Newsletter MARCH 2008

Article
Preventive Medicine for Adults

Research Review
High Blood Pressure Increasing Among US Women
Exercise after Menopause Boosts Immunity

Ask the Doc
Preventing Miscarriage

Doctor’s Pick
Protect Women’s Right to Choose Bioidentical Hormones

Recipe of the Month
Brown Rice Risotto with Butternut Squash
Mushroom Leek Soup
Stuffed Cabbage

Quote:
“The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”
Thomas Edison

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Preventive Medicine for Adults
By Sarah Cimperman, ND

Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” He was right. As the prevalence of chronic diseases such as cardiovascular conditions, type two diabetes mellitus and cancer continue to rise, preventive medicine is more important than ever. A healthy diet and lifestyle are essential, but your doctor also plays a significant role. Routine exams and tests can detect physical and biochemical changes that precede illness, offering an opportunity to address abnormalities before conditions fully manifest. This detailed guide to all the ages and stages of adults’ lives can help make the most of medical visits. The following guidelines apply to healthy adults; certain conditions or risk factors may require more frequent monitoring.

Ages 18 to 20
By age twenty, everyone should have at least one full physical exam and routine laboratory testing. Lab tests should include a complete blood count to assess white and red blood cells; a lipid profile to measure cholesterol, triglycerides, homocysteine and cardiovascular risk; a chemistry and metabolic panel to measure blood glucose, electrolytes, minerals, proteins, nitrogen elements and liver enzymes; a thyroid panel to assess thyroid function; and any other tests your doctor feels are necessary.

Every year, skin exams should be performed by a primary care physician or dermatologist to detect moles or other lesions that may need to be monitored during future examinations. Doctors may recommend more frequent check-ups for individuals at high risk of developing skin cancer and those who have suspicious lesions or have had skin cancer in the past. Every month, adults should perform their own skin exams, observing every inch of skin and enlisting the help of a mirror or significant other to examine areas that are difficult to see.

Women should have a primary care physician or gynecologist perform a clinical breast exam every year and do their own self breast exam every month, as demonstrated by their doctor. Annual pelvic exams should be initiated as soon as women become sexually active and include Papanicolaou tests, also known as Pap smears, which detect pre-cancerous changes to the cervix. Men should have a primary care physician perform a clinical testicular exam every year and should perform a self testicular exam every month, as demonstrated by their doctor.

Ages 21 to 39
Adults in their twenties and thirties should have a complete physical exam and routine blood tests every three to five years. They should continue yearly clinical skin exams and monthly self skin exams.

Women should continue annual clinical breast exams, pelvic exams and Pap smears, as well as monthly self breast exams. Women who become pregnant should follow the recommendations of their obstetrician for exams and tests. Also, by age thirty-five women should have a baseline mammogram. Men should continue yearly clinical testicular exams and monthly self testicular exams.

Ages 40 to 49
Adults in their forties should have a complete physical exam and routine blood work every three years and a clinical skin exam every year. They should continue monthly self skin exams and begin yearly clinical rectal exams and stool tests to screen for blood and abnormal growths.

Women should continue monthly self breast exams and yearly clinical breast exams, pelvic exams and Pap smears. Additionally, women should receive a mammogram every two years. When women enter perimenopause, testing for hormone levels can confirm the transition and help doctors make recommendations to ease symptoms. Men should continue clinical testicular exams on a yearly basis and self testicular exams on a monthly basis.

Ages 50 to 65
Adults in their fifties and early sixties should have a complete physical exam and routine blood tests at least every two years. Clinical skin exams, rectal exams and stool tests should be performed every year. Self skin exams should be done every month. Additionally, a proctosigmoidoscopy should be performed every three to five years to screen for colorectal polyps, cancer or other abnormalities.

Women should continue annual breast exams, pelvic exams and Pap smears, as well as monthly self breast exams. Mammograms should be performed on a yearly basis. Men should continue yearly clinical testicular exams and monthly self testicular exams, and begin yearly testing of blood levels of Prostate-Specific Antigen (PSA).

Ages 66 and beyond
Adults over the age of 65 should have a complete physical exam, including skin and rectal exams, and routine blood and stool tests every year. They should continue monthly self skin exams. Proctosigmoioscopies should be performed every three to five years.

Women should continue to have yearly clinical breast exams, pelvic exams, Pap smears, and mammograms, as well as monthly self breast exams. Men should continue yearly clinical testicular exams and PSA testing as well as monthly self testicular exams.

