Wednesday, December 28, 2016

Does our Microbiome Affect our Mood?

Microbes are hot on the scientific agenda. In May, the US government launched a National Microbiome Initiative with an overall budget of half a billion dollars, while the EU is funding more than 300 projects related to the microbiome.  MyNewGut is the largest EU program, with 30 partners in 15 countries.  The director is Yolanda Sanz at the Spanish National Research Council in Valencia.  Much of this article is based on her perspectives.

“Our intestine hosts a complex ecosystem of bacteria; we call it the gut microbiota, which includes at least 1000 difference species. We get most of our gut microbes soon after birth, although there is evidence of colonization even during prenatal life.

Over the first 2-3 years of life, the microbiota is very unstable in its composition. This condition overlaps with a period in which the immune system is still immature. At this stage, the microbiota is greatly influenced by diet, for example whether you are breastfed or not.  When an adult diet takes over, the composition of the gut microbiota becomes more stable and a microbiotic profile emerges. This usually prevails until old age when the diet goes back to being less diverse and more unstable, such as in babies. In some way, the evolution of microbiota reflects our growth and senescence.”  My comment here – keep your diet diverse, in terms of vegetables, fruits, nuts and whole grains as you age.  If you are eating less, make every bite count.

“Each person has a different proportion of bacterial species and strains in his or her gut. If I had to put a figure on it, I would say that about a quarter of the microbiota is unique to each individual, but it's difficult to give a precise estimate. Also, we know that our genome influences our gut flora. We don't know how it works, but at least some features of our microbiota are associated with our DNA.

If you alter your diet dramatically, for instance by changing the proportion of fibres, proteins or fats, you will see relatively quick changes in your microbiota. About 30-40 percent of the bacterial strains will vary in their abundance. Drugs can also alter the microbiota. Recent studies point to antibiotics, of course, but also to proton pump inhibitors, anti-inflammatory drugs and other classes of medications that do not interact directly with bacteria.

There is growing evidence of a microbial gut-brain axis in which bacteria can influence the brain, and vice versa. We know that some strains of intestinal bacteria produce compounds that have an effect on the nervous system: neurotransmitters, for example, or metabolites that alter the blood-brain barrier (a barrier which filters the molecules passing from the body to the brain circulation). We don't yet know the precise mechanisms, but it's quite clear that the gut microbes can influence mood and the behavioural patterns. Most of the information comes from animal studies, but some data in humans are quite conclusive. People with primary depression, for example, show alterations in the microbiota. Transplanting the microbiota of depressed patients into mice can replicate the pathology in the animals.

There have been a few trials where patients with depression have been given probiotic treatments. The results are encouraging, but they are small studies, and there are many steps before we can say whether or not these interventions actually work.

To date, we found many correlations between the gut microbiota and pathologies: to move towards therapy we need to establish a causal relationship, and look closely at the mechanisms by which bacteria interact with the nervous system.”

While waiting for further data and advice from researchers, it’s a good idea to turn to a diet that helps the healthy bacteria in your gut, and see whether your mood can be affected positively.  Remember, your gut bacteria thrive on the fiber from vegetables and fruit, and a diet high in sugars and refined flour cause them to eat the mucus layer lining your intestinal tract, leading to a ‘leaky gut’ and inflammation.  Use your brain to help your gut – it can go both ways!

Researchers at the University of Melbourne published on Omega 3 fish oil in The American Journal of Psychiatry in 2016:  "The strongest finding from our review was that Omega 3 fish oil -- in combination with antidepressants -- had a statistically significant effect over a placebo. Many studies have shown Omega 3s are very good for general brain health and improving mood, but this is the first analysis of studies that looks at using them in combination with antidepressant medication. The difference for patients taking both antidepressants and Omega 3, compared to a placebo, was highly significant. This is an exciting finding because here we have a safe, evidence-based approach that could be considered a mainstream treatment."

Sadja Greenwood, MD, MPH 
Happy New Year, 2017 
Quoting Ananda’s song: May you never, never, never be blue
I know – the country is in for hard times.  Stay strong and resist. s

Tuesday, December 13, 2016

The Microbiome in Your Gut & The 12 hour Fast

 Here are some take-home messages for human health from the recent Commonweal symposium on the microbiome – the trillions of bacteria, viruses and fungi that live on and in our bodies.

