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SPRING / SUMMER 2011

PULSE H I G H

D E S E R T

• Trans fats’ link to depression • Bike your first 100-mile ride • Tips from phenom Matt Lieto

Healthy Living in Central Oregon

The war within

How our battle against bacteria can hurt our health


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PULSE H I G H

D E S E R T

Healthy Living in Central Oregon

SPRING / SUMMER 2011 VOLUME 3, NO. 2

How to reach us Denise Costa | Editor 541-383-0356 or dcosta@bendbulletin.com • Reporting Anne Aurand 541-383-0304 or aaurand@bendbulletin.com Betsy Q. Cliff 541-383-0375 or bcliff@bendbulletin.com Markian Hawryluk 541-617-7814 or mhawryluk@bendbulletin.com • Design / Production Greg Cross Lara Milton Mugs Scherer

Sheila Timony David Wray Andy Zeigert

• Photography Ryan Brennecke Pete Erickson Dean Guernsey Rob Kerr Andy Tullis • Corrections High Desert Pulse’s primary concern is that all stories are accurate. If you know of an error in a story, call us at 541-383-0356 or e-mail pulse@bendbulletin.com. • Advertising Jay Brandt, Advertising director 541-383-0370 or jbrandt@bendbulletin.com Sean Tate, Advertising manager 541-383-0386 or state@bendbulletin.com Kristin Morris, Advertising representative 541-617-7855 or kmorris@bendbulletin.com On the Web: www.bendbulletin.com/pulse

The Bulletin

All Bulletin payments are accepted at the drop box at City Hall. Check payments may be converted to an electronic funds transfer. The Bulletin, USPS #552-520, is published daily by Western Communications Inc., 1777 S.W. Chandler Ave., Bend, OR 97702. Periodicals postage paid at Bend, OR. Postmaster: Send address changes to The Bulletin circulation department, P.O. Box 6020, Bend, OR 97708. The Bulletin retains ownership and copyright protection of all staff-prepared news copy, advertising copy and news or ad illustrations. They may not be reproduced without explicit prior approval. Published: 5/02/2011

Write to us Send your letters of 250 words or less to pulse@bendbulletin.com. Please include a phone number for verification.

Page 4

Updates |

NEW SINCE WE LAST REPORTED

Alzheimer’s testing Researchers have reported progress in developing methods to diagnose Alzheimer’s disease since we wrote “Alzheimer’s: The coming storm” (Fall/Winter 2010). That story reported that the only conclusive diagnosis of Alzheimer’s is done after a patient’s death, through a brain autopsy. A diagnosis for a living patient is a long process that includes thorough analysis of health history and symptoms, and in which other ailments are ruled out through existing tests. One new study centered on a brain imaging procedure in which an injected dye would attach to and reveal amyloid plaques in the brain, uniquely characteristic of Alzheimer’s. The Food and Drug Administration has not yet approved its use but is allowing further development of the brain-scanning procedure to find out if the scans are accurate and beneficial to the general population. Another study said a simple, relatively inexpensive blood test could detect the presence of the beta amyloid protein, which forms the brain plaques, to see if some people are at a greater risk for developing the disease. The Alzheimer’s Associ-

ation reports on its website that the study is intriguing, but similar studies have revealed conflicting results. The test is not ready for clinical use. Doctors may also be able to predict a person’s chance of developing Alzheimer’s disease through an analysis of cerebral spinal fluid. Another study from last year detected proteins in the spinal fluid that were associated with Alzheimer’s. This diagnostic test is not yet in routine use. — ANNE AURAND

Hospital hand washing In our report about hand washing (“Our health is in their hands, but are they clean hands?” Spring/Summer 2009), we told you about the dismal rates of hand washing among health care workers. Now, a Massachusetts program is trying to combat that through a universal human motivator: shame. Some physicians at the University of Massachusetts Medical School recently became part of a pilot project in which the doctor wears a special badge on his or her coat, according The Worcester Telegram & Gazette in Worcester, Mass. If the doctor enters a patient room but does not wash up, sensors on the door, soap dispenser and near the patient’s bed pick up that information. They relay the noncompliance to the badge, which turns a deep shade of red. The computers also instantly relay information back to nurses’ stations and to a professor at Worcester Polytechnic Institute, who

initiated the project and is tracking the data. The program began only recently, so there’s no word yet on whether it increased hand-washing compliance or whether the physicians’ faces matched the color of their badges. — BETSY Q. CLIFF

SPRING / SUMMER 2011 • HIGH DESERT PULSE


Contents |

8

19 33 4 7 14 23 26 28 30 40 42 53 54

HIGH DESERT PULSE

COVER STORY

THE WAR WITHIN Our well-being depends on a healthy population of bacteria. That’s right, bacteria.

14

FEATURES LINKING DIET AND DEPRESSION Trans fats may affect our mental health. THE DANGERS OF DENTAL AMALGAM Are your mercury fillings hurting your health?

30

DEPARTMENTS UPDATES What’s new since we last reported. LETTERS Response from our readers. GET READY: CENTURY RIDE Ride 100 miles in a day. Yes, you can. HOW DOES HE DO IT? Matt Lieto: Fun makes fit. SORTING IT OUT: SURGICAL SUCCESS Tips before going under the knife. GET ACTIVE: GO OUTSIDE AND PLAY Our camera catches a kayaker at Steelhead Falls.

33

HEALTHY OPTIONS Eight guilt-free dishes at some favorite local spots. GET GEAR: BACKPACKS Pick the pack that fits you — and your summer plans. PICTURE THIS: YOUR MEDICINE CHEST Take stock of what’s behind the mirror. BODY OF KNOWLEDGE: POP QUIZ Know the real scoop about ice cream? ONE VOICE: A PERSONAL ESSAY Giving birth in a foreign language. COVER ILLUSTRATION: ANDY ZEIGERT CONTENTS PHOTOS, FROM TOP: ROB KERR, ANDY TULLIS, SUBMITTED IMAGE, ROB KERR

HIGH DESERT PULSE • SPRING / SUMMER 2011

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42


Letters |

READERS RESPOND

Bracing for karma Sheila Miller’s essay about her youthful scoliosis (“Bracing for the eighth grade,” Winter/Spring 2011) reminded me of a wonderfully karmic episode that my wife, Nadine Adkins, shared with me. Nadine, who died a year and a half ago, also was diagnosed with scoliosis as a child and had to wear a back brace for a while, around fifth grade. She spent her youth in Juneau, and there was a family who lived nearby that might be termed “redneck” or “white trash.” I think they had a few sons who terrorized the neighborhood kids with bullying. One day one of those boys came along and started causing trouble, as was his pattern of behavior. At some point he thought he would demonstrate what a big tough guy he was by giving Nadine a hard punch in the stomach. But instead of hurting Nadine, his fist contacted the front of her brace, and he about broke his hand! He went running home crying, and as far as I know, never bothered Nadine again. Isn’t it satisfying to see karma acting so immediately and profoundly? I enjoyed Miller’s essay, and the fact that she could shake off some of that terrible self-consciousness of the eighth grade by appearing overly nonconforming proves that old adage, “When life hands you a lemon, make some lemonade!” I’m sure Nadine would have enjoyed the essay even more than I did. Thanks for sharing.

— Eddie Kinnamon, Bend

HIGH DESERT PULSE • SPRING / SUMMER 2011

FAS: We’ve lived that story

What were you thinking?

My wife and I were most interested in your recent Pulse article on FAS (“The hidden risk of fetal alcohol syndrome” Winter/Spring 2011). We have lived that story for 40 years. We adopted Daryl as an infant in 1970. He was born here in Oregon to a 15-year-old girl, and the adoption was handled by the state. He became a part of our family when he was 2 weeks old. He was cute and smart, and the first two years, he seemed to be just an energetic little boy. And then the “terrible twos” did not go away. We started looking for answers when he was 3. FAS was one of the many diagnoses provided over the years, and it always made sense to me. Your article is probably the first real confirmation we have received. Daryl fits so many of your descriptions. It has been a long road of pain for all of us, and it is not over. Thank you for your wellprepared article. It might be difficult for you to believe what a child like this can do to a family that wants to provide him with a loving, nurturing environment. This information should be more widely available to the public. You have done a good job of dealing with an important issue. Thanks.

As a mental health therapist and adoption social worker (who has helped to facilitate over 100 international and domestic adoptive placements in Central Oregon over the last 12 years), I want to express my deep concern regarding what appears to be a blatant lack of empathy for young Max Hetherington. I do not believe it is appropriate to put his picture on the cover of High Desert Pulse with the giant headline, “Did his birth mother drink?” for all the community, Max’s teachers, Max’s brother and Max’s peers and their parents to read. He has the right to privacy, dignity, and to be able to show respect and appreciation for his birth mother, who undoubtedly made an extremely difficult decision to place him for adoption in the first place. I believe all this has been violated by your decision, as the editor, to approve this cover for your publication, and I am very curious what you were thinking about Max’s rights, his feelings and his future when you did this.

— Michael Bowen, Bend

Go in with eyes open We noticed a link to your Winter/Spring issue on one of our clients’ pages on Facebook and had to explore it. We were particularly interested in the cover story on fetal alcohol syndrome. We are an international adoption agency that deals primarily with special needs children who are looking for their forever families. Consistent with your article, many of the children in our roster are also affected by FAS. It is an important and significant condition that adoptive parents need to explore so that they are going in with eyes wide open. The author had a straightforward and very informative approach when writing on this topic. I’m sure it will be very valuable to anyone considering adopting a child from a foreign country.

— Daniel Roberts, executive director, KIDS TO ADOPT

— Jennifer Noble, Bend

Pulse editor Denise Costa responds: We gave weeks of thought to the choice of photo for the cover of Pulse, because the ethical issues are complex. Among the important reasons for the final decision was Max’s mother’s encouragement, based on her repeated statement of how cruel it is for Max that he looks like any other kid, and people don’t understand why he can’t control himself. To make an issue like this real and personal and understandable for readers, there is no substitute for a photograph of a real person. However, had his mother felt differently, or had we any reason to think the publication would hurt Max in any way, we would not have used the photo that way. Our choice was not made lightly or without serious consideration.

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Cover story |

OUR BODIES’ VITAL BACTERIA

GERM

WARFARE The body is a battlefield, pitting bad bacteria against good bacteria. But sometimes, in our quest to keep healthy, we wipe them all out.

BY BETSY Q. CLIFF

I

n the spring of 2008, after nearly nine months of illness, Kandice Knudsen was desperate to be healthy. What had started as a minor incident, an infected bee sting, had turned into a serious intestinal illness. By her fourth hospitalization, the already small woman had lost a quarter of her body weight. She was weak and in constant pain, with severe diarrhea. Her husband and the nurses who treated the now 53-year-old Portland pharmacist at Providence St. Vincent’s hospital thought she might die. Knudsen had been diagnosed with a bacterial infection called Clostridium difficile, or C.diff. It kills about 20,000 people each year in the United States. Doctors had spent months trying to treat Knudsen with standard therapies, but nothing was working. The bacteria continued to run rampant through her body. Ironically, the most common way to get C.diff is to take antibiotics.

In the U.S., about 20,000 die each year from C.diff — often caused by taking antibiotics. JOHN KLICKER

Kandice Knudsen was in danger of becoming part of that statistic, until she tried an experimental — and highly unusual — treatment. Page 8

Antibiotics have saved millions of lives, and they helped heal Knudsen’s infected bee sting. But taking antibiotics disturbs the vast and diverse community of microscopic organisms that live in our bodies. Some of these organisms, particularly the bacteria that live in our gut, prevent harmful infections, including C.diff. Antibiotics kill bacteria, and for Knudsen, they likely wiped out the ones that had kept C.diff from flourishing. As she continued to waste away, Knudsen was referred to a physician, perhaps the only one in Oregon, who treats C.diff patients in a highly experimental way. He attempts to cure the infection by restoring the normal balance of bacteria to the gut. He uses one of the richest sources of helpful bacteria: human feces.

Modern medicine’s favorite villain Bacteria rarely get anything but scorn in modern medicine. But the truth is, we’ve long known that these microorganisms live congenially with us. In a scientific paper published in 1863, Dutch scientist Antonie van Leeuwenhoek, an early maker of microscopes, used one of his devices to look at plaque from his teeth. He found “very many small animals, which moved themselves very extravagantly.” His and other early work inspired scientists to attempt to harvest and study these tiny critters, though until a few years ago we had only a crude understanding of their influence. Now, thanks to technology that is allowing scientists to take a more detailed look at the microscopic world inside us, knowledge in this area is racing forward. We now know that these microorganisms are not just benign creatures. It turns out that

SPRING / SUMMER 2011 • HIGH DESERT PULSE


ease? Which bacteria are good? Which are bad? What we do know is that the microbiome is incredibly diverse. There are thousands, perhaps hundreds of thousands, of bacterial species living in or on our bodies at any one time. In fact, we contain more microbial cells than human cells — about Yes, these 10 times more. Because the microbial cells are typically smaller organisms can than human cells, we don’t see or feel them, but they are just as be your friends much a part of us as our own flesh and blood. Bacteria have a reputation as being harmful The study of the microbiome, at least in a scientific sense, to our health. In fact, there are some we can’t may begin to change our whole concept of who we are. We are live without. Certain bacteria, for example, not actually a single organism, each an individual life. Instead, extract vitamins from the foods we eat we are collections of organisms; each of us is our own ecosysand make them available to our bodies. tem. We contain multiple habitats — the dry surface of the skin, Others calm gut inflammation. Still others help break down drugs the wet warmth of the mouth, the dark soup of the gut — that and process alcohol. are home to bacteria, fungi and other organisms that have adapted to live in those environments. “In a big city, you have downtown, the suburbs, Chinatown,” said George Weinstock, an associate director at The Genome Institute at Washington University in St. Louis and a national expert on the microbiome. “This is like that. It has that same richness to it.”

