Back to school, Labor day: is it time to make lists and get organized? Here are ten suggestions from the August issue of Tufts University Health and Nutrition Letter. Next week I’ll report on Dr Oz’s 10 simple habits that could help you live to 100.
1. Combining moderate regular exercise and mentally stimulating activities can help protect your memory as you age, according to a Mayo Clinic study.
2. Raisins, a handful eaten 3 times a day, can reduce blood pressure significantly in mildly hypertensive people according to study from the Louisville Metabolic and Atherosclerosis Research Center. This may be because raisins are high in potassium, and also in fiber and healthful anti-oxidants. There are opposing views on whether raisins promote or prevent tooth decay, so keep flossing.
3. Your waist to hip ratio can predict you risk of sudden cardiac death. Best measurements are under 0.82 for women and 0.92 for men. Use a tape measure.
4. Regular jogging, at a slow to average pace, increases longevity, according to the Copenhagen City Heart Study. (Be sure to check with your doctor before starting to jog, if you don’t do so currently).
5. Fiber may help to protect against heart disease and stroke, according to a Swedish study.
6.Switching from white rice to brown rice could reduce your risk of diabetes, according to a Harvard study. This is especially important for Asians if they eat a lot of white rice.
7. Skip sugar sweetened beverages to reduce your risk of heart attack, according to the Nurses’ Health Study and the Health Professionals study. No increased risk was found for diet sodas.
8. Eating a Mediterranean diet, already linked to a lower risk of chronic diseases, leads to a better health-related quality of life, according to Spanish research. This diet is high in vegetables, fruit, fish or poultry, whole grains, nuts and olive oil, with small amounts of low fat milk as yogurt. There is new evidence that olive oil may strengthen bones. The diet avoids red meat and dairy fat. Get a book on this way of eating – The New Mediterranean Diet Cookbook by Nancy Harmon Jenkins and Marion Nestle is a winner.
9. Low-fat dairy may lead to fewer strokes, according to a Swedish Study.
10. Any physical activity: formal exercise, gardening, housework and walking may lower the risk of Alzheimers’s disease, according to a study of older adults at Rush University.
These studies in the Tufts newsletter are a good reminder of what you already know about healthy living.
Here are my additional suggestions for people who watch television, home movies and sit at a desk for work. Invest in a minicycle or pedal exerciser. These small devices use no electricity and can fit under your desk or in a corner for storage. They keep your legs moving with mild but continuous exercise while you sit. On a table, they are also used to exercise the arms and shoulders. The Sunny health and fitness minicycle is about $57 and is available from Amazon and Overstock. You can also look at the Carex Pedal exerciser (lighter and about $45) and the Pedlar Pro #316 (about $34). Alternatively, consider a standing desk. Prolonged sitting (at work, in the car, watching TV) is not good for the metabolism. Several recent studies show that prolonged sitting increases mortality. You may be able to raise your desk on a sturdy brick pile until the desk-top is at elbow height, but if it is not stable, make or buy a standing desk. It takes a few tries to get used to a standing desk, but it is worth the effort in terms of leg strength and endurance. Finally, you can invest in a trek desk, which enables you to walk slowly on a treadmill while working on the computer, reading or thinking. There are manual treadmills that do not require electricity.
There’s a famous t-shirt that says “If it’s physical, it’s therapy.”
Sadja Greenwood MD, MPH back issues on this blog
Leave me a message, or a question, if you like. I'll answer, for sure.
Sunday, August 26, 2012
Sunday, August 12, 2012
More Good News About Exercise and Coffee
We all know that it’s good to get moving, but why? Will walking and other forms of exercise do more than help us stay trim? Here’s a study from Japan, in the British Medical Journal, that shows an association between time spent walking, life expectancy and lifetime expenditure for medical care. Researchers from Japanese medical schools followed 28,000 men and women aged 40-79, and divided them into those who walked an hour or more a day, and those who walked less than an hour. The more active group had a significantly longer life expectancy and lower lifetime medical expenditure. They concluded that increased longevity resulting from a healthier lifestyle does not necessarily translate into an increased amount of medical costs throughout life.
Health care costs are important in Japan, as here, because the country has a universal health care insurance system. People without insurance can join a national insurance program administered by local governments. People can select doctors or facilities of their choice, and cannot be denied coverage. Sounds familiar? This system is similar to the Affordable Care Act being implemented in the US.
A similar study from The University of Texas was recently published the journal Circulation. The authors studied 63,000 men and women over 0-10 years, 10 to 20 years, and beyond 20 years. Their fitness was based on age and sex -adjusted treadmill times, as found at the Cooper Center. High fitness was associated with lesser mortality from all causes and from cardiovascular causes.
