The Benzo Trap
Anti-anxiety drugs ensnare millions of Americans in a web of addiction and pain. Before you fill that prescription, read on.
By Matt Samet from Natural Solutions July/August 2009
Teryn Taylor, of Marion, Indiana, has “benzo” voice: flat, devoid of emotion, almost robotic—the result of her unwitting dependence on anti-anxiety drugs (aka benzodiazepine tranquilizers). Taylor hardly looks the part. A former long-distance runner, straight-A student, and the mother of a 7-year-old daughter, this pretty Midwestern woman reached out for help after her mom died in 1996. Although no one ever diagnosed Taylor as clinically depressed, she received that help in the form of a prescription for Paxil.
After two years, Taylor decided she wanted off the antidepressant, so she quit cold turkey under her doctor’s orders. Bad idea. Almost immediately she experienced high levels of anxiety, a racing heartbeat, and a loss of equilibrium. She was, as she remembers, “a drooling, shaking, heart-palpitating, muscle-constricted mess.” So her doctor prescribed Klonopin, a potent, anti-anxiety benzo. Unfortunately, as her body grew accustomed to that drug, she needed more of it just to keep her anxiety at bay. Any attempt to quit, she says, sent her into a painful and protracted withdrawal—making her even more anxious.
Taylor stayed on benzos for seven years, and her withdrawals came with horrific side effects. “I spent most of my days on the couch,” she says, so weak she could barely function. Plagued by electric jolts called “brain zaps,” difficulty breathing, and a pervasive sense of terror, Taylor likened her experience “to being a prisoner of war.”
While not to undermine the severity of Taylor’s withdrawal symptoms, perhaps the true horror of her story lies in its broad-picture similarity to those of thousands of other benzo “slaves.” An estimated 5 million people in the US take regular “therapeutic doses” of these drugs, and worldwide, at least 3 percent to 15 percent of adults fill benzo prescriptions, according to leading benzo expert Heather Ashton, MD, of the University of Newcastle upon Tyne, in England. Potentially, all of these people face some sort of withdrawal ordeal.
The too-easy solution
So how did these drugs become so pervasive? At first, they seem to offer a cure-all for any type of anxiety. But masking feelings isn’t always the smart thing to do. Fear and anxiety, for example, actually perform a valuable function: They keep us out of harm’s way. In the face of a real or perceived threat, fear triggers the “fight-or-flight” adrenal response—a normal physiological mechanism designed to keep us alive and safe.
Sometimes, however, imagined threats trigger the fear response over and over again, leading to anxiety disorders. The Diagnostic and Statistical Manual of Mental Disorders IV lists 12 types of anxiety under such categories as phobias, generalized anxiety, panic disorders, and obsessive-compulsive disorder.
All of these conditions can cause extreme psychic and physical discomfort. Those in the midst of a panic attack, perhaps the most acute manifestation of anxiety, experience a slamming heart, intense sweats, and hyperventilation—even the fear of imminent death as the sympathetic (arousing) nervous system overwhelms the parasympathetic (calming) response and floods the body with adrenaline and related noradrenaline hormones.
For this type of acute psychological distress, short-term use of benzos—no more than two weeks—can sometimes help, says Ashton. The problem? Many psychiatrists and general practitioners prescribe benzos (most commonly Ativan, Klonopin, and Xanax) as a first-line treatment for everything from muscle pain and insomnia to grief and anxiety—in other words, for the vicissitudes of life.
An in-depth report by Health Canada (the country’s department of health) titled “The Effects of Tranquilization: benzodiazepine Use in Canada” summarized the situation best: “A major factor responsible for the acceptance of these drugs has been the pervasive mythology that there are instant solutions to problems of living and that the most effective and rapid solutions are chemical in nature. Society has come to expect quick responses to any problem, whether it be the common cold, anxiety, or grief.” By accepting this philosophy, continues the report, “many people have come to view benzodiazepines as essentially a social and recreational drug, not unlike alcohol.”
And yet, an established and growing body of research links long-term use of these drugs with such serious neurological and psychological risks as brain atrophy, emotional anesthesia (a numbing of the emotions), memory impairment, and suicidal tendencies.
Let me give you something
Alas, the overprescribing of psychiatric drugs is nothing new. In 1960, Librium, the first benzo, hit the market with the slogan: “Whatever the diagnosis—Librium.” This pushed the idea that common, physiological complaints—asthmas, ulcers, hypertension—were mere manifestations of anxiety. Soon the proto-benzo Valium, later satirized by the Rolling Stones as “mother’s little helper,” burst on the scene as a safe, nonaddictive solution to stress and an antidote to a woman’s inability to cope.
By the 1970s, Valium became the most heavily prescribed drug in America, according to psychiatrist Peter Breggin in his seminal book Toxic Psychiatry (St. Martin’s Griffin, 1994). In fact, in the drug’s 1978 heyday, Americans popped more than 2 billion tabs of Valium. Xanax, stronger yet, replaced Valium in 1986, even though the problems with long-term benzo use (including addiction) had, by that point, been well-documented.
Commonly prescribed benzos today include the aforementioned Ativan, Klonopin, and Xanax, as well as the sleeping pill Restoril. The “non-narcotic” sleeping medicines Ambien, Lunesta, and Sonata, while not technically benzos, act similarly on the brain and can cause the same problems.
benzos have been overprescribed “partly because they were safer than barbiturates [earlier-generation tranquilizers],” says Ashton, “and partly because of very strong drug company pressure, ignorance, and the gullibility of doctors trying to be kind to their patients.”
Doctors, says Ashton, tend to ignore the literature, which warned about the problem at least since the Valium overprescription debacle of the 1970s and 1980s, and they routinely ignore prescribing guidelines (including those of the FDA) that cap daily usage at two weeks.
How they work
benzos don’t get you high or give you a rush. They relax and calm you. They do this by enhancing the action of a neurotransmitter called gamma-aminobutyric acid (GABA), a “built-in calmer or an internal benzo if you like,” says Ashton. Your brain cells have receptor sites for GABA, and benzos increase those receptors’ affinity for the calming neurotransmitter.
But when all your GABA is “enhanced” by benzos, “the brain thinks, I don’t need all this GABA around, so the receptors for it go away—they internalize, or invert, into the inside of the nerve,” says Ashton. As you lose GABA receptors, you begin to feel anxious again, even though you’re still on the benzo drug. Clinicians call this “tolerance withdrawal.”
Now, says Ashton, you have to increase the benzo dosage to get the same calming effect—a vicious cycle that seems to explain the millions of Americans taking regular doses of these drugs.
Other problems also beset those who take benzos daily. The Health Canada report found that long-term use impairs learning ability, motor skills, and sex drive as well as the ability to empathize with others and to cope with stressful situations. “We regularly see individuals with such issues as confusion, generalized fatigue, sleep disorders, slurred speech, and even motor problems like uncoordination and unsteady gait,” says David Perlmutter, MD, a neurologist at the Perlmutter Health Center in Naples, Florida, and author of The Better Brain Book (Riverhead, 2004).
The withdrawal syndrome
The situation worsens when people want to stop taking anti-anxiety meds. Most doctors give their patients the impression that the drugs are nonaddictive and perfectly safe, says Ashton, misinformation that trickles down from the pharmaceutical companies. In reality, during benzo withdrawal, “you go into hyperdrive and acute anxiety,” she says, because your body has become dependent on the tranquilizers. You might also face profound insomnia, panic attacks, muscle tremors, muscle stiffness, sweating, palpitations, gastrointestinal distress, hallucinations, and nightmares.