From birth to 100 trillion they are essential to our health. Scientists call this collection of bacteria and other microorganisms in and on the human body the microbiome. It plays a role in bacterial infections such as C.diff, and concepts from research into the microbiome are beginning to be used to treat people like Knudsen who don’t respond to standard therapies. But the microbiome also figures into health conditions that seemingly have nothing to do with microbes. Researchers are looking into the connection between the microbiome and digestion, cavities, skin conditions, cancer, obesity and autoimmune diseases, to name a few. Some even hypothesize the microbiome plays a role in mental health. Knowledge in this area is so new that we don’t know the answers to the most basic questions: What does a normal microbiome look like? How is it different from the microbiome of a person with a dis-

Glossary: knowing your inner ecosystem • Microorganism: Any type of microscopic organism, as the name implies. In our bodies, we have multiple types of microorganisms, including bacteria, fungi and viruses. Microbe is another name for microorganism. HIGH DESERT PULSE • SPRING / SUMMER 2011

Among the most ambitious projects to study the microbiome is the Human Microbiome Project, a five-year, $140 million effort of the National Institutes of Health that began in 2008. Based on the same principles that guided the Human Genome Project, which completed its sequencing of all human genes in 2003, the microbiome project aims to create a picture of a normal human microbiome. It also will look at how alterations in the microbiome contribute to disease. Scientists have been especially curious about how each of us develops our own individual microbiome. To answer that, they have turned their attention to the moment when we first start accumulating microbes: birth. Babies in utero are sterile, and the uterus is typically a germ-free

• Bacteria: A type of microscopic organism — and the most common organisms in our body. Some are beneficial for our health, some are harmful, but many are just benign. • Microbiome: The collection of microbes that inhabit the human body. Scientists are actively studying the microbiome and finding that it plays an essential role in our health.

• Antibiotic: A chemical substance usually given as a medication to inhibit or destroy microorganisms, principally bacteria, that are harmful to our health. • Probiotic: Live microorganisms, typically bacteria, ingested to supplement the beneficial flora of the gut and improve digestive health. Page 9


Probiotics:

The anti-antibiotic These live microorganisms, primarily in the form of yogurt or nutritional supplements, contain helpful gut bacteria and have been proposed to treat microbial diseases. The theory: By sending an influx of helpful bacteria into the gut, any harmful bacteria are pushed out. The results: At least for treating disease, they have been mixed. Part of the problem is that the field is just too new. “Since we don’t know which types of bacteria confer the benefit, it’s hard to know what to put in the probiotic,” said Dr. James Gern, a pediatric allergist at the University of Wisconsin School of Medicine and Public Health. Some studies have shown positive results with probiotics, but others have shown that they don’t help at all. Dr. Jon Lutz, an infectious disease specialist at Bend Memorial Clinic, said he’s been hesitant to use probiotics because of that. “It’s just that the clinical trial data is kind of scanty.” Other issues with probiotics: One is that they haven’t been regulated very stringently. So, unlike pharmaceutical medications, where there are standard doses and strengths, probiotics have very little standardization. Consumers need to read labels carefully to know exactly what they’re getting. In some cases, that may not even help. An analysis by ConsumerLab.com, a company that tests nutritional supplements for purity, found that some types of probiotics did not contain the ingredients the labels claimed. In one case, the solution contained only 10 percent of the amount of probiotics per dose that it claimed on the label. Nevertheless, they have been used clinically in some cases. A small percentage of inflammatory bowel disease, for example, responds to probiotics. And because doctors say they are very unlikely to cause harm, it probably doesn’t hurt to give them a try. Page 10

Cover story | OUR BODIES’ VITAL BACTERIA environment. A human’s first exposure to microbes comes during delivery. In a study published last year, researchers looked at the bacteria on babies seconds after birth. They found that not only did babies begin accumulating bacteria immediately, but the specific species on the babies depended on how they were born. When babies were born vaginally, they were coated in bacteria commonly found in the cervix. Babies born via cesarean section, on the other hand, were covered with bacteria often found on skin and hands. “A baby is a microbe magnet,” said Lita Proctor, the program director of the Human Microbiome Project, who was not involved in this study. Whatever microbes the baby first comes in contact with — whether from the mother’s birth canal or a doctor’s hands — it picks up. Bacteria quickly colonize the baby and begin to grow, said Proctor. “A newborn goes from zero microbes to (100 trillion) microbes in just a few weeks.” This rapid proliferation of bacteria appears to be essential for normal development, particularly of the immune system. In mice that are born and develop in sterile environments — without any of the normal mouse microbes — something goes wrong. “There’s something screwy genetically, usually in the immune system,” said Vincent Young, an associate professor of microbiology at the University of Michigan who has done some of these studies. Though similar experiments have not tested humans, for obvious reasons, that kind of research has led scientists to surmise that one of the roles of microbes is to help teach the immune system how to behave correctly. These early microbes may help our bodies figure out what bacteria or viruses warrant mounting an attack and which are safe to leave alone. When babies grow and begin to explore their world, they pick up microbes from anything in their environment. The bacteria inside a parent often make their way to children from kisses, touches and feeding. Pets likely pass them a few germs. The air children breathe, whether from a farm or a city, helps shape their microbiomes. New microbes are introduced with solid food. As it develops, the microbiome becomes

more complex. The bacteria colonize and begin to form communities in which different microbes play different roles. Some are immune system teachers. Some likely just take up space, doing nothing harmful but nothing particularly good either. Some, such as the C.diff that struck Knudsen, can be bad actors. And many do work that benefits our bodies. For example, there’s one particular bacterium that seems to play an important role in the health of our intestines. It’s known as Bacteroides fragilis, or B.frag, and it’s been studied extensively by a biologist at the California Institute of Technology named Sarkis Mazmanian. Mazmanian found that B.frag secretes a substance that prevents inflammation of the intestines. An inflamed intestine can cause all sorts of problems, from trouble digesting food and absorbing nutrients to chronic illnesses. There are medications that have antiinflammatory effects on the gut, namely steroids, but these also suppress the body’s natural immune system and cannot be used long-term. B.frag has the remarkable quality of being able to calm gut inflammation with no effects on the immune system. For B.frag, Mazmanian said, keeping us healthy is in the best interest of the bacterium. “We are its home, and if its home is the gut, then an inflamed gut is not a hospitable environment.” The bacterium “has evolved these intricate mechanisms to shape an environment for that purpose. In this particular case, their benefit is our benefit.”

Microbial forest fire With her normal microbial community wiped out, Knudsen felt awful. She was in pain and wasn’t hungry. She had to stay close to a bathroom. She managed to work while she was sick, even completing a doctoral degree in between bouts of illness. But she couldn’t kick the infection. For some people, C.diff is cured when they stop taking the antibiotic that treated the original illness — in this case the infected bee sting — allowing the gut to recolonize with good bacteria. Others need a separate antibiotic that kills C.diff. Neither of those treatments worked for Knudsen.

SPRING / SUMMER 2011 • HIGH DESERT PULSE


She is not unusual. About 20 percent of patients treated with standard antibiotic therapy for C.diff don’t get better and have recurrent bouts of the infection. There are few things, if any, that cause as profound a change in the microbiome as antibiotic treatment. An adult’s internal flora is typically fairly stable. Until one takes an antibiotic. The antibiotic rips through the body, wiping out the bacteria causing infection but destroying the bacteria that keep a person healthy as well. “I always tell patients that it’s similar to when a forest fire goes through a forest,” said Dr. John Townes, an infectious disease specialist at Oregon Health & Science University. Of course, most people taking antibiotics do not develop harmful side effects, and the drugs are necessary to treat a number of conditions. Still, microbiome researchers say we should be cautious with antibiotics because they could cause long-term changes in our internal flora.

The antibiotic rips through the body, wiping out the bacteria causing infection but destroying the bacteria that keep a person healthy as well. “I always tell patients that it’s similar to when a forest fire goes through a forest.” Dr. John Townes, Oregon Health & Science University In one of the few studies to look carefully at how antibiotics affect the microbiome, three healthy individuals took a five-day course of ciprofloxacin, a common antibiotic thought to be relatively gentle on the gut. The researchers, mostly from Stanford University, measured whether the antibiotic had caused any changes in the microbes in the intestines. For each person, about a third of the bacteria in the gut was wiped out by the antibiotic, a change the researchers called “per-

HIGH DESERT PULSE • SPRING / SUMMER 2011

vasive.” Despite the disturbance, none of the three individuals experienced any outward symptoms of the change. For the most part, their guts reverted back to the way they had been within four weeks. But six months down the line, some of the species that had been there before treatment still had not returned. It’s possible that the antibiotic wiped some bacteria out of the intestine permanently. “You can irreversibly change it,” said Young, who was not involved in the Stanford study but has done similar work. In mouse studies, Young has shown that it’s possible to remove species from the gut with antibiotics. Were the subjects in the Stanford experiment worse off? Right now, it’s tough to say. They did not report any health effects from taking the antibiotic. Also, different species of bacteria can perform the same beneficial functions in our gut, so whether it matters to our overall health to have a particular species inhabit the gut is an open question. “We’re just starting to do those studies,” said Weinstock. “I think what will come out is there are some effects” of antibiotic use, though he said it’s unclear what those could be.

Microbes and disease The ultimate goal of microbiome research is to figure out how it is related to disease. As part of the Human Microbiome Project, the NIH is pouring millions into researching just this question. Scientists around the world are finding changes in the microbiome in a diverse number of health conditions. For a relatively simple example of how bacteria can have a direct impact on our health, consider cavities. On a typical tooth surface, there is a community of microbes, typically living in harmony with themselves and with us, said Weinstock. Most of the microbes are good, he said, but “there are a few bad guys in there.” These bad guys secrete an acid that breaks down enamel, causing the tooth to decay and creating a cavity. Normally, Weinstock said, these bad bacteria are minor players. But eating sugar allows them to flourish. “These bad bacteria love to eat sugar, and not all the good bacteria like to eat sugar. So, when you have a lot of sugar, those acid-producing bacteria overgrow.” It’s

THINKSTOCK

The microbiome in your mouth Like all living things, different microbes in our bodies thrive in different environments. Take our mouths, where scientists have found hundreds of species of microbes. And even these microbes are divided among the mouth’s diverse habitats: the teeth, tongue, cheeks — and any other surface you can imagine.

Front of teeth: Home to microbes that like oxygen and light.

Back of teeth: Home to microbes that like oxygen but not light.

Under gums: Home to microbes that do not need light or oxygen.

Top of tongue: Home to various microbes. For people with chronic bad breath, known as halitosis, different species often inhabit the top of their tongues than for people without the condition. Source: Expert interviews, Journal of Clinical Microbiology

Page 11


Cover story | OUR BODIES’ VITAL BACTERIA that overgrowth, and subsequent increase in acid production, that causes cavities. That same principle — a microbial imbalance leading to a bad outcome — is implicated in more serious conditions. Asthma, for example, may develop when a person does not have enough of certain microbes that calm the immune system. A growing body of research suggests that microbial exposure early in life is key to whether the person develops asthma. A study published earlier this year in the New England Journal of Medicine compared asthma rates of thousands of children who lived on farms with thousands who lived in cities or suburbs. The researchers also collected and analyzed the dust the children were exposed to on their mattresses or in their rooms. The children who grew up on farms had lower rates of asthma than the other kids. Further, the more diverse the microbes in the dust that children breathed in, the lower their risk of asthma. “Growing up on a farm seems to be a good thing,” said Dr. James Gern, a pediatric allergist at the University of Wisconsin School of Medicine and Public Health, who wrote an accompanying editorial in the journal. “A lot (of studies) have indicated that bacteria and fungi likely cause changes in the risk of developing asthma.” It’s likely that some of the microbes children are exposed to on farms are protective against the development of asthma. But scientists still don’t know which particular organisms help or how. Researchers studying inflammatory bowel disease are getting closer to that kind of specific information. Inflammatory bowel disease, which encompasses two conditions — Crohn’s disease and ulcerative colitis — causes inflammation of the lining of the intestines. Scientists have long known that in people with the condition there is some malfunction in the immune system in which it attacks the body. But they have not known why that happens. In research that has yet to be published, a team led by Claire Fraser-Liggett, a microbiologist at the University of Maryland, found that people with Crohn’s disease had a different balance of bacteria

Though fecal transplants have been around for decades, the concept has never caught on. As Dr. Paul Sehdev acknowledges, they are “aesthetically challenging.” in the gut than healthy people did. In particular, they have lower levels of a bacterium that keeps inflammation under control. That, she said, could be the explanation, or at least part of an explanation, for why the gut has trouble calming down. The microbial community may even affect obesity, which was once thought to be almost entirely explained by a person’s genes and behavior. A team, again led by Fraser-Liggett, studied an Amish community and found that, at least in this population, a certain combination of genes and microbial bacteria increased a person’s risk of being overweight. When people had a certain variation in a taste receptor gene and low bacterial diversity in their gut, they were more likely to be overweight. People with the taste receptor variant but a diverse community of gut bacteria were typically normal in weight. The combination was key; just the specific gene or bacterial diversity alone was not linked to obesity. The team said in a news release that one day this work could lead to a new understanding of how our genes shape our traits and, perhaps, to new treatments for obesity. In studying asthma, inflammatory bowel disease, obesity and other chronic conditions, a major question remains unanswered: Does the disease shift the microbiome or does a microbial shift cause disease? In other words, it’s not known whether people develop a condition that causes a change in the microbial species inside them or if it’s the other way around, with the bacteria making their way into


Hospice Care doesn’t mean giving up ...

the body and triggering development of a disease. Whichever it is, the answer could well cause a profound shift in the way we deal with these diseases. It may be that one day years from now, when you walk into your doctor’s office with certain symptoms, a physician will test your microbiome to see how he or she might treat you. “Once we understand what the microbiome is and how it contributes to disease,” Proctor said, “I really hope that down the road that everyone could have … routine (tests) to let you know whether your microbiome is going south and what you can do to get it back on track.”

