An Apple a Day…...

Apples are a "miracle fruit" that convey benefits beyond fiber content, according to Dr. Bahram Arjmandi at Florida State University. Animal studies have shown that the pectin and polyphenols in apples improve blood fat levels and lower the production of pro-inflammatory molecules. Arjmandi's 2011 research  randomly assigned 160 women ages 45-65 to one of two dietary interventions: one group received two dried apples daily and the other group ate dried prunes every day for a year. Blood samples were taken at 3, 6 and 12-months. The results surprised Dr. Arjmandi, who stated that "incredible changes in the apple-eating women happened by 6 months- they experienced a 23% decrease in LDL cholesterol," which is known as the ‘bad cholesterol.’ The daily apple consumption also led to a lowering of C-reactive protein (a marker of inflammation). "I never expected apple consumption to reduce bad cholesterol to this extent while increasing HDL cholesterol or good cholesterol by about 4%," Arjmandi said. Yet another advantage is that the extra 240 calories per day consumed from the dried apple did not lead to weight gain in the women; in fact, they lost on average 3.3 lbs. "Reducing body weight is an added benefit to daily apple intake" he said. Part of the reason for the weight loss could be the fruit's pectin, which is known to have a satiety effect.

In a study from Ohio State University, healthy, middle-aged adults who rarely ate apples were given one red or golden

Delicious apple a day, or a capsule containing the polyphenols found in apples, for 4 weeks.  The apple eaters had a 40% decrease in oxidized LDL, a substance linked to hardening of the arteries. People taking the capsules had a similar effect, but not as large. The author of this study, Dr. Robert DiSilvestro, described daily apple consumption as significantly more effective in lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.

The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health.

In the Christmas edition of the prestigious British Medical Journal, there is an article comparing apples and statins for the prevention of cardiovascular deaths.  Using mathematical models, a team of researchers at Oxford set out to test how the150 year old proverb  - An apple a day keeps the doctor away -might compare with the more widespread use of statins in the UK population. They calculated that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.  However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes. The researchers conclude that the public health message: An apple a day… is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, “although by all means eat more apples.”

My message to readers is similar – eat a daily apple, don’t change your medications without talking with your doctor, and have a wonderful holiday season. 

Sadja Greenwood, MD   back issues on this blog.  Check out my novel, Changing the Rules, at Stinson Beach Books, Point Reyes Books & Amazon

Oregano

Oregano is an important culinary and medicinal herb that has been used in medicine and cooking for thousands of years. It belongs to the mint family.  Its name comes from the Greek words oros (mountain) and ganos (joy)!

 In folk medicine, oregano is used to treat respiratory problems, gastrointestinal (GI) disorders, menstrual cramps, and urinary tract disorders.  It is also applied topically – as oregano oil - to help treat a number of skin conditions, such as acne, dandruff, skin infections and athlete’s foot.   (Full disclosure – I use it on my sore fungal toes, and it’s helping.)

 Oregano contains a fair amount of vitamin K - an important vitamin which promotes bone growth, the maintenance of bone density, and the production of blood clotting proteins. Although dried basil, thyme and oregano contain high levels of vitamin K, a teaspoon of these herbs in their fresh form contain only a small amount and can be used by people taking Coumadin.  Check with your doctor on this. 

Oregano, allspice and garlic essential oils (EOs) can be effective, natural barriers against E. coli, Salmonella and Listeria, according to a study in the Journal of Food Science, published by the Institute of Food Technologists. The  study from government researchers revealed that oregano oil was found to be the most effective antimicrobial used in cooking, followed by allspice and garlic.  While this information can make you happy to include these herbs in your dishes, you should never forget the important rules about food safety to prevent bacterial contamination.  .

Researchers at Long Island University (LIU) have found that an ingredient of oregano could potentially be used to treat prostate cancer. Dr. Supriya Bavadekar, PhD, RPh, Assistant Professor of Pharmacology at LIU is currently testing carvacrol, a constituent of oregano, on prostate cancer cells. The results of her study demonstrate that the compound induces apoptosis in these cells. Apoptosis, is programmed cell death, or simply "cell suicide." Dr. Bavadekar and her group are presently trying to determine the signaling pathways that the compound employs to bring about cancer cell suicide. "We know that oregano possesses anti-bacterial as well as anti-inflammatory properties, but its effects on cancer cells really elevate the spice to the level of a super-spice like turmeric," said Dr. Bavadekar. Though the study is at its preliminary stage, she believes that the initial data indicates a huge potential in terms of carvacrol's use as an anti-cancer agent. "A significant advantage is that oregano is commonly used in food and has a 'Generally Recognized As Safe' status in the US. We expect this to translate into a decreased risk of severe toxic effects. Some researchers have previously shown that eating pizza may cut down cancer risk. This effect has been mostly attributed to lycopene, a substance found in tomato sauce, but we now feel that even the oregano seasoning may play a role," stated Dr. Bavadekar. "If the study continues to yield positive results, this super-spice may represent a very promising therapy for patients with prostate cancer."

Oregano grows very well in Bolinas gardens.  Mine survived the recent frost and seems to be growing well all year long.  You can put it in salads, soups and stir fries, as well as pasta sauces and pizza. 

Sadja Greenwood, MD, MPH  back issues on this blog.  Check out my novel, Changing the Rules, at the Point Reyes Bookstore and on Amazon.

