Monday, May 21, 2012

The Ethics of Eating Meat

The Ethicist, Ariel Kaminer, writing in the New York Times Sunday magazine, recently proposed a contest to readers – make an ethical case for eating meat. Thousands of people sent in essays. Five judges, who included Mark Bittman, Peter Singer and Michael Pollan, narrowed the entries down to six finalists, whose main ideas are summarized below. (Readers noted that all these judges were white men; many readers wanted nutrition professor Marion Nestle of New York University to be among them.). New York Times readers then voted on the essays.

*Her Australian father taught her to love hunting and a high meat diet. When her father developed gout, colon cancer, heart problems and stroke, the writer became aware of the ethical problems of killing animals, and took a 40 year hiatus from meat eating. She now looks forward to eating meat again without worrying about health, cruelty to animals or environmental degradation. She thinks that meat will soon be available, grown from cow, chicken, pig and fish cells in laboratories – without manure lagoons or contamination with dangerous bacteria. This essay received the most votes, but it turned out that the writer was a member of People for the Ethical Treatment of Animals (PETA) and had used their mailing list to garner votes. The essay was disqualified from winning under these circumstances.

*The writer is a young woman farmer who says that small scale farming requires the use of animals to clear cropland – goats and chickens – and to nourish the soil with their manure. Animal husbandry teaches her about the natural order of life and death. When you eat eggs or drink milk, you should know that the male roosters or bulls must be culled from the herd, and either eaten or wasted. The eating of animals is part of a balanced system of food production that is regenerative. Without farm animals, food production would require more use of fossil fuels in the forms of fertilizers and chemicals. This is why eating animals is ethical.

*The writer is a vegetarian who returned to meat eating. He feels that animals are raised and killed in cruel conditions, animals receive grain that should be given to hungry people, pasture land leads to deforestation, and eating meat is killing a sentient being. However, in some climates, such as dry grasslands, eating animals is a better choice than trying to grow vegetable sources of protein. Eating meat is ethical if you realize that all life is solar energy stored in an impermanent form, if you choose ethically raised vegetables, grains or meat, and if you give thanks. This was the winning essay.

*The writer is a farmer who became a lacto-vegetarian at age 7 because of love for animals. When s/he became a farmer s/he realized that bone and blood meal, fish emulsion and domestic animals were an integral part of vegetable farming. Animals are essential in a balanced food system. It is not ethical to eat animals raised in industrial-scaled confinement operations. There is an ethical option, even responsibility, to eat animals raised in a sustainable farm system and slaughtered with compassion.

*The writer discusses many moral choices we make, such as spending money on ourselves rather than charities, and having children rather than adopting them. We may choose to feed our family meat because of lack of time or knowledge on how to prepare vegetable protein. We need to rank the reasons for various moral decisions, realizing that the moral world is complex and the quest for any one good thing may require the sacrifice of others. We should attempt to tread more lightly on the earth, and realize that eating meat can be both ethical and tragic.

*The writer feels that it is morally permissible to kill and eat animals, if their basic needs are met in their lives, and their killing is painless. However, the killing of animals for food can be harmful to people, because most of us love animals and are upset by the idea that they are slaughtered for us. We learn to put this idea out of our heads, but it continues to affect us. The author felt a considerable freedom and lightness by giving up meat. As feeling creatures, there is a powerful self-interested reason to not eat meat.

I find these essays to be compelling. As a skeptic, I think the essay on ‘in vitro meat’ to have an element of science fiction, at least for feeding the world’s growing population, or being available in the near future. However, the Dutch have been working on this for years. Scientists at Maastricht University plan to produce sausage and hamburger in 2012. It is probable that animal growth factors and antibiotics will be necessary in the production process, which could lead to serious health concerns.

Here in West Marin, we are fortunate to have many organic farmers who raise animals in a careful way to help with the farming and provide meat, eggs and milk. There is a slowly growing awareness throughout the country of the brutality of factory farming of animals, and its unhealthy consequences for the environment. McDonalds and Target ended their relationship with a company that produced eggs in a factory farm with horrendous conditions for the animals, after an underground video went viral. We all need to eat animal products with great respect, and support our local farmers.
Sadja Greenwood, MD, MPH

Tuesday, April 24, 2012

Sleeping Pills - the downside

The most popular prescription drugs for insomnia these days are Ambien, Lunesta and Sonata. Many people also use pills called benzodiazepines, such as Valium, Restoril, Ativan, and Xanax. While effective, such pills have side effects and can be habit forming if used continuously. Sleep apnea can become worse with these powerful sleeping pills. In some people, Ambien is associated with sleepwalking, and eating when asleep without conscious awareness. Driving under the influence is hazardous. Elderly users of these medications have an increased risk of heart failure, falls and cognitive side effects.

