Rhubarb – Its History and Uses

The Chinese were using rhubarb as a medicinal plant for thousands of years before its introduction to Europe.  It was found to be valuable because of its laxative properties.  The rhubarb root was also considered to have anti-cancer properties.  This article will be discussing the properties of the rhubarb stems, and not the root, which is not used in the west and little has been published about its safety.

Rhubarb was imported into Europe along the silk road, beginning in the 7^th or 8^th century; Later it started arriving via maritime routes or overland through Russia.  It was expensive in medieval Europe, more so than cinnamon, opium and saffron, Nevertheless it was poplar because of its laxative and purgative properties. Apothecaries in medieval times preferred the plants that came from Russia – Siberian rhubarb. 

In the United States, medicinal and culinary rhubarb was grown in the early 1700s.  Jefferson planted it at Monticello, and is quoted as saying that the leaves are excellent as spinach.  In this he was greatly mistaken – rhubarb leaves are extremely toxic, high in oxalic acid, and should never be eaten or given to animals. Put them in your compost.  I hope Jefferson did not encourage his slaves to eat them.People who have had urinary stones containing oxalic acid, calcium oxalate stones, should drink lots of water and avoid too much food high in oxalate, such as rhubarb, beets, okra, spinach, Swiss chard, nuts, tea,and chocolate.

On the positive side, rhubarb is high in vitamin K, which supports healthy bone growth and brain functioning.  It contains lutein, beneficial for the eyes, calcium, and many other vitamins and minerals.

Researchers are interested in substances in rhubarb that kill human leukemia cells and slow the growth of lung cancer cells in mouse models. 

Rhubarb is sour – cooks need to add sweetening to make it palatable for most people.  You can cook it with raisins and cinnamon, and add a bit of sugar or honey at the end to taste.  There are some good recipes on the web for rhubarb chutney.  If any readers have a good rhubarb recipe low in sugar, please leave me a message on this blog, and I will publish it next week. 

Sadja Greenwood MD, MPH  

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Diet Sodas – the Bad News

About one in three Americans drink a can of sweetened soda every day, which is – as you already know – a bad habit leading to weight gain and diabetes.  Many people have switched to diet soda, hoping to avoid these outcomes but still enjoy the taste of a sweet, cold, fizzy can of Coke, Pepsi. Mountain Dew, or Dr. Pepper.  You may be immune to pressure to buy these drinks, but they are ubiquitous and their marketing is pushed at teens and young adults. 

Research suggests that excess sugar, especially the fructose in sugary drinks, may damage the brain.  Data from the Framingham Heart Study found that frequent users of sugary beverages are more likely to have poorer memory, smaller overall brain volume, and a smaller hippocampus – an area of the brain important for leaning and memory.

A follow-up study found that people who drank a diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not.  The researchers took age, smoking, diet quality and other factors into account, but acknowledged that they could not completely control for preexisting conditions like diabetes, which is a known risk factor for dementia.  They concluded tat it was somewhat surprising that diet soda consumption led to these outcomes.  While previous studies have linked diet soda intake with stroke risk, the link with dementia was not previously known. The studies did not differentiate between types of artificial sweeteners.  Scientists have put forth various hypotheses about how artificial sweeteners may cause harm, from transforming gut bacteria to altering the brain’s perception of ‘sweet’, but they conclude that more work is needed to figure out the underlying mechanisms.

  Sudha Seshadri, professor of neurology at Boston University School of Medicine, and senior author on the papers, wrote “these studies are not the be-all and end-all, but it looks like there is not very much of an upside to having sugary drinks, and substituting the sugar with artificial sweeteners doesn’t seem to help.  Maybe good old fashioned water is something we need to get used to.

The following is Greenwood  writing: You could also try unsweetened iced coffee or tea, or plain sparkling water with a slice of lemon or orange.  Plain carbonated water does not adversely affect your bones or teeth, and may improve swallowing problems in some people.

Sadja Greenwood, MD  back issues at sadjascolumns.blogspot.com

Tea Can Help Prevent Dementia and Tooth Decay

According to a study from the Yong Loo Lin School of Medicine at the National University of Singapore, tea drinking reduces the risk of cognitive impairment in older persons by 50 per cent and as much as 86 per cent for those who are genetically at risk of Alzheimer's.

