Fall 2013 1

The health magazine forBody, Mind & Motivation

Published quarterly by the Lewiston Tribuneand the Moscow-Pullman Daily News

BalanceVolume 5 – Issue 3 – Fall 2013

CANNERS BEWAREFollow established recipesor face the consequences

MOLD MADNESSIt’s everywhere but experts sayquick action can keep it at bay

GET-FIT GUYSpokane’s Ben Green� eldmakes a name for himself

FASTING FEARS� ose in the know warn

it’s not worth the risk

�  Balance

Fall 2013 3

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Contents Balance – volume 5, issue 3 – Fall 2013

COVER STORY

CANNERS BEWAREExperts warn of consequences when customizing recipes

16

FITNESS

THE GET-FIT GUYLewiston native Green� eld making a name for himself in the � eld of � tness

12

ALSO | GERMS 10 | FOOD ALLERGIES 18 | ALZHEIMER’S 20

HEALTH & WELLNESS

MOLD MATTERSEven in drier climates, mold is present and can lead to health concerns

6

NUTRITION

FASTING FEARSExperts warn of downfalls for popular weight-loss method

14

Fall 2013 �

LOCAL CONTRIBUTORS

ELAINE WILLIAmSLewiston Tribune staff writerElaine started reporting at the Tribune in 1991 and has covered the business beat since 2000. She’s an aspiring distance runner who completed the Lewis-Clark Half Marathon in 2 hours, 25 minutes and 23 seconds, her best time yet.

More. Better. Brighter.

JESSE HUgHESGraphic designerJesse has worked for the Daily News and Lewiston Tribune since 2008 in the advertising department. He and his wife try to eat a healthy, well-balanced diet and stay active by walking, hiking, and being kept on their toes by two boys.

Balance is published quarterly by the Lewiston Tribune and Moscow-Pullman Daily News and printed at the Tribune Publishing Co. Inc.’s printing facility at 505 Capital St. in Lewiston. To advertise in Balance, contact the Lewiston Tribune advertising department at (208)848.2216 or Advertising Director Kim Burner at kburner@lmtribune.com, or the Moscow-Pullman Daily News advertising department at (208)882.5561 or Advertising Manager Craig Staszkow at cstaszkow@dnews.com. Editorial suggestions and ideas can be sent to Tribune City Editor Craig Clohessy at cclohessy@lmtribune.com or Daily News City Editor Murf Raquet at murf@dnews.com.

KERRI SANdAINELewiston Tribune staff writerKerri covers the southeast corner of Washington for the Tribune. Her favorite activities are tennis, running marathons and chasing news stories.

KEvIN gABOURyOregon native Kevin Gaboury formerly covered education for the Tribune.

ELIzABETH JAmESElizabeth James is a freelance who contributes occasionally to the Lewiston Tribune.

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�  Balance

Even in drier climates, mold is present and can lead to health concerns

By ElizaBEth JamEs

M old is everywhere.Some 70,000 species of

mold surround us constantly and are impossible to keep out of homes. They enter through windows and doors, through heating and cooling systems, or are transported on the bodies and clothing of humans and pets.

Mold and mildew might seem prevalent in humid climates like the Eastern U.S., but dry regions such as north central Idaho and eastern Washington are by no means immune.

Ed Marugg, environ-mental health director for the Lewiston office of Public Health-Idaho North Central District, said mold is more of an irritant in the region than a major problem.

Sensitivities to mold vary tremendously, but for most healthy individuals, the mold that routinely exists in homes is not dan-gerous. Some people may experience mild upper respiratory symptoms; vul-nerable populations, including the elderly, pregnant women, those with compromised immune systems, and highly allergic indi-viduals may have more severe reactions.

Marugg’s office receives 15 to 20 calls per month about mold in homes during the fall, winter, and spring months, but the health department does not consider it to be a major health concern.

Extensive mold growth, however, can

also become a significant financial prob-lem and any home can experience mold growth.

“The key is air management,” said Bruce Prindle, general manager of CTR Cleanup and Total Restoration in Lewiston. He agrees that it is not a major problem in the region, but it can and does happen in homes throughout the area.

Moisture — water intrusion — is the

source of mold growth, and any place with improper ventilation is susceptible. Base-ments and crawl spaces are especially at risk when a building’s foundation cracks or is otherwise compromised and moisture is regularly present.

Roof leaks are another source of mold problems, especially on foreclosed or part-year homes where residents are not neces-sarily present to detect and repair the leaks.

Mold matters

epa.gov

(Top Left) Mold grows inside a wall where it’s dark and damp. (Above) A common growth area for mold is the shower where moisture abounds. (Left) A heavy growth of mold on a poorly stored suitcase.

Fall 2013 �

Newer homes tend to have more ef-ficient air circulation but, Prindle warns, new homes can also create mold problems by being too tightly closed, which allows condensation to build up. That, in turn, en-courages mold growth. It usually happens in windows and siding, where outdoor and indoor temperatures often compete and collide.

Mold is detected by sight and smell. A musty odor in the basement, for example, is a sure sign of mold growth. The true ex-tent of the problem can only be determined by an indoor environmental test, which is performed before an abatement program begins.

Depending on the degree of the prob-lem, remediation can run into thousands of dollars. Removing mold from a basement,

for instance, might involve excavation, seal-ing the foundation, and even repairing the home’s landscape.

While homeowners can never elimi-nate mold and moisture from their homes, financial and physical health warrant caution and care to keep them to a mini-mum. Whether heating or cooling a home, ensuring proper air circulation is the first and most important step to mold preven-tion, Prindle said.

On the Net:http://www.cdc.gov/mold/stachy.htm#Q1http://idahopublichealth.com/environment/files/mold-homes.pdfhttp://idahopublichealth.com/environment/files/mold-in-rentals-fact-sheet.pdfhttp://www.epa.gov/mold/moldguide.html

epa.gov

A heavy growth of mold on a sheet rock wall and molding.

Mold prevention tipsl Keep humidity levels as low as you can — no higher than 50 percent all day long. An air

conditioner or dehumidifier will help you keep the level low. Bear in mind that humidity levels change over the course of a day with changes in the moisture in the air and the air temperature, so you will need to check the humidity levels more than once a day.

l Be sure your home has enough ventilation. Use exhaust fans that vent outside your home in the kitchen and bathroom. Make sure your clothes dryer vents outside your home.

l Fix any leaks in your home’s roof, walls, or plumbing so mold does not have moisture to grow.

l Clean up and dry out your home thoroughly and quickly (within 24 to 48 hours) after flooding.

l Add mold inhibitors to paints before painting.l Clean bathrooms with mold-killing products.l Remove or replace carpets and upholstery that have been soaked and cannot be dried

promptly. Consider not using carpet in rooms or areas like bathrooms or basements that may have a lot of moisture.

Source: Centers for Disease Control 3 9 2 7 9 4 i 2 _ 1 3

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�  Balance

Tribune/Kyle Mills

Lewiston-Clarkston Valley nearly disappears from the view point atop Lewiston Hill from smoke from area fires and other pollution.

