The day of discharge from the hospital – any hospital — is like being at a bad party or uncomfortable family reunion.  It’s interminable.  Everybody’s ready for it to be over, including you; you just want to go home.

 Shortly before it’s time to go, a nurse goes over your discharge instructions.  Maybe you nod a lot – but maybe you also glaze over, feeling too worn out or overwhelmed to think about the big list of medications and follow-up appointments.

If this haziness about what you’re supposed to do when you leave the hospital sounds familiar, that’s because you’re not alone.  It happens to a lot of us, and this is not good; that discharge information is crucial.  More than 39 million hospital discharges happen every year in the U.S., and nearly 20 percent of those people wind up back in the hospital within a month.   

Francoise Marvel

Courtesy of FSU College of Medicine

These are dismal statistics.  Francoise Marvel, M.D., a second-year resident in internal medicine at Johns Hopkins Bayview Medical Center, wants to change them – starting with helping heart attack patients who are at highest risk of being readmitted within that critical first 30 days.  I recently interviewed Marvel for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Her key to helping these people recover: their cell phones. 

Studies show that about 80 to 90 percent of Americans own a cell phone capable of receiving medical information.  Rich or poor, young or old, tech-savvy or not; doesn’t matter.  Cell phones transcend demographics.

“Unfortunately,” says Marvel, who plans to specialize in preventive cardiology, “hospital discharge is a process that is fraught with patient safety issues.”  The discharge instructions are often written by an intern or medical student, and frankly, the quality varies.  That information is then handed off to a nurse, who conveys it to the patient.

Also, the timing is bad.  Patients may get the go-ahead to leave in the morning, but the actual discharge usually doesn’t happen until late afternoon.  The day drags on, and the last thing those people may feel like doing is sitting through a mini-seminar on medications, lifestyle and dietary changes.     

And yet – especially for those who have stents put in to help a clogged artery stay open – understanding and following this information truly is a matter of life and death.  Another problem, says Marvel, is that the proverbial wheel is being reinvented with every patient.  If you have been a heart patient yourself or been in the hospital room with a relative who has, you know the drill:  Go to cardiac rehab, avoid salt, measure your pulse and blood pressure, avoid alcohol and stop smoking.  Etc. 

But if you have a newly placed stent, what you hear in those discharge instructions is extra important: You must take aspirin and Plavix, two essential blood-thinning medications – these allow your blood vessel to knit a blanket of cells to cover the stent.  That stent is very sticky. Until the cells grow around it, without those blood thinners it’s almost certain that a clot will form. 

That message doesn’t always come through loud and clear, and some patients don’t understand the urgent need to take these pills every single day and not stop for any reason, and that “if they don’t do this, they will have a massive heart attack.”

This is far too important to tell people “right before they get in a wheelchair and get picked up by a family member,” says Marvel.  She cites a 2013 study published in the Journal of the American Medical Association, showing that 40 percent of patients over 65 “who felt that they had a good understanding of their discharge instructions” could not accurately describe the reason for their hospitalization, and 54 percent “did not accurately recall instructions about their follow-up appointment.”

hospital doorAnother study of recently discharged patients aged 64 and older found that “the majority did not understand the new dosing of medications they were taking” or the reasons for medication changes.  “What we know from the research,” Marvel says, “is that many patients are likely to come back to the hospital for avoidable reasons,” and the discharge process is largely to blame.

She is designing the Health-e App for smartphones.  It will serve as a “discharge navigator,” helping patients transition from the hospital to the home after a heart attack.  Designed for people who, like most of us, “don’t know the first thing about cardiac rehab,” the app will help patients follow up with the heart doctor and connect with a pharmacy.  It will walk them through changing their diet and also will connect patients with social services and help them apply for insurance if they don’t already have it.

  After a heart attack, most patients stay four days.  Marvel plans to give the app on Day 2, to “so they feel comfortable with it and have a chance to preview the app so they’ll know why and how they need to take care of themselves when they get home.”  This user-friendly, guided, evidence-based approach, she envisions, will be much better than “the four to five pages of relatively unhelpful, EMR (electronic medical record)-automated, inconsistent instructions.” 