*the good ones can be our friends – they want us to survive (from an
evolutionary standpoint) so they can survive.  We can work with them.  We want them to outnumber the bad bacteria that promote disease.

*good microbes in our guts eat fiber – from vegetables and fruits.  If we don’t give them plenty of fiber, they start eating the mucus lining of our intestines.  This promotes a ‘leaky gut’, allowing bacteria to enter our bloodstream.  This promotes inflammation and human disease. Eat plenty of fiber – meaning vegetables and fruits.  They have many other benefits in terms of vitamins and related nutrients. Avoid refined flours and sugars, which lack fiber and promote obesity.

*Good bacteria are found in probiotic foods, especially fermented foods, such as yogurt, kefir, kimchi, sauerkraut, miso, and also in probiotic supplements.  Have a probiotic food daily, including when you take antibiotics. Take a probiotic supplement if you don't eat these foods daily.

*Vegetables and fruits grown organically in healthy soil will be good for the earth and for you – you will benefit from their good bacteria.

More on the 12 Hour fast
Researchers from UC San Diego and the Salk Institute have done extensive work with mice  - showing that restricting food intake to an 8 to 12 hour time is beneficial.  Mice fed ad lib throughout 24 hours become obese and diabetic, whereas mice eating the same calories in an 8 to 12 hour window stay at normal weight and do not develop diabetes.

These researchers have not yet done human studies, as funding is scarce.  However, many previous studies done in mice been shown to be helpful in humans, as we share a similar metabolism.  Here is a quote from the Salk Institute – “The daily feeding-fasting cycle activates liver enzymes that breakdown cholesterol into bile acids, spurring the metabolism of brown fat -- a type of "good fat" in our body that converts extra calories to heat. Thus the body literally burns fat during fasting. The liver also shuts down glucose production for several hours, which helps lower blood glucose. The extra glucose that would have ended up in the blood -- high blood sugar is a hallmark of diabetes -- is instead used to build molecules that repair damaged cells and make new DNA. This helps prevent chronic inflammation, which has been implicated in the development of a number of diseases, including heart disease, cancer, stroke and Alzheimer's. Under the time-restricted feeding schedule studied by Panda's lab, such low-grade inflammation was also reduced.”

It’s easy and beneficial to do a 12 hour fast.  (It’s safe for most people – consult your doctor if you are taking meds for diabetes, have type 1 diabetes, or any other questions.)  Eat enough healthy food during the day, and see if it works for you.

Sadja Greenwood, MD, MPH  back issues on this blog.  Leave me a message, and I'll answer you.

Monday, November 28, 2016

Your Microbiome & Chronic Fatigue syndrome

There is tremendous current interest in the relationship between the microbes in and on our bodies and our state of health and disease. The origins of chronic fatigue syndrome (CFS) have been mysterious; studied for years.  This problem is now believed to be related in some ways to the bacteria in our gut. 

CFS is a condition where normal exertion leads to debilitating fatigue that isn't alleviated by rest. There are no known triggers, and diagnosis requires lengthy tests administered by an expert. Now, for the first time, Cornell University researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

In a study published June, 2016 in the journal Microbiome, the team describes how they correctly diagnosed chronic fatigue syndrome in 83 percent of patients through stool samples and blood work, offering a step toward understanding the cause of the disease.
"Our work demonstrates that the gut bacterial microbiome in chronic fatigue syndrome patients isn't normal, perhaps leading to gastrointestinal and inflammatory symptoms in victims of the disease," said Maureen Hanson, a professor in the Department of Molecular Biology and Genetics at Cornell and the paper's senior author. "Furthermore, our detection of a biological abnormality provides further evidence against the concept that the disease is psychological in origin."  The researchers concluded that when they have more information, clinicians could consider changing diets, using prebiotics such as dietary fibers or probiotics to help treat the disease.

