A Wellspring for Our Community Renewing Mind, Body and Spirit From Stephanie Taylor, M.D., Ph.D.
“True wellness and deep healing is more than the application of a pill to a diagnosis. I have pioneered a new approach to healthcare that is based on personal and community wellness. Here is what this means:
The first community is you. Each person is a composite of their own life experiences and their own circle of support. Every factor needs to be evaluated to develop a picture of the whole person. Each element can then be recruited into the healing process.
The second community is where you live. The majority of public health research shows that the health of individuals is not separate from the health of the community. We have an obligation to ourselves to care for our community. This means taking the ecological initiative and also supporting the small businesses that are based in our community, especially our local farmers. Over time the community that you care for will also care for you.
The center of the program is the office visit. We offer 30 and 60 minute patient visits. This gives us enough time to really get to know you. The relationship does not end at the office visit. You will enter a supportive community linked by regular newsletters and educational programs. You will have the opportunity to re-discover yourself and the joys of living on the Monterey Peninsula. Visit Medical Program and Educational Program and see how this unique holistic program can benefit you and assist you in achieving your life’s purpose.”
- Bisphenol A plastics, carbonless paper, can linings
- Perfluoroalkyl Nonstick cookware, water-repellent fabrics
- Organotins In Agriculture and industry, wood preservative
- Dithiocarbamates Cosmetics and Ag products
- Nonylphenol Cosmetics and household cleaners
- Pesticides Gardening, household control and pet collars
- Atrazine Contaminates drinking water
- DDE Breakdown product of DDT
- PCBs Lubricants and flame retardants
- HCB Fungicide, now banned
- Oxychlordane Pesticide, now banned
- Dioxanes and furans PVC plastics
- PBDEs Flame retardants
- Phtalates Some plastics-See scorecard
- Prescription Rx DES, some antidepressants, Thiazolidinediones(PPAR-ɣ agonists)
- Glyphosate Food, water, herbicides
Mini-Med 20176 Whole Foods: the Re-discovery of Nature-Beef/Pork/Lamb
Stephanie Taylor MD PhD
June 3, 2017
“Rather than focusing on more product for less price, we must focus on replenishing the soil. The weakening of our nation’s soil contributes to an unavoidable chain reaction leading to the destruction of energy and Life as we know it. A depleted soil begets our foods lack of nutrients. Food without proper mineralization begets bodies that lacking the energy and minds lacking the clarity to live a fulfilling life……Statistics from the USDA reveal that today’s food has 30-70% less nutritional value than food 50 years ago…..An unhealthy soil grows unhealthy plants.” from Son of a farmer, child of the earth, by Eric Helm, pg. 104-5.
Our Third Mini-Medical School asked the question-Is some “organic” better than others? The answer was a resounding YES. The Washington Post recently published an expose of the organic factory dairies. In addition to data collection and aerial photography, they also compared the composition of the milk to conventional, non-organic milk. In this analysis, organic factory farm milk was essentially identical to non-organic milk, despite commanding a premium price.The full story can be found at: https://www.washingtonpost.com/business/economy/why-your-organic-milk-may-not-be-organic.
In an effort to level the playing field, the Organic Animal Welfare Standards were finalized under the Obama administration, but implementation has been delayed by the current administration. The USDA requested an additional public comment period and this was completed today, June 9, 2017. The improved regulations will clarify overly broad definitions and guidelines. For example, chickens labelled "cage-free, organic"can be running in a grassy pasture or spend their entire life in large buildings. They are un-caged, but certainly not “free range”. While we wait for better regulations, you can use the Cornucopia scorecard results that follow to guide your shopping.
The following chemistry lesson reviews three key markers of good organic animal products in the essential fatty acid family, and then lists candid recommendations for consumers. The scorecard was accessed at Cornucopica.org June 2, 2017.
First some chemistry:
Good fats are the Omega 3 essential fatty acids (EFA): alpha linolenic acid (ALA), EPA and DHA.