Wildfire season is winding down, but experts say air quality is a year-round concern

By JOEL MILLS

W ildfire season is winding down and air quality is trend-ing up, but there are plenty

of other pollutants floating around that can harm sensitive populations.

“The biggest issue we deal with every year is wildfire smoke,” said Ed Marugg, environmental health director for Idaho North Central District Public Health. “It’s hard to avoid it because it’s so ubiq-uitous.”

Smoke is an obvious, visible prob-

lem. But those sensitive to air quality can also be affected by more insidi-ous culprits: mold, pets, plants, radon, formaldehyde, pesticides, asbestos and secondhand smoke.

Mold, especially, can pose a respi-ratory threat during the three cooler seasons, Marugg said.

“You get the colder conditions outside, and the way buildings are built these days, there’s not a lot of air exchange be-tween the indoor and outdoor air,” he said.

Humans produce humidity naturally by breathing, and through regular daily

activities like cooking, bathing and cleaning. And if that moisture is intro-duced into a poorly insulated environ-ment with cold walls, condensation can form.

“Because it stays moist, it’s a perfect environment for mold and mildew

to get growing,” Marugg said.

And that can pose short- and long-term prob-lems for what Public Health defines as “sensi-tive groups.” Air quality is impor-tant to everyone,

but it can have a pronounced effect on pregnant women, children, the elderly, people with respiratory issues and peo-

Smoke: A visible threat

“Even though this year it looks like fire season is pretty much over, when people see really smoky, hazy conditions, that means that there’s probably something in the air and you should avoid heavy exertion out there.”

Ed MaruggEnvironmental health director for

Idaho North Central District Public Health

Fall 2013 �

ple with conditions like heart disease or diabetes.

Marugg said mold isn’t a huge prob-lem in the region, but Public Health gets multiple calls about its occurrence every year, especially during the fall, winter and spring when it starts to cause allergic reactions. Controlling humidity and insulating exterior walls can help prevent it from growing.

Formaldehyde is another common irritant because the chemical is present in glues used to assemble cabinets and lay carpeting. The vapors emitted from those products can be especially potent in new construction, Marugg said.

People who breathe too much form-aldehyde complain of bad smells and headaches. Vapor emissions usually diminish over time, but those affected should try to keep their homes well-ventilated, he said.

Asbestos remains an issue, even though people have been aware of its harmful effects for years. Marugg said

it was used as a construction material for so long that it continues to pop up everywhere.

“A lot of those old buildings are still standing,” he said. And when people or businesses remodel, they can stir up some nasty particles.

The best way to avoid asbestos expo-sure is to have it removed by a licensed contractor.

So while other threats are abundant,

Marugg said wildfire smoke poses one of the biggest dangers. But he said the best point to remember is to take it easy.

“Even though this year it looks like fire season is pretty much over, when people see really smoky, hazy condi-tions, that means that there’s probably something in the air and you should avoid heavy exertion out there,” he said. “That’s the biggest thing that people should know about with air quality.”

Some simple and effective measures to breathe a little easier during wildfire season:l Stay inside with the doors and windows closed as much as possible to limit exposure

when wildfire smoke is present.l Wash or change filters on air conditioners and furnaces frequently, and use the “recycle”

mode in the home or car to keep the filtered air inside.l Avoid heavy work or exercise outside, and wear an appropriate mask if it is unavoidable.l Stay with someone else if the home does not have air conditioning and temperatures are

extreme.l Call a doctor if shortness of breath, uncontrolled coughing, sneezing, choking or chest

discomfort develop.l Have at least a five-day supply of medications for a heart or lung condition.l Drink plenty of water to keep airways moist. Breathing through a warm, wet washcloth

can also relieve dryness.

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10 Balance

Germs 101 TRIBUNE/STEVE HANKS

A thorough hand washing prevents the spread of germs.

When it comes to bacteria-related ailments, the best prevention is wash your hands

BY ELIZABETH JAMES

Y our cellphone is a breeding ground for bacteria. So is your kitchen sink. And your desktop. Public places like

restaurants and hotel rooms are full of germs as well.

Disinfectants help sanitize surfaces, said Anna Olson, sta� epidemiologist at the North Central Public Health District in Lewiston. But, she cautions, in order to be e� ective, following manufacturer directions is para-mount. And not every disinfectant will kill every germ.

� e only most e� ective way to keep bacteria to a minimum, according to health experts, is to wash your hands regularly. Olson calls the practice an integral part of health. While a certain amount of bacteria on human skin is completely normal, she said, hand washing will substantially reduce the numbers of bad germs that make people sick.

Sandra McCurdy, Extension food safety specialist at the University of Idaho, agreed, adding simply that hand washing is “really important.”

But even if you faithfully and conscien-tiously wash your hands a� er using the rest-room, not everyone necessarily does. A 2007 study observing public restroom behavior of 6,000 adults showed that only 77 percent washed their hands a� er using the facili-ties. � e study, reported by WebMD, also uncovered a gender disparity: 66 percent of the monitored men washed their hands while

88 percent of women did so. In contrast, in a concurrent telephone survey asking individu-als about their hand-washing behavior, 92 percent of 1,000 people surveyed claimed to always wash their hands when using a public restroom.

� e single most reliable way to keep yourself and others from getting sick with the cold, � u, or worse infections, is to wash your hands. Mere touch spreads bacteria, viruses, fungi, and parasites to everything we touch — cellphones, ATM machines, door knobs and handles, grocery carts, desktops, and more. According to the blog, “Learn About Germs,” by Kelly Reynolds, associate professor of public health at the University of Arizona, some germs can live for up to two hours on hard surfaces, and other bacteria can grow and divide every 20 minutes. At the end of a single day, that single cell multiplied to 8 million germs.

Fall 2013 11

No matter how reliably and often we wash our hands, there are still some surpris-ing places that can expose us to unpleasant germs. The website Prevention.com lists the “8 Germiest Public Places” and “10 Worst Germ Hot Spots.” Restaurants are high on the list, but not just the public restrooms. Menus and condiment bottles have been found to harbor millions of germs. Held and perhaps coughed and sneezed on by up to a dozen people in the course of a single day, these items are not usually cleaned or disin-fected. In addition to the other customers, we rely on the good faith of food preparers and servers to wash their hands regularly. The lemon wedges served with your ice tea can harbor microbes such as E. coli.

The good news is that most food service facilities are clean. Neither Olson nor Mc-Curdy recall any recent major outbreaks in the region due to food-borne pathogens.

McCurdy points out that from a mar-keting standpoint, it only makes sense for vendors to serve safe food, whether in a restaurant, farmers market, or county fair.

Nonetheless, even in homes, germs thrive in unexpected places. News stories in

recent years have reported some surprising studies. The mere act of flushing a toilet, for example, sends an aerosol of fecal bacteria throughout your bathroom. In the kitchen, sponges and cutting boards are known to be virtual petri dishes of bacteria and viruses.

But some places we might not think about include jewelry, according to Preven-tion.com. Our bling can harbor millions of germs, holding them next to your skin when you wear your favorite necklace, bracelet, or earrings. (Silver is a natural antimicrobial, however, so silver jewelry tends to shelter less bacteria than other materials.) Purses and backpacks are other germ condomini-ums — they get tossed about and set just about anywhere, including bathroom floors. When was the last time anyone sanitized a purse?

