Sadja's columns

Luteolin - Another fascinating compound in plants

2012-02-02T14:04:00.000-08:00

Luteolin is a flavonoid – a compound in plants that gives yellow or red/blue pigments designed to attract pollinators. Flavonoids also fix nitrogen, regulate plant physiology and inhibit plant diseases. When we humans eat plants, the flavonoids therein may have many beneficial effects. Research on luteolin is an example.

Dr. Daniel Hwang is a molecular biologist at UC Davis. He has studied the ways in which luteolin (and other plant compounds – quercetin, eriodicytol, hesperidin, naringenin) apparently act as anti-inflammatory agents. These compounds target an enzyme in humans that can increase inflammation. Luteolin was found to be the most effective inhibitor of this enzyme. Since unchecked inflammation is associated with heart disease, cancer and problems of aging, this finding is a step on the way to prevention.

Researchers at the University of Illinois, led by Dr. Rodney Johnson, study anti-inflammatory compounds and their effects on the brain aging. They have found that luteolin can reduce inflammation in the brain as well as in other parts of the body. When infection occurs anywhere in the body, brain cells called microglia produce inflammatory chemical messengers that help to fight off the infection. This process is beneficial if it is limited to the acute infection. The inflammatory response is associated with sleepiness, loss of appetite, fever and lethargy, and sometimes a temporary diminishment of memory and learning. Some neurons may self-destruct in this process. Inflammation in the central nervous system can be serious if it goes on too long. Luteolin was found to diminish this inflammatory response, by shutting down a key component in the inflammatory pathway.
When aged mice were fed a diet supplemented with luteolin, they did better on tests of learning and memory tasks than the aged mice controls; the levels of inflammatory markers in their brains were similar to younger adult mice. The researchers concluded that natural compounds in fruits and vegetables, by being anti-inflammatory, could inhibit cognitive aging. Johnson thinks that his team’s results are applicable to other conditions with an inflammatory component, including diabetes and obesity.

Just published research by Professor Jung Park in Korea has shown that luteolin inhibits cell signaling pathways important for the growth of colon cancer cells. Blocking these pathways can stop colon cancer cells from dividing, and can lead to cancer cell death.

Dietary sources of luteolin include celery, green pepper, thyme, chamomile, carrots, olive oil, peppermint, rosemary and oregano. Luteolin is also being sold as a supplement, and should not be taken as such. You may remember the study showing that smokers taking beta-carotene supplements developed more lung cancer and had higher death rates than those without such a supplement. It was felt that taking an excess of one carotene may have inhibited the absorption of other carotenes from food. There are many flavonoids in plant foods, and they may act synergistically with each other. Taking any one of these as a supplement is unwise and untested. Earlier in this article I wrote about quercetin – found in apples, capers and onions, and eriodicytol, hesperidin, and naringenin - found in citrus fruits. The take home lesson from research on flavonoids is – keep eating a wide variety of vegetables and fruits. Remember what Michael Pollan said: Eat food, not too much, mostly plants.
Sadja Greenwood, MD,MPH back issues on this blog

Go to Health: Teenagers’ diets, Your feet, B12 update

2012-01-18T10:17:00.000-08:00

What Teenagers are Eating:
Nationwide, teens are eating very few fruits and vegetables; this isn’t news to many parents who are struggling financially and competing with chips and soda in their kid’s diets. Data from a national survey of high school students show that typical daily intake of fruits and vegetables combined was slightly more than one serving a day. More than 25% of students ate fruit less than once a day, and 33% ate vegetables less than once a day. My partner, Alan, has a grandson, now 21, who refused to eat a single vegetable until recently, when his savvy girlfriend persuaded him to try some greens. I asked my 12 year old neighbor, Ibarra, for her advice to parents and teens. Her answer was immediate – kids love the smoothie shop in downtown Bolinas – make smoothies at home and put fruit in them. Make pasta for dinner and put vegetables in the sauce, disguised by blending them if necessary. Make fruit salad. Thanks, Ibarra for your thoughtful advice.

Your Feet:
Anthropologists studying the evolution of the foot say that as we became bipedal, the foot was under selection pressure to deal with both balance and propulsion in a highly efficient way. Think about balance and propulsion when you select your shoes. Your toes should not be compressed, because from the big toe to the fifth toe, they assist your balance as they spread out, and then they push you forward into the next step. There is a new interest in barefoot walking, and in shoes that enable you to walk in a way that resembles being barefoot, but gives protection to your soles on hard or rocky surfaces. Take shorter strides to allow you to land more softly on your heel with your knees slightly bent. Roll forward until the ball lands, and spreads slightly as your toes spread and bend to push you forward. Shoes that enable this kind of walking are light and flexible. Several shoe companies have ‘barefoot’ models. Be sure to get one with a wide toe box. Beginners’ advice – walk the beach barefoot, and take off your shoes at home. Women - rethink high heels if you want to keep your toes happy and your calf muscles from shortening. Stretch your calves whenever you take off high heels. Foot binding in China kept women in thrall, and Thorstein Veblen, writing in 1899, thought high heels were indicative of conspicuous consumption and the subjugation of women. Times have changed, and heels have become symbols of sexiness and power. But our feet haven’t caught up. Should we change our views on glamour? It won’t be easy, but thinking women are already making huge changes in the world.

Vitamin B12 Update:
A new study from Rush University looked at levels of vitamin B12 in people over 65, and found that B12 deficiency was associated with smaller total brain volume and lower scores on tests of memory and cognition. These finding are supported by earlier (2008) study at Oxford University in England which found that over five years, people with higher vitamin B12 levels were 6 times less likely to experience brain shrinkage compared to those with lower levels. Vitamin B12 is found only in animal food, and is especially high in clams and other shellfish. Fortified breakfast cereals are an important source of vitamin B12 for vegans, who should also take a B12 supplement. Older people may have difficulty absorbing B12 from food, because of a lack of a substance called ‘intrinsic factor’ in the stomach that enables B12 absorption. Therefore, B12 supplements are recommended for seniors; getting the sub-lingual (under the tongue) kind that is absorbed directly into the bloodstream is the best. Low B12 levels are also related to depression, bone loss and macular degeneration in the eye. It’s worth paying attention to this issue.
Sadja Greenwood, MD, MPH back issues on this blog

The Role of Spices in Cancer Prevention

2011-12-18T13:25:00.000-08:00

In their recent lecture at Commonweal, The Cancer-Fighting Kitchen, Dr Jeanne Wallace and chef Rebecca Katz talked about foods and spices that have special relevance in cancer prevention. Wallace spoke about the ability of diet and lifestyle changes to modulate gene expression, changing the probability of getting a disease and also surviving after a diagnosis. She described Nuclear Factor Kappa B (NF-kB) as a master switch for genes involved in tumor growth and invasion. NF-kB is a protein complex that controls DNA transcription, and regulates various steps in cancer cell growth. NF-kB also controls many genes involved in inflammation. While drug companies are researching new medicines to inhibit NF-kB, herbs and dietary plants have been found to inhibit NF-kB activation.

Wallace showed a slide of spices that inhibit NF-kB, and here is the list: anise, basil, black pepper, caraway, cardamom, chili pepper, cinnamon, clove, coriander, cumin, fennel, fenugreek, flaxseed, garlic, ginger, Holy basil, lemongrass, licorice, mint, mustard seed, nutmeg, oregano, parsley, rosemary, saffron, tamarind, turmeric. Note that spices in this list are used in many ethnic foods. Each one has unexpected properties as well as distinctive tastes. I will write about many of them in future articles; today I want to focus on cinnamon, clove and nutmeg, as these are so commonly used in the winter holidays - for baking, mulled wine, chai, spiced apple juice and eggnog.

Cinnamon: In addition to NF-kB inhibition, cinnamon has been shown to control blood sugar in people with type 2 Diabetes. Subjects using ¼ to ½ teaspoon daily were found to lower their fasting blood sugar, their hemoglobin A1C as well as their triglycerides and LDL cholesterol. Blood sugar spikes after a meal were lessened. Healthy people without diabetes had showed improvement in their glucose tolerance tests after daily cinnamon intake. Cinnamon has also been found to inhibit vaginal yeast infections and the bacterium Helicobacter pylori infection in the stomach.

Cloves: In addition to NF-kB inhibition, cloves have a long history as pain relievers in dentistry. Oil of clove is a mild topical anesthetic, and also has anti-inflammatory and antibacterial properties in the mouth for teeth and gums. Eugenol, the scientific name for oil of clove, is used in India for stopping the growth of H. pylori in the stomach. Cloves are used in Ayurvedic medicine, Chinese medicine and western herbalism. They can increase hydrochloric acid in the stomach, and improve intestinal action,. Cloves should be use sparingly, as the taste is strong, and high doses can be toxic to the liver. Following a tried and true recipe should yield good results

Nutmeg: In addition to NF-kB inhibition, nutmeg has been used by herbalists as a brain stimulant, and for its ability to kill rotaviruses, a common cause of diarrhea. Used in very large quantities, nutmeg can cause intoxication and hallucinations. This use in dangerous, but will not occur with the amounts used in everyday cooking. Some cooks use nutmeg in savory dishes as well as sweet ones, such as bean soups, stews, and vegetable casseroles.

Before closing, I wish all readers a good holiday season, with an emphasis on seasoning, and a suggestion that you look at the book Healing Spices, by B.B. Aggarwal, a prominent cancer researcher at the University of Texas M.D.Anderson Cancer Center . One of his sayings is: Put more spice in your life, to prolong your life.
Sadja Greenwood, M.D. past issues on this blog

Inflammation - What to do About it

2011-11-20T13:32:00.000-08:00

We are all familiar with acute inflammation: you cut yourself with a knife and it hurts, the area around the cut gets red, warm and swollen, and the process takes a few days to heal. Bacteria entered the wound, and your body’s immune system went into gear to send more blood with white blood cells to prevent infection, which caused the swelling, redness and tenderness. (Sometimes you need antibiotics and/or a tetanus booster as well.)

Chronic inflammation is another story – and many of us have it without awareness. It has been called ‘a slow burn’ that is detected by a rise in inflammatory markers – proteins produced by the immune system. High –sensitivity C reactive protein is such a protein, and your doctor or nurse-practitioner can order this test if needed. Obesity is a major cause of inflammation, along with gum disease, untreated infections with bacteria, parasites or viruses, smoking., and other factors.

Chronic inflammation is associated with coronary heart disease, by helping to build the plaque that narrows arteries and can lead to a heart attack. When the person is overweight and has high blood pressure, high blood sugar, and high triglycerides, the risk is greater.

Chronic inflammation has also been associated with a number of cancers, including stomach, colon, lung, esophagus, cervix and liver. The evidence that regular aspirin use reduces the risk of colon cancer is believed to be related to aspirin’s anti-inflammatory effects.

Inflammation has also been linked to Alzheimer’s disease – a Harvard study of people in their 70’s and 80’s showed that people with high levels of inflammatory markers were twice as likely to be diagnosed with Alzheimer’s than those with lower levels. Inflammation has also been linked to declining muscle strength with aging.

What helps prevent inflammation? Weight loss is the big factor here – along with regular, moderate exercise that will assist in weight loss. In a recent seminar at Commonweal (The New School at Commonweal, Bolinas, California) Dr. Jeanne Wallace and the chef, Rebecca Katz, discussed the foods that can reduce inflammation. I have my additions in italics.

*Increase your intake of fruits and vegetables to 8 servings a day. Have leafy green vegetables and cruciferous vegetables regularly (cabbage, broccoli, cauliflower, kale and many more). Eat pumpkin, butternut squash, yams and carrots.

*Eat cold-water fish, grass-fed animal foods, omega-3 eggs, walnuts, hemp, chia and flaxseed meal. I advise adding fish-oil capsules as a supplement. Read the label to make sure it is molecularly distilled to avoid mercury.

*Avoid foods with sugar and refined flours. This is a hard one for many people. Learn to treat yourself with dried or fresh fruit, and satisfy your between meal hunger with nuts, raw vegetables or an apple..

*Use spices liberally, especially curry, ginger, garlic, parsley and hot peppers.

*Use olive oil for cooking and salads.

*Eat dark chocolate -in moderation because of the sugar. I advise using fair-trade unsweetened cocoa powder, in hot chocolate sweetened with xylitol or stevia. Mash a banana and add some nut butter and cocoa powder for a sugar-free treat.

*Eat berries – blueberries, cherries, raspberries. These can be found frozen when their season is over.

*Eat legumes – lentils, peas, beans, dried beans. A Spanish study showed that obese men and women told to cut calories and eat four servings a week of legumes lost weight and lowered their C Reactive Protein levels, even after adjustment for the weight loss.

Since many of us have chronic inflammation without knowing it, and since it is related to such devastating problems as heart disease, cancer, Alzheimer’s and muscle loss, it is time to start paying attention to this condition. You can find all the slides of the talk by Wallace and Katz on line at The New School Commonweal, November 3rd, 2011, The Cancer-Fighting Kitchen. I plan to write more about their seminar in future columns.

Happy holidays to all. I suggest snacking on raw vegetables and nuts and avoiding that extremely hungry feeling followed by that overstuffed feeling. Remember what the Japanese say Hara hachi bu – eat until 80% full.
Sadja Greenwood MD – back issues on this blog

Update on Coffee, Vitamin D, and your Brain

2011-10-30T21:28:00.000-07:00

Coffee – Mood - MRSA! A recent Harvard study showed that over a 10 year study period, women who drank 2-4 cups of coffee a day had a 15-20% lower risk of depression than women drinking one cup a day or less. The researchers suggested that consistent use of caffeine may have long term effects on the brain, binding to receptors for brain chemicals associated with mood elevation.

A new study from the Medical University of South Carolina showed that hot tea or coffee may give a 50% reduction in the likelihood of carrying MRSA (methicillin- resistant Staphylococcus aureus) inside the nose. About 1.4% of over 5000 people tested carried MRSA in their noses.. MRSA can cause serious problems when the bacteria come in contact with an open skin wound, and in people with weakened immune systems. Compounds in hot tea and coffee seem to have volatile antimicrobial compounds that reach the nose in vapor form. Cold coffee and tea do not have this effect. More research is needed here, but the news is hopeful!

Vitamin D: Take your Vitamin D supplements with food – a study from the Cleveland Clinic showed that this fat soluble vitamin is better absorbed with the largest meal of the day, which is likely to contain the most fat.. New studies show that newborns low in Vitamin D are at higher risk of lung infections, breast cancer patients low in D may have more aggressive tumors, and people with low D levels are at higher risk of developing diabetes. If possible, have a blood test for 25-hydroxyvitamin D, and aim for a level of 40ng/ml or higher. As winter is coming, sun exposure will not boost your level at our latitude. Most people can safely supplement with 1000 IU of D daily, or more if deficient. .

Alzheimer’s Disease: An epidemiologic study from UCSF looked at data involving hundreds of thousands of participants from many countries. In the US, the biggest modifiable risk factors for dementia are – in descending order - physical inactivity, depression, smoking, mid-life hypertension, midlife obesity, low education and diabetes. These risk factors are associated with up to 54% of Alzheimer’s cases in the US. Researchers said that this data suggests that simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a big impact on preventing dementia. They caution that their conclusions are based on the assumption that there is a causal connection between each risk factor and Alzheimer’s, which is being investigated in various laboratories. Another study from the Neuroscience Center at the School of Medicine at Louisiana State University showed that DHA – a component of fish oil – is concentrated in the nervous system and plays a key role in vision, neuroprotection, successful aging and memory. It is anti-inflammatory and as such may help with pain, heart disease and many other ailments. DHA is believed to lower the risk of Alzheimer’s, macular degeneration in the eye, Parkinson’s disease and other brain disorders. Both DHA and EPA (a related omega-3 fatty acid) are found in coldwater fatty fish and fish oil, and both are essential for brain function. If you are not familiar with the benefits of fish oil, here’s a good website at the University of Maryland:
www.umm.edu/altmed/articles/omega-3-

That’s it for this week – in summary – coffee can be really helpful as well as enjoyable in amounts that do not interfere with sleep; take your Vitamin D with a meal containing fat, and prevent dementia with a daily walk, not smoking, and taking fish oil.
Sadja Greenwood, MD, MPH

News about Coffee

2011-09-25T16:33:00.000-07:00

Positive news about caffeine and coffee is on the rise! Annia Galano, a Cuban chemist, recently published a paper suggesting that coffee is one of the richest sources of healthful antioxidants in the average person’s diet. It scavenges free radicals that can have damaging effects on the body. Here is a summary of recent research.

Cognitive decline: A study by French neuropsychologist Karen Ritchie found that women over age 65 who drank over three cups of coffee a day showed less cognitive decline over 4 years than those drinking one cup or less. No such relationship was found for men in this study. A study in mice at the University of South Florida found that caffeinated coffee increases a growth factor called GCSF (granulocyte colony stimulating factor) . GCSF improves memory performance in Alzheimer’s mice, acting to remove harmful beta-amyloid protein that initiates the disease. GCSF also creates new brain connections and increases the birth of new neurons. Decaf coffee and caffeine alone did not give this protection.

Heart disease: While coffee may increase blood pressure in certain people, it can also increase blood vessel elasticity. If your blood pressure is high, it is important to assess the effects of coffee with a home blood pressure cuff and a talk with your doctor. Researchers in the Netherlands found that people drinking 2-4 ups of coffee daily had a 20% lower risk of heart disease, and a slightly reduced risk of death from heart disease and all other causes.

Reduced stroke risk: A study from Sweden’s Karolinska Institute found that women who drank one or more cups of coffee a day had a 22% lower risk of stroke – both the kind from arterial blockage and from bleeding in the brain. Men were not included in this study, as the population of 35,000 women were in a mammography study.

Breast cancer risk: Another Swedish study showed that drinking coffee specifically reduces the risk of estrogen-receptor negative breast cancer. There has been speculation that the boiled coffee used by Swedes has more beneficial compounds against cancer than the filtered coffee preferred in this country, but this remains an unproven question. Boiled coffee can increase cholesterol levels.

Prostate cancer risk: A recent study from Harvard School of Public Health of 48,000 male health professionals showed that men who drink coffee (regular or decaf) had a lower risk of developing a lethal form of prostate cancer. Men consuming 6 or more cups daily had a 20% lower risk of developing any form of prostate cancer. They had a 60% lower risk of developing lethal prostate cancer. Drinking 1-3 cups daily was associated with a 30% lower risk of lethal prostate cancer. Additional studies of the mechanisms involved are underway.

Diabetes risk: Past studies have suggested that regular coffee drinking may reduce the risk of type 2 diabetes. At the University of Nagoya in Japan, lab mice commonly used to study diabetes were fed either water or coffee. Coffee consumption prevented the development of high blood sugar and improved insulin sensitivity. There were also beneficial changes in inflammation and fatty liver. Caffeine was felt to be the anti-diabetic compound. However, another recent study from Duke University found that in humans, caffeine can increase insulin resistance in people without diabetes , and produce an exaggerated blood glucose spike in diabetics after they eat carbohydrates. More research needed here.

Gout: A Harvard study of male health professionals looked at 46,000 men over age 40 with no history of gout. After controlling for risk factors for gout, they found that men who drank 4-5 cups of coffee daily had a 40% lower risk of gout, and those drinking 6 or more cups had a 59% lower risk. Decaf coffee showed a more modest lower risk. Tea drinking had no effect on gout, and factors other than caffeine were believed responsible for the benefit.

Coffee makes most users feel energetic, and for many people it is a great pleasure. However, the caffeine in coffee can be a big problem for people with irregular heart rhythms, insomniacs and children. These recent studies should help to clarify what to do with this amazing beverage. Consult your body and your medical history; use it wisely.
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health: News about Walnuts & Cranberries

2011-09-17T21:42:00.000-07:00

Walnuts – Breast and Prostate Cancer:
Dr Elaine Hardman, at Marshall University School of Medicine in West Virginia, has been investigating diet and cancer for years. She noted that walnuts contain multiple ingredients that slow cancer growth, including omega-3 fatty acids, antioxidants, and phytosterols (healthy compounds in plants that are similar to cholesterol, and reduce cholesterol in humans). Hardman worked with mice that are genetically likely to develop breast cancer at high rates. She studied mice given walnuts during pregnancy through weaning, and then the pups were fed a walnut supplemented diet. These mice developed breast cancer at less than half the rate of a group on a typical lab-mouse diet. Additionally, the number of tumors and their sizes were smaller. Gene analysis showed that those on the walnut diet had different expression of genes associated with the breast cancers in mice and humans. The amount of walnuts fed to the rats would correspond to about 2 oz. daily in humans. One cup of walnut halves is about 3 1/2 ounces. Hardman also found that increases in omega-3 fatty acids did not fully account for the anti-cancer effect, and that tumor growth decreased when dietary vitamin E increased. Dietary vitamin E is found in nuts, sunflower seeds, spinach and other leafy vegetables, and many natural foods.

Dr. Paul Davis at UC Davis has studied the benefits of walnuts in mice genetically programmed to develop prostate cancer. When he compared 8 week pups given added walnuts to control pups given added soy oil, those in the walnut group had cancers 30-40% smaller. They also had reductions in several proteins that may increase cancer growth, including insulinlike growth factor-1. Davis said the amount of walnuts humans should eat to correspond to the mouse diet was about 2.4 ounces daily.

Walnuts also contribute to heart health, by decreasing LDL cholesterol, lowering the risk of clotting, and decreasing inflammation. Numerous studies have shown that they do not cause weight gain, but rather make people less hungry for other high-fat, sugary foods.

Cranberries- Blood vessel flexibility and infection prevention:
Researchers at Boston and Tufts Universities recently reported that people with heart disease (coronary artery disease) showed a decrease in the stiffness of the aorta after drinking double-strength cranberry juice. Blood vessel dilation and blood flow to the arms also improved, but in an uncontrolled pilot study. Subjects drank 16 ounces of a cranberry drink that was 54% cranberry juice daily. Authors of the study point out that the flavonoids in plant foods have multiple benefits. Flavonoids are plant pigments that that have anti-inflammatory, anti-microbial and anti-cancer activities. In the case of cranberries, the heart benefits are added to known anti-bacterial benefits. A recent study that looked at daily cranberry pills compared to antibiotics to prevent bladder infections in women. Those taking the antibiotic (Bactrim) had the fewest bladder infections, although the cranberry pills were also effective. However, women taking the antibiotic developed resistance to Bactrim and other antibiotics. Cranberries are believed to be helpful by preventing bacteria from sticking to the walls of the bladder and urethra and multiplying.

Rather than taking cranberry pills, it is probably better to drink the whole juice on a daily basis, for heart health (if you have narrowed arteries), or to prevent frequent bladder infections. Note – people on Coumadin should not drink cranberry juice without talking to their doctor – it can increase the risk of bleeding. For all other interested people, I suggest looking for an unsweetened cranberry concentrate, which you can usually find in health food stores. Mix it with water, add a little apple juice for sweetener or put it in your shake. Some people love its sour taste. Fall is coming, and whole cranberries will be in the market soon!
Sadja Greenwood, MD MPH back issues on this blog

Go to Health: the link between fiber, overweight and cancer

2011-08-31T11:37:00.000-07:00

You may be confused, and skeptical, about the importance of a high fiber diet. The connection between dietary fiber and a reduced risk of colon cancer has been disputed because of conflicting studies and differing measurements of dietary fiber. However, according to the American Institute for Cancer Research (AICR – a non-profit that fosters research on diet and cancer), a diet high in whole grains, fruits, legumes and vegetables is valuable to reduce both overweight and several cancers. AICR looked at over 7,000 studies worldwide, finding evidence that whole grains in the diet do lower the risk of colorectal cancer. In a large prospective cohort study, subjects who ate the most whole grains had a 20% lower risk of colorectal cancer than those who ate the least.

As readers know – whole grains include minimally processed wheat, spelt (an ancient variety of wheat) oats, rye, corn, barley, millet, quinoa and amaranth. When buying these grains as bread, crackers or pasta, it is important to read the label, and make sure that your product does not contain a deceptive sprinkle of whole grain but is 100% what you are looking for - the whole grain.

Foods high in fiber are relatively low in energy density; they contribute to a feeling of fullness and reduce the risk of overweight. Here is another way that whole grains prevent disease. Overweight is related to an increased risk of several cancers, including colon, uterine, breast (in women post menopause), esophagus, pancreas, gall bladder, liver, and kidney.

A study from Tufts University showed that the distribution of body fat varied with whole and refined grain intake. Subjects with the highest intake of whole grains had the lowest amount of deep abdominal fat – known as visceral adipose tissue. Around our waists and in our buttocks and thighs, fat lies under our skins, which we can feel by pinching ourselves gently. This fat poses less of a problem in normal-weight people. However, visceral fat lies inside the abdominal cavity, packed in between the stomach, liver, intestines and kidneys. This visceral fat has been shown to be a risk factor for insulin resistance, type 2 diabetes, cardiovascular disease and a shorter life. Visceral fat is associated with chronic inflammation in the body, and higher insulin levels – both linked to an increased risk of cancer. It is also linked to higher total and LDL cholesterol, and lower HDL (good) cholesterol.

Obviously, fat in the diet is essential – for the absorption of vitamins A, D, E and K from foods, for essential fatty acids like omega-3s, for taste, satiety and maintenance of stored energy reserves. Healthy fat intake is good, but having excess amounts of visceral fat is dangerous.

Here’s advice from Harvard Medical School on how to reduce visceral fat.
*Regular moderate intensity physical exercise – 30 to 60 minutes a day. This would include brisk walking, biking, and gym workouts. Check with your MD or NP before beginning a program if you have not been active.
*Reduce portion size and emphasize whole grains and lean protein over white flour, rich desserts, sugary food and drinks, and alcohol.

It’s that simple – in theory at least – and such a program will work. Many people welcome the help of a program such as Weight Watchers or Overeaters Anonymous to get started and keep going.

Marion Nestle, a professor in the Department of Nutrition at New York University and the author of many books on food and food policy, has a daily blog which you may enjoy: www.foodpolitics.com. She has short, humorous and cogent posts on the latest in food science, how to eat, and how to improve our food system.
Sadja Greenwood, MD, MPH – back issues on this blog

Go to Health: Garlic

2011-08-13T19:30:00.000-07:00

Garlic has been used by humans for over 4000 years; it originated as a wild plant in Central Asia and spread all over the world. It has been found in the tombs of Egyptian pharaohs dating back to 3200 B.C.E. Garlic is a rich source of organosulfur compounds, which are thought to be responsible for its aroma and flavor as well as its potential health benefits. Garlic has been found to inhibit bacteria, viruses and some types of fungus in the laboratory, but this has not been reliably shown in humans. Nevertheless, garlic supplements are among the best selling in the US today; I will try to explain the evidence behind its popularity as an herbal medicine. Its use in enhancing the flavor of food must be experienced: “and there was a cut of some roast…which was borne on Pegasus-wings of garlic beyond mundane speculation” C.S. Forester.

Heart Disease: Many randomized controlled trials have looked at the effect of garlic and garlic supplements on people with elevated cholesterol, LDL cholesterol and triglycerides. Some trials showed an improvement in 3 months, but no lasting effects by 6 months. However, most studies have shown that garlic supplements significantly decrease platelet clumping, which is a first step in the formation of blood clots. Because of this effect, people on blood thinners should talk to their doctors before taking garlic supplements. There is no solid evidence so far that garlic supplements reduce blood pressure or prevent the progression of plaque in the arteries, leading to heart attack or stroke. However, some studies do show benefits in these areas, and research continues.

Cancer of the stomach and colon: Studies from China, other Asian countries and Europe show that people eating raw or cooked garlic have a lower rate of cancers of the stomach, colon and rectum. However, the amount of garlic eaten, either raw or cooked, and the variable amount of vegetables also eaten made it difficult to be precise about rates of reduction, which were 30 to 50%. Aged garlic extract in high doses was also found to decrease the number of precancerous polyps in the colon. These are important benefits.

Effects of cooking: the organosulfur compounds that give garlic its beneficial effects can be inactivated by heat. The protective effects of garlic can be partially conserved by crushing or chopping garlic and letting it stand for 10 minutes before cooking. Powdered or dehydrated garlic is made from garlic cloves dried at low temperatures to prevent inactivation; the dried garlic is pulverized and made into tablets. The beneficial compounds vary greatly among commercial products – enteric coated tablets that pass the USP ‘allicin release test’ are likely to be the best. Garlic supplements are also made from fluid extracts, garlic oil and aged garlic extracts. In my opinion, the most beneficial way to use garlic for health and pleasure is to eat it raw in salad and cooked in many dishes. Follow the 10 minute rule for cooking – crush or chop garlic and let it stand for 10 minutes before cooking, to preserve its benefits.

Adverse Effects: Some people report gastrointestinal symptoms after eating garlic, some have allergic responses such as asthma, and some have skin rashes. Occasional cases of serious bleeding have been reported. However, these reactions are rare. For most of us, garlic is a strong, or subtle, delight.
There are many miracles in the world to be celebrated and, for me, garlic is the most deserving. Leo Buscaglia (the love doctor)
Sadja Greenwood, MD, MPH

Saving Health Care by taxing junk food?

2011-07-29T21:45:00.000-07:00

IHOP Bacon ‘N Beef Cheeseburger has 1,250 calories, plus 620 for onion rings. The Cheesecake Factory Farmhouse Cheeseburger has 1,530 calories, 1900 with fries. A PB&C milkshake at Cold Stone has 2010 calories; it contains peanut butter, chocolate ice cream and milk, with 68 grams of saturated fat and 153 grams of sugar. Since the new health-care law mandates calorie count information on menus, starting in 2011, will this make a difference? Most fast-food chains now offer lower calorie choices – whether this is helping people make wiser choices is not yet clear.

As readers know, the ‘standard American diet’ (SAD) of fast food laden with sugar, fat and salt, is causing an epidemic of obesity, with resultant high rates of diabetes and its many complications. Mark Bittman, a well known food writer and New York Times columnist, analyzes the impact of taxing junk food on our health and health care costs in the July 24th edition of the NYTimes. His premise is that the food industry is interested in profits, not the public health, and that the federal government should establish a bold, national fix. Much of this column is based on Bittman’s ideas. I should add that I agree with him.

The Rudd Center for Food Policy and Obesity at Yale says that taxes become a significant force in changing buying habits for soda at about a penny an ounce. The average American consumes 44.7 gallons of sweetened sodas a year, and another 17 gallons of non-carbonated sweetened drinks. With a 20% tax in the price of sugary drinks, there would be an estimated 20% decrease in consumption, resulting in the prevention of obesity of 1,500,000 Americans (over 10 years) and 400,000 fewer cases of diabetes, saving about $30 billion dollars in health care costs. The money gained in taxes could be used to subsidize the purchase of staple foods like vegetables, whole grains, dried legumes and fruit. This is an essential part of the plan: making healthy foods available and affordable, bringing grocery stores into ‘food deserts’, teaching children and adults how to shop and cook, and supporting farmers markets and community gardens.

