June 19th, 2008 by Dr. Val Jones in Expert Interviews
4 Comments »
I recently discussed the emerging black market for raw (unpasteurized) milk and the FDA’s crackdown on California farmers. Soon after I posted my comments, a reader asked some detailed questions about heat, enzymes, and milk’s nutritional value. At the same time I received an email from the Vice President of Nutrition Affairs-Health Partnerships at the National Dairy Council, offering to connect me with a dairy product scientist to further the discussion. Isn’t it nice when all the stars align correctly?
I just interviewed Gary Rogers, Ph.D., the Editor-In-Chief of the Journal of Dairy Science and Professor of Animal Science and Dairy Extension Leader at the University of Tennessee in Knoxville. You may listen to the podcast, or enjoy my synopsis below:
Dr. Val: What is pasteurization?
Dr. Rogers: Pasteurization is the heating of milk to a specific temperature for a specified period of time to kill harmful bacteria that may be living in the milk.
Dr. Val: Raw milk enthusiasts argue that pasteurization decreases the health benefits of milk. What exactly is lost when milk is pasteurized?
Dr. Rogers: There are really no important changes that occur (from a nutritional standpoint) to milk when it’s pastuerized. Heat treatment is simply used to kill the bacteria that may present a health risk to those of us who consume milk. Research over the years has shown that there are no significant nutritional benefits to raw milk, but there are risks associated with exposure to bacteria.
Dr. Val: Some people say that raw milk is easier to digest than pasteurized milk. Is that primarily a myth?
Dr. Rogers: Yes, that’s a myth. There is no scientific evidence to suggest that raw milk is easier to digest than pasteurized milk. In fact, many people who have digestive difficulty with fluid milk can eat cheese and yogurt without any difficulty.
Dr. Val: I’ve heard some people claim that there are certain beneficial enzymes in raw milk that are destroyed in the pasteurization process. Is there any truth to that?
Dr. Rogers: There are dozens of enzymes in milk, but most of them are proteases that are involved in the break down of milk proteins and fats. While it’s true that heating can destroy some of these enzymes, they really have no role in human digestion. The enzymes are responsible for milk spoilage, so removing them extends the shelf life of the milk.
Dr. Val: Tell me about UHT milk (the boxed milk that is stored at room temperature) – does it differ -nutritionally and chemically – from pasteurized milk?
Dr. Rogers: UHT (or “ultra-high temperature”) milk undergoes a pasteurization process at a much higher temperature than regular milk. This increases its shelf life, but nutritionally and chemically it’s no different from regular pasteurized milk. It contains all the calcium, phosphorus, and protein of regular milk. However, UHT milk does have a different flavor that some Americans don’t like. In Europe, though, they really enjoy the flavor of UHT milk and often prefer to drink it over pasteurized milk. In the U.S. we use it for flavored milk products, and for military personnel who can’t keep their milk refrigerated as easily.
Dr. Val: I think the key confusion that people have here is that they think of heating milk like heating vegetables. We all know that when we boil vegetables for a long time the nutritional value decreases because their vitamins are removed in the water. However, with milk we’re essentially heating it without removing the “water” part.
Dr. Rogers: That’s exactly right. Pasteurization doesn’t add or subtract anything from milk nutritionally, it’s just a heat treatment to destroy bacteria like listeria and salmonella.
Dr. Val: Are US cows exposed to antibiotics and hormones that could find their way into milk?
Dr. Rogers: I know that consumers are very concerned about these issues, but they need to know that every milk tanker is required by law to be tested for antibiotics. There’s a huge incentive for milk producers not to include milk from cows that may have been sick and treated with antibiotics because any tanker that’s found to have any trace of antibiotic in the milk will have its milk discarded. Not only that, but since tankers usually carry milk from multiple producers, one small contribution of contaminated milk will cause all the neigboring farms’ milk to be destroyed. So there’s a lot of peer pressure to keep the milk supply clean. Farmers who contribute milk from cows on antibiotics are fined for the losses of other producers’ milk as well.
As far as “hormones” are concerned, you’re talking about RBST (recombinant bovine growth hormone) to enhance milk production in cows. Although no lab test was ever able to distinguish milk from RBST treated cows from non-treated cows, consumers expressed such concerns about the practice that few milk producers use RBST anymore. I’d say that maybe 10-15% of dairy producers use it, and then it’s not for fluid milk sale, but rather cheese and other dairy products. Those numbers are continuing to decline.
Dr. Val: What does it mean when milk is labeled “organic?” Given the high price of groceries, are there advantages to purchasing organic milk?
