Thursday, January 22, 2015

Why You Shoul Know Your Numbers!

This is not math – this is your key to long-term survival.  The important numbers for most people are:  blood pressure, blood sugar, cholesterol levels, and weight. For some of these numbers you will need a collaborative relationship with your doctor, nurse practitioner, or physician’s assistant.  We are so lucky to have great clinics and health systems here in West Marin.  With a few appointments you can find your numbers and work on getting them in a healthy range.   Young people tend to feel invincible, middle aged people are too busy, and many (not all) men bypass health checkups for a wide variety of reasons.  I won’t speculate on what they are, but I have been told  (by several guys) that it’s a guy thing!  In addition, even with better health insurance coverage, a clinic visit and lab teats can be expensive.  However, once you understand your initial numbers, you can do a great deal of self-monitoring. By bringing your numbers into the normal range, you may be saving your future.  That’s a big deal. 

Blood Pressure:  High blood pressure is often a symptomless disease, that can lead to heart attack, congestive heart failure, stroke, kidney damage and many other problems.  You should know your blood pressure numbers, and discuss them with your clinician if they are abnormal..  You should have a reliable home blood pressure kit that you use regularly, and take medication  if advised to do so.  You can reduce high blood pressure with a regular walking program, the DASH diet, gradual weight loss, and self-calming practices such as meditation.  Books on the DASH diet are available at the library.  DASH stands for Dietary Approach to Stop Hypertension.  You will not go hungry on the diet, and you will start to feel better.

Blood Sugar: -High blood sugar, better known as blood glucose, can be a sign of impending diabetes or full-blown diabetes.  Normally your blood glucose levels increase after you eat, causing the pancreas to release insulin, and enabling your cells to absorb glucose for energy production.  You can find out your blood glucose level by having a blood test at the clinic after an overnight fast, 
or by having a slightly different blood test that will show your glucose levels in the past month.  Recent studies show that 27% of adults over age 65 have diabetes, and 35% of all adults have pre-diabetes.  The rise in this illness is related to the overweight and obesity crisis in the US to day.  Once you know your blood glucose level, if it is high you can self-monitor with a home blood glucose meter.  You can bring your glucose levels down with regular exercise (walking is fine) and an eating plan that emphasizes vegetables and protein and avoids foods with sugar and refined flour.  The Mayo Clinic Diabetes Diet is a good place to start.  Get the book out of the library, or from your book store.

Cholesterol Levels:  Cholesterol is a substance made in the liver and found in animal foods that we eat.  While the body makes, and needs, some cholesterol, too much can increase the risk of heart disease.  You probably know that sub-fractions of cholesterol have different effects on us  - HDL cholesterol is the “good cholesterol” that can help prevent heart disease, while the LDL type is “bad” and can promote blockage in the arteries.  Family history, age and gender all play important roles in the cholesterol story.  Your clinician will do a blood test to determine the levels of all your blood fats, including triglycerides, and advise you on a plan to achieve or maintain normal levels.  If your levels are elevated, you may need to take medication, or you may be able to use diet, exercise and weight loss to bring your levels down.  It is a good idea to have a blood test for blood fats (also called lipid levels) in your twenties, and follow up as needed.  Know your levels, and proceed accordingly, in collaboration with your clinician. 

Weight:  As a country, we have gained a lot of weight.  The causes, as you know, are inactivity and unhealthy food.  Get a bathroom scale, and start weighing yourself regularly.  Many people weigh themselves daily to maintain a normal weight.  You can find your ideal weight at the clinic, or on the web – weight.  This link will also give you your BMI, or Body Mass Index.  Keeping a healthy weight is not just a question of how you look, but is directly associated with heart disease, diabetes, many cancers, and other problems.  The New York Times Magazine on 1/18/15 has an article about mice who were allowed to eat regular kibble, high fat food, or food with fats and sugars.  Those who could eat only in a 9 or 12 hour window remained sleek and healthy, in all groups. The researchers think that this ‘time restricted eating’ influences the body’s internal metabolic clock, and will probably help humans as well as mice.  “The clock starts with that first cup of coffee with cream and sugar.”  If you have had trouble with other weight loss plans, you could try this one.  However, every body needs healthy food – especially vegetables, protein, fruits and unrefined  grains.  Don’t eat junk food or mouse kibble for 12 hours instead of 24!