The American Heart Association estimates that one in five men, and one in four women, die within a year after having a heart attack.  “Looking at the risk factors for why you would die within that window, medication and therapeutic adherence – knowing what you need to do and take, and being consistent – is the number one reason,” Marvel says.  “It keeps you up at night when you realize we keep giving the same basic instructions that were typed out 50 years ago. We’re doing a huge disservice to our patients.”

Smart phones, Marvel says, can become a tool for “wraparound care.”  But right now, hospitals are not routinely using them as such.  “If I ask you, where are your car keys, you might have to think about it.  But if I ask, where’s your phone, you know where it is.  You’re wearing it, or it’s right beside you.”  She believes that using the cell phone “is going to bring us closer to our patients.  In the hospital, they see us for 15 minutes, maximum, when we’re on rounds; in fact, that’s a long encounter.  It could be as little as four or five minutes.”

Marvel is developing a prototype with the help of student volunteers from the Johns Hopkins Whiting School of Engineering.  

©Janet Farrar Worthington

Do you feel connected, or tethered?

While you’re mulling that over, here’s another one: Can you handle downtime?  The art of loafing — made famous by such characters as Huckleberry Finn; the morbidly obese passengers of the spaceship, Axiom, in the Pixar movie WALL-E; and cats everywhere – has its good points.  There’s something to be said for taking some time to daydream.

Tell that to the experts who want to help us stay on task and be more productive.  “We’ve come to consider focus and being on as ‘good,’ and idleness – especially if it goes on for too long – as ‘bad’ and unproductive.  We feel guilty if we spend too much time doing nothing,” says Stanford psychologist Emma Seppälä, Science Director of the Center for Compassion and Altruism Research and Education.  She has written a book, The Happiness Track: How to Apply the Science of Happiness to Accelerate Your Success.

Goofing off in moderation can be very helpful, especially when you’re trying to think creatively.  In fact, Seppälä says, truly successful people “are successful because they make time to not concentrate.”  By just leaving the desk and taking a walk, for instance.  “As a consequence, they think inventively and are profoundly creative.  They develop innovative solutions to problems and connect dots in brilliant ways.”

Here are three simple ways you can “unfocus” your hard-working brain – and free it up for tackling problems in new ways:

mindless wanderingDo something mindless.  Don’t just sit there staring at your computer or focusing on one monumental task.  “To get a new perspective on something, we actually need to disengage from it,” Seppälä says. Don’t worry – your brain keeps right on working on a problem, even when you aren’t actively thinking about it.  Take a shower, or go for a walk around the block, or empty the dishwasher.  You and your brain will feel refreshed.

Do nothing at all.  Silence is powerful, says Seppälä.  Meditation or even just taking a “silence break” helps you think outside the box.  This is not that easy for many of us:  “When your mind wanders, thoughts and feelings can emerge that are not necessarily pleasant.  Being alone or being un-busy or quiet can open the door to troublesome thoughts or even anxiety.”  But hang in there.  If you keep at it, you can sit through these thoughts, “or walk through them, if your silent practice is a hike or a walk,” and “they will eventually pass, leaving room for free-flowing thoughts and daydreams.”  Doing nothing is its own form of exercise, and you get better with practice.

Play.  “We are the only adult mammals who do not make time for play, outside of highly structured settings like a Sunday neighborhood soccer game or playtime with a child,” says Seppälä.  Play stimulates positive emotion, and this, in turn, leads to “greater insight and better problem solving.”  Feeling good helps you see the bigger picture, instead of feeling trapped by the details.  If you’ve gotten rusty at playing, don’t worry – this is a skill that can be relearned.

And now, back to feeling constantly connected to the world:  this is not as good as thing as the smartphone makers would like you to believe.  Just ask Jenna Woginrich, who gave up her smartphone 18 months ago.   She wrote about it in the UK newspaper, The Guardian.

She didn’t just get a low-tech flip phone to “simplify.”  No, she jettisoned having a cell phone – any cell phone — altogether.