The hospitals, detox centers, and doctors who follow a typical addiction-treatment protocol frequently insist that patients, like Taylor, wean themselves from benzos, even at high doses, in a matter of weeks or even days. But when stopped abruptly—and in an unlucky few, even when tapered slowly—benzos can foster a withdrawal syndrome much more severe than almost any other drug. Such rapid cessation can lead to complications like protracted (18-plus-month) withdrawal periods, and even psychosis, seizures, and death. “In this respect, getting people off benzos may be just as challenging as cocaine and other ‘street drugs,’” says Perlmutter.
And to make matters worse, he continues, these drugs enjoy legal sanction, so there’s often “less compassion offered to individuals addicted to benzos, compared to those addicted to more glamorous drugs.”
Escape the trap
The best way to avoid the dangers of anti-anxiety drugs, of course, is not to take them in the first place—or to take them only in acute, emergency situations and even then for no longer than two weeks. In times of stress, anxiety, or panic, look to exercise, diet, mind-body practices, and other techniques to bolster your body’s ability to calm itself.
If you’re already dependent on benzos, keep in mind you must wean yourself from them slowly. “The inverted GABA receptors—big protein molecular structures that take a lot of brain and body energy to resynthesize—have to come back again,” says Ashton. “This takes time and a lot of metabolic energy, but it does happen.” Depending on your starting dose and how you taper, the GABA receptors can sometimes take years to fully regrow, so that the neurotransmitter can do its job and relax you.
Anyone looking for guidance in slowly tapering off anti-anxiety drugs should turn to the Ashton manual (benzodiazepines: How They Work and How to Withdraw; benzo.org.uk/manual" target="_blank">www.benzo.org.uk/manual.) The so-called “Ashton Method” draws from Ashton’s research and years of experience running an outpatient benzo withdrawal clinic, during which time she saw hundreds of people safely wean themselves from the meds.
First off, Ashton encourages patients to switch to Valium, which has the longest half-life of any benzo. (The half-life is the time it takes for half a given dose to leave your body, which is 200 hours for Valium.) Because Valium clears a little bit at a time, the drug is almost self-tapering, with a gradual comedown that creates less anxiety than faster-acting benzos like Xanax and Klonopin. The more slowly you taper, the greater chance your GABA receptors have to regenerate with each dose reduction.
You can further ease the withdrawal by adding anxiety-reducing techniques such as yoga, breathing exercises, and streamlined nutrition (see “Survival Tips” below).
Alison Kellagher, who has a master’s degree in counseling, works with those who want to quit or who are currently in withdrawal mode. A benzo survivor herself, Kellagher under- went five abrupt withdrawals, the final one off 7 mg a day of Klonopin in 2002. Kellagher took three years to heal before returning to the Nordic skiing and competitive cycling she’d been forced to set aside while benzo sick.
Because she knows just how bad withdrawal can be, Kellagher coaches her patients in acceptance, using simple breathing and relaxation techniques and calming (nonstrenuous) yoga poses to combat the fear state of withdrawal. “The central thing is to help people recognize the syndrome,” she says. “They need to understand that this is an existing and understood withdrawal syndrome, and recognize where they are in the process.”
Kellagher also counsels patience; simple living (eating well, avoiding stress, and sleeping when you can); and caution when adding outside agents (vitamins or supplements) to try to mend the nervous system. Concentrated amounts of individual nutrients may further upset the delicate neurochemical balance in benzo patients, she says, so it’s better to get your nutrients from foods.
Calm waters ahead
Despite these formidable challenges, people do escape the benzo trap. For those who taper slowly, Ashton pegs relapse rates at only 10 percent. After the withdrawal period, people rarely get cravings. The body heals itself, and life goes on. Many even say their lives are much better than before.
Now tapering her final psychiatric medicine at a slow, cautious rate, Teryn Taylor moves closer to her goal of wellness with each cut in dosage. She says she’ll consider herself completely healed when her symptoms subside 100 percent, and that she’ll be the “happiest person on the planet to have made it through this.” Taylor won’t return to her old job as a speech therapist—instead she wants to focus on helping other people addicted to benzos.
“It’s still hard for me to believe that this is my story,” she says. “It’s just so barbaric.”
Matt Samet, a Boulder, Colorado-based freelance writer, just celebrated two-and-a-half years’ freedom from benzodiazepines after 13 years on them.
>> For more ways to treat anxiety disorders naturally… Visit our Condition Centers at www.naturalsolutionsmag.com.
Survival Tips
When tapering off benzos, the following tips will help see you through the withdrawal:
Pace yourself.
Do not push too hard—physically, socially, or emotionally—even when you feel good. Overextending can lead to heightened withdrawal and demoralizing setbacks, says benzo survivor Alison Kellagher. Your system, she says, wants you to “sit down and heal.”
Avoid caffeine and sugar. Patients in benzo withdrawal, says neurologist David Perlmutter, MD, can become hypersensitive to the stimulating effects of sugars. Instead, he recommends whole, organic foods and an intake of “adequate dietary protein” several times daily, as well as complex carbohydrates (like whole grains), to smooth out blood-sugar levels.
Learn acceptance, patience, and wisdom. Many have chased dead ends with doctor’s visits and needless therapy, only to recover fully from their anxiety issues once the withdrawal ended. In withdrawal, “we have to learn to use our minds to calm ourselves—not just our bodies,” says Kellagher. “Looking to the wisdom traditions—yoga, meditation, prayer—is probably the best place to go.”
Walk. According to Perlmutter, exercise—even mild exercise—releases the brain-calming chemical serotonin. So while jumping on a treadmill or stationary bike may seem overwhelming, a short walk is doable even on the worst days. You should walk with “conscious awareness that it’s not just to get from one place to another, but is a meaningful activity serving an integral role in your recovery,” advises Perlmutter.
Distract yourself. Any pleasant diversion, such as a crossword puzzle, phone conversation, or nonviolent movie, will fill time and declaw certain withdrawal symptoms. “I took a job in a bakery five months after stopping benzos,” says Kellagher. “The structured time was really, really helpful.”
Breathe. Diaphragmatic breathing—drawing breath in through the nose and out through the mouth, with a two-second pause after exhalation—calms the nervous system. For breathing exercises that ease anxiety, go to www.naturalsolutionsmag.com and search for pranayama.
Yoga. Very light yoga, in a therapeutic yoga class, with a partner, or using a DVD, will help you feel at peace. Kellagher does yoga with her clients, running through a routine based on grounding movements and those that bring a sense of safety and security. “It helps people to do the yoga with someone else, too, to feel connected,” she says.
The Needle Solution
According to Boulder, Colorado-based oriental medicine practitioner David Scrimgeour, LAc, acupuncture works as an integral part of a withdrawal plan by:
• Stimulating the release of feel-good neurotransmitters such as endorphins, inducing an overall calming and balancing effect on the body’s central nervous system.
• Decreasing anxiety during the withdrawal phase by prompting the release of chemicals in the body that occupy the receptor sites once targeted by the benzo. It also lowers ACTH (adrenocorticotropic hormone) levels—like excess adrenalin or elevated cortisol—further balancing the nervous system.
