Monday, August 31, 2015

Some Good News About Family Planning, and Some Bad News

The U.S. has one of the highest rates of teenage pregnancy in the developed world, with more than 600,000 teens becoming pregnant each year.  Recent efforts to make contraception available, accessible and cost-free have made progress.  A program launched by Washington University School of Medicine in St. Louis, Contraceptive CHOICE, enrolled over 1400 girls ages 14-19 who were sexually active, and followed them from 2007-2011.  Teens were told about all methods of family planning, and instructed that long-acting reversible methods were the most effective.  These methods were contraceptive implants, chosen most often by younger teens, and IUDs, preferred by teens ages 17-19.  The program was free of charge.  Findings were that the teenage pregnancy rate among girls in the study was 34/1000 teens, compared to 159/1000 teens nationally.  The abortion rate of girls in the study was 9.7/ 1000 teens, compared to 41.5/1000 nationally. 

Despite the success of the CHOICE program, there is hesitancy on the part of some parents and family planning providers, who fear that greater access to more effective contraception will encourage young people to have sex.  Similar fears exist with respect to sex education in schools.  Many studies have shown that this is not true.  Other fears are based on the belief that long acting contraception such as IUDs and hormonal implants will cause infertility, which is also not shown to be the case.  In the current political climate in the US, finding federal funding for family planning will be difficult.  Private foundations funded the St Louis project.   However, since contraception is provided free of charge in Obamacare, regional efforts to prevent teenage pregnancy with long-acting, reversible methods are underway. Family planning clinicians will need training for insertion and removal of contraceptive implants in the upper arm.

Legal Abortion in Latin America
 Cuba, Puerto Rico and Guyana allow abortion upon request.   Many Caribbean countries have liberal policies. Since 2008, first trimester abortions have been legal in Mexico City, where they are provided free of charge at public health centers and hospitals.  Abortions are also available for a fee from private clinics.  However, some Mexican states still have very restrictive laws and have jailed women for seeking or obtaining abortions. According to the United Nations, more than 500,000 Mexican women seek illegal abortions every year, with more than 2000 dying from unsafe procedures. Poverty and difficulty in getting to Mexico City plays a role in this situation.    Uruguay legalized abortion in 2012.  Prior to legalization, the punishment for having an abortion was 3-12 months in prison, while performing an abortion could lead to 6-24 months in prison.  The new law, passed in 2012, legalizes abortion within the first 12 weeks, provided it is discussed with a panel of social workers and doctors, who will advise the woman on risks.  The woman must then wait 5 days to ponder her options, and the last word is hers.  The procedure is paid for by the country’s universal health care.
Colombia has also made abortion legal under certain circumstances – rape, incest, mental health of the woman, and serious fetal malformations, but the procedure is very difficult to obtain and most women still go the illegal route in that country.  Latin America is home to 5 of the 7 countries in the world where abortion is banned in all instances, even when the life of the mother is at risk: Chile, Nicaragua, El Salvador, Honduras and the Dominican Republic.  (The 2 countries outside Latin America are the Vatican City and Malta. )

Currently, in the U.S., many states are passing or planning to pass laws restricting access to abortion.  Planned Parenthood is under attack for accepting money for the costs of providing fetal tissue to universities for stem cell research, and may completely lose its funding from Congress. This makes up about 40% of its yearly income. It should be noted that federal funding for Planned Parenthood is not for abortion care but for contraception, and testing for sexually transmitted diseases and breast and cervical cancer.  What will happen as a result of this is the subject for another article.  Look for a substantial increase in the use of  misoprostol  for do-it-yourself abortions. While this method is much safer than the coat-hanger abortions of the past, it is a tragic and infuriating development in the land of the free.
Sadja Greenwood, MD, MPH  past issues on this blog


Friday, August 21, 2015

How Your Diet Affects Your Brain

A study at Oregon State University, published in the journal Neuroscience, showed that diets high in fat and/or sugar cause changes in gut bacteria that appear related to a loss of ‘cognitive flexibility’.  This is the power to adjust and adapt to changing situations.  A high sugar diet had the strongest effect, also showing an impairment of  long and short term memory.  

