Sustainable Eating

This article is based on a special report from the Tufts University Health and Nutrition Letter, August 2019.

There is a dietary pattern that can help you and the earth – by promoting sustainable agriculture. Sustainable agriculture refers to ways of growing food and raising animals that conserve natural resources and have minimal impact on the environment.  Sustainable eating means choosing foods that are good for our bodies and the environment.  

The United Nations Sustainable Development Goals state that we must change the way we produce food to increase productivity and sustainability while also improving human health. Raising cattle has the biggest impact on the planet of any single human activity. It produces 15% of the world’s greenhouse gases and uses 1/3 of the world’s fresh water.  Decreasing beef consumption is an important way toward a more environmentally friendly use of resources.  

Nicole T. Blackstone, PhD, an assistant professor at the Friedman School of Nutrition and Policy, analyzed the three diets recommended by the Dietary Guidelines for Americans – the Healthy US-style, Mediterranean and vegetarian dietary patterns.  Her results, published in The Lancet Planetary Health, showed that the US-style diet was tops in land use and CO2 emissions, because it includes the largest amount of red meat consumption.  The Mediterranean diet was highest in water pollution, mainly because of water use in Spain to produce olive oil.  (Data on the Mediterranean diet came from Spain).  A vegetarian eating pattern had the lowest impact on all sectors – CO2 emissions, water depletion, land use, pollution of fresh water, oceans and the air.  This does not mean that all conscientious eaters must become completely vegetarian, but that we should all make gradual changes in that direction.  

In January of 2019 a body of experts published a report entitled Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.  They aimed to use the latest scientific evidence to develop a “planetary health diet” that is both health promoting and environmentally sustainable.  Their proposed pattern is largely plant based but optionally includes modest amounts of fish, meat and dairy foods.  Worldwide, adhering to this diet would mean doubling per-person intake of  fruits, vegetables, legumes and nuts while cutting consumption of red meat and sugars at least in half.   According to Nicole T. Blackstone these recommendations would mean eating no more than the equivalent of 3 ounces of red meat per week, which is about the size of a deck of cards.  Currently the average American eats 5 to 6 times that much..  This would be a big shift. Such changes can be made gradually.

 Regardless of what we eat, cutting down on food waste is of great importance.  U.S. consumers throw away nearly one pound of food per day.  All that food in landfills produce greenhouse gases.  Planning meals ahead, storing food properly, and using frozen fruits and vegetables are ways to save food and money.  Find someone who composts and give your food waste to him/her. For many of my readers in West Marin, these changes will not be difficult.  Please write me a note on this blog if you have questions.  Subscribe to the Tufts Health and Nutrition Letter if you want a great source of reliable information monthly – 800-274-7581

Sadja Greenwood MD, MPH

What's in Your Nail Polish? Berries and Brain Function

What's in Your Nail Polish?

This article is taken from the July,2019 Wellness Letter of the University of California, Berkeley.  Nail polish contains plasticizers to make it flexible and chip resistant, but also endocrine disruptors that may adversely affect reproductive health, fetal development and thyroid function.  There has been an effort in recent years to ban ingredients of known risk, but the substitute ingredients may be just as toxic. Nail polish is clearly an occupational hazard for salon workers.  For you, dear reader, go to the Environmental Working Group’s Skin Deep Cosmetic Database to look for guidance for choosing safer nail polish.  Alternatively, you could decide to give up nail polish and find other ways to decorate your toes and fingers.  At the present state of knowledge, this may be the wise thing to do. 

Berries and Brain Function

Blueberries have attracted a good deal of scientific attention for their ability to help the brain, but strawberries, raspberries, blackberries, and cranberries contain similar pigment compounds called anthocyanins, which give berries their red, purple and blue colors.  Anthocyanins can cross the blood-brain barrier to become localized in areas of the brain related to learning and memory.  Anthocyanins decrease the vulnerability to the oxidative stress that occurs with aging.  They reduce inflammation and may increase neuronal signaling.  In the Nurses’ Health Study, an analysis of 16,000 women over 70 suggests how berries might affect aging brains. The women were tested for memory and other cognitive functions every 2 years and completed dietary questionnaires every 4 years.  Those who consumed two or more half –cup servings of strawberries or blueberries per  week had a slower mental decline over time of up to 2 ½ years of delayed aging. Previous studies conducted at Tufts University found that blueberries improved short-term memory, navigational skills, balance, coordination and reaction time.  Berries retain their healthy qualities even when dried or frozen. You can enjoy them year round.

