Beneficial Bacteria in your Body

Microbiologists are excited about recent studies showing that the bacteria in our guts, throat, genital organs and on our skin can have newly discovered beneficial roles in health. We have some 500 different strains of bacteria in our intestinal tract; the average healthy adult carries about 5 pounds of them. From the mouth to the colon, they help us break down and digest our food and allow for its absorption. They also synthesize a range of vitamins, from the B group to vitamin K.

About 70% of our immune system resides in the lining of the gut; signals from good bacteria influence immune cell development and susceptibility to infections and inflammatory diseases. Researchers at the University of Pennsylvania have shown that when mice are treated with antibiotics to reduce numbers of beneficial bacteria, they have an impaired antiviral immune response and delayed clearance of systemic viruses or influenza in the airways. The researchers concluded that signals from beneficial bacteria stimulate immune cells in a way that is optimal for antiviral immunity.. This may be a way that good gut bacteria reduce your susceptibility to colds and flu.

The same researchers also looked at allergic lung inflammation, similar to asthma in humans, and found that mice given antibiotics had higher levels of basophils in their white blood cells, and elevated seum IgE – seen in allergic disease. Researchers at the University of British Columbia found that mice treated with the antibiotic vancomycin reduced the diversity of microbes in the gut and increased the susceptibility of the animals to experimentally induced asthma. They conclude that normal bacterial populations can positively influence the response to allergens in the environment, making inflammation and asthma less likely. The bacterial multitudes in our bodies may have functions never before appreciated.

Antibiotics are life-saving drugs in many situations, including streptococcal throat infections (that can lead to heart valve damage), bacterial meningitis, bacterial pneumonia, urinary tract infections, et al. The purport of this column is not to criticize their use when needed, but to underline the importance of beneficial bacteria in the gut.

Research on the ‘microbiome’ is a hot topic currently, with exciting implications for human health. Microbiome is defined as the totality of microbes in the body (bacteria, viruses and fungi), their genetic elements and environmental interactions. What you can do right now to keep your microbiome in good shape is to feed your helpful intestinal bacteria the right food. Sugary foods that are low in fiber allow the ‘bad’ microbes to thrive. Avoid them. Certain foods are known as ‘prebiotics’ can help our beneficial bacteria. Examples are whole grains, oats, bananas, garlic & onions, artichokes and asparagus. In addition, many people take a ‘probiotic’ supplement that contains beneficial bacteria, and also eat fermented foods such as yogurt, kefir, and sauerkraut. Make sure the yogurt you buy contains living cultures, and avoid ones that are sweetened – it’s better to add fruit yourself. You can buy probiotic capsules at many grocery stores. Look in the refrigerated section and keep the capsules refrigerated at home to preserve the life of the bacteria therein.

If you take antibiotics for a bacterial infection, it’s a good idea to take a probiotic to restore your beneficial bacteria. This may help to prevent serious diarrhea after antibiotic use, which can occur when bad bacteria such as Clostridium difficile take over. Wait at least 2 hours after taking the antibiotic, so it can be absorbed into your bloodstream, before taking the probiotic. If you have asthma, a probiotic supplement might help – talk to you doctor about this.

Sadja Greenwood, MD, MPH - back issues on this blog. Write me a comment, and I'll answer you.

GMO labeling, the Farm Bill, & anti-cancer herbs and spices

In November we will be voting on a referendum in California requiring that all genetically engineered foods be labeled. If it passes, California will be the first state to require such labeling on packaging. Citizens in Europe, Japan and other countries (almost 50 in all) have access to such knowledge. This is an historic occasion for voters – you should know that companies such as Dow and Monsanto will put up a strong campaign against the referendum, and may sue the state if it passes, as they threatened to do in Vermont, where a legislative bill for labeling did not make it out of committee.

