Update on flu, apples, coffee, vitamin D, and polio in India

*Flu – there have been at least 29 deaths from this year’s flu epidemic in the Bay Area, with many more people in intensive care.  It’s not too late to get the flu vaccine, which contains protection against the HINI virus.  Get yourself protected.

*Apples – I previously reported on the benefits of apples in prevention of cardiovascular disease. See my column on 12/23/13.  Researchers at Cornell University have identified compounds in the peel of apples that have anti-cancer effects in the laboratory against liver, breast, and colon cancer cells.  So – buy organic apples whenever possible, and eat the peel!

*Coffee –New positive votes for coffee!   Researchers in Turkey have reported on numerous studies showing that coffee drinking is associated with a lowered risk for metabolic syndrome, as well as a reduced risk for non-alcoholic fatty liver disease.  Metabolic syndrome is a name for a group of risk factors for diabetes, heart disease and stroke.  These factors are: a large waist line (apple shape), an elevated triglyceride level, high blood pressure, low HDL cholesterol (the ‘good’ cholesterol) and a high fasting blood sugar.  Non-alcoholic fatty liver disease affects about 25% of the US population.  It is a buildup of fat in liver cells, not caused by alcohol, that tends to develop in people who are overweight, have diabetes, high cholesterol or high triglycerides.  A previous large study on coffee, run by the National Institutes of Health (400,00 men and women followed for 12 years)  showed that coffee drinking – either caffeinated and decaffeinated – is associated with a lower risk of death from heart disease, stroke, respiratory disease, injuries and accidents, diabetes and infections.  Coffee is also associated with a lower risk of uterine cancer in women, and of basal cell skin cancer.  A recent large Harvard study showed that caffeinated coffee, but not decaf, is associated with a 50% decrease in suicide.  This is huge.

Oh, I almost forgot – researchers at Johns Hopkins have found that caffeine enhances memory.

*Vitamin D – The American Geriatrics Society advises that older people should have a vitamin D intake sufficient to keep their blood level at about 30ng/ml. This level has been associated with a lower risk of falls and fractures.  While the influence of vitamin D on bone density is small, the impact on muscle strength and fall prevention is impressive.  If you, or a relative, are over 65, getting a vitamin D level is important. The test is called 25(OH) D. Supplementation with vitamin D can bring your level up, and the amount of D to take should be discussed with your health care provider.  The Geriatrics Society suggests that doctors prescribe up to 4000 IU daily to achieve good blood levels.  I suggest getting a blood level before taking 4000 IUs daily – start with 1000-2000 IUs and talk to your doctor or NP.  Calcium intake is also important for strong bones: I will write more on this mineral in a forthcoming column. 

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*Polio eradication in India!  India, a country of 1.4 billion people, has successfully eradicated polio, with no cases reported for the past 3 years.  India had 150,00 cases in 1985, 6,028 cases in 1991, 741 cases in 2009, and the last  one case – on Jan 13^th, 2011.  The country used 2.3 million vaccinators each year; mobile teams immunized children (with oral vaccine – kept cold for potency – no small feat) in homes, in railway stations, inside running trains, at bus stands, marketplaces, and at construction sites. They walked miles to towns not connected to roads. Muslim leaders were identified and went along with the program.  The vaccinators publicized this message  - wherever you stay, wherever you go, protect your child against polio.  This was an astounding public health success, funded by the government of India, the Bill and Melinda Gates Foundation, the U.S. government and many other countries and organizations.   Only 3 countries still have cases of polio – Nigeria, Pakistan and Afghanistan.  In these areas there has been very tragic threatening and killing of vaccination teams.  May the opposition see the light and protect their people against paralysis. 

Sadja Greenwood, MD , MPH  Check out my novel, Changing the Rules, at local bookstores or Amazon.

More Good News About Exercise and Coffee

We all know that it’s good to get moving, but why? Will walking and other forms of exercise do more than help us stay trim? Here’s a study from Japan, in the British Medical Journal, that shows an association between time spent walking, life expectancy and lifetime expenditure for medical care. Researchers from Japanese medical schools followed 28,000 men and women aged 40-79, and divided them into those who walked an hour or more a day, and those who walked less than an hour. The more active group had a significantly longer life expectancy and lower lifetime medical expenditure. They concluded that increased longevity resulting from a healthier lifestyle does not necessarily translate into an increased amount of medical costs throughout life.

Health care costs are important in Japan, as here, because the country has a universal health care insurance system. People without insurance can join a national insurance program administered by local governments. People can select doctors or facilities of their choice, and cannot be denied coverage. Sounds familiar? This system is similar to the Affordable Care Act being implemented in the US.

A similar study from The University of Texas was recently published the journal Circulation. The authors studied 63,000 men and women over 0-10 years, 10 to 20 years, and beyond 20 years. Their fitness was based on age and sex -adjusted treadmill times, as found at the Cooper Center. High fitness was associated with lesser mortality from all causes and from cardiovascular causes.

A recent article in the Journal of the National Cancer Institute reviewed the effects of physical activity on people with cancer. Edward Giovannucci of the Harvard School of Public Health, made the following comments in his review of the article. Survival after cancer, although it may be dependent on the destructive behavior of the tumor, is also related to the general health of the patient. Health is often enhanced by activity. In addition, physical activity can have a direct effect on the cancer by altering various hormones, including insulin, insulinlike growth factor 1, estrogen and adiponectin (a protein involved in regulating blood sugar and fatty acid breakdown). These factors can promote or inhibit cell growth; insulin is a possible growth promoter for cancer, and exercise results in lower insulin levels. Observational studies of breast cancer (17 studies) and colon cancer (6 studies) suggest that physically active people have better cancer-specific and all-cause survival. Despite problems in comparing types of breast and colon cancer, and the presence or absence of metastases, the studies look promising. Few other leads have shown as much promise in extending the lives of cancer survivors, and activity can also improve the quality life of survivors. Giovannucci concludes that physical activity should be a standard part of cancer care.

More good news about coffee: In a new study from the National Institutes of Health, coffee drinkers who did not smoke were less likely to die in the next 14 years from a wide variety of illnesses. Total mortality was less in coffee drinkers, but deaths from cancer did not show this trend. Men showed an increasing benefit from coffee for up to 5 cups a day, and women who drank 2 cups a day showed a mortality benefit. Decaf coffee was also helpful.

If coffee helps you get out for a walk, a jog, a game of tennis or a swim, go for all of it! Now that it’s foggy and cool in West Marin, it’s great time to get started and keep it up.

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