Diabetes – A New form of Treatment and Reversal

In the U.S. today one in 8 adults have type 2 diabetes and one in 3 have prediabetes.  The number is much higher in those over 65.  (Type 1 diabetes is an auto-immune disease and is not being discussed here.)  News from England is exciting- they have found a way to reverse diabetes, with strict dieting and exercise to induce weight loss.  Patients are given a liquid diet of 800 calories – four daily servings of soup or vitamin rich shakes.  They report reduced hunger after the first few days.  They have a small salad of non-starchy vegetables like tomatoes and cucumbers.  They go off their insulin as the diet begins and are carefully watched by their doctor.  Type 2 diabetes is due to too much fat inside the liver and pancreas.  Losing weight reduces this fat and allows the pancreas to work again by producing insulin. In the English study,88% of those who last 33 pounds or more no longer had diabetes.  In the U.S., the English prescription of diet and exercise is being studied at the Gonda Diabetes Centers at UCLA Medical Center in Santa Monica and Westwood, California.  Anyone interested in trying to reverse their diabetes should work with their primary care doctor.  People stop their insulin when they start the low-calorie diet, which is why you must work with your doctor, who will advise you and monitor your blood sugar levels. Note that the diet and weight loss does not work for 100% of people – depending on how long you have had diabetes, and other factors.  

Scattering the Ashes of Someone who Died

I have had 3 experiences of this which may be helpful to others.  I scattered my mother’s ashes in 1992 in a small town in North Carolina. It was inside a circle.  There were spicules and small pieces, all of which stayed above the ground.  Her husband did not attend the ceremony.  He had started calling himself Charly Big Paw.  My mother did not want to become Mrs. Big Paw.  I afound the ceremony to be serious and meaningful.  I scattered the ashes of my long-time companion Alan Margolis at our home in Bolinas.  Alan had made a plaque when we buried our beloved dog Ladi – the plaque depicted stairs which she would walk to meet him on the other side.  Alan was not religious, but the idea had sad and serious meaning.   I dug a small circular 

trench around the plaque and buried his ashes in it.  I visit it whenever I go back to Bolinas.  Ferns and other native plants surround the site.  It’s good to be able to visit it.  Last week I went to San Francisco with my two sons and stepdaughter to scatter the ashes of their father, my ex, Bob Goldsmith.  Fortunately, Bob and I remained friends after the divorce. We walked up a steep trail to a site where he and his partner liked to look out at the city.  We said the 23^rdpsalm and a Hebrew Kaddish.  It was very meaningful.  It is a place where the group can visit again. This is like returning to a grave.
Sadja Greenwood, MD, MPH

Thanksgiving - how to make it Peaceful, Healthy and Happy

Thanksgiving is a time to give thanks to people who have made life better for you and the world.  Gratitude is powerful - here are my choices.  You will have good ones of your own.  I am grateful for my loving family.  I am grateful for Greta Thunberg, the 16 year old who has brought powerful awareness of the dangers of climate change to youth and adults throughout the world.  I am grateful to Boyan Slat, an inventor from the Netherlands, for the Ocean Cleanup.  They are developing technologies to extract plastic from the ocean and prevent rivers from adding more plastic.  I am grateful for Amory Lovins and The Rocky Mountain Institute for their work on battery technology and indoor cooling, which will be important worldwide.

Here are some suggestions for a peaceful Thanksgiving gathering.  If there is potential discord among  people, ignore politics!  Talk about sports if that will work, or about cooking, and how you made your favorite dish.  Follow the Six Precepts of Tilopa (988-1069) and say very little, letting other members talk while you beam on them.  Here are the precepts - No thought, no reflection, no analysis, no cultivation, no intention, let it settle itself.

When it comes to the Thanksgiving meal itself - more gratitude for the food.  If you want to make it healthy, don't show up extremely hungry. Have some nuts and/or yogurt in the morning ahead of time.  Fill your plate with vegetables and salad first.  If you are eating turkey, go easy on the amount you take.  Be moderate with mashed potatoes and sweet potatoes.  For desert, try small servings of pumpkin or apple pie and even discard some of the crust.  Notice when you are feeling satisfied and have had enough.  Drink water or sparkling water throughout the meal.  Don't drink alcohol if you are pregnant or taking medications that can be affected by alcohol, or if you have cancer.  Otherwise, limit yourself to one glass of wine or one serving of spirits.  At the end of the meal you will feel peaceful and glad not to be overstuffed.  Deal with leftovers the next day in the same way.  Always start with vegetables.
Sadja Greenwood, MD, MPH

Meditation

From the National Institutes of Health

Interesting article:

Meditation and Yoga can Modulate Brain Mechanisms that affect Behavior and Anxiety-A Modern Scientific Perspective

Please go to this link:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769029/

Urban Farming in Washington D.C. – an exciting story

Urban Farming in Washington D.C. – an exciting story

You can read the whole article and see pictures of the land and people described here by going to civileats.com. Civil Eats is a constantly interesting website. Gail Taylor, an African American woman has set up the first organic farm with CSA (community supported agriculture) in Washington D.C. She currently has about 200 CSA members, and city farms in seven locations. Rooftop farms are being planned.

