Emergency preparedness kits: Buy one or make one?

When disaster strikes, you’ll need quick, easy access to the right supplies to keep you and your loved ones safe and healthy. One of the best ways to make sure you’re ready for an emergency is to have a preparedness kit (PDF).

You can buy a ready-made preparedness kit off the shelf, or you can make one yourself. Both options will provide you with important supplies, but if you buy a kit, check to make sure that all of the items included meet the needs of you and your family. For example, a purchased toolkit may not come with items you need if you have pets to care for.

To cover all of your bases, start with a checklist. APHA’s Get Ready campaign offers tips for packing and creating (PDF) a preparedness kit. Use this as a guide to help you gather the items you need to make your own kit or to make sure a store-bought kit has the right contents.

The Get Ready checklist also gives you tips for storing your kit and how often to check the kit to make sure the items are still fresh. This important information isn’t included in many pre-assembled toolkits. And if you have pets, check out the fact sheet (PDF)
on including emergency supplies for pets.

Similar checklists and tips are available from the Centers for Disease Control and Prevention, the American Red Cross and the Federal Emergency Management Agency.

So which is better, making your own preparedness kit or buying one? Both are fine, but make sure your kit contains everything you’ll need. A checklist will help. Also, make sure it has enough supplies to last at least three days. Creating your own kit will take a little extra effort, but you can be sure it includes everything on your list. And when disaster strikes, a well-stocked kit will provide a special something not on a checklist: peace of mind.

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Do You Look Happy?

(Click on image for a larger version.)
Source: How to Find Your Man by Joe Bonomo, 1954

Grains as Food: an Update

Improperly Prepared Grain Fiber can be Harmful

Last year, I published a post on the Diet and Reinfarction trial (DART), a controlled trial that increased grain fiber intake using whole wheat bread and wheat bran supplements, and reported long-term health outcomes in people who had previously suffered a heart attack (1). The initial paper found a trend toward increased heart attacks and deaths in the grain fiber-supplemented group at two years, which was not statistically significant.

What I didn't know at the time is that a follow-up study has been published. After mathematically "adjusting" for preexisting conditions and medication use, the result reached statistical significance: people who increased their grain fiber intake had more heart attacks than people who didn't during the two years of the controlled trial. Overall mortality was higher as well, but that didn't reach statistical significance. You have to get past the abstract of the paper to realize this, but fortunately it's free access (2).

Here's a description of what not to eat if you're a Westerner with established heart disease:
Those randomised to fibre advice were encouraged to eat at least six slices of wholemeal bread per day, or an equivalent amount of cereal fibre from a mixture of wholemeal bread, high-fibre breakfast cereals and wheat bran.
Characteristics of Grain Fiber

The term 'fiber' can refer to many different things. Dietary fiber is simply defined as an edible substance that doesn't get digested by the human body. It doesn't even necessarily come from plants. If you eat a shrimp with the shell on, and the shell comes out the other end (which it will), it was fiber.

Grain fiber is a particular class of dietary fiber that has specific characteristics. It's mostly cellulose (like wood; although some grains are rich in soluble fiber as well), and it contains a number of defensive substances and storage molecules that make it more difficult to eat. These may include phytic acid, protease inhibitors, amylase inhibitors, lectins, tannins, saponins, and goitrogens (3). Grain fiber is also a rich source of vitamins and minerals, although the minerals are mostly inaccessible due to grains' high phytic acid content (4, 5, 6).

Every plant food (and some animal foods) has its chemical defense strategy, and grains are no different*. It's just that grains are particularly good at it, and also happen to be one of our staple foods in the modern world. If you don't think grains are naturally inedible for humans, try eating a heaping bowl full of dry, raw whole wheat berries.

Human Ingenuity to the Rescue

Humans are clever creatures, and we've found ways to use grains as a food source, despite not being naturally adapted to eating them**. The most important is our ability to cook. Cooking deactivates many of the harmful substances found in grains and other plant foods. However, some are not deactivated by cooking. These require other strategies to remove or deactivate.

Healthy grain-based cultures don't prepare their grains haphazardly. Throughout the world, using a number of different grains, many have arrived at similar strategies for making grains edible and nutritious. The most common approach involves most or all of these steps:
  • Soaking
  • Grinding
  • Removing 50-75% of the bran
  • Sour fermentation
  • Cooking
But wait, didn't all healthy traditional cultures eat whole grains? The idea might make us feel warm and fuzzy inside, but it doesn't quite hit the mark. A recent conversation with Ramiel Nagel, author of the book Cure Tooth Decay, disabused me of that notion. He pointed out that in my favorite resource on grain preparation in traditional societies, the Food and Agriculture Organization publication Fermented Cereals: a Global Perspective, many of the recipes call for removing a portion of the bran (7). Some of these recipes probably haven't changed in thousands of years. It's my impression that some traditional cultures eat whole grains, while others eat them partially de-branned.

In the next post, I'll explain why these processing steps greatly improve the nutritional value of grains, and I'll describe recipes from around the world to illustrate the point.

* Including tubers. For example, sweet potatoes contain goitrogens, oxalic acid, and protease inhibitors. Potatoes contain toxic glycoalkaloids. Taro contains oxalic acid and protease inhibitors. Cassava contains highly toxic cyanogens. Some of these substances are deactivated by cooking, others are not. Each food has an associated preparation method that minimizes its toxic qualities. Potatoes are peeled, removing the majority of the glycoalkaloids. Cassava is grated and dried or fermented to inactivate cyanogens. Some cultures ferment taro.

** As opposed to mice, for example, which can survive on raw whole grains.

The Cover Girl

(Click on images for full-size versions.)
Source: American Hairdresser, November 1942

It's been a while. Did you miss me?

Of Course You Can Have Pretty Hands

(Click on the images to enlarge.)
Source: 1000 Hints Beauty #7, 1956

The Egg Box Camera

Returning home yesterday afternoon from the far north eastern corner of the Dengie Peninsular in Essex, I saw this sign at the side of the road near Bradwell-on-Sea. Obviously amused, I carried on driving and then, after a mile or so decided I really should've photographed it. So I turned back, and very intrigued I carefully opened the makeshift box that had painted on it 'Bulls Eggs In Here'. Of course it contained boxes of hen's eggs, but I now know that the owners of the chickens are David and Ruth Bull. How do I know? Well, after buying half-a-dozen eggs I drove back home to Leicestershire, and a hundred miles or so later I came to a halt on the A14 at Cambridge due to an accident. As I sat there waiting I thought I'd check my shots. Of course I would've done if I'd had my camera. I hadn't, because it was still sitting on top of the egg cupboard in Essex. But after a very long haul back and a spell of furious googling by my girlfriend, I eventually arrived back at the egg box. No camera. But a man carrying buckets of eggs across a field (the gate had 'Beware Of The Bull' on it) stopped and stared at me. "Are you Mr.Bull?" I called out, "I'm Peter". He put the buckets down and shouted back "Then I'm just about to reunite you with your camera". Thankyou so much Mr & Mrs.Bull, thankyou Tess of the D'Urbervilles. Full acknowledgement will be rendered elsewhere. Right, where's my egg timer. Phew.

