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Tuesday, December 1, 2009

Mammograms Misunderstood

The United States Preventive Services Task Force recently changed their recommendations regarding screening mammography. After a thorough review of the research, this independent panel of experts appointed by the Department of Health and Human Services concluded that most women should be tested every two years between the ages of 50 and 74, replacing previous recommendations for yearly lifelong tests starting at age 40.

The new guidelines have been met with confusion and outrage. Critics have dismissed them as a cost-cutting measure and described them as “a giant step backward.” The new recommendations have been called “deadly for women” and even “gendercide.” Although they could save billions of dollars in unnecessary testing and treatment, the financial savings are only a bonus. The new guidelines really are good for women and a review of the literature can quickly clear up the controversy.

Zero Benefit

In 2001 the benefits of screening mammography underwent serious scrutiny by the well-respected Cochrane Collaboration, an international, independent, not-for-profit research organization. They performed an objective and systematic review of the seven largest screening mammography studies ever done and examined the effects in a half million women from the United States, the United Kingdom, Canada and Sweden.

Two of the seven studies met the gold standard for research: randomized controlled trials. They followed 130,000 women for 13 years and compared women who received regular mammograms to those who did not. Researchers found that the rate of death from breast cancer, and from any other cause, was the same in both groups. When all seven studies were considered, mammograms were still not associated with a statistically significant reduction in the risk of death. Surprising as these studies are, the results are clear: screening mammography does not save lives.

False Positives

Mammograms are positive when abnormal tissue is detected. False positive tests occur when mammograms mistakenly identify cancer in normal tissue. A 2005 review of randomized controlled trials published in the Journal of the American Medical Association found that 95 percent of positive mammography results are false. A Harvard study published in the New England Journal of Medicine found that only three percent of abnormal mammography results were valid, making the frequency of failure 97 percent.

False positive results can be a grave matter. A study published in the Annals of Internal Medicine found that 47 percent of women with high-suspicion mammograms experience substantial anxiety. While most women are relieved to learn that their test results were wrong and they do not have cancer, many suffer unnecessary emotional turmoil.

Harmful Effects

Screening mammography can have other harmful effects. Women with false positive results are needlessly subjected to biopsies, lumpectomies and associated adverse effects, including pain, infection and scarring. Those with true positive results are too often treated for cancers that would have otherwise gone unnoticed. A 2009 study published in the British Medical Journal concluded that one out of every three breast cancers identified on screening mammograms is overdiagnosed and would not cause symptoms or death. The surgery, chemotherapy and radiation used to treat these tumors are always harmful. Side effects and complications can include mouth sores; fatigue; vomiting; digestive problems; skin rashes; hair loss; damage to peripheral nerves; changes in brain function affecting memory, concentration and learning; premature menopause; leukemia (cancer of the blood); and death.

Ionizing radiation from mammograms is another valid concern. It can damage genetic material in cells and cause cancerous mutations. These tests are used to find cancer, but taking too many of them can also cause cancer. This detail has been overlooked in the past because the benefits of mammograms – saving lives – were thought to outweigh the harmful effects. But for most women, screening mammography does not save lives and the risks associated with radiation can no longer be ignored. There is a direct relationship between cumulative exposure to radiation and the risk of cancer, so the more mammograms (and other procedures involving ionizing radiation like CT scans) that women receive over their lifetimes, the more likely they are to develop cancer.

Some Exceptions

Screening mammography may not reduce the risk of death for most women, but for certain women, the benefits can outweigh the dangers. Women who have the highest risk for developing breast cancer have the most to gain from screening tests. These include women with two first-degree relatives (mother, daughter, sister) or second-degree relatives (aunt, grandmother) diagnosed with breast cancer before the age of 50; women who have three first- or second-degree relatives with breast cancer diagnosed at any age; individuals with a history of chest radiation between the ages of 10 and 30; and those who have a known gene mutation linked to breast cancer. These individuals should talk to their doctor about the best screening schedule for them.

Diagnostic mammograms are another exception. Unlike screening mammography, which is performed on healthy women, diagnostic mammography is used to evaluate known breast problems. For women with lumps, tissue abnormalities, nipple discharge or a history of cancer, these tests can provide life-saving information for diagnosis and treatment.

Accurate Alternative

Thermography is a promising alternative to mammography. This infrared imaging technique is painless, non-invasive and free of radiation. It measures heat patterns on the surface of the skin related to blood flow and angiogenesis, the formation of new blood vessels. Angiogenesis is a critical step in the growth of cancer because as abnormal cells increase in number, so do their requirements for oxygen and nutrients, the food needed to fuel proliferation. To meet their expanding needs, tumors generate new blood vessels to increase blood flow, which increases skin temperature.

Because these vascular changes can be detected sooner than solid tumors, which may take years to grow large enough to block x-ray beams and be identified on mammograms, thermograms can identify signs of cancer in its earliest stages. Some experts estimate that thermography recognizes cancerous or pre-cancerous changes up to 10 years earlier than any other procedure, mammography included.

Studies have shown that thermograms are also much more accurate than mammograms. A review of 15 large-scale studies published in the International Journal of Thermal Sciences concluded that breast thermography had an average sensitivity and specificity of 90 percent. (Sensitivity is the percentage of accurate positive results and specificity is percentage of accurate negative results.) Other studies have found sensitivity as high as 98 percent and specificity as high as 94 percent. With rates of false positive and false negative results averaging only 10 percent, thermography is an accurate alternative to mammography.

The Bottom Line

Like any medical procedure, the pros and cons of mammograms must be considered carefully. Given the frequently false positive results, lack of benefit and exposure to radiation, screening mammography is not an effective tool for detecting breast cancer in the general population. For most women, preventive measures are much more beneficial: exercising regularly, maintaining an ideal weight, breastfeeding, avoiding pesticides and eating a healthy diet that includes seven or more daily servings of fruits and vegetables, especially cruciferous and dark green leafy vegetables.

REFERENCES

Elmore JG, Fletcher SW et al. Screening for breast cancer. Journal of the American Medical Association, 293(10):1245-56, 9 Mar 2005.

Fletcher SW and Elmore JG. Mammographic Screening for Breast Cancer. New England Journal of Medicine, 348(17):1672-1680, 24 Apr 2003.

Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001877. DOI: 10.1002/14651858.CD001877.pub3.

Griffey RT and Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. American Journal of Roentgenology, 192(4):887-92, Apr 2009.

Haberman J. The present status of mammary thermography. CA: A Cancer Journal for Clinicians, 18: 314-321,1968.

Jorgensen KJ and Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. British Medical Journal, 339:b2587, 9 July 2009.

Lerman C et al. Psychological and behavioral implications of abnormal mammograms. Annals of Internal Medicine, 114(8):657-61, 15 Apr 1991.

Nelson HD et al. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(10):727-37, W237-42, 17 Nov 2009.

Ng EY-K. A review of thermography as promising non-invasive detection modality for breast tumor. International Journal of Thermal Sciences, 48(5):849-859, May 2009. DOI:10.1016/j.ijthermalsci.2008.06.015.

Ng EY et al. Computerized detection of breast cancer with artificial intelligence and thermograms. Journal of Medical Engineering & Technology, 26(4):152-7, Jul-Aug 2002.

Stark A and Way S. The Screening of Well Women for the Early Detection of Breast Cancer Using Clinical Examination with Thermography and Mammography. Cancer 33:1671-1679, 1974.

Sunday, November 15, 2009

Urban Composting

According to the Lower East Side Ecology Center, the Department of Sanitation in New York City collects 13,000 tons of garbage everyday, and almost 5,000 tons – close to forty percent – account for organic materials that could be composted. Composting not only reduces waste, it also saves greenhouse gas emissions from refuse transport and provides nutrient-rich plant food for gardens, yards and parks. Because the health of the planet plays an important role in our own health, composting is something to be taken seriously and everyone can participate. Many urbanites wouldn’t consider composting compatible with city life, but surprisingly, it is.

Get Started

Worm bin composting requires few materials, little maintenance and less than three cubic feet of space. Properly managed, worm bins are discrete and odorless, and they do not attract pests. Bins can be tucked away inside a closet or pantry, under the kitchen sink, or in any shady spot, as long as the air vents are unobstructed and the temperature remains between 50 and 80 degrees Fahrenheit. A standard size bin, sometimes called a Worm Condo, usually measures 12 by 16 by 19 inches, but any lidded plastic container of similar size, with air holes and drainage holes, will work well.