 Gail Taylor started out her work in Guatemala, promoting healing for women recovering from the trauma of civil war. Returning to the U.S., she began to share her passion for farming with other African Americans who recognized the power of food production to revitalize their communities. She approached the Oblates of Mary Immaculate, a Catholic order of missionaries with vacant land on their property.  They were able to set up the D.C. Urban Farming and Security Act that allows a 90% reduction in property taxes to owners of vacant lots who create partnerships with independent urban farmers. 

Gail Taylor and her group grow organic vegetables, herbs and flowers.  She plants a third of her farmed areas with oats, rye and crimson clover as cover crops between plantings.  Nearby orchards and farms run by women and farmers of color bring products like fruit, cheese, honey, rice, herbs and eggs.  They donate food to soup kitchens and food pantries.  Gail Taylor calls her CSA ‘Three Part Harmony’ because musicians in her family have created the music and the food together.  

Sadja Greenwood – past issues at sadjascolumns.blogspot.com

p.s. Deaths from vaping in the US have risen to 20.  The number was 6 when I last reported 2 weeks ago.  Do not vape.

 p.p.s. Melania Trump has continued to use and endorse the vegetable garden at the White House started by Michelle Obama.  She invites children to visit, plant and understand how food is grown.  The White House gardeners and kitchen tend to and serve the food daily.  How’s that for good news?

The Dangers of Vaping

The use of electronic cigarettes – e-cigarettes – e-cigs – vape pens – has been increasing among high school students.  Vaping in high schools rose from 1.5% of students in 2011 to 20% in 2018.  Middle schools may also be affected.  This is a serious matter, because of the dangers of vaping. Juul is the brand name for e-cigarettes. Juul has flavored e-cigs that appeal to youth.

In September of 2019 the Centers for Disease Control and Prevention, and the US Food and Drug Administration sent out a warning – urging people to consider not using e-cigarettes and also to avoid buying them off the street.  Currently there have been at least 380 cases of severe lung illness reported from vaping, and 6 deaths.  Unfortunately, more deaths are expected.

Vaporizers heat and aerosolize the nicotine or nicotine plus marijuana meant to be inhaled.  Vaping solutions consist of particles associated with toxicity to the heart and lungs, such as formaldehyde.  Vaping can irritate the lungs and lead to damage. It increases lung inflammation and paralyzes cilia – the hair-like projections in airways that remove microbes and debris. This increases the risk of pneumonia. A new finding has been lipoid pneumonia – the presence of fat in the lungs as a result of vaping. This is a relatively new illness with long term consequences.  Articles in the British Medical Journal and the New England Journal of Medicine have cited cases of hospitalized patients with vomiting, chest pain, shortness of breath, fever, and weight loss.  Recovery can be slow, and complete recovery from lipoid pneumonia may not occur. Vaping has also been linked to seizures and damage to the endothelial cells that line the blood vessels. In one case, the e-cigarette exploded in the mouth of a user.

I think the lessons here are clear.  Do not vape. If you are a cigarette smoker and want to quit, talk to your health care provider about safe methods.  Go to the website of the Mayo Clinic for their suggestions.  You can do it – many have succeeded – be safe, and keep your children safe.  

Sadja Greenwood, MD, MPH

Many Drugs have Dangerous Interactions with Alcohol – Be Aware

Information in this column is based on a newsletter called Worst Pills, Best Pills.  I suggest subscribing to this newsletter (800-289-3787) if you or members of your family take over-the- counter or prescription drugs. You do not need medical knowledge to understand the content of this newsletter, and it can be lifesaving.  

Research from the National Institute on Alcohol Abuse and Alcoholism has shown that many people, especially those over 65, may be incurring a risk by using alcohol when taking prescription drugs.  Alcohol, itself a drug, becomes more intoxicating if the drug taken will block the stomach’s ability to metabolize alcohol.  This is true of commonly used drugs for treating gastrointestinal ulcers such as ranitidine (Zantac and Tagamet), and also true for the smoking cessation drug Chantix.  

People combining alcohol and sedatives, including benzodiazepines (such as Valium or Ativan) and sleeping pills of all kinds, can experience increased sedation, impaired breathing, and be more likely to fall or have serious accidents.  Respiratory arrest can occur.  

Alcohol can impair the metabolism of drugs, resulting in risk of drug overdose.  This could happen with the drug warfarin (Coumadin), used as a blood thinner, and could result in an increased risk of bleeding. Conversely, long term heavy drinking could increase the metabolism of warfarin and increase the risk of blood clots. It is clear that people on warfarin should not drink heavily and be aware of their levels of the blood thinner.

Alcohol can interact with antibiotics, anti-fungal drugs, antidepressants, antihistamines, diabetes drugs, opioids, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen (Advil and Aleve), and Tylenol.  

People who are used to having a glass of wine with dinner may not experience problems with medications. However, heavier drinking can cause serious problems.  Therefore, the following advice is very important: check with your pharmacist and your health care provider before using alcohol with any prescription or over-the-counter drug. Read the warning labels on the bottle or package.  If it says not to drink alcohol – don’t drink it! 

Sadja Greenwood, MD, MPH

What YOU can do about Global Warming

Speak up – to your friends, neighbors and elected officials. Tell California officials you are proud of their policies on fuel economy standards. A pushback is coming immediately from the Trump administration.  Stay tuned.

