We used to worry about meth labs in West Marin, even in Bolinas, picturing a cluttered house stocked with tubing, tanks of explosive chemicals, and a stove with bubbling beakers of a toxic brew. It’s gotten a lot simpler in recent years. Meth is now made in cars. There is a faster, cheaper and simpler method of making small amounts of meth. The ingredients – pills with the decongestant pseudoephedrine (Sudafed) and household chemicals are shaken in a 2 quart soda bottle. No flame is required. The back seat of a car or a bathroom stall are the new makeshift labs. The batches of meth are much smaller, so the addicts who make them are harder to apprehend. According to the NYTimes (4/15/10) roadsides throughout the country are littered with discarded pop bottles and chemicals from these car labs. Cleanup is dangerous and time-consuming, and addicts in cars are hard to apprehend. They are also very dangerous drivers.
The basis for meth production is pseudoephedrine, made in labs in Mexico, China and other countries, often from petroleum-based compounds. The chemical comes into the country illegally. However, most of the new car-based labs use pseudoephedrine pills known as Sudafed, Actifed or Contac. In California, these drugs are no longer directly available over the counter, and a limited amount is sold at any one time. However, drug addicts and dealers employ ‘smurfers’ - people who travel to various pharmacies, using different names, to buy as much Sudafed as possible
States are trying out different techniques to stop the new car labs. Oregon has gone the farthest, with a 2006 law that makes medicines with pseudoephedrine available only with a prescription. The state has seen a marked decrease in seizures of meth labs and in property crime,. Identity theft and child abuse are also linked to meth use. A similar law has been proposed in California, opposed by drug companies and chain drug stores. Oregon’s Senator Ron Wyden has introduced a bill in the US Senate called the Meth Labs Elimination Act, which would take Oregon’s law nationwide. This proposed legislation has been targeted and opposed by drug companies eager to protect their $500 million allergy and cold care business.
Sudafed and related drugs cause stimulation of the central nervous system, including sleeplessness, excitability, dizziness and anxiety. In certain people they can cause blood pressure elevation, a very rapid or irregular heart beat, and stroke.
There are safer ways to deal with nasal congestion due to colds or allergies. Work on eliminating allergens in your home. Rinse your nose with a solution of 4 ounces warm water, ¼ teaspoon salt and 1/8 teaspoon baking soda, using a bulb syringe or a neti pot. Alternatively, you can buy a Sinus Rinse kit in local pharmacies. Use an antihistamine such as Benadryl or Chlor-trimeton, being aware that these drugs can make you sleepy, or Claritin. Vitamin C in high doses is a natural antihistamine; many people take a gram of C every 3-4 hours when they have a runny nose due to a cold or allergy, and get relief without fatigue as a side effect.
But back to meth – here are some steps you can take for the safety of your family and the wider world. Call Jared Huffman, our assemblyman: 415-479-4920. Ask him to support the Wright bill, a measure that would require a prescription for drugs containing pseudoephedrine, which can be made into methamphetamine. Also call Mark Leno, our state senator, 479-6612, with the same message. Take your activism a step further and call Lynn Woolsey, our Congresswoman – 507-9554, and Senators Feinstein -393-0707, and Boxer – 403-0100. These are all local numbers. Ask these congresswomen to support Senator Ron Wyden’s bill to require a prescription for drugs containing pseudoephedrine.
Meth is not a benign recreational drug; it is a killer drug that threatens our youth and also our budgets. If you have any doubts about this, read Tweak, by Nic Sheff, a local youth whose life was profoundly disturbed by methamphetamine. Annual costs for meth detection, cleanup and health care in the US exceed $23 billion. It’s time to try what worked in Oregon to combat this drug.
Sadja Greenwood, MD, MPH - back issues on this blog.
Tuesday, April 27, 2010
Monday, April 5, 2010
Biological Exuberance; a new view of animal homosexuality
In his 1999 book Biological Exuberance – Animal Homosexuality and Natural Diversity – the biologist Bruce Bagemihl writes about same-
sex behaviors in a wide variety of primates, other mammals and in many bird species, explaining homosexual courtship, affection, sex, pair bonding and parenting. Same-sex behavior has been documented in over 450 species of animals; biologists point out that only a fraction of the more than a million species known to exist have been studied in any depth, so the number may be far larger. Bagemihl writes that western science has overstressed the importance of heterosexual sex for passing on genes and failed to notice many other kinds of sexual behavior – such as same sex mounting, necking (among male giraffes), oral sex and masturbation- mutual and solo.
Bonobos – pygmy chimpanzees (with whom we share over 99% of our genes) - are predominantly bisexual; females and males have frequent hetero and same-sex contact with each other, including with juveniles. Females also have sex during their pregnancies. Clearly their ‘exuberant’ sexual behavior has meanings beyond reproduction – anthropologists see it as beneficial to the group by creating tribal cohesion and preventing fights over food. These animals truly do make love not war.
Bagemihl points out that western science has attempted to explain animal homosexuality for over two hundred years but has had problems explaining behavior that is non-reproductive. However, from the point of view of biological exuberance, natural systems are driven as much by abundance as by limitations and practicality. Seen in this light, homosexuality and non-reproductive heterosexuality are “expected occurrences” – they are one manifestation of an overall “extravagance” of biological systems that has many other expressions.
Bagemihl. 1999. (Think of the peacock’s tail.)
In 2006, the Natural History Museum in Oslo opened the first-ever museum exhibition dedicated to gay animals. The exhibit , titled Against Nature?, showed photographs of the more than 1500 species (their count)where homosexuality has been observed – from insects to mammals. The curators stated that a greater understanding of how extensive and common this behavior is among animals could help to demystify homosexuality among people. You can see a few of the outstanding photographs of this exhibit by going to google : Against Nature? Exhibition in Oslo.
In today’s New York Times Magazine, April 4, 2010, the article The love that Dare Not Squawk its Name concerns new studies on animal homosexuality, mostly among seabirds. Careful observation of the Laysan Albatross, who nest in Hawaii, reveals that a third of nesting pairs are made up of two females. One or both mate briefly with a male and then return to their female nest-mate, with whom they may bond for many years. Taking off from Bagemihl’s theories, scientists are thinking that homosexuality must be seen as having different ‘purposes’ or manifestations in each species - it is a byproduct of reproductive sex, but cannot easily be explained by our current Darwinian model. New thinking is needed about the possible benefits of homosexuals to the family or the group, and also about homosexuality and bisexuality being a by-product of exuberant desire for sexual play.
