Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Good to the last drop

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New research suggests drinking coffee might actually be good for you

Coffee drinkers, rejoice!

The heavenly brew, once deemed harmful to health, is turning out to be, if not quite a health food, at least a low-risk drink, and in many ways a beneficial one. It could protect against diabetes, liver cancer, cirrhosis, and Parkinson’s disease.

What happened? New research – lots of it – and the recognition that older, negative studies often failed to tease apart the effects of coffee and those of smoking because so many coffee drinkers were also smokers.

“Coffee was seen as very unhealthy,” said Rob van Dam, a coffee researcher and epidemiologist at the Harvard School of Public Health. “Now we have a more balanced view. We’re not telling people to drink it for health. But it is a good beverage choice.”

As you digest the news on coffee, keep in mind that coffee and caffeine are not the same thing. In fact, “they are vastly different,” said coffee researcher Terry Graham, chair of Human Health and Nutritional Sciences at the University of Guelph in Ontario, Canada. One can be good for you; the other, less so.

“Coffee is a complex beverage with hundreds, if not thousands, of bioactive ingredients,” he said. “A cup of coffee is 2 percent caffeine, 98 percent other stuff.”

Before we rhapsodize further, a few caveats:

Caffeine – whether in coffee, tea, soft drinks, or pills – can make you jittery and anxious and, in some people, can trigger insomnia. Data are mixed on whether pregnant women who consume caffeine are more likely to miscarry. In general, 200 milligrams a day – the amount in one normal-size cup of coffee – is believed safe for pregnant women, said van Dam.

For people with hard-to-control hypertension, a sudden, big dose of caffeine may boost blood pressure because caffeine constricts blood vessels. But decaf is fine. And even caffeinated coffee doesn’t increase blood pressure much once you drink it for a week or so, said van Dam.

In fact, the caffeine in coffee seems to have less of an effect on blood pressure than the caffeine in colas because there are so many other substances in coffee that have the opposite effect physiologically from caffeine.

One final caveat: The new research heralding coffee’s health benefits is not perfect. Most of the studies are observational, that is, they followed people over time and correlated health outcomes with coffee drinking – based on people’s recollections of how much coffee they consumed. The studies don’t prove that coffee was the cause of improved health outcomes.

Still, the sheer volume of the research, and the fact that the conclusions line up so neatly, make it reasonably credible, researchers say.

Now for the good news. Twenty studies worldwide show that coffee, both regular and decaf, lowers the risk for Type 2 diabetes, in some studies by as much as 50 percent. Researchers say that is probably because chlorogenic acid, one of the many ingredients in coffee, slows uptake of glucose (sugar) from the intestines. (Excess sugar in the blood is a hallmark of diabetes.) Chlorogenic acid may also stimulate GLP-1, a chemical that boosts insulin, the hormone that escorts sugar from the blood into cells. Yet another ingredient, trigonelline, a precursor to vitamin B-3, may also help slow glucose absorption.

For both heart disease and stroke, recent studies are reassuring that frequent coffee consumption does not increase risk. In fact, coffee may – repeat, may – slightly reduce the risk of stroke. A study published in March in the journal Circulation looked at data on more than 83,000 women over 24 years. It showed that those who drank two to three cups of coffee a day had a 19 percent lower risk of stroke than those who drank almost no coffee. A Finnish study found similar results for men.

For cardiovascular disease other than stroke, there doesn’t appear to be a preventive benefit from drinking coffee, but there is also no clearly documented harm; the studies looked at the effect of drinking up to six cups of regular coffee a day.

As for affecting cancer risk, coffee research has come up empty – with one big exception: liver cancer. Research consistently shows a reduction in liver cancer risk with coffee consumption, and there is some, albeit weaker, evidence that it may lower colon cancer risk as well.

Coffee also seems to protect the liver against cirrhosis, especially that caused by alcoholism. It’s not clear, either for cancer or cirrhosis, whether it’s coffee or caffeine that may be protective.

With Parkinson’s disease, a progressive, neurological illness, it’s the caffeine, not coffee, that carries the benefit. No one knows for sure why caffeine protects. Several studies show that coffee drinkers, men especially, appear to have half the risk of Parkinson’s compared to nondrinkers. Women also get a benefit, but only those who do not use post-menopausal hormones, said Dr. Alberto Ascherio, a professor of epidemiology and nutrition at the Harvard School of Public Health. All it takes for a measurable reduction in Parkinson’s risk, he said, is about 150 milligrams a day, the amount in an average cup of coffee.

When it comes to athletic performance, it’s clear that it’s caffeine, not coffee per se, that delivers the big boost, said Graham, the researcher from Ontario. In fact, caffeine was once deemed a controlled substance by the International Olympic Committee.

Caffeine is a powerful “ergogenic agent,” meaning it promotes the ability of muscles to work. Studies show that caffeine boosts performance in both very short and very long athletic events, said Graham.

It used to be thought that caffeine worked by stimulating the release of sugar (glycogen) in muscles, but recent research suggests it helps muscles release calcium, allowing muscles to contract with more force. It takes only a medium cup of regular coffee for a 130-pound athlete to see a measurable improvement in performance, Graham added.

One last bit of coffee advice: Don’t drink unfiltered coffee – the kind that is popular in Scandinavia and is made in French presses. Filtered coffee, which most Americans drink, is much better because the paper filters catch a substance called cafestol, which boosts “bad” cholesterol (LDL). Filtered coffee has no effect on either good or bad cholesterol.

If, despite all this good news, you still worry that you’re drinking too much coffee, by all means cut back or quit. But don’t go cold turkey. Abrupt caffeine withdrawal can trigger headaches, noted Dr. Alan Leviton, a neurologist at Harvard Medical School who consults for the National Coffee Association, an industry group. So, taper off instead.

On the other hand, if reading this makes you want an extra cup, go for it. And enjoy it – guilt free!

Good night? Good luck.

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As the economy sinks, insomnia increases and America searches for a good night’s sleep

Chris Dalto is an affable fellow, a happily married father of two and a lawyer-turned-financial planner. Normally, he sleeps like a baby.

