New York Times' Columnist Travels To Africa

I've been following New York Times' columnist Nicholas Kristof on Facebook. If you have a Facebook account, you can follow him, or "fan" him at: http://www.facebook.com/kristof

He just arrived home from a trip to 5 west African countries with a sophomore from the University of South Carolina, Paul Bowers, who won a trip to accompany him.

Several of their reports focused on nutrition - the outstanding lack of it. Here's one of their videos from Sierra Leone:


Many of the commenters on Kristof's blog On The Ground, Facebook account, and Times' articles expressed sadness, outrage, and desire to help. There was one comment that stood out for me. I hope the author doesn't mind me sharing it. It was from the blog post, Malnutrition and the Economic Crisis:

"Seldom is the story of a starving child in Africa only about that starving child and his or her lack of food. It is emblematic of a profound break down in community that signals every aspect of human rights violations, abusive governments, poverty — and the misspending of Western funds.* It’s a complex problem not dealt with solely by putting iodine in water or zinc in flour."

* I'll add unfair trade practices and inequitable effects of climate change to this.

The problem is big, it's complex, but it's not intractable.

Here's another comment that struck me, although not in a positive way. When I mentioned the need for aid to developing countries, someone replied:

"Let them eat local. They should grow their own. The US can't be feeding the world's population."

Is this reflective of the locavore movement? If so, then it has either lost its way, or I've lost my understanding of it. The local food movement grew from the broader sustainability movement. Sustainability means meeting the needs of the present, as well as the future. Right now, we're not meeting the needs of the present.

I question a movement for which it's more important that someone eat "the best and most delicious food" grown locally, than whether someone has food at all, especially when that someone's lack of food is in part our doing:

"Around 45 million of the 900 million people estimated to be chronically hungry are suffering due to climate change." And ... "The vast majority of deaths [due to climate change] -- 99 percent -- are in developing countries which are estimated to have contributed less than one percent of the world's total carbon emissions."
- Report: Climate Change Crisis 'Catastrophic'

How can crops be grown, self-reliant food economies established, if the ground available to plant is being decimated by rich countries' greenhouse gas emissions?

Aid has many forms. I believe the US and other rich nations do have a responsibility to aid the world's hungry. Unfortunately, much of the aid we've promised to help people cope with droughts, floods, heatwaves, and other climate disasters hasn't been sent:

"World's richest countries have pledged nearly $18bn* to help poorer countries adapt to climate change, but less than $1bn has been disbursed."
- Rich Nations Failing To Meet Climate Aid Pledges

* The UN estimates $50-70 billion is needed immediately just to tackle effects due to climate change.

And this aid is distinct from other forms of aid that impact nutrition - aid to relieve effects of poverty, lack of education, and healthcare.

It's nice to see someone with Mr. Kristof's reach drawing attention to this topic.
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Dalai Llama Enjoys Meditating On The Treadmill

Dalai Llama's morning routine includes a little treadmill, "sometimes 30 minutes."

"After getting all sweat. Then, very, very, how to say, eager, to shower."

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Contaminated Drinking Water May Increase Risk For Cancer

ElDoubleVee, that polluted water guess is a good one. I was working on something about diabetes (arsenic in water is linked to type 2 diabetes) and stumbled across this:¹

It shows contamination of well water by Volatile Organic Compounds (VOCs). "VOCs come from a wide variety of sources, including gasoline, plastics, paints, dyes, solvents, adhesives, insecticides, and spot removers."

This study only tested 2401 wells, between 1991 and 2002. A pittance, since "about 400,000 new wells are drilled every year." Of those 2401:

"65% had detectable levels of VOCs, and 1% had levels above the EPA [limit]."

Exposure to VOCs is a known risk factor for cancer: EPA: Drinking water Contaminants.

So, except for California and the Northwest, there does seem to be a gross correlation between this and the map of colon cancer rates in my previous post.
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This doesn't let public water off the hook. Municipal water is chlorinated to kill microorganisms. Byproducts of chlorination include a group of compounds called trihalomethanes:

"Studies conducted at NIEHS have shown that administration of certain trihalomethanes, by-products of water chlorination, and several brominated chemicals cause colorectal cancer in experimental animals. Epidemiologic studies now suggest a link between the consumption of chlorinated water and increased human risk for colorectal cancer."
- Trihalomethanes and Colorectal Cancer, and Trihalomethanes and Other Environmental Factors That Contribute to Colorectal Cancer, Environmental health Perspective, 1994.

Yep, that water guess has merit.
________¹ VOCs Turn Up in Well Water: Sensitive Measure Reveals Groundwater Contaminant, Environmental Health Perspectives, 2007.

How Would You Categorize Your Diet?

Your diet:

1. Vegan (no food from animal sources)
2. Vegetarian (vegan plus eggs, dairy, and honey)
3. Pescetarian (vegetarian plus seafood)
4. Flexitarian (vegetarian who occasionally eats meat)
5. Omnivore (most foods)
6. Carnivore (emphasis on animal foods)

There's a poll for this question on the sidebar. I've added this post for a place to comment.


Results:

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Photo of boy eating stink bugs in Indonesia from NOVA: Bugs You Can Eat. The caption read:

"If one must, it's advisable to begin by eating insects that crisp up well when roasted. I wouldn't suggest starting with anything too chewy, like a worm, or too fleshy, like cicadas. You want to ease into the experience while not making a total fool of yourself. It's helpful if the people with whom you are feasting are under the age of ten. They will be paying more attention to the meal at hand than to you. … Stink bugs fit the category of crispy insect. … The taste experience is rather like eating a bitter sunflower seed, shell and all, without salt. I chew quickly."

