Tuesday, June 29, 2010

FDA suggests limiting use of antibiotics in meat

This is again something I advocate in  my book "The Asian Diet"  The policies of big Agra are maddening.  We put all the cows into a tight space with no sanitation and they respond by getting sick.  The answer?  We don't need to give them more space nor realistic living conditions, we just need to pump them full of antibiotics.  If they were a contractor and I had flooding in my basement, their advice would be for me to get a scuba tank and a set of waders.  
The FDA is asking for the reduction of AB use, but is not mandating it.  Way to almost protect us, guys.

Here's the article By Mary Clare Jaolnick
  Borrowed from http://www.huffingtonpost.com/2010/06/29/fda-antibiotics-meat-limi_n_629484.html
WASHINGTON — The Food and Drug Administration is urging meat producers to limit the amount of antibiotics they give animals in response to public health concerns about the drugs.
The FDA said antibiotics in meat pose a "serious public health threat" because the drugs create antibiotic-resistant bacteria that can infect humans who eat it. The agency is recommending that producers use the drugs judiciously, limiting their use unless they are medically necessary and only using them with the oversight of a veterinarian.
"Developing strategies for reducing (antibiotic) resistance is critically important for protecting both public and animal health," the agency said in draft guidelines printed in the Federal Register on Monday.
The agency said misuse and overuse of the drugs has led to the development of antibiotic-resistant bacteria. Antibiotics have been given to animals to kill pathogens for more than 50 years, and the FDA acknowledged that practice has had "tremendous benefits" to animal and human health.
Of greater concern, the agency said, is when producers use antibiotics on healthy animals to speed growth and reduce feed costs. The agency is also concerned about antibiotics that are given continuously through feed or water to entire herds or flocks of animals.
The agency said it is expecting to issue more specific guidelines soon, but FDA Principal Deputy Commissioner of Food and Drugs Joshua Sharfstein would not say whether the agency eventually plans to issue stricter regulations. He said the guidelines are just a first step and the agency will be watching industry response and also patterns of antibiotic resistance.
Advocates on both sides of the issue criticized the decision.
Sam Carney, a pork producer from Adair, Iowa, and president of the National Pork Producers Council, said reducing the amount of antibiotics given to animals could harm their health.
"As we know, healthy animals produce safe food, and we need every available tool to protect animal health," he said.
But Steven Roach, a public health advocate with the group Keep Antibiotics Working, a coalition dedicated to eliminating the overuse of antibiotics, said the guidelines don't go far enough.
"It shows the FDA still has no plan to take the necessary steps to protect public health by stopping the non-therapeutic use of antibiotics in animal agriculture," he said.

Sunday, June 27, 2010

medication vs. lifestyle changes

This is a great article by Dr. David Katz, borrowed from http://www.huffingtonpost.com/david-katz-md/health-and-nutrition-life_b_610128.html

