Pacific Health Magazine Spring 2013

IN THIS ISSUE:

Fluoride'S SWiFt Current

Boost or threat to public health?

tootH deCAy epidemiC

untreated cavities jeopardize children’s health

HoliStiC nutrition = preVentiVe CAre

Charting the Food-Health evolution PLUS How To Eat for Health • Recipes To Revitalize Breakfast

2 | Pacific Health Spring 2013

Pacific Health

Spring 2013

THE MAGAZINE OF PACIFIC FOUNDATION FOR MEDICAL CARE

Inside Our Spring Issue From the CEO 3 How the Affordable Care Act Affects redwood Health Services

By John Nacol

Foundation News 4 About PFMC | PFMC new Members Making A Difference 5 Sonoma Valley Health roundtable tackles diabetes 6 PFMC supports community health partners Health News Handoff 7 Making rounds: Health news Briefs Health Care Reform 8 rolling Out the Affordable Care Act How Sonoma County is preparing for 2014 | By Shirlee Zane Cover photograph by robb McDonough

Public Health 10 Water Fluoridation: A boost or a threat to public health?

A Q&A with Sonoma County’s health officer about the facts and the controversy 32 Understanding Fluoridation Concerns | By Patricia Dines

Oral Health 15 Treating tooth decay today benefits everybody tomorrow Why children’s dental health is so shockingly poor | By Sara Randall

10

Integrative Medicine 18 Acupuncture: East Meets West Embodied A long-time practitioner demystifies acupuncture and its ascension in Western health care

Is water fluoridation the best way to tackle the widening epidemic of dental disease?

Healthy Aging 22 rabbit Stew: reconnecting With your Inner (younger) Athlete A family doctor re-discovers the thrill of competitive sports | By Jim DeVore

Health & Nutrition 24 Holistic nutrition Comes of Age Bauman College founder charts the evolution of the food-health connection

Plus:

Tips for physicians to support better patient nutrition Basic guidelines on Eating for Health

WALkIng THE TALk: A physician rekindles his hoops mojo to stay fit and have fun.

You Are What You Eat 30 revitalizing Breakfast Delicious recipes to give your day a nutritional kick-start

Spring 2013 Pacific Health | 1

WE WANT TO HEAR FROM YOU!

Pacific Foundation for Medical Care Our Mission: We are deeply committed to serving our community and our customers, and to promoting their good health.

pFmC Board of Trustees

president Dan Lightfoot, MD – Ophthalmology Santa Rosa (Sonoma County)

Secretary Joanne Berkowitz, MD – Internal Medicine Sacramento (Sacramento County)

treasurer

P

acific Health Magazine is a publication of Pacific Foundation for Medical Care focusing on health care and healthful living in communities throughout California where our members live and work. This magazine seeks to explore the transformation of health care and illuminate the many contributing influences on individual and community health.

We want to hear from you! Send an email to lhouston@pacifichealthmagazine.org for any of the following:

Feedback We invite you to express your feedback, criticism, praise, and general comments about the contents of this magazine. If you have suggestions for articles you would like to see, let us know.

medical director of pFmC

Mailing List If you would like to receive Pacific Health Magazine regularly to read more about health care and healthy living in the North Bay, join our mailing list by sending an email message with the subject line “PH mailing list.”

Members of PFMC automatically receive Pacific Health Magazine as one of many membership benefits.

William A. Pitt, MD – Cardiology San Diego (San Diego County)

Editorial Submissions Pacific Health Magazine publishes both solicited

Dorothy Coleman-riese, MD – Pediatrics Rohnert Park (Sonoma County) John nacol, CPA CEO Pacific Foundation for Medical Care

Marek Bozdech, MD – Hematology/Oncology Santa Rosa (Sonoma County) Peter Bretan, MD – Urology Novato ( Marin County) Brad Drexler, MD – Obstetrics & Gynecology Healdsburg (Sonoma County) L. Dale Lapp, MD – Obstetrics/Gynecology San Diego (San Diego County) Michael rensink, MD – Otolaryngology Chula Vista (San Diego County) Larry McLaughlin Corporate Attorney

Redwood Health Services

redwood Health Services Board of Directors

president Michael Lazar, MD – Urology Santa Rosa

Secretary William Meseroll, MD – Radiology Santa Rosa

treasurer robert Trifunovic, MD – Obstetrics/Gynecology Escondido John nacol, CPA CEO Redwood Health Services robert Logan Faust, MD – Gastroenterology Santa Rosa Dan Lightfoot, MD – Ophthalmology Santa Rosa Larry McLaughlin Corporate Attorney

2 | Pacific Health Spring 2013

and unsolicited articles. Contact us by email with your proposal, abstract, full article, or other editorial content for consideration.

Copyright/Reprint Permission Original articles published in Pacific Health Magazine are the property of PFMC and are copyrighted by PFMC. Any requests to reprint Pacific Health articles must be approved by the editor and/ or Editorial Board. Attribution to Pacific Health Magazine must accompany any reprints. No reprints may be used for commercial purposes.

Advertising To inquire about advertising opportunities with Pacific Health Magazine, please call .. or email wtognetti@pacifichealthmagazine.org.

Pacif ic Health Magazine editorial Staff lori Houston, Editor | Steve Graydon, Creative Director Advertising Wendy tognetti, Account Executive editorial Board John nacol, Chief Executive Officer kathy Pass, PFMC Credentialing Manager ron Burton, Accounting Manager | Stacy Tucker, Executive Assistant to CEO professional Services William A. Pitt, MD, PFMC Medical Director nancy Manchee, PFMC/RHS Professional Review Manager Pacific Health Magazine is a publication of Pacific Foundation for Medical Care, a nonprofit organization dedicated to improving patient access to physicians. PFMC is part of the California Foundation for Medical Care, one of the largest preferred provider organizations in California, with more than 35,000 physicians, hospitals, and other health care providers throughout the state.

For more information, visit www.pfmc.org.

3510 Unocal Place, Suite 108 • Santa Rosa, CA 95403 pfmc.org Printed on recycled paper with vegetable-based soy ink ©2013 Pacific Foundation for Medical Care

From the CEO

How the Affordable Care Act Affects Redwood Health Services

F

aced with steep increases in medical insurance premiums, many employers have gravitated toward high-deductible insurance plans to be able to continue offering health benefits to their employees.

These high-deductible products generally save an employer 20-30 percent in premium costs. Employers can share this savings with their employees by paying either part or all of the deductible requirement.