To set up a worm bin, begin with bedding materials referred to as “greens” and “browns.” Greens are organic materials rich in nitrogen. These can include fruit and vegetable scraps, coffee grounds, coffee filters, tea leaves, tea bags and fresh green plant materials like wilted flower bouquets, weeds and grass clippings. Browns are rich in carbon. These include newspaper, office paper (nothing shiny), paper bags, cardboard, food-soiled napkins and paper towels, dryer lint, saw dust, wood shavings, egg shells, corn cobs, stale bread and dry plant material like fall leaves, dead pine needles and dried flowers.

Place up to three pounds of green materials in one corner of the bin. Shred some newspaper into one-inch strips (you will need about five newspapers if this is the only brown material you plan to use). Dip them in water and squeeze out as much moisture as possible. Separate the strips and drop them into the bin, along with any other browns, on top of the greens. Fill the container up to the bottom of the air vents, roughly three inches from the top. All of the greens should be covered by browns. The browns should have a fluffy appearance and allow for plenty of air circulation, creating a humid, but not wet, environment.

On top of the browns, add one pound of Red Wigglers – approximately 1,000 worms – and cover the container tightly. Ensure that the air vents at the top are open and unobstructed. There should be little drainage, but a small amount is normal, so place the bin on a tray lined with an old towel or newspaper to absorb any liquid.

To maintain the worm bin, place up to three pounds of greens in the bottom of the bin each week (a volume approximately equivalent to a standard size bread bag). Imagine that the bottom of your bin is divided into six equal areas and use one area each week. Rotate your disposals around the bin, returning to the first area six weeks later. Each time you add greens, be sure to place them at the bottom and cover them with browns.

After approximately four months, the bedding will begin to resemble crumbly black dirt and the compost will be ready to harvest. Move everything to one side of the bin and stop adding greens to this compost. On the empty side, add new greens and browns and continue composting.

Two weeks later, most of the worms should have moved over to the new bedding. Remove the compost and redistribute the browns to the empty side of the bin, adding more if necessary. Use the compost you harvested to feed plants, trees or grass. If you can’t use all of the compost yourself, donate it to local farms or community gardens.

Follow Four Rules

To avoid odors and infestations, follow four simple rules. First, maintain roughly equal amounts of greens and browns inside your bin, but always add slightly more browns. Greens are typically damp materials, and if there are too many, the environment will become too wet and foster microbial growth. If this happens, add more browns, which are typically dry materials, to absorb excess moisture.

Second, refrain from adding oily foods to your worm bin. This includes salad dressings, sauces, meat and fish scraps, cheese and other dairy products. Because fats and oils turn rancid more quickly at room temperature, they can become smelly.

Third, avoid adding the skins and peels of citrus and tropical fruits to your worm bin, or treat them first. Fruit flies often lay eggs on these fruits, and eggs that hatch inside a worm bin can quickly create an infestation. To kill any fruit fly eggs before they can hatch, freeze citrus peels and tropical fruit skins overnight or heat them for one minute in the microwave (and cool to room temperature) before adding them to your worm bin.

Fourth, avoid adding anything to the bin that might threaten the health of your worms and their ecosystem. This includes pet waste, diseased plants, pesticide-treated plant materials, pressure-treated lumber, glossy paper, charcoal, weeds with seeds, invasive weeds, dead animals, and inorganic materials like plastic, metal and glass.

Learn More

The Lower East Side Ecology Center in New York City offers informative workshops like Worm Composting 101, a Children’s Wormshop, and Worm Composting for the Classroom, designed for teachers who want to start class projects. They sell materials, including Worm Condos and the Red Wigglers that love them, and accept donations of organic materials for composting (approximately 1,000 households currently donate six tons per week). The Center also offers a free composting hotline to answer questions and help troubleshoot problems (212-477-3155).

Visit their website at www.lesecologycenter.org or stop by their stand at the Union Square Greenmarket any day it is open (8 to 5 every Monday, Wednesday, Friday and Saturday) to get more information, register for a class, donate your organic waste, or buy some authentic New York City compost.

Sunday, November 1, 2009

Preventing Swine Flu

The upper respiratory infection caused by the H1N1 influenza virus, commonly called the swine flu, has everyone on alert. Preliminary reports suggest that most cases are limited to mild illness and unless the virus mutates or combines with a more dangerous virus, an above-average incidence of death and disability are unlikely. Immunization efforts are underway but swine flu vaccines have sparked controversy and concern over questionable ingredients and inadequate safety information. My patients frequently ask me to make recommendations for alternatives to vaccination, so here I share some simple strategies to enhance immunity and prevent infection during swine flu season.

Common Sense


The swine flu is much like the regular flu. The symptoms are similar – fatigue, fever, chills, sore throat, cough, runny nose, headache, body aches – and like other influenza viruses, H1N1 is transmitted through contact with respiratory secretions of infected individuals, usually after coughing, sneezing or touching common surfaces. To prevent transmission, avoid touching your mouth, nose, or eyes and wash your hands often with hot, soapy water and lots of friction, for at least twenty seconds. Although people can become contagious before symptoms even start, use your best judgment and avoid contact with individuals who appear to be sick. If you are ill, stay home to prevent spreading the infection to others.

Good Nutrition

While a multiple vitamin-mineral supplement can provide the nutrients necessary for a healthy immune system, it is no substitute for whole foods. Eat a wide variety of fruits, vegetables, whole grains, beans, raw nuts and seeds. If you eat meat, choose pasture-raised and grass-fed animals. If you eat seafood, choose small fish that live in cold water, like anchovies, sardines, herring and wild salmon, and avoid large fish at the top of the food chain, like tuna and swordfish. Avoid processed foods, trans-fats, hydrogenated oils, refined carbohydrates like white flour and sugar, and excessive intake of alcohol. Unless you have kidney disease or your doctor has told you otherwise, drink plenty of fluids. The best choices are filtered or spring water and unsweetened herbal or green tea.

Sufficient Sleep

Getting enough sleep is important for a healthy immune system. A study published in the Archives of Internal Medicine found that healthy adults who slept at least eight hours each night had a higher resistance to upper respiratory infections. Participants reported their sleep duration and sleep efficiency (time spent in bed asleep) every night for two weeks before they were exposed to a rhinovirus known to cause the common cold. Those who reported less than seven hours of sleep per night were almost three times as likely to develop a cold than those who slept eight hours or more. Participants who reported poor sleep efficiency (less than 92 percent) were five and a half times more likely to come down with a cold compared to those who reported a high sleep efficiency (98 percent or above). Although this study focused on rhinoviruses, sufficient sleep is most likely an essential element in preventing other upper respiratory infections, like swine flu, as well.

Regular Exercise

Exercise can also impact immunity. One study, published in the American Journal of Medicine, followed 115 sedentary postmenopausal women for one year to study the effects of physical activity on resistance to upper respiratory infections. Participants were divided into two groups: one exercised for 45 minutes at a moderate intensity, five days each week, while the other attended one 45-minute stretching session, one day per week. Researchers concluded that the stretchers had a much greater risk of getting sick than the exercisers, by a factor of three in the final three months of the study. If regular exercise can increase resistance to upper respiratory infections in older women, there is a good chance it can be helpful for the prevention of swine flu in others.

Vitamin D

Studies have shown that vitamin D can stimulate the production of white blood cells responsible for identifying and destroying abnormal cells, like the H1N1 virus, and producing anti-microbial peptides that protect the respiratory system from infection. Studies have also shown that low blood levels of vitamin D are associated with an increased incidence to colds and flu. Vitamin D production is stimulated in the skin upon exposure to ultraviolet radiation and levels may be low during colder months when we spend less time in the sun. Blood levels of Vitamin D can be tested by your doctor and should ideally fall between 60 and 90 nanograms per milliliter (ng/ml). If levels are low, vitamin D can be taken in supplement form to increase immunity during cold and flu season.

Probiotics

Probiotics are healthy bacteria that normally live on our bodies and inside our gastrointestinal tracts. These supplements are most commonly used to treat digestive disorders but studies show that probiotics can also play an important role in respiratory tract infections. In a double-blind, placebo-controlled study published in Pediatrics, researchers followed 326 healthy children between the ages of three and five years taking a placebo or probiotic product (lactobacillus acidophilus alone or in combination with bifidobacterium) twice daily for six months. Compared to placebo, the kids who took probiotics experienced fewer cold- and influenza-like symptoms, including fever, cough and runny nose, and they recovered faster when they did get sick. They reported less illness-related school absences and required fewer prescriptions for antibiotics. If probiotic supplements can be protective against the flu, they may be useful in preventing the swine flu as well.

