"Scientists are becoming increasingly concerned about the various effects of mercury, a potent neurotoxin, which now permeates the environment in virtually all countries with coal-burning power plants and many of those with gold mines.
The EPA reports that "mercury form power plants settles over waterways, polluting rivers and lakes, and contaminating fish."
In 2006, 48 of the 50 states in the US issued a total of 3,080 fish advisories warning against eating fish from local lakes and stream because of their mercury content
EPA research indicates that 1 out of every 6 women of childbearing age in the US has enough mercury in her blood to harm a developing fetus. This means that 630,000 of the 4 million babies born in the country each year may face neurological damage from mercury exposure before birth."
While fish may be a good source for vitamin D and omega-3, they're also a good source for mercury.
Below are some differences between vitamin D made from exposure to sunlight vs. that supplied from diet (food or supplement):
1.Sunlight exposure draws down the body's pool of cholesterol.
Vitamin D production begins in the oil glands of our skin, where the steroid 7-dehydrocholesterol is converted to previtamin D3 after absorbing specific wavelengths of light in the ultraviolet range. Exposure to heat converts previtamin D3 to vitamin D3 or cholecalciferol. All of this occurs on/in skin.
2.Sunlight exposure creates reservoirs of vitamin D3 throughout the body that may be tapped during winter or when needed (that is, when calcidiol or 25(OH)D3 is low). Dietary vitamin D does not get distributed in this way.
Much of the vitamin D3 manufactured in skin is deposited throughout the body in muscle and fat cells before it arrives in the liver. Much of the vitamin D3 absorbed from the digestive tract (food or pill) is delivered directly to the liver.
3.Absorption of vitamin D from diet is poor. Only about 50% of what we eat gets absorbed. In addition:
Diseases that compromise health of intestinal cells (e.g. irritable bowel syndrome, lactose intolerance, inflammatory bowel disease (Crohn's), infectious agents, cancer) lower absorption.
Bile is required for absorption, so liver conditions (hepatitis, cirrhosis, hepatic steatosis or fatty liver) lower absorption.
Fat is required for absorption, so if there is steatorrhea or fat malabsorption (many causes, e.g. anemia, cystic fibrosis, celiac, Whipple), absorption will be lower. (There is usually adequate fat in food to ensure absorption.)
Some medications, such as bile acid sequestrants which are used to lower cholesterol, lower absorption.
4.Vitamin D intakes "contribute only a negligible fraction" to blood stores compared to sun exposure.
"To offer some perspective here, an adult with white skin [pigmented skin takes longer to manufacture vitamin D], exposed to summer sunshine while wearing a bathing suit, generates about 250 µg (10,000 IUs) of vitamin D3 in 15 to 20 minutes." - Vitamin D Insufficiency: No Recommended Dietary Allowance Exists For This Nutrient, Reinhold Vieth and Donald Fraser, CMAJ, 2002
5.Relying upon dietary sources to supply vitamin D necessitates consuming higher amounts of environmental pollutants.
Both vitamin D and many organic pollutants (e.g. pesticides) are fat soluble. As such, they reside in fat tissue. Organic pollutants have been shown to bioaccumulate in animal tissue and are found in greater amounts higher up the food chain.
6.Some oil-based formulations of vitamin D may be harmful to the liver.
There is thinking that fish oil, and some forms of oil-based vitamin D, can be harmful to the liver.1 This is related to number 2 above, in that oral D is sent directly to the liver. Anecdotally - some people experienced elevated liver enzymes while taking fish oil (a common source for vitamin D) only to have them fall back into the normal range when they stopped. More study is needed there.
_______
1The Association Of Increasing Dietary Concentrations Of Fish Oil With Hepatotoxic Effects And A Higher Degree Of Aorta Atherosclerosis In The Ad Lib.-Fed Rabbit, Institute of Scientific and Technical Information (France), 1998
(To the right is a map showing countries that have universal healthcare. We'll have to color in parts of Africa and Asia now. Click to enlarge.)