Redwood Health Services, the subsidiary of Pacific Foundation for Medical Care, provides a vehicle to help employers accomplish this arrangement without any tax consequences to employees: Health Reimbursement Accounts (HRAs).

health insurance in 2014, must pay a penalty of $2,000 per year per full-time employee beyond the first 30 employees.

All employer-provided insurance must pay for at least 60 percent of employees’ covered health care expenses and the cost of coverage cannot exceed 9.5 percent of their total family income. If it does, such employees can choose to buy coverage through the new state insurance exchange, in our case now known as Covered California.

Other provisions of the ACA already implemented that affect all employer groups regardless of size include: • Extending dependent coverage for adult children up to age 26.

Health Reimbursement Accounts make insurance more affordable to both employers and employees.

The majority of Redwood Health Services’ HRA products are combined with high-deductible plans from major insurance carriers such as Blue Cross or Blue Shield. This approach has worked well because both employers and employees save money on health insurance and payroll taxes. By making health insurance more affordable, many employees are able to cover their families as well.

Leading up to full implementation of the Affordable Care Act (ACA), we have monitored the development of the rules and regulations closely to assess their impact on Redwood Health Services’ business, specifically with regard to HRAs. The ACA divides employer groups into two areas—small groups (2-49 employees) and large groups (50 employees or more)—with different requirements for each. Small group employers, which are Redwood Health Services’ primary market, are not required to offer health insurance to their employees. Employers with 25 or fewer employees and average wages up to $50,000 may be eligible for a health insurance tax credit. Their employees can also purchase insurance products in state-run insurance exchanges and even receive subsidies if qualified.

Large group employers are under stricter requirements and penalties for not conforming to ACA provisions. Large group employers that do not offer coverage and have at least one employee, and that receive a federal subsidy to purchase

• Prohibiting health plans from excluding children under age 19 due to pre-existing conditions.

• Requiring health plans to cover preventive services, also known as Essential Health Benefits, without cost sharing.

• Eliminating lifetime benefi t limits and phasing out of annual benefit limits.

Overall, business prospects are good for Redwood Health Services as long as we are able to continue making our HRA products available to both small and large group employers. There is much talk about health insurance premiums increasing with full implementation of the ACA. Our ability to offer the HRA approach helps make health insurance more affordable for both employers and employees through tax savings and lower insurance costs.

John Nacol Chief Executive Officer

Spring 2013 Pacific Health | 3

FOUnDATIOn nEWS

Welcome to PFMC’s Newest Members These health care professionals are now part of one of California’s largest preferred provider organizations (PPOs) thanks to PFMC’s affiliation with the California Foundation for Medical Care. The nonprofit, physician-run PFMC/CMFC network is designed to benefit and support members—not squeeze them for profits—to keep providers focused on patient care.

Anesthesiology

Gastroenterology

Marriage & Family Therapy

Yulia Rozen MD

Aruna Jayaraman MD

Barbara Anna Hayes MFT

Cardiovascular Disease

Internal Medicine

Jon Portnoff MD

Stewart Allen MD

1165 Montgomery Dr Santa Rosa, CA 95405 707-546-3210 Albert Einstein College of Medicine

1210 Sonoma Ave Ste B Santa Rosa, CA 95405 707-544-5093 Jefferson Medical College

260 Hospital Dr Ste 207 Ukiah, CA 95482 707-463-2400 American Univ Caribbean

999 Adams St Ste 106 St. Helena, CA 94574 707-963-4997 Wake Forest Univ School of Medicine

Guy Delorefice MD

Dermatology

3325 Chanate Rd Santa Rosa, CA 95404 707-573-5221 Creighton Univ School of Medicine

Helena Longin MD

3883 Airway Dr Ste 130 Santa Rosa, CA 95043 707-521-7760 Pennsylvania St Univ College of Medicine

Benjamin Meyer MD

6 Woodland Rd Ste 304 St. Helena, CA 94574 707-963-7200 Univ of South Alabama College of Medicine

Endocrinology

Pooja Sherchan MD 3883 Airway Dr Ste 202 Santa Rosa, CA 95403 707-521-7777 University of Delhi

3328 Parker Hill Rd Santa Rosa, CA 95404 707-526-8306 Dominican College San Rafael

Anna Joyce MFT

1815 4th St Santa Rosa, CA 95404 707-569-8299 John F Kennedy University

Patricia Stenger MFT 4912 Stonehedge Dr Santa Rosa, CA 95405 707-537-1511 Sonoma State University Thoracic Surgery

Andreas Sakopoulos MD 6 Woodland Rd Ste 304 St. Helena, CA 94574 707-963-7200 Univ of Pisa School of Medicine, Italy

A searchable directory of all PFMC members—and all members of the  medical foundation partners that comprise the California Foundation for Medical Care—is available online at cfmcnet.org.

Family Practice

Michelle Mertz MD

3569 Round Barn Cir Ste 200 Santa Rosa, CA 95403 707-303-3600 Univ of Vermont College of Medicine

OVE RVIE W OF SE RVI C E S

provider network PPO • EPO • WCO

medical review Services

third party Administration other employee Benefit products

lease to payers

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GrAntS

Glossary Basic Plus Health insurance product that combines major medical care and routine doctor’s office visits PPO Preferred Provider Organization, designated networks of providers for insurance plans EPO Exclusive Provider Organization, provider networks for insurance plans that do not allow any outside provider care WCO Workers Compensation Organization, provider networks specifically for workers comp insurance carriers Medical Review Services Physician-led quality assurance conducted by peers Payer Entities other than patients that finance or reimburse the cost of health services Third Party Administration Health benefits plan management on behalf of payers

MAkIng A DIFFErEnCE

Sonoma Valley Health Roundtable

pFmC grant seeds project to prevent diabetes Y

N

SO

LE

acIFIc FounDatIon FoR MeDIcaL CaRe is with recommended diabetes care and screening proceMA VA L O supporting the work of Sonoma Valley Health dures and reduce rates of serious complications from Roundtable, a collaborative of health organizaRoundtable diabetes such as foot ulcers, amputation, and death. tions and community members, to tackle the PFMC grant funds are supporting Sonoma Valley growing diabetes epidemic by launching a coordinated Health Roundtable efforts to close the gaps in services outreach campaign to educate the public and connect and increase pubic awareness by: people to needed preventive and support services.