The referendum is important because ‘superweeds’ have developed in response to the herbicide ‘Roundup’ (glyphosate). The result has been heavier spraying of the Roundup Ready corn and soybeans that have been genetically modified to withstand such spraying. About 90% of soybeans and 70% of corn and cotton grown in the US are Roundup Ready crops. Additionally, Dow Chemical has asked for USDA approval of a type of corn that can withstand spraying by 2,4D (a defoliant similar to 2,4T used in Agent Orange in Vietnam war days). Many large-scale farmers in the Midwest approve of Dow’s new crops, saying that resistant weeds have become a crisis and without new chemical approaches, farmers would have to plow more and thereby increase soil erosion. On the other hand, Sweden, Norway and Denmark have banned the use of 2,4D, because of toxicity to workers (central nervous system symptoms, dermatitis, possible long term effects on the children of women exposed in pregnancy, and possible increase in lymphomas). Farmers who do not use GMO crops fear genetic drift from the altered plants’ pollen, and also drift of the herbicides used.

This is clearly a complicated question, and we will hear a great deal about it in the run-up to the November election. Here is another reason to exercise your right to vote!

Th US Senate is currently considering the 2012 Farm Bill. Senator Kirsten Gillibrand (D- NY) is opposing a $4.5 billion cut from food stamps, which will then be opposed in the House of Representatives where a majority of Republicans have said they want deep cuts in food stamps. In addition, she wants to help markets that sell fresh produce in areas where it is not available, and encourage the creation of insurance for specialty crops such as apples and onions. To take action on Gillibrand’s amendment that would restore cuts from nutrition programs and redirect $500 million to healthy food programs, you can call Lynn Woolsey (415-507-9554), Senator Boxer (415-403-0100) and Senator Feinstein (415-393-0707). Senators Bernie Sanders (D-Vermont) and Barbara Boxer ( D-California) have introduced an amendment requiring GMO foods to be labeled nationwide. Call Senator Boxer about this as well, if you agree with such labeling.

I have just returned from a nutrition conference put on by the Center for Mind-Body Medicine. One of the speakers on cancer was Jeanne Wallace, who also spoke here at Commonweal last year with chef Rebecca Katz. Wallace listed the top 10 foods to block angiogenesis – the growth of new blood vessels that encourage cancer growth. They are:
*Spices – especially curry, ginger, garlic, parsley
*Berries – all types
*Green tea
*Parsley, peppermint, thyme
*Curry - turmeric, coriander, cumin
*Garlic
*Brazil nuts – for the selenium
*Cold-water fish/ Grass fed meat - for the omega-3 fatty acids
*Traditional soy foods - edamame, tempeh, tofu, plain soy milk
*Peanuts (boiled), red grapes/wine - resveratrol

I will write more about this conference in future columns. In the meantime, if you eat, be a food activist!
Sadja Greenwood, MD, MPH

Update on calcium

Recent reports of an increased risk of heart attack in people taking calcium supplements have been very confusing. For years we have been told to take calcium pills to supplement dietary sources of this mineral. Here’s the evidence so far. Calcium is critical for building and maintaining strong bones and teeth; it also plays a role in muscle contraction, nerve transmission, blood clotting and blood vessel flexibility.

A recent study in the Archives of Internal Medicine looked at 39,000 older women in the Iowa Women’s Health Study, and found a small decreased risk of death among women taking calcium supplements. This contrasts with two studies from the University of Auckland (British Medical Journal, 2010 and 2011) which looked at the U.S. Women’s Health Initiative and found that calcium supplements, with and without vitamin D, modestly increased the risk of a heart attack. The data are difficult to interpret, and more studies and further analysis is needed. A Canadian journal said “if 100 patients take calcium supplements, less than 1 will have a fracture prevented, and less than 1 will develop a heart attack
or stroke.” A small increased risk of kidney stones has also been shown in people taking supplemental calcium, but not with dietary calcium.

The Institute of Medicine concluded in 2010 that adults should get 1000 mg a day of calcium, and post-menopausal women should get 1200 mg. An adequate calcium intake is especially important in pregnancy and breast feeding. Girls ages 9 – 18 often do not get enough calcium in their diets due to a preference for sodas, fake foods and dieting. Supplements of calcium, magnesium and vitamin D as chewable tablets may be beneficial for them, as this is a critical time for bone building.

