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CNBC VIDEO – One Nation Overweight

Your comments or thoughts?   Welcome here or on the Facebook page.

Disease:  Around the Corner for Many (On Basil and Spice.com)

Eva Markvoort’s Story – And What It Means for You (On this blog site)

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To follow-up on our meeting, here are links to the two articles that we discussed would be of benefit to all who attended today.  Additionally, I update this blog often with emerging research and critical information on chronic disease prevention.   Please feel free to check in and  join the conversation anytime. 

Will update you on the new site that is coming up shortly.  Here are the links:

Heart Disease, Cancer, Diabetes – What’s (Sustainable) Food Got to Do With It?

Reaction vs. The Current Idea of Prevention vs. TRUE Prevention – Take Your Pick

Given the above statistics, and especially the fact that certain cancers such as those of the breast and the prostate are so widespread in the Western nations, I find that most individuals who learn of the statistics I have stated above generally live with both a sense of foreboding and apprehension (due to the fear of cancer) and frustration (due to not knowing what they can do pro-actively to improve their chances of preventing this disease).   After all, most have long believed that cancer is one disease they have little or no control over.    

The purpose of this post is to help you radically change that erroenous viewpoint.  While it is not possible – in a blog post – to delve deeply into how certain cancers may be prevented, the critical point I want to highlight here is this:  The weight of research conclusively tells us that only 5–10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90–95% have their roots in an individual’s environment and lifestyle (1).   Recent research from the Department of Experimental Therapeutics at The MD Anderson Cancer Center concludes that the top lifestyle factors that contribute to cancer genesis are:

• Cigarette smoking
• Diet (Especially fried foods and red meat)
• Alcohol
• Sun exposure
• Environmental pollutants
• Infections
• Stress
• Obesity, and
• Physical inactivity

Here is the breakdown of the causal factors in deaths that can be attributed to cancer: Of all cancer-related deaths, almost 25–30% are due to tobacco, as many as 30–35% are linked to diet, about 15–20% are due to infections, and the remaining percentage are due to other factors like radiation, stress, physical activity, environmental pollutants etc.   These numbers clearly suggest that while we may not have absolute or 100% control over our destinities vis-a-vis cancer, we are decidely far from helpless.  It is past time, therefore, for us to dicard the erroneous view that cancer is a disease that attacks us arbitrarily.

What can you do today to improve your chances of preventing several cancers?  For now, here is a cursory, but useful list.   I will be addressing this topic in signficant detail in my upcoming book.

1.  Cease smoking, or work in that direction if you have been a long-time smoker.

2.  Increase consumption of a wide variety of fruits and vegetables.

3.  Reduce the use of alcohol; limit to 1-2 drinks a day maximum.  If you are dealing with cancer, avoid alcohol completely.

4.  Maintain an optimal or close to optimal weight by regular exercise and moderate eating habits.

5.  Minimize meat consumption, especially the consumption of red meat.

6.  Maximixe your use of whole grains.  Think past whole wheat, in order to include other good whole grains as well such as whole millet, whole barley, whole brown rice, whole gram (chick pea and lentil) flour, and whole oats.

7.  Use prophylactic vaccinations as needed under the  guidance of a physician - keeping in mind your specific needs in order to protect yourself against cancers that may be related to infectious causes.

8.  Obtain regular check-ups and be pro-active about your health.

SEEKING SOLUTIONS IN TRUE PREVENTION VERSUS IN TREAMENTS ALONE

As a long standing student of chronic disease research, I find that when it comes to chronic diseases, we tend to look for answers -whether for diagnosis or treament – disproportionately in new “breakthrough” drugs, or often even in genetic manipulation as in utilizing our knowledge of the human genome.   But, a rational overview of the breakdown of causal factors (listed above) that contribute to cancer genesis seems clearly to suggest that what we can do by learning how to pro-actively prevent cancer exceeds by far what we might accomplish even by a “breakthrough” discovery tomorrow in cancer treatment.  This is not to be construed as a case against cancer research.  Certainly, we need research both for cancer prevention and treament, but given the data above, it would be folly, in fact, even fatal for us not to give at least a proportionately equal or even higher weight  to cancer prevention.  

Given the vast and increasing sweep of cancer worldwide, the answer for anyone serious about learning how to prevent cancer is to commit to educating themselves about this disease.  Start by reading several posts right here on this blog, and then link back to the research cited to learn more.  I have provided links to some useful articles and research below.  While many say they don’t know where to find solid information on chronic diseases, it is interesting to note, isn’t it, then when we get really serious about learning or doing something, the answers are usually right in our current field of vision?   

Please pass on this post to others who may benefit.

NOTES

1.  Cancer is a Preventable Disease that Requires Major Lifestyle Changes, Dept. of Experimental Therapeutics, The MD Anderson Cancer Center.

2.  World Health Organization Factsheet.

LINKS

Why Early Detection Alone is Not the Best Protection.

Heart Disease, Diabetes, and Cancer – What’s (Sustainable) Food Got to Do With it?

More Confirmation that Diet Influences Prostate Cancer Risk

About a month ago on March 27, a former beauty queen named Eva Markvoort passed away at the age of 25 after a prolonged and difficult struggle with Cystic fibrosis.  Her story is touching and poignant, and one of courage – and I believe that there is a message in it for us all.   Eva’s life story was recently featured on CNN, and when you are able, I recommend that you take a few minutes to read it at this link:  Death at 25: Blogging the end of a life

Reading Eva’s story gave me what I might best describe as a “deja-vu” feeling.   Why?  Because more than once, I have sat across the table and talked to people who looked fine on a Monday morning, but that same week passed away on Friday from a deadly cancer.  I have met countless people in audiences I have spoken to across the country who shared with me that they had been ”shocked” into incredulous disbelief when they suffered from a heart attack at age 42.   Being continuously involved in Medicine and public speaking, I  have also seen numerous families endure the tragedy of chronic disease and unfathomable loss due to the premature death of a young or middle-aged family member.

When we and those around us (such as those in our family) are enjoying even a modicum of good health, we tend to think that chronic disease “statistics” apply to “other” people; that we ourselves will enjoy good health indefinitley; and, that a premature health crisis can simply not happen to us or those we love.   After 15 plus years of being intimately involved in the study of health and medicine, I am compelled to share with you that those thoughts are illusions - and dangerous ones at that. 

THE LAW OF ENTROPY AND YOUR HEALTH

The reality – hard as it may be – is that without consistent and deliberate effort, disease is around the corner for the overwhelming majority of individuals.   We live in an entropic universe, and the Law of Entropy applies squarely to the state of our health.   I have learnt through simple observation that when it comes to our health (especially beyond the age of 30 or so), if you are not “gaining,” you are “slipping”  - There is no “standing still.”  In simple words, that means – if today, you are not actively investing in educating yourself about creating health, applying the results from solid health research to your life, and taking positive steps to improve your well-being – then you should not be too surprised if you wake up one morning like millions of others do – “shocked” at that “unexpected(!)” heart attack, or cancer, or… 

THE BOTTOM-LINE?

After age 25 or 30, good health is a privilege – one that has to be earned.  Eva was the unfortunate victim of a genetic disorder, but for most of us, that is seldom the case.   The quality of our health – and consequently our lives – rests largely in our  own hands.  

Eva’s story is a potent reminder of the brevity of life.   What are you doing today to invest in your health and well-being?  And, more importantly - Are you sufficiently healthy to live a life of passion and purpose before its over?

Here is a link to a brief, but excellent summary post on what constitutes a healthy diet from The Harvard School of Public Health’s online magazine – The Nutrition Source.   It is well worth the five minutes it will take for you to read it, and perhaps this can be your first step today in the direction of making a positive change to improve your health for the long term:

FROM HARVARD’S – THE NUTRITION SOURCE – What Should You Eat?

Enjoy, learn, pass it on!

Hello Friends!   I have been on a hiatus for about 3 weeks.  Thank you for your patience during this time.  Over the last week, I received numerous emails and questions on the recent controversy over the FDA approval of the cholesterol drug Crestor in healthy people, and therefore, decided to address that  issue briefly in this post.

Recently, the Food and Drug Administration (FDA) approved new criteria for the use of the cholesterol drug, Crestor.  Under this criteria, Crestor may be used as a preventive drug, that is, those who do not have cholesterol problems or overt heart disease may be deemed suitable candidates for the use of this drug.  Under these criteria, an estimated 6.5 million individuals will be candidates for using Crestor as a preventive measure against heart disease.   In particular, Crestor may be prescribed as a preventive drug to those who may be older (men over 50, and women over 60), and to those whose blood tests indicate an elevated inflammation level in the body. 

QUESTIONS AND CONCERNS

Two concerns have surfaced with the FDA approval of Crestor under the new guidelines, and both of these relate to the side effects of this drug which falls under the class of statins:

1.  Patients have reported muscle aches with statin use; thus there is a legitimate concern about expanding the use of statins, especially among healthy individuals who do not have existing heart disease or  high levels of cholesterol. 

2.  The second concern is in response to a study published in the British Journal, The Lancet in March of this year, which indicated that statins could raise an individual’s risk of developing Type 2 diabetes by 9%.  The Lancet study analyzed major clinical studies of statins as well as the results of the Crestor study that was recently reviewed by the FDA.  At present, the FDA has instructed AstraZeneca, Crestor’s manufacturer, to indicate the increased the risk of diabetes on the Crestor label.

ARRIVING AT RATIONAL ANSWERS (AND BEHAVIORS)

While there has been significant pandemonium over the new criteria approved by the FDA for the use of Crestor, I believe that it is not only possible, but indeed critically essential to view this development in the light of a larger, over-arching perspective.   Such a perspective takes into account previous studies and a larger body of research when evaluating options.  With that in mind, it may be useful to consider the following points:

1.  The FDA approval of Crestor as a preventive drug is an option, not a mandate.   While I believe unequivocally that the first line of prevention against any disease must involve nutritional and lifestyle changes, there are those who simply refuse to alter their diet and lifestyle in order to pro-actively prevent disease.  If you are such an individual, taking an anti-cholesterol medication may be an option for you. 

2.  Notwithstanding the point made above, a solid body of corroborative research indicates that with careful attention to nutrition and lifestyle choices, nearly 80% of heart attacks are preventable.  In light of this, if you do not wish to take cholesterol medication as a preventative, and are otherwise healthy, it would be prudent to discuss with your physician the option of a nutrition and exercise regimen that is aggressive enough to help you create an ideal or close to ideal cardiovascular profile.

3.  If you are an individual at high risk for heart disease (example: you have one or more of these factors to be concerned about – smoking, being sedentary, diabetes, poor diet, etc.), then taking a statin may make sense.  However, I believe strongly that drug use must  accompany positive nutritional & behavioral changes simultaneously for the best possible results.  The critical thing to remember here is that any statin use must be monitored carefully by regular tests of your liver enzymes.  All doctors prescribe these tests, but many patients overlook their importance.  Be sure to get regularly tested for liver function while on a statin drug.

CLOSING THOUGHTS

In light of developments such as the one discussed in this post, many individuals have shared with me that they often feel like “pawns” in the hands of higher powers that control their health and lives.  But, I disagree strongly with that mindset.  Keeping up with scientific research can be daunting, yes, but it is incumbent upon each one of us to learn all we can that is relevant to creating sound health.  Irrespective of the “event” or “development” of the day, there is always a larger framework within which ALL decisions must be evaluated.  This is because such an approach is the only one that allows for a truly rational and considered perspective that is essential to good decisions, especially decisions that can critically affect our health – and thus our lives.  And, it is simply not possible to cultivate such a perspective without committing to educating yourself regularly with sound knowledge.  You really have no other choice if you want to live a full, healthy and happy life.

Type 2 diabetes is a major risk factor for heart disease.  Consequently, historically, physicians have prescribed aggressive drug treatments to lower the risk of heart disease among patients with Type 2 diabetes.  Typically, these drugs include medications that lower blood pressure, blood cholesterol, and serum triglycerides.   However, results from three substantial studies (especially, in terms of sample size) presented at the annual meeting of the American College of Cardiology in Atlanta this past Sunday, Mar 14, indicated that some of the most widely prescribed medications to reduce the risk of  heart disease in Type 2 diabetics appeared not to provide much protection to patients at all, and in some cases, such therapy may even be doing harm.

Data for these conclusions come from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial.  This was a three-part study launched a decade ago to investigate whether aggressively lowering 3 key risk factors for heart disease, i.e., blood sugar, cholesterol, and blood pressure – would reduce heart disease risk in patients with diabetes or pre-diabetes.  Interestingly, 2 years ago, the blood-sugar lowering arm of the study was terminated when patients who drastically reduced glucose levels suffered a higher overall mortality rate as compared to those not receiving such therapy.

RESULTS - IN A NUTSHELL

• Results of the two remaining arms of the trial (One, in which patients received aggressive treatment to lower blood pressure, and the other, in which they received statins to reduce blood cholesterol as well as other medications to reduce triglycerides) indicated that aggressive drug treatment did little to reduce the risk of diabetics developing heart disease.  These study arms had 4,700 and 5,500 patients each – a factor, that gives substantial weight to these findings.  These findings were published online in the New England Journal of Medicine.
• In addition to the above, results of two other related large studies that measured effects of aggressive blood pressure and blood sugar reduction were also published online.  Results of these studies also indicated no benefit of aggressive blood pressure & blood sugar lowering treatments in reducing the risk of heart disease.

WHAT ARE PHYSICIANS (AND PATIENTS) TO MAKE OF THESE RESULTS?

In light of the results from the above statistically large, prospective studies, many researchers and physicians appear to be in a quandary regarding how best to incorporate these results into recommendations for practice.  At first glance, to most researchers who are directly involved with the studies, these results appear counterintuitive.

My first comment (as an epidemiologist) is that large-scale studies that investigate several complex factors simultaneously always have to face up to the challenge of “teasing out” the many subtle relationships that are present among the variables under study.  If that sounds too esoteric, here is a simple way to understand it — Patient histories, exercise levels, diet(s), stress levels, and other factors are ALL relevant to disease outcomes.  Thus, it is difficult, if not impossible, to arrive at a standard set of recommendations that are universally applicable.  For example, in one of the studies under discussion, it appeared that older patients with more advanced disease benefited less from drugs than younger or newly diagnosed patients.   Such nuances only come to surface with very specific examination of the study data.  It is thus possible that some of these very complex associations among study variables may become clearer as the data is investigated further in the future. 

My second comment is a much more practical one.  Whether or not aggressive drug treatment lowers heart disease risk in Type 2 diabetics may be up for discussion and discourse, but what immediate advice is imminently relevant to Type 2 diabetics…AND, incidentally, is not subject to prolonged debate?   The answer – It is the straightforward advice of improving their diet, their exercise patterns and their stress levels.  Why?  Because there is a safety factor “built-in” in positive lifestyle and nutritional changes that is nearly always absent in treatment with drugs; and especially so, in the case of “aggressive” treatments with drugs – as these very substantial studies have amply testified.

THE BOTTOM LINE – COMING FULL CIRCLE

Speaking generally – certainly, drugs can be beneficial, and even life-saving, especially in numerous acute situations.  But, the weight – both of experience and research - suggests that drugs alone are seldom the complete answer, especially when dealing with complex chronic diseases.  Rather, it is nearly always the case that most patients can benefit from nutritional and lifestyle modifications in tandem with drug use, and often, even utilize such modifications as stand-alone therapies when they are implemented under professional guidance.

In the aftermath of the (counter-intuitive) results of the studies under discussion, numerous researchers and physicians are now anticipating a move toward the “re-introduction” of nutritional and lifestyle modifications as perhaps a useful primary mode of treatment for diabetics, after all.  But, one question remains –  Did we really have to wait for the results of these studies to “re-introduce” patients to the idea of sensible eating & living?   Is it not intuitive to introduce patients to the merits of correct nutritional and behavioral choices – irrespective of whether these choices accompany drug use (as needed/indicated)?  

We appear to have come full circle.   The most basic and intuitive of all choices - that of seeking and maintaining quality in the foods we eat, and moderation in the lives we live – is now ratified by hard science.  How much more proof do we need to believe that how we eat and live matters?   This day, and how you  live it matters, after all.  Make a start.

On March 4, the US Food and Drug Administration announced the recall of a commonly used flavor enhancer known as Hydrolyzed Vegetable Protein or HVP – after samples of the product were found to contain a bacterium identified as Salmonella Tennessee.  The bacteria were found in HVP manufactured by Basic Food Flavors Inc. of Las Vegas, Nevada. 

HVP is a flavor enhancer used in thousands of processed food products such as soups, sauces, dips, dressings, chilis, stews, hot dogs, gravies, seasoned snack foods, and numerous other products.  Fortunately, many products that contain HVP involve cooking prior to eating, which would kill any bacteria present.  However, items that contain HVP but do not require cooking prior to ingestion are currently in the process of being recalled.  Here is the link to the list of products that have been recalled, or are currently in the process of being recalled:  Searchable Database of Recalled HVP-Containing Products.

Concerns over our nation’s food safety have been brought to the forefront in the past year owing to recalls associated with contaminated meat, cookie dough, peanut butter, and contaminated spinach/packed salads.  Now, this latest recall of an item that is present in literally thousands of foods has numerous food safety advocacy groups deeply concerned.  There is no doubt that preventive measures that would eliminate the possibility of mass contamination of foods are essential and pressing.  The multiple food recalls of the last year have significantly undermined public confidence in the overall safety of our nation’s food supply chain.

Notwithstanding the above, here is a thought I would like to leave you with:  HVP and similar other “flavor enhancers” are industrial products that are used on a mass scale in processed foods.  Is it really that radical a thought to consider that we CAN make foods delicious without such industrial agents?   As a research scientist who happens to have a professional culinary background, I have studied both traditional and contemporary food preparation methods utilized in  cultures around the world.  Of note is the fact that for centuries, food has been prepared across the globe and in disparate cultures – with only the purest, most natural flavoring agents  (such as locally grown herbs, spices, etc.) – a technique which, incidentally, has been historically demonstrated to have a “built-in” safety factor.   However, it seems to me that only now, in our present times in which the reliance on artificial, chemical, and largely “industrial” flavoring agents has skyrocketed, our worries about food safety have skyrocketed also.

I believe that the solutions to what often seem like mass, insoluble problems are actually quite simple, and inevitably lie in falling back on the fundamentals.  We can live without processed foods, or at the very least , we can minimize their use.   The evidence of history shows that those who do are the better for  it.

Heart disease, Diabetes, Obesity, Cancer – It is no secret that at present, the U.S. is mired in an unprecedented epidemic of these and other deadly chronic diseases.  But, how serious is the situation really?  The answer: 1 in 3 individuals in the U.S. currently have one or more forms of cardiovascular disease; nearly 70 million of our population is clinically obese (not just overweight)  and more than 2 out of every 5 individuals in the U.S. now face a lifetime risk of cancer.   These numbers represent us; They tell the story of how we are doing individually with our health, and collectively as a nation.   And, frankly, how we are doing does not look good.

