Eat the Whole Orange

As a conscious omnivore, when I eat meat, I eat as much of the animal as possible.

I like to treat fruits and vegetables the same way.

I save scraps like leek tops and shiitake stems for soup stock. I buy beets with their greens attached and eat those too. I roast the seeds from squash and pumpkins. And I always eat the outer layer of fruits and vegetables whenever possible because they are most nutritious with their skins and peels intact.

Antioxidants, which protect plants from the sun's ultraviolet radiation, are concentrated in the outer layer of fruits and vegetables. Produce peels and skins are also good sources of fiber, minerals and other important phytonutrients.

Citrus fruits have exceptional peels. They contain flavonoids like nobiletin and tangeritin that have anti-inflammatory and anti-tumor effects in the body. Studies show that these flavonoids can induce the death of cancer cells (apoptosis) and reduce the chance that tumors will spread to other parts of the body.

Limonene, a monoterpene compound found in the essential oils of citrus fruit peels, also has anti-cancer activity. It stimulates enzymes in the liver that break down carcinogens and alters gene expression in cancer cells to inhibit their growth. Monoterpenes like limonene have been shown to prevent cancers of the breast, colon, liver, lung, pancreas and skin.

Because pesticides are often concentrated on the outer layer of produce, only eat peels from citrus fruits that have not been sprayed. When your citrus fruits are organic, always eat their zest.

Citrus fruits are easy to find in the winter and several varieties abound: grapefruits, oranges, blood oranges, tangerines, clementines, mandarins, satsumas, lemons, limes, kumquats, etc. When you buy by the bag, prices for organic fruit can be comparable to their conventional counterparts.

How can you eat citrus zest?
  • Stir it into yogurt and smoothies
  • Sprinkle it on top of oatmeal and granola
  • Whisk it into vinaigrettes and sauces
  • Grate it into soup or risotto
  • Dry it and add it to loose leaf teas, seasoning blends, and dry rubs
  • Make a citrus reduction that you can drizzle over yogurt or whisk into vinaigrette (recipe follows)

Blood Orange Reduction

Make extra of this reduction if you can because it's lovely to have some leftover in the fridge. I like to stir it into cooked steel cut oats and add a dollop of plain whole milk Greek yogurt. (To make steel cut oats, bring 1 part rinsed oats and 3 parts water to a boil, turn off heat, cover, allow to sit overnight, then cook on the stove top over low heat for 10 minutes or until thickened as desired.)

If you can't find organic blood oranges, use another variety.

2 organic blood oranges, zest and juice
Zest of 2 organic lemons (save the juice for another purpose)
Pinch sea salt

Add all the ingredients to a small saucepan and warm over medium heat. Once the mixture starts to simmer, turn the heat down to low. Swirl occasionally and allow it to reduce until it becomes a few spoonfuls of a thick sauce. Taste for seasoning and adjust if necessary. Cool completely and store in an airtight container.

Blood Orange Balsamic Vinaigrette

This recipe is the perfect amount for a big salad. If you want to have some leftover, double or triple the batch.

1 tbsp blood orange reduction
1 tbsp balsamic vinegar
3 tbsp extra virgin olive oil, first cold pressing
Ground peppercorn to taste
Pinch sea salt (optional)

Whisk all ingredients together until smooth. Use immediately or store in an air-tight container in the fridge.


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Crowell PL, et al. Human Metabolism of the Experimental Cancer Therapeutic Agent D-Limonene. Cancer, Chemotherapy and Pharmacology, 1994;35:31-37.

Crowell PL and Gould MN. Chemoprevention and Therapy of Cancer by d-Limonene. Critical Reviews in Oncogenesis, 1994;5(1):1-22.

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Hensrud DD and Heimburger, DC. Diet, Nutrients, and Gastrointestinal Cancer. Gastroenterology Clinics of North America, June, 1998;27(2):325-346.

Lee YC et al. Nobiletin, a citrus flavonoid, suppresses invasion and migration involving FAK/PI3K/Akt and small GTPase signals in human gastric adenocarcinoma AGS cells. Molecular and Cellular Biochemistry. 2011 Jan;347(1-2):103-15. Epub 2010 Oct 21.

Leonardi T et al. Apigenin and naringenin suppress colon carcinogenesis through the aberrant crypt stage in azoxymethane-treated rats. Experimental Biology and Medicine (Maywood). 2010 Jun;235(6):710-7.

Orange Peel Oil Studied as Cancer-Fighting Agent. Medical Tribune, May 30, 1991;11.

Potter JD. Your Mother Was Right: Eat Your Vegetables. Asia Pacific Journal of Clinical Nutrition, 2000;9(Suppl.):S10-S12.

Schardt D. Phytochemicals: Plants Against Cancer. Nutrition Action Health Letter, April 1994;21(3):7-13.

Stavric B. Role of Chemopreventers in Human Diet. Clinical Biochemistry, 1994;27(5):319-332.

Steinmetz K and Potter JD. Vegetables, Fruit and Cancer II: Mechanisms. Cancer Causes and Control, 1991;2:427-442.

Steinmetz KA and Potter JD. Vegetables, Fruit, and Cancer Prevention: A Review. Journal of the American Dietetic Association, 1996;96:1027-1039.

Is Calcium Dangerous?

An article published earlier this year in the British Medical Journal concluded that taking calcium supplements is associated with an increased risk of having a heart attack.

However, there were several problems with this study. Among them:
  • It was a meta-analysis, a study of studies, but the studies selected excluded several trials that linked calcium supplements to a reduced risk of heart attack. 
  • Vitamin D helps our bodies absorb calcium, but the study excluded people who took calcium in combination with vitamin D.
  • According to the researchers, the increase in heart attacks was only "modest" and there was no increase in the number of deaths from heart attacks.
This isn't the first poorly designed trial to grab headlines while misleading and confusing the public, but it raised an important issue. Too many people take too much calcium.

Of course our bodies need calcium. Most of it is used to strengthen bones and teeth, but calcium has other important functions. It stabilizes cell membranes and aids the transport of compounds into and out of cells. Calcium regulates neurotransmitters, substances that transmit nerve impulses, and helps initiate blood clotting. And without calcium, muscles, including the heart, don't contract properly.

Bone Metabolism

Putting more calcium into your body doesn't necessarily mean putting more calcium into your bones. Bones are constantly remodeling themselves and this complex process is controlled by a complex system of hormones. It is not controlled by the amount of calcium you take in (although calcium must be present in the blood before it can be incorporated into bone matrix).

Many factors are involved in bone mass: bone cell growth, bone cell destruction, mineralization (adding more minerals like calcium to bone matrix) and resorption (removal of minerals like calcium from bone matrix).

In childhood, when bone cell growth exceeds bone cell destruction, our bones and our bodies become bigger. Once we're fully grown, bone growth balances bone destruction. After the age of 30, bone destruction slowly begins to exceed bone growth and we gradually lose bone mass as we age. After 50, declining levels of estrogen and testosterone can speed the process.

At any age, exercise can slow or even reverse bone loss. Simply put, our bones stay strong when we stay active. Weight-bearing exercises and activities that place forces on bones stimulate growth, ensuring that the body will be able to withstand future forces. When we become sedentary and forces that stimulate bone growth no longer exist, we lose bone mass. 


The number one reason that people take calcium supplements is to prevent bone loss and osteoporosis. But for most older people, osteoporosis is not a disease at all. It's a natural aging process.

The real danger is not weak bones. Falls and fractures have a much greater impact on quality of life. Only 1 in 4 elderly individuals who sustain such injuries are able to return to their pre-fracture activity level. 75 percent of older adults who survive falls require specialized long-term care in a rehabilitation facility or nursing home, and 25 percent die within one year.

Regular exercise not only keeps bones strong, it also improves balance and coordination, making falls and fractures less likely. Studies have shown that walking at least 2 hours each week can reduce the risk of hip fractures in elderly adults. For best results, I recommend participating in a variety of activities that apply forces to a variety of bones.  People who do not exercise regularly should talk to their doctor before they start.

To further reduce the risk of falls and fractures, older adults should live in clutter-free environments with good lighting, have their sight and hearing tested annually, wear rubber-soled shoes and use caution when walking on slippery or uneven surfaces.