• Activating ear points, which (as scientists discovered in the 1970s) have a very strong sedating and regulating effect on both the sympathetic and autonomic nervous systems.
Wednesday, January 28, 2009
Saturday, January 17, 2009
The Scary Truth About Statins
The Scary Truth About Statins
What you need to know before you fill that prescription
BY ERIN QUINN from Natural Solutions Magazine January 2009
The notion that high cholesterol causes heart disease has allowed doctors to write millions of prescriptions for cholesterol-lowering drugs called statins that can reduce the risk of it. That seemingly indisputable notion has long suffered from an inconvenient fact: Half the people who have a heart attack don’t have high cholesterol. So, increasingly, doctors have flagged inflammation within the cardiovascular system as the culprit in these cases—an idea that has gained added currency from a study published late last year— and have discovered a drug that can help lower the risk of heart attacks for these folks: Lo and behold, it’s a statin.
The new research, called the JUPITER study, focused on C-reactive protein (CRP) because it is a marker of inflammation in the body. CRP levels in the blood go up whenever the body revs up the immune system. The study found that giving the statin rosuvastatin to men and women with normal levels of LDL cholesterol (the “bad” kind) but high levels of CRP (i.e., inflammation) reduced the incidence of heart attacks, stroke, and cardiovascular-related deaths by 44 percent. While this result does indeed seem “remarkable,” as the researchers say, it and the study itself raise some interesting questions.
First off, what does this new link between high CRPI inflammation and heart disease say about the millions of people currently taking statins, cholesterol drugs that include billion-dollar brands such as Crestor, Lipitor, and Zocor? Will they avoid heart disease even if their CRP levels are normal? Should everyone take statins to ward off heart disease, just in case? “I think this is the biggest myth in medicine right now,” says cardiologist Stephen Sinatra, MD, of the New England Heart & Longevity Center in Manchester, Connecticut “Would I prescribe statins to a 60-year-old man who has high CRP levels and hardened arteries? Absolutely,” says Sinatra, “but I’m not convinced statins are worth it as a preventative measure.
3 Ways to Get Your Number Down
Break A Sweat: Endurance exercise, such as jogging or biking, is one of the best ways to lower inflammation. Heart-pumping activities also increase beneficial HDL cholesterol levels. Aim for 30 to 45 minutes of aerobic exercise five times a week.
Lose Your Belly: Women with waists that measure more than 35 inches (more than 40 for men) likely have high inflammation in the body, which creates higher cholesterol levels. Reduce your inflammation risk by whittling a few inches off through diet and exercise.
Quite Smoking: Smoking hardens and inflames the arteries. If you’ve never smoked, don’t, and if you do—stop now. You’ll reduce inflammatory chemicals immediately. Especially for women—the risks and side effects are just too great.
Side Effects May Vary
If you believe the small-print warnings on ads for statins, the major side effect, muscle weakness and pain, occurs only rarely. The actual incidence is much higher, however, and muscle pain is a major reason why people stop taking the drugs. “Patients describe it as a general aching in their joints and muscles,” says Mark A. Moyad, MD, MPH, the Jenkins/Pokempner director of preventive and alternative medicine at the University of Michigan Medical Center in Ann Arbor. “The pain can start as soon as someone begins taking a statin—or not for several years. There’s no timeline.”
James Wright, MD, PhD, at the University of British Columbia, worries about more serious problems, including peripheral neuropathy, interstitial pneumonitis, and various cognitive and psychiatric effects. “I think we don’t really have a good handle on what’s happening there,” he says about these Alzheimer’s-like symptoms, “and some of the patients appear to have permanent effects.” For women, an elevated risk of breast cancer should be a major concern. “Along with blocking cholesterol, statins also block squalene, an antioxidant and immune system booster that is vital to preventing breast cancer:’ says Sinatra, who notes that all side effects are more common in women, particularly postmenopausal women.
How Low Is Too Low?
Beyond its potential to undermine the original rationale for taking statins—that too much LDL cholesterol in the blood leads to cardiovascular disease—the JUPITER study also raises questions about the impact of lowering cholesterol
levels too much. After all, every cell in the body needs LDL cholesterol to grow and repair itself, and the body uses it to produce hormones—including those governing sexual function.
In the study, the stat coup’s median LDL level dropped from 108 to 55 after a year. Researchers have already linked low LDL cholesterol to Parkinson’s disease and possibly to amyotrophic lateral sclerosis (known as AL.S or Lou Gehrig’s Disease), but they don’t really know the ramifications of keeping LDL levels as low as those achieved in the JUPITER study—especially for the years and even decades someone might stay on statins.
They do know that statins inhibit the synthesis of cholesterol in the brain, specifically by blocking what’s called the mevalonate pathway in the glial cells. This severely curtails the growth of new synapses and thus impedes communication between neurons—which may account for the amnesia, confusion, forgetfulness- disorientation, and dementia reported by some statin takers. Furthermore, in blocking this pathway, statins also inhibit the synthesis of other vital biochemicals, notably heart-friendly Co-QlO.
Who Should You Believe?
Mainstream medical doctors hailed the JUPITER study as a major scientific advance and Business Week predicted a new boom in the sale of statins. But critics soon identified some serious problems. Perhaps the study’s full name made them skeptical: JUPITER stands for Justification for Use in Prevention: an Intervention Trial Evaluating Rosuvastatin. Or maybe it was the fact that the study was sponsored by AstraZenica, the company that makes Crestor (rosuvastatin). Among a number of specific issues, the critics pointed out that the much-touted 44 percent reduction in overall mortality actually represents a very small set of numbers: The placebo group did not experience significantly more deaths overall than the statin group. And, in fact, the difference between the two groups was narrowing when the study was suddenly stopped. Furthermore, the combination of low LDL cholesterol and high CRP that characterized the study subjects is very unusual—typically both are high— which means the study results aren’t readily applicable to most Americans.
Get Healthy On Your Own
Many forward-thinking cardiologists recommend getting a CRP test (cost: $50 to $80) as part of a complete heart checkup. It and other tests will provide a more accurate assessment of your heart health than cholesterol levels alone. But don’t get complacent about your high cholesterol—most cardiologists still recommend getting your LDL level under 110 and your HDL above 50 (40 for men). Just make sure you do that with natural means before opting for a statin. A number of supplements produce the same effects as statins, but the first step should be making changes to your diet and exercise program. Give yourself three to six months to lose weight, eat better, and stress less—all things that can eliminate your need for statins completely. “This is an ongoing problem in medicine,” says Moyad, “a quick trigger to solve a problem that you could have solved with lifestyle changes. But people have to remember that statins aren’t a quick fix. They’re powerful drugs that come with unpleasant side effects and other huge risks.”
Already Taking Statins?
If you’re one of millions of people on a statin drug, here are a few supplements to ease side effects and boost the drug’s benefits.
Coenzyme Q10. Commonly referred to as Co-Q10, this vitamin-like biochemical acts as an antioxidant to protect your body from damage. It provides specific benefits to the heart and muscles (and lessens the muscle pain that comes with taking statins). Since these drugs reduce the body’s ability to synthesize Co-Qt0 naturally, Stephen Sinatra, MD, recommends taking 100 to 180 mg a day.