The longitudinal study, involving 957 Chinese seniors aged 55 years or older, found that regular consumption of tea lowers the risk of cognitive decline in the elderly by 50 per cent, while APOE e4 gene carriers, who are genetically at risk of developing Alzheimer's disease, may experience a reduction in cognitive impairment risk by as much as 86 per cent. The research team also discovered that the role of tea consumption on cognitive function is not limited to a particular type of tea -- so long as the tea is brewed from tea leaves, such as green, black or oolong tea.

"While the study was conducted on Chinese elderly, the results could apply to other races as well. Our findings have important implications for dementia prevention. Despite high quality drug trials, effective pharmacological therapy for neurocognitive disorders such as dementia remains elusive and current prevention strategies are far from satisfactory. Tea is one of the most widely consumed beverages in the world. The data from our study suggests that a simple and inexpensive lifestyle measure such as daily tea drinking can reduce a person's risk of developing neurocognitive disorders in late life," explained the researchers. "Based on current knowledge, this long term benefit of tea consumption is due to the bioactive compounds in tea leaves, such as catechins, theaflavins, thearubigins and L-theanine. These compounds exhibit anti-inflammatory and antioxidant potential and other bioactive properties that may protect the brain from vascular damage and neurodegeneration. Our understanding of the detailed biological mechanisms is still very limited so we do need more research to find out definitive answers."

In this study, tea consumption information was collected from the participants, who were community-living elderly, from 2003 to 2005. At regular intervals of two years, these seniors were assessed on their cognitive function using standardized tools until 2010. Information on lifestyles, medical conditions, physical and social activities were also collected. Those potential confounding factors were carefully controlled in statistical models to ensure the robustness of the findings. The research team published their findings in the journal The Journal of Nutrition, Health & Aging in December 2016.

Future Research

The research team is planning to embark on further studies to better understand the impact of Asian diets on cognitive health in aging. They are also keen to investigate the effects of the bioactive compounds in tea and test them more rigorously through the assessment of their biological markers. They plan to conduct randomized, controlled  studies that assign participants into experimental groups or control groups to eliminate biased results.

Tea and Tooth Erosion

Today, the average size soft drink is 20 ounces and contains 17 teaspoons of sugar. More startling is that some citric acids found in fruit drinks are as erosive as hydrochloric or sulfuric acid.  These refined sugars and acids found in soda and citrus juice promote tooth erosion, which wears away the hard part of the teeth, or the enamel.

 According to a 2008 article in the journal General Dentistry, the peer-reviewed journal of the Academy of General Dentistry, the  drink to avoid tooth erosion is water or brewed tea,

Mohamed A. Bassiouny, DMD, BDS, MSc, PhD, the lead author of the study, compared green and black tea to soda and orange juice in terms of their short- and long-term erosive effect on human teeth. He found that the erosive effect of tea was similar to that of water, which has no erosive effect. And, when comparing green versus black, he discovered that green tea was superior over black due to its natural flavonoids (plant nutrients) and antioxidants. 

If you do drink tea, experts suggest avoiding additives such as milk, lemon, or sugar because they combine with tea's natural flavonoids and decrease the benefits. In addition, stay away from prepackaged iced teas because they contain citric acid and high amounts of sugars. It does not matter whether the tea is warm or cold—as long as it is home brewed without additives.

Sadja Greenwood, MD, MPH   back issues on this blog

Mediterranean Diet and Brain Volume; Red Meat and Diverticulitis

People who follow a Mediterranean diet seem to retain more brain volume as they age, compared to people who don’t follow this diet.  A recent study from the University of Edinburgh in Scotland, published in the journal Neurology, followed 967 people without dementia, around age 70, testing them at 3 years and again at 6 years.  The subjects had an MRI brain scan at each follow-up.  The scans measured overall brain volume, grey matter volume and thickness of the brain’s cortex.  The measurements were compared to how closely the subjects followed a Mediterranean diet. People who didn’t follow the diet closely were found to have a higher loss of brain volume that people who followed it more closely.  The researchers adjusted for other factors that could affect brain volume, such as such as age, education, and having diabetes or high blood pressure.  The researchers concluded that the diet may be able to provide long-term protection for the brain, but more studies are needed to confirm the results.

The Mediterranean Diet includes large amounts of vegetables and fruits, olive oil, beans, cereal grain such as wheat and rice, moderate amounts of fish, dairy and wine, and limited amounts of meat.