Calcium Supplements

Getting enough calcium is important but more isn't necessarily better. Worldwide population studies have shown that people who consume the most calcium – like those in Scandinavian countries and the United States – also have the highest rates of fracture, while people who consume the least – like those in Asian and Mediterranean cultures – have the lowest fracture rates.

Ideally, calcium should come from our diet.  When it doesn't, it must be supplemented. Our bodies probably need about 1000 mg of calcium each day. But before you start taking supplements, evaluate your diet and estimate your true needs.

Each day, the average person usually consumes at least 300 mg of calcium from foods that are not especially rich in calcium. So assume a starting point of 300 mg and add what you get from these calcium-rich foods:
  • 1 cup of cooked spinach = 300 mg of calcium
  • 1 serving of dairy (1 cup of milk or yogurt, or 1.5 ounces of cheese) = 300 mg of calcium
  • 3 ounces of fish with soft bones that you eat like canned wild salmon and sardines = 400 mg of calcium
  • 1 cup of cooked collard or turnip greens = 400 mg calcium
Adults who eat, on average, at least one daily serving of dairy, dark green leafy vegetables or fish (with bones) already get 600 mg of calcium from food alone. So they only need to supplement 400 mg per day.

Adults who eat at least three servings of these foods have no need to supplement calcium at all. This is a good goal.

Calcium supplements come in many forms. Calcium carbonate is inexpensive to produce and widely available, but it is more difficult to digest and can cause constipation. Larger doses are required because a lower percentage is absorbed.

Better choices include calcium citrate, calcium malate and calcium aspartate. These forms are more costly to produce and take up more space inside capsules and tablets, but they are better tolerated and more easily digested and absorbed by the body.

Those who do take calcium supplements should supplement an equal amount magnesium. Get magnesium from foods too. Good sources include tofu, cherries, figs, beans and lentils, halibut, dark green leafy vegetables like Swiss chard and beet greens, and nuts like almonds and cashews.

Vitamins D and K are necessary for the absorption and utilization of calcium. Vitamin K should not be taken in supplement form unless your doctor recommends it, but you should include food forms in your diet. Turnip greens and broccoli are by far the best source of vitamin K, but other green leafy vegetables, cabbage, liver and green tea are also good sources. Make sure to eat these foods with some form of fat to ensure that the vitamin is well-absorbed. Vitamin K plays an important role in blood clotting, so individuals taking blood-thinning medications should get specific dietary recommendations from their doctor.

Sunlight stimulates the skin to produce vitamin D - which is why deficiencies are most common in winter and in areas furthest from the equator - but vitamin D can also be found in food. Good sources include cod liver oil, fish (especially sardines, which are also a good source of calcium when consumed with the bones), mushrooms, egg yolk, lamb and beef.

Vitamin D can also be found in supplements. Because it is fat-soluble, vitamin D should always be taken with food or fish oil.

However, taking too much vitamin D in supplement form can cause it to accumulate in the body and reach toxic levels. Small amounts are usually not worrisome, but larger amounts (1,000 IU per day or more) should only be taken if blood tests show that levels are low. If you aren't sure, ask your doctor for the test. It's worthwhile because low levels of vitamin D have been linked to an increased risk of osteoporosis, autoimmune disease, depression, heart disease and cancer.

Remember that supplements are no substitute for a healthy diet and that calcium output is as important as calcium intake. Excessive consumption of coffee or alcohol, and diets high in sodium, animal protein and grains can cause the kidneys to increase excretion of calcium. But plant-based diets high in vegetables and fruits and low in sodium additives cause the kidneys to increase calcium retention. It's a great reason to eat plenty of dark leafy greens and avoid processed foods.


Bolland MJ et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691.

Feskanich D et al. Walking and Leisure-Time Activity and Risk of Hip Fracture in Postmenopausal Women. Journal of the American Medical Association. 2002;288(18):2300-2306. doi: 10.1001/jama.288.18.2300

Koot VC et al. Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients. The European Journal of Surgery. 2000 Jun;166(6):480-5.

Aspirin Against Cancer?

Aspirin recently made headlines as an anti-cancer drug.

In a new study, researchers followed more than 25,000 people who took aspirin regularly for five years. They concluded that taking aspirin daily was associated with a 21% reduced risk of cancer.

This does make some sense.

Aspirin is an anti-inflammatory drug, and inflammation has a strong association with cancer. Inflammatory mediators stimulate cell division and inhibit cell death, prompting tumors to get bigger. Inflammation also triggers tumors to release vascular endothelial growth factor (VEGF), a protein that stimulates the growth of new blood vessels needed to fuel tumor growth and spread malignant cells throughout the body.

Researchers at the Glascow Hospital in Scotland have also linked inflammation to cancer survival. They found that cancer patients with the lowest levels of inflammation lived longer and those with the highest levels of inflammation had the worst prognosis.

Aspirin may reduce inflammation, and reducing inflammation may reduce the risk of cancer, but aspirin isn't the best strategy for cancer prevention. Common side effects include nausea, vomiting and heartburn, especially when taken long term. But more serious and life-threatening adverse reactions can occur, like hepatitis (inflammation of the liver) and internal bleeding.

A Better Strategy

Eating an anti-inflammatory diet and leading an anti-inflammatory lifestyle is a healthy way to prevent cancer and reduce the risk of other chronic illness like cardiovascular disease, diabetes and obesity.

An anti-inflammatory diet is rich in antioxidants and omega-3 fatty acids found in:
  • Vegetables and fruit 
  • Raw nuts and seeds
  • Nontoxic seafood like wild salmon, Pacific halibut, herring, sardines and anchovies
  • Meat, eggs and dairy products from animals raised on pasture and never exposed to pesticides, antibiotics or hormones
To follow an anti-inflammatory diet, it is important to avoid trans-fats, simple carbohydrates and omega-6 fatty acids found in:
  • Flour and foods made from flour
  • Sugar, sugar substitutes, corn syrup, agave nectar and sweet foods and beverages
  • White rice
  • Meat, eggs and dairy products from animals fed grains (even if those grains are organic)
  • Industrial fats like corn, soybean, sunflower, safflower, canola oils and vegetable oils
An anti-inflammatory lifestyle involves avoiding exposure to toxic and carcinogenic chemicals. Regular exercise is also important because it has anti-inflammatory effects in the body and it helps improve cardiovascular and musculoskeletal fitness, balance, coordination, mood and sleep.

Fish Oil

If you seeking a supplement to provide anti-inflammatory and anti-cancer effects, consider fish oil.

Like aspirin, fish oil reduces inflammation in the body and prevents cells from getting too sticky and forming clots. But unlike aspirin, fish oil is safe for long term use and does not compromise the gastrointestinal lining. Individuals who are allergic to fish and those who take blood-thinning medications should seek individualized recommendations from their doctor before taking fish oil.

Purity is important because toxic contaminants like heavy metals and industrial pollutants are stored in animal fat, i.e. oils from fish. Look for a reputable brand that can provide proof of purity from an independent lab. I like Nordic Naturals because their fish oils are pure and they use only sustainably harvested fish to make their products.


Rothwell PM et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. The Lancet, Early Online Publication, 7 December 2010.  doi:10.1016/S0140-6736(10)62110-1

Safe Alternatives to Toxic Household Products

Last month I wrote about toxic and carcinogenic ingredients in best selling brands of common household products.

This week I share my top twelve ways to protect yourself and your family, as well as my recipe for making your own Non-Toxic All-Purpose Cleaner.