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Nicolas Kristof on holiday gifts

In a recent New York Times (Sunday, December  1^st, 2013) columnist Nicholas Kristof wrote some ideas for gift giving that most of us have not heard of. First he writes about gifts to established charities – they will tell your friend or family member that you gave the gift in their name:

*Buy a year of schooling for a girl in Ethiopia through the International Rescue Committee (gifts.rescue.org)

*Buy a flock of geese for an impoverished family in a poor country through Heifer International (heifer.org)

 Here are his more unusual suggestions: –

*Help to prevent unwanted pregnancies in kids here at home. The Carrera Adolescent Pregnancy Prevention Program is a school curriculum “devised by a New York City education expert, Dr. Michael Carrera, who recognized that it’s not enough to hand out condoms.  One also needs to give kids in high poverty neighborhoods a stake in a better future, a reason to think they can succeed.  So the curriculum includes comprehensive sex education but also financial literacy, job preparation and summer internships, S.A.T. coaching and much more.  The program has now spread to more than 20 states, and follow-up studies suggest it reduces pregnancy rates by half.  For $50, you can fund a student’s college savings account, part of the financial literacy element (information is at childrensaidsociety.org).”

*Afghan Institute of Learning, founded by an Afghan woman to run empowerment and training programs for Afghan women and girls.  The institute was founded in the 1990s, when it was illegal, as girls’ education is threatening to the Taliban. $65 pays for a year of literacy classes for a girl or woman.  (AfghanInstituteofLearning.org.)

*GlobalGoodsPartners.org will sell you gifts under $30 made by people all over the developing world, such as a hand-embroidered scarf made by Afghan widows.

*HELP – Haitian Education and Leadership Program.  HELP searches across Haiti for the most outstanding students from disadvantaged backgrounds and sends them to college, while providing counseling, English and computer tutoring and stipends.  HELP students pledge to contribute 15% of their earnings for their first 9 years of employment, to make the program sustainable.  (UHelp.net)

*Reach Out and Read is a U.S. literacy program for the disadvantaged that uses doctors to encourage parents to read to their children.  They hand out free books and leaflets promoting bedtime stories, thereby ‘prescribing’ reading to the child.  Families in this award winning program are more likely to describe reading as a child’s favorite activity.  Books are donated by publishers like Scholastic.  $50 covers a child’s cost for five years.  (ReachOutandRead.org)

Nicholas Kristof  and his wife Sheryl WuDunn are heroes of mine.  They wrote Half the Sky – Turning Oppression into Opportunity for Women Worldwide in 2010.  They travel the world to find people making a difference for humanity in difficult places.  I try to pay attention to their suggestions.

Readers, have a thoughtful and joyous holiday season.  Let’s hope for rain.

Sadja Greenwood, MD, MPH    back issues on this blog

Try a bigger breakfast

When you eat a day’s worth of food really does make a difference, according to Daniela Jacubowicz, a professor at Tel Aviv University.  In a recent study, published in the journal Obesity, she randomized 93 overweight and obese women into 2 groups and followed them for 12 weeks.  Both groups ate 1400 calories a day, consuming a healthy variety of poultry, fish, egg whites, vegetables, fruits and whole grains.  The ‘breakfast group’ had 700 calories for breakfast, 500 for lunch and 200 for dinner.  A sweet treat was included as part of their breakfast, such as a small chocolate bar, to stave off cravings for the rest of the day. The ’dinner group’ had exactly the same foods in reverse order - 200 calories for breakfast, 500 for lunch and 700 for dinner.  I presume that their chocolate bar came with dinner.

At the end of 12 weeks, the results were striking.  The ‘breakfast group’ lost an average of 19 pounds while the ‘dinner group’ lost 8.  Waist circumference decreased by 3 inches in the ‘breakfast group’ compared to 1.4  inches in the ‘dinner group’.  Glucose and insulin levels dropped significantly more in the ‘breakfast group’.  They did not experience the high spikes in glucose levels that can happen after a meal and are considered dangerous. Triglyceride levels fell 34% in the ‘breakfast group’ but increased by 15% in the ‘dinner group’.  Triglycerides are a main form of fat in the body; high levels of triglycerides have been associated with greater risk for heart disease. Average hunger scores were significantly lower in the ‘breakfast group’. 

The authors of this study concluded that a high calorie breakfast with reduced intake at night is a useful alternative for the management of obesity.  Previous studies from Tel Aviv University also looked at overweight men, and came to similar conclusions. In summary, our metabolism is impacted by the body’s 24 hour circadian rhythm. The time of day we eat can have a real impact on the way our bodies process food.

What are the implications of this study for you, the reader?  I am not suggesting a 1400 calorie diet, but a change in when you eat the amount of food that is right for you. Your weight may be just right, or you may be overweight, or too thin.  You may be a person who is never hungry in the morning, or who really relishes a big dinner at the end of a busy day.  I think it makes sense to ease your way into bigger breakfasts and lighter dinners because of the benefits on glucose and insulin levels, and because of the greater energy you will experience after a hearty (healthy) breakfast.  If you are never hungry in the morning, try a very light dinner one night, such as a bowl of cereal or a dish of cooked vegetables.  You will probably wake with an appetite.  If your usual breakfast is toast and tea, or a pastry and coffee, you may notice that your energy drops mid morning and more coffee is needed to keep you going.  When you add healthy protein and whole grains to your breakfast you will notice a smoother feeling of energy that lasts until your next meal.  What to do about the big dinner you have always loved?  When you start to follow this plan, you may find that you want to make it simpler and smaller without too much difficulty.  You may like spending less time cooking. Another benefit from a smaller dinner is feeling more energy in the evening. Having a lot to digest at night makes some people sleepy. 

Finally, Professor Jacubowicz suggests an end to late night snacking, in front of the computer or television.  She feels that this is a major contributor to the obesity epidemic, causing weight gain and a greater risk of cardiovascular disease, due to the midnight spike in blood sugar. 

Sadja Greenwood, back issues at sadjascolumns.blogspot.com

Appreciating Blood

As blood flows from the heart through arteries, capillaries and veins, this amazing substance keeps us alive. The beautiful red color of blood is due to the iron in hemoglobin, the molecule in red cells that carries oxygen.

Blood delivers oxygen, hormones and nutrients to body cells and picks up waste products from them.  White blood cells contain the many elements of the immune system.  Blood helps to control body temperature.  It carries a clotting system to control blood loss after injury. 