She doesn’t miss it.  She still has a computer and a landline.  “There are a dozen ways to contact me between e-mail and social media,” she says.  “My phone has become ‘the phone.’ It’s no longer my personal assistant; it has reverted back to being a piece of furniture – like ‘the fridge’ or ‘the couch,’ two other items you also wouldn’t carry around on your butt.  I didn’t get rid of it for some hipster-inspired Luddite ideal… I cut myself off because my life is better without a cell phone.  I’m less distracted and less accessible, two things I didn’t realize were far more important than instantly knowing how many movies Kevin Kline’s been in at a moment’s notice.”

connected cablesEven though her friends think her decision was nuts, she feels “rich,” she says, because the addiction was getting to her.  “I hated that anyone, for any reason, could interrupt my life.”  Worse, she adds, “I was constantly checking e-mails and social media, or playing games.  When I found out I could download audiobooks, the earbuds never left my lobes.  I was a hard user.  I loved every second of it. I even slept with my phone by my side.  It was what I fell asleep watching, and it was the alarm that woke me up.  It was never turned off… It got so bad that I grew uncomfortable with any 30-second span of hands-free idleness.  I felt obligated to reply to every Facebook comment, text, tweet and game request.”

No mas.  She got clean.  “I look people in the eye.  I eat food instead of photographing it and am not driving half a ton of metal into oncoming traffic while looking down at a tiny screen… And while I might be missing out on being able to call 911 at any moment, it’s worth the sacrifice to me.”

Woginrich says she’s glad to be back in the world again.  “It beats waiting for the notification alert telling me that I exist.”

You probably don’t want to give up your smartphone.  But think about putting more distance between yourself and it.  Loosen the tether, and see what happens.

 

©Janet Farrar Worthington

This post, as many Vital Jake posts do, came because of a conversation I happened to have with a guy at church.  He said he felt bad, and that he had been waking up with itchy eyes and a headache.  I asked him how often he changed his sheets, and he was stumped.  He didn’t know.  A few times a year, he said.

That’s not nearly enough (see below).  It’s also pretty gross.  Because even though a guy may consider himself a clean person – he showers daily, brushes his teeth, and wears clean clothes – if his sheets are chock full of days’ or months’ worth of his skin cells, dust mites, etc., then those sheets may be making him feel bad.

Sick in bedMaybe you made resolutions this New Year — things you want to do better, maybe a goal or two you hope to reach.  Here are two easy-peasy changes you can make in your life.  Both have the potential to make you feel better quickly.   

Change Your Sheets

Sheets can become gross fairly quickly.  I’m not even talking about that “what body fluids would a black light pick up?” way, either.   Sheets have to deal with a lot, including skin cells; food crumbs, if you eat in bed; dander and hair from humans and any pets; oils from the skin and hair; sweat; maybe some drool; residue from any skin care products you may use; and your own daily dirt, if you don’t take a shower or bath before bed.  All of these things can accumulate fairly quickly.  If you share your bed with a partner, a kid, and/or any pets, there’s even more of a buildup on those sheets.

dog in bedBacteria feast on sweat and oils.  Dust mites chow down on skin cells.  If you, like millions of Americans, are allergic to dust mites, this can be really bad – in terms of stuffiness, headaches, dry and itchy eyes, respiratory problems, and if you already have asthma, making it worse.  Most experts recommend changing your sheets at least once a week.  If your allergies are severe, you may need to change them every day.  My husband and I are both allergic to dust mites, and we have found, through trial and error, that we need to change our sheets every four or five days.  If we don’t, what happens is predictable:  we wake up with headaches and stuffiness.  When we change the sheets, we notice the difference immediately.   

Skeptical?  Try an experiment:  If you are having a headache, stuffiness and other respiratory symptoms — particularly if symptoms are worse when you first wake up — change your sheets and see how you feel the next morning.  At least, change your pillowcase, and if that helps, go whole hog and change the sheets and bedspread, too, and then keep doing it as often as you need to.

Then what?  Wash your sheets in hot water, or on the allergy or steam cycle in your washing machine.  If the water is cold or just warm, it’s not enough to kill the resilient, powerful, and evil dust mites.   

If you have fancy sheets that can’t tolerate hot water, you could find a washer with a steam cycle, get them dry cleaned – or better yet, get cheaper sheets that can take the heat. 

Also, vacuum your bedroom.  Look under your bed.  If there’s a lot of dust, guess what you’re breathing in?  If you have a fan either over the bed or aimed at it, check that out, too.  If there’s dust, that’s also blowing on you and your poor respiratory system all night long.  So vacuum or dust that, too, and don’t forget dust-trappers like curtains.  It all adds up.