Omega 6 essential fatty acids: Linoleic acid (LA).
Conjugated linoleic acid (CLA): isomers of LA.
Health Benefits of EPA/DHA: decreases cardiac arrhythmias, coronary heart disease, lowers triglyceride levels, diabetes, modulates immune function, improves mental health, and facilitates neural development.
Health benefits of ALA: Coronary heart disease and possible cancer risk.
Health Benefits of CLA: Cancer, heart disease and possibly diabetes and immune function.
Health benefits of LA: heart disease. Note ratio of Omega 6/3 is important. Historically this was 1:1 and now is 10:1.
Current Private Party labeling standards for pastured ruminants:
American Grass-fed Certification: Diet — Animals are fed only grass and forage from weaning until harvest. Confinement — Animals are raised on pasture without confinement to feedlots.
Antibiotics and hormones — Animals are never treated with antibiotics or growth hormones.
Origin — all animals are born and raised on American family farms.
Food Alliance Certification: Healthy and humane animal treatment – with no use of growth promotants or sub-therapeutic antibiotics, Integrated pest, disease and weed management, Soil and water conservation, Safe and fair working conditions, Wildlife habitat and biodiversity conservation. Grass-fed option available.
Animal Welfare Approved: Continuous outdoor pasture access is required for all beef cattle in addition to extensive animal welfare requirements.
The Union of Concered Scientists (UCS) reviewed 13 studies on Fatty acid composition of beef. Here are the conclusions:
Total fat was significantly lower in pastured (grass-fed) beef.
Pastured beef has higher levels of ALA, EPA/DHA and CLA. The Ration of Omega 6/3 is more favorable in pastured beef.
Is it possible to consume meat and dairy in a way that is good for the environment?
Recent research on soil remediation shows that rotation grazing and careful management of ruminants actually improves soil quality and that healthy soil can trap significant quantities of atmospheric carbon. California has initiated a Healthy Soils initiative which will be implemented in the late fall of 2017. This will bring the research directly to ranchers and provide an incentive for conservation practices.
Here are pertinent general references if you wish more in depth coverage or research data support:
California Healthy Soils initiative: https://www.cdfa.ca.gov/oefi/healthysoils/
From the Union of Concerned Scientists-
UCS: Greener Pastures. How grass fed beef and milk contributes to healthy eating.
A shorter version with cooking advice.
California State University at Chico Grass fed Beef research data and recipes.
Books-The references in each book are most edifying.
Herm, Eric. Son of a Farmer, Child of the Earth: A path to Agriculture’s Higher Consciousness. Dreamriver Press, 2010.
Miller, MD, Daphne. Farmacology: What Innovative family farming can teach us about health and healing Harper-Collins, 2013.
Salatin, Joel. Folks, this ain’t normal: A farmer’s advice for happier hens, healthier people and a better World. Hatchett, 2011.
Gibbons, Euell. Stalking the Wild Asparagus: Fiftieth Anniversary Edition. Alan Hood & Co., 1960. This is a favorite book, but be careful wildcrafting plants as they may be sprayed with herbicide. Only highly experienced persons should ever gather mushrooms. We have several poisonings annually and some are fatal. This includes your dogs!