• Developing diabetes education curriculum and pre“The Health Roundtable was created in 2008 to develop senting a series of at least a dozen community forums ROUNDTAB ROUNDT OUNDTABLE strategies to promote health and well being, catalyze this year throughout the Sonoma Valley. local movement, and strengthen health care access for everyone • Developing resources and tools for the Health Roundtable’s in Sonoma Valley,” says Patricia Talbot, RN, founding member English and Spanish web sites. and current chair of the Roundtable. “After two strategic planning • Creating the Sonoma Valley Resource Guide to provide sessions, it was clear that diabetes education and prevention was information to the community about all health and human everyone’s top priority.” services located in Sonoma Valley and about the County’s Diabetes and obesity are major concerns in Sonoma Valley and 211 Call Center, as well as a campaign to increase public countywide. A 2007 report revealed that Sonoma County’s rate of awareness through printed flyers, brochures, and media comhospital admissions due to uncontrolled diabetes is significantly munications. higher than California’s overall rate. In Sonoma Valley, a diagnosis of • Hiring a consultant to identify and evaluate certain data to be diabetes is considered a death sentence to the Hispanic community, used for tracking and measuring the effects of the initiative’s in part because many do not receive necessary health care until it various programs. is too late to reverse, according to a needs assessment from that • Building a long-term support strategy for diabetes prevention and education through community sponsorships. same year. Risk factors for this chronic disease include age, race, ethnicity, heredity, nutritional lifestyle, and lack of physical activity.

The Health Roundtable’s overall vision is for a healthy, robust, and “With no parks and recreation department, no major organized resilient community, where all persons have access to a wide range adult physical activity, no organized education for the prevention of of integrated and quality health services. Other initiatives include: diabetes, and little coordination of care for those who have diabetes, • Developing the Virtual Wellness Center, an online portal Sonoma Valley residents are at a higher risk for developing diabetes to health and wellness information and resources for the or having uncontrolled diabetes,” Talbot says.

Sonoma Valley community, as well as a community calendar However, lifestyle changes and better management can prevent, of health-related events. delay, or reduce the onset or intensity of the disease. The goals of • Launching iMOVE, a campaign that embraces and promotes the Sonoma Valley Health Roundtable Prevention and Treatment all forms of exercise for all ages as an extension of Health Acof Diabetes project are to: tion’s iWALK initiative.

• Identify existing programs and services as well as resource Sonoma Valley Health Roundtable members include represengaps and unmet needs in the Sonoma Valley. tatives from Sonoma Valley Hospital, Sonoma Valley Community • Publicize the current system of coordinated diabetic prevenHealth Center, City of Sonoma, Sonoma Valley Unified School tion and care available in Sonoma Valley.

District, St Joseph Health, Boys and Girls Club of Sonoma Valley, • Engage more local partners to aid in improving diabetes Sonoma County Department of Health Services, and more. prevention and treatment.

In 2012, Sonoma Valley Health Roundtable became a chapter of • Raise public awareness about diabetes prevention and treatment. Sonoma County Health Action, a countywide collaborative effort to • Develop and implement diabetes education tailored to the make Sonoma County the healthiest county in California. Sonoma needs of various communities.

Valley Health Roundtable is one of four such community-based • Defi ne how to measure success and track the eff ects of the “chapters” of Health Action to form since 2007. Other local chapters diabetes initiative. include Windsor, Petaluma, and Healdsburg.

The Roundtable’s goals are aligned with countywide and national More information: Healthy People 2020 diabetes goals “to reduce the disease and eco• Sonoma Health Action: sonomahealthaction.org nomic burden of diabetes, and improve the quality of life for all per• Healthy people 2020: healthypeople.gov sons who have or are at risk for diabetes.” In addition to improving • Coming soon: iHealthSonomaValley.org (English) diabetes education, Healthy People 2020 aims to improve compliance iSaludSonomaValley.org (Spanish)

HEALTH

Spring 2013 Pacific Health | 5

MAkIng A DIFFErEnCE

PFMC Grants Support Community Health Partners Pacific Foundation for Medical Care supports non-profit, health related organizations and/or projects that enhance the availability or quality of health services in communities. Since 1993, PFMC has provided more than $1.5 million through grant awards to 76 different organizations and programs in the North San Francisco Bay Area.

transitions@lifeWorks (LifeWorksSC.org)

PFMC has awarded a grant to Scholarship Sonoma County for its 2013 Health Careers Scholarship Fund, to assist post-secondary students with financial need who are pursuing degrees in health care-related fields of study. The U.S. Department of Labor reports that eight of the 20 most rapidly growing job sectors in California are in the health care field. The health care industry is forecast to grow 22 percent through 2016, compared to 11 percent for all other combined industries. In total, about three million new health care jobs will be created and by 2018, 61 percent of those jobs will require post-secondary education.

PFMC grant funds are supporting Transitions@LifeWorks, a program of the nonprofit mental health agency LifeWorks to provide resources to young adults with Asperger’s Syndrome or Nonverbal Learning Disorder (NLD). The funds will be used to teach community integration and socialization skills to the clients through supervised community outings, provide art supplies, and expand the organization’s resource library.

Transitions@LifeWorks provides art activities and materials for their client’s nonverbal self-expression, which helps them with managing their feelings, improving their communication skills, and working through social challenges.

Since 2006, Transitions@LifeWorks has provided counseling, academic and occupational assistance, case management, social skills groups, living skills education, work experience opportunities, and linkage with community agencies for 18-25 year-olds diagnosed with Asperger’s or NLD to foster greater self-reliance.

This is the only program in the North Bay Area providing the level of support, therapy, and advocacy that these individuals and their families need.

Photo by Jesse Irizary

Scholarship Sonoma County (sonomacf.org)

HoW to Apply L to r: Current 10,000 Degree Institute students Hardy gomez, Claudia Farias, Anahi Hernandez (Sonoma Valley High School), and Abigail king (Healdsburg High School Junior).

Scholarship Sonoma County, a program of Community Foundation Sonoma County, provides scholarships to language and income disadvantaged freshmen, continuing undergraduate students, and graduate students who are pursuing degrees and certificates in fields such as nursing, pre-medicine studies, medicine, radiology, nutrition and dietetics, pharmacology, emergency medical technology/paramedic studies, and dental hygiene.

Because only 24 percent of low-income students who do make it to college actually complete their degree programs, Scholarship Sonoma County also provides services including college preparedness, financial aid advocacy to leverage scholarship awards with additional financial aid, mentorship, and ongoing support to help students complete their degree or certificate programs.