  • The Household Product Labeling Act is currently being reviewed by the US Senate. Contact your senators and urge them to require product labeling that protects consumers and the environment, not manufacturers.
  • Use cookware made of cast iron, stainless steel, copper, glass or ceramic. Avoid non-stick cookware.
  • Avoid food and beverages that have been in plastic containers or metal cans. Use stainless steel or glass water bottles.
  • Look for fragrance-free household and personal products and remember that labels like "green,” "organic" and "natural" are not legally defined.
  • Research personal products on the Environmental Working Group's Skin Deep Cosmetics Safety Database. Search by product, ingredient or company to read safety reviews and make good choices when selecting items like soap, shampoo, toothpaste, deodorant, contact lens cleaner, make-up, nail polish, sunscreen, hair care and baby products.
  • If your air is malodorous, open some windows and circulate the air. As an alternative to air fresheners, use essential oil diffusers with 100% pure essential oils. Avoid perfume oils.
  • Use essential oils also for cleaning. They are anti-bacterial and can be used in solution to clean kitchen and bathroom surfaces (see recipe below). Tea tree essential oil is especially effective at removing mold and mildew.
  • Use baking soda as an abrasive agent to remove residue and stains from glass, ceramic, stainless steel and silver. Add a few drops of water to make a baking soda paste for cleaning the stove, sink, counters, toilet and tub. You can also use baking soda paste as an alternative to toothpaste.
  • To keep drains free of blockages, flush them with boiling water on a weekly basis. To unclog drains, first pour ½ cup of baking soda down the drain, then pour in 1 cups of white vinegar. Wait for foaming to reside, then flush with plenty of boiling hot water.
  • Use olive oil to polish wood furniture. Mix 3 parts of an inexpensive olive oil (not extra virgin) with 1 part freshly squeezed lemon juice. Apply it with a soft cloth, rub briskly and allow the area to air dry. (You may want to test a small area before you apply it to an entire piece of furniture.) The solution is only good for one day, so mix up just enough for your immediate needs and discard what you don’t use.
  • Coarse salt can be used to scour cookware. To remove rust stains, sprinkle salt over the area, squeeze fresh lemon juice on top and allow it to sit for several hours before you wipe it off.
  • Use white vinegar to wash windows and floors, polish mirrors, and soften laundry (add one half cup to the rinse cycle in place of store-bought fabric softener). White vinegar is the base for my Non-Toxic All-Purpose Cleaner below, which can be used on counters, sinks, stove tops, appliances and tiles.

Dr. Sarah's Non-Toxic All-Purpose Cleaner

1 cup white vinegar
5 drops tea tree essential oil
5 drops lavender or orange essential oil
½ cup water (optional)

Add all the ingredients to a new, clean spray bottle. Label the container with the ingredients and date. Store it out of the reach of children.

To use, shake the bottle gently to incorporate any essential oils that may have separated. Spray the cleaner on dirty surfaces and wipe off with a clean wet sponge. For tougher cleaning jobs, omit the water and leave the solution a few minutes longer before wiping it off. Do not use this cleaner on wooden or delicate surfaces.

Health Benefits of Hydrotherapy and Saunas

One of the oldest and most natural treatments available, hydrotherapy dates back to ancient Roman and Greek traditions. The therapeutic application of water was popularized in the 1800’s by Sebastian Kneipp and remains an important tool in naturopathic medicine today.

The concept is basic: heat expands tissues and cold contracts them. When hot water is applied to the body, local blood vessels dilate and muscles relax. Increased circulation brings more oxygen, nutrients and immune cells to affected areas, promoting healing.

In contrast, cold applications constrict local blood vessels, reducing swelling and inflammation. While blood flow to the skin is decreased, blood flow to internal organs is increased, supporting normal body functions like digestion and detoxification. Cold temperatures also increase muscle tone and have a numbing effect on nerves, which can relieve pain.

Alternating between hot and cold applications gives the benefits of both and increases circulation throughout the body. In general, a 3-minute application of hot water is followed by a 30-second application of cold water, and the cycle is repeated at least 3 times.

I recently visited the Spa Castle in Flushing, New York, in the borough of Queens, and thought I had gone to hydrotherapy heaven.

How could applying hot and cold water be easier and more fun than immersing yourself in beautiful baths, pools and whirlpools? I was impressed by the wide range of options: 4 different temperatures of hot water and 2 different temperatures cold water, as well as underwater jets and cascades to stand beneath.

And on the weekends, they offer special “Event” baths that incorporate herbs (on Saturdays) and rose petals (on Sundays). It’s a pleasant combination of hydrotherapy, herbal medicine and aromatherapy.

I also love Spa Castle because they have a wide range of hot saunas of various temperatures lined with natural materials like mineral salts, yellow earth, jade (my favorite) and gold. There is also an infrared sauna and a cold sauna lined with ice crystals. I love the option of alternating between hot and cold temperatures in dry rooms as well as wet environments.

Traditional saunas heat through conduction at temperatures generally above 185 degrees Fahrenheit. Infrared saunas heat through infrared radiation and transfer a greater amount of energy, so they are more comfortable because they require lower temperatures, generally between 120 and 150 degrees Fahrenheit.

A slight increase in body temperature increases metabolism and the repair of damaged cells. It also helps resolve infections because bacteria and viruses are less likely to survive higher body temperatures (which is one reason why, when we are sick, fevers are beneficial). Saunas are also associated with improved energy and better sleep.

Traditional saunas and infrared saunas have been studied for their roles in treating disease. They have been found to improve conditions such as heart failure, chronic pulmonary hypertension, fibromyalgia, chronic fatigue syndrome, and autoimmune conditions like rheumatoid arthritis, ankylosing spondylitis and Sjögren syndrome.

Sauna therapy is something that I recommend as part of my detoxification program because it encourages the body to excrete toxins through the largest organ of elimination: the skin.

Here are my rules for enjoying the benefits of saunas and hydrotherapy:
  • If you are pregnant or in poor health, get permission from your doctor before you begin.
  •  If you have a weak constitution, avoid rapid cooling.
  •  Take caution not to become too hot. If at any time you feel dizzy, nauseous, or overheated, leave the environment, drink some water and rest until you feel well again.
  •  When using alternating hot and cold treatments, always start with hot and always end with cold.
  •  Never begin a treatment when feeling chilled.
  •  Take time to rest afterward.
  •  Drink plenty of water before, during and after hot treatments (unless you have kidney problems or have been directed otherwise by your doctor).
  •  After hot treatments, replace electrolytes by making a meal from foods that contain them.* Avoid Gatorade and other sports drinks because they usually contain sweeteners, artificial color and flavors.
* These foods are good sources of electrolytes:

Avocado, apricots, cantaloupe, papaya, figs, lima beans, parsnips, pumpkin, watermelon, raisins, kiwi, sardines, squash, broccoli, pinto beans, pomegranate, sweet potato, kidney beans, artichokes, prunes, peaches, steamed spinach, nectarine, mustard greens, blackberries, mushrooms, cherries, celery, asparagus, raspberries, apple, cauliflower, grapefruit, green beans, apples, bananas, carrots, potatoes, oranges and strawberries


American College of Cardiology 57th Annual Scientific Session, Chicago, March 29-April 1, 2008.  Yoshiyuki Ikeda, MD, department of cardiovascular, respiratory and metabolic medicine, Kagoshima University, Kagoshima, Japan

Kihara T, et al.  Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure. Circulation Journal. 2004 Dec;68(12):1146-51.

Kihara T, et al. Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. Journal of the American College of Cardiology. 2002 Mar 6;39(5):754-9.

Masuda A. [A new treatment: thermal therapy for chronic fatigue syndrome.] Nippon Rinsho. 2007 Jun;65(6):1093-8.

Matsushita K, et al. Efficacy of Waon therapy for fibromyalgia. Internal Medicine. 2008;47(16):1473-6. Epub 2008 Aug 15.

Miyata M, et al. Beneficial effects of Waon therapy on patients with chronic heart failure: Results of a prospective multicenter study. Journal of Cardiology. 2008 Oct;52(2):79-85. Epub 2008 Aug 27.

Mussivand T, et al. Thermal therapy: a viable adjunct in the treatment of heart failure? Congestive Heart Failure. 2008 Jul-Aug;14(4):180-6.

Oosterveld FG, et al. Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis : A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clinical Rheumatology. 2009 Jan;28(1):29-34. Epub 2008 Aug 7.

Tei C, et al. Remarkable efficacy of thermal therapy for Sjögren syndrome. Journal of Cardiology. 2007 May;49(5):217-9.

Umehara M, et al. Repeated waon therapy improves pulmonary hypertension during exercise in patients with severe chronic obstructive pulmonary disease.  Journal of Cardiology. 2008 Apr;51(2):106-13.

Research Studies Are Often Invalid

David H. Freedman's article, "Lies, Damned Lies, and Medical Science" recently published in The Atlantic calls into question the validity of scientific studies that doctors rely on to make important medical decisions.