A recent article in the Journal of the National Cancer Institute reviewed the effects of physical activity on people with cancer. Edward Giovannucci of the Harvard School of Public Health, made the following comments in his review of the article. Survival after cancer, although it may be dependent on the destructive behavior of the tumor, is also related to the general health of the patient. Health is often enhanced by activity. In addition, physical activity can have a direct effect on the cancer by altering various hormones, including insulin, insulinlike growth factor 1, estrogen and adiponectin (a protein involved in regulating blood sugar and fatty acid breakdown). These factors can promote or inhibit cell growth; insulin is a possible growth promoter for cancer, and exercise results in lower insulin levels. Observational studies of breast cancer (17 studies) and colon cancer (6 studies) suggest that physically active people have better cancer-specific and all-cause survival. Despite problems in comparing types of breast and colon cancer, and the presence or absence of metastases, the studies look promising. Few other leads have shown as much promise in extending the lives of cancer survivors, and activity can also improve the quality life of survivors. Giovannucci concludes that physical activity should be a standard part of cancer care.
More good news about coffee: In a new study from the National Institutes of Health, coffee drinkers who did not smoke were less likely to die in the next 14 years from a wide variety of illnesses. Total mortality was less in coffee drinkers, but deaths from cancer did not show this trend. Men showed an increasing benefit from coffee for up to 5 cups a day, and women who drank 2 cups a day showed a mortality benefit. Decaf coffee was also helpful.
If coffee helps you get out for a walk, a jog, a game of tennis or a swim, go for all of it! Now that it’s foggy and cool in West Marin, it’s great time to get started and keep it up.
Sadja Greenwood, MD back issues at
sadjascolumns.blogspot.com
Health care costs are important in Japan, as here, because the country has a universal health care insurance system. People without insurance can join a national insurance program administered by local governments. People can select doctors or facilities of their choice, and cannot be denied coverage. Sounds familiar? This system is similar to the Affordable Care Act being implemented in the US.
A similar study from The University of Texas was recently published the journal Circulation. The authors studied 63,000 men and women over 0-10 years, 10 to 20 years, and beyond 20 years. Their fitness was based on age and sex -adjusted treadmill times, as found at the Cooper Center. High fitness was associated with lesser mortality from all causes and from cardiovascular causes.
A recent article in the Journal of the National Cancer Institute reviewed the effects of physical activity on people with cancer. Edward Giovannucci of the Harvard School of Public Health, made the following comments in his review of the article. Survival after cancer, although it may be dependent on the destructive behavior of the tumor, is also related to the general health of the patient. Health is often enhanced by activity. In addition, physical activity can have a direct effect on the cancer by altering various hormones, including insulin, insulinlike growth factor 1, estrogen and adiponectin (a protein involved in regulating blood sugar and fatty acid breakdown). These factors can promote or inhibit cell growth; insulin is a possible growth promoter for cancer, and exercise results in lower insulin levels. Observational studies of breast cancer (17 studies) and colon cancer (6 studies) suggest that physically active people have better cancer-specific and all-cause survival. Despite problems in comparing types of breast and colon cancer, and the presence or absence of metastases, the studies look promising. Few other leads have shown as much promise in extending the lives of cancer survivors, and activity can also improve the quality life of survivors. Giovannucci concludes that physical activity should be a standard part of cancer care.
More good news about coffee: In a new study from the National Institutes of Health, coffee drinkers who did not smoke were less likely to die in the next 14 years from a wide variety of illnesses. Total mortality was less in coffee drinkers, but deaths from cancer did not show this trend. Men showed an increasing benefit from coffee for up to 5 cups a day, and women who drank 2 cups a day showed a mortality benefit. Decaf coffee was also helpful.
If coffee helps you get out for a walk, a jog, a game of tennis or a swim, go for all of it! Now that it’s foggy and cool in West Marin, it’s great time to get started and keep it up.
Sadja Greenwood, MD back issues at
sadjascolumns.blogspot.com
Monday, July 30, 2012
Eve Ensler and The Vagina Monologues
She is one of the most energetic revolutionaries in the world today, with her ambition to end violence against women and girls, everywhere. Eve Ensler has launched a global movement known as V-Day, to end rape, battery, incest, female genital mutilation and sex slavery. She has set up a community in the Democratic Republic of the Congo, called the City of Joy, to help Congolese women who have been raped. Classes in literacy, self-defense, communication, political action and mental and physical healing were held in the first year. A terrible history of widespread and violent rape had made such a center important in the Congo.
Through V-Day campaigns, volunteers and college students in this country put on benefit performances of Ensler’s plays, including The Vagina Monologues. They hold teach-ins and workshops for men, to raise awareness and funds for grassroots anti-violence groups. V-Day has produced a documentary film, Until the Violence Stops; this72 minute documentary is available from Netflicks. It shows women from Harlem, Ukiah, Pine Ridge Reservation to the Philippines and Kenya, revealing their experiences of abuse and genital mutilation, and what they are doing to improve their situations. A five minute trailer for this film can be seen on You Tube.
Funds raised by V-Day support local and national organizations worldwide, including Egypt, Iraq and Afghanistan. The V-Day movement exists in 140 countries from Europe to Asia, Africa, the Americas, and the Caribbean.