Last hope While science works out the details of the microbiome, a handful of doctors have been willing to try things that are radical — even repulsive — to help people whose microbiomes have become dysfunctional. Dr. Paul Sehdev, an infectious disease specialist at Providence St. Vincent’s in Portland, is one of those physicians, and he was the last hope for Knudsen. By her fourth hospitalization, in May 2008, the Knudsens had run out of options. “We knew we had to take it to a whole new level,” said Knudsen’s husband, Mark, who is also a pharmacist. That’s when they first met Sehdev. Within days, he had scheduled Knudsen for a fecal transplant, a procedure in which fecal matter from a healthy person is injected down the throat and into the gut. The hope is that the beneficial bacteria in the fecal matter repopulate the gut and push the C.diff out, in essence giving Knudsen a new, healthy intestinal microbiome. Though fecal transplants have been around for decades, the concept has never caught on. As Sehdev acknowledges, they are “aesthetically challenging.” In recent years, due in large part to microbial research, there’s Continued on Page 50

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Get ready | ONE DAY, 100 MILES

Cyclists ride down Shevlin Park Road. Page 14


Joining the draft

The ride of a

‘century’

Drafting — or riding closely behind another rider to take advantage of the lack of wind resistance — allows riders to conserve energy. Practice with regular cycling buddies, and on the day of the event, don’t draft behind a stranger without asking first.

Air and wind

100 miles in a single day may seem a long way, but with training, even novice cyclists can make it Slipstream BY BETSY Q. CLIFF PHOTO BY RYAN BRENNECKE

I

know it’s there. It’s stuffed in the corner of your garage, with a flat tire and a ripped seat. It hasn’t seen the sun for months, maybe even years. Yes, it’s your bike. Thanks to the proliferation of area bike races in recent years, there are summer weekends when it seems every other car around here has a bike on top. But there are still many of us who haven’t yet jumped on the bandwagon — or rather, into the bike lane. Riding a bike can be a great way to see Central Oregon, or any area. It’s the perfect pace: fast enough to cover some ground, but not too fast to keep from really noticing the scenery. One of the milestone events for road bikers is a century ride, going 100 miles in one day. And, local cyclists and trainers say, it’s an achievable goal for someone who wants to train for a road bike event. Even if you’ve never cycled before. If you have three to four months, “it’s definitely doable,” said Dr. Matthew Lasala, an internal medicine physician at Bend Memorial Clinic who is head of the clinic’s roadbiking team. “If you never exercise, that

HIGH DESERT PULSE • SPRING / SUMMER 2011

might be a little more challenging, but if you have some base with skiing or running,” it shouldn’t be too hard. A century ride is not a race, Lasala added, so you don’t need to worry about speeding through it. “You can certainly do it at your pace.” On the other hand, 100 miles is a long way, and experts say you need to be ready to spend some time in the saddle.

Getting going To train for a century ride in about three months, you should plan to ride a minimum of three or four days a week, said Bart Bowen, a cyclist and coach at Rebound Sports Performance in Bend, an athletic training studio. Bowen said one or two of those days could be at a spin class, particularly for people who are pressed for time. But he said it’s important to ride outside because spinning “doesn’t teach you to ride and pedal your bike as efficiently as you will learn outside.” Bowen suggested starting with rides of about 15 to 20 miles, which should take no longer than a couple of hours. “One to two hours for your first ride is going to be plenty.” Then, you should increase the distance and time gradually. To do a century, he

Page 15

How to: Ride about a foot behind the other rider and off to one side. Riders can expend up to 30 percent less energy by riding in another rider’s slipstream.

Drafting with decorum “What’s really important is that if someone is drafting, they are choosing the wheel to ride behind,” said Muffy Roy, a former road bike racer who now works at Sunnyside Sports in Bend. “A good rider to draft behind is someone who rides in a straight line, and any move they make is in slow motion.” The best way to draft, Roy says, is to ride behind someone you know and who knows you. If you can, practice drafting on training rides before an event. And, she said, there is an etiquette to it. “An accomplished rider is welcome to ride with another accomplished rider,” even if they don’t know each other. Otherwise, if you’re not sure, ask if they mind if you ride on their wheel. GRAPHIC BY GREG CROSS


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said, “you’re going to have to build up about 10 percent per week.” That means if you ride 20 miles one week, then go about 22 the next week, 25 the week after that, and so on. As with marathon training, Bowen said, each week you can do a few shorter and faster rides, plus one long, distancebuilding ride. That can help those who work or have other obligations that prevent them from getting out for several hours each day. Lasala said it’s important to build distance gradually, and he endorsed the 10-percent-per-week guideline. “A lot of people go too hard too quickly,” he said. “Get your muscles and ligaments and such used to it.” Lasala and Bowen both advocated a training technique called periodization. For three weeks, cyclists train fairly hard, getting in several good workouts during the week and long rides on weekends. On the fourth week, they cut back. “When you drop down is when the body acclimates to the stresses you’ve been putting on it,” said Lasala. “That’s where your body really gains the fitness you’ve been accumulating.” By the time the century ride nears, you should have ridden at least 80 to 85 miles at one time, trainers said. The rule of thumb for many types of long rides is that if you go 80 percent of the distance in training, you can go the full distance in the actual event.

Learn the sport

To Advertise Contact Kristin Morris 541.617.7855 kmorris@bendbulletin.com

There are a couple of aspects of road biking that are different from other distance sports. “A 100-mile ride is very different than a marathon,” said Bowen. “For runners, things are very steady, and the pace doesn’t change that much. But in biking it’s very dynamic.” Riders can vary their speed five-fold depending on whether they are chugging up a steep hill or cruising down the other side. Because of that variation, Bowen said, it’s a good idea to do some hills, ride sprints and vary your bike workout. Biking is also best done with friends, or at least people you get along with well

Page 16

HIGH DESERT PULSE


Organized century rides These events are 100-mile rides unless noted. Many also include shorter routes, so if you don’t want to go the full 100 miles, there are options. Most of the events are supported, meaning you’ll have food and water stops, but also entry fees. Check each ride for specifics. Hat Rock Century Begins near Pendleton, May 28 www.cyclependleton.com

Tour des Chutes Begins in Bend, July 16 tourdeschutes.org

Pioneer Century Begins in Canby, June 4 www.pwtc.com

CASA Ride through Paradise Begins in Klamath Falls, July 23 klamathfallscasa.org

Strawberry Century Begins in Lebanon, June 11 www.santiamspokes.org Petal Pedal Begins in Silverton, June 18 www.petalpedal.com Firecracker Ride A metric century (100k/62 miles). Begins in Alfalfa, July 4 www.mbsef.org

Cascade Gran Fondo 85 miles. Begins in Bend, Aug. 20 www.cascadegranfondo.com Portland Century Begins in Portland, Aug. 21 www.portlandcentury.com

Alpine Century Begins in Alpine (near Corvallis), Aug. 13 www.alpinecommunity.net

Cycle Umpqua Vineyard Tour Begins in Roseberg, Sept. 10 cycleumpqua.com

Crater Lake Century Begins in Fort Klamath (outside Chiloquin), Aug. 20 www.craterlakecentury.com

Tour de Frog Begins in Milton-Freewater, Sept. 10 www.eosportstraining.com

Two bike routes on the Cascade Lakes Highway Century Drive is so named because it was once part of a 100-mile loop promoted by area tourism associations. The loop makes a nice ride, but for a route with less traffic, try the Mt. Bachelor Loop.

Bend START

Century Drive (100 miles) Mt. Bachelor Loop (85 miles) 97

Cascade Lakes Highway 46 46

45

Sunriver

40

Crane Prairie Reservoir MILES 42 97 46

Wickiup Reservoir

0

5

La Pine

enough to draft behind. Drafting, common in competitive cycling, is a technique in which cyclists stay close to one another to take advantage of the lack of wind resistance directly behind another rider. “If you have people around you, in draft, you save 20 to 30 percent of the effort,” said Lasala. Lasala said that because drafting requires riding about a foot away from someone’s back tire, the century ride isn’t the place to learn. He suggested going out with friends or finding a riding group.

Gearing up Of course, to ride a bike, you’ll need one. And that one that’s been collecting dust in the garage may not be your best bet. Lasala and Bowen said fit is the most important. “That will make the ride more comfortable,” said Bowen. Muffy Roy, a former road bike racer who now works at Sunnyside Sports in Bend, said it’s also important to make sure the bike has the correct gears for a ride. “If it’s a hilly course, then make sure there are gears that are easy enough to go up those hills.” Roy also advocated getting clip-in pedals. “It allows the rider to push and pull all the way around the pedal stroke,” she said. That lets you use all of your leg muscles, not just the quadriceps, to move the pedal. In addition, cyclists should carry food and water, particularly on long rides. “If you go hard for two hours and you don’t fuel up, you’re going to bonk,” said Bowen, referring to the energy crash that people sometimes call hitting a wall. Bowen said you should have two water bottles on your bike — and use them. For food, many people like bars and goos, but Lasala said a peanut butter and jelly sandwich can work just as well if you can digest it easily. After you’ve put in all that preparation, Lasala said to remember what is perhaps the most important point: You started doing this because you wanted to. “Have fun with it,” he said. “After all, it should be enjoyable.” •

MAP BY GREG CROSS

HIGH DESERT PULSE • SPRING / SUMMER 2011

Page 17


Mental health |

Does your

THE ROLE OF DIET

food affect mood?

A recent study reinforces the link between diet (think fats) and depression

BY ANNE AURAND

J

eana Sheldon has endured depression for most of her adult life. She mostly suffered silently, masking her emotional turmoil when she was with friends, co-workers, family. She cried alone. “I didn’t want to be diagnosed with depression,” she said. “I was stubborn.” Sheldon said family members battled depression, and she didn’t want to be like that. She refused to take antidepressants and lived with a “get over it” attitude about depression for more than 15 years. Then, late last year, Sheldon, 41, made changes in her diet that she believes are responsible for pulling her out of it. She originally went to see chiropractor Jason Kremer, owner of the Wellness Doctor clinic in Bend, after a fall on the ice gave her a concussion

ILLUSTRATION BY GREG CROSS

Page 19


Mental health | THE ROLE OF DIET and whiplash. Kremer routinely examines the diet of any client willing to discuss it. Because Sheldon had been losing weight and wanted to continue to do so, Kremer’s lifestyle educator helped her adopt a new diet. Along with reducing sugar and increasing lean proteins, she eliminated artificial and processed foods, including all trans fats. Sheldon said goodbye to deep-fried foods, which she said she still misses: “egg rolls, taquitos, fried chicken, that sort of stuff.” She soon noticed her depression fading away. “The black cloud lifted off my brain,” she said. She had experienced good moods before, but the highs usually didn’t last more than a few weeks. This new, good feeling has lasted for months. Sheldon, a customer service specialist at Juniper Swim & Fitness Center in Bend, said people started complimenting her freckled skin’s new glow. Her curly reddish-brown hair grew in thicker. Her energy improved. “I feel so much better and so much more alive,” she said. “It seems like it’s such a small thing to do to save yourself.”

Linking diet and depression There’s no proof that Sheldon’s new diet improved her state of mind, but the idea of a link between mood and food is nothing new. Many doctors and counselors advise patients to clean up their diets for various health reasons. But a new study out of Spain specifically links higher consumption of trans fats with a higher risk of depression. Sheldon simultaneously shed both trans fats and depression from her life. Many doctors and psychiatrists are not aware of the new study. But its message did not surprise Kremer, who believes the notoriously fatty, processed foods prevalent in the American diet can be blamed for depression as well as other health problems.

Skip this Jason Kremer suggested these substitutions, which can help you avoid trans fats in your diet.

Pick this

RYAN BRENNECKE

Jeana Sheldon dealt with depression all her life but refused to seek professional help. In an effort to lose weight, she made drastic changes to her diet, eliminating deep-fried, processed and artificial foods. What she soon noticed even more than the loss of weight was the loss of depression.

Kremer, who earned his doctorate in chiropractic care and his bachelor’s degree in exercise science and nutrition, advises his clients to limit saturated fats in foods such as beef and butter and to avoid trans fats by eliminating processed foods. He encourages clients to consume monounsaturated and polyunsaturated fats, which are the “good” fats from plant products such as avocados, nuts and olives. He also recommends vitamin D and fish oil supplements. He’s seen plenty of evidence in his office that the typical “bad” American diet is associated with poor concentration and body composition, obesity, sluggishness and low

self-esteem. He said “all that could relate to depression.” Over the years, researchers have examined connections between mental health and everything from fats to folic acid. Most of these studies, like the new one from Spain about trans fats, suggest correlations but can’t prove that eating or avoiding a certain food will create or prevent depression. However, other studies have provided support for the idea that good fats are helpful to mental health. For example, an article recently published in Nature Neuroscience said mice fed a diet low in good fats such as omega-3 fatty acids

White bread and margarine

Processed cereal

French fries and ketchup

Wholegrain bread and olive oil

Oatmeal and fruit

Baked potato and salsa


(found in foods such as salmon, some vegetables, seeds and nuts) had neuronal dysfunction and depressive behaviors. And the Journal of Nutritional Health and Aging recently published a randomized, double-blind trial that took place in an Italian nursing home. Studying 46 female senior citizens who were depressed, the trial concluded that consuming the polyunsaturated fatty acids that are prevalent in fish oil would reduce depression.

