Important News on Roundup

The International Agency for Research on Cancer (IARC), part of the World Health Organization, has classified glyphosate  - commonly known as Roundup – as “probably carcinogenic to humans”. Glyphosate is one of the world’s most widely used herbicides  -used in growing corn, soy, vegetables, fruits, winemaking, and in home gardens. It has been used in forests to clear underbrush, in cities to deter pavement weeds, and on railroad tracks to kill unwanted vegetation.  It is used on sugarcane to increase crop yield and through crop desiccation to increase sucrose concentration before harvesting.

Monsanto developed glyphosate, which it calls Roundup, in the 1970’s. Since 1980, Monsanto has developed genetically modified soy, corn, canola, cotton, sugar-beets and alfalfa.  These GMO crops are designed to resist the herbicide Roundup, which is used to kill weeds and increase crop yields.  The seeds of these modified crops  must be purchased again each year from Monsanto by the farmer.  The development of super-weeds, resistant to Roundup, has recently been a growing problem, requiring heavier spraying of glyphosate and  other herbicides such as 2-4D (a component of Agent Orange, used as a defoliant in the Vietnam war.) 

Monsanto’s patent on glyphosate expired in 2000, and many other companies now make the product worldwide.   

Here’s what the new IARC report said, as published in the journal Lancet Oncology:

‘

“For the herbicide glyphosate, there was limited evidence of carcinogenicity in humans for non-Hodgkin lymphoma .  The evidence in humans is from studies of exposures,

 mostly agricultural, in the USA , Canada, and Sweden published since 2001.  In addition, there is convincing evidence that glyphosate also can cause cancer in laboratory animals.  On the basis of tumors in mice, the US

Environmental Protection Agency originally classified glyohosate as possibly carcinogenic to humans in 1985.  After a re-evaluation of that mouse study, the US EPA changed its classification to evidence of non-carcinogenicity in humans in 1991. The US EPA Scientific Advisory Panel noted that the re-evaluated  glyphosate results were still significant using two statistical tests recommended in the IARC Preamble.  The IARC  Working Group that conducted the evaluation considered the significant findings from the US EPA and several more recent positive results in concluding that there is sufficient evidence of  carcinogenicity in experimental animals. Glyphosate also caused DNA and chromosomal damage in human cells, although it gave negative results in tests using bacteria.  One study in community residents reported increases in blood markers of chromosomal damage (micronuclei) after glyphosate formulations were sprayed nearby.”

This is a complex subject, which is why I have quoted the IARC’s document precisely.  You can see the different opinions of the IARC and the US FDA.  Companies making glyphosate have criticized the report in the last few days.   Whether the US EPA will make any regulatory changes remains to be seen.   

Here in West Marin we are immensely lucky to be able to buy organic food.  However, the re-evaluation of glyphosate  by the WHO’s IARC is bound to  have an impact on the world and its food supply,  and on the movement to label genetically modified foods.

Here are some topics to think about:. 

*Are there safer herbicides and pesticides that can be used on cereal crops that are feeding the world?

*To what extent can organic agriculture and integrated pest management feed the world?

*Much of US GMO corn and soy is fed to animals destined for human consumption.  If meat prices rise due to a ban on dangerous herbicides, can we switch as a society to eating less meat and more plant protein?

*Is world population growth inevitable, or can education and family planning for women in developing countries help to slow this growth?

*Why are we so reluctant to talk about  family planning as a factor in our environmental crises? 

Stay tuned.  The discussion on glyphosate is only beginning.

Sadja Greenwood, MD, MPH  past issues on this blog

p.s. Here are two unrelated topics you may enjoy reading about:

 *Science Daily 3/12/15 You are when you eat – limiting flies to specific eating hours protects their hearts against aging, study finds.

 *Caya Diaphragm - safe and hormone free contraception

www.caya.eu/en   

Another Reason to Love Green Vegetables, Nuts and Olive Oil

An amazing dietary study was launched in Spain in 2003, to look at the effects of a Mediterranean diet on the prevention of cardiovascular disease. Researchers also looked at all cause mortality, diabetes, cancer, dementia and other diseases.   7000 asymptomatic participants ages 55 -80 were selected and followed for 5 years.  The subjects were divided into 3 groups – one given extra-virgin olive oil - one liter per week, one given supplemental nuts (walnuts, almonds, and hazelnuts) about 2 tablespoons a day,  and one advised to follow a low-fat diet.  The first two groups were instructed to follow the Mediterranean diet, high in vegetables and fruits, fish, legumes, grains, and olive oil, and low in meat and dairy products.  Wine was permitted, sweets limited.  The control group was instructed on a low fat diet.  After 5 years, participants following the diets enhanced with olive oil or nuts had a 30% lower risk of dying from cardiovascular disease or having a heart attack or stroke, compared to those on a low fat diet.   They also had less cognitive decline.  These are impressive results.