The list of places where germs hide and multiply is endless. The bottom line is that it is impossible to avoid being exposed to them. But people can take control of how much they spread germs, and counter the exposure they do get, Olson said, simply by completely and frequently washing their hands.

What is the right way to wash your hands?l Wet your hands with clean, running water (warm or cold) and apply soap.l Rub your hands together to make a lather and scrub them well; be sure to scrub the backs

of your hands, between your fingers, and under your nails.l Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy

Birthday” song from beginning to end twice.l Rinse your hands well under running water.l Dry your hands using a clean towel or air dry them.Source: www.cdc.gov/handwashing

When should you wash your hands?l Before, during, and after preparing foodl Before eating foodl Before and after caring for someone who

is sickl Before and after treating a cut or woundl After using the toiletl After changing diapers or cleaning up a

child who has used the toiletl After blowing your nose, coughing, or

sneezingl After touching an animal or animal wastel After handling pet food or pet treatsl After touching garbageSource: www.cdc.gov/handwashing

31 Places That Germs Love 1. Toothbrushes 2. Yoga mats 3. Desk tops 4. Kitchen sponges 5. Restroom door handles 6. Grocery carts 7. Jewelry (except silver) 8. Pillows 9. Purses10. Gas pumps11. Communal buttons (elevators,

ATMs, vending machines, debit card touchscreens)

12. Reusable grocery bags13. Kitchen faucet14. Garbage disposal15. Welcome mat16. Vacuum cleaner17. Dish towel18. Car dashboard19. Soap dispensers20. Restaurant condiment bottles/dis-

pensers21. Refrigerator seal22. Restaurant menus23. Lemon wedges24. Airplane bathrooms25. Doctor’s office26. Stair and escalator railings27. Backpacks28. Gym machines29. Cellphones and covers30. Television remote31. Kitchen knobs and handlesSource: Center for Disease Control and Prevention

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12  Balance

Lewiston native Greenfield making a name for himself in the field of fitness

By KERRI SANDAINE

L ewiston native Ben Greenfield is the go-to guy when it comes to triathlons, exercise and nutrition.

He’s only 31, but Greenfield is already a highly respected author, speaker and consul-tant in the fitness and nutrition industry.

He owns a successful home-based busi-ness called Pacific Elite Fitness and provides training plans, books, DVDs and custom coaching programs on his website, BenGreen-fieldFitness.com. His two podcasts — “the Get-Fit Guy” and “the Ben Greenfield Fitness Podcast” — have been rated No. 1 on iTunes in the fitness category.

Greenfield, who has a master’s degree in exercise physiology from the University of Idaho, is also an endurance athlete who competes internationally. He and his wife, Jessa, are the parents of twin 5-year-old boys named River and Terran, and currently live in the Spokane Valley.

With a resume like that, Greenfield was asked to share some of his tips with our Balance readers. He recently competed in IronMan Canada and was headed to London when we caught up with him via email.

Balance: How did you get started in this line of work?

Ben Greenfield: All five years of university, I worked as a personal trainer and wellness consultant, and aside from a brief four-month stint working in surgical sales for Biomet straight out of college, all I’ve ever done is help people achieve better bodies and higher performance. Until my kids were born, I ran personal training studios and

gyms, and now I primarily coach and consult online, and speak and put on training clinics around the world.

B: What is your fitness philosophy?BG: I love getting fit, feeling good about

the way my body looks, and fulfilling my deep-seeded drive to live life to the fullest by

achieving difficult feats of physical per-formance. But I was fed up with feeling like crap from all the extreme exercising, strange foods, feeling of constant stress and soreness, and worry

about the toll my hectic lifestyle was taking on my body. So I created a way of training, eating and living that is perfectly healthy and natural, but still allows me to look, feel and perform at my peak capabilities.

B: What does your daily training schedule

look like?BG: I exercise for 60 to 90 minutes a day

— typically with some morning stretching and yoga, and then an afternoon of high-intensity cardio or weights workout. Once a week, I take a rest day that simply includes playing a new sport, doing yoga or simply

The Get-Fit Guy

“I love getting fit, feeling good about the way my body looks, and fulfilling my deep-seeded drive to live life to the fullest by achieving difficult feats of physical performance.”

Ben GreenfieldLewiston native and owner of Pacific Elite Fitness

Fall 2013 13

hanging out with my family.B: What fitness accomplishment are you

most proud of?BG: I just completed my ninth Ironman

triathlon and fifth time qualifying for Iron-man Hawaii, which will be my 10th Ironman triathlon. I’m proud of getting each of those big races under my belt.

B: Any quick and easy advice for our read-ers when it comes to diet and exercise?

BG: Lots. My biggest three tips are:1. Write down exactly what you want to

accomplish and how you are going to do it. If it’s not in writing you probably won’t do it.

2. Sleep and de-stress as much as humanly possible. This will keep you healthy, which allows you to consistently exercise and get the body you want. When given the choice to beat yourself up or to relax, then relax.

3. Fuel your body with real food. The best exercise program on the face of the planet is useless if it’s fueled by fake foods.

For more information and tips, readers can check out BenGreenfieldFitness.com.

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14  Balance

Experts warn of downfalls for popular weight-loss method

By Kevin GaBoury

Fasting, the willing abstention from food or drink for a period of time, has been around for centu-ries.

A number of religions, includ-ing Islam, practice fasting as a means of demonstrating faith or spiritual reflection. The his-torical figure who often comes to mind at the mention of fasting is Ghandi, who used fasting as a non-violent form of protest against British rule in India.

In recent years, fast-ing or similar diets

have emerged as a quick, easy way to lose weight. It seems simple enough: Just stop eating, and watch the pounds melt away.

But most nutrition experts agree that when it comes to fasting, the risks out-weigh the benefits and it can cause more harm than good, said Courtney Goff, an outpatient dietician at St. Joseph Re-gional Medical Center in Lewiston.

“Generally, nutrition experts agree that fasting is potentially dangerous and not an effective way to lose weight,” she said.

When someone initially loses weight while fasting, it’s primarily water weight, not fat, she said. When a person doesn’t eat for a period of time, a num-ber of things happen. As they continue fasting and the body uses up its stores of glycogen, a substance stored in the liver and muscles, the muscles begin to break down and the body goes into conservation mode, where the metabo-lism slows down so calories are burned more slowly.

Fasting: Benefits not worth the risk

Fall 2013 15

“It can result in health problems, like muscle loss,” she said. “The body starts to eat itself, or lose muscle.”

There’s also a higher rate of fat break-down, which can result in ketosis. When fat is broken down, it yields ketone, which can act as a substitute energy source for the body, although not a pre-ferred one, Goff said. Ketosis can cause fatigue, headaches and mental dullness.

“It can put a strain on the kidneys,” she said. “I get very concerned about folks with diabetes. It’s very dangerous for someone who has diabetes.”

Once they’re done fasting, most people quickly gain the weight back, and can become distraught or discour-aged, she added.

Some people also fast to rid the body of toxins, but this is also a myth, Goff said.

