Tuesday, September 29, 2009

Malocclusion: Disease of Civilization

In his epic work Nutrition and Physical Degeneration, Dr. Weston Price documented the abnormal dental development and susceptibility to tooth decay that accompanied the adoption of modern foods in a number of different cultures throughout the world. Although he quantified changes in cavity prevalence (sometimes finding increases as large as 1,000-fold), all we have are Price's anecdotes describing the crooked teeth, narrow arches and "dished" faces these cultures developed as they modernized.

Price published the first edition of his book in 1939. Fortunately,
Nutrition and Physical Degeneration wasn't the last word on the matter. Anthropologists and archaeologists have been extending Price's findings throughout the 20th century. My favorite is Dr. Robert S. Corruccini, currently a professor of anthropology at Southern Illinois University. He published a landmark paper in 1984 titled "An Epidemiologic Transition in Dental Occlusion in World Populations" that will be our starting point for a discussion of how diet and lifestyle factors affect the development of the teeth, skull and jaw (Am J. Orthod. 86(5):419)*.

First, some background. The word
occlusion refers to the manner in which the top and bottom sets of teeth come together, determined in part by the alignment between the upper jaw (maxilla) and lower jaw (mandible). There are three general categories:
  • Class I occlusion: considered "ideal". The bottom incisors (front teeth) fit just behind the top incisors.
  • Class II occlusion: "overbite." The bottom incisors are too far behind the top incisors. The mandible may appear small.
  • Class III occlusion: "underbite." The bottom incisors are beyond the top incisors. The mandible protrudes.
Malocclusion means the teeth do not come together in a way that's considered ideal. The term "class I malocclusion" is sometimes used to describe crowded incisors when the jaws are aligning properly.

Over the course of the next several posts, I'll give an overview of the extensive literature showing that hunter-gatherers past and present have excellent occlusion, subsistence agriculturalists generally have good occlusion, and the adoption of modern foodways directly causes the crooked teeth, narrow arches and/or crowded third molars (wisdom teeth) that affect the majority of people in industrialized nations. I believe this process also affects the development of the rest of the skull, including the face and sinuses.


In his 1984 paper, Dr. Corruccini reviewed data from a number of cultures whose occlusion has been studied in detail. Most of these cultures were observed by Dr. Corruccini personally. He compared two sets of cultures: those that adhere to a traditional style of life and those that have adopted industrial foodways. For several of the cultures he studied, he compared it to another that was genetically similar. For example, the older generation of Pima indians vs. the younger generation, and rural vs. urban Punjabis. He also included data from archaeological sites and nonhuman primates. Wild animals, including nonhuman primates, almost invariably show perfect occlusion.

The last graph in the paper is the most telling. He compiled all the occlusion data into a single number called the "treatment priority index" (TPI). This is a number that represents the overall need for orthodontic treatment. A TPI of 4 or greater indicates malocclusion (the cutoff point is subjective and depends somewhat on aesthetic considerations). Here's the graph: Every single urban/industrial culture has an average TPI of greater than 4, while all the non-industrial or less industrial cultures have an average TPI below 4. This means that in industrial cultures, the average person requires orthodontic treatment to achieve good occlusion, whereas most people in more traditionally-living cultures naturally have good occlusion.

The best occlusion was in the New Britain sample, a precontact Melanesian hunter-gatherer group studied from archaeological remains. The next best occlusion was in the Libben and Dickson groups, who were early Native American agriculturalists. The Pima represent the older generation of Native Americans that was raised on a somewhat traditional agricultural diet, vs. the younger generation raised on processed reservation foods. The Chinese samples are immigrants and their descendants in Liverpool. The Punjabis represent urban vs. rural youths in Northern India. The Kentucky samples represent a traditionally-living Appalachian community, older generation vs. processed food-eating offspring. The "early black" and "black youths" samples represent older and younger generations of African-Americans in the Cleveland and St. Louis area. The "white parents/youths" sample represents different generations of American Caucasians.


The point is clear: there's something about industrialization that causes malocclusion. It's not genetic; it's a result of changes in diet and/or lifestyle. A "disease of civilization". I use that phrase loosely, because malocclusion isn't really a disease, and some cultures that qualify as civilizations retain traditional foodways and relatively good teeth. Nevertheless, it's a time-honored phrase that encompasses the wide array of health problems that occur when humans stray too far from their ecological niche.
I'm going to let Dr. Corruccini wrap this post up for me:
I assert that these results serve to modify two widespread generalizations: that imperfect occlusion is not necessarily abnormal, and that prevalence of malocclusion is genetically controlled so that preventive therapy in the strict sense is not possible. Cross-cultural data dispel the notion that considerable occlusal variation [malocclusion] is inevitable or normal. Rather, it is an aberrancy of modern urbanized populations. Furthermore, the transition from predominantly good to predominantly bad occlusion repeatedly occurs within one or two generations' time in these (and other) populations, weakening arguments that explain high malocclusion prevalence genetically.

* This paper is worth reading if you get the chance. It should have been a seminal paper in the field of preventive orthodontics, which could have largely replaced conventional orthodontics by now. Dr. Corruccini is the clearest thinker on this subject I've encountered so far.

Monday, September 28, 2009

Diabetics on a Low-carbohydrate Diet, Part II

I just found another very interesting study performed in Japan by Dr. Hajime Haimoto and colleagues (free full text). They took severe diabetics with an HbA1c of 10.9% and put them on a low-carbohydrate diet:
The main principle of the CRD [carbohydrate-restricted diet] was to eliminate carbohydrate-rich food twice a day at breakfast and dinner, or eliminate it three times a day at breakfast, lunch and dinner... There were no other restrictions. Patients on the CRD were permitted to eat as much protein and fat as they wanted, including saturated fat.
What happened to their blood lipids after eating all that fat for 6 months, and increasing their saturated fat intake to that of the average American? LDL decreased and HDL increased, both statistically significant. Oops. But that's water under the bridge. What we really care about here is glucose control. The patients' HbA1c (glycated hemoglobin; a measure of average blood glucose over the past several weeks) declined from 10.9 to 7.4%.