Researchers also looked at the Vitamin K intake of participants in this study.  People with the highest intake of foods containing Vitamin K were 46% less likely to die of cancer and 36% less likely to die from any cause than those with the lowest intake.  Again - impressive results.

Vitamin K – named for the German word for coagulation – helps blood to clot by activating certain proteins made in the liver.  It is found in a variety of foods, but mainly in leafy green and cruciferous vegetables. People taking Coumadin to reduce the propensity of blood to form clots are counseled to eat a consistent amount of leafy greens daily to match their dose of Coumadin. 

Vitamin K has also been studied for its role in bone metabolism.  A Japanese study found that people from regions where vitamin K foods were eaten in abundance had fewer hip fractures.  Several other studies from Europe have shown similar results.  While supplementation with vitamin K is not considered necessary for most people, eating green vegetables is always a plus. 

Sadja Greenwood, MD  MPH

A 12-Hour Window for a Healthy Weight

Here’s what researchers at the Salk Institute in La Jolla, CA found out about mice.  The results were so striking that they were reported in the New York Times Magazine on 1/18/15.  Many people are trying out the pattern in advance of human studies, since it seems easy, sensible and safe.

 In 2012 Salk researchers published a study on mice who could consume high fat food and could not exercise.  The mice eating this food at all hours grew fat and sick and had symptoms of diabetes.  Another group, on the same diet, could eat only within an 8 hour window.  They gained a little weight but developed no metabolic problems.  This study was enlarged and repeated, with results published in the journal Cell Metabolism in December 2015.  This time, adult male mice were divided into 4 dietary groups – high fructose, high fat, high fat and high sucrose, and regular mouse kibble.  Some mice in each group were allowed to eat whenever they wanted, and others were restricted to feeding periods of 9, 12, or 15 hours.  The caloric intake for all the mice was the same.  At the end of 38 weeks, mice eating at all hours were generally obese and metabolically ill, as in the previous study.  However, the mice that ate within a 9 or 12 hour window remained ‘sleek and healthy’, even if they cheated occasionally on weekends by eating outside the window.  Also, mice switched out of an eat-anytime schedule to a time restricted one lost some of the weight they had gained.  Mice who ate regular kibble at fixed time periods  had less body fat than those who could eat whenever they wished.  The 15 hour window was not as effective as the 9 or 12 hour restriction.

The main researcher, Dr. Satchidananda Panda, is looking at connections between circadian rhythms  - the sleep-wake cycle, and eating patterns.  He has found that even those with genetic variations that may predispose to nighttime eating and weight gain can do well with a time-restricted pattern. He titled his press release “another case against the midnight snack”.  Dr. Panda also looked at gut microbes in the mouse intestine during a 24 hour period, and found a complex daily cycle, with some bacteria at high levels at night, and different ones peaking during the day.  These fluctuations disappear in obese mice, which may be a contributing factor to metabolic disease.  In addition, fluctuations in levels of bacteria in the gut can cause fluctuations in bile acids – microbes that play key roles in controlling cholesterol levels, fat absorption and body metabolism.

Dr. Panda and his group have written that human studies on time-restricted diets would be useful, but may not have started. 

I think a time restricted diet is sensible and sounds easy, especially if you choose the 12 hour interval,  It’s important to follow a good eating pattern – plenty of vegetables, fruits, healthy protein, including beans and whole grains, and healthy fat including olive oil. Avoid sugars, refined flours and junk food.  Remember that alcohol counts as food.   I’m trying a 7am to 7pm pattern and find it satisfying.  Going to bed without too much food in the stomach helps many people sleep.  I haven’t tried cheating on the weekend yet, but it sounds promising, and who wouldn’t want to look ‘sleek and healthy’?

Sadja Greenwood, MD, MPH

Why You Shoul Know Your Numbers!

This is not math – this is your key to long-term survival.  The important numbers for most people are:  blood pressure, blood sugar, cholesterol levels, and weight. For some of these numbers you will need a collaborative relationship with your doctor, nurse practitioner, or physician’s assistant.  We are so lucky to have great clinics and health systems here in West Marin.  With a few appointments you can find your numbers and work on getting them in a healthy range.   Young people tend to feel invincible, middle aged people are too busy, and many (not all) men bypass health checkups for a wide variety of reasons.  I won’t speculate on what they are, but I have been told  (by several guys) that it’s a guy thing!  In addition, even with better health insurance coverage, a clinic visit and lab teats can be expensive.  However, once you understand your initial numbers, you can do a great deal of self-monitoring. By bringing your numbers into the normal range, you may be saving your future.  That’s a big deal. 

