Reduce your blood pressure with what?

Chocolate: Recent studies have shown that compounds in cocoa, called flavanols, reduce blood pressure via the formation of nitric oxide (NO) in the body.  NO is a signaling molecule in the body, which causes blood vessels to relax and open wider.  The people living on San Blas Island off Central America drink cocoa every day, as their main beverage, and have normal blood pressure regardless of age. Cocoa or chocolate has more protective flavanols if it has not been ‘Dutch processed’, so read labels carefully, and buy unsweetened cocoa powder (not Dutch-processed) or a dark chocolate bar with 70% cacao content.  You can sweeten the cocoa powder with xylitol, and do a favor to your teeth.  (Xylitol is a sweetener derived from plants that prevents bacteria from sticking to the teeth.) A recent report from the University of L’Aquila in Italy showed that elderly people with mild cognitive impairment showed improvement with cocoa flavanols, as well as reductions in their blood pressure.

Beets and beet juice:  numerous recent studies have shown that drinking beet juice lowers blood pressure and improves athletic performance.  The nitrates in beets (also found in leafy green vegetables) are translated into nitric oxide in the body.  Blood vessels widen, allowing for more blood flow.  In addition, beet juice reduces the amount of oxygen needed by muscles during activity.  For example, test subjects used less oxygen while walking, reducing the effort it took to walk by 12%.  This could be helpful for the elderly, and those recovering from heart and lung problems.  When competitive male cyclists were given beet juice before a timed trial, they were able to improve their racing times by 3%. Since in the world of elite sports a 3% improvement is big, athletes are turning to beet juice, as well as tart cherry juice, with enthusiasm.  Beet juice and freeze-dried beet juice powder are widely available on the Internet – although fairly costly. 

Celery and celery seed:  these foods have a long history in Indian Ayurvedic medicine to treat fluid retention, arthritis, gout and other problems. Chinese medicine also recommends celery to treat high blood pressure.  A substance called phthalide in celery acts as a diuretic, and apparently causes an equal loss of both sodium and potassium, which is helpful in maintaining sodium-potassium balance in the blood.  It also works by relaxing smooth muscles lining blood vessel walls.  A study done at the University of Chicago in the 1990s showed that a celery extract given to laboratory rats lowered their blood pressure 12-14%. In humans, a comparable daily ‘dose’ of celery would be about 4 stalks.  There are numerous individual reports of people using celery for blood pressure, but no further studies on this question.  Perhaps this is because it is hard to get funding for natural substances.   Celery seed, used as a spice, comes from a different plant related to edible celery.  Like celery, it acts as a diuretic, promoting loss of excess fluid in the body.  It is also used as an anti-inflammatory food. Chefs suggest that you add celery seeds to soups, tomato dishes, salads and eggs.   Light toasting brings out a sweet flavor. 

-->

If you take medicines to bring down your blood pressure, don’t stop them.  Chocolate, beet juice and celery may help, but should be factored in gradually.  Daily exercise and the DASH Diet are also essential.  Talk to your doctor about your plans!

Sadja Greenwood, MD    back issues on this blog

HPV – Who Knew All it Could Do?

-->

HPV – the Human Papilloma Virus – has been known for years to be the main cause of cervical cancer in women. There are over 40 types of HPV that are transmitted by direct skin to skin contact during vaginal, anal and oral sex, and most do not cause disease.  However, infection with certain viral types,  mainly but not exclusively  HPV 16 and 18, can cause cervical cancer if not treated. This is why the Pap test is so important for women who are or have been sexually active, with men or with women.  The Pap test is a procedure in which cells are scraped from the cervix and looked at under a microscope. The Pap test can detect abnormal cells before they become cancerous, and early treatment in the doctor’s office can get rid of the problem. However, some women don’t know about the need for regular pelvic exams, or can’t afford them. There were 4,200 deaths from cervical cancer in the US last year.  Cervical cancer is a very serious problem in developing countries which cannot afford to do Pap screening. 

