Wednesday, August 31, 2011

Ontario Breast Screening Program opens door for younger women at high risk for breast cancer

By Dr. Yun Yee Chow, Radiologist, Rouge Valley Health System

Cancer Care Ontario has recently announced the expansion of the Ontario Breast Screening Program (OBSP) to include screening for women aged 30 to 69, who are at high risk for breast cancer. The funding, which went into effect July 1, 2011, provides younger women at higher risk for developing breast cancer with annual mammograms and magnetic resonance imaging (MRI) scans.

Prior to the announcement, only women 50 and over were eligible for OBSP mammography screening. Early detection can significantly improve the chances of survival once diagnosed with breast cancer. This new development is great news for women under 50 who are at high risk for breast cancer.

The OBSP was formed in 1990 primarily for screening and allowed patients to receive a mammogram without obtaining a requisition from their family physician. In effect, they refer themselves, making the service more accessible for many women. It provided an environment with quality of care assurance, Canadian Association of Radiologists (CAR) accreditation and standardized reports and reminders. The breast screening clinic’s system navigator also helps to facilitate and guide the patients through urgent surgical and cancer care referrals.

The general screening OBSP population includes women 50 years of age and older, who have no acute breast symptoms or problems, no implants, no personal history of breast cancer, and have not had a mammogram in the past 11 months.

The newly-expanded high risk program will be available initially at certain sites called OBSP Assessment Centres with a family doctor or nurse practitioner referral only.  A genetic assessment can be arranged for certain gene mutations such as BRCA1and BRCA2, which can be seen in first degree relatives such as mother, sister or child.

Rouge Valley Centenary is currently in the process of becoming such a centre, with Rouge Valley Ajax & Pickering expected to follow in the near future.  The centres will feature state-of-the-art radiologic equipment and services, while surgical and oncologic departments will be available to breast patients. Our new system navigator, Channie Mak is on hand to help guide patients through difficult and complex breast issues.

Approximately 34,000 women in Ontario are at high risk of developing breast cancer. It is expected that the stringent screening process with MRI and mammography will detect an additional 17 cancers a year for every 1,000 women screened.

For most women, genetic screening assessments will be needed to determine whether or not they are at high-risk for breast cancer. However, high-risk factors include:

  • Women who are known to be carriers of the BRCA1 or BRCA2 gene mutation;

  • Women with a first degree relative that is a known carrier of the BRCA gene mutation carrier;

  • Women with strong family history in first and second degree relatives with breast and ovarian cancer;

  • Patients who have had chest irradiation for cancer prior to 30 years of age.

Speak with your physician for more information on genetic testing.

Women at high risk have a 25 per cent or greater lifetime risk of developing breast cancer. In other words, their risk is two to five times higher than most other women. Many of these breast cancers detected in younger women are more aggressive than those seen at a later age.

Finding breast cancer early means:

  • A better chance of treating and curing  the cancer successfully;

  • A lesser chance that the cancer will spread;

  • More treatment options.

Currently the five-year survival rate for breast cancer in Ontario is 88 per cent. Mammography is still considered the screening tool of choice. Both Rouge Valley Centenary and Rouge Valley Ajax Pickering’s breast clinics feature new low-dose full-field digital mammography units, as well the capability to perform stereotactic and ultrasound guided breast biopsies. This means that our patients have access to the highest standard of breast screening care, right in their own community.

Remember that prevention and early detection are key to living a long life. If you're not sure about what screening test to arrange, or how frequently you should be screened, you can have your questions answered by a short Cancer Care Ontario self screening on- line tool here or ask your family physician.

And learn more about Rouge Valley’s mammography program here.

Thus commences the first week of the rest of our lives…by Avi Kopstick, August blogger of the month