Shopping and Sourcing
Where to buy pastured meats on the internet:
Mini-Med 2017 June Whole Foods: the rediscovery of Nature-Dairy
Stephanie Taylor MD PhD
Ranking of Organic Dairy Producers (incorporating Animal Welfare measures)
Five Cow rating (Outstanding): All ratings from Cornucopia.org
Organic Pastures Dairy Company Milk, cheese, butter, colostrum, kefir
Green Valley Organics- goat milk yogurt
Four Cow rating (Excellent):
Supernatural (Kalona Organics)-Yogurt
Organic Valley (CROPP)-Full line of dairy products
White Mountain Foods-Yogurt
Julie's (Oregon Ice Cream)-Ice Cream
365 organic (Whole Foods)-Fluid milk
Straus Family Creamery- Full line dairy
Clover Organic Farms-Fluid milk products
Sunnyside Farms (Save Mart, Lucky, Food Maxx)-Milk
Sierra Nevada Cheese Company-Cheese
One Cow-Private Label
NO COWS (Ethically Deficient) Most produce or purchase factory farm milk and/or refused to participate in the study: Alta Dena, Back to Nature (Kraft), Borden Dairy (Dean Foods), Challenge Dairy products, Earth’s Best (Hain, Celestial), Green Mountain Creamery (Ehrmann Dairies), Horizon (White Wave), Humboldt Creamery (Foster Farm Dairy), Pavel’s Yogurt, Source Naturals (Protein Powder), St. Benoit Yogurt. See more at: https://www.cornucopia.org/dairysurvey/index.html
Yogurt Yogurt is a superb health food but not if it has multiple additives. Recommended daily intake of added sugars is 24 Grams for women and 36 grams for men. Yogurt scores based on organic score, and the presence of thickeners, carrageenan, artificial sweeteners, added sugar ( 4 grams=1 teaspoon), added coloring, added artificial flavors, synthetic nutrients, milk protein concentrate, or preservatives. Printable yogurt scorecard at:
Mini-Med 2017 June Whole Foods: the rediscovery of Nature-Eggs
Ratings below are reported by Cornucopia.org
Data Accessed June, 2017 at:
“5-egg” rating (2260-2700): “Exemplary”—Beyond Organic
Producers in this top tier manage diverse, small to medium-scale family farms. They raise their hens in mobile housing on well-managed and ample pasture or in ﬁxed housing with intensively managed rotated pasture. They sell eggs locally or regionally under their farm’s brand name, mostly through farmer’s markets, food cooperatives and/or independently owned natural and grocery stores and sometimes through larger chains like Whole Foods.
Stueve's Certified Organic
by Stueve's Certified Organic
by Vital Farms
“4-egg” rating (2000-2250): “Excellent”—Organic Promoting Outdoor Access
Producers in this category provide ample outdoor space and make an eﬀort to encourage their birds to go outside. They provide an excellent outdoor environment, often either rotated pasture or well-managed outdoor runs, with an adequate number of popholes/doors for the chickens to reach the outdoors.
Mary's Organic Eggs
by Pitman Family Farms
3-egg” rating (1800-2000): “Very Good”—Organic, Complying with Minimum USDA Standards
Brands with a three-egg rating are very good choices. Eggs from brands in this category either come from family-scale farms that provide outdoor runs for their chickens, or from larger-scale farms where meaningful outdoor space is either currently granted or under construction. All producers in this category appear committed to meeting organic standards for minimum outdoor space for laying hens.
by Noble Foods
2-egg” rating (1000-1800): “Fair” —Some Questions Remain Concerning Compliance with Federal Standards
These are either industrial-scale operations or others with outstanding questions or concerns regarding their compliance with USDA regulations. One of the primary features that distinguish these organizations from the ethically challenged brands below is their willingness to share with their customers (and Cornucopia researchers) some of the details as to how their chickens are cared for and how their eggs are actually produced.
“1-egg” Rating (Name Brand) 0-1000: “ethically deficient - industrial organics/no meaningful outdoor access and/or none were open enough to participate.”
Brands with a “1-egg” rating are generally produced on industrial-scale egg operations that grant no meaningful outdoor access. “Outdoor access” on these operations generally means a covered concrete porch that is barely accessible to the chickens. Means of egress from the buildings are intentionally small to discourage birds from going outside, and make it possible for only a small percentage of birds to have “access” to the outdoors. No producers in this category were willing to participate in The Cornucopia Institute’s project, and none shared their production practices with Cornucopia researchers. This is disturbing to many organic consumers, since transparency has always been viewed as a hallmark of the organic food movement.
