Health for life

If youve worked with kids lately, or if youre a new parent yourself, then Im sure you know all about this epidemic of food allergies.  According to a 2011 study, 8% of American children under 18 have at least one food allergy, and that is up from 4% in 2009 (1).  Peanut allergies in particular have been on the rise.  In one Midwestern county, the prevalence of peanut allergies in children tripled between 1999 and 2007 (2).  But you dont need numbers to realize its a problem.  Just spend a day in a school cafeteria.  Or a summer camp.  Just enter an elementary school classroom at all and youll hear about it; the concern is clearly growing.  Dairy may be the most common allergy, and it seems kids can have a reaction just looking at a peanut, but there are others to worry about as well, including wheat, eggs, soy, tree nuts, fish, and shellfish.

But it wasnt always this way.  When I was a youngster, I dont recall ever hearing about another kid having a food allergy.  Maybe the most I ever heard was that a classmate was lactose intolerant.  But there was no mention of peanuts.  Nobody had a wheat allergy.  Nobody went into anaphylactic shock at the mercy of a pistachio.  So what gives?? Why are food allergies exploding?

Well, sadly I dont think we know the answer to that question.  Much has changed in the food and health world over the past few decades, so we have many likely culprits.  Over these next few posts, Ill be exploring the options, in a sort of thinking-out-loud fashion.  Excuse me if what follows turns into an incoherent mess.


Genetically Modified Organisms
This seems to be a hot topic right now.  Genetically modified organisms (GMOs) are plants or animals that are created through gene splicing techniques.  This merges the DNA from different species, creating a new variation of a species that wouldnt be possible through traditional crossbreeding.  Example.  Say biotech giant Monsanto finds a bacteria that naturally resists an herbicide like Round Up.  (They did.)  Then they isolate the gene that allows that bacteria to resist the pesticide, and they splice it into corn.  (Again, they did.) Now they have a genetically modified strain of corn that resists Round Up.  Lets call it Round-Up Ready corn.  Now we can grow mass quantities of corn and spray mass quantities of Round-Up on it to kill those pesky things like weeds and bugs, while leaving the corn unaffected.  Yes, believe it or not, true story.

The following foods have been approved to be genetically modified:  alfalfa, canola, corn, cottonseed, papaya, soy, sugar beets, and green/yellow summer squash (3).  You may say, well, thats only 8 foods, thats not that bad.  But canola, corn, cottonseed, soy, and sugar beets are nearly ALWAYS genetically modified, and theyre found in nearly ALL processed food.  Youd be hard-pressed to find anything in a box or a bag that doesnt contain at least one of these, just look next time youre shopping.


So how do you know if what youre eating contains GMO ingredients?  Its not easy.  Companies arent required by the FDA to label a product as GMO, contrary to the wishes of the American people.  So if you want to know, youve gotta be a detective and read the ingredient list.  Or, if you want to make it easier on yourself, you can buy organic.  Any food certified organic is free of GMOs.  In addition, apparently, GMO fruits and veggies must be labeled with a 5-digit code beginning with an 8, rather than the conventional 4-digit code.   Ive yet to see one of these for sale, but no doubt its coming.

But the worst part... we dont even know if eating this stuff is safe.  There are some people claiming that the studies have been done and theyve been swept under the rug to hide the incriminating evidence (4).  Who knows if theres any truth to that.  Then there was this recent study from France, showing that rats eating GMO corn developed breast cancer at a far greater rate than control rats fed non-GMO corn (5).  And of course, biotech companies like Monsanto swear by their safety.  Its no different than regular corn, they say.

But the fact remains... GMO foods are a science experiment.  Nobody in the history of the earth has consumed anything like this, and wed be giving ourselves too much credit as scientists to say "its just the same as corn".  Were not even close to understanding all the intricacies of how the human body works, let alone how a brand new franken-food is going to interact with said body.  I dont think we know how much we dont know, which is why its always a good idea to default to evolutionary biology... Were designed to eat plants and animals; were not designed to eat herbicide and pesticide resistant corn.  We are the subject of a science experiment, and nobody knows how its going to turn out.

But are GMOs causing food allergies?
Is it possible that the recent spike in food allergies has a link to these genetically modified foods?  It sure is.  The timing works perfectly... GMO foods as we know them today burst onto the scene in the late 1990s (6).  Thats just enough time for families to start eating them and start popping out kids with food allergies.  Theres no way to know, as of yet, just what GMOs are doing to our health.  But given all that Ive said so far, it does seem a bit fishy doesnt it?  Yes, fishy indeed.  One thing is for sure... if I were to have kids today, GMOs would be one of the first things Id watch out for. 


What are your thoughts, reader(s)?  Id love to hear your opinion on GMOs.

And stay tuned for the rest of the series.  Ill be discussing all kinds of fun stuff, like antibiotics, medications, and dwarf wheat.  Come on back!