Soda taxes have been proposed in Philadelphia, San Francisco, and New York. France and Hungary are also proposing a tax on junk food, while Brazil is subsidizing produce for the poor in its ‘Zero Hunger ‘ program. The idea is gaining ground.

Currently, instead of taxing junk food, we are paying – with tax dollars - to support corn farmers whose corn is made into high-fructose corn syrup – used to sweeten soda! So far, efforts to change what Americans eat through education and persuasion have failed, partly due to the 4 billion spent annually on advertising by the fast-food industry. Bittman says that 86% of food ads seen by children are for foods high in sugar, fat and sodium. The percentage of obese children has tripled in the last 30 years, and of obese adults has more than doubled.

Efforts to tax certain foods will be opposed by those decrying the ’nanny -state’. However, we are faced with a health crisis with serious budgetary implications. Public health regulations have been very successful in other areas.
We now tax cigarettes over $2 per pack – a combination of state and federal excise taxes – and the US smoking rate has fallen from 40% to 20%. Although over 400,000 people still die each year from tobacco, the toll was twice as high before taxation. We have government mandates for seat belts and children’s safety car seats in most states, which are estimated to save over 15,000 lives each year. Government regulation of drinking water and food safety, driving speeds, and building codes have saved countless lives and reduced health care costs.

Here in West Marin we are tremendously lucky to have organic farmers, farmers’ markets and healthy produce. We also have great tasting water. We should all thank our farmers, eat more produce and drink fewer calories, whether it’s soda, sweetened bottled tea, or beer. OK, beer drinkers, I said less, not none! And – support a tax on sweetened soda if it comes around, as it will reduce your health care costs.
Sadja Greenwood, MD, MPH back issues on this blog

Turmeric - an ancient spice with exciting modern research

2011-07-02T09:26:00.000-07:00

Turmeric has been gathered and cultivated in India for over 2500 years, used as an orange dye, a medicinal plant and a spice in curry. Today there is renewed interest in turmeric and its main ingredient curcumin for their potential activity against cancer, Alzheimer’s disease, arthritis and many other health problems.

At the University of Texas MD Anderson Cancer Center, Dr. Bharat Aggarwal is studying curcumin. Aggarwal, a biochemist and molecular biologist, considers turmeric to offer great promise for health. He says that the combined rate of the four most common cancers in the United States—lung, prostate, breast, and colon—is much lower in India, where turmeric (in curry) is a staple in the diet. Aggarwal is studying the ability of curcumin to shut down nuclear factor kappa B (NF-kB), which is involved in the regulation of inflammation and many other processes. By blocking the activity of this ‘master switch’, curcumin appears to interfere with the cancer process at an early point, impeding multiple routes of growth: reducing the inflammatory response, inhibiting the proliferation of tumor cells, inducing their self-destruction, and discouraging the growth of blood vessels feeding tumors. These effects can shrink tumors and inhibit metastasis. Also, shutting down NF-kB can enable chemotherapy drugs to destroy cancer cells more effectively. Research on curcumin and various cancer types is still preliminary, and laboratory based; there have been few human trials. It would be unwise to stop cancer chemotherapy to take curcumin, however some oncologists are interested in curcumin as a supplement. People under treatment for cancer should confer with their oncologist, as curcumin may alter the efficacy of chemotherapy drugs. A detailed discussion of curcumin used in cancer can be found at Dr. Aggarwal’s website www.curcuminresearch.org.

Alzheimer’s Disease: Based on the finding that there is 4 times less Alzheimer’s disease in India than in the US (turmeric is used as a daily spice in Indian curries), researchers at UCLA are studying the ability of synthetic curcumin and Vitamin D to clear the amyloid plaques found in the brains of people with Alzheimer’s. Laboratory experiments have shown that blood cells called macrophages are able to destroy amyloid plaque when incubated with Vitamin D and a form of synthetic curcumin. Studies using Vitamin D and curcumin in human patients are underway at UCLA, USC and various universities in India. At present, there is no recommended dose of curcumin for treatment or prevention.

Since curcumin is anti-inflammatory, it is being tried in the treatment of rheumatoid arthritis, with trials at UCLA. Osteoarthritis may also be helped, according to a trial at Western Ontario and McMaster Universities, where researchers used a mixture of curcumin and soy phospholipids, called Meriva. At the University of Arizona, there is a study on curcumin’s ability to prevent bone loss in mid-life women.

Inflammatory Bowel Disease: Both Crohn’s Disease and ulcerative colitis can result in abdominal pain, diarrhea, weight loss and fatigue, and often strike children or young adults. At the U. of Arizona there are studies showing that daily curcumin pills were able to decrease intestinal damage and cut the number of relapses by 50%. The researchers stressed that curcumin should not replace standard therapies.

Cautions: Curcumin is safe, but should not be used in pregnancy or in people with gall bladder disease because it stimulates bile secretion and gallbladder contractions. Most people, however, can try curcumin supplements, which are better absorbed if combined with pepperine (black pepper). If you look at the recent book by Dr. Aggarwal, Healing Spices, you will find more information on turmeric as well as ways to make your own curries.
Sadja Greenwood MD, MPH –back issues on this blog

HarvestPlus and the world food crisis

2011-06-05T21:06:00.000-07:00

Rising temperatures, droughts and floods are causing agronomists and country leaders great concern. Food staples, such as wheat, corn, rice, and soybeans may not be reliably harvested in the amounts needed for a growing world population. Climate change is considered a significant reason for the problems with crops.

Micronutrients: Beyond rising prices for staple grains, poor people in developing countries are affected by a lack of essential micronutrients in the diet. The World Health Organization has identified iron, zinc and vitamin A as the most limiting elements. Lack of these in a diet of rice or cassava can lead to blindness, stunting and susceptibility to infectious disease. More than 2 billion people in developing countries may have ’hidden hunger’ for essential micronutrients, as they subsist on staple foods (maize, wheat and rice) but have little access to fruits, vegetables, and protein foods. Lack of vitamin A causes about half a million children to go blind every year. Zinc deficiency impairs brain and motor functions; shortage of iron causes anemia and weakness, and affects half the women of childbearing age in some poor countries. A supplement program to provide these nutrients is not affordable or feasible. Policymakers are now asking whether farming could do more to improve nutrition.

HarvestPlus, funded by the Bill and Melinda Gates Foundation and other donors, is working to reduce hidden hunger and provide micronutrients to people directly through the familiar, staple foods they eat. At this point they are using mainly conventional breeding techniques, rather than genetic engineering, to select plants high in iron, zinc and the carotenes that become vitamin A in the body. Their work on developing ’biofortified’ crops is done in collaboration with more than 200 agricultural and nutrition scientists around the world. Biofortification programs are active in China, India, Bangladesh, Latin America and Africa. They are working on cowpeas (a drought tolerant, warm-weather legume, well adapted to drier regions of the tropics), other beans, rice, corn, pearl millet, wheat, sweet potatoes, and cassava. Once biofortified crops are developed, they can be distributed and grown by farmers, year after year, by seed saving.

The traditional sweet potatoes used in Africa and Latin America are light in color and lacking in the needed carotenes that will become vitamin A in the body. Biofortified sweet potatoes, orange in color, have been bred and used in Uganda and Mozambique. Getting people to accept a different looking food item takes planning and education, and is becoming successful. Pearl millet high in zinc and iron will be introduced in India in 2012. Wheat high in zinc will be introduced in India and Pakistan in 2013. Beans high in iron will be tried in Ruanda, cassava high in provitamin A in Nigeria and maize high in provitamin A in Zambia.

World Population: There were 3 billion of us in 1960, and close to 7 billion at present. Food production rose during those years, so that people in developed countries had plenty to eat. In poor countries there could have been adequate calories if distribution had been improved. In many cases, however, crops for export to rich countries used land at the expense of food for the local poor.

In recent years the impact of climate change has raised fears of increasing food scarcity. Crops that can grow despite rising temperatures, drought, and flooding are needed. Arable land is potentially in short supply due to development. We are facing difficult times on this earth, and many are wondering what to do about the challenges. Here are some suggestions:

*Get involved in food politics in the US. See Marion Nestle’s blog, Food Politics, and Healthy Food Action, which will work to improve the 2012 farm bill.

*Support your local food bank.

*Support family planning nationally and internationally, by contributing to Planned Parenthood, the International Planned Parenthood Federation, or other family planning organizations

*Support HarvestPlus. The Gates Foundation can’t do it all!

Sadja Greenwood, MD, MPH back issues on this blog

Beets and Green Vegetables Relax Your Arteries

2011-05-30T21:07:00.000-07:00

A recent conference on Nutrition and Health, sponsored by the University of Arizona, contained many useful ideas for everyday life. The problems with sugar, in last week’s column, were on the menu. Here is another topic.

Beets and Greens: These foods contain nitrates, which used to be considered harmful because of serious health problems when infants drank contaminated well water. However, it was found that the main problem was fecal bacteria in the wells, rather than excess nitrates. In the 1970’s, researchers found that dietary nitrates (NO3) are converted into nitric oxide (NO), in the presence of L-arginine (an amino acid) and oxygen. NO is an important ‘signaling molecule’ in the body, diffusing rapidly – as it is a gas – across cell membranes. It causes relaxation of the smooth muscles that line blood vessels, resulting in lower blood pressure and increased blood flow. Nitroglycerine works to lessen the pain of angina (chest pain resulting from lack of oxygen for the heart muscle) by its conversion to NO. Viagra works to simulate penile erection by the release of NO. The production of NO is elevated in people living in high altitudes, which helps them get more oxygen by dilation of the blood vessels in their lungs. NO transmits messages between nerve cells and is associated with memory, learning, sleeping, feeling pain, and depression.

Researchers at Wake Forest University studied volunteers over age 70 given a diet containing beet juice and high nitrate vegetables. The subjects were found to have increased blood flow to their brains, potentially helping to avoid dementia. Studies on beet juice, at the University of Exeter, found it enables people to exercise up to 16% longer. The amount of nitrate in studies on athletes was the equivalent of what is found in 2-3 red beets or a plate of spinach. Other vegetables high in nitrates are kale, lettuce, parsley, cabbage, celery, radishes and turnips.

People with high blood pressure may be interested to know that the DASH Diet (Dietary Approach to Stop Hypertension) may owe at least some of its effectiveness to an emphasis on green leafy vegetables. For those who want quick results without cooking, beet juice is available on line. Mix it with soda water or plain water, and start with a little at a time. A few people don’t feel well after drinking beet juice.

The Dash Diet This diet, which has been shown to be effective in lowering blood pressure, can work surprisingly well within two weeks. DASH is described on line at the WebMD site and also in the book – The DASH Diet Action Plan – based on the National Institutes of Health Research. This book has great reviews, and should be read by anyone who is serious about reducing blood pressure and possibly getting off of blood pressure medications. Of course, it is important to talk to your doctor about changing your medicines. For those who want to start the eating plan right away, here it is. Eat more vegetables, fruits and low or non-fat dairy foods. Eat less red meat, processed meat, sweets and foods high in fat. Eat more whole grains, fish, and poultry. Read labels carefully, and avoid foods high in salt. For snacks, try unsalted popcorn (avoid the buckets in movies!), unsalted nuts of all kinds, raisins, and low or non-fat yogurt. Don’t forget that the nitric oxide (NO) in green vegetables and beets will rapidly go to work for you, by relaxing your arteries, increasing blood flow, and lowering your blood pressure. And, of course, there’s moving the body, which is also good for you, your arteries and your blood pressure. See you on the trails!
Sadja Greenwood, MD, MPH

Go to Health: “Fructose is alcohol without the buzz”

2011-05-17T19:31:00.000-07:00

So says Dr. Robert Lustig, Professor of Pediatric Endocrinology and director of the children’s obesity program at UCSF. His talk – Sugar: The Bitter Truth – has been watched over a million times on Youtube; I will try to summarize his points in this column.

The obesity epidemic in the US has been growing steadily since the public was told in the 1980s to decrease fats in their diet. The introduction of low-fat processed foods, laden with sugars for palatability, and devoid of fiber, laid the groundwork for our weight gain. Roughly half of teenage boys drink more than two six-packs of soft drinks every week. Today, one in 50 adults is severely obese (with a BMI of 40 or higher) and 34% of us are obese (BMI 30 or higher). The share of obese children has tripled in that time, to 17%. This is more than double the percentages of 30 years ago. Someone whose height is 5’6” is obese at 186 pounds; a 6’ person is obese at 221 pounds.

Understanding sucrose, glucose, fructose and starch: Sucrose is derived from sugar cane and sugar beets. It is 50% glucose and 50% fructose. High fructose corn syrup is 55% fructose and 45% glucose. From the point of view of the liver, they are about the same – neither is good for us. The fructose in whole fruit is fine, because it is encased in fiber, which slows its absorption. Whole fruits also have many beneficial compounds for health. Starch is a complex carbohydrate, made up of joined glucose molecules, used by many plants for energy storage. Our digestion easily breaks down most starch to glucose.

Glucose digestion: When we eat plants, from cabbage to potatoes, we break down their starch to glucose; this travels in the bloodstream to all our body cells for energy use. About a quarter of the glucose goes to the liver, where it makes glycogen – a useful and necessary storage compound for energy. A small amount is translated into fat.

Fructose digestion: When we eat or drink sugar (sucrose) or high fructose corn syrup (HFCS), the 50% or 55% that is fructose goes to the liver, as only the liver can metabolize it. This is in contrast to glucose, used by all our body’s cells. Some fructose is broken down into uric acid and excreted by the kidneys. Uric acid increases the risk of gout, and also elevates blood pressure. Much of it is metabolized to fat, leading to a problem called non-alcoholic fatty liver – rarely if ever seen before the recent sugar craze. Some of it goes into the blood stream as triglycerides, which become fat. As triglycerides rise, and body fat increases, cells become resistant to insulin. Insulin, produced by the pancreas, causes cells in the liver, muscle and fat to take up glucose from the blood, for energy production and storage. When blood glucose rises, due to the cells’ insulin resistance, diabetes results. A diet high in fructose also is associated with ‘leptin resistance’ – the body does not respond to the hormone called leptin that cuts off appetite. The eater keeps on eating.

Alcohol digestion: Alcohol is fermented sugar. When it enters the liver, it is digested in a way that is similar to fructose, resulting in high blood pressure, fat deposition in the liver (ultimately cirrhosis) and increased triglycerides in the bloodstream. Alcohol also leads to obesity (beer belly), insulin resistance and possible addiction. A small amount of alcohol, especially as red wine, is heart-healthy (1 five ounce glass for women, 2 for men). However, even small amounts of alcohol raise women’s risk for breast cancer.

What to do!
Here is the formula that Dr. Lustig gives to the families with children in his obesity clinic: He says it works – they lose weight – if they can follow it and stay off of soda.
1.Only drink water or plain milk
2.Eat carbohydrates with their natural fiber.
3.Wait 20 minutes before seconds.
4.Buy screen time minute for minute with physical activity. Screen time includes TV, DVDs, computer games, et al.
Look at 2 in this table. This would mean avoiding all foods made with sugar – cakes, cookies, pies, candy, ice cream, jam, syrup, the works. These foods were occasional treats one hundred years ago, and now they are everywhere, and often cheaper than real food. It also means eating whole grain pasta, 100% whole grain bread, and brown rice. Even Dr Lustig admits to an occasional dessert, and lets his kids eat ice cream on Sunday (according to another Youtube video). However, he still labels sugar a ‘toxin’ and would like FDA regulation. Others are calling for a tax on high-sugar soft drinks, which would decrease use and help pay for health care reform. Stay tuned for a discussion of this proposal. In the meantime – opt for water, unsweetened coffee and tea, and an orange for dessert!
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health – Cinnamon

2011-05-08T19:20:00.000-07:00

This common and amazing spice was first grown in Ceylon (Sri Lanka) and was imported to Egypt, the Mediterranean world and Europe as early as 2000 BCE. Spices like cinnamon, that we take for granted, were great luxuries in times past; they were used for flavoring, to prevent food spoilage, and for treating many ailments. Cinnamon was found to inhibit bacterial growth in stored food, which was very useful before the days of refrigeration.

Blood Sugar lowering: Currently, the interest in cinnamon centers on its role in lowering blood sugar. A study in normal subjects from the University of Lund in Sweden showed that adding cinnamon to a meal significantly lowered blood sugar an hour later, and also delayed stomach emptying. A study from the Beltsville Human Nutrition Research Center (US Department of Agriculture) on men and women with type 2 diabetes showed that cinnamon (given as 1, 3, or 6 grams daily in capsules) significantly reduced fasting blood sugar, LDL cholesterol, total cholesterol, and triglycerides. This is important, as people with type 2 diabetes have an increased risk of heart disease and stroke. The results from 1 gram of cinnamon were effective, and this amounts to about 1/5th teaspoon per day. Cinnamon had a sustained effect on levels of blood sugars and fats, even if not consumed every day. The authors of this study note that a number of other herbs have been reported to yield blood-sugar lowering effects in patients with diabetes: bitter melon, Gymnema (see below), Korean ginseng, onions, garlic, and flaxseed meal. The authors write that cinnamon may work by increasing glucose uptake by cells and activating the synthesis of glycogen ( a normal storage compound for glucose). Also, cinnamon is believed to stimulate cell receptors for insulin.

Gymnema sylvestris is an herb from India where it has been used to treat diabetes since before modern medicine. It curbs sugar cravings, and may also stimulate insulin secretion. It is available in the U.S. (online and in some natural food stores) as a supplement. Not enough is known about its side effects and dosage levels, so people who use it should work with their health-care practitioner. It should not be used in pregnancy or at the time of any surgery.

Polycystic Ovary Syndrome is a disorder associated with infertility in women, who also have multiple cysts on their ovaries, elevated glucose, weight problems, excess body hair and menstrual irregularities. A study was published in 2007 from Columbia University showing that oral cinnamon (1 gram daily) improved their glucose levels. More studies are underway using cinnamon for this condition.

Brain chemistry: A professor of psychology at Ohio Northern University found that students scored higher on attention, memory and visual-motor response speed when smelling cinnamon or chewing cinnamon-flavored gum.

How much is enough? There is concern that a substance called coumarin in cinnamon may be toxic to the liver in certain sensitive individuals. Liver damage is reversible if cinnamon is stopped. Since the genetics of this potential problem is not worked out, it is prudent to use cinnamon as a spice rather than in large doses. People with diabetes should talk to their doctors or nurse practitioners about using 1/5th teaspoon a day on oatmeal, baked apples or other foods, in case their need for medications decrease. Other people can continue to use cinnamon sensibly on favorite dishes and enjoy the wonderful flavor of this spice.

I have enjoyed reading Healing Spices by Bharat B. Aggarwal as a takeoff for this column on cinnamon. Aggarwal is a molecular biologist and cancer researcher at the M.D. Anderson Cancer Center of the University of Texas in Houston. Look for a wonderful collection of spices at the Bolinas People’s Store, or at most natural food stores. Leave me a comment, or a question!
Sadja Greenwood, MD, MPH back issues on this blog.

Phthalates – what are they & how to avoid them

2011-05-02T07:58:00.000-07:00

Phthalates are a class of chemicals added to plastics to increase their flexibility and durability. About a billion pounds per year are produced worldwide. They are found in the enteric coating of pills and supplements, in adhesives and glues, personal care products, medical devices, detergents, paints, printing inks, shower curtains, vinyl upholstery, car interiors and many other plastic products. They easily diffuse into the environment as plastics age. We all have phthalates in our bodies – from our diet, skin exposure (from personal care products) general environmental contamination and inhalation. Cheese, butter and meats are a source of phthalates in food, in part from plastic packaging.

Shana Swan at the University of Rochester School of Medicine has studied the exposure of pregnant women to phthalates. She has written that most findings concern male children, where she found a correlation between a shortened distance between the anus and penis, and a smaller penis size with higher concentration of phthalates in the mother’s urine during pregnancy. These measurements may indicate an anti-androgen effect of phthalates, which was also found in some experimental animals. Swan writes that sensitive biomarkers to assay human phthalate exposure have been available for a short time (10-11years), so that the long term effects may not yet be known. The necessary epidemiological studies are expensive and slow, so that animal studies and small human studies will be necessary. Results from these are controversial. Some recent studies have found correlations between low sperm counts and phthalate levels in men. . Studies on early puberty in girls have not reliably shown a correlation with phthalates at this point.

Studies on phthalate levels in pregnant women and their babies/children have been done in several universities. Women exposed to phthalates and pesticides in the workplace are more likely to take six or more months to conceive and to have lower birth-weight babies, according to a recent study at Erasmus Medical College in Rotterdam. Researchers at Mt Sinai (NYC), Cornell and the US Centers for Disease Control found that higher prenatal exposure to phthalates was connected to disruptive and problem behaviors in children ages 4-9. Behaviors included aggressiveness, and ADHD.

What you can do
Lowering exposure to phthalates is prudent, and especially important if you are pregnant or care for children. Body-care products containing phthalates are a source of exposure for infants. Read the ingredients whenever you buy a product: avoid personal care products (hair products, nail polish, deodorants, perfumes, lotions, etc) with DBP, DEP, BzBP. Be aware that the term ‘fragrance’ can mean that phthalates are present. This may mean a serious change in your use of body-care products and cosmetics. You can find safer cosmetics of all kinds at the website of the Environmental Working Group: www.ewg.org/skindeep/.

DEHP is used in PVC plastics. DMP is in insect repellents. Choose plastics with the recycling code 1,2 or 5. Codes 3, 6 and 7 may contain bisphenol A or phthalates. Parents should not buy soft plastic PVC toys for children. California has a law – signed by Governor Schwarzenegger – that bans products containing more than 0.1% phthalates from toys as well as baby bottles and other items that children can put in their mouths.

Something positive!
After reading about the widespread nature of phthalates in our environment, as well as bisphenol A, you are probably ready for some better news. Dr. B.B. Aggarwal, a cancer researcher at the University of Texas MD Anderson Cancer Center, has written a new book called Healing Spices in which he brings together ancient traditional medicine and modern medical research to show how herbs and spices can promote healing and health. I will report on his findings in subsequent columns. In the meantime, know that he has a chapter on cocoa and chocolate, and is also a strong proponent of turmeric. See his website – Curcumin – The Indian Solid Gold, and prepare to be surprised at the science on the actions of curcumin against cancer and other diseases. Curcumin is the active agent in turmeric. Make some curry for dinner!
Sadja Greenwood, MD, MPH – back issues on this blog

Go to Health: More on Brassica Vegetables aka Cruciferous

2011-04-22T17:01:00.000-07:00

This genus of plants contains more plants for human consumption than any other. You can think of them as roots: radishes, rutabaga, turnips, daikon, as stems: kohlrabi, as leaves: cabbage, kale, collards, bok choy, Brussels sprouts, arugula, cress, as flowers: cauliflower, broccoli, and as seeds: mustard seed and oil producing rapeseed (canola). Wasabi is also a brassica.

There are numerous beneficial compounds in these plants. Besides vitamins, carotenes and fiber, they contain nutrients with anti-cancer properties – the most promising one being sulforaphane.

Plants in the genus brassica produce sulforaphane (SGS) to defend against insect predators. Researchers at Johns Hopkins found that SGS is especially high in broccoli sprouts. SGS is an ‘indirect antioxidant’ that eliminates many types of free radicals before they can harm cells, and cycles over and over again, triggering a long lasting process. It stimulates other natural antioxidants, such as glutathione, the body’s most abundant antioxidant. Studies from the University of Michigan found that SGS, from broccoli, inhibits breast cancer stem cells in mice and cell cultures, and prevents new tumors from growing. Studies are also ongoing on protection against ovarian and prostate cancer. There is preliminary work on the ability of SGS to protect against skin cancer, ulcer-producing bacteria in the stomach (helicobacter pylori) and inflammation of blood vessels in the heart.
The researchers at Johns Hopkins have established a company that sells regular or decaf green or black tea with SGS – it is available from the Baltimore Coffee and Tea Company at 800-823-1408. You can also make home-grown broccoli sprouts – organic broccoli seed for sprouting is available by calling 800-695-2241. If you want some help in making broccoli sprouts at home, watch “how to grow broccoli sprouts with your homemade sprouter” on You Tube. The best way to prepare regular broccoli to maximize SGS is to steam it lightly for 3-4 minutes- until it is tough-tender.

There is a downside to brassica vegetables – eaten in high amounts they can interfere with the formation of thyroid hormone, and induce goiter formation. So – include them in your diet, especially if you are a cancer survivor, but eat a lot of other vegetables and fruits as well.

Dietary spices – These include onions, garlic, ginger, cloves, cinnamon, cardamom, mint, all Indian curry ingredients, all Italian herbs etc. These and other spices/herbs have been studied at MD Anderson Cancer Center at the University of Texas for their many roles in preventing cancer. There is interesting science here. Include them in your diet every day. I will be writing more details about these ‘nutraceuticals’.

Sadja Greenwood, MD, MPH see back issues on this blog

Bisphenol A (BPA): What you should know

2011-04-01T15:19:00.000-07:00

BPA is one of the most commonly manufactured chemicals in the world. It is a component of polycarbonate plastic and is found in a wide range of common materials and food packaging. It has been known for many years that BPA has estrogenic properties; its effects on the reproductive systems of animals -fish, amphibians and mammals - have raised concern for humans. The chemical has been called an endocrine disrupter, which can mimic the body’s own hormones and lead to negative health effects. Animal studies (those unfortunate mice and rats) have suggested effects of BPA on the brain, breast, prostate, thyroid, obesity, sexual behavior et al. Some studies suggest an increased risk for breast and prostate cancer. Newborns and children may be specially affected by environmental BPA levels, due to their reduced capacity to eliminate the substance and their higher daily exposure, adjusted for weight. A study from Rockefeller University on primates in 2008 showed that even at relatively low exposure levels, BPA abolishes the ability of spinal synapses to respond to estrogen, which may play a critical role in cognition and mood. An English study published in the JAMA (University of Exeter - 2008) showed that higher levels of BPA in the urine of US adults correlated with cardiovascular disease, diabetes and abnormal liver enzyme levels. A study carried out by the Division of Research at Kaiser in Oakland showed that male workers in China with high occupational exposure to BPA had a significantly higher risk of lowered sexual desire, erectile dysfunction and difficulty ejaculating. This study is obviously important to men, and a motivator for youth to avoid exposure as much as possible. I have cited only a few examples of research on BPA that suggest negative health effects on humans and animals. While studies abound, our response in the US has been painfully slow.

Canada announced its intent to ban the import and sale of polycarbonate baby bottles containing BPA in 2008. Walmart announced soon thereafter that it would stop selling food containers, water and baby bottles, sippy cups and pacifiers containing BPA at its Canadian stores. In 2010, Canada declared BPA to be a toxic substance and is proceeding to decrease its use overall. European countries have been slower to act. But the European Union executive commission plans to stop the manufacturing of polycarbonate baby bottles containing BPA by June, 2011. Minnesota, Chicago, Connecticut, Massachusetts and Maine have taken steps to ban products containing BPA from baby food containers and other products. However, in 2009, California’s EPA unanimously voted against placing BPA on the state’s list of chemicals that are believed to cause reproductive harm.

What you can do
1) Shop wisely: BPA is found in the internal coating of food and beverage metal cans to protect the food from the metal. Choose fresh or frozen foods over canned whenever possible. Eden Organic has eliminated the use of BPA in their canned and packaged food, and Muir Glen organic tomato products will be BPA free this year. These products are available at natural food markets.
2) In your kitchen: If you feed your baby from a bottle, use glass, and avoid plastic pacifiers and cups. Don’t microwave food in plastic containers, and store leftovers in glass or ceramic containers. Carry extra water in a stainless steel or glass bottle. Nalgene is now selling plastic water bottles made of copolyester , with non-BPA materials. Hikers will want to have a light-weight water bottle, but more research may be needed on the long term safety of these new materials.
3) Go to the website of healthyfoodaction.org and sign their petition asking President Obama to eliminate the use of potentially cancer-causing chemicals in our environment, including BPA
4) Ask our assemblymember, Jared Huffman, to work on banning BPA containing products in California. Mention the 2009 California EPA vote when you call or write. Huffman is an environmentalist – 479-4920. Contact Governor Jerry Brown while you are at it: 916-445-2841. Go citizens!
Sadja Greenwood MD, MPH back issues on this blog

Go to Health: The 2012 Farm Bill: What you can do

2011-03-17T10:39:00.000-07:00

Every five years, Congress writes a Farm Bill that establishes our nation’s food and agricultural policies. The 2012 Farm Bill will cost approximately 300 billion. It’s largest slice, the Nutrition Title, governs foods bought by those on food stamp assistance. Currently, farm policy has driven down the price of commodities such as corn and soybeans, resulting in lower prices for high fructose corn syrup and soybean oils. Our consumption of unhealthy foods made with these substances has increased. At the same time we have grown and eaten fewer vegetables and fruits; their production has not been subsidized, and their prices have increased over the years.

Many organizations interested in local food production, water and soil quality, and the health of our population are working on changing the way we support farmers. A prestigious group of nutrition experts, including Walter Willett of the Harvard School of Public Health, Marion Nestle at New York University and Andrew Weil, have written a charter for a healthy farm bill, which concerned citizens are urged to sign. The charter calls for a new food system that is:
*healthy – accounting for health impacts on farmers, workers in food industries, and eaters
*sustainable – protecting natural resources and biodiversity
*resilient – overcoming challenges of climate change, pest resistance, and problems with expensive water and energy
*fair – providing fair access to affordable and healthy food, and fair conditions for farmers, workers, and eaters
*economically balanced – providing economic opportunity across the nation’s states, for a diverse range of farmers and workers , from local to global in scale
*transparent – farmers, workers and eaters should be able to participate in decision making on food production distribution, marketing, and disposal.

You can sign the Charter for a Healthy Farm Bill by going to the website of www.healthyfoodaction.org. There will undoubtedly be more discussion and controversy than ever before as the new farm bill is debated and written. Energized and informed people (you are probably one of these!) confront a system that has given rise to overproduction of foods for animal feed and underproduction of healthy vegetables and fruits, and a national health crisis. This column will continue to discuss the new Farm Bill in coming months.

While you are at the website for healthyfoodaction.org, you can also sign a petition asking President Obama to set the course for a new cancer prevention strategy, by eliminating the use of potentially cancer-causing chemicals in our food and environment, such as Bisphenol-A (BPA) and Dioxin.

BPA is a compound used to make polycarbonate plastics and epoxy resins.. BPA is known as an ‘endocrine disrupter’ because of its estrogenic properties and possible effects on fetuses and young children. It has been found in the internal coating of food and beverage metal cans to protect the food from direct contact with metal. It is also found in polycarbonate bottles. Eden Foods has eliminated the use of BPA in their canned and packaged foods, and Muir Glen organic tomato products will be BPA free this year. You can find foods from Eden and Muir Glen at many natural food stores.