Diverticulitis  A recent study from Harvard, published in the journal Gut, suggests that eating red meat is associated with an increased risk for developing diverticulitis.  Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine – the colon.  Diverticula may never cause problems. However, one or more of these pouches may become inflamed or infected; this condition is known as diverticulitis. Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits.  Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery.  The Harvard researchers analyzed health and diet information reported by more than 46,000 men over 26 years.  Men who ate the most red meat per week (about 13 servings) were 58% more likely to develop diverticulitis during the study period, compared to men who ate the least red meat. The association was strongest with steak.  The risk went down when people in the study substituted poultry or fish for red meat. Dr. Andrew Chan, the lead author of this study, wrote  “There is an idea that there is some pro-inflammatory state mediated by red meat that could contribute to inflammation in certain organs, Diverticulitis is a clear example of inflammation with serious consequences.”

Dear readers – there is an obvious take home lesson from these studies – eat thoughtfully!  Don’t forget that the helpful probiotic bacteria in your gut love fiber – found in vegetables, beans, fruits and whole, unprocessed grains.  

Sadja Greenwood, MD, MPH   back issues on this blog

Prediabetes – A lot of us Have it and Don’t Know it

Prediabetes is defined as a condition in which blood sugar levels are higher than normal but not high enough to be classified as full-blown diabetes.  According to studies from a number of universities and national surveys, 37% of U.S. adults have prediabetes and 12-14% have diabetes, indicating that about half of adults in this country are affected by high blood sugar.  Most cases of prediabetes are not diagnosed - people don’t know they have it. 

There are two types of diabetes, type 1 and type 2.  Type 1 diabetes, which often comes on in childhood, is an autoimmune disease and is not being discussed in this column. 

In type 2 diabetes, people have a fasting plasma glucose level of 126 mg/dl or higher on two occasions.  If you have a blood glucose level of 200 at random times, not after fasting for 8 hours, you may also have diabetes.  Another test commonly used is hemoglobin A1c, which indicates blood sugar levels in the recent past. Levels of 6.5 or higher are seen in diabetes; 5.7 to 6.4 may indicate prediabetes, and levels below 5.7 are normal. 

 Readers probably already know that diabetes is an unpleasant and dangerous disease, affecting vision, the brain, the heart, the nervous system, kidneys, and feet.  It can be reversed, by medication, exercise and a careful diet, but it is better to prevent it. 

Prevention programs are widespread, and generally consist of emphasizing weight loss (loosing even 5-7% of present body weight is very helpful), and exercise (walking or other activities that raise your heart rate), and a healthy diet.  Walk about 30 minutes almost every day.  There is widespread agreement that a diet to prevent diabetes would decrease or eliminate drinks with added sugar, replacement of red meat with beans, nuts, poultry, fish and yogurt.  Yogurt, rather than other sources of dairy foods, seems to reduce the risk of diabetes.  To facilitate weight loss, cheese should be used sparingly, as a condiment. Foods containing white flour, other refined starch, sugars and white potatoes should be avoided.   In a Harvard study by Walter Willett, coffee and decaf coffee decreased the risk of diabetes. Good news for coffee lovers – but avoid adding sugar!  Stevia seems to be a safe sweetener.   Magnesium containing foods, such as leafy greens, beans, nuts and whole grains also decreased the risk.  Following this diet carefully will naturally lead to weight loss in most people.

Walter Willett, an esteemed professor of nutrition at Harvard and the Harvard School of Public Health, has some encouraging words about lifestyle changes to prevent diabetes.  “If you make a change in your diet or lifestyle today, you’re taking your foot off the accelerator, and this happens almost overnight.  If you exercise today, your insulin resistance goes down within hours. And if you keep up the daily exercise, within a day or two your risk of diabetes drops.  Changing your diet might take longer to make a difference, but it’s a matter of weeks, not years.  Even if you are right at the brink of diabetes, you can still rapidly reduce your risk.”

Our local Coastal Health Alliance is a good place to go to get tested for prediabetes.  They have programs to help you if your blood sugar is too high.  We are lucky to have their services so close by. 

