Emergency Contraception - The Morning-After Pill

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

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

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

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

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

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

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

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

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

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

Atrazine

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

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

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

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

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

Ginger

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Access to Abortion is Declining in Many States

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

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

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

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

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

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

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

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

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

An Apple a Day…...

Apples are a "miracle fruit" that convey benefits beyond fiber content, according to Dr. Bahram Arjmandi at Florida State University. Animal studies have shown that the pectin and polyphenols in apples improve blood fat levels and lower the production of pro-inflammatory molecules. Arjmandi's 2011 research  randomly assigned 160 women ages 45-65 to one of two dietary interventions: one group received two dried apples daily and the other group ate dried prunes every day for a year. Blood samples were taken at 3, 6 and 12-months. The results surprised Dr. Arjmandi, who stated that "incredible changes in the apple-eating women happened by 6 months- they experienced a 23% decrease in LDL cholesterol," which is known as the ‘bad cholesterol.’ The daily apple consumption also led to a lowering of C-reactive protein (a marker of inflammation). "I never expected apple consumption to reduce bad cholesterol to this extent while increasing HDL cholesterol or good cholesterol by about 4%," Arjmandi said. Yet another advantage is that the extra 240 calories per day consumed from the dried apple did not lead to weight gain in the women; in fact, they lost on average 3.3 lbs. "Reducing body weight is an added benefit to daily apple intake" he said. Part of the reason for the weight loss could be the fruit's pectin, which is known to have a satiety effect.

In a study from Ohio State University, healthy, middle-aged adults who rarely ate apples were given one red or golden

Delicious apple a day, or a capsule containing the polyphenols found in apples, for 4 weeks.  The apple eaters had a 40% decrease in oxidized LDL, a substance linked to hardening of the arteries. People taking the capsules had a similar effect, but not as large. The author of this study, Dr. Robert DiSilvestro, described daily apple consumption as significantly more effective in lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.

The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health.

In the Christmas edition of the prestigious British Medical Journal, there is an article comparing apples and statins for the prevention of cardiovascular deaths.  Using mathematical models, a team of researchers at Oxford set out to test how the150 year old proverb  - An apple a day keeps the doctor away -might compare with the more widespread use of statins in the UK population. They calculated that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.  However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes. The researchers conclude that the public health message: An apple a day… is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, “although by all means eat more apples.”

My message to readers is similar – eat a daily apple, don’t change your medications without talking with your doctor, and have a wonderful holiday season. 

Sadja Greenwood, MD   back issues on this blog.  Check out my novel, Changing the Rules, at Stinson Beach Books, Point Reyes Books & Amazon

Oregano

Oregano is an important culinary and medicinal herb that has been used in medicine and cooking for thousands of years. It belongs to the mint family.  Its name comes from the Greek words oros (mountain) and ganos (joy)!

 In folk medicine, oregano is used to treat respiratory problems, gastrointestinal (GI) disorders, menstrual cramps, and urinary tract disorders.  It is also applied topically – as oregano oil - to help treat a number of skin conditions, such as acne, dandruff, skin infections and athlete’s foot.   (Full disclosure – I use it on my sore fungal toes, and it’s helping.)

 Oregano contains a fair amount of vitamin K - an important vitamin which promotes bone growth, the maintenance of bone density, and the production of blood clotting proteins. Although dried basil, thyme and oregano contain high levels of vitamin K, a teaspoon of these herbs in their fresh form contain only a small amount and can be used by people taking Coumadin.  Check with your doctor on this. 

Oregano, allspice and garlic essential oils (EOs) can be effective, natural barriers against E. coli, Salmonella and Listeria, according to a study in the Journal of Food Science, published by the Institute of Food Technologists. The  study from government researchers revealed that oregano oil was found to be the most effective antimicrobial used in cooking, followed by allspice and garlic.  While this information can make you happy to include these herbs in your dishes, you should never forget the important rules about food safety to prevent bacterial contamination.  .