The most problematic aspect of these prescription drugs is found in an article published in the British Medical Journal on February 27th, 2012. Entitled Hypnotics’ association with mortality or cancer: a matched cohort study, this article concludes that people who received prescriptions for sleeping pills had an increased risk of death or a cancer diagnosis, when followed for 2.5 years between 2002 and 2007. The word ‘hypnotic’ refers to a medication causing sleep. The study was done at Scripps Health in San Diego. The authors searched the electronic medical records of a large health system in rural Pennsylvania, and matched 10,529 patients who received sleeping pill prescriptions with 23,676 matched controls who did not. The average age was 54 years. Patients prescribed any sleeping pill (Ambien, Lunesta, Sonata, benzodiazepines, barbiturates and sedative antihistamines) had an elevated risk of death, with a dose-response association. Even people taking 18 pills a year or less showed some increased risk. Sleeping pill use in the upper third of the cohort was associated with a small but significant elevation of a cancer diagnosis. The researchers did not think that the death or cancer hazards were associated with pre-existing conditions. The authors stated that 24 previous studies have shown an association between use of prescription sleeping pills and mortality. No studies have shown that the use of such pills prolongs life or prevents cancer!

The mechanisms involved in these associations have yet to be worked out. The authors state that sleeping pills can increase depression, and when used with alcohol can lead to accidental death. Suicide may be a factor in some cases. Ambien can lead to ‘heartburn’ - regurgitation of food mixed with stomach acid that can injure the esophagus or lead to respiratory infections. Laboratory studies with rodents show that sleeping pills can cause chromosomal damage. This finding could be related to the rise in cancer.

Here are some conclusions I draw from this disturbing study. If you have been given prescription sleeping pills in the hospital, or at a very difficult time in your life, don’t worry. The use of such pills for people who are dying is absolutely justified. However, for most of us it is better not to take prescription sleeping pills. If you have been using them nightly for more than two weeks, you should decrease the dose very gradually; you may want to talk to your doctor or nurse-practitioner about a schedule to help you get off them.

What should we do to fall sleep and stay asleep more naturally? Sleep researchers say we should maximize our own output of melatonin – the sleep hormone. Melatonin is secreted by the pineal gland in our brains as darkness falls. It makes us sleepy and reduces our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age.

Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. You can find these goggles, which can be worn over reading glasses, at LowBlueLights.com, with a lot of interesting commentary on why they are effective. A less expensive version of the goggles is found at BluBlocker.com. Wearing these goggles, you can easily read, work on the computer, watch television, etc.

Daily exercise is a way to increase your natural melatonin secretion. A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine.

There is compelling evidence from shift workers that disruption of melatonin secretion can be a problem. Dr. Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.
A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

Daniel Kripke, the lead author on the Scripps paper, suggests the following for better sleep - keep the light out in your bedroom, try meditation or prayer, and learn progressive muscle relaxation or self-hypnosis. He also suggests taking melatonin tablets if you are a night owl, to reset your sleep-wake rhythms. He suggests talking to your doctor about an appropriate low dose of melatonin to try at bedtime. My advice is – start with 0.5 mg, and go up to 1-3 mg as needed. The kind that dissolves under the tongue goes most directly into your bloodstream. But – get those blue-blocking glasses, for the most natural sleep!
Sadja Greenwood, MD, MPH