Wash Your Towels

dirty laundryIf your answer to how often you change your towels is, “when they stink,” or “when they get gross,” maybe you need to have a better plan.   According to Steve Boorstein, who co-wrote a book called The Clothing Doctor’s 99 Secrets to Cleaning & Clothing Care, you should wash your bath towel often – like, after every three times you use it.  Bath towels tend to develop a distinct musty smell over time, for several reasons: 

One, we shed an estimated an estimated 1 billion skin cells every day.  A lot of them get rubbed off in our clothes, sheets (see above), washcloths, towels, and even in the washing machine (which also needs to be cleaned every so often, by running an empty load with a cup of vinegar or 1/4 cup of bleach.)

Two: Thick, luxurious bath towels may not dry out completely between showers, so they’re just a breeding ground for bacteria.  If you chuck your towel on the floor or in a hamper and then use it again, that constant dampness is basically hanging out the welcome sign for more bacteria to join the party, and stink up your towel.

Three: Fabric softeners not only make towels less absorbent, they can trap odors inside fabric.  So don’t use one on your towels and washcloths, and see if you notice a difference.

Bottom line:  If you can’t manage to change your towel a couple of times a week, then try to do it at least once a week.  Wash your laundry with hot water.  If you still feel like your towels aren’t getting clean, run bleach or vinegar through the washer.

Also, if you wash your face with the same washcloth day after day, you’re just rubbing that same dirt and bacteria right back onto your skin.  So don’t wash your face with a dirty washcloth, either.   If you can’t change it every day, at least, change it more often and see if you don’t feel better.

©Janet Farrar Worthington

grilled meatGood news for people who love barbecue, hot dogs, burgers, and steak cooked on the grill: It pays to eat your veggies.

The key to this story is something called “PhIP.” A few years ago, noted Johns Hopkins scientist Bill Nelson, M.D., Ph.D., director of the Sidney Kimmel
Comprehensive Cancer Center, began investigating its role in cancer. PhIP is a funny little word. (Pronounced “fipp,” it’s a short name for a long chemical
compound.) It sounds so harmless: “Hey, let’s get PhIP and go over to the club for some tennis,” or “I don’t give a PhIP what you do,” or “Let’s do some
PhIP shots!” But it’s not.

PhIP is found in meats cooked at high temperatures. It is a “pro-carcinogen,” a chemical that turns into something that can attack and mutate DNA, and is
known to cause prostate, breast, and colorectal cancer in rats. Unfortunately, we create carcinogens, or cancer-causing agents, with every steak we grill
or piece of chicken we fry, and PhIP is one of them. In 2007, Nelson and pathologist Angelo De Marzo, M.D., Ph.D., reported in Cancer Research
that when rats are exposed to PhIP, DNA mutations occur in the prostate. Since then, they have learned much more about this little sucker’s role as a
dietary contributor to cancer. I recently wrote about Nelson’s work for Discovery, the research magazine for the Brady Urological Institute at Johns
Hopkins.

The scientists have discovered that veggies help counteract the effects of PhIP. “When we fed rats tomato and broccoli along
with PhIP, the animals lived longer and showed reduced incidence and severity of prostate neoplasms (new, abnormal cell growth; particularly of PIN,
prostatic intraepithelial neoplasia – funny-looking cells that are linked to prostate cancer), intestinal cancers and skin cancers as compared to rats fed
PhIP alone,” says Nelson. “This provides even more evidence that eating vegetables may protect against cancer-causing agents like those in overcooked
meats.”

grilled veggiesThere is a twist to the story: Food safety pays off, too.
Nelson, along with De Marzo and scientist Karen Sfanos, Ph.D., has also explored the idea that prostate cancer may involve a combination of “environmental insults” – bad things in the diet, plus something else that weakens the body, like an infection. They wondered whether chronic inflammation, caused by bacterial infection, would make a difference in rats that had consumed PhIP. Using a specific strain of E.coli isolated from a patient with chronic prostatitis/chronic pelvic pain syndrome, they found to their surprise that the charred food plus the nasty bug seemed to have a systemic effect.