Where's That Then? No 22

How romantic, a castle on a hill in winter sunlight. But where is it? One clue might be that a big BBC Sunday night serial was filmed here in the early eighties. And that it's neighbour could not be more different in character. Extra toast for the name of the programme. With Tiptree's Orange & Tangerine Marmalade.

Winners of APHA’s 2010 Get Ready Scholarship announced

Six students have been chosen as the recipients of APHA’s second annual Get Ready Scholarship.

The scholarship, which is awarded in conjunction with APHA’s Get Ready campaign, encourages high school, undergraduate and graduate college students to recognize emergency preparedness as a public health issue.

The six winners are:
• Leah Wight— Golden Valley High School, Merced, Calif. (high school level)
• Courtney Farr — Robert L. Patton High School, Morganton, N.C. (high school level)
• Brittany Voorhees — Holy Names University, Oakland, Calif. (undergraduate level)
• Delaney Moore — Indiana University-Purdue University Indianapolis, Indianapolis, Ind. (undergraduate level)
• Tazeen Dhanani — George Mason University, Fairfax, Va. (graduate level)
• Kristen Paz — Pepperdine University, Malibu, Calif. (graduate level)

This year’s scholarship recipients were chosen from 900 applicants from across the nation. They will receive a $500 scholarship for school-related costs as well as a one-year APHA membership. Winners were determined through an essay contest on the importance of emergency preparedness and infectious disease prevention.

"APHA firmly believes in encouraging today’s youth to become tomorrow’s public health leaders," said Georges C. Benjamin, MD, FACP, FACEP (E), APHA’s executive director. "We are pleased to be able to award these talented, young students with financial assistance to help further their education."

Excerpts from the winning entries can be viewed online now.

Congratulations to our scholarship winners and our thanks to everyone who submitted an essay!

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Smokeless Tobacco Dangers

The Partnership for a Tobacco-free Maine (PTM) is the Maine CDC’s tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life.

Snus is a new smokeless tobacco product that can be found nationwide and is becoming more prevalent. Consumption of smokeless products has risen over the past few years as cigarette consumption has decreased.

A recent segment on 60 Minutes about snus may not have presented enough information about the harmful effects of these products, such as:

· Tobacco is tobacco. ALL tobacco is harmful. Snus is not a safe alternative to smoking. National agencies such as CDC, NCI, and NIH all recommend that any form of tobacco be avoided and discontinued.

· Maine's strong tobacco laws have been proven to discourage youth smoking and support people seeking tobacco treatment, but these new products counter our efforts. Smokers wishing to quit should be encouraged to use approved methods such as counseling, NRT, and medications.

· These products appeal especially to young people and can be a gateway to addiction. These products can be used discretely and are advertised as a way to circumvent smoke-free laws. The piece also briefly discusses the new dissolvables and how they are attractive to youth.

· Using smokeless products can, in a dual user, increase the level of addiction to nicotine. These products allow the individual who may have otherwise quit smoking to perpetuate his or her addiction to nicotine by allowing use in areas where smoking is prohibited.

· Swedish snus and U.S. snus are not the same product. They are regulated and manufactured differently. Dr. Fagerstrom discusses the Swedish form. The Swedish version contains fewer toxins than the American counterpart. Long term research on the health effects of the U.S. snus does not exist.

· Placement of advertising for new products is an issue (most signs are on convenience store entry doors below the waist high handle to become familiar and seen by children). This is not addressed in the piece.

· These are cheap products – they cost about half the price of a pack of cigarettes. Taxes on non-cigarette products have not increased at the same rate as taxes on cigarettes. Increased prices discourage initiation among youth and young adults, prompt quit attempts, and reduce consumption among current users.

· The very fact that the tobacco industry is promoting these products as a harm reduction tool should be concerning to us. Harm reduction is neither an acceptable nor ethical public health practice.

Post & Rail

Two enthusiams in one. Here is the donations box for the Gloucestershire & Warwickshire Railway, a preserved line that runs from Toddington, where the box is, through Winchcombe to Cheltenham Race Course. I'm not quite sure where Warwickshire comes into it, but I believe the 'The Honeybourne Line' as they now call it once ran up to Stratford-upon-Avon in the neighbouring county. This beautiful Victorian pillar box has now been repainted in the Great Western Railway's original light and dark stone colours, as is the footbridge behind it. Which, if you're ever in this delightful neck of the Cotswolds woods, you'll see couldn't be more complementary to the landscape. I've yet to travel on this line, but intend to do so this year as the GWR celebrates it's 175th anniversary. Toot toot!

Get Ready Mailbag: Tsunamis can be an unexpected coastal danger

Welcome to another installment of the Get Ready Mailbag, when we take time to answer questions sent our way by readers like you. Have a question you want answered? Send an e-mail to getready@apha.org.

Q. What exactly is a tsunami? What I can do to be prepared in case I ever experience one?

A. A tsunami is a series of huge waves that happen after an undersea disturbance, like an earthquake, volcano eruption or landslide. From the area where the tsunami begins, waves move outward in all directions. Tsunamis can move hundreds of miles per hour in the ocean and then crash into land with waves as high as 100 feet or more.

The massive earthquake in Chile in early 2010 set off tsunami warnings across the Pacific, including warnings in Hawaii. Fortunately, the waves were less destructive than feared.

A tsunami can strike almost anywhere along the U.S. coastline. And though they may not damage every coastline they strike, all tsunamis are potentially dangerous. The most destructive tsunamis in the United States have occurred along the Pacific coast. So pay particular attention if you are along the shores of Hawaii, California, Oregon, Washington or Alaska.

If you are ever on the beach and notice that the water recedes from the shoreline, move away immediately. This is a sign that a tsunami is coming.

If you are in a coastal area and you experience an earthquake, turn on your radio to learn if there is a tsunami warning. If there is a warning and officials say to evacuate, do so immediately and follow your evacuation plan. Get away from the shoreline right away and move to higher ground.

Knowing how to prepare for a tsunami is the best way to stay safe in an unlikely event that you experience one.

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Important information on Lyme disease

A special Review Panel has unanimously agreed that no changes need be made to the 2006 Lyme disease treatment guidelines developed by the Infectious Diseases Society of America (IDSA), the nation’s pre-eminent authority on infectious diseases. These guidelines promote a short-term course of antibiotics for the treatment of Lyme disease.

