What's the Connection between Sleep, Exercise and the Immune System?

When we get sick – with an infection, other illness or traumatic event – we want to sleep more.  It’s a natural reaction seen in other animals as well.  Recent research at the University of Pennsylvania showed that sleep helps to facilitate the immune response by increasing resistance to infection and survival after infection.  This research was done on fruit flies – but don’t discount it too quickly.  The genetic pathways found in these insects are preserved in mammals.  The take-home message from this work is that when you get sick – sleep as much as your body tells you to.

Research at the Finnish Institute of Occupational Health showed that healthy young adults restricted to 4 hours of sleep per night for 5 days  showed marked changes in their immune systems, with pro-inflammatory changes and an increase in allergic reactions and asthma.  Sleep deprivation also affects metabolism, leading to obesity, heart disease and diabetes. 

What are some natural ways to get enough sleep?  If you work at home and can’t sleep well at night, try a nap during the day – any time from 10 to 30 minutes may revive your day.  Regulate your 24 hour (circadian) rhythms by exposing yourself to bright light n the morning – sunlight or a ‘happylight’ during foggy days or the winter.  Before bedtime, wear blue-blocking glasses for an hour, while you read, compute, play music or watch television.  When you block the short blue wavelengths of the light spectrum with these orange colored glasses, you prevent the suppression of your natural melatonin. Melatonin is a hormone produced by the brain’s  pineal gland, located behind your eyes.  Melatonin outflow promotes good sleep. As an anti-oxidant, it has many salutary effects on the body, which we have suppressed with the artificial light of light bulbs, televisions, tablets et al.  Go to the website LowBlueLight.com to read about the benefits of normal melatonin release - by wearing the glasses for an hour or more before bedtime.  You can get a pair that will fit over your regular glasses and allow you to read, compute, or watch TV.  You can also take 1-3 mg of melatonin as a sleeping pill - start with the lowest dose.  This is safer than prescription sleeping pills such as Ambien or Valium.

Exercising  is another way to induce melatonin release and help sleep.   Morning exercise may be the most effective in increasing melatonin secretion in the evening, but exercise at any time of day can work for many people.  Here’s another benefit of exercise – a recent study from UCLA showed that maintaining muscle mass through resistance exercise (or plain hard work such as lifting, or farming) is more important than BMI (body mass index) in determining the risk of death from any cause.  So – turn your compost, get out those weights, take a Pilates class or do pushups to increase your muscle mass.

I will be away for a few weeks; my column will resume on Monday, May 26^th. Keep eating those colorful vegetables and fruits, a brassica vegetable every day, herbs, olive oil, pre and probiotic foods, and nosh on nuts.  Get some blueblocking glasses for evening use, and thereby improve your sleep. They are widely available on the Internet; I think the ones at LowBlueLight are the best – but more expensive. If you are sleep deprived at night, remember that taking a daytime nap does not mean you are lazy  - just look at your dog or cat..  Write me a comment and I’ll reply. 

Sadja  Greenwood, MD – back issues on this blog

Regulate your Blood Sugar with the Right Plant Foods

Dietary compounds known as flavones and anthocyanins, found in many herbs and vegetables, can help to regulate blood sugar and lower inflammation.  Recent research from the University of East Anglia and King’s College London looked at nearly 2000 women who were twins, and compared their dietary histories with their blood levels of glucose, insulin and inflammatory markers.  The research focused on flavones, found in herbs and vegetables such as parsley, thyme and celery, and anthocyanins, found in berries, red and purple grapes, wine, and other red or blue-colored fruits and vegetables.

Findings were that those who ate the most foods with flavones and anthocyanins had lower insulin resistance.  This means that their cells were able to respond to insulin and take in blood glucose in a normal way.  People with high insulin resistance have elevated levels of insulin in their blood, and may experience weight gain, increased blood pressure, high triglycerides, low HDL (good cholesterol), and other health problems. Diabetes is a frequent result. 