Making the Most of Medical Visits
There are several ways to make the most of visits to your doctor. Bring along detailed records of medical conditions that have been diagnosed, medicines that have been prescribed, immunizations that have been given and your family medical history. Heredity is a significant risk factor for many diseases and your doctor may ask you if certain illnesses, such as heart disease, diabetes, cancer, osteoporosis, allergies, blood disorders and metabolic conditions, have affected any of your family members. Also keep copies of tests that have been performed. If you are going to see a doctor who did not order the tests you have had done, bring along copies or arrange for the results to be transferred to their office prior to your appointment.

Write down your questions. Medical visits can be short and it can be easy to forget issues you wanted to discuss with your doctor. Bringing a list of your concerns can give your physician a full picture of your current condition and help prioritize issues in the time available.

If you have a chronic condition that requires monitoring, keep track of significant measurements. People with hypertension should keep records of blood pressure readings and those with diabetes should record blood glucose levels. If you are visiting with a naturopathic doctor, nutritionist or other holistic-minded practitioner, keep a diet diary the week prior to your appointment and bring it with you to the appointment.

Finally, always tell your doctor about any medicines are taking, whether natural or pharmaceutical. Bring along any prescriptions and/or supplements you are taking that were not prescribed by the doctor you will be seeing so she or he can be sure of the ingredients. This will help identify any side effects or potential interactions. The more information your doctor has, the better she or he can diagnose problems and seek solutions.

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Research Review: High Blood Pressure Increasing Among US Women

Researchers from Harvard University and the University of Washington recently analyzed information from the National Health and Nutrition Examination Survey to determine trends for high blood pressure in the United States. They found that rates of hypertension (high blood pressure) were reaching a plateau in adult men but increasing in adult women. Trends differed across the country, but the study concluded that in every state a higher percentage of women had hypertension compared to men. Approximately one in four women in the United States have high blood pressure.

Serious health effects are associated with uncontrolled hypertension, including atherosclerosis, eye problems, kidney disease, stroke, heart disease and heart failure. Fortunately, diet, exercise, nutritional supplements and botanical medicines can be effective interventions. If you have high blood pressure, talk to your naturopathic doctor about the best treatment options for you.

Ezzati M et al. Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States. Circulation, DOI:10.1161/CIRCULATIONAHA.107.732131, Feb 2008

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Research Review: Exercise After Menopause Boosts Immunity

Researchers at the Fred Hutchinson Cancer Research Center in Seattle studied the long-term effects of exercise on upper respiratory tract infections. Participants included 115 postmenopausal, overweight, sedentary women who were divided into two groups. For one year, one group exercised at moderate intensity for five days each week while the other group attended one weekly 45-minute stretching session. Researchers found that the group of exercisers had a much lower risk of contracting colds compared to the stretchers. In the final three months of the study, the stretchers had three times greater risk than the exercisers.

Although this study focused on postmenopausal women, results may be applicable to the general population. Regular exercise can support a healthy immune system in everyone.

Chubak J et al. Moderate-intensity exercise reduces the incidence of colds among postmenopausal women. American journal of medicine, 119(11):937-42, Nov 2006.

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Ask the Doc: Preventing Miscarriage

My recent pregnancy ended in miscarriage. What can I do to prevent it from happening again?

Isadora
Staten Island

That depends on the cause. The most common cause of miscarriage is chromosomal abnormality and experts estimate that genetic defects are responsible for up to half of all cases.

Other medical conditions can increase the risk for miscarriage: fibroids, especially submucosal fibroids protruding into the uterus; infections; obesity; hormonal imbalances, particularly high levels of luteinizing hormone (LH) and low levels of progesterone; autoimmune disorders; and anatomical abnormalities affecting the competency of the cervix and the shape of the uterus. If any of these conditions affect you, addressing them with your doctor is the first step to reducing the risk of future miscarriage.

Environmental effects also play an important part because certain elements can increase the risk of chromosomal abnormalities. Exposure to radiation, smoking cigarettes and consuming alcohol all increase the risk of miscarriage and affect both partners. To support healthy sperm, eggs and cell division, both partners trying to conceive should eliminate cigarettes and alcohol and avoid sources of radiation.

Caffeine can also be a factor. Studies have shown that women who consume 200 milligrams or more of caffeine per day have twice the risk of miscarriage. 200 mg is approximately the amount of caffeine in two regular cups of coffee, but caffeine can also come from tea, soda, other caffeinated beverages and chocolate. Women trying to conceive and pregnant women should monitor caffeine intake from all sources. If you can’t eliminate coffee, enjoy it as an occasional treat, drink coffee decaffeinated by the Swiss water method, or limit yourself to one cup per day. Everyone should avoid soda, pregnant or not. Regular soda is high in sugar and diet sodas contain unhealthy artificial sweeteners. Drink water instead.