Monday, April 9, 2012

Restorative Sleep

The lights we depend on after dark – to work, read, use the computer, and get around - the huge advantages of electric light - have a downside. They upset our natural sleep-wake cycle. The pineal gland, located midbrain, behind the eyes, secretes a hormone called melatonin, synthesized from the amino acid tryptophan. Melatonin comes out as the day gets dark, making us sleepy and lowering our body temperature. When we turn on the lights and stay up late working or playing, this reduces the time we are in darkness. Less melatonin is put out, and sleep can become elusive. We may fall asleep, but not stay asleep – a common complaint of older people, who secrete less melatonin with advancing age. Instead of deploring the genius of Thomas Edison, we can be grateful for current researchers who have found out how we can live with the advantages of light and still sleep. Studies have shown that it is the blue component in light that causes the most melatonin suppression; it is possible to block blue light by wearing goggles that filter out over 90% of the blue light. By putting on these yellow-orange goggles for 1-2 hours before bedtime, melatonin will flow out and sleep will improve. To apply this research to your own sleep patterns, go to LowBlueLights.com. Meet Richard Hansler, at the Lighting Innovations Institute at John Carroll University in Cleveland. Hansler, now 87, is a physicist who has pushed the development of lighting that does not disrupt melatonin outflow. At this website they sell blue blocking glasses, as well as special lights low on the blue part of the light spectrum, both incandescent and fluorescent. Their glasses, which can be worn over reading glasses if needed, cost from $68 to $80. I have used these glasses for over 2 years and find them very effective. Much less expensive blue blocking glasses can be found elsewhere on the internet – read customers’ comments carefully to find out if they are effective.

Eva Schernhammer at Harvard has studied the effects of night light on cancer risk through the melatonin pathway. She found that nurses who had worked for more than 15 years on rotating night shifts had a 35% higher risk of breast cancer than those who never worked rotating shifts. Shift workers have disrupted melatonin output. She also found that women with invasive breast cancer had less of a melatonin metabolite in their overnight urine. She found that women who were totally blind had a lower rate of breast cancer than blind women who still respond to light. Dr. Schernhammer concluded in a 2009 paper that melatonin is able to fight breast and other cancers by being a powerful antioxidant that can destroy damaged DNA before it can initiate cancer, by preventing cell mobility that causes metastasis, and preventing blood vessel growth that may nourish cancer cells.

A Japanese study in 2006 found that men who worked rotating shifts had a significant increased risk of prostate cancer over those who worked non-rotating shifts.

A 2005 Canadian paper showed a positive correlation between the duration of exercise and the amount of melatonin produced in overnight urine. This is suggested as a mechanism by which exercise reduces the risk of breast cancer.

Here’s my take-home lesson from the research on melatonin. Investigate blue-blocking glasses - and try using them 1-2 hours before your regular bedtime. Increase the duration of your daily exercise if you have trouble sleeping, or staying asleep. And – if you do wake at night and can’t fall back to sleep, get up and have a small snack of food, especially one containing milk. Milk contains enough tryptophan to promote sleep. Something sweet, like a piece of banana, will stimulate insulin which helps transport tryptophan across the blood-brain barrier.

In my next column I will write about new data on the potential dangers of prescription sleeping pills, and more natural alternatives. Also – there is new data on the importance of sleep in the prevention of diabetes and dementia. Stay tuned!

Sadja Greenwood, MD, MPH back issues on this blog

Sleep is the best meditation – the Dalai Lama

Monday, March 26, 2012

Go to Health – Health Insurance for Everyone

T.R. Reid wrote a brilliant book in 2010 – The Healing of America – A global quest for better, cheaper and fairer health care. He examined industrial democracies around the world and explained their different yet effective health care systems. By a variety of means, they achieve nearly universal coverage and good outcomes. If you don’t have time right now to read a book – albeit an entertaining one –as the health care debate is being discussed in the Supreme Court, here’s a short cut. Fareed Zakaria has written a two page article in the March 26th issue of Time that summarizes many of the issues. The requirement that everyone buy health insurance – called the individual mandate – is at the center of the constitutional controversy. Government subsidies would be given to help those without sufficient funds to buy insurance.

Reid and Zakaria both point out that Switzerland, a business-friendly democracy, had a system like ours 20 years ago, with private insurance and incomplete coverage. People without insurance went to emergency rooms, insurers rejected people with pre-existing conditions, and costs were mounting. The country decided that to make health care work, everyone had to buy insurance. They reformed their system in a way similar to Obama’s proposals. Now, 20 years later, everyone is insured, the quality of care is high, and costs have moderated. I can attest to this, as I visit my sister in Switzerland every year, and have seen her in the hospital there. The care is excellent. Taiwan is another with a free-market economy that decided to create a universal health-care system in the mid 1990’s. It studied all existing models and decided against private insurers, and for a single payer system that is effective and very low cost. ”. The Swiss and Taiwanese found that it is imperative for everyone to be covered by health insurance to keep costs down and provide a system where everyone has basic care.