As blood travels throughout the body, its red cells deliver oxygen to all body cells and remove carbon dioxide.  After returning to the heart, blood travels to the lungs, giving off carbon dioxide and picking up fresh oxygen. Blood picks up digestive products from the intestines and carries them to cells for metabolism/energy production.  At the same time, it removes waste products from cells and delivers them to the kidneys for excretion.  All this is happening at great speed – a red blood cell will circulate through the body and return to the heart every 60 seconds. 

Have you ever wondered why your skin will bleed when pricked with something as tiny as a pin?  There is a capillary exceedingly close to every cell in the body. Capillaries are the smallest and most numerous blood vessels in the body, with an inner diameter just wide enough for a red cell to squeeze through.  It is estimated that there are 25,000 miles of capillaries in an adult human body.

Blood vessels help to regulate body temperature by dilating close to the skin when we are overheated, as in a hot flash or after exercise.  Heat is thereby lost to the outside air.  When we are cold, blood vessels in the skin constrict, saving warmth in our core. (Shivering also helps to create more heat.)

We have 6-8 liters of blood in our adult bodies, or about 10 pints.  About 45% of this is cells, and 55% plasma.  Plasma is a watery tissue containing dissolved proteins (albumin, globulin and fibrinogen), glucose, blood fats, clotting factors, electrolytes, hormones and carbon dioxide.  It is the protein reserve for the body.

Red and white blood cells and platelets are produced in the bone marrow of our ribs, sternum, vertebrae and pelvis.   We produce billions of blood cells a day, to replace those that have a short life.  Red blood cells live 120 days, and white cells a much shorter time. Platelets are small clear cell fragments that are essential in preventing blood loss by forming a plug at the site of an injury.  Blood components come from stem cells - undifferentiated biological cells that can become specialized - in the bone marrow they give rise to red cells, white cells and platelets.

The blood clotting system consists of numerous factors that circulate continuously through the body in an inactive form. When platelets make a plug to stop bleeding, a substance called fibrin starts to form a clot, and the many  other clotting factors are activated in a chain reaction called the coagulation cascade.

This has been a simple explanation of the functions of blood, probably familiar to all readers.  In a subsequent column I will write a more detailed description of the immune system. In the meantime, here are some ideas for keeping your blood working well for you.

Avoid blood-born diseases such as Hepatitis B and C and AIDS by never sharing a needle, and practicing safe sex with condoms with any new partner.

Have a complete blood count (CBC) when you see your doctor, to test for anemia (this is especially important for women with heavy periods).  Eat iron containing foods and take an iron supplement if needed.  There are forms of anemia that do not require iron, but may require B vitamins.  Find out; don’t guess.  It’s important.

Breath deeply, exercise and keep good posture to fully oxygenate your blood.  Don’t smoke.  In addition to damaging your lungs, smoking constricts your blood vessels and impedes circulation to your heart, your limbs and your vital organs.

If you are taking a blood thinner such as Coumadin, aspirin, Pradaxa, or similar new anti-coagulants, keep something on hand that helps to stop bleeding from nosebleeds, small cuts or external injuries.  Several products are available on line and in pharmacies without a prescription, containing a powder that causes blood to coagulate.  You sprinkle it on the wound, or introduce it into your nose with an applicator, and then apply pressure.  I am familiar with a product called QR – it is quite helpful with small cuts or nosebleeds.  It should not be used if stitches are necessary, a wound is infected, or if bleeding is arterial.  For gushing arterial bleeding, apply direct pressure with a clean cloth or bandage, and get emergency help at once. 

Sadja Greenwood, MD    Past columns on this blog.  Check out my novel, Changing the Rules, at the Grand Hotel, Uniquities, the Stinson Beach and Point Reyes Book Stores, and Amazon.

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Go to Health - Cranberries

Cranberries will be plentiful in stores as holiday meals approach.  According to researchers at Rutgers University, they are among the top foods with proven health benefits.

 Cranberries are full of anti-oxidants, which protect cells from unstable molecules known as free radicals. The National Institutes of Health is funding research on cranberry’s effects on heart disease, yeast infections and other conditions. 

So far, research has found that drinking cranberry juice  - unsweetened is best – can help to prevent urinary infections by binding to bacteria so they can’t adhere to cell walls, especially cells lining the bladder and urethra.  Once a urinary tract infection is established, however, there is no hard evidence that cranberry juice can treat it – antibiotics may be needed.  Unsweetened cranberry juice in small bottles is available at the People’s Store.  Dilute and drink – or gargle for your teeth and gums.  Then swallow!!

A compound in cranberries – proanthocyanidine – prevents plaque formation on teeth.  Mouthwashes are being developed to prevent periodontal disease.  In the meantime, you can try rinsing your mouth with slightly diluted unsweetened cranberry juice. 

 In some people, regular cranberry juice consumption for weeks or months can kill H. pylori bacteria, which can cause stomach ulcers.

Drinking cranberry juice daily may increase levels of HDL, or good cholesterol and reduce levels of LDL, or bad cholesterol.  Research is also going on about substances in cranberries that are effective against cancer.

Here’s a recent abstract from a scientific journal, reporting on work from the University of Massachusetts. 

 Emerging evidence is elucidating how non-nutrient phytochemicals underlie the health promotion afforded by fruits and vegetables. This review focuses on Vaccinium macrocarpon, the American cranberry, compiling a comprehensive list of its known phytochemical components, and detailing their prevalence in cranberry fruit and its products. Flavonoids, especially colored anthocyanins, abundant flavonols, and unique proanthocyanidins, have attracted major research attention. Other notable active components include phenolic acids, benzoates, hydroxycinnamic acids, terpenes and organic acids. Health effects of cranberries, cranberry products, and isolated cranberry components in humans and animals, as well as in vitro, are debated. Evidence for protection from several bacterial pathogens, cancer, cardiovascular disease, and inflammation is compelling, while neuroprotection and anti-viral activity also have begun to draw new consideration. Emerging bioavailability data is considered and potential molecular mechanisms are evaluated, linking phytochemicals to health effects through their biochemical properties and reactions.

