I was considering omitting a website article this week. It’s been a tough week… A very good friend died from virulent leukemia. But I am back in the office and seeing patients and yes, I did look at some of the articles. The one that I thought might be of interest was a report by the FDA and the Environmental Protection Agency encouraging pregnant women as well as women who may become pregnant or breast-feeding as well as young children to eat more fish.

In their draft guidance, the agencies are calling for women to consume 8 to 12 ounces of a variety of fish that are lower in mercury; that amounts to an average of 2 to 3 servings per week. The fish that have lower mercury levels include salmon, shrimp, pollock, tuna (light canned), tilapia, catfish and cod. The US Department of Agriculture suggests an amount of 3 to 5 ounces per week for children under the age of six and 4 to 6 ounces per week for children age 6 to 8. The agencies feel that there is “long standing evidence of nutritional value of fish in the diet. Fish contain high-quality protein, many vitamins and minerals, omega-3 fatty acid and are mostly low in saturated fat, and some fish even contain vitamin D. The nutritional value of fish is especially important during growth and development before birth, in early infancy for breast-fed infants, and in childhood.”

There have been long standing concerns about the mercury content of fish and as a result the FDA found that 21% of pregnant women consume no fish and 50% are eating fewer than 2 ounces per week. There are some types of fish that the FDA still suggest that women and children avoid: these include tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel. They also recommend limiting white (albacore) tuna to 6 ounces per week for adults and even less for children.

So there you have it…as usual recommendations can be changed. And now those issued by the FDA/EPA in March 2004 have been replaced with a recommendation of simply consuming up to 12 ounces of a variety of fish per week (two average meals) avoiding the four types of fish I listed above because that have a high mercury content.

Hooray for salmon! Now I just have to figure out what gefilte fish is made of…

This week I’m going to diverge from my usual review and commentary of articles published in peer-reviewed journals and write about one that I read in the New York Times. The headline read “Younger Skin Through Exercise” and after I dutifully read the pages devoted to the conflicts in the Ukraine and Syria, I was delighted to find a good-news health article which pertained to aging skin.

The author cited a study which was presented this month at the American Medical Society for Sports Medicine. Having just returned from The Golden Door where, for a week, I exercised up to six hours a day with hikes, tai chi, yoga, dance, stretching, toning and Pilates I thought “wow not only did I get my body and mind in better shape, but I may have helped my skin!” So obviously I was intrigued, and unless you read the article in The New York Times, here is a summary:

The first part of the study was conducted on 29 male and female volunteers between the ages of 20 and 84. Half of the participants were active and exercised moderately or vigorously for at least three hours every week. The other half were sedentary, doing nothing or exercised for less than an hour per week. The scientists did skin biopsies from the volunteers buttocks. (They chose the tush area in order to examine skin that had not been exposed to sun… I assume the participants were not nudists.) The older volunteers had thicker outer layers of the skin and significantly thinner inner layers. But when they compared those who exercised and those who did not, they found that after age 40 the men and women who exercised frequently had markedly thinner, healthier outer layers and thicker inner layers in their skin. (Note, if for the top layer is thick it is also dryer, flakier and crocodile-like and when the underlying layer begins to thin it loses elasticity giving it a saggier appearance.)

The researchers understood that other factors, including diet, genes and lifestyles might have influenced the difference in the skin condition between the exercising and sedentary group. So they took a group of sedentary volunteers who were age 65 or older and who had normal skin for their age and had them begin an endurance training program. The volunteers worked out twice a week by jogging or cycling for 30 minutes for a period of three months. At the end of the three months, the researchers again biopsied the volunteers skin. (They were certainly brave volunteers.) Lo and behold, when viewed under the microscope, the volunteers’ skin looked like that of younger persons!

