More about Meat

Looks sort of pretty, right? But this scanning electron micrograph shows clumps of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Source: CDC

If you're concerned about the meat you eat, today's New York Times carried a must-read blog posting by Mark Bittman. It can be found here.

Some choice parts:

"A study earlier this year by a nonprofit research center in Phoenix analyzed 80 brands of beef, pork, chicken and turkey from five cities and found that 47 percent contained staphylococcus aureus, a bacteria that can cause anything from minor skin infections to pneumonia and sepsis, more technically called systemic inflammatory response syndrome (SIRS), and commonly known as blood poisoning — but no matter what you call it, plenty scary. Of those bacteria, 52 percent were resistant to at least three classes of antibiotics."

What does this mean? Fasten your seat belts...

"So when you go to the supermarket to buy one of these brands of pre-ground meat products, there’s a roughly 25 percent chance you’ll consume a potentially fatal bacteria that doesn’t respond to commonly prescribed drugs." 

Really? A one in four chance?

And it's all because of this:

"A staggering 80 percent of the antibiotics sold in the U.S. are given to farm animals, mostly, as I said, prophylactically: the low-dose drugs help the animals fatten quickly and presumably help ward off diseases caused by squalid living conditions. The animals become perfect breeding grounds for bacteria to gain resistance to the drugs, and our inadequate testing procedures allow them to make their way into stores and our guts." 

Sadly, the FDA, which is the government agency tasked with overseeing this issue, doesn't seem to have much regulatory bite when it comes to creating and enforcing strict regulations on antibiotic use in livestock. Therefore, it is up to consumers to reduce their risks of ingesting potentially fatal bacterial. The choices are clear: don't eat meat, or if you do, buy organic. Employing intense food hygiene and appropriate cooking practices at home can help, too. You can read more about how to reduce your risk of getting bacteria from meats here.

Remember, people, the best defense is a good offense.

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The Food Issue

I cannot remember an issue of the New Yorker than I enjoyed as much as the recent food issue (November 21, 2011). Unfortunately, the articles are behind a pay wall, and there is no way I can do the authors' marvelous writing justice by paraphrasing it, so if you're not a subscriber to the magazine or missed the issue at the newsstand, you'll just have to take my word for it. It was superlative.

But here are some teasers: There is an article by the indefatigable Calvin Trillin - truly a national treasure - explaining his signature dishes in his signature way. An article on apples  helped me understand the science (large cells!) of why the tasty HoneyCrisp apples and next generation SweeTango are juicier than other varieties. There is an article on coffee and one on foraging, that art of finding food in the great outdoors. I initially thought a New Yorker-length article on foraging would be boring and, honestly, I trudged into reading it with an "it will be good for me" attitude. Thank goodness I persevered, because the author approached the topic from a delicious blended perspective of travel writing, botanical science, and foodie insight that transported me far away from my urban kitchen table to a place where anything growing is potential food. After chewing on that piece for awhile, I realized why I was so enamoured with the entire issue of the magazine: it broadened my thinking about food. In fact, I raised my head from the page and looked out my window at my shady and sloping front yard and dreamt of raised beds strategically placed to catch the spotty sun and wondered how much it would cost to terrace the back yard.

Mark Bittman wrote recently in the New York Times that the United States, bestowed with some of the world's most perfect soil and climate to grow plants, imports more fruits and vegetables than it grows. Isn't that weird? Years of farm economics have pushed America's breadbasket, that great swath of Midwestern black soil, to become America's corn basket, at the expense of filling those baskets with the very foods we should be eating. If you've been following HealthTwisty, you know I was raised on a farm that created hybrid corn and beans for farmers to grow But when I was a kid, we did not focus solely on those two crops. We also raised wheat and oats, alfalfa and hay, with periodic forays into sorghum and sunflowers. When my grandparents were still active, the farm was still a sustenance place, where the people living there grew gardens, tended stands of fruit and nut trees, managed tracts of timber, and raised animals in addition to the row crops. I don't think my grandparents bought much at grocery stores other than paper products and baking and canning supplies, and, as they grew older and didn't want the responsibility of keeping a milk cow, dairy products.

I'm not idealizing that lifestyle because I know how much work it is. Well, maybe I am idealizing it a bit. But really, I just mention it in a roundabout way to exemplify the changes that have happened in just two generations of farming.

Which brings me to my point. Over those two generations, our food supply has become tragically narrow and it is to the detriment of our health, and our planet's health. Currently, there is a farm bill winding its way through Congress. The Environmental Working Group has posted a leaked copy of the bill here, but I don't know if it represents the most recent version. Even though the farm bill was originally initiated to help US farmers, it has evolved to the point where author Michael Pollan notes

"It isn't really a bill just for farmers. It really should be called the food bill because it is the rules for the food system we all eat by."

So we should all care what the farm bill says. The draft of the farm bill posted by EWG does have language about expanding support for fruit and vegetable growers, at least with federal crop insurance. And there is wording about limiting some subsidies and allowing others to expire with the current bill in 2012. Those are positive steps towards refocusing our nutritional attention on fruits, vegetables, and lean proteins. The 600-pound gorilla in the room, though, is the immediate concern of economically feeding the growing population of this country and the world. There are worries that the new farm bill will reduce the Supplemental Nutrition Assistance Program, aka food stamps, and few discussions about increasing access to fruits and vegetables. Farm economics are complicated and contentious, interwoven with politics and laden with big money influence. I don't have the answers, but I support those who are trying to come up with the win/win situations that will allow farmers to continue to practice their livelihoods and grow nutritious food that can be turned into reasonably priced products - including those used for energy - for consumers.

Since the debt committee has thrown up its hands, the farm bill will continue to be negotiated. In the interim, I urge you to find a copy of The New Yorker's food issue. The writing is delectable, to be sure, and the contents take you so far away from standard supermarket fare that you feel like you've been on a field trip to the bright side. Broadening our thinking about food allows us to dream, which then allows us to "begin with the end in mind," as Steven Covey famously laid out as an important step in intentionally starting on a new path. And that is my wish for Congress - please begin with the end in mind in creating a farm bill that can make good use of the farming resources this country offers in order to feed us all in a healthy way. That's all.

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Turkey!

By far, Thanksgiving is my favorite holiday. I love that the only thing you're pressured to buy is food, and the only thing you're supposed to do is be thankful (well, other than cook). No gifting, no stuffing candy in plastic eggs, no singing, no pine needles in the carpet. Just the F's: food, family, and friends.

But now we can add some additional letters to the holiday: M-R-S-A, as in methicillin-resistant Staphylococcus aureus. And MRSA is bad stuff. Because not only is the problematic bacteria that causes staph infections resistant to the antibiotic methicillin, it is becoming resistant to other antibiotics and it is showing up in more and more places. It left the realm of hospitals long ago, and now is common in locker rooms and sporting fields, and unfortunately, it is all over our food.

Ick.