Freedman highlights the work of meta-researcher Dr. John Ioannidis, one of the world's leading experts when it comes to the validity of medical research. Ioannidis believes that "as much as 90 percent of the published medical information that doctors rely on is flawed."

Even randomized trials, the scientific community's gold standard, can be wrong. Several problems are at play, including study design and duration, subject selection, measurements and analysis, and financial conflicts of interest.

But maybe even more importantly, the big questions that studies set out to answer in the first place could be the real issue. After all, research results that make media headlines are more likely to receive funding than those that confirm what other studies have already "proven" to be true.

What is the solution?

For doctors, understanding which studies have the potential to yield valid results and applicable information is essential.

For everyone else, Ioannidis suggests adjusting our expectations.


Toxic Ingredients Are Often Unlisted

Research studies done by government, academic and independent researchers reveal that before babies are even born, their bodies are contaminated with up to 358 different chemicals. They include flame retardants, pesticides, fragrances, insulating materials, industrial coolants and lubricants, perfluorocarbon used to make non-stick cookware, and bisphenyl A (BPA) used to make plastic and epoxy resins found in electronics, metal cans, and plastic food and beverage containers.

Many of these chemicals have been linked to cardiovascular disease, type two diabetes, weakened immune systems, imbalances in thyroid and sex hormones, and even cancer. Last April, the President’s Cancer Panel, a joint effort by the US Department of Health and Human Services, the National Institutes of Health and the National Cancer Institute, urged everyone to reduce their exposure to chemicals in foods, water, cigarette smoke, medicines, medical tests and household products.

But identifying dangerous chemicals can be difficult if not impossible. A study recently published in the Environmental Impact Assessment Review analyzed 25 common household products and found toxic ingredients in every single sample. Cancer-causing compounds were also detected in nearly half of the products tested. Products included best selling brands of laundry detergent, dryer sheets, fabric softener, soap, shampoo, lotion, hand sanitizer, deodorant, dish detergent, all-purpose spray, household disinfectant and air fresheners (solids, sprays and oils).

Each product was placed in an enclosed glass container at room temperature and the surrounding air was analyzed for evaporated chemicals using gas chromatography/mass spectrometry (GC/MS). All together, the 25 products released 421 chemicals, including 133 different volatile organic compounds (VOCs), chemicals with known effects on the environment and/or human health. Of the 133 VOCs identified, 24 are classified as toxic or hazardous under US laws.

Researchers found that alone, each product emitted an average of 17 VOCs and at least one toxic or hazardous compound. Almost half the products (11 out of 25) contained carcinogens recognized by the US Environmental Protection Agency. And emissions from products promoted as “green,” "organic," and "natural" did not significantly differ from other products.

Manufacturers of household products are not required to list all ingredients on the labels, nor are they required to disclose any ingredients regarded as "fragrance." (And a single "fragrance" can contain several hundred ingredients.) In the study, only one of the 133 VOCs (ethanol) was listed on a product label and only two were listed on any material safety data sheet, a widely used system for cataloging information about a chemical's risks, safety and effect on the environment.

What can you do to protect yourself and your family?

Read this post for my top twelve recommendations.


Enviornmental Working Group. Pollution in People: Cord Blood Contaminants in Minority Newborns. 2009. Available online at:

Reuben SH et al for the President’s Cancer Panel. Reducing Environmental Cancer Risk: What We Can Do Now, 2008-2009 Annual Report. April 2010. Available online at:

Steinemann AC et al. Fragranced Consumer Products: Chemicals Emitted, Ingredients Unlisted. Environmental Impact Assessment Review, 2010. DOI: 10.1016/j.eiar.2010.08.002

Tea Protects Cognitive Health and Bone Mineral Density

True tea – whether black, oolong, green or white – comes from the Camellia sinensis plant. White tea comes from young leaves that are steamed immediately after harvest. Green tea has undergone minimal fermentation. Oolong tea is partially fermented and black tea is fully fermented.

All varieties contain powerful antioxidants. One in particular, a catechin called epigallocatechin gallate-3 or EGCG, has been shown to fight cancer by inhibiting angiogenesis (the growth of new blood vessels to feed tumors) and inducing apoptosis (cancer cell death).  EGCG also reduces inflammation and activates enzymes in the liver that detoxify toxic compounds to facilitate their removal from the body. White and green teas contain the highest concentration of EGCG.

Studies have shown that regular consumption of black and oolong teas is associated with protection against cardiovascular disease. Research published in the American Journal of Clinical Nutrition highlight two more health benefits: protection against cognitive decline in older adults and preservation of bone mineral density in older women.

A study in Singapore examined the relationship between tea consumption and cognitive decline in more than 2500 Chinese men and women 55 years of age and older. Researchers measured tea intake and scores on Mini-Mental State Examination tests over a two year period. They found that regular consumption of black and oolong teas was associated with lower risk of mental impairment and cognitive decline. No correlation was found between coffee intake and cognitive status.

In the other study, researchers in Australia followed 1500 women aged 70 to 85 years for five years to study bone mineral density (BMD). A cross-sectional analysis of more than 1000 participants compared tea intake with BMD. After 4 years, the tea drinkers had lost significantly less mineral density in hip bones compared to non-tea drinkers. Researchers concluded that drinking tea is associated with preservation of BMD in older women.


Tze-Pin Ng et al. Tea consumption and cognitive impairment and decline in older Chinese adults. American Journal of Clinical Nutrition, 88(1):224-231, July 2008.

Devine A et al. Tea drinking is associated with benefits on bone density in older women. American Journal of Clinical Nutrition, 86(4):1243-47, October 2007.

Most New Drugs Offer More Harm Than Benefit

In a recent study, independent reviewers found that approximately 85% of new drugs brought to market have few if any new benefits over existing drugs and that many are associated with harmful adverse effects.

Donald Light, author of “Pharmaceuticals: A Two-Tier Market for Producing 'Lemons' and Serious Harm,” explained in a press statement that only “one in seven new drugs is superior to existing drugs, but two in every seven new drugs result in side effects serious enough for action by the U.S. Food and Drug Administration (FDA), including black box warnings, adverse reaction warnings, or even withdrawal of the drug.”

According to Light, an analysis of 111 pharmaceutical applications for FDA approval revealed that evidence of efficacy was lacking in 39%, flawed testing of dosages was found in 40%, adequately randomized trials were lacking in 42%, and 49% raised concerns about serious side effects.

Pharmaceutical companies design their own studies and the research is often biased, too short to uncover long term problems, and conducted on people who are healthier than the target population. And because the FDA is funded in part by the drug companies it oversees, applications are often sped through the review process without adequate consideration. When important details of dangerous drugs finally come to light, many times it is too late.

According to the FDA, studies published in the Journal of the American Medical Association indicate that more than 2 million serious adverse drug reactions (ADRs) occur each year and that ADRs are the fourth leading cause of death in the United States.


American Sociological Association. Toxic drugs, toxic system: sociologist predicts drug disasters. Washington DC, 3 August 2008. (accessed September 2010).

Lazarou J et al. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. Journal of the American Medical Association. 1998 Apr 15;279(15):1200-5.

Light D. Pharmaceuticals: A Two-Tier Market for Producing 'Lemons' and Serious Harm. 105th Annual Meeting of the American Sociological Association, Atlanta, 17 August 2010.

US Food and Drug Administration. Preventable Adverse Drug Reactions: A Focus on Drug Interactions. (accessed September 2010).

Ghosts, Ghouls, and Worms

The Lower East Side Ecology Center promotes a sustainable New York City through recycling programs, green space preservation, urban gardening and educational events.

Join them this fall for two fun and informative workshops on indoor composting.

Ghosts, Ghouls, and Worms:  Halloween Composting

Join the NYC Compost Project in Manhattan to learn about indoor worm composting, make biodegradable Halloween decorations, and take home your own pumpkin. Costumes are welcome and all project materials will be provided.