by Dean Foods
Barnstar Family Farms
Glaum Egg Ranch
by Glaum Egg Ranch
Judy's Family Farm
by Petaluma Farms
by National Food Corp
"1-Egg" Rating (Private Label) 0-1000
Private‐label, or store‐brand, eggs rated with one egg are sold by grocers or distributors who have the obvious desire of wanting to grow their presence in the organic marketplace. Unfortunately, there is an inherent limitation in private‐label organic products: organic consumers tend to want to know where their food is coming from and how it is produced, and private‐label products are anonymous by their very nature. Our research indicates that the vast majority of organic eggs for private label brands are produced on industrial farms that house hundreds of thousands of birds and do not grant the birds meaningful outdoor access.
by Whole Foods
by Associated Wholesale Grocers
Trader Joe's by Trader Joe’s
Mindfulness: Practical Applications
Mini-Medical School #2, April 8, 2017
Stephanie Taylor MD, PhD
Between stimulus and response there is a space.
In that space is our power to choose our response.
In our response lies our growth and our freedom.
Viktor E. Frankl
Mindfulness is attending to the present. There is nothing foreign, difficult or exotic about mindfulness. Mindfulness as applied to stress reduction is the most widely known practice, and was developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center. It is, at its heart, a meditation practice that can be learned and used by anyone. It was initially applied in medical settings with excellent results on depression, anxiety and fear of disease recurrence.
Mindfulness means attending to your current internal and external perceptions. This is greatly facilitated by attending to breathing. Here is a three minute body scan meditation:
Begin by bringing your attention into your body. You can close your eyes if that’s comfortable for you. You can notice your body seated wherever you’re seated, feeling the weight of your body on the chair, on the floor. Take a few deep breaths. And as you take a deep breath, bring in more oxygen enlivening the body. And as you exhale, have a sense of relaxing more deeply. You can notice your feet on the floor, notice the sensations of your feet touching the floor. The weight and pressure, vibration, heat. You can notice your legs against the chair, pressure, pulsing, heaviness, lightness. Notice your back against the chair. Bring your attention into your stomach area. If your stomach is tense or tight, let it soften. Take a breath. Notice your hands. Are your hands tense or tight? See if you can allow them to soften. Notice your arms. Feel any sensation in your arms. Let your shoulders be soft. Notice your neck and throat. Let them be soft. Relax. Soften your jaw. Let your face and facial muscles be soft. Then notice your whole body present. Take one more breath. Be aware of your whole body as best you can. Take a breath. And then when you’re ready, you can open your eyes.
Mindfulness based exercises are currently applied in a wide variety of settings.
We will review several and give practical tips for application.
Schools and Education
Relationships and Parenting
Everyday Blessings: The inner work of mindful parenting by Jon Kabat-Zinn
Veterans, First Responders, Police Officers
In 2010 alone, 8,030 veterans died by suicide. This represents more loss of life than the total number of deaths in the Iraq and Afghanistan conflict since 2003.
The Mindful Athlete: Secrets to Pure Performance by George Mumford, who was the mindfulness coach for the Chicago Bulls Basketball team.
Here are his three principle points in quotes taken from Mindful Feb 2016, pg. 47-54 written by Hugh Delehanty, www.mindful.org:
“Be still and know”: Mumford learned the power of stillness from Tai Chi practice. “When the mind is still you have an inner knowing when and how to strike.” This has also been describes as being in the flow.
Forget Yourself, Find Yourself: “not how you are doing but what are you doing.”
Mindfulness and more: “Steadiness of mind, right effort and wisdom.”
Specific examples from Tai Chi Chuan Practice.
Exercise in focused attention. Tai Chi walking for fall prevention.
Tools: Useful cell phone apps: Headspace, and
Mini-Medical School #1 2017
Navigating the Health Care System with Stephanie Taylor MD PhD
Introduction: The basis of integrative health is the harmonious union of mind, body and spirit. An additional essential component is the health of the environment and of our socio-political system. We are in a time of rapid evolution, and it is in our best interest to understand these processes in depth and to act for positive outcomes. Medicine is no exception, and this Mini-Medical School provides basic tools for understanding healthcare USA.
