New Thinking About Calories

A paper just published in the American Journal of Clinical Nutrition has caused nutrition experts to rethink the adage – a calorie is a calorie.  In terms of weight gain in humans, “foods have complex mechanisms that help or hinder weight long term”  according to the paper’s authors.  Researchers from Tufts and Harvard Universities examined 24 years of data on 121,000 men and women.  Subjects were nurses and doctors from the Nurses’ Health Study and the Health Professionals Follow-Up Study.  Subjects, initially free of obesity or chronic illness, completed detailed food questionnaires.  Their weight gain was measured every four years, and results were adjusted for lifestyle changes such as physical activity, sleep, and total calorie intake.  The study found the following associations between protein foods and weight:

1) Meats, chicken with skin and regular cheese were associated with weight gain..

2) Milk, legumes, peanuts and eggs were not associated with weight gain or loss.

3) Yogurt, peanut butter, walnuts and other nuts, skinless chicken, low fat cheese and seafood were associated with relative weight loss.

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

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

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

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

Sadja Greenwood, MD, MPH

Short Walks, Squirm to Learn, Diet Swap to Prevent Colon Cancer

Short Walks Reverse the Problems of Sitting

You probably know that prolonged sitting isn’t healthy – it can actually reduce your lifespan.  Here’s the good news – taking a 2 minute walk every hour can reverse the damage. Research from the University of Utah has shown that people who engage in two minutes of walking every waking hour come close to achieving the 2.5 hours of moderate exercise each week - the amount that strengthens the heart, muscles and bones and extends the lifespan.  My suggestions – set an alarm when you are working at your desk, and walk around with gusto every hour.  Get up during all commercials when you watch television – that will give you much more strolling time.    This regimen may be better than sitting all day and then taking a run or going to the gym.  Stay tuned. 

Squirm to Learn

A new study from the University of Central Florida showed that children with attention deficit/ hyperactivity disorder (ADHD) learn better if they are allowed to engage in foot tapping, leg swinging and chair scooting movements. This kind of movement is vital to how they remember information and work out cognitive tasks. Children without hyperactivity learn less well if kept in motion.  Mark Rapport, head of the Children’s Learning  Clinic at the University of Central Florida said ”The message isn’t ‘let them run around the room’ but that you need to be able to facilitate their movement so that they can maintain the level of alertness necessary for cognitive activities.  A majority of students with ADHD could perform better on classroom work, tests and homework if they’re sitting on activity balls or exercise bikes, for example.”  This message may be true for adults as well – if you have always been a fidgeter and think you have a version of attention deficit disorder, try reading on a slow treadmill or exercise bike.  It may improve your concentration. 

Diet Swap has dramatic effects on colon cancer risk

Scientists at Imperial College in London and the University of Pittsburgh have found dramatic effects on risk factors for colon cancer when American and African volunteers swapped diets for just two weeks. Western diets, high in protein and fat but low in fiber are thought to raise colon cancer risk compared to African diets high in fiber and low in fats and protein.  Colon cancer rates are much higher in the western world than in Africa or Asia.  A group of 20 African American volunteers and another group of 20 people from rural South Africa swapped diets under tightly controlled conditions for two weeks.  The volunteers had colonoscopy exams before and after the diet swap – researchers also looked at biological markers for colon cancer and samples of colonic bacteria.  In the start, almost half of American subjects had colonic polyps (which can progress to cancer) and none of the Africans had these growths.  After two weeks on the African diet, the Americans had significantly less inflammation in the colon and reduced biomarkers of cancer risk. In the African group. measurements indicating cancer risk had increased dramatically after two weeks on the western diet.

Professor Stephen O'Keefe at the University of Pittsburgh, who directed the study, said: “our study suggests that westernization of the diet induces changes in biomarkers of colon cancer risk in the colonic mucosa within two weeks. Perhaps even more importantly, a change in diet from a westernized composition to a 'traditional African' high fiber low fat diet reduced these biomarkers of cancer risk within two weeks, indicating that it is likely never too late to change your diet to change your risk of colon cancer."

The study found that a major reason for the changes in cancer risk was the way in which the bacteria in the gut -- known as the microbiome -- altered their metabolism to adapt to the new diet. In the American group, the researchers found that the African diet led to an increase in the production of butyrate, a byproduct of fibre metabolism that has important anti-cancer effects.

