I’ve been feeling a bit more skeptical of the supposed benefits of “organic” foods lately. It’s hard to imagine any greater purity as I watch this fruit in a bowl on my kitchen counter top – a sad modern still life, festooned with brand name stickers. The high grocery bills I’ve been racking up combined with a few recent studies casting doubt over the differences between conventionally grown versus organically grown foods have given me pause.

A large systematic review concluded that organic foods in general are no more nutritious than conventionally produced foods, but did find less antibiotic resistant organisms and pesticide residues on organic foods. More studies are needed to determine if this has any clinical significance for our health.

This echoed a previous analysis published in 2009 which concluded that the nutritional advantage of organically produced food is doubtful when compared to conventional.

The American Academy of Pediatrics recently published guidance on the advantages and disadvantages of organic foods.

The foods that seem to be worth buying organic have been ranked here by Environmental Working Group (EWG) and include apples, celery, sweet bell peppers, peaches, strawberries, nectarines, grapes, spinach, lettuce, cucumbers, blueberries, potatoes, green beans and kale.

EWG has also compiled a list of other vegetables that are low in pesticides anyway, and might not be worth buying organic (simply in terms of personal pesticide exposure). One should also consider the harms to the environment that are inherent in mass conventional produce production.

But I guess the bottom line is that a bowl full of “organic” fruits labeled, tracked, and defined by logo stickers is less than inspiring. The great still lifes hanging in the museums of the world recount a much more sensuous experience of food – exchanged hand to hand at markets, grown from the sweat and care of human toil, and I would imagine savored like rare treasures from the earth, instead of the consumed inputs of someone’s minimum 5 fruits a day.

Dr. Andrew Weil delivered the keynote address at the 2012 American Academy of Family Physicians Scientific Assembly.  I admit that I don’t know much about him or his wellness empire, but apparently Time Magazine has anointed him one of the top 25 visionaries in the world.  Here is the gist of his keynote address, as heard by someone with a relatively unbiased unfamiliarity.

My first impression of him was influenced by a Santa Claus-worthy white beard. He decried our “disease management system” that masquerades as a health care system.  A true sentiment, yet all the better intentions in the world will not change the fact that there are a lot of diseases to manage.

Dr. Weil scolded the medical profession for its over reliance on medications. Instead, he is a proponent of Integrative Medicine, a concept that emphasizes the body’s own ability to heal, and incorporates such things as botanicals.  I’m not sure how much he promotes supplements or chiropractic, but there is a slippery slope here. On the other hand he is absolutely correct that physicians and patients have come to expect that a pill can cure many problems without the more arduous attention needed to improve our lifestyles. He feels direct to consumer advertising by the pharmacy industry is wrong. It’s hard to disagree with that as well.

He is a proud General Practitioner, and has created an active education curriculum for residents, physicians, medical students to promote his integrative approach. He emphasized the lack of training in nutrition during medical school, and that most courses look more like biochemistry. Dr. Weil stated that his is an evidence-based curriculum (yet later downplayed the importance of evidence based medicine).

He feels we don’t need more rigorous studies of St Johns Wort, but we do need more outcomes studies showing his integrative, lifestyle medicine approach works better.  

His lofty goal is to make his curriculum a standard part of the education of every physician.

He called for a grassroots movement among doctors and patients to reform healthcare outside of government, and feels both political parties offer few inspiring solutions. I would certainly agree with this sentiment, but to build any consensus on what a utopian health care system might look like seems impossible to me.

He blames government subsidies of corn and soy for having made the least nutritious foods the cheapest.  He calls for subsidies for vegetables and fruits instead. Sounds good. Dr. Weil beleives one small step that would create a major positive impact would be eliminating or even outlawing sugary beverages like soda.  

He stated that many people have no idea of the difference between fruit and fruit juice.  Dr. Weil believes we should tell patients they are drinking soda when counseling them about juice. If you compare grams of sugar this is often true. Most breads labeled as “whole grain”  are still pulverized and have an unhealthy glycemic index.

The grand finale of his keynote address was the demonstration of a breathing technique which he touted as a kind of panacea.  By doing this breathing, the voluntary nervous system sets the tone for the involuntary autonomous systems.  He went on to actually demonstrate this breathing technique with elaborate counting, breath holding, and forceful exhaling.  According to Dr.Weil, we must do this twice a day “religiously.” He claims it is almost impossible to have a panic attack while doing these exercises, and cites 5 cases of this technique correcting atrial fibrillation.