These problems may be linked to alteration in the microbiome, the complex mixture of about 100 trillion microorganisms living in your digestive system.  It is comprised of many different species of bacteria, yeast, fungi and even viruses.  
These microbes help us obtain nutrients from foods we normally can’t digest, and also help to protect us from infections by disease causing bacteria.  The microbiome in each person changes over time, depending on the food that is eaten.  Different microorganisms prefer different food, so species may grow or decline in numbers depending on what you choose to eat.  Some people take foods that contain live bacteria, such as yogurt or probiotic supplements.  Probiotics must be consumed regularly to maintain the bacteria they contain, or the microbiome may revert to what it was before their introduction.  

The study at Oregon State was done by Kathy Magnusson, who tested laboratory mice who consumed different diets.  The animals then faced a variety of tests, assessing changes in their mental and physical function.  She found that after just four weeks on a high-fat or high-sugar diet, the performance of mice on various tests of mental and physical functioning began to drop compared to animals on a normal diet. 

 Mice have proven to be a particularly good model for studies relevant to humans on such topics as aging, spatial memory and obesity, according to Dr. Magnusson.  Comparable studies in humans would be extremely costly, due to difficulties in recruiting subjects, securing agreement on the assigned diet, and keeping subjects adhering to the plan for weeks.

The mechanisms by which diet can affect behavior is still under study.  Bacteria in the microbiome can release compounds that act as neurotransmitters, stimulate sensory nerves and modulate the immune system.  It is also possible that the types of fatty acids and carbohydrates in a particular diet my be transformed by the microbiome into compounds that enter the blood stream and affect cognition.  In the Oregon study discussed here, cognitive impairment in the mice was specifically related to an increased number of one group of intestinal bacteria  (Clostridiales) and a loss of two others (Bacteriodales and Lactobacillales).  The researchers guessed that the bacteria themselves somehow brought about the brain changes. 

Here’s a take-home lesson from this study: think about the importance of your microbiome and protect the good bacteria therein.  They thrive on vegetables and fruits, lots of fiber, healthy protein and healthy fats.  Don’t send donuts, soda pop or junk food their way.  Sugary foods may make your thinking less flexible.  Who needs that?  We all need to be able to adapt to our world of continuous, rapid change.

Sadja Greenwood, MD, MPH  back issues on this blog  Leave me a message if you wish

Wednesday, August 12, 2015

A New Approach to Interval Training & The MIND Diet

A New Approach to Interval Training
It has long been known that highly motivated athletes benefit from interval training, but that most people don’t stick to programs that call for all-out effort for 4 minutes, or even 30 seconds.  It’s hard!  Researchers in Denmark looked for easier ways to improve athletic endurance that would keep people motivated, even non-athletes.  They devised a method called 30-20-10 (some prefer to call it 10-20-30) that keeps the all-out effort down to 10 seconds, and yet is effective in improving overall speed, endurance, and also may bring down blood pressure and LDL cholesterol in some adherents.  Here’s how it works.  Warm up at an easy pace by jogging, riding a bike, rowing, or walking before you begin the intervals.  Then start by spending the first 30 seconds at a easy, gentle pace, the second 20 seconds going moderately hard, and the final 10 seconds in all out effort.  Do five of these 30-20-10 intervals in a row, and then rest for two minutes by standing or walking slowly.  Do one more set of the five intervals and then stop for the day.  The Danish researchers recommend that you take a day off between this method of training.  

If you are already a jogger, rower or cyclist, this type of interval training my help you improve your speed in less time and with less pain.  If you are not in shape, be sure to have a checkup with your healthcare provider, and start with a gentle walking program.  Don’t take chances with your heart!  If all goes well, you can bring interval training into your walking program as time goes on.