Know Your Numbers.  Don’t smoke. Avoid a beer belly.  That’s my final word for today.

Sadja Greenwood, MD, MPH

Sunday, January 11, 2015

Medication Abortion - A Worldwide Trend

Do you remember the story of a Dutch ship sailing to Ireland in 2001, to provide abortions in international waters?  Rebecca Gomperts, the ship’s doctor, had set up an abortion clinic on board.  Hundreds of Irish women sought appointments when they docked in Dublin, However, conservative politicians in the Netherlands denounced Gomperts for potentially breaking a law that required a special license for any doctor performing abortions after 6 ½ weeks, a license they had failed to give to her.  Gomperts felt she must turn around without performing a single abortion, which she had planned to do with the abortion pills – mifepristone (formerly called RU-486) and misoprostol.  The pills are highly effective, about 98%.

Mifepristone has an anti-progesterone effect, causing the placenta to separate from the uterine lining.  Misoprostol causes uterine contractions which expel the early pregnancy through the cervix.  Misoprostol can also be used during labor, and to prevent or treat post-partum hemorrhage. It is sold in this country as Cytotech, and in this form used to prevent stomach ulcers.  It is sold in many countries, including Mexico, as an inexpensive, over the counter generic.  Women are using misoprostol alone, without mifespristone, frequently without directions as to the dose needed.  This is true in Texas as well as Mexico, as Texas has closed the majority of its abortion clinics.  Used correctly, misoprostol is about 80% effective in producing a complete abortion in early pregnancy. 

Back to Rebecca Gomperts - she did not abandon her plans, traveling with her ship to Poland, Portugal and Spain.  The enormous publicity resulting from her trip to Portugal in 2004 resulted in the legalization of abortion in that country in 2007.

As the word spread that there were pills that could end early pregnancy, women in many countries where abortion was restricted sent emails to the Gomperts website - Women on Waves, now also called Women on Web.  They currently receive about 2000 queries per month from women the world over seeking help with medical abortions.  After a doctor reviews each case to determine whether symptoms might indicate a tubal pregnancy, and whether the dates of last menstrual period mean that the pregnancy is not over 9-10 weeks, a prescription is sent electronically to a drug exporter in India, who sends the package with a tracking number.  Women on Web also sends an emails to the woman telling her how to take the pills and what to expect in terms of bleeding, cramping and pain. The help desk at Women on Web will answer questions during the process, and urge the woman to seek medical help if it sounds like there is a complication, such as excessive bleeding.  Women can claim they are having a spontaneous abortion in places where abortion is illegal.

The Indian company that exports the drugs is run by a man who is said to be dedicated and sympathetic to the women who need his services; he helps them with mail tracking problems, and keeps his prices low.

Women on Web will not provide service in any country with safe abortion services, such as the US, even though it can be hard to obtain abortions here in many areas.  Local laws and the FDA have made it difficult for doctors and clinics to provide what are called ‘medication abortions’ with the pills.   Nevertheless, the Guttmacher Institute says that 23% of non-hospital abortions are done with medication, and 36% of all abortions done before 9 weeks.  The percent of all US abortions done with medications has been increasing yearly, while the total number of abortions has decreased – currently about 1 million a year.  One US woman in 3 has had an abortion by the age of 45.  Abortion is one of the safest procedures done in the US, with fewer than 0.5% of women experiencing a complication. The risk of death associated with abortion is about one-tenth of that associated with childbirth. 

However, there are about 47,000 deaths annually from unsafe illegal abortions worldwide, mostly done with non-sterile instruments by untrained operators. 