This article is taken from the journal Environmental Nutrition, a newsletter of food, nutrition and health. This newsletter is highly recommended by your writer, Greenwood.  Here’s another addendum from Greenwood:  Strawberries should be purchased in organic form whenever possible, as they are treated with about 20 pesticides, and are on the ‘dirty dozen’ list of the Environmental Working Group.  

Sadja Greenwood, MD, MPH

Do Not Open or Crush Tablets or Capsules Without Checking with Your Doctor or Pharmacist!

Information in this column comes from Public Citizen’s newsletter:  Worst Pills, Best Pills News. 

Some patients find it difficult or impossible to swallow large tablets or capsules.  This is especially true of the elderly, people with Parkinson’s disease or dementia, and young children.  To cope with this problem, patients may crush or chew tablets, or open capsules and sprinkle the resulting powder or fragments onto food or into liquids.  A review article from Prescrire International in 2014 warned that for many medicines this may have very serious results.  Drug companies combine their medicines so that they will be released at a specific rate and in specific locations in the digestive tract, such as the stomach or small intestine. Crushing, opening or chewing the medication can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach, or intestines.  

Drugs that have a low margin of safety for overdosing include digoxin (Lanoxin) and blood thinners.  Serious injuries including death can occur with tampering with these drugs.   A drug such as Prilosec, frequently given for gastroesophageal reflux (so called heartburn) and/or ulcers can be made ineffective by crushing or chewing the tablet, allowing the stomach acid to inactivate the Prilosec and rendering the drug ineffective.  Prilosec and related drugs are available over the counter.  The label advises consumers to swallow the medicine whole.  Many people ignore these warnings.  Do not be one of them!  You should never crush a tablet, open a capsule or chew one without checking first with the prescribing health care provider or the dispensing pharmacist.  There may be a smaller tablet or capsule of the same drug, or another drug that you can swallow, or that can be safely crushed or opened before ingesting.  

Sadja Greenwood  MD, MPH

Magnificent Trees Should Not Go Down the Drain

 This article is taken from a report by the Natural Resources Defense Council, (NRDC).

Below the Arctic Circle, the largest intact old growth forest rings the globe.  Canada’s share of this boreal forest is vast.  It is a dense mix of spruce and fir trees mixed with aspen and birch, with peat bogs and verdant wetlands. More than 3 billion birds migrate there to breed – whooping cranes, the great gray owl, and a majority of North American songbirds.  Year-round residents include the Canada lynx, moose, pine marten and woodland caribou, as well as more than 600 communities of indigenous people who have relied on the forest’s bounty for millennia.  

Canada’s boreal forest is being leveled at an alarming rate – a million acres a year.  The oil and gas industries have added to the destruction, but the greatest threat is from logging, driven in large part by the rapacious demand in the U.S., the destination of more than 3/4ths of all boreal wood products.  The wood ends up as lumber, packaging and throwaway tissue products like paper towels and toilet tissue.  No major brand of toilet paper, facial tissue or paper towels, such as Procter & Gamble, Kimberly-Clark or Georgia-Pacific contains any recycled content. A recent paper by Shelley Vinyard at the NRDC, entitled The Issue with Tissue: How Americans are Flushing Forests Down the Toilet was followed by a call to action targeting Procter & Gamble, maker of Charmin. the top selling brand of  toilet paper in the U.S.  More than 80,000 NRDC members and online activists wrote to the Procter & Gamble’s CEO.  

The NRDC has evaluated several brands of paper products that are sustainable: Green Forest, 365 Bath Tissue, Natural Value, Earth First, Seventh Generation, and Trader Joe’s Bath Tissue.  Note that 365 Sustainably Soft and Trader Joe’s Super Soft Bath Tissue do not make the grade as sustainable.  

Another critical threat to the forest’s survival is the extraction of tar sands oil, which levels the forest and transforms the denuded earth into an industrial area of strip mines and toxic tailings pits.  The NRDC and its allies have fought to stop three quarters of the dozen tar sands pipelines the industry proposed, and continue to fight the Keystone XL pipeline. 

