Archive for the ‘Publications’ Category

Listeria

Friday, October 14th, 2011

The culprits, this time.

Reading "USA Today" online, I found an article detailing the repercussions of the recent/ongoing outbreak of disease linked to cantaloupes coming from one specific farm in Colorado. That operation, Jensen Farms, re-called its fruit in mid-September. The Food and Drug Administration and the Seattle-based Institute for Environmental Health have not yet found the root cause of the outbreak. Since the normal shelf life for cantaloupe is ~two weeks, none of the Jensen Farm product should still be in stores. And no other sources have been implicated. Nonetheless, cantaloupe producers in California and Arizona, the two states with the largest crops of this fruit, are seeing sales plummet 80% or more.

That probably shouldn't surprise us. Spinach sales, devastated by the 2006 E. coli outbreak, are still down nearly a third in one California county.

As of October 12, the current outbreak had led to 116 illnesses and 23 deaths, making it the deadliest in more than a quarter century. There was another outbreak in Texas in October of 2010; that one was related to celery and resulted in 10 total illnesses and five deaths.

I went to several online medical sites to refresh my memory on Listeriosis. When I dealt with infections from this bacteria it was in immuno-compromised patients. Listeria is found worldwide, often in association with farm animals, many of which are otherwise healthy carriers of the bacterium. People can also be carriers and perhaps five to ten percent of us have Listeria in our bowel flora.

There are roughly 2,500 US cases of Listeria infections yearly and about a fifth of those infected die. Most are isolated cases, not major outbreaks The bacteria isn't transferred from person to person with the exception of pregnant women and their fetuses or newborn babies.

This is a foodborne illness, most commonly associated with improperly processed deli meats or unpasteurized milk products.

About 30% of all reported US cases occur in pregnant women. As opposed to the majority of us, who may have nonspecific symptoms, or none at all, pregnant women can transmit the infection to their fetuses or to their newborn infants. They also may have minor symptoms, if they are otherwise healthy, but Listeria can lead to miscarriages, stillbirth, premature birth or, potentially, to serious disease or death of newborn babies.

Others at higher risk for serious disease when infected with this bacterium include the elderly, diabetics, cancer patient, AIDS patient, those with significant kidney disease and anyone on immunosuppressive drugs.

It's tough to diagnose Listeria infections: the most common signs and symptoms include fever, muscle aches, nausea and/or diarrhea. There are no reliable tests for the bacteria, so the diagnosis is difficult in the absence of a history of exposure to a potentially contaminated food source during an outbreak.

Most of us clear the infection without any treatment; those at higher risk should be considered for immediate IV antibiotics and consultation with an Infectious Disease specialist is recommended (and if a pregnant woman has the inception, an Ob-Gyn specialist and a Pediatrician should be involved.

It's Yo-Yo time again

Wednesday, October 12th, 2011

take pills or eat right, is that the question?

 

 

 

 

A recent edition of The Wall Street Journal had an article titled "Supplements Offer Risks, Little Benefit, Study Says." It quoted a long-term study of Iowa women, uniform Caucasian and with a mean age of 61.6 in 1986 when the research began. This was not a prospective, randomized controlled trial (RCT), but a cohort study, i.e., a number of people grouped together for a particular reason.

When I Googled the original purpose of the research project I found the following statement:

The Iowa Women's Health Study (IWHS), started in 1986, is a cohort of 41,836 postmenopausal women aged 55-69 at baseline. The primary aims of the study were to:

1) Determine if the distribution of body fat (waist/hip) predicts incidence of chronic diseases, with the primary endpoints being total mortality, and incident cancers of the breast, endometrium, and ovaries, and

2) Determine to what degree diet and other lifestyle factors influence risk of chronic disease.

So who could resist this incredible pool of data?  I was intrigued to note the authors of this paper were from Finland, Minnesota, South Korea and Norway; three were PhDs and one had a Doctorate in Pharmacy + a Masters degree in Public Health. I somewhat doubt they were the originators of the IWHS.

I found other papers stemming from this study: one concluded that drinking lots of decaf coffee was associated with less type 2 Diabetes, another looked at rheumatoid arthritis, another at colon cancer incidence.