Dioxins are chemicals that enter the atmosphere as by-products of the bleaching of paper pulp, chemical and pesticide manufacture, and burning of trash. The defoliant Agent Orange, used by the US in the Vietnam war, contained dioxin. Stay tuned for a more complete discussion of BPA, Dioxin and other chemicals in my forthcoming columns. You will be pleased to know that Bolinas citizen Sharyle Patton, working at the Biomonitoring Resource Center and the Collaborative on Health and the Environment at Commonweal, is a world expert on the chemicals in our environment and their effects on our bodies. Her research is having an important impact on policy in many countries.
Sadja Greenwood, MD back issues on this blog

Go to Health: Strategies that work for weight loss

2011-02-21T14:32:00.000-08:00

Researchers at Brown Medical School and the University of Colorado have established the National Weight Control Registry to follow people who have successfully lost 30 pounds or more and have kept it off for long periods of time. These people’s approaches are diverse and inspiring. Given the obesity epidemic among adults and children in the US, with an associated rise in diabetes and health care costs, the subject is important for all of us. Here are some salient findings from people who joined the registry:
*Weight losses range from 30 to 300 pounds.
*Duration of successful loss: 1-66 yrs.
*Some lost weight rapidly, others very slowly – over as many as 14 years.
*55% lost weight with the help of a program or support group.
*98% modified their food intake
*94% increased physical activity, most frequently by walking.
*78% eat breakfast every day
*75% weigh themselves at least once a week
*62% watch less than 10 hours of TV per week
*90% exercise about 1 hour a day

Mayo Clinic on Weight Loss: Here are some ideas from the Mayo Clinic Diet Book, which is sensible and pays attention to motivation as well as food and exercise. Permanent weight loss takes time and effort, and is a lifelong commitment. Address the other stresses in your life, so that you can focus on changing your habits. Find your inner motivation – looking better, or getting healthier. Pick people to support you in positive ways. Set realistic goals, such as losing 1-2 pounds a week, or walking at least 30 minutes a day. Enjoy healthier food – fruits, vegetables, whole grains, olive oil, nut butters, low-fat dairy products. Cut back on sugars, and limit meat consumption. Stay physically active. Work out a way to gradually change the habits and attitudes that have sabotaged your past efforts.

Childhood Obesity: 20% of children are now overweight or obese, mainly due to lack of physical activity and unhealthy eating patterns. Michelle Obama has put forth an action plan – “Let’s Move” to solve the problem of childhood obesity within a generation. Her plan includes getting parents more informed about nutrition and exercise, improving the quality of food in schools, making healthy foods more accessible in poor neighborhoods, and focusing on physical education. The American Academy of Pediatrics recommends that children under 2 not watch any TV, and those older than 2 watch no more than 1-2 hours a day of quality programming. Children who consistently watch more TV and computer screens – including computer games - are more likely to be overweight. Here are some other tips for parents to keep their children healthy and slim: don’t drink soda, and don’t have it at home. Keep kid-friendly snacks in the house: fruit, nuts, low fat yogurt, nut butters, whole grain bread and pre-cut vegetables. Avoid storing cakes, chips, full-fat cheese, white crackers and most lunch-meats. Make healthier versions of favorite recipes, like cookies and pizza. Be active together – get everyone out for a bike ride or hike. Don’t make it about losing weight; make it about being healthy. Be a good example!

Sleep: getting too little sleep adds to weight gain in children and adults. The relationship in children is strongest, and may be related to disrupted levels of the hormones – gherlin and leptin – that regulate hunger. Sleep deficits also elevate levels of cortisol from the adrenal glands, raising blood sugar levels. Catching up on lost sleep on weekends is not as effective as maintaining a consistent pattern of sleep. If you are working on weight control, regular and adequate sleep will help you.

Some Extra Exercise Ideas: Get a pedometer in order to measure your steps every day, and slowly increase your walking. I recommend a Digi-walker SW - 200, available on-line. Put bricks under your desk, so that the top is at elbow height. You then have a standing desk – used by Benjamin Franklin and Thomas Jefferson among other enlightenment thinkers. Standing will increase your strength as you work on your computer, or pay bills, or write your poems. Put a stationary bike or other exercise equipment in front of your television, and pedal as you watch your favorite programs. You can easily get to that hour a day recommended by the people who successfully lost weight. Get an exercise pal – who could be a dog.
Sadja Greenwood, MD, MPH back issues on this blog

Updates on Brains, Vitamin D and Green Vegetables

2011-02-09T12:24:00.000-08:00

Your brain on weights: You’ve probably heard that running, brisk walking and other aerobics increase blood flow to the brain and may be linked to the creation of new brain cells. Recent research shows that weight training may do the same. Rats with weights tied to their tails (!) who climbed ladders, or rats on loaded running wheels, packed on muscle mass and had higher levels of ‘brain derived neurotropic factor’, which is thought to spark the growth of new brain cells. Older women who lifted weights did better on tests of cognitive functioning than women in toning classes. Teresa Liu-Ambrose at the University of British Columbia speculates that resistance training, by strengthening the heart, improves blood flow to the brain, which is associated with better cognition.

Confusion on Vitamin D: A recent report from the Institute of Medicine (IOM) recommended that adults get 600 IUs of Vitamin D daily, and those over 71 get 800. They said that most people get this amount from foods (fatty fish and fortified milk) and sun exposure, and do not need supplements. These recommendations were contrary to the more widespread view in recent years that considered the importance of Vitamin D for bone health and other benefits, including protection against certain cancers and auto-immune diseases. Beth Dawson-Hughes, a vitamin D researcher at Tufts University, criticized the IOM recommendations as insufficient for the following groups:
*people with little sun exposure, including winter residents at higher latitudes, shut-ins, those who use sunscreen, those with dark skin (absorbs less D).
*osteoporosis patients
*obese people – it is thought that vitamin D is deposited in body fat and is less available from skin or dietary sources.
*people with gastrointestinal disorders that affect absorption.

Dawson-Hughes, as well as other vitamin D researchers, said that a laboratory level of 30 ng/mL (rather than the 20 ng suggested by the IOM) is good insurance, and is difficult to achieve by diet alone. Most adults need 1000 to 2000IU daily in supplement form, depending on their blood levels.

More benefits of Green Vegetables
Nitrate (NO-3) is found in vegetables such as red beets and spinach, and has been considered either without nutritional value or potentially toxic. Researchers at the Karolinska Institute in Sweden have found, however, that dietary nitrate is transformed by friendly bacteria in the mouth into nitric oxide (NO) – an important molecule in our bodies. NO helps blood vessels relax, lowering blood pressure and promoting more blood flow. It also makes the mitochondria that power our cells perform more efficiently. A high intake of vegetables and fruits has been found to protect against diabetes and heart disease. Boosting the nitrate to NO pathway may be one mechanism by which vegetables exert their protective effect. Readers may recall that dark chocolate also results in NO production in the body. But – try leafy greens first! And – think twice about using a strong mouthwash – we need oral bacteria for the system to work.
Sadja Greenwood, MD back issues on this blog. Leave a message or question.

Pesticide & herbicide residues in food - what to do

2011-01-28T19:54:00.000-08:00

According to the Environmental Working Group, people can greatly reduce their exposure to pesticides by avoiding the most contaminated fruits and vegetables and eating the cleanest ones. Eating organic produce avoids these problems, but is usually more expensive. Even if you generally rely on organic food, you may eat conventionally grown foods in take-out or in restaurants. Here is the 2010 list of foods with highest pesticide residues, based on testing by the US Department of Agriculture and the FDA. The list reflects measurable pesticide residues after a food is washed and peeled.
The Dirty Dozen:
*Celery – with no protective skin it is hard to wash off the 64 pesticides found in residues on this vegetable.
*Peaches – conventional orchards use multiple sprays - 62 pesticides have been found on peaches.
*Strawberries – 59 pesticides found. If you buy out of season, they may come from countries with less regulation of pesticide use.
*Apples – 42 pesticides found. Peeling an apple removes many beneficial nutrients, and still there is residue.
*Blueberries – 52 pesticides found. This fruit is new on the list in 2010, possibly due to it popularity and intensive cultivation.
*Nectarines – 33 pesticides found.
*Bell peppers – 49 pesticides found.
*Spinach – 48 pesticides found.
*Kale – generally considered resistant to pests, but high pesticide residues were found in 2010. (Note – it is easy to grow your own organic kale almost year round in our climate.)
*Cherries – 42 pesticides found. Cherries grown in US had more pesticide residue than imported.
*Potatoes – 37 pesticides found.
*Grapes – only imported grapes made the ‘dirty dozen ‘ list in 2010. Wine can also harbor many pesticides.
Salad greens, carrots, and pears have been on the ‘dirty dozen’ list in recent years; when possible, look for organic varieties.

Organic Foods –If you don’t want to eat foods on the ‘dirty dozen’ list, and are able to pay more for organic varieties, what are the benefits? Organic agriculture is better for the environment, avoiding the problems of monoculture. The ocean, rivers and lakes are not contaminated with chemicals and high nitrogen fertilizers that promote the rapid growth of algae, reduce oxygen levels and create ‘dead zones’ in oceans and lakes. The soil is treated with healthier fertilizers and crops are rotated to enrich nitrogen retention. You will probably benefit from greater amounts of beneficial plant compounds that the plant makes to fight off insects, fungi, viruses and bacteria. Farm workers are not exposed to dangerous chemicals, which have resulted in high pesticide blood levels and serious health problems. You and your family will also have lower levels of pesticides and herbicides in your body. The role of such chemicals in disease promotion is under study, and is controversial. With a rapidly growing population the world needs more food, and its production probably requires a mix of industrial and organic agriculture.
This leads us to the question of choosing safer, ‘cleaner’ conventional foods:

The Clean 15: These foods have fewer pesticide residues. They should be washed, and peeled if applicable:
onions, avocados, sweet corn, pineapple, mango, asparagus (fewer pests/diseases ergo fewer chemicals used), sweet peas, kiwis, cabbage, eggplant, papaya, watermelon, broccoli, tomato (used to be on the ‘dirty dozen ‘ list, but is no more), sweet potato.

Note that the grains and beans used as fill-up foods by most of humanity are not on this list. Unless they are grown organically, they also have chemical residues. Corn and soybeans are increasingly genetically modified to be ‘Roundup ready’ , with a potential problem with ‘super-weeds’ needing more Roundup (glyphosate ) spray. What will happen to super-weeds and the results of increased use of Roundup is yet to be known.

Global food prices have currently reached a record high, because of food shortages. This has recently caused riots in several North African and Middle Eastern countries. At such a time, it may seem elitist to be concerned with chemical residues in food. However, the problems of industrial agriculture, climate change (droughts and floods impeding food production) and population growth are interrelated. These and other crises facing humanity are daunting. Among the many proposed solutions are several that seem extremely important to this writer: limiting population growth with voluntary and accessible family planning, the spread of regional and sustainable food systems, and working to diminish global warming. Think globally, act locally
Sadja Greenwood MD, MPH Back issues on this blog

Walk, Dance and Eat Your Way Through 2011!

2011-01-13T09:54:00.000-08:00

Walking one & 1/4 miles daily, or 9 miles a week, can protect the grey matter of your brain. This was the finding of a study at the University of Pittsburg which looked at older adults over a 13 year time span. Those who walked 9 miles a week had half the risk of cognitive impairment of more sedentary subjects. You know the other benefits of walking – weight control, reduced risk of high blood pressure, heart disease and diabetes, reduced risk of falls and fractures, and mood improvement . There are also studies showing a lower risk for cancers of the breast, uterus, colon and prostate with physical activity. Here are some strategies to make regular walking a part of your life.
*get a pedometer – I suggest the Digiwalker SW-200, available from Amazon for $22.50 or from Step into Health. Get it with a strap that secures it to your pants. This simplest pedometer only measures steps – for most people a walk of 3200 steps would be one & 1/4 miles. Some people wear a pedometer all day long, and work up to 10,000 steps a day, which is the amount popularized in Japan by research showing better health at that level of activity. If you get a digiwalker, a booklet on the 10,000 step philosophy will come along with it. It’s a great motivator. You’ll be surprised at the number of steps you take in the house and yard, and you may find you want to take more trips to the compost pile.
*find a walking partner – a person or a dog who will motivate you to keep going. If you like to talk and socialize, choose a compatible person – if you want to tune into your own rhythms, try a dog. It could be your neighbor’s dog.
*dance at home to your favorite upbeat music on rainy days. You can get endless amounts on Pandora radio (on your computer or smart phone). I favor Cajun and Zydeco to keep me moving. Don’t wait for a dance partner – go free form. For ballroom dancing, Cenize Rodriguez and Don Jolley run great classes at the Stinson Beach Community Center, and Carol Friedman teaches at the Dance Palace. You can go to these classes with or without a partner. They are fun! If you don’t live in West Marin, find a class through the yellow pages or a community college.
*For the arms and spirit – try conductorcise. Maestro David Dworkin leads classes of older people , standing or seated, through the exercise of conducting classical music. Watch him at www.conductorcise.com and put on your favorite symphony. Using the upper body this way is invigorating, and moving to the music is thrilling.

Eat for Your Brain A French study showed that older people who took good care of their brains had a lower risk of developing dementia. Taking care of the brain meant avoiding diabetes and depression, and eating lots of fruits and vegetables. Here is a list of fruits and vegetables with the highest antioxidant values. Prunes, which lead the list have the greatest ORAC value (oxygen radical absorbance capacity): prunes, raisins, blueberries, blackberries, kale, strawberries, spinach, raspberries, Brussels sprouts, plums, broccoli, beets, oranges, red bell peppers. Many other vegetables and fruits not on this list are also valuable sources of antioxidants and other nutrients. We are so lucky to have great organic produce at the Bolinas People’s store and our local farm stands.

Update on citrus peel After my column last week on the benefits of hesperidin in citrus fruit and peel, a friend told me that her daughter had become violently nauseated after putting a whole orange in a blender drink, and had to go to the ER with intractable vomiting. This will not happen to you when you make or eat marmalade, but avoid too much peel in blender drinks.
Sadja Greenwood, MD, MPH Back issues on this blog

What’s new in school food, food safety, arsenic, and hesperidin

2011-01-03T20:43:00.000-08:00

An important bill on child nutrition was signed by President Obama in December. It gives schools extra money for meeting nutrition standards for breakfast and lunch, requires the USDA to develop new meal/snack patterns based on current science, allocates funds for school gardens and farm to school programs, enables the USDA to establish national nutrition standards for all food sold on school grounds (including vending machines), funds state and local organizations that promote healthy eating and fitness, funds projects to research and end child hunger and child obesity, promotes breastfeeding, and helps foster children get free meals. While food in our local Stinson-Bolinas schools is already healthy, and even organic, this bill bodes well for the rest of the country. Nutrition activists, parents and students will need to be vigilant in insisting that changes take place rapidly. $8 billion will be available over 10 years. Possibly Stinson-Bolinas schools could benefit from the farm to school programs.

The Food Safety Modernization Act was also signed by Obama in late December. This bill gives the FDA power to directly issue a food recall – previously a company could stall because the recall was voluntary. Companies must develop plans to prevent contamination, share them with the FDA, and show the FDA how effectively they carry out their plans. Any whistleblower in a company will be protected when providing information to the FDA. Inspection of foreign food facilities must happen more frequently. There is a long lead time for important provisions to go into effect, and the ability of the FDA to enforce the law will depend on funding. This funding could well be cut by the next congress. However, major industry groups are in favor of the bill because of the harm that recalls can do to sales. Stay tuned.

Arsenic in poultry and pig feed: A compound called roxarsone, containing arsenic, is routinely added to feed for poultry and hogs to control intestinal parasites and thereby promote growth. There have been a few media stories on this practice, including a recent one about two children in Utah who developed arsenic poisoning by eating eggs from their backyard chickens. Some large poultry producers, including Perdue Farms and Foster Farms, have stated that they do not use arsenic (however they may well use other antibiotics in their feed). Arsenic is a poison, and also a carcinogen. Until there is more action on roxarsone, I advise readers to buy organically raised poultry, and to feed backyard chickens organic feed. Also, be careful about the use of chicken manure in your garden, unless you are sure about the source. I find it disgraceful that the media and the FDA have paid so little attention to the widespread use of arsenic in our food supply. Vast amounts of chicken manure from confined animal feeding operations are spread on fields throughout the US, endangering workers and the public. Roxarsone is banned in the European Union.

Some good news – Hesperidin: When I watched a friend eat a whole organic Meyer lemon, peel and all, I felt she might be on to something. A recent study looked at the effects of orange juice on blood pressure, and found that both o.j. and a compound called hesperidin found in citrus fruits and peel lower diastolic pressure. The juice and hesperidin both resulted in dilation of blood vessels, compared to a placebo. Hesperidin, also found in green vegetables, is an anti-oxidant, anti-inflammatory agent with some effect in lowering cholesterol. You can get more hesperidin by making your own marmalade - cut oranges, tangerines or lemons into small pieces with the skin, soften them by boiling in a little water, then add honey or maple syrup and cook until your favorite consistency. Yum.
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health – Our Food System – what YOU can do to improve it!

2010-12-18T10:57:00.000-08:00

Food-borne disease – think eggs, ground beef, peanut butter, spinach – is difficult to trace to its sources because of the complex web of national and international shipments of food. Antibiotics are routinely fed to factory-farmed animals (European meat producers & US organic farmers do not use them). These substances end up in manure, leach into ground water, and breed resistant bacteria. The FDA and the CDC (Centers for Disease Control) have both stated that the routine use of medically important antibiotics in animal feed is a significant public health problem. Pesticides, food dyes and hormone-disrupting bisphenol A (recently banned in Canada) are found in the foods and containers commonly used by most of us. Mercury has been found in high-fructose corn syrup. According to Dr. David Wallinga, writing in the November issue of San Francisco Medicine, these crises are an interrelated result of our industrialized food system, which is unhealthy, responsible for the fast (junk) food eaten by many of us, and for the obesity and health care crises. The food system is desperately in need of change. Individual change can only go so far – think about smoking and seat belt use before laws were in place. Here are some action-oriented organizations suggested by Wallinga: For children and schools – www.iatp.org, and www.OneTray.org. For communities –www.HealthyFoodAction.org is an excellent source for understanding the present and future policies around food and the farm bill in a very readable way.

Take Action: Brian Raymond, a Senior Policy Consultant for Kaiser Permanente Institute of Health Policy, wrote an article in San Francisco Medicine entitled Taking Action. Here are some of his ideas. The Farm Bill is revised every 4 years, and will be reauthorized in 2012. This important bill addresses issues such as nutrition, food stamps, and food policy. The 2008 bill did not have health sector involvement, and this must change.

*The new bill should include more support for sustainable and organic agriculture, small and mid-sized farms, and regional food systems.

*Food safety and expanded plant inspections should be included.

*Subsidies for corn, wheat and soybeans, mainly used for animal feed and unhealthy calories should be shifted to support fruits & vegetables.

*CAFOs – huge enclosed animal feeding operations should be regulated to protect the communities surrounding them, their water supplies, and the public health. Our local author and rancher, Nicolette Hahn Niman, has written about CAFOs in her fascinating and persuasive book, Righteous Pork Chop.

*The use of routine antibiotics for healthy animals should be stopped.

*Support for healthy food access in underserved neighborhoods is needed.

*Food stamp programs should be increased and used to support farmers markets and grocery stores.

*Advertising of unhealthy food to children on television should be addressed.

*Food labeling should include information about chemicals, hormones, and additives. Food that has been genetically engineered should be labeled, to give consumers a choice to assess the environmental implications of this food – be it corn, soy, canola oil, salmon et al.

Each one of these proposed changes will meet strong political resistance, so citizen pressure and action will be needed. Your awareness of the issues involved in the politics of food will enable you to make a difference this year and next. After writing this column, I am changing from being a health-foodie to a political-health-foodie. Take a look at www.HealthyFoodAction.org keep up with what’s going on, and to learn how you can influence the outcome.
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health - Six suggestions for your Stash, or Cache

2010-12-03T21:35:00.000-08:00

No, this is not about marijuana; it’s my suggestions for some other useful things. Press on regardless, as a friend of mine often says.
1) QR – Quick Relief, for bleeding from cuts. QR is a non-prescription ‘powder bandage’ that is made from a potassium salt and a polymer (a substance made of large molecules with repeated structural units) that absorbs fluid. If a wound or cut is bleeding profusely and will not stop with manual pressure, pour QR onto the wound and then press with a clean (preferably sterile) bandage or cloth. Bleeding generally stops with one or two applications. Wounds should always be cleaned, and QR does not replace stitches if these are needed. There is a separate QR substance for use with nosebleeds, which is also really effective. Anyone taking Coumadin or aspirin, or people with frequent cuts or nosebleeds, might consider having a handy stash of QR. Find this product on line, or ask your pharmacist to order it for you.

2) Alkamax - If you have problems with gastric reflux (GERD), a condition in which backward flow of acid from the stomach causes a burning feeling in the chest, you may be taking drugs such as Zantac, Pepcid, Prilosec or Nexium. These drugs are really important in certain situations, including the prevention of esophageal cancer and stomach ulcers. If your doctor has prescribed them, do not stop without her/his OK. However, many people are taking these meds without knowing why, or for minor problems that can be treated more naturally. If you have occasional discomfort after a big meal you may not need to suppress your stomach acid all the time – that acid helps your digestion. Try eating frequent small meals, and have dinner at least 3 hours before bedtime. If you do experience reflux pain, try drinking a few ounces of water with a scant teaspoon of Alkamax – potassium bicarbonate. This will usually cause you to burp and feel better. If you have a comfortable reclining chair, sip your Alkamax, cover your eyes, and go to sleep. The ‘alkaline tide’ will send you into dreamland. I buy it online.

3) Prescription Drugs – have a one month stash if possible, in case of an earthquake or other emergency.

4) Cabbage – this healthy and tasty brassica vegetable lasts a long time in the refrigerator. If you always have one on hand, you can make slaw or a stir-fry or cabbage borscht even when you have run out of other veggies and the grocery store has closed. Have I mentioned that Johns Hopkins University has a brassica lab and a brassica foundation that studies the chemopreventive effects of brassica vegetables? More in a future column – for now, try a cache of cabbage.

5) Fava Beans - For gardeners, beginners, or anyone who has access to a little piece of mother earth, there is an easy, tasty and virtually foolproof plant – the fava bean. You buy dried favas at a plant store, and poke a few into the ground, two inches deep. Separate them by about 4 inches. You can plant them now, and actually year round in our mild California climate. They don’t need to be staked, and rarely need water. First come the green shoots – when they are leafed out you can enjoy the leaves in salad or as a cooked vegetable. Fava shoots have become a gourmet food, because they are delicious. The beans are very tasty too, but need a little more preparation. Growing favas will enrich your soil, as they fix nitrogen in little nodules on their roots. Some people (mostly men) with origins in Greece and other Mediterranean countries develop anemia and other problems when eating fava beans – if you have a family history of this problem, get a blood test and don’t eat favas until you find out. This problem is rare in the US, so most of us enjoy this really easy plant. Get a stash!

6) Be Happy – A friend who is prone to depression told me about this book by an English author, Robert Holden. I make a beeline for the self-help section in bookstores, so I’ve read a lot of these books, starting with Dale Carnegie when I was 16. I’m quite taken with Be Happy; it is a summary of an 8 week course that Holden gives in London every year. He is a psychologist with the National Health Service. After reading it, I decided to go back and do the written (or spoken) exercises, and my partner, Alan, is doing them with me. We are finding out new things about ourselves and each other; this has been a very positive experience. If you want to have new views on happiness, and to become happier, add this book to your stash. It’s in our local library system, or can be ordered from your book store..
Sadja Greenwood, MD, MPH. Back issues on this blog. Leave me a message!

Go to Health – New Data on Falls & Fractures

2010-11-08T16:26:00.000-08:00

Bess Dawson-Hughes, a professor of medicine at Tufts University School of Medicine in Boston, has written extensively on the factors that predispose aging people to falls and fractures. The November issue of the Nutrition Action Health Letter has an interview with her that summarizes her current advice.

Loss of bone and muscle mass: She points out that we lose bone and muscle mass as we age, and also the ability to keep our balance. This predisposes us to falls and fractures. The common dietary factor in bone and muscle loss is the ‘acid load’ in our diet, contributed by protein and grains. When these foods are metabolized, they release sulfuric and other acids into the bloodstream. Because of declining kidney function, older people don’t handle the acid load in these foods as well as they did in their youth, and therefore their blood pH becomes slightly more acidic. Normal human arterial blood pH is between 7.35 and 7.45; as you recall from chemistry, a lower level of your blood pH would mean a more acidic fluid. Since aging kidneys can be less effective in regulating pH, our bodies break down bone and muscle to neutralize the acid. However, protein is needed to build strong bones and muscles. Your target protein in grams is roughly half your weight in pounds. A table to calculate the protein content in foods you eat is found at http://www.herbalvitality.info/list-of-high-protein-foods.htm. We should cut down on excess protein and refined grains to reduce our acid load, according to Dawson-Hughes.

Fruits and vegetables in the diet have an opposite effect, since they are broken down into alkaline products that help to neutralize acids. This includes fruits that may taste acidic, like citrus. Sugars and fats are generally neutral with respect to pH. Dawson-Hughes suggests that people really maximize produce – she suggests 9 to11 servings a day to neutralize excess acids! A serving of cooked vegetables is a half-cup, and of salad greens is a full cup. Such a diet is possible, but would take planning, and would not fit into some people’s budgets or work schedules. I will outline a plan at the end of this column.

Potassium bicarbonate (KHCO3) Because of the difficulty of her recommendations, Dawson-Hughes is working on finding the appropriate amount of KHCO3 that could be taken to neutralize excess acids. KHCO3 is an alkalinizing agent. She found, in one small study, that women taking KHCO3 had reduced markers of bone turnover and muscle wasting, and performed better on a leg press at the gym. However, she cautions people not to take KHCO3 at present, as the right dose has not been found, and too much potassium in supplements can be dangerous to people with compromised heart and kidney function.

Exercise is vitally important in maintaining bone and muscle strength. Dawson-Hughes, and many other experts, advises at least 30 minutes a day of weight-bearing exercise like walking or dancing. Strength training is also necessary; you can read Miriam Nelson’s book Strong Women Strong Bones and find an excellent guide to building muscle and bone.

Vitamin D is another key to building strong bones. Dawson-Hughes, and many other experts, advise that people over 60 take supplemental Vitamin D – about 1000 IU daily, in order to keep their blood levels of D at 30 nanograms per milliliter.

Calcium is essential for bone building, and must be accompanied by adequate Vitamin D. Dawson-Hughes has suggested about 800 mg per day, from food and supplements.

Salt in the diet contributes to bone loss. When the kidney gets rid of excess salt, it also excretes calcium that is leached from bones. Here is another reason for a diet lower in salt.

How to maximize fruits and vegetables without going crazy: Along with your other foods, try the following: 2 fruits for breakfast, say an orange, or orange juice, and a banana. Mid-morning – a glass of low-salt Very Veggie or V8. For lunch include a carrot and a tomato, or have vegetable soup. Mid-afternoon – an apple, or raisins or dried figs (both very alkaline). Dinner – include a salad and a cooked vegetable, and a fruit desert. That makes 9. Another glass of Very Veggie or low salt V8 will take you close to the top!
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health: Can Beet Juice Beat High Blood Pressure?

2010-10-23T20:01:00.000-07:00

About one in three US adults has high blood pressure; this is a big problem because blood pressure elevation is a leading contributor to heart attacks and stroke. Amrita Ahluwalia, a professor of vascular biology at Queen Mary’s William Harvey Research Institute in England, has found that blood pressure can be lowered effectively by natural means – drinking 8 ounces of beet juice daily. The nitrate (NO-3) found in beet juice is converted in saliva, by bacteria on the tongue, to nitrite (NO-2); in the acidic environment of the stomach. Nitrite is then converted by various enzymes to nitric oxide (NO). Nitric oxide is a gas that diffuses freely across cell membranes, and signals the smooth muscle surrounding blood vessels to relax, thus resulting in lower blood pressure and increased blood flow. NO also prevents blood platelets and white blood cells from sticking to blood vessel walls, thereby helping to lessen a buildup of plaque. Viagra and related drugs stimulate erections primarily by providing increased NO to blood vessels in the penis. Nitroglycerin, used to decrease the pain of angina, also works by releasing NO to dilate blood vessels in the heart muscle.

Professor Ahluwalia and her team found that in healthy volunteers, blood pressure was reduced within an hour of drinking about 8 ounces of beet juice, with a peak at 3-4 hours later, and some degree of reduction for 24 hours. Since nitric oxide is also formed after eating green leafy vegetables, the mechanism of action of the DASH diet may be similarly explained. The DASH diet – Dietary Approach to Stop Hypertension – emphasizes eating large amounts of vegetables and fruits, along with some low-fat dairy products and little added salt. Look at dashdiet.org for a good discussion of this effective plan.

A recent study of beet juice showed that athletes given beet juice could complete a cycling test for a significantly longer time than when given a placebo. They were able to use oxygen more efficiently during endurance exercise. This finding may also help people with poor fitness who need to increase their exercise tolerance.

Beet juice can have side effects, so it is important to discuss these with you doctor before starting to use it regularly. This is especially true for people taking medication to lower blood pressure. Drinking beet juice can cause dizziness, perhaps because of the drop in blood pressure. Beets can cause red urine and feces, which is a harmless side effect but could make the uninformed think they are bleeding internally. Occasionally people drinking beet juice have a temporary paralysis of the vocal cords, making it hard to talk for a period of time. This can be alarming – and should signal the user to stop the beet juice regimen. Some people are allergic to beets – there is a correlation here with allergy to latex. Beet juice should not be given to children.

If you don’t have your own juicer, it may be expensive to buy beet juice. Biotta sells organic beet juice (17 ounce bottle) on line for $5 plus shipping: With enough demand, your local natural foods store might stock the juice. If this is all too much, you may get the same good results in lowering blood pressure from the DASH diet.

Readers of this column may remember that chocolate contains compounds that activate the nitric oxide system in our bodies. The Kuna Indians who live off the coast of Panama drink lightly processed cocoa as their main beverage and do not show an increase in blood pressure with aging. It is hard to consume chocolate or cocoa regularly and not get an overdose of sugar and in some cases fats. However, by using plain unsweetened cocoa powder combined with xylitol, mashed banana or pomegranate juice, chocolate lovers can stay on a healthy diet!
Sadja Greenwood, MD, MPH back issues on this blog

Go to Health: Sugar - What's good about it, and what's Not

2010-09-21T12:19:00.000-07:00

In the past 20 years we US citizens have gained a lot of weight. In 2007, 74% of us (adults) were overweight or obese. In children and adolescents, about 25% are overweight or obese, a tripling of the rate of 20 years ago. The speed of this development is alarming, and has many reasons - less time spent on physical activity, more TV & computer games, more cheap fast food, less available produce in inner cities, and the neglect of home cooking by busy people.