Worldwide, boreal forests store more carbon per hectare than any other forest biome, making them one of the best natural defenses against climate change.  Mandy Gull, deputy grand chief of the Cree Nation, says: As Indigenous peoples in the boreal forest, we live on the food from our land.  The forest is our supermarket, with aisles of berries and meats and fish.  My hope is that, once people know that their choice of tissue will determine whether food will be there for us tomorrow, they will help protect our homelands by switching to recycled and responsibly sourced products.

For the full report from the NRDC, including a buyer’s guide to tissue products, go to : nrdc.org/tissues. Sadja Greenwood, MD, MPH

Why is the Mediterranean Diet So Important?

The Harvard T.H. Chan School of Public Health and the Mayo Clinic are endorsing the Mediterranean Diet as a way to reduce the risk of heart disease, inflammation, blood sugar and body mass index.

  

The diet is a plant based eating plan consisting of a daily intake of whole grains, olive oil, fruits, vegetables, beans and other legumes, nuts, herbs and spices. The preferred animal protein is fish and other seafood at least twice weekly.  Poultry, eggs and low-fat dairy can be eaten in small portions daily, or a few times per week.  Olive oil replaces butter or margarine. Avocados, nuts and oily fish like salmon or sardines are other sources of healthy fat.  Red meat is limited to a few times per month.  Water is the main beverage.  Plain coffee and tea are fine.  Fruit juices contain too much sugar, and should be replaced by eating the whole fruit.  Wine, especially red wine, can be consumed with meals.  Women should drink no more that one 5 ounce glass per day, and men should stop at 2 glasses.  People who do not drink alcohol do not need to begin.  Eating and socializing with other people is encouraged. Daily physical activity is important.

The Mediterranean diet emphasizes whole grains, such as whole wheat, rye and barley.  People wanting a gluten free diet can use brown rice, quinoa, buckwheat, millet, oats and corn.  

 Research has shown that the Mediterranean diet reduces the risk of cardiovascular disease and overall mortality.  A study of 26,000 women over 12 years showed a 25% lower risk of developing heart disease and stroke among those whose eating plan was close to the Mediterranean diet.  Favorable changes in inflammation, blood sugar, 

Type 2 diabetes and body mass index were also seen.  

Fat intake is high in the Mediterranean diet, consisting of 39-42% of daily calories – note that the fats are healthy ones, such as olive oil, nuts, avocados and oily fish.  This promotes satiety – feelings of fullness – so that the diet is easy to follow.  The Ketogenic diet is also high in fat, but relatively low in plant food while emphasizing meat eggs, and cheese. The lack of a wide variety of plant foods means a considerably smaller intake of protective antioxidants.  This diet has been popular for weight loss without hunger.  Compared to the Mediterranean diet it is less healthy for the individual and ultimately for the planet.  

Sadja Greenwood, MD, MPH

The Carter Center's Amazing Work on Guinea Worm Disease

Since 1986, The Carter Center has led the international campaign to eradicate Guinea worm disease. Guinea worm disease is a parasitic disease caused by a nematode roundworm parasite called Dracunculus. It is contracted when people consume water from stagnant sources contaminated by Guinea worm larvae. Inside a human’s abdomen, male and female worms mature and grow.  After about a year, the female Guinea worm, one meter long, creates an agonizingly painful lesion on the human’s skin as it slowly emerges.  Guinea worm sufferers often try to seek relief from burning sensations and immerse themselves in water.  The emerging worm releases its larvae into the water and so the cycle of infection goes on.  

In 1986 there were an estimated 3.5 million cases of Guinea worm disease in 21 countries in Asia and Africa.  Today that number has been reduced by 99.99% to 28 cases in 2018. It could be the second human disease, after smallpox, to be eradicated without the use of a vaccine or medicine.  The Carter Center has worked closely with ministries of health and local communities, US Centers for Disease Control and Prevention, the WHO and UNICEF.  Community based interventions have included teaching people to filter all water, done in some ingenious ways, and keeping people with an emerging worm from entering water sources.  