Scientists studying animal sexual behavior have generally been careful not to extrapolate their findings to human society, but of course their findings have had an impact on the wider world. After publishing, the authors have been reviled by homophobes and cheered by many liberals and the GLBT community. The culture wars go on – and will undoubtedly be affected by new findings from other animals.
Sadja Greenwood, MD – back issues on this blog
sex behaviors in a wide variety of primates, other mammals and in many bird species, explaining homosexual courtship, affection, sex, pair bonding and parenting. Same-sex behavior has been documented in over 450 species of animals; biologists point out that only a fraction of the more than a million species known to exist have been studied in any depth, so the number may be far larger. Bagemihl writes that western science has overstressed the importance of heterosexual sex for passing on genes and failed to notice many other kinds of sexual behavior – such as same sex mounting, necking (among male giraffes), oral sex and masturbation- mutual and solo.
Bonobos – pygmy chimpanzees (with whom we share over 99% of our genes) - are predominantly bisexual; females and males have frequent hetero and same-sex contact with each other, including with juveniles. Females also have sex during their pregnancies. Clearly their ‘exuberant’ sexual behavior has meanings beyond reproduction – anthropologists see it as beneficial to the group by creating tribal cohesion and preventing fights over food. These animals truly do make love not war.
Bagemihl points out that western science has attempted to explain animal homosexuality for over two hundred years but has had problems explaining behavior that is non-reproductive. However, from the point of view of biological exuberance, natural systems are driven as much by abundance as by limitations and practicality. Seen in this light, homosexuality and non-reproductive heterosexuality are “expected occurrences” – they are one manifestation of an overall “extravagance” of biological systems that has many other expressions.
Bagemihl. 1999. (Think of the peacock’s tail.)
In 2006, the Natural History Museum in Oslo opened the first-ever museum exhibition dedicated to gay animals. The exhibit , titled Against Nature?, showed photographs of the more than 1500 species (their count)where homosexuality has been observed – from insects to mammals. The curators stated that a greater understanding of how extensive and common this behavior is among animals could help to demystify homosexuality among people. You can see a few of the outstanding photographs of this exhibit by going to google : Against Nature? Exhibition in Oslo.
In today’s New York Times Magazine, April 4, 2010, the article The love that Dare Not Squawk its Name concerns new studies on animal homosexuality, mostly among seabirds. Careful observation of the Laysan Albatross, who nest in Hawaii, reveals that a third of nesting pairs are made up of two females. One or both mate briefly with a male and then return to their female nest-mate, with whom they may bond for many years. Taking off from Bagemihl’s theories, scientists are thinking that homosexuality must be seen as having different ‘purposes’ or manifestations in each species - it is a byproduct of reproductive sex, but cannot easily be explained by our current Darwinian model. New thinking is needed about the possible benefits of homosexuals to the family or the group, and also about homosexuality and bisexuality being a by-product of exuberant desire for sexual play.
Scientists studying animal sexual behavior have generally been careful not to extrapolate their findings to human society, but of course their findings have had an impact on the wider world. After publishing, the authors have been reviled by homophobes and cheered by many liberals and the GLBT community. The culture wars go on – and will undoubtedly be affected by new findings from other animals.
Sadja Greenwood, MD – back issues on this blog
Tuesday, March 30, 2010
Magnesium - for your bones, energy and brain
Magnesium is in the center of the chlorophyll molecule – just as iron is in hemoglobin. How impressive is that!
Magnesium is abundant in green vegetables (think chlorophyll), beans, whole grains, nuts, edible seeds such as pumpkin and sunflower, bananas, chocolate and many other unrefined plant foods. How can it be that a recent report from the US Department of Agriculture indicated that only 32% of us were getting adequate magnesium in our diet? Perhaps this is because we are not following Michael Pollan’s rule “If it came from a plant, eat it; if it was made in a plant, don’t.” A lot of us are filling up on things our ancestors would not recognize as food.
Bones: Magnesium is stored in bones; if there is not enough, bones become more brittle. A study from Tufts University of 900 elderly men and women found higher dietary magnesium intakes were associated with increased bone mineral density at the hip. Eating an unrefined plant based diet gives abundant magnesium as well as potassium, and will help bone strength by creating a more alkaline urine, thereby minimizing calcium loss.
Energy: The body provides energy for all metabolic processes by transforming carbohydrates and fats into a molecule called ATP, which exists as a complex with magnesium. A study from the Agricultural Research Service in North Dakota showed that people with inadequate levels of magnesium need more oxygen during exercise, and tire more quickly, than those with adequate levels.
Heart: Magnesium helps to maintain a normal heart rhythm. Magnesium supplements are sometimes suggested by cardiologists for people with intermittent atrial fibrillation or with cardiac failure. Studies have shown that a high dietary intake of magnesium (lots of unrefined plant food) may decrease blood pressure. This kind of diet is also rich in potassium and calcium, so it is difficult to sort out the factors involved.
Brain: An international study Tsinghua University in Beijing, University of Toronto, MIT, and Tel Aviv University showed that increased levels of magnesium in the brain enhanced learning and memory (in rats). The researchers used a new supplement that passed the blood-brain barrier and entered the brain. While this supplement is not available, they stated that people should get their magnesium from dietary sources – noting that half of all people in industrialized countries have magnesium deficiencies.. A better, plant-based diet may delay the cognitive impairment of aging.
Getting Enough Magnesium (Mg) It’s easy to get plenty of magnesium by eating green vegetables, beans, nuts, seeds and whole grains. Taking Mg as a supplement can be dangerous for people with kidney disease – especially for older people - so check with your doctor. The Institute of Medicine has set a ‘tolerable upper intake’ for Mg pills at 350 mg/day, and many women take that amount with their calcium supplements. Higher levels can cause diarrhea and gastrointestinal discomfort. Magnesium citrate is commonly used as a safe supplement in sensible doses. Two forms of Mg are laxatives and should not be taken regularly – magnesium sulfate (Epsom salts) and magnesium hydroxide (Milk of Magnesia).. Final word – here's another reason to go for the greens!