Summer orientation is over. We passed our Emergency Medicine exam. We moved into what will potentially be our new homes for the next four years. We met, shook hands with, and shared a few drinks with the classes above us… Now what?
(Disclaimer: For those of you who have come to know and, I’m sure, love my humorous writing style/musings over the past month, I will be sorry to disappoint. Whereas my previous posts mainly functioned to report on the lived-experiences here at MSIH and in Beer Sheba, I decided instead to shift my focus for this last entry. If you want to know more about what Beer Sheva is like, I invite you to come visit – I hear tickets are pretty cheap this time of war ;). Or you can just return to this blog next week, where I am sure one of my classmates will be continuing with some first-rate blogging on our first-year here at MSIH.)
… Now what? It’s a scary thought, but become first-rate doctors, I’m assuming. It’s what we’ve always wanted to do. It’s what we all gave up so much to come here to do.
Before attending MSIH, one of my classmates worked as a nuclear chemist. After nearly a decade of building her career, she sold her apartment, found new parents for her beloved pet, and boarded a plane to Israel to study medicine. Another classmate of mine taught science in high school. First in, first out to go be a doctor. We said goodbye to family, friends, those we loved, those we were learning to love, all to pursue something completely different from what we have ever know. Some of us left high paying jobs, in pharmaceutical companies for example. I myself was well on my way to becoming one of the top Starbucks baristas/karaoke hosts in Toronto.
And for what? For this experiment we call medical school. Who knows what will be in four years from now? Of course, we will learn an incredible, incredible amount. We will pass, become doctors, etc. But when we go back to the places we came from, will it be the same? Will we be the same? What will the economic situation be at that time? We’ve taken out huge loans and lines of credit and forsaken the next for years of employment. Will we be able to easily pay back all that we’ve borrowed? One of my classmates will be required to enlist when he returns to his country of citizenship. How will he be able to repay his loans? And even if our transition back is an easy one, will being a doctor really be everything that we’ve always dreamed of?
This post is dedicated to my classmates, my peers, my new friends. These are the sacred sacrifices we’ve made. This is the forbidden dance we now follow with the unknown. May our next four years here at MSIH be meaningful, productive, challenging, engaging, enjoyable, and worth everything we’ve given up. May our dreams be attained and our goals actualized. May we become the doctors we’ve always wanted to be and help the people we’ve always wanted to help. I look forward to spending the next four years with you on this adventure we call medical school.  - blogger of the month, Avi Kopstick

Providing pregnant women access to emergency care in northern Nigeria

Drivers demonstrating how they transport a woman
(with a scarf) in labor into their car.
Nigerian women have a 1 in 23 lifetime risk of maternal death, and the country's maternal mortality ratio is the 9th highest in the world. With roughly 50% of Nigerians living in rural areas, cost and lack of physical access are two of the major barriers to Nigerian women having access to maternal health care.

The northern region is particularly burdened. As it is more rural, with lower education rates and certain cultural practices, women in the north tend to have less access antenatal care and are less likely to give birth in health facilities than in southern regions.

A user of the Emergency Transport
System (ETS)
Loosing a mother during childbirth is a reality for many in northern Nigeria, and it doesn't just effect individual families. Maternal deaths deeply impact communities who often feel (and, in reality, are) helpless to stop them. I worked for two months with the Partnership for Reviving Routine Immunizations in Northern Nigeria – Maternal, Child and Newborn Health (PRRINN-MNCH), based in northern Nigeria, and saw firsthand how they are working with local communities to break down some of these barriers.

In the communities in Zamfara state where I was living, increasing access to maternal health is incredibly complex. Not only does it require access to cars and passable roads, but the cars must work and have fuel, families must know where to find the drivers if the need them (which may require a phone), communities must be educated on when you need to go to the health facility and why, and the health facilities must be staffed, with the drugs and tools necessary to deliver a child.

And these are just a handful of the barriers I saw.

Through a variety of access programs, PRRINN-MNCH is working to break down some of these barriers. Two years ago, it launched the Emergency Transport System (ETS) program in the 4 states where it works. Using commercial drivers who volunteer their services, ETS provides pregnant women with emergency transportation to a health facility when they need it. Many women who have used ETS thus far, if not most, were suffering from excessive bleeding or were already unconscious when the ETS driver was called.

While their children did not usually survive, without ETS these women would not have either.
Calling a commercial driver would have been out of financial reach. Commercial drivers often charge extra to transport women in emergency situations. Combined with the hospital fees, these costs can make a family choose between food and basic survival and going to the hospital. In describing what he liked about the program, one community leader stated, "We are helping ourselves."

Despite these successes, a big question remains: Without financial incentives for drivers, health facility staff and community volunteers, is ETS sustainable?

Ambulances do exist, but a functioning ambulance system in Zamfara is far off. It's clear that finding an alternative is imperative to improving maternal health outcomes, and ETS has been the best alternative in the locations where it operates. Yet, ETS drivers often use their own money for fuel and loose commercial customers when transporting a woman. Their work is inspiring and admirable and they are undeniably proud to be volunteers and ETS drivers, helping their communities. Speaking with them, most of them said they do not want anything in return for the services they provide. They are helping their communities and believe they will be thanked in the afterlife for their work.

Focus group of women who used ETS
However, even with all of this they still need to provide for their families. How long will it be until the financial burden on them is too much? At what point will mothers be left to die?

PRRINN-MNCH isn't willing to wait to find out. In a few months, a series of incentives will be piloted for ETS drivers, health facility staff and community volunteers. The goal is to understand whether they work, amidst fear that providing monetary incentives, however small, will alter the altruistic spirit of the program. If drivers are seen as gaining personally from helping women, will they lose the sense of pride they have in helping the community? If so, will the program become less effective? These answers will help improve the ETS program in northern Nigeria and provide a model to improve global maternal health outcomes.