Date:  Tuesday October 26, 2010
Time:  3:00pm - 4:00pm
Location:  Whole Foods Market Tribeca, 270 Greenwich Street, New York, NY 10007
Open to:  Children age 5 and over accompanied by parents
Attendance fee:  $5

Teacher Wormshop:  Composting for the Classroom

Next month, the NYC Compost Project is hosting a special workshop for teachers. It will cover worm bin set-up and maintenance, troubleshooting, and how to incorporate composting into your lesson plans. Worms and worm bins will be available for purchase at a reduced cost.

Date:  Monday November 15, 2010
Time:  6:00pm - 8:00pm
Location:  Friend's Seminary, 222 East 16th St, New York, NY 10003
Open to:  Teachers only
Attendance fee:  $5

Forest Therapy

The popular practice of shinrin-yoku in Japan translates to forest bathing, or being surrounded by a forest environment. It may not seem like therapy but forest bathing has been shown to improve mental and physical health. Studies have documented reduced stress, lower blood sugar, better concentration, diminished pain, improved immunity and even anti-cancer effects.

Results have been so impressive that Japanese companies are starting to include forest therapy in employee health care benefits and wellness programs with free check-ups are available inside Japanese forests. A look at the research reveals why a walk in the woods is an unusual but promising prescription.

Reduced Stress

A recent review of field experiments across Japan compared physical markers of stress in natural environments to those in city settings. 280 adults spent time in forest and urban areas on alternate days. Compared to city environments, forest settings were associated with lower levels of cortisol, slower heart rates, lower blood pressure, greater activity of parasympathetic nerves that promote relaxation, and reduced activity of sympathetic nerves associated with “fight or flight” reactions to stress.

Another study of forest bathing measured fluctuations in salivary amylase, an indicator of changes in sympathetic nervous activity, and also concluded that forests were associated with less environmental stress.

Researchers have studied the psychological effects of forest bathing as well. Almost 500 Japanese adults were surveyed on days they spent time in a forest and also in their normal environment. Statistical analyzes revealed that, compared to their normal environments, inside a forest the participants reported significantly less depression and hostility, and felt significantly more lively. And the greater the level of stress individuals experienced, the greater the positive effects of forest bathing. Researchers concluded that forests are “therapeutic landscapes” and that forest bathing may decrease the risk of stress-related diseases.

Lower Blood Sugar

Forest therapy may also help control blood sugar. A Japanese study followed 87 adults diagnosed with type-two diabetes for six years. During this time, participants walked in a forest for 3 or 6 kilometers (1.9 or 3.7 miles), depending on their physical ability, on nine different occasions. At the end of the study, researchers found that the forest walkers had lower blood glucose (synonymous with blood sugar), improved insulin sensitivity, and decreased levels of hemoglobin A1c, an indicator of how well blood glucose has been controlled over the past 3 months.

This wasn’t a controlled study and, in general, any form of exercise practiced regularly can help improve blood sugar regulation in people with diabetes. But given the frequency of the walks (only nine times in six years) and the fact that blood sugar levels were significantly decreased but not significantly different between those who walked the long distance and those who walked the short distance, researchers concluded that factors other than exercise also contributed to the positive long-term results, including changes in hormonal secretion and nervous system function associated with blood sugar metabolism.

Better Concentration

Research in the United States has investigated the effects of outdoor green spaces on symptoms of attention-deficit/ hyperactivity disorder (ADHD) in children. In a randomized controlled study, doctors specializing in environmental psychology at the University of Illinois studied 17 children diagnosed with ADHD who were exposed to three different environments.

After 20-minute walks in a city park, children experienced substantially improved concentration compared to 20-minute walks in downtown and residential settings. Researchers concluded that the positive results were comparable to the effects of Ritalin.

Diminished Pain

Researchers at Johns Hopkins University School of Medicine studied the effects of nature scenery and sounds on pain perception. The randomized controlled clinical trial included 120 adults undergoing bone marrow aspiration and biopsy performed with only local anesthetic, a painful procedure, in one of three settings.

One group experienced nature scenery and sounds during the biopsy, the second group city scenery and sounds, and the third group a standard medical setting. Overall, the procedure was poorly tolerated, but researchers concluded that viewing a nature scene and listening to nature sounds is a safe and inexpensive way to reduce pain during bone marrow biopsy.

Improved Immunity

Studies in Japan have examined markers of immunity in both men and women after three-day trips to the forest. Healthy volunteers participated in three two-hour sessions of walking in a forest. Before, during and after the experiences researchers measured the number and activity of natural killer cells, immune cells that destroy cancerous cells in the body; anti-cancer proteins including perforin, granulysin and granzymes A/B; and levels of stress hormones adrenaline and noradrenaline. They also measured levels of phytonicides in the forest air. (Phytonicides are essential oils released by trees and plants to defend against insects, animals and decomposition.)

Compared to control measurements taken on normal working days, forest walking significantly decreased levels of stress hormones, increased anti-cancer proteins, and increased the number and activity of natural killer cells. 30 days after the experience, natural killer cells were still more active, suggesting that monthly forest walks could be an important lifestyle factor in the prevention of cancer as well as helpful adjunctive therapy for people diagnosed with cancer.

Researchers believed that the wood essential oils were at least partially responsible for the positive effects of forest air. Separate studies have further investigated phytonicides in laboratory settings and confirmed that they can increase anti-cancer proteins and enhance natural killer cell activity.

A Pleasant Prescription

The therapeutic benefits of forest bathing may be difficult to fully explain. Green scenery, soothing sounds of streams and waterfalls, and natural aromas of wood, plants and flowers in these complex ecosystems likely all play a part. Forest therapy is a good example of how our own health is dependent on the health of our natural environment. It’s also an excellent reason to go for a walk in the woods.


Karjalainen E et al. Promoting human health through forests: overview and major challenges. Environmental Health and Preventive Medicine. 2010 Jan;15(1):1-8.

Kawakami K et al. Effects of phytoncides on blood pressure under restraint stress in SHRSP. Clinical and Experimental Pharmacology and Physiology. 2004 Dec;31 Suppl 2:S27-8.

Kuo FE and Taylor AF. A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study. American Journal of Public Health. 2004 Sep;94(9):1580-6.

Lechtzin N et al. A randomized trial of nature scenery and sounds versus urban scenery and sounds to reduce pain in adults undergoing bone marrow aspirate and biopsy. The Journal of Alternative and Complementary Medicine. 2010 Sep;16(9):965-72.

Li Q et al. A forest bathing trip increases human natural killer activity and expression of anti-cancer proteins in female subjects. Journal of Biological Regulators and Homeostatic Agents. 2008 Jan-Mar;22(1):45-55.

Li Q. Effect of forest bathing trips on human immune function. Environmental Health and Preventive Medicine. 2010 Jan;15(1):9-17.

Li Q et al. Forest bathing enhances human natural killer activity and expression of anti-cancer proteins. International Journal of Immunopathology and Pharmacology. 2007 Apr-Jun;20(2 Suppl 2):3-8.

Li Q et al. Phytoncides (wood essential oils) induce human natural killer cell activity. Immunopharmacology and Immunotoxicology. 2006;28(2):319-33.

Morita E et al. Psychological effects of forest environments on healthy adults: Shinrin-yoku (forest-air bathing, walking) as a possible method of stress reduction. Public Health. 2007 Jan;121(1):54-63.

Ohtsuka Y et al. Shinrin-yoku (forest-air bathing and walking) effectively decreases blood glucose levels in diabetic patients. International Journal of Biometeorology. 1998 Feb;41(3):125-7.

Park BJ et al. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environmental Health and Preventive Medicine. 2010 Jan;15(1):18-26.

Taylor AF and Kuo FE. Children with attention deficits concentrate better after walk in the park. Journal of Attention Disorders. 2009 Mar;12(5):402-9.

Tsunetsugu Y et al. Trends in research related to "Shinrin-yoku" (taking in the forest atmosphere or forest bathing) in Japan. Environmental Health and Preventive Medicine. 2010 Jan;15(1):27-37.

Yamaguchi M et al. The effects of exercise in forest and urban environments on sympathetic nervous activity of normal young adults. The Journal of International Medical Research. 2006 Mar-Apr;34(2):152-9.


