Some Good News About Family Planning, and Some Bad News

The U.S. has one of the highest rates of teenage pregnancy in the developed world, with more than 600,000 teens becoming pregnant each year.  Recent efforts to make contraception available, accessible and cost-free have made progress.  A program launched by Washington University School of Medicine in St. Louis, Contraceptive CHOICE, enrolled over 1400 girls ages 14-19 who were sexually active, and followed them from 2007-2011.  Teens were told about all methods of family planning, and instructed that long-acting reversible methods were the most effective.  These methods were contraceptive implants, chosen most often by younger teens, and IUDs, preferred by teens ages 17-19.  The program was free of charge.  Findings were that the teenage pregnancy rate among girls in the study was 34/1000 teens, compared to 159/1000 teens nationally.  The abortion rate of girls in the study was 9.7/ 1000 teens, compared to 41.5/1000 nationally. 

Despite the success of the CHOICE program, there is hesitancy on the part of some parents and family planning providers, who fear that greater access to more effective contraception will encourage young people to have sex.  Similar fears exist with respect to sex education in schools.  Many studies have shown that this is not true.  Other fears are based on the belief that long acting contraception such as IUDs and hormonal implants will cause infertility, which is also not shown to be the case.  In the current political climate in the US, finding federal funding for family planning will be difficult.  Private foundations funded the St Louis project.   However, since contraception is provided free of charge in Obamacare, regional efforts to prevent teenage pregnancy with long-acting, reversible methods are underway. Family planning clinicians will need training for insertion and removal of contraceptive implants in the upper arm.

Legal Abortion in Latin America

 Cuba, Puerto Rico and Guyana allow abortion upon request.   Many Caribbean countries have liberal policies. Since 2008, first trimester abortions have been legal in Mexico City, where they are provided free of charge at public health centers and hospitals.  Abortions are also available for a fee from private clinics.  However, some Mexican states still have very restrictive laws and have jailed women for seeking or obtaining abortions. According to the United Nations, more than 500,000 Mexican women seek illegal abortions every year, with more than 2000 dying from unsafe procedures. Poverty and difficulty in getting to Mexico City plays a role in this situation.    Uruguay legalized abortion in 2012.  Prior to legalization, the punishment for having an abortion was 3-12 months in prison, while performing an abortion could lead to 6-24 months in prison.  The new law, passed in 2012, legalizes abortion within the first 12 weeks, provided it is discussed with a panel of social workers and doctors, who will advise the woman on risks.  The woman must then wait 5 days to ponder her options, and the last word is hers.  The procedure is paid for by the country’s universal health care.

Colombia has also made abortion legal under certain circumstances – rape, incest, mental health of the woman, and serious fetal malformations, but the procedure is very difficult to obtain and most women still go the illegal route in that country.  Latin America is home to 5 of the 7 countries in the world where abortion is banned in all instances, even when the life of the mother is at risk: Chile, Nicaragua, El Salvador, Honduras and the Dominican Republic.  (The 2 countries outside Latin America are the Vatican City and Malta. )

Currently, in the U.S., many states are passing or planning to pass laws restricting access to abortion.  Planned Parenthood is under attack for accepting money for the costs of providing fetal tissue to universities for stem cell research, and may completely lose its funding from Congress. This makes up about 40% of its yearly income. It should be noted that federal funding for Planned Parenthood is not for abortion care but for contraception, and testing for sexually transmitted diseases and breast and cervical cancer.  What will happen as a result of this is the subject for another article.  Look for a substantial increase in the use of  misoprostol  for do-it-yourself abortions. While this method is much safer than the coat-hanger abortions of the past, it is a tragic and infuriating development in the land of the free.

 

Sadja Greenwood, MD, MPH  past issues on this blog

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How Your Diet Affects Your Brain

A study at Oregon State University, published in the journal Neuroscience, showed that diets high in fat and/or sugar cause changes in gut bacteria that appear related to a loss of ‘cognitive flexibility’.  This is the power to adjust and adapt to changing situations.  A high sugar diet had the strongest effect, also showing an impairment of  long and short term memory.  