Physicians- Degree is M.D or D.O., and they are the only provider that can use the designation “Physician”. Four years of Medical School after College. Average debt from medical school alone is $170,000. In order to enter private practice, a residency is mandatory. Duration of this apprenticeship is 3-8 years depending on specialization and pay is $50-60,000/year for a 100-140 hour work week. Specialty board examinations are required, and maintenance is mandatory. Physician salaries are proportional to specialty. The ability to perform procedures dramatically increases income. Average duration of office visits is 15-20 minutes.
Naturopathic Doctors-Degree is N.D. Usually four years of Naturopathic School after four years of college. No residency required to practice. Bastyr (Seattle) is the best followed by Southwest College (Tempe, Ariz) and The National College of Naturopathic Medicine in Portland. Licensing varies by state.
Nurse Practitioner-Degree is R.N., N.P. and requires 4 years of nursing school (after high school), and 1-3 year Masters level training. They function semi-independently.
Physician’s Assistant-Degree is P.A. and certification usually requires 2 years after a four year college. PA’s require direct physician supervision, physically or by electronic communication.
Midwife-Certified Nurse Midwives (CNM) are registered nurses who have taken additional training. They are regulated by the California Board of Registered Nurses. Certified professional midwives/licensed midwives complete a three year post-secondary program in an approved midwifery school and pass the licensing exam. Licensed midwives are regulated by the Medical Board of California.
Insurance-Persons under age 65 are usually insured through their employer. The rest are in the “individual” insurance market. State supported insurance in California is called MediCal. At 65, citizens who have qualifying earnings may have Medicare. Thirty million remain uninsured.
The cost of your premium is not everything: Your cost out of pocket depends on your deductible, formulary and covered benefits.
Medicare- It is not as complex as it appears:
Part A- Hospitalization. Funded primarily by payroll taxes
Part B-Doctor’s fees and visits. Funded by general revenues and premiums.
Part C- Medicare Advantage (combines A, B and D)
Part D- Drug Plan. Funded by general revenues and premiums.
Supplemental-Covers to 20% that Medicare does not pay.
Medicare is more financially stable since the passage of the Affordable Care Act (ACA/Obamacare), and is currently solvent until 2028. Repealing the ACA would increase Medicare spending by $802 billion over 10 years. People over 80 account for most of the spending. Prescription drug coverage is projected to grow faster than any other cost segment.
Formulary- A list of drugs covered by your plan. Your cost depends on the Tier of the drug, usually 1-5. This changes annually. You are mailed a copy annually and it is vital that you keep this accessible for reference as your needs change. Your doctor does not have access to your formulary.
The Explanation of Benefits (EOB) is an important report generated when you have a billed medical expense and you must understand and save the form or be able to access it on line. Here is an example:
|Claim date and provider||Billed Amount||Allowed Amount||Non-Allowed Amount||Applied to Deductible||Paid Amount||Remark Code|
Changes to Healthcare considered: The Affordable Care Act instituted many positive and popular reforms: Children on parents insurance until 26, no exclusion for prior conditions, no retroactive cancellations, subsidies for low income, increased coverage for preventive services, contraceptive and maternity coverage. There are also effects on Medicare, specifically closing the Doughnut hole. There are over a hundred subprograms of the ACA and any changes will affect the entire structure. An excellent summary of the current ACA and the Ryan and Price plans are available at the Kaiser Family Foundation Site.
Summary of the ACA:
Summary of the Speaker Ryan Proposal:
Summary of Rep. Price Proposal:
Summary of Medicare Financial Outlook:
AARP Action Plan for Medicare:http://www.aarp.org/politics-society/advocacy/info-2016/why-medicare-matters-special-report.html
During our discussion, the rising cost of health care attributable to administrative fees was identified as a key concern. Corporations are required to articulate a primary duty to their shareholders to maximize financial return on investment. A suggestion was made to require insurance companies to be structured as B Corporations. In California, B Corps received legal status in 2012. Rather than shareholder profit, the B Corp primary duty is to create general public benefit. Further information can be found at:
“Change will not come if we wait for some other person or some other time. We are the ones we have been waiting for. We are the change that we seek.”