“It does sound logical that it could cleanse your body, but there is no sci-entific evidence that fasting can cleanse the body of toxins,” she said. “When someone is fasting, toxins can increase because you become dehydrated.”

The liver, kidneys, skin and lungs are all perfectly capable of removing toxins on their own, she added.

Rather than take a drastic weight-loss approach like fasting, Goff recommends working with a dietician to find a healthy eating plan that they can stick to over the long term. This, done in con-junction with regular physical activity, is the only effective way to lose weight and keep it off.

As for fasting, Goff said there really are no positives.

“It’s a quick fix, and that’s what at-tracts people,” she said. “This type of approach does not work over the long term.”

“Generally, nutrition experts agree that fasting is potentially dangerous and not an effective way to lose weight.”

Courtney GoffOutpatient dietician at St. Joseph

Regional Medical Center in Lewiston

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16  Balance

Experts warn of consequences when customizing recipes

By ELAINE WILLIAMS

C ustomizing your home-canned salsa could produce disastrous results.

Salsa is one of the most popular foods for amateurs to can and it can also be one of the trickiest to get right because of acidity levels, said Sandy McCurdy, exten-sion food safety specialist at the University of Idaho in Moscow.

Understanding a little food science is important even for the growing number of first-time canners since the price of a mistake can be drastic.

“People are interested in where their food comes from and having control over their own food,” McCurdy said of why so many folks are turning to canning.

But the pH level in any food needs to be at or below 4.6 for it to be canned in a water bath. At 4.6 and below it’s safe for anyone other than very young infants to consume foods with spores of clostridium botulinum, the bacteria that causes botu-lism, McCurdy said.

If the pH reading is higher, the food contains less acid and needs to be pre-served in a pressure canner so the tem-perature reaches 240 degrees and kills the spores, McCurdy said.

The problem with salsa is it contains a mixture of ingredients with lower acidity, such as onions and peppers, and ones that have higher acidity, like tomatoes, Mc-Curdy said.

Recipes from credible sources like the National Center for Home Food Preserva-tion carefully calibrate the mixtures to keep them at the right acidity level. (See related information.)

But if a home cook tinkers the same way they might if they’re making spaghetti sauce, and, say, adds an extra onion, it could push the acidity too low, McCurdy

said.“It’s one area that worries me a little, that

people get too creative.”Salsa isn’t the only potential place that

canners stumble. Vegetables with low acid-ity, such as green beans, need to be pro-cessed in a pressure canner unless they’re

being pickled using a credible recipe, McCurdy said.

Using the right cook times and adjusting the pressure at altitudes of more than 1,000 feet are just two of the key steps, McCurdy said. “It’s very specific on how you need to do it. You need to vent your canner

Canners beware

Fall 2013 17

properly.”Dial gauges for pressure canners should

be calibrated annually by experts at places like county extension offices since they can get thrown off easily in a number of ways, including being dropped, McCurdy said.

Even jam, long considered one of the safest forms of canned food, can get com-plicated.

Often jam is made from acid fruit like apricots and peaches grown on trees where it’s less vulnerable to clostridium botuli-num than vegetables raised on the ground, McCurdy said.

Beside the fruit, recipes used to have two other ingredients: sugar and pectin to thicken the mixture, McCurdy said.

Just like salsa, what people put in jam is

growing more diverse, creating new haz-ards. Sometimes people will add herbs or they’ll experiment with a sweetener other than sugar, McCurdy said.

Those methods can be safe as long as the person who created the recipe did so following the right food safety principles, McCurdy said. “These days we have a lot more alternatives.”

The basics of safe canningl Use recipes only from credible sources such as the following websites:

http://www.cals.uidaho.edu/edComm/catalog.asp?category1=Family%20and%20Consumer%20Issues&category2=Food%20and%20Nutrition http://uga.edu/nchfp/publications/publications_usda.html http://extension.usu.edu/htm/publications/index.cfm (Click on food and health. Then go to food preservation.)

l Check the elevation of where you live before you start canning, because it makes a difference in canning times and pressure. In places such as the Lewiston Orchards, where the elevation is 1,000 feet or higher, for example, five minutes needs to be added to the times of water bath canning recipes. Google Earth provides the exact elevation of any home.

l Have the dial pressure gauge on your canner tested annually, something that can be done at extension offices.l If you purchase a used pressure canner, look for the Universal Underwriters Laboratory symbol. That’s an indication it was manufactured

after 1970 when safety features became standard. Take the canner to an extension office before you use it to check its safety.l Use bottled lemon juice in recipes that call for it. The acidity of it is standardized.l Add a small sliver of butter to jam and jelly recipes while they cook. It reduces the foam.l Be sure to get rid of air bubbles and wipe the lids of the jars before screwing on the lids.l Monitor the canning process. If the water stops boiling in your canner before the specified amount of time in the recipe has passed or the

pressure on a pressure canner falls below the level specified in the recipe, you have to start the time over.l Allow the jars to cool overnight at room temperature before taking off the rims, wiping the tops of the jars again, labeling the jars with the

date and contents and storing them.l Make sure there’s absolutely no give in the top of the lid. If there is, put it in the refrigerator and use it in the same length of time as some-

thing that wasn’t preserved.

(Opposite) The green beans should be washed and drained, their ends removed and then cut to a desired length. (Above Left) After the cut green beans have been blanched, they are transferred to the sterilized canning jars. (Above Right) After the jars

have been filled with green beans and the lids put in place, they go into the pressure canner, where they will eventually be sealed.

18  Balance

By Karen KaplanLos Angeles Times

LOS ANGELES — Children’s allergies to peanuts, dairy and other foods cost the U.S. nearly $25 billion a year, according to the first survey to come up with a comprehen-sive price tag for a condition that affects 8 percent of American kids.

Researchers led by Dr. Ruchi Gupta, a pediatrician at Ann & Robert H. Lu-rie Children’s Hospital of Chicago and a professor at Northwestern University’s Feinberg School of Medicine, surveyed 1,643 parents around the country who have at least one child with a food allergy. The parents’ responses were weighted to match the actual distribution of children with food allergies in the United States.

Here’s what they found:Doctors’ appointments, hospital stays,

trips to the emergency room and other direct medical expenses accounted for $4.3 billion of the tab, researchers reported. The lost productivity of parents who had to take their children to these appointments added $773 million.

Then there were the expenses associated with buying special allergen-free foods, placing children in allergy-sensitive schools and making special arrangements for child care in facilities that are willing to banish peanuts. These costs totaled $5.5 billion.

The biggest cost by far was the money parents gave up by staying out of the workforce, taking lesser jobs or otherwise restricting their careers to accommodate their children’s medical condition. Among the parents surveyed, 9.1 percent said they had incurred some type of work-related opportunity cost. (Some parents even said they’d been fired as a result of dealing with their kids’ allergies.) Altogether, these costs added up to $14 billion a year.

The grand total for these expenses came

to $24.8 billion a year, or $4,184 per child, the researchers found. After excluding medical expenses that would be covered by health insurance, the costs borne by families was $20.5 billion.

To make sure their number was in the ballpark, the researchers asked parents to consider this hypothetical question: How much would you pay each month for a medicine that would cure your child’s al-lergy? The average response, annualized, was $3,504.