Are you interested in stocking up on cranberries?  You can freeze them and have some available all year. Worried about the amount of sugar needed to offset the sour taste?  Try putting cranberries in a fruit shake, or make cranberry sauce with an orange, cloves, cinnamon and xylitol, the low glycemic sugar that comes from trees and is good for your teeth and less problematic for diabetics.   Xylitol is available in many natural food stores and on line. (Try it for hot chocolate too! )

Cranberry – Coumadin interaction:  if you are taking Coumadin (warfarin) to prevent blood clotting, you should avoid drinking cranberry juice daily.  It may increase your risk of bleeding.  Small amounts of cranberries should be safe – check this out with your doctor. 

Sadja Greenwood, MD  back issues at sadjascolumns.blogspot.com   Check out my novel, Changing the Rules, at the Grand Hotel, Uniquities, the Stinson Beach and Point Reyes book stores, and Amazon.

What Is It About Brassicas?


I lead a discussion on nutrition at the Commonweal cancer retreats every few months, along with the renowned chef and author, Rebecca Katz. We have a handout of general suggestions for healthy meals, and then give each person individual guidance. One of our first guidelines is to eat a brassica vegetable every day. These vegetables include broccoli, arugula, kale, collards, mustard greens, bok choy, Brussels sprouts and turnips. The reasons these vegetables are important for people with cancer, and people who want to prevent cancer, have been studied at Johns Hopkins University’s Brassica Chemoprotection Laboratory. They have focused on broccoli, which contains a compound known as sulforaphane. It is a potent natural inducer of what are called phase2 detoxification enzymes. These enzymes break down free radicals and environmental toxins, enabling the body to excrete them in urine, bile or stool. The Johns Hopkins researchers found that these detoxifying enzymes were boosted in function by the sulforaphane in brassicas, and that broccoli contains high levels. Broccoli sprouts contain the highest amounts of sulforaphane, up to 50 times more than mature broccoli. Recent studies at Baylor College of Medicine have shown that a concentrated form of sulforaphane is active against lymphoblastic leukemia cells in the laboratory. Other researchers at the University of Arizona are looking into topical sulforaphane to prevent skin cancer. Preventive effects on breast, prostate and colon cancer are also under study.






It is important not to overcook broccoli, as this will destroy its ability to release anti-inflammatory and cancer protective compounds. Steam lightly for a few minutes. Since broccoli sprouts are such a potent source of sulforaphane, you should know that it is easy to make your own. You can call 800-695-2241 and order organic broccoli sprouting seed. If you are new to sprouting, consult sproutman.com. He has an almost overwhelming number of ideas and devices to help you sprout.






At the cancer retreats, we also suggest that people consider drinking the green tea or black tea with broccoli seed extract, formulated at the Johns Hopkins Brassica Chemoprotection Laboratory. The tea is high in sulforaphane and related compounds. A portion of the proceeds from the sale of these teas will go to further Hopkins’ research on vegetables. Regular and decaffeinated teas are available. If you don’t have time for sprouting right now, just go for the tea. Call the Baltimore Tea and Coffee Company at 800-823-1408 to order. The teas do not taste like broccoli!






Sulforaphane is also found in kale, cabbage and all the other brassica (cruciferous) vegetables. If you don’t like broccoli, you can still get the benefits of sulforaphane in these foods.






At the last cancer retreat, one of the participants was a patient at Johns Hopkins. She said that her oncologist had never mentioned the Brassica lab, and it seemed strange that she would come to California to find out about it. Yeah, California!






At the Commonweal cancer retreats, Rebecca Katz has come up with a good way to help people drink fluids, even when they are not feeling well. She suggests a special pitcher for water, in which you place orange and lemons slices, with the peel (organic is best), chunks of cucumber, and a sprig of thyme, mint or rosemary. Rebecca calls this ‘spa in a glass’. It will be easier to drink than plain cold water, and will have beneficial qualities.






Sadja Greenwood, MD, MPH


You can find a copy of my novel, Changing the Rules, at Pt. Reyes Books, the Grand Hotel, Uniquities, or at Amazon.com.

Go to Health: How to Preserve Your Brain, Muscles, and Bones



















Your Brain – Keep it sharp. Here are some of the proven ways to help memory and brain function:







Exercise at least 30 minutes every day. Upper body exercise counts if walking is hard for you. Play music to keep you going. Ride a stationary bike in front of your TV. Get an exercise pal or join a class. Exercise will help you grow new neurons and oxygenate your brain.







Vitamin B12 is important to prevent brain shrinkage in people over 60. It is found in animal foods. Vegans should always take a B12 supplement. Some older people don’t absorb it well from food. Get a B12 blood level from your doctor, and take B12 tablets sublingually if you are low.







Eat vegetables and fruits, legumes, fish and poultry. Limit fatty meat and foods containing sugar, to prevent obesity and keep your arteries clear. Avoid too much alcohol and addictive drugs, legal or illegal.







Olive oil should be your major fat source. A compound in extra virgin olive oil called oleocanthal may help prevent Alzheimer’s. See the 6/5/13 column at sadjascolumns for details.







Get enough sleep: 7-8 hours, so that you wake refreshed. Sleep is essential for good brain functioning.







Learn something new: a new language, a new skill, a musical instrument, drumming, a dance routine. According to a 2009 Gallup Poll, 85% of Americans who don’t play a musical instrument wish that they could. You can! You will forge new pathways in your brain.







Don’t smoke - smoking will decrease the blood supply to your brain.



















Your Muscles: . As we get older, our muscles grow weaker, and it’s important to work on staying as strong as possible. You don’t have to join a gym to keep your muscles strong, but if you do, enjoy your workouts. Walk daily, run in place, bike, dance, skip rope, garden, lift weights at home. Light weights are fine for beginners and many women. Resistance bands are useful. Invest in a few sessions with a personal trainer if you have never tried strength training. Take a class in yoga, Pilates, or dance. We have great classes in Bolinas. Use a standing desk so you don’t sit too much.