- Laura Baringer, MPH/MPA '12, Population and Family Health

August 31, 2011

Tuesday, August 30, 2011

Free Android and iPhone apps to create home inventory for insurance

The National Association of Insurance Commissioners has launched an Android application that lets you  use your mobile device to create a home inventory to document your possessions for insurance purposes.

The free app let you easily photograph your stuff, add descriptions and serial numbers, and stores the information electronically for safekeeping. It organizes everything by room and categoy, and creates an e-mailable backup file.

There's also an improved iPhone version, which is also free.

The apps are available through iTunes and the Android Marketplace. Search "NAIC" or "" at either site to download them.

Don't have a smartphone or other mobile device? You can still be prepared. Here's a simple, printable home inventory checklist, also from the NAIC.

Monday, August 29, 2011

Insurance and college students

As students head off to college, here are some things to consider:

Health insurance:
  • Federal health care reform now means that your children, up to age 26, can stay on your health insurance plan. That's likely to be the option that provides the most medical benefits.

  • Another option is to buy an individual insurance plan for the student. 

  • Or you could consider a student health plan, typically offered by the college. Be aware that these policies tend to have limited benefits and more exclusions than traditional health insurance plans.

Renter's insurance:
  • If the student lives off-campus, consider renter's insurance. It's pretty inexpensive, and covers personal property (computers, TVs, bicycles, furniture, etc.) if it gets destroyed, damaged or stolen. It can also provide coverage if someone gets hurt where the student lives.

  • If the student lives on-campus, the parent's homeowner's policy will generally cover his or her belongings. If they have expensive electronics, though, they might need extra coverage. Talk to your agent or company.

Auto insurance:
  • If the student drives a car to college, his or her existing auto coverage typically goes with them. But check with your agent to be sure.

  • It's also a good idea to let the agent know each quarter or semester if the student maintains good grades. Many companies offer a "good student" discount.

Need help? Feel free to give us a call at 1-800-562-6900. We won't try to sell you anything; we're the state agency that regulates insurance in Washington state.

Men who are skinny-fat: There are quite a few of them

The graph below (from Wikipedia) plots body fat percentage (BF) against body mass index (BMI) for men. The data is a bit old: 1994. The top-left quadrant refers to men with BF greater than 25 percent and BMI lower than 25. A man with a BF greater than 25 has crossed into obese territory, even though a BMI lower than 25 would suggest that he is not even overweight. These folks are what we could call skinny-fat men.

The data is from the National Health and Nutrition Examination Survey (NHANES), so it is from the USA only. Interesting that even though this data is from 1994, we already could find quite a few men with more than 25 percent BF and a BMI of around 20. One example of this would be a man who is 5’11’’, weighing 145 lbs, and who would be technically obese!

About 8 percent of the entire sample of men used as a basis for the plot fell into the area defined by the top-left quadrant – the skinny-fat men. (That quadrant is one in which the BMI measure is quite deceiving; another is the bottom-right quadrant.) Most of us would be tempted to conclude that all of these men were sick or on the path to becoming so. But we do not know this for sure. On the standard American diet, I think it is a reasonably good guess that these skinny-fat men would not fare very well.

What is most interesting for me regarding this data, which definitely has some measurement error built in (e.g., zero BF), is that it suggests that the percentage of skinny-fat men in the general population is surprisingly high. (And this seems to be the case for women as well.) Almost too high to characterize being skinny-fat as a disease per se, much less a genetic disease. Genetic diseases tend to be rarer.

In populations under significant natural selection pressure, which does not include modern humans living in developed countries, genetic diseases tend to be wiped out by evolution. (The unfortunate reality is that modern medicine helps these diseases spread, although quite slowly.)  Moreover, the prevalence of diabetes in the population was not as high as 8 percent in 1994, and is not that high today either; although it tends to be concentrated in some areas and cluster with obesity as defined based on both BF and BMI.

And again, who knows, maybe these folks (the skinny-fat men) were not even the least healthy in the whole sample, as one may be tempted to conclude.

Maybe being skinny-fat is a trait, passed on across generations, not a disease. Maybe such a trait was useful at some point in the not so distant past to some of our ancestors, but leads to degenerative diseases in the context of a typical Western diet. Long-living Asians with low BMI tend to gravitate more toward the skinny-fat quadrant than many of their non-Asian counterparts. That is, long-living Asians generally tend have higher BF percentage at the same BMI (see a discussion about the Okinawans on this post).