IDSA’s guidelines, voluntarily used by physicians to help them decide what treatments are best and safest for patients, were the subject of an antitrust investigation about whether the guidelines’ authors had conflicts of interest and failed to consider divergent medical opinions. IDSA maintains those assertions were unfounded and voluntarily agreed to a one-time special review of the guidelines by an independent scientific Review Panel whose members were certified to be free from any conflicts of interest by an independent ombudsman.

The review panel concurred that IDSA’s guidelines, which stated that long-term antibiotic treatment is unwarranted and potentially dangerous, are medically and scientifically valid and do not need to be changed. The full report is available here.

Follow these links for more information on Lyme disease in Maine and recently signed legislation to expand Lyme disease awareness in Maine.

Update on Health Reform

The Congressional Research Service issued this 100-page report reviewing the public health, health workforce, and quality provisions in the Patient Protection and Affordable Care Act (health reform).

Healthreform.gov is a comprehensive federal website on health reform, including this webpage with information on Maine. This link on the same site has information about dependent adults under age 26 being eligible for health insurance in advance of September’s start up date.

This open letter from the president and CEO of the Maine Health Access Foundation includes a summary of the health reform legislation and how it relates to Maine. It also includes links to other summaries.

Gov. Baldacci has formed a committee to work on implementing the health reforms in Maine.

P-P-Pick Up A Penguin

Ludlow, Shropshire, Sunday morning. What could be better. The sound of Housman's bells cascading down over the rooftops, little old ladies with prayerbooks hurrying back to cottages up shaded alleys, early spring sun lighting up brass letterboxes on gloss painted front doors. And then look what catches my eye in the market place. I was going to self indulgently show you the Dinky Toy 3 ton army lorry I got for eight quid, but thought this was far more edifying. I thought we could scan the shelf and see how many we'd read. I just have, and am ashamed to admit it's only one. But which? I'll think of a prize for the first one there. Probably a dog-eared Penguin. That'd be novel.

Where's That Then? No 21

In line with Commentator Diplo's request for a monochrome photograph of an Up-to-Date Puzzle Location, I give you....? The only help this week is that it's a location within the borders of my most recent travelling (qv). I didn't stay at this inn, but the place it's in does give rise to many thoughts about the current nature of the contemporary English village. Of which, of course, more later.

Dinner with Taubes, Eades and Hujoel

Gary Taubes gave a lecture at UW last Thursday. Thanks to all the Whole Health Source readers who showed up. Gary's talk was titled "Why We Get Fat: Adiposity 101 and the Alternative Hypothesis of Obesity". He was hosted by Dr. Philippe Hujoel, the UW epidemiologist and dentist who authored the paper "Dietary Carbohydrates and Dental-Systemic Diseases" (1).

Gary's first target was the commonly held idea that obesity is simply caused by eating too much and exercising too little, and thus the cure is to eat less and exercise more. He used numerous examples from both humans and animals to show that fat mass is biologically regulated, rather than being the passive result of voluntary behaviors such as eating and exercise. He presented evidence of cultures remaining lean despite a huge and continuous surplus of food, as long as they stayed on their traditional diet. He also described how they subsequently became obese and diabetic on industrial foods (the Pima, for example).

He then moved into what he feels is the biological cause of obesity: excessive insulin keeping fat from exiting fat cells. It's true that insulin is a storage hormone, at the cellular level. However, fat mass regulation involves a dynamic interplay between many different interlacing systems that determine both overall energy intake and expenditure, as well as local availability of nutrients at the tissue level (i.e., how much fat gets into your fat tissue vs. your muscle tissue). I think the cause of obesity is likely to be more complex than insulin signaling.

He also offered the "carbohydrate hypothesis", which is the idea that carbohydrate, or at least refined carbohydrate, is behind the obesity epidemic and perhaps other metabolic problems. This is due to its ability to elevate insulin. I agree that refined carbohydrate, particularly white flour and sugar, is probably a central part of the problem. I'm also open to the possibility that some people in industrial nations are genuinely sensitive to carbohydrate regardless of what form it's in, although that remains to be rigorously tested. I don't think carbohydrate is sufficient to cause obesity
per se, due to the many lean and healthy cultures that eat high carbohydrate diets*. Gary acknowledges this, and thinks there's probably another factor that's involved in allowing carbohydrate sensitivity to develop, for example excessive sugar.

I had the opportunity to speak with Gary at length on Thursday, as well as on Friday at dinner. Gary is a very nice guy-- a straightforward New York personality who's not averse to a friendly disagreement. In case any of you are wondering, he looks good. Good body composition, nice skin, hair and teeth (apologies to Gary for the analysis). Philippe and his wife took us out to a very nice restaurant, where we had a leisurely four-hour meal, and Dr. Mike Eades was in town so he joined us as well. Mike has a strong Southern accent and is also a pleasant guy. Philippe and his wife are generous and engaging people. It was a great evening. The restaurant was nice enough that I wasn't going to be picky about the food-- I ate everything that was put in front of me and enjoyed it.

* I'm talking about prevention rather than cure here. I acknowledge that many people have had some success losing fat using low-carbohydrate diets, including two gentlemen I met on Thursday.

H1N1 fact sheet now available in 10 Asian, Pacific Islander languages

Today's guest blog entry is by Kathy Lim Ko, President and CEO for the
Asian & Pacific Islander American Health Forum.

One of the biggest challenges we face in working to improve the health of Asian Americans, Native Hawaiians and Pacific Islanders is making sure that our communities receive health care services in a language they can understand. We also work to make sure that health care organizations and governments at the local, state and federal levels are aware of how culture influences how people take care of their health needs. Due to differences in nationality, ethnicity and culture, as well as immigration histories, we all have varying perspectives on health and healthy behavior.

When our nation faces a public health crisis, as it has with the H1N1 “swine flu” epidemic over the past months, it is even more important to make sure that the people in our communities receive information that they can understand to protect themselves and their families.

To prepare our communities for the H1N1 flu epidemic and other public health and national emergencies, the Asian & Pacific Islander American Health Forum has collaborated with the U.S. Department of Health and Human Services Office of Minority Health, the National Council of Asian Pacific Islander Physicians and the Association of Asian Pacific Community Health Organizations to make sure information is available to our communities that is language-appropriate and takes cultural differences into account.

As part of this collaboration, we have worked to translate the APHA Get Ready campaign’s H1N1 fact sheet into 10 languages. The translated fact sheets are now available in the public health alert section of our Web site, on the Get Ready Web site, and on our partners’ Web sites. The translations are in Chinese, Chamorro, Chuukese, Japanese, Korean, Marshallese, Samoan, Thai, Tongan and Vietnamese.