Scholarship Sonoma County works with scholarship students to secure as much free financial aid (federal, state, institutional and private) as possible to enable them to complete their programs with as little debt as possible. Health Careers Scholarships are awarded to close financial aid gaps as needed, leveraging these funds to support more students pursuing degrees and certificates into the future. Scholarship Sonoma County works in partnership with , Degrees, a national college access organization, as well as local partners such as Redwood Credit Union and the Hispanic Chamber of Commerce of Sonoma County.

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The PFMC Grant Committee and Board of Trustees evaluate grant proposals on the basis of merit, priorities, values, and duration of support. Projects that tend to receive funding are those that maximize the numbers of people served, show other sources of support, and demonstrate adequate planning for continuation as selfsustaining programs. PFMC Trustees periodically evaluate the organization’s grant award guidelines and application procedures to ensure that these are timely and support community needs.

PFMC accepts proposals and awards grants twice per year.

Proposal deadlines are April 2 and October 1, followed by awards in June and December. For more information about proposal criteria and how to apply, please visit pfmc.org or contact Kathy Pass at 707.525.4281 or kpass@rhs.org.

HEALTH nEWS HAnDOFF

Making Rounds

Health news Briefs prn* SAntA roSA Community HeAltH CenterS eArnS ACCreditAtion Santa Rosa Community Health Centers (SRCHC) recently earned accreditation from The Joint Commission, indicating compliance with certain global standards for measuring health care quality and safety. As an independent, not-for-profit organization, The Joint Commission accredits and certifies more than , health care organizations and programs in the United States including hospitals, doctors’ offices, nursing homes, surgery centers, behavioral health facilities, and home care providers.

To earn accreditation, all eight SRCHC facilities were required to pass a comprehensive four-day survey conducted onsite by physicians and nurses, evaluating the quality and safety of care based on criteria such as: • Providing a safe environment for care and performing quality evaluation • Educating patients about the risks and options for diagnosis and treatment in ways they can understand • Protecting patient rights, including confidentiality • Evaluating medical conditions before, during, and after diagnosis and treatment • Protecting patients and staff from infection • Planning for emergency situations SRCHC is the only community health center in Sonoma County and the second Federally Qualified Health Center in Northern California to earn this accreditation. Only  percent of Federally Qualified Health Centers in the United States have earned this accreditation.

“We wanted to be able to affirm to the community that we not only say we provide high quality, but we have been externally reviewed and found to meet national standards for excellence,” says Naomi Fuchs, SRCHC chief executive officer. “The process of preparing for the accreditation survey was an excellent framework for staff to review, assess, and improve our systems of care.”

SRCHC cares for , patients per year, providing primary health care and health education for underserved people in Santa Rosa, regardless of ability to pay. SRCHC is also certified now as a Primary Care Medical Home, which means that health provider teams work in partnership with patients to provide coordinated, effective, and timely care. Learn more at srhealthcenters.org.

ACA reQuireS no-CoSt ColonoSCopy AND polyp remoVAl the Affordable Care Act already requires coverage for colonoscopies as part of preventive services to be provided at no cost to individuals. Until recently, when a polyp was discovered and removed during this procedure, insurance carriers designated the procedure as therapeutic, allowing them to charge deductibles and/or copayments. This practice often makes colonoscopies financially cumbersome for many people.

Now the federal government has designated polyp removal as an integral part of a colonoscopy screening procedure, therefore requiring insurers to cover this as part of no-cost preventive

services. This change is based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society of Gastroenterology Nurses and Associates.

Join tHe iWAlK CHAllenGe Looking for a simple, fun way to encourage loved ones, friends, patients, colleagues, or perhaps yourself to become more active?

Join the iWalk Challenge by committing to  minutes of exercise per week—that’s  minutes a day, five days a week—between now and May , . Any type of exercise counts—swimming, cycling, running, hiking, dancing, and, of course, walking.

This year’s iWALK Challenge concludes with the Human Race event (Saturday, May ). Track your minutes with your own app or by downloading a fitness tracker when you register for the iWALK Challenge at iwalksonoma.org.

The iWALK Challenge is part of the countywide movement to reduce obesity through exercise, one of many initiatives created

by Sonoma Health Action to work toward becoming the healthiest county in California.

HEALTH EDUCATION & WELLNESS CLASSES OFFERED The Northern California Center for Well-Being and the Petaluma Health Care District are offering the following family oriented classes.

Healthier living—A chronic disease self-management class for individuals. Six 2.5-hour sessions. Fee: $15 Wednesdays, April 17-May 22, 2:00-4:30pm living With diabetes: Wellness Series—Accredited by American Diabetes Association. Four 2.25-hour sessions. Fee: $435.

Covered by many insurances and scholarships available.

Mondays, May 6th-June 3rd, 3:00pm-5:15pm preventing diabetes and Heart disease—Preventing metabolic syndrome, reducing risk, recognizing symptoms.

Four 2-hour sessions. Fee: $15 Tuesdays, May 14-June 4, 6:00-8:30pm

Classes are held at the Petaluma Health Care District Building Conference Room at 1425 N. McDowell Blvd.

Pre-registration is required by calling 707.766.8647. (*PRN is a medical abbreviation meaning: “As Needed”)

Spring 2013 Pacific Health | 7

Medicare tax increase

Administration simplification

Medicare Part A tax rate on wages goes up from 1.45% to 2.3% for certain individuals.

Establishes rules to make payment, enrollment, claims and authorization processes simpler.

Employers must inform employees of health options Employers must provide

employees with info on employer plans, health exchanges and subsidies.

HEALTH CArE rEFOrM

Voices from the Community

rolling out the Affordable Care Act … the time is now!

T

By Shirlee Zane

he County oF Sonoma is about to undergo a surgical transformation that will impact thousands of lives for years to come. The long awaited Affordable Healthcare Act (ACA) that will enable the County to bring healthcare coverage to thousands of residents is rolling out right now during 2013, to be fully in place by next year’s deadline.

Of course, many individuals and families are already benefiting from early provisions of “health care reform.” Seniors on Medicare are benefiting from lower prescription drug prices and better preventive care centered on no-cost annual exams and planning with primary care physicians. Mammograms and other screening procedures are now required to be covered for the first time. Our children can no longer be denied health coverage because of preexisting conditions; our sons and daughters, as they struggle to enter the work force after completing an education, are now able to remain on their parents’ insurance plan through age 26. And the ACA provides incentives to encourage states to take early action.