Researchers at Long Island University (LIU) have found that an ingredient of oregano could potentially be used to treat prostate cancer. Dr. Supriya Bavadekar, PhD, RPh, Assistant Professor of Pharmacology at LIU is currently testing carvacrol, a constituent of oregano, on prostate cancer cells. The results of her study demonstrate that the compound induces apoptosis in these cells. Apoptosis, is programmed cell death, or simply "cell suicide." Dr. Bavadekar and her group are presently trying to determine the signaling pathways that the compound employs to bring about cancer cell suicide. "We know that oregano possesses anti-bacterial as well as anti-inflammatory properties, but its effects on cancer cells really elevate the spice to the level of a super-spice like turmeric," said Dr. Bavadekar. Though the study is at its preliminary stage, she believes that the initial data indicates a huge potential in terms of carvacrol's use as an anti-cancer agent. "A significant advantage is that oregano is commonly used in food and has a 'Generally Recognized As Safe' status in the US. We expect this to translate into a decreased risk of severe toxic effects. Some researchers have previously shown that eating pizza may cut down cancer risk. This effect has been mostly attributed to lycopene, a substance found in tomato sauce, but we now feel that even the oregano seasoning may play a role," stated Dr. Bavadekar. "If the study continues to yield positive results, this super-spice may represent a very promising therapy for patients with prostate cancer."

Oregano grows very well in Bolinas gardens.  Mine survived the recent frost and seems to be growing well all year long.  You can put it in salads, soups and stir fries, as well as pasta sauces and pizza. 

Sadja Greenwood, MD, MPH  back issues on this blog.  Check out my novel, Changing the Rules, at the Point Reyes Bookstore and on Amazon.

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Nicolas Kristof on holiday gifts

In a recent New York Times (Sunday, December  1^st, 2013) columnist Nicholas Kristof wrote some ideas for gift giving that most of us have not heard of. First he writes about gifts to established charities – they will tell your friend or family member that you gave the gift in their name:

*Buy a year of schooling for a girl in Ethiopia through the International Rescue Committee (gifts.rescue.org)

*Buy a flock of geese for an impoverished family in a poor country through Heifer International (heifer.org)

 Here are his more unusual suggestions: –

*Help to prevent unwanted pregnancies in kids here at home. The Carrera Adolescent Pregnancy Prevention Program is a school curriculum “devised by a New York City education expert, Dr. Michael Carrera, who recognized that it’s not enough to hand out condoms.  One also needs to give kids in high poverty neighborhoods a stake in a better future, a reason to think they can succeed.  So the curriculum includes comprehensive sex education but also financial literacy, job preparation and summer internships, S.A.T. coaching and much more.  The program has now spread to more than 20 states, and follow-up studies suggest it reduces pregnancy rates by half.  For $50, you can fund a student’s college savings account, part of the financial literacy element (information is at childrensaidsociety.org).”

*Afghan Institute of Learning, founded by an Afghan woman to run empowerment and training programs for Afghan women and girls.  The institute was founded in the 1990s, when it was illegal, as girls’ education is threatening to the Taliban. $65 pays for a year of literacy classes for a girl or woman.  (AfghanInstituteofLearning.org.)

*GlobalGoodsPartners.org will sell you gifts under $30 made by people all over the developing world, such as a hand-embroidered scarf made by Afghan widows.

*HELP – Haitian Education and Leadership Program.  HELP searches across Haiti for the most outstanding students from disadvantaged backgrounds and sends them to college, while providing counseling, English and computer tutoring and stipends.  HELP students pledge to contribute 15% of their earnings for their first 9 years of employment, to make the program sustainable.  (UHelp.net)

*Reach Out and Read is a U.S. literacy program for the disadvantaged that uses doctors to encourage parents to read to their children.  They hand out free books and leaflets promoting bedtime stories, thereby ‘prescribing’ reading to the child.  Families in this award winning program are more likely to describe reading as a child’s favorite activity.  Books are donated by publishers like Scholastic.  $50 covers a child’s cost for five years.  (ReachOutandRead.org)

Nicholas Kristof  and his wife Sheryl WuDunn are heroes of mine.  They wrote Half the Sky – Turning Oppression into Opportunity for Women Worldwide in 2010.  They travel the world to find people making a difference for humanity in difficult places.  I try to pay attention to their suggestions.