The researchers then analyzed the skin of those who had exercised and found elevated levels of a substance produced in working muscles, a myokin called IL-15. The skin samples contained almost 50% more IL-15 after exercising then at the start of the study. But before we start thinking we can just rub on some IL 15 or take a pill containing this myokin, the chief investigator specifically stated that it was unlikely that this would replicate the skin benefits of a work out.

This is a small study but I found it fascinating and felt it adds to our knowledge about the importance of exercise. Remember, the one intervention that has been found to prolong our lifespan and health span is exercise. Of course it helps to be in fabulous surroundings, focus one’s mind with meditation, get daily massages and eat great and nutritious foods… Last week was health week at The Golden Door and I was asked to give a talk on women’s health each day. I hope this was helpful to the other women there. But I have to admit that my personal health and well being significantly benefitted and perhaps it was also good for the layers of my skin! I’ll notify my dermatologist…

This week I’m going to give a lecture at the annual conference of the Academy for Anti-Aging in Las Vegas. They asked me to give a talk months ago, and hey, a weekend in Vegas sounded great. I will report on the conference and my talk next week. When I power-pointed my talk, I included some general dietary recommendations and one was “Eat your nuts”. So when I saw the article in the November 21 issue of the The New England Journal of Medicine titled “Association of nut consumption with total and cause-specific mortality” I looked for new data to support this recommendation. And it was there…

The authors examined the association between nut consumption and subsequent mortality among 76,464 women in the Nurses Health Study (all woman) which was conducted between 1980 and 2010 as well as 42,498 men in the Health Professional Follow-up Study (all men) that went on between 1986 and 2010. (In other words, 30 years of study on a huge number of women and men.)

They found that for those who ate nuts as compared to those who did not there was a significant decrease in mortality during the 30 years of follow up. And this decrease in death rate was directly correlated with the number of times a week they ate nuts. Their risk of death was decreased by 7% with nut consumption once a week, 13% for 2 to 4 times a week, 15% for 5 to 6 times a week and a whopping 20% for those who ate nuts seven or more times a week. This inverse association was observed for most major causes of death, including heart disease, cancer and respiratory diseases. The results were similar for all tree nuts and peanuts. Not only that, the studies showed that the concern that frequent nut consumption can result in weight gain does not appear to be valid. In these two large studies, increased nut intake was associated with less weight gain and a decreased risk of obesity. So, how many nuts you should eat? In the study they considered a serving of nuts to be 28 grams or 1 ounce.

Why are nuts so healthy so healthy? They contain unsaturated fatty acids, high-quality protein, fiber, vitamins (folate, niacin and vitamin E), minerals (potassium, calcium and magnesium) as well as phytochemicals (flavonoids). These nutrients may have significant heart protective, cancer protective, anti-inflammatory and antioxidant properties.

Bottom line: I guess the advice to eat your nuts is appropriate. I’m off to eat eight almonds. (Yes, they are the salty kind.)

I just spent an amazing week at a spa near San Diego where I was able to hike, perform tai chi, yoga, dance, work out in a gym, meditate and even create art. It was a wonderful week of healing and renewal for my body and soul. Upon return, my state of “zen-hood” was altered when I discovered that only 20% of adult Americans meet federal recommendations for aerobic and muscle-strengthening activity.

Although during my spa week, I didn’t have the time nor the desire to read medical journals, once home on Sunday I felt a wee bit guilty (so much for being at peace with my zen-being) and quickly glanced at my favorite journal, JAMA. And there was an article titled “US Adults Are Lax On Meeting National Exercise Guidelines”. And in my current exercise euphoric state, I just had to read the article and feel a sense of exercise superiority as I unpacked. (It was a short article.) Here is what it reported:

Only 20% of adult Americans meet federal recommendations for both aerobic and muscle-strengthening activity. The federal government’s physical activity guidelines for Americans recommend two hours and 30 minutes of moderate intensity exercise or 75 minutes of vigorous aerobic exercise or an equivalent combination of both each week. Aerobic exercise can be walking, running, swimming and bicycling and should be in increments lasting at least 10 minutes spread throughout the week. They state that the health benefits of aerobic exercise include lowering the risk of coronary heart disease, stroke, hypertension, type 2 diabetes and depression. (We also know that it significantly increases longevity, perhaps more so then any medication!) Adults should also get at least two sessions a week of muscle strengthening exercise that works the body’s major muscle groups in the legs, hips, back, chest, abdomen, shoulders and arms. Working with a resistance band, lifting weights, doing push-ups and sit-ups or Pilates are a few of the recommended ways to increase bone strength and muscular fitness. Although the official physical activity guidelines don’t set a defined amount of time for this the exertion, they do state that it should be continued to the point that another repetition would be difficult. (We have all been there, after 10 or 15 reps, lifting that weight one more time or repeating that stretch is just too much of an effort.)

These woeful statistics were gathered through The Behavioral Risk Factor Surveillance System, a telephone survey of adults aged 18 years or older conducted by state health departments. It showed that Colorado did best and 27% of residents met the guidelines for both aerobic and muscle-strengthening exercise. The lowest rate in the country was in Tennessee with about 13% meeting the guidelines.

Although I won’t have a chance to go back for a glorious spa week for another year, I do intend to keep up the daily walking and twice weekly muscle strengthening work out. Statistics are worrisome, but sensing how well one feels as a result of doing the “right thing” is convincing.

Imagine going through an entire pregnancy only to have your baby die at or within a month of birth. Nor do we expect to lose our lives during childbirth. Most American women would say that this is a tragic scenario that is far more likely to occur in developing countries. That’s correct, but a new report issued by Save the Children for Mother’s Day gives us pause for concern about our self satisfaction regarding our country’s maternal, newborn and child safety status. But before I report on America’s less than stellar statistics, let me give you some global ones:

Every year, nearly 7,000,000 children die before the age of five.
Every year, 40 million women give birth at home without the help of the skills birth attendant.
Every day, 100 women died during pregnancy or childbirth and 8,000 newborn babies die during the first month of life.
Newborn death accounts for 43% of all deaths among children under age 5.
3 million newborn babies die every year – mostly due to easily preventable or treatable causes such as infections, complications at birth and complications of prematurity.
60% of the infant deaths occur in the first months of life. Among those, nearly 3/4 die in their first week. And more than a third die on the date of birth.

Save the Children has compiled a yearly mother’s index that uses five indicators, definitions and data sources in order to rate the well-being of mothers and their children. These include: Lifetime risk of maternal death, under-five mortality rate, expected number of years of formal schooling, gross national income per capita and finally participation of women in national government. Now as underwhelming as this may be, our country ranks 30th on this mother’s index. Overall, the US performs quite well on educational and economic status (10th best in the world) but it lacks behind all other top ranked countries on maternal health (46th in the world) and children’s well-being (41st in the world) and performs poorly in political status (89th in the world!) And here is why:

In the US, women face a 1 in 2,400 risk of maternal death. Only five developing countries in the world – Albania, Latvia, Moldova, the Russian Federation and Ukraine – perform worse than in the United States on this indicator. A woman in the US is more than 10 times as likely as a woman in Estonia, Greece or Singapore to eventually die from a pregnancy related cause.
In the US, the under five mortality rate is 7..5 per 1,000 life births. This is roughly the same as the rates in Bosnia and Herzegovina, Qatar and Slovakia. At this rate, children in the US are three times as likely as children in Iceland to die before their fifth birthday.
Women hold only 18% of seats in the United States Congress. Half of all countries in the world perform better on this indicator. Sixteen countries have more than doubled this percentage of seats occupied by women. In Finland and Sweden, for example, women hold 43 and 45% of parliamentary seats respectively.

So who ranks first? Finland wins, followed by Iceland and the Netherlands and then Denmark. Ahead of us in the mother’s index is Estonia, followed by Canada, United Kingdom, Czech Republic, Israel, Belarus, Lithuania, Poland and Luxembourg. Then and only then we follow. The worst countries for mothers and their children are in sub-Saharan Africa and include Niger, Mali, Sierra Leone; last on the mother’s index is the Democratic Republic of the Congo.