Yesterday, the Prime Minister of Britain, Gordon Brown, gave a speech here in the US announcing a deal that would fund universal healthcare in developing countries:
"Today at this United Nations General Assembly, we will see history being made with the beginnings of universal free health care in Africa and Asia," Mr. Brown said in New York.
"Ten million people will now for the first time get the treatment they need without being turned away of fearing how they will pay."
- $5.7bn Plan To Expand Health Care In Africa, Asia, ABC News AU
The plan is backed by more than $5.7 billion from UN member nations. I can't find details of US (the only industrialized nation without universal health care) participation. In fact, I can't find decent coverage of this story inside the US. The excerpt above is from Australia.
"The reduced use of health services in 20 African countries charging fees was alone responsible for 233,000 child deaths a year. Other estimates suggest that at least three million children have died as a direct result of user fees.
The evidence is shocking and conclusive and the entire world should be shamed into action.
I will call on every country in the developed world to help poor countries achieve the goal of universal health coverage. ... One step we can take immediately: to stop charging poor people for health services that they cannot afford.
I hope today it will be a turning point: a day when the battle to provide healthcare to all and abolish user fees won a significant victory."
I expect, as one of the richest countries in the world, we were called upon by Brown's Taskforce "to help poor countries achieve the goal of universal health coverage."
I wonder how our contribution to universal healthcare in the developing world conflicts, if at all, with our national stance against universal healthcare.
________
Map of countries with universal healthcare from Freebase.
I've been asked to weigh in on the soda tax debate by someone from Newsy.com. For perspective, here's their 3-minute recap of the arguments for and against the tax:
I'm against an end-user soda tax. It's a regressive tax. It disproportionately affects the poor1 and minorities.2
Go into poor urban areas and note what foods are available. Sweetened beverages, chips, candy, and snacks. These residents have limited choices. There aren't supermarkets here, let alone farmers markets. I might go along with the tax if fresh, local, organic food was available here, everywhere, at affordable prices. Let's fix that first. Let's make sure people have a choice before we tax their options.
Also, those in lower socioeconomic classes should have a say in whether this tax gets approved, especially because they end up paying proportionately more of it. I can't help but see this tax as being levied upon those who don't have the political or economic clout to fight it.
And then ... Why tax soda? Why not tax meat? Hasn't that also been linked to poor health? And we know it's ransacking the environment.
Or let's tax fresh, local and organic food. The people who buy these can arguably afford a tax more than the people who buy soda.1 We could use the money to provide more fresh, local and organic food to underserved areas, and to offset the price. We could use the money to increase funding to SNAP (food stamps), which covers only 3 weeks out of the month.
Or, instead of taxing the output (soda), tax the inputs (high fructose corn syrup, sugar). I think that would distribute the burden more evenly. And it wouldn't let manufacturers off the hook.
Along those lines, how about removing the subsidies for growing commodity crops that get turned into corn syrup and other cheap refined junk foods? You could raise a pretty penny there. (Oh, the irony of subsidizing and then taxing the same foods.)
How about a carbon tax? Carbon emissions are terrible for health, and the planet.
The poor suffer higher rates of obesity. This "obesity tax" is quite clearly a tax on the poor. If you are looking to a soda tax to "raise billions of dollars in revenue that could be used to fund healthcare," you are looking to fund healthcare on the backs of people who can least afford it. Is that ethical?.
It's unfortunate that my opinion puts me on the bench with companies that manufacture junk food, or that my opinion sounds like I agree with those who decry a "nanny state." I don't typically align myself with either group.
________
1Does Social Class Predict Diet Quality?, American Journal of Clinical Nutrition, 2008 2Sweetened Beverage Consumption Increases Dramatically In US, ScienceDaily, 2008
"Among race/ethnicity groups, the percentage of sugar-sweetened beverage drinkers and per capita consumption of sugar-sweetened beverages was highest among blacks followed by Mexican Americans."