The study also found that those who ate the most anthocyanins were least likely to suffer from chronic inflammation.  Inflammation – as seen by redness, swelling, and pain, is a normal and necessary part of the body’s reaction to injury.    As healing occurs, the inflammatory response goes away.  However, chronic inflammation is a risk factor for many illnesses and should be identified and reduced.  It can be caused by chronic infections, gum disease, and obesity, especially abdominal obesity.  The usual antidote has been to eat less, follow a Mediterranean type of diet, and move more.  This new study indicates which foods may be especially helpful.  Anthocyanins are concentrated in foods that are red, purple or blue, but are found in most plants, in leaves, stems, roots, flowers and fruits.  The highest amounts are found in blueberries, cranberries, blackberries, black currants, cherries, eggplant peels, black rice, dark colored grapes, red cabbage, red-fleshed peaches, beets, and blood oranges. 

The researchers also cited dark chocolate and red wine as compounds with anthocyanins, and cautioned that moderation is the key, because of the potential for too much sugar (chocolate) and addiction/inebriation (wine).  Here’s a no sugar chocolate recipe:  mash a ripe banana, add unsweetened cocoa powder and some peanut butter to taste. Stir it up with a fork, and share it with a pal for dessert.  Put it on a whole grain cracker for crunch, or add chopped nuts. 

This is an exciting study because it is one of the first large-scale human studies to look at how flavones and anthocyanins can reduce chronic inflammation and also affect insulin resistance, blood glucose regulation and the risk of diabetes.  A study of twins is especially valuable, as it eliminates or modifies the role of genetics.

The take home message of this article is – go for dark colors in your food choices.  Also go for the flavones in celery, parsley, thyme and other herbs.  You can find these foods year-round at natural food stores and many markets.  Try growing purple potatoes – I can’t stop them in my garden.   Thyme and parsley are also easy to grow in our climate.

Sadja Greenwood, MD, MPH   back issues on this blog

Birth Imbalance – Where are the Girls?

Jimmy Carter has a chapter titled ‘The Genocide of Girls’ in his new book A Call to Action: Women, Religion, Violence and Power. Under ordinary circumstances, about 105 boys are born for every 100 girls.   In most populations, adult males tend to have higher death rates than adult females, both due to natural causes such as heart attacks and strokes, and also to violent causes, such as homicide and war.  In early adulthood there are roughly equal numbers of men and women, and later on women predominate. 

However, the sex ratio has changed drastically in several Asian countries, including India and China, due to a strong cultural preference for boys.  Boys carry on the family name, are considered stronger workers, and are expected to provide for their parents in old age. Girls traditionally leave to go their husband’s home. In India, girls have been considered a burden because of the need to provide a dowry for their wedding.  The dowry system was banned by law in 1961, but is still pervasive.  The strong cultural preference for boys resulted in infanticide and starvation of girls in earlier times.  At present, ultrasound has enabled women to know the sex of their fetus at about 12 weeks of pregnancy, and sex-selective abortion is easy to obtain in India, China, and other countries. Studies of sex ratios indicate that gender-based abortion or female infanticide may also be occurring in Afghanistan, Bangladesh, Pakistan, countries in the Caucasus and elsewhere.  Sex ratios over 110 (male) to 100 (female) are common in these areas, reaching as high as 120 to 100 in parts of India and China.

Carter goes on to discuss some of the results of the altered sex ratio, such as a shortage of brides, increased demand for prostitutes and abduction or trafficking of young women to become brides - for a price, mainly pocketed by the traffickers. Carter cites the 2011 book Unnatural Selection: Choosing Boys over Girls, and the Consequences of a World Full of Men, by Mara Hvistendahl, a contributing editor for Science magazine.  In another 2004 book, Bare Branches - The Security Implications of Asia’s 

Surplus Male Population, authors Valerie Hudson and Andrea M. den Boer argue that historically, high male-to-female ratios often trigger domestic and international violence. Most violent crime is committed by young unmarried males who lack stable social bonds. Although there is not always a direct cause-and-effect relationship, these surplus men often play a crucial role in making violence prevalent within society. Governments sometimes respond to this problem by enlisting young surplus males in military campaigns. Countries with high male-to-female ratios also tend to develop authoritarian political systems.  The name ‘Bare Branches’ is a Chinese saying for unattached males.  The authors say that the surplus male population in Asia’s largest countries will have serious global implications.

