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 -->

Umami – The Fifth Taste
















Why are Claire Heart’s soups at the Bolinas People’s Store so delicious? It’s partly the mystery of a great cook, but another reason is that she uses fresh organic ingredients, and makes sure that all the tastes on our taste buds are stimulated. (Maybe with the exclusion of bitter, although people who like coffee and beer, or flavor foods with citrus peel, are enjoying the mild taste of bitter.) We have taste buds on the tip of our tongues, where you can actually see them as tiny bumps; they are also located all over the tongue, the mouth and the throat. Each taste bud has receptor cells for sweetness, sourness, saltiness, bitterness and umami. Umami taste is described as savory and brothy. Except for the bitter taste, great cooks like Claire add just the right amount of each flavor. Coconut milk often adds to the mixture, giving a wonderful fragrance and the smooth mouth feel of fat. Flavors beyond the basic five are detected by our sense of smell.



















Umami is a transliteration of the Japanese word for a pleasant, savory taste. The receptors for umami are not the same as those for salt – umami receptors on the tongue respond to the amino acid L-glutamate. To get a first hand experience, chew a very ripe tomato (try a sun-dried one at this time of year), taste the flavor carefully, and feel the sensation in your mouth and cheeks. You’ll taste sweet and sour, and also umami.



















Here’s a bit of biochemistry: glutamate is the most abundant excitatory neurotransmitter in the human nervous system. It is involved with learning and memory. When sensitive people ingest too much glutamate, in the form of MSG (monosodium glutamate), they can develop headache, tightness in the face and jaw, heart irregularities, and even seizures. Most restaurants stopped using MSG in the 1990’s because of publicity about these problems, and customer complaints; they were adding it to food because it enhanced the taste so much.



















Umami found in natural foods will enhance taste but will not cause harm.







Most humans’ first taste of umami comes in mother’s milk; we learn to like it early! Foods high in the umami taste include kombu, nori, fish and shellfish, mushrooms, ripe tomatoes, green tea, soy beans, sweet potatoes, Chinese cabbage, carrots, and cheeses. Using these foods to enhance your home-made meals will bring you pleasure and good health. Eat cheese sparingly for flavor – it is high in saturated fat and salt.



















The FDA has stated that MSG is ‘Generally Recognized As Safe’, but requires that the words ‘monosodium glutamate ‘ be written on the label if it has been added to the food. However, there is a significant amount of controversy about other additives found in processed foods and fast food restaurants. These additives contain free glutamic acid but are not MSG; hydrolyzed vegetable protein, hydrolyzed soy protein, yeast extract and autolyzed yeast are examples. They impart an umami flavor to food. It is difficult to know if there is a valid concern about eating small amounts of these substances. However, the more we know about the way packaged and processed foods are designed to increase your wish to overeat them, the less desirable they seem. Too much fat, sugar, salt are causing health problems that are easily avoided by the thoughtful eater.



















Eden Foods: Here’s a sad and controversial new development. Eden







Foods is suing the Obama Administration over its mandate to cover birth control under the Affordable Care Act. Michael Potter, the company’s owner and CEO, claims that his religious beliefs are being violated by requiring him to pay for healthcare services, including contraception. You may know that Eden Foods is a pioneer in using cans that are free of Bisphenol A, and has many excellent organic products. The lawsuit has caused a good deal of controversy among groups supportive of reproductive rights. Some are choosing to boycott Eden products. Stay tuned.







Sadja Greenwood, MD, MPH

Go to Health: Protect Your GI Tract!






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






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






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






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






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


Sadja Greenwood, MD , MPH

Cold Chain Problem for Vaccines - Silk Worms can Help!

-->

The elimination of serious infectious diseases such as small pox and polio requires immense international collaborative effort. The World Health Organization, UNICEF, the Rotary Foundation, the Bill and Melinda Gates Foundation and many other groups are currently working on a number of infectious diseases, such as polio, tuberculosis, HIV/AIDS and diarrheal diseases.   Small pox was successfully eradicated in 1977, a momentous victory that required decades of work.   For polio and other serious infectious diseases, problems in poor countries include wars, lack of basic health infrastructure, lack of roads and electricity, ignorance and suspicion of the West, and anger stemming from the purported misuse of a Hepatitis B immunization program in Abbottabad to obtain DNA samples from suspected relatives of Osama bin Laden.  Workers bravely carrying out immunization campaigns in Pakistan, despite a fatwa from Islamist groups prohibiting vaccination, were killed in December 2012, and again January of 2013. Nine workers giving polio vaccine were killed in Nigeria in February, 2013.  Nigeria, Pakistan and Afghanistan are the only countries still reporting cases of polio. In resource-poor countries infectious diseases make up more than half of all deaths, and those who most need effective vaccines and antibiotics may not get them.  Measles is a leading killer of children worldwide, and can be prevented by vaccine, when and if it is available.