Some subtypes of HPV can also cause cancers of the vulva, penis, anus and the mouth and throat.  Sexually transmitted HPV type 16 causes about 85% of anal cancers according to the National Cancer Institute. The risk for anal cancer is much higher in gay and bisexual men than heterosexual men.  Women who have anal sex are also at greater risk.

Condoms, which help to prevent pregnancy and HIVAIDS, can prevent HPV infection by about 70% if used every time.  Skin to skin transmission can still occur outside of the condom.  Still  - condom use is important with new partners.   The good news is that most HPV infections are cleared by the immune system in a few years and never cause a problem.  However, some people don’t clear the virus, and their infections remain. 

In recent years there has been an increase of cancers of the throat and base of the tongue, caused by HPV 16.  Previously known risk factors for throat cancer included smoking and alcohol, but throat cancers are now seen in younger people who don’t smoke or abuse alcohol. Throat cancers from HPV are more commonly seen in men, but women are also affected.  Oral sex is considered to be a major predisposing factor.  The increase in throat cancer is considered serious, because it can be hard to detect early.

Since most people do have genital and oral sex, how can we view this threat and deal with it?  Prevention and early detection are vitally important.  This would include:

*consistent condom use with new partners, even with oral sex.  This may seem unlikely, especially for teenagers trying to do the right thing to avoid pregnancy.  However, they should be informed about the problem.

*Make sure your children get the HPV vaccine, Gardasil or Cervarix – given in 3 shots over 6 months.  Both are effective in preventing infections that cause cervical cancer.  Gardasil is believed to prevent more HPV types, those that cause cancer of the anus, vulva and vagina.  HPV vaccination is recommended by the Centers for Disease Control for 11 and 12 year old girls, and girls and women age 13 through 26 who have not been vaccinated.  Gardasil has been found to be safe and effective for males age 9-26.  Vaccinating a boy with Gardasil will help his partners, and also help him to prevent oral cancer.  The cost of the vaccine is about $130 per dose - $390 for the series.  Most health insurance plans cover the cost, and the Vaccines for Children program may be able to help.

*Pap tests are still important for women, even if vaccinated, because the vaccines do not prevent about 30% of HPV types that can cause cervical cancer.

*Being in a faithful relationship with one partner, limiting the number of sex partners, and choosing a partner with few prior sex partners can be helpful.   However, it is not always possible to know if a partner or oneself is currently infected with HPV. 

*Early detection of cervical, vaginal, vulvar and anal cancer can be done by regular medical examinations, self exams, and alertness to anything that feels like a persistent sore or abnormal growth. 

*Early detection of cancers of the mouth and throat can be done by regular visits to the dentist and dental hygienist, who should look for abnormalities in the mouth and throat, including hidden areas at the back of the tongue.   Everyone should be aware of symptoms such as a persistent sore throat or mouth sore, a feeling of a mass in the throat, a lump in the neck, or difficulty swallowing.  

Check it out!

* Keep your immune system strong by getting enough sleep, exercising moderately, eating healthy food (lots of vegetables!), and avoiding tobacco, dangerous drugs, and excess alcohol.

Our venerable sage Ben Franklin told us:  An ounce of prevention is worth a pound of cure.  Let’s follow his advice. 

Sadja Greenwood, M.D., MPH  back issues on this blog

Arsenic in Rice?

Arsenic is a chemical element found in water, soil and air. For this reason, it is inevitably found in some foods. Human activities have added arsenic to the environment, through burning coal, oil, gasoline and wood, and through the use of arsenic compounds in pesticides, herbicides and wood preservatives. The Food and Drug Administration (FDA) monitors foods in our diet; it has analyzed arsenic levels in rice for 20 years, and has not found evidence of change in arsenic levels. However, researchers are now better able to measure whether existing levels represent more or less toxic forms of the element. It plans to complete its analysis of about 1,200 rice products (rice milk, rice cakes, infant cereal, etc) by the end of the year, and to issue guidelines.