I conclude that it is vitally important to get enough calcium from our diets, and to use supplemental vitamin D if needed to raise levels of D to 30 ng/ml or higher. Good dietary sources of calcium include low fat milk products (think unsweetened yogurt and cottage cheese and nonfat or 1% milk), green vegetables (especially broccoli, collards, kale & bok choy), almonds, Brazil nuts, sunflower seeds, sesame seeds and dried beans. Calcium fortified soy milk and orange juice can help vegans get enough calcium. Some tofu is high in calcium; read labels to be sure. People with osteoporosis should talk to their doctor or nurse practitioner about the risks and benefits of supplemental calcium.

Studies of men have suggested that a high intake of calcium from dairy products may increase the risk of prostate cancer, but the evidence for this is inconsistent. Men can consider getting a maximum of dietary calcium from non-dairy sources of the mineral.

A 2006 study from the University of Pennsylvania showed that use of proton pump inhibitors (Nexium, Prilosec, Prevacid and others ) to reduce acid reflux is associated with an increased risk of hip fracture in people over 50, probably due to decreased calcium absorption and other mechanisms. Long-term use of these medicines increases the risk. Short term use is often indicated, but many people stay on these anti-reflux drugs for years. These medicines can also increase the risk of pneumonia, vitamin B12 deficiency and low magnesium levels. There are other ways of dealing with acid reflux, including weight loss, avoiding trigger foods and high fat meals, eating frequent small meals, and sleeping in a Lazy-Boy chair or with a wedge pillow if the problem comes on at night.

Here in West Marin are blessed to have local organic dairies that produce wonderful yogurt. Yea for farmers’ markets with their abundance of calcium rich vegetables

Sadja Greenwood, MD, MPH back issues on this blog
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The Ethics of Eating Meat

The Ethicist, Ariel Kaminer, writing in the New York Times Sunday magazine, recently proposed a contest to readers – make an ethical case for eating meat. Thousands of people sent in essays. Five judges, who included Mark Bittman, Peter Singer and Michael Pollan, narrowed the entries down to six finalists, whose main ideas are summarized below. (Readers noted that all these judges were white men; many readers wanted nutrition professor Marion Nestle of New York University to be among them.). New York Times readers then voted on the essays.

*Her Australian father taught her to love hunting and a high meat diet. When her father developed gout, colon cancer, heart problems and stroke, the writer became aware of the ethical problems of killing animals, and took a 40 year hiatus from meat eating. She now looks forward to eating meat again without worrying about health, cruelty to animals or environmental degradation. She thinks that meat will soon be available, grown from cow, chicken, pig and fish cells in laboratories – without manure lagoons or contamination with dangerous bacteria. This essay received the most votes, but it turned out that the writer was a member of People for the Ethical Treatment of Animals (PETA) and had used their mailing list to garner votes. The essay was disqualified from winning under these circumstances.

*The writer is a young woman farmer who says that small scale farming requires the use of animals to clear cropland – goats and chickens – and to nourish the soil with their manure. Animal husbandry teaches her about the natural order of life and death. When you eat eggs or drink milk, you should know that the male roosters or bulls must be culled from the herd, and either eaten or wasted. The eating of animals is part of a balanced system of food production that is regenerative. Without farm animals, food production would require more use of fossil fuels in the forms of fertilizers and chemicals. This is why eating animals is ethical.

*The writer is a vegetarian who returned to meat eating. He feels that animals are raised and killed in cruel conditions, animals receive grain that should be given to hungry people, pasture land leads to deforestation, and eating meat is killing a sentient being. However, in some climates, such as dry grasslands, eating animals is a better choice than trying to grow vegetable sources of protein. Eating meat is ethical if you realize that all life is solar energy stored in an impermanent form, if you choose ethically raised vegetables, grains or meat, and if you give thanks. This was the winning essay.

*The writer is a farmer who became a lacto-vegetarian at age 7 because of love for animals. When s/he became a farmer s/he realized that bone and blood meal, fish emulsion and domestic animals were an integral part of vegetable farming. Animals are essential in a balanced food system. It is not ethical to eat animals raised in industrial-scaled confinement operations. There is an ethical option, even responsibility, to eat animals raised in a sustainable farm system and slaughtered with compassion.