Cornell researchers collaborated with Dr. Susan Levine, a CFS specialist in New York City, who recruited 48 people diagnosed with CFS and 39 healthy controls to provide stool and blood samples.
The researchers sequenced regions of microbial DNA from the stool samples to identify different types of bacteria. Overall, the diversity of types of bacteria was greatly reduced and there were fewer bacterial species known to be anti-inflammatory in CFS patients compared with healthy people, an observation also seen in people with Crohn's disease and ulcerative colitis.
At the same time, the researchers discovered specific markers of inflammation in the blood, likely due to a leaky gut from intestinal problems that allow bacteria to enter the blood.  Bacteria in the blood will trigger an immune response, which could worsen symptoms.
The researchers have no evidence to distinguish whether the altered gut microbiome is a cause or a whether it is a consequence of disease. In the future, the research team will look for evidence of viruses and fungi in the gut, to see whether one of these or an association of these along with bacteria may be causing or contributing to the illness.

Probiotics are microorganisms that are believed to provide health benefits when consumed. The term probiotic is currently used to name ingested microorganisms associated with benefits for humans and animals. The introduction of the concept is generally attributed to Nobel recipient Élie Metchnikoff, who postulated that yogurt-consuming Bulgarian peasants lived longer lives because of this custom. He suggested in 1907 that "the dependence of the intestinal microbes on the food makes it possible to adopt measures to modify the flora in our bodies and to replace the harmful microbes by useful microbes.”  Although some claims for probiotics have not been substantiated, randomized controlled trials at the University Hospital, Tuebinden, Germany, published in 2016, found that certain commercially available strains of probiotic bacteria when taken by mouth in adequate doses for 1–2 months, possess treatment efficacy in certain psychological disorders, e.g. anxiety, depression, autism spectrum disorder, and obsessive-compulsive disorder – and improved certain aspects of memory.  

Prebiotics are non-digestible fiber compounds that pass undigested through the upper part of the gastrointestinal tract and stimulate the growth or activity of advantageous bacteria that colonize the large bowel by acting as substrate for them. Most fruits and vegetables have indigestible fiber. Some most effective prebiotics include onions, garlic, leeks, wheat bran, asparagus, chicory, and raw banana.

There will be a symposium on the microbiome, in healthy soil and in the human body, on Sunday, December 4th at 2pm, at Commonweal in Bolinas.  The microbiome is a subject of substantial current research and excitement, with a relationship to many aspects of health and disease. Please attend if you are interested!
Sadja Greenwood, MD, MPH

Tuesday, November 1, 2016

The Benefits of Dark Chocolate, Placebos, and Safe Abortion in Ireland

Dark Chocolate: Compounds in cocoa called flavanols are believed to benefit cardiovascular health; a systematic review and meta-analysis of 19 randomized controlled trials of cocoa consumption was recently published in the Journal of Nutrition. Dr. Simin Liu, professor and director of the Center for Global Cardiometabolic Health at Brown University, who worked with epidemiology graduate student and lead author Xiaochen Lin, found that “cocoa flavanol intake may reduce dyslipidemia (elevated triglycerides), insulin resistance and systemic inflammation, which are all major subclinical risk factors for cardiometabolic diseases."  Flavanols are plant compounds found in many foods, and are especially high in tea, blueberries and cocoa. 
Liu noted some limitations in the trials. All studies were small and of short duration, not all of the biomarkers tracked in these studies changed for the better, and none of the studies were designed to test directly whether cocoa flavanol consumption leads to reduced cases of heart attacks or type 2 diabetes.
But taking into account some of these heterogeneities across studies, the team's meta-analysis summarizing data from 19 trials found potential beneficial effects of flavanol-rich cocoa on cardiometabolic health. There were small-to-modest but statistically significant improvements among those who ate flavanol-rich cocoa product vs. those who did not. "The treatment groups of the trials included in our meta-analysis are primarily dark chocolate -- a few were using cocoa powder-based beverages," Lin said. "Therefore, the findings from the current study apparently shouldn't be generalized to different sorts of chocolate candies or white chocolates, of which the content of sugar/food additives could be substantially higher than that of the dark chocolate."