 According to a 2011 Gallup poll, American parents favor boys by a 40% to 28% margin. The results were similar to a survey in 1941, when Americans preferred a boy to a girl by a 38% to 24% margin. The overall preference was driven by men, of whom 49% preferred a son compared to 22% who preferred a daughter. Men's preference for sons was most pronounced among men aged 18 to 29. Women, on the other hand, showed no preference for either sex, with 33% stating that they preferred a girl and 31% responding that they favored a boy. In the United States, there are numerous centers where prospective parents can go to choose the sex of their offspring, before or after pregnancy has occurred. Methods used before pregnancy involve in-vitro fertilization; these methods, similar to IVF, are quite expensive and involve discomfort and some risk to the woman  Methods after pregnancy involve sex-selective abortion, and can be done by about 10 weeks with a blood test.  Sex selective abortions in the US are done mainly to prevent inherited diseases that affect a male child -such as hemophilia and Duchenne's muscular dystrophy. There is some evidence that immigrant groups in the US from countries with a strong male preference are using sex-selective abortion.   However, there has not been an imbalance in sex ratios in this country at the present. 

This has been a discouraging column so far, and I would like to end in a more upbeat way, with suggestions for change.  Be aware of the problem - in virtually every religion and known human society there has been gender inequality (with the possible exception of Paganism).   This awareness is leading to slow but positive social change.  Teach your sons, daughters and friends to see the problem and correct it, as they can.  Support one of many organizations working to give women access to education, tools and family planning, such as Oxfam America.  Consider Kiva; with a $25 loan you can support a person of your choice who is starting a small business                    , and get paid back if and when her project is successful.   

Sadja Greenwood, MD   prior columns on this blog

Jimmy Carter's new book on Violence Against Women

"Yet although economic disparity is a great and growing problem, I have become convinced that the most serious and unaddressed worldwide challenge is the deprivation and abuse of women and girls, largely caused by a false interpretation of carefully selected religious texts and a growing tolerance of violence and warfare, unfortunately following the example set during my lifetime by the United States.“  These are the words of Jimmy Carter in the introduction to his new book A Call to Action: Women, Religion, Violence and Power. Carter states that the Bible, the Koran and other cherished texts proclaim a commitment to justice and mercy, and equality of treatment between men and women.  However, “some selected scriptures are interpreted, almost exclusively by powerful male leaders within the Christian, Jewish, Muslim, Hindu, Buddhist and other faiths, to proclaim the lower status of women and girls.   He goes on to say that these claims are used to justify gross and sustained acts of discrimination and violence against women, including unpunished rape and other sexual abuse, infanticide of newborn girls and gender selective abortion of female fetuses, a worldwide trafficking of women and girls, honor killings, genital mutilation, lower pay and fewer promotions for women and greater political advantages for men.

Because the Carter Center has worked to combat neglected tropical diseases throughout the world, its people have interacted with remote communities in some 70 developing countries.  They have seen how religious beliefs and violence have impacted the lives of women in patriarchal societies.  “Almost everywhere, we find that women are relegated to secondary positions of influence and authority within a community but almost always do most of the work and prove to be the key participants in any successful project.  When there is a shortage of food or limited access to education, the men and boys have the first priority……when a civil conflict erupts, women are the primary victims of bombs and missiles, the displaced adults in charge of children, and the victims of rape. Beyond all this are the special biases that come from the distortion of religious beliefs and the imposition of discriminatory tribal customs that lead to honor killings, genital cutting, or child marriage.”

You have probably read enough to make you decide that you must read this book, or you can’t stand any more.  I found the book disturbing and hopeful, because President Carter and The Carter Center have not only discussed an array of terrible problems but have suggested helpful, local approaches.  In subsequent columns I will write about their approach to genital cutting, child marriage and dowry deaths, and sexual slavery and prostitution (including what goes on in the Bay Area).  For now, think about your religion or spiritual path followlng an egalitarian mother-father God, or moving beyond humans to embrace all living things.  Whatever is best for you.