Blood Pressure:  High blood pressure is often a symptomless disease, that can lead to heart attack, congestive heart failure, stroke, kidney damage and many other problems.  You should know your blood pressure numbers, and discuss them with your clinician if they are abnormal..  You should have a reliable home blood pressure kit that you use regularly, and take medication  if advised to do so.  You can reduce high blood pressure with a regular walking program, the DASH diet, gradual weight loss, and self-calming practices such as meditation.  Books on the DASH diet are available at the library.  DASH stands for Dietary Approach to Stop Hypertension.  You will not go hungry on the diet, and you will start to feel better.

Blood Sugar: -High blood sugar, better known as blood glucose, can be a sign of impending diabetes or full-blown diabetes.  Normally your blood glucose levels increase after you eat, causing the pancreas to release insulin, and enabling your cells to absorb glucose for energy production.  You can find out your blood glucose level by having a blood test at the clinic after an overnight fast, 

or by having a slightly different blood test that will show your glucose levels in the past month.  Recent studies show that 27% of adults over age 65 have diabetes, and 35% of all adults have pre-diabetes.  The rise in this illness is related to the overweight and obesity crisis in the US to day.  Once you know your blood glucose level, if it is high you can self-monitor with a home blood glucose meter.  You can bring your glucose levels down with regular exercise (walking is fine) and an eating plan that emphasizes vegetables and protein and avoids foods with sugar and refined flour.  The Mayo Clinic Diabetes Diet is a good place to start.  Get the book out of the library, or from your book store.

Cholesterol Levels:  Cholesterol is a substance made in the liver and found in animal foods that we eat.  While the body makes, and needs, some cholesterol, too much can increase the risk of heart disease.  You probably know that sub-fractions of cholesterol have different effects on us  - HDL cholesterol is the “good cholesterol” that can help prevent heart disease, while the LDL type is “bad” and can promote blockage in the arteries.  Family history, age and gender all play important roles in the cholesterol story.  Your clinician will do a blood test to determine the levels of all your blood fats, including triglycerides, and advise you on a plan to achieve or maintain normal levels.  If your levels are elevated, you may need to take medication, or you may be able to use diet, exercise and weight loss to bring your levels down.  It is a good idea to have a blood test for blood fats (also called lipid levels) in your twenties, and follow up as needed.  Know your levels, and proceed accordingly, in collaboration with your clinician. 

Weight:  As a country, we have gained a lot of weight.  The causes, as you know, are inactivity and unhealthy food.  Get a bathroom scale, and start weighing yourself regularly.  Many people weigh themselves daily to maintain a normal weight.  You can find your ideal weight at the clinic, or on the web – cdc.gov/healthy weight.  This link will also give you your BMI, or Body Mass Index.  Keeping a healthy weight is not just a question of how you look, but is directly associated with heart disease, diabetes, many cancers, and other problems.  The New York Times Magazine on 1/18/15 has an article about mice who were allowed to eat regular kibble, high fat food, or food with fats and sugars.  Those who could eat only in a 9 or 12 hour window remained sleek and healthy, in all groups. The researchers think that this ‘time restricted eating’ influences the body’s internal metabolic clock, and will probably help humans as well as mice.  “The clock starts with that first cup of coffee with cream and sugar.”  If you have had trouble with other weight loss plans, you could try this one.  However, every body needs healthy food – especially vegetables, protein, fruits and unrefined  grains.  Don’t eat junk food or mouse kibble for 12 hours instead of 24!

Know Your Numbers.  Don’t smoke. Avoid a beer belly.  That’s my final word for today.

Sadja Greenwood, MD, MPH

Medication Abortion - A Worldwide Trend

Do you remember the story of a Dutch ship sailing to Ireland in 2001, to provide abortions in international waters?  Rebecca Gomperts, the ship’s doctor, had set up an abortion clinic on board.  Hundreds of Irish women sought appointments when they docked in Dublin, However, conservative politicians in the Netherlands denounced Gomperts for potentially breaking a law that required a special license for any doctor performing abortions after 6 ½ weeks, a license they had failed to give to her.  Gomperts felt she must turn around without performing a single abortion, which she had planned to do with the abortion pills – mifepristone (formerly called RU-486) and misoprostol.  The pills are highly effective, about 98%.