So, what is the remedy for the health and chronic disease crisis that appears to be overwhelming our nation?  Are the answers to be found only in better insurance policies, adding more money into the System, and/or in better medical technology?  I believe not.  Rather, I believe that the time is ripe for another strategy – one that appears to have been universally overlooked.  And, that strategy is: Education.  But, it is not ordinary education I am talking about here.  Rather,  I am talking about education that will help the average individual arrive at lasting knowledge & clarity with respect to the critical choices that have a profound effect on one’s health.   Why bother with education of the kind I am describing?

Simple.  In his book, The Omnivore’s Dilemma, Michael Pollan accurately observes that we live in times in which most anyone with a medical degree and enough resources can topple the existing “food pyramid.”  Incidentally, the precise contents and design of the “food pyramid” themselves are often the final product of political battles that are fought every few years by multiple groups that have a stake in it.  Add to this, the ubiquitous presence and perpetual entry of new “diet” books on the market - and it is little surprise that the average person is overwhelmed with confusion and anxiety about how best to eat to achieve the simple objective of sound, long-term health.

Given the above, the question arises: Is it possible to arrive at  final answers with respect to our basic food and heath-related choices?  And, my answer is a resounding, Yes!  Notwithstanding all the factors mentioned in the previous paragraph, I believe that not only are knowledge and clarity possible with respect to knowing how to eat; they are the pre-requisite conditions for creating health.  Knowledge and clarity ARE the antidote to anxiety.  And, arriving at clarity alone  is worth the study and struggle that a good scientist endures.

Today, we do have the benefit of greater knowledge vis-a-vis which food/health-related choices can serve us best in the long run, but the benefit of such knowledge seldom reaches the average person.   As a research scientist who has been studying health, nutrition, and medicine for nearly 20 years now, I remember that from my earliest days of study, I was obsessed with the quest for knowledge, which in turn leads to clarity.  Even today, I find that the most important thing I can teach an audience is not just “what to eat,” but how to discern objectively whether what I, or any another scientist/speaker is sharing with them, is accurate.  It should be obvious why this is so crucial, but to really spell it out, here is why:  A good researcher is after the truth.  Period.  He/she is not after an agenda, profit or sales.  Further, a good researcher invests in learning and teaching about OBJECTIVE CRITERIA that can help anyone arrive at the truth.

In our Western world of nearly infinite food choices, I believe that education regarding optimal choices that can promote health is now absolutely crucial to help us turn the tide of the avalanche of chronic diseases that is falling upon us.  And yes, the choices recommended by any scientist must necessarily be grounded in objectivity, NOT opinion.  We arrive at such objectivity by relying on a body of corroborative scientific research, and further, by evaluating the observational evidence passed down to us over the centuries.  And, of vital interest, both research and observational evidence tell us that certain foods and ways of eating ARE INDEED better than others.

What then, are these foods and ways of eating?  The answer to that question will be addressed in a book that I am completing now, and that will be available on the market later this year.  In the meantime, in the next few weeks, I will write periodically on some of the most ideal food and health choices you can make with respect to achieving and maintaining good, sound health.  Stay tuned for that, and remember – When it comes to your health, there is simply no investment more worthy, and no time better spent than that utilized in truly educating yourself.

February is American Heart Month, and a good time to be reminded that Heart Disease still remains the number one cause of death in the United States.   Research indicates that about every 25 seconds, an American will have a coronary event, and about one every minute will die from one (1).   Although heart disease is often thought of as a condition more prevalent in men, the reality is that it is the leading cause of death for both men and women in the US, and women account for nearly 50% of all heart disease related deaths.

The good news is that we now know a great deal about pro-active steps that can be taken both to prevent and control the risk factors that contribute to heart disease.   Common conditions that put your heart at greater risk or increase the risk of death or disability generally include the following:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Tobacco use
• Secondhand smoke inhalation
• Peripheral Artery Disease
• Arrhythmia or irregular heart beat
• Heart failure

NUTRITION AND LIFESTYLE CHOICES CAN INFLUENCE CARDIOVASCULAR RISK PROFOUNDLY

By now, we have a corroborative body of research that confirms that the risk of heart disease can be reduced in most cases by making food and lifestyle choices that greatly influence heart health.   While many people believe that they “know” how to eat correctly, the reality remains that for most, it is hard to eat correctly, consistently.  Here are just a few reminders of the guidelines to bear in mind at ALL times:

1.  Whenever possible, choose foods that have a low glycemic index.  While that concept may seem complex, it simply refers to minimizing the use of carbohydrates that get absorbed very quickly in the bloodstream (example: table sugar, white flour, high fructose corn syrup, white potatoes, etc.).  Choose whole grains and whole foods, whenever possible. 

2.  Watch your portion sizes.  Avoid second and third helpings.

3.  Reduce or minimize the consumption of saturated fats and trans-fats.  Choose quality mono-unsaturated fats such as extra-virgin olive oil or canola oil for cooking, dips and dressings.  Choose lean, skinless meats whenever possible. 

4.  Minimize salt consumption.  The recommended daily allowance for salt is less than 2, 300 mg per day, but in reality, most people do better with far less than that amount.

5.  Drink alcohol only in moderation.  This translates to no more than one drink a day for a woman, and no more than 2 per day for a man.

6.  Under a physician’s care, plan a regular exercise regimen and plan physical activity in your routine daily.

7.  Avoid smoking completely, and avoid secondhand smoke to the maximum extent possible.  A recent report by The Institute of Medicine suggests that even brief exposure to secondhand smoke can trigger a heart attack (2). 

The above guidelines, though valuable, are cursory in nature.  Please refer to additional resources at the end of this post for more comprehensive guidelines.

 BE PRO-ACTIVE, BE AWARE

One of the most insidious problems associated with underlying heart disease is that a heart attack can occur suddenly without significant warning.  Be aware of signs and symptoms of an impending heart attack so that when necessary, help can be obtained promptly.  The most common signs that accompany a heart attack are:

• Uncomfortable pressure, squeezing, overt pain, or a sense of fullness in the chest – The discomfort may go away and come back.
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach. 
• Lightheadedness, a distinct sense of nausea or cold sweat
• Shortness of breath or difficulty breathing with or without chest discomfort

DO NOT THINK IT CANNOT HAPPEN TO YOU

While I do not intend to make the above statement in order to sound an alarm, the fact remains that often I meet people who say that they never imagined a heart attack could have happened to them.   The reality is that for most individuals, a high-stress, low-rest lifestyle accompanied with a poor diet is the norm, not the exception.   Without a concerted effort to eat correctly and pay attention to regular physical activity and other prevention measures, it is quite easy to develop heart disease.  If that seems hard to believe, consider these numbers:   While heart disease is the leading cause of death among women aged 65 and older, it is also the second leading cause of death among women aged 45-64 years, and the third leading cause of death among women aged 25-44 years.  Among men, nearly half of those who have a heart attack under age 65 die within 8 years.

Notwithstanding all our progress with sophisticated procedures and pharmaceuticals, these are still sobering numbers.  While we must be grateful for what Medicine can do for us, let us not underestimate what we can first do for ourselves pro-actively to prevent serious and often debilitating heart disease from occurring in the first place to the maximum extent possible.  To start toward that desirable end, re-read the guidelines presented here, look up key resources at the end of this post, throw out that soda and cigarette for good, and share this post with all who may benefit.  You heart – and theirs – will thank you for it!

Notes & Resources

(1) Lloyd-Jones D, Adams R, Carnethon M, et al. Heart Disease and Stroke Statistics—2009 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21-e181.

(2) Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington, D.C.: National Academies Press;2009.

American Heart Association

American Stroke Association

In several previous posts, I have cited statistics and trends with respect to heart disease, diabetes, cancer, and other chronic diseases that are currently rampant in the Western nations.   Historically, in the US and other Western nations, we have relied primarily on prescription drugs to address these and other chronic diseases.   But, is that strategy still viable?  Let’s consider the following.

Data suggests that in 2005, the total number of prescriptions purchased in the United States was 3.6 billion and in 2006, the average number of retail prescriptions per head was 12.4 (1)  In the United Kingdom, on average, people aged 60 and over received 42.4 items per head in 2007, compared to 22.3 items in 1997 – indicating that the average number of prescription items dispensed to older people doubled in a decade in that country (2).  Research from Medco Health Solutions Inc. (a company that manages prescription benefits for 1 in 5 Americans) indicates that prescription drug use is on the rise not just among Seniors.  In fact, the biggest jump in the use of chronic medications is in the 20-44 year-old age group – adults in the prime of life who are already on the committed path of drugs “for life” for conditions such as Depression, Diabetes, Asthma and ADD (Attention Deficit Disorder), amongst others. 

Economist Paul Zane Pilzer (Author, The New Wellness Revolution, 2^nd Edition, Wiley, 2007) has an interesting perspective on this rise in the use of prescription drugs.  In one of his recent articles, he stated that prescription drugs were first developed by individuals such as Dr. Jonas Salk and Dr. Alexander Fleming – physicians who developed the polio vaccine and antibiotics such as penicillin.  These agents either prevented disease from occurring in the first place or cured acute disease relatively quickly.  According to Pilzer, however, today about 95% of prescription drugs are “maintenance drugs” – that is, these drugs do not prevent disease, but treat only disease symptoms, and for most individuals (once they are on them) are designed to be taken “for life.”  In spite of these traits, the world’s five top-selling prescription drugs (Lipitor, Zocor, Nexium, Prevacid, and Zoloft) presently account for more than $25 billion in sales in the United States alone (3). 

TOUGH QUESTIONS THAT MUST BE ANSWERED

In light of the general rise in chronic disease rates (i.e. the rise in new cases of diabetes, heart disease, etc.) in the US and the West, even in the face of an astronomical rise in the use of prescription drugs, the question inevitably arises:  If we are so well medicated in the West, why are we still so sick?  If prescription drugs alone are the answer to our problems, then why are rates of diseases such as heart disease, diabetes, cancer, and many other conditions generally on the rise?  

My answer to the above (apparent conundrum) is that one of the main reasons why chronic disease rates are on the rise in the Western nations is because we are grossly failing to address the fundamental root causes of these diseases to the extent it is possible to do so, given our current state of knowledge.   I am not against the use of prescription drugs.  I believe that they can be, and often are, life-saving especially in acute situations.  However, I am against their excessive use,  and abuse,  in situations that evidence indicates should be – and can be – ameliorated far more safely with simple nutritional and lifestyle changes.  While I believe that there is certainly a right and proper place for the use of prescription drugs, the numbers cited above clearly indicate that our reliance on drugs has become way out of hand.  In light of these numbers, I am obliged to confirm Paul Pilzer’s conclusion that of the millions of individuals on “maintenance drugs,” few should be taking them “for life.”  Rather, these individuals should be working with competent health professionals to improve their diet and lifestyle to address and overcome the underlying causes of their condition, whenever it is possible to do so.

GETTING TO CAUSES, AND TO LASTING SOLUTIONS

In upcoming posts, I will outline some of the key causes that have made conditions such as obesity, diabetes, heart disease, and cancer nearly synonymous with living in the West, or in Western-style nations.  But as daunting as they may seem, these problems have solutions.  Through research and time-tested evidence, we have the knowledge today to affect powerfully the prevention of many of these diseases and conditions.  If we fail to use this knowledge, we will have made poor use not only of decades of diligent research, but also of our own ability to affect positively and benevolently the state of our health and consequently, the course of our lives.

NOTES

(1) US Prescription Drug Trends

(2) UK Prescription Drug Statistics for Seniors

(3) Pilzer, Paul Zane – From the article, “A Perfect Storm.”  Success from Home (Magazine) Vol1, Issue 6.

In August of 2009, I wrote an article on how CEO’s of Fortune 500′s as well as those of smaller businesses can win the health-care battle for their employees and companies.  Recent predictions of unrelenting increases in health-care costs through 2010 seem to have caused a significant sense of pandemonium both for employers and employees, causing this issue to be one that is engulfed with renewed anxiety on all fronts.

New predictions indicate that health-care costs are expected to grow by another 9% this year, and although this growth percentage represents a slightly slower rate of growth than in previous years, it continues to significantly outpace inflation and wage increases.  With corporate profits having taken a beating for many of the Fortune 500′s as well as for smaller companies in 2009, many employers have resolved to shift the costs of health care upon employees in terms of higher insurance and deductibles.  However, this strategy is not without its challenges.  History suggests that it often leads to two consequences:

1.  As employees deeply value health-benefits (that U.S. companies are often unable to pay), foreign companies become more attractive to American workers resulting in the loss of American employees to foreign firms.  Companies that radically slash benefits also risk losing their best employees to other domestic companies that resolve to maintain or provide better health benefits.

2.  Mid-size and large companies often have to confront powerful worker unions that can drive a company to Chapter 11 bankruptcy protection.

What is the way out of this crisis for CEO’s of both the Fortune 500′s and the mid-size firms?  And, is there one that is so foundationally sound that it can truly be relied upon?  My answer is: Yes – there is a way out of this crisis, and as in the case of ALL conundrums, it lies in falling back on the fundamentals.  In this case, that means understanding employees’ fears surrounding their health and rooting out those fears by truly empowering them with solid, research-based knowledge that can prevent the majority of illness in the first place.   For a fuller understanding of how addressing the Primary Causes of chronic diseases can directly and powerfully control your company’s health-care costs, please refer to my previous article on the subject.   As a follow-up to that article, I have put together a list of 5 mistakes that CEO’s often make (albeit unwittingly) that cause them to lose either their profits and/or their best employees as a result of issues surrounding health-care.  These have been gleaned from my experience both as an epidemiologist (who oversees large-scale trends in health-care) and from speaking to businesses of all sizes:

1.  FAILURE TO UNDERSTAND FULLY THE ALL-CRITICAL IMPORTANCE OF HEALTH-CARE TO EMPLOYEES IN THE CURRENT ECONOMY – Research unequivocally suggests that U.S. employees value health-care benefits significantly more than increases in wages.  Ignoring the importance of health-care to employees is tantamount to committing company suicide.

2.  FAILURE TO INCORPORATE MARGINAL ECONOMIC THINKING INTO BUSINESS MANAGEMENT PLANS - This basic principle of Economics is often overlooked by most everyone.  In simple language, incorporating marginal economic thinking into business management plans means fully recognizing that people pursue a preferred good (be it a product or service) to the point where their perceived costs equal their perceived benefits.  When people “perceive” they are paying “more” for something (especially as “premiums” they must pay for health care), they will demand MORE of it.  This suggests that visits to doctors and absenteeism at work will increase (The mindset is, “I am paying for it; let me take full advantage of it”).  On the other hand, if we rely on classical Socialized Medicine, that too leads to a double whammy.  This time, people perceive that health-care is “free” or “already PAID FOR,” and thus also demand for health services shoots through the roof.  In either case, companies suffer massive losses in terms of employee productivity and work efficiency.  

3.  FAILURE TO PROVIDE TRULY EFFECTIVE, RESEARCH-BASED WELLNESS PROGRAMS – The “way out,” to a great extent, from the losses businesses incur as a result of the factors mentioned in point 2 above is to teach your employees truly how to be well for life.  This is not a simplistic answer.  Research indicates that when employees are truly well and feel good (both physically and emotionally in their work environment), the incentive to pursue either “paid for” or “free” health-care is greatly offset.  A truly effective, research-based wellness program is capable of helping employees create lasting health from the ground-up.  By enhancing employee health and their sense of well-being, companies are able to make solid economic gains as they now reduce the real costs associated with having sick employees – which are employee downtime and associated losses in profits and productivity.

4.  FAILURE TO EVALUATE THE HEALTH OF THE WORK ENVIRONMENT – Is your Corporation housed in a “sick” building?  This simple evaluation is one of the most overlooked factors that (surprisingly) effects both employee health and health-care costs.  Data suggests that buildings that have no or few windows and have recycled air (rather than large quantities of fresh air) can be psychologically depressing and illness producing.  This is not a small matter, as epidemiologic data suggests that 1 in 3 American workers have at least one symptom of (often work-related) clinical depression.

5.  FAILURE TO UNDERSTAND THE ALL-CRITICAL IMPORTANCE OF THE WELLNESS OF THE WHOLE PERSON FROM THE STANDPOINT OF BOTH COSTS, AND ITS RELEVANCE TO BUSINESS SURVIVAL AND SUCCESS - Employee morale is directly related to employee effectiveness and productivity.  When discussing health-care costs, businesses seldom account for cost increases related to social factors.  Again, research indicates that it is critical for employers to oversee and (if necessary) “weed out” those at work who may have a tendency to bully, insult, or belittle others.   Failing to recognize the social aspects of a healthy work environment has a profoundly deleterious effect both on employee morale and workplace effectiveness which directly translates to costs.

The bottom-line of all this analysis?  It is NOT simple to control health-care costs.  Factors from within and without will profoundly affect the viability and success of firms big and small this year (as they do every year).  But, those who will resolve to learn and apply the hard lessons learned from Epidemiology, Economics, History, and most of all, from hard won real-life experiences will stand to fare the best of all.

DESIREE’S KNOCKOUT CRANBERRY SALSA

One bag (1 lb) frozen or fresh (unsweetened) whole cranberries

One third cup lemon juice

One third cup (or a little more if desired) Demerara pure cane sugar (Available at most whole foods stores)

One bunch finely chopped spring green onions or chives

7 to 8 cloves finely chopped garlic cloves

5 to 6 finely chopped seeded jalapeno peppers

Salt to taste

Recipe – Bring a quart of water to boil.  Turn off the heat and add the cranberries.  Let cranberries soak in the water for about two minutes, then drain them very well (they should not be watery) and let them cool.  In a separate bowl, mix lemon juice, Demerara sugar, chopped chives or green onions, garlic and jalapeno peppers.  Add the cranberries and mix gently.  Add salt and adjust taste.  The mix should taste medium sweet-sour, a little spicy hot and not too salty – In other words, it should be a harmonious blend of the complex flavors of the ingredients used in this recipe.  Put the prepared mix in a beautiful serving bowl and let it chill in the fridge for a few hours.  

Service – Prior to serving, arrange some high quality whole grain or multi grain crackers on a platter and place the cranberry salsa in the serving bowl in the middle.  Garnish the salsa with some fresh, finely chopped chives.   This salsa makes for an ultra-delicious and unique appetizer that also goes well with a couple of French cheeses like Organic Camembert or Brie.  A glass of quality semi-sweet red wine can be served along with the crackers. 

Enjoy the mutually complementary health benefits of fresh cranberries, whole grains, a little organic cheese, and a good wine - ALL in this ONE fabulous appetizer!