For example, California has implemented the Pre-Existing Conditions Insurance Plan, which provides coverage to Californians who otherwise would not have access to health insurance.

In a previous edition of this publication, my former colleague on the Board of Supervisors, Valerie Brown, through her work on the President’s Prevention Advisory Council, wrote about these and other provisions as well as the need to shift the national dialogue about health care from “sick care” to prevention-based “health care.” The National Prevention Strategy lays out a road map to help communities create healthy and safe environments, enhance preventive services, and eliminate health disparities that are often

linked to social, economic, or environmental disadvantages.

Pacific Health Magazine has done a great job of highlighting Sonoma County’s approach to health and how we are working hard to achieve the goal of becoming the healthiest county in the state by the year 2020. Critical to that goal is Health Action, the public-private community council established by the Board of Supervisors in 2007. Early Health Action initiatives, such as iGROW and iWALK, gained broad community support and brought greater attention to our nutrition and physical activity goals.

Other initiatives, such as iCARE, focused increased attention on the importance of ensuring that everyone has a prevention-based primary care medical home.

Now, Health Action is taking aim at the primary “determinants” of health: education, income, and our local health system. Great momentum is building around Cradle To Career, our local effort focusing on the critical connection between educational attainment and health. Diverse stakeholders have come together to better link the educational continuum during a person’s development, starting at birth and ending with successful establishment in the workforce. Toward this end, we are mobilizing the necessary resources within our County’s educational system that will improve these connections.

The ACA’s emphasis on prevention is an important part of this law. One dollar spent on prevention is proven to return five dollars in savings down the road. In addition, we will see more people receiving behavioral health care as mental health and substance use disorders will be reimbursed at rates that are on par with other chronic conditions such as diabetes and heart disease.

About the Author: Shirlee Zane was elected to the Sonoma County Board of Supervisors in November 2008 and began her second term in January. She has more than 25 years of experience working as a family therapist, minister, hospital chaplain, educator, and inner city social worker. A fluent Spanish speaker, Shirlee holds Master of Arts degrees in both theology and family counseling. Before taking public office, she served for 10 years as CEO of the Council on Aging, a private nonprofit that provides services for seniors countywide. As a member of the National Association of Counties (NACO) Health Steering Committee, Shirlee advocates at the local, state, and federal levels to ensure that Sonoma County receives funding and other support for health and human services.

No preexisting condition exclusions Coverage cannot be denied for those with preexisting conditions.

8 | Pacific Health Spring 2013

timeline: the patient protection and Affordable Care Act

Comprehensive coverage requirement Individual and small group plans must include essential health benefits.

Limits on deductibles & copayments

Group health plan deductibles are limited to amounts allowed for HSA plans.

Individual mandate

Everyone must have health coverage or pay penalty.

Employer mandate Employers with more

than 50 employees must provide coverage or pay penalty if any employee receives a subsidy.

Sonoma County simply will not reach our goal of becoming the healthiest county in the state unless we make sure those without health insurance are covered. Families with young children, people who have lost their jobs, lower income single adults, and seniors all will benefit from healthcare coverage. Regardless of how you feel about ACA, as the pool of insured persons increases, we will drive down costs and improve health in our communities.

As we move toward 2014, now is perhaps our greatest opportunity through the ACA to address an appalling fact in our country – that many people cannot obtain health insurance. In Sonoma County we currently have an estimated 70,000 uninsured residents. By 2014, we have the chance to help 50,000 of those people become covered through Medicaid expansion as well as enrollment via California’s Health Benefits Exchange. With the Supreme Court’s affirmation of these two components of the ACA, states can now make Medicaid (MediCal in California) available to people

In the coming months, Sonoma County will create a no-wrong-door approach to health insurance enrollment. who are at 133 percent of the federal poverty level, equivalent to an annual income of $15,000 for an individual, or $30,000 for a family of four. Individuals and families who fall between 133-400 percent of the federal poverty level ($45,000 for an individual or $90,000 for a family of four) can purchase commercial coverage through state exchanges and receive tax credits.

In California, our health benefits exchange—called “Covered California”—is rapidly preparing to launch on January 1, 2014.

This will help working families who have seen their healthcare costs skyrocket as well as those who have lost their insurance due to unemployment. The vision of the Covered California is to improve the health of all Californians by assuring their access to affordable, high quality care. The Exchange seeks to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plans and providers offering the best value.

Just as each of us has a part to play in our community’s health, we must all pitch in to ensure that the maximum number of people who can enroll for health insurance do so and remain enrolled.

This not only provides the benefits to individuals and families as I’ve noted, but also strengthens health care providers in Sonoma County by reducing the financial burden of caring for those without health insurance.

Ban on all annual limits

Plans may no longer impose any annual benefit limits.

Large employer auto enrollment

Employers with more than 200 full-time employees that offer coverage must autoenroll employees. Employees can opt out.

Health Insurance Exchanges operating

States must have exchanges up and running by 2014 or feds will come in and set it up themselves.

In the coming months, Sonoma County will finalize plans and strategic investments with both local health system and community partners to make sure the public is aware of the full benefits and true opportunities presented by the ACA—particularly with regard to access to affordable health insurance—and to create a no-wrong-door approach to enrollment. This starts with high profile, consistent communications supported by hiring and funding staff to act as “certified application assistors” or “navigators.”

Navigators are trained specifically to help consumers sort through the complex requirements and processes of enrolling in appropriate programs, including obtaining health insurance through Covered California. Sonoma County’s Human Services Department is hiring staff to work with our residents. Our Department of Health Services has provided funding to key community partners including Redwood Community Health Coalition, which is administering the navigator program to train all navigators, with 29 of them already working in community clinics throughout Sonoma County.

The County plans to fund additional partners, paying particular attention to ensure that every area has such resources available.

As a public official dedicated to the health of individuals and families, pursuing health care reform has felt like a marathon, full of challenges, hope, and inspiration along the way. We may even encounter a few more hurdles as we push to cross the finish line but we will finish this race. Full implementation of the federal Patient Protection and Affordable Care Act will enable more people in our communities achieve better health and vitality for years to come.

MORE INFORMATION AND RESOURCES: How the Affordable Care Act works: whitehouse.gov/issues/health-care/ Cradle To Career: ccsonomacounty.org California’s Health Benefit Exchange, Covered California: coveredca.com Pre-Existing Condition Insurance Plan: pcip.ca.gov Getting ready for the Health Insurance Marketplace: healthcare.gov Information about how to find health insurance that fits your needs and budget. Enrollment begins October .