I need to catch up with Bill Marler. He's been busy! He and his group just debuted a new food safety site, intended to be a one-stop shop for food safety news: FoodSafetyNews.com
Coincidentally, the government just revamped their food safety site: FoodSafety.gov
This is going to be challenging for the government because the responsibility for food safety is distributed among many departments and agencies. For example:
The Department of Agriculture (USDA) is responsible for chicken.
The Food and Drug Administration (FDA) under the Department of Health and Human Services (HHS) is responsible for whole eggs from chickens.
The USDA is responsible for processed eggs from chickens.
The USDA regulates cheese pizza.
The FDA regulates pepperoni pizza.
The USDA regulates open-faced sandwiches.
The FDA regulates closed-faced sandwiches.
The government's "Gateway to Federal Food Safety Information" is going to require a good dose of coordination to be effective.
Also, while the government may be privy to recall information sooner than the general public, they aren't always as forthcoming with that knowledge. This summer, bloggers (including Marler who blogs at Marler Blog) beat the USDA to posting lists of retail establishments that received JBS Swift recalled meat.
For the week or so I've been watching these vying sites, I've noticed Marler's Food Safety News is updated more often, at least daily, and is markedly more sophisticated. Where FoodSafety.gov is maintaining links to proper storage and cooking temperatures (and hasn't changed their graphics from day one yet), FoodSafetyNews.com is posting interviews with political (Richard Raymond: Former Under Secretary For Food Safety Speaks Up) and academic (Marion Nestle: Q&A: Marion Nestle on Food Safety Politics) insiders.
There's a niche for both of them, but I'll be hitting FoodSafetyNews.com more often.
Here's another study in the same vein: Toxins In Transgenic Crop Byproducts May Affect Headwater Stream Ecosystems, PNAS, 2007
It's not about mice, but insects that inhabit streams near fields where genetically engineered (GE) corn is planted.
When these insects were fed the byproducts of a corn plant engineered to produce a toxic pesticide in every cell (Bt corn), they experienced reduced growth and increased mortality. Caddisflies (Lepidostoma liba), which are not considered a "target" for the pesticide:
"... had >50% lower growth rates when they were fed Bt corn litter compared with non-Bt corn litter (P=0.008)." (Lower growth rates reduce this species' ability to reproduce.)
Caddisflies (Helicopsyche borealis) that ate Bt corn pollen had a significantly higher mortality (43%) than flies that didn't (18%).
This next part was incredible. The authors state:
"Previous research assumed that transgenic crop byproducts would remain on fields."
And took these photos:
Click to enlarge.
(B) Illustrates a typical headwater agricultural stream during pollen shed with a buffer strip of grass and adjacent corn fields. (C) Illustrates accumulations of corn byproducts after harvest.
They showed:
"... that corn byproducts, such as pollen and detritus, enter headwater streams and are subject to storage, consumption, and transport to downstream water bodies.
"toxin-containing crop byproducts are dispersed through the landscape by streams."
They warned that:
"Stream insects are important prey for aquatic and riparian predators, and widespread planting of Bt crops has unexpected ecosystem-scale consequences."
I wouldn't want my dog or child playing near those streams. Then I realize we all eat the toxin-containing corn from those genetically engineered plants every day.
________
Photo at top is of "just hatched caddis fly larvae in a blob of jelly on a leaf." Credit for the photo goes to Sandrine Angelibert. From The Garden Pond Blog. Beautiful. Unfortunate that they are needlessly dying.
The tone is snide, but the reporting is worthy. Here's Matt Taibbi laying out the state of healthcare reform (as of Sept 3), and decrying the lack of a single-payer proposal, in his article for Rolling Stone:
Sick and Wrong "How Washington is screwing up health care reform – and why it may take a revolt to fix it"
He describes 5 ways Congress "gut the measure until there was nothing left:"
Step One: Aim Low
Abandon single-payer:
Heading into the health care debate, there was only ever one genuinely dangerous idea out there, and that was a single-payer system. Used by every single developed country outside the United States (with the partial exceptions of Holland and Switzerland, which offer limited and highly regulated private-insurance options), single-payer allows doctors and hospitals to bill and be reimbursed by a single government entity. In America, the system would eliminate private insurance, while allowing doctors to continue operating privately.