I recently saw a patient who, like many others before her, had decided it was time to get serious about her health. She wanted my help with better nutrition, weight loss and modifying her risk factors for chronic disease. Making such assessment in the customary ways, I was fully convinced she was motivated, serious and committed.
Unfortunately, in between visits with me, my patient had a primary care appointment that went rather badly. Apparently disgusted that the patient was not taking a recommended medication, this primary care doctor derided the value of lifestyle interventions and told the patient, "It won't be my fault if you leave here and have a heart attack!" She also, apparently, summed up the possibility that weight loss might not fully reflect body fat loss (and muscle gain) as "bull!" I recently learned of all this when the patient called me, confused and distraught.
With my patient's permission, I hope to speak soon with my colleague and attempt a meeting of the minds. For the time being, though, we have a situation nicely summed up by Cool Hand Luke: "What we've got here is a failure to communicate." Apparently, Luke had just left his doctor's office.
My patient did, indeed, have chronic disease risk factors, including slightly elevated blood pressure and cholesterol, along with early signs of diabetes risk. She is well aware of this, having addressed it with her primary care provider on prior occasions. She had been prescribed medication for lowering her cholesterol, but had not tolerated it well. She came to see me to explore other options.
Those other options are readily available. The American Heart Association, the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program all recommend lifestyle changes -- diet, exercise and weight control -- as the primary approach to cholesterol lowering. The method is referred to as "therapeutic lifestyle changes," or TLC.
The American Diabetes Association places an emphasis on TLC for both diabetes prevention and management, although in the case of management, medication is used as well. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (I have always felt their name could do with a makeover!) also front-loads with TLC as the first and best method for controlling elevated blood pressure.
The dietary recommendations of these diverse groups -- and, for that matter, the American Cancer Society -- are noteworthy for overlap. By and large, the emphasis is on foods that are close to nature, minimally processed and rich in nutrient value: vegetables, fruits, beans, lentils, whole grains, nuts, seeds, lean meats and fish, eggs, low-fat dairy. Regular physical activity at a moderate level, and the weight control that generally results from eating well and being active, are common recommendations as well.
Evidence that this basic approach is effective when truly followed is decisive. Studies such as the Lyon-Diet Heart Study have shown that a Mediterranean diet based on the foods above lowers the risk of heart attack in high risk individuals by as much as 70 percent. The Dietary Approaches to Stop Hypertension (DASH) studies have shown that a mostly plant-based diet with low- or non-fat dairy can lower blood pressure as effectively, and more safely, than medication.
The Diabetes Prevention Program showed that lifestyle was twice as effective as the drug metformin in preventing diabetes in high-risk individuals, reducing its occurrence by 58 percent. The Portfolio Diet study by my friend, Dr. David Jenkins at the University of Toronto, proved the principle that diet can lower LDL cholesterol as effectively as statin drugs.
So, there is nothing at all radical -- particularly in a patient who is reticent about taking drugs -- in attempting to modify cardiometabolic risk with a lifestyle intervention.
My patient and I did exactly that, with gratifying results. Between her first visit and her follow-up, she had already lost six pounds by making sensible and sustainable changes to her diet and physical activity patterns. Her blood pressure was lower at follow-up as well; blood work is pending. Because she has been exercising vigorously, it is likely the six-pound weight loss does not fully reflect the loss of body fat, and gain of muscle. We will be doing a body composition test to verify this.
The primary care doc simply refuted all of my advice to the patient, rather than speaking with me. The result was a patient caught between competing medical opinions, and probably trusting both of them less as a result. TLC often doesn't work for lack of follow through; when adopted well, it works well. This patient was doing a great job and deserved encouragement, not discouragement. She got "bull!" from my colleague; from me, she gets: "You go, girl!"
There is no question in the scientific literature that body fat loss can greatly exceed weight loss in someone who is exercising and gaining muscle. My most noteworthy personal experience with this was on the TV show, Celebrity Fit Club, when I supervised weight loss in the over-450-pound comedian, Ralphie May. When the scale wasn't moving, despite Ralphie's diligent efforts, we used body composition analysis to track his progress -- and it showed a dramatic shift from body fat to muscle.
TLC is slower in its effects than medications such as statins, or antihypertensives. But it is ultimately both safer and more potent. Lifestyle can reduce chronic disease risk by 80 percent; no single drug comes close. I of course recommend medication use when TLC isn't getting the job done, for whatever reason.
As for this patient's risk of walking out the door and having a heart attack, I see that differently. We can think of medical danger as being too near a fire: there is the risk of getting burned. This patient, however, was walking briskly away from the fire. No immediate need to put on a suit of asbestos.
In my current practice -- labeled integrative care -- we are very accustomed to stating explicitly that the patient is the boss. We rely on a model for using evidence in treatment decisions called CARE, clinical applications of research evidence, that emphasizes five considerations: safety, effectiveness, quality of scientific evidence, available alternatives and patient preference. Each of these matters, and warrants discussion.
Doctors need to talk to their patients. We also need to talk to other doctors about the care of our patients, so patients are not left in a no (wo)man's land of conflicting opinion. In that divide, we've got a failure to communicate that could readily result in a more fundamental failure: the failure to meet the needs of our patients, and help them be well.

