Sunday, April 26, 2015

The Dirty Dozen and the Clean Fifteen

If you look at labels carefully and aim to buy organic food, you can feel healthy and wise.  Toby’s, the Palace Market, the Farmer’s Market (coming soon!). the Bolinas People’s Store, the Murch and Weber Farm Stands will provide you with wonderful choices of organic produce.  Whole Food, The Good Earth, Trader Joe's are other good options You can send this column to your friends who live on fast food.  But, if you eat out on occasion, pay attention. 

The Dirty Dozen  
Every year the Environmental Working Group analyzes pesticide residues on produce and publishes a guide for shoppers and eaters.  Here is their 2015 guide to fruits and vegetables containing containing the heaviest  pesticide residues: They have named these items the Dirty Dozen.  Try to find organic versions of these foods, or grow them yourself if possible. 
Apples, peaches, nectarines, strawberries, grapes, celery, spinach sweet bell peppers, cucumbers, cherry tomatoes, snap peas (imported), potatoes.

The average potato had more pesticides by weight than any other item.  A single grape sample and a sweet bell pepper sample contained 15 pesticides.  Single samples of cherry tomatoes, nectarines, peaches, imported snap peas and strawberries contained 13 different pesticides.  Additionally, hot peppers, kale and collard greens were frequently found to be contaminated with pesticides. 

 The Clean Fifteen
 Avocados, sweet corn, pineapples, cabbage, sweet peas (frozen), onions, asparagus, mangoes, papayas, kiwi, eggplant, grapefruit, cantaloupe, cauliflower, sweet potatoes

Avocados were the cleanest: only 1% of avocado samples showed any detectable pesticides.  89% of pineapples, 82% of kiwis, 80% of papayas, 88% of mangos and 61% of cantaloupes had no residues.  When you think about your food budget, you can buy non-organic forms of the ‘clean fifteen’ with less concern.  However, all produce should be washed with tap water before eating; adding dilute vinegar will also help to remove bacteria and other germs.

Should You Worry about Pesticides
According to the Stockholm Convention on Persistent Organic Pollutants, 9 of the 12 most dangerous and persistent chemicals are pesticides.  Reviews have found that most studies on non-Hodgkin lymphoma and leukemia showed positive associations with pesticide exposure.  Strong evidence also exists for an association between pesticide exposure and neurological problems, birth defects, fetal death and developmental disorders of the nervous system.  Pesticide exposure has been linked to melanoma in farm workers.  Studies on links to other diseases are ongoing.  Pesticide exposure to farm workers who apply these chemicals is especially strong. 

I advise readers to keep a list of the dirty dozen and clean fifteen in their wallet, so that they can ask questions and/or be wary when eating at a restaurant or a party.  We should count our blessings to live in West Marin, where organic food is so easy to obtain, and – if you choose wisely – affordable.  Finally – check out the website of the Environmental Working Group, and make a donation if you are so inclined. They do a great job in keeping us informed. 

Sadja Greenwood, MD, MPH  

Monday, April 6, 2015

Know What You Are Taking!

The internal functions of our bodies are controlled by the so called ‘autonomic nervous system’, which is made up of the sympathetic system, the ‘fight or flight’ branch, and the parasympathetic system, the ‘rest and digest’ branch. This article will focus on the parasympathetic system, and drugs that block its actions.   These drugs are called anticholinergics; they are found in a wide variety of over the counter and prescription medications, including some antihistamines, certain antidepressants, and drugs used for an overactive bladder. 

Several recent studies have shown an increased risk for pneumonia and also for cognitive decline in older people (ages 65-94) using these drugs.  A study from the University of Washington, published in the Journal of the American Geriatrics Society, showed a significantly higher risk of developing pneumonia among 3000 elderly members of a group health plan if they had taken prescription or over the counter anti-cholinergic medications in the past 90 days.   Another study from this same group showed a significantly increased risk of developing dementia, including Alzheimer’s disease, in elderly patients taking anticholinergic meds at higher doses for a longer time.  These drugs included Benadryl, which is used in several over the counter sleep aids, such as Nytol, Excedrin PM, Midol PM, Tylenol PM, and Advil PM. The study was published in JAMA Internal Medicine in 2015.

The authors of these studies concluded that patients should tell their doctors about all over the counter remedies they are using, and doctors should similarly inquire about all meds being taken.  The most commonly used medications in the dementia study were tricyclic antidepressants like Sinequan, antihistamines like Chlor-Trimeton, and Ditropan for control of an overactive bladder.  The risk of dementia increased after 3 years of use.  The authors concluded that substitute drugs that would be safer include SSRI antidepressants such as Celexa or Prozac, Claritin for allergies, and behavioral changes, rather than drugs, for an overactive bladder.  This would mean cutting back on caffeine and alcohol, and setting an alarm for every hour or two during the day as a reminder to urinate.

There are natural ways to get in close touch with your parasympathetic nervous system, which all my readers will know:  breathing exercises designed for self-calming, the relaxation response, meditation, massage, yoga, and chi-gong.  Wear blue-blocking glasses for an hour before bedtime to maximize your brain's production of melatonin to help you relax into sleep. (See Restorative Sleep, 4/9/12, on this blog)

Be sure to talk to your doctor or nurse practitioner about all meds and supplements you are taking at your next visit.  If you are older, or have elderly parents, be especially mindful.

 Sadja Greenwood, MD, MPH    Leave me a message, and I'll reply.