Here's a graph showing the improvement in HbA1c. Each line represents one individual:

Every single patient improved, except the "dropout" who stopped following the diet advice after 3 months (the one line that shoots back up at 6 months). And now, an inspirational anecdote from the paper:
One female patient had an increased physical activity level during the study period in spite of our instructions. However, her increase in physical activity was no more than one hour of walking per day, four days a week. She had implemented an 11% carbohydrate diet without any antidiabetic drug, and her HbA1c level decreased from 14.4% at baseline to 6.1% after 3 months and had been maintained at 5.5% after 6 months.
That patient began with the highest HbA1c and ended with the lowest. Complete glucose control using only diet and exercise. It may not work for everyone, but it's effective in some cases. The study's conclusion:
...the 30%-carbohydrate diet over 6 months led to a remarkable reduction in HbA1c levels, even among outpatients with severe type 2 diabetes, without any insulin therapy, hospital care or increase in sulfonylureas. The effectiveness of the diet may be comparable to that of insulin therapy.

Diabetics on a Low-carbohydrate Diet
The Tokelau Island Migrant Study: Diabetes

Thursday, September 24, 2009

Another Fatty Liver Reversal, Part II

A month ago, I wrote about a reader "Steve" who reversed his fatty liver using a change in diet. Non-alcoholic fatty liver disease (NAFLD) is a truly disturbing modern epidemic, rare a few decades ago and now affecting roughly a quarter of the adult population of modern industrialized nations. Researchers cause NAFLD readily in rodents by feeding them industrial vegetable oils or large amounts of sugar.

Steve recently e-mailed me to update me on his condition. He also passed along his liver test results, which I've graphed below. ALT is a liver enzyme that enters the bloodstream following liver damage such as hepatitis or NAFLD. It's below 50 units/L in a healthy person*. AST is another liver enzyme that's below 35 units/L in a healthy person*.

Steve began his new diet in November of 2008 and saw a remarkable and sustained improvement in his ALT and AST levels:

Here's how Steve described his diet change to me:
I totally eliminated sugar, heavy starches, and grains. Started eating more whole, real foods, including things like grass-fed beef and pastured pork and eggs, began supplementing with good fats and omega-3 (pastured butter, coconut oil, cod liver oil). Ate more fruits and vegetables instead of refined carbs. Also completely gave up on the idea that I had to eat only "lean" meats. After my last results, the GI doc said that I wouldn't need the biopsy at all, that things were great, and that if I kept it up I "would live forever."
He did experience some side effects from this diet though:
My triglycerides also went from pre-diet measures of 201 and 147 to post diet 86, 81, and 71.

The added bonus, of course, was that my weight went from 205 pounds to 162 pounds and my body fat percentage from 24% to 12% in the matter of five months--all without the typically excessive cardio I used to try unsuccessfully for weight loss.
The liver is the body's "metabolic grand central station". It's essential for nutrient homeostasis, insulin sensitivity, detoxification, and hormone conversion, among other things. What's bad for the liver is bad for the rest of the body as well. Don't poison your liver with sugar and industrial vegetable oils.


* The cutoff depends on who you ask, but these numbers are commonly used.

How to Fatten Your Liver
Excess Omega-6 Fat Damages Infants' Livers
Health is Multi-Factorial
Fatty Liver Reversal
Another Fatty Liver Reversal

Organic, Jersey Fresh Apples!!!

This past Saturday 3 Healthy Chicks headed to Princeton for the Global Mala for Peace. After doing 108 Sun Salutations in Palmer Square we drove to Terhune Orchard's Apple Day! Terhune Orchards is located on Cold Soil Road just outside of Princeton. One of the more fabulous things about Terhune (and there are many to list!!!) is that it has recently been awarded Organic Certification by the New Jersey Department of Agriculture for 8 acres!

Portions of the farm and orchards that are not designated as organic are maintained in a sustainable manner, according to the rules of crop rotation. This means regularly changing the variety of plantings in each field, guards against nutrient depletion and reduces the use of fertilizers and pesticides. Growing in a sustainable manner and implementing crop rotations helps to ensure that the produce grown has the best flavor, color, and size. Organic Certification is not an easy designation to achieve, so congratulations Terhune!

Apple Day at Terhune was fabulous! The farm was bustling with fresh fruits, vegetables and home made goods. Before we headed into the pick your own area of the farm, we enjoyed a fresh apple cider slushy. This is how slushies should be made! No additives, no preservatives, just freshly pressed apple cider and ice! They were refreshing and thirst quenching!

The pick your own apples (Empire, Delicious and Stayman Winesap) were a vibrant red and practically falling off the branch into your hands! Children were running in sugared bliss, sticky faces with caramel and candy apples in hand. There was a corn stalk maze, tractor rides and even live music by the Daisy Jug Band! The smell of apples hung thick in the air. Is there really anything better than picking fresh, juicy apples on an warm September day?? If there is, please let us know so we can put it on our next weekend agenda!

Fun aside, there is a lot more to apples than enjoying a social day in the sun. Apples are one of those amazing fruits given to us by Mother Nature that not only tastes as sweet as candy, but it's good for us as well. We've all heard the saying "an apple a day keeps the doctor away" but did anyone ever stop to ask why? What are the health benefits of apples?

Since 3 Healthy Chicks left Terhune Orchards with no less than 4 bags of apples, of course we took the time to find out why exactly we should be eating an apple a day to keep the doctor away. Here's what we learned: Apples are high in fiber, vitamins and minerals. Fresh apples contain quercetin, which are great for protecting your brain from free radicals and pectin which assists in lowering bad cholesterol. Additional health benefits of apples include: prevents diarrhea and constipation, reduces risk of cancer, reverses appendicitis, fights depression, slows aging, protects the heart, lowers cholesterol and prevents Alzheimer's! That's a lot of benefits!!

It seems like the apple a day theory just may hold some credence. I am on to McIntosh number 2 right now.


Keep it Fresh!
3HC

Preliminary accreditation results outstanding!

By: Rik Ganderton
President and CEO RVHS
To: All staff, physicians and volunteers of RVHS


Congratulations and a big thank you!

Thank you to all staff, physicians and volunteers! The work you do everyday at Rouge Valley lives up to our vision to be the best at what we do. I want to thank everyone involved in the Accreditation Canada survey that was completed Wednesday. The preliminary report presented yesterday to staff, physicians and volunteers, by the surveyors, was extremely positive and one that we should take great pride in. I want to thank you not only for the tremendous efforts by all related to the rigorous accreditation process, but also for the patient-focused work and improvements you have all actively driven forward at Rouge Valley Health System. The Accreditation Canada surveyors noticed. More importantly, our patients are noticing.

The surveyors’ report shined an external light on the progress and top-notch work you all perform.

We will get official notification of formal accreditation status in 10 days time. Overall, we believe our results are outstanding and we should all be extremely proud of the accomplishments we have made as a team.

There are several opportunities for improvement, which we welcome and will act upon. What makes even the opportunities for improvement so telling about the quality of work you all do, is that you are already addressing most of the issues. In fact, many of you, actually identified the opportunities for the surveyors.