Saturday, June 12, 2010

Green Tea: The elixir of life

This article is from Dr. Moshing Ni and borrowed from http://www.huffingtonpost.com/dr-maoshing-ni/tea-heath-benefits-tea-el_b_593346.html

It should be no surprise to anyone following my writing that I agree with the opinions presented.  Green tea is a big part of The Asian Diet

Lengthen your years, starting with this one simple tip: drink more tea. Delicious, low-calorie and brimming with antioxidants, tea is one of the most commonly enjoyed beverage by centenarians around the world, second only to water. Even in the US, its popularity is rapidly growing. With the healthy longevity benefits you stand to gain, you too will want to drink up.
What is tea and what makes it so healthy?
Technically speaking, "tea" is the dried and processed leaves of Camellia sinensis, a tree that is indigenous to Asia. There are four main varieties of tea: black, oolong, green, and white tea. (Yellow and pu-erh are two other varieties of tea, but are not as widespread.)
Black tea, produced when tea leaves undergo an oxidizing process that turns the leaves black, has the strongest flavor and the highest caffeine content -- about one third the caffeine you would get from the same cup of coffee. Oolong tea is slightly less oxidized and has less caffeine. Green tea is steamed, rolled and dried immediately after harvest, which halts the oxidation process, allowing the leaves to retain their green color. White tea undergoes the least processing -- the young tea buds are picked and air-dried. All of these varieties have different health benefits, with green tea and white tea leading the pack.
According to studies published in the Journal of American Medical Association, tea lowers your risk of death from all forms of cardiovascular diseases. And, there is growing evidence that tea potentially has cancer-fighting properties, plays a role in improving beneficial intestinal microflora, wards off diabetes, and helps protect your brain from free-radical damage. Also, the amino acid L-theanine, found almost exclusively in the tea plant, actively alters the attention networks of the brain, stimulating the production of alpha waves in the brain and producing feelings of well-being. Because it crosses the blood/brain barrier, it can increase levels of the neurotransmitter dopamine, which benefits mood while improving learning and concentration.
While all the choices are good, in many ways, green tea brings the most benefits to the table. Research has found that green tea has the power to effectively protect against Alzheimer's disease and other forms of mental degeneration with its natural anti-oxidative and anti-inflammatory properties. Green tea is packed with polyphenols, antioxidants that have been found to increase cognitive acuity and learning ability. One particular polyphenol is responsible for these beneficial brain effects: catechin. The concentration of catechins in green tea is four times that of black tea. Researchers aren't exactly sure why, but some conjecture that the minimal processing used for green tea may help to preserve a higher concentration of the antioxidants.
How to get the benefits into your body? A study from Purdue University found that more antioxidant catechins are absorbed in the bloodstream when citrus is added to the tea, so for best effects, squeeze a little lemon in your teacup.
What about herbal tea?
Well, herbal tea is not really tea at all, but actually an infusion or tisane made from various leaves, flowers, fruit or herbs. For thousands of years, the Chinese have blended specialized herbal teas from plants that exhibited medicinal properties to maintain health and prevent illness.
While "real" tea has many health benefits, a major pro to herbal tea is that it is caffeine-free. Originating from plants, herbal tea also offers many of the same polyphenol antioxidants that benefit your long-term health. Also, you can tailor your tea to your needs by selecting herbs and plants that address the health issue you want to target. To soak up some of the health benefits, try the following key herbal teas for health and longevity.
Peppermint has many well-documented properties: it increases healthy gastric secretions, relaxes the intestines, soothes spasms, settles the stomach, and alleviates gas.
Ginger, also extensively studied, has been shown to soothe the digestive lining and balance gastric juices. It will also naturally fire up your energy. Make ginger tea by slicing fresh ginger root into two inch long slices and boil in one cup of water for five minutes. Strain out the ginger and sip the tea slowly.
Chamomile is another excellent herb for settling the stomach. It also soothes the nervous system and relaxes the muscles, making it a perfect choice for the evening, an hour before bed.
For maximum health benefits, I suggest you work with a licensed acupuncturist or traditional Chinese medicine practitioner to find an herbal blend tailored specifically to your health needs. Among my patients, a very popular herbal tea is Internal Cleanse Tea, which is specially combined to detoxify, calm nerves, clear the mind, balance emotions and ease digestion.
Here are some brewing tips for the best health benefits:
• Tap water affects the taste of tea, so it is better to use water from a high-performance filtration system, such as Aquasana.
• To extract the most beneficial compounds from the tea leaves or bags, let them steep for three to five minutes.
• It is best to drink tea unsweetened and without milk, which can minimize some of the health benefits. Forgo the sugar and try instead honey, stevia products, or a stick of cinnamon.
I hope you drink to your health for years to come! May you live long, live strong, and live happy!