In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.
Step Two: Gut The Public Option
Simply by removing the profit motive, the government plan would be cheaper than private insurance. "The goal here was to offer the rock-bottom price, the Walmart price, so that people could buy insurance practically at cost," says one Senate aide.
However, legislators, concerned that providers might not be paid enough, upped the amount they would be reimbursed:
In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, "about the same as what we have now," as one Senate aide puts it.
Step Three: Pack It With Loopholes
A real mess here, from drug companies being permitted to hold patents on their drugs for 12 years (so, no generics during the time), to removing a consumer's choice to opt out of their paltry employer-based healthcare benefit (e.g. Wal-Mart's).
Step Four: Provide No Leadership
Taibbi paraphrases former labor secretary Robert Reich (Reich writes about healthcare at length on his own blog):
There were now so many competing ideas about how to pay for the plan and what kind of mandates to include that even after the five bills are completed, Congress will not be much closer to reform than it was at the beginning. "The president has got to go in there and give it coherence," Reich concluded.
In this section, Taibbi revels a depressing statistic, via Dr. Steffie Woolhandler:
Three-quarters of all people who file for bankruptcy because of medical reasons have insurance when they get sick — and they're bankrupted anyway.
Step Five: Blow The Math
If it's not done right, it's going to cost:
Without a real public option to drive down costs, the federal support to make sure everyone gets coverage is going to get very expensive very fast," says Behan, the aide to Sen. Sanders.
________
There's no consolidated bill yet. Since this piece was written, the fifth and final committee, the Senate Finance Committee chaired by Senator Max Baucus, released an outline of their proposal. It's the only one of the five (3 House, 2 Senate) not to recommend a public option. Baucus' plan instead proposed the watered-down "nonprofit insurance cooperatives."
I'm getting the sense that what's going to pass as reform won't be the simplified, cost-contained prospect reformers want.
A 2006 study in the American Journal of Preventive Medicine found that from 5% to 43% of three tests (EKG, x-ray, urinalysis) were ordered for apparently healthy, asymptomatic individuals during routine preventive exams - tests which evidence and guidelines recommended against performing.
"Annual direct costs for the three interventions range from $47 million to $194 million."
I suppose if we're willing to accept the ordering of tests that go beyond guidelines, we're willing to accept increases in medical costs that accompany them.
Below is a personal account by physician Jack Coulehan that appeared in the recent issue of Health Affairs journal:
Shingles Does It, Health Affairs, Sept/Oct 2009 "After a doctor-professor with a bad case of shingles arrives in the ER, he discovers what it’s like to be a patient in pain during this age of aggressive medicine."
Dr. Coulehan is professor emeritus of preventive medicine and senior fellow at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, NY. He advocates against excessive medical testing. Given his position and experience, he "felt fortunate that there was absolutely no way I’d ever be stuck in such a scenario."
Stuck he was. On Easter morning, 2008, while experiencing intense pain from shingles, Coulehan visited an emergency room to confirm his diagnosis and get prescriptions. He left 12 hours later after seeing 2 physicians, a neurologist, an ophthalmologist, and undergoing 2 MRIs and a CT scan of his head. The hospital ER bill: $9000.
"By the time I learned the total of that ER bill, I’d also come to grips with my feelings about the Great ER Caper. At first I felt angry and embarrassed about spending a whole day at the hospital, subjecting myself to multiple expensive and unnecessary tests and playing along with the culture of medical overkill that I’ve spend decades teaching students to avoid. How stupid!"