I've written about this issue before, but not since last year. By all accounts, the situation is becoming more grim, with more types of supermarket meat containing drug-resistant Staph. Originally limited to pork products, these superbugs have been found also in beef, chicken, and, just in time for Thanksgiving,  turkey. Other strains of Staph aureus on meat have shown resistance to other antibiotics, including tetracycline (TRSA?). Maryn McKenna, over at Wired.com, follows this issue closely and keeps us updated on the decided lack of progress in addressing it. Here is her most recent report on the topic.

What can you do to reduce your risk of being exposed or infected by MRSA or other superbugs from your meats? Well, I think a reasonable approach is to treat your kitchen like it is a laboratory.

When you work in a lab, there are standard practices to avoid contamination and keep your samples sterile. While most home cooks will not keep a squirt bottle of ethanol handy to wipe down their stainless steel surfaces or work under a negative-flow ventilation hood, there are consumer-friendly practices to maintain a clean work environment in your kitchen and not spread bacteria that may be on your pre-cooked food to your work surfaces where it can then contaminate other foods.

As always, the first line of defense is prevention. Try not to bring MRSA-tainted meat into your home in the first place. That means buying meat derived from animals that were raised organically. They will not have have been fed antibiotics without reason and have a far lesser chance of harboring antibiotic-resistant bacteria.

Even mass-produced meats can be handled safely with a few extra precautions. For example, purchase a non-porous (that means no wood) cutting board specifically for meat. This board comes out only for meat and is put in the dishwasher immediately after meat is prepared on it. If you don't have a dishwasher, boil water and use that along with dishwashing soap to clean the board after use. The water has to be super hot in order to sterilize the surface. Same with the utensils you used to prep the meat.

Before you begin working with the meat, you may want to consider how to turn on your water with your elbow, or turn it on before you start working with the meat so you will not have to touch the handles (visualize surgeons scrubbing down and going into the operating room with their hands parallel to their bodies and pushing open doors with their bodies, etc). Handles are petri dishes for germs.

After you work with the meat and put the cutting board away, wipe down your counters with hot soapy water or a disinfectant, using a sponge dedicated for this purpose or disposable paper towels or wipes. Microwave the sponge, or put it in the dishwasher, after you have used it.

Then, wash you hands with soap and hot water. If you have cuts on your hands or fingers, or if your hands are dry enough to have cracked skin, consider wearing gloves when you handle meat. Bacteria living on the surface of your skin may not be a problem (except for spreading it around), but bacteria entering your body through a cut can be a whole different story.

Cooking foods properly will kill MRSA and other bacteria, so make sure the big holiday turkey is completely done before you take it out of the oven. And, I'd think twice about cooking stuffing inside the bird. There have always been concerns that the moist stuffing inside the bird is a breeding ground for bacteria, but now that bacteria is so much more dangerous, I just wouldn't go there.

What I've just outlined is merely an amping up of common-sense kitchen rules. But because of our overall lack of education in food preparation, I rarely see people practice them. If you do them diligently, they'll go a long way toward lowering your risk of contaminating your food with all sorts of  food-borne bacteria, not just MRSA.

So Happy Thanksgiving! Be safe and enjoy this meaningful US holiday.

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Counting Sheep

Today's New York Times carried an article on a topic that HealthTwisty intern Chelsea Leonard and I have been discussing: sleep deprivation. Even though Chelsea, a college sophomore, and I, a middle-age working mom, are at different stages in our lives, we share the same problems that interfere with sleep: high expectations for work (and schoolwork, in Chelsea's case), personal interactions, and volunteer time. And we both suffer from a love/hate relationship with the electronic devices that allow us to manage our ever-increasing to-do lists while simultaneously keeping us tethered to our obligations when we should be focusing on winding down for the day.

And it's not just Chelsea and me who have problems with sleep. The article in today's Times notes that over 15 million women aged 40 to 59 in the US had a prescription for the generic form of the sleep drug Ambien last year. That's a phenomenal number when you consider there are only about 43 million women in those age groups in the United States, which means over one quarter of them (us!) have a prescription for one specific drug. The problem is much, more worse when you realize that 15 million does not include prescriptions for Ambien itself, or for anti-anxiety or anti-depression meds that are used off-label to encourage sleep, or the over-the-counter meds, like Tylenol PM, or even the medicinal glass of wine that is commonly used to fall, and stay, asleep.

I'd say this is an epidemic. And it seems to be starting young.

Chelsea writes from the perspective of a college student:

"It seems like no one I know gets the amount of sleep they want or need. People are always preoccupied with one thing or another, and then end up spending the next day in a sort of lethargic blur. Sleep hygiene, a combination of regular sleep and good bedtime habits, feels like an impossible task sometimes. My doctor tells me to associate my bed with sleep only (and to watch TV, eat, and do work elsewhere). But I’m a little skeptical about this strategy. I spend so much time testing out new energy drinks, but have never tested ways to just get a good night’s sleep."

And because she is a neuroscience major, Chelsea is interested why we have problems sleeping and the results of sleep deprivation:

"There’s a pretty strong connection between the rise in Internet accessibility and decline in sleep. The problem is that sleep needs are biologically determined. The “sleep clock” is located in the brain’s hypothalamus region, and (unfortunately) hasn’t evolved along with technology. When this system is tampered with consistently, it actually leads to some serious physiological effects. The most obvious of these are memory and attention level. The biggest shock to me, though, was that a seventeen-hour day could have the same results on performance as a blood-alcohol level of 0.05%.  Some states impose penalties on drivers at this level. Lack of sleep probably isn’t considered a huge concern, with drunk or high drivers on the roads, but nearly one in every ten 25-35 year olds reports falling asleep at the wheel in the last month alone. That’s a big deal. Lack of sleep is not only a health concern for the individual, but is becoming a safety concern for people around them."

So how much sleep do we need? Chelsea's research turned up this information:

"Of course, a good night’s sleep is based on what you need at your age. The National Sleep Foundation notes that newborn babies need around 18 hours of sleep a night, whereas adolescents can function perfectly well on only 9-10 hours. For adults, the general consensus is about 7-9 hours. The amount of sleep a person needs depends on two components: their basal sleep need (the hours of sleep needed for optimal performance) and sleep debt (loss of sleep due to restfulness, etc). An easy way to tell if you’re getting the sleep your body needs is how long it takes to fall asleep at night. If it takes you less than five minutes to fall asleep at night, your body needs more rest! If you’re the type of person, like me, who shifts around for a while, consider what’s keeping you up. Often, it’s too much screen time before bed or preoccupation with the day’s worries."

The National Sleep Foundation offers these tips for falling, and staying, asleep:

• Establish a regular bed and wake time
• Avoid nicotine altogether and avoid caffeine close to bedtime
• Avoid alcohol
• Exercise regularly (but complete the workout at least 3 hours before bedtime)
• Establish a consistent relaxing “wind-down” bedtime routine
• Create a sleep-conducive environment that is dark, quiet and comfortable
• Discuss the appropriate way to take any sleep aid with a healthcare professional.