-President Barack Obama
Contacting your Representative and Senator:
Rep. Jimmy Panetta
228 Cannon House Office Building
Washington, D.C. 20515
Senator Dianne Feinstein
331 Hart Senate Office Building
Washington, D.C. 20510
Senator Kamala Harris
112 Hart Senate Office Building
Washington, D.C. 20510
Avoiding Weight Gain-it is not what you think.
Mini-Medical School #6 2016
Stephanie Taylor MD PhD
The holiday season is a very special time of the year and there are very special foods associated with holiday celebrations. Most celebration foods are high-calorie and many of us worry about weight gain during the holiday season. Traditional cookies are gingerbread, Pfefferneuse, Springerle, Lebkuchen, Pizelle, Spitzgeback, Repostria and Tirggel. Tirggel has been a traditional holiday food since the third millennium BCE. All of these are wheat based and high fat foods. The calorie count alone is enough to make you fret but in our complex contemporary society, today’s cookie is not the same treat it was just 100 years ago.
The world is experiencing a dramatic increase in body weight. Surveys comparing 1982 body weight to 2008 body weight show a doubling of obesity in adults and tripling in children. There are 100 million obese adults in the United States and 25.8 million adult onset diabetics. The incidence of diabetes is rapidly increasing.
Just how do you gain weight? You need to consume 3500 calories to gain 1 pound. To gain 100 pounds you need to consume an additional 350,000 calories or 1500 candy bars, or an additional 500 calories a day for 700 days. The observed increase in obesity does not directly match the increase in caloric intake, leading to an investigation into other causes of the obesity epidemic. In 2006, researchers at UC, Irvine discovered and named a class of chemicals which they call Obesogens. Obesogens cause weight gain not attributable to increased calories, exerting their metabolic effects on multiple pathways. They prevent mobilization of fat stores for energy and give directions to increase fat deposition. Obesogens also change metabolic set points which determine your body’s ideal weight or fat percentage. Even more concerning, animal studies show that these changes can pass through to subsequent generations.
You can be exposed to Obesogens from many sources, some quite unexpected. A common source is food and water. Obesogens are fat soluble and accumulate in animal and fish fat, especially if animals are fed non-organic feeds. Plastics and can linings can leach chemicals into food. Many herbicides and pesticides are obesogens. Another very common exposure is house dust. Household dust contains flame retardants from foam furniture, and degrading plastic from kitchen appliances and computers. Spraying of agricultural fields exposes children and adults to drift. Obesogenic air pollutants include auto exhaust, and particulates from the road and burning fuels. Many chemicals can be absorbed through the skin, and are present in cosmetics, skin products and household cleaners. In addition to the weight gain issue, many of these chemicals, especially glyphosate, are linked to other very serious diseases: diabetes, autism, neurological degeneration of all types, osteoporosis, atherosclerosis, mitochrondrial damage and chronic fatigue, overgrowth of pathogenic gut bacteria, infertility and even prion diseases.
Obesogens-the Rogues Gallery
This last chemical, glyphosate is more familiar as an ingredient in the herbicide, Roundup. Exposure to glyphosate has dramatically increased since 1975, and especially with the recent adoption of pre-harvest spraying. In the last 10 years, 2.4 Billion pounds of Roundup have been used in the USA. Roundup is used on all GMO (genetically modified) crops, and also non-GMO crops to facilitate the harvest processing. . In the USA, 93% of all soybeans, and 89% of all corn crops are genetically modified. Additional staple foods that are usually GMO are cotton, sugar beets and canola. These basic foods are processed into other common ingredients such as canola oil, high fructose corn syrup, and beet sugar. They are incorporated into about ¾ of all processed foods. Non-GMO grains which are sprayed pre-harvest are: wheat, oats, barley and other grains. Purchasing a grain labelled Non-GMO does not protect you from glyphosate exposure. The label must state the grain is produced organically. Unfortunately, even organic foods are contaminated with glyphosate due to groundwater contamination and drift. Roundup cannot be removed by washing or peeling. It is incorporated into the body of the plant.