Reid writes that the Swiss have an ethic of ‘solidarity’ that helps maintain their unity despite having 4 official languages. Solidarity means community and equal treatment. Everyone should have equal access to vote, have a jury trial, an old age pension, a good school system and a good health care system. Some people have much more money than others in their capitalist system of government, but everyone has their basic needs for health care met.

Zakaria writes that we have “the most expensive, least efficient system of any rich country on the planet.” Chronically ill patients , 5% of the population, account for 50% of our health care costs. Their care drives up insurance premiums if they are insured, and federal, state and local health care costs if they lack insurance. Universal coverage would bring healthy people into the system and thereby result in lower average premiums. A downside to Obama’s plan is that it maintains the connection between employment and health care that is inefficient and a burden on American business. It is hard for companies to be competitive globally when they are paying large amounts for their employees and former employees. German, Canadian, Japanese and British companies pay next to nothing in health care costs, in comparison.

I hope our country can edge away from rugged individualism into more solidarity, with passage of universal health care. Stay tuned throughout the week as it is debated at the Supreme Court. E pluribus unum.
Sadja Greenwood, MD, MPH - back issues on the blog

Thursday, March 8, 2012

Volumetrics - a plan to reach the right weight and stay healthy

Here’s an interesting finding – as long as food is equally palatable, people tend to eat the same weight of food. The March issue of the Nutrition Action Health Letter features an interview with Dr. Barbara Rolls, at Penn State University, who has been studying this for years with the aim of helping people lose weight more easily. Her latest book – The Ultimate Volumetrics Diet – will be out in April; previous books include The Volumetrics Eating Plan. She has looked at ways to change the amount of water in foods, thereby adding weight and volume but no calories. This is done by adding vegetables to each recipe, and making sure the food is tasty. The result, found in careful studies, was that people reduced their calorie intake by about 25%. In a trial of 700 people, she found that when people ate a diet that was less calorie dense (more vegetables included) they were eating significantly more food – about a pound more food a day – yet they were eating fewer calories and easily losing more weight. In another study, people who successfully lost 10% of their maximum body weight and maintained the weight loss for at least five years were found to eat five servings of vegetables a day. Overweight participants ate three and a half servings. Besides adding more vegetables to recipes, calories are cut by reducing fat and sugar in sauces, using small amounts of olive oil instead of cream, switching to whole grain pasta or brown rice, and removing fat and skin from poultry or meat. Dr. Rolls advises adding vegetables to mixed dishes, soups and stews, and putting cooked vegetables in a blender for sauces. She suggests adding vegetables to breakfast, lunch and dinner for children and adults. She found that baked goods with added vegetables – such as extra carrots in a carrot cake – made the cake even more palatable, so people ate more. However, at the end of the day they had consumed fewer calories.

Studies done on portion size were also important – Dr. Rolls found that while people tend to eat the same weight of food day after day, when exposed to large portions they get thrown off very easily. Portion control is still important for all eaters, and it starts with visual awareness. Some people use a 10 inch rather than a 12 inch plate at home and automatically eat less. Some divide a restaurant entrĂ©e in half, and share the food or take half home for the next day. Some ask for a child’s plate, which is easy if you are ordering takeout. People interested in portion control avoid buffets and all-you-can-eat restaurants, or exercise great care therein.

Mindful eating is another important way to slow down and appreciate food. Become more aware of your hunger before eating and feelings of fullness as the meal goes on. It can take 15-20 minutes for the brain to register that you have had enough, so overeating is easy when you are rushed. Some people set a timer for 20 minutes and make sure they savor their food while making it last until the bell chimes. Eating while reading or watching television can lead to mindless stuffing for some people. Become aware of gratitude for the food you have, for the animals who gave their eggs, milk or life, and for the people who harvested and prepared food for your table. Be aware of your personal triggers for mindless eating, such as anxiety, depression, alcohol, marijuana or certain chips and sweets.

For anyone who wants to keep up on the science of healthy eating, subscribing to Nutrition Action Health Letter is a great idea. Go to www.cspinet.org.
Sadja Greenwood MD, MPH back issues on this blog

Sunday, February 19, 2012

Seven Billion, and Counting - What to do about it?