Together, E.coli and PhIP caused an increase in the development and progression of cancer in the skin and digestive tract. (Note: many people have E.coli in their gut and it is harmless, but some strains can get into meat when it’s processed and can survive if the meat is undercooked.) The rats that received the double punch of E.coli plus PhIP fared worse than rats that ate the PhIP alone. In one study, the bacteria- and PhIP-consuming rats developed more precancerous lesions within the prostate and might have developed even more problems – except they also died sooner.

In further experiments, they found that “when we inoculated PhIP-fed rats with E.coli in the prostate, the animals developed acute and chronic
prostate inflammation out of proportion to that seen with PhIP ingestion or E.coli inoculation alone, and had more prostate neoplasms, intestinal
cancers, and skin cancers,” says Nelson. “This hints that prostate infections and dietary carcinogens might interact to promote chronic prostate
inflammation and prostate cancers, and that prostate infections might augment carcinogen effects on other tissues, as well.”

What does this mean for you? One, that if these things cause changes in the prostate, it’s a pretty good bet that they are hurting you elsewhere, as well,
so take precautions: eat a veggie in addition to a potato. Potatoes are delicious, but they don’t help fight cancer the way green, leafy vegetables and
tomatoes do. Two, tomatoes and broccoli probably aren’t the only vegetables that can help diffuse the bad effects of charred meat; these are just the ones
that were studied in this particular investigation. Three, don’t eat undercooked meat. You’re not just risking food poisoning, which comes in like a
freight train and goes away quickly; you may be adding to your risk of developing cancer.

Nelson, along with De Marzo, Sfanos, and Hopkins colleagues recently published two papers on these striking new findings in the journals PLoS ONE
and Cancer Prevention Research.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

sand_sun_beachIn 2002, when I ghostwrote the first edition of The Paleo Diet for Loren Cordain, I thought we were writing sacrilege when he said people need sunlight.  That’s because our view of what’s normal and natural has gotten skewed.  “Oh, no!” I thought.  “Must have sunscreen.  Sunscreen good, sun bad!”  Just a few steps away from Frankenstein being terrified of fire.

I’ve lightened up, so to speak, since then.  Cordain was right:  Yes, excessive sunlight exposure is linked to skin cancers, including squamous cell cancers, which form on the top layers of the skin; basal cell cancers, which form on the bottom layers of the skin; and melanomas, which form within the skin’s pigment-producing cells, the melanocytes.  However, avoiding sunlight is not the way to prevent disease.

“The experience of our hunter-gatherer ancestors proves helpful,” Cordain wrote.  “Many studies have shown that people with high lifetime sunlight exposure, similar to that of hunter-gatherers, have lower rates of melanoma than those with low sunlight exposure.  Also, indoor workers have a greater risk of melanoma than outdoor workers.  Even more puzzling, melanomas often arise in body areas that are infrequently or intermittently exposed to sun.”  Many scientists believe that severe sunburn during childhood — like that time where you went to the beach and came home red as a lobster, and maybe your mom (as mine did) treated it with baking soda and/or aloe, apple cider vinegar, or other home remedies — or intense burns in areas that usually don’t see the sun are bigger risk factors for the development of melanoma.

“When your exposure to sunlight is gradual, moderate and continuous,” Cordain explained, your body responds “in a manner guided by evolutionary wisdom.”  Your skin begins to get tan, because your body is ramping up its production of melanin.  The darkened skin helps protect you from the sunlight’s most damaging ultraviolet rays.  Also important: Vitamin D levels in the blood start to increase, too, as the UV light hits the skin and your body starts to convert cholesterol into Vitamin D.

Vitamin D is a really good thing.  It’s actually a hormone, which is mostly formed in the skin.  As an aside, jumping to other books I’ve co-written: In Dr. Patrick Walsh’s Guide to Preventing Prostate Cancer, Walsh, the noted Johns Hopkins urologist, points out that “over the last 25 years, the death rates from prostate cancer in America have been the highest in the regions of the country that get the least sunshine” (north of 40 degrees latitude).  However, Walsh cautions, taking too much Vitamin D is not a great approach, either.  If you’re going to take a Vitamin D supplement, he advises not taking more than 4000 IU per day.