For a complete change of pace - here’s what the Point Reyes Light (3/27/14) reported about alcohol use in Marin from ‘available data’.  Nearly one-quarter of the county’s adults reported binge drinking in the past month. The county has averaged 32 deaths annually from drug overdoses in recent years - mostly from prescription drugs.  Nearly half the county’s 11th graders drink alcohol and one-third binge drink.  A new program to deal with teen drug and alcohol problems is being developed at the San Geronimo Valley Community Center.  A meeting in Bolinas will take place on May 13th, 9:30-11:30 am.   Watch the Hearsay for more information.

Sadja Greenwood   past columns on this blog    Leave me a message, and I will answer you.

The Pros and Cons of Acid -Suppressing Drugs

 The use of drugs such as Prilosec, Nexium and Prevacid is very common.   These drugs, known as Proton-Pump Inhibitors (PPIs) are available over the counter and in higher doses by prescription.  PPIs are the third largest class of drugs sold in the US, with over 10 billion in yearly sales.  A slightly weaker series of drugs known as H2 blockers are also available over the counter, as Tagamet, Pepcid and Zantac and in higher doses by prescription. 

These drugs are important in the treatment of peptic ulcer disease of the stomach, the prevention of esophageal cancer and in cases of severe reflux – known as GERD or gastroesophageal reflux disease.  People with frequent severe acid reflux are at greater risk of cancers of the vocal chords and throat; acid-suppressing drugs may play an important role in prevention. 

Obviously, these drugs have been beneficial to many. However, there are serious downsides to their overuse.  A study from the University of Washington found that women between 50 and 79 using PPIs were at increased risk of spine, forearm or wrist fractures, despite no decrease in bone mineral density or increased hip fractures.  Other studies have shown an increase in hip fracture with long-term use, and lessened calcium absorption.

Daily use of PPIs is associated with a 74% increase in Clostridium difficile infections in hospitalized patients, according to a Harvard study.  The gastrointestinal infections, with severe diarrhea, are very serious, can be fatal, and are difficult to treat. 

PPIs are also associated with an increased risk of hospital-acquired and community-acquired pneumonia.  By suppressing stomach acidity, pathogenic bacteria that are ordinarily killed by acid can be aspirated into the lungs.  H2 blockers may also have this effect, but to a lesser degree. 

Use of PPIs and H2 blockers for two years or more is associated with an increase in vitamin B12 deficiency, which can lead to anemia, neurologic problems and dementia, according to a study done at Kaiser Permanente.  The definitive study on low B12 levels and cognitive decline was done at Oxford University. 

PPI use is also associated with low magnesium levels, which can lead to muscle spasms and an irregular heart beat.

These findings present a dilemma.  There are obviously benefits of acid blocking drugs for people at risk for esophageal cancer, bleeding stomach ulcers, and severe reflux disease.  The problem is that many people are using these drugs for ‘convenience’, making it possible to eat large late dinners without suffering from reflux.  Some people are not sure why they are taking these drugs, once prescribed by a doctor.  The risks may well outweigh the benefits.   Here are some ways to prevent reflux discomfort without drugs.  Eat a smaller early dinner, avoiding foods that give you reflux, such as tomato sauce, chocolate, chiles and too much fat. You probably know your own triggers.  Don’t eat within 3-4 hours before bedtime.  Raise the head of your bed, or fix your pillows so that you can sleep sitting up if you feel GERD coming on.  Lose some weight if you are overweight – try Weight Watchers or a book on ‘volumetrics’, by Dr. Barbara Rolls.  Go to The National Weight Control Registry and read the success stories of people who have lost 30 pounds or more and kept it off.  You will find great ideas that can work for you.   

Get off PPIs slowly, as you may experience rebound stomach acidity for the first two weeks, before getting back to normal.   