Meanwhile, Consumer Reports, published by Consumers Union, has stated that its tests of more than 60 samples of rice and rice products found inorganic arsenic, a probable human carcinogen, in most samples. Earlier this year, they had found worrisome levels of arsenic in apple and grape juices, and called on the FDA to set limits for arsenic in these juices. They are now asking the FDA to set limits for arsenic in rice.

Consumer Reports’ study found:
*White rice grown in Arkansas, Missouri, Louisiana and Texas had higher arsenic levels than samples from California, India, and Thailand.
*Brown rice had higher levels than white rice, comparing rice from within a tested brand.
*Infant rice cereals and drink products contained worrisome levels of arsenic.
*Groups who rely on rice as a staple, such as some Asians and Hispanics, were found to have higher arsenic levels.

Rice grown in Texas, Louisiana and other gulf coast states have high levels of arsenic because of cotton growing in times past. Arsenic pesticides were used to control the boll weevil. California rice, and Asian rice have considerably lower levels.

Consumer Reports advises that children under 5 not be given rice drinks daily. Similar advice has been given in the United Kingdom.

Consumer Reports has asked the FDA to ban the feeding of arsenic containing drugs to animals (used for growth promotion and disease prevention). The manure of these animals contains arsenic, which can be used to fertilize food crops. It also asked for a phase out of arsenic containing pesticides.

Philip Landrigan, an epidemiologist, author and pediatrician at New York’s Mt. Sinai School of Medicine, suggests that pregnant women and babies avoid rice, or use only small amounts of California rice, or switch to other grains, such as oats or barley.

Arsenic has been implicated as a cause of skin cancer (non-melanoma), and is also related to cancers of the liver, lung, kidney and bladder. The evidence for this comes from studies in Taiwan, where well water contains high amounts of arsenic. The same is true in Bangladesh – tube wells drilled to protect the population from bacterial diarrheal disease have been found to have high levels of arsenic. This is a very serious situation in parts of India as well. Current remedial efforts include digging very deep wells, where water may have lower arsenic levels.

What can you do about arsenic in food and water? There is virtually no arsenic in Bolinas water. Call your local water department to find levels if you live elsewhere. Avoid apple and grape juice unless it is organic – even then, it’s better to eat the whole fruit. Avoid chicken, unless it is organic. Eat California rice, but don’t make it your everyday staple. Try almond milk if you usually drink rice milk. If you are avoiding gluten, try millet as a rice substitute. Millet should be rinsed first, and cooks in 20 minutes. You can make it very tasty by cooking it with onions, garlic, chopped nuts, and spices. When cooking, I always think of chef Rebecca Katz’ suggestion: FASS. F stands for a bit of fat, such as olive oil. A stands for acid – meaning a little something sour, like a squeeze of lemon. S stands for sweet – a drop of maple syrup, or pomegranate juice, or some frozen corn. S stands for salty – a pinch of salt. Put this in every dish, and you’ll love the result!

Sadja Greenwood, MD, MPH see more on this blog

What Are the Benefits of Organic Food?

A recent study from Stanford University looked at 17 studies comparing people who ate organic or conventional diets, and 223 studies comparing the bacterial, fungal or pesticide contamination of such foods. There were no long-term studies of health outcomes between the two diets in their analysis. The studies showed no consistent differences in the vitamin content of organic products, although there were higher levels of omega-3 fatty acids in organic milk. The study did find that organic produce had a 30% lower risk of pesticide contamination, but the pesticide levels in all food generally fell within the allowable safety limits. They found that children on organic diets had lower levels of pesticide residues in their urine, and organic chicken and pork reduced exposure to antibiotic resistant bacteria, but the clinical significance of all these findings were found to be unclear.

Many people have been confused by these findings from Stanford. Is organic food worth the extra money? Charles Benbrook, a professor at Washington State University’s Center for Sustaining Agriculture and Natural Resources, wrote a compelling answer in the October issue of Nutrition Action Healthletter. Benbrook has worked for the National Academy of Sciences, and consults for The Organic Center. He says that 60% of studies do show a higher nutrient content in organic foods, especially when the comparison is between fruits and vegetable grown in similar locations. The Stanford study did not consistently make such comparisons.

