A major initiative to promote health and lower the burden of chronic diseases among the South  Asian  population ( people with their origins in India, Pakistan, Bangaladesh, Nepal, and Sri Lanka) was organised in Fraser Health Authority in 2010. The prevalence of chronic diseases amongst South Asians is very high, some 3 to 4 times that of the  general population. The common non communicable chronic diseases are diabetes, hypertension, cardiovascular diseases, stroke, and chronic renal diseases. These conditions represent a major population health issue.

The conference was organised by Canada India Network Society and co hosted by Fraser Health Authority  and Simon Fraser University The proceedings and full recommendations are available on www.thecins.org.

Among chronic diseases prevalent in South Asians diabetes is major concern,. It is estimated that in BC alone the direct cost of diabetes to the  population is approx 776 million dollars and predicted to rise some 75% by 2016.The conference provided a comprehensive approach to possible solutions. Thus, besides academic research, clinical management, and technology,  the major emphasis was on health promotion, and public health issues. The prevention of disease has to be a major component of any strategy to lower the burden of chronic disease. Specifically for the South Asian population life style changes such as increased physical activity and reduction of caloric intake were key recommendations. The South Asian diet which has high salt and soluble (simple) carbohydrate may be a key factor in the  high prevalence of diabetes amongst the South Asian population.

The conference also encouraged the practice of Yoga as having a significant role in life style factors and suggested that  a holistic approach to health should be promoted.  Further infromation contact Dr Arun K Garg CoChair for the CINI 2010 (arun.gargfraserhealth.ca)

What is air pollution?

Pollution refers to the introduction of materials into a natural environment that causes harm. Air pollution refers to the introduction of chemicals, particulate matter, or biological materials into the atmosphere at levels sufficient to be potentially harmful to human health, animal and plant health, or the environment. The atmosphere is a mixture of colourless, odourless gases that surround the earth. This mixture of gases is referred to as air and is essential to human life. Pure air is primarily a mixture of nitrogen (78%) and oxygen (21%) with the remainder of air consisting of small quantities of many other gases including carbon dioxide, water vapour, and even argon.

Where does the air pollution come from?

Air pollution is not a new concept and has probably been around, and affected human health, throughout history. Smoke exposure occurred early through the use of indoor fire for cooking and heat. Industrialisation brought in new types of pollution (power plants, automobiles) and the subsequent centralization of humans into urban areas, along with unprecedented growth of some of these areas into “megacities”, led to air pollution on massive scales. More recently concern has been raised about the health effects of indoor air pollution generated by humans and arising from the building materials used to construct our homes and places of work.
Sources of pollution vary from region to region, but in BC the most common sources of air pollution arise from transportation (motor vehicles), outdoor burning, indoor burning (wood stoves), industry, and construction.

What are the major sources of outdoor air pollution?

Air pollutants can generally be grouped into four major categories including: 1) common air contaminants (examples include: particulate matter [PM], nitrogen oxides [NO], sulfur oxides, carbon monoxide [CO], ammonia [NH3]), 2) persistent organic pollutants (dioxins), 3) heavy metals (mercury), and 4) air toxins (benzene, polycyclic aromatic hydrocarbons).

In BC the most significant air pollutants are particulate matter and ground level ozone.Particulate matter refers to small particles present in the air that range in size from microscopic to some that are visible with the eye. These particles are measured in micrometers [um] (one micron = one millionth of a meter). The size of the particle determines how far it will travel inside the airways of our lungs, with smaller particles travelling further distance. Larger particles are filtered from the air by hairs in our nose and mucous within our airways. Particles less than 2.5um are referred to as PM2.5 and are of the greatest concern because they bypass our natural filtration and get deposited very distantly in our lungs where they cause inflammation associated with multiple health issues. Particulate matter can occur naturally, such as ash from a volcano, or can come from human activity such as burning fossil fuels to run an automobile.

Ground level ozone is not a single chemical or gas, but rather is formed from a chemical reaction between nitrogen oxides [NO] and volatile organic compounds [VOC] such as methane, benzene, and toluene. These chemicals are largely the result of fossil fuel combustion and ground level ozone typically builds up during the warmer months of the year in urban areas with high levels of NO and VOC. At low levels ground level ozone is not a problem, but at higher levels, ground level ozone becomes a key component of smog and is associated with health problems.

What are the major sources of indoor air pollution?

Canadians spend approximately 90% of their time indoors, so understanding indoor air pollution is essential. The major types of indoor air pollution include: biological contaminants, combustion by products, volatile organic compounds, asbestos, and radon.

Biological contaminants include bacteria, viruses, fungi (moulds), insects (mites, cockroaches), animal dander, dusts, and pollens. Not all biological contaminants cause disease, but if small enough, they can be inhaled and lead to health problems. Bacteria and viruses can lead to infection. Other particles, such as moulds, pollens, and dander can lead to hypersensitivity/allergic reactions and cause symptoms such as wheeze, cough, difficulty breathing.

Combustion by products consist of gases (such as carbon monoxide [CO], carbon dioxide [CO2], nitrogen oxide [NO]) and particulate matter from incompletely burned fuels such as wood, coal, oil, and propane. Common sources for this type of pollution include woodburning stoves, furnaces, generators, fireplaces, car exhaust, and cigarette smoke.

Volatile organic compounds [VOCs] consist of several gases that are emitted from materials commonly found in homes and buildings. Formaldehyde is one of the most common VOCs and is present in buildings materials such as particle board, plywood, and foam insulation. Concentrations of VOCs are typically much higher indoors than outdoors, particulary in poorly designed buildings with inadequate ventilation. There are innumerable sources for VOCs which can include paints, varnish, printer/copying machines, and textiles. The health effects caused by VOCs depend on both the length of time exposed and the level of exposure. Typical symptoms can include: headache, nausea, dizziness, airway irritation.