Most of my patients, as well as readers of my website, know that I’m very involved with Save the Children and indeed serve as a trustee. I am particularly proud of our global newborn and child survival campaign. We are currently working on four fronts:

  • Increasing the awareness of the challenges and solutions to maternal, newborn and child survival. (as part of the campaign Save put out this year’s state of the world mothers report.
  • Encouraging action by mobilizing citizens around the world to support programs to reduce maternal, newborn and child mortality.
  • Working in partnership with national health ministries and local organizations and are supporting efforts to deliver high quality health services throughout the developing world. This means improving pregnancy and delivery care, vaccinating children, treating diarrhea, pneumonia and malaria as well as improving nutrition
  • The program Saving Newborn Lives launched in 2000 with the grant from Bill and Melinda Gates Foundation has helped deliver better care practices and improve health interventions to save newborn lives in 18 countries.At home we, the concerned women (and men) can help. Our votes and letters can have a huge impact…Congress should create a national commission on children to address the needs of 16 million children in the US now living in extreme poverty. Congress should also protect US global health funding and increase support for maternal and child health and nutrition. If every woman is afforded appropriate maternal health care (and hopefully the new health laws that go in effect in 2014 will help ensure this), we need not be ranked 30th in the world.

    So now I will do my trustee thing….If you want to learn more or help us make a difference in the lives of millions of children please go to www.savethechildren.org/newborn-action.

We all know that Bacchus was a man. Based on gender stereotypes, most of us assume that women are less likely to excessively imbibe alcohol then men. (For the sake of transparency, the Superbowl was playing while I wrote this and all that celebrated testosterone caused me to make that last statement). But not necessarily so… According to a recent CDC report in “Vital Signs,” more than 14 million US women binge drink about three times a month and consume an average of six drinks per binge. This number includes one in eight women and one in five high school girls! The report states that binge drinking is most common in young women, women who are white or Hispanic, and among women with household incomes of $75,000 or more. Oh…and half of all high school girls who drink alcohol report binge drinking.

A woman’s ability to metabolize alcohol differs significantly from that of a man. When we drink alcohol it is absorbed more quickly, deactivated by enzymes less efficiently, and gets to the brain faster. (Well, we always knew that our brains have rapid and superior circulation. ) We generally weigh less than men so we are also less likely to dilute the stuff. As a result, one drink for a women has the impact of two for a man.

The definition of binge drinking for a woman is consumption of four or more alcohol drinks on an occasion. And an occasion is considered to be 2 to 3 hours. Although binge drinking in high school or college can lead to a higher incidence of alcoholism in later life, most binge drinkers are non-alcoholics and not alcohol dependent. The CDC reports that drinking too much (which of course includes binge drinking) results in about 23,000 deaths in women and girls each year and increases the chances of breast cancer, heart disease, sexually-transmitted diseases, unintended pregnancy as well as other health problems. If a woman binge drinks while pregnant, she risks exposing her baby to high levels of alcohol during its development which can lead to miscarriage, low birth weight, sudden infant death syndrome (SIDS), attention deficit/hyperactivity disorder (ADHD), and fetal alcohol syndrome (facial disfigurement and mental deficiencies). This is where I’m supposed to say it’s not safe to drink alcohol any time during pregnancy.

Aside from giving warnings, the CDC and its Guide to Community Preventive Services recommend certain strategies for preventing excessive alcohol consumption.. These include:  

*Increasing alcohol taxes.

*Reducing the number and concentration of stores that sell alcohol in a given area.

*Continuing government controls over alcohol sales.

*Maintaining or reducing the days and hours of alcohol sales.

*Enhanced enforcement of laws prohibiting sales to minors.

*Electronic screening and counseling for excessive alcohol use.