A recent study of tomatoes in Spain showed that organic tomatoes had twice the antioxidant levels as conventional tomatoes. There are two reasons for this. Organic plants have to fend off a range of insects, so they develop more defensive compounds that also keep us healthy. Conventional crops are produced with large amounts of nitrogen fertilizer, which drives up yields and fruit or leaf size, but dilutes the levels of vitamins, minerals and antioxidants.

Contaminants that cause food poisoning can grow more readily in conventional fields, because of extra nitrogen, and the lesser microbial diversity due to pesticide use. In organic fields there is more microbial biodiversity, so pathogens may not last as long or become as numerous.

Organic foods may not be pesticide free, because of traces blown in from conventional fields. However, pesticide levels are markedly lower. Benbrook has devised a scoring system, the Dietary Risk Index (DRI) that measures the number of different pesticide residues and their levels. Looking at organic versus conventional strawberries, blueberries, apples, grapes, nectarines, peaches and pears grown in the US, the DRI was 3 for organics, versus 24 for conventional fruits. Imported conventional fruits from Chile and Argentina have much higher DRIs than those grown in the US, because of more stringent regulations of pesticide use in the US.

According to Professor Benbrook, there is compelling evidence that low level exposure to organophosphate insecticides in food are contributing to neurologic and developmental problems in children, such as lowered IQ. Lead exposure was found to be most harmful in a Harvard study, followed by organophosphate pesticides and methylmercury. The most compelling evidence of harm comes from the insecticide chlorpyrifos, which has been banned by the EPA for home use, but is still permitted in agriculture. Its level in pregnant farmworkers correlated with lower IQs in their children. When researchers at Emory University in Atlanta gave children organic fruits and vegetables, chlorpyrifos levels fell to almost undetectable levels in their urine in 5 days. Chlorpyrifos is made by Dow Chemical. A coalition of farmworker and advocacy groups filed a lawsuit against the EPA in 2007 seeking to ban the use of chlorpyrifos; the suit is still pending.

Professor Benbrook thinks that the most important dietary change we can make is to eat more fruits and vegetables, and less bad fat, added sugar and processed food. I’m going to add – eat with the seasons, so that you avoid imported produce with its higher levels of pesticides. The second most important is – of course - to eat organic produce and organic grains. If you can afford it, this is your most important step.

Subscribe to the Nutrition Action Healthletter if you want to keep up with the science of nutrition in an easy, readable format. It’s easy to find the address on-line, and 10 issues cost only $10!

Finally – let always give thanks to our local organic farmers, and to the Bolinas People’s store with its daily array of luscious, healthy food!

Sadja Greenwood MD back issues at on this blog

Olive Oil - What are its advantages?

New studies show some surprising benefits for olive oil, including a possible protective effect on bone. Spanish research, to be published in the October issue of the Journal of Clinical Endocrinology and Metabolism, shows that consumption of a Mediterranean diet enriched with olive oil is associated with increased serum osteocalcin and other bone formation markers. Osteocalcin is produced by bone cells called osteoblasts, and is used as a marker for bone formation. Prior to this study, it had been noted that the incidence of osteoporosis in Europe was lower in the Mediterranean basin. All subjects in this study were instructed to eat a Mediterranean diet, rich in fruits and vegetables, lean protein from fish, poultry, and beans, and whole grains instead of white flour bread and pasta. Olive oil was their added fat.

Another Spanish study in 2010 showed that the phenolic compounds in extra virgin olive oil change how genes function. Phenols are chemical compounds found in plants that have many unique properties. In conjunction with a Mediterranean diet, genes related to atherosclerosis were down regulated, and there was a positive impact on oxidation of fats and DNA, insulin resistance, inflammation, carcinogenesis and tumor suppression. Atherosclerosis is a disorder that occurs when fat, cholesterol and other substances build up in the walls of arteries and form hard structures called plaques. This diminishes blood flow and can lead to heart attack and stroke.