But last fall, when Lehman Brothers tanked and the stock market fell apart, Dalto began waking up at 3 a.m. “You take on the clients’ stress, which made it impossible to get back to sleep,” he says. He would spend the wee hours fretting and checking on the already-open Asian markets. Then, come 6 a.m., it was off to work again.

Even in normal times, an estimated 40 million Americans have trouble sleeping, according to the National Institutes of Health. Sleep troubles are more prevalent now because of the economy, some psychologists and psychiatrists say. A third of all Americans are losing sleep worrying about money, according to a poll done last fall and released last week by the National Sleep Foundation, a nonprofit research organization.

Uncertainty – and especially the fear of job loss – are precisely the kind of worries that makes for sleepless nights, says Carol Kauffman a McLean Hospital psychologist. “A hypothetical emergency is often harder to deal with, and can cause more insomnia, than an actual one,” she says; the worst place to be is “in limbo, waiting for the other shoe to drop, and there’s a millipede up there raining shoes.”

So what are the stressed out masses supposed to do to get some sleep? Sleeping pills, once frowned upon by doctors, are now increasingly prescribed if non-drug treatments don’t help.

Stress management, meditation, exercise, nighttime habits more conducive to sleep, and, of course, talk therapy, should be tried first, says psychologist Cynthia Dorsey, director of behavioral sleep medicine at the Sleep Health Centers, a for-profit network of sleep disorder clinics

But for those who need more – and many do; doctors wrote more than 56 million prescriptions in 2008, according to IMS Health, a healthcare information company – sleeping pills are an acceptable alternative.

What changed? For one thing, it’s clearer that extended use of some sleeping pills can be safe. Until relatively recently, doctors advised patients to take sleeping pills for no more than two weeks, partly out of the “concern that nightly use of sleeping pills would lead to ‘tolerance’ – the need to increase doses to get the desired effect,” says Dr. John Winkelman, medical director of the Sleep Health Center affiliated with Brigham and Women’s Hospital.

But then a study, funded by the makers of Lunesta, showed that the sleeping pill was just as effective at six months as at day one, suggesting that people did not become tolerant, and thus would not be inclined to boost their dosage. The US Food and Drug Administration approved Lunesta in 2004 for long-term use. Ambien CR and Rozerem are also now approved for long-term use, although there is less data on whether patients develop tolerance to these drugs.

The other change was in attitude. There is now “more acceptance of the fact that sleep disorders are very disturbing to the individual who has them,” says Winkelman. Thus, the medical community sees more value in correcting the problem, which can harm both mental and physical health, says Winkelman, a consultant to several companies that make sleeping pills.

A new study from Carnegie Mellon University illustrates the health risk of insomnia. It links poor sleep “efficiency” (the percentage of time in bed actually asleep) and shorter duration of sleep to a higher risk of coming down with a cold. People who slept fewer than 7 hours were 3 times more likely to get sick than people, equally exposed to the cold virus, who slept 8 hours or more.

Still, many people view sleeping pills with suspicion. A common worry is that stopping sleeping pills use will cause withdrawal symptoms, including worse sleep. This can happen, but is often preventable if a person tapers off a drug gradually, rather than stopping abruptly.

People also worry that sleeping pills will make them do strange things in the middle of the night. Bizarre side effects are rare, but people on Ambien have reported cooking, eating, talking on the phone, even having sex – with no memory of such things the next day.

Still others fear that sleeping pills will make them groggy the next day, which can occur if the dose is too high or taken too late into the night.

On the plus side, having a sleeping pill handy may help – even if you don’t take it, says Kauffman, the McLean Hospital psychologist. Much of the problem in insomnia is not worrying about a real fear – such as losing a job – but is the “secondary anxiety” about losing sleep. Just knowing you can take a sleeping pill if you really need it can allay this secondary fear.

As for Chris Dalto – the sleep-deprived accountant worried about his clients, me among them – he never turned to sleeping pills. Nor did he seek therapy or change his sleep habits.

What he did do was to figure out what he could, and what he could not, control. The larger economy, clearly, was out of his hands. So he focused intently on managing his clients’ portfolios – more bonds, fewer stocks – to reduce the inevitable losses of a bad market. It worked.

“Gradually,” he says, “I started to string together two, three, four normal nights’ sleep. Now, I’m sleeping like a baby.”

‘I . . . feel like a man again’

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Testosterone was once off limits for men with prostate cancer. Things are changing. 

Manny Hamelburg, 68, a retired businessman from Holbrook, had fought prostate cancer for years. First he tried radiation, then a drug with side effects that nearly killed him, and finally Lupron, a drug that blocks production of testosterone, the hormone that can fuel prostate cancer.

The cancer disappeared. But life was miserable. Without normal levels of testosterone, Hamelburg said he had no energy, and “zero libido for seven years. I was like a eunuch. I was chemically castrated. Sex was just hugs.”

So three years ago, with his cancer undetectable and his oncologist and urologist cautiously on board, Hamelburg made a decision that many doctors consider anathema: He took testosterone supplements.

So far, says Hamelburg, “The cancer hasn’t come back, but my libido has, my sense of being alive. It’s like a fog cleared. It’s being aware of things, being more vibrant.”

For decades, the idea of giving testosterone to a man who had had prostate cancer was forbidden – “verboten” in the words of Hamelburg’s urologist, Dr. Abraham Morgentaler of Beth Israel Deaconess Medical Center.

“It would have been considered heresy, or malpractice,” says Morgentaler.

But that thinking is changing, due in part to Morgentaler, and his new book, “Testosterone for Life.” Morgentaler argues that, while depriving tumors of testosterone does make them shrink, other evidence is beginning to suggest that it may be safe to give testosterone to men who have been successfully treated for prostate cancer, and appear to be cancer free.

One revolutionary aspect of Morgentaler’s theory is the observation that prostate cancer is often found in men with low testosterone levels, not high ones, underscoring the idea that taking it may not be an added risk.