Asbestos is a mined mineral that was used historically as an insulator and fire retardant. It is not commonly used commercially anymore but can still be found in buildings around hot water pipes, furnaces, and ceiling/floor material. Asbestos does not pose a health risk if it is not disturbed or deteriorating and releasing fibres into the air. Fibres from asbestos can be inhaled into the lungs where they become trapped and cause low levels of inflammation. Asbestos exposure is associated with several lung conditions including lung cancer, mesothelioma, and fibrotic lung disease (asbestosis).

Radon is a colorless, odourless, radioactive gas released naturally from trace levels of uranium found in the soil. Radon levels vary substantially from region to region and are more problematic for subterranean dwellings such as basements. Typically levels released are so low that they are of no concern, however, concentrations can build up substantially in enclosed, indoor spaces and lead to adverse health effects. Short term exposure is not a problem, however long term exposure is associated with a small increased risk of lung cancer. Radon is measured in units called Becquerels and can be measured by commercially available in-home devices.

How do we measure air pollution?

Air pollution can be measured and is monitored in various regions depending on public resources. In British Columbia the provincial government uses several different techniques to measure outdoor air pollution including monitoring stations, mobile instruments (on planes and trucks), and industrial smoke stack monitors. Not all forms of air pollution are monitored, but common contaminants measured include particulate matter, ground level ozone, carbon monoxide, sulfur dioxide, hydrogen sulfide. Raw data from these monitoring stations is used for various publications and reports as well as for air quality indices. An air quality index is a method of reporting air quality to the public Different indices exist and in BC include the Ventilation Index, Air Quality Index, and Air Quality Health Index (AQHI). The latter is a public information tool that measures the most common air pollutant levels (particulate matter, ground level ozone, and nitrogen dioxides) and estimates the short-term, relative risks posed by the combination of these pollutants and provides health messages that individuals and care-takers can take to limit short-term exposure to air pollution.

How does air pollution affect health?

The effects of air pollution on human health are vast and highly variable, ranging from a sense being unwell to death. Depending on the type of pollution and level of exposure, air pollution has been associated with short-term (cough) and long-term health effects (risk of heart and lung disease, cancer).

The most common effect of air pollution is respiratory complaints including cough, nose and throat irritation, and shortness of breath. Those with pre-existing respiratory diseases (such as asthma or chronic obstructive pulmonary disease [COPD]) are at increased risk of worsening symptoms during air pollution outbreaks leading to increased rates of hospital admission. Typical air pollution levels in Canada, and BC in particular, are not felt to be a major contributor to asthma exacerbation.

Air pollution can also affect other areas of the body. Carbon monoxide exposure for instance, can dramatically impair our body’s ability to transport and utilize oxygen, a condition called carboxyhemoglobinemia. Depending on the severity of exposure, symptoms can range from nausea, headache to seizures and coma.

Air pollutants such as ozone and nitric oxide, have been linked to increased rates of clinically significant respiratory tract infections. Nitric oxide in particular has been shown to impair immune system function against viral and bacterial infections in animal models.

Fine particulate matter (particularly PM2.5 or less) has been linked to increased rates of stroke, heart attack, and even death. Research in this area has shown that particulate matter exposure leads to systemic inflammation and the development of plaque within the arteries, a condition called atherosclerosis.

Asbestos and Radon are defined as respiratory carcinogens as exposure has been linked to a small, increased risk of developing lung cancer. The association between cancer and other types of pollution such as particulate matter and VOC’s is less well established.

Where can I go for more information?

World Health Organization:

• Air quality and health: http://www.who.int/mediacentre/factsheets/fs313/en/index.html
• Air Quality Guidelines (Desktop): http://www.who.int/phe/health_topics/outdoorair_aqg/en/index.html

Health Canada:

• Air Quality Health Index: http://www.ec.gc.ca/cas-aqhi/default.asp?lang=En&n=CB0ADB16-1
• Documents: http://www.hc-sc.gc.ca/ewh-semt/pubs/air/index-eng.php
• Health Effects: http://www.hc-sc.gc.ca/ewh-semt/air/out-ext/effe/health_effects-effets_sante-eng.php

BC Ministry of Health:

• BC Air Quality: http://www.bcairquality.ca/index.html
• BC Air Quality Health Index: http://www.airhealthbc.ca/default.htm

BC Health Link:

• Dr. AM Young MD, RCPSC (UBC Pulmonary Medicine Fellow) Saving Health Care Fraser Health Authority Environment: http://www.healthlinkbc.ca/healthfiles/environment.stm#Environment01

BC Lung Association:

• Air Quality: http://www.bc.lung.ca/airquality/airquality.html
• Canadian Medical Association: No Breathing Room Report (2008): http://www.airhealthbc.ca/default.htm

What can we do to prevent these injuries?

1. Wearing seatbelts is the law in BC and it saves lives!
2. All children aged 12 and under should ride in the back seat when in a car.

Infants (0-1 year old): * Use infant-only car seat or rear-facing convertible until the infant weighs at least 20-22 lbs. * Harness straps should be at and below shoulder level. * Never put an infant in the front seat of a car with passenger side airbags. Toddlers (1-2 years old): * Forward -facing car seat for toddlers weighing over 20 – 40 lbs. Preschoolers (3 – 4 years old): * Forward-facing car seat until preschooler weighs 40 lbs. * Forward-facing belt positioning booster seat for preschoolers over 40 lbs. * Belt positioning booster seats must be used with both lap and shoulder belt. 5-14 Years Old Young children should graduate from car seats to booster seats. Booster seats are required until the child is age 9 and 4’9″ tall and 80 lbs. *Older children and teenagers wear seatbelts

1. Strict adherence to the speed limits at all times, special attention to speed limits on school and playground zones.
2. Do not drive impaired. Plan ahead and get home safely. Take the bus, call a cab, arrange for a designated driver or call a friend or a family member for a ride.
3. Wearing a helmet while biking, skating, skiing, snowboarding, and skateboarding can prevent serious head injuries and may save your life!