Breast cancer risk may also be modified by virgin olive oil. Spanish scientists at the University of Barcelona decoded the signals within breast tumor cells activated by olive oil, concluding that benefits include decrease in activity of an oncogene, and stimulation of tumor cell death. An oncogene is a gene that has the potential to cause cancer, if activated by mutations in another gene or certain environmental factors. Olive oil also showed ability to prevent DNA damage. Corn oil and some other vegetable oils high in polyunsaturated fatty acids, can increase the aggressiveness of cancers.

Virgin olive oil is oil produced by crushing olives mechanically, with no chemical treatment. It has an acidity of less than 1.5%. Extra virgin olive oil comes from virgin olive oil and is lower in acidity (less than 0.8%) and is judged to have the best taste. Virgin olive oils contain the highest levels of phenolic compounds and anti-oxidants that have been linked with better health.

Using olive oil or canola oil on your salads will give you the best absorption of carotenes from colorful vegetables, according to a new study from Purdue University. Low fat and non-fat salad dressings resulted in minimal carotene absorption. Carotenes are pigments that occur in vegetables and fruits and have multiple healthy properties. Avocado is another healthy fat that enhances carotene absorption. If you do use canola oil, make sure that it is organic. Otherwise you will be using genetically modified canola that may be high in pesticides and herbicides, as ‘superweeds’ and resistant insects have evolved to make the application of Roundup less effective. More spraying is necessary.

Your vote in support of Proposition 37 in November will help to ensure that genetically modified food products are labeled in California. This is a huge issue for food companies, who have raised millions against the proposition. Stay tuned, and read the arguments on your ballot carefully.

Sadja Greenwood, MD, MPH back issues on this blog

Dr. Oz on Longevity

Who is Dr. Oz? Mehmet Oz is a cardiac surgeon from Columbia University who has become a popular author and energetic television promoter for getting fit, losing weight and staying healthy. His books, co-authored with Michael Roizen, include You: The Owner’s Manual, and You: On a Diet; they explain the workings of the body and its organs clearly and simply. Dr. Oz’s television program (weekdays at 4, channel 2)) shows a charismatic doc in surgical scrubs promoting a great variety of techniques for staying fit and losing weight, along with numerous products to help you on your way. He is fun to watch. Here are his 10 simple habits that could help you live to 100, with my comments tacked on.

1. Add red foods to your diet. Oz suggests red cabbage, as cruciferous vegetables help to protect against cancer, and beet juice, with nitrates that relax blood vessels. I will add that beets are a great food because the nitrates in beets, also found in green leafy vegetables, are a source of nitric oxide in the body, which dilates blood vessels, improves blood flow, and lowers blood pressure. Other red foods are tomatoes and watermelon, high in the beneficial antioxidant lycopene, and red wine and red grapes, with resveratrol. Resveratrol is currently under study as a substance with anti-inflammatory properties and cardiovascular benefits. It is also found in peanuts and chocolate. I think it is wiser to get resveratrol in foods than in supplements.

2. Black tea – have a cup daily to boost your survival after a heart attack. I will add that research from The Netherlands showed that drinking 3-6 cups of tea daily was associated with a 45% reduced risk of death from heart disease.

3.Dial one phone number from memory every day. Oz advises using your memory rather than relying on your devices. I will add that there are many ways to exercise your memory, including memorizing new words, school work, a new language, poems, music and songs. Work on this while you walk or work out, and just before sleep at night.

4. Use the first stall in a public restroom to prevent getting sick. Oz says the first stall is used less often, as people want more privacy, and it contains the lowest bacteria counts. I’ll add that washing your hands is also very important. Taking a daily probiotic is vital to amp up your immune system (the majority of your immune tissue lines your gut). Vitamin D also helps to prevent respiratory illness.