Vegetarianism And Cancer

Much of this May issue of the American Journal of Clinical Nutrition concentrated on vegetarian diets. Below are three that address RB's question about colon cancer and vegan diets. Although they looked at vegetarianism (includes eggs and dairy), not veganism (excludes eggs and dairy):

1. Fruit, Vegetables, And Colorectal Cancer Risk: The European Prospective Investigation Into Cancer And Nutrition

This was the EPIC study (10 European countries), 452,755 men and women completed a dietary questionnaire in 1992–2000 and were followed for cancer incidence and mortality until 2006.

"The association between fruit and vegetable consumption and colorectal cancer risk was inverse in never and former smokers, but positive in current smokers."

2. Cancer Incidence In Vegetarians: Results From The European Prospective Investigation Into Cancer And Nutrition (EPIC-Oxford)

This was an arm of the EPIC study (only the United Kingdom), 63,550 men and women recruited throughout the 1990s.

"The overall cancer incidence rates of both the vegetarians and the nonvegetarians in this study are low compared with national rates. Within the study, the incidence of all cancers combined was lower among vegetarians than among meat eaters, but the incidence of colorectal cancer was higher in vegetarians than in meat eaters."

3. Vegetarian Diets: What Do We Know Of Their Effects On Common Chronic Diseases?

This was a review of this issues' findings.

"A number of studies have evaluated the health of vegetarians. Others have studied the health effects of foods that are preferred or avoided by vegetarians. The purpose of this review is to look critically at the evidence on the health effects of vegetarian diets and to seek possible explanations where results appear to conflict. There is convincing evidence that vegetarians have lower rates of coronary heart disease, largely explained by low LDL cholesterol, probable lower rates of hypertension and diabetes mellitus, and lower prevalence of obesity. Overall, their cancer rates appear to be moderately lower than others living in the same communities, and life expectancy appears to be greater. However, results for specific cancers are much less convincing and require more study. There is evidence that risk of colorectal cancer is lower in vegetarians and in those who eat less meat; however, results from British vegetarians presently disagree, and this needs explanation. It is probable that using the label "vegetarian" as a dietary category is too broad and that our understanding will be served well by dividing vegetarians into more descriptive subtypes. Although vegetarian diets are healthful and are associated with lower risk of several chronic diseases, different types of vegetarians may not experience the same effects on health."

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So, the first study found that fruit and vegetable consumption was protective against colon cancer, except if you smoked. Then, oddly, eating fruit&veg increased your risk for colon cancer.

The second study found that vegetarianism was protective against all cancers, except colon cancer. In which case, not eating meat seemed to increase risk for colon cancer.

The last study, or review, reiterated previously documented benefits of vegetarianism and, as a way of explanation for the UK study in number 2 above, proposed that some vegetarian diets are better than others.

The photo I used for this post is exemplary of this last point. It could be a photo of a vegetarian meal (using vegetable-based meat analogs like tofurkey or fake bacon: "facon"), or a photo of a non-vegetarian meal with meat.
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Social Media And Public Health: The Age Factor

virginia, If I overlay your graph of colon cancer rates in the US as a function of age:

With this marketing graph of Facebook users:


I can understand a little better why the CDC posted only (exclusively) about swine flu for the first 13 days of its Facebook account, even though chronic diseases like cancer and heart disease make up a big chunk of their work.

This same marketing site says that, where about a quarter (24%) of Facebook users are 55 or older, only 1% of Twitter users are that age (although I've read elsewhere that figure may be higher, ~10%.)

No wonder I hear very little about chronic diseases on these sites.
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Colon Cancer Incidence Rates In US: 2005

Here's a map from the CDC showing incidence rates for colorectal cancer in 2005.*

I'm thinking ... If meat-eating was a strong predictor for colon cancer, rates wouldn't vary so much geographically, unless Americans' meat consumption varies geographically.

It's not that meat-eating has no effect (some other factor(s) could be weakening or strengthening effect of meat), but there's clearly more to the story. What's going on along that strip from Maine to Louisiana? And why were the coastal states spared?

* The CDC source link also shows mortality rates.
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New Research On Meat And Cancer

The American Journal of Clinical Nutrition published a couple studies on the relationship between meat and colon cancer this month. Here they are. (Keep in mind my previous post, where the former editor-in-chief of the New England Journal of Medicine said, "It is simply no longer possible to believe much of the clinical research that is published," because of industry influence.)
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1. Meta-Analysis Of Animal Fat Or Animal Protein Intake And Colorectal Cancer

This one was funded by the US National Cattlemen's Beef Association and the US National Pork Board. It looks like the engineering consulting firm Exponent was contracted to run the numbers. It was not an original study, but a meta-analysis, a reanalysis of data obtained from previously conducted studies.

It found no association:

"The available epidemiologic evidence does not appear to support an independent association between animal fat intake or animal protein intake and colorectal cancer."

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2. Heterocyclic Aromatic Amine Intake Increases Colorectal Adenoma Risk: Findings From A Prospective European Cohort Study

This one was funded by the Kurt-Eberhard-Bode-Foundation (promotes medical and science research), the European Commission, and German Cancer Aid. It was an original epidemiological study of a German subset (25,540 participants) of the European EPIC prospective cohort.

It found an association. Compounds in cooked meat raised the risk of colon cancer:

"The results support data from case-control studies of a positive association between HCA intake and colorectal adenoma risk." (HCAs are Heterocyclic Aromatic Amines that come from cooking meat or fish at high temperatures.)

"Adenoma risk also increased with the consumption of strongly or extremely browned meat."

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Corrupted Research

When a former editor-in-chief of The New England Journal of Medicine, says:

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."

It's worth paying attention.