Wednesday, June 9, 2010

Red meat does not cause disease, processed does

This is what I have been saying and assert in my book The Asian Diet.  Of course too much of anything is not good, but people have been running from red meat with no good reason. We should get a little of it.  The following article by Dr. David Katz is borrowed from http://www.huffingtonpost.com/david-katz-md/nutrition-advice-the-trut_b_584758.html

A study recently published online by the journal Circulation provides some rather meaty data to chew on. Red meat may not increase the risk of heart disease. Processed meat, in contrast, apparently does.
But before the carnivores start licking their chops and stoking their coals, the food for thought served up in this paper requires considerable slicing and dicing. So out with the steak knives, and let's get to it.
The new study is a meta-analysis examining the effects of red meat and processed meat on heart disease, stroke and diabetes risk. Meta-analyses can be very powerful, but they are intrinsically limited to the quality of the research from which they are pooling data.
In this case, that is an important limitation. Data in the new report are all derived from trials in which consumption of red meat and processed meat were compared. There are relatively few such studies that exclude poultry and fish; the studies in question control variably for other health behaviors that might confound the findings; and most importantly, all of the studies were observational.
That means participants simply reported what they ate, rather than being assigned. While intervention studies are designed to establish cause and effect, observational studies can generally only suggest associations. It may be, for instance, that people who eat beef, but avoid processed meat, are generally more health conscious than those who eat both.
Still, the meta-analysis assessed over a million people. So its findings are worthy of consideration, even if they come encumbered by caveats.
The study suggests that when isolated from processed meat, pure red meat has no meaningful association with heart disease risk. Total meat intake was, the authors state, "associated with a trend toward higher [heart disease] risk."
Each daily serving of processed meat raised the apparent risk of heart disease by a relative 40 percent. Each serving of total meat per day was linked to a 12 percent rise in the apparent relative risk of diabetes.
Some of the findings came down to statistical subtleties. For example, a 19 percent increase in diabetes risk associated with processed meat intake was significant, whereas a 16 percent increase in such risk with red meat consumption was not. That three percent relative risk difference is decisively trivial. The review lacked statistical power for stroke, but there were positive associations between red meat, processed meat and total meat with stroke risk.
Research findings are more reliable when there are mechanisms to account for them, and in this case, there are. In general, processed meats are higher in saturated fat and lower in protein than pure red meats. More importantly, processed meats are much higher in sodium, and contain compounds such as nitrates and nitrites -- both linked to vascular injury and atherosclerosis -- in relatively high concentrations.
Of course, red meat does contain saturated fat and cholesterol, which is what makes an apparent lack of association between its intake and heart disease noteworthy. As for saturated fat, it is not all created equal. We have already learned to distinguish saturated fat from unsaturated varieties, and most people know that some sub-categories of fat, such as omega-3, have unique health effects. Our next collective step forward will be to refer to the health effects of specific fatty acids within a given class. About a third of the saturated fat in red meat is stearic acid, which appears to be free of the harmful effects of its classmates.
Dietary cholesterol is very weakly associated with heart disease risk, and may be all but irrelevant. This is unsurprising -- cholesterol has been a normal part of the human diet since the Stone Age, when it came from meat and eggs.
Our Stone Age proclivities do not, however, directly support a modern carnivorous bent. Anthropologists suggest that antelope flesh is fairly representative of the meat our ancestors ate. While the flesh of beef cattle is roughly 35 percent fat by calories, most of it saturated, the flesh of antelope is as low as five percent of calories from fat, all of it unsaturated, and some of it omega-3. Not all ungulates are created equal.
The new study cannot distinguish among varieties of red meat. Some is leaner, some is fattier. Just as we are what we eat, so, too, is what we eat. The flesh of grass fed cattle, for example, is more nutritious than that of grain fed cattle.
The study looked at heart disease, stroke and diabetes only. Many studies have linked higher intake of red meat with increased cancer risk, colon cancer risk in particular. This study was blind to that issue.
Also ignored was the fact that eating more meat probably means eating less of other foods. Other foods -- namely vegetables, fruits, whole grains, nuts, seeds and fish -- have been shown to reduce the risk of heart disease, and of premature death from any cause. What we eat matters both because of what it puts into our mouths, and what it bumps out. A switch to more meat-based eating could very well confer net harm in part because of what it is taking out of your diet.
As pointed out by, among others, T. Colin Campbell in 'The China Study,' prevailing protein intake in the U.S. tends to be much in excess of need, and is likely associated with adverse effects on everything from bone density to cancer risk. Eating more meat would compound such concerns.
Raising feed animals comes at a very high environmental cost. As Michael Jacobson and colleagues point out in "Six Arguments for a Greener Diet", it takes roughly seven lbs of corn to grow one pound of beef; five times as much water to grow feed grains for cattle as to grow fruits and vegetables for ourselves; and roughly ten times the acreage to raise cattle for food as to raise comparable plant food calories for direct human consumption.
Processed meats -- sausage, bacon, and the like -- are almost certainly harmful in ways that simple, unprocessed red meats are not. But however you choose to digest the news about meat, chew on this: Red meats are, at best, less harmful; there is nothing to suggest they actually promote health. Plant foods do -- for people and planet alike.
However you dice the new data, in other words, Michael Pollan's advice still stands: eat food, not too much ... mostly plants!
Dr. David L. Katz; www.davidkatzmd.com