Everyone can help prevent serious trauma by taking an active part in maintaining their safety and the safety of those around them.

References:

• 1. Vos PE, Battistin L, Birbamer G et al. EFNS Task Force. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. European Journal of Neurology. 2002;9:207-219.
• 2. .(2003).Heads Up. Facts for physician about mild traumatic brain injury. National Center for Injury Prevention and Control. Center for Disease Control and Prevention. Atlanta.
• 3. McCrea M, Kelly JP, Randolph C et al. Immediate neurocognitive effects of concussion. Neurosurgery. 2002; 50(5):1032-1042.
• 4. Kushner D. Mild traumatic brain injury. Toward understanding manifestations and treatment. Archives of Internal Medicine. August 1998;158:1617-1624.
• 5. Ingebrigsten T, Romner B and Knock-Jensen C. Clinical management update. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries. The Journal of Trauma: Injury, Infection and Critical Care. 2000;48(4):760-766.
• 6. .(2003). Head Injury. Triage, assessment, investigation and early management of head injury in infants, children and adults. Clinical Guideline 4. National Institute for Clinical Excellence. Downloaded from http://www.nice.org.uk/pdf/cg4niceguideline.pdf in June 30, 2003.
• 7. Van der Naalt. Prediction of outcome in mild to moderate head injury: a review. Journal of Clinical and Experimental Neuropsychology. 2001;23(6):837-851.
• 8. Phillips LA, Voaklander DC, Drul C, Kelly KD. The epidemiology of hospitalized head injury in British Columbia, Canada. Can J Neurol Sci. 2009; 36(5):605-11.
• 9. D.E. Konkin, NR Garraway et al. , Population-based analysis of severe injuries from nonmotorized wheeled vehicles. The American Journal of Surgery 191 (2006) 615–618
• 10. Pirouzmand F. Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. J Neurosurg Spine. 2010;12(2):131-40.

Links:

• BC Injury Research and Prevention Unit http://www.injuryresearch.bc.ca/index.aspx
• BC Injury Prevention Centre http://www.injuryfreezone.com/index.php
• Fraser Health Concussion Clinic http://www.injuryresearch.bc.ca/documents/Fraser%20Health%20Concussion%20clinic%20brochure.pdf
• Safe Kids Canada http://www.safekidscanada.ca/
• World Health Organization Injury Prevention http://www.who.int/violence_injury_prevention/en/
• Public Health Agency of Canada-Injury Prevention http://www.phac-aspc.gc.ca/inj-bles/index-eng.php

What’s Happening to our Health?

In the year 2000, for the first time in human history, the number of overweight people in the world rivalled the number of underweight people. (While the world’s underfed population had declined slightly since 1980 to 1.1 billion, the number of overweight people had surged to 1.1 billion.) The Worldwatch Institute in Washington, DC noted that “Often, nations have simply traded hunger for obesity, and diseases of poverty for diseases of excess.”¹ They also emphasized that both the overweight and the underweight suffer from malnutrition!

Obesity isn’t just a problem of aesthetics. The World Health Organization states that “obesity and overweight pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease (which can cause heart attacks, strokes and kidney failures), hypertension … and certain forms of cancer.”² The U.S. National Cancer Institute warns that “cancers of the colon, breast (postmenopausal), endometrium (the lining of the uterus), kidney, and esophagus are associated with obesity. Some studies have also reported links between obesity and cancers of the gallbladder, ovaries, and pancreas.”³. Obesity has also been linked with some autoimmune diseases⁴ (e.g. asthma⁵, rheumatoid arthritis⁶, gout⁷), possibly through a hormone, leptin, produced by fat cells.^{8, 9} And there are well-documented relationships between obesity and many musculo-skeletal disorders like knee osteoarthritis.¹⁰ Apart from the risk of premature death presented by some of the above diseases, they all decrease our functional health and the potential we have for enjoyment in our lives.

The United States now has the fattest population in the known history of the world, and Canada isn’t far behind. While North America’s life expectancy gradually increased over the last hundred years (due mostly to improved sanitation, vaccinations and immunization technology as well as increased access to an evolving medical treatment system) it may be about to start decreasing. Some experts are predicting that both longevity and healthy lifespan may be decreasing now, and that our children may become the first generation to live shorter lives than their parents.¹¹ Why? What has gone wrong?

How did we get to this point?