While I think the idea of breathing exercises is excellent, and there is good evidence we can reduce stress, anxiety, and the downstream health effects of tension, he inflated this power to curative proportions. I think of breathing exercises as a coping mechanism with beneficial physiologic and health effects, but his method came off as proprietary and ritualistic, admittedly derived as it is from a kind of Yoga.

He ended his speech by pointing out that the word “conspiracy” is derived from the root “breathing together.”

At best I think his heart is in the right place, and his talk has at least piqued my interest in learning more about his integrative curriculum. There are a lot of things wrong with the institution of medicine, and the fight against a robotic system that relies on technology and ignores our own innate capacity to improve our health is righteous. However it seemed from his talk that he glorified the placebo effect, the anecdote, and the wisdom of accumulated clinical experience.  He downplayed the primacy of evidence based medicine, and the authority of the randomized double blind placebo controlled clinical trial – methods which have been invaluable in elevating medicine above the shaman. I think the art of medicine is derived from a continuum spanning rigorous science and respect for our desire to believe, but must always be informed by the scientific method as the best arbiter of truth.

Again, I don’t really know much about Dr. Weil. I do respect the medical blogger ORAC, and he wrote this scathing post about the selection of Dr. Weil as a keynote speaker. The Dr. Weil who showed up here certainly knew his audience, and tempered his more magical thinking, allowing just a hint of quackery to shine through. Thanks ORAC.

While picking up some diapers at the pharmacy I noticed the adjacent, ironic placement of condoms in the same aisle.

I suppose as a medical professional who does his fair share of counseling about safe sex I should appreciate the not-so-subtle juxtaposition of products rimmed for pleasure and fitted for maximum absorption. Yet I couldn’t help feeling that I was being manipulated.

If I were buying condoms, would I feel that the smiling, freely pooping images of children staring back at me were a reinforcement of my good judgement to control fertility? Or might I think that despite my free choice to protect myself, some pharmacy overlord is righteously asserting the proper function of sex as a procreative process, the success or failure thereof determined by a higher power?

As a purchaser of diapers, should I chuckle at the implied commiseration of someone who thinks that maybe I should rethink my ability to raise a second child? Or should I frown, sensing that beautiful, smiling babies on the packaging have been cynically labeled as co-producers of unwanted bodily fluids?

I really don’t know what to think, except that somebody certainly wants me to think something.

What do you think?

I walked past this advertisement posted at a bus stop the other day and had to pause. It announces a new medication for the treatment of HIV-related belly fat, or lipodystrophy. It is remarkable for many reasons, but perhaps most strikingly it represents the latest sign that the battle against HIV/AIDS has further matured into chronic disease management and a tame discussion in the public realm. It hasn’t always been so of course.

Imagine this advertisement splashing across billboards in the 1980’s when there were no effective treatments for the disease, and the general public feared contracting the disease from any sort of contact with infected individuals. There has been, and continues to be, much suffering from HIV/AIDS. But when one considers the seismic cultural, scientific, and public health shifts that were needed to discover, educate, prevent, and manage this terrifying killer – a sign post proclaiming we can now help the cosmetic effects upon the belly is nothing short of a miracle.

Cynically we can look at this ad and lament the fact that even one penny is being diverted into “weight loss” medications instead of an all out continuing effort to defeat HIV/AIDS in total. One might also notice the irony of the discarded high fructose corn syrup soda bottle on the street beneath the sign. It might also lead to the false assumption that we have already won the battle, and that misery across the world and behind closed doors is only experienced when looking at the belly in the mirror.

Far from it.

But for some reason I felt like this sign was a glimpse of a promising future, and a reminder of a much darker past, in the saga against HIV/AIDS. Weight loss, wasting, and cachexia are now giving way to lipodystrophy and belly fat, according to the signs of the times at least.

These ads from the 1980’s seem rightfully dated:

I’d like to post an email I received from a friend:

Hello All,

I am writing this letter to you because I am truly fearful for our country, my own children and their children. The only way that I can think of combating this fear is to try and let people know what we have been learning about this past month.

In the last few weeks, we have attended a few meetings concerning the process of hydraulic fracturing for natural gas (fracking). The information we obtained gave us some cause for worry, enough to write our state legislators about our concerns. However, last night we decided to watch the documentary recommended to us about fracking. It is called “Gasland.” I am sure many of you have heard about it and maybe a few of you have actually watched it. Until I saw this Oscar-nominated documentary, I didn’t believe that water could burn.