The take home message here is – eat plant foods high in fiber. Refined flours, sugars and all kinds of processed foods should be seriously questioned and left on the grocery shelf. 

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

The Dirty Dozen and the Clean Fifteen

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

The Dirty Dozen  

Every year the Environmental Working Group analyzes pesticide residues on produce and publishes a guide for shoppers and eaters.  Here is their 2015 guide to fruits and vegetables containing containing the heaviest  pesticide residues: They have named these items the Dirty Dozen.  Try to find organic versions of these foods, or grow them yourself if possible. 

Apples, peaches, nectarines, strawberries, grapes, celery, spinach sweet bell peppers, cucumbers, cherry tomatoes, snap peas (imported), potatoes.

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

 The Clean Fifteen

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

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

Should You Worry about Pesticides

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

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

Sadja Greenwood, MD, MPH  

Know What You Are Taking!

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

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

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

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

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

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

Important News on Roundup

The International Agency for Research on Cancer (IARC), part of the World Health Organization, has classified glyphosate  - commonly known as Roundup – as “probably carcinogenic to humans”. Glyphosate is one of the world’s most widely used herbicides  -used in growing corn, soy, vegetables, fruits, winemaking, and in home gardens. It has been used in forests to clear underbrush, in cities to deter pavement weeds, and on railroad tracks to kill unwanted vegetation.  It is used on sugarcane to increase crop yield and through crop desiccation to increase sucrose concentration before harvesting.

Monsanto developed glyphosate, which it calls Roundup, in the 1970’s. Since 1980, Monsanto has developed genetically modified soy, corn, canola, cotton, sugar-beets and alfalfa.  These GMO crops are designed to resist the herbicide Roundup, which is used to kill weeds and increase crop yields.  The seeds of these modified crops  must be purchased again each year from Monsanto by the farmer.  The development of super-weeds, resistant to Roundup, has recently been a growing problem, requiring heavier spraying of glyphosate and  other herbicides such as 2-4D (a component of Agent Orange, used as a defoliant in the Vietnam war.) 

Monsanto’s patent on glyphosate expired in 2000, and many other companies now make the product worldwide.   

Here’s what the new IARC report said, as published in the journal Lancet Oncology:

‘

“For the herbicide glyphosate, there was limited evidence of carcinogenicity in humans for non-Hodgkin lymphoma .  The evidence in humans is from studies of exposures,

 mostly agricultural, in the USA , Canada, and Sweden published since 2001.  In addition, there is convincing evidence that glyphosate also can cause cancer in laboratory animals.  On the basis of tumors in mice, the US

Environmental Protection Agency originally classified glyohosate as possibly carcinogenic to humans in 1985.  After a re-evaluation of that mouse study, the US EPA changed its classification to evidence of non-carcinogenicity in humans in 1991. The US EPA Scientific Advisory Panel noted that the re-evaluated  glyphosate results were still significant using two statistical tests recommended in the IARC Preamble.  The IARC  Working Group that conducted the evaluation considered the significant findings from the US EPA and several more recent positive results in concluding that there is sufficient evidence of  carcinogenicity in experimental animals. Glyphosate also caused DNA and chromosomal damage in human cells, although it gave negative results in tests using bacteria.  One study in community residents reported increases in blood markers of chromosomal damage (micronuclei) after glyphosate formulations were sprayed nearby.”

This is a complex subject, which is why I have quoted the IARC’s document precisely.  You can see the different opinions of the IARC and the US FDA.  Companies making glyphosate have criticized the report in the last few days.   Whether the US EPA will make any regulatory changes remains to be seen.   

Here in West Marin we are immensely lucky to be able to buy organic food.  However, the re-evaluation of glyphosate  by the WHO’s IARC is bound to  have an impact on the world and its food supply,  and on the movement to label genetically modified foods.

Here are some topics to think about:. 

*Are there safer herbicides and pesticides that can be used on cereal crops that are feeding the world?

*To what extent can organic agriculture and integrated pest management feed the world?

*Much of US GMO corn and soy is fed to animals destined for human consumption.  If meat prices rise due to a ban on dangerous herbicides, can we switch as a society to eating less meat and more plant protein?

*Is world population growth inevitable, or can education and family planning for women in developing countries help to slow this growth?

*Why are we so reluctant to talk about  family planning as a factor in our environmental crises? 

