An Apple a Day…...

Apples are a "miracle fruit" that convey benefits beyond fiber content, according to Dr. Bahram Arjmandi at Florida State University. Animal studies have shown that the pectin and polyphenols in apples improve blood fat levels and lower the production of pro-inflammatory molecules. Arjmandi's 2011 research  randomly assigned 160 women ages 45-65 to one of two dietary interventions: one group received two dried apples daily and the other group ate dried prunes every day for a year. Blood samples were taken at 3, 6 and 12-months. The results surprised Dr. Arjmandi, who stated that "incredible changes in the apple-eating women happened by 6 months- they experienced a 23% decrease in LDL cholesterol," which is known as the ‘bad cholesterol.’ The daily apple consumption also led to a lowering of C-reactive protein (a marker of inflammation). "I never expected apple consumption to reduce bad cholesterol to this extent while increasing HDL cholesterol or good cholesterol by about 4%," Arjmandi said. Yet another advantage is that the extra 240 calories per day consumed from the dried apple did not lead to weight gain in the women; in fact, they lost on average 3.3 lbs. "Reducing body weight is an added benefit to daily apple intake" he said. Part of the reason for the weight loss could be the fruit's pectin, which is known to have a satiety effect.

In a study from Ohio State University, healthy, middle-aged adults who rarely ate apples were given one red or golden

Delicious apple a day, or a capsule containing the polyphenols found in apples, for 4 weeks.  The apple eaters had a 40% decrease in oxidized LDL, a substance linked to hardening of the arteries. People taking the capsules had a similar effect, but not as large. The author of this study, Dr. Robert DiSilvestro, described daily apple consumption as significantly more effective in lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.

The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health.

In the Christmas edition of the prestigious British Medical Journal, there is an article comparing apples and statins for the prevention of cardiovascular deaths.  Using mathematical models, a team of researchers at Oxford set out to test how the150 year old proverb  - An apple a day keeps the doctor away -might compare with the more widespread use of statins in the UK population. They calculated that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.  However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes. The researchers conclude that the public health message: An apple a day… is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, “although by all means eat more apples.”

My message to readers is similar – eat a daily apple, don’t change your medications without talking with your doctor, and have a wonderful holiday season. 

Sadja Greenwood, MD   back issues on this blog.  Check out my novel, Changing the Rules, at Stinson Beach Books, Point Reyes Books & Amazon

What Is It About Brassicas?


I lead a discussion on nutrition at the Commonweal cancer retreats every few months, along with the renowned chef and author, Rebecca Katz. We have a handout of general suggestions for healthy meals, and then give each person individual guidance. One of our first guidelines is to eat a brassica vegetable every day. These vegetables include broccoli, arugula, kale, collards, mustard greens, bok choy, Brussels sprouts and turnips. The reasons these vegetables are important for people with cancer, and people who want to prevent cancer, have been studied at Johns Hopkins University’s Brassica Chemoprotection Laboratory. They have focused on broccoli, which contains a compound known as sulforaphane. It is a potent natural inducer of what are called phase2 detoxification enzymes. These enzymes break down free radicals and environmental toxins, enabling the body to excrete them in urine, bile or stool. The Johns Hopkins researchers found that these detoxifying enzymes were boosted in function by the sulforaphane in brassicas, and that broccoli contains high levels. Broccoli sprouts contain the highest amounts of sulforaphane, up to 50 times more than mature broccoli. Recent studies at Baylor College of Medicine have shown that a concentrated form of sulforaphane is active against lymphoblastic leukemia cells in the laboratory. Other researchers at the University of Arizona are looking into topical sulforaphane to prevent skin cancer. Preventive effects on breast, prostate and colon cancer are also under study.






It is important not to overcook broccoli, as this will destroy its ability to release anti-inflammatory and cancer protective compounds. Steam lightly for a few minutes. Since broccoli sprouts are such a potent source of sulforaphane, you should know that it is easy to make your own. You can call 800-695-2241 and order organic broccoli sprouting seed. If you are new to sprouting, consult sproutman.com. He has an almost overwhelming number of ideas and devices to help you sprout.






At the cancer retreats, we also suggest that people consider drinking the green tea or black tea with broccoli seed extract, formulated at the Johns Hopkins Brassica Chemoprotection Laboratory. The tea is high in sulforaphane and related compounds. A portion of the proceeds from the sale of these teas will go to further Hopkins’ research on vegetables. Regular and decaffeinated teas are available. If you don’t have time for sprouting right now, just go for the tea. Call the Baltimore Tea and Coffee Company at 800-823-1408 to order. The teas do not taste like broccoli!






Sulforaphane is also found in kale, cabbage and all the other brassica (cruciferous) vegetables. If you don’t like broccoli, you can still get the benefits of sulforaphane in these foods.






At the last cancer retreat, one of the participants was a patient at Johns Hopkins. She said that her oncologist had never mentioned the Brassica lab, and it seemed strange that she would come to California to find out about it. Yeah, California!






At the Commonweal cancer retreats, Rebecca Katz has come up with a good way to help people drink fluids, even when they are not feeling well. She suggests a special pitcher for water, in which you place orange and lemons slices, with the peel (organic is best), chunks of cucumber, and a sprig of thyme, mint or rosemary. Rebecca calls this ‘spa in a glass’. It will be easier to drink than plain cold water, and will have beneficial qualities.






Sadja Greenwood, MD, MPH


You can find a copy of my novel, Changing the Rules, at Pt. Reyes Books, the Grand Hotel, Uniquities, or at Amazon.com.

Olive Oil and Your Brain, and a New View on Produce






Olive oil is known to have protective effects on bone, heart disease and breast cancer risk. Its use in the Mediterranean diet has been associated with a 30% lower risk of death from heart attacks and stroke in a recent Spanish study. Here’s more!