I know some of this sounds excessive and may go against our sense of what the government should and should not do. (There are no blue laws in California, and according to that wonderful series Boardwalk Empire, prohibition doesn’t work!) To help avoid teenage binging, the best plan might be to make sure that our teens can’t get into our liquor closet and of course, maintain zero tolerance for alcohol use before, during and after school parties. And then we should listen to the anti-binge advice ourselves. Remember abstaining from that second and certainly the third drink may lessen our risk for breast cancer, heart disease, stupid behavior, and worse yet, the wrong sexual and reproductive decisions. We just don’t need that extra glass of wine, cocktail or beer to enjoy the game, the dinner or the party. The salute ” Le Chaim” (translated, for those of you who need it) to “To Life” need not be accompanied by 4 drinks…one is healthier and should suffice.

A quick personal note: I am traveling to Mozambique next week with several women to see the school we built through the LA Associates of Save the Children. I will be happy to share pictures and stories upon my return.

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Every once in a while I have a culinary break down and snack on potato chips….they gratify so many tastes: salt, fat, crispy carbs and empower a feeling of “so what.”  Turns out that I (and you) would be better off snacking on nuts. At least that’s the conclusion of a prospective investigation of lifestyle behaviors and diet published in the June issue of The New England Journal of Medicine. The authors combined questionnaires on lifestyle factors and weight change for 120,877 women and men who were free of chronic disease and who participated in 3 studies with follow-up periods ranging from 1986 to 2006 (The Nurses Health Study), 1991 to 2003 (the Nurses Health Study II…this involved younger nurses; Nurses I and II were all women) and 1986 to 2006 (the Health Professionals Follow-up Study… all male). Their diets were assessed as to consumption of fruits, vegetables, whole grains, refined grains (what I call the white stuff), potatoes (including boiled, mashed potatoes and french fries), potato chips, whole-fat dairy products, low-fat dairy products, sugar-sweetened beverages, sweets and desserts, processed meats, unprocessed red meats, fried foods and trans fats. In other words, pretty much everything we know that can be bad for our health. The studies also evaluated nuts, 100%-fruit juices, diet sodas and subtypes of dairy products and potatoes. The participants were questioned about their physical activity, television watching, alcohol use, sleep duration and cigarette smoking.

The participants’ food and weight changes were assessed every 4 years. When the average weight gain was calculated for the 3 groups it was 3.35 lb…doesn’t sound like a huge amount, but when calculated over 20 years this comes to 16.8 lb. (There goes a size 6, an 8 and even a10!) And here are the foods and behaviors that were associated with weight gain, as well as those that were related to weight loss:

FOOD OR BEHAVIOR

WEIGHT GAIN (+) or L0SS (-) PER 4 YEARS

  • Potato Chips
  • Potatoes
  • Refined grains
  • Sweets and desserts
  • Sugar Sweetened beverages
  • Unprocessed Red Meats
  • Processed meats
  • Vegetables
  • Whole grains
  • Fruits
  • Nuts
  • Yogurt
  • Physical activity
  • Alcohol use
  • Smoking cessation (new quitters)
  • Former smokers
  • Sleep (weight gained with less than 6 hours or more than 8 hours)
  • Television watching

+ 1.69 lb
+1.28 lb
+0.37 lb
+ 0.41 lb
+1.0 lb
+ 0.95 lb
+ 0.92 lb
- 0.22 lb
- 0.37 lb
- 0.49 lb
- 0.57 lb
- 0.82 lb

- 1.76 lb

+ 0.41 lb per drink per day
+ 5.17 lb

+ 0.14 lb

+ 0.31 lb per hour per day

I’m sure you will (and should) now ask: How many potato chips or nuts does one have to consume to gain or lose weight during that 4 year period? Just one serving per day! (And for the amount that constitutes a serving, you have to look on the package or bottle insert and/or use common nutritional sense.)