WHERE TO FIND ASSISTANCE RIGHT NOW: If your income is low or if you are uninsured, you may be able to get help with medical, dental, urgent/emergency, and medication services through MediCal, the County Medical Services Program (CMSP), or PathHealth program. Call .. or visit sonoma-county.org/human/eco_assistance.htm Search online for locally available health resources: myhealthresource.org (Californians for Patient Care)

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Spring 2013 Pacific Health | 9

Water Fluoridation:

A boost or a threat to public health?

Fluoridation of Sonoma County’s water supplies is in the public eye due to growing concern over widespread dental disease among people of all ages and its long-term health impacts.

Pacific Health Magazine speaks with Dr. Lynn Silver Chalfin, Sonoma County Public Health Officer, about the facts and the controversy surrounding this approach to tackling a growing epidemic.

Dr. Chalfin recently produced a flouridation assessment report available at sonoma-county.org PH: Why is fluoridating Sonoma County’s water supply being considered?

LSC: Dental disease is an enormous problem in Sonoma County.

In fact it’s the most common health problem for children. Thousands of kindergarteners and third graders have serious dental health problems including abscesses, inflammation, and pain. [Editor’s note: see article “Treating tooth decay today benefits everyone tomorrow” on page 15.]

Dental disease is also a major problem for adults, particularly for pregnant women and the elderly. In fact, one third of poor elderly in the United States have no teeth remaining.

Amongst middle-aged adults, aged 45–64, nationally only 29 percent have a full set Lynn Silver Chalfin, MD, MPH of permanent teeth. This also varies by race 10 | Pacific Health Spring 2013

and ethnicity: 19 percent of Hispanic adults and 11 percent of non-Hispanic black adults have a full set, compared with nearly 35 percent of white adults.* Since Medi-Cal coverage of dental services was ended July 2009 as a result of the budget crisis, access for lowincome adults in California is even more of a serious challenge.

Even for the middle class, care for caries, root canals, extractions and infections represent a frequent and significant burden of preventable suffering, lost productivity, and family expenditures.

Widespread dental disease is one of the most common and eminently preventable causes of illness, suffering, and avoidable expenditures in our county. Fluoridation has been found to reduce tooth decay by 30 to 50 percent, according to the U.S. Preventive Services Task Force.

PH: What is the current status of fluoridation? Is this a “done deal”?

LSC: Healdsburg’s water supply has been fluoridated since 1952,

PUBLIC HEALTH as is the Coast Guard Station in Petaluma.

But the rest of the county is not fluoridated.

A preliminary assessment report was just finalized and made public on the Sonoma County Department of Health Services website. Initial technical discussions have taken place with representatives of health care providers, business, and environmental groups, as well as individuals, many of whom have expressed concerns.

As this article goes to press, the Sonoma County Board of Supervisors just voted to strengthen the county’s oral health education and preventive programs, and to create an advisory committee to study fluoridation.

Those committee meetings would be open to the public. The Board also approved a preliminary engineering study to estimate how much fluoridation would really cost. A recent public hearing included passionate testimony from doctors, dentists, and school nurses who see the toll of tooth decay every day and are advocating for fluoridation, as well as from concerned individuals.

Our county is a democracy with transparent procedures so everything that is under discussion has a process. Further discussions will occur with the many local water retailers and with the community, with ample opportunity for public comment. A financial plan would also have to be developed. In other words, this is a long process and the final decision about whether or not to proceed will not be made for many more months.

PH: Does the State of California mandate fluoridating public water supplies?

LSC: Yes. Since 1996 the state has required fluoridation in systems with more than 10,000 connections, if funding is made available. Santa Rosa and Petaluma, as the largest water systems, are already obligated under state law to fluoridate if funding is available. Systems in Los Angeles, San Diego, Sacramento, and other large California cities have met the requirement in the last few years. In December 2012, Santa Clara County, which includes San Jose’s large population, just decided to fluoridate. San Francisco and the East Bay have been fluoridated for many years.

PH: Did the County’s recent feasibility study reveal anything new or unexpected?

LSC: First, the study documents the tremendous progress with fluoridation

nationally and in California. In the U.S., 74 percent of people with access to public water supply now have fluoridated water. California has increased to over 58 percent of people during the last decade. To say this approach is outdated or is being reversed everywhere is just plain wrong. While some areas have discontinued fluoridation due to opposition, the documented benefits have convinced more and more communities to adopt the policy. The trend is clearly in favor of fluoridation.

The report’s other important contribution is to clarify that the most sensible approach to fluoridation for Sonoma County would be through the Sonoma County Water Agency.

More than 100,000 county residents receive their water from wells or from small local water companies. About 350,000 get their water mostly from the Sonoma County Water Agency, sometimes in combination with local sources. This includes people in Santa Rosa, Petaluma, Sonoma, Cotati, Forestville, Rohnert Park, and the Valley of the Moon Water District. For each of these jurisdictions to act independently would be far more expensive than to implement fluoridation through the Sonoma County Water Agency.

PH: Should the Sonoma County Board of Supervisors give final approval, what would be the expected timeline for fluoridation to be implemented?

LSC: If there were a decision to fluoridate, from final approval to implementation would probably still take the Sonoma County Water Agency at least two to four or more years. Plans must be developed, any required environmental impact assessments met, and construction contracts awarded and carried out. Further fluoridation of supplemental local wells might occur over 10-20 years.

Most of the western and northern parts of the county would not be affected by Water Agency fluoridation and would require separate study.

PH: What exactly is fluoride?

LSC: Fluoride is a mineral naturally present in fresh water. It comes from rock formations that store water naturally. Its concentration varies widely in nature. In Sonoma County, the natural fluoride levels are low: 0.13 mg/L in the water agency system, for example. Community water fluoridation seeks to standardize that level at 0.7 mg/L. The federal Environmental

Protection Agency allows more than five times that level, that is, 4 mg/L in water, although the National Research Council has recommended lowering the maximum.

Fluoride for water treatment comes from crushing and processing apatite rock. It is supplied in high-grade preparation in either solid or liquid form that must meet rigorous quality standards and controls on contaminants to be used in potable water.

Water providers are already required to do regular water quality testing.

PH: What is the scientific and medical basis for taking this approach to preventive oral health? What are the benefits?