Sugars: Another reason for our weight gain relates to the sugars found in processed foods, from breakfast cereals to donuts, cookies, cakes, jam, candy, energy bars, deserts, soft drinks, etc. In 1900 the average yearly consumption of sugar was 5 lbs, and now it is 135 lbs per person! Sucrose – the sugar that comes from sugar cane and sugar beets, is a 50-50 mix of glucose and fructose. Glucose, derived from food, is the main sugar that circulates in our bodies, fueling our brains, muscles and body processes. Fructose is the main sugar in tree fruits, berries and melons. When fruits are eaten, fructose contributes to their good taste and to our health, because of the many other nutrients in these foods.

High fructose corn syrup (HFCS), however, is another story. Between 1970 and 1990, the consumption of HFCS increased 1000% in the US! It is a mixture of 55% fructose and 45% glucose, and is manufactured from corn. HFCS has been used in soft drinks because of it is 40% cheaper than cane sugar. Animal studies indicate that it contributes to greater weight gain, cardiac risk factors and non-alcoholic liver disease when compared to sucrose. A recent study from UCLA showed that pancreatic cancer cells grew more rapidly in the presence of fructose. HFCS is also implicated in high blood pressure. Researchers at the University of Colorado used survey data on 4,500 adults, and found that people said they consumed about 4 soft drinks a day, imbibing 74 grams of fructose. The more fructose they had in their diet, the more likely they were to have high blood pressure, even when adjustments were made for other factors causing hypertension, such as obesity, salt, or alcohol.

Public recognition of problems with HFCS has led some companies, such as Starbucks, to eliminate it from bakery products; some soft drink makers, such as Gatorade, have cut back on its use. Food companies such as Cargill and Archer Daniels Midland insist that the product is similar to ordinary sugar, and are trying to rename it ‘corn sugar’. Nutrition expert Michael Jacobson, director of Center for Science in the Public Interest, and founder of the Nutrition Action Health Letter, takes a somewhat similar stand by saying that the main issue is that people need to consume less sugar – “Soda pop sweetened with sugar is every bit as conducive to obesity as soda pop sweetened with high fructose corn syrup.”

What to tell ourselves about sugar:
1) As a species, we like the taste of sweet foods, and have receptors for them in our mouths. We evolved eating tree fruits and berries. This pattern will keep us healthy.
2) Refined sugar from cane and beets is all right for special occasions, but there are caveats, as follows …
3) Sugar beets make up about 50% of US sugar, and are mainly genetically engineered (Roundup Ready). ‘Superweeds’ are evolving to Roundup, so that more pesticides may be needed. There is currently a temporary ban on GE sugar beet planting in the US because of environmental concerns. Genetically modified cane sugar research is underway in Brazil, Argentina and India; vast amounts of land has been cleared in these countries to grow sugar. If we did not eat as much sugar, the land could be used for real food, or revert to forest. You can find organic cane sugar, which is not genetically modified, but it is more expensive, and much less likely to be used in processed foods.
4) All refined sugars except for xylitol , mannitol, sorbitol and maltitol contribute to tooth decay and tooth loss, which is a big problem, especially among uninsured, low-income children and adults.
5) Refined sugars are empty calories, and are usually combined in foods with other empty calories, such as refined flour and fat. These foods contribute to obesity, diabetes, and many other serious health problems, as mentioned in this article.
6) Sugar-laden foods displace natural foods such as fruits, vegetables, whole grains and protein in our diets. You can train yourself to satisfy your sweet cravings with tangerines, bananas, dried figs and dates – it takes time and persistence, but your body will be happy for your choices. Be sure to fill up on healthy foods, including protein, before you encounter sweets.

Sadja Greenwood, MD, MPH Back issues on this blog

Go to Health: Unwanted Pregnancy & Ella, the new emergency contraceptive

2010-08-29T19:17:00.000-07:00

Have you noticed that sex scenes in movies almost never include any discussion of whether the woman is using the pill or an IUD, and whether the man has a condom? Stopping to talk about AIDS doesn’t happen either. Film producers are getting better about cigarettes, but apparently condoms are too risqué. There is even controversy about requiring actors in pornographic movies to be protected by condom use. Our inability to get real about sex and to make protection available translates into our high rate of unintended pregnancies. It is not surprising that the US has a higher rate of unintended pregnancy than other developed countries. In France, about one third of pregnancies are unintended. In the US our rate is close to 50%; married and unmarried women are included in this number. Of the 800,00 pregnancies in teenagers per year, over 80% are reported as unintended. One third end in abortion. Teens who become mothers are less likely to finish high school or find decent jobs, and more likely to live in poverty.

The most rational plan for sexually active females and males is to talk about contraception ahead of time and use highly effective methods such as the pill, the IUD and condoms. Teenagers need to rehearse the way they will handle such talks, as they are not easy at first. Since sexual desire often overtakes rational thinking, a ‘plan B’ is needed to prevent unintended pregnancy. It’s called emergency contraception, and the foremost pill on the market is called ‘Plan B’!

Plan B One-Step contains levonorgestrel, a progesterone-type hormone that is used in many birth control pills. It prevents pregnancy primarily by stopping ovulation (the maturation and release of eggs from the ovaries) or by preventing fertilization of the egg if ovulation has already occurred. Plan B One-Step also alters the lining of the uterus, making it less receptive to a fertilized egg. Plan B One-Step is available without prescription to women and men 17 and older; it consists of a single pill that should be taken as soon as possible after unprotected intercourse, or if the condom breaks or pills have not been taken regularly. (Men don’t take Plan B,, but can buy it for their partners.) Girls younger than 17 can get Plan B One-Step with a doctor’s prescription. Women who have been raped should ask for Plan B One-Step in the emergency room. Plan B One-Step can be used up to 5 days after sex but loses some of its effectiveness after 3 days. Other emergency contraceptive pills on the market are Plan B and Next Choice. These both contain two pills, with instructions to take them 12 hours apart. However, studies have shown that both pills can be taken together.

Ella: In mid August, 2010, the FDA approved a new emergency contraceptive that has been used in 22 European countries since October 2009 and is said to be considerably more effective than Plan B. Ella works by preventing ovulation – the release of an egg from the woman’s ovaries, and probably also by changing the uterine lining to make it less receptive. It is similar in chemical configuration to RU 486, and thus has aroused opposition from groups who oppose abortion. Studies have shown Ella to be more effective that Plan B, and useful for up to 5 days after sex. Ella should be available by prescription by October or November of 2010. The approval of Ella by the FDA has been seen as evidence of a shift in the influence of political ideology at the FDA. Approval of Plan B, on and then off prescription, was very slow and controversial, while the approval of Ella was faster and unanimous. Ella and Plan B should not be used if the woman is already pregnant, or breastfeeding.

The Copper T IUD is the most effective way to prevent pregnancy after unprotected sex, It can be inserted within 5 days after sex and is said to be 99% effective in preventing pregnancy. It can remain in place for 10 years, This method is not the best birth control for women who may be at risk for sexually transmitted diseases, as infections in the pelvic organs can occur with IUDs. However, for monogamous couples, the IUD is an excellent choice.

Final Thoughts: If you are reading this column and it doesn’t apply to you, pass on the information to a young person who may need it.

If anyone can explain to me why film-makers find it impossible to include the question of contraception in sex scenes, please leave me a message and let me know. Films have enormous influence on our consciousness, and could do a lot of good by being honest on this subject. The scenes could be made as funny or poignant as real life.

Sadja Greenwood, MD, MPH Past issues on this blog

Go to Health: Ghrelin and Leptin – the hunger hormones

2010-08-15T10:30:00.000-07:00

There are many influences that govern what, when and how much we eat. Clearly our family of origin, habits and thinking play a big role in this, and so do the temptations of sweet, salty and rich foods in every store and restaurant. Most of us probably want to get in touch with our body’s signals that tell us when and how much to eat. Several hormones are constantly playing an unseen and important role in this. Ghrelin (the word comes from “ghre" in Proto-Indo-European languages meaning “grow") is made in the stomach and pancreas; it stimulates hunger. To pronounce this word, make ghrel rhyme with dwell, then add an ‘in’. Leptin (derived from the Greek word ‘leptos’ meaning thin) is formed mainly in fat tissue and inhibits
appetite.

Ghrelin levels increase before meals and when blood sugar is low. Ghrelin stimulates hunger. The hormone circulates in the blood and affects areas of the brain that cause an increase in growth hormone and the dopamine reward area. The pleasurable aspects of food (and alcohol) are reinforced. Ghrelin has also been found to reinforce learning and memory (think of a hungry animal looking for clues to find food). Short sleep duration is associated with increased levels of ghrelin, increased hunger and obesity – so getting enough sleep is important to maintaining a normal weight.

Leptin is a hormone secreted mainly from fat cells – receptors are found in brain areas known to be important in regulating hunger, body temperature and energy expenditure. When an animal gains weight and has larger amounts of body fat, leptin levels rise. Normally, hunger and food intake go down, and body temperature rises. Leptin counteracts the effects of anandamide, a neurotransmitter that stimulates eating and binds to the same receptors as THC in marijuana. Anandamide makes food pleasurable, as does marijuana, while leptin signals the brain that the body has had enough to eat. A recent study in rats showed that animals fed a diet high in fructose became resistant to leptin, and gained more weight than animals on a diet with similar calories but without fructose. This study gives a clue to the rise of obesity in the US. It’s fine to eat fruit, but avoid sweetened drinks, especially if they contain fructose.

The ‘Appestat’ The regulation of appetite has been the subject of much recent research, primarily because of the marked increase in weight gain in our population. The hypothalamus in the brain is the main regulatory organ for appetite; it is influenced by ghrelin, leptin and many other hormones and neurotransmitters. Research indicates that it takes time for the brain to register a feeling of fullness after eating, possibly up to 20 minutes. People who eat rapidly, or are distracted by watching television, may eat more than they need, by ignoring and not waiting for the body’s signals of fullness. Foods that contain more water, fiber and/or protein have the greatest ability to promote feelings of fullness. Most vegetables, fruits and beans or animal foods fall into this category. Whole grain pasta, bread and cereal contain more fiber than foods with refined flour foods, and are 50% more filling. However, choosing healthy food when you are hungry, and confronted with foods like chocolate cake or cheeseburgers, takes considerable resolve! Carrying some nuts, fruit or dried fruit in your backpack or purse can help.

Self-knowledge There are many valuable ways to stay in touch with your body – meditation, conscious relaxation, mindful breathing, and slow walking, come to mind. Slow and conscious eating can also be a great help in staying in touch with your body’s need for the right amount of healthy food.
Sadja Greenwood, MD, MPH – back issues on this blog

Go to Health: Almonds, Peanuts, and PlumpyNut

2010-08-08T09:32:00.000-07:00

Almonds are a delicious food, and one considered heart-healthy - because of studies showing that they decrease blood sugar and insulin response after a meal, and also lower damage to ingested protein as it is metabolized. Researchers at the University of Toronto followed this study with a look at ‘the portfolio diet’, in which subjects with elevated cholesterol followed an eating plan containing many heart-healthy foods: oatmeal, beans, olive oil, soy products, fibrous vegetables and a daily ounce of almonds (20-24 almonds). LDL cholesterol decreased by 29.6% in 4 weeks, compared to a 33.3% decrease on lovastatin. The ‘portfolio’ concept was to combine many known heart-healthy foods. Researchers called almonds a ‘mini-portfolio’ because they contain several components stressed in the eating plan - vegetable proteins, fiber, and plant sterols (structural components in cell membranes that lower cholesterol in humans). Almonds also are a good source of vitamin E, magnesium, heart-healthy monounsaturated fat, protein and calcium. Adding a daily ration of almonds to a weight loss diet is helpful, as their fat content can prevent overeating. Following salmonella outbreaks from raw almonds in 2001 and 2004, the USDA has mandated that all almonds be pasteurized to reduce bacterial contamination. This move has been very distressing to the raw food community. Some unpasteurized almonds can still be found, labeled as such. Other people prefer the taste of roasted almonds, and are not concerned by the ruling.

Peanuts are believed to have been domesticated about 7000 years ago in Peru; they are members of the bean family and grow underground. The Portuguese took them to China in the 1600s and to Africa in the 1800s; they became important in the diet of both areas. Besides being high in protein (25% by weight), peanuts have numerous health benefits. In 2003, the FDA allowed the following health claim: scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, including peanuts as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. (1.5 ounces of most nuts is about 1/3 cup.) Peanuts contain as much antioxidant capacity as blackberries and strawberries, and are richer in anti-oxidants than carrots or beets. Certain of their antioxidants are increased by roasting. They are also a good source of resveratrol, a compound in some plants that is studied for its anti-aging effects and protection against heart disease and cancers. Resveratrol is known to be present in grapes and concentrated in red wine – for non-drinkers, peanuts are a good alternative. For dieters, and people dealing with diabetes, a 2002 study from the Harvard School of Public Health found that women who ate 5 or more 1 ounce servings of peanuts or other nuts per week reduced their risk of type 2 diabetes by almost 30%. A similar finding was found among women eating 5 tablespoons of peanut butter per week.

Peanut allergy can be serious; it affects .6 to 1% of the US population, but is much less common in developing countries – possibly due to different ways of processing the nut. Peanuts can be contaminated with a mold called aflatoxin that can be carcinogenic; processing peanuts at high temperatures makes this contamination unlikely in the US.

PlumpyNut is a high protein, high energy peanut based paste that also contains vegetable oil, powdered milk, sugar, vitamins and minerals. It was specially formulated by a French nutritionist in the 1990s for use in famine conditions in Africa, where it has been lifesaving for emaciated children. It comes in a foil-wrapped bar which the child can use to feed herself or himself. You can see the remarkable results of PlumpyNut feeding on the 60 Minutes program of Oct 21st, 2007, narrated by Anderson Cooper. Recently there has been serious controversy about the patent on PlumpyNut held by the French company that makes it. Regardless of this problem, PlumpyNut is distributed by Doctors Without Borders and other relief organizations, which are worthy of our support.
Sadja Greenwood, MD, MPH Back issues on this blog

Go to Health: Walnuts

2010-07-25T20:33:00.000-07:00

Recent studies on the benefits of eating walnuts have made nutrition headlines: a reduction in the risk of prostate cancer (in mice) and slower growth of breast cancers (also in mice). These unfortunate mice have been bred or treated to develop these particular cancers. Researchers say that it is too soon to draw conclusions for humans from these studies. However, there are several other good reasons to include walnuts in your daily diet. Walnuts, flax seeds, and to a lesser extent canola oil (buy organic forms of this oil) contain relatively high amounts of an omega-3 fatty acid called ALA (alpha-linolenic acid). ALA is a plant precursor to the EPA and DHA found in fish oil. Green leafy vegetables, exclusively grass-fed animals, seeds such as pumpkin seeds and a vegetable known as purslane also have ALA. ALA is converted to EPA and DHA in our bodies, although the conversion is incomplete. Omega-3 fatty acids, from fish and plant sources, are essential for the human brain and body. Besides its ALA content, walnuts have other health benefits which are under investigation. Read on!

No Weight gain: walnut consumption, even in sizable amounts, has not led to significant weight gain. A recent study from Loma Linda School of Public Health asked subjects (but not a control group) to add 1/3 of a cup of walnuts (~280 calories) to their daily food intake. They were given no other dietary guidelines. Participants showed no greater weight gain than the control group over a 6 month period. They ate slightly less food when adding the walnuts, in a voluntary manner. Similar findings have been seen among people who regularly eat other nuts. Nuts lead to satiety, and may make it easier to ignore candy, cake and other empty calories.

Preventing Heart Disease Another Loma Linda study looked at people with moderately high cholesterol levels; when they added slightly less than 1/3 cup of walnuts to their usual diet, their total cholesterol and triglyceride levels decreased significantly. Subjects with the highest baseline readings improved the most. Men with elevated levels of lipoprotein(a) showed a significant decrease in this protein; lipoprotein(a) may increase the risk of heart attack. Another Loma Linda study contrasted the effects of walnuts and fatty fish (fish contain the omega-3 fatty acids DHA and EPA). The fish diet – 2 weekly servings of 4 oz of salmon – decreased triglycerides and increased HDL (good cholesterol) more than the control diet or walnut diet. The walnut diet, adding 1/3 cup of walnuts 6 days a week – showed better effects on LDL cholesterol, and lipoprotein(a). The authors concluded that including walnuts and fatty fish in the diet was helpful in decreasing the risk of heart disease. (While fresh or frozen salmon has become very expensive, you can still find wild-caught Alaskan salmon in cans for about $4.00. Get the unsalted kind if possible.) Researchers at the University of Barcelona have recently shown that in addition to lowering cholesterol, walnuts can improve the elasticity of the arteries, allowing blood to flow more easily throughout the body. This is an important finding.

Melatonin in walnuts Melatonin is the hormone secreted by the pineal gland, behind our eyes, that regulates our sleep-wake cycle. Darkness causes its levels to rise, and bright light inhibits it. As we get older, our nighttime melatonin levels wane, making it harder to fall asleep or stay asleep. Melatonin also acts as an anti-oxidant that helps the body resist toxic molecules called free radicals. Free radicals, that can damage DNA, are thought to be important in aging, cancers, brain disease et al. Melatonin is made by plants as well as animals and is fairly abundant in walnuts. Researchers at the University of Texas in San Antonio found that when laboratory rats were fed walnuts, their blood levels of melatonin went up, as did the total antioxidant capacity of their blood. The researchers surmised that the combination of melatonin and omega-3 fatty acid in walnuts made these nuts unusually beneficial. I surmise that walnuts may be a perfect bedtime snack, and an easy food to have by your bedside when the dreaded two a.m. insomnia makes your world look impossible. Dried tart cherries are said to have a similar helpful effect on sleep, again due to their melatonin content.
Sadja Greenwood, MD,MPH back issues on this blog
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Go to Health: Walnuts

2010-07-25T20:24:00.000-07:00

Cannabidiol - a Little Known Compound in Marijuana

2010-06-28T21:30:00.000-07:00

Cannabidiol, known as CBD, makes up about 40% of extracts from the cannabis plant. It is said to be non-psychoactive, and to counteract the psychoactive compounds known as THC. Researchers at the Canadian Department of Agriculture have found that hemp - the type of cannabis grown for fiber or in the wild in temperate climates - is low in THC and high in CBD. The plant that originated in hot climates has different genetics, and is high in THC but low in CBD. Most cannabis currently grown for street and medicinal use is the latter type, bred to be high in THC, low in CBD. This is important for growers, as CBD is known to block the effects of THC. In other words, CBD prevents a marijuana ‘high’. In addition, CBD has been found to have interesting and promising medicinal uses. Research reports on CBD are now found in the medical literature.

Pain/Sativex : Several recent studies have shown that CBD, often combined with THC, is effective against pain in patients with advanced cancer whose pain is not controlled by medicines like morphine.. Patients appreciate the lack of hallucinogenic side effects. CBD/THC extracts have also been helpful with pain and spasticity in patients with multiple sclerosis. Canada released a medicine called Sativex in 2005, which was licensed for use in patients with multiple sclerosis and cancer pain. Sativex is a mouth spray; its full effect is achieved in about an hour. It is a mixture of THC and CBD, derived from the whole plant. Sativex is currently being used in England and Spain, for multiple sclerosis, severe nerve pain, malnutrition due to AIDS, and nausea/vomiting from chemotherapy. The US FDA has approved Sativex for certain clinical trials for cancer pain.

Cancer: Research has shown that CBD may work as an anti-cancer agent with low toxicity. Researchers at CPMC in San Francisco have been working on the ability of CBD to inhibit the growth and spread of breast cancer cells in a mouse model. If the work goes well, clinical trials of CBD in human breast cancer patients may take place. CBD is also being studied as a therapy for leukemia and brain tumors known as gliomas.

Other Uses: CBD has been tested in schizophrenia, epilepsy, ulcerative colitis, and Crohn’s Disease. As yet, there are no definitive answers as to its efficacy.

CBD in the leaf: Some people with severe pain are chewing the green leaves of marijuana plants for relief. The balance between THC and CBD in the leaf is said to be helpful without giving hallucinations or a ‘high’. People differ in their response to the leaf. They find that if the leaf is green and newly harvested, they can get pain relief and stay sober, even energized, by simply chewing it. If leaves are heated or aged, however, certain effects of THC are felt, and users can become tired and feel unwell. Because of current laws on individual use, this is anecdotal information.

November Ballot: Californians will be voting in November on an initiative to legalize the recreational use of marijuana for those over 21, and to allow small residential cultivation of the plant. Local governments, but not the state government, will be able to tax and regulate marijuana. A bill is pending in the California legislature that would legalize, tax and regulate marijuana, which could generate income for the whole of California. Many proponents say that the initiative is the first step toward a rational drug policy, and will save millions by not putting users in prison. Opponents are anxious about addiction, driving under the influence, use of the drug by more teenagers, and a further proliferation of pot dispensaries. Stay tuned for a detailed discussion of the pros and cons of this important issue as November approaches.
Sadja Greenwood, MD, MPH back issues at on this blog

Cell Signaling via Hormones

2010-06-21T20:27:00.000-07:00

You probably have a cell phone and you may have a computer; many of you contact the world and your friends with calls, texting, email, facebook, twitter, and old-fashioned talk. Within your body, your cells are connected in a much more intricate way, constantly signaling each other through the bloodstream, nerves, and direct or short distance contact. What goes on between your 10-100 trillion cells is amazing; no cell can live in isolation – survival depends on an elaborate intercellular communication network that coordinates the growth and metabolism of cells in diverse organs. In this column I will outline the function of endocrine glands that produce hormones, chemicals that circulate in the bloodstream and affect cells and organs throughout the body.

Endocrine Glands in the Brain
Hypothalamus: this tiny key gland, located near the center of the brain, regulates the anterior pituitary, increasing or decreasing its hormonal output. It regulates the autonomic nervous system, body temperature, and many other functions.
Anterior pituitary: this gland regulates growth hormone, the thyroid gland, the adrenal gland, the ovaries and testes, and milk synthesis in the breast
Posterior pituitary: this gland regulates uterine contraction, milk letdown, and kidney functions in men and women..
Pineal gland: located behind the eyes, the pineal regulates the sleep-wake cycle via the hormone melatonin. Bright light suppresses melatonin and wakes you up, darkness promotes melatonin secretion and puts you to sleep.

With all this happening in glands of the brain, it is clearly important to keep your brain safe and healthy. My advice – avoid brain injury by always wearing helmets for riding bikes or horses, and be very careful on motorcycles. Don’t hit soccer balls with your head, and don’t allow your children to do so. Football and boxing often injure the brain. Avoid drugs and excess alcohol. Treat high blood pressure, to avoid a stroke. Exercise daily and eat healthfully.

Some other Endocrine Glands
Thyroid Gland: located in the lower neck, the thyroid secretes hormones known as T3 and T4, that stimulate the body to consume oxygen, use energy, and thereby increase the rate of metabolism. They also promote protein synthesis. Calcitonin, produced by specialized cells in the thyroid gland, stimulates bone construction.
Adrenal Glands: Located above the kidneys, these glands put out cortisol, which stimulates glucose production, suppresses inflammation, and inhibits immune responses. They also produce aldosterone, which increases blood volume and blood pressure. The adrenals produce androgens, which give women increased facial hair, and become a source of estrogen for women after menopause. The inside of the adrenal glands produce epinephrine – the fight-or-flight hormone, which also increases blood pressure, heart rate and muscular readiness.
Pancreas: Located below the stomach and adjacent to the liver, this organ secretes insulin, which promotes the uptake of glucose from the bloodstream, enabling cells to use it for energy, and the liver to store it as glycogen. The pancreas also secretes glucagon, which acts in the opposite direction, increasing blood glucose levels when needed for activity.
Ovary: Estrogen, produced from pre-puberty to menopause, stimulates the growth of the uterus and its lining, as well as breast cells. It has many effects throughout the body and brain. Estrogen increases the secretion of cholesterol in bile, which is why women in their reproductive years are more prone to gall stones. Progesterone, produced by ovaries in the second half of the menstrual cycle, and during pregnancy, helps to sustain pregnancy. It also has favorable effects on the thyroid, bones, teeth, gums, joints and tendons.
Testis: Androgens from the testes, mainly testosterone, increase muscle mass and strength, deepen the voice and promote the growth of bodily hair. Testes also secrete some estrogen, which helps with bone strength.

There are other hormone secreting organs in the body as well, including the heart, kidneys, skin, gastrointestinal tract, and fat. Imagine all these hormones circulating in the bloodstream, influencing your trillions of cells. It gives me a feeling of awe - of evolution, of our closeness to other animals, who share these hormones, and of the wisdom of our bodies. Stay as healthy as you can, and your body should reward and amaze you with its intricate workings.
Sadja Greenwood, MD, MPH
Back issues at on this blog

Go to Health - Save Your Eyesight

2010-06-08T09:22:00.000-07:00

“Sans teeth, sans eyes, sans taste, sans everything” wrote Shakespeare in As You Like It about the final stage of life. All the world’s a stage is great poetry, but certain steps not available in Shakespeare’s time can preserve your eyesight into old age. (As far as teeth are concerned, visit your dentist! I’ll take up the tooth issue in a later column.)

Glaucoma: A regular checkup by an eye doctor to screen for increased pressure in the fluid of your eyes will detect glaucoma, an eye disease leading to progressive loss of sight. Treatment with medicinal eye drops and laser surgery is effective. Most people should start eye checks at age 35- 40, and follow the testing advice of their eye doctor. Older people, African Americans, Hispanics, and those with a family history of glaucoma are more at risk.

Cataracts are changes in the lens inside the eye that focuses light on the retina (in the back of the eye). When the lens becomes cloudy, vision is impaired. Some causes of cataracts can be avoided – excessive exposure to UV light – wear sunglasses on bright days, and when on the water or in the snow. Start using sunglasses early in life. Don’t smoke! Smoking is a risk factor for cataracts. Stay active and of normal weight, to avoid diabetes, another risk factor for cataracts. Cataracts can be successfully treated with surgery, with the implantation of a new lens.

Macular Degeneration is a deterioration of the central portion of the retina – the interior layer of the eye that transmits signals into the optic nerve. With the macula we see detail – to read, recognize faces, do crafts, and get around safely. There is a dry and a ‘wet’ form of macular degeneration – the wet form can give rapid loss of vision due to blood vessel leaking that scars the retina. Macular degeneration is more common among lightly pigmented people (‘whites’), in smokers, in people who are obese, and in those with a family history of the disease.

Prevention of macular degeneration is important and the following steps are part of a program for healthy living that you already know. The health of your eyes is not separate from the rest of your body:

*Stop smoking! It’s a risk factor for blindness.

*Eat lots of vegetables, especially leafy greens. Kale, spinach. collard greens, broccoli, green peas and Brussels sprouts are all good sources of the antioxidants lutein and zeaxanthin that are especially helpful for the retina. Prolonged cooking decreases the bioavailability of lutein, so steam your greens lightly, and eat a raw salad daily. Egg yolk is another good source of these antioxidants. Chickens that have been out in green pastures lay eggs with the deepest orange yolks, with more lutein.

*Eat fish and/or take fish oil supplements - the omega-3 fatty acids may reduce the risk. A 2009 study at the National Eye Institute in Bethesda showed that a diet with high levels of omega-3 fatty acids resulted in slower progression of macular degeneration (in mice), with improvement in some lesions. The mice also had lower levels of inflammatory makers, which may explain the protective effect.
*Exercise and maintain a healthy weight. A study from the University of Wisconsin found that people who were physically active were markedly less likely to develop macular degeneration.

*Wear sunglasses – they protect the retina

*See your eye doctor regularly

There is great beauty in this world, despite its terrible problems. To enjoy this visual beauty into old age, follow the steps in the column.
Sadja Greenwood, MD, MPH Leave me a message!

Go to Health –Blueberries

2010-05-31T21:12:00.000-07:00

Most of us know that blueberries are healthy – but what do we know to back up this claim? Blueberries were an important food source for Native American tribes in the east; berries, leaves and roots were also considered medicinal. In the last 10 years there has been an increasing research in compounds in blueberries that may prevent disease. Wild blueberries have been found to have a higher antioxidant capacity than cranberries, strawberries, plums, and raspberries. Here is some of the data.

The Brain: blueberries contain ‘anthocyanins’ - pigments found in red/purplish fruits and vegetables – such as purple cabbage, beets, blueberries, cocoa, cherries, raspberries and purple grapes. These pigments are antioxidant and anti-inflammatory, helping to protect brain cells and enhance their ability to signal one another. Researchers at the University of Cincinnati worked with a small group of older adults with early memory changes. Those who drank 2 cups of blueberry juice per day showed improved memory and learning, reduced depression and improved glucose levels after 3 months. Similar results have been found in experimental animals. A study from Reading University in England on people of all ages showed that people taking 200 gm (2 cups) of blueberries in a morning smoothie did better on mental tasks 5 hours later compared to people having a smoothie without blueberries. Two cups is a large (and expensive) amount of blueberries. Strawberries, cocoa and raspberries were said to have similar effects on the brain. A study at Tufts University in Boston on experimental animals showed that blueberries improved motor and navigational skills.

Cancer prevention: Studies at the University of Illinois have looked at 3 phases of cancer development – initiation, promotion and proliferation (metastasis). Various compounds in wild blueberries are helpful in prevention all 3 phases, Researchers at several universities have looked at the ability of blueberry extracts to inhibit the growth of prostate, colon, breast and cervical cancer cells. The work looks promising, but is still laboratory-based and preliminary.

Urinary Tract infections: Rutgers University has a Blueberry-Cranberry Research Center; they have found that both fruits prevent bacteria from adhering to urinary tract tissues, and this help prevent urinary tract infections. A half-cup of blueberries a day may be sufficient for this benefit.

Heart Health: A study on rats at Tufts University and the National Institute on Aging showed that when the animals had a major artery to their hearts tied off, those on a blueberry enriched diet had less damage to their hearts than those on a control diet, and were less likely to develop heart failure. Several studies in Canada and at UC Davis have shown that blueberries can reduce LDL Cholesterol (the kind that can lead to heart attack and stroke).

Diabetes: The anthocyanins in blueberries have been found to reduce blood sugar levels in rodents bred to develop diabetes, according to studies at North Carolina State University. This may mean that blueberries and their juice are safe for people with diabetes. People with high blood sugar should proceed with caution and check their levels. This may be a helpful fruit.

Blueberries and their European cousin, bilberries, are now being grown all over the world. There is said to be a blueberry juice craze in Japan, with the idea that blueberries reduce eyestrain. This has also been studied with bilberries in Europe. Most markets carry frozen blueberries all year, and fresh ones in the summer. They are a good investment.
Sadja Greenwood, MD, MPH Back issues here. Leave me a message!