Sadja Greenwood, MD, MPH    back issues on this blog

Two Amazing Tales: Obstetric Fistula Repair, and Women on Waves outside Guatemala

Obstetric Fistula: Women in some African countries may endure days of obstructed labor, due to an immature pelvis secondary to early marriage, or a contracted vaginal opening due to female genital mutilation.  (See my latest column on genital mutilation at sadjascolumns.blogspot.com.)  The baby is often stillborn, or the woman dies in labor because of a lack of hospitals performing Cesarean sections.  If she survives, the prolonged pressure on the vaginal walls often causes openings to appear between the vagina and the rectum or bladder.  She will leak urine and feces, becoming an outcast, often living alone and prone to suicide.  The story of one such woman is remarkable.  After three days of obstructed labor in Ethiopia, and a dead baby, she was taken to a hospital in Addis Ababa that specializes in fistula surgery. The hospital is run by two Australian doctors, who spend their lives in fistula reconstruction. The patient, Ms. Mamitu, was cured and decided to stay on at the hospital.  She was given a job making beds for other patients.  Then she began helping out during surgeries. After a couple of years of watching, the doctor asked her to cut some stitches.   Eventually, she was performing the entire fistula repair herself.  .  She gradually became an experienced fistula surgeon, teaching gynecologic surgeons from many countries.  Still illiterate, she decided to go to night school to learn to read and write.  When last heard of, she was in third grade. This is a wonderful story of enormous perseverance and a drive to help regardless of qualifications.

•                Women on Waves (WoW) has sent a ship to international waters outside of Guatemala. Women on Waves is a Dutch prochoice, non-profit organization created in 1999 by Dutch physician Rebecca Gomperts, in order to bring reproductive health services, particularly non-surgical abortion services, to women in countries with restrictive abortion laws. Other services offered by WoW include contraception and reproductive counseling. Services are provided on a commissioned ship that contains a specially constructed mobile clinic. When WoW visits a country, women make appointments, and are taken on board the ship. The ship then sails out to international waters (where Dutch laws are in effect on board the ship) to perform the medical abortions (abortion performed in the first 10 weeks of pregnancy with pills).  Abortion is legal in Guatemala only if the woman’ life is in danger from the pregnancy, and if the procedure is endorsed by two doctors. As a result an estimated 65.000 illegal and unsafe abortions take place in Guatemala each year. Yearly, approximately 21.600 women are hospitalized with complications, and unsafe abortions are the third cause of maternal death in the country. Especially at the dawn of the Zika crisis, access to safe abortion is fundamentally an issue of social justice. WoW is asking the Guatemalan government to remove abortion from the penal code, to provide evidence based sexual education in schools and to ensure  access to contraceptives;

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On 22 February 2017, the WoW ship docked in Puerto Quetzal on the Pacific coast for a planned five-day visit. On 23 February, a scheduled press conference was shut down shortly after it started and a blockade
was imposed by Army troops, preventing the activists from disembarking and visitors from boarding. 

WoW  is active in many countries throughout the world where abortion is illegal.  When contacted by phone or Internet, they will send abortion pills by mail, with careful instructions for use.  They have sent pills into Poland by drone!  You can donate to Women on Waves by check or credit card - by going to their

website.

Sadja Greenwood, MD, MPH

Female Genital Mutilation

This column reports on a cruel and dangerous practice – female genital mutilation (FGM). Along with honor killing and bride burning, FGM is a practice to control the female - by taking away her pleasure in sex, making intercourse painful, and thereby ensuring a man’s confidence in paternity. FGM reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. As it is carried out on minors, it is a violation of the rights of children. The practice violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

According to Wikipedia. FGM has been going since about 800 years BCE.   UNICEF reports that at least 200 million girls and women alive today have undergone female genital mutilation in 30 countries and 3 million are at risk every year.  The practice is found in many African countries, the Middle East, India and Indonesia, among peoples who follow Islam, Christianity and animism. However, it is not mentioned in the Koran or the Bible and is not part of their religious teachings.

FGM is classified into 4 major types

•                Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

•                Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).

•                Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris.

. Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

FGM is generally performed by village women using unsterilized instruments and no anesthesia. The terrified young girl is forcibly held down. Bleeding and infection are common results.  When the vaginal opening is narrowed, childbirth is often obstructed.  Extremely long labor can result in death, or an obstetric fistula – an opening between the bladder or rectum and the vagina, causing constant leakage.  This makes the woman a social outcast.  There are a few hospitals in Africa formed to repair obstetric fistulas – their dramatic story is the subject of another column.

Obviously FGM must be stopped, and this long entrenched practice must be stopped by the people in the affected societies.  England has been a leader in supporting an Africa-led movement to end FGM with a program called The Girl Generation – a social change initiative of African collectives working to end FGM in one generation.  In The Gambia, nearly 400 member organizations are working to end FGM.  In 2015 the president enacted a law banning the practice.  There are also active youth networks in Kenya and Nigeria, driving forward their own action plans to end FGM.  Similar programs will take place wherever FGM is practiced, led by young activists.   The United Nations is involved through UNICEF and UNFPA; The Population Council is also involved.