We are happy to make these resources available for you to easily share with your community. We hope that they will be widely used to help people protect themselves and their loved ones from being infected with — and spreading! — H1N1 flu.

Blog editor’s note: The Get Ready H1N1 flu fact sheet is also available in English and Spanish. All 12 language versions can be downloaded from the Get Ready Web site.

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Unmitigated Essex

Just a quick one, as I'm off now to the Welsh Borders (well, the English side that is: Herefordshire and Shropshire) and will be out of range of the Blogosphere radar. But I thought you'd like this, a very uncompromising shed on the hard at Tollesbury. And yes, the side view shows it's got a corrugated iron roof. The only sound is the constant tap-tap of wire against aluminium masts and the voices of blokes in overalls tarring boats shouting nautical / weather notes at each other. One of my very favourite places, south of Tiptree which means you can call in for tea and scones at the jam factory served with a jar of Wilkin's 'Little Scarlet' strawberry preserve. Right, off to Offa's.

Copper in Food

Sources of Copper

It isn't hard to get enough copper-- unless you eat an industrial diet. I've compiled a chart showing the copper content of various refined and unrefined foods to illustrate the point. The left side shows industrial staple foods, while the right side shows whole foods. I've incorporated a few that would have been typical of Polynesian and Melanesian cultures apparently free of cardiovascular disease. The serving sizes are what one might reasonably eat at a meal: roughly 200 calories for grains, tubers and whole coconut; 1/4 pound for animal products; 1/2 teaspoon for salt; 1 cup for raw kale; 1 oz for sugar.

Note that beef liver is off the chart at 488 percent of the USDA recommended daily allowance. I don't know if you'd want to sit down and eat a quarter pound of beef liver, but you get the picture. Beef liver is nature's multivitamin: hands down the Most Nutritious Food in the World. That's because it acts as a storage depot for a number of important micronutrients, as well as being a biochemical factory that requires a large amount of B vitamins to function. You can see that muscle tissue isn't a great source of copper compared to other organs.

Beef liver is so full of micronutrients, it shouldn't be eaten every day. Think of it in terms of the composition of a cow's body. The edible carcass is mostly muscle, but a significant portion is liver. I think it makes sense to eat some form of liver about once per week.

Modern Agriculture Produces Micronutrient-poor Foods

The numbers in the graph above come from NutritionData, my main source of food nutrient composition. The problem with relying on this kind of information is it ignores the variability in micronutrient content due to plant strain, soil quality, et cetera.

The unfortunate fact is that micronutrient levels have declined substantially over the course of the 20th century, even in whole foods. Dr. Donald R. Davis has documented the substantial decline in copper and other micronutrients in American foods over the second half of the last century (1). An even more marked decrease has occurred in the UK (2), with similar trends worldwide. On average, the copper content of vegetables in the UK has declined 76 percent since 1940. Most of the decrease has taken place since 1978. Fruits are down 20 percent and meats are down 24 percent.

I find this extremely disturbing, as it will affect even people eating whole food diets. This is yet another reason to buy from artisanal producers, who are likely to use more traditional plant varieties and grow in richer soil. Grass-fed beef should be just as nutritious as it has always been. Some people may also wish to grow, hunt or fish their own food.

Where's That Then? No 20

I thought I'd try something different for this week's puzzle picture. Instead of rummaging through dusty books for old photographs, I thought for this 20th in the series (please tell me if you're fed up with it and I'll think of something else) I'd get you guessing where I was yesterday afternoon. Clue: unless I'd got a handy rowing boat, I was sixteen miles away from a pint in the Rose & Crown.

Two Brief Cases

(Click on the images to see the full-size versions.)
Source: American Hairdresser, June 1946

Full-fat Dairy for Cardiovascular Health??

[2013 update: a few colleagues and I have published a comprehensive review paper on the association between full-fat dairy consumption and obesity, metabolic health, and cardiovascular disease.  You can find it here.]

I just saw a paper in the AJCN titled "Dairy consumption and patterns of mortality of
Australian adults
". It's a prospective study with a 15-year follow-up period. Here's a quote from the abstract:
There was no consistent and significant association between total dairy intake and total or cause-specific mortality. However, compared with those with the lowest intake of full-fat dairy, participants with the highest intake (median intake 339 g/day) had reduced death due to CVD (HR: 0.31; 95% confidence interval (CI): 0.12–0.79; P for trend = 0.04) after adjustment for calcium intake and other confounders. Intakes of low-fat dairy, specific dairy foods, calcium and vitamin D showed no consistent associations.
People who ate the most full-fat dairy had a 69% lower risk of cardiovascular death than those who ate the least. Otherwise stated, people who mostly avoided dairy or consumed low-fat dairy had more than three times the risk of dying of coronary heart disease or stroke than people who ate the most full-fat diary.  This result is an outlier, and also observational so difficult to interpret, but it certainly is difficult to reconcile with the idea that dairy fat is a significant contributor to cardiovascular disease.

Contrary to popular belief, full-fat dairy, including milk, butter and cheese, has never been convincingly linked to cardiovascular disease. What has been linked to cardiovascular disease is milk fat's replacement, margarine. In the Rotterdam study, high vitamin K2 intake was linked to a lower risk of fatal heart attack, aortic calcification and all-cause mortality. Most of the K2 came from full-fat cheese.

From a 2005 literature review on milk and cardiovascular disease in the EJCN:
In total, 10 studies were identified. Their results show a high degree of consistency in the reported risk for heart disease and stroke, all but one study suggesting a relative risk of less than one in subjects with the highest intakes of milk.

...the studies, taken together, suggest that milk drinking may be associated with a small but worthwhile reduction in heart disease and stroke risk.

...All the cohort studies in the present review had, however, been set up at times when reduced-fat milks were unavailable, or scarce.

A prepared community is a healthier community: Small ways to have a big impact

During the past few days, thousands of people throughout the country have been celebrating National Public Health Week and its theme of “A Healthier America: One Community at a Time.”

Part of having a healthy community is being prepared, whether it’s for a natural disaster, disease outbreak or human-made emergency. This year, National Public Health Week organizers are urging participants to “smart small, think big,” which is also a great lesson for community preparedness. While preparing your community for anything and everything that can go wrong can be a daunting task, every one of us can take small steps that help bring us closer to that goal.

In that spirit, the Get Ready campaign is offering these reminders of small ways that you can help make your community more prepared:

• Find out where your nearest emergency shelters are located, and let your neighbors know where to go during a disaster.

• Ask your supervisor for a copy of your workplace emergency plan and become familiar with it.

• Find out where flu immunization clinics will be held in your community, and spread the word to your friends and family via e-mails, Facebook or other means.

• Sign up for a CPR or first aid class and invite others to join you.

• Set up a table with free preparedness materials at your library or community center.