Vitamin D is important for muscle strength and to prevent falls and fractures. Many people benefit from taking 1000 IU daily as a supplement. Talk to your doctor or nurse practitioner about this. Keep your blood level of Vitamin D3 at 30 ng/ml or higher.







Don’t smoke - smoking will reduce the blood supply to your muscles and harm your lungs.



















Your Bones: Osteoporosis is common in women after menopause – it is defined as bones that are porous, brittle and subject to fracture. It can also occur in men as they age. Your doctor can arrange a test called DEXA, or bone densitometry, that can diagnose osteoporosis. There are various medicines that help with this problem. Whether or not you take a medicine, you should definitely eat a diet with adequate calcium, possibly take supplementary calcium (to be discussed with your doctor) and take Vitamin D as noted above. Good foods high in calcium include non-fat or low fat yogurt, calcium fortified soy milk, kale, collards, watercress, arugula, broccoli, okra, beans, almonds, sardines with their bones, and many others. Make bone soup, by adding vinegar to a bone broth to help release the calcium. Aim for a diet high in green vegetables, nuts and seeds. There is preliminary evidence that using olive oil as your main fat will help to preserve bone strength.







Exercise, especially walking, running, dancing and resistance exercises help keep bones strong. When your muscles contract, your bones react.







Don’t smoke – smoking will weaken your bones.







Here’s an exciting new development: UCSF now has a service for Skeletal Health in the Department of Orthopedic Surgery, developed and staffed by Aenor Sawyer, MD, who is a Bolinas resident whenever she can break loose from work. Those of you who know Aenor are aware that she is as compassionate as she is expert, and the opportunity to visit her new service is truly a blessing.







Sadja Greenwood, MD. MPH

Go to Health: Driving Under the Influence Of...


Mothers against Drunk Driving (MADD) has taken on an added cause – drugged driving. According to the National Highway Traffic Safety Administration, one in 8 weekend, nighttime drivers test positive for illicit drugs, and one in 3 drivers killed in auto crashes test positive for drugs. They are referring to illicit and prescription drugs, as well as alcohol. All cause dangers for drivers and their passengers.







The Institute of Medicine has reported that 20% of serious injuries from driving can be attributed to driver sleepiness. Here’s the problem – insomnia is very common, and can of course cause sleepiness and danger at the wheel. However the drugs used to treat insomnia, like Ambien, can also contribute to dangerous driving the next day. An article in the August 22nd New England Journal of Medicine reports on driving impairment in Ambien users. The relationships between drug dose, time of use, and the concomitant use of alcohol or other substances have not yet been completely worked out. However, people using these drugs should know, and should be warned by their doctors, that their driving the next day may be impaired. Studies have shown that they may not be aware of their impairment.







Ambien is the most widely used prescription drug for insomnia. Recent studies have shown that the usual 10 mg dose is too high for women and the elderly, who should start with a 5 mg dose. Because some people can fall asleep easily but wake later and can’t go back to sleep, a lower dose of Ambien, called Intermezzo, has been marketed for midnight wakefulness, to be dissolved under the tongue if the user has at least 4 hours more of sleep-time. Again, the suggested dose is lower for women than men. While the lower doses are more appropriate, daytime hangover is still a problem for many users.




Sonata, Lunesta, and Silenor are other prescription drugs used for insomnia, and may also cause driving impairment the next day, especially in people over 55, according to a French study. All these drugs are also habit forming if used nightly.




Valium and other drugs called benzodiazepines (Ativan, Xanax, Restoril, Halcion, Klonopin) are very useful drugs for anxiety, panic disorder, seizures and other problems. When used for sleep, they can be habit forming and may impair driving the next day.




Marijuana use and its effects on driving have been studied at the University of Washington’s Alcohol and Drug Abuse Institute. Laboratory studies and driving simulator studies have shown a dose-dependent impairment of ability to steer, keep a steady speed, follow another car, reaction time and lane positioning. The combined effects of marijuana and alcohol affect driving even more.




Alcohol, so commonly used, and such a pleasant relaxant for many people, can lead to tragedy behind the wheel. Every day in American, another 27 people die as a result of drunk driving crashes. ‘One for the road’ should be a soft drink or coffee consumed by a designated driver who has remained sober.




Stimulants such as amphetamines, methamphetamine, cocaine, ecstasy, and Ritalin, can make driving extremely unsafe by affecting coordination and attention. Users often drive aggressively and take risks. Drowsiness and rebound fatigue occur when the drug effects wear off. Amphetamines combined with alcohol or opiates are equally dangerous.




Opioid drugs given for pain, such as morphine, codeine, oxycodone and fentanyl patches, can be associated with safe driving in very low doses, but the dangers of road trauma increase with higher doses. People taking these drugs should check with their doctors concerning their driving abilities and safety. When such drugs are taken illegally, often in high doses, the dangers of erratic driving escalate.




Over the counter antihistamines such as Benadryl and Chlor-Trimeton can cause drowsiness and may impair driving abilities.




The average car today weighs 3-4000 pounds. Hurtling along the road at 55 miles per hour or faster, it is both an amazing machine and a dangerous one. We all know people who have been killed or seriously hurt in car crashes. Here’s my take-away from writing this column:




*Never drive under the influence




*Always designate a sober driver at a party




*Suspect all other cars on the road – who knows what the driver has used.




*Pull over for faster drivers and motor cycles




*Respect pedestrians and bicyclists (they may be under the influence too)




*Avoid road rage in yourself and others




*Don’t text, talk on the phone, or take chances




*Give yourself plenty of time to get there so you don’t speed













Sadja Greenwood, MD, MPH. See my column of 4/24/2012 for safe ways to deal with insomnia.