Mifepristone has an anti-progesterone effect, causing the placenta to separate from the uterine lining.  Misoprostol causes uterine contractions which expel the early pregnancy through the cervix.  Misoprostol can also be used during labor, and to prevent or treat post-partum hemorrhage. It is sold in this country as Cytotech, and in this form used to prevent stomach ulcers.  It is sold in many countries, including Mexico, as an inexpensive, over the counter generic.  Women are using misoprostol alone, without mifespristone, frequently without directions as to the dose needed.  This is true in Texas as well as Mexico, as Texas has closed the majority of its abortion clinics.  Used correctly, misoprostol is about 80% effective in producing a complete abortion in early pregnancy. 

Back to Rebecca Gomperts - she did not abandon her plans, traveling with her ship to Poland, Portugal and Spain.  The enormous publicity resulting from her trip to Portugal in 2004 resulted in the legalization of abortion in that country in 2007.

As the word spread that there were pills that could end early pregnancy, women in many countries where abortion was restricted sent emails to the Gomperts website - Women on Waves, now also called Women on Web.  They currently receive about 2000 queries per month from women the world over seeking help with medical abortions.  After a doctor reviews each case to determine whether symptoms might indicate a tubal pregnancy, and whether the dates of last menstrual period mean that the pregnancy is not over 9-10 weeks, a prescription is sent electronically to a drug exporter in India, who sends the package with a tracking number.  Women on Web also sends an emails to the woman telling her how to take the pills and what to expect in terms of bleeding, cramping and pain. The help desk at Women on Web will answer questions during the process, and urge the woman to seek medical help if it sounds like there is a complication, such as excessive bleeding.  Women can claim they are having a spontaneous abortion in places where abortion is illegal.

The Indian company that exports the drugs is run by a man who is said to be dedicated and sympathetic to the women who need his services; he helps them with mail tracking problems, and keeps his prices low.

Women on Web will not provide service in any country with safe abortion services, such as the US, even though it can be hard to obtain abortions here in many areas.  Local laws and the FDA have made it difficult for doctors and clinics to provide what are called ‘medication abortions’ with the pills.   Nevertheless, the Guttmacher Institute says that 23% of non-hospital abortions are done with medication, and 36% of all abortions done before 9 weeks.  The percent of all US abortions done with medications has been increasing yearly, while the total number of abortions has decreased – currently about 1 million a year.  One US woman in 3 has had an abortion by the age of 45.  Abortion is one of the safest procedures done in the US, with fewer than 0.5% of women experiencing a complication. The risk of death associated with abortion is about one-tenth of that associated with childbirth. 

However, there are about 47,000 deaths annually from unsafe illegal abortions worldwide, mostly done with non-sterile instruments by untrained operators. 

Gomperts has left Women on Web, after a quarrel about her management style -  the so-called founder’s syndrome.  She obtained a Masters degree in Public Policy at Princeton, and is pursuing a PhD at the Karolinska Institute in Sweden.  We will probably hear more of this amazing woman in the future.  If you are interested, look at the websites of Women on Waves and Women on Web.  Donations help, as many desperate women in developing countries cannot afford the relatively small cost of the needed services.  The New York Times Magazine on Sunday, August 31^st, has a full story on Gomperts and her work. 

Sadja Greenwood, MD , MPH  back issues on this blog

Forests Forever?

Forests play an important role in the carbon cycle of the planet, taking

carbon dioxide from the air and putting it into their wood, roots and the soil beneath them.  According to the New York Times, 12/23/14, humans (that’s us) have cut down, burned or damaged three-quarters of the world’s forests, which has accounted for much of the excess carbon that is warming the earth. Scientists concluded years ago that deforestation must be stopped, to limit climate change and preserve biological diversity.  According to Nigel Sizer, director of forest programs at the World Resources Institute, “Every time I hear about a government program that is going to spend billions of dollars on some carbon capture and storage program, I just laugh and think, what is wrong with a tree?”  Richard Houghton, acting president of the Woods Hole Research Center, has argued for turning some 1.2 billion acres of marginally productive agricultural lands into forests.  This could be possible, researchers say, if farming in poor countries could become more efficient.  Dr. Houghton believes that his target of regrowth and protection of existing forests could slow the rapid growth of carbon dioxide, or possibly halt it.  This, he believes, would give the world a few decades for an orderly transition away from fossil fuels

Environmental organizations, such as Greenpeace, and mounting worldwide pressure, have helped corporate and governmental leaders in countries with tropical forests to begin to slow the cutting.  Forest regrowth is also in the works. Costa Rica is considered a forest success.  Although much of the country’s old growth forest had been cut down, new policies encouraged regrowth to cover more than half the country.  However, there is a threat to reforestation - a boom in pineapple farming that gives landowners an incentive to cut down recovering forest plots.  The pineapples will mainly be exported as a cash crop.