1. We became separated from the origins of our food.
   Our ancient ancestors were omnivores, living off the land by foraging for berries and edible plants, and hunting wild animals. Then farming began about 10,000 years ago, probably first in “the Fertile Crescent” – areas that now form Turkey, Iraq and the Middle East¹². Farming freed many people from having to hunt and gather. In turn, this allowed occupational specialization. For example, some people could become soldiers to defend their communities and barter their services for food from the farmers. And this specialization has continued to increase until today, when most of us have nothing to do with the production or distribution of our food.
2. We became sedentary.
   Technology has changed the nature of the specialized work that we do, so that today most people no longer have to spend hundreds of calories a day doing physical work.
3. 3. Food production became subsidized.
   Western governments made conscious, mostly well-intentioned decisions to subsidize the production of food, thereby decreasing its cost to the consumers in an attempt to ensure that even poor people would be able to afford enough to eat. But there would be many unintended consequences of this approach which are still being felt today! (For example, farmers in many Third World countries, whose governments cannot afford to provide subsidies, cannot compete with western producers and their subsidized and more efficient large-scale operations.)
4. The profit motive became dominant.
   Small farmers began selling their farms to corporate conglomerates, increasing efficiency through economies of scale. This resulted in increased food abundance, but there was a cost! Mechanical planting and harvesting increased crop production, but required a great deal of fuel energy. Chemical fertilizers became necessary to overcome depleted farmland, and pesticides were used to protect huge swaths of identical crops from predators. For livestock, the efficiency of crowded pens stimulated the use of biological treatments like antibiotics to prevent the rapid transmission of disease, while growth hormones were often used to maximize the weight of the livestock animals. Agribusiness took over the production and distribution of our food, and the financial bottom line became more important than our health, the environment, or the humane treatment of our livestock animals.
5. Food became dependent on oil.
   Mechanical planting and harvesting, automated processing and mass transportation to the wholesalers and retailers improved our access to food but required more fuel energy, so that by the early 1970’s it was taking more than a calorie and a half of fuel (oil) energy to produce one calorie of food energy¹³. The first oil crisis in 1973 drew attention to this difficult-to-sustain predicament.¹⁴ It has become much worse today! For example, each calorie of iceberg lettuce imported by plane to the U.K. from the U.S.A. takes 127 calories of aviation fuel¹⁵.
6. Food became abundant.
   The combination of government subsidization and agribusiness “efficiencies” resulted in food abundance (at least in western democracies) and low prices (when fuel costs remained low).
7. Healthy foods became inconvenient.
   With chemical fertilizers and pesticides becoming more necessary for industrial agriculture, and with more preservatives required for the longer transportation distances and the increasing retailer shelf life required by our now international food supply system, our foods became unhealthier. Organically grown whole foods gave way to processed and packaged commodities. And the competition for food profits increased the emphasis on taste, with the instant gratification of saturated fats and simple sugars leading the charge.
8. “Fast” foods became convenient.
   While most of us are no longer involved in growing, harvesting or distributing our food, our busy lifestyles have even made it difficult to find the time and energy to prepare our foods. We have become seduced by the concept of “fast foods” and the ubiquitous advertizing engaged in by these profitable businesses.¹⁶ McDonald’s, Wendy’s, Burger King and other fast food chains now dominate the urban commercial landscape (particularly in poor areas!). We are no longer intimately involved with what we eat.
9. Portion sizes increased.
   Abundant cheap food and the need for restaurants to compete against each other resulted in ever-increasing portion sizes in restaurants and, ultimately, in the expectations of our brains.

10.  Food advertizing became ubiquitous.
Not only did food become abundant, but so did the advertizing of it by fast-food outlets, restaurants and grocery store chains. Even when we’re not eating, we are constantly presented with images of food in our environment. Magazines, television and billboard ads constantly present images of food that appeals to our taste buds.

11.  Behavioural Changes
A series of cultural changes occurred that, often by accident, increased the likelihood of our becoming fat and unhealthy. For instance, a century ago eating was a social activity, often involving friends and family sitting around a table eating and talking. The talking would slow down our eating, giving time for stomach stretching (due to the food eaten) to turn off our hunger. Today, we are much more likely to be eating alone, often when we’re hungry, and we’re likely to gulp down our food quickly before giving time for our feedback mechanisms to let us know that we’re full. Another example is eating while watching television. Like Pavlov’s dogs, we may begin to associate the two behaviours so that eventually, whether we’re hungry or not, we may want to eat every time the television is turned on.

12.  “Foodies” perverted the virtues of taste and presentation.
While the taste and presentation of foods is of course an important component of how and why we eat, many famous chefs, food reviewers and other celebrities have focussed exclusively on these characteristics while ignoring the environmental costs of their favourite dishes (e.g. shark fin soup) and the horrific animal abuse that is involved (e.g. as with veal and foie gras).

13.  Propagation of unscientific myths.
In the 19^th century, protein was synonymous with meat. Early scientists like the German Carl Voit (1831-1908) found that “man” needed only 48.5 grams/day, but he recommended 118 grams/day.¹⁷ (He obviously came from the “If something is good, more is better!” school of thought.) Well-known nutrition researcher Max Rubner stated that “a large protein allowance is the right of civilized man,”¹⁸ (hmmm! Food is a right?) and that protein intake (to him, meaning meat) was a symbol of civilization. The cultural bias was set. If you were rich, you ate meat. If you were poor, you ate staple plant foods like potatoes and bread. For over half a century now, the meat industry has promoted their products in often unsavoury ways, first by suggesting erroneously that meat protein was superior to plant protein, and more recently by vacuously associating meat consumption with masculinity and sex appeal. (A 2010 Taco Bell television commercial for the chain’s Bacon Club Chalupa has one attractive young woman giving advice to another: “Men like bacon!”)  The dairy industry has perpetrated its own misleading self-promotions over the last few decades, coming close to stating that mothers are not looking after the health of their children if they’re not giving them cow’s milk. (Did millions of years of evolution really make us dependent on the milk of another species?) As a result of all this nonsense, western nations shifted towards a diet comprised much more heavily of animal protein. And now developing countries are insisting on making the same mistakes we made!

Back to Basics:

Our food is broken down into the following nutritional components:

1. Carbohydrates
2. Fats
3. Proteins
4. Minerals
5. Vitamins and Phytochemicals
6. Water
7. Dietary Fiber (*technically not a nutrient but very essential for good health)

These components provide the following basic functions:

1. Energy
   Energy is provided by the first three components (carbohydrates, fats and proteins), although the human body will only use protein as a fuel during very long-duration exercise (e.g. marathons and iron-man triathlons) or in cases of under-nutrition and starvation. While we always burn a mixture of fats and carbohydrates at rest and during exercise, carbohydrates (in the form of blood glucose and stored muscle and liver glycogen) are the preferred fuel for shorter and more intense exercise, while fats (from triglycerides stored in our muscle and adipose tissue) become dominant in lower intensity, longer duration exercise. Carbohydrates and fats are both made up of carbon, hydrogen and oxygen. When we take in more carbohydrates and fats than we burn, the excess calories are stored as fat in our adipose tissue.Carbohydrates and proteins are capable of providing 4 kcal of energy per gram, whereas fat can provide 9 kcal/gram (more than twice as much!). Fat is therefore considered to be a dense form of energy storage for the body, although it requires more oxygen to be oxidized than does carbohydrate.
2. Body Building and Repair
   Body building and repair require protein and minerals. Like carbohydrates and fats, protein is also made up of carbon, hydrogen and oxygen, but protein has nitrogen as well. Our bodies cannot store extra protein, though, so when we take in more than we can use at the time, our kidneys throw away the nitrogen as urea (uric acid) and we store the other chemicals as fat. Remember, excess calories above metabolic requirements, regardless of the source, become fat. (This process largely explains why gout, the “disease of kings”, frequently occurs in people who have diets too rich in protein. The pain of gout is caused by a build-up of uric acid in the joints. These people are often fat as well!)Minerals are also required for body building and repair, but the relationships are often complex. For example, adequate dietary calcium is important for bone health, but we also require vitamin D and repetitive forces on the bones (e.g. through exercise) in order to encourage bone growth in children and to maintain bone density in adults. Without vitamin D and repetitive forces, we will not be able to adequately use the calcium in our diet.
3. Protection
   Fat is important not just as a fuel, but for protection as well. It is a component of the membranes surrounding all cells and protecting their contents, limiting what can get into the cell. A small amount of fat surrounds many organs in our bodies, providing insulation and padding protection. Fat is also used to make hormones. (Female endurance athletes sometimes lower their body fat to the point where they no longer produce estrogen and their menstrual cycles temporarily stop. This can lead to problems retaining calcium in the bones.) And fat is used to run our immune systems. (Extreme endurance athletes whose fat levels get too low seem to have increased frequencies of colds and flues.) While we make fat (too much of it these days!) from excess calories, it is important to have some in our diets.Vitamins are organic substances (meaning they contain carbon, oxygen and hydrogen) but they cannot provide energy directly (i.e. they have no calories). However, they are important for protection in that they are catalysts for many of the chemical reactions that are necessary for us to live. They must be included in our diets because the body can’t make them. It is better to have vitamins in the food that we eat, rather than as vitamin supplements. However, a once-a-day vitamin supplement is probably a good idea for people whose diets are less than ideal, particularly if they’re not getting enough fresh fruits and vegetables.The relatively “new news” has to do with substances called phytochemicals (there are thousands) which are found naturally in plants and which help them to protect themselves from bacteria and disease. Some act as antioxidants, limiting and repairing cell damage caused by free radicals. Others act as hormone-like substances to help block the enzymes that promote the development of cancer and other diseases. There are many whose functions we do not yet fully understand.

A great deal is known about the seven nutritional components listed above, so the following paragraphs will only outline some general principles regarding each component.

Carbohydrates

Carbohydrates come in the following forms:

When carbohydrates are digested they enter the blood as glucose. The simple carbohydrates are digested quickly and can increase blood glucose levels quite rapidly, prompting the pancreas to secrete insulin which moves the glucose into the cells for use as fuel or, if not required, for storage as fat. People who are constantly eating simple carbohydrates (junk food, pop, etc.) will not only store increased fat from the excess calories, they will also have chronically high levels of blood insulin, which can lead to type 2 diabetes. The speed with which carbohydrates increase blood glucose levels is called the ‘glycemic response’ and scientists have created the ‘glycemic index’ as a measurement of how fast different foods will raise blood sugar levels, as is shown in the diagram below. Much information on this topic can be found at the Australian home web site of the Sydney University Glycemic Index Research Service (http://www.glycemicindex.com/).¹⁹

Foods with a high glycemic index “spike” the glycemic response, often resulting in a “pancreatic overshoot” (i.e. the pancreas sends out too much insulin, with the result that blood sugar levels may fall below what they were before the ingestion of the carbohydrate). Eating complex carbohydrates (especially when accompanied by some proteins and fats) slows down the glycemic response and prevents this rush of insulin. Also, foods high in complex carbohydrates are likely to have other important nutrients like minerals, vitamins, phytochemicals and water (instead of just “empty calories”).

Fats

Cholesterol is a derived fat; a waxy steroid lipid found in cell membranes (to protect the cell) and transported there in the blood from the liver (where it is manufactured). Unfortunately, it is a primary constituent of the plaque that builds up on the walls of blood vessels in people with cardiovascular disease, and so high blood levels of cholesterol are thought to be a risk factor for heart disease and strokes.

Lipoproteins are compound fats (fats combined with protein). They are vehicles for transporting fat and cholesterol in the blood (which is water-based!). Low density lipoproteins (LDL) carry cholesterol from the liver (where it’s manufactured) to the cells of the body, and high levels of LDL are considered to be bad. High density lipoproteins (HDL) collect cholesterol from the body’s tissues and bring it back to the liver (thereby getting it out off the blood vessels). High levels of HDL are considered to be good for health, keeping blood cholesterol levels low.

Saturated fats consist of triglycerides containing only molecules that have no double bonds between the carbon atoms. They are solid at room temperature. Most animal-derived fats (meat and dairy products) are saturated, as are a few plant fats like coconut oil and palm oil. They tend to raise blood cholesterol levels and thus have been associated with the development of cardiovascular disease. Although some recent research casts doubt on the strength of that relationship, ²⁰ it is prudent to reduce dietary saturated fat in light of many animal studies and previous human studies suggesting these risks.

Unsaturated fats have one or more double bonds in the fatty acid chain. A fat molecule is monounsaturated if it contains one double bond, and is polyunsaturated if it contains more than one double bond. Unsaturated fats are liquid at room temperature and are found in most plants and fish oils. They have consistently been shown to reduce blood cholesterol levels and to increase the HDL (sometimes called the good cholesterol). Unsaturated fats are therefore considered to be healthy fats. Most foods contain a combination of both unsaturated and saturated fats, with what makes up the majority being all that is normally advertized. Thus, various unsaturated fat vegetable oils, such as olive oil, also contain some saturated fat.

Trans fats (unsaturated fats that have undergone hydrogenation and changed from liquid to solid) are particularly risky because the double bond stereochemistry allows the fat molecules to assume a linear conformation. This leads to efficient packing and artery plaque formation. They are more dangerous than saturated fats for the development of cardiovascular disease.