5. Take two steps at a time when you climb stairs. If you can’t do that, try walking up the stairs twice. I’ll add that keeping your legs strong is important for balance as well as for walking and other sports. If you don’t have stairs at home, you can get step-up blocks or risers at a sporting goods store or on the internet. Resistance training at home or in a gym is really important.

6. Stretch after a hot shower to prevent pain – stretching is best when muscles are warm; stretching improves posture and prevents muscle soreness. Oz suggests raising your arms, bending forward to the right slowly, and then to the left. I would add that that any other standing stretching exercise you like can also be helpful.

7. Hold your breath: take a deep breath, hold for 10 seconds, and then slowly exhale through pursed lips. I think this is a wonderful daily practice, not only for singers and wind instrument players but for all of us who breathe. Yoga classes emphasize many kinds of breathing, to stimulate and relax the body.

8. Do the Reverse Warrior Pose: For this exercise, I suggest you watch Yoga Reverse Warrior Pose by Jennifer Kostel on YouTube. Her presentation is simple and not extreme. Do it on both sides. It promotes balance, flexibility and strength.

9.Chew your food 20 times – slowing down your eating will increase your enjoyment of food, and help to prevent diabetes. If this is hard, put down your fork between bites. I have found the chewing practice to be extremely helpful in preventing reflux pain at midnight. By extra chewing, you start the digestive process (with digestive enzymes in saliva) and make less grinding work for your stomach. It can empty faster. I’m a convert.

10. Cut your cravings in half to cut calories. When confronted with ‘must have’ chips or cookies, Dr. Oz wants you to ‘halve them’. Put the second half away and out of sight. My thinking is that this works well for some people, but others with food addictions need to have the tempting foods out of the house. Don’t shop when you are hungry, and don’t buy foods you will binge on.

Dr. Oz is a television wonder, on a nationwide mission to get us slimmer and more fit. I know it’s daytime TV, but watch him if you have a chance.

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

Lists for Longevity

Back to school, Labor day: is it time to make lists and get organized? Here are ten suggestions from the August issue of Tufts University Health and Nutrition Letter. Next week I’ll report on Dr Oz’s 10 simple habits that could help you live to 100.
1. Combining moderate regular exercise and mentally stimulating activities can help protect your memory as you age, according to a Mayo Clinic study.
2. Raisins, a handful eaten 3 times a day, can reduce blood pressure significantly in mildly hypertensive people according to study from the Louisville Metabolic and Atherosclerosis Research Center. This may be because raisins are high in potassium, and also in fiber and healthful anti-oxidants. There are opposing views on whether raisins promote or prevent tooth decay, so keep flossing.
3. Your waist to hip ratio can predict you risk of sudden cardiac death. Best measurements are under 0.82 for women and 0.92 for men. Use a tape measure.
4. Regular jogging, at a slow to average pace, increases longevity, according to the Copenhagen City Heart Study. (Be sure to check with your doctor before starting to jog, if you don’t do so currently).
5. Fiber may help to protect against heart disease and stroke, according to a Swedish study.
6.Switching from white rice to brown rice could reduce your risk of diabetes, according to a Harvard study. This is especially important for Asians if they eat a lot of white rice.
7. Skip sugar sweetened beverages to reduce your risk of heart attack, according to the Nurses’ Health Study and the Health Professionals study. No increased risk was found for diet sodas.
8. Eating a Mediterranean diet, already linked to a lower risk of chronic diseases, leads to a better health-related quality of life, according to Spanish research. This diet is high in vegetables, fruit, fish or poultry, whole grains, nuts and olive oil, with small amounts of low fat milk as yogurt. There is new evidence that olive oil may strengthen bones. The diet avoids red meat and dairy fat. Get a book on this way of eating – The New Mediterranean Diet Cookbook by Nancy Harmon Jenkins and Marion Nestle is a winner.
9. Low-fat dairy may lead to fewer strokes, according to a Swedish Study.
10. Any physical activity: formal exercise, gardening, housework and walking may lower the risk of Alzheimers’s disease, according to a study of older adults at Rush University.