That quotation is by former NEJM editor Dr. Marcia Angell from her review of three recent books which (including one she authored herself) shine a light on the influence businesses, in this case drug companies, have on research that appears in even the most respected, peer-reviewed science and medical journals ... and how businesses influence the behavior of medical professionals, in all fields - healthcare, research, academia, and government.

Here's her review:
Drug Companies & Doctors: A Story of Corruption, New York Review of Books, January 2009.

I'll list the books she was reviewing because I think their titles help tell the story:

• "Side Effects: A Prosecutor, A Whistleblower, And A Bestselling Antidepressant On Trial"
  by Alison Bass
  
  This is the story of pharmaceutical giant GlaxoSmithKline, who "buried evidence that its top-selling antidepressant, Paxil, was ineffective and possibly harmful." GSK agreed to settle charges of consumer fraud for $2.5 million - their cost for doing business, since Paxil continued to bring in about $3 billion a year.
  
  
• "Our Daily Meds: How The Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines And Hooked The Nation On Prescription Drugs"
  by Melody Petersen
  
  The story of how drug companies engage in "disease-mongering," convincing prospective patients and their doctors "that they have medical conditions that require long-term medical treatment." Here, Pfizer pled guilty for illegally marketing Neurontin, laying out $430 million to resolve the charges. Again, this was just the cost of doing business, since Neurontin, which was initially approved to treat epilepsy, continued to bring in billions annually - for precisely the off-market uses Pfizer illegally advanced, "bipolar disease, post-traumatic stress disorder, insomnia, restless legs syndrome, hot flashes, migraines, tension headaches, and more."
  
  
• "Shyness: How Normal Behavior Became A Sickness"
  by Christopher Lane
  
  This is another story of disease-mongering: Drug makers creating diagnoses for which drug intervention is not indicated (e.g. the diagnosis of "social anxiety disorder" for shyness), let alone adequately researched, yet proceeding to aggressively market their drugs anyway.

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Selling Pills On Inference Instead Of Science

The field of psychiatry is particularly vulnerable to disease-mongering since diagnoses are largely subjective. However, Senator Charles Grassley, who exposed damaging conflicts-of-interest in the psychiatry field, has shifted his attention to the cardiology field - where cocktails of powerful drugs are being peddled without the backing of convincing published scientific evidence. (The polypill for heart disease comes to mind. It's an untested pill containing a statin, ACE inhibitor, diuretic, aspirin, and others.)

Ways Industries Corrupt Research

There are many ways that industries influence research. One is by suppressing unfavorable results of industry-sponsored studies. Here's an example using antidepressants:

"Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive."
- Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy, NEJM, 2008

Other ways include:

• Setting up trials that are all but certain to show market worth, e.g. by comparing your drug to a placebo instead of to another similarly-classed drug.
  
  
• Writing a paper that shifts focus away from a drug's poorly substantiated primary effect to a peripheral effect that appears more favorable.
  
  
• Reanalyzing data from published studies, that is, performing a "meta-analysis," where included studies can be cherry-picked, or statistical analyses performed to deemphasize negative findings (i.e. broadening confidence intervals).

Dr. Angell says that "many reforms would be necessary to restore integrity to clinical research and medical practice. ... Many would involve changes in the FDA." I hope the new FDA Commissioner makes these reforms part of her agenda.
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Traveling Through Philadelphia

Aerial view of the I-76 Schuylkill Expressway ("The Surekill") near City Avenue (US 1):
________If you landed here looking for the real Schuylkill Expressway, there's a nice historical overview of the road at PhillyRoads.com
Photo: Bix

"I Am Thankful For Laughter, Except When Milk Comes Out Of My Nose." - Woody Allen

New research from Psychosomatic Medicine:

Divergent Effects of Laughter and Mental Stress on Arterial Stiffness and Central Hemodynamics

• Laughter decreased arterial stiffness. (Participants watched a 30-minute laughter-inducing film. Wish I could get into this study to see the film.)
  
  
• Stress increased arterial stiffness. (Participants watched a 30-minute stress-inducing film.)

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And an older one (which shows that acute stress, such as seen above, can have a prolonged effect):

Acute Mental Stress Has a Prolonged Unfavorable Effect on Arterial Stiffness and Wave Reflections, Psychosomatic Medicine, 2006

• Stress* increased arterial stiffness.
  
  * "Participants were instructed to subtract the number 7 from a 4-digit number, continuously and as quickly and as accurately as possible, for 3 minutes. During the test, participants were intentionally frustrated by being asked to perform faster and by being immediately corrected in case of wrong answers. A metronome was played loudly as an additional distracter."

Arterial stiffness is linked to blood pressure - the stiffer the arteries the higher the pressure. Stiff arteries, as well as hypertension, are also related to atherosclerosis and cardiovascular disease.

This is one reason nutritional studies are difficult to interpret. Non-dietary factors can confound results. It doesn't detract from the worth of studies; it just reveals the challenges in controlling and analyzing them.

Where health (or disease) lies on the right side of the equation, the number of variables on the left is probably innumerable.
________Photo of orangutans from the Guardian. Their gallery here.

Black Beans And Adzuki Beans

At 6:00 am:


At 11:00 am:


________Photos: Bix. I love playing with dried beans.

Stairs

________Photo: Bix

Antioxidant Supplements Might Increase Risk For Diabetes: So Say Authors Of Recent Study

There's rumbling in the diabetes community. It has to do with slowly accumulating evidence showing dietary antioxidants, e.g. vitamins C and E, interfere with the body's ability to handle glucose. This is not good news for supplement makers, not when 80 million Americans have diabetes or pre-diabetes.