But he realized what he was up against - entrenched profit-based medicine:
"In today’s medical culture, we almost always consider that more is better. Each new machine creates pressure to expand the ways it can be used. In most health care settings, the doctor has far greater incentive than disincentive to order excessive services."
And the trust we are compelled to place in that system when we fall ill:
"I learned how difficult it is to remain objective when you’re feeling very sick."
I've been reading about thermogenesis and came across this study: Determinants of 24-hour Energy Expenditure in Man, Journal of Clinical Investigation, 1986
Lots of processes in our bodies require energy, burn calories if you will. Eating uses energy. Thinking uses energy. Repairing tissue uses energy. Breathing uses energy. Sex uses energy. Moving molecules within cells and between cells uses energy. And, of course, activity or physical exertion uses energy:
"A highly significant correlation was observed between activity and energy expenditure (P < 0.0001 in the 118 subjects)."
But not all activity is the kind you see in aerobics classes. There are less overt forms, such as opening the refrigerator door, or "movements of the limbs with little displacement of the body's center of gravity," what these authors called "fidgeting." These are what was measured as "activity" in the above quote.
In this study, 118 subjects spent time in a respiratory chamber and "were not allowed to carry out physical exercise such as isometric exercises or calisthenics." Nonetheless, the spontaneous physical activity they could perform, "strolling around the chamber" and fidgeting cost them between 95 and 903 kcal/day.
The authors concluded:
"A large portion of the variability of [24-hour energy expenditure] among individuals, independent of differences in body size, was due to variability in the degree of spontaneous physical activity, i.e., "fidgeting."
________
Know someone who can't stop fidgeting? They could have the fidget gene(s): A Role for Brain-Specific Homeobox Factor Bsx in the Control of Hyperphagia and Locomotory Behavior, Cell Metabolism, 2007.
"It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition." Coverage Denied: How The Current Health Insurance System Leaves Millions Behind, HealthReform.gov, August 2009
And ...
"A pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage."
Thousands of people are arguing against changing these practices.
In his healthcare speech to Congress last night, Obama said:
"Nothing in this plan will require you or your employer to change the coverage or the doctor you have."
The Associated Press wrote:
"That's correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether."
The AP made an additional point ...
"The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it."
... which Maggie Mahar of Health Beat claims is unfounded:
"Here CBO was not “scoring” legislation; it was pretending to read minds. No one knows how many employers might decide to drop benefits if the House bill passed. What we do know is that, if we do nothing, health-care spending will continue to spiral. And if costs rise as sharply as they as they have over the past ten years, by 2019 premiums will double. At that point, we can be certain, a great many employers will be forced to get out of the benefits business."
By 2019 premiums will double? Possibly:
Maybe premiums won't skyrocket if employers offer less generous plans. But, according to the White House, that would force workers "to spend a larger fraction of their take-home pay on deductibles and co-payments."
It appears this is already happening:
I wonder where employer-sponsored healthcare benefits will be in 20 years.
________
Source for graphs: White House Council Of Economic Advisers, The Economic Case For Health Care Reform, Executive Summary, June 2009
I was speaking with a healthcare provider recently who told me she thought the government should not be involved in healthcare. "It's socialized medicine," she said, looking aghast.
She said if someone needs care, "People on their block should chip in and help." She believes in "Community."
Update #1: I found the above video on USHealthCrisis.com. Some background on how the video came about, from Karoli via the source link:
"In the spirit of truth, my friend Matte Black (@Shoq on Twitter) and his brother took their video camera to Canada on vacation to interview Canadians about their health care system. When we talked about it, I asked him to try to get negative views with specifics for balance. Here is the result. It has been edited for brevity, but the negative views were not removed, because there were none. He could not find one Canadian who thought they should kill the system. These are everyday people. They have no agenda at all other than being patriotic Canadians."
Update #2: I was wondering, since Canada manages to cover everyone, if their taxes are higher. I found this from the Denver Post: Debunking Canadian Health Care Myths
"In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent."