Follow Swedish teenager Greta Lundberg as she mobilizes youth to fight climate change. They want to inhabit a livable world.  She is currently at the U.N. in NYC.  I have her on Google Alert, so I can read about her every day.  

What would happen if everybody in the United States cut back on driving?It turns out that even driving just 10 percent less — if everyone did it — would have a big impact on greenhouse gas emissions. That’s because Americans drive trillions of miles every year, helping to make transportation the biggest contributor to United States greenhouse gas emissions. In 2017, light-duty vehicles in the United States (including cars, S.U.V.s, pickups and most of the vehicles used for everyday life) produced 1,098 million metric tons of carbon dioxide equivalents.  That’s about one fifth of the country's total emissions footprint. A 10 percent cut, therefore, would be roughly 110 million metric tons of carbon dioxide, or the same as taking about 28 coal-fired power plants offline for a year.  While not easy, that target is realistic for most people, said Tony Dutzik, a senior policy analyst at the Frontier Group, a nonprofit research organization. Walk, bike or take public transit when possible. Car-pool, and work from home when you can. Emissions from a full bus or train are vastly lower than a car.  Fly less – take a train or bus instead.  

Weatherize your dwelling – make sure to seal drafts and have good insulation.  There may be federal tax breaks for some of this.  Invest in energy efficient appliances – look for the Energy Star label on them.  Find power plug-in devices that are rarely used and turn them off – I found two immediately in my apartment.  

It takes energy to heat your water and make it clean.  Take shorter showers, turn off the tap when you brush your teeth, wash your clothes in cold water. 75 to 90% of the energy used by your washing machine goes to warming the water.   Set a timer to run your dishwasher at night, to save on electricity, gas and water costs.  If you have time, dry your clothes on a bamboo clothes drying rack.  

Eat less meat – there are large energy and water costs in producing meat and cleaning animal refuse.  Eat vegetable protein such as nuts, and organic soy.  Combined with wholegrains, you will get a complete protein. Consider drinking nut milk instead of milk and cream.  Follow the Monterey Bay Aquarium Guide for advice on sustainable seafood.  

Buy LED lightbulbs – they use 90% less power than incandescent bulbs and are much longer lasting. They will cost you more up-front but save money and power.  

Find a way to plant trees in your community – either on your property if feasible, or possibly through a local school where the children participate.  Contact the Arbor Day Foundation to find suitable trees for your area.  

Keep at it!   Sadja Greenwood, MD, MPH

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Eggs – Good or Bad For You?

Data for these reports come from the Tufts University Friedman School of Nutrition Science and Policy.  I consider their publications to be extremely well researched.

Eggs: the protein in eggs provides all the essential amino acids your body needs as well as essential nutrients such as biotin, selenium, vitamins B12, A and D, iodine, potassium and phosphorus.  Egg yolks are high in lutein and zeaxanthin that may help to protect against age-related macular degeneration.

The controversy about eggs comes from the cholesterol in the yolk.  Too much LDL cholesterol in the blood can lead to a build-up of plaque in the arteries, increasing the risk for heart attack and stroke. Recent research has shown that for most people dietary cholesterol is not significantly related to LDL cholesterol in the body.  Saturated fat in the diet is more of a problem. 

Studies published in the last year have shown data on both sides of the subject of eggs in the diet.  Here is a prudent way to look at it.  If you have diabetes, have had a heart attack or are at high risk for heart disease, talk to your doctor about avoiding eggs altogether.  Enjoy an egg white omelet.  Get tested for diabetes if you are overweight or obese – many people have diabetes without knowing it.  

If you are not in the high risk category, eat eggs in moderation.  The American Heart Association suggests no more than one egg a day. Avoid unhealthy sides with your egg, such as bacon, ham, sausage, white bread or other refined grains, or fried white potatoes.  Eat eggs with vegetables, beans and whole grains instead. Store eggs in the refrigerator. Cook them until the yolk is firm to decrease the risk of salmonella infection.

Saturated fat is found in butter, lard, cheese, meats, chicken with the skin, and many baked good such as doughnuts, piecrusts, frozen pizza and cookies.   Fast food restaurants use trans-fats for frying because the oil can be used over and over again. Avoid when possible. Read the label on processed foods and margarine to look for partially hydrogenated oil. Avoid it.  Coconut oil is a saturated fat that many people enjoy because of its distinctive taste.  According the Dr. Walter Willett of the Harvard School of Public Health – “for now, I’d use coconut oil sparingly.  Most of the research so far has consisted of short-term studies to examine its effect on cholesterol levels.  We really don’t know how coconut oil affects heart disease.  And I don’t think coconut oil is as healthful as vegetable oils like olive oil and soybean oil, which are mainly unsaturated fat and therefore both lower LDL and increase HDL.  Coconut oil’s special HDL boosting effect may make it ‘less bad’ than the high saturated fat content would indicate, but it’s still probably not the best choice among the many available oils to reduce the risk of heart disease.”

