Driving under the influence is hazardous. Elderly users of these medications have an increased risk of heart failure, falls and cognitive side effects.

The most problematic aspect of these prescription drugs is found in an article published in the British Medical Journal on February 27th, 2012. Entitled Hypnotics’ association with mortality or cancer: a matched cohort study, this article concludes that people who received prescriptions for sleeping pills had an increased risk of death or a cancer diagnosis, when followed for 2.5 years between 2002 and 2007. The word ‘hypnotic’ refers to a medication causing sleep. The study was done at Scripps Health in San Diego. The authors searched the electronic medical records of a large health system in rural Pennsylvania, and matched 10,529 patients who received sleeping pill prescriptions with 23,676 matched controls who did not. The average age was 54 years. Patients prescribed any sleeping pill (Ambien, Lunesta, Sonata, benzodiazepines, barbiturates and sedative antihistamines) had an elevated risk of death, with a dose-response association. Even people taking 18 pills a year or less showed some increased risk. Sleeping pill use in the upper third of the cohort was associated with a small but significant elevation of a cancer diagnosis. The researchers did not think that the death or cancer hazards were associated with pre-existing conditions. The authors stated that 24 previous studies have shown an association between use of prescription sleeping pills and mortality. No studies have shown that the use of such pills prolongs life or prevents cancer!

The mechanisms involved in these associations have yet to be worked out. The authors state that sleeping pills can increase depression, and when used with alcohol can lead to accidental death. Suicide may be a factor in some cases. Ambien can lead to ‘heartburn’ - regurgitation of food mixed with stomach acid that can injure the esophagus or lead to respiratory infections. Laboratory studies with rodents show that sleeping pills can cause chromosomal damage. This finding could be related to the rise in cancer.

Here are some conclusions I draw from this disturbing study. If you have been given prescription sleeping pills in the hospital, or at a very difficult time in your life, don’t worry. The use of such pills for people who are dying is absolutely justified. However, for most of us it is better not to take prescription sleeping pills. If you have been using them nightly for more than two weeks, you should decrease the dose very gradually; you may want to talk to your doctor or nurse-practitioner about a schedule to help you get off them.

What should we do to fall sleep and stay asleep more naturally? Sleep researchers say we should maximize our own output of melatonin – the sleep hormone. Melatonin is secreted by the pineal gland in our brains as darkness falls. It makes us sleepy and reduces our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age.

Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. You can find these goggles, which can be worn over reading glasses, at LowBlueLights.com, with a lot of interesting commentary on why they are effective. A less expensive version of the goggles is found at BluBlocker.com. Wearing these goggles, you can easily read, work on the computer, watch television, etc.

Daily exercise is a way to increase your natural melatonin secretion. A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine.

There is compelling evidence from shift workers that disruption of melatonin secretion can be a problem. Dr. Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.
A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

Daniel Kripke, the lead author on the Scripps paper, suggests the following for better sleep - keep the light out in your bedroom, try meditation or prayer, and learn progressive muscle relaxation or self-hypnosis. He also suggests taking melatonin tablets if you are a night owl, to reset your sleep-wake rhythms. He suggests talking to your doctor about an appropriate low dose of melatonin to try at bedtime. My advice is – start with 0.5 mg, and go up to 1-3 mg as needed. The kind that dissolves under the tongue goes most directly into your bloodstream. But – get those blue-blocking glasses, for the most natural sleep!
Sadja Greenwood, MD, MPH

Restorative Sleep

The lights we depend on after dark – to work, read, use the computer, and get around - the huge advantages of electric light - have a downside. They upset our natural sleep-wake cycle. The pineal gland, located midbrain, behind the eyes, secretes a hormone called melatonin, synthesized from the amino acid tryptophan. Melatonin comes out as the day gets dark, making us sleepy and lowering our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age. Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. To apply this research to your own sleep patterns, go to LowBlueLights.com. Meet Richard Hansler, at the Lighting Innovations Institute at John Carroll University in Cleveland. Hansler, now 87, is a physicist who has pushed the development of lighting that does not disrupt melatonin outflow. At this website they sell blue blocking glasses, as well as special lights low on the blue part of the light spectrum, both incandescent and fluorescent. Their glasses, which can be worn over reading glasses if needed, cost from $68 to $80. I have used these glasses for over 2 years and find them very effective. Much less expensive blue blocking glasses can be found elsewhere on the internet – read customers’ comments carefully to find out if they are effective.

Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.

A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine. This is suggested as a mechanism by which exercise reduces the risk of breast cancer.

Here’s my take-home lesson from the research on melatonin. Investigate blue-blocking glasses - and try using them 1-2 hours before your regular bedtime. Increase the duration of your daily exercise if you have trouble sleeping, or staying asleep. And – if you do wake at night and can’t fall back to sleep, get up and have a small snack of food, especially one containing milk. Milk contains enough tryptophan to promote sleep. Something sweet, like a piece of banana, will stimulate insulin which helps transport tryptophan across the blood-brain barrier.

In my next column I will write about new data on the potential dangers of prescription sleeping pills, and more natural alternatives. Also – there is new data on the importance of sleep in the prevention of diabetes and dementia. Stay tuned!

Sadja Greenwood, MD, MPH back issues on this blog

Sleep is the best meditation – the Dalai Lama

Go to Health – Health Insurance for Everyone

T.R. Reid wrote a brilliant book in 2010 – The Healing of America – A global quest for better, cheaper and fairer health care. He examined industrial democracies around the world and explained their different yet effective health care systems. By a variety of means, they achieve nearly universal coverage and good outcomes. If you don’t have time right now to read a book – albeit an entertaining one –as the health care debate is being discussed in the Supreme Court, here’s a short cut. Fareed Zakaria has written a two page article in the March 26th issue of Time that summarizes many of the issues. The requirement that everyone buy health insurance – called the individual mandate – is at the center of the constitutional controversy. Government subsidies would be given to help those without sufficient funds to buy insurance.

Reid and Zakaria both point out that Switzerland, a business-friendly democracy, had a system like ours 20 years ago, with private insurance and incomplete coverage. People without insurance went to emergency rooms, insurers rejected people with pre-existing conditions, and costs were mounting. The country decided that to make health care work, everyone had to buy insurance. They reformed their system in a way similar to Obama’s proposals. Now, 20 years later, everyone is insured, the quality of care is high, and costs have moderated. I can attest to this, as I visit my sister in Switzerland every year, and have seen her in the hospital there. The care is excellent. Taiwan is another with a free-market economy that decided to create a universal health-care system in the mid 1990’s. It studied all existing models and decided against private insurers, and for a single payer system that is effective and very low cost. ”. The Swiss and Taiwanese found that it is imperative for everyone to be covered by health insurance to keep costs down and provide a system where everyone has basic care.

Reid writes that the Swiss have an ethic of ‘solidarity’ that helps maintain their unity despite having 4 official languages. Solidarity means community and equal treatment. Everyone should have equal access to vote, have a jury trial, an old age pension, a good school system and a good health care system. Some people have much more money than others in their capitalist system of government, but everyone has their basic needs for health care met.

Zakaria writes that we have “the most expensive, least efficient system of any rich country on the planet.” Chronically ill patients , 5% of the population, account for 50% of our health care costs. Their care drives up insurance premiums if they are insured, and federal, state and local health care costs if they lack insurance. Universal coverage would bring healthy people into the system and thereby result in lower average premiums. A downside to Obama’s plan is that it maintains the connection between employment and health care that is inefficient and a burden on American business. It is hard for companies to be competitive globally when they are paying large amounts for their employees and former employees. German, Canadian, Japanese and British companies pay next to nothing in health care costs, in comparison.

I hope our country can edge away from rugged individualism into more solidarity, with passage of universal health care. Stay tuned throughout the week as it is debated at the Supreme Court. E pluribus unum.
Sadja Greenwood, MD, MPH - back issues on the blog