The Amazon, spreading across nine countries of South America, is the world’s biggest tropical forest.  Brazil has cut down millions of acres of the Amazon for timber, cattle ranching and soybean farming.  The soybeans were mainly used to produce meat for Western fast food companies. After Greenpeace invaded McDonald restaurants and put up poster of Ronald McDonald with a chain saw, McDonald and other companies pressured their suppliers to stop buying products linked to deforestation.  Pressure from the Brazilian government and large business groups has resulted in a sharp drop of deforestation, by 83% over the past decade.  The Brazilian Ministry of Agriculture focused on helping farmers raise yields without needing additional land.  The carbon dioxide kept out of the air by Brazil’s  actions far exceeded anything done in the world to slow global warming, according to the New York Times article.

Indonesia is the new test case for environmental groups; deforestation is rampant there – to clear land for the production of palm oil from a type of palm tree. Palm oil is used in many processed foods – ice cream, candies, baked goods and even lipstick. 

Since the (partial) demise of hydrogenated oils – so called trans fats – palm oil has been used as a replacement.  Despite its high levels of beta carotene, it is not a health food, as it is a saturated fat that can raise levels of cholesterol.  Deforestation of Indonesian forests to produce palm oil has resulted in serious environmental damage and has put the Sumatran orangutan on the critically endangered list.  Indonesia is working on better forest regulation.  This has caused palm oil producers to move to Africa.

Here is action plan for us, the lowly enlightened eaters.   Do not buy animal food if the animals have been fattened with soybeans – the beans have probably come from Brazil (and sprayed with Roundup since they are GMO).  Soybeans from the US, unless they are organic, are also sprayed with Roundup, which has endangered the Monarch butterfly by killing milkweed.  2,4-D is also being used on US soybean crops.  Do not buy pineapples from Costa Rica – support their ecotourism instead.   Read labels very carefully on all manufactured foods, and don’t buy anything containing palm oil. Support family planning in every way you can. Population growth is destroying the environment.  Plant a tree. Your actions count – every day!  Happy New Year.  Feliz y Prospero Año Nuevo.

Sadja Greenwood, MD, MPH  Leave me a message!

Chocolate - A Holiday Update

 

The first people known to have made chocolate from the cacao tree were members of the ancient cultures of Mexico and Central America. The Maya and Aztec people took the tree from the rainforest - they harvested, fermented, roasted and ground the seeds into a paste. When mixed with water, chile peppers, cornmeal and other ingredients, this paste made a frothy spicy chocolate drink. The word ‘chocolate’ comes from a combination of the terms ‘choco’ (foam) and ‘atl’ (water).

*Nitric Oxide (NO) Dr. Norman Hollenberg at Harvard University has studied the ability of cocoa to increase the amount of nitric oxide (NO) in the body. NO is a gaseous ‘signaling molecule’ that crosses membranes and freely diffuses between cells. It signals the muscular coating around arteries to relax, thus improving blood flow and lowering blood pressure. Several medicines are based on this effect - nitroglycerin is a vasodilator because it is converted to NO in the body and Viagra stimulates erections by the effects of NO on blood vessels in the penis. Another protective effect of NO on the cardiovascular system is its inhibition of blood clotting and the adhesion of white blood cells to the lining of blood vessels.

*Flavonoids – Flavonoids are a group of compounds found widely in plants that produce healthy effects on animals who eat them. Many flavonoids activate the nitric oxide system. Cocoa is one of the richest sources of flavonoids (although current processing techniques reduce the content). Dr. Hollenberg and colleagues in Panama studied the Kuna Indians who live off the coast of Panama; the Kuna drink lightly processed cocoa as their main beverage and therefore have one of the world’s richest diets in flavonoids. The Kuna do not show an increase of blood pressure with aging, or decline in kidney function. Their death rates from heart disease, stroke, diabetes and cancer are markedly lower than those of genetically similar Kuna in mainland Panama, where cocoa is replaced by local foods. The researchers wrote a paper on the Kuna, concluding that “the comparatively lower risk among Kuna in the San Blas islands from the most common causes of morbidity and mortality in much of the world, possibly reflects a very high flavanol intake and sustained nitric oxide synthesis activation. However, there are many risk factors and an observational study cannot provide definitive evidence.”