• Pick up a few extra canned goods every time you go to the grocery store to donate to your community food bank.

For more small ways you can help make your community a healthier — and more prepared — place, download the National Public Health Week toolkit (PDF). And if you’ve already done something to improve the health of your community, share your story online.

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Duck, cover and hold: Advice for earthquake preparedness

Earthquakes are unpredictable and often common in many regions — even in the United States. Just this week, a quake occurred in Mexicali, Mexico. While earthquakes with the power of the one that hit the Haiti in January 2010 are fairly rare, less severe earthquakes happen regularly and can interrupt your daily life and cause injury.

The key to minimizing damage from an earthquake is to be prepared. It’s important to create disaster plans and have an emergency supply kit (PDF) on hand. According to preparedness experts, the best thing to do during an earthquake is to drop to the ground, take cover under a sturdy desk or table and hold on until the shaking stops. This may protect you from falling ceiling lights or furniture such as bookshelves.

Making a plan is the best way to get ready for an earthquake:
• Identify a “meet up” spot for family members in case you are separated and can’t reach home after an earthquake.

• Learn about evacuation procedures for your town and child’s school or daycare.

• Immediately put shoes on to protect your feet from broken glass or sharp objects.

• Check for gas leaks. If you discover one, immediately shut off
the main gas valve.

For more tips on preparing for earthquakes, download this fact sheet (PDF) from the Get Ready campaign.

Have you ever been in an earthquake? Share your experience by commenting on this blog entry.
Photo: Transportation crews work to repair a road cracked by earthquakes in Hawaii in 2006. Photo by Adam Dubrowa, courtesy FEMA.

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“Eat Local, Eat Organic”

Image via foleyfeatures.

A remarkable policy resolution came out last week during the American Medical Association’s (AMA) annual meting. They voted to support “practices and policies…that promote and model a healthy and ecologically sustainable food system.” The health part is expected, but the “ecologically sustainable” portion is a surprising huge step forward for organic and local food advocates and producers around this country.

My fellow board members at The Organic Center celebrated as word of the resolution came out. Finally, information from the AMA promoting the benefits of organic and local foods, raised in a sustainable manner, with the environment’s health, as well as our nation’s people’s health in mind. This is a significant step up from the same message of ‘get your five a day, eat less meat, more fiber and less fats’ that we’ve been hearing for years.

The report, created by the AMA’s Council on Science and Public Health, says it pretty clearly,

“Beyond the issue of poor nutritional quality are methods of food production and distribution that have additional negative effects on human and environmental health. These methods have contributed to the development of antibiotic resistance; air and water pollution; contamination of food and water with animal waste, pesticides, hormones, and other toxins; increased dependence on nonrenewable fossil fuels (including fertilizers); and a food system that is increasingly vulnerable to accidental or intentional contamination. These methods of food production and distribution are inherent parts of the prevailing agricultural system, which is may be referred to as “conventional farming, modern agriculture, or industrial farming.”

In other words, it’s time to find a new way of doing things.

As part of the AMA policy resolution:

- That our AMA support practices and policies in medical schools, hospitals, and other health care facilities that support and model a healthy food system, which provides food and beverages of naturally high nutritional quality, is environmentally sustainable and economically viable, and supports human dignity and justice.

- That our AMA encourage the development of a healthier food system through the US Farm Bill and other federal legislation.

- That our AMA consider working with other health care and public health organizations to educate the health care community and the public about the importance of healthy and ecologically sustainable food systems.

According to the same Council on Science and Public Health report “Optimal public health requires a good, healthy food supply, but the United States cannot have a good, healthy food supply without a sustainable food system.”

Samuel Fromartz, author of Organic, Inc. made an interesting reference at the end of his blog posting about the AMA resolution. He wrote on how the AMA fought with JI Rodale, an early pioneer and oft-called father of organic farming, for his over-zealous promotion of vitamins throughout the 1950’s and ‘60s. And, though it may have taken them decades, the AMA has finally changed its position and endorsed one point that Rodale had right all along: “That the way food is produced effects health.”

Ask Doctor Healthy: Why don’t my Generic pills look like the Brand-Name?

The Prescription Access Litigation blog’s resident Advice Columnist, Ask Pharmie, has been on hiatus for a while — but now he’s back! Ask Pharmie answers readers’ questions about the pharmaceutical industry, drug marketing, drug pricing, and the like. Send him your questions! (Keep in mind, he does not answer medical or treatment questions, or render medical advice.)

So, reaching into Ask Pharmie’s mailbag, here’s our latest question:

Question: I recently switched from a brand name drug to a generic version to save money. Although the generic works just as well, the pill is a different color and shape from the brand-name. This is confusing. Why don’t the generic pills look the same as the brand name pills?

Good question! After all, generic drugs are the same medicine as the brand-name – they have the same active ingredient, and the same effectiveness. So it stands to reason that the pill would look the same, right? Not necessarily.

When a brand-name drug first comes on the market, the manufacturer has a patent on the drug that prevents any other companies from making or selling that drug. However, when the patent expires or gets invalidated, generic drug companies can apply for FDA approval to sell identical generic versions of the drug.

Generic drugs are required to have the same active ingredient and to work the same as the brand name. But this does not also mean that generic drug companies can copy the appearance of brand name drugs. If the appearance, shape, name and/or color of the drug is trademarked, it cannot be copied. Trademarks are words, names and symbols used to identify goods from a particular manufacturer. Unlike patents, which last a maximum of 20 years, trademarks never expire. While many brand name drug companies have traditionally only trademarked the names of their drugs, there is a trend towards trademarking the appearance of the drug as well.

For example, Pfizer has trademarked both the name Viagra and the well-known blue diamond shape of the Viagra pill. AstraZeneca has trademarked not just the name Nexium, but also the phrase “Purple Pill” and the characteristic purple-with-yellow-stripes appearance of Nexium.

viagra pill nexium capsule

So why have drug companies started to trademark the appearance of their drugs? In the past several years, brand name drug companies have started to make the appearance of their pills part of their marketing campaigns. By making consumers associate a particular appearance of a pill with the medicine contained in the pill, the drug company builds what’s called a “brand identity.” This helps convince the consumer that the product is superior and builds what’s called “brand loyalty.”

Drug companies use this strategy to stand out from their competitors. They also use it to try to convince patients to keep paying for the more expensive brand-name version of the medicine when a generic version becomes available. They hope that the patient will equate the look of the pill with its effectiveness. A generic pill can look “drab” in comparison, to, say a colorful Nexium pill, with its bright purple and its yellow stripes. It is a testament to how effective drug company marketing has become that consumers even notice the color of their pills!