How Antioxidants Interfere With Glucose Metabolism

When we exercise (or when we eat, or when we perform many metabolic tasks) we generate free radicals. This is normal. However, free radicals can harm healthy cells; they can damage DNA and cause fats in our body to oxidize, or "go rancid" as cooking oils do. DNA damage and oxidized fats are factors in the development of cancer and atherosclerosis (and so heart disease). It is this negative aspect of free radicals, their power to oxidize, that gave rise to supplemental anti-oxidants. Antioxidants prevent oxidation by neutralizing free radicals (by donating electrons, or "reducing" them).

Since production of free radicals is a natural occurrence, you'd think we've evolved mechanisms to mitigate their damage. We have. Free radicals [which usually include an oxygen molecule and are known collectively as Reactive Oxygen Species (ROS)], act as signals telling cells to make more of our own, in-house (endogenous) antioxidants - like the powerful enzymes superoxide dismutase and glutathione peroxidase.

But before they're neutralized ...

• Free radicals partake in a positive feedback loop giving us more energy. Muscles need oxygen and glucose to work. When we increase the work of our muscles, e.g. when we exercise, we increase the muscle's need for glucose and oxygen. Byproducts of muscle work are ROS ... ROS act as signals to produce more mitochondria. Mitochondria are energy-producing factories inside cells that use the glucose and oxygen the muscles take up. More mitochondria lead to --> more glucose uptake, lead to --> more energy.
  
  
• Free radicals spur the expression of genes that increase sensitivity to insulin - Done through stimulation of PPARs and other compounds. (The thiazolidiediones, a class into which the diabetes drugs Avandia and Actos fall, also stimulate PPARs.)
  
  
• Free radicals stimulate the release of the hormone adiponectin. Adiponectin is produced by our fat cells and has been shown to increase insulin sensitivity. Low levels of it correlate with increased diabetes risk.

All of these actions (endogenous antioxidant production, mitochondria manufacture, gene expression, hormone release), and others, are blocked when we consume too many antioxidants. At least, that's where the evidence is leading us.

Studies

This first one is getting a lot of attention:

Antioxidants Prevent Health-Promoting Effects Of Physical Exercise In Humans, PNAS, May 2009.

"Exercise increased parameters of insulin sensitivity only in the absence of antioxidants in both previously untrained and pretrained individuals."

"If transient increases in oxidative stress are capable of counteracting insulin resistance in humans, it is possible that preventing the formation of ROS by, for example, antioxidants might actually increase, rather than decrease, the risk of type 2 diabetes."

These authors went so far as to say:

"Published findings tentatively suggest that fruits and vegetables may exert health-promoting effects despite their antioxidant content and possibly due to other bio-active compounds." (Emphasis theirs.)

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This one I blogged about at: Vitamin C Supplementation And Exercise Don't Mix.:

Oral Administration Of Vitamin C Decreases Muscle Mitochondrial Biogenesis And Hampers Training-Induced Adaptations In Endurance Performance, AJCN, January 2008.

"Vitamin C supplementation decreases training efficiency because it prevents some cellular adaptations to exercise. [...] The common practice of taking vitamin C supplements during training (for both health-related and performance-related physical fitness) should be seriously questioned."

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How Much Is Too Much?

The DRI for vitamin C is 75 mg for women, 90 mg for men. (Both of the above studies used 1000 mg.)
The DRI for vitamin E is 15 mg, about 22 IU. (The first study used 400 IU.)

DRIs or RDAs typically contain a buffer. An estimated average requirement is multiplied by a factor to account for individual variation - to, well, play it safe.

There are about 63 mg vitamin C in a small orange.
There are about 51 mg vitamin C in a half cup of cooked broccoli.
There are about 7 mg (11 IU) vitamin E in 1 ounce of almonds.
________Photo: not of me, not by me. I can't recall from where at the moment.

Get Screened For Colon Cancer

The CDC (Centers for Disease Control and Prevention) released this video, a PSA (Public Service Announcement), of actor Terrence Howard talking about his mother's death from colon cancer. It promotes getting screened, that is, getting scoped (a colonoscopy or sigmoidoscopy) if you're 50 or older. I think it's a great idea - both the PSA and the scope.


This PSA works. It has all the necessary ingredients: good info, delivered simply - by someone with broader appeal than a doc in a lab coat. It's emotional. It implies that having good health coverage can't cure everything. And it ends with something someone can do.

I commented the above on the CDC's new Facebook page, which they started on May 1. For 13 days, the only thing they posted about was Swine Flu. So I commented, asking why they were focused solely on this one communicable disease, to the exclusion of all other diseases, notably the chronic ones - heart disease, diabetes, cancer - which kill more people in one day than swine flu has probably killed since its discovery. Shortly after that comment, this video appeared. Circumstantial, I know, but I'm going to think the CDC, and perhaps other government agencies, can be responsive to the public. Go have your say on Facebook.
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Nicotine In ... Mushrooms?

Too Much Nicotine In Wild Mushrooms: EU Watchdog, Reuters, May 11, 2009

"High nicotine concentrations were found in wild mushrooms -- mainly porcini mushrooms (Boletus edulis), but also truffles and chanterelles -- of various origins, although most of them came from China."

The European Food Safety Authority said it was unclear why nicotine, an alkaloid that occurs in tobacco, was showing up in mushrooms. They speculated, "it could be pesticide use."

"In European countries, the use of plant protection products containing nicotine as an insecticide will be phased out by the latest in June 2010, but its use in other countries may continue and may lead to residues of nicotine in food, the agency said."

I suppose this isn't something we can wash off?
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Dr. David Kessler: "That's Not Going To Make Me Feel Good. In Fact, That's Disgusting."

Remember my analogy between the Chinese endorsement of tobacco and the US endorsement of junk food (China Tells Citizens To Smoke), both to make money at the expense of health? I feel vindicated.