However, Chelsea notes,

"A lot of commonly recommended sleep tips aren’t practical for me in my schedule. I can’t block out all noise, because I have night-owl roommates, and I don’t like herbal tea or warm milk. But there are definitely some reasonable strategies for better sleep. No one needs a can of Coke before bed, or a three-hour nap around dinnertime."

As for me, I've found the most effective way to get a good night's sleep is to vigilantly guard my time. This means saying no to too many volunteer tasks; to ensuring that all members of my family share in the details of our lives, such as making sure everyone has haircuts, or good food to eat, or is ready for the day ahead; and to ensuring that I have at least an hour of down time before going to bed at a regular time. By decreasing my mental clutter, I have found it easier to stay asleep without waking to fret over the myriad details of work and family life.

And a final word from Chelsea:

"If everyone consciously tried to get a good, consistent night’s sleep most days of the week I’m sure it would reduce most of the stresses that kept them up at night in the first place."

I think she's right about the Catch-22 of sleep - we often wake up to worry, then worry about worrying. A good night's sleep can help put it all in perspective.

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Occupy Every Street Until We Get It Right

This whole Occupy Wall Street thing has really sucked me in. At first, it was an abstract concept, and I was all, "Go, activists! Get out there and wave some signs." Honestly, I thought it was a tilting-at-windmills type of thing. Now that it has been going on for awhile, I've taken a deeper look, including reading the compelling companion blog, "We are the 99 percent." You'd have to be a cold person, indeed, if you are not moved by story after story of massive student debt, no decent job prospects, the unfulfilled desire to work, the lack of health care, the lack of health care, the lack of health care. I applaud all those brave souls who are sharing their realities in hopes that the collective power of their stories will reach those who can make a difference.

A common theme that emerges from those stories is that people who feel squeezed place their health low on their list of priorities. Totally understandable - you've got to live somewhere and eat, and feed the kids if you have them, so buying your diabetes medicine that costs $400 per month may not seem as urgent. It's short-sighted, definitely, but these stories make clear that long-term thinking has being pushed aside in order to take care of immediate necessities.

Our government is in such dire straits that I don't look for it to solve all these problems (except for health insurance: shame on those who consider health care a privilege only for those who can afford it). And I think we can't live in the past: Seth Godin, an entrepreneur and writer, is quite clear in documenting that the old way of work is not coming back. The jobs we've lost may be gone for good. That means we have to think different (intentional shout out to Steve Jobs). I've also been reading more about putting our money where our mouths are. Supporting the companies in the stock market means supporting business as usual, which means tacit support of bizarrely outsized pay for CEOs, even if they do a bad job and are fired. What about investing in local businesses? Community banks or credit unions versus multinational banks? Is this the revolution - individuals, one at a time, choosing to take their toys and play elsewhere while increasing their self-sufficiency so that perhaps we may not need the jobs that seem to be gone?

The only thing I know for sure is that game has changed and a lot of people are caught playing by the old rules. No one is looking out for your best interests but you, so you might as well take control. And that means control of your health, too, so you can stay out of the "doctors' pockets," as one of my grandmothers used to say. Also? If you are doing OK and you know people who aren't, there is no better time than now to pay it forward.

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Home Ec: It's Not Just for Dummies (and it never was)

Embarrassing memory: When I was in high school, I wasn't very respectful of my fellow students who took home economics ("home ec"). After all, I had places to go and I was in a hurry, and my schedule of math, science, and literature did not allow me the time to take home ec.  I'm afraid I was fairly dismissive of what was actually being taught in those classrooms on the second floor that housed stand mixers and sewing machines.

And now? Now I see what a total dummy I was.

Because all those life skills that were taught in home ec either didn't happen for me, or they happened in a haphazard, on-the-fly type of way. You know all those beautiful end-of-summer fruits and vegetables that are currently available? I can only enjoy them in season because I don't know how to preserve them with anything other than the most basic freezing techniques. Canning actually scares me - and I don't scare easily.  I know how to plan meals economically only because I watched my mom do so and I learned through trial and error once I had a family. I've never figured out a cleaning cycle that allows everything in every room in my house to be clean and tidy at the same time. I spend a fortune having my clothes altered. So, yeah, I'm afraid the home ec students are having the last laugh on me.

Of course, many of these tasks can be outsourced, which I, and many of my friends, gladly do. But hiring people costs significant money and without the basic how-to knowledge we can never really oversee the tasks we hire out. In other words, we are at the mercy of the maids, the dry cleaners, the tailors, and the local grocery stores to tell us the best way to clean a bathtub, to remove a red wine stain from an heirloom tablecloth, to hem our  pants or shorten our sleeves so that our clothes look like they were made specifically for us, or to supply a quick meal on the go. We've lost some important control in our lives by not knowing how to do basic life skills.

An interesting article in the New York Times makes the case that bringing back home ec might be good for another reason: to combat obesity. And I think it has merit.

Home ec is where individuals learn the science behind healthy eating - why fruits and vegetables and lean proteins should be the centerpieces of all meals, as well as how to shop, prepare, and store foodstuffs so that a roast chicken enjoyed for Sunday dinner becomes fajitas on Tuesday and finally soup on Friday. That's the economics part of home ec. It sounds like common sense, and it is, but only after you've learned the secrets of cooking and repurposing. Without those keys, your head may be turned by seemingly economical foods (and fake foods) that may offer immediate satiation, but can't go the distance to feed a family for three or more meals.

I come from a long line of home ec'ers. My grandmothers were masters at creating good food for their families with seasonal, local ingredients (their own!) and in preserving those ingredients so that long winters did not mean a lack of vitamins from nutritious foods. My mom,  who holds a degree in home economics/early childhood education, taught meal planning and preparation to women with low incomes and big families. Even my grandfather got involved during the Great Depression and World War II by teaching urbanites how to plant and grow gardens (Victory Gardens!). Side note: times were so difficult during the Depression that my grandfather recounted how families would eat the beans they were given to plant rather than have the patience to plant them and reap an entire crop.

So, even as our schools have become better at AP classes and IB programs, perhaps there is still room in our education system for the life skills that home ec can provide. After all, even if you don't know how to turn on your kitchen appliances, you still need to eat. Fortunately, there are online blogs and resources rushing in to fill the voids in our knowledge. These resources cover everything from tracing the source of a mildewy smell in your home to figuring out how long to cook a turkey. And Martha Stewart is perhaps the most famous home ec'er of all, creating an entire industry around the arts of home making. But you have to seek out those resources rather than have them imparted as part of a well-rounded education. Personally, I think learning the basics of real food vs processed food, how to plan and cook meals, and how to read labels may make a positive difference in addressing the growing roundness of the citizens of this country. At the least, it's food for thought about the tools we all need to live healthy, practical lives.