A challenge to eradication has been the emergence of Guinea worm disease in animals, such as domesticated dogs, who may eat infected fish and fish entrails.  Cash rewards are being paid to the reporting of infected animals, and the use of veterinary deworming drugs.  In 2018 Ethiopia reported infections in 11 dogs, 5 cats and 1 baboon. Another challenge is insecurity – conflicts make some areas unsafe for travel.  

Enormous dedication and attention to detail is critical for all field supervisors and the thousands of community-based volunteers charged with executing the campaign.  The disease has been eliminated in 17 countries. 80 million cases have been averted among the world’s poorest and most neglected people. 

WHO is responsible for certifying countries as free of Guinea worm disease.  The US Centers for Disease Control and Prevention provide technical assistance and verify whether worms from patients are truly Guinea worms. UNICEF helps to provide safe sources of drinking water. 

Dear Readers – the take home message from this column is one of hope and awe, that President Jimmy Carter has provided such important leadership in the relief of suffering. Donations to his center are always appreciated.  I am dedicating this column to the memory of my ex- husband, Dr. Robert Goldsmith, father of my 2 sons and step-daughter. Dr. Goldsmith died last week in San Francisco. His children provided a beautiful and meaningful memorial service for him yesterday.  He was a Professor of Tropical Medicine at UCSF, and would have known all about the efforts to eliminate Guinea worm disease.   I am sorry I could not discuss this matter with him.  

Sadja Greenwood, MD, MPH

Too Busy to Floss? This Could Change Your Mind!

There is new research on how bacteria involved in gum disease can travel through the body, exuding toxins connected to Alzheimer’s disease, rheumatoid arthritis and aspiration pneumonia.  Experiments in mice, using  bacteria from people with Alzheimer’s disease, showed that the bacteria can find their way from mouth to brain.  The bacterium is Porphyromonas gingivalis (P g for short).  It is involved in periodontitis – inflammation of the gums. According to Jan Potempa, PhD, DSC, a professor at the University of Louisville School of Dentistry and head of the Department of Microbiology at Jagiellonion University in Krakow, Poland, oral hygiene is important and will decrease the risk of many serious diseases. Researchers  compared brain samples of deceased people with and without Alzheimer’s disease, same age at death, and found that P g was more common in the samples from people with Alzheimer’s , as evidenced by DNA and the presence of certain key toxins.  Studies in mice showed that P g can move from mouth to brain. An experimental drug that blocks bacterial toxins is in phase 1 clinical trial for Alzheimer’s.  About 20% of people have low levels of P g in their gums by age 30.  While not necessarily harmful, if it grows to large numbers it creates inflammation. Smokers and older people are at increased risk.  

The take-home message here is clear.  Brush your teeth and floss regularly.  Visit your dentist and dental hygienist, at least yearly.  

Sadja Greenwood, MD, MPH

We All Depend on the Survival of Bees

In the film Fantastic Fungi by Louie Schwartzberg, amazing time lapse photography shows the growth of numerous kinds of fungi as they digest dead plant and animal material and in so doing enrich the earth.  Fungi, a separate form of life from plants and animals, have healing properties for the immune systems of animals, including humans, which are beginning to be researched.  The film, which stars the mycologist Paul Stamets, among others, has an important section on the use of fungi to help bees resist viruses in their hives.

According to a new paper from Washington State University (WSU), and colleagues at Fungi Perfecti, a mushroom extract fed to honey bees greatly reduces virus levels in their hives.  Colonies fed mycelium extract from amadou and reishi fungi showed a 79-fold reduction in deformed wing virus and a 45,000-fold reduction in Lake Sinai virus compare to control colonies. 

Mycelium is the vegetative part of a fungus consisting of a mass of branching, threadlike hyphae.  It penetrates deep into the soil.  Fungi Perfecti is a business dedicated to promoting the cultivation of high quality medicinal mushrooms.  Paul Stamets grows his mushrooms organically in the Pacific Northwest.  

"Our greatest hope is that these extracts have such an impact on viruses that they may help varroa mites become an annoyance for bees, rather than causing huge devastation," said Steve Sheppard, a WSU entomology professor and one of the paper's authors. "We're excited to see where this research leads us. Time is running out for bee populations and the safety and security of the world's food supply hinges on our ability to find means to improve pollinator health."

The research was published in the journal Scientific Reports.