In June, 2012, Michigan State Representative Lisa Brown was banned from speaking during a debate on a bill putting new restrictions on abortion providers, because she had used the word ‘vagina’ in her remarks. As a result, four days later a special and rousing performance of The Vagina Monologues was staged on the steps of the state capital, before a crowd of 5000. Eve Ensler was on hand. You can watch the action on You Tube – Vagina Monologues at Michigan’s Capitol Steps.
The Vagina Monologues was written in 1996 and first performed in Greenwich Village, New York City. It has been translated into 48 languages and performed in over 140 countries. Clearly it has been a powerful opening for women to talk about their sexual selves, their joy, their anger and their liberation from prudery and restrictive customs. Ensler has written numerous other plays, including “I am an Emotional Creature: The Secret Life of Girls Around the World.” This play was recently staged at the Berkeley Repertory Theater. It features a cast of 6 young women who talk, sing, and dance their way through a script that covers cliques, popularity, sex, sexual slavery, genital mutilation, slave labor in a Barbie Doll factory and more. The brilliant cast has now gone to New York City.
Here’s the big news of this column. The Vagina Monologues is coming to Marin, and specifically to Bolinas! It will play at the Bolinas Community Center on Saturday, September 22nd at 7:30 pm. It will be staged at the San Geronimo Cultural Center on September 15th, and at Toby’s in Point Reyes on Friday September 21st. This play (which I have seen several times) is different at each staging as the cast and venue changes. It is much more than a ladies’ night out; men and couples will also get a lot out of it, including humor, sadness, surprise, and a powerful understanding of the human condition.
Sadja Greenwood, MD, MPH: back issues on this blog. Leave me a note, and I'll answer you pronto. Pura Vida
Through V-Day campaigns, volunteers and college students in this country put on benefit performances of Ensler’s plays, including The Vagina Monologues. They hold teach-ins and workshops for men, to raise awareness and funds for grassroots anti-violence groups. V-Day has produced a documentary film, Until the Violence Stops; this72 minute documentary is available from Netflicks. It shows women from Harlem, Ukiah, Pine Ridge Reservation to the Philippines and Kenya, revealing their experiences of abuse and genital mutilation, and what they are doing to improve their situations. A five minute trailer for this film can be seen on You Tube.
Funds raised by V-Day support local and national organizations worldwide, including Egypt, Iraq and Afghanistan. The V-Day movement exists in 140 countries from Europe to Asia, Africa, the Americas, and the Caribbean.
In June, 2012, Michigan State Representative Lisa Brown was banned from speaking during a debate on a bill putting new restrictions on abortion providers, because she had used the word ‘vagina’ in her remarks. As a result, four days later a special and rousing performance of The Vagina Monologues was staged on the steps of the state capital, before a crowd of 5000. Eve Ensler was on hand. You can watch the action on You Tube – Vagina Monologues at Michigan’s Capitol Steps.
The Vagina Monologues was written in 1996 and first performed in Greenwich Village, New York City. It has been translated into 48 languages and performed in over 140 countries. Clearly it has been a powerful opening for women to talk about their sexual selves, their joy, their anger and their liberation from prudery and restrictive customs. Ensler has written numerous other plays, including “I am an Emotional Creature: The Secret Life of Girls Around the World.” This play was recently staged at the Berkeley Repertory Theater. It features a cast of 6 young women who talk, sing, and dance their way through a script that covers cliques, popularity, sex, sexual slavery, genital mutilation, slave labor in a Barbie Doll factory and more. The brilliant cast has now gone to New York City.
Here’s the big news of this column. The Vagina Monologues is coming to Marin, and specifically to Bolinas! It will play at the Bolinas Community Center on Saturday, September 22nd at 7:30 pm. It will be staged at the San Geronimo Cultural Center on September 15th, and at Toby’s in Point Reyes on Friday September 21st. This play (which I have seen several times) is different at each staging as the cast and venue changes. It is much more than a ladies’ night out; men and couples will also get a lot out of it, including humor, sadness, surprise, and a powerful understanding of the human condition.
Sadja Greenwood, MD, MPH: back issues on this blog. Leave me a note, and I'll answer you pronto. Pura Vida
Saturday, July 7, 2012
The Affordable Care Act - what it means to you
In a dramatic and unexpected move , Supreme Court Chief Justice John Roberts sided with liberal justices Stephen Breyer, Ruth Bader Ginsberg, Elena Kagan and Sonia Sotomayor to allow most of President Obama’s health care law, the Affordable Care Act, to remain intact. Here are the essential features that may be of interest.
The “mandate” that everyone will need to buy insurance by 2014 was the most controversial part of the new law. The justices decided that it will remain under the taxing power of the government. Anyone who refuses to buy insurance will be taxed $95 in the first year, and subsequently more, until the tax reaches $695 or 2.5 percent of income, whichever is more. However, there will be federal subsidies for people who cannot afford insurance. Many uninsured people with pre-existing conditions will be eligible for insurance and will probably sign up quickly. If a substantial fraction of healthy young people also sign up, insurance companies will be able to even out costs and charge less.