We were commended for many activities and processes.
· Of the 1,700 Quality Criteria/Dimensions applicable to RVHS we met 1,636 or 96.5% - this is fantastic!
· One of our approaches to patient safety, our Passport to Safety, has been identified and will be recommended to Accreditation Canada as a leading practice and national benchmark. Our three senior management team members, who have experience as accreditation surveyors, tell me they have rarely seen organizations where this has happened before. While the report is not approved yet, even a recommendation like this is outstanding!
· Strategic Plan-on-a-Page and everyone’s, including external stakeholders, knowledge of and active implementation of it was cited in the report.
· The Personal Business Commitments process stood out for the surveyors.
· Our use of Lean in our ongoing transformation of patient care quality improvement and hospital services.
· Our Quality and Risk Framework and our commitment to quality, plus staff and patient safety were highlighted as strength.
· Our communications processes and community relationships were also listed as strengths.
· Financial controls and our balanced budget plan impressed the surveyors.
· Pandemic planning and code policies and procedures were also strengths.
· Patient focus in ambulatory care was noted as was our focus on patient flow in emergency.
· Our attention to emerging health needs in paediatrics was noted as a strength.
· Improved turnaround time for reports in diagnostic imaging was cited.

I could go on and on, so please read the presentation by the surveyors themselves.

The presentation is posted on our intranet as a PDF, accessible internally for staff, physicians and volunteers, only.

This significant external validation of your work says more than anything about your daily commitment to our patients, to our hospital, to our community and to our team.

Be proud Rouge Valley. You’ve earned it.

Freshen Up Your Life: Getting Clear About Your Intentions

Sometimes during a change of season you can start to feel stagnant or discouraged. As summer winds down you may begin feel like you're spinning your wheels but not moving forward. At these times in your life you need to remember to slow down and look from a different vantage point. The energy of the seasons are changing and so should your perspective. Gaining perspective from a different view enables you to get clear about your intentions and goals.

If you don't know if you need a different perspective, ask yourself the following questions:

~ Do I know what my goals and intentions are?
~ Have I started working on these goals?
~ Am I satisfied with my progress?
~ Am I moving the right direction?
~ Have I achieved something that I am satisfied with?

If you answered no to any of the above questions, it's time to put everything in perspective and more forward with competence, flair and confidence. Get fresh about your life!! When you feel frustrated and stagnant 3 Healthy Chicks want to remind you of a few things:

~ You are unique, fresh and exciting!
~ Breathe and take things in stride, one step at a time!
~ Small changes are lasting changes!
~ Visualize and be clear about your intentions, see your end goal as your reality and work towards it with confidence!
~ Fuel your body with positive energy and fresh wholesome foods!
~ Take time to yourself.
~ Know that you can achieve anything!
~ What you believe, you receive!

The most important thing to remember is this: To be ready at any moment to give up what you are for what you might become. ~ W.E.B. Du Bois

Tuesday, September 22, 2009

Thank you and stay the course!

A joint Blog by RVHS Board Chair Janet Ecker and President/CEO Rik Ganderton
- To all staff, physicians, volunteers of RVHS


Progress.

If we had to pick one word that describes what has been achieved by the Rouge Valley team, then that would be the word.

Making progress is no small feat in the constantly challenging healthcare environment.
Thank you for your commitment to driving progress at our community hospital. It has been, is and will continue to be, a team effort.

As we move through the period of leadership transition, the Board wants our staff, physicians and volunteers to know that we fully support continuing on the road of transformation, accountability and quality focus that we have started on.
President and CEO Rik Ganderton and Chief of Staff Naresh Mohan are completing their terms in their respective positions. Both are staying on until the searches for their replacements are complete.

The RVHS Board of Directors wants everyone to know that it is totally committed to the transformative direction that you as staff, physicians and volunteers have been implementing with such success. The board is looking for new leaders to build on those successes; leaders who will continue our focus on quality, constant improvement and accountability.

Thank you for earning our achievements through your active participation in transformation initiatives and teamwork.
As you know, we have made progress on the key measures aligned with our Strategic Plan – www.rougevalley.ca/strat_plan.pdf.

• The designation this year by the Central East Local Health Integration Network (CE LHIN) of Rouge Valley Cardiology as the regional centre for the 401 corridor was an important recognition and reaffirmation for us. The designation set out in the Hospital Clinical Services Plan also supports our Strategic Plan, which selected cardiac care as one of our centres of excellence.

• Quality patient care is another area of progress, as evidenced by our published quality indicators. Continued focus by our staff and physicians is demonstrating success – www.rougevalley.ca/indicators.

• We are living within our means, as mandated by the province. We had an excellent first fiscal year of our three-year Deficit Elimination Plan. We maintained service volumes and improved quality while generating a small surplus. Although we are hitting some challenges in the first quarter results of this, the second fiscal year, we know we can succeed by applying greater focus on funded health services, as highlighted in our Town Halls in September.
We need to continue to improve our quality of care and our financial position by improving our management of volumes and case mix, by eliminating conservable days, following the new standardized clinical pathways and eliminating waste through the aggressive use of Lean principles. By doing this we can:
-Generate sufficient surpluses to enhance our core services, as we identified in our Strategic Plan;
-Cover unfunded inflation costs;
-Address capital needs; and
-Pay down our working capital deficit and long-term debt.
All of this will help us sustain and improve the healthcare we provide to our patients.

• Transformation of processes for delivering services to patients has been a success, as evidenced by:
-Improved patient flow and discharge planning for our patients at both campuses;
-Faster turn around time for lab test results for our patients at both campuses;
-Improved emergency department discharges at Rouge Valley Centenary, where 83.3 per cent of ambulatory patients are now discharged in less than three hours (among the lowest of discharge times in Toronto).

• Commitment to our vision to be the best at what we do, evidenced throughout Rouge Valley Health System in the improving care provided everyday. This commitment also comes through in the Personal Business Commitments starting with the CEO’s Personal Business Commitments, aligned throughout senior management. (www.rougevalley.ca/business_committments_rganderton_09_10.pdf/)

• Leadership. Rouge Valley Health System is increasingly seen as a leader in quality, accountability, and in our application of Lean as part of our ongoing transformation journey.

We really can’t stress enough that these successes, and many others, are the direct result of your daily attention to providing the best healthcare experience for our patients and their families.

So as we face funding challenges in the near future, and work to get patients home sooner (reducing conservable days) we ask you all to focus your plans and daily efforts for our hospital and our patients.

Thank you and stay the course!