These problems may be linked to alteration in the microbiome, the complex mixture of about 100 trillion microorganisms living in your digestive system.  It is comprised of many different species of bacteria, yeast, fungi and even viruses.  

These microbes help us obtain nutrients from foods we normally can’t digest, and also help to protect us from infections by disease causing bacteria.  The microbiome in each person changes over time, depending on the food that is eaten.  Different microorganisms prefer different food, so species may grow or decline in numbers depending on what you choose to eat.  Some people take foods that contain live bacteria, such as yogurt or probiotic supplements.  Probiotics must be consumed regularly to maintain the bacteria they contain, or the microbiome may revert to what it was before their introduction.  

The study at Oregon State was done by Kathy Magnusson, who tested laboratory mice who consumed different diets.  The animals then faced a variety of tests, assessing changes in their mental and physical function.  She found that after just four weeks on a high-fat or high-sugar diet, the performance of mice on various tests of mental and physical functioning began to drop compared to animals on a normal diet. 

 Mice have proven to be a particularly good model for studies relevant to humans on such topics as aging, spatial memory and obesity, according to Dr. Magnusson.  Comparable studies in humans would be extremely costly, due to difficulties in recruiting subjects, securing agreement on the assigned diet, and keeping subjects adhering to the plan for weeks.

The mechanisms by which diet can affect behavior is still under study.  Bacteria in the microbiome can release compounds that act as neurotransmitters, stimulate sensory nerves and modulate the immune system.  It is also possible that the types of fatty acids and carbohydrates in a particular diet my be transformed by the microbiome into compounds that enter the blood stream and affect cognition.  In the Oregon study discussed here, cognitive impairment in the mice was specifically related to an increased number of one group of intestinal bacteria  (Clostridiales) and a loss of two others (Bacteriodales and Lactobacillales).  The researchers guessed that the bacteria themselves somehow brought about the brain changes. 

Here’s a take-home lesson from this study: think about the importance of your microbiome and protect the good bacteria therein.  They thrive on vegetables and fruits, lots of fiber, healthy protein and healthy fats.  Don’t send donuts, soda pop or junk food their way.  Sugary foods may make your thinking less flexible.  Who needs that?  We all need to be able to adapt to our world of continuous, rapid change.

Sadja Greenwood, MD, MPH  back issues on this blog  Leave me a message if you wish

A New Approach to Interval Training & The MIND Diet

A New Approach to Interval Training

It has long been known that highly motivated athletes benefit from interval training, but that most people don’t stick to programs that call for all-out effort for 4 minutes, or even 30 seconds.  It’s hard!  Researchers in Denmark looked for easier ways to improve athletic endurance that would keep people motivated, even non-athletes.  They devised a method called 30-20-10 (some prefer to call it 10-20-30) that keeps the all-out effort down to 10 seconds, and yet is effective in improving overall speed, endurance, and also may bring down blood pressure and LDL cholesterol in some adherents.  Here’s how it works.  Warm up at an easy pace by jogging, riding a bike, rowing, or walking before you begin the intervals.  Then start by spending the first 30 seconds at a easy, gentle pace, the second 20 seconds going moderately hard, and the final 10 seconds in all out effort.  Do five of these 30-20-10 intervals in a row, and then rest for two minutes by standing or walking slowly.  Do one more set of the five intervals and then stop for the day.  The Danish researchers recommend that you take a day off between this method of training.  

If you are already a jogger, rower or cyclist, this type of interval training my help you improve your speed in less time and with less pain.  If you are not in shape, be sure to have a checkup with your healthcare provider, and start with a gentle walking program.  Don’t take chances with your heart!  If all goes well, you can bring interval training into your walking program as time goes on.

The Mind Diet

Researchers at Rush University in Chicago have published a study in the journal Alzheimer’s and Dementia in which they describe the benefits of what they call the MIND Diet .  This diet, a combination of the Mediterranean diet and the Dietary Approach to Stop Hypertension (the DASH diet) was shown to lower the risk of Alzheimer’s by as much as 53% in participants who adhered to the plan rigorously, and by about 35 % in those who followed it moderately well.  The diet advises people to eat the following foods:  green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and a glass of wine.  Salad is advised daily, along with another vegetable.  Three servings of whole grains are advised.  The diet also involves snacking on nuts most days, eating beans every day or so, poultry and berries at least twice a week and fish at least once a week.  Blueberries and strawberries are considered especially helpful for the brain.  