Those politically opposed to the act will advise the public not to purchase insurance, which could result in higher premiums for those who do. This dynamic has already started, and it will greatly influence how the new law will work. Here’s a way for healthy young people to think about insurance: Their likelihood of having a heart attack and other chronic disease is low, so they can probably save money by just paying the tax. However, should they have a serious accident or develop an unexpected illness, they might receive expensive emergency hospital care, be ineligible for some important forms of treatment, and be burdened by large debts while recovering. Getting health insurance will avoid these problems. It is a smart and prudent option.
New money is being offered to states to help enroll people with limited finances into Medicaid programs. If a state turns down the new funding from the act, it can still keep its current federal Medicaid funds. Republican governors may want to turn down the new funds; however, hospitals and care providers are going to pressure them to accept the greatly expanded funding in order to have more of their patients insured.
California will benefit from the new funding for Medicaid — currently we have 7 million uninsured people, a number expected to fall by more than half by 2016 due to the new funds. There will be a substantial increase in the number of people insured by Medi-Cal, and county and University of California hospitals are working to improve their delivery of care. California plans to enroll more low-income seniors and people with disabilities into managed care. These plans must have a sufficient number of providers and be geographically near the patients. As this occurs, California and other states will face challenges in finding enough primary care providers to care for more insured people.
Coverage of children under 26 in their parents’ insurance policies is already in force and is very popular. Starting in 2014, people with pre-existing conditions will be able to buy insurance. Insurance companies will not be able to charge the sick more than the healthy, nor can they charge women more than men. Free wellness checkups will be part of all plans. Insurance companies will have to spend at least 80 percent of their revenue on medical care, which may limit their administrative costs and high executive salaries.
By January 1, 2014, states will be required to have new marketplaces, called exchanges, in which individuals and small businesses can examine a variety of competing plans, their costs and their policies, before purchasing them. States must begin talking to a federal hub that is being created to help determine who is eligible for subsidies. Within 10 days after the November election, states are supposed to report to the federal government on their readiness to set up the exchanges, and must get them ready in 2013. If a state does not comply, residents can access a federal “fallback” exchange. To get a subsidy, you must buy your insurance through an exchange.
Readers may be happy to know that California is a leader in working toward having an exchange ready by late 2013.
The Affordable Care Act is a start on the path towards healthcare for everyone. It is not as efficient as an expansion of Medicare for all, which would be like a single payer plan. It is extremely controversial, so we can expect a lot of political fallout in coming months. Republicans vow to overturn the ACA if they return to power. However, it is a great accomplishment of the Obama administration in the current political climate. Here’s one more compelling reason to vote in November.
Sadja Greenwood, MD, MPH
Read back issues on this blog. Leave me a message, and I'll answer you!
The “mandate” that everyone will need to buy insurance by 2014 was the most controversial part of the new law. The justices decided that it will remain under the taxing power of the government. Anyone who refuses to buy insurance will be taxed $95 in the first year, and subsequently more, until the tax reaches $695 or 2.5 percent of income, whichever is more. However, there will be federal subsidies for people who cannot afford insurance. Many uninsured people with pre-existing conditions will be eligible for insurance and will probably sign up quickly. If a substantial fraction of healthy young people also sign up, insurance companies will be able to even out costs and charge less.
Those politically opposed to the act will advise the public not to purchase insurance, which could result in higher premiums for those who do. This dynamic has already started, and it will greatly influence how the new law will work. Here’s a way for healthy young people to think about insurance: Their likelihood of having a heart attack and other chronic disease is low, so they can probably save money by just paying the tax. However, should they have a serious accident or develop an unexpected illness, they might receive expensive emergency hospital care, be ineligible for some important forms of treatment, and be burdened by large debts while recovering. Getting health insurance will avoid these problems. It is a smart and prudent option.
New money is being offered to states to help enroll people with limited finances into Medicaid programs. If a state turns down the new funding from the act, it can still keep its current federal Medicaid funds. Republican governors may want to turn down the new funds; however, hospitals and care providers are going to pressure them to accept the greatly expanded funding in order to have more of their patients insured.
California will benefit from the new funding for Medicaid — currently we have 7 million uninsured people, a number expected to fall by more than half by 2016 due to the new funds. There will be a substantial increase in the number of people insured by Medi-Cal, and county and University of California hospitals are working to improve their delivery of care. California plans to enroll more low-income seniors and people with disabilities into managed care. These plans must have a sufficient number of providers and be geographically near the patients. As this occurs, California and other states will face challenges in finding enough primary care providers to care for more insured people.