Squalene. This antioxidant and immune system booster is found in olive oil. “Researchers suspect that Spanish and Greek women who eat a Mediterranean diet get less cancer than American women because of the squalene effect,” says Sinatra. Add one to two tablespoons of olive oil to your diet each day.
Lycopene. A powerful antioxidant found in tomatoes, watermelon, pink grapefruit, and papaya, lycopene lowers inflammation levels throughout the body. Take 100 to 250 mg daily.
Turmeric. A frequent component of Indian cuisine, this potent anti-inflammatory herb also comes in supplement form. “I use it on a day-to-day basis,” says Sinatra. “I’ve been using it not only as an anti-inflammatory but also in the treatment of left ventricular hypertrophy and congestive heart failure.” Another option is the supplement Zyflamend, which is a mix of 10 different herbs, including turmeric.
Cholesterol Without Drugs
Red Yeast Rice Extract. This fermented food has been shown to lower cholesterol as much as a statin. Work closely with your doctor to find the right dosage.
Niacin. This form of vitamin B3 boosts HDL (“good”) cholesterol by 15 to 35 per cent, it also lowers both LDL (“bad’) cholesterol and triglycerides (another heart disease—related fat in the blood).
Fish Oil. With its high levels of omega-3 fatty acids, fish oil has been shown to reduce the uptake of triglycerides in the body. In fact, the American heart Association recommends that people with high triglycerides take 2 to 4 grams of fish oil supplements daily.
Glucomanann. These vegetable fibers (from the Asian plant konjac) lower cholesterol by absorbing the bile acids in your intestines. After digestion your body pulls cholesterol from your bloodstream to replenish its store of bile acids. Take 5 to 10 grams daily.
Syrintol. Research published in the journal Alternative Therapies found that taking this supplement daily reduced total cholesterol levels by 20 to 30 percent.
Fucothin. This metabolism booster has been found to help people lose weight, especially in the belly area. “It doesn’t lower cholesterol,” says Moyad. “But in the majority of cases, losing belly fat is naturally going to lower inflammation and blood pressure.”
ERIN QUINN is a freelance writer in
Austin, Texas.
What you need to know before you fill that prescription
BY ERIN QUINN from Natural Solutions Magazine January 2009
The notion that high cholesterol causes heart disease has allowed doctors to write millions of prescriptions for cholesterol-lowering drugs called statins that can reduce the risk of it. That seemingly indisputable notion has long suffered from an inconvenient fact: Half the people who have a heart attack don’t have high cholesterol. So, increasingly, doctors have flagged inflammation within the cardiovascular system as the culprit in these cases—an idea that has gained added currency from a study published late last year— and have discovered a drug that can help lower the risk of heart attacks for these folks: Lo and behold, it’s a statin.
The new research, called the JUPITER study, focused on C-reactive protein (CRP) because it is a marker of inflammation in the body. CRP levels in the blood go up whenever the body revs up the immune system. The study found that giving the statin rosuvastatin to men and women with normal levels of LDL cholesterol (the “bad” kind) but high levels of CRP (i.e., inflammation) reduced the incidence of heart attacks, stroke, and cardiovascular-related deaths by 44 percent. While this result does indeed seem “remarkable,” as the researchers say, it and the study itself raise some interesting questions.
First off, what does this new link between high CRPI inflammation and heart disease say about the millions of people currently taking statins, cholesterol drugs that include billion-dollar brands such as Crestor, Lipitor, and Zocor? Will they avoid heart disease even if their CRP levels are normal? Should everyone take statins to ward off heart disease, just in case? “I think this is the biggest myth in medicine right now,” says cardiologist Stephen Sinatra, MD, of the New England Heart & Longevity Center in Manchester, Connecticut “Would I prescribe statins to a 60-year-old man who has high CRP levels and hardened arteries? Absolutely,” says Sinatra, “but I’m not convinced statins are worth it as a preventative measure.
3 Ways to Get Your Number Down
Break A Sweat: Endurance exercise, such as jogging or biking, is one of the best ways to lower inflammation. Heart-pumping activities also increase beneficial HDL cholesterol levels. Aim for 30 to 45 minutes of aerobic exercise five times a week.
Lose Your Belly: Women with waists that measure more than 35 inches (more than 40 for men) likely have high inflammation in the body, which creates higher cholesterol levels. Reduce your inflammation risk by whittling a few inches off through diet and exercise.
Quite Smoking: Smoking hardens and inflames the arteries. If you’ve never smoked, don’t, and if you do—stop now. You’ll reduce inflammatory chemicals immediately. Especially for women—the risks and side effects are just too great.
Side Effects May Vary
If you believe the small-print warnings on ads for statins, the major side effect, muscle weakness and pain, occurs only rarely. The actual incidence is much higher, however, and muscle pain is a major reason why people stop taking the drugs. “Patients describe it as a general aching in their joints and muscles,” says Mark A. Moyad, MD, MPH, the Jenkins/Pokempner director of preventive and alternative medicine at the University of Michigan Medical Center in Ann Arbor. “The pain can start as soon as someone begins taking a statin—or not for several years. There’s no timeline.”
James Wright, MD, PhD, at the University of British Columbia, worries about more serious problems, including peripheral neuropathy, interstitial pneumonitis, and various cognitive and psychiatric effects. “I think we don’t really have a good handle on what’s happening there,” he says about these Alzheimer’s-like symptoms, “and some of the patients appear to have permanent effects.” For women, an elevated risk of breast cancer should be a major concern. “Along with blocking cholesterol, statins also block squalene, an antioxidant and immune system booster that is vital to preventing breast cancer:’ says Sinatra, who notes that all side effects are more common in women, particularly postmenopausal women.
How Low Is Too Low?
Beyond its potential to undermine the original rationale for taking statins—that too much LDL cholesterol in the blood leads to cardiovascular disease—the JUPITER study also raises questions about the impact of lowering cholesterol
levels too much. After all, every cell in the body needs LDL cholesterol to grow and repair itself, and the body uses it to produce hormones—including those governing sexual function.
In the study, the stat coup’s median LDL level dropped from 108 to 55 after a year. Researchers have already linked low LDL cholesterol to Parkinson’s disease and possibly to amyotrophic lateral sclerosis (known as AL.S or Lou Gehrig’s Disease), but they don’t really know the ramifications of keeping LDL levels as low as those achieved in the JUPITER study—especially for the years and even decades someone might stay on statins.
They do know that statins inhibit the synthesis of cholesterol in the brain, specifically by blocking what’s called the mevalonate pathway in the glial cells. This severely curtails the growth of new synapses and thus impedes communication between neurons—which may account for the amnesia, confusion, forgetfulness- disorientation, and dementia reported by some statin takers. Furthermore, in blocking this pathway, statins also inhibit the synthesis of other vital biochemicals, notably heart-friendly Co-QlO.
Who Should You Believe?
Mainstream medical doctors hailed the JUPITER study as a major scientific advance and Business Week predicted a new boom in the sale of statins. But critics soon identified some serious problems. Perhaps the study’s full name made them skeptical: JUPITER stands for Justification for Use in Prevention: an Intervention Trial Evaluating Rosuvastatin. Or maybe it was the fact that the study was sponsored by AstraZenica, the company that makes Crestor (rosuvastatin). Among a number of specific issues, the critics pointed out that the much-touted 44 percent reduction in overall mortality actually represents a very small set of numbers: The placebo group did not experience significantly more deaths overall than the statin group. And, in fact, the difference between the two groups was narrowing when the study was suddenly stopped. Furthermore, the combination of low LDL cholesterol and high CRP that characterized the study subjects is very unusual—typically both are high— which means the study results aren’t readily applicable to most Americans.