Placebo Effects Conventional medical wisdom has long held that placebo effects depend on patients' belief they are getting pharmacologically active medication. A paper published in the journal Pain is the first to demonstrate that patients who knowingly took a placebo in conjunction with traditional treatment for lower back pain saw more improvement than those given traditional treatment alone.
"These findings turn our understanding of the placebo effect on its head," said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. "This new research demonstrates that the placebo effect is not necessarily elicited by patients' conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship -- even if you know it's a placebo -- is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms."
Kaptchuk, with colleagues at Instituto Superior de Psicologia Aplicada (ISPA) in Lisbon, Portugal, studied 97 patients with chronic lower back pain (which causes more disability than any other medical condition worldwide.) After all participants were screened and examined by a registered nurse practitioner and board certified pain specialist, the researchers gave all patients a 15-minute explanation of the placebo effect. Only then was the group randomized into one of two groups; the treatment-as-usual (TAU) group or the open-label placebo (OLP) group.
The vast majority of participants in both groups (between 85 and 88 percent) were already taking medications -- mostly non-steroidal anti-inflammatories (NSAIDS) -- for their pain. (Patients taking opioid medications were excluded from the trial.) Participants in both the TAU and OLP groups were allowed to continue taking these drugs, but were required not to change dosages or make any other major lifestyle changes, such as starting an exercise plan or new medication, which could impact their pain.  In addition, patients in the OLP group were given a medicine bottle labeled "placebo pills" with directions to take two capsules containing only microcrystalline cellulose and no active medication twice daily. Patients who knowingly took placebos reported 30 percent less pain and 29 percent reduction in disability compared to control group. 'Open-labeling' addresses longtime ethical dilemma, allowing patients to choose placebo treatments with informed consent.
Dear Reader – this study could be interpreted in various ways – that the caring and interest of health-care providers is powerful, or that doing something for pain is better than doing nothing, or that we have strong cultural belief in the taking of a pill.  All of these are probably operative, but I think the caring and attention from a provider is the most powerful.

Safe Abortion in Ireland Women on Waves is a Dutch organization that sends the pills that can safely produce an early abortion to women in countries where abortion is illegal.  The British Journal of Obstetrics and Gynecology recently reviewed and published the results of 5,650 abortions done in Ireland with these medications.  All abortions were done at home.  Women
were diverse with respect to age, pregnancy circumstances, and reasons for seeking abortion. Study findings include:
                Among women completing early medical at-home abortion, 97 percent felt they made the right choice and 98 percent would recommend it to others in a similar situation.
                The only negative experiences commonly reported by women were the mental stress caused by pregnancies they did not want or felt they could not continue, and the stigma, fear, and isolation caused by current restrictive abortion laws.
Women with financial hardship had twice the risk of lacking emotional support from family and friends.
The author of the article stated
“Women in Ireland and Northern Ireland accessing medical abortion through online telemedicine report overwhelmingly positive benefits for health, wellbeing, and autonomy ,This examination and subsequent findings provide a new evidence to inform the policy debate surrounding abortion laws in Ireland and Northern Ireland.”  

Sadja Greenwood, MD, back issues at

Habits You Need Throughout Life

In the Science Times of October 25th, Tara Parker Pope wrote a column about the advice eight scholars gave to people in their twenties.  Experts in nutrition, obesity, cardiology and other disciplines each gave one strategy that would help young people stay healthy throughout their lives.  As I read these short pieces I thought that they are relevant at every age – it’s never too late to form healthy habits.  Here they are:

1) Weigh yourself often – buy a scale and keep track of your weight – it’s easier to lose 5 pounds than twenty.  Carrying excess weight is harmful to your overall health and your leg/foot joints.
2) Learn to cook – find tasty ways to boost your intake of vegetables, fruits, whole grains and proteins.  This will save you money, decrease your intake of unhealthy fats, sugar and salt, and possibly help your social life.
3)   Cut back on sugar – by eliminating sugared soft drinks, breakfast cereals with added sugar, and being careful with cookies, cakes, candy et al.  This step alone will prevent unwanted weight gain.
4)   Live an active life – Build physical activity into every day – by biking, walking, gardening, doing housework, upper body exercises, et al.  Move to music!
5)   Practice portion control – let your hand be your guide – a serving of chicken, fish or meat should be the size of your palm, and of whole grain starch should be the size of your fist. 
6)   Eat your veggies – this advice is from Marion Nestle, professor of nutrition at New York University. ’Nutrition science is complicated and debated endlessly, but the basics are well established: eat plenty of plant foods, go easy on junk foods, and stay active. The trick is to enjoy your meals, but not eat too much or too often.”
7)   Adopt a post-party routine – if you do a lot of drinking and snacking, ensure that you exercise a lot to offset all those extra calories.  (Good advice for the holidays)
8)   Find a job you love – this advice is from Hui Zheng, a professor of sociology at Ohio State University.  “If I can give just one piece of health advice for a twenty year old person, I would suggest that he or she find a job they feel passionate about.  This is turn will make them more engaged in life and healthier behaviors, which will have long-term benefits for their well being.” I think this advice is pertinent at every age.  Find ways to make your work life meaningful.  After retirement, it is also important to find activities that you are passionate about – volunteering for a cause you believe in, finding pleasure in a creative project, taking up a paintbrush, modeling clay, or a musical instrument.  Write poems and short stories. Don’t be afraid to be a beginner. 