It’s not surprising that Morgentaler – who has received honoraria and research funding from companies selling testosterone-related products – has generated controversy with his ideas.

“To say that testosterone replacement therapy is safe because we have no evidence it’s harmful is making an assertion on faith, not facts,” said Dr. Ian Thompson, chairman of the department of urology at the University of Texas Health Science Center at San Antonio, echoing the view of other doctors who disagree with Morgentaler.

But amid often-confusing testosterone research results, there are hints that Morgentaler and like-minded physicians may be on to something. In the test tube, prostate cancer cells have been shown to grow faster when testosterone is added, but only up to a point. Then the growth plateaus, even if more testosterone is added.

In 2006, Morgentaler cowrote a study on 345 men with low testosterone. The study – published in the journal Urology and not industry funded – showed prostate cancer risk was higher in men with the lowest testosterone, a finding supported by a handful of other small-scale studies using human subjects. That was contrary to findings suggested by the Physicians’ Health Study in 1996, a discrepancy doctors can not fully explain.

And last February, an analysis of data from 18 studies around the world involving nearly 4,000 men with prostate cancer, and more than 6,000 without, showed no correlation between high testosterone levels and cancer risk. The study was published in the Journal of the National Cancer Institute.

Understanding the pros and cons of testosterone replacement is not easy.

An estimated 2 million to 6 million American men have low testosterone, and the benefits of replacement therapy can be huge: revival of sagging libido, better mood, more energy, more muscle mass, better bone density, more red blood cells.

But there are also risks, in large part because many seemingly healthy men have undetected prostate cancer, which could be stimulated by taking testosterone. Indeed, studies suggest prostate cancer is lurking in as many as 25 percent or more of men 50 and older.

Only when a man has a “clean” biopsy – an invasive procedure in which snippets of the prostate are surgically removed and tested – can a doctor confidently say the man doesn’t have cancer.

As an extra measure of safety, Morgentaler says he biopsies men over 50 before he prescribes testosterone for them. But most doctors don’t, says Dr. Marc Garnick, a cancer specialist at Beth Israel Deaconess Medical Center and editor in chief of Harvard Medical School’s publication, Perspectives on Prostate Disease.

Even with apparently healthy men, “Nobody has proven that it is completely safe” to give testosterone,” says Dr. Philip Kantoff, head of the Prostate Cancer Program at Dana-Farber Cancer Institute.

So what’s a guy to do?

The traditional recommendations are to steer clear of testosterone supplementation if you have prostate or breast cancer; or if you meet one of several criteria: your physician can feel a nodule on the prostate during a digital rectal exam; your PSA (a marker of potential cancer) score is higher than 3 nanograms per deciliter; your hematocrit (red blood cell count) is greater than 50 percent; you have untreated sleep apnea, severe urinary tract symptoms or heart failure.

These standards are set by the Endocrine Society, a professional group of doctors who study and treat patients with hormones.

And if you have had prostate cancer that appears to be gone?

Proceed with caution. “Most physicians consider testosterone replacement therapy contraindicated for men with a history of prostate cancer,” says Dr. Matthew Smith, director of genitourinary medical oncology at Massachusetts General Hospital Cancer Center.

But if you do wish to explore testosterone supplements, it’s smart, given the controversy, to get a second opinion. Grill your doctors on how serious your prostate cancer was to start with – that is, how high your PSA was, and how many gland segments contained cancer. Also, keep being monitored for cancer recurrence.

Hamelburg is glad he eventually opted for testosterone. “My body was my enemy,” he says. “Now, I just feel like a man again.”

Steve Drouin, 56, a mason in Northfield, N.H., who has also had prostate cancer, echoes that view. “He’s not tired all the time,” says his wife, Jean. And has their sex life improved? “Yeah,” she says. “It has.”

Cold comfort

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Think you know how to avoid the sniffles? Maybe not.

If there’s any good news about the common cold, it might be this: You don’t have to stop kissing your sniffling loved one’s lips just to avoid catching their colds. But you probably will want to stop holding hands.

That insight comes from research into the more than 100 viruses, called rhinoviruses, that cause the common cold. The more researchers learn about these viruses, the more it challenges our common assumptions about how colds spread – sneezing, for example, does not seem to be as important a route of transmission as touching. With time and luck, this knowledge could lead to better ways of preventing colds.

Rhinoviruses infect the lining of the nose. But surprisingly, these viruses don’t live in saliva, says Dr. J. Owen Hendley, a leading rhinovirus specialist and professor of pediatrics at the University of Virginia School of Medicine. The lining of the nose “is a different form of epithelial tissue from the lining of the mouth and throat,” he says. And the cold virus, having come from the nose, does not fare as well in the dissimilar environment of the mouth.

Colds typically spread when virus-laden mucus from a sick person’s nose gets onto the fingertips of a well person who then rubs his own nose or eyes. In short, says Hendley, that means that “kissing is okay, but hand holding is not.”

Viruses also go from the tear ducts down into the nose, says Dr. Diane E. Pappas, an associate professor of pediatrics also at the University of Virginia. And it’s almost impossible to refrain from touching your eyes and nose. “We touch our eyes and nose multiple times an hour,” she says – whether we know it or not.

Usually, the fingertips get contaminated from directly touching the sick person, but there’s growing evidence that cold viruses can live for at least a day on surfaces such as doorknobs, telephones, countertops.

Scientists disagree about how easily cold viruses are transmitted by coughing and sneezing, and they cite data to support their position. Dr. Kimon Zachary, an infectious disease specialist at Massachusetts General Hospital, contends that cold viruses “can be transmitted by sneezing on someone,” though touch is the more common route. Unlike viruses such as chicken pox that can be spread through the air across a room, the cold virus droplets in sneezes and coughs only travel 3 feet, he says.

Hendley, on the other hand, says, “I don’t think the rhinovirus spreads through the air” at all.

Whoever is right, there’s no harm in asking people with colds to cough or sneeze into their elbows (not their hands) and in your trying to stay out of the line of fire. If you’re sick, throw out your own used tissues.