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Apples Don't Fall Far From the Tree

Chart of the Weasley, Potter, Malfoy, and Scamander families,
courtesy of Harry Potter Lexicon

Where did you get that red hair?

One kid I knew growing up was taught to say "from the mailman" in response to that question, because neither of his parents had red hair. But there were relatives in their extended family tree with the same phenotype - red hair and blue eyes - indicating that those recessive traits were being carried throughout the generations, but waiting to be matched with other recessive genes in order to become apparent. Because the truth of the matter is that we are all genetic combinations of our parents, grandparents, and beyond - combinations that result in physical traits that are recognizable from generation to generation.  But what lies beneath the surface - our health traits - is just as easy to spot if we think about it.

Therefore, today's HealthTwisty comes with an assignment: create a family tree. Not just one with names and dates of births and deaths, but one that includes all the health and occupational information you can mine from your family. These intergenerational facts are actually clues to your own health and can provide a road map on how to protect or enhance it.

If you've poked around HealthTwisty for awhile, you know that personal genetics or susceptibilities are the basis of much of the information here. Choices about food and our environments can work for or against our basic genetic make up, so it is important to know the genetic hand we are dealt. After all, we can't change our genetics (yet). But we can change our environments.

To get started, here are some things I'd include in a family medical history:

• names, gender, dates of birth and death of first and second-degree family members.
• causes of death.
• known illnesses, allergies, and conditions, such as cancers, a penicillin allergy, arthritis, or infertility.
• mental health issues, such as depression, addiction, or alcoholism.
• inborn genetic issues, such as Downs syndrome or cystic fibrosis. 
• learning issues, such as dyslexia.
• unusual family traits, such as eyes that are different colors, premature greying, or a shock of white hair, all of which could signify underlying conditions.
• occupations, which could account for or contribute to some diseases.
• place of residence, such as a farm, an urban setting, or the suburbs.
• anything else of interest.

This exercise is just a riff on what a good family physician asks about during a comprehensive exam. In recognition of the basic importance of knowing one's family history, CDC offers a computer program where family members can record and share their histories. CDC even has a campaign running in this season of family reunions that encourages people to seek health information while they are gathered together. While researching resources, I found out that the US Surgeon General has declared every Thanksgiving since 2004 as "National Family History Day" for this exact purpose. Who knew?

It's an interesting exercise. I've done a medical history for my grandparents and parents and my husband's parents and what we know of his grandparents, as well as for my husband and myself. By mapping it out, I was reassured that for the most part, both sides of my family and one branch of my husband's family generally live into their 90s in reasonably good health. But we have a lot to watch out for: different branches of our families have autoimmune diseases, cardiovascular disease, or eye problems like macular degeneration and glaucoma. Because so many of those conditions  have things you can control (like body weight to prevent diabetes) or can be screened for in order to facilitate early treatment, there are measures we can take to minimize our risks of developing them or to catch them early if they do occur.

Of course, the way genes combine is not always straightforward, which means that biology does not always equal destiny. In other words, just because one of your parents developed cancer does not mean you will. The concept of how complicated genetics can become was brought home to me years ago when I attended and wrote the report for a conference on sex and gene expression. This extremely technical conference focused on the differences in development and disease by sex and in the ways genes can be expressed. One interesting aspect called crossing-over occurs during the meiotic phase of cell division. The end result of this process is that we inherit large chunks of DNA from our grandparents. Therefore, examining your grandparents' traits may be as important as your parents' in determining your genetic make up.

Further, it is established that diseases such cancers need a series of mutational hits to form, so merely the presence of a genetic mutation that puts you at higher risk does not mean a cancer will develop.  This is why it is important to consider the environmental aspects of family members' diseases. For example, if you have a grandfather who died from lung cancer, it would be good to know if he smoked, if he worked in the construction industry where he may have been exposed to asbestos, or if he was a lawyer exposed to nothing more harmful than fumes from the copy machine. If he smoked or worked with asbestos, chances are those external factors caused his lung cancer and therefore you are not at increased risk of developing it (as long as you don't smoke or work with asbestos!).

This type of observation costs nothing more than your time spent in putting it together. You can also opt to spend some money and purchase a personalized genetic test. For about $100-$500, you can find out risk factors for certain diseases, the presence of carrying a heritable disease, and how you might react to certain drugs.

For the most part, these tests tell you that you may have the genetic makeup that predisposes you to something, but can only provide a relative chance that disease will actually develop unless the disease is a genetically dominant, like Huntington's Disease. Further, there are many steps involved in gene expression that are not captured by a recitation of the base pairs.  However, overall, these tests can be very useful - especially if you don't have information on your birth family.

Making a family history of health is not a quick process. Many people only remember what relatives died from, but not illnesses or conditions for which they may have been treated during their life. Or they may not think it important to recall that Grandpa Joe immigrated from an impoverished country where he was malnourished during his early years - a factor that could help explain his short stature and weak bones. So some probing and detective work may be required. Even only mapping your immediate family can be beneficial and may provide information to better manage your health. If you have kids, giving them a family health history can be important, not only for their current health, but in the future as the field of genetics advances in great strides.

In honor of the final Harry Potter movie, I chose the illustration at the top of this article that maps out the family trees of some of the most well-known wizards of our time. But there's nothing magic about genetics (even though there are surprises, like red hair popping up every now and then) and making a family health history can take away some of the mystery behind illnesses or just plain not feeling as well as we should. Using these clues to make sense of our own health and adjusting our environments accordingly is something even us Muggles can get behind!

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Maybe it's Not All in Your Head

Para nuts, fresh from the rain forest, at the outdoor market
 in Belem, Brazil

Everyone knows that food can cause all sorts of physical effects on our bodies. Sugary desserts can cause cavities, sodas can leach calcium out of our bones, and too many carbs can make us soft and push us toward diabetes. None of that is disputed.

What is disputed, and is a topic of ongoing research, is the effect certain foods have on our mental health. There is a growing body of evidence showing that for certain individuals, some foods can cause mental fogginess, depression, anxiety, and can aggravate more severe mental issues, such as schizophrenia. The flip side to that cause and effect is that removing the offending foods may allow individuals to alleviate their symptoms and eliminate or reduce certain medications - a very promising concept.

Before I go on, a quick fact: did you know that about 10% of all adults in the United States (and about 2% of all children - yikes) have prescriptions for anti-depressants? And that number doubled between 1995 and 2005 (coinciding with the advent of direct-to-consumer advertising, by the way). So there are a lot of people out there being medicated for depression.

Let me state up front that I believe some individuals do have brain chemistries that can benefit from anti-depressants. And for those individuals, medications can be lifesaving. However, I am suspicious that 1 in 10 adults in the United States need an anti-depressant. Therefore, I do wonder if there are commonalities in our environments, like, say, an intolerance to wheat or dairy products, or an inability to process ever-increasing amounts of sugar, that affect the brains in individuals with susceptibilities to those products.

There is a lot of interest in the food/brain connection.