Sadja Greenwood MD, MPH Back issues on this blog
Magnesium is abundant in green vegetables (think chlorophyll), beans, whole grains, nuts, edible seeds such as pumpkin and sunflower, bananas, chocolate and many other unrefined plant foods. How can it be that a recent report from the US Department of Agriculture indicated that only 32% of us were getting adequate magnesium in our diet? Perhaps this is because we are not following Michael Pollan’s rule “If it came from a plant, eat it; if it was made in a plant, don’t.” A lot of us are filling up on things our ancestors would not recognize as food.
Bones: Magnesium is stored in bones; if there is not enough, bones become more brittle. A study from Tufts University of 900 elderly men and women found higher dietary magnesium intakes were associated with increased bone mineral density at the hip. Eating an unrefined plant based diet gives abundant magnesium as well as potassium, and will help bone strength by creating a more alkaline urine, thereby minimizing calcium loss.
Energy: The body provides energy for all metabolic processes by transforming carbohydrates and fats into a molecule called ATP, which exists as a complex with magnesium. A study from the Agricultural Research Service in North Dakota showed that people with inadequate levels of magnesium need more oxygen during exercise, and tire more quickly, than those with adequate levels.
Heart: Magnesium helps to maintain a normal heart rhythm. Magnesium supplements are sometimes suggested by cardiologists for people with intermittent atrial fibrillation or with cardiac failure. Studies have shown that a high dietary intake of magnesium (lots of unrefined plant food) may decrease blood pressure. This kind of diet is also rich in potassium and calcium, so it is difficult to sort out the factors involved.
Brain: An international study Tsinghua University in Beijing, University of Toronto, MIT, and Tel Aviv University showed that increased levels of magnesium in the brain enhanced learning and memory (in rats). The researchers used a new supplement that passed the blood-brain barrier and entered the brain. While this supplement is not available, they stated that people should get their magnesium from dietary sources – noting that half of all people in industrialized countries have magnesium deficiencies.. A better, plant-based diet may delay the cognitive impairment of aging.
Getting Enough Magnesium (Mg) It’s easy to get plenty of magnesium by eating green vegetables, beans, nuts, seeds and whole grains. Taking Mg as a supplement can be dangerous for people with kidney disease – especially for older people - so check with your doctor. The Institute of Medicine has set a ‘tolerable upper intake’ for Mg pills at 350 mg/day, and many women take that amount with their calcium supplements. Higher levels can cause diarrhea and gastrointestinal discomfort. Magnesium citrate is commonly used as a safe supplement in sensible doses. Two forms of Mg are laxatives and should not be taken regularly – magnesium sulfate (Epsom salts) and magnesium hydroxide (Milk of Magnesia).. Final word – here's another reason to go for the greens!
Sadja Greenwood MD, MPH Back issues on this blog
Sunday, March 21, 2010
Important Supplements
IMPORTANT SUPPLEMENTS
Dear readers: this is a summary of a talk I gave at Commonweal on March 7, 2010. Below are some suggested supplements that may help to give you maximum health. However, eating a good diet is the first key to health. Here in West Marin we are blessed to have great organic farmers giving us wonderful vegetables and fruits. Have these every day, along with local diary products and eggs, and small amounts of poultry, fish and meat. Walk, run or bike - spring is on its way. And remember to give thanks to your local farmers, especially organic farmers, for their hard work and provisions.
WOMEN 18-50
*Multivitamin (for folic acid) in case of pregnancy. Folic acid helps prevent birth defects. Multis should contain iron because of menstrual blood loss.
*Calcium - 600-1000 mg daily – to get 1200 mg from pills and diet. Calcium helps bone strength and may help with premenstrual tension.
*Magnesium 300 – 350 mg daily. Magnesium helps bone strength and has numerous positive effects on the body.
*Vitamin D – 1000 – 2000 IU – or enough to keep blood level of 25 hydroxy vitamin D 35 – 40 ng/ml. People with darker skin may need more D to get to these levels. Vitamin D helps with bone strength, prevention of infection and cancer and keeps your brain sharp.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule – or eat fish 2-3 times a week. The omega-3 fatty acids in fish oil help your heart and are important for your brain and mood.
*Probiotic on arising – these contain beneficial bacteria that help your immune system fight off colds, and infections of the vagina and bladder
WOMEN OVER 50
*Multivitamin without iron – if diet is haphazard
*Calcium and magnesium as above
*Vitamin D, Vitamin C, Probiotic -the same as for women under 50.
*Fish Oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500pg/ml is desirable. As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
MEN 18-50
*Multivitamin without iron–if diet is haphazard
*Vitamin D – 1000 IU -2000- or enough to keep blood level of 25 hydroxy vitamin D 35 - 40 ng/ml. People with darker skin may need more D to get to these levels.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule - or eat fish 2-3 times a week
*Probiotic on arising
MEN OVER 50
*Multivitamin without iron–if diet is haphazard
*Vitamin D , Vitamin C, Probiotic, the same as for men under 50
*Fish oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500 pg/ml is desirable
As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
Sadja Greenwood, MD, MPH back issues on this blog
Dear readers: this is a summary of a talk I gave at Commonweal on March 7, 2010. Below are some suggested supplements that may help to give you maximum health. However, eating a good diet is the first key to health. Here in West Marin we are blessed to have great organic farmers giving us wonderful vegetables and fruits. Have these every day, along with local diary products and eggs, and small amounts of poultry, fish and meat. Walk, run or bike - spring is on its way. And remember to give thanks to your local farmers, especially organic farmers, for their hard work and provisions.
WOMEN 18-50
*Multivitamin (for folic acid) in case of pregnancy. Folic acid helps prevent birth defects. Multis should contain iron because of menstrual blood loss.
*Calcium - 600-1000 mg daily – to get 1200 mg from pills and diet. Calcium helps bone strength and may help with premenstrual tension.
*Magnesium 300 – 350 mg daily. Magnesium helps bone strength and has numerous positive effects on the body.
*Vitamin D – 1000 – 2000 IU – or enough to keep blood level of 25 hydroxy vitamin D 35 – 40 ng/ml. People with darker skin may need more D to get to these levels. Vitamin D helps with bone strength, prevention of infection and cancer and keeps your brain sharp.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule – or eat fish 2-3 times a week. The omega-3 fatty acids in fish oil help your heart and are important for your brain and mood.