“There’s no denying that shrinking our health care system will cause dislocation among workers and lower profits for some sectors of the medical industry. But America’s industries are undergoing constant change, and in any other arena of our economy we would never tolerate the degree of waste and inefficiency and lack of accountability that’s rife in health care.”  (Page 302)

In her compelling and eye-opening book, Overtreated, award-winning journalist Shannon Brownlee investigates the US health care system and demonstrates how too many tests and treatments are not just unnecessary and sometimes dangerous, but they are the root cause of escalating health care costs. She explores the history of our current health care system to explain how we ended up in such a mess.

Her message is also a hopeful one. Brownlee takes readers inside model systems like the Mayo Clinic to demonstrate how good health care can be. It really is possible to improve the quality of care while controlling costs and extending health insurance to the uninsured. This book is a page-turner that should be required reading for doctors, patients and lawmakers alike.

Free Workshops on Breastfeeding, Childbirth and More

Choices in Childbirth is a non-profit organization promoting good maternity care. Through education, advocacy and outreach they give women the information they need to make informed decisions about where and how to give birth.

This fall, Choices in Childbirth is offering free workshops on important topics to new and expecting parents in New York City. This first one happens TODAY. To learn more, click below to follow the link or call 212-983-4122.

Breastfeeding Workshop
Date: Monday, September 20, 2010
Time: 6:15 - 8:30 pm

Sex During and After Pregnancy
Date: Tuesday, September 28th
Time: 7 - 9 pm

How to Have a Great Hospital Birth
Date: Monday, October 18th, 2010
Time: 6:15 - 8:30 pm

Building Your Birth Team: Focus on Support
Date: Monday, November 15th, 2010
Time: 6:15 - 8:30 pm

Also join Choices in Childbirth for the 8th annual Miles for Midwives 5K Race and Community Wellness Fair on Saturday, October 2 from 10 am to 2 pm in Prospect Park (Bartel-Pritchard Square, 15th Street and Prospect Park West). There will be a silent auction and free activities including yoga, massage and acupuncture. Proceeds from this event benefit the work of Choices in Childbirth and the American College of Nurse-Midwives to improve maternity care in our community.

Register in advance ($20 or $50 VIP) on their website by Thursday, September 30 or on the day of the event (8:30-9:30 am, $25). All race participants receive gift bags. VIP registrants receive extra products and coupons in their gift bags as well as post-race snacks.

Endocrine Disruption Prevention Act

Endocrine-disrupting chemicals in the environment can take a serious toll on the health of humans and wildlife. They mimic or block natural hormones made by the body and have been linked to irreversible reproductive and developmental problems like early puberty, infertility and cancer.

Evidence is mounting that these chemicals also interfere with neurological and immune systems and contribute to thyroid disorders, obesity and cardiovascular disease.

Endocrine-disrupting chemicals are found in food, water, air, consumer products, plastics, pesticides, industrial chemicals and fuel. Because most are fat-soluble, they are stored in tissues, rather than excreted, and accumulate in the body. They can be transferred from mother to child through the placenta or breast milk.

The Endocrine Disruption Prevention Act (S 2828 and HR 4190) would authorize the National Institute of Environmental Health Sciences to conduct research on hormone-disrupting chemicals in the environment and determine their safety.

A panel of scientific experts, free of conflict of interest, will evaluate the findings and determine the level of concern. Their findings will be passed on to regulatory agencies, including those listed below, which must propose a course of action in response to the findings.

•    Environmental Protection Agency
•    US Food and Drug Administration
•    Consumer Product Safety Commission
•    Occupational Safety and Health Administration
•    Department of Agriculture

If this bill becomes law, it would create the following protocols to develop reliable and reproducible methods to identify chemicals that can disrupt hormones in the human body and impact health.

•    Address the full range of possible health outcomes, including reproductive, behavioral, intellectual, metabolic, and endocrine disorders
•    Detect effects at levels relevant to human exposure
•    Consider the effects of exposure to multiple chemicals

Congress is back in session but scheduled to recess on October 8, 2010.  There is a lot of work to be done in this short period of time, so please write your elected officials today and encourage them to cosponsor this legislation.

It’s easy to take action with Capwiz. This legislative tool allows you to send emails or printed letters directly to your Senators and Congressman. Follow this link to enter your zip code and contact information, customize the suggested text and send the letter to all of your elected officials.


Diamanti-Kandarakis E et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocrine Reviews. 2009 June; 30(4):293-342.

Colborn T et al. Developmental effects of endocrine-disrupting chemicals in wildlife and humans. Environmental Health Perspectives. 1993 October; 101(5):378-84.

Adverse Effects of High Heels

Wearing high heels has long been associated with foot pain and problems like ingrown toe nails, corns, calluses, bunions, neuromas, hammertoes and other deformities. A recent study shows that women who wear high heels are also at risk for structural and functional changes in muscles and tendons of the lower leg.

Researchers at Manchester Metropolitan University in England compared the lower limbs of women who wear high heels regularly with those who don’t. The regular wearers had thicker and stiffer Achilles tendons and less range of motion in their ankles. They also had shortened gastrocnemius muscles. The gastrocnemius is the major muscle in the lower leg and women who wore high heels regularly had 13 percent shorter fibers. Some also reported pain when wearing flat-soled shoes, a result of shorter muscles and tighter tendons.

For healthy feet, ankles and legs, save high heels for special occasions and follow these rules when selecting shoes:

•    Choose shoes that fit your feet well

•    Opt for lower heels with a gradual slope over higher heels with a steeper slope

•    Look for shoes with good cushion or insert silicone pads under the ball of each foot for added shock absorption

•    Choose open-toed shoes to relieve pressure on feet

•    Wear thicker heels that provide more stability to maintain better balance and ease pressure on the knees, hips and back


Csapo R et al. On muscle, tendon and high heels. Journal of Experimental Biology. 2010 Aug 1;213(Pt 15):2582-8.

Health Hazards of Agave and Fructose

Advertised as a natural sweetener with a low glycemic index, agave nectar has become popular with dieters and diabetics alike. Although agave doesn't immediately increase blood sugar levels, it can still contribute to insulin resistance and increase the risk for diabetes, obesity, premature aging, heart disease and liver problems. Understanding the way it works in the body reveals why everyone should avoid agave and other products full of fructose.


Traditional agave sweetener is boiled sap from the succulent desert plant native to Mexico and the southwest United States. But the modern agave nectar found in stores today is an entirely different food. This syrup is made by refining the starchy root bulb through chemical processes using genetically modified enzymes to concentrate fructose. Like high fructose corn syrup, agave contains more fructose than glucose so it scores low on the glycemic index, where foods are ranked according to their effects on glucose levels in the blood.

Fructose occurs naturally in fruits and some root vegetables, but it is present in only small amounts and exists as part of a complex. Bound to fiber, fatty acids, vitamins and minerals, natural fructose in whole foods is digested and absorbed slowly. In contrast, fructose found in simple carbohydrates like agave nectar, agave syrup, high-fructose corn syrup and sugar (which is 50 percent glucose and 50 percent fructose) is free, unbound, quickly digested, and absorbed into the bloodstream in large quantities.

Carbohydrate Metabolism

After carbohydrates are consumed and digested, rising levels of glucose in the blood trigger the pancreas to secrete insulin. This hormone allows glucose to enter cells where it is burned for immediate energy. Insulin also prompts the body to store excess glucose for future energy use, as glycogen in the liver and muscles and as fat in adipose tissue. When insulin levels are high, the body will always accumulate fat.

High levels of insulin send a message to the brain that immediate energy needs have been met and the brain responds with feelings of satiety. Insulin also triggers fat cells to secrete leptin, another hormone that reduces hunger and food intake. But fructose enters cells through transporter proteins that are absent from brain cells and insulin-producing cells in the pancreas, so fructose can never trigger the secretion of insulin or leptin, nor their signals to stop eating.

Large amounts of fructose in the blood inhibit the conversion of glucose to glycogen. As a result, glucose levels remain high and the pancreas secretes even more insulin in an attempt to clear it from the blood. If levels of insulin are chronically high, over time cells will compensate by becoming resistant. When cells aren't sensitive to insulin, they can't take up glucose as effectively, and without enough glucose, cells starve. Starving cells stimulate appetite and the body is motivated by hunger to continue eating. This cycle is a key contributor to weight gain and obesity.