We humans now number seven billion, and we are growing fast. Nearly 80 million people are added to the earth’s population each year. Relentless population growth affects many of our current problems, from food scarcity in poor countries, water shortages, pollution, habitat loss and species extinction, climate change, degradation of the oceans and lakes, and human & animal suffering. The welfare of humans is deeply linked to nature, and our propensity to ignore this has been disturbing.

Population Connection (formerly know as ZPG – for Zero Population Growth) is an organization working to understand the reasons for population growth. Its goal is to educate the public – including policy makers – on solutions to the problem, including access to voluntary family planning, education for girls as well as boys worldwide, and ensuring social justice for women and the poor.

In the February issue of The Reporter (the magazine of Population Connection) the theme is child marriage. Ten million young girls become brides every year throughout the world, having children while children. Child marriage is defined as the marriage of a person before the age of 18. The practice is most common in sub-Saharan Africa and South Asia. In Mali, 71% of girls are married before they turn 18. In Bangladesh, the median age of marriage for girls is 15, and 4 out of five girls first meet their husbands at their weddings, according to The Reporter. Child marriage can have serious health implications – in Africa, pregnancy related deaths are the leading cause of mortality for 15-19 year old girls. Many girls have sex before their first period. An estimated 100,000 girls each year develop a fistula, or opening, between the bladder and vagina because of obstructed labor in childbirth. The pelvis is too small, incompletely formed. As a result, they leak urine constantly and can become social outcasts. There are heroic doctors and nurses who spend their lives on surgical repair of this problem, but the hospitals and know-how for fistula repair are scarce.

Archbishop Desmond Tutu is hopeful that the practice of child marriage can end in a generation. He has said “I am confident that change can happen very quickly. No woman who has had the benefit of staying at school and marrying later in life can inflict child marriage on her daughters.”

National Geographic published an article on child marriage in the June 2011 issue, with arresting photographs.

John Bongaarts, a demographer at the Population Council and the National Academy of Sciences, calculates that if the average age of childbearing increased by 5 years, future population size could be reduced by 15-20 percent. This is a striking finding. If readers want to help with this issue, they can visit Population Connection on line, or call them at 800-767-1956. Population Connection has classroom curricula for teachers of social studies and environmental studies that are used in the US and all over the world.

The issue of access to voluntary family planning has been at the top of the news recently here at home, with Obama’s push to give women free access to birth control through their insurance policies. The pushback we have seen against voluntary family planning harks back to Margaret Sanger’s jailing in 1917 for distributing the diaphragm. In 2012, is this absurd, or what? Nicolas Kristof, writing in the New York Times on Sunday, Feb. 12th, aptly called it ‘pelvic politics’. I see it as a woman’s issue, a man’s issue, and a big environmental issue as well. The Sierra Club has declined to take on US population growth directly and forcefully, fearing being criticized as racist. They see it as an issue about immigration. I prefer the stand of the Center for Biological Diversity, which is working to save a vast diversity of wild animals and plants, to secure a future for all species hovering on the brink of extinction. Toward this end, among other educational programs, they hand out endangered species condoms, and have a ‘hump smarter hotline’ (800-628-2399) to ‘make sure that this one roll in the sheets doesn’t push some poor creature into extinction’. Check it out - they have a great message. They point out that 50% of pregnancies in the US are unplanned, and more people conceive a child on New Year’s eve than any other time in the year. Obviously, there are ways to talk about population and the environment without being racist. Wake up, Sierra Club! We could all use some new thinking on these issues. Despite our smaller families, our resource heavy lifestyles make us part of the problem.
Sadja Greenwood, MD back issues on this blog!

Thursday, February 2, 2012

Luteolin - Another fascinating compound in plants

Luteolin is a flavonoid – a compound in plants that gives yellow or red/blue pigments designed to attract pollinators. Flavonoids also fix nitrogen, regulate plant physiology and inhibit plant diseases. When we humans eat plants, the flavonoids therein may have many beneficial effects. Research on luteolin is an example.

Dr. Daniel Hwang is a molecular biologist at UC Davis. He has studied the ways in which luteolin (and other plant compounds – quercetin, eriodicytol, hesperidin, naringenin) apparently act as anti-inflammatory agents. These compounds target an enzyme in humans that can increase inflammation. Luteolin was found to be the most effective inhibitor of this enzyme. Since unchecked inflammation is associated with heart disease, cancer and problems of aging, this finding is a step on the way to prevention.