*Probiotic on arising – these contain beneficial bacteria that help your immune system fight off colds, and infections of the vagina and bladder
WOMEN OVER 50
*Multivitamin without iron – if diet is haphazard
*Calcium and magnesium as above
*Vitamin D, Vitamin C, Probiotic -the same as for women under 50.
*Fish Oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500pg/ml is desirable. As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
MEN 18-50
*Multivitamin without iron–if diet is haphazard
*Vitamin D – 1000 IU -2000- or enough to keep blood level of 25 hydroxy vitamin D 35 - 40 ng/ml. People with darker skin may need more D to get to these levels.
*Vitamin C - 500 mg daily – taking 250 twice a day is ideal
*Fish oil capsule - or eat fish 2-3 times a week
*Probiotic on arising
MEN OVER 50
*Multivitamin without iron–if diet is haphazard
*Vitamin D , Vitamin C, Probiotic, the same as for men under 50
*Fish oil capsules 2 daily
*Vitamin B12 500-1000 mcg sublingually once or twice a week. A level of 500 pg/ml is desirable
As you get older, you may not absorb this essential vitamin from the meat, fish, dairy or eggs that you eat. B12 prevents anemia and keeps your brain sharp. Letting it dissolve under your tongue will take it directly into your bloodstream.
Sadja Greenwood, MD, MPH back issues on this blog
Sunday, January 24, 2010
Folic acid: an essential B vitamin with a warning on overdose
Folate is the naturally occurring form of vitamin B9, while folic acid is the synthesized form. This vitamin is essential in the synthesis and repair of DNA, in the production of red and white blood cells, in the synthesis of important amino acids, and in any period of rapid cell growth, such as childhood and pregnancy.
The urgent need for Folate in pregnancy Neural tube defects are among the most dreaded birth defects, affecting 1 in 1500 births in the US today. The baby is born without a major portion of its brain and skull (and dies shortly after birth) or with incomplete closure of the spinal cord in the back, leading to some degree of paralysis, pain, and problems with bowel and bladder function. Insufficient folate in the diet (along with genetic and unknown factors) plays a role in this problem, and supplementation of the mother’s diet can decrease the incidence of neural tube defects by more than 70%. The folic acid supplement, as well as adequate dietary intake of folate, should start even before the beginning of pregnancy, as the neural tube starts developing in the first month. It is extremely important for young women to take a multivitamin containing 400 micrograms (mcg) of folic acid on a regular basis; even if she does not plan to become pregnant (at least 50% of pregnancies are unplanned; in celibate or lesbian women the multi will also help with a possibly haphazard diet.) More folate is needed during pregnancy and lactation. Because not all girls and young women take vitamins, the FDA mandated the fortification of refined grain products (white flour, pasta, breakfast cereals) with folic acid in 1998. It is estimated that young women get about 100 mcg a day of folic acid from fortified cereal grains – which is an improvement, but insufficient. An excellent diet and/or a multivitamin is still important. Studies show an approximate 50% reduction in neural tube defects in the US since fortification in 1998. Similar programs of fortification have taken place in Costa Rica and many European countries. Other problems in pregnancy, such as fetal cleft lip, premature delivery and serious bleeding at delivery from placental detachment, have been associated with folate deficiency. See http://www.nytimes.com/2010/01/03/opinion/03kristof.html for Nicolas Kristof’s opinion page article on the benefits of micronutrient enrichment of foods in Honduras and elsewhere.
Homocysteine: Homocysteine is an amino acid that used to be associated with higher rates of heart disease amd stroke; it can be lowered by conversion into methionine (another amino acid) by folic acid, vitamins B6 and B12. However, studies from two Canadian Universities in 2006 showed that lowering homocysteine levels with these B vitamins did not decrease the risk of heart attack or death from heart disease, but did significantly decrease the risk of stroke. Studies also show that lowering homocysteine levels with B vitamins in people with former strokes lowers their risk of hip fractures.
Anemia: People with a low intake of folate from food, or with chronic alcoholism, can develop a kind of anemia characterized by large, malformed red blood cells. This anemia is akin to ‘pernicious anemia’ related to vitamin B12 deficiency, and can have serious consequences. Medical care is essential.
Cancer: There is growing controversy over the effects of giving high dose folic acid supplements to prevent cancer or other diseases, since recent clinical trials have shown an increase in lung cancer and polyps of the colon. Animal experiments show that small amounts of folic acid supplements can decrease cancer risk, and high amounts can increase it. However, no amount of folate in foods is dangerous and studies show a decreased cancer risk, including breast cancer, among those with the highest dietary intakes.
Foods containing folate: All forms of green leafy vegetables, broccoli, avocado, asparagus, peas, beans of all kinds, lentils, peanuts, wheat germ, oranges and other citrus fruits, and many other whole foods contain folate. You will benefit from folate by making vegetables and fruits the center of your diet. Cooking can destroy folate, so it is best to steam or stir fry vegetables lightly, or cook them in a microwave. Avoid boiling in abundant water.
What’s the bottom line with folate and folic acid supplements?
Keep eating as many vegetables and fruits as possible, and include raw salads in your daily fare. You will be ingesting plenty of folate, which is a very good thing. Young women who might become pregnant should take a daily multi with 400 mcg of folic acid and special vitamins during pregnancy. Adult multivitamins with 400 mcg of folic acid should be taken by people with high risk of stroke or a prior stroke, and by those dependent on alcohol. For other adults, a multi is probably safe, if it contains no more than 400 mcg of folic acid. Who said it would be simple?