I renewed my long-expired membership in the American Medical Association this morning (it's very inexpensive for an older retired physician) in order to have access to the full article.These authors looked at vitamin and mineral supplement use in 38,772 of the women. I agree with their take on supplement use in general (it helps in those clearly deficient; the rest of us who take them do so in hope of preventing chronic diseases and lowering our risk of dying prematurely).

The data from numerous studies, in terms of mortality risk, has been inconclusive. There have only been a few RCTs (mostly looking at calcium supplementation and vitamin use) that have said it's good to take supplements. Others have said not only do they not help, they may harm.

I read the conflicting reports with a jaundiced eye, but this one has a lot of accumulated data and it's at least worth paying close attention to. The basic conclusions in this particular population set (white women in Iowa) were that calcium supplements are good, iron supplements are bad and the rest don't help.

There are a few, maybe more than a few caveats. This is an association, not a causation, although the authors tried to eliminate many of the possible differences between those who did and those who did not take supplements. The fact that this wasn't an RCT meant the two groups differed in a number of fundamental ways. This was not a study originally set up to test if supplements helped or hurt or neither.

Bottom line: the paper is impressive, but won't change my own use of supplements in any way

 

 

More on the heatwave and its consequences.

Thursday, September 1st, 2011

Here's one way to cool off

This morning I read in the New York Times Breaking News that comes to my Kindle that NYC has recently seen an unprecedented number of heat-related deaths. The age range of the victims varied considerably; youngsters, a 45-year-old  woman and some elderly folk all were struck down. Today I'd like to concentrate on older adults.

You may or may not believe in global warming (I certainly do) and, if you do, whether humans are making a significant contribution to it. But in the meantime we seem to be experiencing a hot patch and we have to cope with that.

I got up fairly early, took Yoda, my Tibetan terrier, to Whole Foods to buy a sack of his dog food and then took him for a walk. All in 72 to 75 degrees on a day that will later see a 95+ degree peak temperature. And this is in Colorado at 5,200 feet elevation. I checked out temp predictions for Denver and for the mountains; the former will be just under 100 degrees later on today whereas those areas at considerably higher elevation will stay in the 70s.

But agewise, I'm also in my 70s, as of April, and therefore read with interest the National Institute on Aging's paper titled "NIH tips for older adults to combat heat-related illnesses." The basic concepts are threefold: we lose some of our ability to adapt to heat as we get older; we are in a group that frequently has underlying diseases/conditions that fare poorly in hot weather; the meds our physicians use to treat those diseases sometimes limit our ability cope with the  heat.

I'll add a link to the article below, but will paraphrase some of their points and add my own spin.

Firstly some of the physiologic changes we experience as we age limit our ability to respond to elevated temperatures. Those include our cooling via sweating or , in some cases, our limited mobility and, in other cases, our mental responses or lack thereof. Additionally, our ability to vasodilate small blood vessels may be compromised.

Then we're experiencing, as a nation, an epidemic of obesity and concurrently those who exceed their weight goal by a large amount experience more heat-connected problems. I searched medical websites for the rationale and, if I were a teenager, would have said, "Duh!" The layer of adipose tissue the obese accumulate is the equivalent of wearing an insulted suit, something you wouldn't want to do in the heat of a summer day.

And then there are all those medications we take as we age. One article I found said older people take 2 to 6 prescribed drugs while also taking a number of OTC medications. Those drugs can directly alter our response to heat while potentially causing increased body temperature in a number of other ways, e.g., hypersensitivity reactions or the pharmacological action of the drug itself.

That helps

So if you're an older adult, avoid the heat of the day, get enough fluids and, if necessary, contact the Low Income Home Energy Assistance Program (through HHS) for help with home cooling.

http://www.nia.nih.gov/NewsAndEvents/PressReleases/PR20110718hyperthermia.htm

Can there be long Life without Life?

Tuesday, August 30th, 2011

A "fountain with Youth" that's real

I was reading two articles, in our local paper last weekend when I realized I was channeling Yogi Berra and his famous quote, "It's déjà vu all over again. What's happened is a return to Herodotes, the Greek historian (5th century BCE) who told of a fountain in Ethiopia responsible for extraordinary lifespan and to Ponce de Leon, the Spanish explorer who traveled on Columbus' second voyage (1493) and described the Fountain of Youth, supposedly found in Florida.