Monday, September 21, 2009

Skills survey for pandemic planning

President's Blog by Rik Ganderton

We have developed a Pandemic Inventory of Skills Survey to aid in the roll out of our pandemic plan. This survey will allow us to capture employees’ skills sets and list how they can benefit the hospital during a pandemic.

We would use this information to optimize our available human resources and ensure patient-centered care. With the urgency surrounding preparation for the fall and a resurgence of H1N1, it is imperative that all full-time and part-time employees complete this survey. The survey is available from today (Sept. 21) to Oct. 5, 2009, which is when all surveys must be complete.

Here’s the link to the survey (for staff and physicians only).

If you do not have an Outlook email address at RVHS, please fill out the intranet form, print it, then give it to your manager/supervisor/delegate. I ask all managers and directors to ensure the surveys are completed by all staff.

I thank you for your support as Rouge Valley takes this proactive and measured approach to pandemic planning. Thanks, as always, for supporting the Rouge Valley team.”

** For more information on H1N1, please visit our website H1N1 section.

Wednesday, September 16, 2009

Diabetics on a Low-carbohydrate Diet

Diabetes is a disorder of glucose intolerance. What happens when a diabetic eats a low-carbohydrate diet? Here's a graph of blood glucose over a 24 hour period, in type II diabetics on their usual diet (blue and grey triangles), and after 5 weeks on a 55% carbohydrate (yellow circles) or 20% carbohydrate (blue circles) diet:


The study in question describes these volunteers as having "mild, untreated diabetes." If 270 mg/dL of blood glucose is mild diabetes, I'd hate to see severe diabetes! In any case, the low-carbohydrate, high-fat diet brought blood glucose down to an acceptable level without requiring medication.

It's interesting to note in the graph above that fasting blood glucose (18-24 hours) also fell dramatically. This probably reflects improved insulin sensitivity in the liver. The liver pumps glucose into the bloodstream when it's necessary, and insulin suppresses this. When the liver is insulin resistant, it doesn't respond to the normal signal that there's already sufficient glucose, so it releases more and increases fasting blood glucose. When other tissues are insulin resistant, they don't take up the extra glucose, also contributing to the problem.

Glycated hemoglobin (HbA1c), a measure of average blood glucose concentration over the preceding few weeks, also reflected a profound improvement in blood glucose levels in the low-carbohydrate group:

At 5 weeks, the low-carbohydrate group was still improving and headed toward normal HbA1c, while the high-carbohydrate group remained at a dangerously high level. Total cholesterol, LDL and HDL remained unchanged in both groups, while triglycerides fell dramatically in the low-carbohydrate group.

When glucose is poison, it's better to eat fat.

Graph #1 was reproduced from Volek et al. (2005), which re-plotted data from Gannon et al. (2004). Graph #2 was drawn directly from Gannon et al.

Welcome to Fall!!!

The transition from summer to fall has been pretty amazing on the Jersey Shore. September has graced us with warm sunny days and cool nights without frost. One of the many reasons I love September! September 21 marked the Fall Equinox....summer gracefully bows out and fall ushers in. The fall equinox celebrates the end of summer and the beginning of the harvest season. Just because the youthful days of summer have past, doesn’t mean the growing season has drawn to a close.

On the contrary, fall is the bountiful harvest! All the Jersey Fresh farm stands and farmers market should still be bustling with life and produce well into October. You can find apples, corn, eggplant, grapes, lettuce, okra, onions, squash and tomatoes through September. Cauliflower, cranberries, peppers, pumpkins, lima beans beets, broccoli, cabbage and collards through October!

Since the fall harvest is so bountiful, its a great idea to buy fresh produce from the farmers market in bulk. Don't worry we're not going to let you waste your beautiful Jersey Fresh produce! Most fresh vegetables can be easily frozen. Simply wash them, separate them into useable quantities, pop in zip lock bags and send them to the deep freeze! You'll be eating cranberries, beets and greens well into February! If you don’t have room in your freezer, or freezing isn't for you, canning is the way to go.

Now don't be afraid of a word like canning. It's not that hard and you don't have to have grey hair to try it out. There are variations in canning methods depending on what food you are canning but you can find everything you need to know at CanningUSA.com. Fruits and vegetables can be canned alone, as jellies, in syrups, in vinegars (pickling!) and don't forget soups and sauces!

I personally love to eat home made, hearty soups and stews throughout the fall and winter. One of my favorites is a Winter Squash Stew. You can easily double or triple this recipe when all the beautiful butternut, acorn and pumpkin squashes are in season. Any soup left-over can be frozen or canned!!

Winter Squash Stew
Prep Time: 5 minutes
Cooking Time: 15 minutes
Yields: 4 servings

Ingredients:
1 tablespoon olive oil1 onion, finely minced2 cloves of garlic, finely minced1 winter squash, seeded, peeled, chopped (butternut, acorn, pumpkin, delcata) Veggie or chicken stock, 2 teaspoons curry powder, 1 ½ teaspoons cumin.

Directions:
Sauté onions and garlic in olive oil until onions become translucent. In a pot place squash and fill with stock until just covered. Add curry powder, cumin, onion and garlic. Boil until squash becomes tender and remove pot from heat. Purée the squash until smooth in a blender, you can set aside some of the squash if you like a chunky soup or blend it all for a smooth soup. Add chopped fresh cilantro or parsley and/or toasted pumpkin seeds for garnish.

This stew also travels really well! Heat it up and pour it into your thermos and take a hike or go for a walk on the beach. When you're ready to take a break, you'll have sweet and delicious soup to warm your insides from the fall wind!

Monday, September 14, 2009

Yoga For Health Series

Please join Lauren Forney, Terra Pfund and Jill Rizzi of 3 Healthy Chicks at The Yoga Studio in Fair Haven, NJ for a three part Yoga For Health Series. All workshops will explore breathing and yoga techniques for specific health concerns that coincide with the change of the weather and the stress of the holiday season.

Yoga For Energy
Sunday, October 4, 2009
4:00 - 6:00 pm

Yoga For Digestion
Sunday, November 1, 2009
4:00 - 6:00 pm

Yoga For Stress Relief
Sunday, December 6, 2009
4:00 - 6:00 pm

Each class is $45 and will include giveaways. Register for all three classes for $120. For more information please contact 3healthychicks@gmail.com If you are unable to attend but know someone who may be interested, please feel free to forward the information and contact email.

Om Shanti Shanti Shanti!