Volumetrics - a plan to reach the right weight and stay healthy

Here’s an interesting finding – as long as food is equally palatable, people tend to eat the same weight of food. The March issue of the Nutrition Action Health Letter features an interview with Dr. Barbara Rolls, at Penn State University, who has been studying this for years with the aim of helping people lose weight more easily. Her latest book – The Ultimate Volumetrics Diet – will be out in April; previous books include The Volumetrics Eating Plan. She has looked at ways to change the amount of water in foods, thereby adding weight and volume but no calories. This is done by adding vegetables to each recipe, and making sure the food is tasty. The result, found in careful studies, was that people reduced their calorie intake by about 25%. In a trial of 700 people, she found that when people ate a diet that was less calorie dense (more vegetables included) they were eating significantly more food – about a pound more food a day – yet they were eating fewer calories and easily losing more weight. In another study, people who successfully lost 10% of their maximum body weight and maintained the weight loss for at least five years were found to eat five servings of vegetables a day. Overweight participants ate three and a half servings. Besides adding more vegetables to recipes, calories are cut by reducing fat and sugar in sauces, using small amounts of olive oil instead of cream, switching to whole grain pasta or brown rice, and removing fat and skin from poultry or meat. Dr. Rolls advises adding vegetables to mixed dishes, soups and stews, and putting cooked vegetables in a blender for sauces. She suggests adding vegetables to breakfast, lunch and dinner for children and adults. She found that baked goods with added vegetables – such as extra carrots in a carrot cake – made the cake even more palatable, so people ate more. However, at the end of the day they had consumed fewer calories.

Studies done on portion size were also important – Dr. Rolls found that while people tend to eat the same weight of food day after day, when exposed to large portions they get thrown off very easily. Portion control is still important for all eaters, and it starts with visual awareness. Some people use a 10 inch rather than a 12 inch plate at home and automatically eat less. Some divide a restaurant entrée in half, and share the food or take half home for the next day. Some ask for a child’s plate, which is easy if you are ordering takeout. People interested in portion control avoid buffets and all-you-can-eat restaurants, or exercise great care therein.

Mindful eating is another important way to slow down and appreciate food. Become more aware of your hunger before eating and feelings of fullness as the meal goes on. It can take 15-20 minutes for the brain to register that you have had enough, so overeating is easy when you are rushed. Some people set a timer for 20 minutes and make sure they savor their food while making it last until the bell chimes. Eating while reading or watching television can lead to mindless stuffing for some people. Become aware of gratitude for the food you have, for the animals who gave their eggs, milk or life, and for the people who harvested and prepared food for your table. Be aware of your personal triggers for mindless eating, such as anxiety, depression, alcohol, marijuana or certain chips and sweets.

For anyone who wants to keep up on the science of healthy eating, subscribing to Nutrition Action Health Letter is a great idea. Go to www.cspinet.org.
Sadja Greenwood MD, MPH back issues on this blog

Seven Billion, and Counting - What to do about it?

We humans now number seven billion, and we are growing fast. Nearly 80 million people are added to the earth’s population each year. Relentless population growth affects many of our current problems, from food scarcity in poor countries, water shortages, pollution, habitat loss and species extinction, climate change, degradation of the oceans and lakes, and human & animal suffering. The welfare of humans is deeply linked to nature, and our propensity to ignore this has been disturbing.

Population Connection (formerly know as ZPG – for Zero Population Growth) is an organization working to understand the reasons for population growth. Its goal is to educate the public – including policy makers – on solutions to the problem, including access to voluntary family planning, education for girls as well as boys worldwide, and ensuring social justice for women and the poor.

In the February issue of The Reporter (the magazine of Population Connection) the theme is child marriage. Ten million young girls become brides every year throughout the world, having children while children. Child marriage is defined as the marriage of a person before the age of 18. The practice is most common in sub-Saharan Africa and South Asia. In Mali, 71% of girls are married before they turn 18. In Bangladesh, the median age of marriage for girls is 15, and 4 out of five girls first meet their husbands at their weddings, according to The Reporter. Child marriage can have serious health implications – in Africa, pregnancy related deaths are the leading cause of mortality for 15-19 year old girls. Many girls have sex before their first period. An estimated 100,000 girls each year develop a fistula, or opening, between the bladder and vagina because of obstructed labor in childbirth. The pelvis is too small, incompletely formed. As a result, they leak urine constantly and can become social outcasts. There are heroic doctors and nurses who spend their lives on surgical repair of this problem, but the hospitals and know-how for fistula repair are scarce.

Archbishop Desmond Tutu is hopeful that the practice of child marriage can end in a generation. He has said “I am confident that change can happen very quickly. No woman who has had the benefit of staying at school and marrying later in life can inflict child marriage on her daughters.”

National Geographic published an article on child marriage in the June 2011 issue, with arresting photographs.

John Bongaarts, a demographer at the Population Council and the National Academy of Sciences, calculates that if the average age of childbearing increased by 5 years, future population size could be reduced by 15-20 percent. This is a striking finding. If readers want to help with this issue, they can visit Population Connection on line, or call them at 800-767-1956. Population Connection has classroom curricula for teachers of social studies and environmental studies that are used in the US and all over the world.