And it’s best to “avoid contact with infected clothing – people still wipe their noses on their shirts,” says Dr. Martin Hirsch, an infectious disease specialist at MGH. [Parents: This means washing your hands after you handle your sick kid’s clothes.]

Besides endless hand washing, there is one way to kill viruses on your fingertips before you spread them to your nose and eyes. It’s iodine – but you probably don’t want to go there. Data show that iodine does block viral transmission from drippy-nosed kids to mothers’ hands. But it turns hands brown and dries out the skin, said Hendley.

As for those increasingly popular alcohol-based sanitizing gels, sorry, but they may not measure up to plain soap and water. “Rhinoviruses like alcohol. They think it’s tasty,” says Hendley. For whatever reason, adds Zachary of MGH, “cold viruses are not as susceptible to alcohol-based hand disinfectants as other viruses and bacteria.”

And what of the common assumption that the same nasty cold virus can get passed back and forth endlessly within a couple or family? Not true. Most of the time, the next round of colds is because of a new virus.

But if you find that you are recovering from a cold, only to feel sick again, it does not necessarily mean a new virus is at work. “Some cold viruses can be biphasic,” says Hirsch, which means that the sufferer can feel sick, then feel better, and then feel sick again – all with the same viral infection. In addition, other microbes, including bacteria, can cause secondary infections such as sinusitis and ear infections.

It may help to know that the time of greatest infectivity is when the sick person is producing the most nasal mucus. Typically, that period lasts three days. If you can manage superb hygiene for those three days, you may not get sick. But you can’t necessarily count on the three-day limit; sometimes people shed virus for up to three weeks, warns Hirsch.

The incubation period for rhinoviruses is a day and a half to two days – so if you’ve been exposed but don’t start getting symptoms within two days, you probably have escaped.

Sadly, there are no vaccines against the common cold – there are simply too many viruses that you’d have to be vaccinated against. But researchers’ greater understanding of how the virus spreads holds hope for more effective prevention. As consumers get more refined information on how the virus spreads, everyday habits – starting with when it’s most important to wash your hands, or the best way to disinfect surfaces – will adjust accordingly, with greater prevention the outcome.

For now, consumers are left with treatments of uncertain efficacy. Many people swear by zinc-based products, but doctors are unconvinced of their value. Gargling with salt water can make a sore throat feel better and nasal lavage with salt water can provide mild symptomatic relief.

Better antiviral drugs for the common cold are nowhere in sight. “Antiviral medications are more difficult to make than antibacterials,” says Zachary of MGH.

So back to the good news: Once you become immune to a particular strain of rhinovirus, you’re probably immune to that strain forever. But with more than 100 strains, if you get two colds a year, it takes 50 years to acquire immunity to all of them.

In the meantime, wash your hands a lot if your loved one has a cold, and don’t worry about the occasional kiss on the lips.

 

Comparing apples to organic apples

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We’d like to think pesticide-free food is better for us, but scientific proof remains elusive.

With the recession breathing down our necks, you may be looking for ways to cut the household budget without seriously compromising family well-being. So here’s a suggestion: If you buy organic fruits and veggies, consider going for the less pricey nonorganic produce instead.

I know, I know, abandoning an organic way of life seems unthinkable in this chemical age. But hold the e-mails and hear me out. There really is no proof that organic food, which costs about a third more, is better for us than the conventionally grown stuff.

Yes, it makes sense, intuitively, that crops grown without pesticides should be better for us. It’s appealing, politically, to think that food grown the old-fashioned way, by rotating crops and nurturing the soil naturally, would be superior to food that is mass-produced and chemically-saturated.

Many people feel that way. Sales of organic food and beverages have grown from $1 billion in 1990 to well over $20 billion this year, according to the Organic Trade Association, an industry group.

But the unfortunate truth is that, from a hard-nosed science point of view, it’s still unclear how much better, if at all, organic food is for human health.

“Organic,” for the record, means food grown without most conventional pesticides or fertilizers made with synthetic ingredients, according to the US Department of Agriculture’s website (usda.gov). To carry the “organic” seal, a product must be certified by a federally accredited agent as having been produced according federal regulations. Small farmers are exempt.

Prepared food made with organic ingredients also tends to be processed more gently, with fewer chemical additives, said Charles Benbrook, an agricultural economist who is chief scientist at the Organic Center. The nonprofit research group is based in Boulder, Colo., and supported by individuals and the organic food industry.

But the word organic has not been designated as an official “health claim” by the government. Such a designation is used only when there is evidence of significant health benefits – and so far, that evidence is lacking for organic food.

It’s clear, however, that conventionally grown food has remnants of pesticides on it. A 2002 study in the journal “Food Additives and Contaminants” showed there are more pesticide residues on conventional than organically grown food, even after the food is washed and prepared. There’s also clear evidence that pesticides can get into people, a major reason Environmental Protection Agency regulations exist to keep farm workers from entering recently sprayed fields.

A study by Emory University researchers and others published in 2006 in “Environmental Health Perspectives,” a peer-reviewed journal published by the National Institutes of Health, showed that when children are fed a conventional diet, their urine shows metabolic evidence of pesticide exposure, but that when they are switched to an organic diet, those signs of exposure disappear.

All of which raises the question: How much harm do the pesticides cause?

A number of studies suggest that, at high doses, organophosphate chemicals used in pesticides can cause acute poisoning, and even at somewhat lower doses may impair nervous system development in children and animals. But at the amounts allowed by the government in the American food supply? That’s where nutritionists and environmental scientists seem to part company.

“We don’t have any good proof that there is any harm from fruits and vegetables grown with the pesticides currently used,” said Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the Division of Nutrition at Harvard Medical School. The real issue is to get people to eat more fruits and vegetables, whether they’re grown conventionally or organically, he added.

“Keeping herbicide and pesticide levels as low as possible does make sense, although there is no clear evidence that these increase health risks at the levels consumed currently in the US, ” said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health.