When extrapolated across every single kid with a food allergy in the entire coun-try, the parents’ total willingness to pay to

be rid of allergies was $20.8 billion per year. That was surprisingly close to the $20.5 billion per year that food allergies actually cost them, and seemed to validate the high price parents pay in their careers (or lack thereof).

Parents “often need to be at school, so-cial events, or camp to educate and affirm the seriousness of their child’s condition,” the researchers noted in their report, which was published online in the journal JAMA Pediatrics. “In case of an emergency, care-givers may not be able or willing to take a job that requires travel or many hours away from their child.”

Kids’ food allergies cost U.S. nearly $25 billion a year, study finds

Fall 2013 19

By Tim mcmanusThe Philadelphia Inquirer

PHILADELPHIA — Althea Zanecosky takes her chocolate milk seriously.

When she traveled to watch her daugh-ter, Rebecca, run in the Pittsburgh Mara-thon, she didn’t leave anything to chance. Zanecosky packed a cooler with chocolate milk, carted it across the state, stowed it in a hotel room refrigerator and then hauled it to the finish line.

“I am both the sports nutrition mom and the dairy mom,” Zanecosky said. “Ev-eryone in the party knows that I carry the chocolate milk.”

A former sports nutrition professor at Drexel and registered dietitian who repre-sents the Mid-Atlantic Dairy Association, Zanecosky used to get funny looks when she trumpeted the recovery benefits of chocolate milk.

“There seems to be this disconnect: If it tastes good it can’t be good for me,” Zanecosky said. “Chocolate milk is the one delicious thing that all of us can have no guilt about because it’s doing the body this wonderful good.”

After a long race, Zanecosky said, runners need carbohydrates and protein in roughly a 3 to 1 ratio. Chocolate milk provides that naturally, along with the nec-essary fluids and electrolytes. Zanecosky said the trend toward chocolate milk began in the cycling community and migrated to running.

All that would have been news to Zanecosky back in the 1980s and ’90s when she participated in about 10 Philadelphia Distance Runs. At the time, Zanecosky typified the competitive element of the running circuit. Her best marathon time is 3 hours, 5 minutes, and she completed the Boston Marathon.

In the 30 years since, running has exploded into a mass participa-tion sport. Races designed for fun have drawn weekend warriors focused more on finishing than a fast time. For those non-elite runners, proper recovery is all the more important.

“How much do people spend on shoes? $120?” Zanecosky said. “We know that it’s important to have the right equipment. Part of that equipment is your food.”

Zanecosky said the first 30 minutes to two hours after the race is the most important time to refuel. She suggests ditching the traditional, carb-heavy pancake breakfast for a meal balanced between carbs and protein, like cereal in milk with yogurt and fruit.

And of course, she has an idea about what to drink: “We’ve got exactly what you need.”

Runner touts chocolate milk

“Chocolate milk is the one delicious thing that all of us can have no guilt about because it’s doing the body this wonderful good.”

Althea Zanecosky Former sports nutrition professor at Drexel and registered dietitian who represents the

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20  Balance

By LAURAN NEERGAARDAssociated Press

WASHINGTON — David Hilfiker knows what’s coming. He was diagnosed with Alzheimer’s so early that he’s had time to tell his family what he wants to happen once forgetfulness turns incapacitating.

“When it’s time to put me in an institu-tion, don’t have me at home and destroy your own life,” said the retired physician, who is still well enough that he blogs about the insidious progress of the disease. “Watching the Lights Go Out,” it’s titled.

Nearly half of all seniors who need some form of long-term care — from help at home to full-time care in a facility — have dementia, the World Alzheimer Report recently reported. It’s a staggering prob-lem as the global population ages, placing enormous strain on families who provide the bulk of that care at least early on, and on national economies alike.

Indeed, cognitive impairment is the strongest predictor of who will move into a care facility within the next two years, 7.5 times more likely than people with cancer, heart disease or other chronic ailments of older adults, the report found.

“It’s astonishing,” said Marc Wortmann, executive director of Alzheimer’s Disease International, which commissioned the report and focused on the problems of care giving. “What many countries try to do is keep people away from care homes because they say that’s cheaper. Yes it’s cheaper for the government or the health system, but it’s not always the best solution.”

And dropping birth rates mean there are fewer children in families to take care of ag-ing parents, too, said Michael Hodin of the

Global Coalition on Aging. “Very shortly there will be more of us

over 60 than under 15,” he noted. Today, more than 35 million people

worldwide, includ-ing 5 million in the U.S., are estimated to have Alzheimer’s. Barring a medi-cal breakthrough, those numbers are

expected to more than double by 2050.The U.S. National Institutes of Health

announced recently that $45 million in new Alzheimer’s research, with most of the money focused on finding ways to prevent

or at least delay the devastating disease. The Obama administration had hoped to invest $100 million in new Alzheimer’s research this year, a move blocked by the budget cuts known as the sequester. Overall, the nation has been investing about $400 million a year in Alzheimer’s research.

But the disease’s financial toll is $200 bil-lion a year in the U.S. alone, a tab expected to pass $1 trillion by 2050 in medical and nursing home expenditures — not counting unpaid family care giving. The world report puts the global cost at $604 billion.

Families affected by Alzheimer’s and ag-ing advocates say it’s time for a global push to end the brain disease, just like the world’s

Rising Alzheimer’s creates strain on caregivers

AP Photo/Cliff owen

Retired physician David Hilfiker, of Washington, leaves the National Press Club on his bike after talking about his life with Alzheimer’s in Washington. Hilfiker, was diagnosed in September 2012, and has been writing about the experience of losing his mental capacity in his blog “Watching the Lights Go Out.” Nearly half of all seniors who need some form of

long-term care, from help at home to full-time care in a facility, have dementia, according to the World Alzheimer Report.

“When it’s time to put me in an institution, don’t have me at home and destroy your own life.”

David Hilfikerretired physician and author of the blog

“Watching the Lights Go Out,

Fall 2013 21

governments and researchers came together to turn the AIDS virus from a death sen-tence into a chronic disease.

“We need a war on Alzheimer’s,” said Sandy Halperin, 63, of Tallahassee, Fla., who was diagnosed with early stage Alzheimer’s three years ago. He now finds himself stum-bling for words, but still visits lawmakers to urge more funding.

Meanwhile, the world report focuses on care giving, stressing how the needs of peo-ple with dementia are so different than those of other ailments of aging, such as cancer and heart disease. People with dementia begin needing some help to get through the day early on, to make sure they don’t leave the stove on or get lost, for example. Eventually, patients lose the ability to do the simplest activities of daily life, and can survive that way for a decade or more. Often family members quit their jobs so they can provide round-the-clock care, and the stress can harm their own health.

The world report said families need early education about what services are available to help before they’re in a crisis, plus train-ing in how to handle the behavioral prob-lems of the disease — such as not to argue if their loved one thinks Ronald Reagan is still president, or how to handle the agitation at dusk known as sundowning, or how to react when the patient hits someone.

Two-thirds of the calls that Home Instead Senior Care, which provides in-home per-sonal care services, receives are from fami-lies that did no planning until the patient had a crisis, such as wandering or a fall, said its president, Jeff Huber.