*The writer discusses many moral choices we make, such as spending money on ourselves rather than charities, and having children rather than adopting them. We may choose to feed our family meat because of lack of time or knowledge on how to prepare vegetable protein. We need to rank the reasons for various moral decisions, realizing that the moral world is complex and the quest for any one good thing may require the sacrifice of others. We should attempt to tread more lightly on the earth, and realize that eating meat can be both ethical and tragic.

*The writer feels that it is morally permissible to kill and eat animals, if their basic needs are met in their lives, and their killing is painless. However, the killing of animals for food can be harmful to people, because most of us love animals and are upset by the idea that they are slaughtered for us. We learn to put this idea out of our heads, but it continues to affect us. The author felt a considerable freedom and lightness by giving up meat. As feeling creatures, there is a powerful self-interested reason to not eat meat.

I find these essays to be compelling. As a skeptic, I think the essay on ‘in vitro meat’ to have an element of science fiction, at least for feeding the world’s growing population, or being available in the near future. However, the Dutch have been working on this for years. Scientists at Maastricht University plan to produce sausage and hamburger in 2012. It is probable that animal growth factors and antibiotics will be necessary in the production process, which could lead to serious health concerns.

Here in West Marin, we are fortunate to have many organic farmers who raise animals in a careful way to help with the farming and provide meat, eggs and milk. There is a slowly growing awareness throughout the country of the brutality of factory farming of animals, and its unhealthy consequences for the environment. McDonalds and Target ended their relationship with a company that produced eggs in a factory farm with horrendous conditions for the animals, after an underground video went viral. We all need to eat animal products with great respect, and support our local farmers.
Sadja Greenwood, MD, MPH

Sleeping Pills - the downside

The most popular prescription drugs for insomnia these days are Ambien, Lunesta and Sonata. Many people also use pills called benzodiazepines, such as Valium, Restoril, Ativan, and Xanax. While effective, such pills have side effects and can be habit forming if used continuously. Sleep apnea can become worse with these powerful sleeping pills. In some people, Ambien is associated with sleepwalking, and eating when asleep without conscious awareness. Driving under the influence is hazardous. Elderly users of these medications have an increased risk of heart failure, falls and cognitive side effects.

The most problematic aspect of these prescription drugs is found in an article published in the British Medical Journal on February 27th, 2012. Entitled Hypnotics’ association with mortality or cancer: a matched cohort study, this article concludes that people who received prescriptions for sleeping pills had an increased risk of death or a cancer diagnosis, when followed for 2.5 years between 2002 and 2007. The word ‘hypnotic’ refers to a medication causing sleep. The study was done at Scripps Health in San Diego. The authors searched the electronic medical records of a large health system in rural Pennsylvania, and matched 10,529 patients who received sleeping pill prescriptions with 23,676 matched controls who did not. The average age was 54 years. Patients prescribed any sleeping pill (Ambien, Lunesta, Sonata, benzodiazepines, barbiturates and sedative antihistamines) had an elevated risk of death, with a dose-response association. Even people taking 18 pills a year or less showed some increased risk. Sleeping pill use in the upper third of the cohort was associated with a small but significant elevation of a cancer diagnosis. The researchers did not think that the death or cancer hazards were associated with pre-existing conditions. The authors stated that 24 previous studies have shown an association between use of prescription sleeping pills and mortality. No studies have shown that the use of such pills prolongs life or prevents cancer!

The mechanisms involved in these associations have yet to be worked out. The authors state that sleeping pills can increase depression, and when used with alcohol can lead to accidental death. Suicide may be a factor in some cases. Ambien can lead to ‘heartburn’ - regurgitation of food mixed with stomach acid that can injure the esophagus or lead to respiratory infections. Laboratory studies with rodents show that sleeping pills can cause chromosomal damage. This finding could be related to the rise in cancer.

Here are some conclusions I draw from this disturbing study. If you have been given prescription sleeping pills in the hospital, or at a very difficult time in your life, don’t worry. The use of such pills for people who are dying is absolutely justified. However, for most of us it is better not to take prescription sleeping pills. If you have been using them nightly for more than two weeks, you should decrease the dose very gradually; you may want to talk to your doctor or nurse-practitioner about a schedule to help you get off them.