Dr. Rogers: I work with both conventional dairy producers and organic dairy producers in my “day job” so I have friends on both sides. As far as nutrition and healthfulness is concerned, organic and conventional milk are equal. The “organic” label has to do with the production practices on the farms that produce the milk, not the properties of the milk itself. On organic farms, they do not use chemical fertilizers or pesticides to raise the crops that they feed to their cows. Some people like the idea of supporting organic farmers and consumers have every right to do that. But both organic milk and conventional milk are safe and equivalent nutritionally.
Milk is heavily regulated and controlled so that even on conventional farms, the pesticides do not get into the milk. All milk is tested for pesticides, and in my experience it has always contained far lower levels than the standard set for safety by the FDA.
Dr. Val: But isn’t it possible that the organic milk might have an even lower level of pesticides in it than conventional milk?
Dr. Rogers: Actually the tests that I’ve seen have not been able to distinguish organic from conventional milk as far as pesticide levels are concerned. However, I haven’t received results from all the organic farms in the U.S. But keep in mind that pesticides exist in such small quantities in milk that usually we can’t even detect them with the most sensitive instruments that we have in the laboratory.
Dr. Val: Is soy milk a good substitute for cow’s milk?
Dr. Rogers: It’s really hard to replicate the nutrition that comes from traditional milk sources. The calcium absorption, amino acids, vitamin, and mineral contents of milk provide a distinct advantage over soy milk, unless you have a specific dairy allergy. In a large recent study on baby formula, for example, there was no advantage to using soy based formulas over cow’s milk. People may prefer to use soy milk for its flavor, or because they support vegetarian food sources. But most soy milk is processed by dairy farms anyway.
*Listen to the interview with Gary Rogers*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 18th, 2008 by Dr. Val Jones in Expert Interviews
No Comments »
Currently, women make up about 15 percent of the active duty forces in Iraq and Afghanistan and by the year 2020 one in five young veterans will be female. Walter Reed and other Veterans Affairs (VA) hospitals are treating more and more injured women than ever before – but are these hospitals prepared to handle all the distinctively female health issues that will be coming their way?
This is the subject of a CBS news segment being released tomorrow night, June 19th. The producers gave me an early head’s up so that I could alert my readers to it, and I immediately reached out to Revolution Health expert, Dr. Iffath Hoskins, for comment.
Dr. Hoskins is well-versed in both military healthcare and women’s health. She completed an obstetrics and gynecology residency at the National Naval Medical Center in Bethesda, Md. and a maternal fetal medicine fellowship at the Uniformed Services University of the Health Sciences. (This includes the National Naval Medical Center and the Walter Reed Army Medical Center in Washington, D.C.). She has been the Chair and Residency Director of the Department of Obstetrics and Gynecology at the New York University Downtown Hospital, and the Chief of Obstetrics at Bellevue Hospital. She currently serves as the Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.
Dr. Val: What sort of gaps in care will women military personnel encounter at the VA?
Dr. Hoskins: First of all, the gaps in care are not only for women personnel, but there are gaps in care for all personnel due to resource constraints at the VA hospitals. When the VA system was originally conceived there was no need to support women’s health services as very few women worked as full time military personnel. Now about 15% of military personnel are women. Of course, women have many of the same sorts of health problems as men (migraine headaches, high blood pressure, heart disease, etc.) and the VA system is adept at handling those concerns. But when it comes to female reproductive health, contraception, pregnancy, and disorders of menstruation, the VA system is simply not equiped to handle that.
Dr. Val: How can the VA adapt to serve this influx of women veterans?
Dr. Hoskins: First of all the VA needs to recognize the unique needs of women and identify personnel within the VA system who are capable of meeting these needs. Even in the field some of the rules surrounding uniform requirements have not been adapted to suit the needs of women. During wartime and/or deployments, resources for menstruating women (eg private toiletries, contraception, etc) were scarce. So, the women often bled onto their uniforms and this created problems with personal hygeine.
Dr. Val: Does the VA treat military wives and daughters? What sort of care are they currently getting and could women soldiers benefit from those services?
The VA does not treat dependents because they were designed to meet the healthcare needs of individuals returning from serving their countries in a wartime model. TRICARE is the coverage provided to them and many large hospitals and clinics accept this insurance nationwide.
Dr. Val: Do you think that physical disfigurement affects women differently than men?
Dr. Hoskins: I don’t believe that this is an issue. Women soldiers are tried and true professionals. They know that they are in the military to serve their community, unit, battalion, company, and country and have accepted the potential consequences of death and disfigurement. After working closely with these women for 26 years, I know that they consider themselves soldiers, sailors, marines, and airmen first and foremost and are committed to doing whatever is expected and required of them.