Foods to avoid include: red meat, butter and stick margarine, cheese, pastries and sweets, fried foods and fast foods.  Butter should be less than a tablespoon daily, the other foods should b eaten less than once a week.

Subjects for the Rush University study were volunteers already participating in the Rush Memory and Aging Project.  They were enlisted among residents of Chicago-area retirement communities and senior public housing.  The study began in 1997; an optional food frequency questionnaire was added from 2004 to 20013.  There were 923 volunteers, and 144 cases of Alzheimer’s developed in this cohort.  In this study, the diet plan was shown to lower the risk of Alzheimer’s by as much as 53% in participants who adhered to the plan rigorously, and by about 35 % in those who followed it moderately well.  

It is important to know that there are lifestyle interventions that can help reduce the risk of dementia.  Exercise is one of them, and the dietary approaches outlined here (familiar to all my readers!) can be added to the list.   Give a virtual hug to our local farmers and the workers at the People’s Store, who make adherence to a healthy diet so easy and pleasant.

Sadja Greenwood, MD, MPH   

New Thinking About Calories

A paper just published in the American Journal of Clinical Nutrition has caused nutrition experts to rethink the adage – a calorie is a calorie.  In terms of weight gain in humans, “foods have complex mechanisms that help or hinder weight long term”  according to the paper’s authors.  Researchers from Tufts and Harvard Universities examined 24 years of data on 121,000 men and women.  Subjects were nurses and doctors from the Nurses’ Health Study and the Health Professionals Follow-Up Study.  Subjects, initially free of obesity or chronic illness, completed detailed food questionnaires.  Their weight gain was measured every four years, and results were adjusted for lifestyle changes such as physical activity, sleep, and total calorie intake.  The study found the following associations between protein foods and weight:

1) Meats, chicken with skin and regular cheese were associated with weight gain..

2) Milk, legumes, peanuts and eggs were not associated with weight gain or loss.

3) Yogurt, peanut butter, walnuts and other nuts, skinless chicken, low fat cheese and seafood were associated with relative weight loss.

Starches with minimal fiber, such as white bread, white potatoes, and white rice were associated with weight gain, and found to be similar to added sugar.  (Many breakfast cereals are almost entirely refined starch with added sugar.)

The take-home message from this paper, as I see it, is that protein foods vary greatly in their ability to keep you sleek and healthy.  Choose from groups 2 and 3 as often as possible, and always be mindful of the need for vegetables, fruits, fiber and healthy fats.

More on Fiber:  Another study from Harvard, published in BioMed Central Medicine, showed that middle aged and older subjects, followed for over 10 years, gained substantial benefits from whole grain foods.  Those who ate the most whole grain were 17% less likely to die in the study period compared to those who ate the least amount.  They were less likely to be obese, and less likely to suffer premature death from lung disease, diabetes and cancer.  People sensitive to gluten in wheat can still get plenty of whole grain and fiber from oats, quinoa, buckwheat, brown rice and corn.

,More on Vitamin D:  A recent study from Tufts University showed that a vitamin D supplement will be better absorbed when taken in a meal containing fat.  Fat stimulates the release of bile into the small intestine, which will make it easier for the body to absorb fat-soluble vitamin D.

Sadja Greenwood, MD, MPH

Short Walks, Squirm to Learn, Diet Swap to Prevent Colon Cancer

Short Walks Reverse the Problems of Sitting

You probably know that prolonged sitting isn’t healthy – it can actually reduce your lifespan.  Here’s the good news – taking a 2 minute walk every hour can reverse the damage. Research from the University of Utah has shown that people who engage in two minutes of walking every waking hour come close to achieving the 2.5 hours of moderate exercise each week - the amount that strengthens the heart, muscles and bones and extends the lifespan.  My suggestions – set an alarm when you are working at your desk, and walk around with gusto every hour.  Get up during all commercials when you watch television – that will give you much more strolling time.    This regimen may be better than sitting all day and then taking a run or going to the gym.  Stay tuned. 