We rented it through Netflix. My Husband actually didn’t want to watch it since he thought it would be too depressing. It was more than that. It scared us enough to wreck our night’s sleep. Seeing this movie was so much more enlightening than reading information in articles and on websites. I urge all of you to get your hands on it and watch it. In our opinion, we are putting the entire country’s’ water supply and consequently our food supply at risk. It has the real possibility of becoming the worst nightmare our country has ever faced.

So far the states that have been most affected are Pennsylvania, Colorado, Texas, Arkansas, Wyoming and Louisiana. Thousands and thousands of these wells have already been drilled. And all of this has occurred in one mere decade. However there are plans in the works to drill wells in at least 34 of the 50 states.

These gas companies are exempt from most of our laws concerning clean water and clean air. The more than 500 hazardous (proprietary) chemicals, many of them toxic organics, are injected deep into the ground. There is a real risk that they will get into the aquifers we use for drinking water and for the irrigation of our crops.

There is not only the toxicity of the chemicals to worry about, but the wastewater that is recaptured from the underground drilling has been found to have radioactive contaminants. These radioactive contaminants are released from the rocks deep underground and are brought up to the surface in the drilling mud and in the natural gas. There is no way to scrub the radioactive gases from the gas. Every time you light your stove, you are introducing radioactive gases into your home.

Due to the exemptions given to the gas industry, these gas companies do not have to act responsibly and they do not. The EPA is powerless. The Fracturing Responsibility and Awareness of Chemicals Act exempts the gas industry from the Clean Air Act, Clean Water Act, Safe Drinking Water Act, and other “right to know” laws. The gas industry does not need to clean up toxic discharges from these fracking well sites whether it is to the ground or to nearby streams.

They don’t want to be bothered to clean-up their toxic sludge or any of the other damage they cause to the land, air or local water supplies. When people complain, the gas companies say “prove it” and “go find a lawyer.” People who get sick and sue the gas companies are fought tooth and nail, and the last person standing is often bought-off and silenced with non-disclosure agreements.

If any of you would like to read more about the issues, there are websites with more information. Two I know of are www.foodandwaterwatch.org and www.sierraclub.org. The Union of Concerned Scientists also has information.

I know many of you don’t particularly like environmentalists; however, I urge to watch this movie for the sake of your children, grandchildren and the many American citizens who have already been harmed by this process. If you watch it and feel there is no cause for concern, then you have only lost about an hour of your time. For those of you who feel the same fear we do, it is time to take action. One easy step we can all take is to write our State and Federal representatives about our concerns. (email your State Representatives and Senators and Governor)

We all love this country both for its great beauty and diversity as well as the ideals we hold dear. Please do not consider this a political issue. It is one that will affect all of us.

****

In addition to the valid concerns expressed in this letter, it is also worth noting that in Pennsylvania there is an outrageous gag order placed upon physicians who might try to counsel their patients about the deleterious health effects of fracking in their communities. From Physicians News Digest:

The law, known as Act 13 of 2012, an amendment to Title 58 (Oil and Gas) of the Pennsylvania Consolidated Statutes, requires that companies provide to a state-maintained registry the names of chemicals and gases used in fracking. Physicians and others who work with citizen health issues may request specific information, but the company doesn’t have to provide that information if it claims it is a trade secret or proprietary information, nor does it have to reveal how the chemicals and gases used in fracking interact with natural compounds.

If a company does release information about what is used, health care professionals are bound by a non-disclosure agreement that not only forbids them from warning the community of water and air pollution that may be caused by fracking, but which also forbids them from telling their own patients what the physician believes may have led to their health problems.

A strict interpretation of the law would also forbid general practitioners and family practice physicians who sign the non-disclosure agreement and learn the contents of the “trade secrets” from notifying a specialist about the chemicals or compounds, thus delaying medical treatment.

The clauses are buried on pages 98 and 99 of the 174-page bill, which was initiated and passed by the Republican-controlled General Assembly and signed into law in February by Republican Gov. Tom Corbett.

It is sad and infuriating to me that this kind of law could be passed. I can’t see how it is constitutional, and it certainly seems immoral. But even more distressing is the disregard we have for the environment and our own health.

I would urge you to learn more about this process since chances are it will be coming to a watershed near you.