These studies in the Tufts newsletter are a good reminder of what you already know about healthy living.

Here are my additional suggestions for people who watch television, home movies and sit at a desk for work. Invest in a minicycle or pedal exerciser. These small devices use no electricity and can fit under your desk or in a corner for storage. They keep your legs moving with mild but continuous exercise while you sit. On a table, they are also used to exercise the arms and shoulders. The Sunny health and fitness minicycle is about $57 and is available from Amazon and Overstock. You can also look at the Carex Pedal exerciser (lighter and about $45) and the Pedlar Pro #316 (about $34). Alternatively, consider a standing desk. Prolonged sitting (at work, in the car, watching TV) is not good for the metabolism. Several recent studies show that prolonged sitting increases mortality. You may be able to raise your desk on a sturdy brick pile until the desk-top is at elbow height, but if it is not stable, make or buy a standing desk. It takes a few tries to get used to a standing desk, but it is worth the effort in terms of leg strength and endurance. Finally, you can invest in a trek desk, which enables you to walk slowly on a treadmill while working on the computer, reading or thinking. There are manual treadmills that do not require electricity.

There’s a famous t-shirt that says “If it’s physical, it’s therapy.”

Sadja Greenwood MD, MPH back issues on this blog
Leave me a message, or a question, if you like. I'll answer, for sure.

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

Eve Ensler and The Vagina Monologues

She is one of the most energetic revolutionaries in the world today, with her ambition to end violence against women and girls, everywhere. Eve Ensler has launched a global movement known as V-Day, to end rape, battery, incest, female genital mutilation and sex slavery. She has set up a community in the Democratic Republic of the Congo, called the City of Joy, to help Congolese women who have been raped. Classes in literacy, self-defense, communication, political action and mental and physical healing were held in the first year. A terrible history of widespread and violent rape had made such a center important in the Congo.

Through V-Day campaigns, volunteers and college students in this country put on benefit performances of Ensler’s plays, including The Vagina Monologues. They hold teach-ins and workshops for men, to raise awareness and funds for grassroots anti-violence groups. V-Day has produced a documentary film, Until the Violence Stops; this72 minute documentary is available from Netflicks. It shows women from Harlem, Ukiah, Pine Ridge Reservation to the Philippines and Kenya, revealing their experiences of abuse and genital mutilation, and what they are doing to improve their situations. A five minute trailer for this film can be seen on You Tube.

Funds raised by V-Day support local and national organizations worldwide, including Egypt, Iraq and Afghanistan. The V-Day movement exists in 140 countries from Europe to Asia, Africa, the Americas, and the Caribbean.

In June, 2012, Michigan State Representative Lisa Brown was banned from speaking during a debate on a bill putting new restrictions on abortion providers, because she had used the word ‘vagina’ in her remarks. As a result, four days later a special and rousing performance of The Vagina Monologues was staged on the steps of the state capital, before a crowd of 5000. Eve Ensler was on hand. You can watch the action on You Tube – Vagina Monologues at Michigan’s Capitol Steps.

The Vagina Monologues was written in 1996 and first performed in Greenwich Village, New York City. It has been translated into 48 languages and performed in over 140 countries. Clearly it has been a powerful opening for women to talk about their sexual selves, their joy, their anger and their liberation from prudery and restrictive customs. Ensler has written numerous other plays, including “I am an Emotional Creature: The Secret Life of Girls Around the World.” This play was recently staged at the Berkeley Repertory Theater. It features a cast of 6 young women who talk, sing, and dance their way through a script that covers cliques, popularity, sex, sexual slavery, genital mutilation, slave labor in a Barbie Doll factory and more. The brilliant cast has now gone to New York City.