DESIREE’S WINTER-MANGO RELISH & APPETIZER

Mangoes are a Summer fruit, but medium-ripe sweet mangoes can be purchased in the Winter months as well, and they can add just the right amount of  fresh scent and taste that can “wake-up” an ordinary holiday menu and make it truly unique and tantalizing.  Try this unique recipe as a side item that will add a unique piquancy to your turkey dinner this year, or serve it by itself as an irresistable appetizer:

3 or 4 Medium-ripe sweet mangoes

2 -3 Teaspoons very finely chopped fresh ginger

1 Small bunch very finely chopped chives or green onions

Salt – A pinch or to taste

3 to 5 Tea spoons lemon juice

2 to 3 Tea spoons brown sugar or soft jaggery powder (Jaggery is a crude cane sugar available at most ethnic stores).

Few dashes soy sauce

1 Tea spoon coarse crushed red chilli peppers

1/2 – 1 Tea spoon very finely chopped jalapeno peppers 

Recipe & Service – Cut magoes neatly into small diamond shaped cubes and chill the cubes in the fridge.  In a bowl, mix all the remaining ingredients.  Add mangoes and let the prepared mix chill for a couple of hours for the flavors to soak into the mango.  Serve the relish with crisp hot whole wheat pita pockets or home made freshly toasted whole-corn chips.   When made right, this is an absolutely unforgettable recipe!   

Enjoy the benefits of a whole-grain snack with fresh fruit and healthy spices in this recipe – Keep the salt and sugar content moderate, and it will still taste fabulously good!

DESIREE’S EAST-WEST BLEND PEANUT BUTTER SAUCE – DIP/SIDE DISH

This recipe for a “killer” peanut-butter sauce is extremely versatile as it can be used both as a delicious dip for fresh-cut vegetables (celery, carrots, water-chestnuts, etc.) OR it can be enjoyed on top of freshly steamed green beans, broccoli, buttered Basmati/Brown rice or Chinese noodles:

8 to 10 Tablespoons (non-hydrogenated) pure peanut butter – smooth or crunchy

Juice of 1.5 – 2 lemons

3 Table spoons soy sauce or Liquid aminos (soy sauce substitute that has naturally low salt)

4-5 Finely chopped garlic cloves

2-3 Tea spoons brown sugar

1-1.5 Tea spoons red chilli powder

Recipe & Service – In a medium size heavy bottom pot, mix the peanut butter with 1 and a half to 2 cups water.  Mix thoroughly with a whisk till smooth.  Put the mix on medium heat till peanut butter comes to a gentle boil.  Add all of the remaining ingredients and cook for approximately 20 minutes on low heat, stirring constantly to make sure that the peanut butter does not stick to the bottom.  Sauce is done when oil floats on top.  The oil on top should have a reddish appearance from the red chilli powder.  The sauce should be of a pouring consistency (not too thick),  Serve as a dip with fresh-cut vegetables, or pour on top of  hot crisp-tender steamed green beans, asparagus, broccoli or other favorite vegetable. 

Peanut butter is rich in mono-unsaturated fats, and in small amounts is a healthy and delectable treat when prepared and served with fresh vegetables as suggested.

Have a comment or thought on the above recipes?   Your thoughts are welcome.  Share them on The Prevention Revolution on Facebook. 

MERRY CHRISTMAS, HAPPY HOLIDAYS….CELEBRATE, ENJOY!

Bisphenol-A or BPA - a substance that is used in food packaging such as in the epoxy lining of food cans and in polycarbonate bottles has been a subject of intense controversy and concern over the last few months.  On Nov 11, I wrote a post listing the specific canned and other foods that were of concern vis-a-vis BPA ingestion, and earlier in June this year, I wrote about the results of a Harvard study that confirmed the leaching of BPA from polycarbonate plastic bottles.   This month, additional research on BPA has brought to surface new and pressing health concerns regarding the ingestion of this chemical.

A recent study by the French National Institute of Agronomic Research (INRA) found that BPA caused a negative reaction in the intestine of rats - even at doses that were 1/10th of the  daily amount considered safe for humans.  Results from this study suggested that BPA lowered the permeability of the intestines and the immune system’s response to digestive inflammation, and that newborn rats exposed to BPA in the uterus and during feeding had a higher risk of developing severe intestinal inflammation in adulthood.  Previous studies on BPA have indicated that high levels of this chemical in the bloodstream are significantly associated with heart disease, diabetes, and abnormally elevated levels of certain liver enzymes, and furthermore, that BPA exposure during development has carcinogenic effects and produces precursors of breast cancer.

In light of the cumulative evidence indicating numerous concerns with BPA consumption, The National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program have warned people – particularly pregnant women and children – not to consume BPA.  The NIEHS has also launched a $30 million research initiative to investigate the effects of BPA, and the United Nations will be holding a summit on BPA safety in 2010.

BISPHENOL-A AND YOUR HEALTH – WHAT YOU CAN DO NOW

Given the mounting evidence indicating that ingestion of BPA may lead to significant health problems, it appears prudent to minimize exposure to BPA via food packaging that utilizes this chemical.  While the US Food and Drug Administration has not yet issued the final word on BPA safety (It has postponed release of its final report), research does indicate that there is significant evidence and good reason to be concerned about BPA consumption.  For this reason, you should carefully review and act on the guidelines presented in previous posts (links above) to minimize BPA exposure.  Here are some key reminders:

1.  Review products that have been found to have high levels of BPA  and minimize or avoid their consumption altogether (These particularly include canned green beans, canned soups, and certain canned juice drinks).

2.  Choose fresh over canned or packaged foods whenever possible.

3.  Do not reheat food or drink in the microwave in plastic containers – Use only glass.

4.  Do not consume food or beverage from containers with the numbers 3 or 7  listed inside the recycle symbol on the container.

IN THE FINAL ANALYSIS…

….I feel both obliged and compelled (in my position as a research scientist, and by virtue of my experience is studying chronic diseases) to share with all that nearly everyday I meet people who “wonder” where their particular chronic disease “came from.”  While it is true that even with all the tools and knowledge at our disposal, we are sometimes unable to discern the ultimate cause(s) of certain diseases, I find that most of us do not begin to take full advantage of the facts we do know that can help us minimize the prospects of disease.  

In Medicine, we learn that, “A disturbed biochemistry is always the antecedent to observed pathology.”  In simple language, that statement simply means that before a disease fully manifests itself, there is almost always (that is, in most cases) a window of time in which we may be able to prevent the disease and/or alter its course.   Given that fact, I wonder how many of us truly take seriously the power that is vested in our own hands both to prevent and/or alter the course of a great many diseases.

Increasingly, in the US and the West, the list of environmental and other exposures that may have  a detrimental, and perhaps even a fatal effect on our health appears to be increasing.  BPA is yet another exposure against which evidence indicates serious caution may be warranted.  Notwithstanding that fact, I have been told that many are going to find it “impossible” to choose fresh green beans over canned, or to undergo the inconvenience of not warming foods in plastic ware.  This is just a friendly reminder to all that it can be exponentially more inconvenient to deal with disease when it occurs, especially in contrast to the “inconvenience” caused by taking the relatively simple steps that can be taken to avoid it.   The window of time to minimize the risk of disease in now; the power to do so is in our hands.  Let’s be sure to use it, and use it well.

Recently, The Centers for Disease Control (CDC) issued a warning that an H1N1 infection can put patients at risk for serious bacterial pneumonia.  The warning was issued in response to the observation of an increase in serious pneumococcal infections around the country.  This is a warning that should be taken seriously as pneumonia can be both a deadly and a potentially fatal condition.   According to the American Lung Association, pneumonia is currently the 7th leading cause of death in the United States, claiming more than 60,000 lives each year.  In order both to prevent and address a pneumococcal infection satisfactorily (in the event it has already occurred), it is important to be aware of the following facts:

PNEUMONIA – CAUSES AND SYMPTOMS

Pneumococcal disease is an infection caused by bacteria; however, nearly half of all pneumonia cases start off as viral infections.  When bacteria invade the lungs, pneumonia can occur.  The bacteria can also invade the body’s bloodstream and/or the tissues surrounding the brain and spinal cord resulting in a condition known as Meningitis.  This is one of the reasons why it is so critical to do all that is possible both to prevent and control a pneumococcal infection.

If you have had the seasonal flu or an H1N1 infection, it is important to be aware of the following symptoms of pneumonia as these symptoms generally appear secondary to a flu infection: 

• High Fever and/or chills
• Sweating
• Cough with thick mucus OR Dry cough
• Shortness of breath
• Chest pain
• Overall sense of extreme fatigue and weakness

TIPS TO PROTECT YOURSELF FROM PNEUMONIA

1.  Strengthen your immune system – As Influenza infections can easily lead to pneumonia, one of the key factors to help prevent pneumonia is to do ALL you can to recover from a flu infection quickly.  To that end, one of the most important factors is to eat sensibly, and obtain adequate rest to strengthen and boost your immune system.  Those that are overworked and under-rested while fighting a flu are the ones who are most likely to come down with a pneumococcal infection.

2.  Discuss vaccination needs with your doctor – The Pneumococcal Polysaccharide Vaccine (PPSV) protects high-risk individuals 2 through 64 years of age against serious pneumococcal disease.  Generally, only a single dose of PPSV is required in a lifetime.  Children less than 5 years of age should receive a different vaccine called Pneumococcal Conjugate Vaccine (PCV7); and high risk children 2 to 4 years of age need both pneumococcal vaccines.  The decision to obtain vaccination may depend on your individual health status, and must be made in consultation with your doctor.

3.  Throw the cigarettes! - If you are a smoker and want to prevent or overcome pneumonia, quitting the smoking habit is simply essential. 

4.  Follow common-sense rules – Washing hands regularly, disinfecting commonly used surfaces such as doorknobs and telephones, and keeping the living environment as clean and germ-free as possible are all common-sense guidelines that help protect against the spread of both the flu and/or a bacterial pneumonia infection.  They must be observed at all times.

THOSE AT HIGH RISK FOR PNEUMONIA

CDC classifies certain groups of people as being those who may be at a higher than average risk for contracting pneumonia.  Specifically, this list includes those over 65 years of age, and those who may have cardiovascular disease, lung disease, diabetes, a weakened immune system, and/or certain other conditions.  Please refer to the full list of those who may be at high risk at this link.  It is particularly recommended that individuals who fall under the “high-risk” category get vaccinated using the PPSV or other appropriate vaccine.

Ordinary seasonal flu or the H1N1 flu can very easily lead to a prolonged infection resulting in pneumonia if your body gets overwhelmed with lack of adequate nutrition or rest.  Protect yourself from pneumonia using the guidelines above, and please refer to the following resources for authoritative additional information.  Please also forward this post to ALL who may benefit from the guidelines and resources provided here.

RESOURCES

CDC – Prevention of Pneumococcal Infections

Information on Pneumococcal Vaccination

Critical Links and Podcasts on Preventing Pneumonia

Astronomically high health care costs in the U.S. have been a matter of ongoing concern for some time now.  The debates surrounding the question of  how best to control these costs have often shed more heat than light on this issue, which is indeed one of the most volatile of all in the health-care arena today.  Why?  Perhaps one reason there is more heat than light on this issue is that hard numbers continue to testify to the steadily rising rates of deadly chronic diseases in the U.S. (as well as the West in general).  As a consequence, not only current but also projected increases in disease rates for certain conditions overwhelm even “smart moves” to bring health-care costs under control.  A University of Chicago study published in the December 2009 issue of Diabetes Care serves to prove this point perfectly. 

According to this new study, in the next 25 years – i.e. By 2034, the number of Americans with diabetes will nearly double to 44.1 million, and the costs of treating these individuals will triple – rising from $113 billion annually to $336 billion.  As staggering as these numbers may seem, what is truly disturbing about them is that the researchers projecting them consider these predictions “very conservative” for the following reasons:

• These numbers do not account for the rapidly growing population of overweight children and teenagers – all of whom represent a high risk group for developing diabetes.
• They do not factor in immigration or the rising population of ethnic minorities that suffer diabetes at higher rates than the US population as a whole.
• Prior estimates from studies vis-a-vis the rise in diabetes in the population have previously predicted dramatic rates of increase of this disease in the US – but in each case, the acutal number of diabetes cases have ended up being larger than the estimates.

A TRUE CONUNDRUM OR ARE WE MISSING THE BOAT?

As a researcher, I am continuously face-to-face with emerging chronic disease statistics; As a speaker on chronic disease prevention and controlling health-care costs, I am continuously in touch with everyday people (both lay and academic) as well as those in the Corporate world dealing with staggering health-care challenges.  The obvious facts that emerge, from both rigorous academic research and my real-life interactions with those dealing with diabetes, are simply these:

1.  About 90% of individuals with diabetes have type 2 diabetes – a condition that develops over a period of time. 

2.  The most common (and preventable) risk factor for type 2 diabetes is simply being overweight.

3.  Research suggests unequivocally that nutritional and lifestyle changes – when followed diligently – can lower the risk of diabetes by 58%, even without medication.

4.  Most people – when they are made aware of how truly difficult and deadly a condition chronic diabetes can be – are motivated to take better care of themselves to make the necessary lifestyle changes to prevent or even reverse this condition.

HEALTH-CARE COSTS CANNOT BE CONTROLLED WITHOUT ADDRESSING PRIMARY CAUSES

Diabetes, and several other preventable chronic diseases, will continue to remain unresolvable conundrums in the US and the West until we become willing to acknowledge and address the true underlying Primary Causes of such conditions.  In the case of diabetes, I believe there are primarily three reasons why numbers for this condition continue to rise in the US:

1)  A re-active approach to treating diabetes after it occurs, rather than a pro-active approach to preventing it in the first place to the extent it is possible to do so;

2)  Widespread use of Industrialized and highly processed foods as foundational foods among the large majority of the population, combined with high stress and largely sedentary lifestyles for most people; and

3)  A lack of systematic utilization of gains made in epidemiological nutritional research (that indeed does constructively bring to surface the Primary Causes of diabetes) for the practical effect of improving health, both individually and socially.  

A one-line summary of the 3 reasons above would be that we (both as individuals and as “A System”) are at present not fully utilizing or taking advantage of the scientific knowledge we do have to pro-actively prevent diabetes.  Type 2 diabetes is one of the most preventable of major chronic diseases.  While it is true that we may not be able to slash ALL costs related to diabetes-care through pro-active prevention efforts, the reality nevertheless remains that if want to see solid, long-term results – both in controlling costs and improving our health – we have no choice but to addressing the Primary Causes of this disease.

THE BOTTOM LINE

Needless to say, addressing the causes of diabetes is an extensive topic – one that will be addressed in my upcoming book.  For now, please refer to another recent post on the issue of addressing Primary Causes.  The bottom line message of the current post and the one you are being referred to is this – Lasting solutions to the chronic disease crisis in the US lie in addressing the underlying and ongoing true causes of disease in the population.  Anything short of doing so is “band-aid” therapy – guaranteed both to increase disease and health-care costs in the long run, regardless of who pays or how.

Cardiovascular Disease is currently the leading cause of death in the United States.  At present, 80 million or 1 in 3 Americans have one or more forms of cardiovascular (heart) disease.  Statistics from the American Heart Association suggest that heart disease is currently the cause of 1 out of every 2.8 deaths.  Estimates for the year 2006 gave the breakdown for that year as follows - In 2006, among those who had heart disease, approximately 73.6 million suffered from high blood pressure, 16.8 million had coronary artery disease (i.e. had experienced an acute heart attack or had active angina or chest pain), 6.5 million had dealt with a stroke, and 5.7 million had experienced heart failure.  

As a research scientist who speaks frequently on chronic disease prevention, I am often asked two recurring questions when I present statistics to my audience(s) on any chronic disease: 1) Why do we need all these numbers – Isn’t this “stuff” just for the academics?, and 2) What does this have to do with me? – Do these numbers really represent me (or should they matter to me) as an individual?  Here are my answers to the above two questions: 1) No, this “stuff” is  NEITHER just academic, NOR is it just for the academics, and 2) Yes, these numbers DO represent you, and include you as an individual – and, they do matter.  Here’s why.

WHEN ACADEMIA MEETS REAL LIFE

Two weeks ago on the morning of November 13, my dear father passed away unexpectedly and very suddenly as a result of an acute, catastrophic, fatal heart failure.  Being a heart patient, he had been on the standard set of drugs that are given to all patients in his situation.  Yet, notwithstanding the beneficial effects of these drugs, he still endured a fatal cardiac arrest without any warning or prior symptoms of an impending problem.  In fact, quite surprisingly, even a minute or two before his demise, he was talking normally and appeared symptom free.   The sudden and unexpected nature of his death has prompted me to write this post for the benefit of those who might find themselves in the midst of a similar crisis.  Given the heart disease statistics cited above, chances are not just high, but indeed very high that you may at some point find yourself facing a similar crisis (either as a patient or a caregiver).   If you happen to be in the position of a caregiver, carefully read the following protocol, as it may quite possibly save someone’s life. 

STEPS THAT CAN SAVE A LIFE DURING AN ACUTE CARDIAC CRISIS

1.  The very first moment you suspect that there may be a serious cardiac emergency at hand, call 911. 

2.  If the patient is at all responsive and able to swallow, give him/her a standard Aspirin tablet (325 mg),  or if a medication such as Nitroglycerin has been previously prescribed for the patient, give the patient the doctor recommended dose sublingually.

3.  If the patient is unresponsive and has collapsed, do not panic.  After calling 911, immediately administer CPR (Cardio-Pulmonary Resuscitation) – CPR can be “Hands-only” or involve both chest compressions and mouth-to-mouth resuscitation (Links on learning how to do this below).  When an adult has a sudden cardiac arrest, his or her survival depends greatly on immediately getting CPR from someone nearby.  Unfortunately, most bystanders – in either fear or ignorance – do nothing to help a patient in such a situation due to fear of making the situation worse.  In doing nothing, they make the worst decision of all.   The data suggests that only 1/3rd of individuals in a cardiac arrest situation at home, work, or in a public place are able to receive immediate and potentially life-saving CPR. 

LEARNING HOW TO DO CPR

Most adults have not attended a formal CPR class or course, and many of them feel that they do not have the time to attend such a course.   To address that problem, here are two links that provide a brief video demonstration of the correct way to administer CPR.  These videos are a “must-see” for all who desire to be equipped with the ability to administer CPR should a cardiac emergency arise:

1.  Two Steps to Save a Life – Learn How to do “Hands-Only” CPR

2.  Learn CPR – Video Demonstration of Standard CPR for Adults

This year an estimated 1.26 million Americans will have a new or recurrent coronary attack.  Thousands of others will have sudden heart failure.   Statistics suggest that greater than 300,000 people die each year of a heart attack either at home or in the emergency room without being hospitalized.  Most of these are sudden deaths caused by cardiac arrest, usually resulting from ventricular fibrillation.  A great many of these deaths can be prevented if prompt CPR is performed on the patient, or if both medication and CPR are administered immediately. 