In 2009, Researchers at Columbia University in New York found that elderly people who were physically active and ate a Mediterranean diet, had a 32-40% lower incidence of Alzheimer’s disease (AD) compared with those who did not. The Mediterranean diet was defined as including a high consumption of vegetables, fruits, legumes, grains and fish, and a lower use of red meat. About 50 milliliters of olive oil (roughly 1/5th cup per day) is consumed.






Research into the lower amounts of dementia on this diet has found a compound in extra virgin olive oil called oleocanthal. Amal Kaddoumi and her colleagues at the University of Louisiana looked at whether oleocanthal helped to decrease the accumulation of beta-amyloid in the brain, as this substance is believed to be the culprit in AD. They applied different concentrations of oleocanthal to mouse brain cell cultures, and also gave oleocanthal to live mice. In both trials, levels of the two proteins that transport beta-amyloid out of the brain as well as enzymes that degrade beta-amyloid increased significantly. The researchers then introduced beta-amyloid into live mice brains. Compared with control groups, the mice given oleocanthal showed significantly enhanced clearance and degradation of the beta-amyloid peptides.






This study has exciting implications for the prevention of AD. While pharmacologists are figuring out how to make a medicine from oleocanthal, you can use extra-virgin olive oil as your main source of fat. Investigate how to make an oliveoil/herb spread for your bread. It is important to note that being physically active and eating a lot of fresh produce is also important to keep your brain healthy.






Breeding the Nutrition out of Food: Jo Robinson, an investigative reporter, has just published a book called Eating on the Wild Side. She notes that over the last 10,000 years since we stopped foraging for wild plants and instituted farming and gardening, we have selected the least bitter plants to grow in our gardens. While this has made some foods tastier, it has decreased their phytonutrients. Robinson is not talking about genetic engineering, but conventional selective plant breeding which has gone on for millennia but has recently accelerated. She notes that purple Peruvian potatoes have vastly more nutrients than the white potato, and blue corn is greatly superior to white corn, even though white corn is sweeter and more popular. I will write more about her findings when I get her book. In the meantime, she suggests arugula, which is very similar to its wild ancestor, and scallions, which resemble wild onions. She suggests using plentiful amounts of fresh herbs in cooking. Rebecca Katz, author of The Cancer Fighting Kitchen and The Longevity Kitchen, also promotes the use of herbs as ingredients in many dishes, including salads. Don’t overlook those amazing deep purple Japanese sweet potatoes if you can find them. Go for color, and spiciness; you will be on the right track.


Sadja Greenwood, MD, MPH -->

Go to Health: Tomatoes All Year!


You might not expect that the latest on the benefits of tomatoes would come from the Lapland Central Hospital in Finland. Despite their short growing season, Finns are said to love tomatoes when they can get them. Finnish researchers studied what blood factors (from diet) were associated with a lowered risk of stroke in men, expecting to find correlations with levels of vitamins E and A. Instead, they found that men in the highest quartile of serum lycopene had a 55- 59% lower risk of stroke than those in the lowest quartile. Alpha and beta carotene, vitamin E and A were not associated with stroke risk.






Researchers at the College of Nursing, University of Kentucky, found that patients with heart failure who had the highest intake of tomatoes in their diet had longer times between adverse cardiac events.






Studies from Chungbuk National University in Korea found that tomato extract added to the diets of mice caused weight loss, despite a high-fat diet. Total cholesterol and LDL cholesterol were also reduced.






Studies from the University of Talca in Argentina found that rats supplemented with tomato extract had a reduction of platelet clumping, which would reduce blood clotting and improve blood flow.






Recent Canadian studies have looked at post menopausal women between 50 and 60 who were given lycopene-rich tomato juice, lycopene supplements or a placebo for 4 months. They were tested for blood markers of osteoporosis. Those taking tomato juice or lycopene were found to have reduced levels of bone breakdown compared to those given placebo. Subsequently, these researchers studied women who were told to restrict their intake of tomatoes or lycopene; in this study bone markers for osteoporosis were significantly increased.






U.S. studies from the 1990’s looking at male health professionals showed that frequent intake of tomato products was associated with a reduced risk of prostate cancer. Because further studies could not confirm this finding, Harvard researchers did a careful re-analysis in 2002 and again found a moderately reduced risk.






Tomatoes, which originated in South America and were first cultivated in Mexico, are clearly loved all around the world. Enjoy them! Do not start taking a lycopene supplement after reading this column. Excess intake of single carotenes may be counterproductive. There are many factors in tomatoes besides lycopene that can be healthy. Do start eating more tomato products while waiting for the ripe ones to come back into season. Tomato paste and low sodium organic Very Veggie are great choices – you can find them in our local stores in glass containers – free of BPA (Bisphenol A) and other chemicals. You can preserve homemade tomato sauce when they are in season; people lacking the time or expertise for home canning can simply freeze them. Here’s a great website from the University of Nebraska on easy ways to preserve tomatoes - http://food.unl.edu/web/preservation/freezing-tomatoes.






The beneficial compounds in tomatoes are best absorbed when eaten with fat, so include a healthy oil, such as olive oil, in your cooking or on your salad. Be careful of the high sodium content in many commercial tomato soups and sauces. You probably know that watermelon is also a good source of lycopene.






Next month I’m going to write about the amazing abilities of silkworm cocoons to keep vaccines and antibiotics cool, even in areas of extreme summer heat. This could be a great boon to immunization programs in Africa and Southeast Asia. Stay tuned!


Sadja Greenwood MD back issues sadjascolumns.blogspot.com

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

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