Here’s the big news of this column. The Vagina Monologues is coming to Marin, and specifically to Bolinas! It will play at the Bolinas Community Center on Saturday, September 22nd at 7:30 pm. It will be staged at the San Geronimo Cultural Center on September 15th, and at Toby’s in Point Reyes on Friday September 21st. This play (which I have seen several times) is different at each staging as the cast and venue changes. It is much more than a ladies’ night out; men and couples will also get a lot out of it, including humor, sadness, surprise, and a powerful understanding of the human condition.
Sadja Greenwood, MD, MPH: back issues on this blog. Leave me a note, and I'll answer you pronto. Pura Vida

The Affordable Care Act - what it means to you

In a dramatic and unexpected move , Supreme Court Chief Justice John Roberts sided with liberal justices Stephen Breyer, Ruth Bader Ginsberg, Elena Kagan and Sonia Sotomayor to allow most of President Obama’s health care law, the Affordable Care Act, to remain intact. Here are the essential features that may be of interest.

The “mandate” that everyone will need to buy insurance by 2014 was the most controversial part of the new law. The justices decided that it will remain under the taxing power of the government. Anyone who refuses to buy insurance will be taxed $95 in the first year, and subsequently more, until the tax reaches $695 or 2.5 percent of income, whichever is more. However, there will be federal subsidies for people who cannot afford insurance. Many uninsured people with pre-existing conditions will be eligible for insurance and will probably sign up quickly. If a substantial fraction of healthy young people also sign up, insurance companies will be able to even out costs and charge less.

Those politically opposed to the act will advise the public not to purchase insurance, which could result in higher premiums for those who do. This dynamic has already started, and it will greatly influence how the new law will work. Here’s a way for healthy young people to think about insurance: Their likelihood of having a heart attack and other chronic disease is low, so they can probably save money by just paying the tax. However, should they have a serious accident or develop an unexpected illness, they might receive expensive emergency hospital care, be ineligible for some important forms of treatment, and be burdened by large debts while recovering. Getting health insurance will avoid these problems. It is a smart and prudent option.

New money is being offered to states to help enroll people with limited finances into Medicaid programs. If a state turns down the new funding from the act, it can still keep its current federal Medicaid funds. Republican governors may want to turn down the new funds; however, hospitals and care providers are going to pressure them to accept the greatly expanded funding in order to have more of their patients insured.

California will benefit from the new funding for Medicaid — currently we have 7 million uninsured people, a number expected to fall by more than half by 2016 due to the new funds. There will be a substantial increase in the number of people insured by Medi-Cal, and county and University of California hospitals are working to improve their delivery of care. California plans to enroll more low-income seniors and people with disabilities into managed care. These plans must have a sufficient number of providers and be geographically near the patients. As this occurs, California and other states will face challenges in finding enough primary care providers to care for more insured people.

Coverage of children under 26 in their parents’ insurance policies is already in force and is very popular. Starting in 2014, people with pre-existing conditions will be able to buy insurance. Insurance companies will not be able to charge the sick more than the healthy, nor can they charge women more than men. Free wellness checkups will be part of all plans. Insurance companies will have to spend at least 80 percent of their revenue on medical care, which may limit their administrative costs and high executive salaries.

By January 1, 2014, states will be required to have new marketplaces, called exchanges, in which individuals and small businesses can examine a variety of competing plans, their costs and their policies, before purchasing them. States must begin talking to a federal hub that is being created to help determine who is eligible for subsidies. Within 10 days after the November election, states are supposed to report to the federal government on their readiness to set up the exchanges, and must get them ready in 2013. If a state does not comply, residents can access a federal “fallback” exchange. To get a subsidy, you must buy your insurance through an exchange.

Readers may be happy to know that California is a leader in working toward having an exchange ready by late 2013.

The Affordable Care Act is a start on the path towards healthcare for everyone. It is not as efficient as an expansion of Medicare for all, which would be like a single payer plan. It is extremely controversial, so we can expect a lot of political fallout in coming months. Republicans vow to overturn the ACA if they return to power. However, it is a great accomplishment of the Obama administration in the current political climate. Here’s one more compelling reason to vote in November.
Sadja Greenwood, MD, MPH

Read back issues on this blog. Leave me a message, and I'll answer you!