Wednesday, June 2, 2010

The Dirty Dozen: some produce items have as many as 67 pesticides

Thanks to Tom S for forwarding this to me.  This post is borrowed from http://www.cnn.com/2010/HEALTH/06/01/dirty.dozen.produce.pesticide/index.html  There is also a video on this page. 

(CNN) -- If you're eating non-organic celery today, you may be ingesting 67 pesticides with it, according to a new report from the Environmental Working Group.
The group, a nonprofit focused on public health, scoured nearly 100,000 produce pesticide reports from the U.S. Department of Agriculture and the U.S. Food and Drug Administration to determine what fruits and vegetables we eat have the highest, and lowest, amounts of chemical residue.
Most alarming are the fruits and vegetables dubbed the "Dirty Dozen," which contain 47 to 67 pesticides per serving. These foods are believed to be most susceptible because they have soft skin that tends to absorb more pesticides.
"It's critical people know what they are consuming," the Environmental Working Group's Amy Rosenthal said. "The list is based on pesticide tests conducted after the produce was washed with USDA high-power pressure water system. The numbers reflect the closest thing to what consumers are buying at the store."
Special report: Toxic America
The group suggests limiting consumption of pesticides by purchasing organic for the 12 fruits and vegetables.
"You can reduce your exposure to pesticides by up to 80 percent by buying the organic version of the Dirty Dozen," Rosenthal said.
The Dirty Dozen
Domestic blueberries
Sweet bell peppers
Spinach, kale and collard greens
Imported grapes
Not all non-organic fruits and vegetables have a high pesticide level. Some produce has a strong outer layer that provides a defense against pesticide contamination. The group found a number of non-organic fruits and vegetables dubbed the "Clean 15" that contained little to no pesticides.
The Clean 15
Sweet corn
Sweet peas
Kiwi fruit
Sweet potatoes
Sweet onions
What is a pesticide?
A pesticide is a mixture of chemical substances used on farms to destroy or prevent pests, diseases and weeds from affecting crops. According to the USDA, 45 percent of the world's crops are lost to damage or spoilage, so many farmers count on pesticides.
The Environmental Protection Agency, the FDA and the USDA work together to monitor and set limits as to how much pesticide can be used on farms and how much is safe to remain on the produce once it hits grocery store shelves.
"In setting the tolerance amount, the EPA must make a safety finding that the pesticide can be used with 'reasonable certainty of no harm.' The EPA ensures that the tolerance selected will be safe," according the EPA's website.
Although the President's Cancer Panel recently recommended that consumers eat produce without pesticides to reduce their risk of getting cancer and other diseases, the low levels of pesticides found on even the Dirty Dozen are government-approved amounts.
Can small amounts of pesticides hurt you?