Submitted by Sadja Greenwood, MD, MPH

Saturday, September 17, 2016

Some Tested Ways to Help Prevent Cancer or Stop its Spread

*Don’t smoke, and drink alcohol very sparingly, if at all.  Recent studies have shown an association between alcohol and cancers of the throat, esophagus, liver, colon, rectum, and breast.  Even light drinking increases the risk of breast cancer.

*Get up and move whenever you can.  Walking is a great exercise, and so is dancing.  Aim for 30 minutes a day, or more, of your favorite movement.  Keep your weight within the normal range – ask your primary care person to help you with this.

*Avoid white flour, sugar, sweetened drinks and junk food.  Keep your blood sugar low and even by eating whole foods with their natural fiber intact.  Eat sweet potatoes, winter squash and fruits when you want something sweet.  If you eat packaged food, remember that 4 grams of sugar equals one teaspoon of sugar. 

*Eat lots of vegetables, and include a member of the brassica family every day.  Brassica vegetables include kale, collards, cabbage, broccoli, arugula, mustard greens, bok choy Brussels sprouts and turnips.  Johns Hopkins University has a laboratory studying the effects of brassica vegetables against cancer. In addition to Brassicas, deeply colored vegetables and fruits are the best.  Eat whole fruits, not their juices, to keep your blood sugar from spiking. 

*Drink green tea - compounds in green tea act against cancer. .
Consider buying a green tea with the beneficial compounds of brassicas.  The Johns Hopkins Brassica lab sponsors such a green tea - regular or decaf - which you can order from the Baltimore Coffee and Tea Company - 800-423-1408.  The tea has no taste of broccoli! 

*Include herbs and spices in your diet.  Try a daily salad that includes herbs such as parsley, basil, mint, cilantro, thyme. oregano, marjoram, rosemary and other herbs you enjoy.  For further information on herbs and spices, look at the book Healing Spices, by BB Aggarwal.  Dr. Aggarwal worked at the M.D. Anderson Cancer Center in Houston.   He feels that turmeric is one of the most promising anti-cancer spices, and suggests that everyone take a 500 mg supplement of curcumin  (the active ingredient in turmeric) daily.

*Eat mushrooms often, always well cooked.  Studies from Japan and China show that many kinds of mushrooms act against cancer.

*Eat plenty of garlic, onions, & scallions - raw or cooked as desired. 

*Eat one or two Brazil nuts daily – selenium in these nuts is an immune booster. Walnuts may be helpful for breast cancer.  Nuts are a healthy snack at any time.

*Ask your primary care provider to measure your vitamin D level, and take vitamin D3 to keep your level at 30 ng/ml or higher.  Consider taking a daily probiotic  for intestinal and immune health.

*Use extra virgin olive oil as your source of added fat.  Fish and fish oil are helpful.

*Go slow on most red meat and processed meat, in favor of fish and poultry.

*Drink plenty of water.  You can flavor it with mint leaves and slices of  orange, lenon or cucumber. Remember that tea, coffee, broths and soups also count as liquids.  Coffee has been found to decrease the risk of cancers of the colon and rectum, whether if is plain, decaf, instant or espresso.

*Go to to read about the anti-cancer benefits of melatonin and its promotion of restorative sleep.  If possible, get blue-blocking glasses and wear them 1-2 hours before your regular bedtime.  These glasses are available from the website, and also from  Blocking the blue component of light allows for the natural outflow of melatonin from the pineal gland.  Use melatonin tablets under the tongue if you need a sleeping pill.