Sadja Greenwood, MD, MPH

  

Breath Meditation – A Way to Relieve Stress

This entry is based on an article in Health.Harvard.edu

Psychological stress is bad for your health, increasing the risk of heart disease and cancer.  Stress can bring memory problems and bodily aches and pains.  Reducing stress helps sleep and may bring down blood pressure.  Focusing attention on breathing can help to make you relaxed, and is a gateway to ‘mindfulness’ – which means that you accept what comes in life, and its challenges.  Dr. Ronald Siegel, an assistant professor of psychology at Harvard Medical School, has written a book on meditation and mindfulness – The Mindfulness Solution: Everyday practices for everyday problems. 

Find a comfortable place with minimal distractions – sit, stand or walk.  Many people find sitting the most helpful.  Repeat a sound, phrase or movement – allowing thoughts to come and go as you focus on repetition.  You can silently count inhalations and exhalations, going from one to four for example, or silently say ‘in and out’ to yourself, or say peace/love, or here/now as you breathe.

Do your meditation at the same time every day, starting with 10 minutes in the morning and evening and working up to 20 minutes or more as it becomes easier.  Mindfulness came from Buddhism originally but is shared by many spiritual traditions and religions.  It means focusing on the present moment and accepting it without judgment.  Embrace life as it is. Much stress comes from fighting reality.

In summary: sit with your spine erect in a comfortable position.

Focus on your breath - it doesn’t matter if it’s long or short.

Allow your thoughts to come and go, returning your attention to your breath.

Get the book by Dr. Siegel mentioned above, or find a meditation site such as Insight Timer. 

Stay tuned for exciting new treatments for the Ebola Virus in Africa and drug resistant tuberculosis in the U.S. and throughout the world.  

Mindfulness does not mean that you abdicate working against injustice and the many problems in the world. It means that you accept your personal stressful situation for a short time every day to achieve a sense of well-being. 

Sadja Greenwood, MD, MPH

Water Safety, Kale, Abortion Pills Should be Everywhere

Water Safety

Drowning is the leading cause of injury death in children ages 1-4 and the third leading cause of unintentional injury deaths in children and adolescents ages 5-19.  In 2017 1000 children in the US were killed by drowning. The American Academy of Pediatrics says that parents must supervise their children constantly, require and model life jacket use, enroll children in swimming classes, keep barriers in place around pools, and know CPR. 

When playing in or near a pool or at the beach, stay in the water with your child and give him/her 100% of your attention.  Ignore your phone - but keep it charged and within reach in case of emergency,  Know the address of where you are swimming.  

Install a 4 sided fence around any pool of water, with a self-latching gate. Make kids buddy up - explain that each kid is responsible for knowing where the buddy is at all times.  Teach your child these water rules - no running, no diving in the shallow end of a pool, no pushing someone in, no pulling another kid under the water, no swimming without adult supervision, ever.  Never leave a child under 4 alone in a bathtub at home or near a bath that is filling.  Keep the toilet cover down and keep the bathroom door closed.

Kale has joined the ranks of 'the dirty dozen' by the Environmental Working Group!  This is probably because it has become so popular as a health food that producers must use herbicides to grow enough.  Be sure to buy organic kale, or grow your own.  

Abortion Pills Should be Everywhere by Farhad Manjoo, in the New York Times Sunday Review, August 4th.  In this article, Manjoo explains that it is possible to order the two pills that can result in a 'medical abortion' if taken within the first 10 weeks of pregnancy.  He was able to obtain the requisite pills on-line multiple times, for $200-300. This method has been shown to be about 97% effective, and much safer than childbirth. It will result in earlier and safer abortions. Manjoo expects that despite the current political efforts to make abortion illegal or difficult to obtain, ordering on-line will be unstoppable. Be sure to read his article on-line or at the library.

Sadja Greenwood, MD, MPH

Sustainable Eating

This article is based on a special report from the Tufts University Health and Nutrition Letter, August 2019.

There is a dietary pattern that can help you and the earth – by promoting sustainable agriculture. Sustainable agriculture refers to ways of growing food and raising animals that conserve natural resources and have minimal impact on the environment.  Sustainable eating means choosing foods that are good for our bodies and the environment.  

The United Nations Sustainable Development Goals state that we must change the way we produce food to increase productivity and sustainability while also improving human health. Raising cattle has the biggest impact on the planet of any single human activity. It produces 15% of the world’s greenhouse gases and uses 1/3 of the world’s fresh water.  Decreasing beef consumption is an important way toward a more environmentally friendly use of resources.  

Nicole T. Blackstone, PhD, an assistant professor at the Friedman School of Nutrition and Policy, analyzed the three diets recommended by the Dietary Guidelines for Americans – the Healthy US-style, Mediterranean and vegetarian dietary patterns.  Her results, published in The Lancet Planetary Health, showed that the US-style diet was tops in land use and CO2 emissions, because it includes the largest amount of red meat consumption.  The Mediterranean diet was highest in water pollution, mainly because of water use in Spain to produce olive oil.  (Data on the Mediterranean diet came from Spain).  A vegetarian eating pattern had the lowest impact on all sectors – CO2 emissions, water depletion, land use, pollution of fresh water, oceans and the air.  This does not mean that all conscientious eaters must become completely vegetarian, but that we should all make gradual changes in that direction.  