Sadja Greenwood, MD, MPH   Check out past columns on this blog, and look at my novel, Changing the Rules, at local book stores and Amazon.

Emergency Contraception - The Morning-After Pill

Emergency contraception (EC) is birth control that can prevent pregnancy after sex; EC methods include pills and the copper IUD.  All sexually active young people should know about these methods.  EC can be used right away or up to 5 days after sex if a woman didn’t use birth control, a condom broke, or in a situation of rape. 

EC makes pregnancy much less likely, but is not as effective as regular contraceptives - the pill, IUD or condoms.  Parents who are worried about EC should know that the methods are safe, and extensive research has shown that their availability does not increase the likelihood that a teenager will engage in sexually risky behavior, such as inconsistent use of contraception or having multiple sexual partners.

Plan B One-Step and the generic Next Choice One Dose contain a progesterone-like compound – levonorgestrel – that is found in many birth control pills.  It does not harm an established pregnancy nor decrease future fertility.  EC is most effective when taken within 2 days after unprotected sex, but has some effectiveness up to 5 days later.  The EC pills are less effective for women who weigh more that 154 pounds.  Plan B One-Step and Next Choice One Dose are available without a prescription to females or males (males don’t take it – but give it to their partners!) age 15 or older.  Younger people must have a prescription.  The cost of Plan B is $40-$50 – probably less at a family planning agency. 

Princeton University has a website that explains EC in detail – ec.princeton.edu.  Some women feel side effects such as headache, fatigue or breast tenderness after EC pills- these symptoms generally go away in a day or two.  Unexpected bleeding or an early or late period may occur – these side effects are not dangerous.  Pharmacies such as CVS and Walgreens carry these pills in the aisles containing other family planning methods. 

Ella is a prescription EC pill that is more effective than Plan B. especially for obese women and in situations when more time has past since unprotected sex.  Its ingredient is ulipristal acetate, which will delay ovulation.  It may also work by preventing implantation of the fertilized egg.  Ella is available online for $40 (including shipping) at www.ella-kwikmed.com. A physician will take a history on-line and prescribe the  pill.  It will be delivered by FedEx within 1-2 days, signature required.  Ella should not be used if the woman has an established pregnancy. 

Copper IUD – this is the most effective form of EC.  The IUD must be placed within 5 days of unprotected sex; it is more effective than pills in preventing pregnancy and it can remain in place for as many as 12 years.  The Affordable Care Act (Obamacare) promises women contraception without copay.  However, the girl or woman must find a family planning agency (such as Planned Parenthood) or a clinician experienced in IUD placement. 

Medical Abortion Pills – Emergency contraceptive pills work before a pregnancy has started, so they do not create an abortion.  However, there are two compounds in current use that can be used for a so-called medical abortion.  Mifepristone – which used to be called RU486, or the French abortion pill, acts by blocking the action of progesterone, a hormone needed to sustain a pregnancy.  Misoprostol, otherwise known as Cytotec, is then taken to soften and open the cervix and cause uterine contractions, expelling the pregnancy.  These two drugs are used together in the first 9 weeks of pregnancy, under the supervision of a trained doctor or nurse practitioner.  Medical abortion is available in California at many family planning clinics.

In states such as Texas where many women’s clinics have been shut down, women are turning to misoprostol pills on their own for inducing an abortion.  They are getting the drug on line, or across the border in Mexico, where it is sold over the counter. They may have very little information as to proper dosage, but when bleeding begins they hope to go to a clinic or hospital for a suction procedure to complete the abortion.  Throughout Latin America, where abortion is mainly illegal, women are taking misoprostol in this manner.  It is tragic and disgraceful that the situation in our country has come to this. Women who are desperate to end a pregnancy should not be abandoned by the medical profession.

You can support Wendy Davis, Democratic candidate for governor of Texas, who has pledged to reopen family planning clinics if she wins.  Support her through Emily’s List, or on numerous Internet websites. 

Sadja Greenwood, MD   back issues on this blog.  Check out my novel – Changing the Rules – at bookstores or Amazon. 