What should we do to fall sleep and stay asleep more naturally? Sleep researchers say we should maximize our own output of melatonin – the sleep hormone. Melatonin is secreted by the pineal gland in our brains as darkness falls. It makes us sleepy and reduces our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age.

Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. You can find these goggles, which can be worn over reading glasses, at LowBlueLights.com, with a lot of interesting commentary on why they are effective. A less expensive version of the goggles is found at BluBlocker.com. Wearing these goggles, you can easily read, work on the computer, watch television, etc.

Daily exercise is a way to increase your natural melatonin secretion. A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine.

There is compelling evidence from shift workers that disruption of melatonin secretion can be a problem. Dr. Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.
A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

Daniel Kripke, the lead author on the Scripps paper, suggests the following for better sleep - keep the light out in your bedroom, try meditation or prayer, and learn progressive muscle relaxation or self-hypnosis. He also suggests taking melatonin tablets if you are a night owl, to reset your sleep-wake rhythms. He suggests talking to your doctor about an appropriate low dose of melatonin to try at bedtime. My advice is – start with 0.5 mg, and go up to 1-3 mg as needed. The kind that dissolves under the tongue goes most directly into your bloodstream. But – get those blue-blocking glasses, for the most natural sleep!
Sadja Greenwood, MD, MPH

Restorative Sleep

The lights we depend on after dark – to work, read, use the computer, and get around - the huge advantages of electric light - have a downside. They upset our natural sleep-wake cycle. The pineal gland, located midbrain, behind the eyes, secretes a hormone called melatonin, synthesized from the amino acid tryptophan. Melatonin comes out as the day gets dark, making us sleepy and lowering our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age. Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. To apply this research to your own sleep patterns, go to LowBlueLights.com. Meet Richard Hansler, at the Lighting Innovations Institute at John Carroll University in Cleveland. Hansler, now 87, is a physicist who has pushed the development of lighting that does not disrupt melatonin outflow. At this website they sell blue blocking glasses, as well as special lights low on the blue part of the light spectrum, both incandescent and fluorescent. Their glasses, which can be worn over reading glasses if needed, cost from $68 to $80. I have used these glasses for over 2 years and find them very effective. Much less expensive blue blocking glasses can be found elsewhere on the internet – read customers’ comments carefully to find out if they are effective.

Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.

A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine. This is suggested as a mechanism by which exercise reduces the risk of breast cancer.

Here’s my take-home lesson from the research on melatonin. Investigate blue-blocking glasses - and try using them 1-2 hours before your regular bedtime. Increase the duration of your daily exercise if you have trouble sleeping, or staying asleep. And – if you do wake at night and can’t fall back to sleep, get up and have a small snack of food, especially one containing milk. Milk contains enough tryptophan to promote sleep. Something sweet, like a piece of banana, will stimulate insulin which helps transport tryptophan across the blood-brain barrier.

In my next column I will write about new data on the potential dangers of prescription sleeping pills, and more natural alternatives. Also – there is new data on the importance of sleep in the prevention of diabetes and dementia. Stay tuned!

Sadja Greenwood, MD, MPH back issues on this blog

Sleep is the best meditation – the Dalai Lama

Go to Health – Health Insurance for Everyone

T.R. Reid wrote a brilliant book in 2010 – The Healing of America – A global quest for better, cheaper and fairer health care. He examined industrial democracies around the world and explained their different yet effective health care systems. By a variety of means, they achieve nearly universal coverage and good outcomes. If you don’t have time right now to read a book – albeit an entertaining one –as the health care debate is being discussed in the Supreme Court, here’s a short cut. Fareed Zakaria has written a two page article in the March 26th issue of Time that summarizes many of the issues. The requirement that everyone buy health insurance – called the individual mandate – is at the center of the constitutional controversy. Government subsidies would be given to help those without sufficient funds to buy insurance.