David Kessler, doctor, lawyer, author, and former FDA Commissioner (1990-1997) said much the same thing in his interview for the Washington Post last month:
Crave Man, April 27, 2009

"Kessler, 57, sees parallels between the tobacco and food industries. Both are manipulating consumer behavior to sell products that can harm health."

Much like nicotine in tobacco alters brain function, a link the tobacco industry has used to their advantage, Kessler says that "certain foods alter brain chemistry in ways that compel people to overeat."

"Highly palatable" foods -- those containing fat, sugar and salt -- stimulate the brain to release dopamine, the neurotransmitter associated with the pleasure center, he found. In time, the brain gets wired so that dopamine pathways light up at the mere suggestion of the food, such as driving past a fast-food restaurant, and the urge to eat the food grows insistent. Once the food is eaten, the brain releases opioids, which bring emotional relief. Together, dopamine and opioids create a pathway that can activate every time a person is reminded about the particular food. This happens regardless of whether the person is hungry."

Obstacles To Change

"For those like Kessler, the key to stopping the cycle is to rewire the brain's response to food -- not easy in a culture where unhealthy food and snacks are cheap and plentiful, portions are huge and consumers are bombarded by advertising that links these foods to fun and good times, he said."

"Deprivation only heightens the way the brain values the food, which is why dieting doesn't work, he said."

Kessler broke his own food addiction with something akin to a nicotine patch, in this case a fat/salt/sugar patch. He allows himself small doses of these while nurturing healthier behaviors, "food rehab" he calls it.

He also says that the way society views certain foods needs to change:

"What's needed is a perceptual shift, Kessler said. "We did this with cigarettes," he said. "It used to be sexy and glamorous but now people look at it and say, 'That's not my friend, that's not something I want.' We need to make a cognitive shift as a country and change the way we look at food. Instead of viewing that huge plate of nachos and fries as a guilty pleasure, we have to . . . look at it and say, 'That's not going to make me feel good. In fact, that's disgusting.' "

Here he is in a video promotion (that's not him in the bathing suit) for his book, "The End of Overeating: Taking Control of the Insatiable American Appetite":


I liked this part:

"Now that we know [the food industry] is selling a highly powerful stimulant, what are they going to do about it, and how are they going to act responsibly, and how do we gain control back."

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Keep An Eye On The Birds

Just a few days ago, a supplier for Tyson killed 15,000 chickens because they were infected with bird flu:

Tennessee Chicken Flock Found With Mild Bird Flu

"The 15,000 birds showed no signs of illness and there appeared to be no threat to human health, Tyson said."

So why did they kill them? Of course there's a threat. It may not be from this virus exactly, but as I wrote in the prior post, viruses are evolving, "disintegrating and reforming," at a furious pace. Keeping a genetically uniform and isolated flock of birds cooped up inside, in unnatural, space-starved quarters is a recipe for illness - not just among birds. Tyson knows this.
________Photo from Tyson Foods, Inc. Caption:

"A senior veterinarian for Tyson Foods takes a blood sample from a live chicken at a poultry farm near Springdale, Arkansas. Such samples are subsequently sent to a Tyson laboratory where they are tested for the presence of avian influenza."

Human Flu Virus: 10 Genes, Furiously Evolving

This is one of those articles where every few sentences I was saying, "How about that."

10 Genes, Furiously Evolving, New York Times, May 4, 2009

"Viruses all have one thing in common, they all reproduce by disintegrating and then reforming.

A human flu virus, for example, latches onto a cell in the lining of the nose or throat. It manipulates a receptor on the cell so that the cell engulfs it, whereupon the virus’s genes are released from its protein shell. The host cell begins making genes and proteins that spontaneously assemble into new viruses. “No other entity out there is able to do that."

Reassortment played a big role in the emergence of the current swine flu...

It is possible that the special biology of pigs helped foster all this mixing. Bird flu and human flu viruses can slip into pig cells, each using different receptors to gain access. “We call the pig a mixing vessel because it can replicate both avian and mammalian influenza virus at the same time,” said Juergen Richt of Kansas State University. “The mixing of these genes can happen much easier in the pig than in any other species.”

The sheer number of viruses on Earth is beyond our ability to imagine...

In a small drop of water there are a billion viruses. ... Virologists have estimated that there are a million trillion trillion viruses in the world’s oceans."

So, 6 billion of us against a million, trillion, trillion of them. They who can "disintegrate and reform," making reality out of a feat humans can only visualize from Star Trek reruns. I say we extend an olive branch, pronto.
________Photo by James Erin de Jauregui via UCLA Magazine.

Ant Ball

Not sure what flowers these are but before they bloom the ants have their way with them. Multitudes of big, hungry ants.
________Photo: Bix

Hospital Food

Do you have a story about hospital food?
Whoosh ... take a look at these:
Hospital Food

I did an internship in a hospital kitchen years back. It wasn't called a kitchen, it was called "Food Service." Learned a ton about quantity food production. When I look at those photos, I have some understanding of what's going on behind them ... still. (After looking at them - if I have to be hospitalized, I want it to be in Japan.)

See that conveyer belt in the photo to the right? You had to fill trays as they moved past, matching the patient's menu. There was a tray checker at the end of the line. I still have nightmares about it. Sometimes Lucille Ball is in them. (In case that ref. is a little old, here's a reminder.)
________Photo of Middle Tennessee Medical Center Hospital kitchen from Tennessee's Murfreesboro Post.

Vitamin D: The Active Form, And The Role Of Calcium

Active vitamin D, the molecule that acts as a steroid hormone in our bodies, is not the same as the vitamin D we eat in food, the vitamin D that we take in a pill, or the vitamin D that is manufactured in our skin. All of those less active forms of vitamin D are precursors. They're stored more easily in the body, and for longer, than active vitamin D.