Stay tuned.  The discussion on glyphosate is only beginning.

Sadja Greenwood, MD, MPH  past issues on this blog

p.s. Here are two unrelated topics you may enjoy reading about:

 *Science Daily 3/12/15 You are when you eat – limiting flies to specific eating hours protects their hearts against aging, study finds.

 *Caya Diaphragm - safe and hormone free contraception

www.caya.eu/en   

Another Reason to Love Green Vegetables, Nuts and Olive Oil

An amazing dietary study was launched in Spain in 2003, to look at the effects of a Mediterranean diet on the prevention of cardiovascular disease. Researchers also looked at all cause mortality, diabetes, cancer, dementia and other diseases.   7000 asymptomatic participants ages 55 -80 were selected and followed for 5 years.  The subjects were divided into 3 groups – one given extra-virgin olive oil - one liter per week, one given supplemental nuts (walnuts, almonds, and hazelnuts) about 2 tablespoons a day,  and one advised to follow a low-fat diet.  The first two groups were instructed to follow the Mediterranean diet, high in vegetables and fruits, fish, legumes, grains, and olive oil, and low in meat and dairy products.  Wine was permitted, sweets limited.  The control group was instructed on a low fat diet.  After 5 years, participants following the diets enhanced with olive oil or nuts had a 30% lower risk of dying from cardiovascular disease or having a heart attack or stroke, compared to those on a low fat diet.   They also had less cognitive decline.  These are impressive results.

Researchers also looked at the Vitamin K intake of participants in this study.  People with the highest intake of foods containing Vitamin K were 46% less likely to die of cancer and 36% less likely to die from any cause than those with the lowest intake.  Again - impressive results.

Vitamin K – named for the German word for coagulation – helps blood to clot by activating certain proteins made in the liver.  It is found in a variety of foods, but mainly in leafy green and cruciferous vegetables. People taking Coumadin to reduce the propensity of blood to form clots are counseled to eat a consistent amount of leafy greens daily to match their dose of Coumadin. 

Vitamin K has also been studied for its role in bone metabolism.  A Japanese study found that people from regions where vitamin K foods were eaten in abundance had fewer hip fractures.  Several other studies from Europe have shown similar results.  While supplementation with vitamin K is not considered necessary for most people, eating green vegetables is always a plus. 

Sadja Greenwood, MD  MPH

A 12-Hour Window for a Healthy Weight

Here’s what researchers at the Salk Institute in La Jolla, CA found out about mice.  The results were so striking that they were reported in the New York Times Magazine on 1/18/15.  Many people are trying out the pattern in advance of human studies, since it seems easy, sensible and safe.

 In 2012 Salk researchers published a study on mice who could consume high fat food and could not exercise.  The mice eating this food at all hours grew fat and sick and had symptoms of diabetes.  Another group, on the same diet, could eat only within an 8 hour window.  They gained a little weight but developed no metabolic problems.  This study was enlarged and repeated, with results published in the journal Cell Metabolism in December 2015.  This time, adult male mice were divided into 4 dietary groups – high fructose, high fat, high fat and high sucrose, and regular mouse kibble.  Some mice in each group were allowed to eat whenever they wanted, and others were restricted to feeding periods of 9, 12, or 15 hours.  The caloric intake for all the mice was the same.  At the end of 38 weeks, mice eating at all hours were generally obese and metabolically ill, as in the previous study.  However, the mice that ate within a 9 or 12 hour window remained ‘sleek and healthy’, even if they cheated occasionally on weekends by eating outside the window.  Also, mice switched out of an eat-anytime schedule to a time restricted one lost some of the weight they had gained.  Mice who ate regular kibble at fixed time periods  had less body fat than those who could eat whenever they wished.  The 15 hour window was not as effective as the 9 or 12 hour restriction.

The main researcher, Dr. Satchidananda Panda, is looking at connections between circadian rhythms  - the sleep-wake cycle, and eating patterns.  He has found that even those with genetic variations that may predispose to nighttime eating and weight gain can do well with a time-restricted pattern. He titled his press release “another case against the midnight snack”.  Dr. Panda also looked at gut microbes in the mouse intestine during a 24 hour period, and found a complex daily cycle, with some bacteria at high levels at night, and different ones peaking during the day.  These fluctuations disappear in obese mice, which may be a contributing factor to metabolic disease.  In addition, fluctuations in levels of bacteria in the gut can cause fluctuations in bile acids – microbes that play key roles in controlling cholesterol levels, fat absorption and body metabolism.