Trans fats and depression While some good fats may improve mental health, trans fats are a different story. The new Spanish study may be the first to connect trans fats intake with depression risk. Trans fats are created when vegetable oils are processed and hydrogen is added, through a process called hydrogenation. Trans fats are more solid than oils and have a longer shelf life. After studying 12,059 people for six years, researchers from the universities of Navarra and Las Palmas de Gran Canaria in Spain said they have demonstrated that consuming trans fats and saturated fats is correlated with an increase in the risk of depression. And, inversely, consuming olive oil is linked with lower levels of depression, according to the study. But might people with undiagnosed depression be more likely to eat worse, creating a downward spiral of depression and more bad food? The study doesn’t definitively say. “We have not analyzed this point,” said Almudena Sánchez-Villegas, the study’s lead author, in an e-mail. “But there are lots of studies that have reported unhealthy dietary habits or an (increase) in the intake of some detrimental foods such as fast food, sugars, etc., among subjects with a depressive disorder.” The participants in this particular study

CHI

PS

Potato chips

were screened at its onset, and anyone with a possible subclinical depression was excluded. Researchers eliminated 1,507 volunteers from the entire study because they had prior tendencies toward depression. Additionally, 257 more subjects who had depression two years into the study were excluded. At the end of the study, from the 12,059 subjects, 657 new cases of clinically diagnosed depression had been detected. The study found that participants who consumed 1.5 grams a day of trans fats, which was on the high end for intake, had a 48 percent higher risk for developing depression than those who consumed no trans fats. (For comparison, one small serving of Burger King french fries can have 4 grams of trans fat.) And, the study said, participants who consumed more polyunsaturated fats, like vegetable and fish oils, together with olive oil, had lower risks of developing a mental health problem. Participants who consumed more than 20 grams a day of olive oil had a 30 percent lower risk of depression than those who consumed little or no olive oil. Sánchez-Villegas said she believes the results are relevant because the magnitude of the depression risk was so high in those with high trans fat consumption. Her study, “Dietary Fat Intake and the Risk of Depression: The SUN Project,” was published in the online peer-reviewed journal PLoS ONE. Observational studies like this one can establish a link between a risk factor and a health condition but cannot prove that one caused the other. Randomized, doubleblind clinical trials are considered the gold standard for proving causation, but they are often difficult to undertake when it comes to measuring the impact of diet. This study was carried out in a Mediterranean population, where the average trans

Hamburger

NON DAIRY

Fat study’s findings The Spanish study followed 12,059 volunteers over six years, enlisting only those who did not suffer from depression at the beginning of the study. At its conclusion six years later, 657 new cases of clinically diagnosed depression had been detected.

BAD FAT: trans fats Researchers found that people who ate 1.5 grams or more of trans fats a day — roughly the equivalent of a 1/3 serving of Burger King fries — had a 48 percent higher risk of depression than those who consumed none.

GOOD FAT: monounsaturated fats Participants who consumed a lot of olive oil, more than 20 grams a day (or about 1.4 tablespoons) had a 30 percent lower risk of depression than those who consumed little or no olive oil. Source: Dietary Fat Intake and the Risk of Depression: The SUN Project. Published in PLoS ONE journal, January 2011

Nondairy creamer RANCH

Nuts

Grilled chicken breast

1% milk

Brandname salad dressing Olive oil and vinegar

GRAPHIC AND ILLUSTRATIONS BY GREG CROSS


Mental health | THE ROLE OF DIET fats intake is 0.4 percent of total consumption. Americans eat differently, and therefore the message may be even more relevant here. “The repercussion of these results might be really important in other settings where trans fatty acids intake is by far higher,” she wrote. “For example, it can be … up to 2.5 percent of total energy intake among the American population.” Sánchez-Villegas wrote that trends in depressive disorders have paralleled the change in sources of fats — from polyunsaturated and monounsaturated fats to more saturated fats and trans fats — in the Western diet.

Depression Depression affects more than 150 million people worldwide, according to the World Health Organization. In America, it affects nearly one in 10 adults annually and nearly twice as many women as men, according to the American Psychiatric Association. The association cites several factors that contribute. First is biochemistry in the brain. Abnormalities in the brain chemicals serotonin and norepinephrine might contribute to symptoms of depression. Genetics is another factor. Depression can run in families. Personality is implicated. People with low selfesteem are susceptible. And environmental factors can contribute. Continuous exposure to violence, neglect, abuse or poverty can make someone even more vulnerable to depression. Depression can be treated. For those who don’t respond to improved diet and exercise, antidepressant medications can be prescribed, and psychotherapy or “talk therapy” is also used in the treatment of depression, according to the American Psychiatric Association.

Differentiating fats Trans fats — AVOID. Most trans fats are consumed through processed, frozen and fast foods. They are created when liquid vegetable oil is hydrogenated and turned into solid fat. Check nutrition labels for “partially hydrogenated.” Most fast food restaurants use trans fats for cooking, so avoiding fast foods is crucial. Also avoid deep-fried foods in restaurants. Trans fats can be found in margarine, doughnuts, french fries, candy bars, nondairy creamers, commercially prepared baked goods such as cookies, crackers, cakes, muffins, pie crusts, pizza dough and some white bread products. Some cake mixes and pancake mixes have them. Generally, trans fats have a longer shelf life than the “good” fats, making them desirable for manufacturers. Small amounts of trans fats also occur naturally in some meat and dairy products. Saturated fats — LIMIT. Saturated fats come from animal products such as beef, veal, lamb, pork, butter and whole milk dairy products including cheese. Saturated fats also come from coconut and palm oil products, but the plant’s fat has a different structure. Coconuts, for example, include antioxidants, anti-inflammatory qualities and some benefits for the immune system. Polyunsaturated and monounsaturated fats — CHOOSE. Commonly referred to as “good” fats, they are found mainly in fish (especially salmon), nuts, seeds, avocados, olives and some vegetables, and liquid vegetable oils such as olive, corn, sesame, safflower and canola. Sources: Jason Kremer, websites for The American Heart Association and Harvard School of Public Health, and www.WebMD.com

Researchers offer theories Exactly how trans fats might trigger depression is speculative, said Dr. Steve Ireland, a Bend neurologist who read the study but was not involved with it. The study offers a couple of good hypotheses, he said. “All of us know there are incredible links between nutrition and the brain.” The study theorizes that trans fats, through a chemical process, cause inflammation of the lining of the blood vessels,

Page 22

to find out which or how many of these theories are true,” Ireland said. Sánchez-Villegas said some follow-up studies are already under way. She doesn’t know of anyone who has tried treating depression specifically through the elimination of trans fats from the diet. The study examined the effect of trans fats and the risk of depression. “So, to avoid its use is preventive advice, not a treatment message,” she concluded.

Preventive health care Preventive care is exactly the kind of medicine Dr. Ron Rosen believes in. Rosen is a longtime Bend doctor whose private medical practice, Open Paths Integrative Medicine, is infused with alternative therapies. Rosen doesn’t specialize in depression but has anecdotal experiences that back up what the study said. “I’ve seen it so many times,” he said, describing scenarios in which depressed clients improved their diets, boosted their intake of healthy fish oils and flax seed oils, and saw a positive change. “Most get off fast food and processed food and eat closer to nature … and they’ll feel better.” Rosen doesn’t isolate trans fats specifically when discussing ailments and treating clients. But he said trans fats would create inflammation that would affect the adrenal glands and eventually translate into an imbalance of neurotransmitters in the brain, generally in line with one of the theories posed by the Spanish researchers. “It’s hard to say just trans fats cause the depression. I see a more holistic perspective,” Rosen said. “But for sure, the idea that everyone needs Prozac is crazy. … Physicians aren’t always looking at the cause of depression. Tons of people change their diets and their moods change.”

Feel like dancing called the endothelium. Inflammation and dysfunction of the endothelium is common in depressed patients, Ireland explained. The researchers also offer the theory that trans fats create chemical changes that interfere with neurotransmitters, including serotonin, which is implicated in depression. (Prozac, a common antidepressant, acts by increasing the availability of serotonin in the brain). “They may need to do more studies

Debbie Harthill, a 56-year-old bookkeeper in Bend, couldn’t agree more. Improving her diet bettered her mind, body and spirit, she said. She’s always been a person who got depressed, she said, and has been on medication for depression in the past. Last year, she had been crying a lot and was privately miserable. She slept poorly and couldn’t lose weight even though she exercised. She Continued on Page 52

SPRING / SUMMER 2011 • HIGH DESERT PULSE


How does he do it? MATT LIETO

Turning fun to fitness BY BETSY Q. CLIFF PHOTOS BY PETE ERICKSON

G

rowing up, Matt Lieto was always the fat kid. He watched his older brother, Chris, compete in triathlons, but he never felt he could be athletic himself. At age 21, he weighed 250 pounds. “At that point,” he said, “I had no thoughts I would be anything but fat my whole life.” Now in his early thirties, Lieto is a svelte 170 pounds and a professional triathlete who has completed more than half a dozen Ironman triathlons. He also coaches elite athletes,

Page 23


How does he do it? | MATT LIETO sharing his secrets of success with people all over the country and even the world. He trains people as far away as Asia. But it all started with a Hawaii trip and a skate park. Back when he was 21, Lieto tagged along with his family to watch Chris compete in the Kona Ironman. That triathlon, like all Ironman competitions, is an almost inhuman distance. Participants swim about 2½ miles, bike 112 miles and then, after all that, run a marathon, 26.2 miles. “I didn’t know what the Ironman was, or what a triathlon was, for that matter,” he said. That week changed his life. He volunteered to hand out water during the run and, stationed at mile 22, he watched runners stream by. “I was trying to run and give them water and I couldn’t keep up,” he said. He thought, “Man, they’ve been out here for nine hours and they’re still doing this.” Back home in northern Arizona, where Lieto was then in college, he resolved to change his life. He began with his diet. He gave up packaged foods and, for a time, meat. He consciously started drinking more water. And he adopted what he calls the king-prince-pauper diet: Eat a big breakfast, medium-size lunch and small dinner. A friend had told him it would jump-start his metabolism. He had tried diets before, he said, always unsuccessfully. But he tried this in an attempt not necessarily to lose weight, but just to get healthier. “There was a small hope” of weight loss, he said. “But, if not, I’m changing my health, just trying to eat healthier.” Because he wasn’t depriving himself and wasn’t on a formal diet, he felt it worked better for him. Lieto also changed his relationship with food. Formerly a comfort eater, he said he started to eat for fuel rather than to fulfill an emotional need. “I enjoy eating, but I think I’ve taken the emotion out of eating,” he said. Now, if he’s bored or unhappy, he does something other than snack. He also makes rules for himself. Sometimes it’s eating only a salad for dinner. Other times, it’s no snacking after 6 p.m. “It’s a very structured way to look at food, but I think for people that are overweight, they need to look at it that way,” he said. “My body always wants to be 250 pounds.” At the same time he changed his diet, a skate park opened down the street. “You can call it dumb luck,” Lieto said. “I woke up in the morning and I saw my skateboard sitting there and I wanted to skate.” Lieto had skated as a kid, but not like this. He was at the park five to six hours a day. “I would just try to ride bowls in the half pipe or things like that, not knowing that I was sitting in the perfect aerobic zone.” But his waistline noticed. He lost about 80 pounds in four and a half months, going from a 38 to 32 pant size. He said skating wasn’t an attempt to get more exercise. “It was purely super fun.” That aspect of his weight loss — just getting out and having fun — was what did the trick, he said. “If I would have gone on

Page 24

SPRING / SUMMER 2011 • HIGH DESERT PULSE


Meet Matt Lieto Age: 32 Occupation: Professional triathlete and coach Typical daily exercise regimen: 1.5 hours of swimming, 2 hours of biking, half hour of running

Followers on Twitter: Nearly 2,500 Recent tweet: “My world would END if I didn’t have my eggs, (gluten free) toast and/or bagel with a touch of Base Performance salt. END.” How he stays motivated: “Enjoying the journey is my mantra.”

SUBMITTED PHOTO

Think that’s Matt Lieto there on the left? Actually, it’s his brother, Chris. Matt is on the right, in this photo from the Kona Ironman competition in 1999, where he went to watch Chris compete. That experience made Matt resolve to change his life — and he started with his eating habits.

Once a comfort eater, Lieto later changed his relationship with food. “I enjoy eating, but I think I’ve taken the emotion out.”

“It’s not just what you want to finish your race in, it’s what’s your goal in life. You have to find something that inspires you, that makes you happy.”

a diet and gone to the gym for an hour a day, it never would have worked.” Lieto said he thinks that finding something you love to do is key to losing weight and maintaining an exercise program. Whether it’s skating, bike riding, jogging or walking, he said, people are more inclined to do something they want to be doing. “There’s so many things to do in this area,” he said, people should choose an activity they enjoy. Lieto entered his first triathlon in 2000. It was a doozy. He chose the Wildflower, a race near San Luis Obispo, Calif., that has a reputation as one of the hardest triathlons in the country. He trained for nine months and set a goal time for himself. Not only did he finish the race, he beat his goal. He was hooked. A few years later, he was ranked in the top five amateur athletes in the country. Then, he turned pro. Now, he’s still training, trying to better himself and beat the competition.

HIGH DESERT PULSE • SPRING / SUMMER 2011

Lieto moved to Bend in 2004 and now coaches at Rebound Sports Performance and through a training studio in San Francisco. He lives with a roommate on the city’s west side. He trains every day and still watches what he eats. Because he works out so often, he eats a lot. “I eat like a champ,” he said. “I eat more than anybody I know.” Along the way, he’s tried never to forget the lesson from the skate park: Make it fun. “Enjoying the journey is my mantra,” he said. Of course, he said, there are days when it’s work, when cold weather makes for long runs or hunger pains strike at the wrong time. But even when those challenges come up, he tries to make sure he’s always doing it for the right reasons. “It’s not just what you want to finish your race in, it’s what’s your goal in life,” he said. “You have to find something that inspires you, that makes you happy.” •

Page 25


Sorting it out | SURGICAL SUCCESS

Tips before going under the knife You know about your surgeon’s role, but what about yours? BY MARKIAN HAWRYLUK

T

hree out of every 100 surgery patients will develop an infection in the hospital or soon after their procedures. Thousands of other patients will be harmed by medical errors or drug interactions. While you might think the chances of avoiding such complications are in the hands of your doctor and the rest of the medical team, there are things you can do to improve your results. Taking the following steps before and after your surgery can help you reduce your risk of complications and get you back on your feet sooner.