Now we have a huge contingent of baby boomers (estimates in the 70 million range) who are about to reach 65 and don't want to grow or look older. The market for anti-aging remedies is currently about $80 billion a year and is expected to top $110 billion in the next four or five years. We live in a society that worships youth and many of our compatriots are being sold magic potions that some claim will prevent aging or at least most of its signs.

One of the articles had an amazing photo of Dr. Jeffrey S.Life, age 72, a body builder and author of a book titled The Life Plan: How Any Man Can Achieve Lasting Health, Great Sex and a Stronger, Leaner Body. You can buy this $26 book for $14.94 on Amazon, but I think I'll skip it.

Dr. Life's program includes diet, exercise and a healthy lifestyle; it also features, for at least some of his patients, injections of human growth hormone (at roughly $15,000 a year) plus testosterone.

The data on these hormone replacement regimens is, to say the least, not as rock solid as Dr. Life's toned torso. The NIH has a division called the National Institute On Aging (see link below), and the Geriatrician who heads this organization is solidly against widespread use of hormone replacement therapies.

http://www.nia.nih.gov/

What makes sense to me is exercising regularly, staying lean (or getting there) and stopping smoking. I noted that Dr Life's mentor died at age 69, a long ways short of my physician Dad's 94-year lifespan. Dad ran most days until his late 70s, stayed trim and quit smoking as a young doc when he realized he had three cigarettes going in three ashtrays in his three-room office.

lots of these out there

I think many baby boomers and others would like to find a magic bullet, a tonic or elixer that would allow them to eat what they want, do what they want and live to 100.

Until you show me a long-term, controlled study that points that way, I think we're as shy of the Fountain of Youth as we were in the days of Ponce de Leon or Herodotes.

Eat less and spend your money on a health club membership or a pair of running shoes instead.

Drinking and driving

Wednesday, August 3rd, 2011

lots of choices, all with alcohol

Twenty-four years ago I was the brand new Deputy Chief of Staff at our largest Air Force medical center. My counterpart at the Army's hospital across town called and asked if I'd like to attend a party. I said, "Sure, what's the occasion?"

His commander had just gotten a second star and, as a new major general, would be moving to DC soon. His immediate boss was going to get the one-star job running the medical center. That never happened. I don't know the exact details, but was told one drink too many led to an off-color comment to the wrong person and then to a lost opportunity.

I got sensitized, through this episode, to drinking at events and, of course, to drinking and driving. I was in a culture where wine and beer flowed freely at parties, but decided I'd be a one-drink person. My wife and I were outliers sometimes; a friend who was a fellow commander when I moved up to lead a small hospital once told me, "I got picked up CWI last night."

"I know what DWI means; what's CWI?"

He replied, "Crawling while intoxicated." Actually he was joking, while telling his story of leaving a party at the commanding general's home and feeling unsteady while slowly walking to his own quarters, two houses down.

The Wall Street Journal on July 2, 2011, had an article titled "Testing the Limits of Tipsy." Our US legal limit for driving used to be a blood alcohol concentration (BAC) of 0.15%; now it's 0.08%. In much of Europe it's 0.05%; in India it's 0,03% and in China it's 0.02%. That exceedingly low BAC limit may turn out to be the most realistic, especially on crowded streets and roads.

But the results can be bad, even to metal bodies

Our alcohol-related traffic fatalities have fallen by 50% since 1980, but still account for one-third of all deaths on the highway. Your BAC after drinking depends on a number of factors: your weight, age, prior drinking history, rate of consumption, if you're also eating (consuming food may slow absorption of alcohol, but some foods help more than others) and menstrual cycle (women apparently metabolize alcohol a little more rapidly just after ovulating).

Once you've absorbed alcohol, your BAC falls roughly 0.015% per hour (for either gender), so it may take a long time to reach a "safe" level, if there is such a thing. As you age your liver tends to metabolize alcohol more slowly; on the other hand, an elevated BAC may affect younger brains more adversely.

Having read this, I'll plan to continue our long-standing policy: when we go to a function one of us is the "designated drinker," and usually has only one drink at that. The other is the designated driver. We've occasionally each had a glass of wine...at an event where we'll be eating and not driving for a number of hours. It may be time to re-evaluate that policy.

