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.

Go to Health: Protect Your GI Tract!






There has been a lot of ‘stomach flu’ in our community this year – actually it is not flu, and is not caused by the influenza virus, which affects the respiratory system. We can call it gastrointestinal disease (the GIs) indicating that it affects the stomach and intestines. The most common cause of the GIs is the norovirus – a group of viruses that cause inflammation of the stomach and large intestine, leading to nausea, vomiting, diarrhea, stomach cramps, low grade fever, headache, muscle aches and fatigue. There is no specific treatment for this disease, but it is vital not to become dehydrated; if you are affected, drink water, diluted fruit juice, and clear soup with some salt or miso. You should recover in 3-4 days, but some cases have lasted longer. Babies and young children can get dehydrated fast – so contact your doctor immediately if your child has serious vomiting and diarrhea. People who are frail or have weakened immune systems should also see their doctor promptly. Prevention of norovirus infection includes avoiding people with the GIs – this virus is highly contagious from handshakes, air droplets, surfaces and food. Wash raw fruits and vegetables carefully. Although the virus is not always destroyed by heat, you should still cook food carefully and completely, and definitely stay away from raw oysters and ceviche if you are determined to avoid getting sick.






Bacterial contamination of food is another serious source of GIs, with resistance to antibiotics a growing problem. Three quarters of antibiotics used in the U.S. are given to animals, not people. They are given to sick animals, and to prevent healthy animals from becoming sick. Antibiotics are also given routinely, to stimulate growth, since animals given low doses of antibiotics grow more quickly on the same amount of food. However, bacteria in the intestines of these animals become resistant to antibiotics, and are excreted in waste. Entering water and soil, they are found on fish, fruits and vegetables. They colonize the GI tracts and skin of farm workers and food processors. They are found in animal meat. They spread to the human population, who may develop antibiotic-resistant infections.






The FDA, the CDC (Centers for Disease Control), and state public-health labs monitor chicken, ground beef and turkey, and pork chops at retail stores nationwide. The percentage of chicken contaminated with salmonella rose to 12% in 2011. More than a quarter of infected samples were resistant to at least five samples of antibiotics.






Here is what you can do: have thoroughly cooked meat and fish when eating out. Forget about medium rare hamburgers unless you are certain the meat is organic. Wash raw vegetables carefully before eating, and know where they were grown, to avoid contamination from nearby factory farming of animals. Avoid fast food restaurants with the exception of Chipotle Mexican Grill, which says it never sells meat from animals treated with antibiotics. Whole Foods makes the same pledge. Niman Ranch, Marin Sun Farms, Applegate organics, Rocky and Rosie chicken and some other companies are also antibiotic free. Organic poultry and meat is less likely to harbor resistant bacteria as organic standards ban meat and fish given antibiotics.






Elderly people in nursing homes are especially vulnerable to illness from antibiotic resistant bacteria. They can benefit – and people of all ages can benefit – from a daily dose of probiotic bacteria. These are healthy bacteria that will colonize your intestines with good organisms which help to fight off the resistant bacteria. Unsweetened yogurt with live cultures can help, but even more beneficial bacteria are found in probiotic capsules, which should be kept refrigerated. We have 3 or more pounds of bacteria in our colons, helping us by digesting fiber and creating important vitamins such as vitamin K and B12. They thrive on the residues of vegetables and fruits, with lots of fiber. These bacteria, and those on our skin, mouth, nose and ears, are called the microbiome. Take care of your microbiome, people!


Sadja Greenwood, MD , MPH