One of the problems with vaccination campaigns is the need to keep vaccines cold, when transporting them in hot areas which lack refrigeration and electricity. High temperatures are found to destroy almost half of the vaccines produced around the world.  Polio vaccine must be kept at 35 to 46 degrees F for vaccination to be successful.  Antibiotics and other medications also need to be protected from heat. According to the World Health Organization (WHO), as recently as 2008, almost half of all vaccines delivered to developing countries were ruined due to poor cold chain services. Further, cold chain “breaks” lead to ineffective vaccines being administered with a consequent loss of life and lack of vaccine compliance.

  Researchers at Tufts University have found that vaccines and other drugs can be stabilized in silk protein made from silkworm cocoons, enabling them to withstand temperatures as high as 140 degrees F for over 6 months.  They start with silkworm cocoons, boil them with sodium carbonate to separate a protein called fibroin, mix this with salt, then mix it with the substance to be preserved (the vaccine, or drug) and spread the result out as films, then freeze-dry it.  The films contain a fibroin matrix filled with tiny pockets that contain the medicine.  They are surprisingly stable for up to six months, regardless of temperature.  Silk protein is acceptable to the human body, used in wound closure, and may even have wound healing properties that are under investigation.  It can be taken orally without problems. Ultimately, substances made from silk may be used to replace a vein or a bone in the human body.  Tufts researchers note that silk protein can be used as packaging, for food and other products, thereby eliminating some of the problems of plastic use and disposal.

A team of four students from Harvard started a company, Vaxess Technologies, that is producing the new products, vaccines and medications, incorporated in silk fibroin.  In cooperation with the Tufts professors who developed the new silk technology, Vaxess hopes to have a product that will solve the cold-chain problem within a few years.  You can watch interesting videos on the new silk technologies presented by David Kaplan and Fiorenzo Omenetto (professors at Tufts) on TED or youtube.

Sadja Greenwood, MD, MPH   See other columns on this blog

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

What Is the Microbiome?


Writing in The New Yorker on Oct. 22nd, Michael Specter explains the amazing new discoveries about the bacteria, viruses and fungi that colonize our bodies and affect our health. His article, Germs are Us, starts out with a discussion of the bacterium Helicobacter pylori (H. Pylori), found in the stomach of half the people on earth. While on the one hand it is a principal cause of gastric and peptic ulcers, and is associated with an increased risk of stomach cancer, its longevity in the human species, at least 200,000 years, makes it likely that it also plays a positive role in human evolution. Specter explains that we are inhabited from birth (the birth canal, mother’s skin, other people, all our surroundings) with a hundred trillion or more microorganisms. These microbes are in our mouths, digestive tracts, and skin – some 10,000 bacterial species, with a weight of about 3 pounds. They help us digest our food, manufacture vitamins in the colon (biotin and Vitamin K), and help our immune systems prevent infections. While the genes we inherit play a role in our health and disease, so does the microbiome. The human body can be seen more as a ‘vast, highly mutable ecosystem …. than like an individual assembled from a rulebook of genetic instructions’. Streptococcus mutans, in the mouth, is a principal cause of tooth decay, releasing acid when we eat sugar. Dentists are working on a number of measures to control this bacterium, including chlorhexidine and xylitol chewing gum. The bacterium Lactobacillus sakei may be capable of warding off sinusitis; this bacterium is destroyed by antibiotics. While antibiotics are ‘the signature medical achievement of the 20th century, and have saved millions of lives’, there is a downside to their use in terms of our microbiome. People without H. Pylori in their gut seem to be more sensitive to allergens, and are more likely to have had asthma as children. Children born by C-section lack many microbes transferred in the birth canal. Research from Finland and Germany indicate that these children may have more allergies. There is also a strong relationship between the presence of H. Pylori and two stomach hormones that control appetite. Ghrelin induces eating, and leptin suppresses the appetite. People whose stomachs have H. pylori have less ghrelin after a meal and stop eating; people without it may not get the message to stop and become obese. The reason that animals (poultry, cows and pigs) fed with antibiotics gain weight faster may have more to do with this mechanism than with treatment of illness. About 40% of children treated with broad-spectrum antibiotics develop diarrhea – and treatment with a probiotic (good bacteria for the gut) may prevent this disease. About 10% of people carry a bacterium called Clostridium difficile (C. difficile), which is normally held in check by other bacteria in the gut. When given antibiotics, people with C. difficile can develop severe, life threatening diarrhea and gut inflammation. Researchers are now using a technique called fecal transplant, in which they take intestinal bacteria from healthy donors and place them in the patient’s intestines. Cures have occurred with this treatment when nothing else has worked.