The Mind Diet
Researchers at Rush University in Chicago have published a study in the journal Alzheimer’s and Dementia in which they describe the benefits of what they call the MIND Diet .  This diet, a combination of the Mediterranean diet and the Dietary Approach to Stop Hypertension (the DASH diet) was shown to lower the risk of Alzheimer’s by as much as 53% in participants who adhered to the plan rigorously, and by about 35 % in those who followed it moderately well.  The diet advises people to eat the following foods:  green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and a glass of wine.  Salad is advised daily, along with another vegetable.  Three servings of whole grains are advised.  The diet also involves snacking on nuts most days, eating beans every day or so, poultry and berries at least twice a week and fish at least once a week.  Blueberries and strawberries are considered especially helpful for the brain.  

Foods to avoid include: red meat, butter and stick margarine, cheese, pastries and sweets, fried foods and fast foods.  Butter should be less than a tablespoon daily, the other foods should b eaten less than once a week.

Subjects for the Rush University study were volunteers already participating in the Rush Memory and Aging Project.  They were enlisted among residents of Chicago-area retirement communities and senior public housing.  The study began in 1997; an optional food frequency questionnaire was added from 2004 to 20013.  There were 923 volunteers, and 144 cases of Alzheimer’s developed in this cohort.  In this study, the diet plan was shown to lower the risk of Alzheimer’s by as much as 53% in participants who adhered to the plan rigorously, and by about 35 % in those who followed it moderately well.  

It is important to know that there are lifestyle interventions that can help reduce the risk of dementia.  Exercise is one of them, and the dietary approaches outlined here (familiar to all my readers!) can be added to the list.   Give a virtual hug to our local farmers and the workers at the People’s Store, who make adherence to a healthy diet so easy and pleasant.

Sadja Greenwood, MD, MPH   

Monday, August 3, 2015

New Thinking About Calories

A paper just published in the American Journal of Clinical Nutrition has caused nutrition experts to rethink the adage – a calorie is a calorie.  In terms of weight gain in humans, “foods have complex mechanisms that help or hinder weight long term”  according to the paper’s authors.  Researchers from Tufts and Harvard Universities examined 24 years of data on 121,000 men and women.  Subjects were nurses and doctors from the Nurses’ Health Study and the Health Professionals Follow-Up Study.  Subjects, initially free of obesity or chronic illness, completed detailed food questionnaires.  Their weight gain was measured every four years, and results were adjusted for lifestyle changes such as physical activity, sleep, and total calorie intake.  The study found the following associations between protein foods and weight:
1) Meats, chicken with skin and regular cheese were associated with weight gain..
2) Milk, legumes, peanuts and eggs were not associated with weight gain or loss.
3) Yogurt, peanut butter, walnuts and other nuts, skinless chicken, low fat cheese and seafood were associated with relative weight loss.

Starches with minimal fiber, such as white bread, white potatoes, and white rice were associated with weight gain, and found to be similar to added sugar.  (Many breakfast cereals are almost entirely refined starch with added sugar.)

The take-home message from this paper, as I see it, is that protein foods vary greatly in their ability to keep you sleek and healthy.  Choose from groups 2 and 3 as often as possible, and always be mindful of the need for vegetables, fruits, fiber and healthy fats.

More on Fiber:  Another study from Harvard, published in BioMed Central Medicine, showed that middle aged and older subjects, followed for over 10 years, gained substantial benefits from whole grain foods.  Those who ate the most whole grain were 17% less likely to die in the study period compared to those who ate the least amount.  They were less likely to be obese, and less likely to suffer premature death from lung disease, diabetes and cancer.  People sensitive to gluten in wheat can still get plenty of whole grain and fiber from oats, quinoa, buckwheat, brown rice and corn.

,More on Vitamin D:  A recent study from Tufts University showed that a vitamin D supplement will be better absorbed when taken in a meal containing fat.  Fat stimulates the release of bile into the small intestine, which will make it easier for the body to absorb fat-soluble vitamin D.

Sadja Greenwood, MD, MPH