Saturday, September 12, 2009

Paleolithic Diet Clinical Trials Part IV

Dr. Staffan Lindeberg has published a new study using the "paleolithic diet" to treat type II diabetics (free full text). Type II diabetes, formerly known as late-onset diabetes until it began appearing in children, is typically thought to develop as a result of insulin resistance (a lowered tissue response to the glucose-clearing function of insulin). This is often followed by a decrease in insulin secretion due to degeneration of the insulin-secreting pancreatic beta cells.

After Dr. Lindeberg's wild success treating patients with type II diabetes or glucose intolerance, in which he normalized the glucose tolerance of all 14 of his volunteers in 12 weeks, he set out to replicate the experiment. This time, he began with 13 men and women who had been diagnosed with type II diabetes for an average of 9 years.

Patients were put on two different diets for 3 months each. The first was a "conventional diabetes diet". I read a previous draft of the paper in which I believe they stated it was based on American Diabetes Association guidelines, but I can't find that statement in the final draft. In any case, here are the guidelines from the methods section:
The information on the Diabetes diet stated that it should aim at evenly distributed meals with increased intake of vegetables, root vegetables, dietary fiber, whole-grain bread and other whole-grain cereal products, fruits and berries, and decreased intake of total fat with more unsaturated fat. The majority of dietary energy should come from carbohydrates from foods naturally rich in carbohydrate and dietary fiber. The concepts of glycemic index and varied meals through meal planning by the Plate Model were explained [18]. Salt intake was recommended to be kept below 6 g per day.
The investigators gave the paleolithic group the following advice:
The information on the Paleolithic diet stated that it should be based on lean meat, fish, fruit, leafy and cruciferous vegetables, root vegetables, eggs and nuts, while excluding dairy products, cereal grains, beans, refined fats, sugar, candy, soft drinks, beer and extra addition of salt. The following items were recommended in limited amounts for the Paleolithic diet: eggs (≤2 per day), nuts (preferentially walnuts), dried fruit, potatoes (≤1 medium-sized per day), rapeseed or olive oil (≤1 tablespoon per day), wine (≤1 glass per day). The intake of other foods was not restricted and no advice was given with regard to proportions of food categories (e.g. animal versus plant foods). The evolutionary rationale for a Paleolithic diet and potential benefits were explained.
Neither diet was restricted in calories. After comparing the effects of the two diets for 3 months, the investigators concluded that the paleolithic diet:
  • Reduced HbA1c more than the diabetes diet (a measure of average blood glucose)
  • Reduced weight, BMI and waist circumference more than the diabetes diet
  • Lowered blood pressure more than the diabetes diet
  • Reduced triglycerides more than the diabetes diet
  • Increased HDL more than the diabetes diet
However, the paleolithic diet was not a cure-all. At the end of the trial, 8 out of 13 patents still had diabetic blood glucose after an oral glucose tolerance test (OGTT). This is compared to 9 out of 13 for the diabetes diet. Still, 5 out of 13 with "normal" OGTT after the paleolithic diet isn't bad. The paleolithic diet also significantly reduced insulin resistance and increased glucose tolerance, although it didn't do so more than the diabetes diet.

As has been reported in other studies, paleolithic dieters ate fewer total calories than the comparison group. This is part of the reason why I believe that something in the modern diet causes hyperphagia, or excessive eating. According to the paleolithic diet studies, this food or combination of foods is neolithic, and probably resides in grains, refined sugar and/or dairy. I have my money on wheat and sugar, with a probable long-term contribution from industrial vegetable oils as well.

Were the improvements on the paleolithic diet simply due to calorie restriction? Maybe, but keep in mind that neither group was told to restrict its caloric intake. The reduction in caloric intake occurred naturally, despite the participants presumably eating to fullness. I suspect that the paleolithic diet reset the dieters' body fat set-point, after which fat began pouring out of their fat tissue. They were supplementing their diets with body fat-- 13 pounds (6 kg) of it over 3 months.

The other notable difference between the two diets, besides food types, was carbohydrate intake. The diabetes diet group ate 56% more carbohydrate than the paleo diet group, with 42% of their calories coming from it. The paleolithic group ate 32% carbohydrate. Could this have been the reason for the better outcome of the paleolithic group? I'd be surprised if it wasn't a factor. Advising a diabetic to eat a high-carbohydrate diet is like asking someone who's allergic to bee stings to fetch you some honey from your bee hive. Diabetes is a disorder of glucose intolerance. Starch is a glucose polymer.

Although to be fair, participants on the diabetes diet did improve in a number of ways. There's something to be said for eating whole foods.

This trial was actually a bit of a disappointment for me. I was hoping for a slam dunk, similar to Lindeberg's previous study that "cured" all 14 patients of glucose intolerance in 3 months. In the current study, the paleolithic diet left 8 out of 13 patients diabetic after 3 months. What was the difference? For one thing, the patients in this study had well-established diabetes with an average duration of 9 years. As Jenny Ruhl explains in her book Blood Sugar 101, type II diabetes often progresses to beta cell loss, after which the pancreas can no longer secrete an adequate amount of insulin.

This may be the critical finding of Dr. Lindeberg's two studies: type II diabetes can be prevented when it's caught at an early stage, such as pre-diabetes, whereas prolonged diabetes may cause damage that cannot be completely reversed though diet. I think this is consistent with the experience of many diabetics who have seen an improvement but not a cure from changes in diet. Please add any relevant experiences to the comments.

Collectively, the evidence from clinical trials on the "paleolithic diet" indicate that it's a very effective treatment for modern metabolic dysfunction, including excess body fat, insulin resistance and glucose intolerance. Another way of saying this is that the modern industrial diet causes metabolic dysfunction.

Paleolithic Diet Clinical Trials
Paleolithic Diet Clinical Trials Part II
One Last Thought
Paleolithic Diet Clinical Trials Part III

Monday, September 7, 2009

Animal Models of Atherosclerosis: Diet-Induced Atherosclerosis

LDL likely plays a role in causing atherosclerosis, with the majority of the damage coming from the oxidized form of LDL. There are at least two ways to increase the concentration of oxidized LDL (oxLDL) in the blood: 1) increase the total concentration of LDL while keeping the proportion of oxLDL the same; 2) increase the proportion of oxLDL. Dietary fats differ in their effects on these two factors, and the net outcome is also dependent on the species eating the fat and the overall dietary context.

The omega-6 polyunsaturated fat, linoleic acid (LA; found abundantly in industrial vegetable oils), may be
a factor in the susceptibility of LDL to oxidation. LDL is rich in LA regardless of diet, yet the amount of LA in LDL still depends on diet to a certain degree. Thus, on the surface, one would expect a diet high in industrial vegetable oil to promote atherosclerosis. Unfortunately, it's not that simple, because LA also lowers the amount of LDL in the blood of a number of species, including humans.