There is no doubt that when we read statistics on a particular disease, or even thoughtfully written research-based articles on disease prevention,  it can all seem very academic, in fact, even very impersonal.  But, to all reading this – the very purpose of academic work, especially in the field of Medicine is to benefit, serve, and whenever possible, save lives.  When academia meets real life, when your loved one is the one in a crisis or when you are –  academic knowledge suddenly seems very important and personally relevant.

Please take the time to view the links and resources in this post – ahead of the time when you just might need them to save someone’s life.  And, please also forward the post to others whom it may benefit.  “Later on,” maybe  just too late. 

RESOURCES:

American Heart Association Heart Hub for Patients

AHA Video Library on Heart Disease and Stroke

Learn CPR – Video Demonstration of Standard CPR for Adults

BPA – BACK IN THE NEWS

BPA is back in the news this month as a result of recent testing of canned products.  Consumer Reports’ latest tests of canned foods, including soups, juice, tuna, and green beans, have found that almost all of the 19 name-brand foods tested contain some BPA.  The highest levels of BPA were found in some samples of canned green beans and canned soups.  Here are some of the key results of the tests:

• Canned Del Monte Fresh Cut Green Beans had the highest amount of BPA for a single sample in Consumer Reports tests, with levels ranging from 35.9 parts per billon (ppb) to 191 ppb. 
• Progresso Vegetable Soup BPA levels ranged from 67 to 134 ppb.  Campbell’s Condensed Chicken Noodle Soup had BPA levels ranging from 54.5 to 102 ppb.
• Average amounts in tested products varied widely. In most items tested, such as canned corn, chili, tomato sauce, and corned beef, BPA levels ranged from trace amounts to about 32 ppb.
• Nestlé Juicy Juice in a can averaged 9.7 ppb of BPA, but there were no measurable levels in the samples of the same product packaged in juice boxes.
• Similac liquid concentrate (infant formula) in a can averaged 9 ppb of BPA, but there were no measurable levels in the powdered version.
• The canned organic foods tested did not always have lower BPA levels than non-organic brands of similar foods analyzed.  Further, the tests also found the chemical in some products in cans that were labeled “BPA-free.”

There is still significant debate surrounding safe levels of BPA that may be ingested, or whether this chemical should be in contact with food at all.  New guidelines vis-a-vis safety levels of BPA in light of new data are presently being worked out by the FDA.

MY COMMENTS

While the jury is still out regarding the final safety levels of BPA ingestion, I believe that there is significant epidemiologic data to merit caution with respect to BPA consumption.  Previous studies have demonstrated that BPA exposure is significantly associated not only with heart disease and diabetes, but also has carcinogenic effects as it may produce precursors of breast cancer.   Consequently, it is prudent to err on the side of caution with respect to levels of BPA ingestion and exposure. 

HERE ARE SOME CRITICAL TIPS TO MINIMIZE YOUR EXPOSURE TO BPA:

1.  Whenever possible, choose fresh over canned foods, beverages, juices, etc.  Minimize the use of canned foods.

2.  Do not heat food/beverages in plastics or expose plastics to hot liquids.  BPA leaches out 55 times faster upon heating that it does under normal conditions.

3.  Use only glass containers in the microwave for heating foods and liquids.  Avoid microwaving food in plastic containers.

4.  Avoid using all food and beverages from containers that have the numbers 3 or 7 listed inside the triangular recycle symbol on the package.

5.  Read and stay informed!  Most people overlook this last critical point.  BPA research is an emerging field of study, and it is crucial to stay well-informed on a topic such as this one.  Start by reading my previous post on this topic that summarizes results from key epidemiologic studies, and please forward this current post to all who may benefit from it.

For those affected severely by the H1N1 virus, it appears that the most common cause of death has been Pneumonia and Acute Respiratory Distress Syndrome, occurring within twelve days of onset of flu symptoms.  These findings are supported by the World Health Organization’s report on The Clinical Features of Severe Cases of Pandemic Influenza.  According to WHO, Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death.  Secondary bacterial infections have been found in approximately 30% of fatal cases, and Respiratory failure and refractory shock have also been the most common causes of death.

The message to take home from this latest study is that overall, severe symptoms of the H1N1 infection appear to be occurring across all age groups with the highest fatality rates being among those over age 50, contrary to the common perception that H1N1 flu affects mostly young people.  Additionally, both the JAMA study and WHO findings suggest that obesity, and especially morbid obesity,  have been present in a large portion of severe and fatal cases of the virus, although the exact role of obesity is not well understood at present.

For more information on distinguishing the clinical features of a severe H1N1 infection, please refer to the following report: WHO – Clinical features of severe cases of pandemic influenza

If you are a woman and concerned about becoming a victim of breast cancer, your doctor might advise you to get regular mammograms for the purpose of “early detection.”  Similarly, if you are a man, and are concerned about prostate cancer, your doctor may ask you to get a “PSA” or Prostate-Specific Antigen test.  While “early detection” as represented by these tests is valuable and important, and does indeed save lives from the standpoint of early treatment, it does nothing to prevent anything; that is, you cannot prevent breast or prostate cancer by early detection!  If you “detect” cancer or even pre-cancerous changes in the body’s tissues, it clearly means that either the cancer, or the pre-cancerous condition, has already occurred.  In other words, you are now obligated to address a problem that has already manifested itself; you have not prevented it in the first place.  Here is my perspective in this matter — I believe that True Prevention can and should occur long before the possibility of disease detection, and a really solid nutrition and lifestyle-based prevention plan might help us make the actual detection of a good percentage of certain cancers irrelevant by putting the effort and emphasis on pro-actively and aggressively preventing these cancers from occurring in the first place.

Now, before you tell me that not all chronic diseases such as certain cancers are preventable, I must interject by asserting that a significant percentage of cancers are in fact preventable.  Research suggests unequivocally that only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95% have their roots in an individual’s environment and lifestyle (1).   Here is the official breakdown of known factors linked to cancer for all cancer-related deaths:

• Almost 25-30% are due to tobacco use
• As many as 30-35% are linked to diet
• About 15-20% are due to infections
• The remaining percentage is due to other factors such as carcinogenic exposures, stress, lack of physical activity, environmental pollutants, etc, i.e. “environmental factors.” 

Research also suggests unequivocally that cancer prevention requires:

• Smoking cessation
• Increased ingestion of fruits and vegetables
• Moderate or no use of alcohol
• Caloric control
• Minimal meat consumption
• Whole grain consumption
• Avoidance of direct sun exposure
• Regular physical activity
• Prudent use of vaccinations as needed

The bottom line?   We can no longer say that we have no control whatsoever over preventing cancer.   The vast majority of cancers are in fact preventable, but they do require major lifestyle changes for most individuals.   Two critical factors, that have been studied very extensively through research, give support to the preventability of cancer:

1.  The link between diet and cancer is revealed by large variations in the rates of specific cancers in various countries, and the changes observed in the incidence of cancer among those who migrate.  For example:  Asians have been shown to have a 25 times lower risk of prostate cancer and a ten times lower risk of breast cancer than do residents of Western countries, and the rates of these cancers increase substantially after Asians migrate to the West (2).

2.  Extensive studies with identical twins have suggested that genes are not the source of most chronic illnesses.   For example, the concordance between identical twins for breast cancer has been found to be only 20% (3).  Data suggest that instead of our genes, our lifestyle and environment account for 90-95% of most chronic illnesses.

The reality is this – The weight of scientific evidence that has emerged especially in the last two to three decades from academic centers globally has convincingly and unequivocally established the potent link between nutritional/behavioral choices and good health.  Given this evidence, it would be folly, in fact even fatal, for us to ignore what True Prevention-based efforts can do for us.  Dr. Walter Willett, Professor of Nutrition at The Harvard School of Public Health recently stated, “With careful attention to the foods we eat, combined with not smoking and regular physical activity, we find that over 80% of heart attacks and greater than 70% of certain cancers can be avoided (4).”  From this statement, it seems reasonable to conclude that while we may not be able to wipe out all of cancer with the strategy of True Prevention, we ought to wipe out the 70% or more of cancer that we can, and so also obviate the 80% of heart attacks that are preventable. 

The concept of pro-actively preventing deadly diseases such as certain cancers is not an idealistic fantasy.  Statistics suggest that every 13 minutes, a woman dies from breast cancer, and increasingly, we are seeing cancer (such as that of the breast) occur in younger women.  In light of these facts, we need to take a much more pro-active stance in preventing this disease to the maximum extent possible.  Instead, I find that here in the West, too many of us have resigned either to doing our best to detect cancer “early,” or simply to wait for the “Magic Bullet” that will one day wipe out cancer.  The point is that while it is incumbent upon us to continue to “race for the cure,” is it sensible not to put to good use the volumes of scientific data that clearly suggests that several common cancers can be prevented through diligent lifestyle modifications?  I believe that failing to incorporate research- and evidence-based nutritional and lifestyle modifications as early as possible in life is tantamount to adopting a “reactive” rather than a “pro-active” stance towards this formidable disease, that may result in the death of millions. 

In light of the above, I strongly believe that early nutritional and lifestyle interventions (and not early detection alone), coupled with educational initiatives to build awareness of environmental and other carcinogenic exposures, are the true keys to eventually winning the battle against deadly chronic diseases such as cancer.  And, while admittedly these interventions may not help us conquer all of cancer, they can decidedly help us conquer a very significant percentage of it.  I also believe that while early detection is advisable and should continue in order to help us save the lives of those who may have already become the unfortunate victims of a cancer, or a pre-cancerous condition, we should bear in mind that we are never going to prevent new cases of cancer from emerging if we don’t also get serious about True Prevention.  I believe that reassuring millions that “early detection is the best protection” is tantamount to giving these individuals a false sense of security that they are doing “their best” to protect themselves, whereas in reality early detection cannot prevent cancer at all – it can only help us treat cancer as early as possible once the cancer or pre-cancerous conditions have already become existent.  Thus, our best efforts to truly protect ourselves from cancer call for a lot more than early detection; they call for early prevention.  

This year, more than 1 million Americans, and more than 10 million people worldwide, are expected to be diagnosed with cancer.  This disease continues to be a worldwide killer and accounts for about 23% of total deaths in the U.S., being the second most common cause of death after heart disease, and in 2010 it is expected to rise to the rank of the first most common cause of death.  Given these numbers, it is past time for us to be encouraged not just to detect cancer(s) early, but to learn all we can and do all we can to prevent cancer(s) from occurring in the first place – at least to the maximum extent possible.

There will always be – and should always be – an important emphasis on catching any disease early.  However, the point of this post is this: Given the vast and increasing reach of cancer even in the face of decades of diligent research, it is simply not enough anymore for us to “detect” or “catch” it early.  While we must do that, we must simultaneously also work committedly at preventing it early.  Perhaps, it is best put this way: Early, committed and diligent efforts to prevent cancer coupled with early detection – are a better strategy than early detection alone.  Conventional doctors are in a position truly to guide and encourage their patients to understand this reality and to help them pro-actively prevent cancer to the greatest extent possible.  Whether we are academics, physicians, or lay individuals, it’s time to embrace a mindset and a culture of True Prevention. Indeed, doing so and catching the spirit of this idea will involve a revolutionary change in how we approach the treatment of chronic diseases, especially cancer.  I dedicate this post to that end.

Notes

 (1)  Anand, et al.  Cancer is a Preventable Disease that Requires Major Lifestyle Changes.  Pharm Res. 2008; September 25 (9): 2097-2116. 

(2) Food, Nutrition, Physical Activity and the Prevention of Cancer; Diet and Cancer Report

(3)  A.S. Hamilton and T.M. Mack.  Puberty and Genetic Susceptibility to Breast Cancer in a Case-Control Study in Twins.  New England Journal of Medicine 348: 2313-22 (2003)

(4)  Third Annual Great Issues in Medicine and Global Health Symposium, 2006.  Linking our Food Choices to Cancer Risk, Dartmouth Hitchcock Medical Center.

RESOURCES

Diet and Cancer Report

Anand et al.  Cancer is a Preventable Disease that Requires Major Lifestyle Changes.   Cytokine Research Laboratory, Dept. of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center.

October is Breast Cancer Awareness Month, and while it is critically important to raise awareness of breast cancer prevention in general; it is also a particularly important time for us ALL – whether we are physicians, research scientists, women, or men – to become acutely aware of a relatively rare, but all too often, poorly understood cancer known as Inflammatory Breast Cancer, or IBC.  

WHY TALK ABOUT IBC, IF IT IS INDEED RARE?

The answer of course, is simple.  First, every life matters, and education and awareness saves lives.  And, second, precisely because IBC is relatively rare (It accounts for 1 to 5% of all breast cancer cases in the US (1)), it is frequently not “caught” early by patients, and is further often misdiagnosed or even completely missed by physicians.  The delay caused in obtaining prompt and necessary treatment by the combination of these two factors is simply too costly, as this disease progresses rapidly and can become lethal in a very short period of time. 

GETTING THE FACTS

IBC is a type of breast cancer in which cancer cells block the lymph vessels in the skin of the breast.  This cancer is referred to as “Inflammatory” because the breast can look externally swollen, red or inflamed.  One of the main reasons why this cancer often goes undiagnosed is because women relate only the presence of a “lump” to breast cancer.  However, it is crucially important for all women (and even some physicians) to know that a breast lump is NOT a necessary pre-condition for breast cancer, and this is especially true in the case of IBC.  Generally, IBC tends to grow in “nests” or “sheets” rather than as a solid tumor.  Here are additional symptoms that are typical of IBC:

• An unexpected pink, red or dark colored area on the breast, usually accompanied with itching or discomfort.
• Swelling of the breast, often up to a cup size or more very rapidly.
• Thickening of breast tissue or ridges on the skin
• Retraction of the nipple
• Discharge from the nipple – may or may not be bloody
• Sharp or stabbing pains in the breast, or a perceptible ache in the breast area
• Breast may feel warm to touch
• Alteration in color or texture of the areola (area surrounding the nipple)
• Swollen lymph nodes under the arm or above the collar bone (or in BOTH places)

The median age at time of diagnosis of IBC is 56 years, relative to about 62 years for non-IBC breast cancer.

LEARNING MORE ABOUT IBC DIAGNOSIS

The presence of IBC is confirmed by clinical examination, usually a biopsy, mammogram, and ultrasound.  IBC is generally diagnosed as Stage IIIB or Stage IV breast cancer.  Stage IIIB refers to cancer that is locally advanced, and Stage IV refers to cancer that has metastasized to other organs of the body.  The resources provided at the bottom of this post are valuable for learning more on IBC Staging.

TREATMENT

IBC treatment generally consists of chemotherapy, surgery, radiation, and hormonal therapy.  Chemotherapy with anti-cancer drugs is generally the first line of treatment for most patients with IBC (It is often referred to as Neoadjuvant therapy).  Post-chemotherapy, patients may undergo surgery or radiation therapy to the chest wall.  Additionally, IBC patients may receive more treatments (such as additional chemo- or hormone-therapy) to help prevent cancer recurrence.   Hormonal therapy is generally geared to reduce the effects of the hormone estrogen that can promote cancer growth. 

IBC PROGNOSIS

As IBC is more likely to have metastasized (that is, spread to other parts of the body) at the time of diagnosis, relative to non-IBC cases (2), the 5-year survival rate for IBC patients is generally between 25 and 50%.   These figures are significantly lower than the survival rates for patients with non-IBC breast cancer.  However, as with all statistics, average survival figures cannot be applied to predicting the prognosis for any particular individual. 

CURRENT RESEARCH AND NEW TREATMENT PROSPECTS

IBC has only recently been recognized as a unique and genetically distinct form of breast cancer (3).  Recently, scientists from the The Cancer Institute at NYU Langone Medical Center identified a key gene—eIF4G1—that is over expressed in the majority of cases of IBC, allowing cells to form highly mobile clusters that are responsible for the rapid metastasis that makes IBC an effective killer.  It is anticipated that this finding will lead to the identification of new approaches, therapies and a new class of drugs to target and treat IBC.  This may be a promising development as IBC generally responds poorly to chemotherapy, radiation, and other current treatments for breast cancer.

PREVENTING TRAGEDIES  & UNDERSTANDING THE CRITICALLY IMPORTANT ROLE OF EDUCATION AND AWARENESS

Perhaps the most unfortunate tragedy associated with IBC is that the absence of a typical “lump” in the breast causes this cancer to be frequently misdiagnosed and misclassified.  Due to the fact that IBC symptoms are often erroneously mistaken for an infection, physicians tend to prescribe antibiotics to patients – which results in unintentional, but a potentially fatal delay in treatment.  Due to the fact that IBC is an extremely aggressive cancer, it can often cause death within 18 to 24 months of diagnosis. 

WHAT YOU CAN DO:  EDUCATE YOURSELF AND OTHERS ABOUT IBC

Here are some simple action steps you can take to help increase awareness of IBC, and promote education about this deadly cancer:

1.  If this is the first time you have read or learnt about IBC, please recognize that there are numerous others for whom knowledge of this disease would be new as well.  Please pass on this post to ALL those it may benefit. 

2.  Utilize the selected important resource links at the end of this post to learn more about IBC.  Share these links with others as well.

3.  This post will be made available at The Prevention Revolution on Facebook.  If you have a question you may want to discuss or share an important comment, please join us on that site. 

4.  Finally, help us SAVE LIVES by joining the cause of  EDUCATION OF INFLAMMATORY BREAST CANCER.  Consider inviting your friends and family to support this effort.

Together, we CAN and SHOULD do more to stop this deadly killer. 

NOTES

1.  Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3^rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.

2.  Chittoor SR, Swain SM. Locally advanced breast cancer: Role of medical oncology. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Diseases. Vol. 2. 2^nd ed. Philadelphia: W.B. Saunders Company, 1998.

3.  Key gene in deadly breast cancer identified (Science Daily – June 2009)

IBC RESOURCES

IBC Q & A – National Cancer Institute

IBC Research Foundation

Mayo Clinic Guide to IBC

MD Anderson IBC Page and Important Links

Information on IBC Clinical Trials - Click on Stage IIIB Clinical Trials

IBC – Clinical progress and the main problems that must be addressed (Full Text Access)

The IBC Foundation

The IBC Support Mailing List Site

As of last Friday, October 9, 2009, a total of 76 H1N1-associated pediatric deaths in the U.S. were confirmed by the Centers for Disease Control and Prevention (CDC).  Over the last three years, deaths among children from the regular seasonal flu have ranged from 46 to 88.  Given that it is yet only early October, the loss of 76 children due to the H1N1 virus raises significant concerns for their protection and safety.  In this post, I address some important facts relevant to the care of children who may be at a higher than average risk for an H1N1-related complication, and also reiterate prevention guidelines that may be of benefit both to physicians and others taking care of such children.