Evolution is a deceptively simple process, which can lead to very odd results.

This “trait-not-disease” idea may sound like semantics, but it has major implications. It would mean that many of the folks who are currently seen as diseased or disease-prone, are in fact simply “different”. At a point in time in our past, under a unique set of circumstances, they might have been the ones who would have survived. The ones who would have been perceived as healthier than average.

Sunday, August 28, 2011

So, what exactly is a Holistic Health Counselor??

As many of you may know 3 Healthy Chicks, Lauren Forney, Terra Pfund and Jill Rizzi are graduates of the Institute for Integrative Nutrition and Board certified Holistic Health Counselors. That sounds very healthy and impressive, but what is the Institute for Integrative Nutrition and what exactly is a Board certified Health Counselor?

The Institute for Integrative Nutrition is the only nutrition school in the world that integrates all the different dietary theories—combining the knowledge of traditional philosophies with modern concepts like the USDA food pyramid, the glycemic index, the Zone and raw foods.

There are big differences between a traditional dietitian or nutritionist and Holistic Health Counselors. While nutrition is an extremely large component to Holistic Health Counseling, it is not the only aspect. Integrative nutrition and holistic health embraces as philosophy and a practical approach to well-being, that food is a secondary source of nourishment, while relationships, career, spirituality, and exercise are primary nourishments that sustain us more deeply.

Founder and director of the Institute for Integrative Nutrition, Joshua Rosenthal states, “You can eat all the broccoli in the world and still be unhappy and unhealthy because other aspects of your life aren’t balanced. When you are satisfied with your career, in a loving relationship, have a spiritual practice, and exercise on a regular basis, you will be more likely to make better decisions about the foods you eat.”

One of the most important aspects of holistic health counseling that 3 Healthy Chicks embrace is the concept of bioindividuality. 3 Healthy Chicks strongly believe that no one diet works for everyone. We take a yogic view to our counseling practice, in that we believe balance is the key to health and happiness. In each of our practices, Center Your Health, Sprouting Wellness and Keola Wellness we individually assist our clients in taking small, but proactive steps to create lasting changes.

As your Holistic Health Counselor 3 Healthy Chicks will work one on one with you to:

~ Set and accomplish goals
~ Explore new foods
~ Understand and reduce cravings
~ Increase your energy
~ Feel better in your body
~ Improve personal relationships
~ Follow your bliss!
~ Learn to love the life you live~

Imagine what your life would be like if you had clear thinking, energy and excitement every day! When was the last time you talked with someone about your health, or that of your child, and received the personal attention you deserve? It’s rare for anyone to get an hour to work on their nutrition and goals with a trained professional. As Holistic Health Counselors, 3 Healthy Chicks are here to create a supportive environment while we explore what really works for you.

Email us today at to schedule your free health consultation and to find out more about taking small steps to lasting change.

Keep it Fresh!

Friday, August 26, 2011

Hurricane Irene storm tracker

For those of you with family, friends, property, etc. in the Northeast, we've temporarily added a Hurricane Irene storm-tracking widget created by the National Oceanic and Atmospheric Administration. It's the little map on the right side of this blog.

(Update: With the storm now largely over (8/29), we're taking it down. You can see what it looked like here.)

Thursday, August 25, 2011

A Roadmap to Obesity

In this post, I'll explain my current understanding of the factors that promote obesity in humans.  


To a large degree, obesity is a heritable condition.  Various studies indicate that roughly two-thirds of the differences in body fatness between individuals is explained by heredity*, although estimates vary greatly (1).  However, we also know that obesity is not genetically determined, because in the US, the obesity rate has more than doubled in the last 30 years, consistent with what has happened to many other cultures (2).  How do we reconcile these two facts?  By understanding that genetic variability determines the degree of susceptibility to obesity-promoting factors.  In other words, in a natural environment with a natural diet, nearly everyone would be relatively lean, but when obesity-promoting factors are introduced, genetic makeup determines how resistant each person will be to fat gain.  As with the diseases of civilization, obesity is caused by a mismatch between our genetic heritage and our current environment.  This idea received experimental support from an interesting recent study (3).

Read more »

What if the Japan quake hit the Pacific Northwest?

Living in the Pacific Northwest, you can't help but ponder or speculate about the "big one" - especially when quakes hit elsewhere. Today's article in "Totally Psyched for the Full-Rip Nine" will likely keep some of us up tonight.

Not sure you can handle it? Here's your teaser: What would happen in the Pacific Northwest, minute by minute, if the Japanese earthquake hit here.

NAIC cancels summer meeting due to Hurricane Irene

Just heard from the NAIC:

The National Association of Insurance Commissioners has decided to cancel its Summer National Meeting, which was scheduled for August 29-September 1 in Philadelphia. More than 1,500 insurance regulators, industry representatives and interested parties had registered to attend the conference.