Gomperts has left Women on Web, after a quarrel about her management style -  the so-called founder’s syndrome.  She obtained a Masters degree in Public Policy at Princeton, and is pursuing a PhD at the Karolinska Institute in Sweden.  We will probably hear more of this amazing woman in the future.  If you are interested, look at the websites of Women on Waves and Women on Web.  Donations help, as many desperate women in developing countries cannot afford the relatively small cost of the needed services.  The New York Times Magazine on Sunday, August 31st, has a full story on Gomperts and her work. 
Sadja Greenwood, MD , MPH  back issues on this blog

Thursday, January 1, 2015

Forests Forever?

Forests play an important role in the carbon cycle of the planet, taking
carbon dioxide from the air and putting it into their wood, roots and the soil beneath them.  According to the New York Times, 12/23/14, humans (that’s us) have cut down, burned or damaged three-quarters of the world’s forests, which has accounted for much of the excess carbon that is warming the earth. Scientists concluded years ago that deforestation must be stopped, to limit climate change and preserve biological diversity.  According to Nigel Sizer, director of forest programs at the World Resources Institute, “Every time I hear about a government program that is going to spend billions of dollars on some carbon capture and storage program, I just laugh and think, what is wrong with a tree?”  Richard Houghton, acting president of the Woods Hole Research Center, has argued for turning some 1.2 billion acres of marginally productive agricultural lands into forests.  This could be possible, researchers say, if farming in poor countries could become more efficient.  Dr. Houghton believes that his target of regrowth and protection of existing forests could slow the rapid growth of carbon dioxide, or possibly halt it.  This, he believes, would give the world a few decades for an orderly transition away from fossil fuels

Environmental organizations, such as Greenpeace, and mounting worldwide pressure, have helped corporate and governmental leaders in countries with tropical forests to begin to slow the cutting.  Forest regrowth is also in the works. Costa Rica is considered a forest success.  Although much of the country’s old growth forest had been cut down, new policies encouraged regrowth to cover more than half the country.  However, there is a threat to reforestation - a boom in pineapple farming that gives landowners an incentive to cut down recovering forest plots.  The pineapples will mainly be exported as a cash crop.

The Amazon, spreading across nine countries of South America, is the world’s biggest tropical forest.  Brazil has cut down millions of acres of the Amazon for timber, cattle ranching and soybean farming.  The soybeans were mainly used to produce meat for Western fast food companies. After Greenpeace invaded McDonald restaurants and put up poster of Ronald McDonald with a chain saw, McDonald and other companies pressured their suppliers to stop buying products linked to deforestation.  Pressure from the Brazilian government and large business groups has resulted in a sharp drop of deforestation, by 83% over the past decade.  The Brazilian Ministry of Agriculture focused on helping farmers raise yields without needing additional land.  The carbon dioxide kept out of the air by Brazil’s  actions far exceeded anything done in the world to slow global warming, according to the New York Times article.

Indonesia is the new test case for environmental groups; deforestation is rampant there – to clear land for the production of palm oil from a type of palm tree. Palm oil is used in many processed foods – ice cream, candies, baked goods and even lipstick. 
Since the (partial) demise of hydrogenated oils – so called trans fats – palm oil has been used as a replacement.  Despite its high levels of beta carotene, it is not a health food, as it is a saturated fat that can raise levels of cholesterol.  Deforestation of Indonesian forests to produce palm oil has resulted in serious environmental damage and has put the Sumatran orangutan on the critically endangered list.  Indonesia is working on better forest regulation.  This has caused palm oil producers to move to Africa.

Here is action plan for us, the lowly enlightened eaters.   Do not buy animal food if the animals have been fattened with soybeans – the beans have probably come from Brazil (and sprayed with Roundup since they are GMO).  Soybeans from the US, unless they are organic, are also sprayed with Roundup, which has endangered the Monarch butterfly by killing milkweed.  2,4-D is also being used on US soybean crops.  Do not buy pineapples from Costa Rica – support their ecotourism instead.   Read labels very carefully on all manufactured foods, and don’t buy anything containing palm oil. Support family planning in every way you can. Population growth is destroying the environment.  Plant a tree. Your actions count – every day!  Happy New Year.  Feliz y Prospero Año Nuevo.
Sadja Greenwood, MD, MPH  Leave me a message!