Squirm to Learn

A new study from the University of Central Florida showed that children with attention deficit/ hyperactivity disorder (ADHD) learn better if they are allowed to engage in foot tapping, leg swinging and chair scooting movements. This kind of movement is vital to how they remember information and work out cognitive tasks. Children without hyperactivity learn less well if kept in motion.  Mark Rapport, head of the Children’s Learning  Clinic at the University of Central Florida said ”The message isn’t ‘let them run around the room’ but that you need to be able to facilitate their movement so that they can maintain the level of alertness necessary for cognitive activities.  A majority of students with ADHD could perform better on classroom work, tests and homework if they’re sitting on activity balls or exercise bikes, for example.”  This message may be true for adults as well – if you have always been a fidgeter and think you have a version of attention deficit disorder, try reading on a slow treadmill or exercise bike.  It may improve your concentration. 

Diet Swap has dramatic effects on colon cancer risk

Scientists at Imperial College in London and the University of Pittsburgh have found dramatic effects on risk factors for colon cancer when American and African volunteers swapped diets for just two weeks. Western diets, high in protein and fat but low in fiber are thought to raise colon cancer risk compared to African diets high in fiber and low in fats and protein.  Colon cancer rates are much higher in the western world than in Africa or Asia.  A group of 20 African American volunteers and another group of 20 people from rural South Africa swapped diets under tightly controlled conditions for two weeks.  The volunteers had colonoscopy exams before and after the diet swap – researchers also looked at biological markers for colon cancer and samples of colonic bacteria.  In the start, almost half of American subjects had colonic polyps (which can progress to cancer) and none of the Africans had these growths.  After two weeks on the African diet, the Americans had significantly less inflammation in the colon and reduced biomarkers of cancer risk. In the African group. measurements indicating cancer risk had increased dramatically after two weeks on the western diet.

Professor Stephen O'Keefe at the University of Pittsburgh, who directed the study, said: “our study suggests that westernization of the diet induces changes in biomarkers of colon cancer risk in the colonic mucosa within two weeks. Perhaps even more importantly, a change in diet from a westernized composition to a 'traditional African' high fiber low fat diet reduced these biomarkers of cancer risk within two weeks, indicating that it is likely never too late to change your diet to change your risk of colon cancer."

The study found that a major reason for the changes in cancer risk was the way in which the bacteria in the gut -- known as the microbiome -- altered their metabolism to adapt to the new diet. In the American group, the researchers found that the African diet led to an increase in the production of butyrate, a byproduct of fibre metabolism that has important anti-cancer effects.

The take home message here is – eat plant foods high in fiber. Refined flours, sugars and all kinds of processed foods should be seriously questioned and left on the grocery shelf. 

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

The Dirty Dozen and the Clean Fifteen

If you look at labels carefully and aim to buy organic food, you can feel healthy and wise.  Toby’s, the Palace Market, the Farmer’s Market (coming soon!). the Bolinas People’s Store, the Murch and Weber Farm Stands will provide you with wonderful choices of organic produce.  Whole Food, The Good Earth, Trader Joe's are other good options You can send this column to your friends who live on fast food.  But, if you eat out on occasion, pay attention. 

The Dirty Dozen  

Every year the Environmental Working Group analyzes pesticide residues on produce and publishes a guide for shoppers and eaters.  Here is their 2015 guide to fruits and vegetables containing containing the heaviest  pesticide residues: They have named these items the Dirty Dozen.  Try to find organic versions of these foods, or grow them yourself if possible. 

Apples, peaches, nectarines, strawberries, grapes, celery, spinach sweet bell peppers, cucumbers, cherry tomatoes, snap peas (imported), potatoes.

The average potato had more pesticides by weight than any other item.  A single grape sample and a sweet bell pepper sample contained 15 pesticides.  Single samples of cherry tomatoes, nectarines, peaches, imported snap peas and strawberries contained 13 different pesticides.  Additionally, hot peppers, kale and collard greens were frequently found to be contaminated with pesticides. 