DEFINING WHICH CHILDREN ARE AT A PARTICULARLY HIGH RISK FOR FLU-RELATED COMPLICATIONS:

1.  It is well known that children younger than 5 years of age, and those who have high-risk medical conditions are at an increased risk of Influenza related complications.  Children at higher risk include all children with immune supression, chronic kidney disease, diabetes, asthma, heart disease, sickle-cell disease, or other problems related to the lungs. 

2.  In addition to the above, children with any condition that affects respiratory function including neurological conditions such as intellectual and developmental disability, cerebral palsy, spinal cord injuries, seizure disorders, metabolic conditions or other neuromuscular disorders have higher risk.

3.  Finally, children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea, and children with an underlying metabolic disorder such as Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency – are more susceptible to both the seasonal flu- and the H1N1 flu related complications.

It is particularly important that parents, caregivers, and physicians stay on the alert for worsening disease symptoms in ALL children, but particularly in high-risk children.  In addition to the expected symptoms of H1N1 (fever, sore throat, cough, etc.), if new symptoms appear in sick children, such as apnea, dehydration, recurring infection, an altered mental state, or extreme irritability - any of these should be a signal to immediately take more aggressive steps to prevent the situation from getting worse.  Children experiencing any one or more of the above mentioned conditions should be under continuous expert care.

CONCERNS ABOUT CONTRACTING PNEUMONIA

One of the main concerns that is relevant both for adults and children is the fact that oftentimes during serious flu outbreaks, bacterial pneumonia infections can also become widespread.  Generally speaking, Influenza predisposes people to community-acquired bacterial pneumonia, and can often be an important related cause of illness and death.   Because of this fact, CDC’s Advisory Committee on Immunization Practices recommends the following:

• A single dose of PPSV23 (pneumococcal polysaccharide vaccine) for all people 65 years and older, and for persons 2 to 64 years of age with certain high risk conditions.  This is due to the fact that people in these groups are at an increased risk of pneumococcal disease as well as serious complications from influenza (both seasonal and the H1N1).
• PCV7 (pneumococcal conjugate vaccine) is recommended for children aged less than 5 years.

COMMON SENSE RULES APPLY

In nearly all cases involving efforts to prevent an H1N1 infection (whether in adults or children), common sense rules must apply – many of which have been stated in previous posts.  Further, keeping well-informed with respect to the types of drugs available, as well as their side-effects is also equally important.  As the H1N1 Flu is an emerging disease, it become particularly critical for us to observe its course carefully, and to stay soundly informed as well as equipped with up-to-date information.  It is quite clear that children are particularly vulnerable to the H1N1 virus; For this reason, it is incumbent upon us to minimize the tragic loss of life in this population by becoming as well-informed as possible with respect to their protection.  To that end, please refer to some critical precautions presented in previous posts (links above) and take advantage of the important resources provided at the end of this one. 

RESOURCES:

Recommendations for use of pneumococcal vaccines & additional links for contraindications, precautions and adverse effects. 

CDC Guidelines for Prevention of Pneumococcal Disease

The Centers for Disease Control announced last week that it had received reports of 60 deaths of children related to the H1N1 flu since April of this year; and 11 of these deaths have occurred within the last week.  Further, between the period from August 30 to September 27, CDC reports that there have been 16,174 hospitalizations nationwide, and 1,379 deaths associated with the H1N1 infection. 

At the present time, the states that are reporting the most widespread flu activity are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas, Tennessee, Virginia, Washington and Wyoming.

Worldwide, more than 340,000 laboratory-confirmed cases of H1N1 and more than 4,100 deaths have been reported to the World Health Organization.

Given the unexpected and significant toll the Swine Flu has taken, efforts are well underway to make the H1N1 vaccine available to all.  In spite of the significant controversy associated with this vaccine, it was estimated (by a CNN opinion poll in late August) that about two-thirds of Americans are planning to take the vaccine.  The campaign to inoculate millions of Americans against the H1N1 Influenza began yesterday, October 5, with health-care workers in Indiana and Tennessee being the first recipients in queue for the vaccine.   Nevertheless, in spite of the assurance of vaccine availability, it appears that widespread pandemonium remains around the nation due to the toll that H1N1 has already taken thus far.

My Comments – I believe that in spite of the significant and legitimate concern about the Swine Flu, common sense principles must apply and that they should not be overlooked with respect to prevention efforts.  The evidence of previous pandemics suggests that there are those who appear to be able not to get sick in spite of widespread disease.  What then, is the secret (if there is one), to avoid contracting a widespread virus  or other infectious disease? 

The above question is complex, and contrary to common opinion, I do not believe that simplistic answers can suffice.  For example – It is well known that certain groups of people (such as pregnant women, chidren, young adults, and those with certain serious chronic conditions such as lung disease or diabetes) are often more susceptible to infectious diseases such as the Flu.  This fact alone tells us that our ability to resist disease is highly individual; that it may depend on our unique biochemical individuality; and further, that it may be contingent upon numerous additional factors such as individual nutrient levels, rest/stress levels, and the state of our overall immunity.  In addition, the level of exposure to disease is a critical factor as well.  It is of course well known that those who spend the majority of time in public places or crowded areas are much more likely to succumb to the possibility of contracting an infection.

Notwithstanding the above, it behooves us (as it does in the case of all things we cannot control fully) that we do ALL we can to make every reasonable effort to prevent sickness.   In spite of the alarm and concern surrounding the H1N1 virus, I find that too many people I meet appear to be unduly concerned about missing a week of school or work - and this, even after they  have experienced the first symptoms of the Flu!   Now, while I agree that missing work/school may be undesirable, perhaps this perceived loss needs to be viewed in terms of a much larger perspective.  Through this post, I would like to remind as many readers as it reaches to seriously consider some of the statistics presented above.   Upon reflection, would you not agree that the cost of work/school missed for a week, or even more time,  is inconsequential relative to the cost and threat of the possible loss of life, or conceivably, even the permanent loss of health? 

We all tend to think that the worst cannot or will not ever happen to us.  But, the reality is that it can.  With that reminder, please refer again to a previous post on some simple, but potent steps you can take to protect yourself (to the extent it is possible to do so) from the H1N1 virus – including staying home if necessary for a week or more in order to protect both yourself, and others.  Certainly, the H1N1 virus is a formidable enemy, but even mere elementary observation suggests that oftentimes, we humans can be our own worst – and even more formidable – enemies relative to any virus or other external agent.  Let this post be a reminder to us all to first be our own best friends!

Resources:

H1N1 Vaccination Information and Resources

CDC – Flu Update

In June of this year (2009), an FDA panel cited the alarming statistic that the commonly used painkiller Acetaminophen (popularly available over the counter in Tylenol, Excedrin, and dozens of other medications) was the leading cause of liver failure in the United States.  The panel further cited that 60% of deaths involving Acetaminophen occurred when also taking one or more prescription medicines.  In light of these numbers, I feel that it is critically important for ALL to understand how to use this widely and commonly used drug safely.

 WHAT IS ACETAMINOPHEN ?

Acetaminophen is the generic name of a drug found in many over the counter (OTC) products such as Tylenol, as well as in prescription products such as Vicodin and Percocet.  In the UK and several other countries, this drug is often referred to as Paracetamol.  Acetaminophen’s  main uses are to help relieve pain and reduce fever.  It is frequently found in combination with other active ingredients, especially in medications used for allergies, colds or the flu.

 INCORRECT ACETAMINOPHEN USE AND RISK OF LIVER INJURY:

Although Acetaminophen is generally considered safe if taken as directed, it is now well known that this drug can cause serious liver damage if more than the recommended amounts are taken.  Symptoms of early stage liver damage may be loss of appetite, nausea, vomiting, or a perception of having the flu.  Because these symptoms can often so easily be ignored as being not very serious, in most cases liver damage can go undetected.  However, liver damage can quickly progress into liver failure or even death.   Here are some simple cautions you can take to lower your risk of liver damage when using Acetaminophen:

• Follow dosage directions strictly as prescribed by your physician or as indicated on the drug label.  Even a small amount of this drug – when used in excess of what has been directed – can cause liver damage or possible liver failure.
• Don’t take more than one medicine that contains Acetaminophen at one time.  This is most likely to happen when you have symptoms such as those of a headache and a cold at the same time.  Consuming two or more medications – each of which contains Acetaminophen - is extremely risky and must be avoided.
• Do not take Acetaminophen longer than is needed or for more days than is directed.

 DEVELOP AWARENESS OF WHICH MEDICATIONS CONTAIN ACETAMINOPHEN:

All medicines have ingredients listed on their labels, but most individuals tend to ignore this information.  Before taking any medication, read the medication label and the drug facts.  If your medicine contains Acetaminophen as an active ingredient, be aware of how much you are taking, and refrain from combining it with other medications that also contain the same drug.  Acetaminophen is often listed on over the counter drug bottles as APAP.  It is NOT safe to use over the counter Acetaminophen if you are a regular alcohol drinker and/or have liver disease.  If this is the case, consult your physician before you take this or any other pain medication.

 SAFETY CONCERNS FOR CHILDREN:

All of the above  precautions should be kept in mind when giving Acetaminophen to children.  Due to the fact that it is very easy to overdose children accidentally, certain extra precautions must be taken as well:

• When dosing children, it is very important to use the measuring tool to dispense the medication that comes with it.  Do NOT use a kitchen or other spoon to measure medication.
• Again, be especially cautious not to give a child more than one medication that contains Acetaminophen at one time.  If the suggested dose does not provide needed relief, consult your doctor rather than risk overdosing.

 EMERGENCY NUMBERS:

Research suggests that in spite of best efforts on the part of many, accidental overdosing can happen.  If that is the case, waiting to get help can be fatal.  If you suspect an overdose of Acetaminophen, immediately call 911 or Poison Control at 1-800-222-1222 to receive directions on the correct course of action to follow.  As signs and symptoms of liver damage are often not noticeable for hours or even days after taking this drug, waiting may lead to severe liver damage, or death.

I hope this article will help you use Acetaminophen with much greater awareness than you may have had before.  As with most medications, Acetaminophen is a useful drug when used correctly.  However, a lack of simple awareness and knowledge vis-a-vis important precautions, that must be kept in mind to use this drug safely, has cost many lives.  Please help build much needed awareness about this very commonly used drug by forwarding this post to any and all that might benefit from it.  

 FOR FURTHER READING:

ACETAMINOPHEN POISONING (Journal of the American Academy of Pediatrics)

FDA – A Guide to Safe Use of Pain Medicines

Although literature suggests that the risk of an infection is low upon the ingestion of a contaminated pharmaceutical product due to the fact that stomach enzymes are usually able to neutralize bacteria, concern remains for those patients who may have lung disease, cystic fibrosis, or perhaps a weak immune system.

For those who may have concerns or questions regarding this issue, McNeil Healthcare has provided a contact number.  They can be reached at 1-800-962-5237 (M-F, 8 am to 8 pm Eastern Time).  The full list of the recalled products and their lot numbers can be accessed at the following site (Lot numbers can be found at the bottom of the packages that contain liquid formulations, and on stickers that surround product bottles):

TYLENOL RECALLED PRODUCTS FULL LIST AND LOT NUMBERS

As an important aside, most individuals appear to be unaware of safety measures that have been published by the U.S. FDA for the use of Tylenol (generically known as ACITAMINOPHEN) - both for pediatric and for adult use.  Due to the widespread reports of liver failure and/or liver damage associated with improper (or excess) Acitaminophen use, these guidelines are important to know.  As this topic is fairly extensive, I shall be writing on this important subject shortly in an upcoming post.  Until then, please pass on this post to those who have children and to others who may have need for this information.

Cardiovascular disease, cancer, and diabetes may indeed be listed in any database as the top three killer diseases in the West.  But, as one studies research carefully, it starts to become evident that these diseases are in fact NOT the Primary Causes of death; rather they represent what may be called the Secondary Causes of death in the vast majority of cases.   What does this mean?  In simple language, this means that if someone dies of a heart attack and we consequently conclude that the cause of death was heart disease – we are engaging in what may be called “circular reasoning.”   The REAL question we must ask and answer is this:  What was the Primay Cause or Causes of the heart disease in the individual who died?  What caused heart disease to happen in the first place?  And the same questions must be asked for cancer, diabetes, and other diseases.  Why do this?

Here is the answer to the above question:  There is mounting evidence to indicate that the vast majority of the actual causes of death (what I am here referring to as Primary Causes) are factors that are often well within our control.  In 1993, a publication in The Journal of the American Medical Association (JAMA) concluded that of the more than 2 million deaths that occurred each year in the U.S. (around that time), more than half – or greater than one million -were occurring prematurely as a result of 10 specific behaviors that included the following:

• Tobacco use
• Poor diet
• Lack of physical activity
• Alcohol abuse
• Exposure to infectious agents
• Expsoure to toxins
• Unsafe sex
• Unsafe driving
• Illicit drug use

Of the one million deaths due to the above causes, more than half a million deaths were accounted for by the top three causes alone, i.e., tobacco use (smoking), being physically inactive, and eating poorly.

Since 1993, other scientific publications have appeared that have ratified the link between a poor diet, sedentary behavior and premature death.  In 2000, another paper published in JAMA by the Centers for Disease Control indicated that tobacco use still remained the leading cause of death accounting for greater than 400,000 deaths that year.  Another 350,000 deaths were attributed that same year to the combination of eating badly and being inactive.   The question is: Does the link between the causes listed above and premature death still hold today?

Indeed it does.  In 2008, researchers from Harvard published a paper in The British Medical Journal entitled, “Combined impact of lifestyle factors on mortality: prospective cohort study in U.S. women.”  This study followed 80,000 women between the ages of 34 and 59 for more than 24 years.  During that period, there were 9,000 deaths in this cohort – of which nearly 2,000 were attributed to heart disease, and 4,500 to cancer.  But again, these could be called the Secondary Causes of death.  What were the Primary Causes?   In studying this sample, researchers found that 5 specific behavioral risk factors were the underyling actual causes of premature disease and death in these women.  The 5 factors were these:

• Smoking
• Inadequate physical activity
• Poor diet quality
• Weight gain/obesity
• Alcohol intake outside of the recommended light to moderate range

Investigators concluded that the combination of the above 5 risk factors increased the overall risk of death more than four-fold in their sample; increased risk of cancer death by more than three-fold, and increased the risk of cardiovascular death more than eight times!   These results can be restated as follows:  The combination of not smoking, being physically active, eating sensibly and well, drinking within recommended guidelines, and maintaining a close to optimal weight is associated with a markedly lower mortality that is equivalent to a nearly 90% reduction in risk of death from heart disease, a 2/3rd or 66% reduction in the risk of cancer, and greater than 75% reduction in risk of death from any cause. 

These numbers suggest that while it is true that we may not have absolute or 100% control over our destinies vis-a-vis our health, we are decidedly far from helpless.  Indeed, it might not be an exagerration to say that what we are able to do with what we already know to influence the state of our health positively far exceeds any major medical breakthrough we may make tomorrow.  This is not an argument against the benefit(s) of future medical research; rather, it is a call to action to energize ourselves to do all we can with what we already know.

At present, greater than two-thirds of Americans (165 million plus) are overweight, of which 30% are clinically obese.  Similar trends are occurring all across other Western and Westernized nations.   As an example, the World Health Organization recently stated that by 2010, 76% of men and 67% of women will be overweight in Australia.  These numbers are equivalent to roughly three-quarters of the entire Australian population!   There is no disputing the fact that overweight and obesity are closely related to heart disease, diabetes, and even certain cancers.  Consequently, rates of these diseases are expected to be  high wherever people are overweight or obese.   Today, any way we look at it, the majority of those living in the West or in the Westernized world are sick.  We are mired in an epidemic of overweight, obesity, and deadly chronic diseases.

So, what is our way out of this quagmire?  Perhaps one way out is for us to start by clearly stating and distinguishing Primary from Secondary Causes of both illness and death.  Is doing so really that essential?  Yes, it is.  Establishing and understanding the Primary Causes of disease is crucial to coming to terms with how much influence we truly have over disease and the state of our health.  In the great majority of cases, heart disease, cancer, and diabetes don’t just “happen” to us.  We are not completely helpless against these diseases.   The reality is that we can exert tremendous influence over the state of our health as well as the quality and the duration of our lives.  That statement is not mere opinion; it is a research-based fact.  

Now, it is true that with our poor diets, our stress-filled hurried lifestyles, and our sedentary habits, many of us who live in the U.S. or other Western nation have been our own worst enemies for a long time.  But, I am convinced that if we decide to, we can just as easily be our own best friends.  Don’t you think its time?

Notes

Combined Impact of Lifestyle Factors on Mortality: Prospective Cohort Study in U.S. Women

 As a research scientist who speaks frequently on Cancer (its current research, prevention, and treatment), I am intrigued to note that among all diseases that exist, Cancer is perhaps the most mis-understood of all diseases even in our current times.  Audiences frequently tell me that they dread this disease more than any other because they perceive that it is the one disease they have the least control over.   And because people erroneously perceive that they have little or no control over preventing the great majority of cancer(s), they tend to just “look the other way” – and especially so after the dust settles on the news of yet another favorite Hollywood star succumbing to this deadly disease. 

But, it’s time to set the record – or at least some facts - straight.  This post is not about Pancreatic Cancer, but about Cancer in general, and the facts that ALL should know.  The facts are these:  Research suggests unequivocally that only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95% have their roots in an individual’s environment and lifestyle (1).   Here is the official breakdown of known factors linked to cancer for all cancer-related deaths:

• Almost 25-30% are due to tobacco use
• As many as 30-35% are linked to diet
• About 15-20% are due to infections
• The remaining percentage is due to other factors such as  exposure, stress, lack of physical activity, environmental pollutants, etc, i.e. “environmental factors.” 

Research also suggests unequivocally that cancer prevention requires:

• Smoking cessation
• Increased ingestion of fruits and vegetables
• Moderate or no use of alcohol
• Caloric control
• Minimal meat consumption
• Whole grain consumption
• Avoidance of direct sun exposure
• Regular physical activity
• Prudent use of vaccinations as needed
• Regular check-ups

The  bottom line?   We can no longer say that we have no control whatsoever over preventing cancer.   The vast majority of cancers are in fact preventable, but they do require major lifestyle changes for most individuals.   Two critical factors that have been studied very extensively through research give support to the preventability of cancer:

1.  The link between diet and cancer is revealed by large variations in the rates of specific cancers in various countries, and the changes observed in the incidence of cancer among those who migrate.  For example:  Asians have been shown to have a 25 times lower risk of prostate cancer and a ten times lower risk of breast cancer than do residents of Western countries, and the rates of these cancers increase substantially after Asians migrate to the West (2).

2.  Extensive studies with identical twins have suggested that genes are not the source of most chronic illnesses.   For example, the concordance between identical twins for breast cancer has been found to be only 20% (3).  Data suggest that instead of our genes, our lifestyle and environment account for 90-95% of most chronic illnesses.