Botanical Medicines

Elderberry has a long tradition of use as treatment for upper respiratory infections and a recent study, published in Phytochemistry, supports its efficacy against the H1N1 virus. Researchers found that elderberry flavonoids can bind the H1N1 virus and block its ability to infect host cells. They concluded that its anti-viral activity is comparable to pharmaceuticals Oseltamivir (Tamiflu) and Amantadine.

Other herbal medicines used to prevent and treat viral upper respiratory infections include Astragalus root and medicinal mushrooms like reishi, shiitake and maitake. These botanicals have been used in traditional Chinese for thousands of years as restorative tonics, immune stimulants, and adaptogenic herbs that increase resistance to stress and illness.

Good Guidance

Like pharmaceutical medications, nutritional and herbal supplements are not appropriate for everyone. Before taking anything new, talk to a doctor trained in the use of natural medicines about contraindications, side effects, potential interactions, and the best dosage for you.

REFERENCES

Cannell JJ et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec;134(6):1129-40.

Chubak J et al. Moderate-intensity exercise reduces the incidence of colds among postmenopausal women. Am J Med. 2006 Nov;119(11):937-42.

Cohen S et al. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7.

Leyer GJ et al. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics. 2009 Aug;124(2):e172-9.

Roschek B Jr et. al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009 Jul;70(10):1255-61.

Thursday, October 1, 2009

Improving and Protecting Memory

Memory is a complicated neurological process and our understanding has progressed rapidly over the last thirty years. Studies have shown associations between environmental factors and the brain’s ability to encode, store and retrieve information. Experts now understand how sleep, exercise, diet, botanical medicine and stress management can improve and protect memory.

Sleep

Sufficient sleep before and after learning is an essential element in committing new information to memory. In 2007, Harvard researchers examined the effects of sleep deprivation after new experiences. The study compared people who got enough sleep the night before learning new information to those who got insufficient sleep. Individuals who didn’t sleep enough had a compromised ability to remember the information they had learned. Even a single night of sleep deprivation caused impairment in the hippocampus, part of the brain’s limbic system that is responsible for encoding information to form new memories.

Physical Exercise

During physical activity, the movement of muscles increases circulation throughout the body. Regular aerobic exercise improves blood flow to the brain and strengthens the cardiovascular system, reducing the risk of deficits in memory and stroke (loss of neurological function following blood loss to the brain).

All physical activity can support a healthy memory, so the best exercise is one that you enjoy and practice often. However, some activities offer benefits besides better memory. Researchers at the McGill University in Montreal studied the health effects of tango dancing on thirty adults between the ages of 68 and 99 years. Half the participants joined a walking program and the other half took lessons for tango, a dance involving a series of complex movements. Both groups improved their scores on memory tests, but the tango dancers also experienced improved self-esteem, balance, coordination and multi-tasking ability.

Mental Exercise

When it comes to memory, mental exercise is as important as physical exercise. Older adults who read, play games, solve puzzles, take classes and learn new things have better memories than those who do not. The more you use your memory, the longer you will enjoy it, so spend at least 10 to 15 minutes every day exercising your brain.

Nutrition

Crucial constituents of brain cells, omega-3 fats like docosahexaenoic acid (DHA) are one of the most important nutrients for memory. Researchers have found that fish, the best source of DHA, is especially good at reducing risk of Alzheimer’s disease and slowing age-related cognitive decline. Many fish are contaminated with mercury and other hazardous pollutants, but in general, species with the lowest levels of toxins and the highest concentrations of DHA include wild salmon, herring, sardines and anchovies. To find the best choices in your area, search the Monterey Bay Aquarium’s Seafood Watch website: www.montereybayaquarium.org/cr/seafoodwatch.aspx. Raw nuts and seeds, including ground flax seed and borage oil, are good sources of omega-3 fats, but they do not contain DHA.

Other nutrients also play key roles in preserving memory. Antioxidants like vitamins C and E protect brain cells against damage from free radicals (reactive oxygen molecules). Studies have shown that flavonoids and polyphenols found in berries can prevent and reverse age-related cognitive decline. B vitamins are necessary for the production of neurotransmitters (chemical messengers in the brain) and myelin (a sheath around brain cells that facilitates cell-to-cell communication). B vitamins are also required for the to body eliminate homocysteine. This amino acid has been linked to Alzheimer’s disease and stroke (common causes of memory loss), as well as heart attack.

Colorful fruits and vegetables are the best source of these necessary nutrients. Choices that are especially good for brain health include blueberries, blackberries, black currants, strawberries, beans, peas, citrus fruit, spinach, kale, and dark green leafy vegetables like dandelion, mustard, beet, collard and turnip greens.

Botanical Medicine

Ginkgo biloba has been used as a medicine for thousands of years and studies have confirmed its cardiovascular benefits. In individuals with compromised circulation, it can improve memory by increasing blood flow to the brain. Evidence has shown that it can also slow certain types of dementia involving memory loss. In 2005, researchers in Poland studied twenty-seven adults with dementia related to Alzheimer’s disease, vascular dementia, or both. They were given Ginkgo extract for six months. The herb was well-tolerated and none of the participants showed loss of cognitive function.

Gingko biloba can increase the risk of bleeding, interfere with some medications, and at high doses, cause side effects like gastrointestinal upset and headaches. Individuals interested in taking Ginkgo should seek guidance from a doctor trained in botanical medicine.

Stress Management

Stress can have a negative affect on memory. Elevated levels of adrenal stress hormones called glucocorticoids can damage the memory center of the brain, the hippocampus. All cells need glucose to function, including brain cells responsible for memory. Glucocorticoids can inhibit the transport of glucose into hippocampal memory neurons. In 1991, researchers at Stanford University found that memory can be affected when stress hormones are elevated for four hours or longer.

Some acute stress is good, like preparing for an important speech or running a race. But when stress is chronic, it increases the risk of high blood pressure and cardiovascular disease, conditions that can lead to stoke and memory loss. Managing stress can be an important part of preserving memory and several effective options exist: exercise, yoga, meditation, breathing exercises, progressive muscle relaxation, and qi gong, among others.

Other Factors

While memory loss may be a normal part of aging, it may also be related to other factors, like Alzheimer’s disease, stroke, infection, head trauma or alcoholism. Individuals affected by these conditions, and those who suspect they may be, should talk to their doctors about treatment. These underlying causes of illness must be addressed before memory loss can improve.

REFERENCES

Bidzan L et al. [Preliminary assessment of ginkgo biloba (Ginkofar) in patients with dementia]. Psychiatr Pol. 2005 May-Jun;39(3):559-66.

Farooqui T and Farooqui AA. Aging: an important factor for the pathogenesis of neurodegenerative diseases. Mech Ageing Dev. 2009 Apr;130(4):203-15. Epub 2008 Nov 21.

McKinley P et al. Effect of a community-based Argentine tango dance program on functional balance and confidence in older adults. J Aging Phys Act. 2008 Oct;16(4):435-53.

Virgin CE Jr et al. Glucocorticoids inhibit glucose transport and glutamate uptake in hippocampal astrocytes: implications for glucocorticoid neurotoxicity. J Neurochem. 1991 Oct;57(4):1422-8.

Yoo SS et al. A deficit in the ability to form new human memories without sleep. Nat Neurosci. 2007 Mar;10(3):385-92. Epub 2007 Feb 11.

Tuesday, September 1, 2009

Multi-Vitamin-Mineral Supplements

Multi-vitamin-mineral formulas are the most popular nutritional supplements in the United States and experts estimate that up to half of all adults take them regularly. But studies have shown mixed results and consumers are concerned. Are they necessary? Are they safe? Who should take them? Are liquids better than capsules? Which brands are best? The following guide will answer these questions and more.

Foods First

Taking nutritional supplements is never a substitute for eating whole foods. Fruits and vegetables are the best sources of the vitamins and minerals our bodies need and most adults should eat seven to nine servings each day. (One serving of fruits and vegetables is one half cup, excluding raw leafy greens like lettuce, which require one cup per serving.)

Two exceptions exist: vitamins B12 and D are found primarily in animal products. Vitamin D is also found in small amounts in mushrooms and sunshine stimulates its production in the skin. Vitamin B12 can be found in trace amounts in sea vegetables and microalgaes but lab tests have shown that this form does not have the same activity as vitamin B12 from animal sources.

Comparing apples to apples and oranges to oranges, some are more nutritious than others. Foods grown in nutrient-rich soils are rich in nutrients and foods grown in nutrient-poor soils are poor in nutrients. After all, plants cannot absorb what is not in the soil. Nutrient depletion largely results from the use of chemical fertilizers that replenish only three of the many nutrients plants need to thrive. But farmers who use natural fertilizers, grow a variety of plants and rotate their crops actually enrich and improve the soil. Find these farmers and their nutritious fruits and vegetables at your local farmers’ market or join their CSA (community-supported agriculture).