Reid and Zakaria both point out that Switzerland, a business-friendly democracy, had a system like ours 20 years ago, with private insurance and incomplete coverage. People without insurance went to emergency rooms, insurers rejected people with pre-existing conditions, and costs were mounting. The country decided that to make health care work, everyone had to buy insurance. They reformed their system in a way similar to Obama’s proposals. Now, 20 years later, everyone is insured, the quality of care is high, and costs have moderated. I can attest to this, as I visit my sister in Switzerland every year, and have seen her in the hospital there. The care is excellent. Taiwan is another with a free-market economy that decided to create a universal health-care system in the mid 1990’s. It studied all existing models and decided against private insurers, and for a single payer system that is effective and very low cost. ”. The Swiss and Taiwanese found that it is imperative for everyone to be covered by health insurance to keep costs down and provide a system where everyone has basic care.

Reid writes that the Swiss have an ethic of ‘solidarity’ that helps maintain their unity despite having 4 official languages. Solidarity means community and equal treatment. Everyone should have equal access to vote, have a jury trial, an old age pension, a good school system and a good health care system. Some people have much more money than others in their capitalist system of government, but everyone has their basic needs for health care met.

Zakaria writes that we have “the most expensive, least efficient system of any rich country on the planet.” Chronically ill patients , 5% of the population, account for 50% of our health care costs. Their care drives up insurance premiums if they are insured, and federal, state and local health care costs if they lack insurance. Universal coverage would bring healthy people into the system and thereby result in lower average premiums. A downside to Obama’s plan is that it maintains the connection between employment and health care that is inefficient and a burden on American business. It is hard for companies to be competitive globally when they are paying large amounts for their employees and former employees. German, Canadian, Japanese and British companies pay next to nothing in health care costs, in comparison.

I hope our country can edge away from rugged individualism into more solidarity, with passage of universal health care. Stay tuned throughout the week as it is debated at the Supreme Court. E pluribus unum.
Sadja Greenwood, MD, MPH - back issues on the blog

Volumetrics - a plan to reach the right weight and stay healthy

Here’s an interesting finding – as long as food is equally palatable, people tend to eat the same weight of food. The March issue of the Nutrition Action Health Letter features an interview with Dr. Barbara Rolls, at Penn State University, who has been studying this for years with the aim of helping people lose weight more easily. Her latest book – The Ultimate Volumetrics Diet – will be out in April; previous books include The Volumetrics Eating Plan. She has looked at ways to change the amount of water in foods, thereby adding weight and volume but no calories. This is done by adding vegetables to each recipe, and making sure the food is tasty. The result, found in careful studies, was that people reduced their calorie intake by about 25%. In a trial of 700 people, she found that when people ate a diet that was less calorie dense (more vegetables included) they were eating significantly more food – about a pound more food a day – yet they were eating fewer calories and easily losing more weight. In another study, people who successfully lost 10% of their maximum body weight and maintained the weight loss for at least five years were found to eat five servings of vegetables a day. Overweight participants ate three and a half servings. Besides adding more vegetables to recipes, calories are cut by reducing fat and sugar in sauces, using small amounts of olive oil instead of cream, switching to whole grain pasta or brown rice, and removing fat and skin from poultry or meat. Dr. Rolls advises adding vegetables to mixed dishes, soups and stews, and putting cooked vegetables in a blender for sauces. She suggests adding vegetables to breakfast, lunch and dinner for children and adults. She found that baked goods with added vegetables – such as extra carrots in a carrot cake – made the cake even more palatable, so people ate more. However, at the end of the day they had consumed fewer calories.

Studies done on portion size were also important – Dr. Rolls found that while people tend to eat the same weight of food day after day, when exposed to large portions they get thrown off very easily. Portion control is still important for all eaters, and it starts with visual awareness. Some people use a 10 inch rather than a 12 inch plate at home and automatically eat less. Some divide a restaurant entrée in half, and share the food or take half home for the next day. Some ask for a child’s plate, which is easy if you are ordering takeout. People interested in portion control avoid buffets and all-you-can-eat restaurants, or exercise great care therein.

Mindful eating is another important way to slow down and appreciate food. Become more aware of your hunger before eating and feelings of fullness as the meal goes on. It can take 15-20 minutes for the brain to register that you have had enough, so overeating is easy when you are rushed. Some people set a timer for 20 minutes and make sure they savor their food while making it last until the bell chimes. Eating while reading or watching television can lead to mindless stuffing for some people. Become aware of gratitude for the food you have, for the animals who gave their eggs, milk or life, and for the people who harvested and prepared food for your table. Be aware of your personal triggers for mindless eating, such as anxiety, depression, alcohol, marijuana or certain chips and sweets.