The details we must attend to – and the specific steps we can take - to modulate our risk factors in order to prevent cancer(s) are (needless to say) an extensive topic worthy of a full length book – one in fact that I am working on.  However, the point of this post is simply to share a lesson that I have learnt through many years of study, and the lesson is simply this:  Health and Disease are NOT random states.  There are laws that govern each – and these laws are external, absolute and irrevocable.  They operate regardless of our awareness or our ignorance of them, so that our state of health or disease is pivotally and critically contingent upon the extent to which we understand these laws.  In simple language, this means that the sooner we learn about and align ourselves and our behaviors with the laws that govern a state of health, the sooner we are likely to arrive at that desired destination.  The longer we stay in a state of ignorance or fear, the more likely it is that we (albeit unwittingly and unknowingly) succumb to disease – cancer or any other.

This year, more than 1 million Americans, and more than 10 million people worldwide are expected to be diagnosed with cancer.   This disease continues to be a worldwide killer and accounts for about 23% of total deaths in the U.S., being the second most common cause of death after heart disease.   However, unlike in the case of heart disease, there  has not been an appreciable reduction in death rates for cancer in the U.S.  in spite of an enormous amount of research dedicated to this disease.  This fact alone should propel us all to learn all we can and do all we can to prevent cancer(s) from occurring in the first place.  

What will you do today to that end?   Here is a suggestion:  Start by reading one of the two seminal resources provided at the end of this post.  I assure you that when you do, you will not feel quite as helpless against cancer as perhaps you once did.  And please, feel free to pass on this post and these resources to those in your circle of family and friends who may benefit as well - The world needs this information, and you can help.

NOTES

(1)  Anand, et al.  Cancer is a Preventable Disease that Requires Major Lifestyle Changes.  Pharm Res. 2008; September 25 (9): 2097-2116. 

(2) Food, Nutrition, Physical Activity and the Prevention of Cancer; Diet and Cancer Report

(3)  A.S. Hamilton and T.M. Mack.  Puberty and Genetic Susceptibility to Breast Cancer in a Case-Control Study in Twins.  New England Journal of Medicine 348: 2313-22 (2003)

RESOURCES

Diet and Cancer Report

Anand et al.  Cancer is a Preventable Disease that Requires Major Lifestyle Changes.   Cytokine Research Laboratory, Dept. of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center.

ZANAMIVIR:

The drug Zanamivir is licensed only for use in persons without underlying respiratory or cardiac disease.   Post marketing surveillance as well as some studies indicate that respiratory function deterioration can occur after inhalation of Zanamivir by those who have underlying airway disease.   For this reason, this drug is notrecommended for patients with such an underlying condition.  Post marketing surveillance has also included reports of allergic reactions such as oropharyngeal or facial edema in some cases with the use of this drug. 

Other common adverse events reported by those using Zanamivir include diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections.   Each of these symptoms was reported by less than 5% of persons in the clinical treatment studies.

OSELTAMIVIR:

Relative to Zanamivir, a greater number of unpleasant side-effects appear to have been reported with the use of the antiviral medication, Oseltamivir.  In clinical treatment trials,  nausea and vomiting were reported more frequently among adults receiving Oseltamivir for treatment (nausea without vomiting, approximately 10%; vomiting, approximately 9%) than among persons receiving placebo (nausea without vomiting, approximately 6%; vomiting, approximately 3%).  Among children treated with Oseltamivir, 14% had vomiting, compared with 8.5% of placebo recipients.  It is recommended that Oseltamivir be taken with food to help reduce the severity of nausea and vomiting.

Another concern with respect to the use of Oseltamivir has been reports oftransient neuro-psychiatric events(such as self-injury or delirium) that appear to have been associated with its use.  Currently, the FDA has advised that persons taking Oseltamivir be monitored closely for abnormal behavior.

AMANTADINE & RIMANTADINE:

At a dosage of 200 mg/day, both Amantadine and Rimantadine can cause Central Nervous System (CNS) and gastro-intestinal side-effects when given to young, healthy adults.  Data suggest that  incidence of CNS side effects (e.g., nervousness, anxiety, insomnia, difficulty concentrating, and lightheadedness) is higheramong persons taking Amantadine than among those taking Rimantadine.  Generally, side effects associated with  both these drugs are mild and cease when the drug is discontinued.  However, serious side effects have been observed (e.g., marked behavioral changes, delirium, hallucinations, agitation, and seizures) among persons who have renal insufficiency, seizure disorders, or certain psychiatric disorders and also among older persons who have been taking Amantadine as prophylactic treatment at a dose of 200 mg/day.

DRUG INTERACTIONS:

Data vis-a-vis drug interactions is limited with respect to both Zanamivir and Oseltamivir.  With regard to the use of the drug Amantadine, caution is advised in using it concurrently with drugs that effect the CNS, including CNS stimulants.  The concomitant administration of antihistamines or anticholinergic drugs can also increase the incidence of adverse CNS reactions in patients.  Currently, no published data are available concerning the safety or efficacy of using combinations of any of these influenza antiviral drugs.  For this reason, awareness and cautions must always be borne in mind while using these medications.  Use this link to refer to helpful criteria for discerning an adverse drug event/interaction.

SAFETY ISSUES DURING PREGNANCY:

The four drugs discussed above fall under “Pregnancy Category C”medications, which indicates that no clinical studies have been conducted to assess the safety of these medications for pregnant women.  Both Amantadine and Rimantadine have been demonstrated in animal studies to be teratogenic (i.e., able to disturb the growth and development of an embryo or fetus) and embryotoxic when administered at substantially high doses.  CDC recommends that the antiviral medications discussed here should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus, and further, that the manufacturers’ package inserts should be consulted prior to the use of these medications.

With an astute awareness on how to use drugs safely, a great many potentially serious adverse events can either be circumvented altogether or treated promptly.  If you are currently dealing with the seasonal flu or an H1N1 infection, stay on the alert while using prescribed medications, and use them according to the parameters provided.  You may also want to keep the above information handy or pass it on to others who may benefit.

ADDITIONAL USEFUL RESOURCES:

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008. MMWR 2008 Jul 17; Early Release:1-60.

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2004. MMWR 2004 May 28; 53(RR06);1-40.

THOMAS QUASTOFF: PHARMACO-EPIDEMIOLOGY'S FIRST FACE

In 1957, an anti-convulsive medication came on the market.  In the late 1950s,  thousands of German and other European women used this apparently safe anti-nausea/anti-convulsive and sleep medication during pregnancy.  By 1960, this drug was marketed in 46 countries, with sales nearly matching those of Aspirin.  In 1961, this drug was withdrawn from the market after being found to be a cause of “Phocomelia” – a birth defect so severe that it caused children to be born without properly developed arms or legs.  The drug was Thalidomide.  It is estimated that the number of individuals that were directly affected by Thalidomide was between 10,000 and 20,000.  It was a tragedy of enormous proportions, and our first full understanding of the fact that drugs can be toxic.  The field of Pharmaco-Epidemiology was born in tragedy. 

Today, it is estimated that adverse drug side effects and drug interactions account for over 200,000 deaths each year in the U.S. alone – which equals approximately 4000 weekly fatalities.  This estimate is according to the Alliance for Aging Research’s Report to Congress that was made in 2001.  This number supports a previous estimate made by The Journal of the American Medical Association (JAMA) in 1995 that reported deaths from adverse drug events to be at 180,000 per year at that time.  The JAMA esimate was considered conservative even then in light of the rapid introduction of new drugs on the market.

More recently, the tragedies surrounding the use of Rofecoxib (Brand name – Vioxx) and several other drugs have raised concerns about the safe use of newly emerging drugs.   For example, when Vioxx was withdrawn from the market in September 2004, 80 million people worldwide were using this drug for conditions such as arthritis and acute pain.  This was one of the most widely used drugs ever to be withdrawn from the market, with revenues of U.S. $2.5 billion in the year before its withdrawal.   The fact that this drug had very serious and potentially fatal side effects was learnt after it had been on the market for a period of time and was fully in use. 

The tragedies surrounding Thalidomide, Vioxx, and numerous other drugs (not mentioned here) give us pause to re-consider how to use drugs safely, especially if they are new to the market.  There are times when it may be promising to consider the use of a new drug for a specific condition or conditions, but is there a way we can be aware of certain cautions we must keep in mind while doing so?   While this topic is by itself a very large field of study, there are certain principles and hard lessons that have been learnt over time through the study of Epidemiology that everyone should know about, and I will share these with you in this post.   These principles help us to use new drugs with greater awareness and objectivity, and also increase our understanding of how we may be able to circumvent a crisis in the event of an adverse drugs event and/or a drug interaction.

When using a new drug (or multiple drugs), a patient or physician must at first draw an informal inference in the event of an unexpected drug side-effect or an unanticipated drug interaction problem.  Here are the critical criteria on the factors involved in doing so – I will explain what they mean at the end of the table below: 

While the contents of the above table may seem esoteric at first, this is information that ALL individuals must take a little time to understand and learn:

 1) The column on the left defines the criteria using which we can determine that there may be a problem with a new drug you have taken.  If immediately or soon after taking  a new drug, you feel unusual symptoms that make you feel perceptibly uncomfortable or anxious; if there is a prior hypothesis or known mechanism indicating that such a symptom or symptoms may occur (usually such factors are mentioned on the inserts that come with the drug), and if the new drug is the ONLY new item you have added to your intake - It is time to draw the informal inference that there may be a problem with this drug’s use for you.  At such a time, rather than taking another dose of the same drug on the prescribed schedule, you should discontinue use of this drug and contact your doctor immediately to make him/her aware of your concerns.

 2)  Sometimes, however, it is not so easy to determine if a new drug you have taken is causing a problem, or if there are other factors that may be involved.  The column on the right defines the factors that make the drawing of an informal inference hard with respect to the true effects of a new drug.  For example, the effects of a new drug may be delayed; they may be unanticipated, and  there may be no prior known mechanism or hypothesis vis-a-vis the symptoms you are experiencing (i.e., they may be readily expected even in the absence of the drug).  Further, you may be taking multiple drugs and it may be impossible to know which one of the drugs  is causing a problem (or if drug-interactions are involved).  A good example of when informal inference was hard was what happend with Thalidomide – Its effects were delayed, unanticipated, and no one knew of any prior hypothesis or mechanism that indicated that its use might result in the culmination of a tragedy. 

 So, what can you do to protect yourself from an unanticipated crisis that might happen with the use of a new drug or while using multiple drugs?   First, use the criteria above as a guide to develop greater awareness surrounding drug use.  Be alert at all times for any and all unsusual symptoms, especially when using multiple drugs.   Here are additional guidlelines you should keep in mind:

• Have a trusted primary care physician (PCP) whom you can contact without hesitation in case of an emergency.
• Have serious respect for drugs; Do not take any drug casually or without due awareness.
• Ask and research information regarding drug interactions.
• It may not always be possible, but when it  is, choose drugs that have been on the market for at least 5 years, or drugs that have a long history of safe use.
• Read all directions, precautions and potential adverse reactions – This information is made available when drugs are purchased, but few individuals take the time to read it seriously.
• Follow-up on ALL physician recommended lab work! – Too many patients refuse to follow-up on recommended blood work or lab tests that have been recommended.  This can be potentially fatal.
• If you suspect any unusual reaction, don’t wait – follow-up with your PCP immediately. 
• Don’t take Over the Counter (OTC) medications or herbal therapies lightly.  
• Know when OTC drugs are contra-indicated. 
• Consult and inform your physician and pharmacist when taking OTC’s.
• Finally, do not self-medicate to address an unexpected problem, and do not self-diagnose.  Obtain confirmation from your doctor with regard to the correct action to take in the event of an unexpected crisis.

Arriving from thin data to causal knowledge with respect to the true effects of a drug, or of drug-related interactions, can sometimes take years and expert epidemiologists often study extensively to understand this difficult field of study.  The point of this post, however, is simply to draw your attention to the fact that simple awareness and even a cursory level of knowledge with respect to the important factors you should bear in mind – can sometimes be sufficient to avert a crisis.   It is also important to know and take advantage of useful resources that can keep you well-informed and on the alert with respect to potential drug-interactions and/or news pertaining to safety issues involved with new drugs.  I have listed a couple of the most useful resources on this subject at the end of this post. 

Finally, as this subject is both critically important and very vast, no single blog post can do full justice to it.  For this reason, I will post a video series on this topic in the upcoming days or weeks.  Stay tuned for that.  Until then, please feel free to pass on this post and the resources provided to all who may benefit.

RESOURCES:

Drug Interaction Table (Indiana University Division of Clinical Pharmacology)

FDA/Drugs

The latest update on the international situation on the H1N1 virus was recently reported by the World Health Organization on August 23, 2009.  As of that date, the total number of laboratory confirmed cases of the 2009 H1N1 virus were 209, 438 with at least 2, 185 deaths.  The laboratory confirmed cases represent an underestimation of the actual number of cases of H1N1 worldwide as most countries now focus surveillance and laboratory testing in persons with severe illness only. 

Overall, at present, decreases in disease due to the H1N1 virus are being reported from South America, parts of Australia, and the U.K.  On the other hand, increase in disease due to the H1N1 virus is being reported from more countries in Africa, Southern Africa, and other tropical countries. 

 UNITED STATES UPDATE 

The latest report on the domestic situation with the H1n1 virus is from the week of August 16-22, 2009.   The Centers for Disease Control (CDC) estimate that the H1N1 activity is either stable, or increasing in some areas of the U.S.  H1N1 activity appears to be increasing in the SouthEast (especially the state of Georgia) based on data reported by health care providers in that area. 

Most state officials across other parts of the country are currently reporting regional or sporadic influenza activity.  However, Alaska and Georgia are the two states that are reporting widespread influenza activity at this time. 

Both in the U.S. and internationally, the H1N1 virus continues to be the most dominant virus in circulation.  With rare exceptions, the H1N1 virus continues to be susceptible to the antiviral drugs Oseltamivir and Zanamivir.   Read more on the resistance of the H1N1 virus to certain antiviral drugs; how antiviral drugs help provide protection against and treatment for Swine Flu, dosage recommendations, and guidelines for use of antiviral medications at the following link:  Antiviral Drugs and The Swine Flu – Getting Equipped.

Over the last few years, hundreds, perhaps thousands (or even more) articles, papers, and opinion-pieces have been written by a multitude of writers and experts on the health-care crisis facing American businesses and corporations.  Having read many of these articles, I have been greatly bewildered by the conspicuous absence of the discussion of some facts that are so fundamentally germane to this issue, that eventually, I felt driven to write this article.  But, surely we don’t need another opinion-piece on the health-care crisis, or do we?  We do.  And, if you are a CEO – whether of a Fortune 500 or a small to mid-size business with 20 or more employees, this article is for you.

I do not wish to reiterate the lengthy facts and figures on health-care costs that have threatened virtually to shut down numerous American businesses; those numbers can be accessed at numerous quality websites on health-care and health-policy.  But, I will summarize what appears to be the heart of the problem that is presently causing an unprecedented crisis for U.S. firms.  The crisis – in a nutshell – is this:  Over the last couple of decades, American manufacturers and businesses have steadily been losing their ability to compete in the global marketplace due to the crushing burden of astronomically high health-care costs.  In 2008, for the first time ever, the health-care costs of some Fortune 500 companies nearly equaled or even exceeded their profits.  In light of the double-digit inflation in health-care costs, companies – big and small – appear to be faced with four major problems:

• Skyrocketing health-care costs make American companies uncompetitive in the global marketplace.  As an example, prior to the recent bankruptcy of General Motors, this company was adding $1,500 to the price of each GM vehicle to cover its health-care costs.  Such costs greatly threaten the viability of U.S. firms in the global market.  
• As employees deeply value health-benefits (that U.S. companies are often unable to pay), foreign companies become more attractive to American workers resulting in the loss of American employees to foreign firms.  
• If American firms, especially the large ones (especially auto, steel, and airline companies) try to institute sharp reductions in health-benefits, or shift health-care costs onto employees in the form of higher co-payments or deductibles, they often have to confront powerful worker unions that can drive a company to Chapter 11 bankruptcy protection. 
• Small to mid-size companies are faced with an even worse crisis.  On average, they pay 18% more per worker than large firms for the same health-insurance policies.  This is because they have a smaller risk pool and have to absorb higher fees and administrative costs per worker.

Given the above scenario, everyone has been crying, “Reform!” and perhaps, justifiably so, keeping in mind the plight not only of American business owners big and small, but also of the millions who remain uninsured. 

BUT, WHAT HAVE WE MISSED HERE?

We want “Reform,” but what kind of “Reform” are we really asking for?  And, what assurance do we have that the type of Reform that is currently being proposed will actually deliver?  What have history and economics taught us about what works and what doesn’t in a matter such as this?  I wish to surface two points here that appear to have been universally overlooked in most papers on this topic, and that are the very reason for this post.

1.  Every introductory course in Economics (particularly Micro- Economics) teaches us that when individuals are shielded from the true costs of the benefits they receive, the demand for those benefits (whether real or only perceived) skyrockets.  It’s the old law of “Supply and Demand;” it hasn’t been repealed yet, neither is it likely ever to be.  The reality is that both in our current dysfunctional health-care system, and in the proposed “reformed” system, individuals are “shielded” from the true costs of the benefits they receive, so the demand for “benefits” remains, and will remain, sky-high. 

In a true free-market, individuals directly bear the real costs of benefits received; thus demand for services is not exaggerated but represents real needs and thus generates an optimal and efficient use of resources.  Furthermore, in a true free-market, genuine competition between service providers brings costs of services close to true costs, rather than inflated or exaggerated costs that are the result of an artificially exaggerated demand and/or an artificially restricted supply.  It is a close to optimal scenario, but of course, we do not today have a true free-market situation with our health-care. 

2.  The alternative scenario currently under discussion is “Universalized” Medicine.  However, the problem that remains with this approach is that the connection between true costs and true benefits is further broken.  In fact, people under such as system erroneously believe that medical care is now “free.”  But, of course, nothing is ever “free.”  When we break the connection between costs incurred and benefits received in this fashion, we create tremendous personal and social dislocation of resources.  How? 

i) At the personal level, people’s fears are artificially mollified as they start to believe that “they will be taken care of should a health crisis occur.”  This leads to complacency and a greatly reduced motivation to really take care of one’s health with responsible habits, and

ii) At the social level, this results in a great waste of national resources to address problems that would not exist if people were motivated to take care of themselves and had to pay “out of their own pocket” for care received.  The examples of Universalized Medicine in Canada and England have taught us that when people believe that medication or doctor’s visits are “free,” they find ways to see the doctor more often than they would have otherwise.

GETTING TO PRIMARY CAUSES OF HIGH RATES OF CHRONIC DISEASES IN THE WEST

Notwithstanding the above, what I wish really to address in this post is something even more important than Free-Market or Universalized Medicine.  We can discuss the pros and cons of one or the other “System” of health-care ad nauseam, but the main issue that I as a research scientist find especially troublesome is this:  We seem to be obsessed with finding new and novel ways to pay for “treatments” and “procedures” for a sick population, rather than with addressing the root causes of why the population is sick in the first place.  Please bear with me momentarily as I explain this further.