How You Can Help Fight Superbugs

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“As soon as antibiotics were discovered and developed for medical use, bacteria began the Darwinian ‘arms race’ that has been fought ever since.”  So wrote Steve Heilig in the most recent Journal of the San Francisco Medical Society, where he is a director. Due to overuse of antibiotics, “antimicrobial resistance has reached a crisis stage in human medicine.”  You are doubtless aware that doctors should not prescribe antibiotics for viral infections (colds and flu) unless there is good evidence of an additional bacterial infection.  You may not know that 70 to 80 percent of all antibiotics produced by U.S. companies are used in farm animals.  These animals are often penned in crowded, dirty conditions; they are fed low doses of antibiotics to prevent infections and promote growth.  Bacteria are killed by the low doses used, but some develop mutations that make them immune to the drugs.  These bacteria are passed on to the farmers, their contacts, and the consumer.  Thorough cooking can destroy them, but beware of cutting boards, knives, your hands, and ‘rare’ burgers. 

In a 1976 study, small amounts of tetracycline were given to a flock of chickens by a researcher.  He found that the chickens began to carry bacteria resistant to tetracycline and other antibiotics.  So did the farmers who tended them.  Based on this kind of evidence, in 1977 the FDA announced plans to ban the feeding of low doses of antibiotics to livestock.  However, there was strong backpressure from legislators and agribusiness, and the FDA failed to act on its own recommendation.  The American Academy of Pediatrics, the Centers for Disease Control, the National Academy of Sciences, and the World Health Organization had identified subtherapeutic use of antibiotics as a human health issue.  More than 30 years later, in 2011, the FDA reacted when sued by the Natural Resources Defense Council and other groups.  It revoked its 1977 recommendation (never implemented) and said a ‘voluntary effort’ would be more effective.  There is no evidence that this has worked.  Currently there are over 90,000 deaths per year due to antibiotic resistance.  The Centers for Disease Control are alarmed.  We all should be.

You may have heard of a dreaded bacterium called MRSA – methicillin resistant Staphylococcus aureus, which is found in the community as well as in hospitals.  MRSA related deaths in the U.S. have risen to over 19,000 per year. from antibiotic resistant bacteria.  In Iowa, large pig farms where 2000 pigs are confined shoulder to shoulder, nearly half of these animals carry MRSA according to a 2009 study.  Almost half the workers there carry MRSA as well.

Here’s news close to home – an Iowa pig farmer who used routine antibiotics joined Niman Ranch’s pork collective; he stopped confining his animals and using antibiotics. He found he had the same results as Danish farmers who banned subtherapeutic antibiotics in 2000.  Pork production rose, and the incidence of resistant bacteria fell dramatically in people and animals. 

What can we do to protect ourselves, our children and the public?  There is a microbiologist in Congress, Louise Slaughter, a Democrat from New York.  Every year she introduces a bill called The Preservation of Antibiotics for Medical Treatment Act. We should make sure our congressman, Jared Huffman, supports this bill.  We should refuse to buy or eat meat, poultry, eggs or fish treated with antibiotics.  If it is labeled organic, this is a given. Otherwise, ask the butcher behind the counter. Trader Joe’s shoppers answered a poll by Consumer Union; 69% wanted the store to stop selling meat raised on antibiotics.  The store has hedged on this; although they do sell some antibiotic-free meats, they “do not presume to make choices” for their customers. Bring up this issue when you shop there. Whole Foods does not sell antibiotic-raised meats.  While these personal choices can make the meat you buy more expensive, eating less of it, and using it as a condiment/flavoring for vegetables is a wise move.  When you eat out, ask about the source of the meat, be sure it is not too rare, or go vegetarian.  There is no conclusive proof as yet that taking a daily probiotic pill, or eating yogurt with live cultures is helpful, but some studies point in that direction.  I think it’s a good idea. 

Sadja Greenwood, MD   back issues at sadjascolumns.blogspot.com

Go to Health: Exercise 2013



New research on exercise is reported in the August issue of Scientific American. You probably know that the ‘runner’s high’ (also felt after vigorous dancing, biking, and many sports) is caused by the brain’s release of endorphins (opioid-like hormones that evoke pleasurable feeling). Recently, research has also shown that exercise increases our ability to concentrate, think and make decisions. Exercise increases the size of a part of the brain called the hippocampus. The specific part of the hippocampus affected by exercise is one that allows people to remember familiar surroundings. Animal studies have shown that exercise increases the level of chemicals responsible for triggering the growth of new neurons. A molecule known as brain-derived neurotrophic factor is responsible. Newborn neurons are thought to help with distinguishing between similar but different events and things. Think about this – go for a hike; create new brain cells!






New research on how exercise prevents heart disease goes beyond the lowering of blood pressure, lowering LDL cholesterol (the ‘bad’ kind) and raising HDL choesterol (the ‘good’ kind). The more important LDL related effect is that exercise increases the number of larger, safer, LDL particles and decreases the number of small, dangerous ones. A couch potato might have an identical cholesterol level as an active person, but be more at risk for heart attack because of the predominance of small LDL molecules.






Exercise is a key to keeping blood sugar normal. As you use your muscles, they need increasing amounts of glucose to fuel their efforts. The liver sends out more glucose and the pancreas releases insulin - to signal cells to draw glucose from the blood. As exercise becomes a daily habit, muscles grow more sensitive to the effects of insulin, so lower levels will accomplish the same result, and the pancreas does not have to work as hard to keep glucose levels normal. This is particularly helpful for people with type 2 diabetes, whose bodies have often become resistant to insulin. Recent studies show that combining aerobic exercise (like brisk walking) with resistance training (weights, leg presses, et al) is the best for keeping blood glucose normal.