In the Dutch Zutphen Study, cocoa intake specifically was associated with a 50% reduced risk of cardiovascular mortality between the highest and lowest quintile of intake in 470 elderly men. These epidemiologic data led to the hypothesis that the health benefits of cocoa may be linked to its flavonoids. Both the flavonoid content and the total antioxidant capacity have been shown to increase in plasma after cocoa consumption.

*The University of Michigan has summarized the benefits of dark chocolate as follows:

*Decreases LDL (“bad”) cholesterol oxidation

*Reduces the risk of blood clots

 *Increases blood flow in arteries and the heart

*May lower high blood pressure

*Cocoa may have a beneficial effect on cholesterol levels because it consists mainly of stearic acid and oleic acid. Stearic acid is a saturated fat, but unlike most saturated fatty acids, it does not raise blood cholesterol levels. Oleic acid, a monounsaturated fat, does not raise cholesterol and may even reduce it.

*May improve mood and pleasure by boosting serotonin and endorphin levels in the brain

*Regular intake is associated with better cognitive performance in the elderly

*Contains a number of minerals, including calcium, magnesium, and potassium

*CocoaVia by Mars The Mars company has been studying the health benefits of chocolate for over a decade, and has isolated the particular flavonol in cocoa that relaxes blood vessels and inhibits clotting. Their formula for this - a trade secret - is in their chocolate bar CocoaVia, along with plant substances (sterols) that lower cholesterol. CocoaVia is available in some stores and on line, in an unsweetened version as well as in a bar.  As far as I know, CocoaVia products are not labeled as organic or fair trade. 

*Theobromine Chocolate has a mild stimulating effect due to theobromine, a substance similar to caffeine. People sensitive to caffeine and parents of young children should be cautious about this, and avoid chocolate close to bedtime.  Do not let your dog eat chocolate – dogs cannot metabolize theobromine and can develop epilepsy, have a heart attack or die from eating it.

*Oxalates – Chocolate is a source of oxalates, which can be a problem for people who have had calcium oxalate kidney stones.  If you are at risk, talk to your doctor – and drink lots of water!

*Healthy Chocolate for You! You can buy organic, fair trade, dark chocolate bars locally, and in many markets.  Look for a bar that has 70% cocoa or higher.  Note the caloric content if you are watching your weight.  You can also find unsweetened cocoa powder, and make sure it is not ‘dutch processed’, which will lower its flavonoid content. Make a cocoa drink with 1% milk, soy or nut milk, or hot water, and sweeten it with xylitol (a healthy sugar that’s good for your teeth!) or stevia or both. You can skip sugar by mashing a banana with unsweetened cocoa powder, and add peanut or almond butter if desired. You can make a shake with your favorite ingredients and add cocoa powder and pomegranate concentrate for sweetness. Purists can buy organic, fair trade cocoa nibs and eat them with raisins for sweetness. Buying ‘fair trade’ cocoa or chocolate bars is important, because cocoa producers in Latin America are often badly underpaid and in Africa child labor is a serious problem. The fair trade label ensures that the cocoa workers are decently treated.

Sadja Greenwood, MD, MPH  back issues on this blog

Sleep Apnea - What is it? What can help? The Didgeridoo?

Each time you breath in, muscles in your throat, chest and diaphragm help you inhale; air flows from your nose and mouth into your lungs  - the breath of life.  During your waking hours your breathing is usually regular and automatic, unless you suffer from asthma or other lung diseases.  Throat muscles are important, although we are generally not aware of their action, by keeping the  airway open and stiff so inhalation is easy. When you sleep, these throat muscles may relax, narrowing your airway.  Normally, this narrowing doesn’t prevent air flow in and out of your lungs.  But if you have sleep apnea, your airway can become partially or fully blocked because of factors like these: 

*Your throat muscles and tongue relax more than normal.  Aging may play a role here.

*Your tongue and tonsils may be large compared to the opening into your windpipe.

*Overweight may cause extra fat tissue to thicken the wall of the windpipe, narrowing it and making it harder to keep open.

*The shape of your head and neck may result in a smaller airway size. 

Apnea is a word that means the suspension of breathing.  During sleep apnea, when the opening to the windpipe is narrowed or closed, people snore loudly and/or stop breathing for a time. Breathing may stop for up to a minute. Blood oxygen levels drop, triggering the brain to disturb sleep.  This helps to tighten airway muscles and open the windpipe.  Normal breathing starts again, often with a snorting sound.  When this happens repeatedly during the night, drops in oxygen levels and constant waking can result in the release of stress hormones.  A risk of high blood pressure, heart attack, stroke and irregular heartbeat is increased.  People with this condition often have excessive daytime fatigue because of sleep disturbance.  They often do not experience REM sleep and do not have dreams. 