Recently, Alice Bradley, the talented writer of the blog Finslippy, wrote about her new diet that eliminated wheat, dairy, sugar, and grains, and focused on fruits, vegetables, and protein. After only a few weeks, she was able to wean herself off of Remeron, Klonopin, and sleep meds, retaining only her prescription for Prozac. If you Google "wheat and depression," you get 11,900,000 hits. Google sugar and depression and you get a whopping 30,600,000 hits. Part of the interest in sugar can be traced to Gary Taubes' fascinating New York Times article on the perils of sugar.

However, once you delve into the research behind the claims, you are quickly confronted with a wide divide between medical professionals who believe food intolerances can cause all sort of mental problems and those who pooh-pooh the entire concept, chalking up any gains made in mental health from altering one's diet to the placebo effect. It's confusing.

A lot of the confusion comes from the research not catching up to the anecdotal evidence. Mental health is difficult to quantify because symptoms are, for the most part, self-reported. Depression and anxiety can vary from person to person and treatment success often boils down to, "I feel fine." But the fact that the placebo effect exists tells us that there are still many mysteries in medicine that cannot be fully explained by science.

Despite the problems with quantifying mental health, there has been compelling information published on how the gut is like a "second brain," with its own nervous system operating independently of the brain. A new field, neurogastroenterology, has been proposed to better understand how the gut mediates the immune response, and there are even murmurings of psychiatry expanding to include treatment of this second brain in addition to the one the field currently focuses on. (Side note: sounds a bit like holistic medicine, no?).

Further, research on the different antibodies, IgE (immediate ones associated with hives and anaphylactic shock) versus IgG (delayed ones associated with food intolerances, a concept that current medical practice does not fully embrace), is plodding along. Fascinating stuff from an academic perspective. But frustrating when you are interested in the practical application of the information. Thus far, no one has scientifically mapped out why foods being digested in the gut can have effects on the brain. So a lot of medical professionals are skeptical of any food/brain effect link.


But I don't think you need clear-cut answers in order to move ahead with managing your health. If you are being treated for anxiety or depression you might want to talk to your doctor about trying an elimination diet to determine if some of the common allergens, such as wheat, dairy, or soy, could be underlying or contributing to your condition.  Here is information on elimination diets, and a good nutritionist can guide you through the challenges of what may at first seem to be a daunting task.

I look forward to the emerging research that will map out how our second brain interacts with our "first" brain. Until then, I think there is enough information to encourage us all to look closely at the link between our diets and our mental health.

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The Green, Green Grass of Home Part II

Just a few weeks ago, I wrote about lawn chemicals and their effects on children's health. Today I learned that that EPA's science advisors will be delivering the results of a two-year study on atrazine, one of the most common weed killers used in the United States. You can weigh in on this issue over at Takepart, the advocacy arm of Food, Inc. Lots of good links on that page, too.

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This is So Bad

Trust for America's Health and the Robert Wood Johnson Foundation have released their annual obesity statistics, and they're not pretty. See that map above? See how it's mostly red? That means over 25% of the adults living in those states in 2010 were not just overweight, but obese. Kids don't far much better. Click here for the children's obesity map, as well as interactive maps for both populations, and the full report (fittingly titled "F as in Fat: How Obesity Threatens America's Future").

What's even more shocking to me than the high percentages of obesity is how quickly the rates are rising. Eight states have obesity rates that are over 30%. Just four years ago, only one state was above 30%.

The report outlines troubling racial and economic disparities - more African Americans and Latinos were obese compared to whites, and more people making less than $15,000 per year were obese compared to those making more than $50,000 per year.

I'm not sure we can legislate ourselves out of this mess. A junk food tax might help pay for the end result of all the medical care that obesity-related conditions require and might dissuade some from purchasing sodas. Better labeling might enable consumers to see how much sugar is in certain foods by grouping all the sources of sugar together, for example. And subsidizing fruits and vegetables might help bring the costs of those important foods down. But the answer still comes down to education and choice. Unfortunately, changing behaviors is one of the most difficult public health challenges to take on, especially after those behaviors have become the norm. For example, if everyone you know snacks on sodas and chips, it is normal. You are odd if you choose fruit or yogurt. If you are surrounded by overweight people, that becomes the new normal for your community, which means it is accepted and even supported in the options available. Slim people may have trouble finding clothes that fit and healthy foods may be even scarcer as merchants cater to the tastes of their clientele. Those barriers are difficult to overcome.

Do you think changing the food labels like the Center for Science in the Public Interest suggests below will help? (Here is the report from which this image was taken.)



Michelle Obama is trying to bring attention to this issue, and kudos to her for using her platform as First Lady for this issue. States are trying to address the problem through school lunch nutrition guidelines and other legislation. But the problem just keeps getting worse. Any ideas?

Update: If you can't view the graphic for the food label, following the link to the report. The graphic is on page 10.

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The Green, Green Grass of Home

My neighborhood is very diverse when it comes to yards.

Directly across the street from me lives the former president of my state's organic farmers society. Because his front yard gets a lot of sun, he has transformed it into a yard/garden, with tomatoes, peppers, squash, eggplants, sunflowers and more. He has planted fig trees, locust trees, and blueberry bushes. When I walk my dog past his yard in the mornings, my movements flush out indigo buntings, yellow finches, and cardinals. There are good caterpillars that turn into blue butterflies, and bad caterpillars that eat the tomatoes. There are bees to pollinate the plants, and rabbits that sneak in to nibble the greens. It is a lively place if you look closely.

At the other end of the yard spectrum are the perfectly green, perfectly clipped lawns.  The chemical trucks show up a couple times each month to visit these lawns. The drivers spray the lawns and then stick little warning signs in them noting that children and pets should stay off of them for at least 24 hours. Even though it is dangerous to walk barefoot on them, these lawns look inviting, like outdoor carpets. When I walk my dog past those lawns, I don't startle many birds.

Other lawns are somewhere in the middle. They do not receive regular pesticide applications, but the owners use chemicals periodically to treat acute problems, like fungus, or use fertilizers to boost the blooms of ornamentals.

But by far  the outdoor carpet yards outnumber the others by a significant amount in this neighborhood. 

That's unfortunate for a number of reasons. Our neighborhood is beautifully hilly. When it rains, the runoff from all of our yards drains into storm sewers and creeks. Many of those chemicals that children and pets are warned against walking on eventually end up in the water supply, where they have to be (one hopes) removed. But before they are, those chemicals affect the wildlife that live in or drink from the creeks. When we first moved to this neighborhood years ago, we would see crayfish and minnows in the creeks near our house. I can't remember the last time I have seen any forms of life in them. I try my best not to let my dog drink out of them.