 The Clean Fifteen

 Avocados, sweet corn, pineapples, cabbage, sweet peas (frozen), onions, asparagus, mangoes, papayas, kiwi, eggplant, grapefruit, cantaloupe, cauliflower, sweet potatoes

Avocados were the cleanest: only 1% of avocado samples showed any detectable pesticides.  89% of pineapples, 82% of kiwis, 80% of papayas, 88% of mangos and 61% of cantaloupes had no residues.  When you think about your food budget, you can buy non-organic forms of the ‘clean fifteen’ with less concern.  However, all produce should be washed with tap water before eating; adding dilute vinegar will also help to remove bacteria and other germs.

Should You Worry about Pesticides

According to the Stockholm Convention on Persistent Organic Pollutants, 9 of the 12 most dangerous and persistent chemicals are pesticides.  Reviews have found that most studies on non-Hodgkin lymphoma and leukemia showed positive associations with pesticide exposure.  Strong evidence also exists for an association between pesticide exposure and neurological problems, birth defects, fetal death and developmental disorders of the nervous system.  Pesticide exposure has been linked to melanoma in farm workers.  Studies on links to other diseases are ongoing.  Pesticide exposure to farm workers who apply these chemicals is especially strong. 

I advise readers to keep a list of the dirty dozen and clean fifteen in their wallet, so that they can ask questions and/or be wary when eating at a restaurant or a party.  We should count our blessings to live in West Marin, where organic food is so easy to obtain, and – if you choose wisely – affordable.  Finally – check out the website of the Environmental Working Group, and make a donation if you are so inclined. They do a great job in keeping us informed. 

Sadja Greenwood, MD, MPH  

Know What You Are Taking!

The internal functions of our bodies are controlled by the so called ‘autonomic nervous system’, which is made up of the sympathetic system, the ‘fight or flight’ branch, and the parasympathetic system, the ‘rest and digest’ branch. This article will focus on the parasympathetic system, and drugs that block its actions.   These drugs are called anticholinergics; they are found in a wide variety of over the counter and prescription medications, including some antihistamines, certain antidepressants, and drugs used for an overactive bladder. 

Several recent studies have shown an increased risk for pneumonia and also for cognitive decline in older people (ages 65-94) using these drugs.  A study from the University of Washington, published in the Journal of the American Geriatrics Society, showed a significantly higher risk of developing pneumonia among 3000 elderly members of a group health plan if they had taken prescription or over the counter anti-cholinergic medications in the past 90 days.   Another study from this same group showed a significantly increased risk of developing dementia, including Alzheimer’s disease, in elderly patients taking anticholinergic meds at higher doses for a longer time.  These drugs included Benadryl, which is used in several over the counter sleep aids, such as Nytol, Excedrin PM, Midol PM, Tylenol PM, and Advil PM. The study was published in JAMA Internal Medicine in 2015.

The authors of these studies concluded that patients should tell their doctors about all over the counter remedies they are using, and doctors should similarly inquire about all meds being taken.  The most commonly used medications in the dementia study were tricyclic antidepressants like Sinequan, antihistamines like Chlor-Trimeton, and Ditropan for control of an overactive bladder.  The risk of dementia increased after 3 years of use.  The authors concluded that substitute drugs that would be safer include SSRI antidepressants such as Celexa or Prozac, Claritin for allergies, and behavioral changes, rather than drugs, for an overactive bladder.  This would mean cutting back on caffeine and alcohol, and setting an alarm for every hour or two during the day as a reminder to urinate.

There are natural ways to get in close touch with your parasympathetic nervous system, which all my readers will know:  breathing exercises designed for self-calming, the relaxation response, meditation, massage, yoga, and chi-gong.  Wear blue-blocking glasses for an hour before bedtime to maximize your brain's production of melatonin to help you relax into sleep. (See Restorative Sleep, 4/9/12, on this blog)

Be sure to talk to your doctor or nurse practitioner about all meds and supplements you are taking at your next visit.  If you are older, or have elderly parents, be especially mindful.

 Sadja Greenwood, MD, MPH    Leave me a message, and I'll reply.  

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:

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“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