LSC: Certain bacteria in the mouth cause tooth decay. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth. Fluoride helps to remineralize tooth surfaces and prevents cavities from continuing to form.

Fluoridation has been studied for more than 60 years. Earlier in the last century, communities with high levels of natural fluoride were noted to have little tooth decay.

Those communities had many times the level of fluoride used in community water fluoridation today. Once it became clear that this reflected elevated natural fluoride in the water, further study revealed that a “sweet spot” of fluoride concentration could be achieved in which little fluorosis, a discoloration or pitting of tooth enamel, occurs but people are still protected from tooth decay. That led to successful trials of adding small amounts of fluoride, which was later adopted as a public policy. Many peer-reviewed scientific studies have been published on the issue. Fluoridation reduces dental decay by 30-50 percent according to the U.S. Preventive Services Task Force Community Guide. Even with wider use of other fluoride products today, water fluoridation still offers significant benefit.

PH: In a 2011 report, the Sonoma County Oral Health Task Force acknowledged that public water fluoridation has “proven to be effective in preventing dental caries,” but did not explicitly recommend this. Why? LSC: The Task Force decided early on to focus initially on areas where they felt they could make immediate progress: perinatal oral health, developing varnish and sealant programs, and expanding access to care.

Spring 2013 Pacific Health | 11

PUBLIC HEALTH Thanks to their hard work, we are making important progress in those areas. The Task Force recently issued a letter endorsing fluoridation and asking county supervisors, city council members, and water district members to support this.

PH: Is there any validity to the potential health risks associated with fluoridation?

LSC: Community water fluoridation is safe. Fluoride is like salt: getting none is not good for you. Your body needs a small amount to keep you healthier. In fact, the Institute of Medicine, part of the National Academies of Science, has established a minimum daily adequate intake of fluoride to assure oral health. Community water fluoridation is designed to help meet that intake without exceeding recommended levels. But, as with salt, way too much is not good for you and can cause health problems.

The Institute of Medicine also established a recommended maximum for fluoride. The EPA requires locations with naturally very high levels of fluoride to treat the water until fluoride reaches safe levels. To give an example, if a man drinks two liters of

optimally fluoridated water in a day he would consume 1.4 mg of fluoride, one third of his daily recommended adequate intake of 4 mg and one seventh of the recommended maximum. He would have to drink over 14 liters to exceed the recommended maximum.

The only confirmed adverse effect of community water fluoridation is that some people may get dental fluorosis. Usually this takes the form of mild white spots on teeth visible only to dentists. One of my daughters has this – and it doesn’t worry me. On rare occasions, fluorosis can be more pronounced. With so many new fluoride products on the market, this has become slightly more common. Therefore, the recommended level for community water fluoridation has just been reduced to 0.7 mg/L, the lower end of a wider range, to reduce the occurrence of fluorosis. Yet the experts are clear, the benefit of reducing the destructive effects of tooth decay far outweigh any fluorosis that occurs as a result of optimally fluoridated water. For example, Dr. John J. Warren of Iowa, an expert in this field whose work is cited by activists opposing fluoridation, is a strong

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advocate for community water fluoridation.

Much of the literature about other health problems associated with fluoride was written primarily about areas with very high levels of naturally occurring fluoride or with fluoride pollution from coal burning.

In 2006, the National Research Council reviewed fluoride and determined that very high levels in water in some places, much higher than those used for water fluoridation, may increase the risk of skeletal fluorosis and fractures. The Council recommended lowering the maximum levels allowed in water, which were already many times greater than the levels proposed for water fluoridation.

Infants who are primarily on formula should be given distilled or de-mineralized water, both of which are readily available, as the fluoride levels in formula can vary.

While this may make things more complicated for a few months, for most families life will be less complicated, as children who are age six months to 12 years will no longer need to get fluoride drops in areas that begin receiving fluoridated water.

The scientific and medical communities have analyzed this issue many times and overwhelmingly determined that fluoridation is safe and effective. The American Medical Association, American Dental Association, American Academies of Pediatrics and of Family Physicians, the Institute of Medicine, World Health Organization, March of Dimes, AFL-CIO, and more than a hundred leading organizations have endorsed water fluoridation’s safety and efficacy. These organizations are not agents of the pesticide industry or conspirators against the environment. For example, one prominent organization that supports fluoridation is the American Cancer Society, which would not be the case if fluoride were known to cause cancer.

The real danger is in failing to act. Every day in Sonoma County 10 to 12 children go under general anesthesia to treat severe tooth decay, with all its attendant risks and costs to families. These are real and immediate dangers that can be prevented.

PH: Are there alternative solutions for administering fluoride on a large scale?

LSC: Fluoride is by far the most effective measure for preventing tooth decay.

By reaching all citizens of all ages every day who receive public water supply, the effects

PUBLIC HEALTH of fluoridation are sustainable for very low cost. The Centers for Disease Control and Prevention estimate that for every $1 the community spends on fluoridation, society saves $38 in restorative dental expenses.

Average dental expenditures in the U.S. are higher than $300 per person each year.

That said, there are other important measures to pursue also. School-based sealant programs are highly effective and recommended in conjunction with fluoridation, as are varnishes, good dental hygiene, and proper dietary practices such as cutting back on sugary drinks. Sealants only protect certain teeth.

Access to dental care is equally important.

The County is working in partnership with a number of organizations to make progress on all these fronts. All these activities require significant ongoing funding and have other challenges that affect the extent of their reach. But these activities are synergistic with fluoridation; they cannot replace its benefits.

PH: Are there any ethical considerations with community water fluoridation?

LSC: Bioethics usually considers four areas: benefit, absence of harm, equity, and autonomy. The most important ethical consideration is that fluoridation reduces enormous social disparities in dental health.

Poor or Latino children are much more likely to have tooth decay and suffer the consequences of untreated disease. One of every five Latino children, and one in ten white children, need early or urgent dental care.

I’ve already mentioned the clear benefit of water fluoridation to reduce dental disease. And, at fluoridation levels used over the last 50 years, absence of harm has also been demonstrated.

Community water fluoridation does reduce autonomy by taking away the ability to choose from those who do not want this.

Finding an appropriate balance between autonomy and protection is a longstanding challenge of public health. For example, adding chlorine to water saves lives by preventing dysentery and cholera yet also reduces the individual’s ability to choose chlorine-free water. The requirement to use seat belts in vehicles save tens of thousands of lives each year but is disliked by some because of constrained movement. Still, most people believe that the benefits are worth it.