BEFORE SURGERY BEFORE THE SURGERY 1. Give your doctors a list of the medications you take. Talk to the surgeon about why you take each medication and whether you should continue to take those drugs until the day of your surgery. 2. Let the doctor or hospital staff know of any allergies you have, particularly to medications. Your surgeon may not be as familiar with your health history as your primary care doctor. Tell the surgeon if you have high blood pressure or diabetes. 3. Stop smoking well in advance of your surgery. Although study results have been mixed, some research suggests that smoking raises the risk of infection after surgery. A recent analysis of the research concluded there was no downside to patients quitting before a procedure. If you’re overweight, losing some weight can also help reduce the risk of infection. PHOTOS FROM THINKSTOCK

Page 26

PETE ERICKSON

A surgery room at St. Charles Bend.


4. Three to five days before the surgery, start to shower daily with chlorhexidine soap. Some hospitals provide this soap to you, but it can also be purchased at drugstores without a prescription. It will help kill dangerous bacteria on your skin. 5. Don’t shave anywhere near your surgery site. If you want to shave your face the day of the surgery, ask your doctor if that’s OK. Microlesions caused by shaving provide a way for bacteria to enter the skin. If the medical team needs to remove hair for the surgery, infection control experts recommend they use clippers. 6. Dress appropriately: Wear clean pajamas to bed the night before and clean clothes to the hospital. Choose loose-fitting clothes with buttons or zippers rather than pullover tops that could be difficult to put on after surgery.

DAYSURGERY OF SURGERY DAY 1. Follow your physician’s instructions about eating and drinking before the surgery.

2. Don’t wear contacts, jewelry, makeup or nail polish.

3. Stay warm: Let the staff know if you feel cold. Keeping warm before and during surgery lowers your risk of infection. 4. Review your medications, allergies and health conditions with the nurses and the anesthesiologist before going in for surgery.

AFTERTHE SURGERY AFTER SURGERY 1. Avoid touching your hands to your mouth and do not set food or utensils on furniture or bedsheets, where they might pick up contamination. Some bacteria can survive for days on surfaces.

2. Make sure all doctors, nurses and visitors wash their hands before entering your room. It’s not rude to ask the medical staff to clean their hands before touching you. Ask your doctor or nurse to disinfect his or her stethoscope, too. 3. If you’re in pain, don’t be afraid to tell your doctor or nurse. Pain can be a sign of a problem with your operation, and the medical staff wants to help you feel comfortable so you can rest and recover. 4. Make sure you understand how to care for your wound and change the dressing before you leave the hospital. Always clean your hands before and after caring for your wound.

5. Lastly, call your doctor if you have any symptoms of infection, such as fever, or any redness, pain or drainage in the surgery area. • Sources: National Patient Safety Foundation, The Partnership for Healthcare Excellence, Institute for Healthcare Improvement, Committee to Reduce Infection Deaths, Mountain View Hospital

Page 27


Get active |

GO OUTSIDE AND PLAY

PHOTO BY PETE ERICKSON

J

eff Frank, a Bend kayaker and the owner of Tumalo Creek Kayak & Canoe, descends Steelhead Falls near Crooked River Ranch during a run in low water. The rapids are ranked at Class IV+ and feature an easy move off the top, Frank says. While Steelhead Falls is clearly a stretch for experts, Central Oregon abounds with kayaking opportunities for all levels. •


Healthy options | DINING OUT Breakfast at the Victorian Café 1404 N.W. Galveston Ave., Bend 541-382-6411 First choice: Sandra Marie Omelet ($10.95), stuffed with portabella mushrooms, yellow squash, zucchini, spinach, roma tomatoes and garlic. It includes fresh mozzarella cheese and pesto made in-house. Craven would substitute egg whites ($1) and ask for the pesto on the side. Why? It’s full of vegetables, garlic, and even the pesto is a healthy fat. Owner John Nolan said this menu item was named after his mother, who is hard to feed because she’s so health conscious. Second choice: Granola, fruit and yogurt ($8.95). Craven warned that granola can be high in calories. (Sorry, but the restaurant’s famous Benedicts are out for the truly health-conscious.)

Eat out, and hold the guilt BY ANNE AURAND • PHOTOS BY ANDY TULLIS

E

ating out can be tough for the health-conscious. Bend Memorial Clinic registered dietitian Eris Craven, a fit runner and a food lover, can enjoy dining out if she scrutinizes the menus for the healthiest options: meals stocked with vegetables and lean proteins. If she wants something she knows is unhealthy, she might save half the meal for another day. She also requests that high-fat toppings be served on the side so she can control how much she eats. What would Craven order if she went to these four restaurants?

Dinner at The Phoenix 594 N.E. Bellevue Drive, Bend 541-317-0727 • www.phoenixcafe.biz First choice: French onion soup ($6) topped with French bread crostini, melted Gruyere and swiss cheeses, plus a large Raspberry Salad, ($10) which has fresh baby greens, cranberries, walnuts, goat cheese and fresh raspberries, with a raspberry walnut oil vinaigrette on the side. Why? While there are surely a lot of tasty items, there are not many lowcalorie entrees on this meat-heavy menu, Craven said. Her choices offer nutritious elements and a colorful salad, which means there’s a variety of nutrients, she said. Chef Matt Dimond said these are popular choices. He noted the onions in the soup are cooked for many hours, and the salad dressing includes fresh pureed raspberries, a little mustard and imported raspberry vinegar from France. Second choice: California grilled chicken sandwich ($9.95), with avocado, lettuce and tomatoes. Hold the mayonnaise, ask for a whole grain bun or skip the bun. Take half home.

Page 30

SPRING / SUMMER 2011 • HIGH DESERT PULSE


Lunch at Angeline’s Bakery 121 W. Main Ave., Sisters 541-549-9122 • www.angelinesbakery.com First choice: A slice of Polenta Pizza ($8.50) and a green salad with Mediterranean tuna (add $3). The pizza is loaded with veggies, marinara sauce and vegan cheese. Why? Craven said it includes all the veggies she could expect for a meal. Two cups of vegetables a day is her minimum goal. Owner Angeline Rhett said the bakery caters to many types of special diets, including gluten-free and dairy-free. Many agave-sweetened and raw food choices are available. Second choice: Veggie Enchilada ($8.50 with salad), with corn tortillas, black beans, green chilies, cheese and more. Craven said skip the sour cream since it comes with cheese, and save half as leftovers.

Dinner at Joolz 916 N.W. Wall St., Bend 541-388-5094 • www.joolzbend.com First choice: Chermoula Seasonal Fish (market price, typically $16-$18). The oven-roasted seasonal fish is rubbed with chermoula spices and served with quick-braised swiss chard and rice pilaf. Craven said skip the rice because it doesn’t offer much nutritional value and request sweet potato fries instead. Why? Seafood is a healthy main dish if it’s not breaded and fried. Craven is looking for a lean protein and vegetables. This might not be a low-calorie option, she said, but it’s quality, nutritious food. Owner and chef Ramsey Hamdan said chermoula is a Moroccan blend of roasted red peppers, cilantro, garlic, ginger, lemon juice, a splash of roasted chilies and cumin. The fish is typically white fish such as rock fish or halibut, or sometimes Copper River salmon when it’s in season. Second choice: Elk burger ($12). Craven would fill up on a salad ($8-$10) first so she could take home half the burger, which is sprinkled with blue cheese.

HIGH DESERT PULSE • SPRING / SUMMER 2011

Page 31

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Is it safe? |

DENTAL AMALGAM

SUBMITTED IMAGE

Two types of fillings In the X-ray above, composite (tooth-colored) fillings appear ghostly white, while amalgam (silver-colored) fillings appear in bright white and are circled. Many dentists still commonly place both types of fillings. Dental amalgam is made by mixing silver, tin, copper and mercury, resulting in a soft metal that can be fitted into a tooth to harden. (At right, amalgam is prepared at Kemple Children’s Clinic in Bend.) But testing has shown amalgam releases mercury vapor over the life of the filling, not just when the filling is placed or removed. ANDY TULLIS

How worrisome is the mercury in your mouth? BY MARKIAN HAWRYLUK

M

ercury is one of the most toxic substances known to man. Slowly but surely, we’ve been protecting ourselves by removing mercury from thermometers, light bulbs, medications and vaccines. So does it make any sense that we routinely and voluntarily put mercury in our mouths? An estimated 200 million Americans carry some 1.5 billion fillings in their mouths, a majority of which are silver-colored dental amalgam. But a recent Zogby poll found that 78 percent of Americans don’t realize that those silver fillings are 50 percent mercury.

HIGH DESERT PULSE • SPRING / SUMMER 2011

Dental amalgam made from mercury has been used in dentistry for more than 150 years, and there is now widespread agreement that those fillings release mercury vapor. But after a century and a half of use, we’re no closer to a consensus about whether that’s a problem or not. Dentists have been arguing about whether mercury fillings are safe since the Civil War. And while the Food and Drug Administration, the American Dental Association and the bulk of the dental and medical establishment continue to uphold the safety of amalgam, the issue is far from resolved. “That’s because, frankly, if you look at all the millions of people who have been treat-

After a billion fillings and 150 years of use, we’re still wondering

ed with dental amalgam over more than 100 years, you don’t see risk. The evidence that amalgam is causing a problem isn’t there,” said Dr. Marjorie Jeffcoat, a professor at the University of Pennsylvania School of Dental Medicine. “And that’s why the FDA always wants to keep looking at it, to see if, with the new tools we have, we can see what’s there.” In December, Jeffcoat chaired an FDA advisory panel taking another look at the data on mercury exposure from amalgam and whether it constitutes any real danger to patients. The agency is now reviewing the guidance provided by that panel to determine whether it needs to change its stance on the

Page 33


Is it safe? | DENTAL AMALGAM mercury vapor over the life of the filling. Tests show that in the first five days, as the amalgam sets, it gives off higher levels of mercury vapor. But the amount of mercury released from the filling drops off after that, remaining at a lower but constant baseline through the life of the filling. Chewing, brushing or high temperatures incrementally increase the amount of mercury vapor released, but not to the levels of when it’s first put in. By some estimates, up to 50 percent of the mercury in the filling is lost over time, one of the reasons why most fillings eventually need to be replaced. The debate has now shifted from whether mercury is released to how much, and

safety of amalgam. Advocates of an amalgam ban don’t expect the agency will rule in their favor, but they aren’t about to concede the argument. That may leave patients and their dentists to decide for themselves whether amalgam and its alternatives are safe.

Inside the numbers Dental amalgam is made by mixing silver, tin, copper and mercury, resulting in a soft, malleable metal that can be fitted into a tooth and allowed to harden. For years, it was thought that patients were exposed to mercury only briefly, when the filling was being put in. But more sensitive laboratory tools developed in the 1970s and 1980s showed that amalgam continues to release

How much exposure to mercury? We can only guess At least 17 studies have estimated the amount of mercury released by amalgam fillings; 13 of those, listed below, tried to determine the average amount of mercury exposure for an adult. Their conclusions are split down the middle: Seven of the studies (shown in blue) estimated that exposure was within the safe level set by the Environmental Protection Agency; six (shown in red) have concluded it exceeded that level.

EPA limit: 3.8 micrograms per day Mean: 6.5

Patterson et al., 1985 1.24

Mackert, 1987

whether that amount poses a danger to patients. The FDA has relied on a 1993 report from the U.S. Public Health Service that estimated the absorbed dose for a person with an average of seven to 10 fillings at 1 to 5 micrograms per day. Amalgam critics, on the other hand, point to studies putting the daily dose of mercury at up to 22 micrograms per day. The FDA uses an estimate of safe exposure levels set by the Environmental Protection Agency at 3.8 micrograms per day. But critics say that level may be too high. In 2008, the California Environmental Protection Agency set the safe level 10 times lower, at 0.38 micrograms per day. Amalgam critics who petitioned the FDA to reassess safe levels hired Mark Richardson, a risk assessment expert with SNCLavalin Environment in Montreal, to review the evidence. Richardson considered 17 separate studies that quantified mercury exposure from amalgams, including three analyses he had conducted himself. Only seven of the 17 estimated daily mercury levels to be within the EPA guideline. At least four more studies estimated exposure at double the safe limit. “I really don’t care what reference dose you pick,” Richardson told the panel in December. “If you pick one — it doesn’t matter

7.7

Clarkson et al., 1988

How many fillings are too many?

9.1

Aronsson et al., 1989 1.7

Berglund, 1990

10

Vimy & Lorscheider, 1990 1.2

Mackert, 1991

2.3

Olsson & Bergman, 1992

9

Weiner & Nylander, 1995

Maximum number of fillings for ...

4.5

Halback, 1995 A Halback, 1995 B

3.4

Richardson & Allan, 1996 A

3.4

Safe limit set by ...

3.7

Richardson & Allan, 1996 B 0 Source: Mark Richardson, SNC-Lavalin

2

It depends. In addition to the safe limit set by the EPA, there have been at least four other attempts to quantify a safe level for mercury exposure. A recent analysis by researcher Mark Richardson suggests that even with the most generous limit, millions of Americans have too many fillings to be considered safe.

4

6

8

10

California EPA, 2008 Richardson et al., 2009 Lettm eier et al., 2010 US ATSDR, 1999 US EPA, 1990

kids

adults

0.6 1.3 1.4 4 6

0.8 1.7 1.8 5.3 8

Source: Mark Richardson, SNC-Lavalin GRAPHICS BY GREG CROSS

Page 34

SPRING / SUMMER 2011 • HIGH DESERT PULSE


How old is it?