Atrazine

The herbicide, atrazine, hit the news with an article in the New Yorker of 2/10/14, featuring the work of Professor Tyrone Hayes at the University of California, Berkeley.  Hayes, a brilliant and renowned researcher, has spent many years studying the abnormal sexual development of male frogs; they have been found to develop ovaries as well as testes, becoming hermaphrodites.  Hayes has experimental evidence that the herbicide atrazine is strongly implicated in these abnormalities and that atrazine, a probable endocrine disrupter, may also be related to the worldwide decline in amphibian populations.

Atrazine is made by the company Syngenta.  According to the New Yorker article, Syngenta has been trying to discredit Hayes and his work in multiple ways, detailed in the fascinating and frightening exposé in the New Yorker.

Atrazine is one of the most widely used herbicides in the U.S.  It is reportedly applied to more than half the corn raised in this country. A study by the EPA found that without atrazine the national corn yield would fall by 6%.  But the herbicide degrades slowly in soil, washes into streams and lakes, and breaks down slowly.  It is one of the most common contaminants of drinking water in the Midwest – an estimated 30 million Americans are exposed to trace amounts of this chemical.  Atrazine, widely believed to be an endocrine disrupter, has been banned by Italy and Germany since 1991 and by the European Union since 2003. The Natural Resources Defense Council (NRDC) and other environmental organizations have filed lawsuits against the EPA for failure to ban atrazine, so far without results.  In August, 2013, a coalition of more than 250 conservation, public-health and sustainable farming groups sent a letter to the EPA asking for a ban on atrazine.  According to the New Yorker article, the EPA is conducting another review of the safety of atrazine at this time. 

If you are upset by this column, you will be very disturbed by the article about Sygenta’s attempts to discredit Professor Hayes in the New Yorker.  Stay tuned – I will keep you informed on this story as more news becomes available. In the meantime, you can support the NRDC, the Center for Biological Diversity, or other environmental organizations that are working on this issue.

Sadja Greenwood, MD,MPH  back issues on this blog – use the index or search at the top left.  Check out my novel – Changing the Rules – at local bookstores or on Amazon

Ginger

Ginger has been used in Asian, Indian and Arabic cooking and as a medicine for at least 4000 years! In herbal medicine it has been used to treat stomach upset, colic, diarrhea, nausea, motion sickness  arthritis, respiratory illness, headaches, and painful menstrual periods.  In the 21^st century, ginger is being studied at various universities for these and other health conditions.  Here are some recent findings.

*Asthma has become more prevalent in recent years; the reasons for this increase are being debated and are obviously complex.  Air pollution may be a factor.  Asthma is characterized by a tightening of the bronchial tubes that carry air in and out of the lungs.  Medicines called bronchodilators are common types of asthma medicines; they work by relaxing the smooth muscles that line the airways.  Researchers at Columbia University have found that components of ginger can work with bronchodilators to relax the airways.  Compounds in ginger affect an enzyme in the lungs that prevents smooth muscle relaxation.  Researchers plan to determine whether aerosol delivery of ginger compounds may have a therapeutic potential in relieving asthma. People with asthma should not abandon their inhalers at this point, but drinking ginger tea might be helpful.  (Also – vitamin D deficiency is common in people with asthma.  Talk to your doctor or NP about  supplemental D if your level is below 30-40 ng/ml.)

*Muscle pain – researchers at the University of Georgia studied oral ginger in a randomized group of volunteers given arm exercises with heavy weights designed to cause muscle pain the following days.   Subjects pretreated with ginger capsules had a 25 % decrease in muscle pain on subsequent days.  This should be of interest to many people who exercise in gyms, on the soccer fields or engage in any sport that causes muscle soreness.   

*Nausea from chemotherapy – Ginger has long been used for nausea in pregnancy and is considered safe and somewhat effective.  Researchers at the University of Rochester Medical Center found that giving ginger supplements 3 days before chemotherapy treatment and 3 days after – along with prescription medicines for nausea – reduced nausea levels by 40% compared to patients just receiving prescription medicines for nausea. 