Unfortunately, this serves to confuse patients. For patients that take many medications, the shape and color of the pill can help them remember what it is and what it’s used for. If drug companies didn’t trademark the appearance of their pills, then generic drug companies could make their pills look the same as the brand-name. This would help patients remember what each of their medications is, and avoid potentially dangerous errors (such as taking a drug at the wrong time, taking too much of the drug, missing a dose, etc).

The main thing to remember is that the appearance of a drug has nothing to do with its effectiveness. By using the color and shape of a drug as a marketing tool, brand-name drug companies are trying to fool you into thinking that these things matter, and to trick you into using an expensive brand-name drug when a less expensive one (generic or a different brand-name drug in the same category) would work just as well.

One last thing to keep in mind: The same generic drug can be made by many different generic drug companies, and each of their pills may look different not just from the brand-name pill, but from each other. If your pharmacy changes which generic drug company it buys your medication from, or if you switch pharmacies, your pills might suddenly look different than they did the last time you filled your prescription. Don’t panic! This doesn’t mean that you got the wrong pills. But, if you are at all uncertain or concerned, talk to your pharmacist. Better safe than sorry.

Unexpected Alphabets No 12

Yesterday was a good day to be on the North Norfolk coast, what with summer-like weather and the first signs of the greening-up of the landscape. More time was spent than was good for us in Burnham Market, there being much to do in the coastal villages. More of that at another time, but I obviously couldn't resist these signs. Nothing more need be said about the fishy business at the top, and although the Hall's Distemper decorators with their plank have often been discussed in Unmitigated England, no image has thus far been forthcoming. We have talked about them as big wooden cut-outs next to railway lines, but this is the first time I'd seen them (or, tantalisingly one of them) in vitreous enamel. What a treat, an Unmitigated Tradesman and an Unmitigated House in glorious hot glass colour. I imagine the full size was too big for one sign, so a pair was made. I wonder where its companion and the other end of the plank is. I will think about it over a fishcake or four.

Flu Update 4/8/10

What’s New with Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at: http://www.cdc.gov/flu/weekly/index.htm.

Maine’s influenza activity was coded “local” this week, mainly because of continued reports of influenza-like illness. Maine’s weekly influenza surveillance report can be found at: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml. Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

Fall Flu Vaccine Campaign. Flu vaccine is recommended for all people for the 2010-2011 season. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The decision on which populations we plan on purchasing vaccine for is based on several factors, including: populations designated by some of the vaccine funding sources available (federal funding sources for flu vaccine for some children); populations without other easy access to vaccine (homeless shelter residents); and people who are at high risk for severe complications (pregnant women, nursing home residents). Seniors and health care workers are in high priority groups for vaccine, but generally have existing access to flu vaccine that is not dependent on state dollars.

Please note that, as in years past, the only state-supplied vaccine earmarked for health care workers is for those who work in nursing homes. However, we strongly encourage all health care personnel, including EMS, to be vaccinated.

Anyone wishing to provide state-supplied flu vaccine in the fall must be a registered Maine Immunization Program (MIP) provider; those who are not currently MIP providers must register by April 30. Vaccine order forms will be sent to all registered providers by the middle of May. More detailed instructions, including a timeline for fall flu vaccine campaign activities, are available in this Health Alert.

A conference call for those interested in providing state-supplied seasonal flu vaccine in the fall will be held from 12 noon to 1 p.m. Monday, April 12. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and to un-mute when you are actively participating.

Don’t Forget Spring Break. This US CDC web page provides information and links for travelers who want to reduce their risk of becoming sick with 2009 H1N1. With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting http://www.maineflu.gov/. The free clinics are in bold font.

Maine Among Top States in H1N1 Vaccine Coverage:

US CDC recently issued two reports that highlight H1N1 vaccine successes as well as opportunities to improve future vaccination rates. Maine is among the top states for vaccine coverage against H1N1 flu for all ages.

Maine’s vaccine rate for those in US CDC’s highest priority groups was tied for first place among all states at 51%, compared with the national rate of 33%. These highest priority groups include pregnant women, all people ages six months to 25 years-old, people ages 25 to 65 with chronic health conditions, and health care workers, including emergency medical services personnel.

60% of Maine’s children ages 6 months to 17 years were vaccinated, compared to 37% nationally. Maine’s childhood vaccination rate was tied for second with Vermont and Massachusetts. Rhode Island was first.

Seniors in Maine also had among the highest vaccination rates in the nation. 40% of Maine residents age 65 and older were vaccinated, which is nearly twice the national rate of 22%, and tied for first among all states.

Maine’s overall rate of vaccinating 37% of all people older than 6 months is significantly higher than the national average of 24%

We at Maine CDC are exceedingly grateful to the thousands of Mainers who worked hard to achieve such remarkable success!

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

In particular, US CDC strongly urges people with underlying health conditions and those over age 65 to get vaccinated against H1N1.

Vaccine supplies are plentiful and the circulating virus still closely matches the one in the pandemic vaccine. We have excellent safety data on the H1N1 vaccine.

Disposing of and Reporting Unused/Expired Vaccine
US CDC issued this Q&A on 2009 H1N1 flu vaccine with long-dated expirations. US CDC is also currently conducting a survey to determine how state laws affect the ability to ship expired vaccine for disposal. The results of this survey will help determine CDC’s centralized national system for vaccine disposal.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form for vaccine administration – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Health Reform

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. Last week, he spoke about health reform when he visited Portland. The entire speech is available here.

This National Association of State Medicaid Directors document gives a side-by-side comparison of the different health care reform bills, while the Kaiser Family Foundation developed this summary of the final law and implementation timeline.

This Trust for America’s Health web page describes the prevention components of the final legislation.

The Association of Maternal and Child Health Programs’ Health Reform web page has a number of helpful links focused on the impact on maternal and child health programs as well as more general information.

Missing Walter

Between the village of Clare and the town of Sudbury in Suffolk runs one of our many River Stours. Meandering in its shallow valley it also forms the county boundary with Essex, and tucked up in the furthest north east of this county are a series of villages with the prefix 'Belchamp'. Which according to Norman Scarfe's Shell Guide to Essex is apparently a Norman reconfiguration of the Anglo Saxon 'Belc-ham' which means 'homestead' with a roof of 'timber beams'. I would think every Norman homestead had a timber-beamed roof by default, but most certainly there is a superb example of Essex / Suffolk vernacular domestic building at almost every turn of the sharply right-angled lanes that twist from Belchamp to Belchamp. Yesterday I found myself wandering around these lanes looking for Belchamp Walter, which I found bowered in trees down by a tributary of the Stour. I was searching for a ruined tower in a field (of cabbages as it turned out) as you do, but on the way I was helped by this signpost at Belchamp Otten. What amused me was the thought that B-Walter had obviously been omitted from the original, and had to have an appendix added, probably after a Belchamp deputation had descended on the council offices in Halstead with burning brands and sharpened pitch forks. Maybe.