What is of growing concern, he said, is the meat industry’s increasing use of growth hormones in animals. Those hormones may be linked to breast cancer in women, he said. (The “organic” label on beef means, among other things, that it was raised without antibiotics and hormones. Some nonorganic beef is also raised without hormones or antibiotics, as noted on its label.)

Even if we don’t yet have all the evidence that organic veggies and fruit might be desirable, Benbrook of the Organic Center said it’s time to change the old notion that “there’s nothing wrong with a little pesticide for breakfast.” Over the last two years, he said, “nearly every issue of Environmental Health Perspectives has had at least one new research report” on how pesticides can harm a child’s neurological growth, particularly on “brain architecture, learning ability and markers for ADHD, [attention deficit hyperactivity disorder].” While this falls short of incontrovertible “proof” that properly washed conventional produce can harm us, it does raise red flags, environmentalists say.

Weighing the value of organic foods also means looking at nutrition, not just the danger of pesticides – and there is also disagreement over whether organic food supplies more nutrients.

Researchers at the University of California, Davis, did a 10-year study in which a particular strain of tomatoes was grown with pesticides on conventional soil right next to the same strain grown on soil that was certified organic. All plants were subject to the same weather, irrigation, and harvesting conditions.

The conclusion? Organic tomatoes had more vitamin C and health-promoting antioxidants, specifically flavonoids called quercitin and kaemperfol – although researchers noted that year-to-year nutrient content can vary in both conventional and organic plants.

Other studies have also shown nutritional advantages for organic food, according to the Organic Center, which reviewed 97 studies on comparative nutrition. Benbrook, the center’s chief scientist, says that although conventionally grown food tends to have more protein, organic food is about 25 percent higher in vitamin C and other antioxidants.

Yet a recent Danish study published in the Journal of the Science of Food and Agriculture showed no vitamins and minerals advantage to organic food.

So, what to eat? I side with the nutritionists who urge us to eat more fruits and veggies, regardless of how they’re grown. If you can afford it, common sense, though not necessarily science, would seem to favor the organics. But if you want, split the difference – buy organic for fruits and veggies that are thin-skinned or hard to wash or peel, and go conventional for those, like bananas, that you can peel easily.

When pain arrives – and help does not

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I never knew such pain existed.

This past spring, my neck suddenly went bonkers — a long-lurking arthritic problem probably exacerbated by hunching over my new laptop.

On a subjective scale of 1 to 10 (there is no objective way to measure pain), the slightest wrong move, such as turning my head too fast or picking something up from the floor, would send my pain zooming from zero to a sobbing, gasping, tears-pouring-down-the-face 10.During these episodes, which happened many times a day for months, it became impossible to talk, and impossible not to yell.  A series of MRIs showed several problems: herniated discs, vertebrae sliding forward over each other, and bone spurs stabbing my nerves.  

These irritated nerves kept firing, causing my shoulder muscles to spasm, which made my head to twist bizarrely to one side, where it would stay “frozen” for a half hour or more.  I couldn’t exercise, work or socialize.  Just going from sitting to lying down was agony.

So new, shocking and self-absorbing was this pain that I felt utterly alone, convinced no one had ever felt like this before. I also became convinced that the medical establishment is nowhere close to adequately addressing chronic pain.

The first point, of course, is completely wrong.

Indeed, in a survey of nearly 4,000 Americans published in May in the journal The Lancet, 29 percent of men and 27 percent of women reported they were in pain  in one given 24-hour period.

Some of this suffering comes from neuropathic pain, that is, pain from nerves damaged by such things as shingles or diabetes. Some comes from inflammation, as in arthritis. And some from diseases such as cancer.

Not only are more than a quarter of Americans living in chronic pain, “nearly 30 percent of them are partially or fully disabled by it,” said Dr. Russell Portenoy, chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York. And pain carries a significant price tag for the country, he said, in lost productivity as well as treatment costs.

Yet less than one percent of the budget of National Institutes of Health is devoted primarily to pain research. In fact, the allocation of public money for pain research has declined in recent years, said David Bradshaw, an anesthesiology researcher at Utah and author of a new report on pain research funding due out in the fall.

“We have gone backwards in treating patients with pain,” said Dr. Perry Fine, an anesthesiologist at the Pain Research Center at the University of Utah. “It’s a huge problem and it won’t go away…. What we need is an interdisciplinary model where we can work on the mind-body connection, on the whole person, not just on medical interventions like drugs and injections that provide only symptomatic relief and don’t necessarily help people get on with their lives.”

This month, the National Institutes of Health is announcing a $375 million-5-year plan to boost funding in six neglected areas, including pain. But for pain patients like me slogging through “the system,” that may not be enough.

For one thing, there’s still too much pressure on doctors to see more patients in less time. My first pain specialist literally told me that we had 10 minutes, during which we could either talk or I could get “trigger point” injections for my spasms. So much for empathy! I got the injections (they didn’t help much) and dumped the doctor,

For another, we’re still caught in the culture wars over painkilling drugs.  Yes, I tried acupuncture, physical therapy, meditation, and it was not enough. Millions of people legitimately need opioid drugs such as Percocet (oxycodone)and Vicodin (hydrocodone).

Even when used properly, these drugs are no picnic. Tramadol, a painkiller, gave me night sweats. Skelaxin, a muscle relaxant, made me sleepy and nauseous. Percocet worked fairly well, but only for three hours at a time.  Even the over-the-counter pills have their problems. Ibuprofen can cause serious bleeding,  Tylenol, liver damage.

Prescription painkillers also raise the thorny issue of abuse. Nobody knows how big the problem really is because the government does not track abuse of prescription painkillers separately from use of illicit street drugs. Beyond abuse, there’s the fear of  “addiction,” which often leads both doctors and patients to under treat pain.  Opioids do create physical dependence, which means that if you abruptly stop taking a drug such as Percocet, you will get withdrawal symptoms such as nervousness, nausea and diarrhea, said Dr. Kathleen Foley [cq], a pain specialist and attending neurologist at Memorial Sloan-Kettering Cancer Center in New York.