Researchers at the University of Illinois, led by Dr. Rodney Johnson, study anti-inflammatory compounds and their effects on the brain aging. They have found that luteolin can reduce inflammation in the brain as well as in other parts of the body. When infection occurs anywhere in the body, brain cells called microglia produce inflammatory chemical messengers that help to fight off the infection. This process is beneficial if it is limited to the acute infection. The inflammatory response is associated with sleepiness, loss of appetite, fever and lethargy, and sometimes a temporary diminishment of memory and learning. Some neurons may self-destruct in this process. Inflammation in the central nervous system can be serious if it goes on too long. Luteolin was found to diminish this inflammatory response, by shutting down a key component in the inflammatory pathway.
When aged mice were fed a diet supplemented with luteolin, they did better on tests of learning and memory tasks than the aged mice controls; the levels of inflammatory markers in their brains were similar to younger adult mice. The researchers concluded that natural compounds in fruits and vegetables, by being anti-inflammatory, could inhibit cognitive aging. Johnson thinks that his team’s results are applicable to other conditions with an inflammatory component, including diabetes and obesity.

Just published research by Professor Jung Park in Korea has shown that luteolin inhibits cell signaling pathways important for the growth of colon cancer cells. Blocking these pathways can stop colon cancer cells from dividing, and can lead to cancer cell death.

Dietary sources of luteolin include celery, green pepper, thyme, chamomile, carrots, olive oil, peppermint, rosemary and oregano. Luteolin is also being sold as a supplement, and should not be taken as such. You may remember the study showing that smokers taking beta-carotene supplements developed more lung cancer and had higher death rates than those without such a supplement. It was felt that taking an excess of one carotene may have inhibited the absorption of other carotenes from food. There are many flavonoids in plant foods, and they may act synergistically with each other. Taking any one of these as a supplement is unwise and untested. Earlier in this article I wrote about quercetin – found in apples, capers and onions, and eriodicytol, hesperidin, and naringenin - found in citrus fruits. The take home lesson from research on flavonoids is – keep eating a wide variety of vegetables and fruits. Remember what Michael Pollan said: Eat food, not too much, mostly plants.
Sadja Greenwood, MD,MPH back issues on this blog

Wednesday, January 18, 2012

Go to Health: Teenagers’ diets, Your feet, B12 update

What Teenagers are Eating:
Nationwide, teens are eating very few fruits and vegetables; this isn’t news to many parents who are struggling financially and competing with chips and soda in their kid’s diets. Data from a national survey of high school students show that typical daily intake of fruits and vegetables combined was slightly more than one serving a day. More than 25% of students ate fruit less than once a day, and 33% ate vegetables less than once a day. My partner, Alan, has a grandson, now 21, who refused to eat a single vegetable until recently, when his savvy girlfriend persuaded him to try some greens. I asked my 12 year old neighbor, Ibarra, for her advice to parents and teens. Her answer was immediate – kids love the smoothie shop in downtown Bolinas – make smoothies at home and put fruit in them. Make pasta for dinner and put vegetables in the sauce, disguised by blending them if necessary. Make fruit salad. Thanks, Ibarra for your thoughtful advice.

Your Feet:
Anthropologists studying the evolution of the foot say that as we became bipedal, the foot was under selection pressure to deal with both balance and propulsion in a highly efficient way. Think about balance and propulsion when you select your shoes. Your toes should not be compressed, because from the big toe to the fifth toe, they assist your balance as they spread out, and then they push you forward into the next step. There is a new interest in barefoot walking, and in shoes that enable you to walk in a way that resembles being barefoot, but gives protection to your soles on hard or rocky surfaces. Take shorter strides to allow you to land more softly on your heel with your knees slightly bent. Roll forward until the ball lands, and spreads slightly as your toes spread and bend to push you forward. Shoes that enable this kind of walking are light and flexible. Several shoe companies have ‘barefoot’ models. Be sure to get one with a wide toe box. Beginners’ advice – walk the beach barefoot, and take off your shoes at home. Women - rethink high heels if you want to keep your toes happy and your calf muscles from shortening. Stretch your calves whenever you take off high heels. Foot binding in China kept women in thrall, and Thorstein Veblen, writing in 1899, thought high heels were indicative of conspicuous consumption and the subjugation of women. Times have changed, and heels have become symbols of sexiness and power. But our feet haven’t caught up. Should we change our views on glamour? It won’t be easy, but thinking women are already making huge changes in the world.