But the problems with the chemicals are not just in our water supply. We can breathe them in when they are sprayed, track them into our homes, and get them on our hands when we pick up baseballs that have been hit into the next yard. Our pets pick them up on their feet, and then they lick them off (did you know up to 50% of dogs develop cancer in their lifetimes? While not all canine cancers can be attributable to lawn chemicals, some probably are. Here is a veterinarian-written article on the risk of various chemicals to our canine friends.) I've come to view these yards as dangerous to my family's health as second hand smoke.

More and more research is showing that those green carpet lawns are wildly dangerous to the environment and to humans - especially children. ADHD, autism, and cancers are just a few of the terrible endpoints that have been linked to lawn chemicals, with headaches, rashes, and asthma, and many other health problems occurring frequently enough to serve as warning signs that something serious is amiss. Recent news noting that environmental factors play a role as large, if not larger, than genetics in autism should have everyone scrambling to remove as many impurities as possible from their personal environments until more is known about this issue.

The United States birth defect rate by month of LMP
versus atrazine concentration.
Source: Winchester, et al.
Acta Paediatr. 2009 April; 98(4): 664–669.

There is so much research on this topic! The graph to the right was published in a 2009 study. Even a grade school kid can see that the months that the concentrations of the weed killer atrazine were highest in surface water is associated with birth defects in kids conceived during those months (LMP stands for last menstrual period and is a marker for conception).

This chart is for atrazine only, which, coincidentally, is banned in many European countries and parts of Canada (the US periodically considers banning it, but never does). Chalk up another instance where our European friends have made it a priority to protect the health of their citizens. In the United States, the northeastern states, such as New Hampshire and Connecticut are leading the way in restricting the use of lawn chemicals. For example, in 2005, Connecticut banned lawn pesticides around daycare centers and schools out of recognition that children should not be playing on them. I think that's a great start.

Choosing to go pesticide free does not mean you are signing up for a patchy eyesore of a lawn. There is a lot of knowledge to tap into, and a lot of tips and techniques to create a green lawn that is indistinguishable from one that uses pesticides.  Here's a nice article from Organic Gardening that offers tips on a healthy lawn. Beyond Pesticides supplies information on lawn care, fact sheets, and "Tools for Change" to work with your neighborhood and policy makers to tighten up control measures for unnecessary pesticide application.  Even the Environmental Protection Agency encourages integrated pest management for lawn care, which includes the use of some chemicals for problems, but stresses the use of beneficial insects to counter harmful ones.

What does my lawn look like? Well, it's a mix of sod and other green things, like clover (obviously we're in need of nitrogen). It was originally all sod, but an unfortunate sewer line incident caused part of the sod to be replaced, and the replacement ground cover didn't completely take. This green mix is quite pretty when it's mowed to a uniform height. (We're not fooling ourselves when we think it's pretty - the EPA notes that the average consumer thinks lawns consisting of up to 15% weeds look fine.) We use dirt from our compost bin to fill the beds where our herbs and flowers live. If you dig into those beds, you'll find lots of worms. I'm thinking about getting one of these signs. After all, the birds in my yard need a place to rest, don't you think? 

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And Vegetables for All

Scrolling through the stats of this blog, I noticed that I was getting an unusual amount of traffic from Austin, Texas. Concerned that my Austin-based friend Erin had fallen asleep with her head resting on the "refresh" button, I followed the URLs back to their sources.

Turns out Erin was responsible for the bump in traffic, but not because she was reading my blog. She had graciously linked to me as an an example of how individuals can support small organic farmers, while also helping out families who cannot afford the fresh vegetables, fruit, eggs and meats from those sources, all from sitting in front of their computers hundreds of miles away.

There is a good story here.

A little over 5 years ago, Erin and her husband Skip embarked on an adventure to fulfill Skip's lifelong dream of being an organic farmer. This was no easy decision - both Erin and Skip had lucrative careers in a big city, an enviable house in an even more enviable neighborhood, two beautiful children who were poised to walk to the high-performing elementary school in their neighborhood. Life was good, and many people would have stopped there and just let it play out.

But something was missing for Erin and Skip. Ever since the two had known each other, Skip had cultivated a backyard garden, volunteered at local community gardens, took classes on organic gardening, raised chickens (yes, in the backyard), and just generally pined to do all that full time. The couple knew that if they didn't make the break and try to live their dream that they would be too old to make the change. So in a now-or-never, incredibly gutsy midlife move, they sold their house, packed up their stuff, and moved to Austin, TX, where Erin had family.

They found a small homestead to rent, with a centuries-old farm house built by the Swedish family who settled there and a few acres to farm. They started small, with vegetables and flowers, then expanded into more vegetables, heritage pigs, chickens that lay softly-hued eggs, sheep, goats, ducks, and more.  Faster than you can say Old McDonald, they had created a real, working farm that they called Green Gate Farms in honor of the green metal gate at its entrance. Last year, they purchased beautiful acreage on the Colorado River to expand their operation. Their delicious vegetables and humanely grown meats grace the menus of some of Austin's most highly regarded restaurants and their farm has become a destination for families who want their children to know where real food comes from.

But the heart of their operation - and of every organic farm's operation - is the community supported agriculture plan (CSA). Subscribers to the CSA get weekly or bi-weekly boxes of seasonal vegetables and flowers and can add on meats, eggs, and milk. Because the CSA is a subscription service, it provides a baseline of income for the farmers and allows them to plan their budgets for the seasons. The farm markets, special events, and restaurants are important for revenue, but only the CSA provides an idea of how much money the coming year will bring. It is as close to a salary as these farmers will come.

Erin with Callie, an orphaned goat.

The down side of a CSA subscription is that it can be pricey. After all, subscribers are committing to a generous weekly ration for an entire growing season. And that priceyness runs counter to one of the goals of the farm: to provide healthy foods to those who need it the most.

Green Gate Farms in located in an area that is not wealthy and where there are many working-class families. Further, Austin, like most American cities, has a significant rate of childhood obesity and chronic diseases, like diabetes, that could be prevented or helped by good nutrition. Erin and Skip wanted the public health aspect of good food to have a wide audience. So, in an effort to accommodate individuals with different incomes, they developed a "workshare" program, where people can work on the farm in order to get their vegetables. But for some people that is not enough. Erin has heard from many families in the area that they are too busy juggling multiple jobs and children to volunteer at the farm in order to get their shares. In response to that need, Erin and Skip instituted another program, one where anyone, anywhere can sponsor a CSA share for a family.

Thus began the Sponsored Share program. If you contact Green Gate Farms at this link, you can sign up to support a local family for the duration of the CSA season. The plan is beautiful because you are also supporting a small, family farm, the type that we desperately need to provide us with the healthiest seasonal produce imaginable, as well as humanely raised meats, free-range chickens and eggs (truly free range - those chickens have a lot of space to move around in), and milk products.

Some of the happy critters at Green Gate Farms

I like this program because Erin could tell me about the family that receives my donation (no names, just number and ages of the children, the mom's desire to get them the best food possible). I firmly believe that childhood nutrition is one key element to producing kids who are ready to learn and in preventing future diseases, so I was delighted to put my money where my mouth is and donate a share that will supply this family with excellent food.