The amount of atherosclerosis produced by feeding different fats depends both on how much LDL oxidation occurs and on how the fat affects the organism's blood lipid profile.
For example, if corn oil lowers LDL by 3-fold relative to lard in a rabbit model, yet increases the proportion of oxLDL by 50%, the rabbit will probably develop more atherosclerosis eating lard than eating corn oil. This is because the total concentration of oxLDL is still higher in the lard group. On the other hand, if corn oil doesn't reduce LDL at all relative to lard in a rhesus monkey, yet the proportion of oxLDL increases by 50%, the corn oil group will probably develop more atherosclerosis, all else being equal.

Then there are other factors that influence atherosclerosis independently of oxLDL, such as the fat-soluble antioxidants, micronutrients and omega-6:3 ratio of the diets. It's also important to keep in mind that atherosclerosis is only one factor that influences the risk of having a heart attack.


In the last post, I argued that feeding excessive cholesterol to herbivorous or nearly herbivorous animals elevates plasma LDL greatly. In many species, saturated fat exacerbates the increase in LDL due to dietary cholesterol overload. However, in the absence of added cholesterol, several commonly used models of atherosclerosis do not show an increase in LDL upon saturated fat feeding. This is similar to the situation in humans.

Rabbits are one of the most commonly used models of diet-induced atherosclerosis. They are very sensitive to dietary cholesterol, due to the fact that their natural adult diet contains virtually none.

I recently found a great study from 1967 titled "Relative Failure of Saturated Fat in the Diet to Produce Atherosclerosis in the Rabbit" (
free full text). Investigators fed rabbits cocoa butter, coconut oil and Crisco (hydrogenated cottonseed oil) at 45% of calories. They found that neither cocoa butter nor Crisco increased the rabbits' cholesterol (they didn't measure LDL directly but it typically increases in proportion to total cholesterol in rabbits), while coconut oil caused a transient increase that disappeared by 6 months on the diet. Cocoa butter caused slight atherosclerosis in some of the animals while none was detected in the coconut oil or Crisco groups.

Next, the investigators fed the rabbits cholesterol along with the fats. 0.25% cholesterol with corn oil or Crisco caused a massive (10-fold) increase in blood cholesterol, and produced atherosclerosis. They didn't pair the saturated fats with cholesterol, but the point is still clear: feeding dietary cholesterol, not saturated fat, to an herbivorous species, is the culprit.


However, subsequent studies in rabbits have shown that saturated fats can produce atherosclerosis without added cholesterol. How can this be? It turns out that it only works in the context of a highly refined "synthetic" or "semi-synthetic" diet (
ref). So the dietary context plays an important role as well.

The ability of saturated fat to produce atherosclerosis in animal models requires it to cause a large enough increase in serum LDL that it overwhelms saturated fat's natural tendency to reduce LDL oxidation (relative to LA). This process is typically helped along by feeding huge amounts of cholesterol. In the absence of a large increase in LDL, atherosclerosis does not result, all else being equal.


Several studies in primates support this concept.
van Jaarsveld and colleagues showed that feeding vervet monkeys 28% of calories from palm oil (SFA-MUFA), sunflower oil (PUFA) or lard (MUFA-SFA) resulted in similar LDL concentrations in the three groups. After more than two years, the palm oil group had the least atherosclerosis and the sunflower oil and lard groups were similar. It's notable that palm oil was the most saturated fat used in this study.

In another telling study by Mott and colleagues, baboons were fed diets containing 40% of calories from a predominantly saturated fat or a predominantly polyunsaturated fat. Each group was further subdivided into two groups: one receiving a small amount of cholesterol in the feed, and one receiving a large amount. Cholesterol feeding increased LDL and atherosclerosis, while the type of fat had a modest effect on LDL and no effect on atherosclerosis both at high and low cholesterol levels. I've noticed that baboons seem to throw a wrench in the gears of the mainstream conception of blood lipid metabolism.

Rudel and colleagues fed african green monkeys and cynomolgus monkeys lard (MUFA-SFA) or safflower oil (PUFA) for 40% of calories, with or without added cholesterol. Without cholesterol, both LDL and the degree of atherosclerosis were low in both monkeys fed both types of fat. Cholesterol feeding raised LDL in both species by 2-3 fold, and caused significant atherosclerosis. Atherosclerosis was more severe in monkeys fed lard plus cholesterol than in monkeys fed safflower oil plus cholesterol, correlating with their considerably higher LDL.

In sum, the ability of a fat to contribute to atherosclerosis depends in part on its ability to increase oxLDL. One way to do this is to massively raise LDL. This can be accomplished by combining dietary cholesterol overload with saturated fat in certain susceptible species.
Saturated fat, in the context of a somewhat normal diet, does not appear to raise LDL very much if at all in most species, in the long term. This includes humans.

A
nimal models of diet-induced atherosclerosis are useful for studying the disease, but they do not support the conclusion that humans should avoid foods containing natural amounts of cholesterol and saturated fat. "Saturated fats" such as lard, palm oil, beef tallow and coconut oil probably have little or no connection to atherosclerosis in humans, or in most species eating a somewhat natural diet.

Lauren's Mango Salsa

I am a freak for Mexican in the summer months, I am not sure why. Maybe its the fresh cilantro that I find so totally refreshing, but either way, I love it and could eat it everyday during the summer. I also love fresh fruit in the summer, so I have been experimenting with making mango salsa, and I wanted to share my recipe with you!


I was never really into mangoes until my trip to India this past Spring. Their mangoes were absolutely divine (literally!), so now each time I have one it takes me back to my time in India.



:) Enjoy!



Ingredients:
1 ripe mango
1/2 small red onion
1/2 cup fresh cilantro
1/2 lime
1 jalapeno chili (optional, I particularly don't need the spicy kick!)
1/2 cup pineapple
Dash of sea salt



Directions:



Peel, pit and cut mango into 1/4-inch pieces. (For directions on how to cut a mango, click here) Place mango in blender and blend gently, until the mangoes have a salsa-like consistency. (If you want a chunkier salsa, like the one pictured above, skip the blender step!) Cut pineapple into small chunks. Chop onion, pepper, and fresh cilantro. Mix all ingredients well, adjust seasoning to your liking. Chill to marinate and marry flavors.



Benefits of Mangoes



Mangoes contain powerful antioxidants, are loaded with iron and are low in carbohydrates. Mangoes are effective in relieving clogged pores of the skin. They are also valuable to combat acidity and poor digestion. Mangoes are a rich source of vitamin A (beta-carotene), vitamin E, and selenium which help to protect against heart disease and other ailments.