Another benefit of produce from local farms is fresher food. Because fruits and vegetables begin to lose nutrients as soon as they are picked, those that travel hundreds or thousands of miles between farm and plate usually contain less vitamins than their freshly picked counterparts. Healthy adults eating plenty of local, fresh-picked fruits and vegetables – and those preserved at peak ripeness – and a minimal amount of animal products probably do not need to take a daily multi-vitamin-mineral supplement (MVMS).

Special Needs

For some, MVMS can provide extra insurance that nutritional needs are being met. People who benefit most include adults who do not eat at least seven servings of fruits and vegetables each day, growing children, couples who plan to conceive, pregnant and lactating women, and older adults whose ability to assimilate nutrients becomes less efficient with age. Individuals following a vegan diet should supplement as well because they are more likely to be deficient in vitamins B12 and D (depending on sun exposure). Individuals with increased needs for nutrients due to chronic medical conditions or prescription medications also benefit. Blood tests can measure levels of vitamins and minerals to determine if supplementation is necessary, and they can also be used to track progress after supplementation.

MVMS are not standardized and different products contain different combinations and concentrations of vitamins and minerals. People with special nutritional needs should ask their doctor for recommendations to ensure they are getting exactly what their bodies require.

Favored Forms

MVMS come in many forms: tablets, chewable tablets, capsules, gel capsules and liquids. Tablets can hold more ingredients but may also contain more fillers and binders to keep everything together. Some companies use animal-derived gelatin to encapsulate their formulas, so individuals avoiding animal products should seek supplements with cellulose capsules. For individuals with compromised gastrointestinal function, liquids and gel capsules are often easier to digest and absorb. Liquids, however, usually need to be refrigerated and may have shorter shelf lives.

Minerals are sometimes chelated (bound to an amino acid) to increase absorption. Because chelated minerals take up much more volume than minerals alone, MVM formulas containing chelates often require a larger daily dose, up to eight capsules per day. Forms most easily absorbed include aspartates, citrates, malates and picolinates.

Extra Ingredients

In addition to vitamins and minerals, some MVMS may contain ingredients like omega-3 fatty acids, probiotics (healthy intestinal bacteria), green tea and other herbs. These can be helpful for some people, but not for others. For example, many diets are deficient in omega-3 fats and could benefit from supplementation, but fatty acids found in fish oil can interfere with certain medications and high doses may increase the risk of bleeding in some individuals. Green tea is a powerful antioxidant and has been studied for its protective effects against cancer and other illnesses, but it also contains caffeine that can aggravate certain conditions like ulcers, anxiety and insomnia. Herbal medicines, including those added to MVMS, should only be taken under the guidance of a doctor trained in their use.

Other ingredients may be used in the manufacturing process, like fillers and binders, or added to improve flavor, appearance and palatability (especially in chewable and liquid products). Always read the list of additional ingredients on the label and avoid supplements containing sweeteners, colors and artificial flavors. Sensitive or allergic individuals should check for gluten, dairy, yeast, corn, soy or shellfish.

Careful Consumption

Because MVMS contain nutrients that require fat for absorption, like calcium and vitamins A, E and D, they should always be taken with food. Food stimulates the secretion of stomach acids, so taking these supplements at mealtimes can also improve the digestion and absorption of nutrients. If you can, spread the dose throughout the day unless directed otherwise.

Safety Questions

Because dietary supplements are regarded as food, the United States Food and Drug Administration does not have standards for testing and manufacturers are responsible for determining that the ingredients they use are safe. Consumer Lab, an independent company that tests supplements for safety, found problems with more than 30 percent of products they recently tested. Some MVMS contained too much of some nutrients, too little of others or dangerous ingredients like lead.

Recent Research

Earlier this year, the Archives of Internal Medicine published a study using data from the Women’s Health Initiative to evaluate potential benefits of supplementation in postmenopausal women. After investigating their use of MVMS, researchers found that the supplements made little or no difference in the women’s risk for common cancers, cardiovascular disease or death. However, there were no standards set for quality or consumption of MVMS and because the women were taking not all taking the same supplement, variations existed in the potency of the formulas and the frequency of their use. Benefits of MVMS cannot be dismissed by studies such as this.

Quality Concerns

High quality MVMS may be expensive, but price isn’t always an indicator of quality. When selecting supplements, choose products that list important information on the label: expiration date, lot or batch number, name and address of the manufacturer, and the scientific name, quantity and part (root, leaf, flower) of any plant ingredient. To ensure that products have been tested by an independent lab and found to contain the ingredients listed on the label, look for brands with seals from Consumer Lab, the United States Pharmacopeia (USP), the National Nutritional Foods Association (NNFA) or National Sanitation Foundation (NSF) International. But keep in mind that such certification does not guarantee the manufacturers started with high quality raw ingredients or tested the supplements in clinical trials. Direct questions like these to the manufacturer or ask a knowledgeable practitioner to recommend reputable brands.

Saturday, August 1, 2009

Cooking With Kids

Good nutrition is important for everybody, but it is especially essential for children during their years of growth and development. Unfortunately, kids can be picky eaters and they aren’t always interested in eating vegetables or trying new foods. But sharing the kitchen may make a difference. In a 2008 research study at Columbia University, children involved in meal preparation were more likely to try new foods, enjoy the foods they cooked, and eat those foods again in the future. If they’re not in the kitchen yet, follow these simple steps to get your kids cooking.

Assign Appropriate Tasks

Adults should always perform or supervise steps involving stovetops and sharp edges, but there are plenty of tasks well suited to young cooks. After they wash their hands with warm, soapy water, children can wash produce and scrub vegetables with a brush. They can measure ingredients and help with stirring, mixing, whisking, mashing and tossing. Kids can use salad spinners and timers. They can peel citrus fruit and assemble fruit kebobs. Those too young to handle knives can use scissors to cut green leafy vegetables and herbs like lettuce, chard, kale, basil and sage. Older children can also help keep the kitchen clean by wiping counters, washing and drying dishes.

Shop Together

Children are more likely to try new foods they pick out themselves, so take your kids to the farmers’ market and the grocery store. Let them pick out fruits, vegetables, beans and whole grains they are interested in eating or cooking. If you don’t know how to cook something your child selects, look it up and learn how to prepare it together. If you have a garden, involve your kids in the process, from planting seeds and tending plants to harvesting and cooking what you grow.

Engage the Senses

When planning meals with kids in mind, aim to engage their senses with a variety of aromas, colors, tastes and textures. Everyone should eat a rainbow of fruits and vegetables every day – red, orange, yellow, green, purple – and kids can have fun keeping track. Use color and texture to introduce new tastes. For example, a child who likes pureed peas may also like pureed spinach or other green foods.

Add Healthy Fat

Fat is an important nutrient and we cannot live without it. It is necessary for the absorption of fat-soluble vitamins in foods, including vitamins A and E in fruits and vegetables. Additionally, fat carries flavor and can make foods that kids usually find unappealing more attractive. Toss steamed vegetables with a little bit of organic butter. Grate some aged Parmesan cheese over roasted vegetables. Drizzle salads with extra virgin olive oil or incorporate it into dressings and vinaigrettes. Spread almond butter on apple slices or use it as a dip for celery and carrot sticks. Or let kids dip pieces of fruit into organic whole milk plain yogurt mixed with a few drops of honey.

Appoint a Salad Maker

Making salads is a great job for kids. They can wash produce, tear lettuce leaves, use a scissors to cut chives and scallions, toss everything together and sprinkle raw nuts and seeds on top. Teach them to make their own vinaigrette by adding extra virgin olive oil, vinegar, Dijon mustard, sea salt and pepper to a clean glass jar and shaking it up until all of the ingredients are thoroughly combined. Assigning salad duty to a willing child will not only ensure that a healthy serving of vegetables will be part of every meal, but it can also make young cooks more enthusiastic about eating greens and allow them to exercise their creativity.

Offer Variety

Because food preferences in children are shaped by what their parents and caregivers make available, especially before the age of four, they should be exposed to a wide variety of whole foods. Unless kids have food allergies, their diet should include fruits, vegetables, whole grains, beans, raw nuts and seeds, nontoxic fish and seafood, and pasture-raised meat and animal products like eggs, milk, yogurt and cheese. To find nontoxic fish and seafood, search by species or geographical location on the website of the Monterey Bay Aquarium’s Seafood Watch Program: http://www.montereybayaquarium.org/cr/seafoodwatch.aspx.