Specter ends his article with cautionary advice on probiotics, which he considers over-advertised without backup research. In the future we may know more about beneficial bacteria, but at present he thinks there is insufficient knowledge to say which bacteria should be used. After reading this, I did a search of current medical research on the use of probiotics. There are considerable findings on the use of beneficial bacteria to decrease antibiotic induced diarrhea, in decreasing childhood allergy, in improving the outcome of patients undergoing surgery for colon cancer, in vaginal infections in women, in the management of adult-onset diabetes, and in many other areas. My own conclusion is that a daily probiotic capsule from a reputable supplement company, with or without the ingestion of high-quality unsweetened yogurt, can help to prevent many gastro-intestinal infections. Use antibiotics when they are needed for serious bacterial infections, but always be mindful of your own beneficial bacteria.


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

Go to Health: Evolution: Snuggle or Struggle?


Writing in the July 2012 issue of Scientific American, Martin Novak outlined the ways in which cooperation has operated to shape evolution. Novak is a professor of biology and mathematics at Harvard; he has looked at evolution in species from amoebas to zebras, and has found that cooperation, and selfless behavior, is a pervasive phenomenon. The view that competition, for resources, mates, prestige, and leadership has been the most important factor explaining survival is challenged by this view.






Novak looked at numerous species to illustrate his views, and identified 5 mechanisms for the evolution of cooperation.


1.Vampire bats will share their blood meal with one who lost out on a given day; bats remember who helped them and later return the favor. Novak calls this direct reciprocity.


2. Neighbors, or friends in a social network, tend to help one another, so in a population with groups of cooperators, clusters develop that can prevail in competition with those who don’t cooperate. Novak calls this ‘spacial selection’.


3. Kin selection occurs when individuals make sacrifices for their relatives, who share their genes, still fostering the spread of these genes. J.B.S. Haldane, who first mentioned kin selection, wrote “I will jump in the river to save 2 brothers, or 8 cousins.”


4. Individuals may help another member of his (her) species based on the needy individual’s reputation. When the helper is in need, s/he may become the beneficiary of more help, having been seen to be generous. Novak calls this ‘indirect reciprocity’., and feels it is especially important in humans.


5. Finally individuals may perform selfless acts for the greater good of the group, as opposed to a single member. This is known as ‘group selection’. Lionesses within a pride will suckle each other’s young. Ants work together and sacrifice themselves to serve their colony. In his book The Descent of Man Darwin wrote that “a tribe including many members who….were always ready to aid one another, and to sacrifice themselves for the common good, would be victorious over most other tribes, and this would be natural selection”.






Novak writes that cooperation has been a driving force in the evolution of life from the beginning, and that it has been particularly useful for humans because of our language. We can share information about each other – from our family members to strangers anywhere on earth. We are intensely interested in who does what to whom, and why. Reputation plays a major role in our decisions of how to position ourselves in the social network around us, what to do, what to support, what to buy.






Researchers looking at the need for cooperation to reduce climate change have found that people are more altruistic when they receive authoritative information about climate research, and they act more generously when allowed to make their contributions publicly rather than anonymously – when their reputation is on the line. When people receive a gas bill that compares their own consumption with the average household gas consumption in their neighborhood and that of the most efficient homes, they lower their consumption. How’s that for the interplay of competition and cooperation?






Our political parties both embrace concepts of individual struggle and cooperative unity, with Republicans leaning more toward individualism and competition, and Democrats more toward mutual help and cooperation. The balance is constantly shifting. In my home town, Bolinas, it seems that cooperation has been on the upswing for years. I am stunned by the work that people do locally for public good. We have the food programs at the Community Center, and at Mesa Park, Food for Families, the new Saturday lunch at St. Aidan’s Church, the free showers at Sam’s House, the free book store, and the immense amount of volunteer work to put on programs at the Community Center. Volunteer work for other local non-profits is outstanding – everyone I know is involved in one or another. Novak sums up his article with the following: “My work indicates that instead of opposing competition, cooperation has operated alongside it from the get-go to shape the evolution of life on earth, from the first cells to Homos Sapiens. Life is therefore not just a struggle for survival, - it is also, one might say, a snuggle for survival.”


Sadja Greenwood – back issues on this blog -->

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