The US Department of Agriculture has been tracking cheese consumption:



Some cheese facts:

• Average US cheese consumption nearly tripled between 1970 and 2003, from 11 pounds per person to 31 pounds.
  
  
• 60% of our cheese comes from eating out (or ordering in).
  
  
• In 2000 cheese contributed:
  • 26% of the calcium in the US diet (up from 11 percent in 1970)
    
  • 12% of the saturated fat (up from 5 percent in 1970)
    
  • 16% of the sodium (up from 6 percent in 1970)

________

The Disease Management Care Blog remembers when one of its patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack. The patient had done his homework, quoting literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirins benefit had less to do with blood thinning than reducing underlying inflammation.

Fast forward to the Feb 2-8 Economist that has an editorial pointing out that U.S. legal expertise may not require the completion of three years of law school. Why not, it asks, cut the requirement back to two years or, even better, skip the school requirement entirely and license anyone who can pass the bar exam?

And then theres the Feb. 11 Wall Street Journal, where "Notable and Quotable" ers to the "BA Bubble." Charles Murray argues that a looming oversupply of college graduates may portend a decline in the employment value of a liberal education. Work careers may consist of serving as "apprentices" and "journeymen" before becoming "craftsmen."

All of which makes the DMCB wonder if the vaunted Doctor of Medicine degree may be vulnerable.

Why should physician education be immune from a perfect storm of over-priced graduate education, "alternative" web-enabled learning with on-the-job-training? The declining value of the formal credential may be less about the university degree and more about competency, turbocharged by flexible licensing and a discerning consumer.
 
Non-physician health care professionals are arguing that their expertise is enough to enable them to deliver babies, administer anesthesia, prescribe drugs and perform surgery. The DMCBs traditionalist colleagues argue that patient safety is at stake and that lay persons may not be able to discern all of the possible risks, benefits and alternatives. When things go occasionally wrong in the delivery suit, operating room or with a drug, they say a credentialed and experienced doc can make the difference between life and death.

The DMCB also remains impressed by the ready availability of medical information in the public domain that is enabling some laypersons to become astonishingly expert.  In addition to the patient above, think about the self-taught parent of a child with a rare condition or the plucky cancer patient who guides the oncologist toward choosing the right life-saving therapy.  Imagine what happens when IBMs Watson is fully commercialized and available to anyone at anytime.

The physician DMCB understands all the perspectives above, but given the decline of the BA and the law degree, it worries that the medical traditionalists may ultimately end up being on the wrong side of history.

While regulators and the markets sort all this out, this may open another business proposition for care management. As patients with chronic conditions continue to seek ways to better share in their self care, theyll also be seeking providers that best suit their needs and expectations.  In other words, the population health vendors can not only help with shared decision making, but provider selection making. 

More on this in a future post.

Image from Wikipedia

Were your blood sugars high when you were pregnant? Did your mother have high blood glucose (BG) levels while she was carrying you?

If so, its a good idea to have your BG levels tested periodically as you age.

The National Institutes of Health reports:

"Up to 40% of women with gestational diabetes develop full-blown diabetes within 5-10 years after delivery. The risk may be increased in obese women."

The American Diabetes Association (ADA) states:

"Gestational diabetes affects about 4% of all pregnant women." Children born to these women have an increased risk of developing type 2 diabetes in adulthood.

And the incidence of gestational diabetes is on the rise. The New York Times (NYTs) published an article in February examining this trend. They reported an increased rate of up to 8% of all pregnant women and highlighted the following high-risk groups:

"Overweight women or those older than 25 are considered at higher risk, and there are steeper rates among African-American, Hispanic, Asian and Native American populations."

Research that appeared in the January issue of The Journal of Clinical Endocrinology and Metabolism corroborated the NYTs story with their finding:

"Asian and South Asian ethnicity are both independently associated with increased insulin resistance in late pregnancy [when compared to Caucasians]."

The rise of gestational diabetes, a condition that forewarns of type 2 diabetes in both mother and child, concerns health professionals. From the NYTs:

"Those who study the diabetes epidemic are concerned that its one more time bomb."

________
For NIH/MedlinePluss fact sheet:
Gestational Diabetes

For ADAs fact sheet:
Gestational Diabetes

For the NYTs article:
Diabetes Is Seen As a Rising Risk In Mothers-to-Be

For The Journal of Clinical Endocrinology and Metabolisms study:
Ethnicity Modifies the Effect of Obesity on Insulin Resistance in Pregnancy: A Comparison of Asian, South Asian, and Caucasian Women

Thanks to ADAM Inc. for another great illustration.