Amalgam fillings have been in use ...

... since these were common dentistry tools These tools are from the collection of the High Desert Museum in Bend: 1 A chrome-plated, hand-operated

1

dental drill, circa late 1800s

3

2 Clove oil, used as an anesthetic, circa

late 1800s

2

3 A nickel-plated steel device used to 4

keep a patient’s mouth open during surgery, circa 1889 4 A tooth extractor, circa 1880,

shown with a human tooth specimen SOURCE: HIGH DESERT MUSEUM PHOTO BY ANDY TULLIS

what it is — a very significant portion of the population exceeds that.” Richardson calculated that using the FDA’s estimates on the amount of mercury being released from fillings, about 63 million people would exceed the EPA limit on exposure. Using the lower California EPA safe level, virtually anyone with a mercury filling would be over the limit. “The minute you start actually measuring, the whole myth of the safety of amalgam goes away because of the numbers,” said Dr. David Kennedy, past president of the International Academy of Oral Medicine and Toxicology, a group that opposes the use of dental amalgam and fluoride.

Margin of error But exceeding the safe levels set by the EPA doesn’t necessarily mean a patient is in any danger. Safe levels are set by looking at cases where exposure to mercury has resulted in some sort of meaningful harm to the patient. Researchers find the lowest exposure levels at which they see an impact and then set the safe exposure level much lower. How much of a buffer to include — called an uncertainty factor — to ensure safety is also a matter of debate. The EPA used an uncertainty factor of 30. The California EPA used a factor of 300, and Richardson proposed 100. Such safety buffers are intended to pro-

HIGH DESERT PULSE • SPRING / SUMMER 2011

tect individuals who might get more mercury exposure than the average person or those who might be particularly sensitive to its effects. Many critics of amalgam argue that the reason we don’t see widespread problems is because the mercury in fillings creates significant issues for only a small swath of the population already predisposed to certain problems. “What most likely is occurring is that people who might be at greater risk for Alzheimer’s, Parkinson’s disease, learning disorders, aging-related auditory deficit, that their risk may be compounded by the elevated risk from inorganic mercury, from elementary mercury from amalgam,” said Gary Ginsberg, a toxicologist with the Connecticut Department of Public Health who also testified at the FDA panel hearing in December. Ginsberg suggested that thinking of a safe level for mercury exposure may be misleading. Unlike some substances that pose a risk only if they exceed a certain threshold, mercury may incrementally increase an individual’s risk with every exposure. “The word ‘safe’ is not the right term. Is there risk? It may be a risk on a level of one in 1,000, one in 100,000, one in 10,” Ginsberg said. “Every molecule that gets in there might have some concrete risk.” For those who are already predisposed to a particular condition, mercury could be the factor that pushes them over the edge. For

others who are genetically more fortunate, even higher levels of exposure might not cause any harm.

No harm, no foul The FDA’s position has been that the current estimates of safe levels of mercury vapor exposure are intended to be “highly protective” against adverse health effects, including for sensitive subpopulations. “Exceeding these levels,” the agency wrote in a 2009 report, “does not necessarily mean that any adverse effects will occur.” That has been the biggest hurdle for antiamalgam advocates. For all their concerns about mercury exposure and safe levels and uncertainty factors, they haven’t been able to show that having mercury fillings leads to any known disease or condition. “There are no scientific, peer-reviewed studies that have found a link between amalgam restorations and any medical disorder,” said Dr. Mary Tavares, a researcher with The Forsyth Institute who was involved in a recent clinical trial on amalgam. The studies that try to determine safe levels of mercury exposure by finding the lowest observable level of harm are based on industrial exposure to mercury, such as in light bulb manufacturing plants. Exposure to high doses of mercury can lead to tremors and twitching, changes in nerve response and emotional changes such as mood

Page 35


Is it safe? | DENTAL AMALGAM swings or irritability. Those exposed often become excessively timid or shy. Chronic exposure can also lead to a decline in cognitive function, kidney damage and death. Mercury exposure is the genesis of the phrase “mad as a hatter,� reflecting the former use of mercury in curing pelts used to make hats in the 19th century. Hatters and mill workers who inhaled mercury fumes often suffered neurological damage, causing confused speech and distorted vision. But those symptoms haven’t been observed in people whose sole exposure to mercury is from their fillings. There simply isn’t a pool of patients whose problems can be conclusively linked to dental amalgam. Dr. Rod Mackert, a professor of dental materials at the University of Georgia, has conducted much of the research that the FDA has relied on to set its estimate of exposure levels. Mackert maintains that an adult would need between 265 and 310 amalgam fillings before even slight symptoms of toxicity would emerge. By his calculations, an

adult with an average of seven fillings absorbs only one microgram of mercury per day from amalgam. The only documented health effects from mercury fillings, he said, are rare allergic reactions. Mackert also maintained that humans get six times as much mercury from food, water or air as they do from their fillings, although other researchers disagree. Richardson, for example, estimates that amalgam accounts for nearly 57 percent of the average adult’s exposure, while fish and seafood account for 43 percent. “It’s mystifying,� Mackert said, “that people persist in saying there is cause for concern with amalgam fillings when there’s no evidence that they cause adverse health effects.� Anti-amalgam advocates maintain it’s not up to them to prove the risks of amalgam, that manufacturers should be required to prove the safety of a compound that contains a known neurotoxin. In fact, had amalgam not been already in use at the time the

FDA was created, amalgam manufacturers would have been required to submit data showing the safety of their products. Faced with continued criticism that amalgam had never been adequately studied, in 1996 the National Institutes of Health funded two randomized, controlled trials, considered the only type of research that can conclusively prove a causal link between a treatment and an effect. The first, conducted at Children’s Hospital Boston, randomly assigned 534 New England children ages 6 to 10 to receive either amalgam or tooth-colored composite fillings. Despite an average of 15 fillings per child, the researchers found no difference in neurological or kidney function. Although the kids in the amalgam group had higher average urinary levels of mercury than the composite group, there were no statistically significant differences in IQ, memory or hand-eye coordination over the five-year study period. A second NIH-funded study, conducted at the Casa Pia elementary school in Portugal by

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researchers from the University of Washington, also randomized its 507 children, ages 8 to 10, to receive either amalgam or composite fillings. Kids in the amalgam group received an average of 18.7 fillings, compared with 21.3 in the composite group, but after five years showed no ill effects. (Children in the amalgam group received tooth-colored composite fillings in their front teeth.) There were no differences between the two groups on measures of memory, attention, hand-eye coordination or nerve function.

Long-term impact Anti-amalgam advocates counter that both studies were poorly designed and of too short a duration to measure the true impact of mercury exposure. “It’s like if you smoked a pack of cigarettes,” Kennedy said. “What harm did you get? Well, it doesn’t happen with the first pack.” But while smoking has become a target of public health campaigns because of its causal link to lung cancer, emphysema and a host

HIGH DESERT PULSE • SPRING / SUMMER 2011

of other conditions, there’s still no disease or disability to put on the anti-amalgam poster. Kennedy counters that the Casa Pia data itself provide the proof of harm. Antiamalgam advocates took the raw data from that study and ranked the children in terms of the amount of mercury they had in their mouths. They found that the more amalgam they had in their mouths, the more of an organic compound called porphyrins they had in their urine. Porphyrins are part of the biological process used to create heme, the red, ironcontaining component of hemoglobin that carries oxygen in your blood. When urinary porphyrins rise, it’s a sign that the heme creation process has been interrupted. “This altered the metabolism of that child,” Kennedy said. “It uncurled an essential enzyme in the metabolic pathway.” Kennedy said the true impact of that metabolic change might not be clear for another 20 years. Anti-amalgam advocates maintain it could lead to multiple sclerosis, Alzheimer’s

“There’s no research out there, really, that says putting amalgam mercury fillings in your mouth is harmful to you. But intuitively, it just doesn’t make sense to me.” Dr. Peter Yonan, Awbrey Butte Dental or Parkinson’s. But according to the American Dental Association, numerous studies that tried to link such medical conditions with amalgam haven’t uncovered any connection. At the FDA panel hearing in December, dozens of individuals testified that they believed their medical conditions were caused by the mercury in their fillings. Although none could prove his or her condition was caused by amalgam, Jeffcoat, the panel chair, said she wanted to give them a chance to speak. “These people do have a bad problem, and they are right to want an answer. The problem is, we don’t have that answer,” Jeffcoat said. “If you have an autoimmune disease, that’s a ter-

Page 37


Is it safe? | DENTAL AMALGAM rible problem. But that doesn’t mean the first thing you looked at caused the problem.” Many of those who testified had opted to have their mercury fillings removed, and some did see their symptoms improve afterward. But the waning of symptoms after removal is no more proof of a link than the emergence of symptoms after implantation. Anti-amalgam groups are collecting anecdotal reports in a database to see if any patterns emerge that might identify a more vulnerable group. “Half the people say a year later, ‘I feel so much better, but I’ve done so much in the last 10 years, I don’t know what to ascribe it to,’” said Dr. Stephen Koral, a Boulder, Colo., dentist who opposes amalgam use. “Other people say, ‘I’m glad I had my amalgams replaced, but I don’t think it made me any better.’”

Consumer opinion Eventually, market forces may make the debate over amalgam irrelevant. The use of amalgam as a restorative material has been steadily declining as many patients prefer the look of tooth-colored fillings. And 50 percent of dentists nationwide now bill themselves as mercury- or metalfree practitioners. “It’s a controversial subject because there’s no research out there, really, that says putting amalgam mercury fillings in your mouth is harmful to you,” said Dr. Peter Yonan, a dentist at mercury-free Awbrey Butte Dental in Bend. “But intuitively, it just doesn’t make sense to me.” Yonan said once he started placing composite fillings, he decided to err on the side of caution and stop placing silver fillings. He believes amalgam is still being used routinely in part for financial reasons. As long as insurance companies can point to the cheaper amalgam fillings as sufficient and safe, they can get away with not paying the higher cost of composites. Most insurance companies will pay for any filling in the back teeth at the amalgam filling rate, leaving the patient to make up the difference in cost for a composite. “So I think part of the patient’s dilemma is, ‘Do I get the procedure recommended and dictated by the insurance company and pay less? Or do I get something that’s more healthy for me and the environment and go

Page 38

THINKSTOCK

Are composite fillings the way to go, then? Amalgam may have its problems, but many dentists have equal concerns about composite fillings (the tooth-colored ones). Some composite fillings contain bisphenol A, or BPA — the same plastic compound that became a concern with water bottles and baby bottles. “We know infinitely more about the human health effects of mercury amalgam than we know about the human health effects of composites,” said Dr. Michael Martin, a University of Washington dentist. “What we do know is that some of the components of composites are endocrine disruptors, allergens and potential carcinogens, and I just think it’s very important that we acknowledge the elephant in the room.”

with the composite filling and pay more for it?’” Yonan said. Dr. David Fuller, a dentist with Family Dental Care in Bend, places both amalgam and composite fillings, based on patient preference. He estimates that in Central Oregon, amalgam fillings cost the patient an average of $150, while composites cost $225. “Until the American Dental Association or the American Medical Association comes up with something concrete, we still feel it’s a reasonable restoration,” Fuller said. “It’s been around for 100-plus years, and there’s a billion of them in place throughout the world, and there’s not a lot of crazy people.” Dentists also like amalgam fillings when providing free care to disadvantaged patients. Silver fillings cost less, take less time and last longer than composites. Resins used to make composite fillings had a notoriously short life span when they were first introduced. But as the technology has improved, composites have closed the gap. Several European countries have banned the use of mercury for any purpose, based on environmental concerns, and use only composite fillings. Many U.S. states, including Oregon, require dentists to

install separators to catch any mercury before it’s released into the groundwater. Both Fuller and Yonan said they have removed silver fillings based solely on the patient’s desire to remove them. But they don’t advocate removing fillings that are still functioning just to get rid of the mercury. In fact, dental boards in most states will sanction dentists who tell patients to remove fillings because of the mercury. Removing the fillings actually increases the amount of mercury released, so dentists take additional precautions to ensure that extra mercury isn’t inhaled or swallowed by the patients.

Next steps The FDA is still reviewing the guidance it received from the advisory panel after the December hearing, but few expect the agency to make a major move on amalgam. Jeffcoat predicted the agency may change the labeling for dental amalgam to conform with the ages for which research exists. No studies have been conducted on children younger than 7 or on pregnant women. In fact, many doctors will avoid doing any dental work on a pregnant woman to minimize any potential risks to a developing fetus. “We try to avoid doing anything that is non-emergent or not urgent care,” said Dr. Mark Jensen, a dentist in Bend. “There are more risks with pregnant women because the fetus is growing so fast.” Dentists can delay some dental work until after birth or provide a temporary solution to get a woman through her pregnancy. And studies have found no correlation between amalgam and mercury in cord blood or breast milk. Jeffcoat, who said she has amalgam in her own mouth and has put mercury fillings in the mouths of her own family, suggests patients talk with their dentists and ask questions about their options. Jensen said he often has that conversation with patients at his Bend office. “We go through all the pros and cons, and they get to make up their minds,” he said. “I’ve removed amalgam in patients’ mouths because they have concerns, but they’re basing their decisions on their own facts, not on my trying to talk them into removing their restorations just because they’re amalgams.” •

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Note: Backpack images not to scale. Page 40

ackpacks offer the ultimate in self-sufficiency — everything you need to survive in the wilderness, right there on your back. Choosing the right backpack, however, is in many ways an exercise in trial and error. You won’t know what backpack really fits you well until you put it on with a heavy load inside. That’s why it’s best to spend at least an hour in the store carrying a weighted backpack before purchasing it. Or you can load it up at home and make sure the fit is right before hitting the trail. There’s no one best pack out there. What works for your friend might not work for you. Here are some tips for choosing the right pack. Size: Most backpacks come in small, medium and large sizes to accommodate various torsos. Backpack manufacturers provide stores with a special sizing tool that helps them determine which size is right for you. Those sizing tools are manufacturer-specific, so they won’t necessarily translate from one brand to another. Women’s packs are sized smaller and angled to fit a woman’s body. Have the salesperson help you choose the right size and adjust the straps to customize the fit. Capacity: Most backpacks now include a number in their name that refers to their capacity in

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Mountain Hardwear Direttissima, MSRP $200 52 liters, 4 lbs. 4 oz. This pack is designed to withstand being dragged over dirt and rocks, and has removable components for when you want to lighten your load.