The issue of access to voluntary family planning has been at the top of the news recently here at home, with Obama’s push to give women free access to birth control through their insurance policies. The pushback we have seen against voluntary family planning harks back to Margaret Sanger’s jailing in 1917 for distributing the diaphragm. In 2012, is this absurd, or what? Nicolas Kristof, writing in the New York Times on Sunday, Feb. 12th, aptly called it ‘pelvic politics’. I see it as a woman’s issue, a man’s issue, and a big environmental issue as well. The Sierra Club has declined to take on US population growth directly and forcefully, fearing being criticized as racist. They see it as an issue about immigration. I prefer the stand of the Center for Biological Diversity, which is working to save a vast diversity of wild animals and plants, to secure a future for all species hovering on the brink of extinction. Toward this end, among other educational programs, they hand out endangered species condoms, and have a ‘hump smarter hotline’ (800-628-2399) to ‘make sure that this one roll in the sheets doesn’t push some poor creature into extinction’. Check it out - they have a great message. They point out that 50% of pregnancies in the US are unplanned, and more people conceive a child on New Year’s eve than any other time in the year. Obviously, there are ways to talk about population and the environment without being racist. Wake up, Sierra Club! We could all use some new thinking on these issues. Despite our smaller families, our resource heavy lifestyles make us part of the problem.
Sadja Greenwood, MD back issues on this blog!

Luteolin - Another fascinating compound in plants

Luteolin is a flavonoid – a compound in plants that gives yellow or red/blue pigments designed to attract pollinators. Flavonoids also fix nitrogen, regulate plant physiology and inhibit plant diseases. When we humans eat plants, the flavonoids therein may have many beneficial effects. Research on luteolin is an example.

Dr. Daniel Hwang is a molecular biologist at UC Davis. He has studied the ways in which luteolin (and other plant compounds – quercetin, eriodicytol, hesperidin, naringenin) apparently act as anti-inflammatory agents. These compounds target an enzyme in humans that can increase inflammation. Luteolin was found to be the most effective inhibitor of this enzyme. Since unchecked inflammation is associated with heart disease, cancer and problems of aging, this finding is a step on the way to prevention.

Researchers at the University of Illinois, led by Dr. Rodney Johnson, study anti-inflammatory compounds and their effects on the brain aging. They have found that luteolin can reduce inflammation in the brain as well as in other parts of the body. When infection occurs anywhere in the body, brain cells called microglia produce inflammatory chemical messengers that help to fight off the infection. This process is beneficial if it is limited to the acute infection. The inflammatory response is associated with sleepiness, loss of appetite, fever and lethargy, and sometimes a temporary diminishment of memory and learning. Some neurons may self-destruct in this process. Inflammation in the central nervous system can be serious if it goes on too long. Luteolin was found to diminish this inflammatory response, by shutting down a key component in the inflammatory pathway.
When aged mice were fed a diet supplemented with luteolin, they did better on tests of learning and memory tasks than the aged mice controls; the levels of inflammatory markers in their brains were similar to younger adult mice. The researchers concluded that natural compounds in fruits and vegetables, by being anti-inflammatory, could inhibit cognitive aging. Johnson thinks that his team’s results are applicable to other conditions with an inflammatory component, including diabetes and obesity.

Just published research by Professor Jung Park in Korea has shown that luteolin inhibits cell signaling pathways important for the growth of colon cancer cells. Blocking these pathways can stop colon cancer cells from dividing, and can lead to cancer cell death.

Dietary sources of luteolin include celery, green pepper, thyme, chamomile, carrots, olive oil, peppermint, rosemary and oregano. Luteolin is also being sold as a supplement, and should not be taken as such. You may remember the study showing that smokers taking beta-carotene supplements developed more lung cancer and had higher death rates than those without such a supplement. It was felt that taking an excess of one carotene may have inhibited the absorption of other carotenes from food. There are many flavonoids in plant foods, and they may act synergistically with each other. Taking any one of these as a supplement is unwise and untested. Earlier in this article I wrote about quercetin – found in apples, capers and onions, and eriodicytol, hesperidin, and naringenin - found in citrus fruits. The take home lesson from research on flavonoids is – keep eating a wide variety of vegetables and fruits. Remember what Michael Pollan said: Eat food, not too much, mostly plants.
Sadja Greenwood, MD,MPH back issues on this blog