Go to Health: The Second Brain in Your Gut!

2010-05-10T16:19:00.000-07:00

We have an extensive network of nerve cells (neurons) lining our guts – some call it ‘the second brain’. This nervous system contains about 100 million neurons, more neurons than the spinal cord or the peripheral nervous system (sensory and motor nerves relaying impulses all over the body). The second brain consists of sheaths of neurons embedded in the long tube of our gut, from the esophagus to the anus, It gives the necessary stimuli for mechanical mixing of food in the stomach, breaking down particles, chemical processing, and rhythmical muscle contractions that move food down the intestinal tract. We can feel the inner world of our gut when we pay attention, especially if it gives us pain from malfunction (think of the cramps of dysentery, the discomfort of gas or the pain of appendicitis). Think of ‘butterflies in the stomach’ when you are anxious, or in love, or a ‘knot’ in your midsection when you are asked to do something you don’t want to do! Sudden fear, often felt in the belly, will stop digestion to route blood to your muscles for flight or fight. These feelings can come on before the brain in your head has understood the situation. The second brain works fast!

The second brain makes many neurotransmitters, just like the brain in our heads. Over 80% percent of the body’s serotonin is located in the gut, where it is made from tryptophan (an amino acid found in the proteins we eat). Serotonin regulates intestinal movements. If irritants are present in our food, gut nerve cells release more serotonin, making the gut move faster to get rid of the noxious substance. It can also induce vomiting. Gut serotonin is regularly released into the blood stream, where it is taken up and stored by blood platelets, and used to help in the clotting process when a cut or wound occurs. Serotonin is also important in the regulation of mood, appetite, sleep, muscle contraction and some cognitive processes.

The SSRI antidepressants (Prozac, Paxil, Zoloft, Celexa, Lexapro and others) increase serotonin levels and are highly effective for some people to alleviate depression and anxiety. However they can also can affect the gut and bone strength. Some, but not all, users have abdominal symptoms with these drugs. Serotonin’s role in bone strength is under study - bones get weaker in the presence of more serotonin. Users of SSRIs have been shown to have greater rates of bone loss than average, and should be extra careful to protect their bones with exercise, vitamin D and special medications if needed.

In addition to serotonin, the brain in the gut also makes the neurotransmitters dopamine, glutamate, norephinephrine and nitric oxide, and two dozen small brain proteins, called neuropeptides. Endorphins, that relieve pain, are also made in the gut, as well as tranquilizing substances. The food-mood connection is real.

You can keep your gut happy and healthy by some simple daily habits. Take a probiotic every morning (keep it refrigerated) to ensure a predominance of healthy bacteria in your colon. Eat plenty of simple plant food to ensure good levels of fiber, vitamins, minerals and other plant nutrients. Go for dried figs, dates or bananas instead of cake and candy. You know the rap! Have you tried dried bananas? Wow!
Sadja Greenwood, MD, MPH back columns on this blog. Leave me your thoughts.

Go to Health: Important Updates on Vitamin D and Chocolate

2010-05-05T21:55:00.000-07:00

Vitamin D
Researchers at the University of Copenhagen have just published an important paper - explaining the mechanisms by which vitamin D helps our immune systems fight off viral and bacterial infections. T cells, the cells that detect and kill foreign pathogens must be triggered into action by vitamin D. When the T cell meets a clump of bacteria or viruses, it extends a signaling device - an antenna - known as a vitamin D receptor. If it finds enough vitamin D in the blood, it is transformed into a ‘killer’ cell that will attack and destroy all cells carrying traces of a foreign pathogen, or into a ‘helper’ call that assist the immune system in acquiring ‘memory’. This memory enables the immune system to recognize the pathogen at the next encounter and launch an enhanced response. If vitamin D blood levels are low, T cells are less likely to be transformed into killer or helper cells.

Prior studies have shown that people with higher blood levels of vitamin D are less likely to get respiratory infections. The Copenhagen group has found a mechanism that may explain this. Many local residents suffered from prolonged colds and coughs this winter – getting adequate D is good preventive medicine and may help from now on..

We are heading into summer and the sun is back – so you can get D from safe sun exposure as well as from pills. While the majority of dermatologists discourage exposing skin to sunlight without sunscreen of 15 spf or higher, a few say that 10 minutes a day of exposure of the arms, legs and back is safe and can result in good levels of vitamin D being formed. Avoid sun exposure on your face by wearing sunscreen and a hat, because of skin damage and wrinkles. Get a blood level of 25 hydroxy vitamin D at the clinic, and aim for 35-40 ng/ml by taking vitamin D3 pills as well as safe sun exposure. Most doctors are now suggesting 1000-2000 IU of D daily in pill form.

A recent study from the University of South Carolina, funded by the National Institutes of Health, showed that pregnant women who took 4000 IU of vitamin D daily, starting at three months of pregnancy, had half the usual risk of premature delivery and ‘small for dates’ babies, and a 25% lower risk of respiratory infections, vaginal infections and gum problems. The pregnant women also had less diabetes, high blood pressure and ‘eclampsia’ - a dangerous complication. The university is now studying extra vitamin D for nursing mothers. (If you are pregnant or nursing, check with your doctor!)

Chocolate
In a previous column on chocolate, I wrote that chocolate increases the amount of nitric oxide (NO) in the body. . NO is a gaseous ‘signaling molecule’ that crosses membranes and freely diffuses between cells. It signals the muscular coating around arteries to relax, thus improving blood flow and lowering blood pressure. Another protective effect of NO is its inhibition of blood clotting and the adhesion of white blood cells to the lining of blood vessels. These findings tie in with a joint Swedish-US study that showed that heart attack patients who had eaten chocolate at least twice a week during the year before their attack were 66% less likely to die at that time from cardiac causes. Over the following 8 years, the risk of cardiac mortality went down as chocolate consumption went up – there was a 44% reduction of risk associated with eating chocolate up to once a week. The authors of this study cautioned that chocolate is not a health food, being high in sugars and fats. However, there are healthy ways to eat it. Buy unsweetened cocoa powder (Green and Black is organic and fair trade) and put it in a shake, sweetened with a date or two, pomegranate concentrate, banana, xylitol or stevia. Mash a banana and some peanut butter, add unsweetened cocoa powder, and eat it right away, or put it on toast.

Here’s another benefit – researchers at the University of Barcelona put 47 men and women (age 55 and older) on diets including 1/4th cup unsweetened cocoa powder and skim milk , to be taken twice a day, and found, after a month, that those who drank cocoa had lower levels of inflammatory markers associated with heart disease, and significantly higher HDL cholesterol (the good kind). People sensitive to caffeine should be careful with these amounts of cocoa, as they give a stimulant effect.

Dear readers – I hope your spirits are rising with the sun and the wonderful green plants in your gardens and all around you.
Sadja Greenwood, MD,MPH - back issues at on this blog. Leave me a message!

Methamphetamine – What YOU can do to stop the labs

2010-04-27T08:02:00.000-07:00

We used to worry about meth labs in West Marin, even in Bolinas, picturing a cluttered house stocked with tubing, tanks of explosive chemicals, and a stove with bubbling beakers of a toxic brew. It’s gotten a lot simpler in recent years. Meth is now made in cars. There is a faster, cheaper and simpler method of making small amounts of meth. The ingredients – pills with the decongestant pseudoephedrine (Sudafed) and household chemicals are shaken in a 2 quart soda bottle. No flame is required. The back seat of a car or a bathroom stall are the new makeshift labs. The batches of meth are much smaller, so the addicts who make them are harder to apprehend. According to the NYTimes (4/15/10) roadsides throughout the country are littered with discarded pop bottles and chemicals from these car labs. Cleanup is dangerous and time-consuming, and addicts in cars are hard to apprehend. They are also very dangerous drivers.

The basis for meth production is pseudoephedrine, made in labs in Mexico, China and other countries, often from petroleum-based compounds. The chemical comes into the country illegally. However, most of the new car-based labs use pseudoephedrine pills known as Sudafed, Actifed or Contac. In California, these drugs are no longer directly available over the counter, and a limited amount is sold at any one time. However, drug addicts and dealers employ ‘smurfers’ - people who travel to various pharmacies, using different names, to buy as much Sudafed as possible
States are trying out different techniques to stop the new car labs. Oregon has gone the farthest, with a 2006 law that makes medicines with pseudoephedrine available only with a prescription. The state has seen a marked decrease in seizures of meth labs and in property crime,. Identity theft and child abuse are also linked to meth use. A similar law has been proposed in California, opposed by drug companies and chain drug stores. Oregon’s Senator Ron Wyden has introduced a bill in the US Senate called the Meth Labs Elimination Act, which would take Oregon’s law nationwide. This proposed legislation has been targeted and opposed by drug companies eager to protect their $500 million allergy and cold care business.

Sudafed and related drugs cause stimulation of the central nervous system, including sleeplessness, excitability, dizziness and anxiety. In certain people they can cause blood pressure elevation, a very rapid or irregular heart beat, and stroke.

There are safer ways to deal with nasal congestion due to colds or allergies. Work on eliminating allergens in your home. Rinse your nose with a solution of 4 ounces warm water, ¼ teaspoon salt and 1/8 teaspoon baking soda, using a bulb syringe or a neti pot. Alternatively, you can buy a Sinus Rinse kit in local pharmacies. Use an antihistamine such as Benadryl or Chlor-trimeton, being aware that these drugs can make you sleepy, or Claritin. Vitamin C in high doses is a natural antihistamine; many people take a gram of C every 3-4 hours when they have a runny nose due to a cold or allergy, and get relief without fatigue as a side effect.

But back to meth – here are some steps you can take for the safety of your family and the wider world. Call Jared Huffman, our assemblyman: 415-479-4920. Ask him to support the Wright bill, a measure that would require a prescription for drugs containing pseudoephedrine, which can be made into methamphetamine. Also call Mark Leno, our state senator, 479-6612, with the same message. Take your activism a step further and call Lynn Woolsey, our Congresswoman – 507-9554, and Senators Feinstein -393-0707, and Boxer – 403-0100. These are all local numbers. Ask these congresswomen to support Senator Ron Wyden’s bill to require a prescription for drugs containing pseudoephedrine.

Meth is not a benign recreational drug; it is a killer drug that threatens our youth and also our budgets. If you have any doubts about this, read Tweak, by Nic Sheff, a local youth whose life was profoundly disturbed by methamphetamine. Annual costs for meth detection, cleanup and health care in the US exceed $23 billion. It’s time to try what worked in Oregon to combat this drug.
Sadja Greenwood, MD, MPH - back issues on this blog.

Biological Exuberance; a new view of animal homosexuality

2010-04-05T20:51:00.000-07:00

In his 1999 book Biological Exuberance – Animal Homosexuality and Natural Diversity – the biologist Bruce Bagemihl writes about same-
sex behaviors in a wide variety of primates, other mammals and in many bird species, explaining homosexual courtship, affection, sex, pair bonding and parenting. Same-sex behavior has been documented in over 450 species of animals; biologists point out that only a fraction of the more than a million species known to exist have been studied in any depth, so the number may be far larger. Bagemihl writes that western science has overstressed the importance of heterosexual sex for passing on genes and failed to notice many other kinds of sexual behavior – such as same sex mounting, necking (among male giraffes), oral sex and masturbation- mutual and solo.

Bonobos – pygmy chimpanzees (with whom we share over 99% of our genes) - are predominantly bisexual; females and males have frequent hetero and same-sex contact with each other, including with juveniles. Females also have sex during their pregnancies. Clearly their ‘exuberant’ sexual behavior has meanings beyond reproduction – anthropologists see it as beneficial to the group by creating tribal cohesion and preventing fights over food. These animals truly do make love not war.

Bagemihl points out that western science has attempted to explain animal homosexuality for over two hundred years but has had problems explaining behavior that is non-reproductive. However, from the point of view of biological exuberance, natural systems are driven as much by abundance as by limitations and practicality. Seen in this light, homosexuality and non-reproductive heterosexuality are “expected occurrences” – they are one manifestation of an overall “extravagance” of biological systems that has many other expressions.
Bagemihl. 1999. (Think of the peacock’s tail.)

In 2006, the Natural History Museum in Oslo opened the first-ever museum exhibition dedicated to gay animals. The exhibit , titled Against Nature?, showed photographs of the more than 1500 species (their count)where homosexuality has been observed – from insects to mammals. The curators stated that a greater understanding of how extensive and common this behavior is among animals could help to demystify homosexuality among people. You can see a few of the outstanding photographs of this exhibit by going to google : Against Nature? Exhibition in Oslo.

In today’s New York Times Magazine, April 4, 2010, the article The love that Dare Not Squawk its Name concerns new studies on animal homosexuality, mostly among seabirds. Careful observation of the Laysan Albatross, who nest in Hawaii, reveals that a third of nesting pairs are made up of two females. One or both mate briefly with a male and then return to their female nest-mate, with whom they may bond for many years. Taking off from Bagemihl’s theories, scientists are thinking that homosexuality must be seen as having different ‘purposes’ or manifestations in each species - it is a byproduct of reproductive sex, but cannot easily be explained by our current Darwinian model. New thinking is needed about the possible benefits of homosexuals to the family or the group, and also about homosexuality and bisexuality being a by-product of exuberant desire for sexual play.

Scientists studying animal sexual behavior have generally been careful not to extrapolate their findings to human society, but of course their findings have had an impact on the wider world. After publishing, the authors have been reviled by homophobes and cheered by many liberals and the GLBT community. The culture wars go on – and will undoubtedly be affected by new findings from other animals.
Sadja Greenwood, MD – back issues on this blog

Magnesium - for your bones, energy and brain

2010-03-30T20:36:00.000-07:00

Magnesium is in the center of the chlorophyll molecule – just as iron is in hemoglobin. How impressive is that!

Magnesium is abundant in green vegetables (think chlorophyll), beans, whole grains, nuts, edible seeds such as pumpkin and sunflower, bananas, chocolate and many other unrefined plant foods. How can it be that a recent report from the US Department of Agriculture indicated that only 32% of us were getting adequate magnesium in our diet? Perhaps this is because we are not following Michael Pollan’s rule “If it came from a plant, eat it; if it was made in a plant, don’t.” A lot of us are filling up on things our ancestors would not recognize as food.

Bones: Magnesium is stored in bones; if there is not enough, bones become more brittle. A study from Tufts University of 900 elderly men and women found higher dietary magnesium intakes were associated with increased bone mineral density at the hip. Eating an unrefined plant based diet gives abundant magnesium as well as potassium, and will help bone strength by creating a more alkaline urine, thereby minimizing calcium loss.

Energy: The body provides energy for all metabolic processes by transforming carbohydrates and fats into a molecule called ATP, which exists as a complex with magnesium. A study from the Agricultural Research Service in North Dakota showed that people with inadequate levels of magnesium need more oxygen during exercise, and tire more quickly, than those with adequate levels.
Heart: Magnesium helps to maintain a normal heart rhythm. Magnesium supplements are sometimes suggested by cardiologists for people with intermittent atrial fibrillation or with cardiac failure. Studies have shown that a high dietary intake of magnesium (lots of unrefined plant food) may decrease blood pressure. This kind of diet is also rich in potassium and calcium, so it is difficult to sort out the factors involved.

Brain: An international study Tsinghua University in Beijing, University of Toronto, MIT, and Tel Aviv University showed that increased levels of magnesium in the brain enhanced learning and memory (in rats). The researchers used a new supplement that passed the blood-brain barrier and entered the brain. While this supplement is not available, they stated that people should get their magnesium from dietary sources – noting that half of all people in industrialized countries have magnesium deficiencies.. A better, plant-based diet may delay the cognitive impairment of aging.

Getting Enough Magnesium (Mg) It’s easy to get plenty of magnesium by eating green vegetables, beans, nuts, seeds and whole grains. Taking Mg as a supplement can be dangerous for people with kidney disease – especially for older people - so check with your doctor. The Institute of Medicine has set a ‘tolerable upper intake’ for Mg pills at 350 mg/day, and many women take that amount with their calcium supplements. Higher levels can cause diarrhea and gastrointestinal discomfort. Magnesium citrate is commonly used as a safe supplement in sensible doses. Two forms of Mg are laxatives and should not be taken regularly – magnesium sulfate (Epsom salts) and magnesium hydroxide (Milk of Magnesia).. Final word – here's another reason to go for the greens!
Sadja Greenwood MD, MPH Back issues on this blog

Important Supplements

2010-03-21T20:34:00.000-07:00

IMPORTANT SUPPLEMENTS
Dear readers: this is a summary of a talk I gave at Commonweal on March 7, 2010. Below are some suggested supplements that may help to give you maximum health. However, eating a good diet is the first key to health. Here in West Marin we are blessed to have great organic farmers giving us wonderful vegetables and fruits. Have these every day, along with local diary products and eggs, and small amounts of poultry, fish and meat. Walk, run or bike - spring is on its way. And remember to give thanks to your local farmers, especially organic farmers, for their hard work and provisions.

WOMEN 18-50
*Multivitamin (for folic acid) in case of pregnancy. Folic acid helps prevent birth defects. Multis should contain iron because of menstrual blood loss.
*Calcium - 600-1000 mg daily – to get 1200 mg from pills and diet. Calcium helps bone strength and may help with premenstrual tension.
*Magnesium 300 – 350 mg daily. Magnesium helps bone strength and has numerous positive effects on the body.
*Vitamin D – 1000 – 2000 IU – or enough to keep blood level of 25 hydroxy vitamin D 35 – 40 ng/ml. People with darker skin may need more D to get to these levels. Vitamin D helps with bone strength, prevention of infection and cancer and keeps your brain sharp.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule – or eat fish 2-3 times a week. The omega-3 fatty acids in fish oil help your heart and are important for your brain and mood.
*Probiotic on arising – these contain beneficial bacteria that help your immune system fight off colds, and infections of the vagina and bladder

WOMEN OVER 50
*Multivitamin without iron – if diet is haphazard
*Calcium and magnesium as above
*Vitamin D, Vitamin C, Probiotic -the same as for women under 50.
*Fish Oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500pg/ml is desirable. As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.

MEN 18-50
*Multivitamin without iron–if diet is haphazard
*Vitamin D – 1000 IU -2000- or enough to keep blood level of 25 hydroxy vitamin D 35 - 40 ng/ml. People with darker skin may need more D to get to these levels.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule - or eat fish 2-3 times a week
*Probiotic on arising

MEN OVER 50
*Multivitamin without iron–if diet is haphazard
*Vitamin D , Vitamin C, Probiotic, the same as for men under 50
*Fish oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500 pg/ml is desirable
As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
Sadja Greenwood, MD, MPH back issues on this blog

Folic acid: an essential B vitamin with a warning on overdose

2010-01-24T19:24:00.000-08:00

Folate is the naturally occurring form of vitamin B9, while folic acid is the synthesized form. This vitamin is essential in the synthesis and repair of DNA, in the production of red and white blood cells, in the synthesis of important amino acids, and in any period of rapid cell growth, such as childhood and pregnancy.

The urgent need for Folate in pregnancy Neural tube defects are among the most dreaded birth defects, affecting 1 in 1500 births in the US today. The baby is born without a major portion of its brain and skull (and dies shortly after birth) or with incomplete closure of the spinal cord in the back, leading to some degree of paralysis, pain, and problems with bowel and bladder function. Insufficient folate in the diet (along with genetic and unknown factors) plays a role in this problem, and supplementation of the mother’s diet can decrease the incidence of neural tube defects by more than 70%. The folic acid supplement, as well as adequate dietary intake of folate, should start even before the beginning of pregnancy, as the neural tube starts developing in the first month. It is extremely important for young women to take a multivitamin containing 400 micrograms (mcg) of folic acid on a regular basis; even if she does not plan to become pregnant (at least 50% of pregnancies are unplanned; in celibate or lesbian women the multi will also help with a possibly haphazard diet.) More folate is needed during pregnancy and lactation. Because not all girls and young women take vitamins, the FDA mandated the fortification of refined grain products (white flour, pasta, breakfast cereals) with folic acid in 1998. It is estimated that young women get about 100 mcg a day of folic acid from fortified cereal grains – which is an improvement, but insufficient. An excellent diet and/or a multivitamin is still important. Studies show an approximate 50% reduction in neural tube defects in the US since fortification in 1998. Similar programs of fortification have taken place in Costa Rica and many European countries. Other problems in pregnancy, such as fetal cleft lip, premature delivery and serious bleeding at delivery from placental detachment, have been associated with folate deficiency. See http://www.nytimes.com/2010/01/03/opinion/03kristof.html for Nicolas Kristof’s opinion page article on the benefits of micronutrient enrichment of foods in Honduras and elsewhere.

Homocysteine: Homocysteine is an amino acid that used to be associated with higher rates of heart disease amd stroke; it can be lowered by conversion into methionine (another amino acid) by folic acid, vitamins B6 and B12. However, studies from two Canadian Universities in 2006 showed that lowering homocysteine levels with these B vitamins did not decrease the risk of heart attack or death from heart disease, but did significantly decrease the risk of stroke. Studies also show that lowering homocysteine levels with B vitamins in people with former strokes lowers their risk of hip fractures.

Anemia: People with a low intake of folate from food, or with chronic alcoholism, can develop a kind of anemia characterized by large, malformed red blood cells. This anemia is akin to ‘pernicious anemia’ related to vitamin B12 deficiency, and can have serious consequences. Medical care is essential.

Cancer: There is growing controversy over the effects of giving high dose folic acid supplements to prevent cancer or other diseases, since recent clinical trials have shown an increase in lung cancer and polyps of the colon. Animal experiments show that small amounts of folic acid supplements can decrease cancer risk, and high amounts can increase it. However, no amount of folate in foods is dangerous and studies show a decreased cancer risk, including breast cancer, among those with the highest dietary intakes.

Foods containing folate: All forms of green leafy vegetables, broccoli, avocado, asparagus, peas, beans of all kinds, lentils, peanuts, wheat germ, oranges and other citrus fruits, and many other whole foods contain folate. You will benefit from folate by making vegetables and fruits the center of your diet. Cooking can destroy folate, so it is best to steam or stir fry vegetables lightly, or cook them in a microwave. Avoid boiling in abundant water.

What’s the bottom line with folate and folic acid supplements?
Keep eating as many vegetables and fruits as possible, and include raw salads in your daily fare. You will be ingesting plenty of folate, which is a very good thing. Young women who might become pregnant should take a daily multi with 400 mcg of folic acid and special vitamins during pregnancy. Adult multivitamins with 400 mcg of folic acid should be taken by people with high risk of stroke or a prior stroke, and by those dependent on alcohol. For other adults, a multi is probably safe, if it contains no more than 400 mcg of folic acid. Who said it would be simple?
Sadja Greenwood, MD, MPH past issues on this blog

Selenium: Take a Supplement, or a Brazil Nut?

2010-01-21T16:59:00.000-08:00

Selenium is an element that is essential in the human diet in small amounts, but toxic at high levels. All animals require selenium, since we evolved from the sea where it is abundant. Plants do not appear to require selenium for survival, but incorporate it into their structures. Edible plants contain differing amounts of selenium, as the element is found in varying amounts in rocks and soil throughout the world. The element is found in higher amounts where there were inland seas.

Thyroid hormone: While iodine is essential for the synthesis of thyroid hormone, a selenium dependent enzyme must be present to activate this hormone, which in turn regulates normal growth, development and metabolism.

Sperm development: a recent study from Vanderbilt University showed that a protein containing selenium is essential for normal sperm development and male fertility.

Viral Infection: selenium deficiency appears to enhance the virulence of some viral infections, by inducing mutations in the expression of some viral genes. In a region of China where soils are very low in selenium, young women and children develop a disease of the heart muscle; this seems to be worsened by a change in a common virus that affects the heart. Selenium supplementation can protect against this, but cannot reverse the damage to the heart muscle.

Cancer – a mixed picture: Chronic infection with viral hepatitis B or C increases the risk of liver cancer; selenium supplements given in China in an area with a high incidence of hepatitis B and liver cancer reduced the incidence of this cancer. Similar findings were seen in Taiwan. A study in Finland showed that low selenium status in creased the risk of lung cancer: the association was more pronounced in smokers. On the other hand, a prospective study of more than 60,000 female nurses in the US found no association between selenium levels and total cancer risk. The data on prostate cancer are confusing – several studies have shown lower selenium levels in men with prostate cancer, but a recent large study from the National Cancer Institute, following 295,344 men who were cancer free on enrollment, found that excessive multivitamin use (more than 7 times per week) increased the risk of fatal prostate cancer compared with never users. The positive association with prostate cancer and excessive multivitamin use was strongest in men with a family history of prostate cancer or in men who took supplemental selenium, zinc, or beta-carotene. Further studies are needed to understand whether selenium levels in the body are linked to prostate cancer, and several are underway. Selenium supplements (200 micrograms daily) increased the risk of squamous cell skin cancer in a study from Memorial Sloan-Kettering, and did not alter the incidence of basal cell skin cancers.

HIV/AIDS: Declining selenium levels are found in HIV infected people and are markers of disease progression and severity. A randomized control trial of HIV positive men and women from the University of Miami found that selenium supplements (200 micrograms a day) taken for 2 years significantly decreased the rates of hospitalization. A further study showed a decreased viral load and more CD4 cells with the same dose of selenium.. Proteins containing selenium negatively affect the replication of the AIDS virus. Many AIDS patients in the US take selenium supplements, and it is also used in some African countries/
Who needs selenium supplements? Based on the information currently available, it is wise for most people to get this trace element in their diet, and not from supplements. Supplemental selenium should be considered by people with HIV infections, and by those with severe gastrointestinal problems such as Crohn’s disease or surgical removal of part of the stomach or intestines.

Food Sources of Selenium: Organ meats, shellfish and other healthy (non-endangered) fish are the important sources of selenium in our diets. Whole grains are also important sources (avoid white flour and white rice), as are sunflower seeds, and other nuts. Whole grains grown in Nebraska and the Dakotas have high levels (but who knows the origin of the wheat in our daily bread?) Brazil nuts grown in areas of Brazil with selenium-rich soil may provide 50 to 100 mcg in one nut, which is an excellent daily amount for adults. However, Brazil nuts grown on selenium-poor soil may provide 10 times less – another ‘who knows?’ conundrum. Studies from New Zealand have shown that the selenium in Brazil nuts improves serum selenium levels as effectively as supplements. My final conclusion from all this is that adults can benefit from a daily Brazil nut! You can give a few Brazil nuts a week to children over age 9. Good news - it seems that the cultivation of Brazil nuts will improve conditions in the rainforests of Brazil; the nut is not suitable for growth in plantations and can only grow in the rainforest itself.
Sadja Greenwood, MD back issues onsadjascolumns.blogspot.com

Is there a Supreme Bean?

2010-01-13T13:17:00.000-08:00

Go to Health: Is there a Supreme Bean?

Some insist that it’s coffee, but for many it’s the soybean, which nourishes hungry people throughout the world; its balance of essential amino acids makes soy a plant protein as valuable as eggs or meat. Soy has been grown in China for some 5000 years, to enrich the soil (like other beans it has bacteria on its roots that fix nitrogen), and for human consumption.

Heart Disease Prevention: Following studies showing significant decreases in serum cholesterol, LDL cholesterol (the ‘bad’ kind) and triglycerides, the FDA granted a health claim for soy in 1999: “25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” HDL, (‘good cholesterol’) did not increase. Recently, new studies have challenged the ‘heart healthy’ claim for soy protein per se, but concede that soy milk, tofu, soy nuts and some soy burgers should be beneficial to heart health because of their polyunsaturated fats, fiber, vitamins and low content of saturated fat. The American Heart Association said: “Using these soy foods to replace foods high in animal protein that contain saturated fat and cholesterol may confer benefits to cardiovascular health.”

Breast Cancer: Genistein and daidzein (so called phytoestrogens, or plant estrogens) are substances in soy that are similar structurally to human estrogen but act differently in the human body. They have much lower biologic activity than human estrogens and in some cases may function as anti-estrogens. A recent study on breast cancer and soy from Vanderbilt University was encouraging. The researchers looked at 5000 Chinese women in Shanghai, ages 20 -75, who were breast cancer survivors. They found those who ate the most soy (15 grams or more of soy protein daily) had a 29% lower risk of dying than those who consumed the least (5 grams or less). A similar benefit appeared for breast cancer recurrence risk regardless of tamoxifen use. The benefits of soy increased up to 11 grams of soy protein daily, and then leveled off or reversed, so more was not necessarily better. The women ate mainly tofu and whole soy beans. The researchers warned that similar benefits can not be extrapolated to dietary supplements containing soy (pills, bars or foods containing isolated soy protein). The associations did not vary with menopausal status, cancer stage, or estrogen receptor status of a woman’s cancer.

Vitamin K2 & Hip Fracture: a recent study from the University of Tokyo School of Medicine showed that natto, a Japanese fermented soybean food, contains large amounts of Vitamin K2; there is increasing evidence that Vitamin K plays a positive role in bone strength and osteoporosis prevention. Serum concentrations of vitamin K2 were significantly higher in frequent natto eaters, and the incidence of hip fracture was correspondingly lower, in every prefecture of Japan.

Soybean foods in the US: Today about 90% of soybeans grown in the US are genetically modified to make the plant resistant to the herbicide Roundup. Ninety percent of these beans are turned into soy oil and defatted soy meal that is fed to chickens, turkeys and pigs. The abundance of soy meal, as well as corn, makes possible the new and very problematic industrial farming of these animals. The US, Brazil and Argentina are major growers and exporters of soybeans, and the Brazilian crop has been responsible for a considerable loss of rainforest. Some soybeans, including organic soybeans, made into human foods in the US are imported from Brazil and China, where organic standards may differ from ours. Most Silk soymilk is no longer organic; the company was bought over by Dean Foods and switched many of their products to “natural” rather than organic. Edensoy products are made from organic soybeans grown in the US; Westsoy, Wildwood and others also have organic soy products. If you care about this issue, read labels! To get the benefits of soy, nutritionists advise people to eat whole soy products, such as tofu, tempeh, soy milk and soy nuts, rather than manufactured foods containing isolated soy protein. Happy New Year, dear readers, and let us all appreciate the natural foods stores and organic farmers in West Marin.

