Of Pathogens and Produce:  Let the salad-lover beware

Of Pathogens and Produce:  Let the salad-lover beware

Until recently, foodborne illnesses have usually been associated with contaminated meat and poultry. Improved surveillance of and practices by those industries, as well as public education about proper handling have helped lower the rates of those sources. But an increase in uncooked vegetables and contamination of these products has developed.

In the International Journal of Environmental Health Research article “Prevalence of multiple antibiotic-resistant Gram-negative bacteria on bagged, ready-to-eat baby spinach,” by S. Walia, et al (Vol. 23, No.2, for April, 2013, pages 108-118), infections caused by pathogens (microorganisms that cause disease) found on uncooked fresh produce are increasing. Perhaps even more concerning is that many of these germs carry the genes for multiple-drug resistance. Thus, if someone consumes these pathogens on their produce, they could get an infection and/or have these dangerous genes passed on to bacteria in their intestines. Antibiotics used in agriculture to increase yield are suspected to have caused the antibiotic-resistant organisms to survive and even thrive. There has been an increase in serious intestinal infections in the most vulnerable – children, the elderly, and those with a weakened immune system.

The study reported in this article noted that pathogens are found even in bagged, ready-to-eat baby spinach. Other studies found pathogens on other produce. High-risk produce includes green onions, spinach and other leafy greens, cilantro, tomatoes, peppers, and alfalfa sprouts.

The CDC’s “Burden of Foodborne Illness:  Findings” which were last updated 7/15/2016, states that 1 in 6 Americans develop a foodborne illness every year. Some half of infections are caused by pathogens not yet identified, and the other half are caused by 31 known microorganisms, but 8 account for the majority of cases of foodborne illness. Norovirus causes the most of these. Salmonella is also a common cause and the most likely to lead to hospitalization or death. (http://wwwnc.cdc.gov/eid/article/17/1/p1-1101 article).

In “Vital Signs:  Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food – Foodborne Diseases Active Surveillance Network, 10 U.S. Sites 1996-2010″ (Morbidity and Mortality Weekly Report for 6/10/2011, Vol. 60, #22) it is noted that most foodborne illnesses occur in people that aren’t included in reported disease outbreaks. Most foodborne illnesses entail mild to severe diarrhea. In the vulnerable such as the elderly, and even in the healthy, severe complications like kidney damage and meningitis can develop.

In Eat, Drink and Be Wary by Charles M. Duncan (Lanham, MD:  Rowman & Littlefield, 2015) it is stated that 20% of our fresh vegetables and 40% of our fruit and nuts are imported. This may be the greatest risk for foodborne infections, but this hasn’t been confirmed. Since fresh produce is the source of about half of foodborne illnesses a year, and since monitoring has decreased the past 5 years, a few precautions are worthwhile:  wash meticulously all fruits and vegetables, even those with a rind you won’t eat, wash 15 seconds and rinse 15 seconds before and after preparing any produce.


Super Star Spinach

Super Star Spinach

Spinach is not only listed as one of the super foods in Dr. Steven Pratt’s SuperFoods Rx (also by Kathy Matthews, NY, NY, 2004), he considers it so rich in so many important nutrients, it is almost in a class by itself. But before I start singing its praises, I have to add his important note that there are other similar foods that also have many of the same impressive substances.

Spinach Knock-offs

  • Kale
  • Collards
  • Swiss chard
  • Mustard and turnip greens
  • Bok choy
  • Romaine lettuce
  • Orange bell peppers (yes, that struck me as a pretty distant relative too)


On to the resume for these super stars (using spinach as the proto-type)

  • The carotenoids lutein, zeaxanthin (both associated with lower macular degeneration and cataract rates), and beta-carotene
  • The antioxidants glutathione (protects DNA), alpha lipoic acid (anti-aging nutrient), vitamin C, and vitamin E
  • Vitamin K (important for blood clotting and thus to be avoided if taking warfarin (Coumadin) a blood thinner)
  • Coenzyme Q10 (needed for cell energy production)
  • B vitamins thiamine, riboflavin, B6, and folate (cancer fighter)
  • Chlorophyll (a potential cancer fighter), Polyphenols, Betaine (may help lower arterial disease risk)
  • Plant-derived omega-3 fatty acids


Which is better, raw or cooked spinach? There are benefits to each. Cooked spinach makes the carotenoids more available and increases lutein, but decreases the vitamin C and folate. So, it is probably best to consume raw and cooked spinach each day. Also, adding olive oil, nuts or avocado to cooked spinach will increase the carotenoid absorption.