It seems that study after study has been touting the benefits of chocolate – eat more of the (delicious!) dark stuff and you might find yourself losing weight, suffering fewer or less severe heart attacks, possessing cleaner arteries, and having a lower blood pressure. Despite the theoretical explanations for chocolate’s health benefits, it is usually found packaged and processed along with some other not so healthy ingredients including saturated fat, sugar, and even lead from the manufacturing process. But the studies keep coming, and as a purported health food chocolate is gaining a celebrity status akin to red wine, coffee, and whole grains.

Are the studies claiming a diet rich in chocolate may be beneficial to human health subject to bias and promotion? Is there a connection between the facts that chocolate, wine, and coffee are the products of multi-billion dollar industries and their frequent mentioning in the health press? Do our collective cravings lead us to read what we want to read?  Why is no one talking about sunchokes? Do we just want to believe in the prudence of our indulgences, or is there some kind of chocolate conspiracy going on?

A quick review of recent diet, nutrition and weight loss journal articles shows a few well-placed chocolate findings:

An article published in the Archives of Internal Medicine last month found that frequent chocolate consumption was associated with lower body mass index. The authors posited that substances called catechins, which are derived from cocoa, might increase metabolic activity, muscle performance, and lean muscle mass. The study even found that chocolate eaters tended to consume more total calories and saturated fat, but tended to have lower weight.

Another study found that chocolate consumption is associated with a lower risk of bad cardiovascular outcomes such as heart disease and stroke. The authors reviewed seven observational studies with a follow up time of 8-16 years, and found in their pooled analysis that those persons eating chocolate more than 5 times per week had an almost 40% reduction in any cardiovascular disease and a 30% reduction in stroke. They speculate that polyphenols present in cocoa products may be the source of this benefit, but caution that the sugar-laden products, if eaten excessively, could produce the unwanted effects of weight gain, diabetes, and obesity.

And finally, a study published in the Archives of Internal Medicine found that women who ate chocolate frequently had a lower risk of being hospitalized or dying from atherosclerotic heart disease. Flavinoids were singled out as the micronutrients most likely to explain this beneficial result from chocolate consumption.

By contrast there were no recent articles that I could find about sunchokes, a homely vegetable with a pasty, sullen and downright mealy consistency, bereft of a worldwide industry that might promote its invigorating primacy among life-extending vegetables. No one seems to revere the sunchoke, except perhaps for the Native Americans who first cultivated it. The Englishman John Goodyear was quoted in 1621 as having described the sunchoke thusly:

…which way soever they be dressed and eaten, they stir and cause a filthy loathsome stinking wind within the body, thereby causing the belly to be pained and tormented, and are a meat more fit for swine than men.

To be fair, most of the chocolate scientific authors are quick to point out that their studies are of inferior quality to the gold standard of scientific evidence – no randomized, double-blind, placebo-controlled, prospective trials have been carried out to really assess the associations between diets rich in chocolate and weight loss, cardiovascular health, and overall healthier body mass index. Most conclude with a tongue in cheek nod to the obvious guilty pleasures the authors took in absolving themselves of the guilt one might otherwise feel eating sugary, velvety, succulent dark chocolate confections. And articles that glorify our guilty pleasures, whether they be indulging in heavenly dark chocolate or a morbid fascination with Brad Pitt, tend to garner attention and readership.

So is there a chocolate conspiracy? I think so. I do hope these associations with better health, lower body mass index, and reduced cardiovascular risk are one day proven by real prospective trials. In the meantime I am eating more chocolate than sunchokes for reasons other than weight loss goals.

By way of contrast, at least one negative article has been published about chocolate. It shines a light on a possible association between higher chocolate consumption and depression. It was difficult to say which came first, the Ghirardelli or the sertraline, the chicken or the egg, the sunchoke or John Goodyear’s bowel troubles. But those who ate more chocolate were found to have more depressive symptoms upon screening.

But I wonder, did any of us bother to read that one?

You may have already heard that the air inside our homes is more polluted than the air in most modern, industrial cities. As the winter months approach, and as we batten down the hatches to stay warm and cut down our heating bills, it is important to remember the potential hidden costs to our health. Contrary to popular wisdom, perhaps a drafty, energy-inefficient home is a worthwhile investment.

The problem in our homes is that there are multiple sources of gas and particle pollutants, and inadequate ventilation to reduce their impact.

Have you ever considered the byproducts of that gas flame on the stove, or the smoke from the wood burning in the fireplace, volatile gases from the glues in the subflooring, building materials, and pressed wood furniture, the carpet, the cabinetry, the products we use to clean our homes, the central heating and cooling systems, and the environmental levels of radon, pesticides, and exhaust from factories and automobiles?