Sunday, September 6, 2009

Pests Aside

Labor Day is here and summer is drawing to a close, which usually means that we are outside soaking up what is left of the warm weather. Unfortunately, being able to enjoy the outdoor BBQs, picnics and beach parties inevitably means one thing... pesky mosquitoes! We may be fortunate enough to not have to worry too much about contracting Malaria or Yellow Fever in the states, but between the chemicals found in candles, bug sprays and topical ointments to treat the itch, mosquito bites can be as hazardous to our health as they are irritating! Insect repellents come in many different forms: candles, lotions, wipes, sprays to name a few. Almost all varieties of these contain one or more unnatural chemicals such as DEET, Picaridin, IR3535 or p-Mentane-3,8-diol. You don't have to know what these are (or be able to pronounce them) to know that you probably don't want to inhale or ingest them. And absorbing them into your bloodstream through your skin is not exactly any safer. The EPA (the Environmental Protection Agency) may deem these chemicals safe in low doses, but did you know that they classify most of them as pesticides? Pesticides by definition are meant to repel pests, but those found in products today are often chemically synthesized versions of repellents that are found in nature. Exposing our bodies to the toxicity of these chemical pesticides, even in small doses, can prove detrimental to our health and to our environment over time.

The good news is that there are alternatives! A non-chemical based insect repellent may be difficult to find, but can be worth searching for. Studies have shown that natural pesticides, such as
Lemon Eucalyptus oil can be just as effective in warding off
mosquitoes and other bugs as their chemical counterparts. There aren't many natural bug sprays out there, but there are a few. 3 Healthy Chick's favorite is Kiss My Face SwyFlotter Tick & Insect Repellent With Lemon Eucalyptus, which can be found in Whole Foods stores. Cutter also makes a natural version of their bug spray that is made with Lemon Eucalyptus as well, and can be found in many large chain stores, such as Wal-Mart.

Often we fail to prepare ahead of time and before we know it we are covered in itchy, swollen, red bites. This can be quite uncomfortable and can force you to reach for the hydrocortisone cream for relief. These treatments contain strong chemical steroids that are also absorbed into the bloodstream through the skin, especially in sensitve areas where skin is thinner, and can supress the immune system and effect the body's hormones. Children are especially susceptible to harmful chemicals found in products today while their bodies and immune systems are still developing. Fortunately, there are much more natural remedies that we can turn to for relief, many of which can already be found in our
kitchen! Avoid scratching those bites, which can lead to infection, and try one of these natural anesthetic or anti-inflammatory remedies instead:

1. Pure
lavender and tea tree oils. Apply directly to the bite with a cotton ball or swab.

2.
Tomato. Tomatoes contain lycopene which is a natural anti-inflammatory. Cut one open and apply directly to the bite.

3. Rub the bite with an all natural
soap.

4.
Onion. Onions have natural anti-inflammatory and anti-bacterial properties. Slice an onion and rub it on the bite while it is still fresh.

5. Mix either
salt or baking soda with water and apply to the bite to relieve itching and swelling.

6.
Banana. Rub the inside of a banana peel directly on the bite to relieve the itch.

7.
Lemon. Cut a lemon in half and rub the pulpy side against the bite to fight infection. (Do not try this on open wounds!)

8.
Apple cider vinegar. Rub directly on the skin with a cotton ball or add to a warm bath to relieve itching.

9.
Oatmeal. Add 1 to 2 cups finely ground, uncooked oatmeal to a warm bath
to relieve itching.

10. Herbs.
Mint contains menthol, which is a natural anesthetic and anti-inflammatory. Basil and cloves contain eugenol, a natural anesthetic.Thyme, which contains thymol, is an anesthetic and anti-inflammatory as well. Crush herbs and apply directly to the skin, or place in boiling water to make a tea and apply a clean cloth soaked in the tea to the bite.

Natural protection and remedies for bites from mosquitos and other pests can let you sit back, relax and enjoy these last few days of summer without worrying about the effects of harmful chemicals on our bodies, our children's bodies or our planet! Many of these remedies can also be found at any farmer's market, so you can stock up, be prepared, and support your local farms all at the same time!

Thursday, September 3, 2009

Animal Models of Atherosclerosis: LDL

Researchers have developed a number of animal models of atherosclerosis (fatty/fibrous lesions in the arteries that influence heart attack risk) to study the factors that affect its development. In the next two posts, I will argue that these models rely on a massive increase in LDL, up to 10-fold, due to overloading the cholesterol metabolism of herbivorous species with excessive dietary cholesterol. This also greatly increases oxidized LDL, leading to atherosclerosis. I will discuss the role of saturated fat, which often receives the blame, in this process.

A reader recently sent me a reference to an interesting paper titled "Dietary Fat Saturation Effects on Low-density-lipoprotein Concentrations and Metabolism in Various Animal Models". It's a review of animal studies that have looked at the effect of different fats on LDL concentration as of 1997. They nail their colors to the mast in the first sentence of the abstract:
Saturated vegetable oils (coconut, palm, and palm kernel oil) and fats (butter and lard) are hypercholesterolemic [raise cholesterol] relative to monounsaturated and polyunsaturated vegetable oils.
But don't let this fool you; the actual data they present are much more interesting. First of all, they expressly exclude studies on models that have an "abnormal degree of response to a hypercholesterolemic diet". In other words, they attempt to create a self-fulfilling prophecy by excluding models that don't support their hypothesis. Even after stacking the deck, the data they present still fail to support their position.

When an investigator wants to study diet-induced atherosclerosis, first he selects a species that's susceptible to it. These are generally herbivorous or nearly herbivorous species such as rabbits, guinea pigs, hamsters, and several species of monkey. Then, he feeds it an "atherogenic diet". This is typically a combination of 0.1 to 1% cholesterol by weight, plus 20-40% of calories as fat. The fat can come from a variety of sources, but animal fats or saturated vegetable fats are typical. The remainder of the diet is processed grains, vitamin and mineral supplements, and often casein for protein.