Proteins

Protein makes all of life possible. All of the antibodies and enzymes, and many of the hormones are proteins. They provide for the transport of nutrients, oxygen and waste throughout the body. They provide the structure and contracting capability of muscles. They also provide collagen to connective tissues of the body and to the tissues of the skin, hair and nails. There are hundreds of thousands of different kinds of protein. And protein is made up of amino acids.

Of the 20 amino acids that make up human protein, 8 are essential in adults (i.e. they must be included in the diet) while 12 are nonessential (i.e. they can be manufactured in the body from other substances, although two of these are also essential in children during rapid growth). As with humans, protein from other animals is always “complete”, in that it contains all the essential amino acids. Different plant foods may have reduced amounts of some of the essential amino acids, and this is why the meat industry always touted animal protein as being “superior”. However, by just eating a small variety of plant protein we can easily obtain all the essential amino acids. Although some plant foods tend to be low in certain essential amino acids, the diets of many cultures have evolved combinations that are complete (for example, rice with beans, or legumes with nuts). Soy protein by itself is complete.

Furthermore, there is no qualitative difference between the specific amino acids derived from plants versus those same ones from animals. An amino acid is the same regardless of its source. In fact, one could make the argument that plant protein is superior to animal protein because it typically has far lower amounts of saturated fats accompanying the protein. (Saturated fats have been linked in many studies to cardiovascular disease!)

Minerals

Minerals can be divided into macrominerals (of which the body needs more than 100 mg per day) and microminerals (of which the body needs only trace amounts). Just because a mineral is classified as a micromineral and is only needed in trace amounts doesn’t mean that it can be ignored, however. In some third world countries, for example, there is a prevalence of thyroid goiters (abnormally enlarged thyroid glands) that can result from a deficiency of iodine in the diet. Only trace amounts of iodine are needed to prevent this problem.

Minerals come from (you guessed it!) the ground, and so they are plentiful in vegetables, especially those that grow close to or in the ground.

Vitamins and Phytochemicals

Fat and water don’t mix, and we can think of our bodies as being divided into a fat component and a water component. The fat-soluble vitamins A, D, E and K reside in the fat component and the water-soluble vitamins B and C reside in (you guessed it again!) the water component. Recommended daily allowances have been established for each of the vitamins, but anyone eating a mostly plant-based diet of whole foods is unlikely to need vitamin supplementation, since most of them come naturally from fruits and vegetables. It is considered better to get your vitamins from whole foods than from vitamin supplements, although a once-a-day vitamin supplement may be wise for someone on a less than optimal diet!

Vitamin D has been getting a lot of attention lately, especially since the latest research suggests that many North Americans may be deficient. Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate blood calcium and phosphate concentrations to enable normal mineralization of bone and prevent decay. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.

“If you are under 50, do not have osteoporosis, and do not have a condition that interferes with vitamin D absorption, Osteoporosis Canada recommends daily supplements of 400 – 1000 IU daily. If you are over 50, supplements of between 800 and 2000 IU are recommended.” ²¹

The Canadian Cancer Society recommends Canadians take in 1,000 IU every day. During the spring and summer, that can be accomplished through normal daily exposure to the sun. In the fall and winter months, a vitamin D supplement may be necessary. Health Canada’s guidelines remain at 400 IU. Health Canada advises people to take a daily vitamin D supplement, since following the revised Canada Food Guide would only provide 200 IU of vitamin D a day.

Be careful with all vitamin supplementation, though, as taking too much (particularly of the fat-soluble ones) can build up toxic levels and actually create health problems. Excess water-soluble vitamins get flushed out in our urine. A Swedish physiologist once joked that North Americans, with their expensive vitamin supplementation habits, have the richest urine in the world! However, too much of even the water-soluble ones can also be a problem, as we saw in the 1960’s when some people were taking excessive amounts of vitamin C for long periods. When they went back to normal levels they developed “rebound scurvy.”

Phytochemicals are relatively new to our understanding of nutrition. We still don’t know what all of them do, but we do know an increasing amount about three general categories:

• Flavonoids, found in apples, strawberries, grapes, onions, green and black tea and red wine, they may decrease atherosclerotic plaque and DNA damage related to cancer development.
• Carotenoids (beta-carotene, lutein, zeaxanthin, crytoxanthin and lycopene) protect the eye from harmful oxidation reactions.
• Lignans, found in flaxseed, seaweed, soybeans, bran and dried beans, are “phytoestrogens” that interfere with the action of the sex hormone estrogen and may help prevent hormone-related cancers, slow the growth of cancer cells, and lower the risk for heart disease.

Water

Water constitutes approximately 60% of a young man’s total body weight and 50% of a young woman’s body weight, although this varies considerably with body composition. A water loss of only 9-12% of total body weight can result in death. Therefore water must be considered an essential nutrient.

On average, our daily intake of water involves 60% from beverages, 30% from moist foods and 10% as a product of normal aerobic respiration. On average at rest, our loss of water involves 60% from the kidneys, 5% from the feces, 5% from sweating, and 30% from insensible (unnoticed) loss from evaporation at the skin and exhalation of water vapour.²² Of course, these percentages of water loss will change for someone who exercises regularly. (It should be noted that while water intake is certainly necessary, there is NO evidence to suggest that we need 8 glasses a day! This myth likely arose because some dietitians and others overlooked the fact that much of the daily need for water cam be met by the water content of the food we eat and the water we produce in aerobic respiration.²³)

Dietary Fiber (*technically not a nutrient but very essential for good health)

Dietary fiber is technically not a nutrient, since it is not digested or absorbed into the blood stream. It is essential in our diet, however, for several reasons. Almost like sandpaper, it helps to clean out the gastro-intestinal tract. It also entices more water into the gut, keeping the stool softer and reducing the incidence of constipation. And, by doing that, it also makes you feel full sooner when eating, tending to reduce the amount that you want to eat.