Get Healthy On Your Own
Many forward-thinking cardiologists recommend getting a CRP test (cost: $50 to $80) as part of a complete heart checkup. It and other tests will provide a more accurate assessment of your heart health than cholesterol levels alone. But don’t get complacent about your high cholesterol—most cardiologists still recommend getting your LDL level under 110 and your HDL above 50 (40 for men). Just make sure you do that with natural means before opting for a statin. A number of supplements produce the same effects as statins, but the first step should be making changes to your diet and exercise program. Give yourself three to six months to lose weight, eat better, and stress less—all things that can eliminate your need for statins completely. “This is an ongoing problem in medicine,” says Moyad, “a quick trigger to solve a problem that you could have solved with lifestyle changes. But people have to remember that statins aren’t a quick fix. They’re powerful drugs that come with unpleasant side effects and other huge risks.”
Already Taking Statins?
If you’re one of millions of people on a statin drug, here are a few supplements to ease side effects and boost the drug’s benefits.
Coenzyme Q10. Commonly referred to as Co-Q10, this vitamin-like biochemical acts as an antioxidant to protect your body from damage. It provides specific benefits to the heart and muscles (and lessens the muscle pain that comes with taking statins). Since these drugs reduce the body’s ability to synthesize Co-Qt0 naturally, Stephen Sinatra, MD, recommends taking 100 to 180 mg a day.
Squalene. This antioxidant and immune system booster is found in olive oil. “Researchers suspect that Spanish and Greek women who eat a Mediterranean diet get less cancer than American women because of the squalene effect,” says Sinatra. Add one to two tablespoons of olive oil to your diet each day.
Lycopene. A powerful antioxidant found in tomatoes, watermelon, pink grapefruit, and papaya, lycopene lowers inflammation levels throughout the body. Take 100 to 250 mg daily.
Turmeric. A frequent component of Indian cuisine, this potent anti-inflammatory herb also comes in supplement form. “I use it on a day-to-day basis,” says Sinatra. “I’ve been using it not only as an anti-inflammatory but also in the treatment of left ventricular hypertrophy and congestive heart failure.” Another option is the supplement Zyflamend, which is a mix of 10 different herbs, including turmeric.
Cholesterol Without Drugs
Red Yeast Rice Extract. This fermented food has been shown to lower cholesterol as much as a statin. Work closely with your doctor to find the right dosage.
Niacin. This form of vitamin B3 boosts HDL (“good”) cholesterol by 15 to 35 per cent, it also lowers both LDL (“bad’) cholesterol and triglycerides (another heart disease—related fat in the blood).
Fish Oil. With its high levels of omega-3 fatty acids, fish oil has been shown to reduce the uptake of triglycerides in the body. In fact, the American heart Association recommends that people with high triglycerides take 2 to 4 grams of fish oil supplements daily.
Glucomanann. These vegetable fibers (from the Asian plant konjac) lower cholesterol by absorbing the bile acids in your intestines. After digestion your body pulls cholesterol from your bloodstream to replenish its store of bile acids. Take 5 to 10 grams daily.
Syrintol. Research published in the journal Alternative Therapies found that taking this supplement daily reduced total cholesterol levels by 20 to 30 percent.
Fucothin. This metabolism booster has been found to help people lose weight, especially in the belly area. “It doesn’t lower cholesterol,” says Moyad. “But in the majority of cases, losing belly fat is naturally going to lower inflammation and blood pressure.”
ERIN QUINN is a freelance writer in
Austin, Texas.
Friday, January 2, 2009
Fowl Play
FOWL PLAY By Tula Karras
From Self Magazine January 2009 Issue
Your favorite lean meat serves up more than protein: There's a good chance the chicken on your plate contains pathogens and poison. What is Uncle Sam doing about it? Diddly squawk. SELF investigates.
Jenelle Dorner, 32, of Bloomington, Indiana, doesn't eat chicken. In fact, she hardly eats anything. "Each night while I sleep, I'm fed nutrients and fluids by IV," says the married mother of one. Eight years ago, Dorner developed gastroparesis, a condition that delays or prevents food from reaching the intestines, where nutrients are absorbed. The possible cause? A hearty helping of bacteria-ridden chicken she ate at a restaurant 14 years ago.
Her story is an extreme one, but poultry can make you sick as easily today as it did to Dorner when she bit into her destructive dinner. In fact, there is a 50 percent chance that the bird you bring home from the grocery store will contain Campylobacter (known as campy for short), the bacteria that was lurking in Dorner's undercooked entrée. The pathogen, found in a chicken's intestinal tract, causes no harm to the animals, but it can make humans very ill, sometimes fatally, if high cooking temperatures don't kill it. Seeing as how the average American puts away more than 42 pounds of poultry per year (equal to 222 chicken breasts), your chances of getting sick are considerable. An estimated 76 million cases of foodborne illness occur each year in the United States, and during the past decade, poultry has caused more cases than any other individual food group, including vegetables, fruit, seafood and beef, according to data from the Center for Science in the Public Interest (CSPI), a food and health watchdog group in Washington, D.C. "Infections of campy are so common that many of us have probably already had it at least once," says Robert Tauxe, M.D., deputy director of the Centers for Disease Control and Prevention's Division of Foodborne, Bacterial and Mycotic Diseases in Atlanta.
Dorner's ordeal began in 1995, when she was a sophomore at the University of Illinois at Urbana-Champaign. Her father took her to a restaurant to celebrate her 19th birthday, and she ordered chicken. "I remember thinking it was slightly pink, but other than that, it seemed fine," she says. Three days later, Dorner began vomiting and experiencing stomach pains and diarrhea. Doctors at the student health center suspected a virus and sent her home with instructions to stay hydrated. But her condition worsened. "I was running a fever, couldn't keep anything down and had bloody diarrhea," Dorner recalls. She returned to the health center, where they took a stool sample and admitted her to the hospital. Dorner's lab work revealed that she had contracted campy. After taking the antibiotic Cipro, she felt better, but her digestive system was never the same. In 2001, Dorner began having severe abdominal pain and couldn't eat a meal without vomiting, the first signs of her gastroparesis. During the next five years, her condition progressed to full-blown digestive failure. "My doctors won't ever be certain, but they believe that my campylobacter infection 14 years ago could have weakened my digestive system and set the stage for the gastroparesis," Dorner says. "I was completely healthy until I had that meal."
Campy isn't the only bug infecting chickens and the women who eat them. Between 2000 and 2005, rates of salmonella, another dangerous chicken-borne pathogen, spiked 80 percent in broiler birds. Although rates have declined slightly since then, the percentage of food poisonings from salmonella has remained steady over the past decade. And in addition to gut-ravaging bacteria, there could be another harmful hitchhiker on your roaster: Conventionally raised birds may also contain arsenic, a known carcinogen. "About 70 percent of broiler chickens in the United States are fed arsenic at some point," says David Wallinga, M.D., director of the Food and Health Program at the Institute for Agriculture and Trade Policy (IATP), a nonprofit think tank focusing on farming and food policy, in Minneapolis. Farmers add arsenic to chicken feed in order to fatten their flocks—birds go from hatchling to slaughter in only six weeks—and to give the birds their pinkish hue. And the practice is actually legal.