Copper and Cardiovascular Disease

In 1942, Dr. H. W. Bennetts dissected 21 cattle known to have died of "falling disease". This was the name given to the sudden, inexplicable death that struck herds of cattle in certain regions of Australia. Dr. Bennett believed the disease was linked to copper deficiency. He found that 19 of the 21 cattle had abnormal hearts, showing atrophy and abnormal connective tissue infiltration (fibrosis) of the heart muscle (1).

In 1963, Dr. W. F. Coulson and colleagues found that 22 of 33 experimental copper-deficient pigs died of cardiovascular disease. 11 of 33 died of coronary heart disease, the quintessential modern human cardiovascular disease. Pigs on a severely copper-deficient diet showed weakened and ruptured arteries (aneurysms), while moderately deficient pigs "survived with scarred vessels but demonstrated a tendency toward premature atherosclerosis" including foam cell accumulation (2). Also in 1963, Dr. C. R. Ball and colleagues published a paper describing blood clots in the heart and coronary arteries, heart muscle degeneration, ventricular calcification and early death in mice fed a lard-rich diet (3).

This is where Dr. Leslie M. Klevay enters the story. Dr. Klevay suspected that Ball's mice had suffered from copper deficiency, and decided to test the hypothesis. He replicated Ball's experiment to the letter, using the same strain of mice and the same diet. Like Ball, he observed abnormal clotting in the heart, degeneration and enlargement of the heart muscle, and early death. He also showed by electrocardiogram that the hearts of the copper-deficient mice were often contracting abnormally (arrhythmia).

But then the coup de grace: he prevented these symptoms by supplementing the drinking water of a second group of mice with copper (4). In the words of Dr. Klevay: "copper was an antidote to fat intoxication" (5). I believe this was his tongue-in-cheek way of saying that the symptoms had been misdiagnosed by Ball as due to dietary fat, when in fact they were due to a lack of copper.

Since this time, a number of papers have been published on the relationship between copper intake and cardiovascular disease in animals, including several showing that copper supplementation prevents atherosclerosis in one of the most commonly used animal models of cardiovascular disease (6, 7, 8). Copper supplementation also corrects abnormal heart enlargement-- called hypertrophic cardiomyopathy-- and heart failure due to high blood pressure in mice (9).

For more than three decades, Dr. Klevay has been a champion of the copper deficiency theory of cardiovascular disease. According to him, copper deficiency is the only single intervention that has caused the full spectrum of human cardiovascular disease in animals, including:
  • Heart attacks (myocardial infarction)
  • Blood clots in the coronary arteries and heart
  • Fibrous atherosclerosis including smooth muscle proliferation
  • Unstable blood vessel plaque
  • Foam cell accumulation and fatty streaks
  • Calcification of heart tissues
  • Aneurysms (ruptured vessels)
  • Abnormal electrocardiograms
  • High cholesterol
  • High blood pressure
If this theory is so important, why have most people never heard of it? I believe there are at least three reasons. The first is that the emergence of the copper deficiency theory coincided with the rise of the diet-heart hypothesis, whereby saturated fat causes heart attacks by raising blood cholesterol. Bolstered by some encouraging findings and zealous personalities, this theory took the Western medical world by storm, for decades dominating all other theories in the medical literature and public health efforts. My opinions on the diet-heart hypothesis aside, the two theories are not mutually exclusive.

The second reason you may not have heard of the theory is due to a lab assay called copper-mediated LDL oxidation. Researchers take LDL particles (from blood, the same ones the doctor measures as part of a cholesterol test) and expose them to a high concentration of copper in a test tube. Free copper ions are oxidants, and the researchers then measure the amount of time it takes the LDL to oxidize. I find this assay tiresome, because studies have shown that the amount of time it takes copper to oxidize LDL in a test tube doesn't predict how much oxidized LDL you'll actually find in the bloodstream of the person you took the LDL from (10, 11).

In other words, it's an assay that has little bearing on real life. But researchers like it because for some odd reason, feeding a person saturated fat causes their LDL to be oxidized more rapidly by copper in a test tube, even though that's not the case in the actual bloodstream (12). Guess which result got emphasized?

The fact that copper is such an efficient oxidant has led some researchers to propose that copper oxidizes LDL in human blood, and therefore dietary copper may contribute to heart disease (oxidized LDL is a central player in heart disease-- read more here). The problem with this theory is that there are virtually zero free copper ions in human serum. Then there's the fact that supplementing humans with copper actually reduces the susceptibility of red blood cells to oxidation (by copper in a test tube, unfortunately), which is difficult to reconcile with the idea that dietary copper increases oxidative stress in the blood (13).

The third reason you may never have heard of the theory is more problematic. Several studies have found that a higher level copper in the blood correlates with a higher risk of heart attack (14, 15). At this point, I could hang up my hat, and declare the animal experiments irrelevant to humans. But let's dig deeper.

Nutrient status is sometimes a slippery thing to measure. As it turns out, serum copper isn't a good marker of copper status. In a 4-month trial of copper depletion in humans, blood copper stayed stable, while the activity of copper-dependent enzymes in the blood declined (16). These include the important copper-dependent antioxidant, superoxide dismutase. As a side note, lysyl oxidase is another copper-dependent enzyme that cross-links the important structural proteins collagen and elastin in the artery wall, potentially explaining some of the vascular consequences of copper deficiency. Clotting factor VIII increased dramatically during copper depletion, perhaps predicting an increased tendency to clot. Even more troubling, three of the 12 women developed heart problems during the trial, which the authors felt was unusual:
We observed a significant increase over control values in the number of ventricular premature discharges (VPDs) in three women after 21, 63, and 91 d of consuming the low-copper diet; one was subsequently diagnosed as having a second-degree heart block.
In another human copper restriction trial, 11 weeks of modest copper restriction coincided with heart trouble in 4 out of 23 subjects, including one heart attack (17):
In the history of conducting numerous human studies at the Beltsville Human Nutrition Research Center involving participation by 337 subjects, there had previously been no instances of any health problem related to heart function. During the 11 wk of the present study in which the copper density of the diets fed the subjects was reduced from the pretest level of 0.57 mg/ 1000 kcal to 0.36 mg/1000 kcal, 4 out of 23 subjects were diagnosed as having heart-related abnormalities.
The other reason to be skeptical of the association between blood copper and heart attack risk is that inflammation increases copper in the blood (18, 19). Blood copper level correlates strongly with the marker of inflammation C-reactive protein (CRP) in humans, yet substantially increasing copper intake doesn't increase CRP (20, 21). This suggests that elevated blood copper is likely a symptom of inflammation, rather than its cause, and presents an explanation for the association between blood copper level and heart attack risk.