Dr. Panda and his group have written that human studies on time-restricted diets would be useful, but may not have started. 

I think a time restricted diet is sensible and sounds easy, especially if you choose the 12 hour interval,  It’s important to follow a good eating pattern – plenty of vegetables, fruits, healthy protein, including beans and whole grains, and healthy fat including olive oil. Avoid sugars, refined flours and junk food.  Remember that alcohol counts as food.   I’m trying a 7am to 7pm pattern and find it satisfying.  Going to bed without too much food in the stomach helps many people sleep.  I haven’t tried cheating on the weekend yet, but it sounds promising, and who wouldn’t want to look ‘sleek and healthy’?

Sadja Greenwood, MD, MPH

Why You Shoul Know Your Numbers!

This is not math – this is your key to long-term survival.  The important numbers for most people are:  blood pressure, blood sugar, cholesterol levels, and weight. For some of these numbers you will need a collaborative relationship with your doctor, nurse practitioner, or physician’s assistant.  We are so lucky to have great clinics and health systems here in West Marin.  With a few appointments you can find your numbers and work on getting them in a healthy range.   Young people tend to feel invincible, middle aged people are too busy, and many (not all) men bypass health checkups for a wide variety of reasons.  I won’t speculate on what they are, but I have been told  (by several guys) that it’s a guy thing!  In addition, even with better health insurance coverage, a clinic visit and lab teats can be expensive.  However, once you understand your initial numbers, you can do a great deal of self-monitoring. By bringing your numbers into the normal range, you may be saving your future.  That’s a big deal. 

Blood Pressure:  High blood pressure is often a symptomless disease, that can lead to heart attack, congestive heart failure, stroke, kidney damage and many other problems.  You should know your blood pressure numbers, and discuss them with your clinician if they are abnormal..  You should have a reliable home blood pressure kit that you use regularly, and take medication  if advised to do so.  You can reduce high blood pressure with a regular walking program, the DASH diet, gradual weight loss, and self-calming practices such as meditation.  Books on the DASH diet are available at the library.  DASH stands for Dietary Approach to Stop Hypertension.  You will not go hungry on the diet, and you will start to feel better.

Blood Sugar: -High blood sugar, better known as blood glucose, can be a sign of impending diabetes or full-blown diabetes.  Normally your blood glucose levels increase after you eat, causing the pancreas to release insulin, and enabling your cells to absorb glucose for energy production.  You can find out your blood glucose level by having a blood test at the clinic after an overnight fast, 

or by having a slightly different blood test that will show your glucose levels in the past month.  Recent studies show that 27% of adults over age 65 have diabetes, and 35% of all adults have pre-diabetes.  The rise in this illness is related to the overweight and obesity crisis in the US to day.  Once you know your blood glucose level, if it is high you can self-monitor with a home blood glucose meter.  You can bring your glucose levels down with regular exercise (walking is fine) and an eating plan that emphasizes vegetables and protein and avoids foods with sugar and refined flour.  The Mayo Clinic Diabetes Diet is a good place to start.  Get the book out of the library, or from your book store.

Cholesterol Levels:  Cholesterol is a substance made in the liver and found in animal foods that we eat.  While the body makes, and needs, some cholesterol, too much can increase the risk of heart disease.  You probably know that sub-fractions of cholesterol have different effects on us  - HDL cholesterol is the “good cholesterol” that can help prevent heart disease, while the LDL type is “bad” and can promote blockage in the arteries.  Family history, age and gender all play important roles in the cholesterol story.  Your clinician will do a blood test to determine the levels of all your blood fats, including triglycerides, and advise you on a plan to achieve or maintain normal levels.  If your levels are elevated, you may need to take medication, or you may be able to use diet, exercise and weight loss to bring your levels down.  It is a good idea to have a blood test for blood fats (also called lipid levels) in your twenties, and follow up as needed.  Know your levels, and proceed accordingly, in collaboration with your clinician. 