At present, the mycelium extract isn't currently available in levels for beekeepers to purchase for their hives.

"We are ramping up production of the extracts as rapidly as is feasible, given the hurdles we must overcome to deploy this on a wide scale," Stamets added. "Those who are interested in being kept up to date, can sign up for more information at http://www.fungi.com."

Sheppard said he and his colleagues plan to do more work to refine their now-published results. That way beekeepers will have the best information when supplies are more available.

"A portion of this project was funded by USDA-NIFA project WNP00604.

 Journal Reference:

1.     Paul E. Stamets, Nicholas L. Naeger, Jay D. Evans, Jennifer O. Han, Brandon K. Hopkins, Dawn Lopez, Henry M. Moershel, Regan Nally, David Sumerlin, Alex W. Taylor, Lori M. Carris, Walter S. Sheppard. Extracts of Polypore Mushroom Mycelia Reduce Viruses in Honey Bees. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-32194-8

 Chlorpyrifos  Another threat to honey bees and other forager bees is the insecticide chlorpyrifos.  Honey bees experience a learning and memory deficit after ingesting small doses of this insecticide, potentially threatening their survival, according to a study in New Zealand.  Chlorpyrifos is a highly neurotoxic organophosphate pesticide used worldwide on crops to protect against insects and mites.

The effects of this insecticide on animals and humans has been widely studied since the 1970s. Chlorpyrifos affects living things to various degrees: it is very toxic to birds and insects, including bees, quite toxic to fish, and also toxic to humans. Home use of chlorpyrifos was banned in 2000, when Dow withdrew it from the market voluntarily, though it is still found in insect baits. Golf courses still combat pests with it, and it is also
used by farmers on nearly 50 crops—many of which we consume, like oranges—and in cattle ear tags.  Farmworkers are exposed, and pregnant farmworkers may have lasting damage to their children.  Recent studies of small children have found a link between chlorpyrifos and lower IQ and developmental problems
Hawaii is the first state to ban Chlorpyrifos.  California should follow suit.  Contact your congressperson, senators and governor Gavin Newsom to ban this highly toxic chemical.  

Sadja Greenwood, MD, MPH

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New and Important News on Sleep

Researchers at Bar-lian University in Israel have identified a function of sleep that can explain why humans as well as all other animals with a nervous system spend a significant portion of their lives in sleep. Even Invertebrates such as flies, worms and jellyfish sleep.  The reason why animals sleep – despite the threat of predators, has been considered one of the biggest questions in life sciences.

In a new study, published in March, 2019 in the journal Nature Communications, researchers at Bar-Ilan University in Israel reveal a novel and unexpected function of sleep that they believe could explain how sleep and sleep disturbances affect brain performance, aging and various brain disorders.

Using 3D time-lapse imaging techniques in live zebrafish, the researchers were able to define sleep in a single chromosome resolution and show, for the first time, that single neurons require sleep in order to perform nuclear maintenance.  DNA damage can be caused by many processes including radiation, oxidative stress, and even neuronal activity.  DNA repair systems within each cell correct this damage. The current work shows that during wakefulness, when chromosome dynamics are low, DNA damage consistently accumulates and can reach unsafe levels.

The role of sleep is to increase chromosome dynamics, and normalize the levels of DNA damage in each single neuron. Apparently, this DNA maintenance process is not efficient enough during the online wakefulness period and requires an offline sleep period with reduced input to the brain in order to occur. "It's like potholes in the road," says Prof. Lior Appelbaum of Bar-Ilan University. "Roads accumulate wear and tear, especially during daytime rush hours, and it is most convenient and efficient to fix them at night, when there is light traffic."

Appelbaum calls the accumulation of DNA damage the "price of wakefulness." He and his doctoral student David Zada, first author of the study, as well as co-authors, Dr. Tali Lerer-Goldshtein, Dr. Irina Bronshtein, and Prof. Yuval Garini, hypothesized that sleep consolidates and synchronizes nuclear maintenance within individual neurons, and set out to confirm this theory.

Their discovery was achieved thanks to the characteristics of the zebrafish model. With their absolute transparency, and a brain very similar to humans, zebrafish are a perfect organism in which to study a single cell within a live animal under physiological conditions. Using a high -resolution microscope, the movement of DNA and nuclear proteins within the cell -- inside the fish -- can be observed while the fish are awake and asleep. The researchers were particularly surprised to find that chromosomes are more active at night, when the body rests, but this increased activity enables the efficiency of the repair to DNA damage. 