Hilfiker, the blogger with early Alzheim-er’s, takes that education idea a step further. He tells everyone he knows that he has Alzheimer’s as a way to break some of the stigma, “so when I make dumb mistakes, I don’t need to be embarrassed,” he said.

He urges other patients to plan their end-of-life care early, while they’re still cognitive-ly able to participate. He believes that telling his wife no extraordinary care — no feeding tubes, for example — will ease her burden.

Hilfiker’s big unanswered question: “If I’m at peace with my disease, does that make it easier to care for me later?”

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22  Balance

By MARILyNN MARCHIONEAssociated Press

H igher blood-sugar levels, even those well short of diabetes, seem to raise the risk of de-

veloping dementia, a major new study finds. Researchers say it suggests a novel way to try to prevent Alzheimer’s dis-ease — by keeping glucose at a healthy level.

Alzheimer’s is by far the most com-mon form of dementia and it’s long been known that diabetes makes it more likely. The new study tracked blood sugar over time in all sorts of people — with and without diabetes — to see how it affects risk for the mind-robbing disease.

The results challenge current think-ing by showing that it’s not just the high glucose levels of diabetes that are a concern, said the study’s leader, Dr. Paul Crane of the University of Washington in Seattle.

“It’s a nice, clean pattern” — risk rises as blood sugar does, said Dallas Ander-son, a scientist at the National Institute on Aging, the federal agency that paid for the study.

“This is part of a larger picture” and adds evidence that exercising and con-trolling blood pressure, blood sugar and cholesterol are a viable way to delay or prevent dementia, he said.

Because so many attempts to develop effective drugs have failed, “It looks like, at the moment, sort of our best bet,” An-derson said. “We have to do something. If we just do nothing and wait around till there’s some kind of cocktail of pills, we could be waiting a long time.”

About 35 million people worldwide have dementia; in the United States, about 5 million have Alzheimer’s dis-ease. What causes it isn’t known. Cur-

rent treatments just temporarily ease symptoms. People who have diabetes don’t make enough insulin, or their bodies don’t use insulin well, to turn food into energy. That causes sugar in the blood to rise, which can damage the kidneys and other organs — possibly the brain, researchers say.

The new study, published in the

New England Journal of Medicine, just tracked people and did not test whether lowering someone’s blood sugar would help treat or prevent dementia. That would have to be tested in a new study, and people should not seek blood-sugar tests they wouldn’t normally get other-wise, Crane said.

“We don’t know from a study like

Study ties higher blood sugar to dementia risk

THINKSTOCK®

New research published in the Aug. 8 New England Journal of Medicine suggests a possible way to help prevent Alzheimer’s disease: Keeping blood sugar at a healthy level. A study found

that higher glucose levels, even those well short of diabetes, seemed to raise the risk for dementia.

Fall 2013 23

this whether bringing down the glucose level will prevent or somehow modify dementia,” but it’s always a good idea to avoid developing diabetes, he said.

Eating well, exercising and control-ling weight all help to keep blood sugar in line.

The study involved 2,067 people 65 and older in the Group Health Coopera-tive, a Seattle-area health care system. At the start, 232 participants had dia-betes; the rest did not. They each had at least five blood-sugar tests within a few years of starting the study and more after it was underway. Researchers aver-aged these levels over time to even out spikes and dips from testing at various times of day or before or after a meal.

Participants were given standard tests for thinking skills every two years and asked about smoking, exercise and other things that affect dementia risk.

After nearly seven years of follow-up, 524, or one quarter of them, had developed dementia — mostly Alzheim-er’s disease. Among participants who

started out without diabetes, those with higher glucose levels over the previous five years had an 18 percent greater risk of developing dementia than those with lower glucose levels.

Among participants with diabetes at the outset, those with higher blood sugar were 40 percent more likely to develop dementia than diabetics at the lower end of the glucose spectrum.

The effect of blood sugar on demen-tia risk was seen even when researchers took into account whether participants

had the apoE4 gene, which raises the risk for Alzheimer’s.

At least for diabetics, the results sug-gest that good blood-sugar control is important for cognition, Crane said.

For those without diabetes, “it may be that with the brain, every additional bit of blood sugar that you have is as-sociated with higher risk,” he said. “It changes how we think about thresholds, how we think about what is normal, what is abnormal.”

Follow Marilynn Marchione on Twitter at http://twitter.com/MMarchioneAP

Online Resources: Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1215740 Alzheimer’s info: http://www.alzheimers.gov Alzheimer’s Association: http://www.alz.org Warning signs: http://www.alz.org/10signs

“We don’t know from a study like this whether bringing down the glucose level will prevent or somehow modify dementia,”

Dr. Paul Crane of the University of Washington in Seattle

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24  Balance

By DAVID CRARyAssociated Press

T he 3-year-old girl wandered away from her grandmother’s home in Wareham, Mass., in mid-April. A frantic search

began almost immediately, and within an hour little Alyvia Navarro was found unresponsive in a nearby pond. She was pronounced dead the next day.

A month later, across the continent, a larger search unfolded over three days as hundreds of emergency service personnel and volunteers fanned out around Clearlake, Calif., looking for 9-year-old Mikaela Lynch after she vanished from her backyard. The outcome grimly echoed the Wareham search: A dive team found Mikaela’s body in a muddy creek.

The two girls were the first of at least 13 children with autism known to have died this year after slipping away from their caregiv-ers. Twelve of them drowned, evidence of a fascination that many autistic children have with water.

The tragic phenomenon goes by various names — wandering, elopement, bolting — and about half of autistic children are prone to it, according to research published last year in the journal Pediatrics. That would be a huge number. A federal survey this year estimated that one of every 50 U.S. schoolchildren is on the broad autistic spectrum — more than 1 million children in all.

Wandering has led to the deaths of more than 60 children in the past four years, and the fear of it can make daily life a harrowing, never-let-your-guard-down challenge for parents.

“We take steps at home — locks on every door, gates, alarms,” said writer Jo Ashline

of Orange, Calif., whose 11-year-old son has autism. “But there’s always, in the forefront of our minds, the thought that one tiny mistake could prove fatal.”

Groups that advocate for autism-affected families, including the National Autism Asso-ciation and Autism Speaks, are now making it a priority to increase awareness of wandering — among parents, professionals who deal with autistic children, and first-responder agencies that handle missing-children cases.

The study in Pediatrics found that half of parents with autistic children had never re-ceived advice or guidance from a professional on how to cope with wandering.

Among those trying to change that is Sheila Medlam of Colwich, Kan., whose 5-year old son, Mason, drowned in a pond in July 2010 after squirming out of the family home through a window that had been raised about 8 inches because the air conditioner went out.

Medlam was at work; her adult daughter was at home but didn’t see Mason’s getaway.

“It only takes a second of inattention and they’re gone,” Medlam said in a telephone interview. “They’re fast, they’re quiet. They can disappear in an instant.”

Medlam now works with autistic children, operates a website that keeps track of wander-ing-related deaths, and lobbies for a national alert system that would improve emergency responses.