Weight:  As a country, we have gained a lot of weight.  The causes, as you know, are inactivity and unhealthy food.  Get a bathroom scale, and start weighing yourself regularly.  Many people weigh themselves daily to maintain a normal weight.  You can find your ideal weight at the clinic, or on the web – cdc.gov/healthy weight.  This link will also give you your BMI, or Body Mass Index.  Keeping a healthy weight is not just a question of how you look, but is directly associated with heart disease, diabetes, many cancers, and other problems.  The New York Times Magazine on 1/18/15 has an article about mice who were allowed to eat regular kibble, high fat food, or food with fats and sugars.  Those who could eat only in a 9 or 12 hour window remained sleek and healthy, in all groups. The researchers think that this ‘time restricted eating’ influences the body’s internal metabolic clock, and will probably help humans as well as mice.  “The clock starts with that first cup of coffee with cream and sugar.”  If you have had trouble with other weight loss plans, you could try this one.  However, every body needs healthy food – especially vegetables, protein, fruits and unrefined  grains.  Don’t eat junk food or mouse kibble for 12 hours instead of 24!

Know Your Numbers.  Don’t smoke. Avoid a beer belly.  That’s my final word for today.

Sadja Greenwood, MD, MPH

Medication Abortion - A Worldwide Trend

Do you remember the story of a Dutch ship sailing to Ireland in 2001, to provide abortions in international waters?  Rebecca Gomperts, the ship’s doctor, had set up an abortion clinic on board.  Hundreds of Irish women sought appointments when they docked in Dublin, However, conservative politicians in the Netherlands denounced Gomperts for potentially breaking a law that required a special license for any doctor performing abortions after 6 ½ weeks, a license they had failed to give to her.  Gomperts felt she must turn around without performing a single abortion, which she had planned to do with the abortion pills – mifepristone (formerly called RU-486) and misoprostol.  The pills are highly effective, about 98%.

Mifepristone has an anti-progesterone effect, causing the placenta to separate from the uterine lining.  Misoprostol causes uterine contractions which expel the early pregnancy through the cervix.  Misoprostol can also be used during labor, and to prevent or treat post-partum hemorrhage. It is sold in this country as Cytotech, and in this form used to prevent stomach ulcers.  It is sold in many countries, including Mexico, as an inexpensive, over the counter generic.  Women are using misoprostol alone, without mifespristone, frequently without directions as to the dose needed.  This is true in Texas as well as Mexico, as Texas has closed the majority of its abortion clinics.  Used correctly, misoprostol is about 80% effective in producing a complete abortion in early pregnancy. 

Back to Rebecca Gomperts - she did not abandon her plans, traveling with her ship to Poland, Portugal and Spain.  The enormous publicity resulting from her trip to Portugal in 2004 resulted in the legalization of abortion in that country in 2007.

As the word spread that there were pills that could end early pregnancy, women in many countries where abortion was restricted sent emails to the Gomperts website - Women on Waves, now also called Women on Web.  They currently receive about 2000 queries per month from women the world over seeking help with medical abortions.  After a doctor reviews each case to determine whether symptoms might indicate a tubal pregnancy, and whether the dates of last menstrual period mean that the pregnancy is not over 9-10 weeks, a prescription is sent electronically to a drug exporter in India, who sends the package with a tracking number.  Women on Web also sends an emails to the woman telling her how to take the pills and what to expect in terms of bleeding, cramping and pain. The help desk at Women on Web will answer questions during the process, and urge the woman to seek medical help if it sounds like there is a complication, such as excessive bleeding.  Women can claim they are having a spontaneous abortion in places where abortion is illegal.

The Indian company that exports the drugs is run by a man who is said to be dedicated and sympathetic to the women who need his services; he helps them with mail tracking problems, and keeps his prices low.

Women on Web will not provide service in any country with safe abortion services, such as the US, even though it can be hard to obtain abortions here in many areas.  Local laws and the FDA have made it difficult for doctors and clinics to provide what are called ‘medication abortions’ with the pills.   Nevertheless, the Guttmacher Institute says that 23% of non-hospital abortions are done with medication, and 36% of all abortions done before 9 weeks.  The percent of all US abortions done with medications has been increasing yearly, while the total number of abortions has decreased – currently about 1 million a year.  One US woman in 3 has had an abortion by the age of 45.  Abortion is one of the safest procedures done in the US, with fewer than 0.5% of women experiencing a complication. The risk of death associated with abortion is about one-tenth of that associated with childbirth. 

However, there are about 47,000 deaths annually from unsafe illegal abortions worldwide, mostly done with non-sterile instruments by untrained operators. 