*To find accurate information on nutrition and supplements, go to ScienceDaily on the web, or write the word ‘university’ in your search.  This will help you avoid websites trying to sell you something.  Several newsletters will keep you up to date on cancer prevention: Tufts University’s Health and Nutrition Letter – monthly, $36/year – 800-274-7581, and Nutrition Action Health Letter, published by the Center for Science in the Public Interest – 10 issues a year; $24, -

*For the latest information on organic and conventional produce and other key environmental issues, check out the Environmental Working Group at

*Last, but not least, stay connected with your friends, family, support systems and the things that make you happy.  Avoiding isolation is very important for our survival.
Sadja Greenwood, MD, MPH  back issues on this blog

Tuesday, August 23, 2016

The League of Women Voters and Your November Ballot

On November 8th we Californians in West Marin will be voting on 17 propositions, in addition to choosing a candidate for President, the Senate, the House of Representatives, the California State Assembly, a Marin Superior Court Judge, and a Supervisor for our district.  Based on your political orientation, you probably already know how you will vote on many of these candidates.  But – how will you figure out how to vote on the 17 propositions? Direct democracy in California has made our choices more plentiful, and also much more difficult.  You may remember on past ballots that you can read careful, reasoned arguments by the League of Women Voters.  Who are they, and how did this come to be? 

The League of Women Voters was founded in1920 during the convention of the National American Woman Suffrage Association. The convention was held just six months before the 19th amendment to the U.S. Constitution was ratified, giving women the right to vote after a 72-year struggle. The League was designed to help 20 million women carry out their new responsibilities as voters. From the beginning, it has been an activist, grassroots organization whose leaders believed that citizens should play a critical role in advocacy. It was then, and is now, a nonpartisan organization. It takes a stand on issues, but does not endorse candidates. However, League members are encouraged to be political themselves, by educating citizens about, and lobbying for, government and social reform legislation.  For example, the League is for universal healthcare, campaign finance reform, action on climate change, gun control and abortion rights.

Most of the League’s work is done by volunteers, both women and men. This year, members in all 50 states are working on registering new voters and getting out the vote.  You can use the League's website for information in every state.

About those 17 Propositions:  you will see the League’s recommendations for at least 11of them on the ballot that will be mailed to you before the election.  For the 6 that are not included, you will need to look at the arguments pro and con and their authors on your ballot. In addition to the League’s analyses, you can go to their website to find out who contributes to all the propositions, and the amounts.  For example, Proposition 56 would increase the tax on cigarettes by $2 per pack, to fund healthcare, tobacco use prevention, research and law enforcement.  The Yes campaign has raised $17 million , mainly from hospitals and health care organizations, which are listed, with amounts given.  The No campaign has raised $35.5 million, entirely from tobacco companies.  Proposition 61 would restrict the amount any state agency could pay for drugs to what is paid by the US Department of Veterans Affairs.  Opponents of 61 have out contributed supporters by 15 to one, and are many of the country’s large pharmaceutical corporations.  Supporters include Bernie Sanders, Robert Reich, the California Nurses Association, and many country Democratic parties.  Contributions so far exceed $68 million; money spent on this proposition may exceed any amount spent so far in California history.

Here’s another one, to make you laugh, or cry, before you finish reading. 
Proposition 60 will require performers in adult films to use condoms during the filming of sexual intercourse.   Funding for support exceeds that of the opposition so far. No on 60 contributors include Californians Against Worker Harassment and the Free Speech Coalition.  Yes funds are from the AIDS Foundation. When you make up your mind about this one, think about sexually transmitted disease, AIDS, pregnancy, and the positive influence on viewers of seeing condom use, or at any rate knowing about it. 

You can support the League of Women Voters online, or become a volunteer. I’m so glad women got the vote , about 100 years ago, after a huge struggle. The League has been going ever since.

Sadja Greenwood MD, MPH  back issues on this blog

Monday, August 8, 2016

Testing of Food for Roundup to Begin

The U.S. Food and Drug Administration (FDA), the nation’s chief food safety regulator, plans to start testing certain foods for residues of the world’s most widely used weed killer, Roundup (chemical name – glyphosate).  The FDA move comes after the U.S Government Accountability Office (GAO) pushed for such an assessment, and rebuked the FDA for not disclosing its short-coming to the public.  The issue is important because the world authority on cancer, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) declared the herbicide glyphosate ‘probably carcinogenic to humans’ in its latest expert assessment.