*Colon inflammation:  researchers at the University of Michigan looked at the ability of ginger supplements to reduce colon inflammation and thereby possibly act as a colon cancer prevention agent.  After 28 days of ginger use, subjects had statistically significant reductions in most markers for colonic inflammation, compared to subjects taking a placebo.  This is important, as colon cancer is the third most common cancer among men and women in the US.

*How to use more ginger- Buy ginger root, cut  a thumbnail size piece and dice it into small pieces, then add it to stir-fries and vegetable dishes.  Grate ginger into many dishes, including rice and quinoa, and in baked goods.  Buy ginger tea bags, or make your own ginger tea.  If you feel a little nauseated from eating too much, ginger tea will really help.  Researchers at Chang Gung University in Taiwan have shown that ginger accelerates the emptying of the stomach.

Sadja Greenwood, MD, MPH    back issues on this blog   Check out my novel, Changing the Rules, at local bookstores or Amazon.

Update on flu, apples, coffee, vitamin D, and polio in India

*Flu – there have been at least 29 deaths from this year’s flu epidemic in the Bay Area, with many more people in intensive care.  It’s not too late to get the flu vaccine, which contains protection against the HINI virus.  Get yourself protected.

*Apples – I previously reported on the benefits of apples in prevention of cardiovascular disease. See my column on 12/23/13.  Researchers at Cornell University have identified compounds in the peel of apples that have anti-cancer effects in the laboratory against liver, breast, and colon cancer cells.  So – buy organic apples whenever possible, and eat the peel!

*Coffee –New positive votes for coffee!   Researchers in Turkey have reported on numerous studies showing that coffee drinking is associated with a lowered risk for metabolic syndrome, as well as a reduced risk for non-alcoholic fatty liver disease.  Metabolic syndrome is a name for a group of risk factors for diabetes, heart disease and stroke.  These factors are: a large waist line (apple shape), an elevated triglyceride level, high blood pressure, low HDL cholesterol (the ‘good’ cholesterol) and a high fasting blood sugar.  Non-alcoholic fatty liver disease affects about 25% of the US population.  It is a buildup of fat in liver cells, not caused by alcohol, that tends to develop in people who are overweight, have diabetes, high cholesterol or high triglycerides.  A previous large study on coffee, run by the National Institutes of Health (400,00 men and women followed for 12 years)  showed that coffee drinking – either caffeinated and decaffeinated – is associated with a lower risk of death from heart disease, stroke, respiratory disease, injuries and accidents, diabetes and infections.  Coffee is also associated with a lower risk of uterine cancer in women, and of basal cell skin cancer.  A recent large Harvard study showed that caffeinated coffee, but not decaf, is associated with a 50% decrease in suicide.  This is huge.

Oh, I almost forgot – researchers at Johns Hopkins have found that caffeine enhances memory.

*Vitamin D – The American Geriatrics Society advises that older people should have a vitamin D intake sufficient to keep their blood level at about 30ng/ml. This level has been associated with a lower risk of falls and fractures.  While the influence of vitamin D on bone density is small, the impact on muscle strength and fall prevention is impressive.  If you, or a relative, are over 65, getting a vitamin D level is important. The test is called 25(OH) D. Supplementation with vitamin D can bring your level up, and the amount of D to take should be discussed with your health care provider.  The Geriatrics Society suggests that doctors prescribe up to 4000 IU daily to achieve good blood levels.  I suggest getting a blood level before taking 4000 IUs daily – start with 1000-2000 IUs and talk to your doctor or NP.  Calcium intake is also important for strong bones: I will write more on this mineral in a forthcoming column. 

. 