Don’t Negotiate

Unless children have a medical or religious reason to avoid certain foods, don’t offer to make extra dishes to satisfy picky eaters. Parents and caregivers should decide which foods children eat and children should decide how much they eat, given the choices they have. Only offer healthy foods, and if kids are hungry, they will eat.

Be Patient

Encourage your children to try new things, but don’t force them to eat what they don’t want. Even if a child doesn’t like or doesn’t want to try a food, continue to offer it. Be patient because it may require several attempts, a dozen or more, before children become interested in trying new foods. Forcing kids to eat things they don’t like can make matters worse, creating negative associations that cause them to continue avoiding the foods. Instead, help them learn to cook things that are unfamiliar or unappealing so they will be more willing to try them.

Set a Good Example

Kids can be curious creatures. If they see their parents and caregivers consistently cooking and eating a wide variety of healthy whole foods, chances are that eventually they will want to try those foods too. But if children see their parents eating processed foods and snacks, like cookies and potato chips, those are the foods they will ask for. So skip the junk food and be a good role model.

Wednesday, July 1, 2009

Exercising on a Budget

As concerns about the economy continue to mount, money-saving strategies take center stage. People who once paid premium prices for private gym memberships and personal trainers are now seeking budget-friendly alternatives. Fortunately, many exist. From not-for-profit gyms to exercising at home or outdoors, frugal fitness opportunities abound.

Not-For-Profit Fitness Centers

Gym memberships at not-for-profit organizations like the YWCA and YMCA are usually much less expensive than those at for-profit fitness centers. Many offer options to fit any budget, from yearly or monthly memberships to day passes and single classes. Financial assistance may also be available for those who qualify.

Facilities, classes and programs at the “Y” vary by branch but many are comparable to more expensive private gyms. Fitness centers usually include free weights, resistance equipment and exercise machines like treadmills, stair steppers, elliptical trainers and stationary bicycles. Most have group exercise classes as well, such as spinning, yoga, pilates, aqua exercise, step and dance-based fitness classes. Some branches offer martial arts instruction, racquetball and squash courts, swimming pools, whirlpools, saunas, steam rooms, indoor running tracks, basketball courts and a complimentary orientation session with a personal trainer for new members. Many have programs tailored to children, teens, pregnant women, adults and seniors. Amenities like sundecks, coat checks, juice bars, complimentary towels, and laundry and spa services may be missing, but the savings can be substantial. To find a local Y near you, visit www.ywca.org or www.ymca.net.

City parks and recreation programs may also offer indoor fitness facilities at reduced rates. The New York City Department of Parks and Recreation offers a standard gym membership for only fifty dollars per year, and membership at centers with indoor pools for seventy-five dollars per year. Starting at age fifty-five, seniors pay only ten dollars annually and youth under the age of eighteen receive free membership. For more information, visit www.nycgovparks.org/facilities/recreationcenters. Several centers are available in each borough.

The Great Outdoors

Find free exercise opportunities in parks and other open spaces. Facilities can include baseball diamonds, soccer fields, disc golf courses, running tracks, hiking trails, paths for walking and in-line skating, and tennis, volleyball and basketball courts. Some offer seasonal facilities like swimming pools and beaches, kayak and canoe rentals, ice-skating rinks and trails for cross country skiing and snow-shoeing. Free fitness classes, after school athletics and instructional sports clinics may also be available. Contact your local city and state parks to learn about options near you. For information about activities, facilities and programs in parks across New York City, visit www.nycgovparks.org.

You can also get creative and make the park your gym. Design your own workout for free using equipment commonly found in parks and playgrounds. Do pull-ups on the uneven bars to strengthen arms. Hang from the monkey bars, tighten your core (torso) muscles and lift your knees toward your chest to strengthen abdominal muscles. Do push-ups on park benches or lower your body off the seats for tricep dips. Use any open space to perform lunges and squats. Find a patch of soft green grass to do abdominal crunches, practice yoga or stretch muscles after you work out.

When exercising outside, it is especially important to stay hydrated. Unless your doctor tells you otherwise, drink an extra sixteen ounces of water an hour or two before physical activity and bring plenty of water with you to drink during your workout. During warm months, avoid the hottest part of the day and wear sunscreen on exposed skin.

Home Exercise Equipment

With minimal investment, you can get a great workout at home. Exercise programs exist for every fitness level and interest. Whether you want to learn yoga or follow an advanced step routine, they can be a good source of motivation and instruction. Look for programs on television and DVD. Recorded materials may even be available at your local library free of charge.

Other inexpensive essentials include resistance bands and jump ropes. Jumping rope adds an aerobic component to your workout and improves balance and coordination. Because it is a weight-bearing exercise, it can strengthen bones as well. Resistance bands can be used to stretch and strengthen muscles in all areas of the body. They can even be utilized to mimic exercises that are traditionally done using resistance machines or free weights, like bicep curls, tricep extension, chest press, lunges and squats. Resistance bands and jump ropes are small and portable, making them perfect for travel. Bring them with you when you workout in the park or take trips away from home.

Activities of Daily Living

Take more time to do the active things you need to do daily. If you take public transportation, get off the bus or subway a stop or two early and walk the rest of the way to your destination. If you drive, park your vehicle further away, either a few blocks down the street or at the back of the parking lot. Take the stairs instead of the elevator and run errands by walking whenever you can. Instead of taking the dog out for a short bathroom break, walk your pet for a half hour or more at least once each day. If you have outdoor space, plant a garden or expand the one you have. Physical activity is just one benefit; free organic food is another.

Permission From Your Doctor

Before starting any new exercise, get permission from your doctor. Also consider scheduling a session or two with a personal trainer to develop a fitness program tailored to your ability, needs and goals. Learn the exercises from an expert so you know how to do them correctly, reducing your risk of strain and injury, and then perform them on your own. For most people, this one-time initial investment will be well worth the cost.

Monday, June 1, 2009

The Seafood Dilemma

Seafood has long been considered an essential element in healthy diets. Population studies have shown that people who eat fish regularly live longer and have lower incidences of chronic disease than those who do not. Research studies confirm the health benefits of omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) which are only found in fish and seafood. However, reports of contamination with toxic compounds and environmental damage from flawed fishing practices leave some skeptical. Can the benefits of eating fish and seafood outweigh the risks?

Health Effects

The essential omega-3 fats in fish and seafood have been found to protect against cancer and heart disease. They can reduce inflammation in the body, improve cholesterol levels, and reduce the likelihood of blood clot formation. Fish fats play important roles in the prevention of heart attack, stroke, cancer and autoimmune inflammatory conditions like rheumatoid arthritis and systemic lupus erythematosus. They may also improve chronic conditions such as insulin resistance, coronary artery disease, high blood pressure, atherosclerosis, diabetes, PMS, memory loss and depression.

DHA and EPA are essential to our diet because our bodies cannot make them. Alpha-linoleic acid (ALA) is a precursor found in flax seeds, walnuts, hemp seeds, purslane and soy. It can be converted into DHA and EPA inside the body, but the conversion process is not efficient. Some experts estimate that less than one percent of ALA is converted into these healthy omega-3 fats. Furthermore, conversion becomes less efficient as we age. This puts elderly individuals who do not eat seafood at higher risk of DHA and EPA deficiency at a time when support for neurological and cardiovascular systems is more important than ever.

Despite the numerous benefits of eating fish and seafood, health concerns exist as well. Studies have shown that some species are contaminated with mercury, lead, cadmium, polychlorinated biphenyls (PCBs), dioxins, antibiotics, insecticides and pesticides. A 2004 study published in Science compared wild salmon to farm-raised salmon from across Europe and North and South America. Researchers found that the farm-raised fish had much higher concentrations of cancer-causing contaminants, including PCBs, dioxins and insecticides dieldrin and toxaphene. Given the increased risk for cancer, many experts advise limiting consumption of farm-raised salmon to one meal per month or less. I recommend avoiding it all together.

Cancer isn’t the only risk associated with eating contaminated fish. Toxins in fish have also been associated with problems in neurological, reproductive, endocrine and immune systems. Mercury can be especially dangerous for pregnant women because it is damaging to fetuses, impairing brain and nervous system development. Problems with memory, cognitive thinking, learning, language, visual and fine motor skills have been associated with exposure to mercury in utero. Symptoms in adults include problems with peripheral vision, sensation, muscle coordination, speech and hearing.

Environmental Damage

As global demand for fish and seafood continues to grow, wild fisheries are becoming depleted and fishing practices contribute to environmental problems. Bottom trawling and dragging dredge nets damage delicate sea and ocean floors. Once compromised, it can take centuries for the coral, animals and plants to return. Also, animals like seals, sea turtles, dolphins, whales and seabirds are caught unintentionally and discarded (dead or dying). The Monterey Bay Aquarium estimates that for every pound of shrimp caught in a trawl net, between two and ten pounds of other animals are harvested unnecessarily as bycatch. Alternative fishing practices such as hook-and-line fishing, trap fishing and longlining are much less damaging to the environment and other animals.