For anyone who wants to keep up on the science of healthy eating, subscribing to Nutrition Action Health Letter is a great idea. Go to www.cspinet.org.
Sadja Greenwood MD, MPH back issues on this blog

Seven Billion, and Counting - What to do about it?

We humans now number seven billion, and we are growing fast. Nearly 80 million people are added to the earth’s population each year. Relentless population growth affects many of our current problems, from food scarcity in poor countries, water shortages, pollution, habitat loss and species extinction, climate change, degradation of the oceans and lakes, and human & animal suffering. The welfare of humans is deeply linked to nature, and our propensity to ignore this has been disturbing.

Population Connection (formerly know as ZPG – for Zero Population Growth) is an organization working to understand the reasons for population growth. Its goal is to educate the public – including policy makers – on solutions to the problem, including access to voluntary family planning, education for girls as well as boys worldwide, and ensuring social justice for women and the poor.

In the February issue of The Reporter (the magazine of Population Connection) the theme is child marriage. Ten million young girls become brides every year throughout the world, having children while children. Child marriage is defined as the marriage of a person before the age of 18. The practice is most common in sub-Saharan Africa and South Asia. In Mali, 71% of girls are married before they turn 18. In Bangladesh, the median age of marriage for girls is 15, and 4 out of five girls first meet their husbands at their weddings, according to The Reporter. Child marriage can have serious health implications – in Africa, pregnancy related deaths are the leading cause of mortality for 15-19 year old girls. Many girls have sex before their first period. An estimated 100,000 girls each year develop a fistula, or opening, between the bladder and vagina because of obstructed labor in childbirth. The pelvis is too small, incompletely formed. As a result, they leak urine constantly and can become social outcasts. There are heroic doctors and nurses who spend their lives on surgical repair of this problem, but the hospitals and know-how for fistula repair are scarce.

Archbishop Desmond Tutu is hopeful that the practice of child marriage can end in a generation. He has said “I am confident that change can happen very quickly. No woman who has had the benefit of staying at school and marrying later in life can inflict child marriage on her daughters.”

National Geographic published an article on child marriage in the June 2011 issue, with arresting photographs.

John Bongaarts, a demographer at the Population Council and the National Academy of Sciences, calculates that if the average age of childbearing increased by 5 years, future population size could be reduced by 15-20 percent. This is a striking finding. If readers want to help with this issue, they can visit Population Connection on line, or call them at 800-767-1956. Population Connection has classroom curricula for teachers of social studies and environmental studies that are used in the US and all over the world.

The issue of access to voluntary family planning has been at the top of the news recently here at home, with Obama’s push to give women free access to birth control through their insurance policies. The pushback we have seen against voluntary family planning harks back to Margaret Sanger’s jailing in 1917 for distributing the diaphragm. In 2012, is this absurd, or what? Nicolas Kristof, writing in the New York Times on Sunday, Feb. 12th, aptly called it ‘pelvic politics’. I see it as a woman’s issue, a man’s issue, and a big environmental issue as well. The Sierra Club has declined to take on US population growth directly and forcefully, fearing being criticized as racist. They see it as an issue about immigration. I prefer the stand of the Center for Biological Diversity, which is working to save a vast diversity of wild animals and plants, to secure a future for all species hovering on the brink of extinction. Toward this end, among other educational programs, they hand out endangered species condoms, and have a ‘hump smarter hotline’ (800-628-2399) to ‘make sure that this one roll in the sheets doesn’t push some poor creature into extinction’. Check it out - they have a great message. They point out that 50% of pregnancies in the US are unplanned, and more people conceive a child on New Year’s eve than any other time in the year. Obviously, there are ways to talk about population and the environment without being racist. Wake up, Sierra Club! We could all use some new thinking on these issues. Despite our smaller families, our resource heavy lifestyles make us part of the problem.
Sadja Greenwood, MD back issues on this blog!

Luteolin - Another fascinating compound in plants

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