Weeds are smart and are increasingly resistant to Roundup. The newer Roundup and herbicide formulations include 2,4-D ( a primary ingredient in Agent Orange) and dicamba which are even more toxic. It is also important to know that the dose does not make the poison. Endocrine disruptors are active at doses much lower than specified toxic levels, and over a longer period of time. These low doses and long durations are not included, nor required, in most applications for safety certification.
Eat Organic, including the feed for the chickens, dairy cows and meat animals.
Vacuum a lot.
Read labels and reject products with unfamiliar chemical names OR “Fragrance”.
Remember “Natural” has no legal meaning.
Environmental toxin screening of blood and urine is available from several specialty labs. Once you have your results, you will need to search your environment for sources, and they are not always what you expect! You may need help tracking contaminants. More physicians, naturopaths and food advocates are educating themselves on the health effects of environmental chemicals. One local active resource is Hayward Healthy House.
Food Democracy Now! Food testing results on glyphosate. Access the full report here:
Food and Water Watch http://www.foodandwaterwatch.org
UCSF Program on Health and the Environment http://prhe.ucsf.edu/
Health and Environment Online https://healthandenvironmentonline.com/
Environmental Working Group http://www.ewg.org/
The Cornucopia Institute. The Cornucopia Institute engages in educational activities supporting the ecological principles and economic wisdom underlying sustainable and organic agriculture. Through research and investigations on agricultural issues, The Cornucopia Institute provides needed information to consumers, family farmers, and the media. The Cornucopia Institute is recognized by the IRS as a tax-exempt 501(c)(3) public interest group. Donations are tax-deductible to the full extent of law. Access at: https://www.cornucopia.org/
Attend the EcoFarm Conference held at Asilomar Conference Center in late January. Single day tickets are available, and you do not need to be a farmer to attend. One of the biggest thrills of EcoFarm is seeing the large number of young people participating.
The scheduled EcoFarm speakers for 2017 are here:
October Mini-Medical School #5
Stephanie Taylor MD PhD
More than twenty years ago Dr. William Dement gave a Community Hospital Grand Rounds on Sleep Medicine. Dr. Dement is one of the founders of the field. At the time it was new and without much professional recognition. His efforts to convince the Traffic Safety officials that drowsy driving was as dangerous as drunk driving met with no success. Somewhat disheartened and at the end of a long day, he settled into his back yard with a beverage to contemplate his next step. Within a few minutes, a car crashed through his fence and safely came to rest in his yard. The driver had, of course, fallen asleep at the wheel. This event was a bit misplaced, since he, himself, did not need convincing, but rather the local officials down the road. It does make a good teaching point, however, as we now have a greater appreciation of the risks of sleep deprivation to both airline and road traffic safely. There has been significant progress since Dr. Dement’s backyard incident. In 2010, the National Transportation Safety Board appointed its first trained sleep scientist, Dr. Mark Rosekind. In 2003, the accrediting agency for graduate medical education approved Sleep Medicine as a formal training program.
Sleep medicine is a vast topic, and this essay will be an introduction to the field with some helpful practical advice.
The two most common sleep complaints are sleep apnea and insomnia.
Sleep apnea (OSA) is defined as the cessation of regular breathing during sleep, usually attributable to a collapse of the airway. The prevalence is variable and can be as high as 20% of the general population. The health risks associated with sleep apnea are: daytime sleepiness, heart failure, hypertension, lung disease, obesity, stroke, depression, and diabetes. Associated morbidities are decreased work performance and an increase in work and leisure time injuries. The cost of untreated OSA is high with OSA related traffic accidents alone reaching $15.9 billion and 1400 lives in the year 2000. OSA is successfully treated with positive pressure ventilation or dental appliances. The difficulty is in getting individuals in to be diagnosed and treated. Common questions on diagnostic questionnaires are: Do you snore? Is your snoring loud? Does your bedpartner notice you not breathing or gasping during sleep? Have you fallen asleep during the day? Do you have high blood pressure?