As an epidemiologist, I study large-scale data and evaluate overall trends in health or illness.  At the present time, the U.S. is mired in an epidemic of chronic diseases such as heart disease, cancer, diabetes, obesity, as well as many others.  On the surface, it looks like people are getting sick and dying from one or more of these chronic conditions, but these conditions are for the most part the “Secondary Causes” in the process of disease  or death.  When you study research closely, you learn that the Primary Causes of high rates of chronic disease in the U.S. and other Western nations are largely nutrition and/or lifestyle related.  So, why are we more obsessed with finding ways to pay for medication and treatments than we are with addressing the Primary or Source Causes of disease?  And, what would happen if we really got serious about addressing these Primary Causes?  Here is what would happen:  In the words of Dr. Walter Willett, Professor of Nutrition at The Harvard School of Public Health, “With careful attention to the foods we eat, combined with not smoking and regular physical activity, we find that over 80% of heart attacks and greater than 70% of certain cancers can be avoided.¹” So, while we may not be able to wipe out all of cancer with the strategy of addressing Primary Causes, we should wipe out the 70% or more of cancer that we can, and should also eliminate the 80% of heart attacks that are preventable.  And, I might add that research indicates unequivocally that by addressing the Primary Causes of disease, similar gains are possible with respect to controlling rates of numerous other common chronic conditions that afflict the American population.

YOUR COMPANY AND EMPLOYEES CAN THRIVE REGARDLESS OF HEALTH CARE “REFORM” – OR NOT

If you are a CEO bearing the weight of what appears to be a no-win situation with health-care, the bottom-line to take home is simply this: Today, we have sufficient knowledge to understand and address the Primary Causes of numerous modern-day chronic diseases. The true solution to our health-care crisis does not lie in finding new ways to pay for “treatments.”  That may be necessary occasionally, but the real answer for you lies in addressing the Primary Causes of high rates of chronic disease in your work force.  With comparatively inexpensive education that addresses what the fundamental or key causes of disease and wellness are, you can eliminate a massive percentage of sickness in your workforce.

In the final analysis, the real costs of having a workforce that is far from well are in terms of various forms of employee downtime such as employees’ calling in sick, employees’ taking time off for doctor’s visits, and other interruptions that reduce productivity.  With the introduction of Universalized Medicine, I expect costs of this nature to increase dramatically for the reasons given above.

The moral of the story is this: Invest in teaching your people how to be well, and give them the cutting-edge resources and knowledge necessary to learn how to be well and avoid sickness.  Use their own motivation to be well.  There is one cost that we all want to be shielded from more than even any monetary cost – and that is the pain and suffering of being ill.  A work force that is healthy and strong is not only a cost-effective workforce; it is a more productive workforce.  It will be a “happy ending” for all concerned.

Notes

¹ Third Annual Great Issues in Medicine and Global Health Symposium, 2006.  Linking our Food Choices to Cancer Risk, Dartmouth Hitchcock Medical Center.

See Also:  Dr. James Geiger’s perspective in his post on Health Care Reform at his blog site.

Antiviral drugs are prescription medications that are active against Influenza viruses, including the Swine Flu virus.  These medications are effective only against Influenza viruses, that is,  they are incapable of preventing or treating symptoms caused by other viruses.  There are essentially four Influenza antiviral drugs that are currently approved for use in the United States.  These are:

1.  Oseltamivir

2.  Zanamivir

3.  Amantadine

4.  Rimantadine

The H1N1 viruses that have been detected in the United States and Mexico appear to be resistant to the drugs Amantadine and Rimantadine.   Tests conducted thus far indicate that the H1N1 viruses are susceptible to Oseltamivir and Zanamavir.  The Centers for Disease Control (CDC) is presently recommending the use of Oseltamivir or Zanamivir for the treatment and/or prevention of infection with Swine Influenza viruses.  Additionally, recommendations from the CDC state that:

• Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent Influenza A and B virus infection in people one year of age and older.
• Zanamivir (brand name Relenza ®) is approved to treat Influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.

HOW ANTIVIRAL DRUGS MAY HELP

PREVENTION:  Antiviral drugs can be used to prevent Influenza.  When given to a person who is not ill, but who may have been exposed to another person or persons with Swine Flu, these drugs are about 70 to 90% effective.  For preventative purposes, the number of days they may be used will vary in light of each individual’s exposure or unique circumstance.

TREATMENT:  Antiviral drugs are beneficial from the perspective of treatment in that they may help speed up recovery and reduce the intensity or severity of symptoms.  These drugs can also help prevent serious Influenza-related complications.  Ideally, they should be given soon after the onset of illness, particularly to those who may be at high risk for Influenza related complications.

INTERIM GUIDELINES & RESOURCES FOR USE OF ANTIVIRAL MEDICATIONS FOR THE SWINE FLU

Recommendations issued by the CDC for the use of antivirals drugs may change as data on antiviral effectiveness,  adverse events from antiviral use, antiviral susceptibility, and other critical data become available.  Current guidelines for use of antiviral medications can be accessed at the following link: 

Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts

Dosage recommendations for use of antiviral medications for both adults and children with respect to treatment of the Novel H1N1 infection may be accessed at the following link.  Additionally, dosage recommendations for children less than 1 year of age can also be accessed through the same link:

Dosage Recommendations 

Finally, information on side effects, possible adverse effects, contra-indications, and drug interactions associated with the use of antiviral medications may be accessed at:  

Antiviral Agents for Seasonal Influenza – Side Effects and Adverse Reactions.

Now, there may be many reading this post who may not take the time to follow the links or study the resources provided above.  But, those who do will become less apprehensive, more informed, and better-equipped both to prevent and to address the H1N1 crisis if it were to arise for them or their loved ones in the near future.  To reiterate, kowledge is the perfect antidote to fear – Now is a good time to become equipped with it.

At present, the Novel H1N1 virus continues to be the dominant Influenza virus in circulation in the world – 71% of all Influenza viruses currently detected globally are the new H1N1.  The Novel H1N1 virus also currently accounts for 66% of Influenza viruses in the Northern Hemisphere and 89% of Influenza viruses in the Southern Hemisphere. 

According to WHO, in the face of the rapid spread of a pandemic virus worldwide, regulatory authorities often have to allow for great flexibility in developing procedures for fast-tracking the approval and licensing of pandemic vaccines.  However, numerous media reports seem to have expressed concern about the safety of vaccines for the H1N1 pandemic influenza due to the fast-tracking procedures in place to bring the vaccine to the market.  The main concern is that the fast-tracking approval of a drug or vaccine generally leads to a situation in which the true adverse effects of the administered agent are fully observed only after the agent has appeared on the market (i.e. at the time of post-marketing surveillance).  Other concerns include the vaccine manufacturing procedure itself.  Numerous individuals appear to be concerned with the use of eggs in the H1N1 vaccine manufacturing process.

Due to the above concers, WHO headquarters issued a briefing recently stating that the regulatory procedures in place for the licensing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality controls.

For those concerned about the safety of the H1N1 vaccine and/or its manufacturing process, here are some useful resources for further study:

WHO latest briefing on the safety of pandemic vaccines

Pandemic influenza vaccine manufacturing process and timeline

1.  CDC’s MMWR (Morbidity and Mortality Weekly Report):  Most people are aware of the Centers for Disease Control (CDC) Website, but few seem to know of CDC’s weekly online publication known as the MMWR.  MMWR is often referred to as “The voice of CDC,” and is CDC’s main method of publishing timely and useful public health information and recommendations that have been received by CDC from the state health departments.  Each issue covers reports that have been received in the week through Friday, that are then  published on the following Friday.  This is an invaluable site to have on hand, especially with respect to issues concerning emerging infectious- or  other critical- diseases of public health concern.  You can subscribe to the MMWR for free using the link above.

2.   Indiana University Division of Clinical Pharmacology (The Cytochrome P450 Table):  While this site may seem esoteric to most individuals not directly involved in the field of Medicine, it is in fact a valuable site for all.  Why?  In a nutshell – The Cytochrome P450 is a family of 60 plus enzymes that the body uses to break down toxins and drug metabolites.  Occasionally, individuals may be on several drugs that may use the same family of enzymes (i.e. The Cytochrome P450 family) for detoxification of the metabolites of the ingested drugs.  In non-technical terms, this can lead to drugs competing for the same enzyme system for clearance of their metabolites, and this is a situation that can be life-threatening.   This is a complex topic, and my objective here is primarily to make you aware that this is an important issue to be aware of, especially if you are taking multiple drugs  for several different conditions at the same time.   You can download The Cytochrome P450 Drug Interaction Table and take it to your physician in the event you have concerns about drug interactions.  Please be sure to read the Disclaimer stated by Indiana University at the bottom of link 2 above. 

3.  FDA/Drugs:  Another useful site to have on hand with respect to information on drug recalls and alerts, drug approvals and clearances, and for critical emerging information on drug-related topics is the FDA/Drugs site.  You can report a serious medical problem related to a drug at this site, and can also have access to regularly updated, often life-saving information on drug safety.

AND NOW…ONTO A COUPLE OF SITES ON FOOD AND HEALTH:

4.  Harvard’s The Nutrition Source:  Enjoy Harvard School of Public Health’s The Nutrition Source – a website maintained by the Department of Nutrition at Harvard.  This site provides valuable tips on healthy eating based on a body of solid, scientific research.

5.  Eat Well Guide:  Sustainable Table’s Eat Well Guide helps you find local, sustainable or organic food anytime, anywhere in the U.S. and Canada.  A great resource to have on hand to find farm fresh food, local farmer’s markets, and restaurants simply by entering your zip code in the search feature on the Eat Well Guide.  If you are planning a trip, Eat Well Everywhere can help you with a printable map of the best local food markets on your travel itinerary. 

Quality health sites can provide information that may be of lasting value, and occasionally, knowledge that may even be life-saving.  I am open to feedback on whether you as a reader find a post of this nature (one that refers you to valuable, non-commerical resources) beneficial, and whether you would like to see additional similar posts occasionally.

It is often easy to forget the results of review studies, as new and more compelling studies often tend to make the news headlines.  For this reason, the results presented by critical review studies are often forgotten, but are worth reiterating.  Ma and Chapman’s paper entitled A systematic review of the effect of diet in prostate cancer prevention and treatment  reviewed the data for dietary-based therapy in the prevention of Prostate Cancer with an aim to provide clarity surrounding the role of diet in preventing and treating Prostate Cancer.  Salient conclusions derived from this review indicated that a diet that may be effective in preventing Prostate Cancer is one that is:

1.  Low in fat

2.  High in vegetables and fruits

3.  Low in an overall energy intake

4.  Low in meat consumption, and

5.  Low in dairy products and calcium intake.

More specifically, according to the review – the consumption of tomatoes, cauliflower, broccoli, green tea, and vitamins including Vitamin E and selenium seemed to propose a decreased risk of Prostate Cancer; whereas the consumption of highly processed or charcoaled meats, dairy products, and fats seemed to be correlated with Prostate Cancer.

Although no single study – or even one that is a systematic review of other studies – can generally give us all the information we may want to have in order to make an unequivocal connection between the variables of interest; the point of this post is this:  In Epidemiology, as in many other fields, researchers look for “consistency of evidence.”  This means that as we gather together a body of scientifically sound studies, we look for valuable corroborative information that often supports previously obtained results.  In the case of the association between diet and Prostate Cancer, it now appears quite clear that undertaking dietary modifications in line with the guidelines suggested above generally has a beneficial effect for most individuals – both with respect to the prevention of this cancer, as well as in its management in the event of an occurrence. 

Finally, although the above guidelines are useful, they are cursory in nature, and there is certainly a lot more to learn about how to prevent Prostate Cancer pro-actively, or manage it effectively in the event it has already occurred.  An excellent book that may benefit many to that end is Dr. Katz Guide to Prostate Health – From Conventional to Holistic Therapies (Author: Aaron Katz, MD/Freedom Press).  

In the final analysis, being truly well-informed, well-read, and therefore, well-equipped is perhaps the best aresenal to beat most any chronic disease.  Take the time to become so equipped.

Notes:

Ma et al. A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics, 2009; 22 (3): 187 DOI: 10.1111/j.1365-277X.2009.00946.x

1.  WHOLE GRAINS EQUAL LESS HEART DISEASE:  Several studies have helped us to understand and confirm the connection between whole grain consumption and reduced rates of heart disease.  Studies published in the Journal of the American Medical Association (JAMA) and the American Journal of Clinical Nutrition (AJCN) in 1999 reported that women in the Nurses’ Health Study who ate the most whole grain foods ( an average of 2.5 servings a day), were 30% less likely to develop heart disease than women eating the fewest (about 1 serving a week).  It is estimated that eating a bowl of breakfast cereal that contains about 5 grams of fiber cuts the chance of heart disease by about one-third.  These results are ratified by other high quality epidemiologic studies as well.

2.  REGULAR WHOLE GRAIN CONSUMPTION SIGNIFICANTLY REDUCES THE RISK OF DEVELOPING TYPE 2 DIABETES:  Epidemiologic research unequivocally suggests that whole grain consumption is fundamental to keeping the body’s blood sugar levels in the ideal range.  Harvard’s Nurses’ Health Study as well as the Health Professionals Follow-Up Study confirmed that those who ate the most cereal fiber from grains (about 7.5 grams per day – which translates to approximately a bowl of oatmeal and 2 slices of whole grain bread) were 30% less likely to develop Type 2 diabetes as compared to those who ate the least grain fiber (less than 2.5 grams per day).  Conversely, the consumption of a combination of low cereal fiber and a high sugar load (from white bread, colas, white rice, etc.) more than doubled the risk of developing Type 2 diabetes.

3.  WHOLE GRAINS HELP WARD OFF MANY CANCERS:  Meta-analyses (several “pooled” analyses) of many epidemiologic studies suggest clearly that whole-grain consumption reduces the risk of developing several cancers  including stomach, colon, mouth, gall-bladder, and ovarian cancer(s).  The pathways through which whole grains protect against all these conditions are not fully understood, but research suggests that the many components of whole grains such as B-vitamins, phytoestrogens, fiber, etc. may all be involved in offering protection against several cancers.

4.  WHOLE GRAINS CAN HELP ALLEVIATE DIFFICULT MENOPAUSAL SYMPTOMS:  For most women, one of the central problems associated with menopause is the fluctuation in estrogen levels that occurs during this stage of life, and the simultaneous bone-loss that often occurs.  Research suggests that fortification of the diet during this time with high quality calcium and magnesium rich foods can help blunt bone-loss, relieve symptoms such as head-aches, and also regulate blood pressure levels.  The bran layer of many whole grains contains essential minerals such as calcium, magnesium, copper, selenium, and manganese – all of which play crucial roles in maintaining metabolic and hormonal health.  Women going through menopause should therefore pay especially close attention to the regular consumption of whole grains.

PUTTING IT INTO PRACTICE

The points made above ought to motivate us all to make a more concerted effort to include a variety of whole grains in our meals.  But, old habits often die hard, and most Americans are hard-wired to eating refined foods.  Here are 5 simple suggestions that will help you make a jump-start on improving your whole grain consumption:

1.  THINK BREAKFAST:  Always start the day with a whole-grain based breakfast.  You can have a bowl of cold whole-grain cereal or a hot cereal made with a mixture of whole grains.  Numerous varieties are now available in whole-foods stores.  Look for oats that have been steel-cut (rather than instant or quick oats) and/or other cereal mixes that contain whole wheat, barley, oats, or whole rye meal.

2.  SNACK ON WHOLE GRAIN-BASED FOODS:  A small lunch or snack can easily consist of a whole-wheat pita pocket with roasted red pepper (or other) hummus, avocado slices, and fresh lettuce/watercress/other greens.  Also, look for 100% whole grain crackers and try them with a little organic goat cheese or freshly made hummus  – Delicious and Nutritious!

3.  TRY HIGH QUALITY, WHOLE GRAIN PASTA:  Do you think that whole  grain pasta tastes too heavy?  Here are a couple of ideas – Try whole-wheat thin spaghetti or angel-hair pasta  rather than “regular” spaghetti, and occasionally, try some of the imported Italian brands.  The thinner versions of the pasta lighten the taste of the whole wheat, and for now, there appears to be a broader selection of these foods in the imported brands. 

4.  LOOK FOR 100% WHOLE GRAIN BREADS:  With more customers asking for whole foods, American grocery stores are adding newer varieties of whole grain breads regularly.  However, it can take a while to decipher the labels on breads.  Whenever possible, buy breads that contain 100% stone-ground whole wheat or other grain flours (as the first ingredient), and look for varieties that are NOT loaded with enriched flour.

5.  STRETCH AND EXPLORE UNFAMILIAR GRAINS!:  There is a whole world of fabulous whole grains out there - Sadly, most individuals in the West are not familiar with them.   Growing up in India, I was exceptionally fortunate to learn how to use what (at that time) seemed like a nearly infinite variety of grains that were used in unimaginably delicious ways.  Consequently, one of my passions is to share that wealth of knowledge with my Western friends and audiences.  As both a passionate chef as well as a research-scientist, I see this knowledge as being of a kind that simply must be shared. 

I’ll conclude this post with a question that I have been asked more often than I can remember: “I want to eat whole grains, but, what exists past whole wheat flour?”  To begin with, a treasure of grains such as whole barley, millet, rye, an unending variety of lentil flours, and combinations of lentil and whole grain flours used for making uncommonly delicious flat breads.  All of these foods provide an unparalleled bounty of taste and health.  I am aware that manyof these foods may be alien to most in the West, but this is a treasure worth learning about and tapping into.   In both my upcoming book, as well as in future posts, I will write frequently on the subject of whole foods.  So, stay tuned for fabulous, one-of-a-kind mouth-watering whole foods recipes from around the globe, as well as other ideas on how to use whole grains and whole foods for creating a lifetime of  vibrant health. 

Until then, Bon Appétit!

Based on several scientific studies listed on their site, The Environmental Working Group (EWG) asserts that different pesticides in the foods we eat have been linked to a variety of toxic effects, including nervous system disorders, hormonal and carcinogenic effects, and skin, eye, and lung irritation.  The EWG claims that the acceptable pesticide residue levels for fruits and vegetables established by the The Environmental Protection Agency (EPA) are too high, and that not enough studies have been done to measure the effects of low-level and multiple pesticide exposure – a reason that warrants due caution with respect to pesticide intake through foods.

On their website, the EWG presents The Shopper’s Guide to Pesticides that ranks pesticide contamination for 47 popular fruits and vegetables based on an analysis of 87,000 tests for pesticides on these foods, conducted from 2000 to 2007 by the U.S. Department of Agriculture and the Food and Drug Administration.  They state that nearly all the studies used to create the list test produce after it has been rinsed or peeled.  You can view more details on the methodology used to create this guide at the EWG website.