Sleep apnea can be greatly helped by  a device called CPAP – continuous positive airway pressure, as well as by certain dental devices.  Many people with sleep apnea have used these treatments, which are important and helpful.  However, it is not easy for everyone to get used to these treatments and use them regularly. Weight loss is also helpful for some people with sleep apnea.

Since the human mind is infinitely inventive, new treatments that involve breathing techniques were bound to emerge. Instructors teaching the didgeridoo noted that their students reported reduced daytime sleepiness and less snoring after practicing the instrument for several months.  In Zurich, a group of doctors, respiratory therapists and sleep therapists decided to test the proposition that training the upper airway by digeridoo playing would reduce daytime sleepiness, due to training the muscles of the upper airways that control airway dilation and wall stiffening.  The recruited 25 patients, average age 50, who had moderate sleep apnea and were willing to learn the didgeridoo.  Half the patients became a control group, who had to wait for 4 months before taking the didg training.  The patients had weekly lessons, and were told to practice for 20 minutes 5 times a week.  They were instructed in circular breathing.  Apparently the practice was enjoyable, as compliance was excellent – the subjects practiced 6 days a week, and there were no dropouts.  The same was true of the control group, who started didg playing 4 months later.  The study found that patients had reduced daytime sleepiness and snoring – the effectiveness of didg playing was slightly less than that of regular CPAP use, but still notable.  The study was published in the British Medical Journal in 2006.

A study in Australia looked at the effectiveness of didgeridoo playing on boys with asthma.  The comparison group was singing lessons for girls.  Asthma is a problem for 15% of Austrian Aborigines, probably because of poverty and poor living conditions.  Girls are not supposed to play the didgeridoo in public for cultural reasons.  Asthma relief was more pronounced for the didg players than the singers. Playing the didg has a pronounced effect on lung capacity, relaxation and the ease of controlled breathing.  The study was published in Music and Medicine in 2013.

I have been taking classes in didgeridoo playing in Petaluma, and have found playing the instrument to be calming, mesmerizing, and helpful for my lungs. I love the sound of the low vibrations. Other people in the classes have found improvement with their sleep apnea.  The teacher, Elise Peeples, will be giving an introductory class in January as well as continuing lessons.  The classes will take place on Saturday morning in Petaluma.  I plan to post fliers about the classes and also give them to local doctors who may want to refer their patients.  Feel free to contact me if you are interested.  Full disclosure – I am crazy about wind instruments. 

Sadja Greenwood, MD, MPH  Back issues on this blog!

The Color Purple

I ‘m not referring to the amazing novel by Alice Walker, which won the 1983 Pulitzer Prize and the National Book Award for fiction.  I’m not writing about the movie with Whoopi Goldberg, Danny Glover and Oprah Winfrey, directed by Steven Spielberg, although I am planning to see it again.  I’m writing about (you guessed it) the benefits of purple foods, such as, purple cabbage, the skin of eggplant, purple corn, black rice, raspberries, cherries, blueberries, blackberries, cranberries, blood oranges, dark grapes and red wines. The dark red and purple color in these foods contain a pigment known as anthocyanin, which may appear red, purple or blue depending on the pH. 

Anthocyanins occur in the leaves, stems, flowers, fruits and roots of many plants.  Their colors attracts pollinators and other animals, enhances the scattering of seeds, and also protect plants from sun damage. 

Researchers at Ohio State University have done studies on human colon cancer cells and in rats, to determine what gives anthocyanins cancer –protective properties.  Extracts derived from purple corn were the most potent, with chokeberry and bilberry extracts also effective in reducing colon cancer cell growth in laboratory dishes. The researchers said that only small amounts of anthocyanin is absorbed by the blood stream in animals, but a large portion travels through the gastro-intestinal tract, where tissues absorb the compound. Anthocyanins may also help with esophageal cancers.   The researchers also noted that plant pigments such as anthocyanins could be used instead of synthetic dyes to color foods and enhance their health-promoting properties.