But that’s different from genuine addiction, which is the behavioral tendency to take a drug despite harm, to take more than is prescribed, to take it for reasons other than pain relief, such as to get high, and wind up “lying around dysfunctional,” Foley said.

Treating pain can be a nightmare. As Foley put it, “Pain wears away your personality. It limits your activities. It makes you find no joy in life. And when patients don’t respond to the treatments we give them, we start to blame their psychological state. We start to stigmatize every pain patient as having significant emotional problems.”

As for me, I went on to see a total of seven doctors, plus two physical therapists, an acupuncturist and an ergonomics consultant, who got me to buy all new office furniture.

I began to get better when I landed at New England Baptist Hospital where the doctors gave me time, understanding, cortisone shots in my cervical spine and rigorous physical therapy. At Beth Israel Deaconess Medical Center, I got Botox injections into my shoulders, which helped reduce the spasms.

So what did I learn from my ordeal? That a doctor’s kindness, always important, is especially important when you’re in pain.

I learned, too, that the immediacy of pain makes it agony to wait weeks for an appointment or an MRI — and that communicating that effectively to your doctor can save you weeks of suffering.  

And I learned that you can’t go it alone. Support from family and friends is not a nice, little luxury – it’s absolutely essential.

Today, I’m still fighting with my insurer to cover continuing physical therapy. I am nowhere near cured, though I am better. But as for the millions of other pain patients, as well as those lucky folks who have yet to encounter severe, chronic pain, I’m afraid that getting help is still a crapshoot. And that really hurts.

Environmental cues affect how much you eat

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Next time you sit down to dinner, dim the lights – but not too much. Both bright light and dim light may make you eat more. Watch the background music, too. If it’s too fast, you’ll eat fast, and therefore more; too slow and you’ll keep eating. And think small for plates – a portion that looks skimpy on a dinner plate looks ample on a salad plate.

The more that researchers study obesity, the more they are finding that portion control is key to successful weight loss. Often, people think they’re eating much less than really are. And these perceptions can be influenced, often outside our conscious awareness, by environmental cues, including lights and music.

There is no question that portion sizes have increased in recent years. Marion Nestle, a professor of nutrition, food studies and public health at New York University, and her colleague Lisa Young, have found that most portion sizes are now two or three times bigger than “serving” sizes, as defined by the US Department of Agriculture and the Food and Drug Administration.

That wouldn’t be so bad, Nestle said, except that research shows that “nobody has any self-control. Everyone, everyone, when presented with larger size portions will automatically eat more calories.” Even dietitians wildly underestimate the number of calories in typical restaurant meals, she said.

“Most people, unless they are anorexic, really don’t have any idea of how many calories they are eating, and the food companies promote this,” said Tufts University psychologist Robin Kanarek. “If you have a small bag of chips, you think it’s a serving. But it’s actually two or two and a half servings. Most people get fooled.”

Whether it’s because we’ve been taught to finish our plates or get our money’s worth in restaurants, most of us eat everything that’s put in front of us, according to surveys by the American Institute for Cancer Research. In 2000, the group found that 67 percent of us finish our restaurant entrees all or most of the time. In 2003, it found that for 72 percent of us, the amount we eat is determined by the amount we are used to eating or the amount we are served “without any attention to hunger, taste, or any other factor,” said the group’s nutritionist, Karen Collins, in an e-mail.

Brian Wansink, who directs the Cornell University Food and Brand Lab, has been a leader in the study of the cues that make us eat too much. In one famous study, he found that people given huge buckets of popcorn at the movies ate an average of 173 more calories than those given smaller containers even though, in both conditions, the popcorn tasted awful because it was five days old.

In other studies, Wansink, who is also executive director of the Center for Nutrition Policy and Promotion at the US Department of Agriculture, has rigged a “bottomless” soup bowl that keeps refilling itself as people eat, prompting people to eat 73 percent more soup. He has also shown that variety on the plate makes people eat more. When people were offered six different jelly bean flavors in a scrambled, disorganized array (lots of visual variety), they ate twice as many jelly beans as when the jelly beans were in an arrangement organized by color.

Wansink’s research also demonstrated the tricky effects of lighting and music on eating.

“The big danger,” said Wansink, “is that we all think we are too smart to be influenced by environmental cues.

“The good news is that it is very easy to reverse these cues and to just as mindlessly eat less.” In fact, he said, most of us won’t even notice if we eat 20 percent more or fewer calories than usual, though we will notice a change of 30 percent.

So, if restaurateurs and food marketers can use environmental cues to get us to eat (and buy) more, we can use the same psychology to take back our waistlines.

At home, for instance, put your dinner on a small plate and pay attention to the “serving” size. A serving of meat, fish, or poultry is about 3 ounces – or about half a can of tuna – but most of us have become accustomed to portion sizes of 8 ounces or more, according to a recent issue of the Tufts University Health & Nutrition Letter.

And serve food on individual plates rather than passing a platter at the table so as not to be tempted into second helpings.

At a restaurant, have two appetizers instead of an appetizer and an entree. Take home the leftovers for a second meal. Or split a meal with someone else. Order two veggies instead of a veggie and a starch.

Ask for salad dressing on the side, ditto for mayonnaise for a sandwich. Don’t waste calories on drinks, except – if you want – for a nice glass of wine. Don’t let music and lighting seduce you into eating more.

And watch out for the mind games you can play on yourself: Since you’ll probably underestimate the calories even in a “healthy” main course, don’t fall into the trap of thinking you deserve a rich dessert because you’ve been so good.

‘Fighting’ isn’t how you deal with cancer

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Fight, Ted, fight!”

This mantra, chanted over and over to give moral support to Senator Edward M. Kennedy as he faces brain cancer, drives me nuts. The caring behind it is wonderful; the metaphor is not.