Selenium, a powerful antioxidant, can protect cells against DNA damage that may lead to chromosomal defects and miscarriage. To reduce the risk, male partners can take 100 mcg per day while trying to conceive and women can take 100 mcg per day from conception through pregnancy. Additionally, a whole foods diet, regular exercise and a good quality prenatal vitamin are also essential to a healthy pregnancy.

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Protect Women’s Right to Choose Bioidentical Hormones

The Food and Drug Administration (FDA) is considering banning estriol, a naturally-occurring female sex hormone, from physician prescriptions and compounding pharmacies. Wyeth, maker of Prempro and Premarin, is urging the FDA to eliminate access to natural hormones in favor of synthetic hormones.

Because bioidentical hormones exactly match human hormones, our bodies are designed to recognize, utilize, and eliminate them efficiently after they have served their purpose. Changing the three-dimensional structure of a hormone changes the biological effects in ways that are not completely understood. Because the structure of synthetic hormones is foreign to the body, they may be metabolized differently, producing harmful break-down products that take longer to excrete. This increases risk of unpredictable and undesirable side effects, including stroke, heart attack, blood clots, breast cancer and dementia.

Pharmaceutical companies have become interested in this issue because synthetic hormones are patentable and profitable while bio-identical hormones are not. Compounds that occur in nature cannot be patented, so there is no reason for pharmaceutical companies to fund studies on their safety and effectiveness. Eliminating access to these competing products in is their best financial interest. But it is certainly not in the best interest of women.

Bioidentical hormones are not the answer to every hormone imbalance. But they can be important options when other therapies, including diet, exercise, nutritional supplements and botanical medicines, fail to provide sufficient support. A woman and her doctor should decide together on the best intervention, but bioidentical hormones should always be an option. They have been a part of the United States Pharmacopeia for decades, and both research and clinical use have proven them to be safe and effective.

If you agree that women and doctors should have access to bioidentical hormones, contact your legislators. Project: Freedom of Access to Natural Solutions makes it easy. They provide a sample letter and will find your US Senators and Congressmen when you click “Take Action” and enter your zip code. Emails can be sent from the site directly to your recipients in seconds.

http://www.projectfans.org/editorial.cfm?EditorialID=23&CategoryID=0

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Brown Rice Risotto with Butternut Squash

Fans of Arborio rice may be skeptical, but it really is possible to make a creamy and delicious risotto using brown rice. Frozen, pureed butternut squash works well in this recipe; thaw it to room temperature and reserve the unused portion for another meal. Feel free to experiment with other herbs; you can substitute dried basil, sage or thyme for the Herbs de Provence. Or use 1 tablespoon of fresh chopped basil or sage instead, but add it with the squash at the end of cooking, rather than at the beginning. Use real parmesan cheese, imported Parmigiano Reggiano or a domestic variety, which should contain only milk, rennet enzymes and salt.

2 cups vegetable or chicken stock
1 tbsp extra virgin olive oil, first cold pressing
1 medium onion, finely chopped
1 clove garlic, crushed
1 tsp dried Herbes de Provence
1 cup brown rice, presoaked, rinsed and drained
½ cup white wine
1 cup butternut squash puree
1 tbsp organic butter
¼ cup freshly grated parmesan cheese
Freshly grated nutmeg to taste
Sea salt to taste
Ground peppercorn to taste

Over medium heat, bring the vegetable stock to a simmer. Cover and reduce heat to the lowest setting.

Warm the olive oil in a large skillet over medium heat. Sauté the onion until soft, about 5 to 7 minutes. Add the garlic and Herbes de Provence and stir to incorporate. Continue cooking until the garlic becomes aromatic, another minute or two. Add the rice, stir to coat with olive oil and cook for 2 more minutes. Add the wine and cook until it has been absorbed by the rice. Then ladle in ¼ to ½ cup of stock at a time, stirring occasionally, and continue cooking until the rice becomes tender, 20 to 40 more minutes. Cooking time and volume of stock required will depend on soaking time.

Once rice is tender, stir in squash, butter and parmesan cheese. Once fully incorporated, season with nutmeg, sea salt and peppercorn. Let stand for 3 minutes to thicken, then serve immediately.

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Mushroom Leek Soup

Pureeing this dairy-free soup makes it exceptionally creamy. If you don’t have a blender, you can make a chunky-style soup, but you’ll lose the creamy texture. Substitute whatever mushrooms are available, dried or fresh, as needed but avoid using white button mushrooms because their flavor is too mild for this soup.