We know that we should be exercising, but many Americans fail to achieve the recommended half an hour of moderate activity for five or more days a week. However, a recent analysis of six studies, totaling 655,000 adults tracked for about 10 years, found that people doing leisurely activities like washing the car or taking a stroll for 11 minutes a day had a 1.8-year longer life expectancy after age 40 than inactive people. Those who met the guidelines for moderate activity gained 3.4 years of life, and those who were active between 60 and 90 minutes a day had greater gains – 4.2 years. It seems that we evolved as creatures who moved – think about walking out of Africa to populate the rest of the world. If you find it hard to begin, get a dog. Then you’ll have to walk, and she’ll always love you.






Sadja Greenwood past issues at sadjascolumns.blogspot.com

Go To Health: Human Papilloma Virus and Its Consequences


Cervical cancer, detected by regular Pap smears before it becomes serious, is caused by a sexually transmitted virus. Nuns and lesbians don’t get cervical cancer if they never have intercourse with men. Condoms offer some protection. Were you ever told this when you (or your partner) went for a Pap test? These facts were ignored for years by the medical profession and popular culture – perhaps because of the discomfort people feel about discussing the nitty-gritty of sex, perhaps because of ignorance. The papilloma virus (HPV) that causes cervical cancer can also cause cancers of the vagina, vulva, penis, anus and throat. Cervical cancer is the most common of these problems, but the number of throat cancers from HPV are now on the rise. The actor Michael Douglas made headlines recently when he told a British newspaper that his throat cancer had come from performing oral sex.






Cancers of the base of the tongue, tonsils and walls of the pharynx are becoming more common. A decade ago, people with head and neck cancers were smokers or heavy drinkers. Now only 20% are smokers or drinkers, and the other 80% have cancers caused by an HPV infection. This year an estimated 14,000 people in the US will be diagnosed with head and neck cancers; most of them will be between 40 and 50 years old, and 3 out of 4 will be men, according to Dr. Robert Haddad of the Dana Farber Cancer Institute. Haddad talks about ‘an epidemic’ of HPV–related head and neck cancers. If oral sex is a factor, the predominance of men may be because vaginal fluid has more virus than the surface of the penis.






There are two vaccines available against HPV infection – Gardisil and Cervarix. These vaccines protect against many of the some 100 strains of HPV, including the high risk strains HPV-16 and 18 which are a known cause of cervical, throat, anal and vaginal cancers. A study supported by the National Cancer Institute has just been published which showed that sexually active young women in Costa Rica had 93% protection against infection with HPV types 16 and 18, after receiving immunization with Cervarix.. Although the study did not include men, it is believed that they would get the same protection with this vaccine.






The Gardisil vaccine was approved by the FDA and the CDC (Centers for Disease Control) for girls ages 9-26 in 2009, and for boys in 2011. Cervarix has also received FDA approval, and may be even more effective. The vaccine is given by 3 injections over 6-12 months. There has been controversy about these vaccines because of reports of serious reactions after injection, but careful studies by the CDC do not show that these reports are valid. Most side effects consist of pain, redness, and swelling at the injection site, and occasional fainting, fatigue, headache, muscle pain, gastrointestinal symptoms, and joint pain.






Women are advised to continue having Pap tests for cervical cancer even after vaccination, as the vaccines are not effective against all strains of HPV. Men and women should know they should not ignore difficulty swallowing or feeling/seeing a lump in the throat or on a tonsil. Seek medical attention promptly if this occurs. Sexually active people should also be aware of many other types of sexually transmitted disease, including HIV/AIDS, syphilis, gonorrhea (rapidly becoming drug resistant), Chlamydia, Herpes et al. Condoms are very helpful but not foolproof for prevention. The birth control pill and IUD are highly effective against pregnancy but do nothing to prevent STDs.. Have you ever wondered why sex scenes in movies and television never involve a discussion of these potential problems? Is it still that controversial? We have calorie counts on some menus, and dire (small print) warning on cigarettes. But nothing is said about sex. Young women in college are initiating hook-ups without emotional involvement so they won’t get derailed from their independent careers. The recent NYTimes article (7/12/13) about this did not mention STDs or birth control. Go figure.






Sadja Greenwood, MD, MPH -->

Just Label It

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Last November the California campaign to label genetically modified organisms (GMOs) was defeated by a 51 to 48 percent vote.  Many large companies and the Grocery Manufacturers Association put $46 million into fighting the proposition. $9.2 million was spent in support. Some people who buy brands like Cascadian Farm, Kashi, Horizon Organic, Muir Glen, and Odwalla were outraged last fall after learning the companies’ corporate owners helped fund the effort to defeat Prop 37. However, efforts to label GMOs in food are still underway.  Connecticut and Maine have passed labeling bills which will kick in when other states, including a neighboring state, pass similar laws.  Whole Foods markets will require GMO labeling on any product it stocks by 2018. The U.S. Department of Agriculture for the first time approved a non-GMO label claim for meat products, Chipotle began voluntarily labeling menu items containing GMO ingredients online, and the Senate Appropriations Committee voted last week to give the U.S. Food and Drug Administration funding to label genetically modified salmon if the agency approves the fish.

GMO cotton, soybeans, canola and corn are modified to make them resistant to the herbicide glyphosate –otherwise known as Roundup, so that weeds could be killed without harming the crop.  Most sugar beets are also genetically modified, although the final product is identical to the sugar from ordinary sugar beets.  Unless it is labeled organic, almost all cotton, canola, soy and corn grown in the US today is GMO.  The problem that has emerged is that weeds are becoming resistant to Roundup.  More must be used, along with other herbicides.   According to ScienceDaily, a website I respect, the annual increase in herbicides required to deal with tougher-to-control weeds on cropland planted to GE cultivars has grown from 1.5 million pounds in 1999 to about 90 million pounds in 2011.   Initially, Roundup was considered a safe herbicide with short duration of action.  However, a recent study from an Environmental Toxicology Program in Thailand, published in Food Chemistry Toxicology, indicates that Roundup may be an endocrine disruptor, inducing human breast cancer cells to grow by effecting estrogen receptors. 