Take a tour around Green Gate Farms' web site. Peruse the blog (bonus: both Erin and Skip have been professional writers for national publications and organizations. They make all that farm stuff sound really darn good). Importantly, they are committed to getting their healthy foods to some of the people who need it the most. I think it's a great model that is worthy of support no matter where you are.

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Can You Hear Me Now? Part II

I had no idea how timely my recent post on cell phones was until this story began moving across the wires.

Just one day after I shared my concerns about kids and cell phones, as well as the measures my family has put into place to minimize exposure to the non-ionizing radiation that they emit, the World Health Organization/International Agency for Research on Cancer (IARC) issued a press release noting that it was classifying such radiation as "possibly carcinogenic," just like some industrial chemicals and a few viruses, such as the human immunodeficiency virus and certain strains of the human papilloma virus.

Here is the IARC classification chart for various agents, with non-ionizing radiation assigned a 2B level.

The WHO/IARC issued a press release prior to the report being published, which is an unusual sequence of events in scientific circles. The report is scheduled to be published in The Lancet Oncology in its July 1 issue and will appear sooner online, perhaps as early as this week.

While the risk of cancer is low from agents in the "possibly carcinogenic" category, it makes sense to reduce your exposures when you can. Additionally, I would think individuals with a family history of brain tumors or other brain disorders, such as epilepsy, would be wise to practice extra precautions. As for children, well, perhaps all those countries that restrict sales or advertising of cell phones to tweens and younger and encourage headsets (France), encourage texting instead of talking (Finland), or even recommend against their use for kids under the age of 18 (Russia) are worth emulating. Fortunately, the chairperson of the WHO/IARC working group that authored the study, Jonathan Samet, MD, from the University of Southern California,  is a member of the United States' National Cancer Advisory Board. The NCAB advises the National Cancer Institute on its research agenda so perhaps Dr. Samet will encourage the United States to become more active in researching this type of radiation, especially its effects on our youngest citizens.

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Can You Hear Me Now?

During this graduation season, the gift of choice for the younger set seems to be a cell phone. By younger set, I'm talking about those kids graduating from elementary school or junior high and moving on to the next step.

A few years ago, this pint-sized arms race of communication technology would seem laughable. But with ever-more affordable phones and (seemingly) economical family plans to run them, most kids I know end up with a cell phone somewhere during their junior high or early high school years. The convenience of having your kids wired can't be beat - knowing when the school's game bus is nearing campus so you don't have to cool your heels waiting or easily locating your kids at crowded venues like outdoor festivals are huge pluses. (I'm purposefully ignoring the benefits my kids associate with cell phones - access to friends, texting, and access to friends.) Yes, cell phones are incredibly useful to organize family life.

But I have my concerns.

And these concerns are shared by others, ranging from governments to health agencies to cancer researchers. For years, in fact for as many years as I've been communicating science, there have been concerns about the effects of radiation from cell phones on the brain. And those concerns are especially acute for younger people, whose skulls are not as thick as those of adults (especially around the ear), which means that their brains, replete with their quickly replicating cells, are exposed to more radiation than an adult's.

No one is sure what these higher levels of radiation exposure mean. After all, we're talking about the usually benign non-ionizing radiation rather than the shorter, more intense waves of ionizing radiation that x-rays or radioactive materials emit. However, even though non-ionizing radiation is much less problematic overall, what is a problem is our increasingly higher and longer exposures to these sources. In other words, the source is less dangerous, but we are exposing ourselves to it for longer periods of time over many more years than ever before.

The EU, which is conducting a large, multi-national, case-controlled study focusing specifically on kids called Mobi-Kids, has a nice primer on electromagnetic fields here.

So what does the science tell us about cell phones and health risks?

Well, cancer surveillance tells us that brain cancers in young people, while still rare, are increasing in frequency. There are many possible reasons, including nutrition, family history, and exposure to chemicals, but non-ionizing radiation has not been ruled out as a contributing factor. Cancer aside, it is well documented that rates of attention deficit disorder and autism, both due to brain differences that were likely triggered in utero, are rising as well. And then there are worries about radiation's effects on other sensitive, still-forming parts of the body, like reproductive organs, especially for guys who often carry their phones in the front pockets of their pants.

To date, this has been a difficult field to research, and much of the research is sponsored by cell phone manufacturers. As a result, the findings are all over the place. Even the American Cancer Society (ACS) noted one of the largest studies to date just complicates the debate because it found heavy cell phone users had lower overall rates of brain cancer, but higher rates of a specific type of brain cancer called glioma. And what was considered heavy cell phone usage at the time of the decade-long study would not be considered heavy use today. The ACS concluded, not surprisingly, that more research is needed, especially for children because they were not included in this large study.

A recent report published in the Journal of the American Medical Association found that glucose metabolism was higher in the brain in areas nearest the cell phone antenna after a 50-minute conversation on a cell phone. No one is speculating what "increased glucose metabolism" means other than a change in brain activity, but it does show that the radiation does have some effect on normal cellular functioning.

Currently, the general consensus among respected organizations, such as the World Health Organization (which, incidentally, sets standards for radiation for mobile devices, as does our FCC), is that there is no evidence of adverse effects from the radiation from devices such as cell phones. However, many of these same organizations hedge their bets by offering tips for reducing personal exposure from those devices.  Sort of a "buyer beware" type of situation.

What's a parent to do?

Personally, I've adopted the tactics of the WHO by assuming a reasonable level of safety with these devices, but practicing precautions nonetheless.

For example, I shopped around and found phones that emitted lower levels of radiation. CNET, which provides tech products reviews, compiled a list of cell phones and their radiation outputs here.

I'm encouraging my family to practice "safe cells" to reduce the amount of radiation they're exposed to by

• limiting the time spent talking on cell phones
• holding the phone away from their heads when talking
• using headsets to create distance from the radiation-emitting phone
• opting to text rather than talk
• being aware of how many bars are in use - the lower the number of bars, the harder the phone has to work, i.e., the more radiation it emits, in order to connect to a tower. Similarly (and counterintuitively)...
• skipping the radiation "shields," which reduce the connection and force the phone to transmit at a higher power, with more radiation 
• carrying the phone away from their bodies, for example, in a backpack, rather than in a shirt or pants pocket
• not sleeping with it turned on near their heads, which means not using it every night for an alarm clock on the bedside table

This New York Times article offers additional ideas for reducing radiation exposure from cell phones.

This issue is being taken seriously by countries around the world. For example, in France, cell phones cannot be advertised to children under 12, they must be sold with hands-free extensions, and there are limits on radiation emissions. In Germany, low-emission phones carry a seal of approval. Finland advises that children should stick to texting rather than talking. The UK's National Radiological Protection Board recommends that children only use cell phones for essential phone calls. Perhaps the most strongly worded warnings come from Russia, which not only mentions cancers may be associated with  electromagnetic radiation, but also epilepsy, nervous system disorders, and immune disorders. In fact, the Russian National Committee on Non-Ionizing Radiation Protection recommends that children under the age of 18 and pregnant women not use cell phones at all.