On holidays like New Years Eve, when we know others will be drinking more than we do, we get off the roads early.

 

Let us eat lettuce...and more

Wednesday, July 27th, 2011

I want more to a salad than just iceberg lettuce

Some years back I told my wife, "I'm tired of the same old salad; could you make a different one?"

We both cook, though she does more of of daily cooking than I do, but salad making is my least favorite part of cooking.

Over the next six weeks she never made a salad I had tasted before; her mix and match approach led to some surprises, but I'm always happy to try new dishes and almost all of them were successes. She added edamame, sunflower seeds, unusual greens; I ate them all. I finally told her, "I didn't mean an entirely new salad every time, just less of the iceberg lettuce, store-bought tomatoes and cucumber with familiar dressing.

We still eat salads at least once a day, sometimes as our main dish with chicken or fish added for protein. Sometimes we'll have a brand new mixture; sometimes I can recognize we've had this blend before and put it on the "keeper list."

Today I read about food companies attempts to get more Americans on the same dietary pathway. The Wall Street Journal had an article titled "The Salad Is in the Bag." I was amazed to read that the typical US adult eats salad with a meal only 36 times a years, roughly once every ten days. Less than half of Americans eat even one "leaf salad" in meals they serve at home in a two-week period.

The two of us are clearly on the far end of that scale when it comes to salad making. Our share of this weeks' vegetables from Grant Family Farms, our CSA, included summer squash, English peas, cabbage, carrots, kohlrabi, cilantro, parsley, green onions, a little broccoli, cylindra beets (new to us) and romaine lettuce. All of those veggies will find their way into salad

I've even gotten more enthusiastic about preparing some of the new salad combinations myself.

So what's going on with the "store-bought" salad concept?

A market research group reported the biggest issue is making salads. Apparently people don't want to take the time to wash produce, inspect it, cut it and come up with mixtures the family will eat (we won't even get into those who abhor greenery).

So some of the major food companies are responding by making salad preparation easier. One concept being explored is adding more kinds of vegetables to bagged lettuce or spinach. That way all you have to do is buy a bag, bring it home, open it before a meal and pour the contents into a salad bowl.

Well that sounds easy, but it turns out to be a bit more complicated than the simple version. One company found wheatberries absorbed moisture; their research director spent six months resolving that issue. Then there's the price issue; bagged salads cost more. Past history and the view of CPSI says there's more risk of pathogen growth and therefore of food-bourne illness.

But pre-washing with newer chemical mixtures, eliminating the need for a second wash at home, may help.

A new and improved version

Salad, anyone?

 

Food Allergies: part two

Wednesday, July 20th, 2011

These may cause hives or much more serious reactions

I was intrigued by the MedicineNet.com comments on Food Allergy that I mentioned in my last post.I printed off a nine-page discussion, but then went back to check on the background of the article's editor and author. The chief editor, who helped found this website fifteen years ago, is a rheumatologist with what appear to be impeccable credentials. The author is a pathologist, not an allergist, but also seems to have a very solid background.

She mentions that roughly 6-8% of kids have food allergies and 3% of adults. Her discussion is detailed, but crucial in it is the fact that true food allergies involve the immune system and may be life-threatening. Many who develop food allergies have relatives who are allergic to pollens or other non-food items (feathers or medicines, for instance). If both your parents have those kinds of allergic problems, you're more likely to develop food allergies than someone from an allergy-free family.

True food allergic reactions happen soon after ingestion of the nuts or shellfish or whatever causes the problem in a particular person. They may cause mild symptoms (such as oral itching), skin reactions such as hives, gastrointestinal reactions (pain, nausea, vomiting, diarrhea) or led to an asthmatic attack).

I'll copy in the Mayo Clinic website's take on the most severe reaction, anaphylaxis.

"Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you're allergic to, such as the venom from a bee sting or a peanut.

The flood of chemicals released by your immune system during anaphylaxis can cause you to go into shock; your blood pressure drops suddenly and your airways narrow, blocking normal breathing. Signs and symptoms of anaphylaxis include a rapid, weak pulse, a skin rash, and nausea and vomiting. Common triggers of anaphylaxis include certain foods, some medications, insect venom and latex.