Sadja Greenwood, MD, MPH past issues on this blog
The urgent need for Folate in pregnancy Neural tube defects are among the most dreaded birth defects, affecting 1 in 1500 births in the US today. The baby is born without a major portion of its brain and skull (and dies shortly after birth) or with incomplete closure of the spinal cord in the back, leading to some degree of paralysis, pain, and problems with bowel and bladder function. Insufficient folate in the diet (along with genetic and unknown factors) plays a role in this problem, and supplementation of the mother’s diet can decrease the incidence of neural tube defects by more than 70%. The folic acid supplement, as well as adequate dietary intake of folate, should start even before the beginning of pregnancy, as the neural tube starts developing in the first month. It is extremely important for young women to take a multivitamin containing 400 micrograms (mcg) of folic acid on a regular basis; even if she does not plan to become pregnant (at least 50% of pregnancies are unplanned; in celibate or lesbian women the multi will also help with a possibly haphazard diet.) More folate is needed during pregnancy and lactation. Because not all girls and young women take vitamins, the FDA mandated the fortification of refined grain products (white flour, pasta, breakfast cereals) with folic acid in 1998. It is estimated that young women get about 100 mcg a day of folic acid from fortified cereal grains – which is an improvement, but insufficient. An excellent diet and/or a multivitamin is still important. Studies show an approximate 50% reduction in neural tube defects in the US since fortification in 1998. Similar programs of fortification have taken place in Costa Rica and many European countries. Other problems in pregnancy, such as fetal cleft lip, premature delivery and serious bleeding at delivery from placental detachment, have been associated with folate deficiency. See http://www.nytimes.com/2010/01/03/opinion/03kristof.html for Nicolas Kristof’s opinion page article on the benefits of micronutrient enrichment of foods in Honduras and elsewhere.
Homocysteine: Homocysteine is an amino acid that used to be associated with higher rates of heart disease amd stroke; it can be lowered by conversion into methionine (another amino acid) by folic acid, vitamins B6 and B12. However, studies from two Canadian Universities in 2006 showed that lowering homocysteine levels with these B vitamins did not decrease the risk of heart attack or death from heart disease, but did significantly decrease the risk of stroke. Studies also show that lowering homocysteine levels with B vitamins in people with former strokes lowers their risk of hip fractures.
Anemia: People with a low intake of folate from food, or with chronic alcoholism, can develop a kind of anemia characterized by large, malformed red blood cells. This anemia is akin to ‘pernicious anemia’ related to vitamin B12 deficiency, and can have serious consequences. Medical care is essential.
Cancer: There is growing controversy over the effects of giving high dose folic acid supplements to prevent cancer or other diseases, since recent clinical trials have shown an increase in lung cancer and polyps of the colon. Animal experiments show that small amounts of folic acid supplements can decrease cancer risk, and high amounts can increase it. However, no amount of folate in foods is dangerous and studies show a decreased cancer risk, including breast cancer, among those with the highest dietary intakes.
Foods containing folate: All forms of green leafy vegetables, broccoli, avocado, asparagus, peas, beans of all kinds, lentils, peanuts, wheat germ, oranges and other citrus fruits, and many other whole foods contain folate. You will benefit from folate by making vegetables and fruits the center of your diet. Cooking can destroy folate, so it is best to steam or stir fry vegetables lightly, or cook them in a microwave. Avoid boiling in abundant water.
What’s the bottom line with folate and folic acid supplements?
Keep eating as many vegetables and fruits as possible, and include raw salads in your daily fare. You will be ingesting plenty of folate, which is a very good thing. Young women who might become pregnant should take a daily multi with 400 mcg of folic acid and special vitamins during pregnancy. Adult multivitamins with 400 mcg of folic acid should be taken by people with high risk of stroke or a prior stroke, and by those dependent on alcohol. For other adults, a multi is probably safe, if it contains no more than 400 mcg of folic acid. Who said it would be simple?
Sadja Greenwood, MD, MPH past issues on this blog
Thursday, January 21, 2010
Selenium: Take a Supplement, or a Brazil Nut?
Selenium is an element that is essential in the human diet in small amounts, but toxic at high levels. All animals require selenium, since we evolved from the sea where it is abundant. Plants do not appear to require selenium for survival, but incorporate it into their structures. Edible plants contain differing amounts of selenium, as the element is found in varying amounts in rocks and soil throughout the world. The element is found in higher amounts where there were inland seas.
Thyroid hormone: While iodine is essential for the synthesis of thyroid hormone, a selenium dependent enzyme must be present to activate this hormone, which in turn regulates normal growth, development and metabolism.
Sperm development: a recent study from Vanderbilt University showed that a protein containing selenium is essential for normal sperm development and male fertility.
Viral Infection: selenium deficiency appears to enhance the virulence of some viral infections, by inducing mutations in the expression of some viral genes. In a region of China where soils are very low in selenium, young women and children develop a disease of the heart muscle; this seems to be worsened by a change in a common virus that affects the heart. Selenium supplementation can protect against this, but cannot reverse the damage to the heart muscle.
Cancer – a mixed picture: Chronic infection with viral hepatitis B or C increases the risk of liver cancer; selenium supplements given in China in an area with a high incidence of hepatitis B and liver cancer reduced the incidence of this cancer. Similar findings were seen in Taiwan. A study in Finland showed that low selenium status in creased the risk of lung cancer: the association was more pronounced in smokers. On the other hand, a prospective study of more than 60,000 female nurses in the US found no association between selenium levels and total cancer risk. The data on prostate cancer are confusing – several studies have shown lower selenium levels in men with prostate cancer, but a recent large study from the National Cancer Institute, following 295,344 men who were cancer free on enrollment, found that excessive multivitamin use (more than 7 times per week) increased the risk of fatal prostate cancer compared with never users. The positive association with prostate cancer and excessive multivitamin use was strongest in men with a family history of prostate cancer or in men who took supplemental selenium, zinc, or beta-carotene. Further studies are needed to understand whether selenium levels in the body are linked to prostate cancer, and several are underway. Selenium supplements (200 micrograms daily) increased the risk of squamous cell skin cancer in a study from Memorial Sloan-Kettering, and did not alter the incidence of basal cell skin cancers.
HIV/AIDS: Declining selenium levels are found in HIV infected people and are markers of disease progression and severity. A randomized control trial of HIV positive men and women from the University of Miami found that selenium supplements (200 micrograms a day) taken for 2 years significantly decreased the rates of hospitalization. A further study showed a decreased viral load and more CD4 cells with the same dose of selenium.. Proteins containing selenium negatively affect the replication of the AIDS virus. Many AIDS patients in the US take selenium supplements, and it is also used in some African countries/
Who needs selenium supplements? Based on the information currently available, it is wise for most people to get this trace element in their diet, and not from supplements. Supplemental selenium should be considered by people with HIV infections, and by those with severe gastrointestinal problems such as Crohn’s disease or surgical removal of part of the stomach or intestines.