The average person ingests an estimated 8.1 micrograms of arsenic a day from chicken, according to a study from the USDA. And when you add that to the small amounts of arsenic you can be exposed to from other sources, such as drinking water, dust and arsenic-treated wood, a steady diet of chicken could quickly become risky. "Chronic exposure [10 to 40 micrograms a day, research suggests] is associated with an increased risk for skin, bladder and respiratory cancer," says Caroline Smith DeWaal, food-safety director at the CSPI. Richard Lobb, a spokesman for the National Chicken Council in Washington, D.C., told SELF that the arsenic found in some chickens could also come from environmental sources—insisting that there is no evidence that arsenic fed to chickens harms humans.
Along with arsenic, farmers are also allowed to lace their birds' feed with antibiotics to control bacteria in crowded quarters. It sounds great in theory, but if you catch a strain of bacteria that was exposed to antibiotics in the chicken's gut, and that strain "learned" to outsmart the antibiotics, then it will be harder for you to recover. "Antibiotic-resistant strains can last longer in your body and are more likely to lead to hospitalization," Dr. Tauxe says. What's more, these superbugs are on the rise, so even though the hens might be healthy, they may be making you sicker. (Lobb reinforced that "food safety is a top concern of the poultry industry" and that it has worked to adopt judicious use of antibiotics in its farming practices.)
Who's guarding the henhouse?
It may as well be the fox himself, considering how little regulatory agencies are doing. The failures start on the farm. Farm is a quaint term that does nothing to conjure up the thousands of chickens crammed together in cramped quarters, making it easier for them to swap bacteria through direct contact and their water supply (see "Follow the Chicken," above). When the birds arrive at the slaughterhouse, they are usually rinsed with hot water and chlorine—a step that can help reduce bacteria levels but isn't required by the USDA. (The chlorine used for rinsing presents no safety issue for humans.) Unfortunately, dirty birds still go under the knife. It is here, when birds are gutted and defeathered, that bacteria travels from the intestines to the surface of muscle meat and the porous poultry skin. A USDA officer is on site in every plant, responsible for giving visual once-overs to about 35 birds a minute. "Inspectors look for things like whether entrails or feces have contaminated the outside of the bird and whether there are bruises or other signs of disease," says Kenneth Petersen, D.V.M., assistant administrator in the Office of Field Operations at the USDA's Food Safety and Inspection Service. But a hen may look fine and still be loaded with microscopic salmonella or campylobacter.
The gold standard for detecting bacteria in chicken is microbial testing. The USDA requires that plants submit to a test for salmonella about once a year. (There is currently no regulatory test for campy.) And in recent months, the USDA has begun reallocating resources to test poorly performing plants more often and plants with better records less often. These cleaner plants undergo testing at least once every two years. During the testing period, the USDA pulls one sample from the plant per day for 51 days. "If more than 12 of those 51 samples test positive for salmonella, it's deemed a performance-standard failure," Dr. Petersen says. Put it another way: A plant can pass even if just under 20 percent of its poultry is riddled with potentially harmful pathogens. And that plant's birds can end up in your grocery store.
In the event that a plant fails to meet even this low standard, the USDA doesn't immediately suspend it. Instead, the agency performs a follow-up test "as soon as possible" and sends an officer to scrutinize the plant's procedures. Once the officer determines the problem, he asks the plant to address it. If the plant refuses to comply, the USDA sends it a letter giving it three days to clean up its act. If that doesn't work, the plant is suspended while it makes corrections. "Of the 135 letters we sent out in 2007, about 30 plants were suspended," Dr. Petersen says. Public health experts are critical. "There are roughly 6,000 processing plants in the United States, and they've suspended only 30? Not impressive," says Carol Tucker-Foreman, distinguished fellow of the Food Policy Institute for the Consumer Federation of America in Washington, D.C., and former assistant secretary of agriculture under the Carter administration. "The USDA works feverishly to prevent a plant from shutting down; they go in and hold hands and grant extensions," Tucker-Foreman says. A USDA spokesperson counters that safeguarding poultry, eggs and meat is the agency's top priority, which it accomplishes "through a dedicated workforce, evolving technology and science and good business practices."
To reduce your odds of purchasing meat from plants that have failed USDA inspection, you have to jump through numerous hoops. The USDA has begun posting the names and identifying digits, or P numbers, of offending plants on its website—a step that has reduced contamination rates, Tucker-Foreman says. To avoid buying a bird from a poorly performing plant, you can check the site monthly to print out the list, then compare it with the packages in your store or toss any chicken you already bought with matching numbers. But not all packages carry P numbers, and because plants can pump out bacteria-ridden chicken and still pass inspection, there is still no guarantee that your bird is bacteria-free.
The USDA claims it has broad authority to enforce regulations and take action against rogue plants if necessary; but, in truth, it is limited in its ability to permanently shut down repeat offenders. In 1999, the USDA tried to close a Supreme Beef meat plant in Texas because its meat failed the USDA's salmonella tests three times in 11 months. Supreme Beef sued the USDA, claiming that the meat could have arrived at the plant already tainted by salmonella, and the law applied only to sanitary conditions within the plant. A 2001 court decision agreed with Supreme Beef, in effect curtailing the USDA's power to make good on its threats. Critics blame the Bush administration for not appealing the decision to the Supreme Court and a Republican-dominated Congress for caving to the meat lobby and refusing to support proposals to bolster the USDA's authority. "The message the Bush administration sent to meat plants was, 'You don't have to worry you'll be shut down because your salmonella levels are too high,'" Tucker-Foreman says. Bottom line: Plants can churn out a virtual petri dish of product. And consumers, who are flocking to chicken in greater numbers each year (it is, after all, one of the leanest sources of meat protein), are paying the price.
Debugging the birds
What should be happening to chicken before it lands in your #4 deli special? Ridding roasters of illness-causing bacteria must begin on the farm. "The industry knows how to produce safer poultry; they're just not doing it as carefully as they should," says Marion Nestle, Ph.D., professor of nutrition at New York University in New York City and author of What to Eat (North Point Press). Less crowding in chicken coops and supplying chlorinated drinking water for the birds are a start. But to help completely eradicate pathogens, the industry should work to rid chicken feed of bacteria by keeping bug-carrying rodents out of chicken houses, and it should test birds for bacteria before slaughter, Dr. Tauxe suggests.
The unlikely McRole model for safer chicken-processing standards: fast food chains. "Companies like McDonald's and Burger King don't count on USDA regulations to keep their product safe," Tucker-Foreman says. Because of the bad rap the fast food industry acquired during the Jack in the Box fatal E. coli outbreak in 1993, major fast food companies now go to extraordinary lengths to safeguard their products.
"We do microbiological testing hourly, every day," says Edward Sabatini, vice president of quality assurance, food safety and regulatory compliance at Burger King Corporation in Miami. The company holds all meat (it's frozen) until results come back, so tainted patties can be weeded out. It also monitors its flocks' feed and water and keeps wild birds, which can easily transfer salmonella to chickens, out of its breeder flocks. Plus, unlike other eateries, fast food chains standardize their cooking process (and cook meat well), so high cooking temperatures kill any wayward pathogen that has eluded Burger King's tightly knit regulatory system.