Readers, have a thoughtful and joyous holiday season.  Let’s hope for rain.

Sadja Greenwood, MD, MPH    back issues on this blog

Try a bigger breakfast

When you eat a day’s worth of food really does make a difference, according to Daniela Jacubowicz, a professor at Tel Aviv University.  In a recent study, published in the journal Obesity, she randomized 93 overweight and obese women into 2 groups and followed them for 12 weeks.  Both groups ate 1400 calories a day, consuming a healthy variety of poultry, fish, egg whites, vegetables, fruits and whole grains.  The ‘breakfast group’ had 700 calories for breakfast, 500 for lunch and 200 for dinner.  A sweet treat was included as part of their breakfast, such as a small chocolate bar, to stave off cravings for the rest of the day. The ’dinner group’ had exactly the same foods in reverse order - 200 calories for breakfast, 500 for lunch and 700 for dinner.  I presume that their chocolate bar came with dinner.

At the end of 12 weeks, the results were striking.  The ‘breakfast group’ lost an average of 19 pounds while the ‘dinner group’ lost 8.  Waist circumference decreased by 3 inches in the ‘breakfast group’ compared to 1.4  inches in the ‘dinner group’.  Glucose and insulin levels dropped significantly more in the ‘breakfast group’.  They did not experience the high spikes in glucose levels that can happen after a meal and are considered dangerous. Triglyceride levels fell 34% in the ‘breakfast group’ but increased by 15% in the ‘dinner group’.  Triglycerides are a main form of fat in the body; high levels of triglycerides have been associated with greater risk for heart disease. Average hunger scores were significantly lower in the ‘breakfast group’. 

The authors of this study concluded that a high calorie breakfast with reduced intake at night is a useful alternative for the management of obesity.  Previous studies from Tel Aviv University also looked at overweight men, and came to similar conclusions. In summary, our metabolism is impacted by the body’s 24 hour circadian rhythm. The time of day we eat can have a real impact on the way our bodies process food.

What are the implications of this study for you, the reader?  I am not suggesting a 1400 calorie diet, but a change in when you eat the amount of food that is right for you. Your weight may be just right, or you may be overweight, or too thin.  You may be a person who is never hungry in the morning, or who really relishes a big dinner at the end of a busy day.  I think it makes sense to ease your way into bigger breakfasts and lighter dinners because of the benefits on glucose and insulin levels, and because of the greater energy you will experience after a hearty (healthy) breakfast.  If you are never hungry in the morning, try a very light dinner one night, such as a bowl of cereal or a dish of cooked vegetables.  You will probably wake with an appetite.  If your usual breakfast is toast and tea, or a pastry and coffee, you may notice that your energy drops mid morning and more coffee is needed to keep you going.  When you add healthy protein and whole grains to your breakfast you will notice a smoother feeling of energy that lasts until your next meal.  What to do about the big dinner you have always loved?  When you start to follow this plan, you may find that you want to make it simpler and smaller without too much difficulty.  You may like spending less time cooking. Another benefit from a smaller dinner is feeling more energy in the evening. Having a lot to digest at night makes some people sleepy. 

Finally, Professor Jacubowicz suggests an end to late night snacking, in front of the computer or television.  She feels that this is a major contributor to the obesity epidemic, causing weight gain and a greater risk of cardiovascular disease, due to the midnight spike in blood sugar. 

Sadja Greenwood, back issues at sadjascolumns.blogspot.com

Appreciating Blood

As blood flows from the heart through arteries, capillaries and veins, this amazing substance keeps us alive. The beautiful red color of blood is due to the iron in hemoglobin, the molecule in red cells that carries oxygen.