The government says that consuming pesticides in low amounts doesn't harm you, but some studies show an association between pesticides and health problems such as cancer, attention-deficit (hyperactivity) disorder and nervous system disorders and say exposure could weaken immune systems.
The Environmental Working Group acknowledges that data from long-term studies aren't available but warns consumers of the potential dangers.
"Pesticides are designed to kill things. Why wait for 20 years to discover they are bad for us?" Rosenthal said.
Some doctors warn that children's growing brains are the most vulnerable to pesticides in food.
"A kid's brain goes through extraordinary development, and if pesticides get into the brain, it can cause damage," said Dr. Philip Landrigan, chairman of the department of preventive medicine at Mount Sinai School of Medicine in New York.
Can pesticides be washed away?
Not necessarily. The pesticide tests mentioned above were conducted after the food had been power-washed by the USDA. Also, although some pesticides are found on the surface of foods, other pesticides may be taken up through the roots and into the plant and cannot be removed.
"We've found that washing doesn't do much," Rosenthal said. "Peeling can help, although you have to take into account that the pesticides are in the water, so they can be inside the fruit because of the soil."
All fresh produce, whether it's grown with or without pesticides, should be washed with water to remove dirt and potentially harmful bacteria. And health experts agree that when it comes to the Dirty Dozen list, choose organic if it's available.
"To the extent you can afford to do so, [parents] should simply buy organic, because there have been some very good studies that shows people who eat mostly organic food reduce 95 percent of pesticides [in their body] in two weeks," Landrigan said.

Tuesday, June 1, 2010

osteoarthritis of the knee - acupuncture

73 year old woman with osteoarthritis of both knees.  Using a cane, can't take stairs.  Asks MD about acupuncture, he scoffs and says he prefers "traditional" treatments like synvisc, which has been used for less than three years.  After four acupuncture treatments, she is taking stairs and often forgets to use her cane because she doesn't feel the need.

I find it amusing and ridiculous that the medicine that I practice is considered "alternative" or "non-traditional" but the drugs that are brand new and hardly-studied are considered "traditional".  I am not against drugs, I just worry about the ones that have not been studied enough.  We have had several instances where the new "miracle drug" had to be pulled off the market because it was killing people.  This is one of the things I love about practicing Oriental medicine.  It is so safe and well-studied.  I do not do anything to a patient that has been studied for less than 1000 years.  

Oriental medicine should be our first line of medicine.  We should start with the least-invasive and longest-studied interventions.   If it doesn't work, then we can go to the more potentially-harmful and potentially-toxic interventions.

Rethink what you consider "traditional" medicine.

btw, if you'd like to read about some of the adverse effects of synvisc, check out http://synviscsurvivor.blogspot.com/