Insulin resistance and elevated glucose levels worsen symptoms of diabetes, and in healthy people, they can cause diabetes. In the short term, high levels of blood sugar can lead to fatigue, dehydration, susceptibility to infections and blurry vision. In the long term, they can cause cardiovascular disease, neurological complications, kidney failure and blindness. Execssive insulin and glucose levels can also stimulate the growth of cancer cells.

Advanced Aging

Other effects of high levels of fructose and glucose in the blood are increased production of reactive oxygen species, like free radicals, and advanced glycation end-products (AGEs). Free radicals are a normal part of metabolism, usually neutralized by antioxidants before they do serious damage to cells. However, too many can overwhelm the body's capacity to control them and increased cellular damage is one cause of aging. Unnaturally high amounts of AGEs can also cause premature aging because they easily bind together in a process called cross-linking and become resistant to natural disposal mechanisms. When AGEs accumulate in tissues, they cause rigidity and interfere with normal function.

Collagen, a fundamental component of connective tissue, is particularly susceptible to cross-linking. Collagen cross-linking in skin causes it to lose elasticity and take on a prematurely old appearance. Collagen cross-linking in bones, cartilage and tendons can cause joints to stiffen. In the cornea, lens and retina of the eye, it can cause browning, opacity and cataract formation. In kidneys: renal failure. In blood vessels: increased pressure and hypertension. In nerve endings: peripheral neuropathy. AGEs have also been found in the brain plaques and tangles associated with Alzheimer’s disease.

Cardiovascular Disease

Because fructose cannot be used as immediate energy like glucose, it is converted into triglycerides in the liver and stored as fat. Triglycerides are attached to lipoprotein molecules that shuttle them through circulation and deposit them in fat cells. Classified as low-density lipoproteins (LDL) and very low density lipoproteins (VLDL), they contain a high percentage of fat and a small percentage (or low density) of protein. After the triglycerides are delivered to fat cells, the proteins become small and dense LDL particles.

Small, dense lipoproteins remain in the blood longer and are more likely to oxidize than the large, fluffy LDL particles produced when triglyceride production is low. Oxidized LDL particles and free radical damage initiate blood vessel injury associated with atherosclerosis and coronary artery disease. Like grains of sand, small, dense lipoproteins get stuck in atherosclerotic plaques and clog blood vessels. Additionally, high levels of insulin stimulate the proliferation of smooth muscle cells that line blood vessels, occluding them even further.

When blood can no longer flow because vessels are too narrow, or because an atherosclerotic plaque ruptures and a piece that breaks off blocks blood flow in a smaller vessel, tissues die. If blood can't circulate through small vessels of the lower leg, it can become gangrenous. If blood flow in the brain is interrupted, a stroke occurs. If arteries around the heart are affected, a heart attack happens. Any organ can be affected.

Liver Disease

Fructose has also been linked to liver problems. A 2008 study found that people who consume it regularly have a two- to three-fold higher risk of developing non-alcoholic fatty liver disease (NAFLD) compared to adults of similar age, gender and body mass index. A 2010 study from Duke University Medical Center found that fructose consumption in people with NAFLD can cause hardening and scarring of the liver which may lead to cirrhosis, liver failure, liver cancer and the need for a liver transplant.

The Bottom Line

Agave nectar is an unhealthy sweetener and it isn't alone. High fructose corn syrup and sugar are also harmful, and artificial sweeteners are poor alternatives. If you're hungry for something sweet, have a piece of fruit. Packed with nutrients and fiber, it's the best sweet treat yet.


Abdelmalek MF et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology. 2010 Jan 28. DOI 10.1002/hep.23535.

Basciano H et al. Fructose, insulin resistance, and metabolic dyslipidemia. Nutrition and Metabolism. 2005 Feb 21;2(1):5.

Elliott SS et al. Fructose, weight gain, and the insulin resistance syndrome. American Journal of Clinical Nutrition. 2002 Nov;76(5):911-22.

Ouyang X et al. Fructose consumption as a risk factor for non-alcoholic fatty liver disease. Hepatology. 2008 Jun;48(6):993-9.

Back to School Guide

The Back to School Guide from the Environmental Working Group details the best choices for nontoxic and green school supplies.

From recycled notebooks and natural-fiber backpacks to water-based art supplies and lunchboxes free of lead, PVC and PBA, learn which products are best for your kids and best for the environment.

Before you start shopping, download the PDF to print out and take along.

Or shop online using EWG's link to Amazon and Amazon will donate a portion of the proceeds to the Environmental Working Group. Get good stuff and support the people who help you make good choices at the same time.

Whole Living Magazine

Dr. Cimperman is featured as one of five "notable" healers in the September issue of Whole Living magazine, on news stands now.

Read about why she chose naturopathic medicine on page 119.

Prostate Cancer Screening: Risks, Benefits and Alternatives

Screening tests for prostate cancer are regularly recommended as tools of prevention. Testing doesn't reduce the risk of developing cancer, it only increases the chance of finding it, but early detection may improve survival and the American Urological Association recommends that men start screening at age 40. However, the procedures carry risks and recent clinical trials have questioned their benefit. Understanding the research, risks, benefits and alternatives helps men make decisions best for them.


Screening tests for prostate cancer commonly include a blood test for prostate-specific antigen (PSA), a compound secreted by prostate tumors (both benign and malignant), and a physical exam, where doctors palpate the gland to detect abnormalities in size or shape, often referred to as a digital rectal exam or DRE. Two large, landmark trials published last year in the New England Journal of Medicine evaluated outcomes associated with these procedures.

The European Randomized Study of Screening for Prostate Cancer included 182,000 men from seven European countries between the ages of 50 and 74. Participants were randomly assigned to two groups. One group received PSA tests once every four years, while the other group was not screened for prostate cancer. At the end of the study, researchers found that the men who were tested experienced 20 percent fewer deaths from prostate cancer than those who were not tested. However, they also found that 1,410 men would have to be screened and 48 would have to undergo cancer treatment in order to prevent one man from dying of prostate cancer.

The other research study followed almost 76,700 men in the United States and randomly assigned them to two groups. One group received "usual care," which sometimes included screening. The other group received regular screening: a PSA test every year for six years and a DRE every year for four years. After seven to ten years of follow-up, researchers analyzed the rates of death from prostate cancer and concluded that there was no significant difference between the two groups.


When screening tests are positive, biopsies are performed so that cells can be evaluated by a pathologist and a diagnosis can be made. When cancer is found, it is often treated with surgery and radiation.

For some men, these tests and treatments save lives. But they do not guarantee that cancer will be cured or that men will live longer. Aggressive prostate tumors can be incurable regardless of how early they are detected.

And not all prostate cancers need treatment. In most men, tumors of the prostate are slow-growing and unlikely to spread to other parts of the body or cause death. Many older men diagnosed with prostate cancer will not live long enough to benefit from treatment because they will die of other causes. Autopsy studies show that more men die with prostate cancer than from prostate cancer.

Additionally, tests and treatments carry risks, side effects and complications. Biopsies can be associated with pain, bleeding and urinary tract infections, and men may have difficulty passing urine after the procedure. Cancer treatment can cause impotence, urinary incontinence and bowel problems.

Side effects of screening tests are not only physical. Studies have shown that false positives (test results that indicate prostate cancer is present when it isn't) cause psychological harm that may persist for up to one year. And false positives are a common occurrence, accounting for approximately 75 percent of all PSA results. According to the Mayo Clinic, only one out of four men with a positive PSA test actually has cancer. False negatives (test results that indicate cancer is not present when really it is) can also occur if malignant tumors grow quickly without producing much PSA.


Certain men may benefit from prostate cancer screening. African-American men, who are more likely to be diagnosed with prostate cancer at a younger age, and whose PSA levels at the time of diagnosis are likely to be higher, may benefit. Any man with a father or brother diagnosed with prostate cancer before the age of 65 has an above-average risk of developing the disease himself and may also benefit. And for men who have already been treated for prostate cancer, monitoring PSA levels can help predict possible recurrence. Men who meet these criteria should consider screening tests and ask their doctors for individualized recommendations.