Fish farming has helped supply the increasing demand for seafood and taken pressure off wild fisheries, but aquaculture poses problems for the environment. Like other confined animal feeding operations, fish farms generate excessive amounts of waste and animals are treated with chemical agents to increase growth and control infections. Surrounding waters become polluted with fish feces, food waste, antibiotics, insecticides and pesticides. This promotes the growth of oxygen-depleting microorganisms, upsets ecosystems and threatens wild populations.

Two exceptions exist. Bivalve farms can be used to clean costal bays and estuaries by filtering farm runoff and preventing algae overgrowth. Rainbow trout aquaculture has a low impact on the environment, and nutritionally, this fish is a very good source of omega-3 fats.

Good Choices

When chosen carefully, fish and seafood can be part of a healthy diet and a sustainable future. Two general rules apply when it comes to selecting healthy and sustainable seafood. First, find species high in DHA and EPA. These usually include oily fish that live in cold water, such as salmon, halibut, herring, sardines and anchovies. Second, eat low on the food chain. Avoid large fish that eat other fish – like tuna, swordfish, marlin and shark – because these predators accumulate higher concentrations of toxic compounds than smaller fish.

The most healthful and most sustainable fish and seafood choices currently include anchovies, wild-caught Alaskan salmon, wild-caught Pacific halibut, wild-caught Atlantic herring and sardines, wild-caught black sea bass, farm-raised rainbow trout, wild-caught pink shrimp (also known as northern shrimp), wild caught spot prawn, diver-caught sea scallops, and farm-raised or wild-caught clams such as steamers, littlenecks, longnecks and cockles.

However, good and bad choices can vary by geographical area. To search for the best choices in your region, visit the website of Monterey Bay Aquarium’s Seafood Watch program. Seafood Watch is a good resource for the most current information and advisories on toxic contaminants and environmental issues, including how fish are harvested. Visit their website to browse the seafood guides and download phone apps or printable pocket versions.

Supplementation

If good seafood is hard to find, or if certain health conditions call for more concentrated consumption, fish oil supplements offer an alternative. Because many toxic compounds are fat-soluble, the purity of fish oil is very important. Companies that produce fish oil supplements should test their products for contaminants and make this information available to consumers. Many good brands exist, but Nordic Naturals stands out because they are committed to using only sustainable sources of fish. Before you take fish oil or any other new supplement, talk to your doctor about whether it is a good choice for you, and ask about an appropriate dosage.

Friday, May 1, 2009

Reducing the Risk of Meningitis

Meningitis is a rare but devastating disease involving inflammation of membranes surrounding the brain and spinal cord. It can have several causes, from immunizations and injuries to medications and surgery, but most cases result from viral or bacterial infections. Individuals can become very sick very quickly and sudden deaths sometimes occur. Understanding the disease, recognizing the symptoms and knowing how to reduce your risk is the best prescription for prevention.

Disease Details

Initial infections usually start in the respiratory system, skin, gastrointestinal system or urinary tract. They progress when microorganisms enter the bloodstream and travel to membranes around the brain called meninges. In teens and adults the most common symptoms of meningitis are fever, headache, a stiff neck and vomiting. Drowsiness, sensitivity to light, confusion, seizures or coma may also be present. Symptoms in infants can also include irritability, cough, a high-pitched cry, poor feeding, a skin rash, bulging fontanelles and convulsions. Viral meningitis and bacterial meningitis can have similar symptoms, but diagnosis is important because the treatments drastically differ.

Viral meningitis is much more common than bacterial meningitis and not likely to cause serious illness. It is usually a self-limiting infection and resolves within ten days without treatment or complications. Sometimes symptoms are so mild that the disease goes undetected; other times it is dismissed as the flu.

Bacterial meningitis is rare but it can be life-threatening. Infected individuals may become very ill in less than twenty-four hours. With immediate antibiotic treatment, the death rate is less than 10 percent, but meningitis is often fatal when treatment is delayed. Twenty percent of survivors have long-term sequelae such as learning disabilities, seizures, problems with hearing or vision, paralysis, personality changes, and damage to the heart, liver, intestines or kidneys.

Many bacteria behind bacterial meningitis are usually harmless and commonly found on our skin and inside our noses, throats and gastrointestinal tract. These include Escherichia coli, Haemophilus influenza, and several species of staphylococcus and streptococcus bacteria. People can pass the microorganisms to others in close contact through the exchange of body fluids from coughing, sneezing, or kissing. Meningitis can be contagious but according to the Meningitis Research Foundation, ninety-seven percent of cases are isolated and unrelated to other cases.

Risk Reduction

Because so many different microorganisms can cause meningitis, no vaccine will prevent it completely. The immunizations most commonly recommended for the prevention of meningiococcal meningitis, Menactra and Menomune, are about 85% effective at protecting against four strains of bacteria. Side effects most commonly include pain and inflammation at the injection site, headache, fatigue and malaise, but Guillain-Barre syndrome (GBS) has also been reported. A rare but serious sequela, GBS is an acute autoimmune inflammatory condition that destroys the myelin sheath surrounding nerves. It's usually temporary but can lead to paralysis, respiratory failure, and death.

Bacteria and viruses can only cause meningitis if they enter the bloodstream, so the best prevention is staying healthy and treating infections before they progress. Sick individuals should seek treatment and ask their doctor when they can expect to feel better and what to do if they don’t.

To reduce the risk of infections, minimize the potential for transmission of organisms. When sick, stay home from work, school and other activities. Do not share food, drinks, or personal items such as utensils and toothbrushes with others. Wash hands frequently and thoroughly with warm, soapy water* and remember that people with colds are contagious before they even exhibit symptoms. Viruses and bacteria can be transmitted by touching common surfaces after an infected person has touched them, so disinfecting regularly is also a good idea. This includes desks, counters, phones and keyboards.

Support a healthy immune system by exercising regularly and eating a balanced diet that includes seven to nine servings of fresh vegetables and fruits each day. Nutritional supplements and botanical medicines can also offer immune support, especially during cold and flu season. But never self-prescribe; instead find a doctor trained in the use of these natural therapies to individualize a protocol for you. She or he will take into account your medical history, risk factors, current symptoms and any potential interactions with medications or supplements you may already be taking.

*Antibacterial soap is neither necessary nor recommended because it can contribute to water pollution and bacterial resistance.

Wednesday, April 1, 2009

Healthy Eating on a Budget

Eating healthy can be expensive, but it doesn’t have to be. The most nutritious foods are whole foods, in their natural state, full of vitamins, minerals, fiber and other phytonutrients. Whole foods are generally less expensive than prepared or processed foods, so strategic shopping makes it possible to have a healthy diet on a tight budget.

Local Produce

Because it has not been shipped long distances, local produce in season is usually fresher and less expensive than what is available in grocery stores. Fruits and vegetables should account for more than half of your diet, so build meals around local produce. Schedule a weekly trip to the farmers’ market to shop for foods in season or join a community supported agriculture (CSA) group for weekly deliveries of local harvest.

When organic foods don’t fit your budget, avoid the “dirty dozen” most contaminated fruits and vegetables: peaches, apples, bell peppers, celery, nectarines, strawberries, cherries, kale, lettuce, imported grapes, carrot and pear.

Instead, shop seasonally for the “clean 15” least contaminated fruits and vegetables: onions, avocadoes, sweet corn, pineapple, mango, asparagus, sweet peas, kiwi, cabbage, eggplant, papaya, watermelon, broccoli, tomatoes and sweet potatoes.

The Environmental Working Group determined that replacing the dirty dozen with the clean 15 reduces exposure to pesticides on produce by almost 90 percent. When you can’t eat organic, this is the next best thing. Download the Shopper’s Guide to Pesticides and take it with you to the market.

Canned Goods

Fresh fruits and vegetables are usually better than their canned counterparts, but exceptions exist. Canned goods contain minimal additives and come pre-cooked.

Compared to fresh tomatoes, canned varieties contain up to nine times more lycopene, a carotenoid and powerful antioxidant currently being studied for its protective role against cancer. Use canned tomatoes in soups, stews and sauces.

Canned beans – cannellini, garbanzo, kidney, black, pinto – are inexpensive and nutritious staples. Use canned beans and black-eyed peas to add protein, fiber, iron, B vitamins, folate, potassium, magnesium and antioxidants to any diet. They are versatile enough to be used in soups, salads, sauces, dips and spreads.