Food Sources of Selenium: Organ meats, shellfish and other healthy (non-endangered) fish are the important sources of selenium in our diets. Whole grains are also important sources (avoid white flour and white rice), as are sunflower seeds, and other nuts. Whole grains grown in Nebraska and the Dakotas have high levels (but who knows the origin of the wheat in our daily bread?) Brazil nuts grown in areas of Brazil with selenium-rich soil may provide 50 to 100 mcg in one nut, which is an excellent daily amount for adults. However, Brazil nuts grown on selenium-poor soil may provide 10 times less – another ‘who knows?’ conundrum. Studies from New Zealand have shown that the selenium in Brazil nuts improves serum selenium levels as effectively as supplements. My final conclusion from all this is that adults can benefit from a daily Brazil nut! You can give a few Brazil nuts a week to children over age 9. Good news - it seems that the cultivation of Brazil nuts will improve conditions in the rainforests of Brazil; the nut is not suitable for growth in plantations and can only grow in the rainforest itself.
Sadja Greenwood, MD back issues onsadjascolumns.blogspot.com
Thyroid hormone: While iodine is essential for the synthesis of thyroid hormone, a selenium dependent enzyme must be present to activate this hormone, which in turn regulates normal growth, development and metabolism.
Sperm development: a recent study from Vanderbilt University showed that a protein containing selenium is essential for normal sperm development and male fertility.
Viral Infection: selenium deficiency appears to enhance the virulence of some viral infections, by inducing mutations in the expression of some viral genes. In a region of China where soils are very low in selenium, young women and children develop a disease of the heart muscle; this seems to be worsened by a change in a common virus that affects the heart. Selenium supplementation can protect against this, but cannot reverse the damage to the heart muscle.
Cancer – a mixed picture: Chronic infection with viral hepatitis B or C increases the risk of liver cancer; selenium supplements given in China in an area with a high incidence of hepatitis B and liver cancer reduced the incidence of this cancer. Similar findings were seen in Taiwan. A study in Finland showed that low selenium status in creased the risk of lung cancer: the association was more pronounced in smokers. On the other hand, a prospective study of more than 60,000 female nurses in the US found no association between selenium levels and total cancer risk. The data on prostate cancer are confusing – several studies have shown lower selenium levels in men with prostate cancer, but a recent large study from the National Cancer Institute, following 295,344 men who were cancer free on enrollment, found that excessive multivitamin use (more than 7 times per week) increased the risk of fatal prostate cancer compared with never users. The positive association with prostate cancer and excessive multivitamin use was strongest in men with a family history of prostate cancer or in men who took supplemental selenium, zinc, or beta-carotene. Further studies are needed to understand whether selenium levels in the body are linked to prostate cancer, and several are underway. Selenium supplements (200 micrograms daily) increased the risk of squamous cell skin cancer in a study from Memorial Sloan-Kettering, and did not alter the incidence of basal cell skin cancers.
HIV/AIDS: Declining selenium levels are found in HIV infected people and are markers of disease progression and severity. A randomized control trial of HIV positive men and women from the University of Miami found that selenium supplements (200 micrograms a day) taken for 2 years significantly decreased the rates of hospitalization. A further study showed a decreased viral load and more CD4 cells with the same dose of selenium.. Proteins containing selenium negatively affect the replication of the AIDS virus. Many AIDS patients in the US take selenium supplements, and it is also used in some African countries/
Who needs selenium supplements? Based on the information currently available, it is wise for most people to get this trace element in their diet, and not from supplements. Supplemental selenium should be considered by people with HIV infections, and by those with severe gastrointestinal problems such as Crohn’s disease or surgical removal of part of the stomach or intestines.
Food Sources of Selenium: Organ meats, shellfish and other healthy (non-endangered) fish are the important sources of selenium in our diets. Whole grains are also important sources (avoid white flour and white rice), as are sunflower seeds, and other nuts. Whole grains grown in Nebraska and the Dakotas have high levels (but who knows the origin of the wheat in our daily bread?) Brazil nuts grown in areas of Brazil with selenium-rich soil may provide 50 to 100 mcg in one nut, which is an excellent daily amount for adults. However, Brazil nuts grown on selenium-poor soil may provide 10 times less – another ‘who knows?’ conundrum. Studies from New Zealand have shown that the selenium in Brazil nuts improves serum selenium levels as effectively as supplements. My final conclusion from all this is that adults can benefit from a daily Brazil nut! You can give a few Brazil nuts a week to children over age 9. Good news - it seems that the cultivation of Brazil nuts will improve conditions in the rainforests of Brazil; the nut is not suitable for growth in plantations and can only grow in the rainforest itself.
Sadja Greenwood, MD back issues onsadjascolumns.blogspot.com
Wednesday, January 13, 2010
Is there a Supreme Bean?
Go to Health: Is there a Supreme Bean?
Some insist that it’s coffee, but for many it’s the soybean, which nourishes hungry people throughout the world; its balance of essential amino acids makes soy a plant protein as valuable as eggs or meat. Soy has been grown in China for some 5000 years, to enrich the soil (like other beans it has bacteria on its roots that fix nitrogen), and for human consumption.
Heart Disease Prevention: Following studies showing significant decreases in serum cholesterol, LDL cholesterol (the ‘bad’ kind) and triglycerides, the FDA granted a health claim for soy in 1999: “25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” HDL, (‘good cholesterol’) did not increase. Recently, new studies have challenged the ‘heart healthy’ claim for soy protein per se, but concede that soy milk, tofu, soy nuts and some soy burgers should be beneficial to heart health because of their polyunsaturated fats, fiber, vitamins and low content of saturated fat. The American Heart Association said: “Using these soy foods to replace foods high in animal protein that contain saturated fat and cholesterol may confer benefits to cardiovascular health.”