She Decides: In my last column, I wrote about Holland’s plan to make up for the Trump administration’s failure to fund international aid related to family planning. Read about it at sadjascolumns.blogspot.com.
In the week following the Netherlands’ announcement of a €10 million contribution to the Dutch-initiated family planning initiative ‘She Decides,’ 13 more countries have also stated their interest in supporting the fund. Canada, Belgium, Luxembourg, Sweden, and Finland have all formally confirmed their support, while additional countries are likely to on March 2, 2017, during an international conference for the fund hosted by Belgium. According to the Dutch Ministry of Foreign Affairs and Development Cooperation, in addition to government support, private persons have donated over €140,000 to the fund as of February 3, 2017.  You can be one of them – go to shedecides.com.

Sadja Greenwood, MD, MPH

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Having a period is unaffordable in Kenya, yet no one wants to talk about it

ZanaAfrica is fighting to get menstruation on the national curriculum as it’s revealed two thirds of Kenyan women and girls cannot afford sanitary padsHaving a period is unaffordable in Kenya, yet no one wants to talk about it

ZanaAfrica is fighting to get menstruation on the national curriculum as it’s revealed two thirds of Kenyan women and girls cannot afford sanitary pads

She Decides – How Holland is Saving Family Planning

On his first Monday in office, President Trump reinstated the ‘Mexico City policy’ that blocks US federal funds for non-governmental organizations that provide abortion counseling or referrals, advocate to decriminalize abortion or expand abortion services.  This policy was implemented in 1984 by Ronald Reagan at a UN population conference in Mexico City.  Hence the name – the Mexico City policy.  It was repealed by Bill Clinton, reinstated by George W. Bush, and repealed by Obama.  (You may remember that Trump was prochoice until it was politically valuable to be for compulsory pregnancy.  Reagan signed the bill allowing therapeutic abortion in California.)

Trump did more than just reinstate the policy, he expanded it to apply to all global health funding, not just to family planning.   Organizations helping with HIV prevention and treatment, immunization, maternal health care, Zika virus prevention et al. will also be affected.  According to Population Action International, a global family planning advocacy organization, the gag rule will apply to $9.5 billion in global health funding, as opposed to $575 million in family planning funding. 

Organizations that provide family planning and safe abortion care, such as the International Planned Parenthood Federation and Marie Stopes International, will not sign on to the gag rule’s conditions.  They point out that the new rule will not reduce abortions, but increase the number of illegal ones, as happened in sub-Saharan Africa during George W. Bush’s time in office. 

Holland has come to the rescue.  Lilianne Ploumen, Holland’s minister for foreign trade and development cooperation, has announced that it is putting 10 million euros ($10.7 million) into an international fund it launched to finance access to birth control, abortion and sex education for women in developing nations after President Donald Trump cut U.S. funding for such services. Ploumen has launched a fund "She Decides - Global Fundraising Initiative" — with a website.

Ploumen says she has received thousands of reactions — the vast majority of them positive — after announcing the fund Tuesday.  Canada has also pledged to sign on to the funding.  In a few days, individuals from all over the world will be able to pledge support through the website– “She Decides – Global  Fundraising Initiative.  I will keep you posted on this website.  Donations will be coordinated by The Rutgers Foundation, and international NGO working on sexual and reproductive rights based in the Netherlands. 

Minister Ploumen  said the withdrawal of U.S. money will create a huge funding gap that can only be filled through a robust reaction by governments, aid organizations and private donors. The fund will "prevent women and girls being abandoned," she added. "Because they, too, must be able to decide for themselves if they want children, with whom and when."  Ploumen said much more money is needed but "I'm confident we can go a long way so that essential services, not just for women, but for the whole of society, can be maintained.” The website, shedecides.eu , is open for individual donations.

At the Women’s March in San Francisco, and from reports of similar marches in Washington and throughout the world, there were many striking and meaningful posters and signs.  I am struck by the power of the two words Lilianne Ploumen selected for her new website and the generous action of the Netherlands – ‘She Decides’. 

If you are burning with indignation at Trump’s actions against women’s health or immigration policy, you can also donate to the International Planned Parenthood Federation or the ACLU.  Any amount helps.  It will be multiplied by the rest of us.

Sadja Greenwood, MD, MPH   back issues on this blog