1 large portobello mushroom cap
Extra virgin olive oil, first cold pressing
2 leeks, halved, thoroughly cleaned and thinly sliced
1/3 pound fresh shitake mushrooms
1 to 2 garlic cloves, crushed
1 tsp fresh thyme leaves or 1 tsp dried thyme or Herbes de Provence
5 cups organic beef stock or vegetable stock
Sea salt
Black pepper

Preheat the broiler. Wipe clean the Portobello with a damp cloth and place gill-side up in a shallow baking dish. Drizzle with olive oil and sprinkle generously with sea salt and ground peppercorn. Broil until the mushroom becomes tender and the gills start to crisp, about 7 minutes. Set aside to cool.

Warm 2 tbsp olive oil in a soup pot over low heat. Add the leeks and sauté until soft but not brown, about 5 to 7 minutes.

Meanwhile, clean the shiitake mushrooms by wiping them with a damp cloth. Remove any tough stem ends and reserve them for stock. Thinly slice the shiitakes and add them to the soup pot with the crushed garlic once the leeks start to soften. Dice the portobello mushroom and add it to the pot as well, along with any juices. Continue sautéing until the shiitakes are soft. Then add enough stock to cover all of the vegetables and bring the mixture to a boil. Reduce heat and simmer for 20 minutes.

Use an immersion blender to puree soup to desired consistency or transfer ¾ of the soup to a regular blender and cool for at least 5 minutes. Process until almost smooth, taking care to ventilate while blending. Return the soup to the pot, taste for seasoning and adjust if necessary. Reheat soup gently over medium-low heat or cool completely and store in the fridge until ready to eat. This soup can be made one day in advance.

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Stuffed Cabbage

To speed preparation, use leftover cooked whole grain. Millet works well, but if you happen to have extra brown rice or quinoa, feel free to use that instead. This recipe calls for blending the sauce into a puree, but if you don’t have a blender or prefer a chunky sauce, feel free to skip this step. Vegetarians can substitute cooked lentils or crumbled tempeh for the ground turkey. Contains nightshades.

The directions appear lengthy, but each step can be done in advance for quick assembly: blanching the cabbage leaves, making the filling, preparing the sauce. You can even assemble the entire dish one day and bake it the next.

1 head Savoy cabbage
28 oz whole peeled tomatoes with their juices
2 tbsp extra virgin olive oil, first cold pressing, divided
1 large onion
1 clove garlic, crushed
2 tbsp red wine vinegar
¼ cup golden raisins
Ground peppercorn to taste
Sea salt to taste
1 pound ground turkey
2 leeks, halved lengthwise, thoroughly cleaned, and thinly sliced
1 tsp paprika
1 roasted red pepper, peeled and chopped
1 cup cooked millet

Prepare a pot with enough boiling water to submerge the cabbage leaves. Remove the core from the cabbage and separate 12 leaves, taking care not to tear them. Alternatively, cut along the base of each leaf to loosen it from the core. Blanche the leaves by submerging each one in the boiling water for one minute. Drain and set it aside to cool.

To prepare the sauce, empty the tomatoes and their juices into a large mixing bowl and crush with clean hands or a vegetable masher. Set aside. Heat 1 tbsp olive oil over medium heat in a saucepan. Add the onion and sauté until soft, about 5 to 7 minutes. Add the crushed tomatoes, garlic, red wine vinegar, raisins and ground peppercorn. Bring to a boil, then reduce heat to lowest setting. Simmer for 30 minutes or more, until the tomatoes have broken down and the sauce has reduced and thickened. Season with sea salt and cool for at least 5 minutes. Transfer to a blender and puree until smooth.

To prepare the filling, heat 1 tbsp olive oil in a large skillet over medium heat. Add the ground turkey and stir frequently, breaking it up as it cooks. Once thoroughly cooked, transfer the turkey to a large mixing bowl. Add the leeks to the pan and add a small amount of additional olive oil if necessary. Sauté until soft, stirring frequently, about 5 to 7 minutes. Reduce heat to low and add the ground peppercorn, paprika and red pepper. Stir and continue cooking for one more minute. Stir in the sea salt, taste and adjust seasoning if necessary. Transfer the mixture to a mixing bowl and toss with the cooked millet until thoroughly combined.

To assemble the dish, preheat the oven to 350F. Pour the sauce into the bottom of a large baking dish. Take one cabbage leaf and cut along the bottom 1/3 of the spine, then remove it. Place approximately ¼ to ½ cup of filling just above the area where the spine was removed, then fold in both sides around the filling and roll it up into a pouch. Place it in the baking dish, seam-side down. Repeat with the other cabbage leaves until the filling has been used up. Use less filling for appetizer portions and more filling for main course dishes.

Cover and bake the stuffed cabbage for 30 minutes. Serve immediately, transferring the pouches to a serving platter and spooning the sauce over the top. Alternatively, serve the sauce on the side.

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