Cancer is not a football game. It’s more of an involuntary dance with a partner you didn’t choose, more judo than battlefield warfare.It’s not that I think that Ted Kennedy should sail quietly off into the sunset with the word “ACCEPTANCE” emblazoned on his shirt. Certainly not yet. I think he should, and no doubt will, muster his considerable intellectual, emotional, spiritual, political, financial, familial, and social power to deal with his cancer on all fronts.

And when the time to die comes, as it clearly will someday for him, just like the rest of us, that too can be faced with grace, not guns. I’ve seen a dear friend do it. I’ve seen my mother do it. I’ve seen my husband do it.

The fighting metaphor is insidious because it subtly and not so subtly implies that if you fight, you can “win.” And if you don’t fight hard enough, you “lose” and are therefore a “loser.” In truth, cancer doesn’t care whether you fight or not, whether you win or not. It’s simply there, just like all the other horrible, debilitating, scary, painful, life-wrecking chronic diseases that millions of Americans deal with every day.

This fighting thing is so American, isn’t it? We think of the world as populated by good guys and bad guys. We believe so naively in our power to triumph over adversity, not just as a moral value but as a life-saver. We think a “good attitude” improves survival, while pessimism begets failure and death. But studies show that, while optimism may feel better than pessimism, it rarely, if ever, affects outcome.

And that’s a good thing, not a bad one, because it takes away the guilt of feeling so responsible for everything — the mistaken belief that we have more control over our fate than we actually do.

So then the challenge for Kennedy, as for all of us, every day, is to figure out where the locus of our limited control lies. Theologian Reinhold Niebuhr said it best in his famous prayer, adopted by Alcoholics Anonymous and other groups: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Kennedy can’t change the fact of his diagnosis. But he can, and already has, chosen his doctors wisely. He is putting his resources now, appropriately, into learning about his cancer, what drives it, what might slow it down. He may have to choose additional doctors, anywhere in the world. That’s great. That’s the stuff that really is under his control. As is choosing how to spend his time and energy.

So, I would change the mantra to “Breathe, Ted, breathe.” Sail your boat. Kiss your wife and your kids. Trust your doctors. Keep doing the work you love.

Time to cleanse? Think again

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To read the Internet ads, you’d think that our bodies were awash in “toxins” – usually unspecified – and that we should therefore go to dramatic lengths, like “colon cleansing” and chelation to get rid of all this bad stuff.

Don’t believe it. Or, to put it a bit more gently, don’t risk your health or your pocketbook on programs that promise to “detoxify” you, without at least doing lots of homework first. Like asking exactly what these supposed “toxins” are. And thinking twice – or 20 times – before undergoing chelation, a procedure that uses powerful drugs to rid your body of heavy metals such as mercury or lead.

Some alternative medicine practitioners, such as Dr. Glenn Rothfeld, medical director of WholeHealth New England in Arlington, believe – although research is skanty – that cleaning out the colon occasionally may help some people, particularly those with irritable bowel syndrome. “Though whether it helps by getting rid of toxins is not clear,” he said.

There’s evidence, Rothfeld said, that the digestive tracts of people who eat typical Western diets may move wastes along more slowly than those of people who eat more fiber. In theory, this longer “transit time” could mean that some substances, like nitrosamines, which are found in preserved meats and are carcinogenic in animals, have more time to cause trouble.

But generally, people don’t need to take dramatic steps to “detoxify” themselves because human bodies have multiple systems for getting rid of wastes, by sweating, exhaling, urinating, and defecating. If you really want a “clean” system, eat more fruits and vegetables and less junk food, all of which we’re supposed to do anyway.

One testimonial ad, next to a truly gross picture on drnatura.com, reads, “How would you feel if long pieces of old toxin-filled fecal matter were stuck to the inside of your colon for months or even years?” But it’s simply not true that waste material gets stuck indefinitely in the colon – though the cleansing products themselves can form the gels that look like huge stools.

“I’ve heard my kids say that there’s stuff in the GI [gastrointestinal] tract for seven years,” said Dr. Douglas Pleskow, a gastroenterologist at Beth Israel Deaconess Medical Center. “That is the urban legend. In reality, most people clear their GI tract within three days.”

The ads for colon cleansing are also remarkably vague about what toxins would be purged with enemas, laxatives, or special diets. Asked what toxins his colon cleansing dietary regimen called “Master Cleanse” gets rid of, author Peter Glick man, an advocate of a raw food diet, spoke of “metabolic toxins,” parasites, and “environmental toxins . . . whatever kinds of stuff we’re breathing in air.”

Wrong, said Dr. Bennett Roth, a gastroenterologist at UCLA: “There is absolutely no science to this whatsoever. There is no such thing as getting rid of ‘toxins.’ The colon was made to carry stool. This is total baloney.”

What’s actually in the intestinal tract is mostly bacteria, which can aid in digestion. “An enema or laxative does not get rid of more ‘bad’ versus ‘good’ bacteria,” said Dr. David Heber, director of the UCLA Center for Human Nutrition. It gets rid of both. “We don’t like the idea of carrying bacteria so lots of folks want to cleanse, but remember bacteria can be your friend.”

Moreover, colon cleansing would do no good at all for environmental pollutants such as PCBs and DDT, which are stored not in the gut but in fat, and can’t be eliminated by colon cleansing.

Perhaps most worrisome, colon cleansing can actually be dangerous because most techniques draw fluid from surrounding tissues into the colon. This disrupts the balance of electrolytes such as sodium, potassium, chloride, calcium, magnesium, and phosphorus, said Pleskow of Beth Israel. This shift in fluids can lead to dehydration and low blood pressure.

As for chelation, it can be useful for getting rid of heavy metals such as lead in people with very high blood levels. But chelation can also be dangerous – the chelating drugs themselves can be toxic to the liver and kidneys.

It is totally inappropriate for people who have near-normal levels of heavy metals to get chelation therapy, said Dr. Rose Goldman, an associate professor of environmental health at the Harvard School of Public Health.