Because when they meet in the stomach, things happen.
How we eat is as important as what we eat. Below are some dietary influences that affect digestion, absorption, and subsequent metabolic processes:
The time of day we eat certain foods.
What's going on - around us and inside us - as we eat.
How foods are processed - both before we put them into our mouths and before we swallow them. (Chewing is considered a form of processing, such that fast eaters digest and absorb differently than slow eaters. We've also seen that external processing can reduce the amount of internal processing. In one study, merely injecting a food with air (e.g. breakfast cereal) induced obesity in rats compared to rats that ate the same number of calories but in less processed form.)
How foods are combined.
Lots to say about that last point, for one... If you're going to eat meat, or any food containing oxidized fat (French fries, bottled oils, rancid nuts), and you're going to drink wine, it's best to do them at the same time. When we swallow a partially oxidized fat, it undergoes further oxidation when it meets acid and other chemicals in the stomach. In fact, oxidation takes off in a chain reaction there. A number of compounds are formed which have been shown to damage gastrointestinal cells. Some are absorbed and can be detected in plasma where they wreak havoc - contributing to chronic diseases such as atherosclerosis, diabetes, arthritis, and certain cancers. These oxidized compounds are especially elevated following a fatty meal. It looks like red wine can prevent products of oxidation from being absorbed, and from forming in the first place. Some studies below.
________
The Stomach As A “Bioreactor”: When Red Meat Meets Red Wine, Journal of Agricultural and Food Chemistry, June 2008 In this study, rats were fed red meat turkey cutlets along with red wine concentrate. As expected, the presence of oxidized compounds in the stomach (indicated in part by concentrations of malondialdehyde: MDA) increased greater than two-fold in rats fed just meat with no wine. Plasma levels of MDA increased by 50% (so it was absorbed). However,
"The consumption of the same meat cutlets simultaneously with concentrated wine totally prevented the elevation in plasma MDA, and even reduced it by 34% below basal level."
So, the entry of oxidized compounds into the blood after eating was not only completely prevented, but reversed - wine-fed rats ended up with lower levels than before they ate.
"These findings explain the potentially harmful effects of oxidized fats in foods and the important benefit of consuming dietary polyphenols during the meal."
A turkey cutlet (red thigh meat) with a glass of water.
A turkey cutlet, soaked in red wine* after cooking, with a glass of red wine (about 3/4 cup).
A turkey cutlet, soaked in red wine before cooking, with a glass of red wine.
* The red wine used to soak meat was an alcohol-free concentrate. Without wine, levels of MDA in plasma increased over three-fold after eating. In the 2nd meal, there was a 75% reduction in MDA absorption. In the 3rd meal, absorption of MDA was completely prevented.
"The harmful results of the consumption of high-fat, partially oxidized foods can be prevented by the addition of food-derived polyphenols to the meal, as was clearly demonstrated by our results."
Of course, many foods have polyphenolic compounds: fruits, vegetables, tea, coffee. Wine isn't special in this regard. And you have to contend with its alcohol. Unfortunately, alcoholic beverages in any form are strongly linked to breast cancer. But the mechanisms by which red wine is thought to prevent harmful effects from oxidized fats may not be generalizable to other polyphenolic-containing foods ... Which leads us back to imbibing.
From Plan B 3.0: Mobilizing to Save Civilization, by Lester Brown, founder and president of the Earth Policy Institute:
Remember these two studies from November of last year that found detrimental effects of genetically engineered corn in mice?
The tone is snide, but the reporting is worthy. Here's Matt Taibbi laying out the state of healthcare reform (as of Sept 3), and decrying the lack of a single-payer proposal, in his article for Rolling Stone:
A 
Below is a personal account by physician Jack Coulehan that appeared in the recent issue of Health Affairs journal:
I've been reading about thermogenesis and came across this study:
I was speaking with a healthcare provider recently who told me she thought the government should not be involved in healthcare. "It's socialized medicine," she said, looking aghast.