On her website, she has written a wrench-ing account of the day Mason died — blaming herself for leaving the window open and for omitting potentially helpful details when she called 911, and blaming the first responders for lack of knowledge about how to search for autistic children.

“If only I could redo that day and just

change one thing. But I can’t,” Medlam wrote. “All I can do is point out the mistakes I made, the mistakes others made, and the lack of re-sources that claimed my child’s life and ripped him from my arms forever.”

Boys and girls with autism aren’t the only children who stray from caregivers, of course, but their wanderings pose distinctive chal-lenges.

While autism encompasses a spectrum of disorders, posing a range of developmental challenges, experts say the wanderers are often among the more severely affected. They often have minimal concept of danger, don’t readily absorb safety lessons, and have limited ability to communicate with others.

And once on the loose, they often make a beeline for a destination of interest that proves fatal: a busy highway or a body of water. Lori McIlwain, executive director of the National Autism Association, says about 90 percent of the wandering fatalities in recent years have been drownings, and most of the other victims were struck by cars.

McIlwain, who lives in Cary, N.C., says her own son, Connor, wandered away from his school in 2007 and might well have ended up in danger had a concerned motorist not stopped and picked up the boy after getting no response to some questions.

In the ensuing years, McIlwain said, it’s been a constant challenge to teach her son how to keep himself safe.

Still, the fear that he’ll bolt remains “what we live with — it doesn’t go away,” she said.

Precautionary measures recommended by experts include locks and alarms on doors and windows, “Stop” signs placed in key locations in the home, and ID bracelets or tracking devices worn by the child.

Other recommendations from the National Autism Association include:

—enrolling the children in swimming les-sons, such as those offered by the YMCA for special-needs pupils.

Deaths of wandering autistic kids prompt action

Online Resources: National Autism Association: http://www.autismsafety.org/wandering.php Fact sheet: http://www.missingkids.com/en—US/publications/SpecialNeeds—Addendum.pdf Study on wandering: http://bit.ly/Sy7klg

Fall 2013 25

—developing a family emergency plan to be used in the event of a wandering incident.

—informing local emergency services, trusted neighbors and staff at the child’s school or day-care center about details of the child’s interests and wandering patterns.

Even after taking such steps, many parents nonetheless sleep in their autistic child’s room to avert a nighttime getaway. McIlwain knows a mother who takes away her daughter’s shoes when they’re home as a deterrent.

Lauri Dupree of Lumberton, Miss., says she and her husband, who are raising their 6-year-old grandson, Boo, have resorted to using a harness during outings and even sometimes at home because of his daily attempts to bolt.

“He has always done this since he learned to walk and has come close to losing his life on several occasions,” Dupree said.

Jo Ashline describes her home in Califor-nia as resembling Fort Knox with its array of security measures.

“There’s always that state of worry — is he going to get out,” Ashline said of her son Andrew. “As he gets older and taller, are we going to be able to outsmart him? It only takes one time for him to outsmart us.”

She and her husband — like many other parents in their situation — shy away from travels and vacations that might expose An-drew to new opportunities to get away.

“The world itself became our greatest nemesis,” Ashline wrote on her blog. “Places most families treasure such as parks, beaches, backyard swimming pools and campsites became staging grounds for our imaginations’ worst nightmares.”

Indeed, several of this year’s wandering victims were on vacations or family outings

— including a camping trip in Ohio and a beach vacation in Florida.

Even festive gatherings at home can be dangerous, according to Bob Lowery, execu-tive director of the missing children divi-sion of the National Center for Missing and Exploited Children.

“The backyard barbecue is probably the most unsafe place to be,” he said. “Everyone assumes someone else is watching that child, and they slip away unnoticed.”

To avoid that outcome, he said, some parents develop elaborate hand-off systems to try to ensure an adult always has their eyes on the child.

Over the past few years, Lowery’s orga-nization has intensified efforts to increase awareness of the wandering phenomenon and improve the way emergency services and search-and-rescue teams respond.

For example, the people who field 911 calls are being encouraged to obtain specific information from the caller such as whether the child is attracted to water, so that search-ers can immediately deploy to local ponds or rivers.

“We know that if there’s a tragedy with a child with autism, it probably will occur very quickly,” Lowery said. “They have a tendency to head straight to water if that’s what they want — you need every able-bodied person available to get to water as soon as possible to head them off.”

Lowery and his colleagues, as well as many advocates for autism-affected families, have been exploring ways of developing a national alert system tailored to deal with wander-ing incidents. He said the existing Amber Alert system is not an option — it’s limited to

cases where a child is believed to have been abducted by someone who poses a danger to them.

One option being looked at is Project Lifesaver, launched in 1998 to help search-and-rescue teams find missing people with Alzheimer’s disease, dementia, autism and Down syndrome. Funding is an issue, how-ever: For the program to function, the people at risk of wandering must wear transmitter bracelets and emergency services must have appropriate tracking equipment.

The driving force behind the recently pub-lished research on wandering was the Interac-tive Autism Network, a program headed by Dr. Paul Law at the Kennedy Krieger Institute in Baltimore.

Law says he is encouraged that people in the autism community and beyond are now talking about the phenomenon.

“Up until now it’s been a silent problem,” he said. “Everyone was expected to deal with it on their own. They didn’t talk to their doc-tor; parent groups didn’t talk about it.”

He said parents coping with the challenges of a wandering child deserved public under-standing and support.

For many parents, there’s damned-if-you-do, damned-if-you-don’t aspect to the non-stop need for vigilance. Some are criticized for turning their homes into fortresses and minimizing their autistic child’s contacts with new environments. Yet when a wandering-related death occurs, the parents can incur harsh criticism in social media, including aspersions that they were negligent.

Follow David Crary on Twitter at http://www.twitter.com/craryap

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26  Balance

By LAURAN NEERGAARDAssociated Press

WASHINGTON — It happens too often: A doctor isn’t sure what’s causing someone’s feverish illness but pre-scribes antibiotics just in case, drugs that don’t work if a virus is the real culprit.

Now Duke University researchers are developing a blood test to more easily tell when a respiratory illness is due to a virus and not a bacterial infection, hoping to cut the dangerous overuse of antibiotics and speed the right diagnosis.

It works by taking a fingerprint of your immune system — how its genes are revving up to fight the bug. That’s very different from how infections are diagnosed today. And if the experi-mental test pans out, it also promises to help doctors track brand-new threats, like the next flu pandemic or that mys-terious MERS virus that has erupted in the Middle East.

That viral “signature could be quite powerful, and may be a game-changer,” said Dr. Geoffrey Ginsburg, Duke’s genomic medicine chief. He leads the team that on Wednesday reported that a study involving 102 people provided early evidence that the test can work.

Today, when symptoms alone aren’t enough for diagnosis, a doctor’s suspi-cion guides what tests are performed — tests that work by hunting for evi-dence of a specific pathogen. Fever and cough? If it’s flu season, you might be tested for the flu virus. An awful sore throat? Chances are you’ll get checked for strep bacteria. A negative test can

leave the doctor wondering what germ to check for next, or whether to make a best guess.

Moreover, rapid in-the-office tests aren’t always accurate and can miss infections. So patients may have blood or other samples sent to labs to try to grow any lurking bacteria and tell if it’s to blame, additional testing that can take days.