A comprehensive review of anthocyanin consumption and human health was published by an Italian research center in 2013.  They cited papers showing that anthocyanins  can protect against heart disease, obesity and diabetes, and gave rodent pancreatic cells increased insulin secretion.  Anticancer activity was found in leukemia cells, colon cancer cells, oral cancer cells, and other forms of cancer.  Laboratory studies have shown that anthocyanins can inhibit malignant cell growth, and stimulate apoptosis (tumor cell death).  The authors cited studies showing potent anti-oxidant activity of anthocyanins, which is enhanced by the other phytonutrients and vitamins in fruits.  Studies have shown neuroprotective  activity in animals with brain injuries, memory problems and visual decline with aging.  Recent studies also indicate that anthocyanins can inhibit the growth of some pathogenic bacteria, and may enhance the growth of healthy bacteria in the intestinal tract. 

What inspired me to write this column were the purple yams now on sale at the Bolinas People’s Store.  They are deep in color and amazingly good.  I also recall that Dr. Donald Abrams, an integrative oncologist at UCSF’s Osher Center, has said that he eats a yam every day of the year.   My advice:  Try those yams and also purple potatoes.  Once you plant the little Peruvian potatoes in your yard (gopher proof area) they will keep on giving, I have some ready to plant – call me if you want a few.  They are hardy in the winter. Include berries in your diet as often as possible, including frozen berries during the winter months.  Stock up on the cranberries now in season, and freeze some for later.  Eat prunes – they are purple plums and are high in anthocyanins.  Get purple popcorn and black rice at a natural food store.  Just think of the color purple; it’s powerful. 

Sadja Greenwood, MD, MPH – back issues on this blog

Artificial Sweeteners Can Undermine Your Diet

All those non-caloric packages of saccharin, aspartame, or neotame (lots of different trade names – Splenda, Equal, etc) you may have been putting in your coffee have been found to make changes in your intestinal bacteria  - changes that can actually move you towards diabetes.  The same is true for sugar free colas and other diet drinks.  Researchers at the Weizmann Institute of Science in Israel started working with mice, and showed that the artificial sweeteners induced glucose intolerance – which occurs when the body cannot cope with the amount of sugar in the diet.  They found that the gut bacteria, known as the gut microbiome, were involved – reacting to the sweeteners even though the body does not recognize these substances as food.  The artificial sweeteners changed the composition of bacteria in the microbiome, and induced glucose intolerance.  The new microbial functions are known to infer a propensity to obesity and diabetes.

The researchers then enlisted a group of human volunteers who did not generally use artificially sweetened food or drink, and had them consume them for a week.  Many, but not all of the volunteers began to develop glucose intolerance after a week.  The composition of their gut microbiome explained the differences.  The researchers found two different populations of gut bacteria – one that induced glucose intolerance when exposed to artificial sweeteners and one that had no effect either way.  They believed that certain bacteria in the guts of those who developed glucose intolerance reacted to the chemical sweeteners by secreting substances that provoked an inflammatory response similar to sugar overdose, promoting changes in the body’s ability to utilize sugar.

Here’s how Dr. Elinav of the Weizmann Institute summarized his findings:  “Our relationship with our own individual mix of gut bacteria is a huge factor in determining how the food we eat affects us.  Especially intriguing is the link between use of artificial sweeteners – through the bacteria in our guts – to a tendency to develop the very disorders they were designed to prevent; this calls for reassessment of today’s massive, unsupervised consumption of these substances.”

What is a person to do with this new information if s/he uses artificial sweeteners?  Here are some answers I found on the internet:  add cinnamon to your coffee, or a little unsweetened cocoa.  Try milk, cream, Almond Milk or unsweetened coconut milk.  Many people use Stevia - from the leaf of a tropical plant. Only a drop is needed, though some find it has a bitter aftertaste.  Not enough research has been done to tell if Stevia can alter the microbiome.  I have used xylitol and concentrated pomegranate juice to sweeten cocoa.  Xylitol is a sugar made from hardwood trees, corncobs or other plants, with 33% fewer calories than sucrose per gram.  It has dental health properties, as it increases saliva production and is not metabolized by mouth bacteria.  Bacteria are unable to produce as much acid in the presence of xylitol, so that the teeth are less damaged by acid and plaque.  Many toothpastes are sweetened with xylitol.  This would be my recommendation for people who want sweeteners in their coffee or tea – carry a little home made packet of xylitol. Chew xylitol gum during the day as well if you have problems with cavities (talk to your dentist first!).  You can get xylitol at the Palace Market, the Bolinas People’s store, and most natural food stores.  A xylitol gum called Spry is also available at markets and on the internet.    If your passion is diet soft drinks, try substituting plain carbonated water with slices of lemons and oranges.

Good luck – it takes time to change a habit, but it can be done. 

Sadja Greenwood, MD, MPH   back issues on this blog