Active vitamin D, also called calcitriol, is a high-energy, twice-hydroxylated¹ compound with a very short half-life (about 5 hours) - such that levels of active vitamin D are tightly controlled by the body. It is primarily calcitriol that is responsible for the benefits we're discovering about this vitamin, e.g. mineral balance and bone mineralization, immunity, blood pressure control, reduction in cancer cell proliferation, and insulin secretion. You can have adequate stores of vitamin D, but unless you're converting it to its most active form, your benefits are limited.²

The body expends energy to make the most active form of vitamin D. A specific enzyme controls its manufacture.^{3, 4} The activity of that enzyme, 1-hydroxylase, is influenced by a variety of factors.

The following inhibit the activity of 1-hydroxylase, resulting in lower concentrations of active vitamin D (calcitriol):

1. High concentrations of calcitriol - A negative feedback mechanism is in play, meaning, the more active vitamin D you have circulating, the less active the enzyme.
   
2. Decreasing levels of parathyroid hormone (PTH) - PTH stimulates 1-hydroxylase.
   
3. High calcium intake/high blood calcium - High calcium levels cause PTH to decline.
   
4. High phosphorus intake/high blood phosphorus. (An aside: Fructose we eat gets phosphorylated, grabbing phosphorus and holding it in the liver. So fructose (fruit) consumption can counter high phosphorus (dairy, fish, meat, soda) intake.)

The following stimulate the activity of 1-hydroxylase, resulting in higher concentrations of active vitamin D (calcitriol):

1. Low concentrations of calcitriol.
   
2. Increasing levels of parathyroid hormone (PTH).
   
3. Low calcium intake/low blood calcium.
   
4. Low phosphorus intake/low blood phosphorus.

Serum concentrations of active vitamin D (calcitriol) are not typically correlated with vitamin D intake, or vitamin D stored as 25(OH)D3. So, taking more vitamin D will not necessarily lead to increased activity of the vitamin.

Another controlling factor: As levels of calcitriol rise, the body makes relatively more of a form of D3 that is thought to be involved in the breakdown of calcitriol, or at least results in lower calcitriol levels.⁵ This is another type of negative feedback loop. It may indicate an Upper Intake Level (UL) for vitamin D since, in contrast to calcitriol, the production of 24,25(OH)₂D3 is correlated with vitamin D intake.

Of course, you need working receptors for that active vitamin D. The manufacture of those receptors, the cells where they're located, and their affinity for circulating calcitriol, are additional variables in the effective function of this hormone. I'll discuss later.

Studies

You can see these mechanisms played out in studies. Looking around I found this one:
Calcium and Fructose Intake in Relation to Risk of Prostate Cancer, Cancer Research, 1998

In 47,781 men from the Health Professionals Follow-Up Study, those who had a high intake of calcium had a higher risk for prostate cancer (recall: the manufacture of calcitriol is inhibited by high calcium intakes):

"Higher consumption of calcium was related to advanced prostate cancer (RR: 2.97) and metastatic prostate cancer (RR: 4.57)."

That's a three-fold increased risk for advanced cancer, and a 4.6 times increased risk for metastatic cancer.

"Our findings provide indirect evidence for a protective influence of high 1,25(OH)2D levels on prostate cancer and support increased fruit consumption and avoidance of high calcium intake to reduce the risk of advanced prostate cancer."

These findings are in line with other blogs I posted:
Dairy Food And Prostate Cancer
More Evidence That Dairy Foods Increase Risk For Prostate Cancer

Which support:

"[Consumption of dairy products] is one of the most consistent dietary predictors for prostate cancer in the published literature."

Dairy foods are good sources of both calcium and phosphorus, two minerals that have been shown to decrease levels of active vitamin D in the body.

There are lots of other studies, especially cancer-related ones (colon, breast) which interest me, but I'm out of time.

In Sum:

To encourage beneficial levels of active vitamin D in the body, it may be helpful to:

• Watch calcium intake.
  
• Watch phosphorus intake.

________¹ On carbons 1 and 25, thus called 1,25-dihydroxycholecalciferol or 1,25(OH)₂D3.
² Stored vitamin D is usually measured as hydroxylated cholecalciferol, that is, 25(OH)D3.
³ 25(OH)D3-1-hydroxylase, or just 1-hydroxylase. This enzyme places an OH group onto carbon 1.
⁴ Since this enzyme is most active in the kidney, actually in the mitochondria of the kidney, people who are on dialysis or who have limited kidney function (many diabetics) may have the hormone calcitriol injected directly.
⁵ 24,25(OH)₂D3.

Photo of vitamin D: Bix

Animation: The Spread of a New, Mutated Virus

"Antigenic shift is the process by which at least two different strains of a virus (or different viruses), especially influenza, combine to form a new subtype having a mixture of the surface antigens of the two original strains."
- Wikipedia: Antigenic shift

________Animation from HybridMedical - "The world's premier provider of high-end 3D medical & scientific animation and illustration."
Thanks again to BL.

Americans' (Vertical) Growth Has Stagnated, Poor Childhood Nutrition Could Be To Blame

The OECD (Organization for Economic Co-operation and Development), a group of 30 developed countries, just published its 2009 "Society At A Glance" report. Lots of great comparative data here.