In January of 2019 a body of experts published a report entitled Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.  They aimed to use the latest scientific evidence to develop a “planetary health diet” that is both health promoting and environmentally sustainable.  Their proposed pattern is largely plant based but optionally includes modest amounts of fish, meat and dairy foods.  Worldwide, adhering to this diet would mean doubling per-person intake of  fruits, vegetables, legumes and nuts while cutting consumption of red meat and sugars at least in half.   According to Nicole T. Blackstone these recommendations would mean eating no more than the equivalent of 3 ounces of red meat per week, which is about the size of a deck of cards.  Currently the average American eats 5 to 6 times that much..  This would be a big shift. Such changes can be made gradually.

 Regardless of what we eat, cutting down on food waste is of great importance.  U.S. consumers throw away nearly one pound of food per day.  All that food in landfills produce greenhouse gases.  Planning meals ahead, storing food properly, and using frozen fruits and vegetables are ways to save food and money.  Find someone who composts and give your food waste to him/her. For many of my readers in West Marin, these changes will not be difficult.  Please write me a note on this blog if you have questions.  Subscribe to the Tufts Health and Nutrition Letter if you want a great source of reliable information monthly – 800-274-7581

Sadja Greenwood MD, MPH

What's in Your Nail Polish? Berries and Brain Function

What's in Your Nail Polish?

This article is taken from the July,2019 Wellness Letter of the University of California, Berkeley.  Nail polish contains plasticizers to make it flexible and chip resistant, but also endocrine disruptors that may adversely affect reproductive health, fetal development and thyroid function.  There has been an effort in recent years to ban ingredients of known risk, but the substitute ingredients may be just as toxic. Nail polish is clearly an occupational hazard for salon workers.  For you, dear reader, go to the Environmental Working Group’s Skin Deep Cosmetic Database to look for guidance for choosing safer nail polish.  Alternatively, you could decide to give up nail polish and find other ways to decorate your toes and fingers.  At the present state of knowledge, this may be the wise thing to do. 

Berries and Brain Function

Blueberries have attracted a good deal of scientific attention for their ability to help the brain, but strawberries, raspberries, blackberries, and cranberries contain similar pigment compounds called anthocyanins, which give berries their red, purple and blue colors.  Anthocyanins can cross the blood-brain barrier to become localized in areas of the brain related to learning and memory.  Anthocyanins decrease the vulnerability to the oxidative stress that occurs with aging.  They reduce inflammation and may increase neuronal signaling.  In the Nurses’ Health Study, an analysis of 16,000 women over 70 suggests how berries might affect aging brains. The women were tested for memory and other cognitive functions every 2 years and completed dietary questionnaires every 4 years.  Those who consumed two or more half –cup servings of strawberries or blueberries per  week had a slower mental decline over time of up to 2 ½ years of delayed aging. Previous studies conducted at Tufts University found that blueberries improved short-term memory, navigational skills, balance, coordination and reaction time.  Berries retain their healthy qualities even when dried or frozen. You can enjoy them year round.

This article is taken from the journal Environmental Nutrition, a newsletter of food, nutrition and health. This newsletter is highly recommended by your writer, Greenwood.  Here’s another addendum from Greenwood:  Strawberries should be purchased in organic form whenever possible, as they are treated with about 20 pesticides, and are on the ‘dirty dozen’ list of the Environmental Working Group.  

Sadja Greenwood, MD, MPH

Do Not Open or Crush Tablets or Capsules Without Checking with Your Doctor or Pharmacist!

Information in this column comes from Public Citizen’s newsletter:  Worst Pills, Best Pills News. 

Some patients find it difficult or impossible to swallow large tablets or capsules.  This is especially true of the elderly, people with Parkinson’s disease or dementia, and young children.  To cope with this problem, patients may crush or chew tablets, or open capsules and sprinkle the resulting powder or fragments onto food or into liquids.  A review article from Prescrire International in 2014 warned that for many medicines this may have very serious results.  Drug companies combine their medicines so that they will be released at a specific rate and in specific locations in the digestive tract, such as the stomach or small intestine. Crushing, opening or chewing the medication can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach, or intestines.  

Drugs that have a low margin of safety for overdosing include digoxin (Lanoxin) and blood thinners.  Serious injuries including death can occur with tampering with these drugs.   A drug such as Prilosec, frequently given for gastroesophageal reflux (so called heartburn) and/or ulcers can be made ineffective by crushing or chewing the tablet, allowing the stomach acid to inactivate the Prilosec and rendering the drug ineffective.  Prilosec and related drugs are available over the counter.  The label advises consumers to swallow the medicine whole.  Many people ignore these warnings.  Do not be one of them!  You should never crush a tablet, open a capsule or chew one without checking first with the prescribing health care provider or the dispensing pharmacist.  There may be a smaller tablet or capsule of the same drug, or another drug that you can swallow, or that can be safely crushed or opened before ingesting.  

Sadja Greenwood  MD, MPH

Magnificent Trees Should Not Go Down the Drain

 This article is taken from a report by the Natural Resources Defense Council, (NRDC).

Below the Arctic Circle, the largest intact old growth forest rings the globe.  Canada’s share of this boreal forest is vast.  It is a dense mix of spruce and fir trees mixed with aspen and birch, with peat bogs and verdant wetlands. More than 3 billion birds migrate there to breed – whooping cranes, the great gray owl, and a majority of North American songbirds.  Year-round residents include the Canada lynx, moose, pine marten and woodland caribou, as well as more than 600 communities of indigenous people who have relied on the forest’s bounty for millennia.  