Another problem with GMO crops is the effect on adjacent farmers and organic farms.  Pollen drift is a problem for farmers who plant non-GMO or organic crops.  Farmers using GMO seeds are required by Monsanto and other companies to buy fresh seed every year.  When GMO pollen blows into adjacent fields, and is harvested, the farmers can be sued for patent infringement.  In one high-profile case (Monsanto Canada Inc. v. Schmeiser) the Monsanto Company sued Percy Schmeiser for patent infringement after he replanted canola seed that he had harvested from his field, which he discovered was contaminated with Monsanto's patented glyphosate-tolerant canola. The Supreme Court of Canada ruled that Schmeiser was in violation of Monsanto's patent because he knowingly replanted the resistant seed that he had harvested, but he was not required to pay Monsanto damages since he did not benefit financially from its presence. In 2008, Schmeiser and Monsanto Canada came to an out-of-court settlement whereby Monsanto would pay for the clean-up costs of the contamination, which came to a total of $660. In May of this year, the US Supreme Court ruled unanimously that an Indiana farmer had violated Monsanto’s patent laws by saving Monsanto seed and replanting it.  He was fined $84,000. On the other hand, a few weeks ago a three-judge panel at the Court of Appeals for the Federal Circuit has ruled that a group of organic and otherwise non-GMO farmer and seed company plaintiffs are not entitled to bring a lawsuit to protect themselves from Monsanto’s transgenic seed patents “because Monsanto has made binding assurances that it will not ‘take legal action against growers whose crops might inadvertently contain traces of Monsanto biotech genes (because, for example, some transgenic seed or pollen blew onto the grower’s land).

Farmers have saved seeds since the beginning of agriculture, and have thus been able to select the best plants for changing conditions, such as drought, heat, cold, etc.  The conflict between traditional practices and patented GMO seed goes on in many parts of the world today – an unfinished story. More food will be needed to feed a world population growing upwards from 7 billion.  Are GMO crops necessary?     Stay tuned, and I will try to address this question.

Sadja Greenwood, MD    back issues on this blog

World Food - from Surplus to Scarcity

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In a recent column I explored the question of labeling genetically modified (GM) crops and discussed the problem of superweeds resistant to ‘Roundup’ and pollen drift from GM fields to adjacent non-GM fields.  I decided to devote this column to the question of whether GM crops are needed to feed a growing world population.  What I found is that while there is controversy about this issue, GM soybeans, corn, cotton and other crops are widely used throughout the world. 

GM cotton has been planted in India and China, with a gene for BT (Bacillus thuringiensis) inserted to serve as insecticide.  Initially successful, it has given rise to resistant pests that have also attacked other food crops.  Farmers also complain that GM seed is 3-8 times more expensive than ordinary seed.

 GM soybeans are widely planted in the US, Brazil, Argentina and China, and are mainly used as feed for cattle, swine and chickens. Without this crop, Europe would have to cut back on meat, dairy and egg production.   Soybean production in Brazil, used for  biodiesel and animal feed, is resulting cutting of the Amazon rainforest. 

Corn originated in Mexico, which is the home for hundreds of varieties.  Mexican framers fear that widespread planting of GM corn will lead to contamination of native varieties.   Mexico has legalized GM corn planting, but the issue is extremely controversial.  88% of U.S. corn is GM.

Golden rice, genetically modified to contain carotenes that will help with Vitamin A deficiency, has been planned for years and is now being tested in the Philippines, India and Taiwan.  Funding has come from the Bill and Melinda Gates Foundation to increase the bioavailability of  pro-vitamin A, vitamin E, iron and zinc in

golden rice, thereby preventing blindness and malnutrition in children in India, the Philippines and many African countries.  Companies that have developed golden rice have said that they will allow farmers to save and replant seed, and will not charge royalties until a farmer makes more than $10,000 year from golden rice.  Greenpeace and Dr. Vandana Shiva, the Indian anti-GMO activist, oppose the introduction of golden rice because of corporate control of agriculture, loss of biodiversity, and ignoring other important sources of carotenes such as green vegetables and fruits. 

On the one hand, GM crops for basic foods like corn, soy and canola are widely planted and used throughout the world. They have been successful in increasing supplies of animal feed and human food.  On the other hand, they have degraded the environment and resulted in resistant pests and weeds.  But these arguments pro and con are dwarfed by the larger reality of the world’s growing population and a transition from food surpluses to food and water scarcity in many parts of the world. There is serious aquifer depletion in China, India and the U.S., countries that produce half the world’s grain.  Food prices are rising and will continue to rise, according to Lester Brown of the Earth Policy Institute.  Brown’s latest book, Full Planet, Empty Plates, takes a serious look food & water scarcity and is a call to action. He calls for cutting carbon emissions by 80% by 2020, emphasizing wind and solar energy.  Brown is also strong on the need for worldwide family planning and the education of women.  The failure to take family planning seriously in most discussions of food and water scarcity, megacities and relentless population growth is troubling.  Wherever it has been introduced widely, on a voluntary basis, there has been a significant drop in birth rates.  South Korea and Taiwan have reduced their birth rates below replacement, and Thailand has also been successful with their program. Meeting women’s wishes for fewer children with modern contraceptives in South Asia and Africa could be tremendously helpful, but providing information and supplies, and overcoming cultural obstacles is a huge task.  An estimated 222 million women in developing countries do not want another pregnancy but lack access to contraception.  Many organizations are working on this, and deserve support. Obama is calling for increased funds for international family planning - $635.4 million.  In the Bill and Melinda Gates Foundation.  Melinda Gates is making family planning/contraception her priority for the next decade.  I should write another column on the many organizations that work on this issue.  If the environment is your issue, take a look at The Center for Biological Diversity, which links work to prevent extinction of wild animals and plants.  I appreciate the fact that they have an endangered species condom project, thereby linking human population growth with species extinction and climate change.  The Sierra Club has yet to take a strong stand on population growth nationally.  Stay tuned.