Coverage of children under 26 in their parents’ insurance policies is already in force and is very popular. Starting in 2014, people with pre-existing conditions will be able to buy insurance. Insurance companies will not be able to charge the sick more than the healthy, nor can they charge women more than men. Free wellness checkups will be part of all plans. Insurance companies will have to spend at least 80 percent of their revenue on medical care, which may limit their administrative costs and high executive salaries.
By January 1, 2014, states will be required to have new marketplaces, called exchanges, in which individuals and small businesses can examine a variety of competing plans, their costs and their policies, before purchasing them. States must begin talking to a federal hub that is being created to help determine who is eligible for subsidies. Within 10 days after the November election, states are supposed to report to the federal government on their readiness to set up the exchanges, and must get them ready in 2013. If a state does not comply, residents can access a federal “fallback” exchange. To get a subsidy, you must buy your insurance through an exchange.
Readers may be happy to know that California is a leader in working toward having an exchange ready by late 2013.
The Affordable Care Act is a start on the path towards healthcare for everyone. It is not as efficient as an expansion of Medicare for all, which would be like a single payer plan. It is extremely controversial, so we can expect a lot of political fallout in coming months. Republicans vow to overturn the ACA if they return to power. However, it is a great accomplishment of the Obama administration in the current political climate. Here’s one more compelling reason to vote in November.
Sadja Greenwood, MD, MPH
Read back issues on this blog. Leave me a message, and I'll answer you!
Thursday, June 28, 2012
Beneficial Bacteria in your Body
Microbiologists are excited about recent studies showing that the bacteria in our guts, throat, genital organs and on our skin can have newly discovered beneficial roles in health. We have some 500 different strains of bacteria in our intestinal tract; the average healthy adult carries about 5 pounds of them. From the mouth to the colon, they help us break down and digest our food and allow for its absorption. They also synthesize a range of vitamins, from the B group to vitamin K.
About 70% of our immune system resides in the lining of the gut; signals from good bacteria influence immune cell development and susceptibility to infections and inflammatory diseases. Researchers at the University of Pennsylvania have shown that when mice are treated with antibiotics to reduce numbers of beneficial bacteria, they have an impaired antiviral immune response and delayed clearance of systemic viruses or influenza in the airways. The researchers concluded that signals from beneficial bacteria stimulate immune cells in a way that is optimal for antiviral immunity.. This may be a way that good gut bacteria reduce your susceptibility to colds and flu.
The same researchers also looked at allergic lung inflammation, similar to asthma in humans, and found that mice given antibiotics had higher levels of basophils in their white blood cells, and elevated seum IgE – seen in allergic disease. Researchers at the University of British Columbia found that mice treated with the antibiotic vancomycin reduced the diversity of microbes in the gut and increased the susceptibility of the animals to experimentally induced asthma. They conclude that normal bacterial populations can positively influence the response to allergens in the environment, making inflammation and asthma less likely. The bacterial multitudes in our bodies may have functions never before appreciated.
Antibiotics are life-saving drugs in many situations, including streptococcal throat infections (that can lead to heart valve damage), bacterial meningitis, bacterial pneumonia, urinary tract infections, et al. The purport of this column is not to criticize their use when needed, but to underline the importance of beneficial bacteria in the gut.
Research on the ‘microbiome’ is a hot topic currently, with exciting implications for human health. Microbiome is defined as the totality of microbes in the body (bacteria, viruses and fungi), their genetic elements and environmental interactions. What you can do right now to keep your microbiome in good shape is to feed your helpful intestinal bacteria the right food. Sugary foods that are low in fiber allow the ‘bad’ microbes to thrive. Avoid them. Certain foods are known as ‘prebiotics’ can help our beneficial bacteria. Examples are whole grains, oats, bananas, garlic & onions, artichokes and asparagus. In addition, many people take a ‘probiotic’ supplement that contains beneficial bacteria, and also eat fermented foods such as yogurt, kefir, and sauerkraut. Make sure the yogurt you buy contains living cultures, and avoid ones that are sweetened – it’s better to add fruit yourself. You can buy probiotic capsules at many grocery stores. Look in the refrigerated section and keep the capsules refrigerated at home to preserve the life of the bacteria therein.
If you take antibiotics for a bacterial infection, it’s a good idea to take a probiotic to restore your beneficial bacteria. This may help to prevent serious diarrhea after antibiotic use, which can occur when bad bacteria such as Clostridium difficile take over. Wait at least 2 hours after taking the antibiotic, so it can be absorbed into your bloodstream, before taking the probiotic. If you have asthma, a probiotic supplement might help – talk to you doctor about this.
Sadja Greenwood, MD, MPH - back issues on this blog. Write me a comment, and I'll answer you.
About 70% of our immune system resides in the lining of the gut; signals from good bacteria influence immune cell development and susceptibility to infections and inflammatory diseases. Researchers at the University of Pennsylvania have shown that when mice are treated with antibiotics to reduce numbers of beneficial bacteria, they have an impaired antiviral immune response and delayed clearance of systemic viruses or influenza in the airways. The researchers concluded that signals from beneficial bacteria stimulate immune cells in a way that is optimal for antiviral immunity.. This may be a way that good gut bacteria reduce your susceptibility to colds and flu.