Sadja Greenwood, MD, back issues at sadjascolumns.blogspot.com

Mushrooms & Green Tea are associated with lower breast cancer risk in a Chinese study

2009-12-21T12:58:00.000-08:00

A study in the International Journal of Cancer, March 15, 2009, looked at 1009 women in China newly diagnosed with breast cancer and compared them with 1009 healthy age-matched women. The researchers – from the University of Perth in Australia - adjusted for known risk factors for breast cancer, such as smoking, passive smoke exposure or close relatives with breast cancer. Working with detailed registers of the women’s consumption of 100 different foods, they found that women who consumed (on the average) more than 10 grams (.353 ounces) of fresh mushrooms a day had 64% less risk of developing breast cancer that those who did not eat mushrooms. The effect was dose dependent – the more mushrooms women reported eating, the lower their risk. Moreover, intake of fresh or dried mushrooms plus green tea had an additive, dose dependent effect on risk. Those who consumed the most green tea plus fresh mushrooms lowered their risk of breast cancer by 89%. All types of mushrooms consumed by the women in this study were counted.; the most common types were white button mushrooms (Agaricus bisporus) and fragrant dried mushrooms (Lentinula edodes). The author of this study, Dr. Min Zhang, noted that the rate of breast cancer in China is 4-5 times lower that that in developed countries. She speculated that the Chinese diet, high in green tea and mushrooms, might play a role. Rates of breast cancer are currently rising in the more affluent parts of China. Researchers have suggested that the adoption of a more western diet may be a causative factor.

So – if you are looking for a way to counteract the western diet of cookies and egg-nog in the next few weeks – here is the famous list of

The 11 Best Foods You Aren’t Eating by nutritionist and author Jonny Bowden, printed in the New York Times and a ‘most viewed story’ of 2008.

Beets – Think of beets as red spinach says Bowden, with folate and red pigments that may be cancer fighters.

Eat them raw – grated into salad

Cabbage – a brassica vegetable, similar to broccoli – with anti cancer effects – see my blog on brassicas.

Swiss Chard - lots of beneficial carotenes in the leaves.

Cinnamon –lowers blood sugar and LDL cholesterol

Pomegranate juice – increases blood flow in the heart muscle. See my blog on pomegranate for details.

Prunes – packed with antioxidants, and a safe laxative

Pumpkin Seeds – good source of protein, magnesium and zinc. Toast and eat.

Canned Pumpkin –an easy way to get lots of carotenes - use in soup and whole grain pancakes.

Sardines – lots of omega-3 fatty acids, high in calcium – try the low sodium kind with bones and skin intact. Turmeric – anti-cancer, good for the brain, see my blog for details. It’s in curry powder. Add to rice and stir fries.

Frozen Blueberries – associated with better memory in studies of aging animals. Add to a yogurt or soy smoothie.

Dear Readers – I wish you a wonderful Solstice as you celebrate the light returning. Stay warm with a cup of green tea and some sauteed mushrooms. They are protective for men as well as women. Have a joyous Christmas, whether you are a Christian, Jew, Atheist, Muslim, Buddhist, Pagan, Pantheist or other spiritual path. It’s the spirit of friendship that counts.

Sadja Greenwood, MD, MPH back issues on this blog

Exploring Slow

2009-12-14T11:25:00.000-08:00

Life in the fast lane: multi tasking, 24/7, the 70 hour work week, texting while driving, texting during sex, road rage, fast food, take-out (wrapped in plastic), after-school classes and scheduled sports every afternoon and weekend. If you want to hang on, you’d better speed up.

However, there’s a counter-trend in the world, called the Slow Movement.

Slow Food In 1986 McDonald’s tried to open a shop near the Spanish steps in Rome; this triggered a movement that has spread to over 132 countries. Slow Food aims to preserve and celebrate the cultural cuisine, associated plants and animals and farming practices of an ecoregion. Its aims include forming seed banks to preserve heirloom varieties of local foods, educating the public on the risks of factory farms, pesticides and fast food, teaching gardening to students and prisoners, preserving family farms and reviving home cooked meals with local ingredients from each locale. Family farmers from every continent attend Terra Madre, the bi-annual slow food conference in Italy, The work of Alice Waters to teach students about food and healthy eating through schoolyard gardens, and Michelle Obama’s organic garden on the White House lawn are all related to the slow food movement.

Slow Parenting Children (in middle and upper class families) are generally enrolled in numerous after-school classes and organized sports – while each of these activities is valuable in itself, the result is that there is little time for free play before or after a heavy load of homework. One rationale is that the world is more dangerous, so that unsupervised play outside is risky; another is that such activities are needed for entry to a good high school or college, and another that both parents are working and need after-school childcare. It is hard for parents to find a way out of these problems, but awareness of the child’s need for free play and an individual learning style is a start. The slow parenting movement advises that children should pick their own activities, rather than fulfill their parents’ dreams. Parents should turn off the television and allow children to play with simple toys, make their own breakfast, and explore the out-of-doors whenever possible. ‘Cramming schools’ to push for higher academic results put children under continuous competitive pressure and take away their own creativity and independence. The slow movement has even reached the Ivy League. In a 2005 letter to Harvard students, the Dean advised students not to become overcommitted with athletics, clubs, arts and classes, or to be stretched too thin to appreciate other aspects of college life, including friendships and time to explore unexpected areas of knowledge.

Slow Medicine American medicine manages acute problems and specialized procedures such as organ transplants, eye surgeries and joint replacements extremely well. Chronic diseases that require education, lifestyle changes and home support are often handled less well by overworked doctors and nurses. Slower acting modalities such as appropriate exercise, healthy eating, and meditation are not paid for or readily available. Some elderly patients are subjected to ‘death by intensive care’ when home-based care would be more comforting and comfortable. The ‘slow medicine’ movement sees family, friends, visiting nurses and hospice workers improving the life of older patients at home by offering emotional support, social stimulation, better nutrition and help with sleeping, moving, bathing and other activities. Many towns and cities have organizations providing such services, and they deserve support.

Slow sex The movement for slow food, and enjoying a slower life began in Italy. So did the discussion of slow sex. There are current articles in our popular magazines about what sex researchers found in the 1960’s – the longer the foreplay, the better the climax for both partners. Many women who cannot achieve orgasm in intercourse can easily do so by clitoral stimulation. The Pointer Sisters have a song that lays it out for heterosexual couples - Slow Hand: I want a man with a slow hand – I want a lover with an easy touch….. (YouTube Pointer Sisters – Slow Hand)

The Slow Movement Summed Up:

“The trouble with the rat race is that even if you win, you’re still a rat.” Lily Tomlin. “Anything worth doing is worth doing slowly.” Mae West

In Praise of Slowness: How a Worldwide Movement is Challenging the Cult of Speed by Carl Honore

Under Pressure: Rescuing Our Children from the Culture of Hyper-Parenting by Carl Honore

Sadja Greenwood, MD, MPH back issues on this website

Go to Health - Vitamin K

2009-12-01T08:00:00.000-08:00

Vitamin K is a fat-soluble vitamin – a substance essential for the human body. The K comes from the German word for coagulation – or blood clotting. Plants synthesize vitamin K1 (phylooquinone); when we eat green vegetables or certain vegetable oils, bacteria in our guts transform the K1 from food to K2, the main active form in our bodies. Vitamin K is essential for blood clotting and bone strength.

Blood Clotting: As soon as a blood vessel is damaged, the body begins to prevent serious bleeding by many mechanisms. Blood platelets form a plug at the site of injury, and proteins in the blood - called clotting factors – are activated to form fibrin strands which strengthen the platelet plug. Vitamin K is essential for the formation of many of the clotting factors in this process. Since these clotting factors are made in the liver, severe liver disease may result in lower blood levels and a risk of uncontrolled bleeding. Alternatively, some people are at risk of forming clots which could block the flow of blood in arteries to the heart, brain or lungs, resulting in heart attack, stroke or pulmonary embolism. If they take Coumadin as an anticoagulant, the drug works by antagonizing the action of vitamin K. Doctors advise patients on Coumadin to have a reasonably constant amount of green vegetables containing vitamin K in their diets, but not to avoid them..

Bone mineralization: Osteoblasts are bone-forming cells that make proteins essential for bone mineralization. Vitamin K plays a role in the synthesis of these proteins (their activity is also regulated by vitamin D). Population studies have shown a relationship between foods containing vitamin K and hip fracture – the Nurses’ Health Study followed 72,000 women for 10 years and found that those with the highest intake of vitamin K had a significantly lower risk of hip fracture than those with lesser intake. Lettuce was the food contributing the most to vitamin K intake. A similar finding was seen in the Framingham Heart Study of men and women – a 65% lower risk of hip fracture in those in the highest quartile of vitamin K intake from food, compared to those in the lowest, despite no association with bone mineral density. Researchers in Japan used very high doses of supplemental vitamin K in patients on hemodialysis and in osteoporotic women and reported significant reductions in bone loss and fracture risk. However, using supplemental K at doses attainable in the diet has shown mixed results with respect to bone density. There are inconsistencies here that need further research.

Foods containing Vitamin K: A good diet that includes a daily intake of green leafy vegetables is endorsed by all vitamin K researchers. Kale, chard, spinach and broccoli are high in K, and lettuce is moderately high. . Levels of K are not reduced by many cooking methods, however it is unwise to cook most vegetables in abundant water if you discard the cooking water. Canola, soy and olive oils all contain vitamin K. To eat the amount of foods high in K associated with a decreased risk of hip fracture in the Framingham Heart Study, an individual would need to eat at least a cup of cooked dark green vegetables a day, or a large salad of mixed greens. Many multivitamins now include small amounts of Vitamin K1; while this may be helpful, it should not substitute for leafy greens in the diet. Using olive, canola or soy oils instead of butter will increase K intake and provide less saturated fat. Prolonged use of broad spectrum antibiotics may decrease the synthesis of K by intestinal bacteria, so extra care will be needed to get adequate levels from food and multivitamins. Here in California we have access to leafy greens throughout the year, often locally grown. A really easy green vegetable to grow yourself is the fava bean – and you don’t have to wait for the beans to form. Their green leaves are delicious and are becoming a culinary trend in salad or cooked.

Sadja Greenwood, MD, MPH. Past issues on this blog. Leave me a comment if you wish.

More on Exercise

2009-11-22T19:52:00.000-08:00

The December copy of Nutrition Action, a monthly newsletter published by Center for Science in the Public Interest - www.cspinet.org - (highly recommended by this writer) has some interesting data on exercise that is a good balance to holiday eating. Here is a summary:

New Brain Cells: Exercise increases blood flow to the brain, and stimulates the growth of new brain cells, synapses, and new blood capillaries. In a study at the University of Illinois, older men and women on an aerobic training program showed an increase in brain volume after 6 months. A control group doing toning and stretching did not develop greater brain volume. The abilities to make logical connections, to navigate in space, and to plan and make decisions are all improved with aerobic exercise.

Cancer protection: Studies on exercise and colon cancer show that the most active people are about 21% less likely to be diagnosed with this disease than the least active people. Numerous studies have shown that women who engage in moderate to vigorous exercise are less likely to get breast cancer. One (but not the only) protective mechanism may be preventing weight gain – weight gain is associated with cancers of the breast (after menopause), colon, uterus, pancreas, and esophagus.

Insulin Sensitivity: Both aerobic exercise and strength training increase the ability of insulin to move blood glucose (sugar) into cells. This is important in the prevention or treatment of diabetes, because in this disease cells become resistant (insensitive) to insulin. As a result, glucose levels rise in the blood instead of entering into cells. Both aerobic and strength training increase the amount of a protein called a glucose transporter, which moves glucose into cells.

Sitting is dangerous!: A Canadian Study looked at 17,000 adults in a fitness survey, and found that mortality rates after 12 years were related to the amount of time people spent sitting. The mortality rate was 20% in people who sat most of the day, 12% in those who sat about half the day, and 6% in those who rarely sat down. The take home message – stand up and move around. Thirty minutes of exercise a day does not counteract the effects on muscles of prolonged sitting, which in turn effects the regulation of insulin and blood glucose.

Visceral Fat: Fat that lies inside the abdominal cavity is linked to insulin resistance, diabetes, and heart disease and is thus more dangerous than fat found under the skin. A daily brisk 30 minute walk will help to decrease visceral fat – but inactivity results in a rise of visceral fat with aging.

Stroke and Heart Disease: Aerobic exercise lowers the risk of both stroke and heart attack. Aim for 30 minutes or more of brisk walking or other exercise 5-6 days a week.

Blood Pressure: Aerobic exercise can lower blood pressure –the effect may be moderate, but some people are able to get off blood pressure medications.

Broken Bones: Weight bearing aerobic exercise and strength training will help to lessen osteoporosis. A study from Harvard showed that walking for at least 4 hours a week was associated with a 41% lower risk of hip fracture compared with women who walked less than 1 hour a week. More time spent standing was also associated with lower risk. Older people who are physically active are also less likely to fall. Balance and strength training are important to prevent falls

Depression and Anxiety: Numerous studies have shown that physical activity helps to relieve depression. Researchers at Princeton and the University of Colorado are finding that in animals and in the human animal, regular aerobic exercise helps to relieve stress and anxiety.

Exercise in West Marin or where you live: We have a wonderful variety of opportunities to move our bodies here at home: hiking trails, some quite steep and all beautiful, beach walking and running, a new bike path, numerous classes in our community centers, including folk, African, and ballroom dancing, special classes for seniors, and two fitness centers. I’ve left out the soccer fields, aerobic gardening and a lot more. For those who need help to get started, I suggest the buddy system: find a friend, make plans together, and keep each other on track. Hopefully we can all look as good as the Obamas one day.

Sadja Greenwood, MD, MPH past issues on this blog

Go to Health - CoQ10

2009-11-16T10:53:00.000-08:00

An enzyme is a protein that acts as a catalyst in chemical reactions in the body, helping to turn simpler molecules into larger and more useful ones. A co-enzyme is a small molecule that enhances the action of an enzyme. Coenzyme Q10 (CoQ10) is a substance found in the mitochondria of every cell in the body, where it helps to transform simple molecules from food into energy. (Mitochondria are tiny energy producing organelles in the cell.) CoQ10 levels are reported to decrease with age, and to be low in people with some chronic diseases, such as heart failure, Parkinson’s disease, and AIDS. The use of statin drugs to reduce cholesterol levels has also been found to lower levels of CoQ10, as CoQ10 and cholesterol are made in the liver by a common biosynthetic pathway. These are the rationales for using CoQ10 as an over-the-counter supplement. Here is some of the evidence:

Parkinson’s disease: A study in 2002 from UC San Diego showed that 1200 mg of CoQ10 daily slowed the progression of Parkinson’s in patients with early onset disease. A larger multi-center clinical trial of 600 patients with Parkinson’s is underway, sponsored by the National Institute of Health, to determine if 1,200 or 2,400 mg of CoQ10 will be more helpful in slowing progression of the disease. Although the supplement has not been shown to have serious side effects, these high doses of CoQ10 should be monitored by a doctor.

Heart Disease: In congestive heart failure, the heart has lost its ability to pump enough blood for all the body’s needs. Fluid may collect in the legs and lungs, and the patient feels substantial fatigue. CoQ10 has been used in this condition, along with usual medical therapies. Although many people use this non-toxic therapy, studies to determine if CoQ10 is helpful in heart failure have not been conclusive so far; another trial is underway.

A trial in India in 1999 showed a significant decrease in blood pressure in hypertensive patients treated with CoQ10 along with their other medications, as did a similar trial in 2001 at the VA Medical Center in Boise. An Australian paper published in 2007 looked at 12 clinical trials of CoQ10 in hypertensive patients, and concluded that it had the potential to lower systolic blood pressure by 17 points and diastolic pressure by 10 points, without serious side effects. This is an important finding, which seems to have been ignored by most doctors.

Many people with elevated serum cholesterol and increased risk of heart attack take medications called statins, which lower the liver’s synthesis of cholesterol, and also of CoQ10. Statins can give side effects such as muscle pain, problems with memory and concentration, mood changes et al. UC San Diego has a helpful website on the side effects of statins and the possible help of CoQ10 with the muscle and cognitive problems that statins can bring. https://www.statineffects.com/info/index.htm

Gum Disease: there is some evidence that people with swelling, redness, bleeding and pain in their gums improved with topical (mouth rinse or gel) and oral CoQ10 . If you have gingivitis/periodontal disease, talk to your dentist about this approach, and just give it a try.

Male Infertility: A study from the University of Ancona in Italy found that young men with unexplained infertility had greater sperm motility after taking 200 mg of CoQ10 twice daily for 6 months, and 14% of couples achieved pregnancy. A similar study from Shahid Beheshti University in Iran showed a significant improvement in sperm counts and motility in men receiving 300 mg of CoQ10 daily for a year. Further studies are needed to see if these results will translate into achieving pregnancy.

Cancer, AIDS, etc

There are numerous case reports of patients with breast cancer, AIDS and other serious illnesses who benefited from taking CoQ10, often in doses of 300 mg or more daily. These cases have not received adequate study, so I advise my readers to look for the evidence and talk to your doctor for advice.

Supplemental CoQ10: CoQ10 is synthesized by the body and also consumed in food – which is sufficient for healthy people. When indicated for illness, supplemental CoQ10 is best taken in gel form, absorbed with fats in a meal. Doses usually range from 100-300 mg - if you take over 100 mg, use divided doses. Side effects are minimal, and the supplement is considered safe. There is a possible interaction with coumadin (warfarin), so talk to your doctor if you take blood thinners.

Sadja Greenwood, MD, MPH past issues at on this blog

Assisted Suicide and Palliative Sedation

2009-11-09T11:38:00.000-08:00

I was helping my sister in her office when she casually handed me a pamphlet for the ‘Exit’ file. It took me a moment to realize that I was in Switzerland, where assisted suicide was legal, and that people knew they could exit their lives under certain conditions. ‘Exit’ is otherwise known as the Association for the Right to Die with Dignity. The dying person must:

*be mentally competent

*have made repeated serious requests

*have an incurable illness

*have intolerable physical or psychological suffering

*have a terminal prognosis

Assisted suicide has been legal in Switzerland since 1940! There are clinics and doctors who assess the patients and provide the medication (usually barbiturates) to cause sleep and then death. Patients come to Switzerland from many countries for assisted suicide, as legal residency is not required. The Swiss government has been criticized for allowing ‘death tourism’, and is now considering stricter guidelines to prevent commercialization of the practice. Patients must be given time to consider their decision, and must freely declare their wish to die. They must have medical certificates from two independent doctors proving their capacity to make the decision, and the existence of a terminal illness. Belgium, Luxembourg and the Netherlands are the other European countries allowing assisted suicide. The Netherlands is the only country in the world that has legalized euthanasia - death by injection – in cases where the patient cannot swallow.

Oregon: Oregon passed a ‘Death with Dignity Act’ in 1994 , which legalized physician assisted suicide with certain restrictions. It was passed by 51.3% of voters; a repeal measure in 1997 was rejected by 60% of voters. The act was challenged by the Bush administration, but upheld by the US Supreme Court (6 to 3) in 2006. People who wish to use the law must:

*be 18 years old or older

*be a Oregon resident

*make 2 oral requests of their doctor, 15 days apart

*provide a written request signed in the presence of 2 witnesses, one of whom is not a relative

*have 2 doctors attest to his/her competency to make the decision

*have a psychological exam if needed

*be fully informed about comfort care, hospice and pain control

*know that s/he can rescind the request at any time

The physician need not be present when the dose is taken, but can be, so long as s/he does not administer the dose. Physicians and pharmacists are not required to take part in the program if they are opposed to it. Oregon has kept careful records of cases under their law – approximately 400 people had died by assisted suicide by 2008. Not everyone who was given the medication used it. Analysis of deaths under the law do not show evidence of abuse – in the sense of overuse by minorities, women, or the disabled.

Washington state: In November 2008 Washington passed a law similar to Oregon’s, by 58% of voters. A state judge in Montana has ruled that doctor assisted suicide is legal under the constitution, but the state is appealing that decision.

Palliative Sedation: Palliative care is comfort care to relieve suffering at the end of life, as is given so expertly by hospices. When suffering is too severe to be alleviated, sedation can be used, not purposefully to hasten death (although it will do so if food, water and other care is withheld), but to put the patient to sleep while the disease takes it course. In California, all doctors must take a course in pain control and palliative sedation, and some hospitals have allotted beds for this purpose.

Fear of death: Fears of intense suffering at the end of life affect most people, especially those with cancer and other debilitating diseases. Laws to allow assisted suicide or the practice of palliative sedation must be monitored extremely carefully to prevent abuse of patient choice and autonomy. That said, they represent – as I see it – an advance in the relief of suffering. It is said that Inuit elders go out on the ice to die alone in the cold. Most of us are not that brave, and may need help at the end of life.

Sadja Greenwood, MD, MPH - past issues on this blog

Go to Health - Pomegranate

2009-11-03T08:32:00.000-08:00

The pomegranate, an ancient fruit from Persia, created the winter and summer in the myth of Persephone and is thought to be the mythical forbidden fruit in the Garden of Eden. Pomegranates are now in season; as you savor their juicy seeds, think about these recent studies on their health-giving properties. The antioxidant capacity of pomegranate juice has been shown to be three times higher than that of red wine and green tea, based on the evaluation of the free-radical scavenging of the juices.. The principal antioxidant ‘polyphenols’ in pomegranate juice are concentrated in the peel, membranes, and piths of the fruit. Commercial pomegranate juice is obtained by pressing the whole pomegranate fruit. Much of the commercially available pomegranate juice comes from a California variety of pomegranate called Wonderful. The 100% pomegranate juice called ‘POM Wonderful’ is from these fruits, and extracts from the POM Wonderful company have been used in many of the research trials worldwide.

Heart Health Laboratory studies at the University of Naples, Italy, and UCLA show that pomegranate juice increases the activity of nitric oxide, a blood gas that increases blood flow in the heart muscle. Pomegranate was found to be more potent than red wine, concord grape or blueberry juice in this regard.. Research at UCSF by Dr Dean Ornish showed that patients with coronary heart disease had a 17% increase in blood flow to the heart after 3 months of drinking 8.5 ounces of pomegranate juice per day. A control group had an 18% worsening of such blood flow. A study of 10 patients in Israel who were given pomegranate juice daily for a year showed a 30% reduction in the abnormal thickening of blood vessels leading to their brains, and a 12% lowering of their systolic blood pressure

Cancer Studies from UCLA have shown that pomegranate extracts inhibit cancer cell growth in the lab, prevent blood vessel growth to nourish cancer cells, and cause death of cancer cells. A 6 year study at UCLA of men with prostate cancer recurrence after surgery or radiotherapy showed a slower increase in PSA levels when treated with 8 ounces of pomegranate juice daily. Laboratory and animal studies are ongoing on pomegranate extracts and lung, breast and other common cancers.

Arthritis Recent laboratory studies from the University of South Carolina show that pomegranate juice extract inhibits certain white blood cells that cause inflammation. Researchers at Case Western Reserve University found that pomegranate extract added to cartilage samples in the lab was able to stop the degrading of cartilage cells by inflammatory molecules. Studies are ongoing to determine the absorption rate of pomegranate fruit extracts into human cartilage cells.

Erectile Dysfunction A study from the University of Southern California looked at 61 men who had difficulty getting or maintaining an erection. The men drank 8 ounces of pomegranate juice or a placebo beverage with dinner, and switched groups after a month. 47% of subjects reported that their erections improved with pomegranate juice, compared to 32% of men on the placebo. This result did not reach statistical significance, and was not as favorable as a related trial of Cialis (73% of men reported a benefit, vs. 26% on placebo). However, compared to Cialis, there are no known dangerous side effects from pomegranate juice; its benefits may result in increased blood flow to the penis, as noted in the studies in heart disease.

Recipes Many delicious ways of using pomegranate seeds in cooking are found in recipes from the middle east. Rave reviews are given to the book 'Pomegranate, 70 Celebratory Recipes', by Ann Kleinberg. I have just ordered a copy, so call me if you want to come to dinner.
Sadja Greenwood, M.D. MPH

Melatonin

2009-10-12T11:15:00.000-07:00

The pineal gland, located in the middle of the brain, receives light signals from our eyes, and has been called “the third eye” in times past. The pineal gland secretes a hormone called melatonin, synthesized from the amino acid tryptophan. Melatonin regulates the sleep-wake cycle, making you sleepy and lowering your body temperature as night comes on. Ever since the development of the electric light, we have been changing our sleep-wake cycle, our “chronobiology”, making sleep a problem for many people. Darkness increases melatonin production, while light, especially the blue part of the spectrum, inhibits its production. It’s not surprising that reading or working in bright lights until late at night makes it hard to fall asleep. Scientists at John Carroll University have developed blue-blocking glasses to wear in the evening to facilitate melatonin output. There are also blue-blocking nightlights, to assist you without disturbing your subsequent sleep.. (Blue-blocking glasses and lights are easily available on the internet.)

Insomnia As darkness stimulates melatonin outflow, it is wise to turn down the lights a few hours before bedtime, and/or wear blue-blocking glasses, which can be worn over reading glasses. Vigorous exercise at night blunts the outflow of melatonin, but exercise earlier in the day is known to improve sleep. According to Chinese traditional medicine, a ten minute slow walk in the dark can be helpful to promote sleep; they call it “a thousand steps at bedtime”. Over-the-counter melatonin tablets can be used on occasion for serious insomnia - start with dissolving ½ mg under the tongue about 30 minutes before going to bed. People differ in the dose they need to ensure sleep. Children with chronic sleep problems have also benefited from better sleep and better daytime behavior with occasional very low doses of melatonin. Talk to your pediatrician first!.

Jetlag Travelers across time zones find it useful to use melatonin at the new bedtime, and to expose themselves to bright light, a walk in the sun, in the morning. Long acting melatonin tablets may be the most helpful; start with a low dose such as 1.5 mg, and take more if needed.

Cancer Studies on lab animals suggest that giving melatonin reduces the incidence of breast cancer and slows its growth if the animal has been exposed to chemical carcinogens. Human breast cancer cells implanted into rats showed greater growth when the rats’ melatonin was suppressed. In humans, women who work night shifts – with increased exposure to light at night and corresponding melatonin suppression - show an increased incidence of breast cancer. The growth of prostate cancer cells is also suppressed by adding melatonin to lab cell cultures. Researchers at McMaster University in Toronto looked at multiple European studies on the use of melatonin in different solid cancers, and found that 10-40 mg/day was associated with increased survival rates and beneficial effects on sleep. Other anti-cancer treatments were used at the same time. Melatonin supplements are not regularly given to people with cancer in the US – if you want to try this approach, you should talk to your oncologist about adding melatonin to other treatments.

Sleeping Pill Withdrawal Many people are accustomed to taking a pill in the valium family (a so-called benzodiazepine) or Ambien/Lunesta for sleep on a regular basis. If you are taking a sleeping pill regularly, check with your doctor or pharmacist about its type, and its addictive potential. After a week or two of nightly use, it can be difficult to quit many prescription pills because of the resultant insomnia and nervousness. Withdrawal can cause serious problems and should be managed in gradual steps by a doctor who understands the problem. Some doctors find that melatonin tablets are helpful with the insomnia and anxiety of withdrawal from prescription sleeping pills. There are few good studies on whether melatonin is addictive, but it is believed to be safe in this regard.

Cautions with melatonin Melatonin tablets can make you drowsy, so avoid drinking alcohol after taking them, and avoid driving or operating heavy machinery. Do not take melatonin if you are pregnant or breast feeding. Do not give melatonin to children without the advice of your doctor. Melatonin supplements are associated with vivid dreams in some people.

The best approach to sleep is to do everything you can to let it occur naturally. Melatonin will be released from your pineal gland and give you restful sleep most of the time if you follow certain guidelines. Avoid caffeine and alcohol close to bedtime. Some people metabolize caffeine slowly and need to avoid it entirely or after breakfast. Exercise every day doing something you enjoy, but not too close to bedtime. Try using blue-blocking glasses in the hours before sleep, or listen to music with really dim lights. Many people sleep better after having an orgasm. If you need a sleeping pill occasionally, melatonin is one of the safer formulations, used at the lowest possible dose – such as ½ (0.5) mg. Avoid taking any sleeping pill every night; that way you should avoid addiction.

Sadja Greenwood, MD – past issues at sadjascolumns.blogspot.com. Columns will resume in November.

Go To Health - Chocolate

2009-09-28T10:13:00.000-07:00

The first people known to have made chocolate from the cacao tree were members of the ancient cultures of Mexico and Central America. The Maya and Aztec people took the tree from the rainforest - they harvested, fermented, roasted and ground the seeds into a paste. When mixed with water, chile peppers, cornmeal and other ingredients, this paste made a frothy spicy chocolate drink. The word ‘chocolate’ comes from a combination of the terms ‘choco’ (foam) and ‘atl’ (water).

*Nitric Oxide (NO) Dr. Norman Hollenberg at Harvard University has studied the ability of cocoa to increase the amount of nitric oxide (NO) in the body. NO is a gaseous ‘signaling molecule’ that crosses membranes and freely diffuses between cells. It signals the muscular coating around arteries to relax, thus improving blood flow and lowering blood pressure. Several medicines are based on this effect - nitroglycerin is a vasodilator because it is converted to NO in the body and Viagra stimulates erections by the effects of NO on blood vessels in the penis. Another protective effect of NO on the cardiovascular system is its inhibition of blood clotting and the adhesion of white blood cells on the lining of blood vessels.

*Flavonoids – Flavonoids are a group of compounds found widely in plants that produce healthy effects on animals who eat them. Many flavonoids activate the nitric oxide system. Cocoa is one of the richest sources of flavonoids (although current processing techniques reduce the content), Dr. Hollenberg and colleagues in Panama studied the Kuna Indians who live off the coast of Panama; the Kuna drink lightly processed cocoa as their main beverage and therefore have one of the world’s richest diets in flavonoids. The Kuna do not show an increase of blood pressure with aging, or decline in kidney function. Their death rates from heart disease, stroke, diabetes and cancer are markedly lower than those of genetically similar Kuna in mainland Panama, where cocoa is replaced by local foods. The researchers wrote a paper on the Kuna, concluding that “the comparatively lower risk among Kuna in the San Blas islands from the most common causes of morbidity and mortality in much of the world, possibly reflects a very high flavanol intake and sustained nitric oxide synthesis activation. However, there are many risk factors and an observational study cannot provide definitive evidence.”

In the Dutch Zutphen Study, cocoa intake specifically was associated with a 50% reduced risk of cardiovascular mortality between the highest and lowest quintile of intake in 470 elderly men. These epidemiologic data led to the hypothesis that the health benefits of cocoa may be linked to its flavonoids. Both the flavanoid content and the total antioxidant capacity have been shown to increase in plasma after cocoa consumption.

*CocoaVia by Mars The Mars company has been studying the health benefits of chocolate for over a decade, and have isolated the particular flavonol in cocoa that relaxes blood vessels and inhibits clotting. Their formula for this - a trade secret - is in their chocolate bar CocoaVia, along with plant substances (sterols) that lower cholesterol. But there’s a big catch, reports the Harvard Heart Letter - the extra calories and saturated fat in these bars make them less desirable as a daily source of flavonols. A product called ‘Acticoa’ in Europe is said to have the same beneficial ingredients as the Mars bars, but is not available in the US.

*Theobromine Chocolate has a mild stimulating effect due to theobromine, a substance similar to caffeine. People sensitive to caffeine and parents of young children should be cautious about this, and avoid chocolate close to bedtime.