Canned coconut milk contains healthy fats and is suitable for vegan and vegetarian individuals. It makes a creamy addition to soups, sauces and smoothies.

Canned fish – wild salmon, herring, sardines, anchovies – are much less expensive than fresh fish and just as nutritious. They are an excellent source of essential omega-3 fatty acids DHA and EPA, calcium (when consumed with the bones) and protein. Avoid canned tuna, however cheap, because it may contain harmful contaminants like mercury and other industrial pollutants.

Dry Foods

Many dried foods are inexpensive and some are available in bulk for an even better deal. This includes whole grains (rice, quinoa, millet, oats, amaranth) and legumes (beans, lentils and peas).

Dried beans require more preparation than canned beans because they have to be soaked overnight and cooked slowly, so they are usually even less expensive than canned varieties.

Raw nuts and seeds can commonly be found in bulk as well, but their fragile omega-3 fats easily oxidize, causing production of harmful free radicals. Ensure they are fresh before buying in bulk.

Other dried foods like herbs, ginger, chili peppers, mushrooms and seaweed are also affordable and nutritious staples.

Some ingredients – like dried shiitake mushrooms, seaweed and coconut milk – can be expensive in regular markets but better deals are often found in groceries that specialize in Asian foods.

Animal Products

When buying animal products, don’t cut corners too closely. Choose meats, eggs and dairy products that are wild or have been raised without hormones, antibiotics and pesticides, even if it means eating smaller portions or buying these foods less often.

Meat can be used to flavor dishes – like soups, salads, risotto, stir-fry and sandwiches – rather than making it the main component of meals.

Buy bone-in cuts or the whole animal. Reserve any bones to make stock for soups and sauces.

The Catch

Making meals from scratch can save money but it requires more time spent shopping and cooking. If your schedule is as tight as your budget, get organized, plan meals in advance and schedule time for shopping and food preparation.

Sunday, March 1, 2009

The Pregnancy Diet

A healthy diet is essential for a healthy pregnancy because we really are what we eat. Foods consumed by mothers-to-be become building blocks for babies’ new cells, tissues and organs. Eating well during pregnancy, breastfeeding and beyond can help optimize health and prevent complications for both mother and child.

New Needs

During pregnancy, women usually gain twenty-five to thirty-five pounds (or thirty-five to forty-five pounds if expecting twins). If women are underweight when they become pregnant, they should gain more during pregnancy, up to forty pounds. Overweight women may gain less, as little as fifteen pounds.

Maintaining a healthy weight is essential for a healthy pregnancy. Mothers who do not gain enough weight put babies at risk for low birth weight, while mothers who gain too much increase the risk for complications such as preterm delivery, gestational diabetes, and preeclampsia (a condition involving high blood pressure, protein in the urine, swelling and reduced blood flow to the placenta).

Depending on pre-pregnancy weight, women generally need one hundred to three hundred extra calories per day during the second and third trimesters of pregnancy. The best way to meet these increased requirements is by eating smaller, more frequent meals. This pattern of eating also sustains energy levels throughout the day, helps prevent heartburn and balances blood sugar levels.

Basic Guidelines

The best diet for pregnant women is also the best diet for almost everybody: a wide variety of vegetables, fruits, legumes, whole grains, healthy fats like olive oil, raw nuts and seeds, and wild cold-water fish. An adequate intake of high-fiber plant foods can be critical to maintaining healthy bowel function and preventing constipation and hemorrhoids during pregnancy. Consuming at least thirty-five grams of fiber each day from a variety of whole foods is a good goal.

Meat and animal products, if eaten, should come from animals raised on pasture and never exposed to pesticides, antibiotics or hormones. Foods should be organic whenever possible, as pesticides have been linked to complications of pregnancy, including birth defects, miscarriage and preterm birth, as well as some cancers and immune disorders.

Limitations and Eliminations

During pregnancy, what women eat is just as important as what they do not eat. Pregnant women (and everyone else) should eliminate from their diet processed foods, deep-fried foods, and foods that contain sugar, white flour, artificial sweeteners or flavors, ripening agents, antibiotics, hormones, pesticides and genetically modified organisms.

Pregnant women should also limit their intake of caffeine. Those who can’t eliminate it completely should consume less than 200 milligrams (mg) per day. Coffee (7 to 8 ounces) and espresso (1 to 2 ounces) can contain between 60 and 175 mg of caffeine. Green tea is a better choice because it contains less caffeine (usually less than 50 mg per cup), acts as a potent source of healthy antioxidants and offers many other health-supportive benefits.

During pregnancy, women should avoid eating uncooked and under-cooked meats, poultry, seafood, eggs, smoked seafood, unpasteurized dairy products and processed meats like hot dogs, sliced deli meat and pate. These foods carry an increased risk of infection with Escherichia coli, salmonella, toxoplasma and/or listeria bacteria that can cause miscarriage or stillbirth. If they are eaten steaming hot, these foods can be consumed safely, but some foods, like processed meat products, are best eliminated from the diet completely because they are not healthful choices at any temperature.

Seafood Advisory

Omega-3 fatty acid docosahexaenoic acid (DHA) is an important nutrient during pregnancy and it is only found in fish and seafood. Vital for brain development, memory, language comprehension, attention span, vision and motor skills, DHA must come from the diet because the human body cannot make it.

Unfortunately, studies have shown that some species of fish and seafood are contaminated with mercury, lead, cadmium, polychlorinated biphenyls (PCBs), dioxins, antibiotics and/or pesticides. These contaminants can be dangerous for anyone but pregnant women have special reason for concern because many of these toxic compounds can cause problems in reproductive, endocrine and neurological systems, all of which are essential for pregnancy.  Exposure to mercury in utero can be especially damaging to fetuses, impairing brain and nervous system development. It has also been linked to problems with memory, cognitive thinking, learning, language, and visual and fine motor skills.

Two important rules apply when it comes to selecting seafood during pregnancy. First, seek out species high in DHA. Look for small, oily fish that live in cold water like salmon, halibut, herring, sardines and anchovies. Second, avoid large fish that eat other fish, such as tuna, swordfish, tilefish, marlin, king mackerel and shark. These predators accumulate higher concentrations of toxic compounds than smaller fish that live lower on the food chain. Also avoid freshwater fish like lake trout, walleye and whitefish because they are more likely than saltwater fish to be contaminated with industrial pollutants like mercury and PCBs. Because good and bad choices can vary by geographical area, find the best options in your region on the Monterey Bay Aquarium's Seafood Watch website .

Vegetarian Women

Women who eat few or no animal products are at risk for deficiencies of certain nutrients, primarily iron, vitamin B12, vitamin D and protein. A good supplement can ensure adequate intake of iron and vitamins, but protein comes from the diet and consuming enough must be a daily priority.

Pregnant women need at least sixty grams of protein each day. Because plant sources are not as concentrated as animal sources, vegetarian and vegan women need to eat several servings of protein-rich foods throughout the day to meet this requirement. Good choices include beans, lentils, peas, tofu, tempeh, seitan (wheat gluten), nuts and seeds. Meatless options also include kefir, yogurt and eggs.

Supplemental Support

During pregnancy, all women require more of certain nutrients, including calcium, iron, vitamins A, C, B6, B12, folate and DHA. Although a diet rich in these nutrients is essential, a multiple vitamin-mineral supplement can offer extra insurance that pregnant women are meeting their nutritional requirements.

Women who don’t eat twelve ounces of wild cold-water fish each week should consider supplementing with fish oil to ensure sufficient DHA during pregnancy. Only buy fish oils that have been tested for purity and keep them in the fridge or freezer. Women who do not consume fish or fish oil should supplement with flax seed oil. Flax is a rich source of alpha-linoleic acid (ALA), a precursor to DHA. ALA can be converted into DHA inside the body, but the conversion process is not efficient. Nutritionally, DHA-rich fish oil is a far superior choice, but ALA-rich flax seed oil is the best vegetarian alternative.

Everyone, especially pregnant women, should talk to their doctor before taking any new medicines. This includes vitamins and fish oil, because interactions can occur and not all supplements are appropriate for all individuals.

Sunday, February 1, 2009

Home Care for Colds and Flu

During cold and flu season, viruses are the most common culprits in upper respiratory infections. Because antibiotics target bacteria, they are not effective treatments. Sleep is often the best prescription, but certain home remedies can also reduce symptoms and speed recovery.