“In evaluating the potential threat of Hurricane Irene, our decision to cancel the meeting was informed by considering the safety of all attendees and members,” said Susan E. Voss, NAIC President and Iowa Insurance Commissioner. “The first priority for all state regulators is responding to disasters and we are fully committed to assisting the states affected by this disaster.”

“Many of our members and attendees had already decided to cancel travel plans due to their responsibilities for assisting consumers in disaster situations, as well as weather-related travel safety concerns,” said Therese M. (Terri) Vaughan, NAIC Chief Executive Officer. “As the storm subsides, we will re-evaluate the priorities and establish next steps for conducting business.”

Information about committee work will be updated regularly on the NAIC website at

The NAIC Fall National Meeting is scheduled for November 3-6 in Washington, D.C.

Wednesday, August 24, 2011

An apple a day...

Apples are good for you. You've heard it from the time you were a tiny kid... "An apple a day keeps the doctor away". But how do apples actually benefit your health?

Apples are a fat free, cholesterol free food, as well as a source of fiber. They are also a natural source of vitamin C, calcium, phosphorus and potassium. But it doesn’t stop there. Apples have also been shown to deliver antioxidants.

In addition to making a quick and easy snack, an apple is a great choice for providing fiber, antioxidants, vitamins and minerals into your diet. Its filling-but-not-fattening properties make it great for people of all ages, especially when grabbing a snack on-the-go is all you have time for.


1. Boost your immunity. Apples contain Vitamin C, which helps your immune system. People who lack Vitamin C in their diet have poor healing, bruise easily and may have bleeding gums.

2. Help prevent heart disease. Apples can prevent coronary heart disease and cardiovascular disease because they are rich in flavonoids., which are known for their antioxidant effects.

3. Make a great portable snack. Eating an apple when craving for candy or chocolate can make the desire disappear since apples in itself contain sugar, but gives you only a fraction of the calories from say, a packaged and processed snack.

4. Are cancer fighting! Apples help to prevent ALL cancers. Yay!

5. Lower cholesterol. Apples contain phenols, which have a double effect on cholesterol by reducing bad cholesterol and increasing good cholesterol. Apples prevent LDL cholesterol from turning into oxidized LDL, a very dangerous form of bad cholesterol, which can be deadly.

6. Keep your teeth healthy. Apples prevent tooth decay, which is an infection that seriously damages the structure of your teeth caused primarily by bacteria. The juice of the apples has properties that can kill up to 80% of bacteria. The tough skin also cleans your teeth by scraping away plaque!

7. Contain 20% of your daily fiber. Apples are high in fiber, which help to keep your colon healthy along with keeping you "regular."

Keep it Fresh!
- Lauren

Tuesday, August 23, 2011

Earthquake insurance 101

An earthquake rumbled across much of the East Coast today, startling folks in a region not known for quakes. So it seemed like a good time to highlight the basics of earthquake insurance. Among them:

  • A standard homeowner's or renter's policy does not, repeat not, cover earthquake damage.

  • Unlike homeowners coverage, earthquake insurance is designed to cover catastrophic damage. Deductibles of 10 percent to 25 percent of a structure's value are common.

  • Earthquake insurers often temporarily suspend sales of new coverage after a quake. They do this to limit their exposure in case of aftershocks.

For more, including tips on what to do before and during a quake, see the earthquake insurance page.

Monday, August 22, 2011

Auto glass company owner ordered to pay $1.6 million in insurance fraud case

A Burien auto glass company owner has been ordered to pay more than $1.6 million in restitution to several insurance companies for an overbilling scam.

Michael Alan Perkins, 44, on Friday was ordered in King County Superior Court to pay the following:
  • State Farm Insurance: $864,640

  • Allstate Insurance Co.: $726,700

  • Metropolitan Property & Casualty Insurance Co.: $24,888

Perkins pleaded guilty July 1 to three counts of first-degree theft. He was sentenced to 9 months in jail, with 30 days of the sentence converted to 240 hours of community service.
Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., both run out of Perkins' Burien home. An investigation by Washington Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found more than $1.5 million in deceptive billing by Perkins' companies between September 2005 and December 2009.

In some cases, the insurers paid full price for car windows that Perkins had gotten from auto wrecking yards. One Toyota windshield billed at more than $1,000 actually cost $92. A Lexus windshield that cost $145 was billed at $1,082.

State Farm was tipped off to the scheme by Lynx Services, a third-party administrator that handles glass claims. Lynx became suspicious after a random search of their database turned up an unusually high percentage of OEM (original equipment manufacturer) glass being installed in cars worked on by Autoglass Express.