PHOTOS BY ROB KERR BACKPACKS COURTESY MOUNTAIN SUPPLY

liters. The Osprey Aura 50, for example, is a 50-liter backpack. The larger size for each pack may have three liters more space, small packs three liters less. Weight: Outdoor equipment manufacturers have embraced the ultralight movement, trying to shave off every last ounce of weight. While virtually all backpacks have gone down in weight over the past decade or two, remember that it takes a stronger suspension system to carry heavier loads. Larger loads carried in an ultralight pack might feel heavier than the same load carried in a heavier pack with a good suspension system. Packs are designed to transfer the load onto your hips, rather than your shoulders. Function: When choosing a pack, tell the salesperson what you intend to do. If you’re only taking weekend trips in the summer, you might want a 40- to 70-liter pack. If you plan to take longer, multi-day hikes or winter overnight trips, you may need a pack ranging from 70 to 90 liters. Decide whether you need a simple pack that’s essentially just a long, narrow tube, or a more elaborate pack with various pockets and sections for organization. The simpler the pack, the less it will weigh. Every zipper, pocket or attachment strap adds weight. •

a pack HIGH DESERT PULSE • SPRING / SUMMER 2011

Osprey Aether 70, MSRP $279 70 liters, 4 lbs. 12 oz. A larger-capacity pack that still keeps the overall weight in check. The hip belt is custom-moldable to provide a better fit and the ability to handle larger loads more comfortably.

Page 41


Picture this |

YOUR MEDICINE CHEST

Allergy season is the perfect time to make sure you’re stocked up on medical essentials. While medicine cabinet needs are unique, having these items on hand could avoid headaches later.

Right where you need it BY ANDY ZEIGERT

Pain medication Cindy Cocanower, pharmacy manager at Bend Pill Box, recommends everyone have 1 Acetaminophen (Tylenol) for minor aches and pains and for reducing fever, and at least one of the following: 2 Ibuprofin (Advil), aspirin or naproxin (Aleve), which are also anti-inflammatories. A common side effect of anti-inflammatories, however, is irritation to the gastrointestinal tract. As always, follow manufacturerrecommended doses.

14

5

9 Bismuth subsalicylate (Pepto Bismol): Used to relieve indigestion, upset stomach and diarrhea. 10 Calcium carbonate (Tums): Used to relieve heartburn, indigestion and upset stomach. 11 Phosphorated carbohydrate solution (Emetrol): Used to relieve nausea and vomiting. 12 Simethicone (Gas-X): Used to treat gas. Page 42

2

12

13 11 10

To remedy colds, Cocanower recommends treating each symptom instead of using all-in-one medications. 5 Guaifenesin (Mucinex): Helps thin mucus in the airways, making it easier to clear out. Be sure to drink lots of water when using guaifenesinbased medications. 6 Saline spray: Non-medicated spray can help relieve dry sinuses and irrigate nasal passages. 7 Throat spray (Chloraseptic) or lozenges: Helps relieve a sore throat. 8 Thermometer: Mercury-free glass thermometers don’t require batteries and tend to be more accurate.

Stomach ailments

1

4

Allergies/flu/cold

3 Diphenhydramine (Benadryl): Used to relieve the symptoms of allergic reaction, such as a runny nose or irritated eyes. 4 Hydrocortisone cream (Cortizone): Used to relieve skin irritations from eczema, insect bites and other allergic reactions.

19

3

• Never dispose of expired medications in the toilet. Instead, Oregon’s Department of Environmental Quality recommends sealing medications in a plastic bag and placing them in the garbage, or bringing them to the sheriff’s office or police department for incineration.

15 20 17

18

7 6 16

9

21

8 For more information on a drug, visit www.ncbi.nlm.nih.gov/pubmedhealth or ask your pharmacist.

13 Docusate (Colace): Most people don’t think of keeping laxatives on hand until they need some.

First aid

14 Assorted adhesive bandages: For minor scrapes and cuts. 15 Gauze and medical tape: For larger scrapes and cuts.

16 Hydrogen peroxide: 3% solution used for cleaning wounds. 17 Triple antibiotic ointment (Neosporin): Used to prevent and fight infection and to speed the healing of wounds. Double- and singleantibiotic ointments are available if you have a sensitivity to triple. 18 Tweezers: Useful for removing

PHOTO BY ROB KERR

splinters and cleaning wounds. 19 Sterile eyewash with cup: Used to rinse eyes in the event of contamination with an irritant. 20 Ace bandage: Used to apply pressure to parts of the body, which can reduce swelling and provide support. 21 Hot/cold pad: Used to relieve pain or reduce swelling. • SPRING / SUMMER 2011 • HIGH DESERT PULSE


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M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y ADULT FOSTER CARE

Absolute Serenity Adult Foster Care

AESTHETIC SERVICES

DermaSpa at Bend Dermatology

ALZHEIMERS & DEMENTIA CARE

Clare Bridge Brookdale Senior Living

ASSISTED LIVING

Brookside Place

CANCER CARE

St. Charles Cancer Center

CARDIOLOGY

The Heart Center

CHEMICAL DEPENDENCY

Serenity Lane Treatment Center

COUNSELING & WELLNESS

Juniper Mountain Counseling & Wellness

DENTISTRY

Masters of Dentistry

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Bend Dermatology Clinic

FAMILY MEDICINE

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INTEGRATED MEDICINE

Center for Integrated Medicine

MEDICAL CLINIC

Bend Memorial Clinic

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NorthStar Neurology

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The Center: -/%+,"!& "0-+.0-$& ( -""."- %

+ /&+*.&*"*!"!)+*!

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PALLIATIVE MEDICINE

St. Charles Medical Group

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

Cascade Foot Clinic

PULMONARY CLINIC

St. Charles Pulmonary Clinic

RADIOLOGY

Central Oregon Radiology Associates, P.C.

REHABILITATION

St. Charles Medical Group

SENIOR CARE HOME

Central Oregon Adult Foster Care

SLEEP DISORDERS

St. Charles Sleep Center

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+ /&+*.&*"*!"!)+*!

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M E D I C A L P R O F E S S I O N A L S B Y S P E C I A LT Y ALLERGY & ASTHMA

ADAM WILLIAMS, MD

Bend Memorial Clinic

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ALZHEIMERS/DEMENTIA & GERIATRIC NEUROLOGY

FRANCENA ABENDROTH, MD

NorthStar Neurology


2011 CENTRAL OREGON MEDICAL DIRECTORY

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BEHAVIORAL HEALTH

RYAN C. DIX, PsyD

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Bend Memorial Clinic

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Bend Memorial Clinic

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Bend Memorial Clinic

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STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

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Bend Memorial Clinic

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Bend Memorial Clinic

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CARDIOLOGY

DERMATOLOGY

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FAMILY MEDICINE

THOMAS L. ALLUMBAUGH, MD

St. Charles Family Care - Redmond

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Bend Memorial Clinic

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 &  #$$(* "

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Mmore Care Clinic - RHC

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St. Charles Family Care - Redmond

$ ("'*!#"

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Mmore Care Clinic - RHC

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Bend Memorial Clinic

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St. Charles Family Care - Redmond

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MAREN J. DUNN, DO

Mmore Care Clinic - RHC

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St. Charles Family Care - Redmond

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MAY S. FAN, MD

Bend Memorial Clinic

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Bend Memorial Clinic

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St. Charles Family Care - Redmond

$ ("'*!#"

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MARGARET J. KING, MD

Mmore Care Clinic - RHC

 !&$&&*$"( 

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CHARLOTTE LIN, MD

Bend Memorial Clinic

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JOE T. MCCOOK, MD

St. Charles Family Care - Redmond

$ ("'*!#"

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St. Charles Family Care - Redmond

$ ("'*!#"

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St. Charles Family Care - Redmond

$ ("'*!#"

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St. Charles Family Care - Redmond

$ ("'*!#"

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DANA M. RHODE, DO

Bend Memorial Clinic

 &  #$$(* "

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2011 CENTRAL OREGON MEDICAL DIRECTORY

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FAMILY MEDICINE CONT.

HANS G. RUSSELL, MD

Bend Memorial Clinic

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 !&$$(* !

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St. Charles Family Care - Redmond

$ (!'* "!

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Mmore Care Clinic - RHC

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 )#"$& (!'* !

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GASTROENTEROLOGY

GENERAL DENTISTRY

GYNECOLOGY

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!%&% "!

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ELIZABETH MCCORKLE, MD

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!%&% "!

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HEMATOLOGY/ONCOLOGY

ROBERT F. BOONE, MD

St. Charles Cancer Center

"&"!%! ! "!

541-706-4701

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St. Charles Cancer Center

"&"!%! ! "!

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CAROLYN S. DOEDYNS, FNP

St. Charles Cancer Center

"&"!%! ! "!

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St. Charles Cancer Center

"&"!%! ! "!

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WILLIAM G. MARTIN, MD

St. Charles Cancer Center

"&"!%! ! "!

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www.stcharleshealthcare.org

HOSPITALIST JOHN R. ALLEN, MD

Bend Memorial Clinic

 !&$$(* !

541-382-4900

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MICHAEL GOLOB, PA-C

Bend Memorial Clinic

 !&$$(* !

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 !&$$(* !

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Bend Memorial Clinic

 !&$$(* !

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 !&$$(* !

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!%&% "!

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Bend Memorial Clinic

 !&$$(* !

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Bend Memorial Clinic

 !&$$(* !

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INFECTIOUS DISEASE JON LUTZ, MD INTERNAL MEDICINE


2011 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

INTERNAL MEDICINE CONT. MATTHEW R. LASALA, MD

Bend Memorial Clinic

  !#(&& *+#

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KAREN L. OPPENHEIMER, MD

Bend Memorial Clinic

 (!$&& *+#

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MATTHEW REED, PA-C

Bend Memorial Clinic

  !#(&& *+#

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M. SEAN ROGERS, MD

Bend Memorial Clinic

  !#(&& *+#

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DAN SULLIVAN, MD

Bend Memorial Clinic

  !#(&& *+#

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$(+#

541-388-3978

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INTERNAL MEDICINE, OSTEOPOROSIS & BONE HEALTH MOLLY OMIZO, MD

Deschutes Osteoporosis Center

NEONATOLOGY CAROL A. CRAIG, NNP

St. Charles Medical Group - Neonatology

 $+#

541-526-6556

www.stcharleshealthcare.org

JOHN O. EVERED, MD

St. Charles Medical Group - Neonatology

 $+#

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SARAH E. REYES, NNP

St. Charles Medical Group - Neonatology

 $+#

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FREDERICK J. RUBNER, MD

St. Charles Medical Group - Neonatology

 $+#

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MICHAEL E. FELDMAN, MD

Bend Memorial Clinic

#'(' "$#

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Bend Memorial Clinic

#'(' "$#

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RUSSELL E. MASSINE, MD, FACP

Bend Memorial Clinic

#'(' "$#

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Bend Memorial Clinic

#'(' "$#

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 $($&'& *+# 

&$'' #&(+#

541-330-6463

www.northstarneurology.com

NEPHROLOGY

NEUROMUSCULAR, NEUROPHYSIOLOGY CRAIGAN GRIFFIN, MD

NorthStar Neurology NorthStar Neck & Back Clinic

NEUROSURGERY MARK BELZA, MD

The Center: &($% )&$')& !&'&

$( $#' ##"$#

541-382-3344

www.thecenteroregon.com

RAY TIEN, MD

The Center: &($% )&$')& !&'&

$( $#' ##"$#

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www.thecenteroregon.com

BRAD WARD, MD

The Center: &($% )&$')& !&'&

$( $#' ##"$#

541-382-3344

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NUTRITION ERIS CRAVEN, MS, RD, LD

Bend Memorial Clinic

#'(' "$#

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www.bendmemorialclinic.com

ANNIE WILLIAMSON, RD, LD

Bend Memorial Clinic

#'(' "$#

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www.bendmemorialclinic.com

OBSTETRICS/GYNECOLOGY WILLIAM H. BARSTOW, MD

St. Charles OB/GYN - Redmond

& *( +"$#

541-526-6635

www.stcharleshealthcare.org

CRAIG P. EBERLE, MD

St. Charles OB/GYN - Redmond

& *( +"$#

541-526-6635

www.stcharleshealthcare.org

AMY B. MCELROY, FNP

St. Charles OB/GYN - Redmond

& *( +"$#

541-526-6635

www.stcharleshealthcare.org

TODD W. MONROE, MD

St. Charles OB/GYN - Redmond

& *( +"$#

541-526-6635

www.stcharleshealthcare.org

ONCOLOGY THEODORE A. BRAICH, MD

Bend Memorial Clinic

#'(' '(' 

541-382-4900

www.bendmemorialclinic.com

KATIE FIFER, PA-C

Bend Memorial Clinic

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OPHTHAMOLOGY


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ORAL & MAXILLOFACIAL SURGERY KEITH E. KRUEGER, DMD, PC

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ORTHOPEDIC SURGERY, FOOT & ANKLE ANTHONY HINZ, MD

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PSYCHIATRIC NURSE PRACTITIONER NICK CAMPO, PMHNP

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PULMONOLOGY JONATHON BREWER, DO

Bend Memorial Clinic

ERIC S. DILDINE, PA

St. Charles Pulmonary Clinic

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

ROD L. ELLIOT-MULLENS, DO

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RODNEY GARRISON, PA-C

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St. Charles Pulmonary Clinic

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LYNETTE SPJUT, PA-C

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REHABILITATION NOREEN C. MILLER, MD RHEUMATOLOGY

SLEEP MEDICINE THERESA L. BUCKLEY, MD

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ARTHUR K. CONRAD, MD

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SPINAL DECOMPRESSION, AUTO ACCIDENTS DAVID HERRIN, DC

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STROKE AND NECK & BACK RICHARD L. KOLLER, MD SURGICAL SPECIALIST

URGENT CARE


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Cover story | OUR BODIES’ VITAL BACTERIA

JOHN KLICKER

Kandice Knudsen displays some of the medications she took to fight C.diff, an infection she likely contracted from taking an antibiotic. At left is vancomycin, itself an antibiotic. She also took ondansetron and oxycodone, for the nausea and pain the C.diff caused.