Only a few studies have looked at the relationship between more accurate markers of copper status and cardiovascular disease in humans. Leukocyte copper status, a marker of tissue status, is lower in people with cardiovascular disease (22, 23). People who die of heart attacks generally have less copper in their hearts than people who die of other causes, although this could be an effect rather than a cause of the heart attack (24). Overall, I find the human data lacking. I'd like to see more studies examining liver copper status in relation to cardiovascular disease, as the liver is the main storage organ for copper.

According to a 2001 study, the majority of Americans may have copper intakes below the USDA recommended daily allowance (25), many substantially so. This problem is exacerbated by the fact that copper levels in food have declined in industrial nations over the course of the 20th century, something I'll discuss in the next post.


(Click on image to enlarge.)
Source: 55 Hair Styles (Dell Purse Book), 1972

Where's That Then? No 19

An ordinary English town that enjoys an international reputation. I wonder if that lingerie shop is still there?

Magnesium and Vitamin D Metabolism

Ted Hutchinson posted a link in the comments section of my last post, pointing to a page on the Vitamin D Council's website where Dr. John Cannell discusses cofactors required for proper vitamin D metabolism. It's actually the site's home page, highlighting how important he feels this matter is. In this case, 'cofactor' simply means another nutrient that's required for the efficient production and use of vitamin D. They include:
  • Magnesium
  • Zinc
  • Vitamin K2
  • Vitamin A
  • Boron
And probably others we aren't yet aware of. On another page, Dr. Cannell links to two papers that review the critical interaction between magnesium status and vitamin D metabolism (1, 2). Here's a quote from the abstract of the second paper:
Magnesium... is essential for the normal function of the parathyroid glands, metabolism of vitamin D and adequate sensitivity of target tissues to [parathyroid hormone] and active vitamin D metabolites. Magnesium deficit is usually associated with hypoparathyroidism, low production of active vitamin D metabolites, in particular 1,25(OH)2 vitamin D3 and resistance to PTH and vitamin D. On the contrary, magnesium excess, similar to calcium, inhibits PTH secretion. Bone metabolism is impaired under positive as well as under negative magnesium balance.
Magnesium status is critical for normal vitamin D metabolism, insulin sensitivity, and overall health. Supplemental magnesium blocks atherosclerosis in multiple animal models (3, 4). Most Americans don't get enough magnesium (5).

The bottom line is that no nutrient acts in a vacuum. The effect of every part of one's diet and lifestyle is dependent on every other part. I often talk about single nutrients on this blog, but my core philosophy is that a proper diet focuses on Real Food, not nutrients. Tinkering with nutritional status using supplements is potentially problematic. Despite what some people might tell you, our understanding of nutrition and human health is currently rather crude-- so it's best to respect the accumulated wisdom of cultures that don't get the diseases we're trying to avoid.

Easter in Somerset

Not a very Easter Sunday kind of picture, but at least there's some daffodils in it. A little piece of 'pleasing decay' found at Stembridge out on the Somerset Levels. A landscape of cold water courses running through a landscape dotted with black willow trees cowed against the wind, and those simply extraordinary Somerset church towers with their pageants of pinnacles. All with the backdrop of the Quantocks and Polden Hills. Happy Easter everybody.

Low Vitamin D: Cause or Result of Disease?

Don Matesz at Primal Wisdom put up a post a few days ago that I think is worth reading. It follows an e-mail discussion between us concerning a paper on magnesium restriction in rats (executive summary: moderate Mg restriction reduces the hormone form of vitamin D by half and promotes osteoporosis). In his post, Don cites several papers showing that vitamin D metabolism is influenced by more than just vitamin D intake from the diet and synthesis in the skin.

Celiac disease patients have low 25(OH)D3, the circulating storage form of vitamin D, which spontaneously corrects on a gluten-free diet. There are numerous suggestions in the medical literature that overweight and sickness cause low vitamin D, potentially confounding the interpretation of studies that find lower levels of illness among people with low vitamin D levels.

Don't get me wrong, I still think vitamin D is important in preventing disease. But it does lead me to question the idea that we should force down huge doses of supplemental vitamin D to get our 25(OH)D3 up to 60, 70 or even 80 ng/mL. When the dosage of supplemental D goes beyond what a tan Caucasian could conceivably make on a day at the beach (4,000 IU?), that's when I start becoming skeptical. Check out Don's post for more.

Universal Childhood Immunization Program

LD 1408, An Act to Establish the Universal Childhood Immunization Program, has passed both chambers of the state Legislature and been signed into law by the Governor.

The program provides universal immunization coverage to children in the state by purchasing and making available to health care providers every vaccine for childhood immunization that is recommended by the US CDC’s Advisory Committee on Immunization Practices, approved by the FDA, and available under contract with US CDC.

For more information on this legislation, visit: http://mainelegislature.org/legis/bills/display_ps.asp?paper=HP0984&snum=124

Thank you to the many stakeholders who worked on this bill for 4 years, and to the bill’s sponsor, Representative Connor! Updates on the bill’s implementation, including timelines, will be forthcoming.

Hints for helping wildlife during a disaster

When disaster strikes, we humans can usually seek shelter in the comfort of our own homes or drive to a safer place. But for the countless wild animals that share the impact of these deadly disasters, weathering the storm sometimes means they end up crossing paths with humans.

If you see an animal in distress after a flood, hurricane or other emergency, keep a few things in mind when dealing with our furry, scaled and feathered friends:

1) Don’t touch them. As much as you may want to come to the aid of wild animals, animal aid groups advise that you do not corner or try to rescue them. Wild animals have a natural “flight” response that will encourage them to flee from anyone who comes too close. If animals feel they are being threatened, they may flee from a relatively safe position — such as atop a makeshift island during a flood — to a harmful and even life-threatening situation — such as into rapidly flowing flood water. If you find an animal in a life-threatening situation, call your local animal control, which has specially trained staff who can help.

2) Get professional help. Naturally, wildlife will search for refuge during natural disasters and your home may be an ideal place for small animals like snakes, raccoons, squirrels and rats to take shelter. If you discover that wildlife is in your home, again, the best advice is not to touch them. Instead, open a window or other escape route for the animal to leave on its own. If this doesn’t work, call your local animal control or wildlife office for assistance.

3) Be watchful. Following natural disasters, wild animals may still be recovering from the traumatic experiences they have just faced. This means that many animals will be hypersensitive and display more erratic behavior than normal. Such unpredictable behavior can be dangerous to both you and the animals themselves. To keep both us and them safe, be watchful of wild animals. If you are confronted by a traumatized animal and are bitten or harmed in any way, seek immediate medical attention.

Photo: An animal protection group rescued these baby squirrels in Texas in October 2008 following Hurricane Ike. Courtesy Leif Skoogers/FEMA

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