Cordain cited evidence from population studies confirming that people with the greatest lifetime sun exposures have the lowest rates of prostate, breast, and colon cancers.  But most important to Cordain, from years of study of our Stone Age ancestors, is this: “Exposure to sunlight is natural for humans.  It is part of our evolutionary heritage.  Without sunlight, it is virtually impossible to achieve an adequate intake of vitamin D from the natural foods that were available to our hunter-gatherer ancestors.  Our food supply has been a significant source of vitamin D for a very short time — less than a century, when dairy producers began adding it to the milk and later, to margarine.  Sunlight exposure is healthy as long as it occurs in a slow, gradual, and limited dose over the course of a lifetime.”

©Janet Farrar Worthington

coffee beansImagine:  John Wayne in True Grit, charging bad guys on horseback, with the reins in his teeth, a Colt revolver in one hand and a Winchester rifle in the other, and suddenly, he veers off and heads for the woods.   He’s acutely regretting that cup of coffee he had back at the campfire.

Well, that didn’t happen, because he’s John Wayne.  But it certainly might happen to us lesser mortals.  In fact, this laxative effect is a known consequence — or, hey! It’s a benefit, depending on how you look at it – of drinking coffee.  The effect can happen in as little as four minutes, according to an English study published in the journal, Gut.

Why does coffee make some people need to poop?  Several reasons.  It’s not the caffeine (decaf can produce the same effect), and it’s not the heat of the beverage; the English scientists tested drinking hot water in the same group of study participants, and nothing happened.  Out of 14 people studied (12 men, two women), eight of those who drank black, unsweetened coffee needed to move their bowels.  The coffee sped up the gut’s motility – movement of food through the digestive tract, using a series of muscle contractions called peristalsis – in the eight responders, but not in the others.  “The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes,” the scientists reported.  “These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.”

The fact that this happened so darned fast, the researchers speculated, doesn’t mean that coffee actually rockets through the system.  Instead, “we suspect that coffee may induce a ‘gastrocolonic response’ by acting on epithelial receptors in the stomach or small bowel.”  This might be activated by nerves or hormones in the GI tract; also, they added, “coffee has been shown to promote release of gastrin, which can increase colonic … motor activity.”  So for some people, coffee shifts the gut into temporary fast-forward mode. 

Why Does Coffee Make You Poop?Coffee is a great way to wake you up, and it’s also a great way to keep you regular. What’s so special about coffee that it makes you poop?—–For a collection of all our videos, check out TestTube Video!

Posted by Discovery News on Wednesday, July 29, 2015

What else does it do?  I am fortunate to be married to an excellent gastroenterologist, Mark Worthington, M.D., formerly on the medical faculty at the University of Virginia and Johns Hopkins and now in private practice in Arizona.  “Basically, coffee causes a net secretion of fluid into the small intestine,” he says.  “For most people, the colon takes up the slack – it sucks up the extra water – but it gets activated in the process.  For some people, coffee actually leads to diarrhea because the colon can’t handle it all.”  People who particularly have trouble with coffee, he adds, are those with colitis (inflammation of the colon).  Also: “coffee sweeteners, such as Stevia, can cause diarrhea in some people.”  If you add a lot of dairy to your coffee, and dairy products are difficult for you, this might make coffee a bit of a digestive challenge, as well.

Is that it?  Well, no, there’s the acid.  Coffee is loaded with a phenol called “chlorogenic acid,” and – again, not in everyone – for those of us who lack cast-iron stomachs and are already prone to acid reflux, or for people who drink coffee on an empty stomach, the acid can irritate the stomach lining.  This is called gastritis, and it can result in heartburn, hiccups, pain in the belly, nausea, and can even make you throw up if you don’t get some food in there to help combat the acid.  Caffeine itself – let’s face it, the major reason we drink coffee – also can cause the stomach to pump out more acid.   

Note:  Don’t think I’m anti-coffee.  I’m not at all.  Coffee also does a lot of good things, including help lower your risk for Alzheimer’s disease, which I will talk about in some future post.  This is not that post.

Good news for your tummy:  If coffee starts your day off with an upset stomach or gives you the rumblies, don’t despair:  You are not alone.  In fact, there are so many people with this problem that gut-friendly coffees – with more available all the time – have been developed just for you.

Which is good news.  However, if you’re one of those susceptible to coffee’s Number Two side effect – no matter how gentle or organic or gourmet your coffee may be — you’ll still probably have to poop after you drink it.

©Janet Farrar Worthington