The same researchers also looked at allergic lung inflammation, similar to asthma in humans, and found that mice given antibiotics had higher levels of basophils in their white blood cells, and elevated seum IgE – seen in allergic disease. Researchers at the University of British Columbia found that mice treated with the antibiotic vancomycin reduced the diversity of microbes in the gut and increased the susceptibility of the animals to experimentally induced asthma. They conclude that normal bacterial populations can positively influence the response to allergens in the environment, making inflammation and asthma less likely. The bacterial multitudes in our bodies may have functions never before appreciated.
Antibiotics are life-saving drugs in many situations, including streptococcal throat infections (that can lead to heart valve damage), bacterial meningitis, bacterial pneumonia, urinary tract infections, et al. The purport of this column is not to criticize their use when needed, but to underline the importance of beneficial bacteria in the gut.
Research on the ‘microbiome’ is a hot topic currently, with exciting implications for human health. Microbiome is defined as the totality of microbes in the body (bacteria, viruses and fungi), their genetic elements and environmental interactions. What you can do right now to keep your microbiome in good shape is to feed your helpful intestinal bacteria the right food. Sugary foods that are low in fiber allow the ‘bad’ microbes to thrive. Avoid them. Certain foods are known as ‘prebiotics’ can help our beneficial bacteria. Examples are whole grains, oats, bananas, garlic & onions, artichokes and asparagus. In addition, many people take a ‘probiotic’ supplement that contains beneficial bacteria, and also eat fermented foods such as yogurt, kefir, and sauerkraut. Make sure the yogurt you buy contains living cultures, and avoid ones that are sweetened – it’s better to add fruit yourself. You can buy probiotic capsules at many grocery stores. Look in the refrigerated section and keep the capsules refrigerated at home to preserve the life of the bacteria therein.
If you take antibiotics for a bacterial infection, it’s a good idea to take a probiotic to restore your beneficial bacteria. This may help to prevent serious diarrhea after antibiotic use, which can occur when bad bacteria such as Clostridium difficile take over. Wait at least 2 hours after taking the antibiotic, so it can be absorbed into your bloodstream, before taking the probiotic. If you have asthma, a probiotic supplement might help – talk to you doctor about this.
Sadja Greenwood, MD, MPH - back issues on this blog. Write me a comment, and I'll answer you.
Friday, June 22, 2012
GMO labeling, the Farm Bill, & anti-cancer herbs and spices
In November we will be voting on a referendum in California requiring that all genetically engineered foods be labeled. If it passes, California will be the first state to require such labeling on packaging. Citizens in Europe, Japan and other countries (almost 50 in all) have access to such knowledge. This is an historic occasion for voters – you should know that companies such as Dow and Monsanto will put up a strong campaign against the referendum, and may sue the state if it passes, as they threatened to do in Vermont, where a legislative bill for labeling did not make it out of committee.
The referendum is important because ‘superweeds’ have developed in response to the herbicide ‘Roundup’ (glyphosate). The result has been heavier spraying of the Roundup Ready corn and soybeans that have been genetically modified to withstand such spraying. About 90% of soybeans and 70% of corn and cotton grown in the US are Roundup Ready crops. Additionally, Dow Chemical has asked for USDA approval of a type of corn that can withstand spraying by 2,4D (a defoliant similar to 2,4T used in Agent Orange in Vietnam war days). Many large-scale farmers in the Midwest approve of Dow’s new crops, saying that resistant weeds have become a crisis and without new chemical approaches, farmers would have to plow more and thereby increase soil erosion. On the other hand, Sweden, Norway and Denmark have banned the use of 2,4D, because of toxicity to workers (central nervous system symptoms, dermatitis, possible long term effects on the children of women exposed in pregnancy, and possible increase in lymphomas). Farmers who do not use GMO crops fear genetic drift from the altered plants’ pollen, and also drift of the herbicides used.
This is clearly a complicated question, and we will hear a great deal about it in the run-up to the November election. Here is another reason to exercise your right to vote!
Th US Senate is currently considering the 2012 Farm Bill. Senator Kirsten Gillibrand (D- NY) is opposing a $4.5 billion cut from food stamps, which will then be opposed in the House of Representatives where a majority of Republicans have said they want deep cuts in food stamps. In addition, she wants to help markets that sell fresh produce in areas where it is not available, and encourage the creation of insurance for specialty crops such as apples and onions. To take action on Gillibrand’s amendment that would restore cuts from nutrition programs and redirect $500 million to healthy food programs, you can call Lynn Woolsey (415-507-9554), Senator Boxer (415-403-0100) and Senator Feinstein (415-393-0707). Senators Bernie Sanders (D-Vermont) and Barbara Boxer ( D-California) have introduced an amendment requiring GMO foods to be labeled nationwide. Call Senator Boxer about this as well, if you agree with such labeling.