One more note about the “knock off” vegetables. Kale, as noted in Super Foods by Tonia Reinhard (Buffalo, NY:  Firefly Books, 2014) has more than twice the level of antioxidants compared with other leafy greens. Okay kale, you’ve got my vote, and a place of prominence in my garden.

Medications and conditions that can cause constipation

Medications and disorders that can cause Constipation

There are many causes of constipation, including some types of medications. Those that already have problems with constipation before starting medications might want to discuss a change in medications if they’ve started one that has that as a side effect.

Medications that can cause or worsen constipation:

Antidepressants including many of the tricyclic antidepressants like Elavil, some of the SSRIs like Prozac, some of the SNRIs

Antipsychotic agents

Calcium carbonate and calcium or aluminum-based antacids

Iron (some are worse than others in this respect)

Antihistamines that are sedating (diphenhydramine for example)

Urge incontinence medications

Calcium channel blockers (an antihypertensive and heart medication)

Disorders the diseases that can cause or worsen constipation:


Irritable bowel syndrome (IBS)



Excess stimulant laxative use

Some cancers


Neuromuscular diseases like MS and Parkinson’s disease



References:  Alison Bardsley, Assessment and treatment options for patients with Constipation in British Journal of Nursing, 2017, Vol. 26, #6

Harvard Health letter, August, 2017, page 7. This is not meant to replace the care of your health care provider.

Adopting good habits and giving up bad ones

Help for making changes to lose weight

Knowing what causes weight gain and weight loss does not lead to permanent weight loss. That is the sad fact that leaves many hopeless about losing weight. In “Improving Cardiovascular health with Motivational Interviewing” (M. Van Nes and J. Sawatzky, Journal of the American Academy of Nurse Practitioners, 2010, 654-659), it is noted that the traditional method of giving advice to change behavior rarely leads to sustained behavior change. In fact, such advising may actually decrease the changes of behavior changes. This article taps into the wisdom of the Transtheoretical Model for Health Promotion (J. Prochasky and C. DiClemente), in which individuals that need to make behavior changes are classified on a continuum with one end being not even appreciating the need for change, then listening, all the way through wanting to change, doing it and then maintaining the change for good. The article authors note statistics that some two-thirds of people that need to make a behavioral change are in one of the first two stages and often stay there.

In Big Fat Crisis, by Deborah Cohen, M.D. MPH (Philadelphia, PA:  Nation Books, 2014), the barrage of processed foods available at grocery stores, fast food restaurants and numerous other places, overwhelms our self-control. The advertising that promotes these foods is meant to lure us, and avoiding those is also smart. Dr. Robert Lustig, author of Fat Chance (New York, NY:  Penguin Group, 2012) writes about changing one’s food environment to stop the hormonal abnormalities that drive overeating. He encourages a high fiber diet to increase fullness and satiety, eating breakfast and include protein if possible, avoiding processed foods and especially sugar, and exercising. But, as he wisely notes, don’t look to exercise to lose pounds but to improve your health (and that is hopefully what you are primarily after, right?).

So, this is the what is needed:  decide to make the change (I assume most of the readers of this blog article are at least approaching this point to even be reading this article). Next, plan what you’ll need to do to make the changes such as avoiding restaurant meals, cutting out soft drinks, eating lots of fiber, staying away from processed foods, going to the Farmer’s market for locally grown fruits and vegetables, etc. YOU CAN DO IT. Set a date for starting, and if you trip and fall off your diet/new lifestyle, start back on your healthy diet the next day. One mistake does not equal failure by any means.

If it is easier to make the changes more gradually, do so! And remember that increasing fiber too quickly can create some gastrointestinal problems so introduce it slowly. I recommend oatmeal with ground flax, bran, and berries. Also, vegetables throughout the day. Avoid juice because they have carbohydrates without the essential fiber. And please, please, dear reader, do what you can to decrease stress because this nasty response can lead to high cortisol levels. As Dr. Lustig notes, exercise, even 15 minutes a day of walking, can lower cortisol levels.