FDA officials dubbed the issue ‘sensitive’ and declined to provide many details of the plans, but they do state that they are considering assignments for Fiscal Year 2016 to measure glyphosate in soybeans, corn, milk, and eggs, and other potential foods. Soybeans, sugar beets and corn are commonly sprayed with glyphosate, the most commonly used agricultural herbicide.

Private companies, academics, and consumer groups are also testing for glyphosate residues  and have recently claimed to have detected such residues in honey, cereal, wheat flour, soy sauce, infant formula, breast milk and other substances.

Since over 90% of corn and soy grown in the US is genetically modified to accept the spraying of  Roundup, most packaged food contains these GMO crops.   Vermont recently passed a law, effective July !st, 2016, to require labeling of foods containing GMO products.  However, this law was opposed by the food industry and a majority of members of Congress.  They countered with a bill, signed into law by President Obama, which allowed food companies to use QR codes instead of words on the package.  A QR code is an array of black and white squares that can be read by a smart phone, after the application is downloaded. Clearly this revision of the Vermont law will make in unlikely that most consumers will know whether there are genetically modified products – generally from corn, soy and sugars - in their packaged foods.  For many people looking for transparency and the right to know, this is  distressing.  Stay tuned, I will write more about this topic in future columns.
Sadja Greenwood, MD,MPH

Thursday, July 28, 2016

Alcohol and Cancer – Some Recent Findings

It has long been known that drinking alcohol can increase a woman’s risk of breast cancer. A recent review from the French International Agency for Research in Cancer looked at 15 meta-analyses on the risk relationship between alcohol consumption (including light consumption) and the risk of breast cancer.   (A meta-analysis is a statistical approach to combine the results from multiple studies in an effort to improve estimates of the size of an effect and/or to resolve uncertainty when reports disagree.)  All but two of these analyses showed a dose-response relationship between alcohol consumption and the risk of breast cancer, even at low levels of consumption.
Researchers at the University of Houston have found a cancer-causing gene that is triggered by alcohol.  Cancer biologist Chin-Yo Lin says: "Our research shows alcohol enhances the actions of estrogen in driving the growth of breast cancer cells and diminishes the effects of the cancer drug Tamoxifen on blocking estrogen by increasing the levels of a cancer-causing gene called BRAF." Along with colleagues, he published his findings in PLOS ONE, an open access, peer-reviewed scientific journal published by the Public Library of Science. The authors estimate that tens of thousands of breast cancer cases in the U.S. and Europe each year are attributable to alcohol consumption and that drinking is also associated with an increased risk of disease recurrence in women with early stage breast cancer.  Another key finding was that alcohol weakened Tamoxifen's ability to suppress the rapid growth of cancer cells. Lin and his colleagues posit that their results suggest exposure to alcohol may affect a number of cancer-related pathways and mechanisms. He says their findings have implications for women who are undergoing hormone replacement therapy for menopausal symptoms, as alcohol can affect the actions of the hormones they take to manage their symptoms. The research highlights potential long-term health effects for college-age women, who might find themselves in situations where heavy or binge drinking is part of the social environment.

"We hope these and future findings will provide information and motivation to promote healthy behavioral choices, as well as potential targets for chemoprevention strategies to ultimately decrease breast cancer incidents and deaths within the next decade," Lin said. "We want to provide women, in general, with more information and insight to be better able to balance their consumption of alcoholic beverages with the potential health risks, including cancer patients who may want to take into consideration the potential detrimental effects alcohol consumption might have on treatments and modify their behavior and habits accordingly."

Alcohol may affect the growth of cancers beyond the breast.  A recent study from the University of Otago in New Zealand was published in the journal Addiction; it was also based on meta-analyses concerning alcohol and a variety of cancers.  The author wrote ”even without complete knowledge of biological mechanisms, the epidemiological evidence can support the judgement that alcohol causes cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and breast.   The measured associations exhibit gradients of effect that are biologically plausible, and there is some evidence of reversibility of risk in laryngeal, pharyngeal and liver cancers when consumption ceases. The limitations of cohort studies mean that the true effects may be somewhat weaker or stronger than estimated currently, but are unlikely to be qualitatively different.”