I have just returned from a nutrition conference put on by the Center for Mind-Body Medicine. One of the speakers on cancer was Jeanne Wallace, who also spoke here at Commonweal last year with chef Rebecca Katz. Wallace listed the top 10 foods to block angiogenesis – the growth of new blood vessels that encourage cancer growth. They are:
*Spices – especially curry, ginger, garlic, parsley
*Berries – all types
*Green tea
*Parsley, peppermint, thyme
*Curry - turmeric, coriander, cumin
*Garlic
*Brazil nuts – for the selenium
*Cold-water fish/ Grass fed meat - for the omega-3 fatty acids
*Traditional soy foods - edamame, tempeh, tofu, plain soy milk
*Peanuts (boiled), red grapes/wine - resveratrol
I will write more about this conference in future columns. In the meantime, if you eat, be a food activist!
Sadja Greenwood, MD, MPH
The referendum is important because ‘superweeds’ have developed in response to the herbicide ‘Roundup’ (glyphosate). The result has been heavier spraying of the Roundup Ready corn and soybeans that have been genetically modified to withstand such spraying. About 90% of soybeans and 70% of corn and cotton grown in the US are Roundup Ready crops. Additionally, Dow Chemical has asked for USDA approval of a type of corn that can withstand spraying by 2,4D (a defoliant similar to 2,4T used in Agent Orange in Vietnam war days). Many large-scale farmers in the Midwest approve of Dow’s new crops, saying that resistant weeds have become a crisis and without new chemical approaches, farmers would have to plow more and thereby increase soil erosion. On the other hand, Sweden, Norway and Denmark have banned the use of 2,4D, because of toxicity to workers (central nervous system symptoms, dermatitis, possible long term effects on the children of women exposed in pregnancy, and possible increase in lymphomas). Farmers who do not use GMO crops fear genetic drift from the altered plants’ pollen, and also drift of the herbicides used.
This is clearly a complicated question, and we will hear a great deal about it in the run-up to the November election. Here is another reason to exercise your right to vote!
Th US Senate is currently considering the 2012 Farm Bill. Senator Kirsten Gillibrand (D- NY) is opposing a $4.5 billion cut from food stamps, which will then be opposed in the House of Representatives where a majority of Republicans have said they want deep cuts in food stamps. In addition, she wants to help markets that sell fresh produce in areas where it is not available, and encourage the creation of insurance for specialty crops such as apples and onions. To take action on Gillibrand’s amendment that would restore cuts from nutrition programs and redirect $500 million to healthy food programs, you can call Lynn Woolsey (415-507-9554), Senator Boxer (415-403-0100) and Senator Feinstein (415-393-0707). Senators Bernie Sanders (D-Vermont) and Barbara Boxer ( D-California) have introduced an amendment requiring GMO foods to be labeled nationwide. Call Senator Boxer about this as well, if you agree with such labeling.
I have just returned from a nutrition conference put on by the Center for Mind-Body Medicine. One of the speakers on cancer was Jeanne Wallace, who also spoke here at Commonweal last year with chef Rebecca Katz. Wallace listed the top 10 foods to block angiogenesis – the growth of new blood vessels that encourage cancer growth. They are:
*Spices – especially curry, ginger, garlic, parsley
*Berries – all types
*Green tea
*Parsley, peppermint, thyme
*Curry - turmeric, coriander, cumin
*Garlic
*Brazil nuts – for the selenium
*Cold-water fish/ Grass fed meat - for the omega-3 fatty acids
*Traditional soy foods - edamame, tempeh, tofu, plain soy milk
*Peanuts (boiled), red grapes/wine - resveratrol
I will write more about this conference in future columns. In the meantime, if you eat, be a food activist!
Sadja Greenwood, MD, MPH
Monday, June 4, 2012
Update on calcium
Recent reports of an increased risk of heart attack in people taking calcium supplements have been very confusing. For years we have been told to take calcium pills to supplement dietary sources of this mineral. Here’s the evidence so far. Calcium is critical for building and maintaining strong bones and teeth; it also plays a role in muscle contraction, nerve transmission, blood clotting and blood vessel flexibility.
A recent study in the Archives of Internal Medicine looked at 39,000 older women in the Iowa Women’s Health Study, and found a small decreased risk of death among women taking calcium supplements. This contrasts with two studies from the University of Auckland (British Medical Journal, 2010 and 2011) which looked at the U.S. Women’s Health Initiative and found that calcium supplements, with and without vitamin D, modestly increased the risk of a heart attack. The data are difficult to interpret, and more studies and further analysis is needed. A Canadian journal said “if 100 patients take calcium supplements, less than 1 will have a fracture prevented, and less than 1 will develop a heart attack
or stroke.” A small increased risk of kidney stones has also been shown in people taking supplemental calcium, but not with dietary calcium.