State Farm investigators began contacting policyholders, inspecting the recently-installed glass, and comparing it to the bills. State Farm turned the case over to the insurance commissioner’s Special Investigations Unit, which obtained search warrants and seized more than 50 boxes of invoices and hard drives belonging to Perkins’ companies.

For more, see the press release we issued when Perkins was charged last year.

Consumer hotline delays -- we're working on it

We are experiencing problems this morning with our toll-free insurance consumer hotline (1-800-562-6900). We believe this resulted from a power failure over the weekend that triggered network problems.

We have a temporary work-around, but callers are experiencing longer-than-usual wait times, and in some cases we cannot connect the call.

Our apologies. We're working to fix this.

Update: 11:54 a.m.: The problem -- which multiple state agencies are having this morning -- means that some of our phone numbers are not able to receive any incoming calls.

Thanks for your patience. We're working on the problem and will get it fixed as soon as we can.

Update: 3:53 p.m.: But a number of our phone lines remain unable to receive incoming calls. If you have a complaint or question, the best thing for the time being is to email us for help or use our online forms for complaints against insurers and agents.

Update: 8:54 a.m. Tuesday: FIXED! Thanks much for your patience.

Tulsi Tea - Holy Basil

During my first trip to India in 2009, I was introduced to Tulsi tea, also known as 'holy basil' tea. I was told to drink it each day I was there to keep my immune system strong. Apparently, it worked because I remained healthy throughout and following my trip. I brought some back with me and have been hooked ever since! Luckily, Organic India makes a delicious line of Tulsi tea's that you can find here at all health food stores, and even in some supermarkets. I swear by the original flavor, but they have many different kinds. My favorite flavor is the Honey Chamomile all summer long, then I fall in love with the Orange Mint during the Fall and enjoy the Vanilla Creme when it's colder. My tastes clearly change with the seasons! If you see a box the next time you're food shopping, give it a try! Read below for all of the wonderful health benefits of this holy basil tea.

About Tulsi Tea

Tulsi tea, which originated in India thousands of years ago, is known for its rich antioxidant and adaptogenic properties that are known to promote wellness by building the body’s immune system, reducing stress and promoting mental clarity. It is recognized as one of India's most sacred herbs because of its health benefits and healing properties. Tulsi Tea's antioxidants protect cells from the damage caused by free radicals that facilitate the cause and progression of various types of diseases. Also referred to as holy basil tea, this herbal brew’s adaptogens serve as powerful anti-stress agents that protect your body from a wide range of health concerns. The adaptogens guard against and deal with physical, chemical, environmental, and emotional factors that produce high levels of stress that compromise physical and mental health.

Potential Health Benefits of Tulsi Tea

· Strengthens the immune system, promotes longevity and enhances well-being.

· Promotes heart health by lowering cholesterol and high blood pressure.

· Reduces the negative physical and psychological effects of stress.

· Increases the body’s efficiency in using oxygen, which improves stamina, strength and endurance.

· Promotes respiratory health.

· Helps with digestion and gastrointestinal problems.

· Neutralizes dangerous biochemicals that contribute to cancer, degenerative diseases and premature aging.

· Facilitates healthy liver function.

· Reduces cell and tissue damage from sun rays, radiation therapy and other radiation sources.

· Relieves inflammation from arthritis and other diseases.

· Helps fight infections.

Keep it fresh!

- Lauren

How come anytime you call someone's cell phone in Israel, instead of a dial tone, you hear the melody for "whatever I said, whatever I did, I didn't mean it..."? It's almost as if everyone in Israel constantly needs to apologize for something! - blogger of the month, Avi Kopstick

 It's been four weeks in Beer Sheva so far, and things are definitely moving forward at an alarming speed. For instance, we are already all completely fluent in Hebrew. To illustrate this, I will write this blogpost completely in Hebrew:

אתם מוכנים ילדים? כן,כן, קפטן! אז תגידו... כן,כן קפטן! ווווווווו........ בתוך אננס הוא חי לו שם: בובספוג, כן, כן! חי לו בכיף מתחת לים: בוספוג, כן, כן! כך לחיות הייתם רוצים! בוספוג, כן כן! אז השליכו חכה אל הדגים! בובספוג, כן, כן! בוב ספוג המרובע, בובספוג המרובע, בובספוג המרובע

Just kidding. I can't speak Hebrew. That was actually the SpongeBob SquarePants theme song in Hebrew... But things are moving rather quickly here in B7. In just one week, we will take our emergency medicine final, say goodbye to our summer ulpan teachers, celebrate my birthday, and start our first semester as full-fledge MSIH'ers. CRAZY. 