Breast Cancer: Genistein and daidzein (so called phytoestrogens, or plant estrogens) are substances in soy that are similar structurally to human estrogen but act differently in the human body. They have much lower biologic activity than human estrogens and in some cases may function as anti-estrogens. A recent study on breast cancer and soy from Vanderbilt University was encouraging. The researchers looked at 5000 Chinese women in Shanghai, ages 20 -75, who were breast cancer survivors. They found those who ate the most soy (15 grams or more of soy protein daily) had a 29% lower risk of dying than those who consumed the least (5 grams or less). A similar benefit appeared for breast cancer recurrence risk regardless of tamoxifen use. The benefits of soy increased up to 11 grams of soy protein daily, and then leveled off or reversed, so more was not necessarily better. The women ate mainly tofu and whole soy beans. The researchers warned that similar benefits can not be extrapolated to dietary supplements containing soy (pills, bars or foods containing isolated soy protein). The associations did not vary with menopausal status, cancer stage, or estrogen receptor status of a woman’s cancer.
Vitamin K2 & Hip Fracture: a recent study from the University of Tokyo School of Medicine showed that natto, a Japanese fermented soybean food, contains large amounts of Vitamin K2; there is increasing evidence that Vitamin K plays a positive role in bone strength and osteoporosis prevention. Serum concentrations of vitamin K2 were significantly higher in frequent natto eaters, and the incidence of hip fracture was correspondingly lower, in every prefecture of Japan.
Soybean foods in the US: Today about 90% of soybeans grown in the US are genetically modified to make the plant resistant to the herbicide Roundup. Ninety percent of these beans are turned into soy oil and defatted soy meal that is fed to chickens, turkeys and pigs. The abundance of soy meal, as well as corn, makes possible the new and very problematic industrial farming of these animals. The US, Brazil and Argentina are major growers and exporters of soybeans, and the Brazilian crop has been responsible for a considerable loss of rainforest. Some soybeans, including organic soybeans, made into human foods in the US are imported from Brazil and China, where organic standards may differ from ours. Most Silk soymilk is no longer organic; the company was bought over by Dean Foods and switched many of their products to “natural” rather than organic. Edensoy products are made from organic soybeans grown in the US; Westsoy, Wildwood and others also have organic soy products. If you care about this issue, read labels! To get the benefits of soy, nutritionists advise people to eat whole soy products, such as tofu, tempeh, soy milk and soy nuts, rather than manufactured foods containing isolated soy protein. Happy New Year, dear readers, and let us all appreciate the natural foods stores and organic farmers in West Marin.
Sadja Greenwood, MD, back issues at sadjascolumns.blogspot.com
Monday, December 21, 2009
Mushrooms & Green Tea are associated with lower breast cancer risk in a Chinese study
A study in the International Journal of Cancer, March 15, 2009, looked at 1009 women in China newly diagnosed with breast cancer and compared them with 1009 healthy age-matched women. The researchers – from the University of Perth in Australia - adjusted for known risk factors for breast cancer, such as smoking, passive smoke exposure or close relatives with breast cancer. Working with detailed registers of the women’s consumption of 100 different foods, they found that women who consumed (on the average) more than 10 grams (.353 ounces) of fresh mushrooms a day had 64% less risk of developing breast cancer that those who did not eat mushrooms. The effect was dose dependent – the more mushrooms women reported eating, the lower their risk. Moreover, intake of fresh or dried mushrooms plus green tea had an additive, dose dependent effect on risk. Those who consumed the most green tea plus fresh mushrooms lowered their risk of breast cancer by 89%. All types of mushrooms consumed by the women in this study were counted.; the most common types were white button mushrooms (Agaricus bisporus) and fragrant dried mushrooms (Lentinula edodes). The author of this study, Dr. Min Zhang, noted that the rate of breast cancer in China is 4-5 times lower that that in developed countries. She speculated that the Chinese diet, high in green tea and mushrooms, might play a role. Rates of breast cancer are currently rising in the more affluent parts of China. Researchers have suggested that the adoption of a more western diet may be a causative factor.
The 11 Best Foods You Aren’t Eating by nutritionist and author Jonny Bowden, printed in the New York Times and a ‘most viewed story’ of 2008.
Beets – Think of beets as red spinach says Bowden, with folate and red pigments that may be cancer fighters.
Eat them raw – grated into salad
Cabbage – a brassica vegetable, similar to broccoli – with anti cancer effects – see my blog on brassicas.
Swiss Chard - lots of beneficial carotenes in the leaves.
Cinnamon –lowers blood sugar and LDL cholesterol
Pomegranate juice – increases blood flow in the heart muscle. See my blog on pomegranate for details.
Prunes – packed with antioxidants, and a safe laxative
Pumpkin Seeds – good source of protein, magnesium and zinc. Toast and eat.
Canned Pumpkin –an easy way to get lots of carotenes - use in soup and whole grain pancakes.
Sardines – lots of omega-3 fatty acids, high in calcium – try the low sodium kind with bones and skin intact. Turmeric – anti-cancer, good for the brain, see my blog for details. It’s in curry powder. Add to rice and stir fries.
Frozen Blueberries – associated with better memory in studies of aging animals. Add to a yogurt or soy smoothie.
Dear Readers – I wish you a wonderful Solstice as you celebrate the light returning. Stay warm with a cup of green tea and some sauteed mushrooms. They are protective for men as well as women. Have a joyous Christmas, whether you are a Christian, Jew, Atheist, Muslim, Buddhist, Pagan, Pantheist or other spiritual path. It’s the spirit of friendship that counts.
Sadja Greenwood, MD, MPH back issues on this blog
Monday, December 14, 2009
Exploring Slow
Life in the fast lane: multi tasking, 24/7, the 70 hour work week, texting while driving, texting during sex, road rage, fast food, take-out (wrapped in plastic), after-school classes and scheduled sports every afternoon and weekend. If you want to hang on, you’d better speed up.
However, there’s a counter-trend in the world, called the Slow Movement.
Slow Food In 1986 McDonald’s tried to open a shop near the Spanish steps in Rome; this triggered a movement that has spread to over 132 countries. Slow Food aims to preserve and celebrate the cultural cuisine, associated plants and animals and farming practices of an ecoregion. Its aims include forming seed banks to preserve heirloom varieties of local foods, educating the public on the risks of factory farms, pesticides and fast food, teaching gardening to students and prisoners, preserving family farms and reviving home cooked meals with local ingredients from each locale. Family farmers from every continent attend Terra Madre, the bi-annual slow food conference in Italy, The work of Alice Waters to teach students about food and healthy eating through schoolyard gardens, and Michelle Obama’s organic garden on the White House lawn are all related to the slow food movement.