When I was deployed in Operation Iraqi Freedom as one of the highest ranking Reserve Marine physicians, I conducted a research survey to explore the reactions of returning veterans to the large number of women involved in the operation. We asked them how they felt about having women living and working with them shoulder-to-shoulder in times of war, and whether it made a difference to the completion of the mission. We surveyed about 8000 military personnel, and 40% of them expressed concern about having women on the battlefield.
Dr. Val: What specific concerns did they have?
Dr. Hoskins: The respondents believed that the physical load and demand on the young men was greater than on the young women. Sometimes this wasn’t because of differences in physical strength but culturally the men wanted to help the women with their loads, and the women sometimes resented the help.The respondents noted that women who needed to retrieve their fallen comrades behaved differently than their male peers (the women were more likely to cry, which was frowned on by the men). Because the women and men were segregated in their sleeping quarters, accounting for everyone’s whereabouts became more difficult.
Overall the survey clearly showed that there was never a concern about whether or not the women were weapons-qualified. The respondents did not believe that the presence of women affected the success of their mission – but it certainly created distractions.
*Listen To The Podcast With Dr. Hoskins*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 7th, 2008 by Dr. Val Jones in Opinion
3 Comments »
Hot and humid weather has spurred on the growth of many of my outdoor plants, including bamboo, rosemary, and various peonies. However, I was unpleasantly surprised by the arrival of three fungal guests, only one of which I could identify: the dog stinkhorn. As its name suggests, it is one unpleasant-smelling organism. A certain mushroom website described it as looking like “a dog phallus dipped in excrement.” They are not too far off. But sadder still was the assertion that there is no known cure for this fungal invader.
As I considered my new mushroom issue, I suddenly realized that there are interesting parallels with the healthcare system. Let me explain.
First of all, what does the average person do when they experience a new medical symptom/problem? The person goes online to research the symptom for possible diagnoses and treatment options. Is s/he successful? Sometimes yes and sometimes no. In my case, I could only identify one of the three types of fungi in my garden, even after finding this very nice mushroom identifier tool. Why wasn’t I successful? I’m not a fungi expert, and really didn’t know how to navigate my way through the complex descriptors required to correctly identify the little beasts. The questions included the following:
Fungus Website (FW): Is the spore color olivacious?
Dr. Val: What part of the mushroom is the spore, and what kind of olive are you referring to? I don’t know how to answer that.
FW: Describe the stem type. Is it lateral, rudimentary, or absent? Does it have a volva?
Dr. Val: Um… If the stem is lateral, does that mean it’s sticking out of the side of the mushroom? What makes a stem rudimentary? Does that just mean it’s not fancy? And as for the last question… that sounds kind of pornographic and I don’t think I’d know a fungus volva if I saw one.
FW: Can the pore material be separated from the flesh of the cap?
Dr. Val: What’s pore material?
FW: Is the mushroom edible, hallucinogenic, or poisonous/suspect?
Dr. Val: Well, it definitely looks “suspect” but there’s no way I’m going to test it out for poisonous or hallucinogenic effects.
And so it went. I tried to answer some of the identifier questions to get me to the correct fungal I.D. and in the end I received this message, “we were unable to find a match for your search.”
When patients try to find a diagnosis for their symptoms online, they will inevitably have a similar experience. Medical speak is like a foreign language, subtle differences between signs and symptoms seem obvious to experts, but can be opaque to patients. And even a very bright and educated consumer is bound to get lost in figuring out appropriate next steps. I’m a savvy woman, but when it comes to mycology (the study of fungus), I’m completely lost. How much more complicated is it to navigate the subject of human disease for those who don’t have formal training in medicine?
My point is this – medicine is incredibly complex, and a knowlegeable heatlhcare provider is critical in helping patients successfully navigate the maze. With all the health information on the Internet, it’s tempting to self-diagnose. But that’s a dangerous proposition – one that might lead you to presume that (to use my analogy) a poisonous mushroom is edible, or that a life threatening symptom is innocuous.
The Internet can be a great educational tool, but use it in conjunction with a close relationship to a trusted expert. If you don’t have a primary care physician, you can find one here. If you’d like to have your question answered by a physician online, try the Revolution Health forums. Not every question is selected for a professional reply, but many are. For a guaranteed response, eDocAmerica is a great resource.
Good luck, and I hope that your garden remains fungus-free. I’m now going to try to find a mycologist to tell me if it’s really true that there’s “no cure” for the dog stinkhorn. Unless any of you know the answer?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 3rd, 2008 by Dr. Val Jones in Expert Interviews
No Comments »
The following interview with Alzheimer’s researcher, Dr. Jeffrey Cummings, is a continuation of part 1…
Dr. Val: Tell me about the comorbidities associated with Alzheimer’s and how caregivers can prepare for them.