The results establish chromosome dynamics as a potential marker for defining single sleeping cells and propose that the restorative function of sleep is nuclear maintenance. "We've found a causal link between sleep, chromosome dynamics, neuronal activity, and DNA damage and repair with direct physiological relevance to the entire organism," says Prof. Appelbaum. "Sleep gives an opportunity to reduce DNA damage accumulated in the brain during wakefulness."

"Despite the risk of reduced awareness to the environment, animals -- ranging from jellyfish to zebrafish to humans -- have to sleep to allow their neurons to perform efficient DNA maintenance, and this is possibly the reason why sleep has evolved and is so conserved in the animal kingdom.”

Journal Reference:

1  D. Zada, I. Bronshtein, T. Lerer-Goldshtein, Y. Garini, L. Appelbaum. Sleep increases chromosome dynamics to enable reduction of accumulating DNA damage in single neurons. Nature Communications, 2019; 10 (1) DOI: 10.1038/s41467-019-08806-w

 ScienceDaily. 5S 5 March 2019. 

The take-home message of this column is that we should find a way to sleep every night until we feel refreshed and rested.  We can’t put it off until the weekend and get the daily needed brain repair.  Going to bed earlier could be an answer for many people.  Zzzzzzzz  Read the news on sleep and heart disease in the previous column on this website.

Sadja Greenwood M.D., MPH

Sleep and Heart Disease

A recent study from Massachusetts General Hospital (MGH), published in the journal Nature, shows how getting enough sleep protects against heart disease. Insufficient sleep increases the production of inflammatory white blood cells that are known to be major contributors of atherosclerosis – the deposition of plaques of fatty material on the inner walls of arteries.  Sleep helps to regulate the production in the bone marrow of these inflammatory cells. Sleep disruption breaks down the control of inflammatory cell production, leading to more inflammation and more heart disease.  According to Filip Swirski, Ph.D. of the MGH Center for Systems Biology, there is a brain hormone known to control wakefulness that controls processes in the bone marrow that protects against heart disease. 

Mice that had been genetically programmed to develop atherosclerosis were subjected to repeated interruptions of their sleep, similar to the experience of someone constantly waking up because of noise or discomfort.  Compared to mice from the same strain that were allowed to sleep normally, those subject to sleep disruption developed larger arterial plaques and had higher levels of inflammatory cells in their blood vessels.  They had a nearly two fold increase in the production of in their bone marrow of stem cells that give rise to white blood cells.  A hormone called hypocretin, produced in the brain structure known as the hypothalamus, which is known to regulate sleep, was found to have an unexpected role in controlling white blood cell production. While normally produced in high levels when animals, including humans, are awake, hypocretin levels were significantly reduced in the sleep deprived mice.  Dr. Swirski, an associate professor of Radiology at Harvard Medical School, plans to explore further mechanisms by which proper sleep maintains vascular health, and further explore this newly identified neuro-immune axis.

The complete article from which this column is based can be found at Science Daily, February 13, 2019.

The take home messages from this study are important.  Safeguard your sleep by reducing or eliminating caffeine from coffee, caffeinated teas, caffeine containing soft drinks, kombucha, etc. late in the day. People who are sensitive to caffeine should not drink it after noon.  Be careful with alcohol around bedtime as well – it can put you to sleep, but will often disrupt your sleep quality later in the night. If you have sleep apnea, take steps to control it. Sleep apnea is a serious sleep disorder  - breathing is interrupted many times each night, resulting in insufficient oxygen for the brain and body. Talk to your doctor about getting a device called CPAP (continuous positive airway pressure) or talk to your dentist about a dental device that may help with sleep apnea.  Losing weight may help, and so will quitting smoking!  Wear blue blocking glasses starting an hour before bedtime, so that bright lights from your home, your TV, computer or cell phone will not reduce your natural melatonin production as bedtime gets near. If you get up at night to go to the bathroom, wear the blue blocking glasses at that time.  All these measures are important, and potentially life saving.

Sadja Greenwood, MD, MPH

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