Canada’s boreal forest is being leveled at an alarming rate – a million acres a year.  The oil and gas industries have added to the destruction, but the greatest threat is from logging, driven in large part by the rapacious demand in the U.S., the destination of more than 3/4ths of all boreal wood products.  The wood ends up as lumber, packaging and throwaway tissue products like paper towels and toilet tissue.  No major brand of toilet paper, facial tissue or paper towels, such as Procter & Gamble, Kimberly-Clark or Georgia-Pacific contains any recycled content. A recent paper by Shelley Vinyard at the NRDC, entitled The Issue with Tissue: How Americans are Flushing Forests Down the Toilet was followed by a call to action targeting Procter & Gamble, maker of Charmin. the top selling brand of  toilet paper in the U.S.  More than 80,000 NRDC members and online activists wrote to the Procter & Gamble’s CEO.  

The NRDC has evaluated several brands of paper products that are sustainable: Green Forest, 365 Bath Tissue, Natural Value, Earth First, Seventh Generation, and Trader Joe’s Bath Tissue.  Note that 365 Sustainably Soft and Trader Joe’s Super Soft Bath Tissue do not make the grade as sustainable.  

Another critical threat to the forest’s survival is the extraction of tar sands oil, which levels the forest and transforms the denuded earth into an industrial area of strip mines and toxic tailings pits.  The NRDC and its allies have fought to stop three quarters of the dozen tar sands pipelines the industry proposed, and continue to fight the Keystone XL pipeline. 

Worldwide, boreal forests store more carbon per hectare than any other forest biome, making them one of the best natural defenses against climate change.  Mandy Gull, deputy grand chief of the Cree Nation, says: As Indigenous peoples in the boreal forest, we live on the food from our land.  The forest is our supermarket, with aisles of berries and meats and fish.  My hope is that, once people know that their choice of tissue will determine whether food will be there for us tomorrow, they will help protect our homelands by switching to recycled and responsibly sourced products.

For the full report from the NRDC, including a buyer’s guide to tissue products, go to : nrdc.org/tissues. Sadja Greenwood, MD, MPH

Why is the Mediterranean Diet So Important?

The Harvard T.H. Chan School of Public Health and the Mayo Clinic are endorsing the Mediterranean Diet as a way to reduce the risk of heart disease, inflammation, blood sugar and body mass index.

  

The diet is a plant based eating plan consisting of a daily intake of whole grains, olive oil, fruits, vegetables, beans and other legumes, nuts, herbs and spices. The preferred animal protein is fish and other seafood at least twice weekly.  Poultry, eggs and low-fat dairy can be eaten in small portions daily, or a few times per week.  Olive oil replaces butter or margarine. Avocados, nuts and oily fish like salmon or sardines are other sources of healthy fat.  Red meat is limited to a few times per month.  Water is the main beverage.  Plain coffee and tea are fine.  Fruit juices contain too much sugar, and should be replaced by eating the whole fruit.  Wine, especially red wine, can be consumed with meals.  Women should drink no more that one 5 ounce glass per day, and men should stop at 2 glasses.  People who do not drink alcohol do not need to begin.  Eating and socializing with other people is encouraged. Daily physical activity is important.

The Mediterranean diet emphasizes whole grains, such as whole wheat, rye and barley.  People wanting a gluten free diet can use brown rice, quinoa, buckwheat, millet, oats and corn.  

 Research has shown that the Mediterranean diet reduces the risk of cardiovascular disease and overall mortality.  A study of 26,000 women over 12 years showed a 25% lower risk of developing heart disease and stroke among those whose eating plan was close to the Mediterranean diet.  Favorable changes in inflammation, blood sugar, 

Type 2 diabetes and body mass index were also seen.  

Fat intake is high in the Mediterranean diet, consisting of 39-42% of daily calories – note that the fats are healthy ones, such as olive oil, nuts, avocados and oily fish.  This promotes satiety – feelings of fullness – so that the diet is easy to follow.  The Ketogenic diet is also high in fat, but relatively low in plant food while emphasizing meat eggs, and cheese. The lack of a wide variety of plant foods means a considerably smaller intake of protective antioxidants.  This diet has been popular for weight loss without hunger.  Compared to the Mediterranean diet it is less healthy for the individual and ultimately for the planet.  

Sadja Greenwood, MD, MPH

The Carter Center's Amazing Work on Guinea Worm Disease

Since 1986, The Carter Center has led the international campaign to eradicate Guinea worm disease. Guinea worm disease is a parasitic disease caused by a nematode roundworm parasite called Dracunculus. It is contracted when people consume water from stagnant sources contaminated by Guinea worm larvae. Inside a human’s abdomen, male and female worms mature and grow.  After about a year, the female Guinea worm, one meter long, creates an agonizingly painful lesion on the human’s skin as it slowly emerges.  Guinea worm sufferers often try to seek relief from burning sensations and immerse themselves in water.  The emerging worm releases its larvae into the water and so the cycle of infection goes on.  