The Institute of Medicine concluded in 2010 that adults should get 1000 mg a day of calcium, and post-menopausal women should get 1200 mg. An adequate calcium intake is especially important in pregnancy and breast feeding. Girls ages 9 – 18 often do not get enough calcium in their diets due to a preference for sodas, fake foods and dieting. Supplements of calcium, magnesium and vitamin D as chewable tablets may be beneficial for them, as this is a critical time for bone building.
I conclude that it is vitally important to get enough calcium from our diets, and to use supplemental vitamin D if needed to raise levels of D to 30 ng/ml or higher. Good dietary sources of calcium include low fat milk products (think unsweetened yogurt and cottage cheese and nonfat or 1% milk), green vegetables (especially broccoli, collards, kale & bok choy), almonds, Brazil nuts, sunflower seeds, sesame seeds and dried beans. Calcium fortified soy milk and orange juice can help vegans get enough calcium. Some tofu is high in calcium; read labels to be sure. People with osteoporosis should talk to their doctor or nurse practitioner about the risks and benefits of supplemental calcium.
Studies of men have suggested that a high intake of calcium from dairy products may increase the risk of prostate cancer, but the evidence for this is inconsistent. Men can consider getting a maximum of dietary calcium from non-dairy sources of the mineral.
A 2006 study from the University of Pennsylvania showed that use of proton pump inhibitors (Nexium, Prilosec, Prevacid and others ) to reduce acid reflux is associated with an increased risk of hip fracture in people over 50, probably due to decreased calcium absorption and other mechanisms. Long-term use of these medicines increases the risk. Short term use is often indicated, but many people stay on these anti-reflux drugs for years. These medicines can also increase the risk of pneumonia, vitamin B12 deficiency and low magnesium levels. There are other ways of dealing with acid reflux, including weight loss, avoiding trigger foods and high fat meals, eating frequent small meals, and sleeping in a Lazy-Boy chair or with a wedge pillow if the problem comes on at night.
Here in West Marin are blessed to have local organic dairies that produce wonderful yogurt. Yea for farmers’ markets with their abundance of calcium rich vegetables
Sadja Greenwood, MD, MPH back issues on this blog
.
A recent study in the Archives of Internal Medicine looked at 39,000 older women in the Iowa Women’s Health Study, and found a small decreased risk of death among women taking calcium supplements. This contrasts with two studies from the University of Auckland (British Medical Journal, 2010 and 2011) which looked at the U.S. Women’s Health Initiative and found that calcium supplements, with and without vitamin D, modestly increased the risk of a heart attack. The data are difficult to interpret, and more studies and further analysis is needed. A Canadian journal said “if 100 patients take calcium supplements, less than 1 will have a fracture prevented, and less than 1 will develop a heart attack
or stroke.” A small increased risk of kidney stones has also been shown in people taking supplemental calcium, but not with dietary calcium.
The Institute of Medicine concluded in 2010 that adults should get 1000 mg a day of calcium, and post-menopausal women should get 1200 mg. An adequate calcium intake is especially important in pregnancy and breast feeding. Girls ages 9 – 18 often do not get enough calcium in their diets due to a preference for sodas, fake foods and dieting. Supplements of calcium, magnesium and vitamin D as chewable tablets may be beneficial for them, as this is a critical time for bone building.
I conclude that it is vitally important to get enough calcium from our diets, and to use supplemental vitamin D if needed to raise levels of D to 30 ng/ml or higher. Good dietary sources of calcium include low fat milk products (think unsweetened yogurt and cottage cheese and nonfat or 1% milk), green vegetables (especially broccoli, collards, kale & bok choy), almonds, Brazil nuts, sunflower seeds, sesame seeds and dried beans. Calcium fortified soy milk and orange juice can help vegans get enough calcium. Some tofu is high in calcium; read labels to be sure. People with osteoporosis should talk to their doctor or nurse practitioner about the risks and benefits of supplemental calcium.
Studies of men have suggested that a high intake of calcium from dairy products may increase the risk of prostate cancer, but the evidence for this is inconsistent. Men can consider getting a maximum of dietary calcium from non-dairy sources of the mineral.
A 2006 study from the University of Pennsylvania showed that use of proton pump inhibitors (Nexium, Prilosec, Prevacid and others ) to reduce acid reflux is associated with an increased risk of hip fracture in people over 50, probably due to decreased calcium absorption and other mechanisms. Long-term use of these medicines increases the risk. Short term use is often indicated, but many people stay on these anti-reflux drugs for years. These medicines can also increase the risk of pneumonia, vitamin B12 deficiency and low magnesium levels. There are other ways of dealing with acid reflux, including weight loss, avoiding trigger foods and high fat meals, eating frequent small meals, and sleeping in a Lazy-Boy chair or with a wedge pillow if the problem comes on at night.
Here in West Marin are blessed to have local organic dairies that produce wonderful yogurt. Yea for farmers’ markets with their abundance of calcium rich vegetables
Sadja Greenwood, MD, MPH back issues on this blog
.
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
*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
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
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
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