Blood delivers oxygen, hormones and nutrients to body cells and picks up waste products from them.  White blood cells contain the many elements of the immune system.  Blood helps to control body temperature.  It carries a clotting system to control blood loss after injury. 

As blood travels throughout the body, its red cells deliver oxygen to all body cells and remove carbon dioxide.  After returning to the heart, blood travels to the lungs, giving off carbon dioxide and picking up fresh oxygen. Blood picks up digestive products from the intestines and carries them to cells for metabolism/energy production.  At the same time, it removes waste products from cells and delivers them to the kidneys for excretion.  All this is happening at great speed – a red blood cell will circulate through the body and return to the heart every 60 seconds. 

Have you ever wondered why your skin will bleed when pricked with something as tiny as a pin?  There is a capillary exceedingly close to every cell in the body. Capillaries are the smallest and most numerous blood vessels in the body, with an inner diameter just wide enough for a red cell to squeeze through.  It is estimated that there are 25,000 miles of capillaries in an adult human body.

Blood vessels help to regulate body temperature by dilating close to the skin when we are overheated, as in a hot flash or after exercise.  Heat is thereby lost to the outside air.  When we are cold, blood vessels in the skin constrict, saving warmth in our core. (Shivering also helps to create more heat.)

We have 6-8 liters of blood in our adult bodies, or about 10 pints.  About 45% of this is cells, and 55% plasma.  Plasma is a watery tissue containing dissolved proteins (albumin, globulin and fibrinogen), glucose, blood fats, clotting factors, electrolytes, hormones and carbon dioxide.  It is the protein reserve for the body.

Red and white blood cells and platelets are produced in the bone marrow of our ribs, sternum, vertebrae and pelvis.   We produce billions of blood cells a day, to replace those that have a short life.  Red blood cells live 120 days, and white cells a much shorter time. Platelets are small clear cell fragments that are essential in preventing blood loss by forming a plug at the site of an injury.  Blood components come from stem cells - undifferentiated biological cells that can become specialized - in the bone marrow they give rise to red cells, white cells and platelets.

The blood clotting system consists of numerous factors that circulate continuously through the body in an inactive form. When platelets make a plug to stop bleeding, a substance called fibrin starts to form a clot, and the many  other clotting factors are activated in a chain reaction called the coagulation cascade.

This has been a simple explanation of the functions of blood, probably familiar to all readers.  In a subsequent column I will write a more detailed description of the immune system. In the meantime, here are some ideas for keeping your blood working well for you.

Avoid blood-born diseases such as Hepatitis B and C and AIDS by never sharing a needle, and practicing safe sex with condoms with any new partner.

Have a complete blood count (CBC) when you see your doctor, to test for anemia (this is especially important for women with heavy periods).  Eat iron containing foods and take an iron supplement if needed.  There are forms of anemia that do not require iron, but may require B vitamins.  Find out; don’t guess.  It’s important.

Breath deeply, exercise and keep good posture to fully oxygenate your blood.  Don’t smoke.  In addition to damaging your lungs, smoking constricts your blood vessels and impedes circulation to your heart, your limbs and your vital organs.

If you are taking a blood thinner such as Coumadin, aspirin, Pradaxa, or similar new anti-coagulants, keep something on hand that helps to stop bleeding from nosebleeds, small cuts or external injuries.  Several products are available on line and in pharmacies without a prescription, containing a powder that causes blood to coagulate.  You sprinkle it on the wound, or introduce it into your nose with an applicator, and then apply pressure.  I am familiar with a product called QR – it is quite helpful with small cuts or nosebleeds.  It should not be used if stitches are necessary, a wound is infected, or if bleeding is arterial.  For gushing arterial bleeding, apply direct pressure with a clean cloth or bandage, and get emergency help at once. 

Sadja Greenwood, MD    Past columns on this blog.  Check out my novel, Changing the Rules, at the Grand Hotel, Uniquities, the Stinson Beach and Point Reyes Book Stores, and Amazon.

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