Beware of practitioners who use hair sampling to detect multiple heavy metals and elements, said Goldman. “This type of hair sampling is highly inaccurate,” she said. Some practitioners push chelation on people who complain of vague symptoms like fatigue and difficulty concentrating, which could easily be due to problems other than heavy metal poisoning.

If you do decide on chelation, ask if the physician is board-certified by either the Accreditation Council for Graduate Medical Education or the American College of Occupational and Environmental Medicine. Be skeptical about practitioners who say they practice “clinical ecology,” which is not a recognized medical specialty.

And before you jump to chelation, said Dr. Alan Woolf, director of the pediatric environmental health center at Children’s Hospital Boston, make sure the environment is as free as possible of the contaminant in question, such as lead, so you don’t recontaminate yourself. And try conservative treatments first, like adding calcium, zinc, and iron to the diet because these minerals can block absorption of lead into the body.

Before you fall prey to the country’s rampant toxic phobia, ponder the whole notion of detoxification. And remember, your body has an extraordinary ability to cleanse itself.

Women athletes win equal time on injury list

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A week from today, 10,375 women – and 14,737 men – are expected to run in the Boston Marathon. The presence of so many women – the most ever entered in the historic race – is a sure sign of how far women have come in athletics.

So is this: In 1972, before Title IX, the law that spurred women’s athletics, fewer than 300,000 high school girls played sports, according to the National Federation of State High School Associations. Now it’s more than 3 million.

But there’s a dark side to this terrific news: The more girls and women play sports, the more they, like boys and men, get hurt. And – attention athletes, coaches, and parents – they get hurt in different ways.

Last week for instance, researchers from the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, reported on a stunning injury rate for young gymnasts, 82 percent of whom are female.

Using data from 100 hospitals across the country, the team reported in the journal Pediatrics that every year, roughly 26,600 children ages 6 to 17 get injured badly enough doing gymnastics to wind up in the emergency room. This is a “very high” injury rate, roughly equivalent to ice hockey, said public health specialist Lara McKenzie, the lead author.

And gymnastics is just the tip of the iceberg. Cheerleading is now the leading cause of direct fatal and nonfatal injuries among high school and college women, according to the Center for Catastrophic Sport Injury Research at the University of North Carolina. “Cheerleading used to be about shaking pompoms,” said the center’s director, Frederick O. Mueller. “Now, it’s about throwing people 20 feet in the air.”

Basketball is not exactly benign, either: It’s brutal on that most vulnerable part of the female athlete’s anatomy: the knees.

And even plain old running seems to be tougher on women’s legs than on men’s, though it’s not clear why.

This “absolutely does not mean that women should not play sports,” said Dr. Lyle Micheli , a consultant to the International Olympic Committee on Women’s Sports Issues and director of sports medicine at Children’s Hospital Boston. After all, in two of the most popular high school sports, soccer and basketball, no significant differences existed in injury rates between boys and girls, according to figures released by the federal Centers for Disease Control and Prevention for the 2005-2006 school year.

But athletic activities can cause different injuries in women and girls than in men and boys. Female athletes and their coaches should pay increased attention to the anatomical differences that put girls and women at disproportionate risks for certain injuries.

The sports injuries that seem to disproportionately affect women include:

  • Tears in the ACL, or anterior cruciate ligament, in the knee, a problem that hits basketball and soccer players especially.
  • Plantar fasciitis, in which activity can cause tiny tears in heel tissue.
  • Compartment syndrome in runners, in which lower leg muscles get too tight for the surrounding space, causing severe pain.
  • Shin splints in runners, in which repetitive stress can lead to pain and even fractures in the lower leg.
  • Kneecap pain.
  • Pain along the outside portion of the leg in the iliotibial band, between the knee and the hip, known as iliotibial band friction syndrome.

Women’s knees are more vulnerable than men’s because the “Q-angle” – the angle between the hip and the knee – is greater in women than in men. While wide hips are good for childbearing, they mean there is more stress on the knee in moves like landing from a jump and twisting. This torque can shred the ACL, a ligament that helps stabilize the knee. This is a major reason why female athletes have four times more ACL tears than men do, said Dr. George Theodore, a Red Sox team physician and sports medicine specialist at Massachusetts General Hospital.

Making matters worse for women’s knees, especially among basketball players, is that women tend to “cut,” or suddenly change direction, differently from men, said Micheli.

“There’s more of a tendency for women to change direction on just one foot, maybe because of the width of the pelvis, while men often use two feet.”

Wider hips also mean that there may be more “pull” on the kneecap, which can cause pain when running uphill. Kneecap cartilage also seems to wear down more in women than in men. And women’s kneecaps slide around more from side to side, in part because women have more estrogen, which can make women’s ligaments more flexible than men’s.

Fortunately, solutions exist for these problems. One is better coaching for females – to teach them how to run, jump, land, and twist safely. Another is orthotics, devices that can be put in shoes to minimize stress on knee, ankle, and hip joints. And, of course, everyone should use appropriate safety equipment, such as thicker mats for gymnasts, helmets for cyclists, and headgear in soccer, which obviously benefit men as well as women.

Strength training, or weight lifting, is an absolute must for female athletes, just as for males, though the emphasis may be on different muscle groups. To help prevent knee injuries, for instance, female athletes need to work extra hard to build up a muscle on the inside of the knee called the vastus medialis and to build up hamstring muscles on the back of the thigh.

“We can’t really change people’s anatomy, but we can rebalance muscles with proper stretching, strength training, and orthotics,” said Theodore of Mass. General.

It’s clear that physical differences are not a reason to keep women from sports or from playing just as hard as men, said Laura Pappano, coauthor with Eileen McDonagh of “Playing with the Boys: Why Separate is Not Equal in Sports.” Pappano said her daughter, now 13, was told that girls play nine-hole golf while boys play a full 18.

“The idea that women are doomed because of injuries is just absurd,” Pappano said. “The whole ‘girls will get hurt’ argument has done more to limit women than anything else.”

I couldn’t agree more. Regardless of your gender, get out there and play hard. But train hard, too. And be sure to get the excellent coaching you need to keep you safe.