How can we wisely react to these recent findings?  Alcohol has been a part of the human experience since our early beginnings. Many other factors are closely related to the development of cancer, such as ionizing radiation, tobacco, the papilloma virus, UV exposure, family genetics, environmental toxins, unhealthy diets et al.  Cancer incidence rises with age, along with DNA changes in our genome.  Alcohol is clearly not the only risk factor for cancer, but it is one we can control.  I think it is wise for women to be very careful about alcohol use, not to exceed one drink a day, and preferably use less, such as a drink only on special occasions.  Women dealing with breast cancer should stop altogether.  Men who drink daily should limit their intake to one or two drinks at most. If there is a strong family history of colon cancer or other cancers, stop completely.  If you are diagnosed with cancer, stop completely.  Go to AA meetings.  If you don’t believe in a God, try nature or your sober friends for support.  My partner used to say ”I need an attitude adjustment” before having a glass of wine.  Now he says “Let’s meditate”.
Sadja Greenwood, MD, MPH 

Monday, July 11, 2016

That Sugar Film – Watch and Think!

In Australia, the average intake of sugar is 40 teaspoons a day.  We’re a little better in the US – we average 23 teaspoons daily – mainly from soft drinks and almost all processed food.  Food manufacturers add sugar – to a breakfast cereal, ketchup, cola, teriyaki frozen dinners et al – until they reach the ‘bliss point’.  Any less wouldn’t be as good tasting, any more would be too much.  Think about that – ‘the bliss point’.  Is it any wonder that we are hooked on sweet tasting food?

That Sugar Film was made by an Australian journalist, Damon Gameau, who decided to ingest 40 teaspoons of sugar a day, although he had not been eating sugar for 5 years.  He consulted doctors and nutritionists before starting.  He did not eat candy bars and ice cream, but selected supposedly healthy foods such as breakfast cereals, sports drinks, baked beans, and smoothies.  He continued to exercise vigorously, and ate the same number of calories as he had before - 2,300 daily. However, he gained 15 pounds, mainly around his waist.  Blood tests indicated that he was developing fat in his liver and a prediabetic state.  He also noted a decreased attention span and moodiness.

While making his film, Gameau traveled to an aboriginal community in northern Australia where the population consumed huge amounts of soft drinks and processed food, thanks to easy access to Coca-Cola and lack of fresh produce at the local food store.  The health effects were devastating.  Aboriginal communities are now trying to return to their old ways., with governmental support and wise local elders.
Gameau also visited a Kentucky town where there had been an epidemic outbreak of ‘Mountain Dew Mouth’  - the result of drinking five or more daily cans of this cola that is loaded with sugar and caffeine.  The film focuses on a teenager whose teeth are rotten and infected.  He wants dentures, but his dentist has trouble with the tooth-extraction since his gums are so infected that local anesthetic works poorly.  After the viewer watches his agony in shocking detail, the teenager says he will continue to drink Mountain Dew after he gets his false teeth.  Obviously, there’s a malicious ‘bliss point’ here – the addictive nature of sugar and soft drinks – when combined with poverty – is underlined.

The dramatic increase in obesity and diabetes in our country, and in many societies worldwide, is related to our consumption of processed foods and their added sugar.  New labeling requirements by the FDA mandate that ‘Added Sugars’ in grams and as percent of Daily Values be added.  While the FDA and the WHO say that added sugars should not exceed 10% of daily calories, many experts think that 5% is a better goal.  This would mean 24 grams of sugar for most people, or 6 teaspoons. Compare this to the 23 teaspoons we are now consuming in the U.S. 

Until the new labels arrive, remember that there are 4 grams of sugar in one level teaspoon.  You can figure it out by reading labels; don’t exceed 24 grams.  Include the sugar or honey you may put in your coffee or tea.   Here’s one final point – when Damon Gameau finished his 60 day sugar diet, he easily returned to his regular weight, his belly size decreased, and his abnormal test results turned around completely.  That Sugar Film is easily available on Netflix and other streaming sources.
Sadja Greenwood, MD, MPH   back issues on this blog