For the majority of men, prostate cancer screening provides no benefit and subjects them to uncomfortable and unnecessary tests and treatments. Instead, most men should focus on optimal health and cancer prevention. Here are the best strategies:

•    Eat a healthy diet full of whole foods, including seven or more servings of pesticide-free vegetables and fruits each day. Choices especially good for reducing the risk of prostate cancer include lycopene-rich tomatoes; foods high in folate like spinach, lentils and beans; and cruciferous vegetables like kale, cabbage and broccoli because they contain diindolylmethane, a nutrient that increases the excretion of hormones.

•    Eat foods rich in omega-3 fatty acids, especially wild fish living low on the food chain like Alaskan Salmon, Pacific Halibut, sardines, herring and anchovies.

•    Include phytoestrogens in your diet. These plant-based compounds can reduce the risk of hormone-related cancers including prostate cancer. The best sources are ground flax seeds and traditional soy foods like tofu, tempeh and miso. Ground flax seeds are an especially good choice because they contain omega-3 fats and lignans, compounds that positively affect the metabolism of hormones in the liver.

•    Drink several cups of green tea each day and alcohol only in moderation, favoring antioxidant-rich red wine.

•    Avoid refined carbohydrates and unhealthy fats. These include processed foods, sugar, flour, refined vegetable oils, oxidized and trans fats, and meat, eggs and dairy products from animals exposed to hormones or pesticides.

•    Avoid foods and beverages that have been stored in plastic containers and cans unless they are labeled BPA-free and phthalate-free.

•    Exercise regularly and maintain a healthy weight. Studies have found that men who are overweight and obese have a higher risk for developing prostate cancer and having more aggressive tumors. Waist-to-hip ratio is also important because excessive abdominal fat may better correlate to cancer risk than adipose evenly distributed.

•    Get plenty of sleep. A large study of Japanese men found that those who slept an average of nine hours or more each night had less than half the risk of prostate cancer compared to those who slept less.

•    Ask your doctor to test your vitamin D. Low levels have been linked to several kinds of cancer, including prostate cancer.


Andriole GL et al. Mortality results from a randomized prostate-cancer screening trial. New England Journal of Medicine. 2009 Mar 26;360(13):1310-9.

Carroll P et al. Prostate-Specific Antigen Best Practice Statement: 2009 Update. American Urological Association.

Kakizaki M et al. Sleep duration and the risk of prostate cancer: the Ohsaki Cohort Study. British Journal of Cancer. 2008 July 8; 99(1): 176–178.

Lin K et al. Benefits and harms of prostate-specific antigen screening for prostate cancer: an evidence update for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2008 Aug 5;149(3):192-9.

Schröder FH et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine. 2009 Mar 26;360(13):1320-8.

Shao YH et al. Contemporary risk profile of prostate cancer in the United States. Journal of the National Cancer Institute. 2009 Sep 16;101(18):1280-3.

United States Preventive Services Task Force. Screening for Prostate Cancer. August 2008.

How to Eat Ethically in a World of Vanishing Seafood

Taras Grescoe’s book, Bottomfeeder: How to Eat Ethically in a World of Vanishing Seafood, offers an adventurous, in-depth exploration of fishing and aquaculture practices around the world.

His quest to find the best fish meal in a world of diminishing choices takes him to seafood capitals like Chesapeake Bay, Nova Scotia, British Colombia, Marseilles, Japan, China and India. From fish farms and fish stick factories to sushi bars, skipjacks, and supermarkets, Grescoe gives an insider’s look at important issues from a variety of perspectives.

Grescoe not only investigates problems surrounding fish and seafood like environmental pollution, ecosystem damage and loss of biodiversity. He also suggests solutions, offers tools for choosing seafood, and discusses the pleasures and virtues of eating at the bottom of the food chain. “For every fish I have crossed off my list,” he writes, “I have added several more.”

Now in paperback, this is a must-read for seafood lovers and environmental advocates alike.

The Toxic Chemistry of Everyday Products

Mark Schapiro’s book, Exposed: The Toxic Chemistry of Everyday Products and What’s at Stake for American Power, is an eye-opening account of common chemicals and environmental toxins that scientists around the world have linked to rising rates of cancer, neurological disorders and reproductive problems including premature birth and infertility.
Common compounds in cosmetics, hair dye, perfumes, shower curtains, toys, construction materials, cars, electronics and even food have been identified as hormone-disrupting chemicals, reproductive toxins, neurotoxins, and carcinogens.

Due to a shocking lack of standards, the United States has become a dumping ground for toxic products banned in European countries. Schapiro explores and explains the problems, and demonstrates that solutions are already available.

Wild Food

We all should include wild foods in our diet. From leafy greens and berries to wild game and mushrooms, wild foods have a lot to offer that cultivated foods do not.

Plants that live in the wild must defend themselves against diseases, insects, animals and UV radiation from the sun. The phytocompounds they need for survival - like antioxidants and bioflavonoids - are nutrients that our bodies need too.

Some constituents, like alkaloids, taste bitter. In our current culture obsessed with all things sweet, bitter foods have fallen out of favor. But many of them are good for us, like baby dandelion leaves that support healthy liver function. (The liver filters out waste products from our blood as well as unnecessary and toxic compounds that we inhale or ingest.)

Common varieties of foods found in stores have not only been selected for sweetness, but also for shelf life. Compared to cultivated foods, their wild counterparts often contain higher amounts of omega-3 fatty acids. These fats are essential to our diet because our bodies cannot make them. Plant sources of omega-3s are fragile, easily oxidized and best picked fresh. (Oxidation turns fats toxic and promotes the production of harmful free radicals.)

Purslane, for example, contains more omega-3 fats than any other green leafy vegetable. This sprawling plant grows close to the ground with succulent reddish stems, green paddle-shaped leaves and tiny yellow flowers. Commonly considered a weed, it is found in lawns and meadows. Purslane's delicious sweet and sour flavor makes a winning contribution to salads, soups and stir fry. And it's easy to forage if you know where to look and how to identify it.

Wild game and fish are also higher in omega-3 fats because they too have foraged for their food and eaten wild plants (or eaten wild animals that have eaten wild plants, in the case of carnivores). In contrast, meat from animals raised in confined animal feeding operations (CAFOs) and fed grain is low in omega-3 fats. Wild animals are also a healthier choice because they haven't been exposed to antibiotics, pesticides or growth hormones common in CAFOs.

But before you forage for your dinner, follow these two important rules:

1. Harvest plants in areas away from traffic that have never treated with chemicals like pesticides or herbicides.

2. Make sure you know what you're picking. If you're not a wild foods expert, find a local guide or join a tour to learn what to look for.

In the New York City area, "Wildman" Steve Brill offers affordable walking tours in all five boroughs,Westchester, the Appalachians, Long Island, Connecticut and even Pennsylvania. Visit his website for details.

I joined him on a recent tour of Central Park and below are some of the wild foods I collected. With them, I made a Central Park Salad for dinner.

Black Cherries

These small fruits are slighty sweet and slightly sour, with a bitter aftertaste.
Black Nightshade Berries

The leaves of this plant are toxic, but the ripe berries are safe to eat. They look like small, smooth blueberries but they taste like tomatoes.

Dogwood Cherries

These look like cherries but they're really berries. More sour than sweet, they are best eaten when dark red and fully ripe.

May Apples

When these fruits turn yellow and fully ripe, they have a flavor and texture similar to passionfruit.

Lamb's Quarters

These green leaves are tender and can be eaten like spinach: steamed, sautéed or tossed in salads.
Yellow Wood Sorrel

This wild green tastes like lemon and has yellow flowers, heart-shaped leaves and tender stems. Everything can be eaten.
Milk Weed Pods

These pods look like pickles and taste like string beans. Harvest only the small pods, an inch or two in length, and simmer them in boiling water for 20 minutes before adding them to salads or stir fry.


These green leaves can be used in small amounts to season foods. They have carminative properties that make them helpful for preventing and treating gas and bloating.

Poor Man’s Pepper

These green seeds taste like pepper and add a mild spice to any dish.

Wild Chervil

These seeds have a sharp flavor reminiscent of parsley.

Wild Field Garlic

These small, tender cloves have a mild garlic flavor. Crush them into vinaigrettes or toss them whole into salads and stir fry.