Dr. Cummings: Being a caregiver is a real challenge. It’s so difficult to take care of someone who may be incontinent, agitated, psychotic or depressed. All of these symptoms occur with increasing frequency as the disease progresses, and can challenge even the most devoted caregiver.
There are educational programs that can help to explain to caregivers where these behaviors are coming from, and can teach them how not to exacerbate the symptoms. For example, it’s important to avoid confrontation with the patient. If he or she doesn’t want to take a shower in the morning, then it’s better just to let it go.
Reducing friction between the caregiver and the patient has been shown to delay the time to nursing home placement, so there are behavioral interventions on the part of the caregiver that can be very beneficial.
Dr. Val: What can online companies like Revolution Health do to support patients with Alzheimer’s disease and their caregivers?
Dr. Cummings: We’ve learned that there are things that people can do to protect themselves against getting Alzheimer’s disease. This includes physical exercise (at least 30 minutes per day 3 times per week), active engagement in leisure time activities, eating a diet high in anti-oxidants (such as salmon, green leafy vegetables, and blueberries), avoiding head trauma (e.g. wear helmets while cycling), controlling high blood pressure, and controlling cholesterol.
It would be great if Revolution Health included all of these healthy lifestyle strategies in a comprehensive Alzheimer’s prevention agenda.
Dr. Val: Is there a role for the “brain games” movement in Alzheimer’s disease?
Dr. Cummings: That’s an interesting question – though I’ve seen very little data supporting brain games in particular. We do know that active intellectual engagement reduces the risk of Alzheimer’s disease, but once one has the disease, it’s less clear whether these kinds of programs can actually reduce progression. At the very least they may reduce agitation by active engagement of the patient, leaving less time for them to be unoccupied. I’d really encourage the people who are developing brain games to test them in well controlled trials. The games could be tested in the same way that drugs are tested.
*Listen to the full interview here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 27th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
1 Comment »
I attended the STOP Obesity Alliance press conference on May 22, 2008, in Washington, D.C. During the conference a new strategy to reduce obesity rates was announced — which provides employers with an obesity management benefit for their employees. I asked Carl Graziano, the vice president of communications for DMAA: The Care Continuum Alliance, to explain what this new benefit is and how it works. (DMAA was formerly known as the Disease Management Association of America.)
Dr. Val: How does the DMAA “prototype obesity benefit” work?
Graziano: The prototype is just that — a suggested approach based on the best available evidence on effective obesity interventions. While we provide a template for possible covered services and suggested pricing, it will be up to individual end users to tailor this benefit to their particular budgets, corporate cultures and values. Generally, we recommend three tiers of coverage, starting with enhanced primary care services, nutritional counseling and pharmaceuticals. A second tier would add treatment by an obesity specialist, and a third level would provide coverage for bariatric surgery and associated supporting services. Plan participants could be subject to an additional premium and co-payments for these services, as with other “riders,” such as vision and dental benefits.
Dr. Val: Which employers are planning to offer this benefit?
Graziano: We’re pleased to have the support of the Service Employees International Union (SEIU), which will consider our benefit approach as it develops coverage for its members. We expect that as experience with the benefit design and awareness grows, other employers will tailor it to their specific needs. As the STOP Obesity Alliance survey shows, while most employers believe in the appropriateness of obesity-related services, less than half say their companies devote enough attention to the problem of obesity. We believe this reflects a lack of guidance on how to provide obesity benefits, and that’s why we developed our suggested approach.
Dr. Val: What can people do to make sure that their employer offers this benefit or something similar?
Graziano: Because this benefit prototype will be freely available from and promoted by DMAA, we expect growing awareness of it among benefits managers over the next year — both through their own efforts to stay current on benefit design trends and recommendations from employees and others.
Dr. Val: How do we know that this program works? What outcomes have you demonstrated so far?
Graziano: Designing a formal approach to obesity benefits is largely uncharted territory, which is precisely the reason why DMAA saw a need to initiate research in this area. That said, our benefit design is strongly rooted in the best available evidence that interventions deliver high-value, positive outcomes. We are breaking new ground here, but we believe the benefit’s value-based approach offers the best chance of positive clinical and financial outcomes in a real-world setting.
Dr. Val: What’s the most important aspect that the public should know about the DMAA obesity benefit?
Graziano: It’s important that the public understand that personal behavior — eating healthfully, exercising and making other lifestyle changes — is essential to the success of any overweight or obesity intervention. While our benefit approach may ultimately contribute to new and expanded care options for the overweight and obese — a change that’s much needed in the face of a growing obesity epidemic — the commitment of plan participants to these interventions will play a large part in reversing the overweight and obesity trend.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