Let's put that amount of cholesterol into human context. Assuming the average person eats about 2 pounds dry weight of food per day, 0.5% cholesterol would be 4.5 grams. That's the equivalent of:
  • 17.5 pounds of beef steak, or
  • 3.8 pounds of beef liver, or
  • 22.5 eggs
Per day. Now feed that to an herbivore that's not adapted to clearing cholesterol. You can imagine it doesn't do their blood lipids any favors. For example, in one study, compared to a low-fat, low-cholesterol "control diet", a diet of 20% hydrogenated coconut oil plus 0.12% cholesterol caused hamsters' LDL to increase by more than 7-fold. A polyunsaturated fat (PUFA) rich diet caused LDL to increase less. This study is typical, and the interpretation is typical as well: SFA raises LDL. But there's another possibility that makes far more sense when you stand back and look at the data as a whole: in the absence of unnatural amounts of dietary cholesterol, PUFA reduces LDL in some species, and SFA has very little effect on it in most.

It's important to remember that this hamster experiment has little to do with the situation in humans. No one is claiming that reducing saturated fat and cholesterol will reduce a human's LDL by 7-fold. Long-term dietary interventions that reduce SFA and dietary cholesterol without increasing PUFA have little effect on LDL cholesterol. Furthermore, humans are fairly resistant to blood cholesterol changes in response to dietary cholesterol, suggesting that we have an evolutionary history metabolizing it. Finally, as I've discussed in a previous post, saturated fat may not substantially influence total blood cholesterol or LDL in humans in the long term, and the effects appear to be modest even in the short term.

But let's get back to the animal models. The hypothesis the paper is attempting to support is that saturated fat raises LDL in a variety of (herbivorous) animal models. If that were true, it should be able to raise LDL even in the absence of added cholesterol. So let's consider only the studies that didn't add extra cholesterol to the diets. And if saturated fat raises LDL, it should also do it relative to monounsaturated fat (MUFA- like olive oil), rather than only in comparison to PUFA. So let's narrow the studies further to those that compared SFA-rich fats, MUFA-rich fats and PUFA-rich fats. In Fernandez et al. (1989), investigators fed guinea pigs 35% of calories from corn oil (PUFA), olive oil (MUFA) or lard (MUFA-SFA). Here's what their LDL looked like:
The same investigators published two more studies showing similar results over the next five years. The next study was published by Khosla et al. in 1992. They fed cebus and rhesus monkeys cholesterol-free diets containing 40% of calories from safflower oil (PUFA), high-oleic safflower oil (MUFA) or palm oil (SFA-MUFA). How was their LDL?
None of the differences were statistically significant. Khosla and colleagues published another study with the same result in 1993. This is hardly supportive of the idea that saturated fat raises LDL in animal models. The most you can say is that PUFA lowers LDL in some, but not all, species. There is no indication from these studies that SFA raises LDL in the absence of excessive dietary cholesterol. I didn't cherry pick studies here; this is every study in the review paper that met my two criteria of no added cholesterol and a MUFA comparison group.

The bottom line is that experimental models of atherosclerosis rely on overloading herbivorous species with dietary cholesterol that they are not equipped to clear. SFA does exacerbate the increase in LDL caused by cholesterol overload. But in the absence of excess cholesterol, it does not necessarily raise LDL even in species ill-equipped to digest these types of fats. Dietary cholesterol has a modest effect on LDL cholesterol in humans, and it has even less effect on LDL particle number, a more important measure. So there does not appear to be a cholesterol overload for saturated fat to exacerbate in humans. 

PUFA vegetable oils do lower LDL in humans, and the effect appears to persist for at least a few years (probably indefinitely). But the evidence is not conclusive that lowering cholesterol in this way actually prevents heart attacks.

Tuesday, September 1, 2009

Limiting pesticides in your produce choices.....

The mission of 3 Healthy Chicks is to help people live healthier, greener lives while keeping it Jersey Fresh. New Jersey is bountiful in produce production; there are fresh options everywhere you turn. Of the thousands of growers in New Jersey, only a select few farms in New Jersey that are certified organic, pesticide free and sustainable (check the Northeast Organic Farm Association of New Jersy for a list). So now you're wondering, "do I buy organic from Mexico or a non-organic from a Jersey Fresh Farm?" It's confusing we know.

Before we offer any suggestions in navigating the organic maze of confusion, we need to offer you a little education on pesticides. In pretty simple terms, pesticides and fungicides are toxins designed to kill things. The logical conclusion would be that we as humans shouldn't injest toxins designed to kill other organisms! Logic aside, research has shown that even small doses of pesticides and other toxins are carcinogenic, can negatively affect the nervous system, disrupt natural hormone patterns and cause eye and lung irritations.. The Environmental Working Group noted that even small doses of pesticides can cause long lasting damage to human health during fetal development and childhood.

Given the damage that can be done, it's important to educate yourself about pesticides and choosing clean or organic produce. EWG conducted extensive research and analysis based on data collected by the U.S. Department of Agriculture and the U.S. Food and Drug Administration. With this information EWG created two lists: The Dirty Dozen and The Clean 15. The Dirty Dozen lists the produce with the heaviest pesticide loads and the Clean 15 lists produce with the lowest pesticide loads.

EWG found that by avoiding the top twelve most contaminated produce and eating the least contaminated instead, consumers lowered their pesticide intake by almost 80 percent! "Eating the 12 most contaminated fruits and vegetables will expose a person to about 10 pesticides per day, on average. Eating the 15 least contaminated will expose a person to less than 2 pesticides per day." EWG has a full list of 47 fruits and vegetables ranked in order from highest pesticide residue to lowest. You can also download a pocket sized version of the Dirty Dozen and the Clean 15 here.

So, to answer the question, "do I buy organic from Mexico or a non-organic from a Jersey Fresh Farm?" it depends. Our first choice is always locally grown organic produce, but there are always exceptions. For those exceptions we offer these tips:

1. Download the Dirty Dozen and Clean 15. Start to understand what is "clean" and what is "dirty" and choose your produce accordingly.

2. Wash your produce. There are lots of veggie wash products on the market today, but a little water and fresh lemon juice works fine too!

3. Peel, Peel, Peel! If do buy non-organic produce from the dirty dozen list, remember to wash it and then peel! We know that some of the best nutrients in an apple or a peach is contained in the peel, but it's just not worth the risk. A new study just linked exposure to pesticides with a 70 percent increased risk of developing Parkinson's Disease!

4. Talk to your local farmers! At every farmers market or roadside vegetable/fruit stand, there is a wealth of knowledge behind the table. Get to know your local farmer and learn about their sustainability practices. Know where your food comes from! You may be surprised to learn that while their produce is not USDA Certified Organic, it may be grown in a sustainable manner with limited use of pesticides.

Stay tuned for the next few September Blog updates....3 Healthy Chicks are going to visit Terhune Orchards to go apple picking and talk with the Mount Family about their farm and how it feels to be one of the few organic apple orchards in New Jersey.

Until then, keep it fresh!