So let's see, what actually happened this week of any interest?.. Hmmm… I can't really think of anything. We got up everyday, went to class, practiced our emergency medicine drills… There was this really big protest in Beer Sheva this week, which was kind of cool... Oh! We found the 11 NIS, all-you-can-eat, lunch deal in the Soroka cafeteria this week!.. But I guess that's not too fascinating… Hmmm. Nope! I guess it was a pretty slow week.

… I mean there was this tiny, little, nothing incident involving the bomb sirens going off this week (actually it happened twice this week), but common, that's no biggie right? **nervous chuckles** Nothing you have to worry about of course... Alright, I'll admit, it was rather frightening, getting ready for bed, hearing a loud, wailing noise outside (which at first I took for being just the wind), and then waiting in our bomb shelter until it was safe to come out. 

And then I guess there was also the quadruple terrorist attack yesterday... That was a tad discomforting, sitting in class, looking out the window, and seeing helicopter after helicopter dropping off victims at the emergency room right under us. But really, I guess it's impossible for life to come to a sudden halt each time these things happen. Honestly, our teachers just continued with their presentation on exam taking, without pause, as if it was the only thing that mattered at that time.
I'm not saying we aren't taking these events seriously. We do. In fact, each time a siren does go off, we get text messages right away from the school, letting us know what is happening, and then another to let us know when it is safe to leave our shelter. The next day, we get calls from our student liaisons and emergency medicine instructors asking us if we're feeling okay, and how we are dealing with the scare after the fact... I'm just saying that if we obsessed over every terrorist attack and let them dramatically derail our focus, how would we ever accomplish what we came here to do? Which is to become the most awesomest, coolest, smartest, handsomest group of doctors that there's ever been. So when I woke up this morning and saw two missed text messages, one telling me that bombs were flying in from Gaza, and another telling me that the danger had passed and it was safe to leave my shelter, I just shrugged my shoulders and started my day as if nothing happened.

So in that vain, let's shrug our collective shoulders, and end this blog post on a positive note: Last Thursday, we went on an incredible night-hike, under a full moon, in the Negev desert. For three hours, we serpentined through Wadi Chaverim, a dried out riverbed, sharing in the peace and tranquility of the desert at night.

 After the hike, we bussed to a bonfire pit and sang the night away around dancing flames and roasting marshmallows. It was a really special time. Thanks to our student liaisons for arranging such a fun and inspiring night. 

I'm going to sign off now, but I look forward to seeing you all next week for my last post, when I'll be handing the torch off someone else in my class. Until then, להתראות!  - by blogger of the month Avi Kopstick

Refined carbohydrate-rich foods, palatability, glycemic load, and the Paleo movement

A great deal of discussion has been going on recently revolving around the so-called “carbohydrate hypothesis of obesity”. I will use the acronym CHO to refer to this hypothesis. This acronym is often used to refer to carbohydrates in nutrition research; I hope this will not cause confusion.

The CHO could be summarized as this: a person consumes foods with “easily digestible” carbohydrates, those carbohydrates raise insulin levels abnormally, the abnormally high insulin levels drive too much fat into body fat cells and keep it there, this causes hunger as not enough fat is released from fat cells for use as energy, this hunger drives the consumption of more foods with “easily digestible” carbohydrates, and so on.

It is posited as a feedback-loop process that causes serious problems over a period of years. The term “easily digestible” is within quotes for emphasis. If it is taken to mean “refined”, which is still a bit vague, there is a good amount of epidemiological evidence in support of the CHO. If it is taken to mean simply “easily digestible”, as in potatoes and rice (which is technically a refined food, but a rather benign one), there is a lot of evidence against it. Even from an unbiased (hopefully) look at county-level data in the China Study.

Another hypothesis that has been around for a long time and that has been revived recently, which we could call the “palatability hypothesis”, is a competing hypothesis. It is an interesting and intriguing hypothesis, at least at first glance. There seems to be some truth to this hypothesis. The idea here is that we have not evolved mechanisms to deal with highly palatable foods, and thus end up overeating them.  Therefore we should go in the opposite direction, and place emphasis on foods that are not very palatable to reach our optimal weight. You might think that to test this hypothesis it would be enough to find out if this diet works: “Eat something … if it tastes good, spit it out!”

But it is not so simple. To test this palatability hypothesis one could try to measure the palatability of foods, and see if it is correlated with consumption. The problem is that the formulations I have seen of the palatability hypothesis treat the palatability construct as static, when in fact it is dynamic – very dynamic. The perception of the reward associated with a specific food changes depending on a number of factors.