Please note that the weight gain that was associated with refined grains was similar to that of a serving of sweets and desserts. Inverse associations with weight gain (i.e. loss) were seen with the consumption of vegetables, whole grains, fruits, nuts and yogurt. No significant differences in weight gain were seen for high-fat versus low-fat and skim milk. The authors weren’t sure why yogurt consumption helped prevent weight gain. They hypothesized that changes in colonic bacteria caused by the yogurt might prevent weight gain. And they thought that even though vegetables, nuts, fruits and whole grains provide calories (and according to thermodynamic law a calorie is a calorie and energy put in the body will be stored unless it is used up); their consumption reduced the intake of  the other foods that were more likely to cause weight gain. It was interesting that drinking 100%-fruit juice was associated with less weight gain than sugar-sweetened beverages. The reason may be that the fruit juices are consumed in smaller portions. (It’s hard to drink a “big gulp” of orange juice!)

Finally, (and we would expect this) the women and men with who exercised daily lost 1.76 pounds within each 4-year period.

Now for the smoking issue… I don’t want this data to stop anyone from deciding to stop.  Smoking is thought to alter the distribution of body fat, promoting internal abdominal fat (called visceral fat) rather than fat on the rest of the body. So weight might be less while smoking but this visceral fat is dangerous and is linked to a high risk of diabetes. Any so called weight loss from smoking is ultimately harmful. (Just think of the fat going invisibly inside your abdomen as your thighs, arms and the tush lose circumference; and that this bad fat can kill you!),  The immediate weight gain that can occur after smoking cessation actually represents a healthier distribution of fat, moreover that weight eventually declines.
Here are some stats that match the overall data from these 3 studies: Between 1971 and 2004 the average dietary intake of calories in the United States increased by 22% among women and 10% among men, mainly due to increased consumption of refined carbohydrates, starches and sugar-sweetened beverages. Just 50 to 150 extra calories a day will cause the gradual weight gains, and over time those pounds add up and demolish our figures (and health).

Bottom line: Eat those vegetables, whole grains, fruits, nuts and yogurt.  Cut down on all those processed carbs and starches. Limit your TV time (you are more likely to eat the bad stuff while sitting there watching TV, even if you Tivo out the commercials for potato chips), make sure you exercise (at least 30 minutes most every day) stop smoking as soon as possible (better yet never start) and  sleep 7 to 8 hours a day. Well our mothers knew all that!

I just returned from Israel and frankly would not be able to function without a caffeine push. To add to my thanks for that cappuccino (or 2) is a new study that appeared in the journal Stroke. (Yes, there are journals that are titled for diseases.) Researchers at the very well known Karolinska Institute in Stockholm followed 35,670 women (ages 49 to 83 years) who did not have a history pf cardiovascular disease or cancer over a 10 year period of time. (These women were actually participating in the Swedish Mammography Cohort study looking at links between diet, lifestyle and disease.) They assessed coffee consumption using a self-administered questionnaire. The questionnaire made no distinction between caffeinated and decaffeinated cups of coffee, but it is well known (reference The Girl with the Dragon Tattoo as well as the other novels by Steg Larsson) that decaffeinated consumption of coffee in Sweden is low.

The researchers found that 1 to even more than 5 cups of coffee a day lowered risk for stroke, cerebral infarction (lack of oxygen and death of the tissue from an occlusion of an artery) as well as sub arachnoid hemorrhage by 25%! The amount of coffee did not seem to make a difference; it just had to be a daily beverage. And when they took into consideration smoking, weight, history of diabetes, hypertension and alcohol consumption, the decrease in stoke incidence was still there if coffee was consumed on a regular basis.  Wow! This doesn’t mean that the latter factors are not important…but even if they exist, coffee appears to decrease the risk of those women who are at risk.

The authors of the study suggested that coffee drinking reduces stroke by decreasing mild inflammation, acting as an antioxidant and improving insulin sensitivity. Right now, I just want it to keep me awake!

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