In 1986 there were an estimated 3.5 million cases of Guinea worm disease in 21 countries in Asia and Africa.  Today that number has been reduced by 99.99% to 28 cases in 2018. It could be the second human disease, after smallpox, to be eradicated without the use of a vaccine or medicine.  The Carter Center has worked closely with ministries of health and local communities, US Centers for Disease Control and Prevention, the WHO and UNICEF.  Community based interventions have included teaching people to filter all water, done in some ingenious ways, and keeping people with an emerging worm from entering water sources.  

A challenge to eradication has been the emergence of Guinea worm disease in animals, such as domesticated dogs, who may eat infected fish and fish entrails.  Cash rewards are being paid to the reporting of infected animals, and the use of veterinary deworming drugs.  In 2018 Ethiopia reported infections in 11 dogs, 5 cats and 1 baboon. Another challenge is insecurity – conflicts make some areas unsafe for travel.  

Enormous dedication and attention to detail is critical for all field supervisors and the thousands of community-based volunteers charged with executing the campaign.  The disease has been eliminated in 17 countries. 80 million cases have been averted among the world’s poorest and most neglected people. 

WHO is responsible for certifying countries as free of Guinea worm disease.  The US Centers for Disease Control and Prevention provide technical assistance and verify whether worms from patients are truly Guinea worms. UNICEF helps to provide safe sources of drinking water. 

Dear Readers – the take home message from this column is one of hope and awe, that President Jimmy Carter has provided such important leadership in the relief of suffering. Donations to his center are always appreciated.  I am dedicating this column to the memory of my ex- husband, Dr. Robert Goldsmith, father of my 2 sons and step-daughter. Dr. Goldsmith died last week in San Francisco. His children provided a beautiful and meaningful memorial service for him yesterday.  He was a Professor of Tropical Medicine at UCSF, and would have known all about the efforts to eliminate Guinea worm disease.   I am sorry I could not discuss this matter with him.  

Sadja Greenwood, MD, MPH

Too Busy to Floss? This Could Change Your Mind!

There is new research on how bacteria involved in gum disease can travel through the body, exuding toxins connected to Alzheimer’s disease, rheumatoid arthritis and aspiration pneumonia.  Experiments in mice, using  bacteria from people with Alzheimer’s disease, showed that the bacteria can find their way from mouth to brain.  The bacterium is Porphyromonas gingivalis (P g for short).  It is involved in periodontitis – inflammation of the gums. According to Jan Potempa, PhD, DSC, a professor at the University of Louisville School of Dentistry and head of the Department of Microbiology at Jagiellonion University in Krakow, Poland, oral hygiene is important and will decrease the risk of many serious diseases. Researchers  compared brain samples of deceased people with and without Alzheimer’s disease, same age at death, and found that P g was more common in the samples from people with Alzheimer’s , as evidenced by DNA and the presence of certain key toxins.  Studies in mice showed that P g can move from mouth to brain. An experimental drug that blocks bacterial toxins is in phase 1 clinical trial for Alzheimer’s.  About 20% of people have low levels of P g in their gums by age 30.  While not necessarily harmful, if it grows to large numbers it creates inflammation. Smokers and older people are at increased risk.  

The take-home message here is clear.  Brush your teeth and floss regularly.  Visit your dentist and dental hygienist, at least yearly.  

Sadja Greenwood, MD, MPH

We All Depend on the Survival of Bees

In the film Fantastic Fungi by Louie Schwartzberg, amazing time lapse photography shows the growth of numerous kinds of fungi as they digest dead plant and animal material and in so doing enrich the earth.  Fungi, a separate form of life from plants and animals, have healing properties for the immune systems of animals, including humans, which are beginning to be researched.  The film, which stars the mycologist Paul Stamets, among others, has an important section on the use of fungi to help bees resist viruses in their hives.

According to a new paper from Washington State University (WSU), and colleagues at Fungi Perfecti, a mushroom extract fed to honey bees greatly reduces virus levels in their hives.  Colonies fed mycelium extract from amadou and reishi fungi showed a 79-fold reduction in deformed wing virus and a 45,000-fold reduction in Lake Sinai virus compare to control colonies. 

Mycelium is the vegetative part of a fungus consisting of a mass of branching, threadlike hyphae.  It penetrates deep into the soil.  Fungi Perfecti is a business dedicated to promoting the cultivation of high quality medicinal mushrooms.  Paul Stamets grows his mushrooms organically in the Pacific Northwest.  

"Our greatest hope is that these extracts have such an impact on viruses that they may help varroa mites become an annoyance for bees, rather than causing huge devastation," said Steve Sheppard, a WSU entomology professor and one of the paper's authors. "We're excited to see where this research leads us. Time is running out for bee populations and the safety and security of the world's food supply hinges on our ability to find means to improve pollinator health."

The research was published in the journal Scientific Reports.

At present, the mycelium extract isn't currently available in levels for beekeepers to purchase for their hives.

"We are ramping up production of the extracts as rapidly as is feasible, given the hurdles we must overcome to deploy this on a wide scale," Stamets added. "Those who are interested in being kept up to date, can sign up for more information at http://www.fungi.com."

Sheppard said he and his colleagues plan to do more work to refine their now-published results. That way beekeepers will have the best information when supplies are more available.

"A portion of this project was funded by USDA-NIFA project WNP00604.