*Healthy Chocolate for You! You can buy organic, fair trade, unsweetened cocoa powder at natural food stores and some supermarkets. Make a cocoa drink with soy milk, 1% milk or hot water, and sweeten it with xylitol (a healthy sugar that’s good for your teeth!) or stevia or both. You can skip sugar by mashing a banana with unsweetened cocoa powder, and add peanut butter if desired. You can make a shake with your favorite ingredients and add cocoa powder and pomegranate concentrate for sweetness. Purists can buy organic, fair trade cocoa nibs and eat them with raisins for sweetness. Buying ‘fair trade’ cocoa or chocolate bars is important, because cocoa producers in Latin America are often badly underpaid and in Africa child labor is a serious problem. The fair trade label ensures that the cocoa workers are decently treated.

Sadja Greenwood, MD MPH, back issues on this blog

Go to Health - Vitamin D Update

2009-09-21T12:36:00.000-07:00

The vitamin D story begins with the evolution of human skin color in Africa. The current hypothesis is that early humans had more of the dark pigment melanin in their skins to provide protection against intense sunlight. But melanin can also block the ultraviolet radiation that triggers vitamin D production in the skin. In Africa, we humans produced the right amount of Vitamin D for our health. As we migrated out of Africa to live at higher latitudes, natural selection favored those with lighter skin, who could absorb more vitamin D from sunlight. People with darker skins were more likely to have Vitamin D deficiency and develop rickets. Women with rickets often have a deformed pelvis and have great trouble giving birth, leading to an evolutionary disadvantage. In the early 20^th century (before vitamin supplementation) blacks in the US were 2-3 times more likely to suffer from rickets as whites. Dark-skinned people in higher latitudes need to be exposed to about 6 to 10 times as much sunlight as white-skinned people for the vitamin D in their blood to reach acceptable levels.

Vitamin D, formed on the skin with sun exposure, is a fat soluble vitamin essential for maintaining many body systems. Virtually all of our cells have receptors for Vitamin D. Current studies show the following:

*Osteoporotic fractures - Women who take calcium and vitamin D supplements have been shown to have a lower risk of fractures in the hip and other areas. Levels of supplementation higher than 400 IU daily were needed to achieve these results. D also helps to prevent tooth loss.

*Muscle strength -Vitamin D is helpful in promoting muscle strength and decreasing muscle pain. Recent studies show that vitamin D decreases falls in the elderly.

*Weight Loss - several studies show that overweight people on diets lose more weight when they take calcium and vitamin D. There is much current interest in adding Vitamin D and calcium supplements to all weight loss regimens.

*Heart disease - Low levels of D is associated with an increased risk of heart disease, high blood pressure, insulin resistance and systemic inflammation

*Cancer – a study from University of California San Diego has shown that higher serum levels of vitamin D are associated with substantially lower rates of colon, breast, ovarian, renal, pancreatic, aggressive prostate and other cancers. The authors of this study conclude that raising serum D in the population to optimum levels (40 to 60 ng/mL) could prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, (This is an astounding theory, and if even partially true it could prevent a great deal of suffering.)

* Autoimmune disease Adequate vitamin D levels may decrease the risk of autoimmune diseases such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis.

* Memory loss with aging A recent English study showed that seniors with the lowest levels of vitamin D were twice as likely to have cognitive impairment (memory, attention span and orientation in time and space) as those with the highest levels of vitamin D. A study from Tufts University in Boston showed that seniors with higher levels of vitamin D did better with planning, organizing and thinking abstractly, and also were less likely to show damage to small blood vessels in the brain.

*Respiratory infections people of all ages with low levels of D are more at risk for colds and other respiratory infections, including tuberculosis. This finding is more important in the current flu season.

*Seasonal affective disorder (winter blues) and depression - Studies are beginning on the use of Vitamin D for SAD, which may be more effective than light therapy.

*Vitamin D deficiency in the US More than 75% of Americans have less than optimum levels of D according to a nationwide nutrition study from 2001-2004. Increasing skin protection from sunburns, less outdoor activity, and declining milk consumption may explain the decrease. Also low levels of vitamin D are associated with obesity, which has been increasing in this country.

How to get enough Vitamin D - Since Vitamin D plays such an important role in health, what should you do to protect yourself? You can start by having your health care provider order a test for a blood level of 25 hydroxy vitamin D. A level above 30 ng/ml is desirable, and 40-60 ng/ml is considered optimum. To achieve this level without high sun exposure, which can carry risks of skin cancer and skin aging, most adults in our area need to supplement with at least 1000 IU daily, and may need more. You can increase this amount until you have the desirable blood level of D. If getting a blood level for D is not practical for you, you will be safe with 1000-2000 IU daily. The researchers at UCSD (see above - Cancer) suggest 2000 IU daily, and affirm its lack of risks.. We form very little Vitamin D on our skin between October and March at this latitude. People with darker skin absorb Vitamin D from the sun more slowly, and may need higher levels of supplementation.

: Sadja Greenwood, MD, MPH –back issues at on this blog

Go to Health: Oats

2009-09-14T11:20:00.000-07:00

Oats have been grown for human food and for livestock since ancient times. In Samuel Johnson's dictionary, oats were defined as "eaten by people in Scotland, but fit only for horses in England." The Scotsman's retort "That's why England has such good horses, and Scotland has such fine men.”

The Hype on Oats & Cholesterol: After the publication of several articles in the 1980’s on the value of oats to lower cholesterol, oat products from candy bars to pasta to chips were promoted with exaggerated claims for health and weight loss.

The Evidence: Oats contain more soluble fiber than other grains; a soluble fiber called beta-glucan is especially valuable, and is found in oats, barley, yeast and certain mushrooms. Beta-glucan in yeast and mushrooms has been found to have favorable immune-enhancing effects. Studies are incomplete on similar effects from eating oats. In 1997, the FDA said that "a diet high in soluble fiber from whole oats (oat bran,oatmeal and oat flour) and low in saturated fat and cholesterolmay reduce the risk of heart disease". The FDA had reviewed 37 studies in which oats were consumedas hot and cold cereals or used in a variety of other foods - muffins, breads, shakes, and entrées. It was concludedthat about 2/3 cup of oatmeal daily would provide the beta-glucan to achieve a clinically relevant decreasein serum total cholesterol concentrations. Most studies have shown a reduction of total cholesterol and LDL cholesterol of 7 to 10% . The soluble fiber in oats appears to reduce the absorption of cholesterol in the intestines. (Soluble fiber with similar effects on cholesterol are found in barley, dried beans, apples, pears, prunes and psyllium seed).

Blood Sugar: Oat fiber has also been shown to lower levels of blood sugar after a meal, making it a good food for people with diabetes. The reduction of the glucose and insulin peak after eating the soluble fiber in oats occurs because oat digestive products in the stomach and small intestine are more viscous, which retards their absorption into the bloodstream.

Inflammation: whole oats contain a beneficial polyphenol (a class of antioxidant compounds found in most plant foods) called Avenanthramides (AV) . Unique to oats, AV interferes with inflammation and the development of plaque on the arteries. Moshen Meydani at the Vascular Biology Laboratory at Tufts University studied AV and found that adhesive molecules cause blood cells to stick to artery walls. Inflammation results, leading to a buildup of plaque that narrows the artery. The suppression provided by the AV in oats may allow better blood flow.

Skin protection: Oatmeal has been used since Roman times or longer to relieve itch and skin irritation. Recent studies show that AV in oats inhibits inflammation in skin cells when applied topically. Itching and scratching are suppressed. AV has been found to be effective in reducing the redness of sunburn when used in the 24 hours after a burn. It will give temporary relief to the itching of poison oak and poison ivy. The use of oatmeal products on the skin as an anti-irritant has potential in the care of infants, people with sensitive skin, sunburns and itchy, dry skin. You can make your own soothing oatmeal bath to relieve skin itching and inflammation by grinding a small amount of rolled oats in a blender; put the resulting flour into a a cheesecloth bag and run warm tap water through it for a bath. Many oatmeal-derived products are available commercially; ask your pharmacist for advice. .

. Sadja Greenwood, MD –back issues at http://sadjascolumns.blogspot.com

Go To Health: Flaxseed

2009-09-07T09:11:00.000-07:00

Flax has been grown since the beginnings of civilization, initially in Babylon & Egypt. It was used to make linen for clothing, fishnets, and to wrap mummies. In the 8^th century, Charlemagne commanded his subjects to eat flaxseed to maintain good health. In the 12^th century, Abbess Hildegard von Bingen used flaxseed poultices to treat boils. Throughout history it has been used to treat constipation, as a bulking agent, combined with plenty of water. While it is still used today to make linen and as a healthy human food, flax is also made into industrial linseed oil, linoleum, and animal feed.

*Flaxseed oil: The oil in flax seeds contains alpha-linolenic acid (ALA), an essential omega-3 fatty acid like fish oil. ALA may not have the same benefits as fish oil (see my blog on omega-3 fatty acids), as it is more difficult for the body to efficiently convert ALA to a form of omega-3 fatty acids that it can readily use –the EPA and DHA in fish oil. However, ALA is a good choice for vegetarians. Flaxseed oil should come in a dark and opaque container and be refrigerated; add it to salad or foods after cooking. It cannot withstand high heat.

*Flaxseed Meal: When you buy whole flax seeds, grind a week’s supply and refrigerate the flax meal. You can eat it on salad, cereal or in smoothies. By eating the whole ground flax seed you are getting the oil as well as beneficial compounds known as lignans. Lignans are plant compounds similar to estrogen that also act as antioxidants. Lignans may lower estrogen in humans by inhibiting enzymes that are involved in estrogen production; the exact mechanisms are not known. There is interest in flaxseed because of the potential for plant estrogens to act differently from the body’s natural estrogen. In animal and preliminary human studies, flax seeds have been shown to inhibit tumors.

Breast Cancer: Researchers at the University of Minnesota studied the effect of flaxseed supplementation in a group of 28 postmenopausal nuns - chosen because of their strict dietary practices. The volunteers were given daily dietary supplements of either zero, five or ten grams of ground flaxseed for seven week cycles over the course of a year. A heaping tablespoon of ground flax weighs about 10 grams. Consumption of five or ten grams of flax significantly decreased blood levels of certain types of estrogen that are characteristic of postmenopausal women. Since previous studies have shown that increased levels of these estrogens (estrone sulfate and estradiol) may increase a woman’s risk of developing breast cancer, reducing levels of these hormones is thought to be advantageous. This study does not show that flaxseed prevents cancer, the researchers caution. Further studies are needed to work out how the supplement lowers estrogen and also to see if flaxseed may inhibit cancer. Besides lignans, the fiber and omega-3 fatty acids in flaxseed could also be protective.

Prostate Cancer A recent study at The M.D. Anderson Cancer Center looked at prostate cancer patients at least 21 days before surgery, and found that proliferation (cancer cell division) was significantly lower in men given supplemental flax seed – 3 tablespoons daily. These findings suggest that flaxseed is safe for men and is associated with biological alterations that may protect against prostate cancer. Previous studies had shown that ALA might not be advisable for men with prostate cancer. Further studies would be helpful on this important subject.

Blood Fats: An international review of studies on the effects of flaxseed meal on cholesterol found that flax significantly reduced total and LDL cholesterol, with the greatest effects seen in people with high cholesterol readings and in post-menopausal women.

Hot Flashes A study at the Mayo Clinic looked at 29 women with bothersome hot flashes who did not want to take estrogen because of the possible increased risk of breast cancer. After six weeks of ground flaxseed therapy, 2 tablespoons daily, their frequency of hot flashes decreased 50 percent, and the overall hot flash intensity decreased an average 57 percent. Participants also reported improvements in mood, joint or muscle pain, chills and sweating; which significantly improved their quality of life. This is an example of the ability of plant estrogens to act as an estrogen as well as an anti-estrogen.

Sadja Greenwood MD, MPH –back issues on this blog http://sadjascolumns.blogspot.com

The Benefits of Brassicas

2009-08-16T15:03:00.000-07:00

The Benefits of Brassicas

Edible plants in the Brassica family (also know as cruciferous vegetables), are grown all over the world – a partial list includes: broccoli, kale, collards, cauliflower, cabbage, napa cabbage, Brussels sprouts, mustards, bok choy, arugula, turnip, radish, daikon, cress, kohlrabi, horseradish, wasabi. These vegetables contain multiple nutrients with anti-cancer properties. In 1992, Drs. Paul Talalay and Jed Fahey of the Johns Hopkins University School of Medicine founded the Brassica Chemoprotection Laboratory, in order to test and cultivate plants that would have the highest levels of protective enzymes.

They isolated a phytochemical in broccoli called SGS, ‘sulforaphane glucosinolate’, an enzyme that helps neutralize cancer-causing chemicals, as well as free radicals, before they can damage DNA and initiate the development of cancer. They found that SGS blocked the formation of mammary tumors in rats treated with a potent carcinogen: The number of rats that developed tumors was reduced by as much as 60%, the number of tumors in each animal was reduced by 80%, and the size of the tumors that did develop was reduced by 75%. Scientists at the American Health Foundation discovered that SGS inhibited the formation of premalignant lesions in the colons of rats. Researchers in Toulouse, France found that SGS induced cell death in human colon carcinoma cells. This study suggests that in addition to the activation of detoxifying enzymes, induction of apoptosis [cell death] is also involved in the sulforaphane-associated prevention of cancer. These results have not yet been validated in humans.

Dr. Talalay and his team have examined a wide range of broccoli plants to determine which had the highest levels of sulforaphane. Varieties of broccoli were found to differ significantly in the amounts of SGS they contained and, as the plant grows older, the concentration of SGS decreased. Conversely, young plants (three-day-old sprouts) yielded much more concentrated enzyme-induced activity. Findings from this research demonstrated that certain varieties of three-day-old broccoli sprouts contain between 20 and 50 times the concentration of SGS as the mature, cooked vegetable. They are now producing and selling their own variety of broccoli sprouts (broccosprouts.com), and Brassica teas (BrassicaTea.com). You can often find broccoli sprouts in markets and you can buy organic broccoli seed for sprouting at home: http://www.healthyeating.com 800-695-2241. Here’s a good site for learning to sprout: http://www.themindfuleater.com/archives/2007/03/making_sprouts.html

Indole-3-carbinol - another compound in Brassica vegetables has also been found to decrease susceptibility to cancer in laboratory animals. It alters estrogen metabolism in a favorable way, and its metabolite 3'Diindolylmethane is a strong androgen receptor antagonist in human prostate cancer cells. Researchers at the University of California and elsewhere warn that it is too early to start using indole-3-carbinol as a supplement for cancer prevention.

However, it’s always a good time to eat more Brassica vegetables. Grow some of your own. Even if you don’t garden, you can grow radishes in deep pots, or make your own sprouts.
Sadja Greenwood, MD, MPH –back issues on this blog. Leave me a message!
no columns on 8/24/09 or 8/31/09.

Serotonin and Your Bones

2009-08-09T18:51:00.000-07:00

Go to Health: Serotonin and your bones

Neurotransmitters are chemicals in our bodies which relay and regulate signals between a neuron (nerve cell) and another cell. The neurotransmitter serotonin is best known for its role in the brain, where it helps regulate mood, sexual desire & function, appetite, sleep, memory & learning, temperature regulation, and some social behaviors such as assertiveness and aggression. However, 90% of our body's total serotonin is made by the cells of the gut, where it is used to regulate intestinal movement. It is synthesized from tryptophan, an amino acid found in protein foods, including plant foods. When you have a ‘gut feeling’, it’s real - you are reacting to serotonin and other neurotransmitters in the intestinal tract! Blood platelets pick up serotonin from the gut and transport it to blood vessels, the heart, the liver and other organs, including bone cells. (Platelets are tiny cells, without a nucleus, that come from white blood cells in the bone marrow. One of their main functions is to prevent bleeding.)

Bones may seem dense, but inside they have honeycomb-like scaffolding that allow them to be strong without being too heavy. Throughout life they are constantly remodeling themselves, making new tissue where needed and clearing out old bone. In recent years, studies have shown that there are molecules that transport serotonin into bone cells. This was an unexpected finding, and research into its meaning is ongoing. What has emerged is that bones get weaker in the presence of more serotonin, and stronger with less.

SSRIs This finding is important for the 8-10% of adults who are taking SSRIs (selective serotonin reuptake inhibitors) to treat depression. These drugs increase the amount of serotonin in the body – thereby helping mood but potentially weakening bone. Studies in Canada and the US have shown greater rates of bone loss and fractures among people taking SSRIs. While these antidepressant drugs – such as Prozac, Paxil, Zoloft, Celexa, Luvox, Lexapro and others – have been very important for many depressed people, their possible side effects on bone should be more widely known.

Users of SSRIs and most midlife women should consider having a test for bone density (called a DEXA scan), and should also work on measures to help build strong bones. New bone growth is helped by exercise, especially strength training. Walk, jog, hike, play tennis or soccer – depending on your age and abilities. A good book for strength training is Growing Stronger – Strength Training for Older Adults. You can download it for free at
http://growingstronger.nutrition.tufts.edu/book.html.

*Most people need extra Vitamin D - get a blood level of 25 hydroxy vitamin D. A level above 30 ng/ml is desirable, and 50 ng/ml is considered optimum. You will probably need to take at least 1000 IU of supplemental D daily.
*Get 1000 mg of calcium and at least 500 mg of magnesium daily in food and supplements. Eat a healthy diet with lots of fruits and vegetables (red, orange and yellow pigments in plant food inhibit bone breakdown).
*Don’t smoke
* If you drink alcohol, stop at 1 drink daily for women and 2 for men.
*Taking sex hormones (estrogen, progesterone, testosterone) by pill or patch can help bone strength but also can increase cancer risk and is not advisable for most people over 50.
*Your doctor may advise a medication to increase bone strength; these can be helpful, but be aware of their side effects too..
Sadja Greenwood, MD, MPH –back issues on this blog. Leave a message!

Go to Health: Turmeric –Curcumin

2009-08-02T19:59:00.000-07:00

Turmeric has been gathered and cultivated in India for over 2500 years, used as an orange dye, a medicinal plant and a spice in curry. Today there is renewed interest in turmeric and its main ingredient curcumin for their potential activity against cancer, Alzheimer’s disease, arthritis and many other health problems.

Cancer: At the University of Texas MD Anderson Cancer Center, Dr. Bharat Aggarwal is studying curcumin. He says that the combined rate of the four most common cancers in the United States—lung, prostate, breast, and colon—is much lower in India, where curry is a staple in the diet. Aggarwal is studying the ability of curcumin to shut down nuclear factor kappa B (NF-kB), which is involved in the regulation of inflammation and many other processes. By blocking the activity of this ‘master switch’, curcumin appears to interfere with the cancer process at an early point, impeding multiple routes of growth: reducing the inflammatory response, inhibiting the proliferation of tumor cells, inducing their self-destruction, and discouraging the growth of blood vessels feeding tumors. These effects can shrink tumors and inhibit metastasis. Also, shutting down NF-kB can enable chemotherapy drugs to destroy cancer cells more effectively. Research on curcumin and various cancer types is still preliminary, and laboratory based; there have been few human trials. It would be unwise to stop cancer chemotherapy to take curcumin; some oncologists are interested in using curcumin as a supplement. See the new book ‘Life over Cancer’ by oncologist Keith Block MD for a full discussion of this supplement and other complementary therapies..

Alzheimer’s Disease: Based on the finding that there is 4 times less Alzheimer’s disease in India than in the US (turmeric is used as a daily spice in Indian curries), researchers at UCLA are studying the ability of synthetic curcumin and Vitamin D to clear the amyloid plaques found in the brains of people with Alzheimer’s. Laboratory experiments have shown that blood cells called macrophages are able to destroy amyloid plaque when incubated with Vitamin D and a form of synthetic curcumin. Studies using Vitamin D and curcumin in human patients are underway at UCLA, USC and various universities in India.. At present, there is no recommended dose of curcumin for treatment or prevention. (see my blog on Vitamin D for dose ideas on Vitamin D)

Arthritis and Bone Loss
Since curcumin is anti-inflammatory, it is being tried in the treatment of rheumatoid arthritis, with active trials at UCLA. Osteoarthritis may also be helped. At the University of Arizona, there is a study on curcumin’s ability to prevent bone loss in mid-life women.

Inflammatory Bowel Disease: Both Crohn’s Disease and ulcerative colitis can result in abdominal pain, diarrhea, weight loss and fatigue, and often strike children or young adults. At the U. of Arizona there are studies showing that daily curcumin pills were able to decrease intestinal damage and cut the number of relapses by 50%. The researchers stressed that curcumin should not replace standard therapies.

Cautions: Curcumin as a supplement should not be used in pregnancy and lactation, or in people with gall bladder disease because it stimulates bile secretion and gallbladder contractions. Most people, however, can find a reputable supplement company (ask a pharmacist) and try 500 mg with food once or twice daily. Everyone can buy (or make) curry powder and cook curries at home!

Sadja Greenwoood MD, MPH –back issues on this blog

The DASH Diet - Dietary Approach to Stop Hypertension

2009-07-26T21:44:00.000-07:00

If your blood pressure is higher than you or your doctor would like, you may be pleased to know how you can help make things better. The DASH diet is a well-researched way to improve your health and your blood pressure. It emphasizes:
*fruits and vegetables
*fat free or low fat milk or yogurt
*whole grains – brown rice, whole wheat, oats, rye, barley, corn, quinoa
*lean meat, poultry or fish
*nuts, seeds and beans
*small amounts of oil or soft (non-hydrogenated) margarine.
*Sweets, soft drinks and added sugars should be very low in this diet.
*Salt and salty foods (read labels!) should be minimized to make the diet effective - try to lower your sodium intake to 1500 milligrams per day. 2/3 teaspoon of salt =1500 mg.
* alcohol can increase blood pressure: men should not drink more than 2 drinks a day, women not more than one.

The potassium found in fruits and vegetables and the calcium in dairy products or fortified soy milk are important in this diet. People have found that their blood pressure begins to decline within the first two weeks of adherence. Remember that celery is effective for lowering blood pressure, and pomegranate juice has also been found helpful. According to researchers at the U. of Maryland, if you already take medication to lower blood pressure, pomegranate juice or extract could make the effects of those drugs too strong, so check with your doctor. You may be able to reduce your dose of medications.

To make the DASH Diet work for you, details and plans for daily meals and snacks are needed. The National Heart, Lung and Blood Institute has a good explanatory website:
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Alternatively, search your local library for the DASH diet; they will probably carry books on the subject. Amazon has several books: ‘The DASH Diet Action Plan: Based on the National Institutes of Health Research’ by Marla Heller, or ‘Your Guide to Lowering Your Blood Pressure With DASH’.

While you explore the DASH Diet, you should know about other approaches that have been shown to lower blood pressure:
*30 minutes of brisk walking daily may keep some people off of medication, and lower the dose for others. Two walks of 15 minutes are also good. Get a pal; make it fun; contact the trees and birds. Biking, swimming and other sustained aerobic exercise will also work.
*weight loss: the Dash Diet and exercise will help with this. Every 2 pounds lost can bring down blood pressure 1 point. After a year of gradual weight loss,, your blood pressure might be normal.
*transcendental meditation has been studied at the University of Kentucky and found to be the most effective relaxation method for lowering blood pressure: http://www.tm.org/national-institutes-of-health. This method of meditation is now non-religious and easy to learn.
*Resperate: this device has been studied at Rush University and the Mayo Clinic, and found helpful in guiding users into deep slow breathing that lowers blood pressure. It should be used 15 minutes 3-4 times a week, and will only be effective as long as it is used. The price is $300, but it can be tried for a month for $25. www.resperate.com or call 877-988-9388.

One in 3 adults in the US have high blood pressure. It is important to pay attention to this problem, in order to avoid having a stroke, heart attack or heart failure. Use a home blood pressure cuff, and work with your doctor and nurse-practitioner to get normal readings!
Sadja Greenwood, MD, MPH

Go to Health - Salt - Sodium Chloride

2009-07-20T10:52:00.000-07:00

Our tongue and palate taste foods that are sweet, salty, sour, bitter and savory (umami). Salt is essential for us, as it is found in our blood, cells, bones, and the fluid between cells. Salt is necessary for the function of our nerves and muscles. The digestion of food in our stomachs by hydrogen chloride also comes from salt. When humans were hunter-gatherers, we got salt from eating animals; they got theirs from finding salt in rocks, brackish water and brine springs. (The city of Buffalo is named for the buffalo who made a wide path to a salt lick near Lake Erie!) When we became farmers, we needed to find sources of salt for our diets; the story of how humans have found, prepared and traded salt is a fascinating one of early commerce. You can find it in "Salt - A World History" by Mark Kurlansky.

How much salt to we need? The answer varies – depending on our body size, the amount we sweat, and problems such as serious diarrhea or kidney disease. The present consensus is that adults need 1000 - 1500 mg of sodium a day, and should not get more than 2400 mg. However, we are now averaging 3436 mg a day. Sodium is present in all animal food we eat, in small amounts in vegetables, but in large amounts in bread and prepared foods, which make up 70-80% of our daily salt intake.

Why does excess salt in our diet matter? You know the answer – it has to do with high blood pressure (hypertension). Increased salt causes more fluid to be retained in the blood vessels, so the heart must work harder to pump blood through the body. Salt may also act on arterioles - blood vessels that dilate and constrict to regulate blood pressure and blood flow. By contracting under the influence of sodium, arterioles increase resistance to the movement of blood and thereby increase blood pressure. Genetics play a role in our sensitivity to salt – some people are more susceptible to high blood pressure, and sodium sensitivity appears to increase with age. African Americans tend to be more salt sensitive than others and should be especially careful to eat less salt. A national study showed that 29% of US adults have hypertension (systolic pressure consistently over 140, diastolic over 90 on multiple readings), and another 28% have prehypertension. (systolic pressure of 120-139, diastolic of 80-89 on multiple readings). An increased risk for heart disease and stroke is the reason for concern about blood pressure.

Since most of the salt in our diets comes from prepared food – be prepared to find it! Carefully read the labels on canned and dried soups, sauces, vegetable juices, salad dressing, lunch meats, bacon, bread, popcorn, crackers and chips. Most of us don’t have the time or desire to make everything at home, but we can all be detectives. Making more foods from scratch saves money as well as health. Your taste for lots of salt is reversible; decrease your use gradually and your taste buds will adjust. As you eat more fruits and vegetables you will be increasing the potassium in your diet. A potassium-rich diet blunts the effects of salt on blood pressure, may reduce the risk of developing kidney stones, and possibly decrease bone loss with age.

When you are on the go, pack fresh and dried fruit in your bag, along with carrots, celery and unsalted nuts. Try low sodium V-8, or Knudsen’s plain or organic low sodium Very Veggie.
Next week I’ll describe the DASH diet, and other ways to lower blood pressure, including the right kind of exercise, and gradual weight loss.
Sadja Greenwood, MD, MPH

Go to Health: Celery and Purslane

2009-07-12T15:12:00.000-07:00

Go to Health: Celery and Purslane

About 40% of medicines in the U.S. today come from plants—or are based on chemicals found in plants. Beyond that, nearly 70 percent of the Earth's 6.2 billion people rely on plant-based medicine. Here are two examples close to home that we may have ignored:
Celery – crunchy and familiar
Purslane - an amazing ‘weed’

Celery lowers blood pressure: Scientists at the University of Chicago and at the Hunan Hematological Research Center in China have determined the mechanisms by which celery lowers blood pressure. Celery contains a chemical called 3-n-butyl phthalide, which relaxes the smooth-muscle lining of blood vessels, making them wider and thereby lowering blood pressure. Phthalide works by lowering the concentration of stress hormones in the blood, which constrict blood vessels. In studies with normal rats, a dose of phthalide equivalent to four stalks of celery in humans lowered blood pressure by an average of 13 percent. The same dose also lowered the rats' cholesterol levels by 7 percent. Celery contains 341 milligrams potassium and 125 milligrams sodium per 100 gram serving. Any food with a ratio of three parts potassium to one part sodium is good for people with high blood pressure. Small studies indicate that celery may also be helpful in reducing uric acid levels in gout.
Some people are allergic to celery. If that is not the case, try 4 stalks a day (not the leaves) for blood pressure problems, and check with your clinic and your home-based blood pressure cuff to see if it is useful.

Purslane has omega-3s and more: Purslane was used in ancient Greece, Africa and India as a medicine. Found throughout the world, it reached the Americas by the 1400s. Purslane contains more alpha linolenic acid (ALA) than any other leafy green vegatable. ALA, also found in walnuts, flax seed and greens, is slowly converted by our bodies into the omega-3 fatty acids found in fish. Purslane has a higher mineral content than most vegetables we eat and has various potent antioxidants. After millennia of widespread use as a folk medicine, it is now being tested on a surprising variety of health problems.
*Oral lichen planus –a chronic condition affecting the lining of the mouth with white patches, which can be painful. Studies done in the US and Iran show that purslane capsules were helpful.
*Diabetes – preliminary animal studies in China show that purslane can lower blood glucose levels and raise HDL cholesterol (the good kind).
*Anti-aging effects – animal studies in China showed that purslane increased memory, mental activity and various biochemical signs of aging.
*Heavy uterine bleeding – Studies at the medical university in Qom, Iran showed that 8 out of 10 women whose abnormal bleeding did not respond to standard treatment had normal periods after taking purslane seed powder for 3 days after the onset of bleeding.
*Phytoremediation: Japanese scientists at the University of Osaka have found purslane can remove bisphenol A - an endocrine disrupting compound with estrogenic properties – from ground water. Indian scientists at the Sardar Patel Centre for Science and Technology have found that purslane picks up heavy metals in industrial effluent, and can be used to clean contaminated areas.

Go purslane, the 21st century vegetable! You can find purslane at some farmer's markets. You can buy seed on line; just search for purslane seed.
Sadja Greenwood, MD –back issues on this blog. Leave me your comments.

Go to Health - Moving Right Along

2009-06-28T19:33:00.000-07:00

Go to Health: Moving right along
Our bodies have magnificently evolved to move, but life can get in the way: computers, sedentary work, commuting, television, child-care, fatigue. Here are two ways for busy people to vary the 30 minutes of dedicated daily exercise that has been shown to reduce cardiovascular risk and keep us fit.