Vitamin B12 Update:
A new study from Rush University looked at levels of vitamin B12 in people over 65, and found that B12 deficiency was associated with smaller total brain volume and lower scores on tests of memory and cognition. These finding are supported by earlier (2008) study at Oxford University in England which found that over five years, people with higher vitamin B12 levels were 6 times less likely to experience brain shrinkage compared to those with lower levels. Vitamin B12 is found only in animal food, and is especially high in clams and other shellfish. Fortified breakfast cereals are an important source of vitamin B12 for vegans, who should also take a B12 supplement. Older people may have difficulty absorbing B12 from food, because of a lack of a substance called ‘intrinsic factor’ in the stomach that enables B12 absorption. Therefore, B12 supplements are recommended for seniors; getting the sub-lingual (under the tongue) kind that is absorbed directly into the bloodstream is the best. Low B12 levels are also related to depression, bone loss and macular degeneration in the eye. It’s worth paying attention to this issue.
Sadja Greenwood, MD, MPH back issues on this blog

Sunday, December 18, 2011

The Role of Spices in Cancer Prevention

In their recent lecture at Commonweal, The Cancer-Fighting Kitchen, Dr Jeanne Wallace and chef Rebecca Katz talked about foods and spices that have special relevance in cancer prevention. Wallace spoke about the ability of diet and lifestyle changes to modulate gene expression, changing the probability of getting a disease and also surviving after a diagnosis. She described Nuclear Factor Kappa B (NF-kB) as a master switch for genes involved in tumor growth and invasion. NF-kB is a protein complex that controls DNA transcription, and regulates various steps in cancer cell growth. NF-kB also controls many genes involved in inflammation. While drug companies are researching new medicines to inhibit NF-kB, herbs and dietary plants have been found to inhibit NF-kB activation.

Wallace showed a slide of spices that inhibit NF-kB, and here is the list: anise, basil, black pepper, caraway, cardamom, chili pepper, cinnamon, clove, coriander, cumin, fennel, fenugreek, flaxseed, garlic, ginger, Holy basil, lemongrass, licorice, mint, mustard seed, nutmeg, oregano, parsley, rosemary, saffron, tamarind, turmeric. Note that spices in this list are used in many ethnic foods. Each one has unexpected properties as well as distinctive tastes. I will write about many of them in future articles; today I want to focus on cinnamon, clove and nutmeg, as these are so commonly used in the winter holidays - for baking, mulled wine, chai, spiced apple juice and eggnog.

Cinnamon: In addition to NF-kB inhibition, cinnamon has been shown to control blood sugar in people with type 2 Diabetes. Subjects using ¼ to ½ teaspoon daily were found to lower their fasting blood sugar, their hemoglobin A1C as well as their triglycerides and LDL cholesterol. Blood sugar spikes after a meal were lessened. Healthy people without diabetes had showed improvement in their glucose tolerance tests after daily cinnamon intake. Cinnamon has also been found to inhibit vaginal yeast infections and the bacterium Helicobacter pylori infection in the stomach.

Cloves: In addition to NF-kB inhibition, cloves have a long history as pain relievers in dentistry. Oil of clove is a mild topical anesthetic, and also has anti-inflammatory and antibacterial properties in the mouth for teeth and gums. Eugenol, the scientific name for oil of clove, is used in India for stopping the growth of H. pylori in the stomach. Cloves are used in Ayurvedic medicine, Chinese medicine and western herbalism. They can increase hydrochloric acid in the stomach, and improve intestinal action,. Cloves should be use sparingly, as the taste is strong, and high doses can be toxic to the liver. Following a tried and true recipe should yield good results

Nutmeg: In addition to NF-kB inhibition, nutmeg has been used by herbalists as a brain stimulant, and for its ability to kill rotaviruses, a common cause of diarrhea. Used in very large quantities, nutmeg can cause intoxication and hallucinations. This use in dangerous, but will not occur with the amounts used in everyday cooking. Some cooks use nutmeg in savory dishes as well as sweet ones, such as bean soups, stews, and vegetable casseroles.