For example, we cannot assign a palatability score to a food without considering the particular state in which the individual who eats the food is. That state is defined by a number of factors, including physiological and psychological ones, which vary a lot across individuals and even across different points in time for the same individual. For someone who is hungry after a 20 h fast, for instance, the perceived reward associated with a food will go up significantly compared to the same person in the fed state.

Regarding the CHO, it seems very clear that refined carbohydrate-rich foods in general, particularly the highly modified ones, disrupt normal biological mechanisms that regulate hunger. Perceived food reward, or palatability, is a function of hunger. Abnormal glucose and insulin responses appear to be at the core of this phenomenon. There are undoubtedly many other factors at play as well. But, as you can see, there is a major overlap between the CHO and the palatability hypothesis. Refined carbohydrate-rich foods generally have higher palatability than natural foods in general. Humans are good engineers.

One meme that seems to be forming recently on the Internetz is that the CHO is incompatible with data from healthy isolated groups that consume a lot of carbohydrates, which are sometimes presented as alternative models of life in the Paleolithic. But in fact among influential proponents of the CHO are the intellectual founders of the Paleolithic dieting movement. Including folks who studied native diets high in carbohydrates, and found their users to be very healthy (e.g., the Kitavans). One thing that these intellectual founders did though was to clearly frame the CHO in terms of refined carbohydrate-rich foods.

Natural carbohydrate-rich foods are clearly distinguished from refined ones based on one key attribute; not the only one, but a very important one nonetheless. That attribute is their glycemic load (GL). I am using the term “natural” here as roughly synonymous with “unrefined” or “whole”. Although they are often confused, the GL is not the same as the glycemic index (GI). The GI is a measure of the effect of carbohydrate intake on blood sugar levels. Glucose is the reference; it has a GI of 100.

The GL provides a better way of predicting total blood sugar response, in terms of “area under the curve”, based on both the type and quantity of carbohydrate in a specific food. Area under the curve is ultimately what really matters; a pointed but brief spike may not have much of a metabolic effect. Insulin response is highly correlated with blood sugar response in terms of area under the curve. The GL is calculated through the following formula:

GL = (GI x the amount of available carbohydrate in grams) / 100

The GL of a food is also dynamic, but its range of variation is small enough in normoglycemic individuals so that it can be treated as a relatively static number. (Still, the reference are normoglycemic individuals.) One of the main differences between refined and natural carbohydrate-rich foods is the much higher GL of industrial carbohydrate-rich foods, and this is not affected by slight variations in GL and GI depending on an individual’s state. The table below illustrates this difference.

Looking back at the environment of our evolutionary adaptation (EEA), which was not static either, this situation becomes analogous to that of vitamin D deficiency today. A few minutes of sun exposure stimulate the production of 10,000 IU of vitamin D, whereas food fortification in the standard American diet normally provides less than 500 IU. The difference is large. So is the difference in GL of natural and refined carbohydrate-rich foods.

And what are the immediate consequences of that difference in GL values? They are abnormally elevated blood sugar and insulin levels after meals containing refined carbohydrate-rich foods. (Incidentally, the GL  happens to be relatively low for the rice preparations consumed by Asian populations who seem to do well on rice-based diets.)  Abnormal levels of other hormones, in a chronic fashion, come later, after many years consuming those foods. These hormones include adiponectin, leptin, and tumor necrosis factor. The authors of the article from which the table above was taken note that:

Within the past 20 y, substantial evidence has accumulated showing that long term consumption of high glycemic load carbohydrates can adversely affect metabolism and health. Specifically, chronic hyperglycemia and hyperinsulinemia induced by high glycemic load carbohydrates may elicit a number of hormonal and physiologic changes that promote insulin resistance. Chronic hyperinsulinemia represents the primary metabolic defect in the metabolic syndrome.

Who are the authors of this article? They are Loren Cordain, S. Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A. Watkins, James H O’Keefe, and Janette Brand-Miller. The paper is titled “Origins and evolution of the Western diet: Health implications for the 21st century”. A full-text PDF is available here. For most of these authors, this article is their most widely cited publication so far, and it is piling up citations as I write. This means that not only members of the general public have been reading it, but that professional researchers have been reading it as well, and citing it in their own research publications.

In summary, the CHO and the palatability hypothesis overlap, and the overlap is not trivial. But the palatability hypothesis is more difficult to test. As Karl Popper noted, a good hypothesis is a testable hypothesis. Eating natural foods will make an enormous difference for the better in your health if you are coming from the standard American diet, and you can justify this statement based on the CHO, the palatability hypothesis, or even a few others – e.g., a nutrient density hypothesis, which would be closer to Weston Price's views. Even if you eat only plant-based natural foods, which I cannot fully recommend based on data I’ve reviewed on this blog, you will be better off.