“This is something we struggle with every day,” said Dr. Octavio Ramilo, infectious disease chief at Nationwide Children’s Hospital in Columbus, Ohio, who wasn’t involved in the new study.

Particularly with children, a respiratory virus and a bacterial infection “in the beginning look completely alike,” he added.

Hence researchers at a number of universities are trying to harness a fair-ly recent discovery: As your immune system detects an invading bug, dif-ferent genes are activated to fend off a viral infection than to fight a bacterial or fungal one. Those subtle molecular changes appear to be occurring even before you feel any symptoms. And they form distinct patterns of RNA and proteins, what’s called a genomic

New test aims to better detect viral infections

(AP Photo/Duke MeDicine, ShAwn Rocco)

In this image provided by Duke University, lab research analyst Marshall Nichols does research relating to developing a blood test to more easily tell when a respiratory illness is due to a virus and not a bacterial

infection, hoping to cut the dangerous overuse of antibiotics and speed the right diagnosis.

Fall 2013 27

fingerprint. The Duke team discovered 30 genes

that are switched on in different ways during a viral attack. The test essen-tially is a freeze-frame to show “what those genes are doing at the moment in time that it’s captured,” explained Duke lead researcher Dr. Aimee Zaas, an infectious disease specialist.

Small studies spotted that viral sig-nature in people who volunteered to be infected with different influenza strains for science.

For a more real-world simulation, the researchers then analyzed blood samples stored from feverish people who had come to the emergency room — and who were eventually diagnosed, the old-fashioned way, with either some type of virus or a bacterial infec-tion.

The genomic test proved 89 percent accurate in sorting out who had a virus, and did even better at ruling out those who didn’t, Zaas reported Wednesday in the journal Science Translational Medicine.

It took 12 hours to get results. The researchers hope to speed that up so that it might work as quickly as some in-office tests.

Still, “it’s a promising tool,” said Ramilo, an Ohio State University pro-fessor who is doing similar research. He called the Duke study an important step toward creating a commercial test, and predicts one might reach the mar-ket within five years.

Why would a doctor want to know merely that a virus is present and not which virus? That’s enough informa-tion to rule out antibiotics, Zaas said. Unnecessary antibiotic use is one factor in the growing problem of drug-re-sistant germs, which the government blames for more than 23,000 deaths a year.

Plus, if a dangerous new virus begins spreading, like MERS, this approach could help avoid quarantining people unnecessarily by telling right away which ones are virus-free, Ginsburg

added. In Ohio, Ramilo is exploring a more

immediate need: When young infants have high fevers, they’re often hospital-ized while doctors run a battery of tests to find the fraction who have a seri-ous bacterial infection. He is leading a study involving 22 pediatric emergency rooms to see if a genomic fingerprint approach could separate which babies really need all that testing.

But the virus-or-not question is just the beginning, Ramilo said. His research suggests genomic fingerprints also can distinguish a flu strain from other common viruses. And the Duke team is analyzing a huge study of stu-dents living in dormitories, to see if the genomic test detected who was incu-bating the flu before their first sniffle — and thus might be useful in stem-ming outbreaks.

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By Monte MorinLos Angeles Times

LOS ANGELES – Thousands of years be-fore the discovery of microbes or the inven-tion of antibiotics, silver was used to protect wounds from infection and to preserve food and water.

The alluring metal, which was fashioned into a multitude of curative coins, sutures, foils, cups and solutions, all but vanished from medical use once physicians began us-ing anti-bacterial drug agents to fight sickness in the 1940s.

But now, as bacteria grow increas-ingly resistant to these medications and new pathogens invade hospitals, some doctors are turning once again to the lustrous element that Hippocrates prescribed for patients in ancient Greece.

In a study published in Science Transla-tional Medicine, researchers found that by adding trace amounts of silver to common antibiotics, the medications became up to 1,000 times more effective in fighting infec-tions in mice.

Also, study authors said they were surprised and excited to find that the silver-antibiotic combo was able to “re-sensitize” bacteria that had developed a resistance to the drugs. It even extended the effectiveness of the commonly used antibiotic vancomycin to a class of bacteria that was previously im-mune to its effects.

“We went from basically no killing to substantial killing,” said senior author James Collins, a professor of microbiology at Boston University.

The study is one of the first comprehensive examinations of the ways that silver affects bacteria that are known as Gram-negative. These bacteria are equipped with an extra

protective membrane that prevents antibiotic drug molecules from penetrating and killing them.

In a series of experiments, Collins and colleagues from BU and Harvard University examined the effects of a simple solution of silver nitrate salt on Gram-negative bacteria like Escherichia coli.

What they found was that even small amounts of silver ran roughshod over some of the toughest bacteria around.

“It did two things,” Collins said. The positively charged silver ions degraded the bacteria’s protective layer, giving the antibiot-ics easier access to the pathogens’ innards. It also messed with the bugs’ metabolism and their ability to man-age their iron levels.

The second effect led to the creation of molecules that can kill bacteria, includ-ing oxygen mol-ecules that are prone to chemical reactions that can damage cells, Collins said.

In one experiment, researchers induced peritonitis in mice by injecting them with E. coli cells. Of the mice treated with silver and vancomycin, 90 percent survived.

Mice treated with just silver or just van-comycin fared much worse. Half of the mice that got silver died, along with 90 percent of the mice treated with antibiotics.

The researchers also observed that silver was effective against biofilms – colonies of slime-protected bacteria that create stubborn infections on medical implants, heart valves and hospital equipment.

Although experiments combining silver and antibiotics have yet to be performed on humans, the study suggests that the metal may become a powerful helper in the fight

against multi-drug-resistant microbes.Researchers who were not involved in

the study said it was timely, given the rising concern over the dwindling power of antibi-otics. The World Health Organization warns that “many infectious diseases risk becoming untreatable and uncontrollable.”

“This is exciting data and should help pave the way for clinical trials into the use of silver,” said Wilmore Webley, an assistant professor of microbiology at the University of Massachusetts, Amherst. “The investigators covered a lot of ground.”

While the precise mechanisms by which silver kills germs remain something of a mys-tery, the element’s medicinal and preservative

qualities have been recorded throughout history.

Silver has been used variously to treat skin ulcers, com-pound fractures and

even bad breath.In his “History of the Medical Use of

Silver,” Dr. J. Wesley Alexander wrote that North American pioneers routinely dropped silver coins into vessels of drinking water during long journeys to ward off infection. In addition, privileged families benefited from using silver eating utensils that often caused “a bluish-gray discoloration of the skin, thus becoming known as ’blue bloods.’”

Argyria, an irreversible condition in which the skin turns blue or gray due to the build-up of silver particles, is the result of consum-ing silver solutions or flecks of the metal over long periods of time.

©2013 Los Angeles TimesVisit the Los Angeles Times at www.latimes.comDistributed by MCT Information Services

Silver used as a type of antibiotic thousands of years before discovery of microbes

“This is exciting data and should help pave the way for clinical trials into the use of silver,”

Wilmore Webleyassistant professor of microbiology at the

University of Massachusetts, Amherst

Fall 2013 29Fall 2013 29

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