In this second installment of my food allergy series, I want to focus on wheat specifically.  As you may know, celiac disease is a destructive disease caused by an immune reaction to gluten, a protein in wheat.  In recent years, the prevalence of celiac has been rising; today it is about four times more common than it had been in the 1950s.  According to recent estimates, about 1% of the population suffers from this disease, many of which are still undiagnosed (1, 2).  But still more people suffer from something called gluten sensitivity.  While not a true allergy, gluten sensitivity can manifest in a variety of ways... chronic migraines, irritable bowel syndrome (IBS), fibromyalgia... you know, all those pesky, seemingly random conditions that youre told you have when your symptoms dont fit neatly into a real disease.  According to the Center for Celiac Research at the University of Maryland, gluten sensitivity affects 7% of Americans (3).  But some estimates have been as high as 15-20%.  Researchers and practitioners agree that gluten sensitivity is far more common today than ever before. 

Very likely about 1 in 10 Americans have some adverse, acute reaction to eating wheat.  So what gives?  Why the sudden problem?


The story of modern wheat is a fascinating one.  Its something Ive never seen discussed in any mainstream media outlet, but the reasons for that will become clear later.  Quite frankly, I didnt believe it when I first read about it in "Wheat Belly", mostly because its a horribly biased book based on scientific fairy tales.  I dislike it so much I wont even link to it.  Dont bother.  But a recent Marks Daily Apple article has convinced me that its true... The wheat and flour products we eat today are distinctly different than what weve eaten in the past.

The wheat we eat today is known as dwarf wheat, a variety developed in the 1960s by Norman Borlaug.  Despite being shorter in stature (hence "dwarf"), this variety of wheat was more disease-resistant and yielded far more per acre than the older varieties.  Dr. Borlaug was praised for his discovery and heralded as "the man who saved a billion lives"; his discovery was instrumental in allowing us to feed the growing world population.  But as is common when we find new ways to feed a greater population (ie. agriculture), we inevitably sacrifice our health in the process.  Heres what we know about modern wheat...

Its more damaging to those with celiac disease
Have you ever seen the TV show Cake Boss?  Have you ever wondered how pastry chefs are able to create such extravagant-looking treats?  Or why the bread today is just so soft and chewy?  Well you have dwarf wheat (in part) to thank.  Because of the structure of the gluten proteins in dwarf wheat, its more conducive to being molded and baked into delicious, succulent treats.  It wasnt always this way.  The bread of the past was far less palatable.  But it may be this difference in protein structure that makes dwarf wheat more problematic.  There is some evidence that the proteins in modern wheat are responsible for the increase in celiac disease (4). And on the flip side, older varieties of wheat like einkorn are significantly less damaging to those with celiac disease (5). 

Its less nutrient-dense
Beginning in 1843, agronomists in England began what is known as the Broadbalk Winter Wheat Experiment.  One of the longest-running continuous agronomic studies in the world, generations of scientists have studied wheat in just about every way possible... different types of wheat, different farming methods, soil mineral content, etc.  Between 1843 and the mid-1960s, the mineral content of wheat (zinc, magnesium, iron, etc.) had remained stable.  Interestingly, its mineral content began to decline after this time, coinciding with the development of dwarf wheat (6).  Turns out, modern dwarf wheat sports a shorter root system than ancient wheat, meaning that it cant extract the minerals from soil as efficiently (7).  This explains why, according to the Broadbalk Experiment, modern wheat contains fewer minerals despite the slight increase in soil mineral content over time.

Its prepared differently
Its something we dont often think about, but for most of our wheat-eating-history as humans, weve been soaking and fermenting flour before we use it.  This is the traditional way we prepared the stuff, as evidenced by the work of Weston A. Price.  Essentially, fermentation allows bacteria to break down some of the undesirable components of wheat, like phytic acid and gluten, for easier digestion and absorption.  And we have evidence that fermentation can break down gluten to the point where even celiacs can tolerate it (8).  Pretty impressive, no?  I know very few people have time these days to soak and ferment their flour, but its important to mention nonetheless, just to emphasize how our wheat-eating habits have changed.


So I ask you, with all of this information in mind, do you think modern wheat has something to do with the increase in wheat intolerance?  Id say the evidence is strong.  But just as were stuck with agriculture as a means of food production, despite the decline in health that followed, were stuck with dwarf wheat as well.  Quantity is indeed the enemy of quality... but what are we to do?  If you ask me, dwarf wheat has done far more good than harm for the human race, but that doesnt mean that we should ignore the negatives it presents.  I may eat it from time to time (lets be real, theres some yummy shit made from wheat), but I wouldnt recommend you make it a staple of your diet, especially if youre suffering from fibromyalgia, migraines, IBS, and the like.  Or if youve got an autoimmune condition.  Or if youre pregnant, planning on being pregnant, or nursing (dont take your chances).  But play around with it; go gluten-free for a month.  If you feel better without it, then youre probably gluten-sensitive.  There are no side effects, and you just might get rid of those nagging migraines :)

Let me know what you think in the comments, Id love to hear your thoughts on the topic.  Has anyone tried any of the ancient varieties of wheat, like emmer or einkorn?  Until next time... Burn, out.