Insomnia is even more common than OSA. The incidence varies depending on the severity, ranging from 20-40% of adults. Insomnia is commonly treated with oral prescription medications. In the last year surveyed, 2011, there were 60 million prescriptions written, amounting to $3.7 billion in sales. Alcohol is also commonly used for relaxation and will induce sleep, but there is usually a recurrence of insomnia between 1 and 3 AM. Taking a sleeping pill regularly is not a solution. Most sleep medications can induce dependence, both psychological and physical. Furthermore, the quality of medication induced sleep is uncertain and is the subject of much research.
Some think it is fashionable to brag about not needing much sleep. This brag is unwise. There is a newly discovered mechanism in the brain called the glymphatic system. It seems to be the “trash collector” for the brain and is most active during sleep. Part of that trash includes beta-amyloid, which is associated with the development of Alzheimer’s disease. It is possible that deliberate reduction of sleep duration will increase risk of dementia. Indeed, the diagnosis of dementia is often preceded by several years of sleep disorder.
There are many more sleep disorders, but OSA and insomnia are the most common and familiar. Here are some practical suggestions for better sleep.
The ideal sleep duration is different for individual adults, but is 7-8 hours is ideal. If you suspect sleep apnea, that requires evaluation by a sleep specialist, but occasional insomnia will respond to home remedies. Pre-sleep preparation is very important. Here are some basic tips:
Minimize stimulants after 2 PM. That would include caffeinated beverages and some nasal decongestants. Do not exercise or eat within 3 hours of bedtime. There is clear association of poor sleep quality and use of cell phones, computers and pads before bed. Not only is the information stimulating, but the blue light prevents the normal release of sleep inducing neuro-chemicals. There are some pads that have a blue filter scheduled to apply at 8 PM, and these are worth investigating if you need to keep working in the evening.
Psychological issues-tension and stress. Avoid stressful activities before bed. This would include listening to the evening news, paying bills, arguments and general worry. You are not going to get anything solved between midnight and 7 AM, so just let it go for the evening.
Plan to go to sleep and arise at a regular time each day. This help train your body to a regular cycle. Stop eating 3 hours before you plan to go to bed. If your gut is busy, your brain will not have a chance to relax. If you get home late and need to eat, try something very light and digestible.
If you are having difficulty sleeping, stop trying after 30 minutes, and leave the bed and do something relaxing, and not computer based. Reading with a small focused light is helpful. Too much illumination will reduce the neuro-chemicals that are needed to induce sleep. If you are fretting, try writing down your worries. You can keep a self-illuminating pen and journal near the bed.
Your best sleep environment is a dark room with no disturbing noises. Background white noise or a HEPA air filter are soothing. Electromagnetic fields are not helpful to sleep, and you should be 8 feet away from those fields. You can assess your environment with a Tri-field meter, and common sources are clock radios, cell phones and computer screens.
Your bed should be a source of comfort, and good mattress, bed linens and blankets contribute to a positive sleep experience. Ariana Huffington wrote a lovely book called The Sleep Revolution that I highly recommend. There is a great list of sleep friendly hotels in the back. Very handy for your next travel adventure. Her TED talk is available at: https://www.ted.com/talks/arianna_huffington_how_to_succeed_get_more_sleep?language=en
Supplements that help sleep are very popular and fairly effective. You may need to try several before you find the right combination for your own chemistry. These are sold over the counter, and like all OTC supplements, you need to be sure you are buying good quality. Popular herbs are Valerian, ashwaganda and passion flower. Supplements that are also effective and safe are glycine, taurine, magnesium, l-theanine and melatonin. If you are on antidepressants, do not take 5-HTP for sleep as it would be contraindicated, but it is otherwise helpful.