All of this is hard work but these changes including regular exercise can go very far in losing weight, keeping it off and avoiding many chronic diseases. And it is worth it, isn’t it? This is not meant to replace the care of your primary health care provider.

What to avoid if you want to lose weight and be healthier

What to avoid if you want to lose weight and be healthier

     Adding positive habits and good foods to one’s life takes work but is relatively easier than giving up practices and foods that have a hold on us. This is the real work of watching what goes in and building a foundation for good health. Following are some of the key things that need to be avoided if living longer and living a fuller, unimpeded life.


It isn’t needed and often leads to fat storage. It is also addictive, so the more of it you eat, the more you crave it. High fructose corn syrup is the worse of the worst, promoting fatty liver and potentially leading to liver failure. It also increases uric acid production and thus gout can develop or worsen.

Fruit juices

These are bad since they have sugar but no fiber. Many have as much sugar as soft drinks.

Artificial sweeteners

Although they don’t have any calories, they can cause hunger. Research studies have linked daily use to weight gain, as well as increased stroke and dementia risk.

Saturated fat

It’s found in beef, lamb, pork, chicken skin, and dairy products made from whole milk. They have a lot of calories, easily leading to weight gain. It also increases the bad type of cholesterol.

Trans fats

It deserves it title as the unhealthiest food. It increases bad cholesterol, decreases the good form of cholesterol, cause a heart attack, stroke, or Alzheimer’s disease. It is found in fried foods, fast foods like French fries, peanut butter, salad dressings, potato chips, crackers, cookies, doughnuts, pies and cake.

Processed meats

Meats like salami, as well as bacon, sausage, and hot dogs are high in saturated fat and thus a concentrated source of calories. They are also high in salt. Some have a lot of nitrate compounds. These chemicals are converted to carcinogens in the body.

Late night snacking

Will power often dwindles by the end of the day. Heading to bed with calories on board when they are least needed, can support weight loss. There is a lot to be said for fasting twelve hours each day. If you wake up in the middle of the night with stomach pain that is relieved with food, it could be the sign of an ulcer and warrants medical evaluation. Treating yourself with an over-the-counter acid reducer could result in inadequate treatment, especially for ulcers caused by a bacterial infection.



10 habits and choices that can help you achieve permanent weight loss

10 habits and choices that can help you achieve permanent weight loss

When most people want to lose weight, they usually go on a diet that restricts calories. These may work, but only temporarily because a return to the person’s normal patterns causes the weight to return. That is frustrating because people try to lose weight with the goal of keeping it off. The key to permanent weight loss is a change in habits. Adopting healthy eating habits and getting rid of bad habits can not only help with lasting weight loss, it can lead to an improvement in health. These are wonderful benefits!

  1. Drink 8 to 10 cups of water each day. Cold water is especially helpful because calories are spent when the body warms it. Tea can aid abdominal fat loss, but it can cause insomnia if consumed after 12:00 p.m. It can also cause some people to urinate too much.
  2. Lift weights at a gym. This helps increase muscle cell size and increase the calories burned even when you are at rest. Muscle burns fifteen times as many calories as fat.
  3. Include some monounsaturated fats in your daily diet. These include walnuts and other nuts, seeds, olives and olive oil, plus avocados. These fats decrease hunger, lower cholesterol, and can help decrease cravings. But they are high in calories so limit them to a small amount daily.
  4. Try to exercise every day, even if it is only for fifteen minutes. This burns some calories, and improves mood.
  5. Eat a rainbow of fruits and vegetables, or, to put it another way, eat a variety of colors of fruits and vegetables. Each color is made of different nutrients and when you eat a variety, you are most likely to get all those you need to burn fat and stay healthy. During winter, choose frozen produce, not canned. Some fruits and many vegetables have fiber that helps you feel full and is good for the intestines. Cabbage, broccoli and cauliflower are especially good at preventing weight gain.
  6. Eggs are an excellent source of protein and have nutrients to help decrease hunger.
  7. Oatmeal is one of the best grains you can eat! It too helps you to feel full, decreases the cholesterol level, is high in fiber but low in calories, and has many important minerals needed for health. It is easy to add other nutrients to oatmeal such as ground flax, wheat germ and wheat bran, ground nuts and berries.
  8. Beans are excellent sources of protein, as well as fiber to help you stay full. They also have many other nutrients.
  9. Another important type of fat to consume each day is omega-3 fatty acids. This is a type of polyunsaturated fat, fats that are essential fatty acids needed for good health. It is most abundant in fatty fish like sardines and salmon. Flaxseeds and walnuts are other sources. They help burn fat, decrease harmful chronic inflammation, and build muscle.
  10. It is important to get at least seven hours of sleep each night. Sleeping less than that increases the hormone ghrelin and that increases hunger feelings. Rest and relaxation also help decrease stress hormones like cortisol that increase the blood sugar level and weight gain.