Gases and particles of combustion so released can cause irritation of the respiratory system leading to symptoms like cough, burning eyes, and headaches. Some of the pollutants contribute to the risk of certain cancers. It is enough to make you want to live in a bubble in northern Canada.

The EPA website has an excellent resource to learn more about these sources of indoor pollution. I highly recommend reading through it, and also recommend voting against political candidates who would dismantle the EPA. Some of the major indoor air pollutants mentioned on the website include:

Radon – estimated to cause between 7,000 and 30,000 lung cancer deaths each year. Radon levels can be tested, and are generally considered acceptable if less that 4 pCi/L. The lower the level the better.

Tobacco smoke – bad. Don’t smoke. Enough said.

Biologicals – molds can thrive in moist walls, ceilings, carpets, furniture, poorly maintained humidifiers, dehumidifiers, and air conditioners. Household pet dander and dust mites cause allergic reactions.

Solutions may include venting kitchens, bathrooms, and dryers to the outside, cleaning humidifiers and emptying the water trays of air conditioners, dehumidifiers, and refrigerators, cleaning or removing water damaged carpets, and using basements as living quarters only if dry and with adequate ventilation and dehumidification to a 30-50% humidity level.

Carbon monoxide – this odorless gas can be released by gas water heaters, gas stoves, woodstoves, leaking chimneys, back-drafting from furnaces, fireplaces, car exhaust from a running engine in an attached garage, and smoking. At low levels it competes with oxygen’s binding to hemoglobin and can cause fatigue.

Those with heart disease and COPD are at even more at risk if oxygen levels drop.  If CO levels reach higher concentrations the symptoms of poisoning (headaches, dizziness, confusion, and nausea) begin and may become fatal.

Adjusting appliances, installing an exhaust fan vented to the outdoors above gas stoves, making sure flues are open in fireplaces, choosing woodstoves that meet EPA emission standards and that have doors that fit tightly, professionally inspecting and tuning up central heating systems annually, installing monitors, and not idling the car inside can all help reduce CO risk.

Nitrogen dioxide – similar in source and remediation to carbon monoxide, usually unvented gas stoves and heaters, kerosene heaters, and smoking are the sources. May irritate the eyes, nose, throat and lungs.

Respirable particles – from fireplaces, woodstoves, kerosene heaters, and tobacco smoke, these particulates are another cause of respiratory, eye, nose, and throat problems and can lead to lung cancer. Proper venting, stove selection, and inspections as noted above can help, as well regularly changing filters on central heating and cooling systems.

Organic gases – emitted from paints, paint strippers, solvents, wood preservatives, aerosol sprays, cleansers and disinfectants, air fresheners, moth repellants, stored fuels and auto products, and dry cleaned clothing.

Organic gases may irritate the respiratory system, cause headaches, coordination problems, nausea, damage the liver, kidney and central nervous system, and may contribute to cancer risk. Steps to reduce exposure include using household products according to direction, providing fresh air when in use, and throwing away partially used containers.

The EPA website does not mention this but there are plenty of less toxic alternatives for cleaning including vinegar, borax, and baking soda. Many paints are available in low or zero VOC ratings, and perhaps going with a more wrinkled look at work will become acceptable one day.

Formaldehyde – this gas is emitted from pressed wood products such as hardwood plywood paneling, particleboard, and fiberboard, and furniture made with pressed wood. It is also released from urea-formaldehyde foam insulation, a type of insulation that is being used much less now. Formaldehyde irritates the lungs, eyes, nose and throat, can cause skin rashes, allergic reactions, and may even contribute towards a modest increase in cancers.

Try to purchase furniture with attention to the nature of the pressed wood (IKEA often uses little to no formaldehyde in their priducts), or spend an arm and a leg to get real wood, inquire about the nature of the wood used in new construction homes, use air conditioning and dehumidifiers, and maintain adequate ventilation.

There are other sources of indoor air pollution including pesticides, rodenticides, asbestos, and lead to name a few more, and more information on these can be found using the excellent link above.

I’m all for conservation of resources, and reducing energy consumption is absolutely a noble goal as our planet overheats from the effects of too many people. But my own plan selfishly includes having a bit of a drafty home this winter to improve air quality (as I wear a sweater and turn the thermostat down, though likely paying a higher electric bill anyway). We can’t avoid pollution, but perhaps an awareness of the common sources within the home will help.

If nothing else, perhaps efforts to remediate the sources may decrease our anxieties if not the medical symptoms caused!