Garlic

Garlic is not only good at fighting infections – it has antibacterial, antiviral and antifungal properties – but it can also help prevent cardiovascular disease and cancer. At the first sign of cold or flu symptoms, such as nasal congestion, sore throat or cough, eat two fresh cloves per day. Chop them into pieces the size of a capsule or tablet, then swallow with water, or crush them and swallow with unsweetened applesauce. If you don’t chew the garlic, the aroma is unlikely to stay on your breath.

Salt Water Gargle

Gargling with salt water can soothe sore throats and prevent complications. Most upper respiratory infections are initiated by viruses, but bacteria in the mouth and throat can cause secondary infections when tissues are inflamed and especially susceptible. Salt water kills bacteria by osmosis (creating a hypertonic environment in which their cell walls rupture). Natural sea salt is preferable to regular table salt that has been refined by industrial processes using chemicals and heat to extract minerals.

To make a salty solution for gargling, add ½ teaspoon sea salt to ½ cup warm water. Taking small sips, gargle with the solution and allow it to coat the back of the throat, then spit it out. Repeat until all of the salt water has been used. Do this twice per day or more as needed.

Steam Inhalation

Steam inhalation can keep mucus membranes moist in the nose, mouth and throat, combating dryness that can cause pain and make these tissues more susceptible to infection. Incorporating essential oils offers additional therapeutic benefits, as they can kill viruses as well as bacteria and clear congestion. The best essential oils to use in steam inhalation for colds and flu are eucalyptus and tea tree oil, but thyme, rosemary, sage also work well. Use only pure essential oils from a reputable source. Perfume oils and essential oils of poor quality will not have the same therapeutic effects.

For a standard steam inhalation, bring four cups of water to a boil. Pour the water into a large bowl and place it on a surface where you can sit comfortably with your face about 6 inches above it. Add four to six drops of pure essential oil to the water, then drape a large towel over your head and the bowl to contain the vapors. Stay under the towel as long as you comfortably can or until the water cools.

Spicy Ginger Tonic

Frequent fluid consumption soothes and moistens sore throats and prevents dehydration during illness. Water and herbal teas are good choices, but this recipe for Spicy Ginger Tonic is particularly therapeutic, as the ginger, chili peppers and garlic will help the body fight infection:

2 inches fresh ginger root, peeled and grated
4 cups water
10 dried chili peppers
Juice of 1 lemon
2 cloves fresh garlic, crushed or grated
1 tablespoon honey

Add ginger, chili peppers and water to a saucepan and bring the mixture to a boil. Reduce the heat to low and simmer for 20 minutes. Turn off the heat, add the garlic and allow the mixture to sit for 10 minutes. Strain, then add lemon juice and honey. Stir to combine. Add additional water if needed to dilute the spicy flavor. Sip the tonic slowly throughout the day. Cooled tonic can be stored in the fridge and consumed cold or reheated as needed. For best results, eat the strained garlic.

Green Soup

Sick individuals should eat only when hungry. Loss of appetite indicates that the body’s energy is better focused on fighting infection than digesting food. When hunger returns, choose foods that are easy to digest and contain immune-supportive ingredients like garlic and onions. This recipe for Green Soup is a good example:

2 medium zucchini
2 cups green beans
2 stalks celery
4 cloves garlic
1 small onion
1 handful chopped parsley
Seasoning: sea salt, ground peppercorn, cayenne pepper

Roughly chop the vegetables into large chunks of similar size and steam until tender. Add the steamed vegetables to a blender with the parsley, the water used for steaming, and enough cold water to cover all of the ingredients. Purée to desired the consistency. Transfer the soup to a pot on the stovetop and season to taste. Gently warm the soup over low heat before serving. Store extra soup in the fridge until ready to eat. Consume two or more bowls per day.

Botanical Medicines

Many herbal remedies exist for colds and flu. Some botanicals act as expectorants to help clear phlegm. Others have anti-spasmodic properties to quiet coughs. Certain herbs relieve head congestion or increase numbers of white blood cells that fight infection. A doctor trained to use these medicines can customize a formula unique to individual symptoms. Anyone seeking herbal remedies should discuss with their doctor all of the medicines she or he is taking, whether natural or pharmaceutical, because interactions can occur.

Doctor Visit

A visit to the doctor is in order if symptoms do not improve after one week, if the sick one is vomiting, or if fevers exceed 103 degrees Fahrenheit. Fevers can be a healing reaction because viruses and bacteria are less likely to survive at higher temperatures and enzymes that the body uses to fight infection become more effective. However, this does not apply to infants less than three months old, children or adults with immune deficiencies, and individuals undergoing cancer treatment. These people should not delay discussing fevers with their doctor.

Thursday, January 1, 2009

Stop Smoking Now

Once prescribed by doctors to ease anxiety, cigarette smoking is now recognized as one of the leading preventable causes of death, contributing to cancer, heart disease, stroke and other chronic diseases worldwide. Although cigarettes are physically and psychologically addictive, and stopping smoking can difficult, quitting is one of the top ten most common New Year’s resolutions. If it’s at the top of your list this year, consider these strategies to help you make a fresh start.

Decide the Date

Once you decide to quit smoking, select a stop date and mark your calendar. Choose a time when you are most likely to be successful. For example, if you smoke to cope with stress, stopping in the middle of final exam week or a new job transition may not work well for you. If you are a social smoker, quitting after all the holiday and New Year celebrations have passed may be best. If your stop date is not today, plan ahead to set yourself up for success.

Write It Down

Keep a journal to help identify the locations, people, activities and emotions you associate most with smoking. As you quit, use this knowledge to avoid triggers or plan ahead to cope with them when confronted. Also, make a list of your reasons for quitting and refer to it when the going gets tough. It may not ease the physical symptoms of withdrawal, but psychologically, it can inspire you to continue on your path as a nonsmoker.

Tell Others

Make a decision and hold yourself accountable, but let others hold you accountable as well. Tell everyone you know that you plan to quit smoking. Develop a network of friends, family members and coworkers who can support your cessation efforts at home, at work, and in between.

Change Your Habits

Until you quit, get rid of all lighters and ashtrays. Instead, light cigarettes with matches and re-use a single glass jar or tin can for ashes and butts. Never buy more than one pack at a time, and always finish one before you buy another. Abandon your favorite brand of cigarettes and smoke something less appealing. Change the location of where you keep your cigarettes. If you keep them in a purse or backpack, move them to a jacket. If you keep them in a pocket on your right side, move them to the left side. Each time you smoke a cigarette, hold and smoke it differently. If you use your right hand, switch to the left. If you use your index and middle fingers, start using your middle and ring fingers instead. If you smoke using the left side of your mouth, change to the right side.

Change Your Routine

If breaking your habits before you break your addiction will help ease the transition, start counting down four weeks before your quit date. Do not smoke while driving, riding in a car, laying in bed, talking on the phone, drinking alcohol, or in other situations you usually associate with smoking. For the first week, do not smoke within fifteen minutes of waking, eating or drinking. For the second week, wait for at least thirty minutes after these activities before smoking. Wait forty-five minutes during the third week, and one hour during week four. Also change cigarettes each week, always decreasing the amount of nicotine per pack.

Consider Cold Turkey

Although quitting smoking gradually may be easier for certain individuals, it hasn’t proven to be the most successful strategy. In a study published in the Journal of the American Medical Association, researchers at the University of Wisconsin analyzed stopping smoking success rates and compared cessation programs to individual methods. They concluded that the method of stopping smoking was the strongest predictor of success (it was even more important than daily cigarette consumption prior to quitting). Ninety percent of successful quitters stopped smoking without the help of an organized program and most of these individuals used a “cold turkey” approach.

Try Again

Stopping smoking isn’t easy, and it's not always successful, regardless of the method. According to the Centers for Disease Control and Prevention, more than half of all adults who try to quit smoking are successful, but not always on the first attempt. If you start smoking again after you’ve quit, identify the reason and work through it, instead of feeling bad about yourself. Then, try again.

Seek Support


If you can’t quit on your own, seek professional support. Therapies that can be helpful in stopping smoking include hypnosis, acupuncture, homeopathic remedies, and botanical medicines (which should only be taken under the supervision of a doctor trained in their use). Or talk to your doctor about nicotine replacement therapy (NRT). Available as gum, patches, inhalers, sprays and lozenges, NRT can ease withdrawal symptoms and reduce the urge to smoke. For additional resources and referrals to programs in your area, call the National Network of Tobacco Cessation Quitlines at 1-800-794-8669 or visit the website of the National Cancer Institute at www.smokefree.gov.

Reward Yourself

When you reach your goal, reward yourself and celebrate your success. Use the money you are saving (now that you’re not buying cigarettes) to treat yourself to something that supports your new, healthier lifestyle, like a professional massage, cooking class, health retreat, or gym membership.