Anaphylaxis requires an immediate trip to the emergency department and an injection of epinephrine. If anaphylaxis isn't treated right away, it can lead to unconsciousness or even death."

Here's another Epi-pen; it can keep you alive

I mentioned an Epi-pen in my previous post on this subject. We keep one in the house since I give my wife her allergy shots; If you've had food reactions that appear to be true food allergy your doctor may want you to have one available.

Adults and kids are more likely to react to those foods commonly served in their particular culture, e.g., rice in Japan, fish in Scandinavia.

And to add to the mix, there are several types of cross-reactivity, e.g., allergic reactions from a food similar to one a person has had a severe reaction to or allergies to fruits (especially melons and apples) during the "hay-fever season"  The latter is caused by uncooked foods and may occur in half of those affected by pollens. Typically they are mild, but a tenth of those affected may have more severe problems and 1 or 2% can even have anaphylaxis.

Similarly, some people, usually teens or young adults, can eat a particular food, then exercise and then develop an allergic reaction. Eating two or more hours before exercising seems to prevent this form of food allergy.

There's lots more information, but suffice it to say food allergy should be taken seriously.

Reading Taubes: part one

Saturday, July 2nd, 2011

Avoid white bread

A while back one of my blog readers asked if I had ever read Taubes. I wasn't sure if that was a book title, a diet plan or an author, so I Googled the word and eventually purchased two books written by a veteran science writer, Gary Taubes.

Taubes studied applied physics at Harvard and areospace engineering at Stanford, then wrote articles for Discover and Science plus four books. He looks for scientific controversises and wades into them. In July 2002 he published an article in the New York Times Magazine titled "What if it's All Been a Big Fat Lie,"

The article takes us back to the Adkins diet craze. Dr. Atkins, trained in cardiology, was significantly overweight and used a JAMA study as a basis for his own personal diet plan. He then published two books urging dieters to severely limit carbohydrate consumption. At one point it was estimated that one out of eleven North American adults were on his diet. His company made over $100 million, but filed for Chapter 11 bankruptcy in 2005, two years after he died.

Taubes explores some of the same turf, saying it's refined carbohydrates that make us fat. His initial plunge into the field was the NYT piece, followed by a 2007 book, Good Calories, Bad Calories and now a 2011 book, Why We get Fat: and What to do About It.

Taubes has hefty credentials as a science writer; he is the only print journalist to have received the Science in Society Journalism Award three times. Currently he's a Robert Woods Johnson Foundation investigator in Health Policy Research at UC Berkeley's School of Public Health. But his initial article ignited a firestorm. In the piece Taubes mentions that the common veiwpoint links the kickoff of the obesity epidemic  (in the early 1980s), to cheap fatty foods, large portion servings (at commercial establishments presumably), an increase in food advertisements and a sedentary lifestyle.

He would beg to differ, invoking what he terms "Endocrinology 101," an explanation that says human evolution was not designed for a high-sugar, high-starch diet. Until a comparatively recent era (roughly 10,000 years ago) we were not agriculturists, but hunter-gatherers. So Taubes thinks the problem is our increased consumption of sugar, high fructose corn syrup, white bread, pasta &  white rice.

Others think he picks and chooses his facts. I don't think he's wrong in his basic premise, but he also disagrees with the ideas of "calories in; calories out," avoiding saturated fats and exercising being important in weight control (He seems to think people who exercise then hurry off to eat more).

more than one way to "thin a cat"

I'm down thirty pounds since early in 2009, have easily kept the weight off by exercising six days a week, avoiding sugar & HFCS foods and eating lots  more veggies and fruits while cutting back on portion size of meat dishes.

I'll read more on Taubes and his detractors and let you know what I agree with and what I don't.

Great tomatoes: memories or not?

Wednesday, June 29th, 2011

Here's what they look like in the supermarket

When I was a kid in Wisconsin, we used to have "beefsteak tomatoes" several times a week. Then I went off to college and medical school, then residency and fellowships and, eventually, the Air Force. At some point I realized I wasn't eating tomatoes as often and, when I did, they just weren't the same.

We raised our own back in large pots on the back patio two years ago, bought a few at farmers' markets and some vine-ripened tomatoes at a supermarket. The taste, in all cases was much, much better than the standard grocery-store tomato, but I hadn't thought much about the reasons.