There are actually two types of dietary fiber. Soluble fiber forms a gel when mixed with liquid. It binds with fatty acids and has been shown to lower LDL (the bad stuff). Insoluble fiber passes through our intestines mostly intact. It promotes regular bowel movement and thereby helps to prevent constipation. It also speeds waste movement through the colon, helping to regulate intestinal pH and to prevent microbes from producing potentially carcinogenic substances.

What about exercise?

About 200 years ago the Industrial Revolution began, and for huge numbers of people it has resulted in them not needing to be physically active in order to earn a living. While 200 years seems like a long time, compared to the millions of years it took for us to evolve as humans, it is only a breath away. We evolved as physically active gatherers and hunters, and our biology remains essentially the same today. We need to be physically active!

Since most of us we no longer require physical activity in our work, we must invent artificial forms of activity to meet our needs. Some adults think of using sport to achieve physical fitness, but that’s probably not a good idea. There’s an old saying among fitness experts:

“You don’t get fit BY playing sports; you get fit FOR playing sports!”

Of course many books have been written about exercise and fitness, but the following is a brief summary of an approach you should take if you’re interested in exercising for health. It involves two types of exercise:

1. Aerobic Exercise
   The body actually uses three energy systems. The Aerobic energy system uses oxygen to burn carbohydrates and fats, and it relies on the cardiovascular system (the heart and blood vessels) to deliver the increased amounts of oxygen that are necessary for this. Improving the functioning of this system is important for many aspects of health. The other two energy systems (the anaerobic alactic and anaerobic lactic systems) use fuels that break down and release energy without the need for oxygen. These energy systems are important for many sports, but they don’t seem to be important for health.

When setting up an exercise program, there are 4 factors that must be considered. They are represented by the mnemonic FITT, where the letters stand for:

FREQUENCY:     How many times a week should you do it?
A minimum program should be three times per week; no more than that if you’re out of shape to begin with. Over a period of months you may wish to build up to 4-6 times per week to achieve more benefits. Even when you’re very fit, though, it’s good to take a day off each week to give your body plenty of time to recover and adapt. If fat loss is the main objective, a frequency of 6 times per week will give much better benefits, even if the intensity is reduced somewhat.

INTENSITY: How hard should you exercise?
The intensity can be roughly determined by the “Talk Test.” In other words, if you’re exercising so hard that you can’t talk to someone next to you, you’re exercising harder than you need to for health. If talking is too easy, you’re not exercising hard enough.

If you’re a stickler for precision, you can try palpating your pulse rate with your index and second finger, or actually monitoring your heart rate with a Garmin or Polar heart rate monitor. To determine your intensity as a percentage of maximum heart rate, divide your working heart rate (in beats per minute) by your maximum predicted heart rate (220-age). ActNow BC²⁴ gives some examples of intensity percentages for different types of activity:

1. Low                 – strolling along           (55-64%)
2. Moderate         – brisk walking            (65-74%)
3. Vigorous          – jogging/running         (75-90%)

TIME: What should be the duration of the exercise?
The minimum duration should be 20 minutes, although thirty minutes is a better starting point even if it means reducing the intensity somewhat. If fat loss is the main concern, a longer duration and lower intensity will burn a greater proportion of fat in the fuel mix, and the reduced intensity should be easier on the joints.

TYPE: What kind of exercise should it be?
Aerobic exercise involves any activity that raises your heart rate and keeps it elevated for 20 minutes or more. Sustained activities like brisk walking, running, roller blading, cycling, rowing, skipping, swimming and circuit training can all be aerobic if maintained at the right intensity and for the minimum duration.

1. Muscle Function
   This category of exercise includes the fitness components of muscular strength, power and endurance, and joint flexibility. Large amounts of these attributes are important for many sport performances, but far lower levels are needed to keep you healthy and reduce the risk of exercise-induced injury. These components can be trained to varying degrees through any of the following activities: weight training, yoga, Tai Chi & other martial arts, Pilates, calisthenics, boot camps, exercise-to-music classes, etc.

FREQUENCY:     How many times a week should you do it?
For strength training, 3 or 4 sessions a week is optimal. No muscle group should be strength-trained twice in a 48-hour period, because the muscles need time to repair themselves from the microtears and other damage that naturally occurs.

INTENSITY: How hard should you exercise?
This depends on your fitness levels, your objectives, and the specific activity you have chosen.

TIME: What should be the duration of the exercise?
This depends on your fitness levels, your objectives, and the specific activity you have chosen.

TYPE: What kind of exercise should it be?
Any of the above activities can be used to improve, to varying degrees, muscular strength, power and endurance, and joint flexibility.

Summary

When someone wants to change their lifestyle or even just a single habit or behavior, getting accurate and helpful information is important. But it’s also easy to get overwhelmed by the amount of information that’s available. So, with that in mind, I’ll summarize everything here into a few hopefully helpful and easy to remember tips.