Gomperts has left Women on Web, after a quarrel about her management style -  the so-called founder’s syndrome.  She obtained a Masters degree in Public Policy at Princeton, and is pursuing a PhD at the Karolinska Institute in Sweden.  We will probably hear more of this amazing woman in the future.  If you are interested, look at the websites of Women on Waves and Women on Web.  Donations help, as many desperate women in developing countries cannot afford the relatively small cost of the needed services.  The New York Times Magazine on Sunday, August 31^st, has a full story on Gomperts and her work. 

Sadja Greenwood, MD , MPH  back issues on this blog

Forests Forever?

Forests play an important role in the carbon cycle of the planet, taking

carbon dioxide from the air and putting it into their wood, roots and the soil beneath them.  According to the New York Times, 12/23/14, humans (that’s us) have cut down, burned or damaged three-quarters of the world’s forests, which has accounted for much of the excess carbon that is warming the earth. Scientists concluded years ago that deforestation must be stopped, to limit climate change and preserve biological diversity.  According to Nigel Sizer, director of forest programs at the World Resources Institute, “Every time I hear about a government program that is going to spend billions of dollars on some carbon capture and storage program, I just laugh and think, what is wrong with a tree?”  Richard Houghton, acting president of the Woods Hole Research Center, has argued for turning some 1.2 billion acres of marginally productive agricultural lands into forests.  This could be possible, researchers say, if farming in poor countries could become more efficient.  Dr. Houghton believes that his target of regrowth and protection of existing forests could slow the rapid growth of carbon dioxide, or possibly halt it.  This, he believes, would give the world a few decades for an orderly transition away from fossil fuels

Environmental organizations, such as Greenpeace, and mounting worldwide pressure, have helped corporate and governmental leaders in countries with tropical forests to begin to slow the cutting.  Forest regrowth is also in the works. Costa Rica is considered a forest success.  Although much of the country’s old growth forest had been cut down, new policies encouraged regrowth to cover more than half the country.  However, there is a threat to reforestation - a boom in pineapple farming that gives landowners an incentive to cut down recovering forest plots.  The pineapples will mainly be exported as a cash crop.

The Amazon, spreading across nine countries of South America, is the world’s biggest tropical forest.  Brazil has cut down millions of acres of the Amazon for timber, cattle ranching and soybean farming.  The soybeans were mainly used to produce meat for Western fast food companies. After Greenpeace invaded McDonald restaurants and put up poster of Ronald McDonald with a chain saw, McDonald and other companies pressured their suppliers to stop buying products linked to deforestation.  Pressure from the Brazilian government and large business groups has resulted in a sharp drop of deforestation, by 83% over the past decade.  The Brazilian Ministry of Agriculture focused on helping farmers raise yields without needing additional land.  The carbon dioxide kept out of the air by Brazil’s  actions far exceeded anything done in the world to slow global warming, according to the New York Times article.

Indonesia is the new test case for environmental groups; deforestation is rampant there – to clear land for the production of palm oil from a type of palm tree. Palm oil is used in many processed foods – ice cream, candies, baked goods and even lipstick. 

Since the (partial) demise of hydrogenated oils – so called trans fats – palm oil has been used as a replacement.  Despite its high levels of beta carotene, it is not a health food, as it is a saturated fat that can raise levels of cholesterol.  Deforestation of Indonesian forests to produce palm oil has resulted in serious environmental damage and has put the Sumatran orangutan on the critically endangered list.  Indonesia is working on better forest regulation.  This has caused palm oil producers to move to Africa.

Here is action plan for us, the lowly enlightened eaters.   Do not buy animal food if the animals have been fattened with soybeans – the beans have probably come from Brazil (and sprayed with Roundup since they are GMO).  Soybeans from the US, unless they are organic, are also sprayed with Roundup, which has endangered the Monarch butterfly by killing milkweed.  2,4-D is also being used on US soybean crops.  Do not buy pineapples from Costa Rica – support their ecotourism instead.   Read labels very carefully on all manufactured foods, and don’t buy anything containing palm oil. Support family planning in every way you can. Population growth is destroying the environment.  Plant a tree. Your actions count – every day!  Happy New Year.  Feliz y Prospero Año Nuevo.

Sadja Greenwood, MD, MPH  Leave me a message!