Than a friend, knowing about my blog, suggested I buy a book called Tomatoland, written by Barry Estabrook. The back cover advance comments included one by Ruth Reichel who was Editor in Chief for Gourmet Magazine for ten years (it went out of business in 2009) and has been restaurant critic for the New York Times and the Los Angeles Times. She felt the original Gourmet article, "The Price of Tomatoes," (which was expanded to become the book) was the one she was most proud to have published during her tenure.

There are two basic themes to Tomatoland: one is that the "industrial tomato," grown in Florida and accounting for a third of all the fresh tomatoes grown in this country (and a much greater percentage of those available in the supermarkets from October to June) is bred for almost everything except taste. His detailed exploration of the Florida tomato, whose attributes are tightly controlled by a state tomato committee, explained what I had known for some time. They add little to salads except for color.

But here's what they look like when they're picked

That especially excludes taste and nutritional benefits. The one thing the modern industrial tomato has over its 1960-era predecessors is sodium; it has considerably less vitamin content and less calcium, according to Estabrook. He has won two James Beard awards, one for his blog http://politicsoftheplate.com. I went to that website and read a recent post which brought me back to the second theme of Tomatoland: the abhorent conditons endured by our migrant farm workers.

There are, according to that post, 400,000 of those low-paid laborers, 70% of whom are estimated to be undocumented. Florida had virtual slavery with crew bosses picking out and often holding workers in dismal settings (locked in a truck, for instance). That situation, has gradually improved in some aspects at least, in  large part due to the efforts of a worker coalition. But Estabrook's recent post said many of the migrant farm hands/pickers skipped working in Georgia this year after a new law mirroring Arizona's harsh legislation was put into place.

So Georgia was short 11,000 farm workers and the farmers were in danger of losing $300,000,000 worth of produce. The governor, who pushed for the new law a few months ago, is now offering those vacant farm jobs to unemployed probationers. The problem is the work is tough and often reuires experience, so the newly employed group is quitting in droves.

Read the book; it's an eye-opener.

 

 

So what should I eat?

Friday, June 24th, 2011

Medical research comes through for us

I was reading my morning papers yesterday, The Wall Street Journal (hard-copy edition) and the New York Times breaking news (on my Kindle). I came across a June 23, 2011, WSJ article titled "You Say Potato, Scale Says Uh-Oh." It detailed a recent research study online in a prominent medical journal. The premise was what you choose to eat will determine what happens to your weight over a four-year period.

The overall conclusion, once again, is picking healthier items for your diet leads to less weight gain. Most American adults gain a pound a year, but if they add a serving of French Fries on a daily basis, they'll gain more (3.35 pounds). The NEJM said the participants in three huge studies (a total of 120,877 U.S. men and women who were free of chronic diseases and non-obese at the start of the studies), gained most if the extra item was potato chips, and lost weight if it was yogurt. The list, after chips, in deceasing correlation to weight gain included potatoes, sugar-sweetened beverages and unprocessed red meat or processed meat.

Negative numbers were noted for the addition of vegetables, whole grains, fruits, nuts and then yogurt. Other lifestyle influences were examined. If one of the subjects exercised regularly, they lost weight; if they watched much TV, they gained pounds.

So what's new here? Huge studies over lengthy time periods + a few different conclusions.

The study's co-author, Dr. Walter Willet, the chairman of Epidemiology and Nutrition at Harvard's School of Public Health was interviewed on NPR New's program "All Things Considered." He commented that highly refined foods-sugar-added beverages and potatoes, white rice and white bread-were related to greater weight gain. The presumption is these foods are rapidly broken down into sugar, absorbed and then quickly removed by the action of insulin. So if you eat these things, in a short while you're hungry again.

high-protein Greek-style yogurt

Nuts have fat, but keep us satiated for a prolonged time. Yogurt was a surprise to the research group (we're talking about natural yogurt without added sugar) and the mechanism for its influence on weight is unclear, but may relate to the healthy bacteria included.

The bottom line may be just because some foods contain fat, doesn't necessarily mean they'll be fattening. On the other hand, foods that keep us satisfied for a longer time may help us control our overall calorie intake over the long haul.