 Journal Reference:

1.     Paul E. Stamets, Nicholas L. Naeger, Jay D. Evans, Jennifer O. Han, Brandon K. Hopkins, Dawn Lopez, Henry M. Moershel, Regan Nally, David Sumerlin, Alex W. Taylor, Lori M. Carris, Walter S. Sheppard. Extracts of Polypore Mushroom Mycelia Reduce Viruses in Honey Bees. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-32194-8

 Chlorpyrifos  Another threat to honey bees and other forager bees is the insecticide chlorpyrifos.  Honey bees experience a learning and memory deficit after ingesting small doses of this insecticide, potentially threatening their survival, according to a study in New Zealand.  Chlorpyrifos is a highly neurotoxic organophosphate pesticide used worldwide on crops to protect against insects and mites.

The effects of this insecticide on animals and humans has been widely studied since the 1970s. Chlorpyrifos affects living things to various degrees: it is very toxic to birds and insects, including bees, quite toxic to fish, and also toxic to humans. Home use of chlorpyrifos was banned in 2000, when Dow withdrew it from the market voluntarily, though it is still found in insect baits. Golf courses still combat pests with it, and it is also
used by farmers on nearly 50 crops—many of which we consume, like oranges—and in cattle ear tags.  Farmworkers are exposed, and pregnant farmworkers may have lasting damage to their children.  Recent studies of small children have found a link between chlorpyrifos and lower IQ and developmental problems
Hawaii is the first state to ban Chlorpyrifos.  California should follow suit.  Contact your congressperson, senators and governor Gavin Newsom to ban this highly toxic chemical.  

Sadja Greenwood, MD, MPH

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New and Important News on Sleep

Researchers at Bar-lian University in Israel have identified a function of sleep that can explain why humans as well as all other animals with a nervous system spend a significant portion of their lives in sleep. Even Invertebrates such as flies, worms and jellyfish sleep.  The reason why animals sleep – despite the threat of predators, has been considered one of the biggest questions in life sciences.

In a new study, published in March, 2019 in the journal Nature Communications, researchers at Bar-Ilan University in Israel reveal a novel and unexpected function of sleep that they believe could explain how sleep and sleep disturbances affect brain performance, aging and various brain disorders.

Using 3D time-lapse imaging techniques in live zebrafish, the researchers were able to define sleep in a single chromosome resolution and show, for the first time, that single neurons require sleep in order to perform nuclear maintenance.  DNA damage can be caused by many processes including radiation, oxidative stress, and even neuronal activity.  DNA repair systems within each cell correct this damage. The current work shows that during wakefulness, when chromosome dynamics are low, DNA damage consistently accumulates and can reach unsafe levels.

The role of sleep is to increase chromosome dynamics, and normalize the levels of DNA damage in each single neuron. Apparently, this DNA maintenance process is not efficient enough during the online wakefulness period and requires an offline sleep period with reduced input to the brain in order to occur. "It's like potholes in the road," says Prof. Lior Appelbaum of Bar-Ilan University. "Roads accumulate wear and tear, especially during daytime rush hours, and it is most convenient and efficient to fix them at night, when there is light traffic."

Appelbaum calls the accumulation of DNA damage the "price of wakefulness." He and his doctoral student David Zada, first author of the study, as well as co-authors, Dr. Tali Lerer-Goldshtein, Dr. Irina Bronshtein, and Prof. Yuval Garini, hypothesized that sleep consolidates and synchronizes nuclear maintenance within individual neurons, and set out to confirm this theory.

Their discovery was achieved thanks to the characteristics of the zebrafish model. With their absolute transparency, and a brain very similar to humans, zebrafish are a perfect organism in which to study a single cell within a live animal under physiological conditions. Using a high -resolution microscope, the movement of DNA and nuclear proteins within the cell -- inside the fish -- can be observed while the fish are awake and asleep. The researchers were particularly surprised to find that chromosomes are more active at night, when the body rests, but this increased activity enables the efficiency of the repair to DNA damage. 

The results establish chromosome dynamics as a potential marker for defining single sleeping cells and propose that the restorative function of sleep is nuclear maintenance. "We've found a causal link between sleep, chromosome dynamics, neuronal activity, and DNA damage and repair with direct physiological relevance to the entire organism," says Prof. Appelbaum. "Sleep gives an opportunity to reduce DNA damage accumulated in the brain during wakefulness."

"Despite the risk of reduced awareness to the environment, animals -- ranging from jellyfish to zebrafish to humans -- have to sleep to allow their neurons to perform efficient DNA maintenance, and this is possibly the reason why sleep has evolved and is so conserved in the animal kingdom.”

Journal Reference:

1  D. Zada, I. Bronshtein, T. Lerer-Goldshtein, Y. Garini, L. Appelbaum. Sleep increases chromosome dynamics to enable reduction of accumulating DNA damage in single neurons. Nature Communications, 2019; 10 (1) DOI: 10.1038/s41467-019-08806-w

 ScienceDaily. 5S 5 March 2019. 

The take-home message of this column is that we should find a way to sleep every night until we feel refreshed and rested.  We can’t put it off until the weekend and get the daily needed brain repair.  Going to bed earlier could be an answer for many people.  Zzzzzzzz  Read the news on sleep and heart disease in the previous column on this website.

Sadja Greenwood M.D., MPH