Slow Parenting Children (in middle and upper class families) are generally enrolled in numerous after-school classes and organized sports – while each of these activities is valuable in itself, the result is that there is little time for free play before or after a heavy load of homework. One rationale is that the world is more dangerous, so that unsupervised play outside is risky; another is that such activities are needed for entry to a good high school or college, and another that both parents are working and need after-school childcare. It is hard for parents to find a way out of these problems, but awareness of the child’s need for free play and an individual learning style is a start. The slow parenting movement advises that children should pick their own activities, rather than fulfill their parents’ dreams. Parents should turn off the television and allow children to play with simple toys, make their own breakfast, and explore the out-of-doors whenever possible. ‘Cramming schools’ to push for higher academic results put children under continuous competitive pressure and take away their own creativity and independence. The slow movement has even reached the Ivy League. In a 2005 letter to Harvard students, the Dean advised students not to become overcommitted with athletics, clubs, arts and classes, or to be stretched too thin to appreciate other aspects of college life, including friendships and time to explore unexpected areas of knowledge.
Slow Medicine American medicine manages acute problems and specialized procedures such as organ transplants, eye surgeries and joint replacements extremely well. Chronic diseases that require education, lifestyle changes and home support are often handled less well by overworked doctors and nurses. Slower acting modalities such as appropriate exercise, healthy eating, and meditation are not paid for or readily available. Some elderly patients are subjected to ‘death by intensive care’ when home-based care would be more comforting and comfortable. The ‘slow medicine’ movement sees family, friends, visiting nurses and hospice workers improving the life of older patients at home by offering emotional support, social stimulation, better nutrition and help with sleeping, moving, bathing and other activities. Many towns and cities have organizations providing such services, and they deserve support.
Slow sex The movement for slow food, and enjoying a slower life began in Italy. So did the discussion of slow sex. There are current articles in our popular magazines about what sex researchers found in the 1960’s – the longer the foreplay, the better the climax for both partners. Many women who cannot achieve orgasm in intercourse can easily do so by clitoral stimulation. The Pointer Sisters have a song that lays it out for heterosexual couples - Slow Hand: I want a man with a slow hand – I want a lover with an easy touch….. (YouTube Pointer Sisters – Slow Hand)
The Slow Movement Summed Up:
“The trouble with the rat race is that even if you win, you’re still a rat.” Lily Tomlin. “Anything worth doing is worth doing slowly.” Mae West
In Praise of Slowness: How a Worldwide Movement is Challenging the Cult of Speed by Carl Honore
Under Pressure: Rescuing Our Children from the Culture of Hyper-Parenting by Carl Honore
Sadja Greenwood, MD, MPH back issues on this website
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Tuesday, December 1, 2009
Go to Health - Vitamin K
Vitamin K is a fat-soluble vitamin – a substance essential for the human body. The K comes from the German word for coagulation – or blood clotting. Plants synthesize vitamin K1 (phylooquinone); when we eat green vegetables or certain vegetable oils, bacteria in our guts transform the K1 from food to K2, the main active form in our bodies. Vitamin K is essential for blood clotting and bone strength.
Blood Clotting: As soon as a blood vessel is damaged, the body begins to prevent serious bleeding by many mechanisms. Blood platelets form a plug at the site of injury, and proteins in the blood - called clotting factors – are activated to form fibrin strands which strengthen the platelet plug. Vitamin K is essential for the formation of many of the clotting factors in this process. Since these clotting factors are made in the liver, severe liver disease may result in lower blood levels and a risk of uncontrolled bleeding. Alternatively, some people are at risk of forming clots which could block the flow of blood in arteries to the heart, brain or lungs, resulting in heart attack, stroke or pulmonary embolism. If they take Coumadin as an anticoagulant, the drug works by antagonizing the action of vitamin K. Doctors advise patients on Coumadin to have a reasonably constant amount of green vegetables containing vitamin K in their diets, but not to avoid them..
Bone mineralization: Osteoblasts are bone-forming cells that make proteins essential for bone mineralization. Vitamin K plays a role in the synthesis of these proteins (their activity is also regulated by vitamin D). Population studies have shown a relationship between foods containing vitamin K and hip fracture – the Nurses’ Health Study followed 72,000 women for 10 years and found that those with the highest intake of vitamin K had a significantly lower risk of hip fracture than those with lesser intake. Lettuce was the food contributing the most to vitamin K intake. A similar finding was seen in the Framingham Heart Study of men and women – a 65% lower risk of hip fracture in those in the highest quartile of vitamin K intake from food, compared to those in the lowest, despite no association with bone mineral density. Researchers in Japan used very high doses of supplemental vitamin K in patients on hemodialysis and in osteoporotic women and reported significant reductions in bone loss and fracture risk. However, using supplemental K at doses attainable in the diet has shown mixed results with respect to bone density. There are inconsistencies here that need further research.
Foods containing Vitamin K: A good diet that includes a daily intake of green leafy vegetables is endorsed by all vitamin K researchers. Kale, chard, spinach and broccoli are high in K, and lettuce is moderately high. . Levels of K are not reduced by many cooking methods, however it is unwise to cook most vegetables in abundant water if you discard the cooking water. Canola, soy and olive oils all contain vitamin K. To eat the amount of foods high in K associated with a decreased risk of hip fracture in the Framingham Heart Study, an individual would need to eat at least a cup of cooked dark green vegetables a day, or a large salad of mixed greens. Many multivitamins now include small amounts of Vitamin K1; while this may be helpful, it should not substitute for leafy greens in the diet. Using olive, canola or soy oils instead of butter will increase K intake and provide less saturated fat. Prolonged use of broad spectrum antibiotics may decrease the synthesis of K by intestinal bacteria, so extra care will be needed to get adequate levels from food and multivitamins. Here in California we have access to leafy greens throughout the year, often locally grown. A really easy green vegetable to grow yourself is the fava bean – and you don’t have to wait for the beans to form. Their green leaves are delicious and are becoming a culinary trend in salad or cooked.
Sadja Greenwood, MD, MPH. Past issues on this blog. Leave me a comment if you wish.
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