This blog article isn’t meant to replace your primary health care provider.

The next article will cover foods, drinks and habits to give up to promote weight loss and good health. The following one will give suggestions on how to make the changes like giving up bad habits and making the good practices part of your everyday routine.

Chromium: The good, the bad, and the not-so-important

Chromium:  The good, the bad, and the not-so-important

Chromium is found and produced in several different forms. The most common forms are metallic, trivalent and hexavalent. The trivalent form occurs naturally and is an essential nutrient. Its needed for fatty acid and cholesterol production and insulin metabolism. It is found in eggs, meat, cheese, whole grains and certain fruits and vegetables. Metallic chromium isn’t pertinent to this article (Pediatric Environmental Health, 3rd edition, Dr. Ruth Etzel, Editor, and Dr. Sophie Balk, Assoc. Editor. Elk Grove Village, IL:  2012).

Hexavalent chromium is the toxic form. The US National Toxicology Program, World Health Organization, EPA, and International Agency for Research on Cancer have all identified hexavalent chromium as a human carcinogen. It comes mostly from industrial emissions and passes into the air, water, and soil. It’s also part of tobacco smoke. Chromium is used in so many ways it isn’t surprising it is found in more than 50% of the National Priorities List superfund hazardous waste sites as well as many landfills. Fossil fuel burning and steel production are major sources of chromium in the air. The movie Erin Brockovich was about The Pacific Gas and Electric Company’s role in the excessive chromium in water and even though it has been out a long time, this is still a real problem.

Absorption of hexavalent chromium from the lungs is high. Gastrointestinal absorption of this form can be as high as 50% but much of it is converted to the trivalent form. Chromium doesn’t stay in the body very long, so antidotes and chelators aren’t in demand. Vitamin C helps convert hexavalent chromium to the trivalent form. Laboratory assessments are not particularly useful, and environmental documentation is more helpful.

Topical chromium is a common cause of allergic contact dermatitis. Swallowing a large amount of hexavalent chromium could cause nausea, vomiting and acute kidney failure.

The biggest concern is with chronic inhalation of the hexavalent form of chromium. Those at highest risk are those working or who have worked in industries where chromium is used. These individuals have an increased chance of developing nasal and lung cancer. The latter risk increases with the duration of an exposure and there’s about a 13 to 30-year latency period. In “Profiling stainless steel welding processes to reduce fume emissions, hexavalent chromium emissions and operating costs in the workplace,” (by M. Keane, et al in Journal of Occupational and Environmental Hygiene, 2016, v. 13#1, pages 1-8) almost half a million Americans do some welding in their work, and that is a potential exposure. Gas metal arc welding was found to create less exposure to toxic gases.

In “Hexavalent Chromium Is Carcinogenic to F344/N Rats and B6C3F1 Mice” (by M. Stout, et al, in Environmental Health Perspectives, v117, #5, for May 2009, pages 716-722), the possibility of an increased risk for oral, stomach and duodenal cancer with chronic consumption of water polluted with excess chromium was raised. The research done involved giving water with various levels of hexavalent chromium in it to the test animals for 2 years. Before you decide that this isn’t relevant to humans, consider the fact that rats and mice are used in research because they share many biological processes and tissue structures with humans.

This all lends support to having water tested, including well water, before even a sip.