Page 50

Continued from Page 13 been a renewed interest in fecal transplants. Sehdev did his first about five years ago. Since that time, he has treated 11 patients this way. Conventional therapies had failed for all of them; all have recovered after a transplant. The person receiving the transplant chooses a donor, a person who donates stool. Knudsen chose her husband. Within a week of meeting Sehdev, the couple were scheduled for the procedure. The lab needed Mark to deliver a fresh sample to the hospital on the morning of his wife’s transplant. The day before, he said, “I was eating a lot of shredded wheat and bran and so forth. It had to be a good one.” Technicians processed the stool, taking out solid matter and filtering it so it contained just liquid. But they didn’t do much else. It’s brown and it stinks, Sehdev said. “It’s poop.”

SPRING / SUMMER 2011 • HIGH DESERT PULSE


That afternoon, Knudsen had a tube placed in her nose and down into her small intestine. Because there’s a danger of vomiting the sample up, the tube is placed far enough into the intestine to prevent that reaction. Sehdev drew the liquid into a syringe and injected it into the tube. “It was cold going down the back of my throat,” Knudsen recalled. She couldn’t smell or taste it, she said. Sehdev gave her two full syringes of the sample. That was a Tuesday. He said if she didn’t feel better within a few days, she should call. She went home that night. Thursday morning, she said, she woke up feeling normal for the first time since getting sick. “I didn’t feel tired,” Knudsen said. “I felt hungry. I hadn’t felt hungry in the whole nine months.” To this day, three years later, she has not had a recurrence of the infection. •

HIGH DESERT PULSE • SPRING / SUMMER 2011

How can you promote a healthy microbiome? Can you promote your own healthy microbiome, or should you try to do so in your kids? Researchers say we just don’t have solid answers to these questions yet. Science hasn’t determined which specific bacteria are helpful and how we come in contact with them. That said, there are some indications that childhood exposure to animals (pets or on the farm) reduces the risk of allergies and asthma. And, some preliminary studies have found that the use of antibiotics in babies could have long-term consequences, including a higher risk of later developing kidney stones or inflammatory bowel diseases. Of course, many of us who don’t live on farms aren’t about to pick up and move. And antibiotics are necessary to treat some infections common to young children. In the things we can control, experts have only one real

piece of advice: relax. “I hate to say this, but try to live as normal a life as possible,” said Dr. John Chunn, a pediatric infectious disease specialist at Central Oregon Pediatric Associates in Bend. “It’s unnecessary to sanitize every surface,” he said. Nor should parents worry about letting their kids play in the dirt, Chunn said. “It’s a time-honored tradition.” Sarkis Mazmanian, a biologist, advised that people stay away from things that unnaturally disturb the microbiome. That includes, he said, antibiotics unless necessary and foods with preservatives, which often have antimicrobial properties. In general, Mazmanian said, people should “try to live as naturally as possible.” But, experts said, people should not stop washing their hands and should not try to expose themselves to harmful germs. There’s no evidence that that behavior helps anything, and it could make for a lot of days stuck in bed. PHOTO: THINKSTOCK

Page 51


Mental health | THE ROLE OF DIET Continued from Page 22

didn’t think it was just menopause. She figured there was more to it. Harthill went to the Wellness Doctor clinic last year, “motivated by the fat around my middle I could not lose no matter how hard I worked out.” Through specialists there, she learned how her diet was hurting her. She nearly eliminated processed foods, sugar, gluten and dairy, although she allows herself a treat, such as a cupcake, every now and then. “My energy went up; my mood went up,” she said. “I still have hot flashes (from menopause), but I think taking those elements out of my diet definitely had an effect on my energy and my mood.” Living alone, she had been eating a lot of TV dinners, she said. “I was a big processedfood person,” she said. “If I couldn’t nuke it, I probably didn’t eat it.” Now she starts most days with something like eggs and potatoes. Throughout the day,

Page 52

she eats frequent small meals, such as rice cakes with almond butter, fruit, lean turkey or vegetables. Dinners often include vegetable-based soups, fish or goat meat. Harthill said she smiles more these days. She feels motivated to get up in the morning, power through her list of things to do, ride her bike, go dancing. “I just feel really good,” she said. It’s been decades since she felt like this, she said. “I’ve had six months of energy and renewed health,” she said earlier this spring. “I have had sad things happen in that time, but they’re not so overwhelming. My spiritual connection has renewed itself. I know without a doubt that diet is a huge component of it.”

Good fats Sheldon and Harthill both battled depression and sought weight loss. Both made major changes to their diets that cut saturated and trans fats. Both uncovered a healthier body and a happier mind. But fats in general are not to be avoided

in a quest for weight loss or better health. Women on low-fat diets tend to fill up on sugars, starches and high carbohydrate diets, which also contribute to depression, said Albuquerque, N.M.-based Kaayla Daniel, who has a doctorate in nutrition and who aims to debunk the notion that low-fat diets are healthy. “People today are suffering from a deficit of nutrient-rich real foods, whole foods and slow foods, the foods Mother Nature intended us to eat,” she said. “Mother Nature’s foods are not low fat. They are, however, free of the type of trans fats created by food processing and known to contribute to and cause many health problems.” Trans fats have “been linked not only to depression but to a multitude of other health problems, including obesity, heart disease, cancer, particularly breast cancer,” she said. The brain is made up of more than 60 percent fat. It needs the right fats to work properly, Daniel said. But “trans fats bollix the works.” •

SPRING / SUMMER 2011 • HIGH DESERT PULSE


Body of knowledge |

POP QUIZ

Test your ice cream IQ BY ANNE AURAND

U

nraveling the mysteries of ice cream and other frozen desserts is more complicated than you might think. Not all ice creams are full-fat anymore. Manufacturers have created light, fat-free and no-sugar-added ice creams and frozen yogurts. And not all frozen desserts are dairy products; sorbets and soy-based desserts are available nearly everywhere ice cream is sold. Most of the time, general assumptions about frozen yogurt or sorbet being better for you are right. But not always. (Hint: Premium brands taste better for a reason.) Before you freezer-burn your fingers rummaging through the frozen section of the local supermarket to read all those Nutritional Facts labels, test your knowledge here. •

1

What’s a typical serving size on the Nutritional Facts label for ice cream? A. 1 cup B. ½ cup C. 1 ounce

2

Which type of dessert typically has the most calcium? A. Soy dessert B. Frozen yogurt C. Ice cream

3

Which has the most vitamin A? A. Ciao Bella mango sorbet B. Purely Decadent coconut flavor, dairyfree, soy-free frozen dessert

C. Dreyer’s slow-churned peach frozen yogurt

4

A serving of Starbucks or Häagen-Dazs coffee ice cream has about as much caffeine as a small cup of: A. Brewed coffee B. Black tea C. Brewed decaf

5

Which has the most saturated fat? A. Soy Delicious almond pecan soy-

6

Which has the most calories? A. Breyers 98% fat-free vanilla ice cream B. Breyers all natural light vanilla ice cream C. Ben & Jerry’s low-fat vanilla frozen yogurt

7

Which has the most sugar? A. Häagen-Dazs mango sorbet B. Häagen-Dazs chocolate ice cream C. Ben & Jerry’s low-fat vanilla frozen yogurt

based, non-dairy dessert B. Purely Decadent coconut flavor, dairyfree, soy-free frozen dessert C. Ben and Jerry’s Half-Baked flavor frozen yogurt

PHOTOS BY RYAN BRENNECKE; ILLUSTRATION BY LARA MILTON

ANSWERS 1. B. That looks like about two golf balls worth of ice cream. Most people probably serve themselves more than that. 2. B. Frozen yogurts typically have more calcium than other frozen desserts. Some people don’t even call frozen yogurt dessert, but rather a healthy snack. But watch out — it’s not devoid of calories or fat. 3. A. Most mango sorbets have a lot of vitamin A, which is good for your eyes and skin, among other things. Mangoes are rich in vitamin A and C.

4. B. Maybe not a good idea before bed, if you’re sensitive to caffeine. These ice creams are made with just a few ingredients, and one of them is real coffee, which is about twice as powerful as black tea. For example, an 8-ounce cup of brewed coffee can typically contain 60 to 150 mg of caffeine, while the same size cup of black tea can have 40 to 70 mg of caffeine. 5. B. Coconuts are full of saturated fat. Coconut oil also has health benefits, though. 6. C. Even Ben and Jerry’s frozen yogurt is premium. Some

Sources: Company websites and nutritional label information, nutritiondata.self.com, www.livestrong.com

less-than-premium ice creams are lighter than premium frozen yogurt. 7. A. Don’t be deceived by the healthy sound of a fruit-flavored sorbet. It’s not uncommon for frozen desserts with less fat to contain more sugar. We’re not talking about health food, after all.

HIGH DESERT PULSE • SPRING / SUMMER 2011

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One voice | A PERSONAL ESSAY

Labor, and a side of cream cheese ing suites always seem surprised that I shared a hospital room during recovery with another erhaps I was mistaken. But I could have woman and infant. Believe me, as a new mother sworn that when I told the midwife I and foreigner, it broke my heart a bit when they was in pain, she said she would be right sent my husband home at 4 in the morning and back to wrap me in cream cheese. I was suddenly alone with an hours-old baby. I was in a hospital bed in Bern, Switzerland, my Communication was sometimes a problem. home of three months, with my beautiful new More than once I showed up for a test and daughter in a bassinet next to me. My husband staff had no idea why I was there, sending and I had moved from Bend to Switzerland in them scrambling to another floor of the hosSeptember 2008 at the start of my third trimespital for paper records. ter, and I had spent my dwindling solo days wadYet I found Swiss health care highly regudling the city and going to German 101 classes. lated and progressive. Insurance companies So I had by then absorbed enough of the lanare required by the government to cover far guage to hear that word she used, “quark.” Yet more than they do here. Due to the nation’s my fledgling language skills had let me down commitment to child wellness, not only were before. I had somehow ended up with yogurt prenatal care and the birth practically free, but and granola for dinner one night in the hospital the services offered seemed astounding. And when I thought I’d asked for pasta. what perhaps would be termed “alternative But cream cheese therapy also didn’t seem medicine” in the United States was more than out of the question. In the land of Novartis once the first alternative in my Swiss care. and Roche, I’d discovered, popping a pill was I stayed five days in the hospital after my child’s definitely not the first alternative. And the Swiss birth, which is the norm for a textbook delivery ROB KERR model of health care doesn’t necessarily match like mine. During that time I saw midwives more Bulletin reporter Heidi Hagemeier and her the American stereotype of the European health than doctors. They taught me how to carry my daughter, Evie Neville, now 2 years old. care experience. infant in a wrap, showed me how to bathe her During my two and a half years living in Switand provided plenty of coaching on breast-feedzerland, I fielded a lot of questions from Americans at home about my ing, a seemingly simple biological task that in fact isn’t always so easy. experience with health care. The Swiss system received publicity here In the hospital, I learned that health insurance pays for up to five during the Obama health care debate as a possible model. Yet folks of- home visits by a midwife to make sure the family is off to a good start. ten assumed, incorrectly, that it is state-run and free. I can’t be entirely certain, but I’m pretty sure the reputable hospiIn fact, Swiss health insurance is pricey, mandatory and not provided tal where I had planned to give birth in Bend would not at any point through your employer, meaning you as the consumer must figure out have offered a cold cream cheese wrap to reduce pain from breast the array of options and pick your plan. engorgement. There are other factors in the consumers’ favor: Swiss salaries Nor would I have been brought lavender oil to deal with other postare higher on average than here, so the premiums aren’t as large partum pain. That worked too, but in that case I also asked for a pill. a portion of the monthly budget. There are also more insurance I must admit I was impressed throughout by the approach, even companies vying for your business. And health insurance is highly if I didn’t always take the staff up on it. (I said no thanks to acupuncregulated by the Swiss government, which extends its reach into ev- ture during labor; I didn’t think that would be the best time for my erything from premium costs to what companies must cover. first experience as a pincushion.) I received prenatal care and gave birth in a mainstream, large hosBelieve it or not, the midwife returned with a dish towel-size gauze pital in Bern, the nation’s capital. While many aspects of that care compress with several centimeters of cold cream cheese in between. were exemplary, it wasn’t always perfect. She laid it across my chest. Ahhhh. Central Oregon residents accustomed to St. Charles Bend’s large birthI really didn’t care that I smelled like a bagel. •

BY HEIDI HAGEMEIER

P

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SPRING / SUMMER 2011 • HIGH DESERT PULSE


Heart Center Cardiology St. Charles-Bend Cardiothoracic Surgeons Pediatric Heart Center of Central Oregon The Heart Center wishes you a happy and heart-healthy 2011.



High Desert Pulse - Spring/Summer 2011