In addition to putting controls in place on the farm, it's also up to the government to develop stricter standards for plant performance. "When the 20 percent salmonella performance standard was set in 1996, the idea was we would gradually ratchet it down to around 5 percent or so," says Michael Taylor, research professor at George Washington University School of Public Health and Health Services in Washington, D.C., and a former USDA administrator who helped write the original rule. "But the strategy of bringing the standard down was not pursued by subsequent departments, and there has been little follow-up," he says.
Some progress has been made on the antibiotic-resistant front. The FDA removed one group of commonly used antibiotics called fluoroquinolones from use in poultry in 2005. "But tetracycline and sulfa drugs are still added to feed," IATP's Dr. Wallinga says. The issue is of such urgency that more than 350 groups, including the American Medical Association, have endorsed a bill—the Preservation of Antibiotics for Medical Treatment Act—that would phase out the routine use of medically important antibiotics in animals. Log on to KeepAntibioticsWorking.org and click the Act Now button to send an automatic form letter in support of the bill to your congressional representatives.
If the state of chicken has ruffled your feathers and made you despair of a diet of tofu and lentils, take heart: There are things you can do to enjoy chicken without worry. Cook your chicken thoroughly (to kill off bacteria) and follow the steps outlined in "Have a Safer Dinner Tonight". You can also get on your squawk box and ask your congressperson to support the Food Safety Authority Modernization Act, which would enact measures to improve testing and inspection. Because, in the end, your tax dollars—which fund the USDA—should make the food you eat safer. "Why should we tolerate spending money on a program that defrauds the public with an archaic system and a seal that says our government has inspected this meat and it's OK?" Tucker-Foreman asks. When it comes to tonight's dinner, you'll have to take your health into your own hands. The greatest weapon against food poisoning is your own roasting pan.
Additional reporting by Lee Cabot Walker
From Self Magazine January 2009 Issue
Your favorite lean meat serves up more than protein: There's a good chance the chicken on your plate contains pathogens and poison. What is Uncle Sam doing about it? Diddly squawk. SELF investigates.
Jenelle Dorner, 32, of Bloomington, Indiana, doesn't eat chicken. In fact, she hardly eats anything. "Each night while I sleep, I'm fed nutrients and fluids by IV," says the married mother of one. Eight years ago, Dorner developed gastroparesis, a condition that delays or prevents food from reaching the intestines, where nutrients are absorbed. The possible cause? A hearty helping of bacteria-ridden chicken she ate at a restaurant 14 years ago.
Her story is an extreme one, but poultry can make you sick as easily today as it did to Dorner when she bit into her destructive dinner. In fact, there is a 50 percent chance that the bird you bring home from the grocery store will contain Campylobacter (known as campy for short), the bacteria that was lurking in Dorner's undercooked entrée. The pathogen, found in a chicken's intestinal tract, causes no harm to the animals, but it can make humans very ill, sometimes fatally, if high cooking temperatures don't kill it. Seeing as how the average American puts away more than 42 pounds of poultry per year (equal to 222 chicken breasts), your chances of getting sick are considerable. An estimated 76 million cases of foodborne illness occur each year in the United States, and during the past decade, poultry has caused more cases than any other individual food group, including vegetables, fruit, seafood and beef, according to data from the Center for Science in the Public Interest (CSPI), a food and health watchdog group in Washington, D.C. "Infections of campy are so common that many of us have probably already had it at least once," says Robert Tauxe, M.D., deputy director of the Centers for Disease Control and Prevention's Division of Foodborne, Bacterial and Mycotic Diseases in Atlanta.
Dorner's ordeal began in 1995, when she was a sophomore at the University of Illinois at Urbana-Champaign. Her father took her to a restaurant to celebrate her 19th birthday, and she ordered chicken. "I remember thinking it was slightly pink, but other than that, it seemed fine," she says. Three days later, Dorner began vomiting and experiencing stomach pains and diarrhea. Doctors at the student health center suspected a virus and sent her home with instructions to stay hydrated. But her condition worsened. "I was running a fever, couldn't keep anything down and had bloody diarrhea," Dorner recalls. She returned to the health center, where they took a stool sample and admitted her to the hospital. Dorner's lab work revealed that she had contracted campy. After taking the antibiotic Cipro, she felt better, but her digestive system was never the same. In 2001, Dorner began having severe abdominal pain and couldn't eat a meal without vomiting, the first signs of her gastroparesis. During the next five years, her condition progressed to full-blown digestive failure. "My doctors won't ever be certain, but they believe that my campylobacter infection 14 years ago could have weakened my digestive system and set the stage for the gastroparesis," Dorner says. "I was completely healthy until I had that meal."
Campy isn't the only bug infecting chickens and the women who eat them. Between 2000 and 2005, rates of salmonella, another dangerous chicken-borne pathogen, spiked 80 percent in broiler birds. Although rates have declined slightly since then, the percentage of food poisonings from salmonella has remained steady over the past decade. And in addition to gut-ravaging bacteria, there could be another harmful hitchhiker on your roaster: Conventionally raised birds may also contain arsenic, a known carcinogen. "About 70 percent of broiler chickens in the United States are fed arsenic at some point," says David Wallinga, M.D., director of the Food and Health Program at the Institute for Agriculture and Trade Policy (IATP), a nonprofit think tank focusing on farming and food policy, in Minneapolis. Farmers add arsenic to chicken feed in order to fatten their flocks—birds go from hatchling to slaughter in only six weeks—and to give the birds their pinkish hue. And the practice is actually legal.
The average person ingests an estimated 8.1 micrograms of arsenic a day from chicken, according to a study from the USDA. And when you add that to the small amounts of arsenic you can be exposed to from other sources, such as drinking water, dust and arsenic-treated wood, a steady diet of chicken could quickly become risky. "Chronic exposure [10 to 40 micrograms a day, research suggests] is associated with an increased risk for skin, bladder and respiratory cancer," says Caroline Smith DeWaal, food-safety director at the CSPI. Richard Lobb, a spokesman for the National Chicken Council in Washington, D.C., told SELF that the arsenic found in some chickens could also come from environmental sources—insisting that there is no evidence that arsenic fed to chickens harms humans.
Along with arsenic, farmers are also allowed to lace their birds' feed with antibiotics to control bacteria in crowded quarters. It sounds great in theory, but if you catch a strain of bacteria that was exposed to antibiotics in the chicken's gut, and that strain "learned" to outsmart the antibiotics, then it will be harder for you to recover. "Antibiotic-resistant strains can last longer in your body and are more likely to lead to hospitalization," Dr. Tauxe says. What's more, these superbugs are on the rise, so even though the hens might be healthy, they may be making you sicker. (Lobb reinforced that "food safety is a top concern of the poultry industry" and that it has worked to adopt judicious use of antibiotics in its farming practices.)
Who's guarding the henhouse?