One piece the authors found interesting: The height of Americans:

KEY FINDINGS: UNITED STATES
"Adult height: Americans are not getting taller. The United States is the only country in the OECD where men and women aged 45-49 are no taller than those aged 20-24 years old, indicating no improvement in health and social conditions determining gains in height. All other 22 OECD countries are seeing greater height gains between these two generations."
- OECD (2009), Society at a Glance – OECD Social Indicators, Key Findings

Click to enlarge.
Why aren't we getting taller? It's not immigration:

"The poorest performer is the United States, where there have been no height gains over a generation. Immigration of comparatively short people in recent times cannot explain height stagnation in the United States."
- OECD (2009), Society at a Glance – OECD Social Indicators, Health Indicators: Height

It could be childhood nutrition:

"Adult height gain indicates country improvements in childhood net nutrition. ... Child poverty [in the US] has fallen since the mid-1990s but one in five US children still live in poverty, a rate exceeded only in Poland, Mexico, and Turkey."
- OECD (2009), Society at a Glance – OECD Social Indicators, Key Findings

Here are the comparative heights:


Click to enlarge.
Who's tallest?

"Males in the Nordic and Northern European countries are the tallest. The shortest men are found in Mexico, Portugal, Korea, and Japan. Similar country patterns [exist] for women.

There is little strong evidence that these country height differences are due to average country differences in genetic endowments (Deaton, 2007).

Overall, men are always taller than women. This sex difference does have a strong genetic component."
- OECD (2009), Society at a Glance – OECD Social Indicators, Health Indicators: Height

Little evidence that these differences are due to genes. How about that.
________Thanks to shaun who sent this link which referenced the OECD report (great discussion there):
Obesity and the Fastness of Food, NYTs, May 5, 2009

China Tells Citizens To Smoke

"The authorities in Gong'an county [China] had told civil servants and teachers to smoke 230,000 packs of the locally-made Hubei brand each year.

Those who did not smoke enough or used brands from other provinces or overseas faced being fined or even fired.

"The regulation will boost the local economy via the cigarette tax," Chen Nianzu, a member of the cigarette market supervision team in Gong'an county, Hubei province, told the Global Times newspaper."
- China Cigarette Order Up In Smoke, BBC News, May 5, 2009

The rule was rescinded yesterday.

Is it fair of me to draw an analogy between the Chinese government encouraging consumption of tobacco and the US government encouraging consumption of (highly processed, genetically engineered) corn? Okay, maybe not.
________Thank you, BL.
Photo: Bix

Swine Flu Vaccine: Yes Or No?

I'm beginning to hear people in the alternative health community advising against getting a swine flu vaccination, recommending instead a host of scientifically-unfounded remedies to "strengthen the immune system." This is tricky territory. The Spanish flu killed those with the strongest immune systems:

"The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths."
- 1918 Flu Pandemic, Wikipedia

We're seeing the same thing with this H1N1 swine flu:

"In Mexico, nine of the 19 dead were between the ages of 21 and 39, which is unusually high."
- Flu Cases Increase, But There Is Some Optimism, NYTs, May 3

Will you get the vaccine if one is made available?
________

When Social Distancing Is Good

"In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918."
- CNN: Scientists Dig For Lessons From Past Pandemics, April 30, 2009

Right now we have a novel virus, one to which humans have never been exposed and have little immunity against. We have a virus that can transmit from person-to-person, unlike the H5N1 bird flu virus which is still predominately bird-to-person. And we have a virus that has done what we'd hoped we could prevent - gone everywhere: "It's too late to contain it."¹

It appears to be waning. Might it return? Is there something we can do?

"[The CDC] examined 43 cities and found that so-called nonpharmaceutical interventions -- steps such as isolating patients and school closings -- were remarkably successful in tamping down the outbreak."

They sure were successful in Gunnison, CO:

"In the mining town of Gunnison, Colorado, in 1918, town leaders built a veritable barricade, closing down the railroad station and blocking all roads into town. Four thousand townspeople lived on stockpiled supplies and food from hunting or fishing. For 3½ months, while influenza raged in nearly every city in America, Gunnison saw not a single case of flu -- not until the spring, when roads were reopened and a handful of residents fell sick."

Now that's isolation. If these interventions work, then we should, as flu-expert Laurie Garrett said in her PBS NewsHour interview from May 1, be enormously grateful for the sacrifices Mexico has made, and is making, on behalf of the rest of the world. The hit they're taking economically, socially, politically, for closing schools, and other social and political venues is enormous. One of my professors used to say, "When public health strategies are successful, nothing happens." That nothing is happening to many of us may be due in part to Mexico's brave actions.
________¹ I just heard David Gregory on Meet The Press say "Our strategy is containment." How could he say that? Where has he been? Hasn't he heard the terrible phrase that every official office has reluctantly repeated the last week? ("It's too late to contain it.") I miss Tim Russert. Anyway, one of his guests on the program, the acting head of the CDC, Richard Besser, corrected him right away.

Photo of from Life.com. Some great 1918 flu photos there.

White House On Twitter

I just saw that the White House opened a Twitter account:
http://twitter.com/whitehouse/ (started May 1)

That's in addition to their other accounts:
http://www.whitehouse.gov/
http://flickr.com/whitehouse/
http://facebook.com/whitehouse/ (started April 10)
http://myspace.com/whitehouse
http://vimeo.com/whitehouse/
http://youtube.com/whitehouse

I'm barely keeping up.

Update: I just saw this graphic:

Click to enlarge.
Newspapers are struggling, aren't they. When I grew up, it was all about newspapers, and a little radio. Television didn't come into play until I was a teenager. Even then, there was just one "Nightly News" broadcast, and if you didn't catch it for the few minutes it aired at 6:00 p.m., you were in the dark until the next day.

Newspapers, on the other hand, published several editions a day. Our Philadelphia Bulletin ran a morning and evening edition, at least that. Editions printed later in the day (and so with fresher news) were designated by more stars. (I think I recall papers with 4 stars, but my memory is fuzzy.) Newspaper carriers would walk the beaches in South Jersey during the summer, with huge canvas sacks slung over their shoulders, calling over and over, "Philadelphia Evening Bulletin, Bulletin here!"