*Polio eradication in India!  India, a country of 1.4 billion people, has successfully eradicated polio, with no cases reported for the past 3 years.  India had 150,00 cases in 1985, 6,028 cases in 1991, 741 cases in 2009, and the last  one case – on Jan 13^th, 2011.  The country used 2.3 million vaccinators each year; mobile teams immunized children (with oral vaccine – kept cold for potency – no small feat) in homes, in railway stations, inside running trains, at bus stands, marketplaces, and at construction sites. They walked miles to towns not connected to roads. Muslim leaders were identified and went along with the program.  The vaccinators publicized this message  - wherever you stay, wherever you go, protect your child against polio.  This was an astounding public health success, funded by the government of India, the Bill and Melinda Gates Foundation, the U.S. government and many other countries and organizations.   Only 3 countries still have cases of polio – Nigeria, Pakistan and Afghanistan.  In these areas there has been very tragic threatening and killing of vaccination teams.  May the opposition see the light and protect their people against paralysis. 

Sadja Greenwood, MD , MPH  Check out my novel, Changing the Rules, at local bookstores or Amazon.

Access to Abortion is Declining in Many States

In a country so dedicated to individual liberty, it is perplexing that conservatives oppose a most fundamental freedom  - to control one’s own reproduction.  State legislatures have passed increasing numbers of restrictions on abortion in recent years – 70 in 2013. (California is not included, we are one of the most liberal states with regard to abortion laws and access.)  Both sides in the abortion debate are preparing for new political campaigns and court battles this year.

Texas made news in June when State Senator Wendy Davis filibustered for 11 hours against regulations that required doctors performing abortions to have admitting privileges in local hospitals, imposed costly surgery-center standards for clinics, sharply limited medication abortions and adopted a 20 week ban.  Senator Davis was not successful in her attempt to block the new bills, but is planning to run for governor this year, along with another woman State Senator for lieutenant governor.  The primary is in March – stay tuned for that. The restrictions on abortion have left much of Texas without access to family planning and abortion clinics.  A federal judge blocked the rules as medically unnecessary, but the US Court of Appeals reinstated them pending a trial.  Stay tuned – the Appeals Court is about to hear arguments in New Orleans. 

South Dakota has a law mandating a 72-hour waiting period between a first visit for an abortion and the procedure. Weekends and holidays cannot count as part of this wait.  This can only be seen as punitive - some women will be waiting 6 days.

North Dakota has passed a law to criminalize all abortions after a fetal heartbeat is detected, at about 6 weeks. By passing this law, which has been blocked while it is being contested, its supporters hope for a reconsideration of Roe v Wade by the Supreme Court.   North Dakota voters will also vote on a bill granting personhood to fertilized eggs this year.

North Carolina passed anti-abortions restrictions inserted at the last minute into a motorcycle safety law.  It required clinics to meet the same safety standards as ambulatory surgical centers, to have transfer agreements with local hospitals, to have physicians present for medication abortions, and a restriction on abortion coverage in the state healthcare exchange. 

Oklahoma passed a law in 2011 to ban off-label use of abortion-inducing medications – legal challenges and state appeals to defend the law continued into 2013.  Numerous other states –including Texas - are attempting to block medication abortions, which are becoming more popular with women.  The Oklahoma law even blocked doctors from treating tubal pregnancies with medication.  The alternative treatment is surgery.  Tubal pregnancies will never develop but will rupture, causing serious internal bleeding, and are fatal if not treated as a surgical emergency.    

If you support a woman’s right to plan her family, or to plan not to have a family, this is a time to get active.  You can contact Planned Parenthood locally or nationally, and send a contribution or volunteer your time.  The same is true for NARAL (National Abortion and Reproductive Rights Action League).  Both organizations have a long track record on behalf of women, men and couples.  NARAL’s work is political, while Planned Parenthood provides a wide range of reproductive health care as well as education on the issues that might limit it.

Flu Season is here!  The viruses circulating this year include H1N1, which caused a major pandemic in 2009 with thousands of deaths worldwide.  Young and healthy people are not immune.  Who wants fever, coughing, sore throat, weakness, headache, aches and pain in the joints and muscles, pneumonia, ear or sinus infections, and dehydration or hospitalization??  If you have not had the vaccine yet, get it at once!

Sadja Greenwood MD, MPH   Check out past issues on this blog - it is finally indexed.  My novel, Changing the Rules, is in local bookstores and on Amazon.