The Treadmill Desk—aka iPLod
Dr James Levine at the Mayo clinic disliked visiting the gym after a long workday. In his lab he is studying ‘Non-exercise Activity Thermogenesis’. He has devised a way for office workers to walk slowly on a treadmill while working on their computers or talking on the phone. His lab also has a two lane walking track that serves as a meeting room. He puts the treadmill on a very slow speed (as slow as 1 mph), which is fast enough to burn an extra 100 calories per hour, and up to 1,000 extra per day on his average 10-hour workday. Levine placed 15 obese workers on treadmills in front of computers and found they burned an extra 119 calories an hour walking at their own pace. During the course of a year, those workers could lose close to 50 pounds if they practiced healthy eating, the researchers said.
Some companies, such as Mutual of Omaha and Humana, are trying out ‘walkstations’, and finding that some employees cannot get used to them, but others find it helps their ability to focus on work. While commercially produced walkstations are expensive, some people with home offices can build their own tray holding a laptop over a treadmill. Another message from this research is that staying on your feet as much as possible during the day – even with slow walking – is beneficial for weight loss or maintaining a healthy weight. Keep moving! Here are two good websites that illustrate these strategies.
http://www.mayoclinic.com/health/treadmill-desk/MM00706
http://www.nytimes.com/2008/09/18/health/nutrition/18fitness.html

Interval Training
Interval training is alternating bursts of intense activity with intervals of lighter activity. Researchers at McMaster University in Ontario are studying whether humans can increase endurance with only a few minutes of strenuous exercise, instead of hours. They had a group of healthy college students, not athletes, ride a stationary bike at a sustainable pace for between 90 and 120 minutes. Another set of students grunted through a series of short, strenuous intervals: 20 to 30 seconds of cycling at the highest intensity the riders could stand. After resting for four minutes, the students pedaled hard again for another 20 to 30 seconds, repeating the cycle four to six times. Each of the two groups exercised three times a week. After two weeks, both groups showed almost identical increases in their endurance, even though the one group had exercised for six to nine minutes per week, and the other about five hours. Additionally, molecular changes that signal increased fitness were evident equally in both groups. People who have a chronic health condition or who haven't been exercising regularly should consult a doctor before trying interval training, and overuse injury of muscles and tendons can also be a problem. Here’ a recent website on interval training:
http://well.blogs.nytimes.com/2009/06/24/can-you-get-fit-in-six-minutes-a-week/

Sadja Greenwood, MD –back issues on this blog, leave a message! no column on 7/6/09; celery & purslane on 7/13/09

Go to Health - Omega-3 fatty acids

2009-06-21T21:06:00.000-07:00

Go to Health – Omega-3 fatty acids
Humans have been eating aquatic animals since the beginning of our evolution. We depended on the rivers, lakes, and marshes to survive in the African heat. Some anthropologists believe we were only able to become large-brained because we regularly included fish and other aquatic animals in our diet. The beneficial fats in fish and shellfish are known as EPA and DHA (also called omega-3 fatty acids); they are made by microalgae in seawater, consumed by fish and accumulated in their fat and organs.. When we eat fish, shellfish or fish oil capsules, we experience some of the following benefits:
*Heart - a current review of 15 large studies, published in the American Journal of Nutrition, states that EPA and DHA consumption markedly reduces the risk of cardiac death. The scientists recommended establishment of a Dietary Reference Intake for EPA and DHA (250-500 mg/day) to reduce the risk of heart disease – the leading cause of death of men and women in the US and other developed countries. The mechanisms by which omega-3 fatty acids work is thought to be by suppressing irregular heart beats, decreasing clotting and inflammation, and lowering triglycerides.
*Brain - the human brain is composed of about 60% fat; studies show that omega-3 fatty acids are essential for nervous tissue growth and function. In 1996, the Journal of the American Medical Association published a study comparing the prevalence of depression across ten nations. The survey showed how the lifetime and annual rates for depression vary widely from country to country. (1.5 in every 100 adults in Taiwan experience depression in their lifetimes while the figure is 19 for every 100 adults in Beirut). A 1998 study published in The Lancet compared this data with fish consumption, finding the higher consuming populations had less depression. A 2003 study published in the American Journal of Psychiatry compared similar cross-national data, involving bipolar disorder, again finding a strong correlation between this illness and seafood consumption. Dr.Andrew Stoll, a Harvard psychiatrist, uses fish oil capsules to treat depression, bipolar disease, and anxiety, in addition to standard treatment in serious cases. His book ‘The Omega-3 Connection’ explains the use of fish oil capsules for mood stabilization in many illnesses, including post-partum depression. Pediatricians are aware that improving maternal DHA/EPA nutrition decreases the risk of poor infant and child visual and neural development. Pregnant and breast feeding mothers are often advised to include (very low mercury) fish or fish oil in their diet, and some infant formulas are now available with added omega-3s.
*Vegetarians – Vegan omega-3 capsules made from microalgae are sold in natural food stores. Walnuts, flax, pumpkin seed and purslane contain a type of fat similar to fish oil, called alpha linolenic acid. This compound is converted to EPA in the body, but the conversion is not complete. Both EPA and DHA are found in fish oil, which makes it the most desirable nutrient for omega-3s. Concern about mercury in fish makes it important to eat wisely, avoiding large fish like swordfish and shark. Look for the words ‘molecularly distilled’ on fish oil caps. Here’s a good website for avoiding both mercury and endangered species of fish:
www.nrdc.org/health/effects/mercury/walletcard.PDF
Sadja Greenwood, MD

2009-06-15T19:10:00.000-07:00

Go to Health - Chewing Gum – some surprising benefits

Chewing gum is prohibited in many schools because it can be noisy, distracting and tends to be stuck under chairs and tables. Chewing gum has been considered impolite and ugly, especially bubble gum. Most commercial gum is made with sugar or questionable substitutes such as saccharin and aspartame. Gum chewers can develop pain in their temporomandibular joints (TMJ), especially if they chew on one side of their mouth for too long. That’s the down side. Here are some interesting benefits.

*Aid in weight loss: chewing gum vigorously (100 chews a minute) has been shown to slightly increase metabolic rate. Gum can also be an appetite suppressant. A study found that chewing gum before an afternoon snack caused people to consume 25 less snack calories. While that is not a high number, even a slight reduction in caloric intake can have significant effects in the long term. Gum can be an alternative to mindless munching. Dieters who crave sweets can chew xylitol sweetened gum after a meal to signal the end of eating. Xylitol is a form of sugar found in plants, trees, fruits and vegetables It has 40% less calories than sugar, and tastes as sweet, with no aftertaste. It may be safe for some with diabetes - check with your doctor.

*Abdominal surgery
A new study has shown that chewing gum after abdominal surgery may help in recovery. Chewing gum reduces the time for the gut to become active, lowering the incidence of obstruction of the bowel and stimulating the release of gut hormones. Furthermore, gum chewers have better chances of avoiding nausea and vomiting after the operation.

*Dental benefits: ingredients such as Xylitol and Peelu in gum may help cleaning your teeth, decreasing tooth decay and dental plaque.. The US Army puts xylitol gum in its MRE (meals ready to eat) because it blocks bacteria from producing the acids that cause tooth decay,. Xylitol also increases saliva flow, which helps neutralize any acids and provides calcium to repair any weakened areas of the teeth. Soldiers returning from combat had been showing serious amounts of dental decay. Now they are advised to chew xylitol gum for 5 minutes 3x daily.

*Memory Aid!: An English study of gum chewing showed that chewers scores were 24% -36% higher than controls on immediate and delayed word recall, and also more accurate on tests of spatial memory. Explanations for the link between recall and chewing gum are varied: Chewing gum raises the heart beat by around 3 beats per minute, increasing blood flow in the cerebral area, which could explain the improvement in such brain activity. Chewing gum while taking in information, and chewing again at the time it needs to be recalled, such as in an exam, may aid in a memory association between the action or taste of chewing gum and the information being remembered. Based on these suppositions, a Stanford student has developed a product called Think Gum, popular on campus at exam time. It contains peppermint, rosemary, ginkgo biloba, vinpocetine from periwinkle plants, the Indian herb bacopa, and guarana, a source of caffeine (10 mg per piece). Since simpler may be safer,
My advice is– try xylitol gum – found in natural food and vitamin stores..
Sadja Greenwood, MD – back issues on my blog http://sadjascolumns.blogspot.com

Mifepristone (RU486), the medical abortion pill

2009-06-07T14:58:00.000-07:00

Go to Health – Mifepristone – the Medical Abortion pill – RU486
Women have been using herbs, poisons, soap solutions, sticks and pointed roots for millennia to try to get rid of an unwanted pregnancy. Illegal, unsafe abortion is a nightmare for women and their health-care providers. Surgical abortion, legal in the US since 1973 (since 1969 in California) has made the process safe, effective and much less traumatic.

In the 1980’s, French doctors began to work on a pill that would induce abortion – it was licensed there in 1988 and called RU486, or mifepristone (Mfp). In the US, it underwent clinical trials in the 1990’s and was approved in 2000. It is legal and available in all 50 states, Washington D.C., Guam and Puerto Rico.

Medical abortion with Mfp can be used as soon as a woman confirms that she is pregnant, and up to 8-9 weeks from the beginning of her last menstrual period. It is most effective if done early. The pills are effective about 95% of the time. In 3% to 5% of cases women will need a suction abortion due to continued pregnancy, prolonged or excessive bleeding.

Mfp works by blocking the action of progesterone, a hormone needed for the continuation of pregnancy. After taking the Mfp pills, in a clinic or doctor’s office, the woman is given a medicine called misoprostol (MSP) to use in a few days. MSP is taken by mouth or inserted into the vagina – clinics differ in their instructions on this. It causes the uterus to contract and expel the pregnancy, often with bleeding that resembles a heavy, crampy period. Infection is a rare side effect of medical and surgical abortions. Women should always be under the care of their clinic or doctor while undergoing an abortion and should follow instructions carefully.

The University of California San Francisco has a helpful website explaining the procedure and comparing medical and surgical abortions: http://www.ucsfhealth.org/adult/edu/abortion.html

Medical Abortion with Mfp is legal throughout Europe (not in Ireland and Poland), and in many Asian countries including India, China, Vietnam and Japan. In Africa, only South Africa and Tunisia allow abortions. In Latin America abortion is legal only in Cuba and Mexico City. The World Health Organization estimates that 21% of all pregnancies in Latin America end in unsafe abortions. MSP, which causes strong uterine contractions, is available over the counter in many areas, sold as Cytotec, a drug designed for preventing stomach ulcers. It is widely used – without Mfp - by women seeking abortion, with very little information on how to use it or handle problems of heavy bleeding, cramping or infection.

The recent murder of Dr George Tiller, a doctor who performed late abortions in Kansas, is a terrible reminder of the passions on both sides of the abortion debate. I had an abortion when it was illegal in this country; I took care of women after illegal abortions, and I performed many thousands of legal procedures. My conclusions – keep it safe and legal; remember contraception.
Sadja Greenwood, MD

New Treatments forAlcohol Addiction

2009-05-31T19:30:00.000-07:00

Go To Health – New Treatments for Alcohol Addiction
Doctors and nurses often use the following screening questions to find and help people with alcohol addiction:
*Have you ever felt you should cut down on your drinking?
*Have people annoyed you by criticizing your drinking?
*Have you ever felt bad or guilty about your drinking?
*Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
Answering yes to 2 or more of these questions indicates a strong possibility of problem drinking. Some reports say that 8% of the population has serious problems with alcohol, and most do not get treatment.

AA is a highly effective treatment for many people. It replaces drinking friends with the fellowship of AA members and sponsors who support sobriety and teach important coping skills. Many members consider that the 12 steps are a guide to a new way of life. Alcoholics who use drug treatments would do well to go to AA as well, for ongoing social support.

Antabuse is a drug that makes people seriously ill if they drink. As long as it is taken it is a deterrent, but it has a mixed record because it does not reduce the craving for alcohol, nor does it treat alcohol withdrawal symptoms. It is more widely used and more successful in Europe, with abstinence rates of 50%

Naltrexone, is used to decrease cravings for alcohol. Alcohol increases the release of brain opioids, compounds that promote a sense of pleasure. Naltrexone, an opioid antagonist, blocks brain receptors for these opioids, making it easier for drinkers to remain abstinent or stop quickly in the event of a slip. Naltrexone can reduce relapse and craving for alcohol in many but not all people. It is also used in treating opiate addiction (heroin, oxycontin, et al.) and smoking. This is important, as heroin use is rising. A monthly injection of Naltrexone has been found to work better than a daily pill, at a lower overall dose. It should not be used if a person has hepatitis or cirrhosis.

Baclofen is prescribed as a muscle relaxant, and has been found to reduce cravings for alcohol. Its structure is similar to a brain neurotransmitter known as GABA, which lowers excitability and relaxes muscle tone. It decreases craving for alcohol, is helpful in withdrawal, and can be used by people with cirrhosis. Baclofen use has been popularized by Olivier Ameisen, an academic cardiologist who wrote ‘The End of My Addiction’. He recounts his recovery from being a serious alcoholic with the use of Baclofen. Trials are also underway to treat cocaine addiction with this drug.

Campral is a new drug that seems to restore chemical balance in the brain after people stop drinking; It does not help with withdrawal symptoms, but may reduce sleep disturbances. It should not be used by depressed people, who may become a suicide risk.

Genetic differences may explain why these 3 drugs are helpful for some but not all. (Pregnant and breast-feeding women should not use them.) Considering the huge personal and social dangers of alcohol abuse, they are important new medications
Sadja Greenwood. MD

Green Tea

2009-05-25T10:33:00.000-07:00

Go to Health – Green Tea

Archeological evidence suggests that people consumed tea leaves steeped in hot water as many as 500,000 years ago! Green tea tastes good, and is both energizing (caffeine) and calming (theanine). Recently scientists have been investigating the potential cancer preventive and therapeutic effects of green tea. The polyphenols in green tea, known as catechins, are considered to be the beneficial molecules The most active of these is known as EGCG (epigallocatechin gallate). Researchers at the Medical Sciences Center, University of Wisconsin-Madison have found that EGCG has several ways in which it may be active against cancer - altering the expression of genes involved in cell growth and division, growth of new blood vessels in the cancer (angiogenesis), cancer cell death (apoptosis) and metastasis. These laboratory studies have been augmented by population-based studies in groups of people who drink a lot of green tea – mostly in China and Japan. Such studies are suggestive, but not definitive.

*Bladder Cancer – women who drank black tea and powdered green tea were less likely to get bladder cancer, and men with bladder cancer who drank green tea had a better survival rate.

*Breast Cancer - In one study of 472 women with various stages of breast cancer, researchers found that women who consumed the most green tea experienced the least spread of cancer. Women with early stages of the disease who drank at least 5 cups of tea every day before being diagnosed with cancer were less likely to suffer recurrences of the disease after completion of treatment. However, women with late stages of breast cancer experienced little or no improvement from drinking green tea. . In one very large clinical study from Japan, researchers found that drinking green tea was not associated with a reduced risk of breast cancer.
*Ovarian Cancer - In a clinical study conducted on ovarian cancer patients in China, researchers found that women who drank at least one cup of green tea per day survived longer with the disease than those who didn’t drink green tea. In fact, those who drank the most tea lived the longest.

*Prostate Cancer - Laboratory studies have found that green tea extracts prevent the growth of prostate cancer cells in test tubes. In a large clinical study conducted in Southeast China researchers found that the risk of prostate cancer declined with increasing frequency, duration and quantity of green tea consumption. However, both green and black tea extracts also stimulated genes that cause cells to be less sensitive to chemotherapy drugs. Given this potential interaction, people should not drink black and green tea (as well as extracts of these teas) while receiving chemotherapy.

Pancreatic Cancer - In one large-scale clinical study researchers compared green tea drinkers with non-drinkers and found that those who drank the most tea were significantly less likely to develop pancreatic cancer.. However, it is not clear from this population-based study whether green tea is solely responsible for reducing pancreatic cancer risk.

*Colorectal, Esophageal, Lung, Stomach Cancer -– conflicting results, including possible increased risk. Extremely hot drinks are can damage the esophagus.

Green tea extracts are also being studied for possible help with inflammatory bowel disease, diabetes, alcoholic liver disease, arthritis, weight loss, dental caries, genital warts, and even prevention of cold and flu symptoms. Stay tuned for more studies.

Green tea contains 20-30 mg of caffeine per cup, compared to 100 mg in a cup of coffee; you can also make decaf green tea.. Pills containing green tea extracts are available, some without caffeine.
Sadja Greenwood, MD - back issues on my blog – http://sadjascolumns.blogspot.com

Emergency Contraceotion - the Morning-After Pill

2009-05-23T13:05:00.000-07:00

Go to Health – the morning-after pill , aka emergency contraception, Plan B

Jessica broke up with her boyfriend, and went off the birth control pill. Three months later they got back together, had a celebratory drink, and had sex without a condom.

Maria and her husband were both in school and working to support their children. When they had sex, the condom broke.

Liza went to a great party, with dancing, liquor, drugs and cute guys. She felt woozy after a drink, and had to lie down in a bedroom. She woke up to find she was being raped.

Fortunately, all these women knew about the morning-after-pill, otherwise known as Plan B , which can prevent pregnancy 89% of the time if taken within 72 hours after unprotected sex. The first pill is taken as soon as possible, and the second 12 hours later. The sooner it is taken, the more effective it is. Side effects can include nausea, abdominal pain, fatigue or headache, but in general are not severe.

Plan B contains a high dose of levonorgestrel, a progesterone-type hormone that is used in many birth control pills. It prevents pregnancy primarily by stopping ovulation (the maturation and release of eggs from the ovaries) or by preventing fertilization of the egg if ovulation has already occurred. Plan B also alters the lining of the uterus, making it less receptive to a fertilized egg.

If a woman is already pregnant, Plan B will not cause an abortion. Also, Plan B should not be used as a regular birth control method, because other methods such as the birth control pill, IUD or condoms are usually much more effective. Plan B is used in emergencies, which is why it is known as emergency contraception.

Plan B is available locally, at the West Marin Pharmacy, Safeway, or Longs. Call first to make sure it is in stock. If you are 17 or older, it is available without a prescription; younger women need a prescription from a doctor. It may be less expensive from a family planning clinic like Planned Parenthood. Men 18 and older can also buy Plan B. Women who rely on condoms, or are forgetful about the birth control pill should have Plan B immediately available in reserve, so they can use it as soon as possible after unprotected sex.

The Copper-T is an intrauterine device (IUD) that some women use for regular birth control, but you can also have it inserted up to five days after sex to prevent pregnancy. It reduces your risk of getting pregnant by more than 99%. Another advantage to the Copper-T IUD is that you can keep it in place to prevent pregnancy for up to ten years. IUDs are a good form of contraception if neither partner has a sexually transmitted disease such as gonorrhea or Chlamydia.

An excellent website for emergency contraception is ec.princeton.edu.

There is a medication that causes abortion in early pregnancy, known as Mifeprex (mifepristone, RU486), which will be described in another of these columns.
Sadja Greenwood, MD

'Plumpynut'

2009-05-23T13:02:00.000-07:00

Go to Health: ‘Plumpynut’

Severely malnourished children in Africa are being saved by a fortified peanut butter known as ‘Plumpynut’. It was developed by Andre Briend, a French pediatric nutritionist with WHO who saw the need for a food that was cheap to produce, ready to eat, and did not need clean water to prepare. It contains peanut paste, vegetable oil, powdered milk, sugar, vitamins and minerals, combined in a foil pouch that equals 500 calories. Peanuts contain monounsaturated fats, which are easy to digest; ‘Plumpynut’ is rich in zinc and protein, good for the immune system and muscle development. According to Doctors Without Borders, there is virtually no peanut allergy among the children they treat.

Mothers who are themselves malnourished can’t produce enough breast milk for their children, can’t afford to buy milk, and lack clean water, electricity and refrigeration.

Doctors Without Borders have been giving out packets of ‘Plumpynut’ in Niger, Malawi, Darfur, and other African countries since 2005 to children who are dramatically underweight and able to be treated as outpatients. Children love the taste and all but the weakest can feed it to themselves. In most cases, their weight gain and return to health is rapid . Please watch the remarkable results of using ‘Plumpynut’ on 60 Minutes with Anderson Cooper
www.cbsnews.com/stories/2007/10/19/60minutes/main3386661.shtml

Doctors Without Borders
estimate there are 20 million malnourished children around the world, and only about 3% are getting foods like ‘Plumpynut’ .

You can support Doctors without Borders by calling
1-888-392-0392

Sadja Greenwood MD

Methamphetamine

2009-05-23T12:59:00.000-07:00

Go to Health: Methamphetamine

Federal surveys indicate that about 1% of the population over age 12 uses meth in a given year. A rising number of users are smoking meth rather than snorting it or taking it orally. Smoking is said to create a faster, jolting high, quicker addiction and more ill effects. A recent study by the RAND Corporation, published on the Meth Project website, computes the annual costs of meth use in the US at $23.4 billion per year. These costs include health care, drug treatment, rehab, foster care for endangered children, the criminal justice system, injuries and deaths from exploding meth labs and cleanup of the toxic waste these labs produce.

There’s a good website on the use and dangers of methamphetamine: methproject.org. The Meth Project is a large-scale prevention program aimed at reducing first-time meth use among young people through public service messaging, public policy, and community outreach. Their messages are aimed at youth, and their motto is ‘not even once’. They have been active and successful in several rural states, including Montana, Idaho, Arizona, Wyoming and Illinois. Their method is to educate the public against trying meth with TV ads, radio, billboards and murals painted by youth. If you are concerned about the dangers of meth for our youth, check it out.

Taking even small amounts of methamphetamine can result in increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and high body temperature. Long-term use leads to extreme weight loss, severe dental problems, facial scarring, anxiety, confusion, insomnia, mood disturbances, and violent behavior. Users can experience paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects creeping under the skin).

Dopamine is a brain chemical with effects on many body systems having to do with activation and pleasure. First time meth users can experience extreme pleasure from an outpouring of dopamine in the brain. After a number of hours, there is an unpleasant crash, leading to a desire for more meth. Repeated use leads to serious addiction; it changes brain chemistry in a way that can take years to reverse. Treatment of meth addiction is a huge problem; there are as yet no effective drugs that decrease the cravings.

Three suggestions:. Parents should know that a dangerous drug mixing meth and ecstacy called Thiz is popular among youth, and has been seen in our local towns. Read the books by David and Nic Sheff on meth addiction - Beautiful Boy and Tweak. Get your dopamine high from working out, coffee, playing music – or whatever drug-free way of being turns you on.

Sadja Greenwood, MD

Probiotics

2009-05-23T12:55:00.000-07:00

Go to Health! – Probiotics

Probiotics are living microscopic organisms that scientific research has shown to benefit health. Most often they are bacteria, similar or identical to the bacteria already in our intestines. The most common probiotic bacteria are Lactobacillus or Bifidobacteria, but there are many other bacterial strains that are useful for various illnesses.

We humans have more than 400 bacterial species in our guts; bacteriali numbers exceed by 10 fold the number of tissue cells in our bodies. About 70 % of the body’s immune system is found in the digestive tract, in lymphoid tissue that stores immune cells such as T and B lymphocytes, and defends against disease causing bacteria and viruses.

Research is ongoing to elucidate the effects of probiotic bacteria on the immune system. Some current uses of probiotics are for the following ailments:

*Infectious diarrhea caused by bacteria (salmonella, campylobacter, some strains of e coli) and viruses (especially rotavirus in children)

*antibiotic related diarrhea – there is evidence that taking probiotics when you start on an antibiotic may halp prevent diarrhea.

* childhood allergy - In a recent trial, Lactobacillus rhamnosus was given to pregnant women for four weeks prior to delivery, and then to newborns at high risk of allergy for six months. As a result that there was a significant reduction in early skin allergies.
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•bladder infections in women – certain strains of e coli in the bowel are responsible for about 85% of bladder infections. Studies have shown that daily oral capsules of certain lactobacillus strains have lowered the risk of repeated bladder infections, when used with weekly insertions of capsules in the vagina.=

*Yeast and bacterial vaginal infections - (not sexually transmitted diseases such as gonorrhea or Chlamydia) there is evidence that oral and vaginal lactobacillus can reduce the recurrence of these common problems

*recurrence of superficial bladder cancer – Japanese researchers have shown that oral capsules of certain probiotics, and the use of probiotics instilled in the bladder along with chemotherapy agents, have prevented recurrence without side effects, or prolonged the time of cancer recurrence.

*Research is ongoing in the use of probiotics for irritable bowel syndrome and ulcerative colitis.

You can easily get the benefits of probiotics by eating yogurt or other cultured milk products. Read the label to make sure that they contain ‘living cultures’. Adults who want a more concentrated form of probiotics can take them in capsules.. Choose a brand from a reputable supplement company; make sure that the capsule contains lactobacillus acidophilus, and bifidobacteria and that each capsule contains at least 3billion bacteria. Capsules should have been refrigerated, and should be refrigerated after you buy them. Since, the beneficial bacteria are only retained for days or weeks, continued use is required. Children can take probiotics; for this, confer with your child’s doctor.

Certain foods, called prebiotics, have carbohydrates that promote the growth of probiotic bacteria in the gut: bananas, berries, asparagus, garlic, whole wheat, oatmeal, barley, flaxseed, tomatoes, Jerusalem artichoke, onions and chicory, many greens ( dandelion greens, spinach, collard greens, chard, kale, mustard greens), and legumes (lentils, and beans). These are great foods that we all should be eating!
Submitted by Sadja Greenwood MD –

Vitamin B12

2009-05-23T12:43:00.000-07:00

Go to Health – Vitamin B12

Vitamin B12 plays a key role in the normal functioning of the brain and nervous system, and in the formation of our red blood cells. It is involved in the metabolism of every cell of the body, especially affecting the synthesis of DNA (our genetic material).

Vitamin B12 is bound to the protein in food from animals (fish, meat, poultry, eggs and dairy); mollusks like clams and oysters are especially high. B12 is not present in plant proteins. Fortified breakfast cereals are an important source of vitamin B12 for vegetarians. Hydrochloric acid in our stomach releases vitamin B12 from proteins during digestion. Once released, vitamin B12 combines with a protein called intrinsic factor (IF). This complex can then be absorbed by the intestinal tract.

Young people eating a variety of animal foods are rarely deficient in Vitamin B12, unless they have an underlying disorder of the stomach or small intestine (such as untreated celiac disease , or surgical removal of these organs). Vegans – who eat no animal protein - should take supplemental B12; pregnant and lactating women should of course be careful to eat well and take supplemental vitamins as prescribed.

Older adults can develop a condition known as atrophic gastritis with inflammation of the stomach, bacterial overgrowth, and a deficiency of the protein known as intrinsic factor. Without intrinsic factor, vitamin B12 cannot be absorbed. This condition can lead to an illness known as Pernicious Anemia, which is treated with Vitamin B12 and other B vitamins. Patients have anemia, fatigue, numbness and tingling in the hands and feet , difficulty in maintaining balance, depression, confusion, dementia, and soreness of the mouth or tongue. Any one with these symptoms should seek medical care, as they will need careful assessment and treatment.

Scientists are now seeing that low levels of B12 can cause problems even if Pernicious Anemia is not present. New studies are showing the benefits of high normal levels of this vitamin.

*Brain Power A recent study from Oxford University in England found that adults over age 60 who had higher vitamin B12 levels were 6 times less likely to experience brain shrinkage than those with lower levels on testing 5 years later. Testing involved brain scans and memory tests. None of the people in this study had what would be called vitamin B12 deficiency. The lead author in this study wrote:
‘Many factors that affect brain health are thought to be out of our control, but this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory.’ The study did not look at whether taking vitamin B12 supplements would have the same effect on memory.

*Link to Depression: A study from the National Institute of Aging found women with low B12 levels were more than twice as likely to develop depression as women with normal B12 levels. This finding did not apply to men in a similar study from Spain.

*Bone strength: several studies show an association between B12 levels and bone strength. B12 seems to help osteoblasts , bone-building cells.

*Age-related Macular Degeneration: this is the leading cause of blindness in the elderly. A Harvard study showed women taking high doses of vitamins B6, B12 and folic acid were found to have significantly more protection from this eye disease than women on placebos. Epidemiologist and study author William G. Christen of Harvard Medical School said that if these findings are successfully replicated in future studies, "the combination of these vitamins might become the first prevention method of early stages of age-related macular degeneration other than avoiding cigarette smoking” He felt that the same results would also be true for men.

Hearing Loss: A study from the University of Georgia showed that hearing loss was associated with low concentrations of serum vitamin B-12 and red cell folate (folic acid – another B vitamin). Animal studies have also shown this correlation..

Based on these recent findings, many doctors are advising people reaching middle age, as well as vegetarians and vegans, to supplement with vitamin B12. A test is available to determine blood levels of the vitamin; levels considered normal have gone up in recent years. Levels below 200 pg per milliliter were considered low in past years, but now optimal levels may range from 500 to 1000 pg/ml. If you have this test, your doctor or nurse-practitioner will advise you about your results.

In cases of deficiency, vitamin B12 can be given by injection. However, people can also take oral B12 tablets that are dissolved under the tongue, so that the vitamin goes straight into the blood stream. Fortunately Vitamin B12 is a safe supplement, and it is becoming more popular among people aware of the aging process. Stay in touch with your body’s needs as the years go by.
Sadja Greenwood, MD –back issues on my blog http://sadjascolumns.blogspot.com

Vitamin D

2009-05-23T12:36:00.000-07:00

Go to Health! – Vitamin D

Vitamin D, formed on the skin with sun exposure, is a fat soluble vitamin essential for maintaining many body systems, including (but not limited to) calcium metabolism and bone strength. All the cells in our bodies have receptors for Vitamin D, so we know it has many effects.t

*Osteoporotic fractures - Women who take calcium and vitamin D supplements have been shown to have a lower risk of fractures, in the hip and other areas.

*Muscle strength -Vitamin D is also helpful in promoting muscle strength and decreasing muscle pain. Recent studies show a possible help of D in decreasing falls in the elderly.

*Heart disease - Low level of D is associated with an increased risk of heart disease, and high blood pressure.

*Cancer - results of some, but not all, human studies suggest that D may protect against certain cancers, including colorectal cancer. D regulates proteins responsible for cell division. Some epidemiologic studies show that women with breast cancer have lower vitamin D levels than matched controls.

* Autoimmune disease Adequate vitamin D levels may decrease the risk of autoimmune diseases such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis.

* Memory loss with aging Recent research shows that older adults with low Vitamin D levels may be at higher risk for cognitive impairment,

*Respiratory infections people of all ages with low levels are more at risk for colds and other respiratory infections, including tuberculosis.

*Seasonal affective disorder (winter blues) and depression Studies are beginning on the use of Vitamin D for SAD, which may be more effective than light therapy.

As Vitamin D plays such an important role in human health, it is a good idea to have your health care provider order a test for a blood level of 25 hydroxy vitamin D. A level above 30 ng/ml is desirable, and 50 ng/ml is considered optimum. To achieve this level without high sun exposure, which can carry risks of skin cancer and skin aging, most adults in our area need to supplement with 1000 IU daily. Some doctors are advising more than this. We form very little Vitamin D on our skin between October and March at this latitude. People with darker skin absorb Vitamin D from the sun more slowly, and may need higher levels of supplementation.

Submitted by Sadja Greenwood, MD, as part of a new series- stay tuned for probiotics, B12, fish oil, the cost of methamphetamine, a new drug to treat addiction, and more.
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