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.
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:
- Removing 50-75% of the bran
- Sour fermentation
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.
(Click on images for full-size versions.)
Source: American Hairdresser, November 1942
It's been a while. Did you miss me?
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!
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.
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.
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.
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.
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.
Asian & Pacific Islander American Health Forum.
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.
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.
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.
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.
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.
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.”
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.
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
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.
- Vitamin K2
- Vitamin A
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.
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.
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.
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