As an epidemiologist, I am inclined in this case to agree with the conclusions arrived at by the EWG.  Pesticides – though often considered a necessary evil – are by definition agents that have an inherent toxicity.  For this reason, it makes sense to minimize our exposure to these agents.  And, precisely because we do not have long-term studies or data to help us decisively know to what extent ingestion of pesticides may be harmful, it seems only prudent for us to err on the side of caution.  To that end, the EWG has created a useful guide.

On the left is a list of “The Dirty Dozen” or the fruits and vegetables found to be most contaminated with pesticides.  It makes good sense to try to buy the organic versions of these foods, whenever possible.  The guide also lists “The Clean 15″ – a list of fruits and vegetables that have been found to be the least contaminated when grown conventionally.  EWG simulation studies show that by avoiding the top twelve most contaminated fruits and vegetables and eating the least contaminated ones instead, consumers can lower their pesticide exposure by nearly 80%.

As a closing note, I fail to see why the matter of minimizing our pesticide intake through choosing certain foods is one that  is surrounded by as much controversy as it is.  In matters pertaining to our health and well-being, when we do not have “all the information” we would like to have, it is prudent to do what we can (based on what we do know) to minimize our risk to exposures that may have the potential for harm – perhaps even significant harm.   And, I might add that in the final analysis, minimizing risks is what health research is all about.

Is it ever an error to err on the side of safety on issues that may have a direct bearing on our very life and health?  I think not.  And you? – What say you?

Notes:

(1)  http://www.cancer.gov/newscenter/pressreleases/AgricultureHealthStudy

(2)  http://www.cancer.gov/newscenter/pressreleases/AHSmyeloma

Resources:

Shopper’s Guide to Pesticides Full List

Results of this study are noteworthy for several reasons.  This was a prospective cohort study with a large sample size.  In this study, researchers followed 60,075 women for more than nine years.  These women were participants in the cohort of the Nurses’ Health Study II from 1997 to 2005.  Due to the fact that data from large, prospective cohort studies had thus far been lacking to study the relationship between lactation and incidence of premenopausal breast cancer; this study adds significantly to our body of knowledge on this subject.

Researchers in this study found that breast-feeding did not affect premenopausal breast cancer risk for women who didn’t have breast cancer in their family.  However, for women with at least one close relative with breast cancer — a sister, mother, or daughter – breast-feeding cut the risk of premenopausal cancer by 59 percent compared to those who didn’t breast-feed.   The main results of the study suggest that:

 1) Nursing can cut the risk of breast cancer in more than half for high-risk women, and

2) The effect of breast-feeding may be the equivalent of taking the drug Tamoxifen for 5 years in those who are at high-risk for breast cancer.

Given that at present, the only conventional options for pro-actively preventing breast cancer for women who are at high risk are Tamoxifen use or Prophylactic Mastectomy – the results of this study represent good news. 

My comments:  This study supports previous observational data on the inverse association between lactation and premenopausal breast cancer; its results are thus confirmatory in nature.  Still, it is important to bear in mind that it is generally not feasible, or even possible, for any one study to rule out all confounding variables that contribute to either the genesis or the prevention of disease.   For example: Nutritional status, body weight, and lifestyle factors are relevant variables in either the genesis or the prevention of breast and other cancers.  It is difficult to know to what extent these other factors may also have played a role in the lower rates of cancer among the high-risk, breast-feeding women. 

The bottom-line:  Based on the evidence thus far, breast-feeding is highly advisable, especially for women who have a family history of breast cancer.  In light of the larger body of research, close attention to maintaining body weight at a normal level, as well as achieving an optimal nutritional status is equally advisable.

Resources:

Lactation and Incidence of Premenopausal Breast Cancer

The Novel H1N1 vaccine will be available shortly; however, in the meantime, a few cautions bear reiterating as students and teachers get ready to return to school this week.   Here are the top 5 things you can do to protect yourself pro-actively from catching the virus:

1.  Consciously take several breaks during the day to wash your hand frequently with soap.  Encourage children to do the same.

2.  Do not touch your nose, eyes, or mouth unless you have thoroughly washed your hands.  Avoid hand-to-face contact to the extent possible.

3.  If anyone around you is coughing, sneezing, or has other flu symptoms, deliberately avoid close contact with them.

4.  Carry your own water bottle(s) rather than drink from a community water fountain.  Do not share your water bottle with others.

5.  If there is a Swine Flu breakout in your community, avoid being in public places or large gatherings.  If possible, stay home from work or school temporarily, and avoid traveling by public transportation.

The  simple precautions above can help you to improve your chances of warding off the virus significantly.  In addition to the resources from the Centers for Disease Control provided previously, you may also want to refer to the following special resources from The Harvard Medical School:

1.  A report, entitled:  Swine (H1N1) Flu: How to understand your risk and protect your health.  This report has been prepared by the editors of the Harvard Health Publications in consultation with Raphael Dolin, M.D., Professor of Medicine, Harvard Medical School.

2.  Special health report, entitled: Viruses and Infectious Diseases: Protecting yourself from the invisible enemy.  This report has been prepared by the editors of Harvard Health Publications in collaboration with Michael N. Starnbach, Ph.D., Professor of Microbiology, Harvard Medical School.

Stay safe, stay well-informed, and protect yourself.

1)  Participants who had high cholesterol, or a value of 240 mg/dl or more, had a 66 percent greater risk of developing Alzheimer’s Disease later in life, and

2)  People with borderline-high cholesterol, between 200 and 239 mg/dl, had a 25 percent spike in risk.

This study merits our attention for two reasons:  First, although previous studies have linked heart and brain health, this is one of the first studies to examine the association between borderline high cholesterol levels and dementia.  Second, the study’s sample size and design weigh in its favor.  Long-term cohort studies (also known as Prospective Studies) that:  i)  have a substantial sample size;  ii) measure study endpoints both through and at the completion of a considerable length of time (in this case, four decades);  iii) control for important confounding variables; and, iv) do so across a diverse study population – give us some of the most valuable information in research.

As millions of individuals in Western nations have borderline or high cholesterol levels during mid-life, I am certain that many may be alarmed by the results of this study.  The good news, however, is that for most individuals, a combination of sound dietary habits, moderate exercise, and a conscious effort to reduce stress levels can help achieve healthy – or even optimal – cholesterol profiles.  Further, a large body of corroborative epidemiologic research suggests that a diet rich in quality whole grains, abundant fresh fruit and vegetables, mono-unsaturated fats such as olive oil, largely vegetarian proteins such as legumes, and a limited amount of red meat can contribute substantially to achieving a healthy lipid profile.

By now, we know what a quality whole-foods diet (that is based largely on plant foods) and moderate daily exercise can do for us.  This study is one more reason to – Just do it!

The above study was founded on the premise that in spite of the growing consumer demand for organic foods, accurate information regarding the nutritional quality of organic foods is lacking.  The study sought to quantitatively assess the differences in reported nutrient content between organically and conventionally produced foodstuffs.  To accomplish this task, study researchers identified 162 studies (137 crops and 25 livestock products) and deemed 55 of these studies to be of satisfactory quality for actual analysis.  Here are the main results of the study:

1.  Conventionally produced crops had a significantly higher content of nitrogen, and organically produced crops had a significantly higher content of phosphorus and higher titratable acidity, and no evidence of a difference was detected for the remaining 8 of 11 crop nutrient categories analyzed.

2.  Analysis of the more limited database on livestock products found no evidence of a difference in nutrient content between organically and conventionally produced livestock products.

In light of the above results, the conclusion of the study reads as follows:  On the basis of a systematic review of studies of satisfactory quality, there is no evidence of a difference in nutrient quality between organically and conventionally produced foodstuffs.  The small differences in nutrient content detected are biologically plausible and mostly relate to differences in production methods.

The point of this post?  As an epidemiologist and a researcher myself, I am greatly intrigued by the results of this study, and feel that it is necessary to comment on it constructively.  Researchers in this study sought to compare the nutrient content between conventionally and organically grown foods, and essentially concluded that there was no evidence of meaningful nutrient differences between the two; Further, if small differences did exist, they would be because of differences in production methods. 

The point I would like to make here is this:  Production methods are precisely the point of departure, and the key difference between conventionally and organically grown foods, and they do matter.  While I applaud the researchers for doing a nutrient quality comparison between conventionally and organically grown foods, it is important to point out that there are several other endpoints that are relevant to health – which were not part of this study.  And, they do indeed relate to production methods.  Here are just a few of the many questions that still remain unanswered:

1.  Did conventional foods and livestock products have higher amounts of antibiotic, hormone, or pesticide residues?

2.  Did foods produced by conventional methods involve the use of Genetically Modified Organisms (GMO’s)?

3.  Was there a perceptible difference in taste quality between conventionally and organically grown foods? 

While the nutrient quality of foods is of great importance, I believe that there are numerous other “confounding” variables that are perhaps equally, if not more relevant, to our long-term health.  The reality is that the cumulative effects of the regular consumption of foods that may have measurable amounts of antibiotics, hormones, or pesticide residues are largely unknown, and there is sufficient epidemiologic evidence to reasonably conclude that the effects of these agents may be deleterious to our long-term health.  Further, many conventional methods of food production utilize GMO’s – the long term effects of which are also unknown.  Thus, prudence demands that we consider the comparison of these critically important factors as well in future studies.  

One of the key principles in the study of Epidemiology is always to remain acutely aware of what we have “left out” in a study.  The study under discussion successfully met its stated objective of nutrient comparison between organic and conventional foods.  However, if we are to use this study’s conclusion as a guideline to long-term health, we must keep in mind the variables that were either: 1) clearly outside of the purview of this particular study, and/or 2) still remain to be examined in future studies.

I wouldn’t consider an occasional (or regular) splurge on organic tomatoes or peaches a waste yet!  Notwithstanding some of the important reasons outlined above, the generally accepted superior freshness, taste, and flavor of locally and often sustainably produced organic foods are sufficient reasons for us to enjoy them still.

Resources: 

AJCN Study Abstract

Here – in a nutshell – is the summary of a problem that is unlike one that has ever been faced previously by mankind in history:  Starting in the Winter of 2006, millions of bees vanished without a trace from their hives across the United States and Europe, and are still continuing to do so.  The disappearance of the  honey bees - who are the  indispensable pollinators of fruits and vegetables – has left billions of dollars of crops at risk and has threatened our food supply in a manner that has never been experienced before.  Given the unprecedented nature of the  problem, and the agricultural nightmare that looms ahead with the loss of the vast majority of fruits and vegetables, scientists are now scrambling to understand the causes behind the disappearance of the honey bees - both in the West, as well as in many other parts of the globe.

One of the main causes that has been identified as being responsible for the disappearance of the honey bees is referred to as CCD or Colony Collapse Disorder.  It has been confirmed that a virus known as IAPV has been found in all CCD hives.  The origin of this virus is in Israel; thus, it remains to be understood how this particular virus made it to the U.S. hives.  Other possible causes of the disappearance of the bees are under study as well.  These include understanding whether the mass relocation/transportation of bees in the service of Industrialized agriculture, high crop yield, and efficiency of production has contributed to a loss of immunity in the bees, resulting in their premature death.

The problem we are left to face is an enormous one.  Scientists featured in the PBS documentary warn that if we are unable to stop the further loss of bees, we are faced with the loss of the very foods (fruits, nuts, and vegetables) that protect us from chronic illnesses.  The reality is that there are no known means to pollinate the blossoms of fruit or nut trees that can begin to compare with the efficiency of honey bees.  As an example, a hive of bees pollinates 3 million flowers a day; however, when an effort is made to pollinate flowers manually, it has been estimated that one human being can pollinate a maximum of only 3 trees a day.  Further, it is estimated that to replace honey bees with human or artificial pollinators would cost about 90 billion dollars a year in the U.S. alone; and even so, such an effort may not be sustainable for long.

The bottom line?   It is amply evident that now is the time for us to put in concerted effort and resources into finding a viable solution to this very serious problem, which,  if left unchecked, is expected to turn into a global crisis.  It is estimated that if the bees continue to disappear at the current rate, the honey bee population in the United States will cease to exist by the year 2035.

What can you do to help the bees, and both our current and future food supply?

1.  Become informed about the gravity of the problem – View The Silence of the Bees.

2.  Learn how you can help by visiting the PBS Nature Site.

3.  Check out the Web and Print Resources designed to create awareness and action steps to address this problem.

4.  Support sustainable agricultural practices that have for centuries preserved the health of honey bees.

5.  Share this post, related information, and the PBS documentary with concerned others.

Our health, our future, and the future of our food supply rests in our own hands.

1.  Pregnant women

2.  People who live with or care for children younger than 6 months of age

3.  Health care and emergency services personnel

4.  Persons between the ages of 6 months through 24 years of age, and

5.  People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

The population groups outlined above total approximately 159 million people in the U.S.  Although a shortage in the supply of the novel H1N1 vaccine is not expected, it is believed that initially the availability of – and demand for – the vaccine may be unpredictable.  For this reason, the Committee has provided additional guidelines in the event the vaccine is available in limited quantities, especially initially, and has recommended that in such a case the following groups receive the vaccine before others:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Health care and emergency services personnel with direct patient contact
• Children 6 months through 4 years of age, and
• Children 5 through 18 years of age who have chronic medical conditions.

It has been further recommended that once the demand for vaccine for the prioritized groups has been met at the local level, providers should begin vaccinating everyone from ages 25 through 64 years.

In light of the above guidelines, the most frequent question seems to be one that expresses concern as to whether the novel H1N1 vaccine is meant to replace the seasonal flu vaccine.  The answer to that question is:  The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine; rather, it is intended to be used alongside the seasonal flu vaccine.  Further, CDC guidelines state that both vaccines may be administered on the same day.

Individuals dealing with specific conditions such as Cardiovascular disease or HIV infection, and groups that may have special needs such as clinicians, child-care providers, etc. should refer to the following key resources for valuable additional information. 

Resources/Further Information:

Read the full CDC Press Release

H1N1 Flu – Important information for specific groups

Information on Antiviral drugs; Self and patient care in the event of an H1N1 infection.

In light of the rapid spread of the H1N1 virus in England, a great amount of concern seems to be developing here in the U.S.  Of greatest concern is the issue of children returing to school during what is considered “peak” flu season.  Although anti-viral medications are available, I sense that there is a great deal of panic surrounding the issue of children contracting the virus in the upcoming Fall months.  Over the weekend, I received numerous e-mails inquiring about the best way(s) to be prepared to deal with a possible infection.

To answer the above, I would like to refer all readers to the Centers for Disease Control Q & A site:  Novel H1N1 Flu and You.   This site should answer all your questions authoritatively and equip you well. 

Panic is never the answer; but being well-armed with knowledge is.  Please stay informed, and pass on the link to all who may benefit.

Due to the fact that the Swine Flu virus has very significant potential to cause illness or hospitalizations, the effort is to have the vaccine tested for safety and effectiveness prior to the flu season — which is officially considered to be in the Fall and Winter.  Upcoming clinical trials are expected to enroll 1000 adults and children at 10 centers around the country.  Additional trials may also be undertaken to test how the Swine Flu vaccine works in combination with the seasonal flu vaccine.

A couple of tips to all concerned as we approach the Fall season:

1.  Like other flu types, H1N1 is thought to be spread mainly from person to person through coughing or sneezing.  Simple precautions of covering one’s nose and mouth while coughing/sneezing, and good hygiene (washing hands frequently) are common sense precautions that all should follow.

2.  CDC recommends that if you are sick, or suspect you are, you must stay at home to prevent the spread of infection to others. 

3.  Stay updated regularly with respect to news on this topic.  Being informed is on top of the list with this pandemic.  The CDC hotline for this subject is 1-800-CDC-INFO.

The alarm surrounding the Swine Flu crisis is due to the fact that the H1N1 virus has spread around the world with unprecedented speed.  WHO has reported that past influenza viruses have needed more than six months to spread as widely as the current H1N1 virus has spread in less than six weeks.

The first human trials of a Swine Flu vaccine are commencing today (Wednesday, 7/22)  in Melbourne, Australia.  The vaccine for the H1N1 virus will be tested on 240 volunteers.  Scientists believe that the H1N1 is a new strain of a tenacious virus that may require a higher and more frequent dosing to generate the desirable immune response in humans.

Let us hope that the results from the vaccine testing are positive.  In the meantime, please stay informed and protect yourself by keeping on top of important news on the subject.  Stay tuned here for critical updates, or check the following authoritative resources for more information.

H1N1 Flu Situation Update from CDC

Critical Information on Preventing H1N1 Infection

CDC Contact Numbers/Information for Reporting Cases

To celebrate, and to kick off our WHOLE FOODS SERIES today, I won’t embellish on research as I usually do.  How about we just start off with a fabulous, but simple whole foods breakfast recipe, and in a day or so, we’ll talk about why it’s so good for you.

Getting a delicious and satisfying breakfast can be hard, especially in the rush of the morning, but this simple recipe just might make you put your RTE cereals aside for a long hiatus!   And, you can be assured that it will nourish you far better than anything else you can get in the limited time often available for breakfast in the morning.  Here it is:

BLUEBERRY PACKED GRANOLA AND YOGURT TREAT

8 oz.  Organic Plain Non-Fat Yogurt (Buy a brand that has abundant live cultures)

1/2 -3/4  Cup Frozen Wild or Maine Blueberries

1-2  Tea sp.  100% Pure Maple Syrup

1/4  Tea sp. Pure Vanilla Essence (Optional)

1  Packet Nature Valley (or other very high quality) Oats and Honey Granola Bars (2 bars)

1  Tea sp. crushed flax seeds (Crushed seeds can be purchased and kept in the refrigerator, or you can purchase whole organic flax seeds and crush them at home in a coffee-grinder)

PREPARATION: 

1.  Let blueberries thaw slightly at room temperature.

2.  Next, crush the granola bars coarsely or finely (according to taste/preference).  Set aside.

3.  In an attractive glass bowl, blend the yogurt with the maple syrup and vanilla till it has a very smooth consistency.

4.  Add the crushed granola and the crushed flax seeds to the yogurt mix, and stir in gently.

5.  Top with the semi-thawed blueberries (They should be juicy, but slightly crunchy)

6.  ENJOY a morning treat that feels like you are eating ice-cream; the difference being that it is packed full of energy, nutrition, and good health!

If you streamline the above recipe (i.e. have all ingredients on hand ahead of time), it should take no more than 5-7 minutes to prepare this delicious treat.  Feed it to your kids as well — It beats any pop-tarts or frozen breakfasts you may be giving them in the interest of saving time.

In the next post, I will talk about what it really means to call a food WHOLE, why it matters so very much, and why the recipe you just read can do you good.   

Until then, Bon Appétit!