Nostalgia concluded.
________

Obama: "H1N1 Could Come Back In A More Virulent Form."

A few more quotes. The first is a statement from Obama from his Friday Cabinet meeting. The second is a recent statement from Laurie Garrett, a follow-up to her 2007 TED talk on H5N1 bird flu.

"Since we know that these kinds of threats can emerge at any moment, even if it turns out that the H1N1 is relatively mild on the front end, it could come back in a more virulent form during the actual flu season, and that's why we are investing in our public health infrastructure."
- Barack Obama, May 1, 2009, from CNN: Number Of Confirmed H1N1 Cases Worldwide Soars

"But the interesting thing is, Why do we have flu so late in the year? Usually the flu season has been over for quite some time, so this is a very unusual situation. And one of the things that's interesting about why flu is seasonal, and is the sort of bad-news endpoint of the paragraph I am now uttering: When flu is coughed or you sneeze it, the virus is suspended in a liquid environment. Ideally an environment with lots of polysaccharides and sugars, an environment like mucus. Suspended in mucus, the virus can go from your hand to a doorknob, from a doorknob to another person's hand; it can go onto the surface of a telephone ... all those things are contagious to others. Mucus also protects the virus from ultraviolet rays. One reason flu is seasonal -- as the temperature rises, these things tend to dry out. So in the summer, it's very, very unusual to see flu virus circulating. The bad new is, if this virus has indeed taken hold, it will move to the Southern hemisphere for their winter, and it will come back to us, possibly in a different mutation, this fall. As our temperatures drop, we may see a return. This is the ominous issue."
- Laurie Garrett, April 30, 2009, from TED's blog: Q&A With Laurie Garrett: "This Is A Huge Wake-Up Call"

________Photo of Obama speaking at an April 29 press conference on H1N1 flu from Whitehouse.gov.

1918 Spanish Flu Pandemic: The First Wave Was Mild

Here's a video from TED I enjoyed. I don't know how interesting it would be to people outside of public health, and it's a few years old, but I'm posting it because I think it's relevant right now.

It's a talk by Laurie Garrett, from the Council on Foreign Relations, from 2007. She discusses lessons learned from the 1918 Spanish flu (that also derived from birds) and how that knowledge can help formulate plans for the possible H5N1 bird flu pandemic. (I'll put her bio in footnotes.¹)

A few things I learned from this video:

• Curiously, 100% of pregnant women who were infected with the 1918 Spanish flu died. They don't know why.
  
• There were two (or three?) waves of the Spanish flu. The first wave was considered "mild"...

  "The 1918 Spanish flu virus went around the world in a mild enough form that the British army, in World War I, actually certified that it was not a threat and it would not affect the outcome of the war. After circulating around the world again it came back in a form that was tremendously lethal."

• Re: Tamiflu - Only about 20% of what we takes gets used by the body. The rest gets excreted, enters the environment, is taken up by waterfowl, and encourages the virus to mutate to a strain that is resistant to, you guessed it - Tamiflu:

  "When a human being ingests Tamiflu only 20% is metabolized appropriately to be an active compound in the human being, the rest turns into a stable compound which survives filtration into the water systems thereby exposing the very aquatic birds that would carry flu and providing them a chance to breed resistant strains. We now have seen Tamiflu resistant strain in Vietnam."

  Also, regarding Tamiflu, no nation had enough stockpiled (in 2007) to cover their populations for more than a few weeks, and the virus is likely to remain present, in some form, for 18 to 24 months. (Do we really want to be taking Tamiflu every day for 2 years?)

This is why it's vital that the CDC monitor the health of people who handle livestock. Prevention is going to be key. The words, "it's too late to contain it," is a death knell.________¹ "Garrett is the author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. As a science writer for Newsday, Garrett won a Pulitzer, a Peabody and two Polk awards; in 2004, she joined the Council on Foreign Relations as Senior Fellow for Global Health. She is an expert on public health -- and the fascinating ways that health policy affects foreign policy and national security."

Pigs "Exchanging Pathogens At Blinding Velocity" In Industrial Farms

From the Guardian, last Monday:
The Swine Flu Crisis Lays Bare The Meat Industry's Monstrous Power

"In 1965, for instance, there were 53m US hogs on more than 1m farms; today, 65m hogs are concentrated in 65,000 facilities. This has been a transition from old-fashioned pig pens to vast excremental hells, containing tens of thousands of animals with weakened immune systems suffocating in heat and manure while exchanging pathogens at blinding velocity with their fellow inmates.

Any amelioration of this new pathogen ecology would have to confront the monstrous power of livestock conglomerates such as Smithfield Farms (pork and beef) and Tyson (chickens)."

So, we're pouring as many potentially volatile organisms as we can into a test tube, shaking it, then closing our eyes?

And this:

"According to the Washington Post, the CDC did not learn about the outbreak until six days after Mexico had begun to impose emergency measures."

This is not good surveillance; rather, this is failed surveillance. It's especially troubling that the failure involved one of the richest, most powerful, and most "prepared" nations in the world. What if this virus was (or becomes) more deadly? Would people still wave off proclamations like, "It's too late to contain it"? When that's exactly what we're paying our governments to do ... contain it?

Someone should be watching the test tube, Mr. President.
________Photo of "boiling tube" from About.com and Getty Images. Caption read:

"A boiling tube is a special variety of test tube that is made specifically for boiling samples. Most boiling tubes are made of borosilicate glass. These thick-walled tubes are usually about 50% larger than average test tubes. The larger diameter allows samples to boil with less chance of bubbling over. The walls of a boiling tube are intended to be immersed in a burner flame."