It may as well be the fox himself, considering how little regulatory agencies are doing. The failures start on the farm. Farm is a quaint term that does nothing to conjure up the thousands of chickens crammed together in cramped quarters, making it easier for them to swap bacteria through direct contact and their water supply (see "Follow the Chicken," above). When the birds arrive at the slaughterhouse, they are usually rinsed with hot water and chlorine—a step that can help reduce bacteria levels but isn't required by the USDA. (The chlorine used for rinsing presents no safety issue for humans.) Unfortunately, dirty birds still go under the knife. It is here, when birds are gutted and defeathered, that bacteria travels from the intestines to the surface of muscle meat and the porous poultry skin. A USDA officer is on site in every plant, responsible for giving visual once-overs to about 35 birds a minute. "Inspectors look for things like whether entrails or feces have contaminated the outside of the bird and whether there are bruises or other signs of disease," says Kenneth Petersen, D.V.M., assistant administrator in the Office of Field Operations at the USDA's Food Safety and Inspection Service. But a hen may look fine and still be loaded with microscopic salmonella or campylobacter.
The gold standard for detecting bacteria in chicken is microbial testing. The USDA requires that plants submit to a test for salmonella about once a year. (There is currently no regulatory test for campy.) And in recent months, the USDA has begun reallocating resources to test poorly performing plants more often and plants with better records less often. These cleaner plants undergo testing at least once every two years. During the testing period, the USDA pulls one sample from the plant per day for 51 days. "If more than 12 of those 51 samples test positive for salmonella, it's deemed a performance-standard failure," Dr. Petersen says. Put it another way: A plant can pass even if just under 20 percent of its poultry is riddled with potentially harmful pathogens. And that plant's birds can end up in your grocery store.
In the event that a plant fails to meet even this low standard, the USDA doesn't immediately suspend it. Instead, the agency performs a follow-up test "as soon as possible" and sends an officer to scrutinize the plant's procedures. Once the officer determines the problem, he asks the plant to address it. If the plant refuses to comply, the USDA sends it a letter giving it three days to clean up its act. If that doesn't work, the plant is suspended while it makes corrections. "Of the 135 letters we sent out in 2007, about 30 plants were suspended," Dr. Petersen says. Public health experts are critical. "There are roughly 6,000 processing plants in the United States, and they've suspended only 30? Not impressive," says Carol Tucker-Foreman, distinguished fellow of the Food Policy Institute for the Consumer Federation of America in Washington, D.C., and former assistant secretary of agriculture under the Carter administration. "The USDA works feverishly to prevent a plant from shutting down; they go in and hold hands and grant extensions," Tucker-Foreman says. A USDA spokesperson counters that safeguarding poultry, eggs and meat is the agency's top priority, which it accomplishes "through a dedicated workforce, evolving technology and science and good business practices."
To reduce your odds of purchasing meat from plants that have failed USDA inspection, you have to jump through numerous hoops. The USDA has begun posting the names and identifying digits, or P numbers, of offending plants on its website—a step that has reduced contamination rates, Tucker-Foreman says. To avoid buying a bird from a poorly performing plant, you can check the site monthly to print out the list, then compare it with the packages in your store or toss any chicken you already bought with matching numbers. But not all packages carry P numbers, and because plants can pump out bacteria-ridden chicken and still pass inspection, there is still no guarantee that your bird is bacteria-free.
The USDA claims it has broad authority to enforce regulations and take action against rogue plants if necessary; but, in truth, it is limited in its ability to permanently shut down repeat offenders. In 1999, the USDA tried to close a Supreme Beef meat plant in Texas because its meat failed the USDA's salmonella tests three times in 11 months. Supreme Beef sued the USDA, claiming that the meat could have arrived at the plant already tainted by salmonella, and the law applied only to sanitary conditions within the plant. A 2001 court decision agreed with Supreme Beef, in effect curtailing the USDA's power to make good on its threats. Critics blame the Bush administration for not appealing the decision to the Supreme Court and a Republican-dominated Congress for caving to the meat lobby and refusing to support proposals to bolster the USDA's authority. "The message the Bush administration sent to meat plants was, 'You don't have to worry you'll be shut down because your salmonella levels are too high,'" Tucker-Foreman says. Bottom line: Plants can churn out a virtual petri dish of product. And consumers, who are flocking to chicken in greater numbers each year (it is, after all, one of the leanest sources of meat protein), are paying the price.
Debugging the birds
What should be happening to chicken before it lands in your #4 deli special? Ridding roasters of illness-causing bacteria must begin on the farm. "The industry knows how to produce safer poultry; they're just not doing it as carefully as they should," says Marion Nestle, Ph.D., professor of nutrition at New York University in New York City and author of What to Eat (North Point Press). Less crowding in chicken coops and supplying chlorinated drinking water for the birds are a start. But to help completely eradicate pathogens, the industry should work to rid chicken feed of bacteria by keeping bug-carrying rodents out of chicken houses, and it should test birds for bacteria before slaughter, Dr. Tauxe suggests.
The unlikely McRole model for safer chicken-processing standards: fast food chains. "Companies like McDonald's and Burger King don't count on USDA regulations to keep their product safe," Tucker-Foreman says. Because of the bad rap the fast food industry acquired during the Jack in the Box fatal E. coli outbreak in 1993, major fast food companies now go to extraordinary lengths to safeguard their products.
"We do microbiological testing hourly, every day," says Edward Sabatini, vice president of quality assurance, food safety and regulatory compliance at Burger King Corporation in Miami. The company holds all meat (it's frozen) until results come back, so tainted patties can be weeded out. It also monitors its flocks' feed and water and keeps wild birds, which can easily transfer salmonella to chickens, out of its breeder flocks. Plus, unlike other eateries, fast food chains standardize their cooking process (and cook meat well), so high cooking temperatures kill any wayward pathogen that has eluded Burger King's tightly knit regulatory system.
In addition to putting controls in place on the farm, it's also up to the government to develop stricter standards for plant performance. "When the 20 percent salmonella performance standard was set in 1996, the idea was we would gradually ratchet it down to around 5 percent or so," says Michael Taylor, research professor at George Washington University School of Public Health and Health Services in Washington, D.C., and a former USDA administrator who helped write the original rule. "But the strategy of bringing the standard down was not pursued by subsequent departments, and there has been little follow-up," he says.
Some progress has been made on the antibiotic-resistant front. The FDA removed one group of commonly used antibiotics called fluoroquinolones from use in poultry in 2005. "But tetracycline and sulfa drugs are still added to feed," IATP's Dr. Wallinga says. The issue is of such urgency that more than 350 groups, including the American Medical Association, have endorsed a bill—the Preservation of Antibiotics for Medical Treatment Act—that would phase out the routine use of medically important antibiotics in animals. Log on to KeepAntibioticsWorking.org and click the Act Now button to send an automatic form letter in support of the bill to your congressional representatives.
If the state of chicken has ruffled your feathers and made you despair of a diet of tofu and lentils, take heart: There are things you can do to enjoy chicken without worry. Cook your chicken thoroughly (to kill off bacteria) and follow the steps outlined in "Have a Safer Dinner Tonight". You can also get on your squawk box and ask your congressperson to support the Food Safety Authority Modernization Act, which would enact measures to improve testing and inspection. Because, in the end, your tax dollars—which fund the USDA—should make the food you eat safer. "Why should we tolerate spending money on a program that defrauds the public with an archaic system and a seal that says our government has inspected this meat and it's OK?" Tucker-Foreman asks. When it comes to tonight's dinner, you'll have to take your health into your own hands. The greatest weapon against food poisoning is your own roasting pan.
Additional reporting by Lee Cabot Walker
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