Before closing, I wish all readers a good holiday season, with an emphasis on seasoning, and a suggestion that you look at the book Healing Spices, by B.B. Aggarwal, a prominent cancer researcher at the University of Texas M.D.Anderson Cancer Center . One of his sayings is: Put more spice in your life, to prolong your life.
Sadja Greenwood, M.D. past issues on this blog

Sunday, November 20, 2011

Inflammation - What to do About it

We are all familiar with acute inflammation: you cut yourself with a knife and it hurts, the area around the cut gets red, warm and swollen, and the process takes a few days to heal. Bacteria entered the wound, and your body’s immune system went into gear to send more blood with white blood cells to prevent infection, which caused the swelling, redness and tenderness. (Sometimes you need antibiotics and/or a tetanus booster as well.)

Chronic inflammation is another story – and many of us have it without awareness. It has been called ‘a slow burn’ that is detected by a rise in inflammatory markers – proteins produced by the immune system. High –sensitivity C reactive protein is such a protein, and your doctor or nurse-practitioner can order this test if needed. Obesity is a major cause of inflammation, along with gum disease, untreated infections with bacteria, parasites or viruses, smoking., and other factors.

Chronic inflammation is associated with coronary heart disease, by helping to build the plaque that narrows arteries and can lead to a heart attack. When the person is overweight and has high blood pressure, high blood sugar, and high triglycerides, the risk is greater.

Chronic inflammation has also been associated with a number of cancers, including stomach, colon, lung, esophagus, cervix and liver. The evidence that regular aspirin use reduces the risk of colon cancer is believed to be related to aspirin’s anti-inflammatory effects.

Inflammation has also been linked to Alzheimer’s disease – a Harvard study of people in their 70’s and 80’s showed that people with high levels of inflammatory markers were twice as likely to be diagnosed with Alzheimer’s than those with lower levels. Inflammation has also been linked to declining muscle strength with aging.

What helps prevent inflammation? Weight loss is the big factor here – along with regular, moderate exercise that will assist in weight loss. In a recent seminar at Commonweal (The New School at Commonweal, Bolinas, California) Dr. Jeanne Wallace and the chef, Rebecca Katz, discussed the foods that can reduce inflammation. I have my additions in italics.

*Increase your intake of fruits and vegetables to 8 servings a day. Have leafy green vegetables and cruciferous vegetables regularly (cabbage, broccoli, cauliflower, kale and many more). Eat pumpkin, butternut squash, yams and carrots.

*Eat cold-water fish, grass-fed animal foods, omega-3 eggs, walnuts, hemp, chia and flaxseed meal. I advise adding fish-oil capsules as a supplement. Read the label to make sure it is molecularly distilled to avoid mercury.

*Avoid foods with sugar and refined flours. This is a hard one for many people. Learn to treat yourself with dried or fresh fruit, and satisfy your between meal hunger with nuts, raw vegetables or an apple..

*Use spices liberally, especially curry, ginger, garlic, parsley and hot peppers.

*Use olive oil for cooking and salads.

*Eat dark chocolate -in moderation because of the sugar. I advise using fair-trade unsweetened cocoa powder, in hot chocolate sweetened with xylitol or stevia. Mash a banana and add some nut butter and cocoa powder for a sugar-free treat.

*Eat berries – blueberries, cherries, raspberries. These can be found frozen when their season is over.

*Eat legumes – lentils, peas, beans, dried beans. A Spanish study showed that obese men and women told to cut calories and eat four servings a week of legumes lost weight and lowered their C Reactive Protein levels, even after adjustment for the weight loss.

Since many of us have chronic inflammation without knowing it, and since it is related to such devastating problems as heart disease, cancer, Alzheimer’s and muscle loss, it is time to start paying attention to this condition. You can find all the slides of the talk by Wallace and Katz on line at The New School Commonweal, November 3rd, 2011, The Cancer-Fighting Kitchen. I plan to write more about their seminar in future columns.

Happy holidays to all. I suggest snacking on raw vegetables and nuts and avoiding that extremely hungry feeling followed by that overstuffed feeling. Remember what the Japanese say Hara hachi bu – eat until 80% full.
Sadja Greenwood MD – back issues on this blog