1. Stop Smoking
   This is the single most important thing you can do for your health and for those who live with you. “Smoking kills more people in BC than all other drugs, motor vehicle collisions, murder, suicide and HIV/AIDS combined.”²⁵ (You’ll also be reducing the risk of setting house fires and wildfires, and you’ll stop annoying the hell out of non-smokers and ex-smokers unfortunate enough to be near you.)
2. Reduce (or Eliminate) Meat Consumption
   Eating red and processed meat has long been associated with an increased risk of heart disease.²⁶ More recently, a major American Cancer Society study found that people who reported the highest consumption of red and processed meat had a significantly higher risk of colorectal cancer than those who reported the least consumption. The study of nearly 150,000 Americans, the largest and most comprehensive to date, added substantially to previous evidence linking the highest consumption of red and processed meat to intestinal cancer.²⁷ But this has to do with more than just your personal health. In an alarming 2006 report, the United Nations warned that raising animals for food generates more greenhouse gases than all the cars and trucks in the world combined. Senior U.N. Food and Agriculture Organization official Henning Steinfeld reported that the meat industry is “one of the most significant contributors to today’s most serious environmental problems.” ²⁸ “On average, land requirements for meat-protein production are 10 times greater than for plant-protein production.” ²⁹ “Producing one kilogram of animal protein generally requires nearly 100 times more water than producing one kilogram of grain protein.” ³⁰ “Less than half the harvested acreage in the U.S. is used to grow food for people. For every sixteen pounds of grain and soybeans fed to beef cattle, we get back only one pound of meat on our plates.” ³¹
3. Shift Towards a Plant-Based Diet
   The American Institute for Cancer Research³² and the World Cancer Research Fund³³ call for choosing predominantly plant-based diets rich in a variety of vegetables and fruits, legumes, and minimally processed starchy staple foods and they suggest limiting red meat consumption, if at all. The American Cancer Society³⁴ recommends choosing most food from plant sources. The American Heart Association³⁵ recommends choosing a balanced diet with an emphasis on vegetables, fruits and whole-grain products. The Heart and Stroke Foundation of Canada³⁶ recommends using grains and vegetables instead of meat as the centerpiece of meals. The Unified Dietary Guidelines³⁷ developed by the American Cancer Society, the American Heart Association, the National Institutes of Health, and the American Academy of Pediatrics call for a diet based on a variety of plant foods, including grain products, vegetables, and fruits, and with very little simple sugar or high-fat foods, especially animal foods, to reduce risk of major chronic diseases.

For those who wish to try becoming vegetarians, the following quote is taken from the Position of American Dietetic Association and Dietitians of Canada: Vegetarian Diets, a scholarly review containing 256 mostly peer-reviewed references:

“It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases.” ³⁸

1. Increase from 5 towards 10 Servings of Fruits and Vegetables per Day
   When you give up something bad, you should reward yourself with something good. Adding more fruits and vegetables to your diet can be an indulgence you will look forward to. A hot vegetable soup in winter or a cold fruit smoothie in summer are just two ways of varying how we eat from this food group. Check out how other ethnic groups eat their fruits and veggies…particularly some East Indian, Italian and Greek dishes!
2. Disregard Advertizing from Commercial Corporations and Industry Lobbyists
   As people improve their lifestyles and consuming habits shift, some businesses and industries may have their financial “bottom-lines” adversely affected. They will then either improve their products or mount massive advertizing blitzes to dissuade people from making those changes. One case in point is the fast food giant, Wendy’s. At a time when the mass media are constantly talking about how obese and unhealthy North Americans are becoming, Wendy’s came out with a new menu item – the ‘Baconator,’ which has been heavily advertized on expensive television commercials.

The ‘Baconator Double’ contains “two hamburger patties with two slices of American cheese, 6 strips of Applewood smoked bacon, mayonnaise and ketchup on a premium bun.”³⁹ At 970 calories, 540 (56%) come from fat. This is far more than the 30% recommended so often recommended, and the 26 g of saturated fat represent 130% of the recommended daily value. ³⁹ But are you swayed by their advertizing?

1. Exercise for joy, not fitness
   Too many people now think of exercise as yet another form of work, and that is a classic case of looking at the half-empty glass. I am 63 years old and I have been running since I was 15. Through the years I have certainly slowed down tremendously, but my fitness level is still higher than the average college student that I teach. (I know, because I’ve been running with them for decades.) While the killer instinct of a competitive runner has long ago disappeared (I probably never really had it), I am now motivated by the joy of being able to do what so many my age cannot. And I don’t want this just for myself. I wish everyone could feel the gratitude that I feel at the end of a good run. Your body should be used, as should your brain. Should an old grand piano lie dormant somewhere unplayed? (OK, my body is more like a honky-tonk piano, but it can still make music!)

Post-Script

I am writing this longer-than-planned-for essay in August of 2010. The U.S. National Climatic Data Center, in its June 2010 report⁴⁰, stated that the combined global land and ocean surface temperatures for March, April, May and June showed them to be the four warmest months on record. Further, they noted that June had been the 304^th consecutive month with a global temperature above the 20^th century average.

In its hottest summer ever recorded⁴¹, wildfires are raging across Russia, causing smoke that is even choking Moscow, making an hour walk outside the equivalent of smoking three packs of cigarettes. At one point 700 people a day were dying from the heat, and the drought has ruined over a third of Russia’s wheat harvest. China is also having its worst flooding in decades, with floods and landslides killing well over a thousand people⁴¹. And in Pakistan, the heaviest monsoon rains on record⁴¹ (12 inches in one 36-hour period) flooded the countryside, killing 1500 people and leaving 14 million homeless, in a calamity that is not yet finished and that may ultimately become the worst natural disaster in human history. And in BC, the “greatest place on earth,” we simply turn on the air conditioners!

There is a price to pay for human selfishness and arrogance, but that price is inevitably paid by the poorest of the poor who have no hand in what usually leads to their demise.

The world’s population is currently estimated to be over 6,800,000,000 and will likely reach over 7 billion in 2011. “Developing countries are adding over 80 million to the population every year, exacerbating poverty and threatening the environment.”⁴² “People in developing countries currently consume, on average, one-third the meat and one-quarter of the milk products per capita compared to the richer North, but this is changing rapidly. The amount of meat consumed in developing countries over the past has grown three times as much as it did in the developed countries. The Livestock Revolution is primarily driven by demand. Poor people everywhere are eating more animal products as their incomes rise above poverty level and as they become urbanized…The incomes and nutrition of millions of rural poor in developing countries are improving. Yet in many cases these dietary changes also create serious environmental and health problems that require active policy involvement to prevent irreversible consequences.”⁴³

There is a real war that we must fight. In the battles for our personal health, the health of our environment, and the morality of our treatment of other humans and animals, we all have the ultimate weapon at our disposal…our wallets!

Link: http://www.colorectal-cancer.ca/

Link: http://www.biac-aclc.ca/

Link: http://www.ccmta.ca/english/index.cfm