The WHO, along with various countries, recently convened an international conference in Slovenia on non-ionizing radiation and children. The report will be issued soon and one hopes it will provide some clarity between Russia's dire warnings and the United States' laissez faire attitude.

But, as with every generation, it seems while the adults are busy fretting and the scientists are figuring out how to study an issue, the kids have moved on. What I've noticed from my older kid is that texting is more popular than talking on cell phones, and that Skype seems preferable to sitting with a phone on your ear for those extended, middle-of-the-night conversations. And really, at this point, the main known health risk of cell phones comes not  from radiation, but from automobile accidents caused by drivers distracted by the phones. So perhaps the concern about radiation is a red herring that diverts us from the real threat of cell phones - fragmented attention - but at this point, no one really knows.

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Zombie Apocalypse!

Regardless of whether you think the world is coming to an end on 5-21-2011, you have to admit that  floods, hurricanes, and other natural disasters happen all too frequently. Just this week, we heard heartstring-tugging stories from individuals who lost everything when a bloated Mississippi river swallowed their homes and towns. A few weeks ago, the earthquake and the resulting tsunami in Japan brought home how quickly nature can destroy civilization - some of the videos I saw showed the progression from dry streets to entire blocks of buildings being washed off their foundations in about 6 minutes.

That's not a lot of time to grab important documents or mementos and to flee the area, or to communicate with loved ones how or where to meet up if you are displaced from your home. That's why organizations, such as the US Centers for Disease Control and Prevention (CDC),* encourage people to think about what they would do if faced with a flood, hurricane, or other natural or man-made disaster in advance of any event actually happening.

Currently, the CDC is running a sort of corny, sort of weird, but ultimately extremely useful campaign for disaster preparedness. By getting our attention with, of all things, warnings of a zombie apocalypse, the government then proceeds to offer very practical advice on  how to prepare for events that could dramatically affect your life.

The site contains useful tips, such as what to put into an emergency kit that everyone should have in their house. Rations of water, food, and other necessary supplies (such as medicines) can get you and your family through the first few days after a disaster when there may be no power or if the roads are impassible. Did you know the recommended amount of water to stockpile is 1 gallon per person per day?

Emergency kits are not just for use in the house - CDC also recommends stocking the kit with copies of important documents in case you have to leave your house quickly. Having copies of your drivers license, insurance information, birth certificate, and so on located in one place makes it much easier to quickly leave a dangerous situation, and also to replace originals or to get appropriate help if, for example, someone is injured and urgently needs medical care.

The site also counsels on a family emergency plan - where you would go in an emergency and how you would get there. Every family should consider this practical issue and select a place to meet if you get separated, whether it is in the front yard by the mailbox, or a location outside of your neighborhood if you are unable to return home.

No one wants to think about the worst that could happen. But CDC's message is a good one - by preparing in advance for the unthinkable, you have a better chance of surviving a disaster and an easier time rebuilding your life after one. Go here to learn more about how you can prepare for and stay safe during an emergency.

CDC knows what it is talking about. This boots-on-the-ground organization sends public health professionals around the world to help countries deal with emergencies. Go here to learn more about CDC's emergency activities and how it responds to disasters around the world. Did you know that part of CDC is actually a branch of the military? The US Public Health Commissioned Corps is one of the seven uniformed services of the United States and consists of 6,500 health professionals that deliver the Nation's public health promotion and disease prevention programs.

Ben Franklin was right: An ounce of prevention is worth a pound of cure. So invest a little time in thinking through scenarios and preparing for the worst. And then you can hope for the best, secure in the knowledge that you will be as ready as possible.

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* Disclosure: CDC, but not this particular center (it's a big place!), is one of my clients. 

Snack Attack

Real fruit at the outdoor market, Belem, Brazil

When my kids were in preschool, it was routine to be assigned certain weeks of the school year to be "snack parent," which meant you were in  charge of purchasing snacks for the entire class for those weeks. Most parents, no matter how overworked and undernourished ourselves, tried diligently to be creative with snacks. Maybe not as creative as these bento-packin' mamas, but most of us tried to find interesting and nourishing foods for our kids to carry to school in the class-assigned snack basket.

We recognized that the purpose of the mid-morning snack was to refuel the kids by providing nourishment that would allow them to focus, follow directions, and play for a few more hours. Some protein, some fruit, a carbohydrate or a vegetable if you could swing it. Just a midmorning snack.

But there were always those parents who thought daily snacks should be like a party. You know those parents...the ones who would bring one huge muffin from a wholesale warehouse for each child, even though those muffins could feed four preschoolers and are just cake in disguise. But the worst offenders were those who brought Fruit Roll-Ups for the fruit part of the snack.

Now, the parents at this preschool were an educated bunch, and I'm fairly certain no one really thought there was any fruit at all in a Fruit Roll-Up. But they would say things like, "But the kids like them!" (Translation: "I want the kids to like me!") I could always tell when one of my kids had a Fruit Roll Up because of the tell-tale blue or green or red lips and tongue and the equally colorful irritation that would be following him around like a cloud.

The folks over at Fooducate, one of my favorite food blogs, have deconstructed another type of "fruit" snack. Check it out. The labels on these are especially mis-informative, tricking the unaware into thinking these snacks are much healthier than they really are. The masterful marketing ties into a well-known juice brand and tries for the halo effect by associating this completely manufactured food with the family farmer, thus implying natural and healthy. Because parents need a PhD in label reading to get past the slick marketing, I bet these snacks make regular appearances in the snack baskets at preschools across the country. What do you think?

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What the World Eats

During the process of researching something else entirely, I ran across this fascinating slideshow.

The photos, by Peter Menzel, are from the 2007 book "Hungry Planet: What the World Eats," which documents what families around the world eat in one week. Faith D'Alusio is the writer.

The week's worth of food is arranged, often in the family's kitchen, with the family standing or sitting around it, so you can see how many individuals are in the family, and their relative ages. It's eye-popping to see a family of six in a refuge camp, sitting with its meager portions of grains, nuts, fruits, and water (for $1.23 per week) neatly displayed in front of them, and then flash to a family of four from North Carolina surrounded by piles of sodas, chips, and holding pizzas in a box for a $341.98 weekly expenditure.

Because the reporter includes the price per week each family spends on food, it's not difficult to make the connection between packaged food and higher food costs. Those eating closest to real foods - fruits, vegetables, grains, fish - have much lower food costs. But other details in the photos make clear that packaged foods are associated with a higher standard of living, as judged by the families' kitchens, their clothes, and the televisions.

Like I said, fascinating.

What would your photo look like? Just imagining what my family's weekly food allotment would look like all lined up on the counter makes me want to practice better nutrition.

And there's more: here's a second slideshow from the book.

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