PH: Does fluoride present any known risks to the environment and wildlife?

LSC: At levels used in community water fluoridation, we have not identified any negative effects. The changes in fluoride concentrations in runoff water in the published literature we have seen are very low and well within the natural variations seen in the county. Fluoride pollution at high levels can exist in certain industrial settings or from coal burning. This is not the case with fluoride at the concentration used in potable water, which is not corrosive. The concentrated product does need careful handling before being massively diluted. This is also true for other concentrated products used to adjust water acidity or for the chlorine added to our water supply to keep people from getting dysentery or cholera. The County continues to be open to receiving any evidence that demonstrates environmental harm has occurred at concentrations used in community water fluoridation.

PH: What are some of the biggest myths or misconceptions regarding fluoridating the public water supply?

Ruben Kalra, MD

LSC: That fluoride is a toxin and that the products used to fluoridate water supplies contains large amounts of lead or arsenic and will destroy the environment, corrode water pipes, poison people, or cause cancer.

None of these are supported by scientific evidence.

Nothing summarizes this issue better than a dentist I recently encountered who worked in another state in the west with fluoridated water and recently moved here to work with low-income children. He told me that every day he sees dental decay and suffering wrought by the absence of fluoridation—a striking contrast to what he saw regularly in his previous practice. *Source: Dye BA, Li X, Thornton-Evans G. Oral Health Disparities as Determined by selected Healthy People 2020 oral health objectives for the United States, 2009–2010. NCHS Data Brief, No 104. Hyattsville, MD: National Center for Health Statistics, 2012 (http://www.cdc. gov/nchs/data/databriefs/db104.htm)

More information: See article “Understanding Concerns About Community Water Fluoridation” on page 32.

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oral health

Children’s Dental Health:

Treating tooth decay today benefits everybody tomorrow

y

M

By Sara Randall

y teeth have brown spots and it hurts to eat.”

She was standing there in pink shoes, a five-year old child, small for her age, with her hand over her mouth. She would not smile and refused to talk to anyone without her hand covering her mouth. Not only did she seem heartbreakingly shy but it became clear how painfully self-conscious she was about her mouthful of brown and decaying teeth. Her mother explained that she had started covering her mouth because other kids often made fun of her. She didn’t want to be different.

For this little girl on this particular visit to a dental surgery facility, 12 of her baby teeth required either a filling, crown, or extraction. While this may seem like an extreme case, sadly this is an everyday occurrence in Sonoma County.

Cavities.

The word alone can make you cringe. The threat of the dreaded drill, the numbness, the missed time from work all are motivators to take good care of our teeth. We brush, we try to floss regularly, we visit a dentist twice a year for preventive care and cleanings. If you are lucky to be part of the 67 percent of Californians with dental insurance, don’t take this for granted. With insurance coverage declining, more people are forced to make difficult choices. Preventive visits to the dentist often take a back seat to more pressing, basic needs such as employment and transportation.

Access to preventive dental care is even lower for families covered by Denti-Cal, the dental program through Medi-Cal, instead of private insurance. But for children covered under Denti-Cal who have little to no access to preventive care in Sonoma County, tooth decay threatens to become extensive and health threatening. There are only 13 dentists in Sonoma County who participate in Denti-Cal and can treat the 109,000 people covered by this program. Recent budget cuts to Medi-Cal have only made matters worse and now a 10 percent additional cut is looming. Sonoma County’s community health centers and dental clinics are left to pick up the slack, becoming the dental health safety net for both Medi-Cal patients

and the uninsured, yet there are only a few dentists in community clinics to provide more than 34,000 visits annually to both adults and children.

Tooth decay epidemic As a result, up to 10 percent of preschool children in Sonoma County currently suffer from early childhood caries in their primary teeth (also known as Baby Bottle Tooth Decay). Left untreated, this becomes pervasive dental disease that can damage a child’s physical health and social development. For many children, living with untreated cavities leads to further health and developmental problems. Chewing food, speaking, and even sitting still becomes increasingly challenging due to pain and social stigma. While older children may be able to express their discomfort, younger children living with undetectable dental pain often are not able to tell a parent or doctor what is wrong.

Lack of adequate insurance or any insurance, lack of access to care, poor dental hygiene, and poor nutrition either by choice or circumstance are all factors that contribute to tooth decay. Dental conditions that could have been prevented through regular dental visits turn into serious health issues requiring expensive surgical treatments to arrest the spread of decay. Sonoma County ranks in the bottom third of California counties (44th out of 58) for the number of children with dental insurance, limiting access to preventive care and creating a financial barrier for preventive dental visits. An almost unbelievable 52 percent of children in Santa Rosa alone have untreated cavities.

About the author: Sara Randall is the former Communications Director at PDI Surgery Center in Windsor. She graduated from Northern Arizona University and was named one of the North Bay Business Journal’s 40 Under 40 in 2012.

She serves on the Board of Directors for the Hispanic Chamber of Commerce.

Spring 2013 Pacific Health | 15

healthy oral enterprise health

Dental disease starts with bacteria in the mouth that metabolize the carbohydrates children eat. Acids eat away at the tooth’s surface, eventually creating cavities. Dental disease can be passed from one person to another through the spread of bacteria, most commonly from mothers to their unborn children. Left untreated, dental disease can become an uncontrolled infection that can spread to other parts of the body and even have fatal consequences in severe cases.

In 2007, a 12-year-old Maryland boy died after infection from an abscessed tooth spread to his brain. He had not received preventive dental care and his Medicaid coverage had lapsed. When he complained of a headache, he was treated at an emergency room for a tooth abscess and sinusitis—but it was too late. The infection had spread to his brain. Tragically, despite two brain surgeries, he died after six weeks of hospitalization.

All children with severe dental infections are at similar risk. In the United States, tooth decay is five times more common in children than asthma and seven times more common than hay fever. In 2000, the U.S. Surgeon General identified tooth decay as a “silent and national epidemic” in the landmark report “Oral Health in America.”

Local picture In Sonoma County, a countywide oral health assessment in 2009 found that almost half of kindergarteners and about 16 | Pacific Health Spring 2013

six out of every 10 of our third graders have experienced tooth decay, and over 16 percent of them have untreated decay. A three-year countywide assessment found: • 76 percent of children had documented tooth decay • 39 percent of children had untreated tooth decay • More than a third of the parents of those children screened reported cavities or pain in their children.

• Almost 10 percent of children screened needed urgent care in 2005 alone.

Equally as critical, tooth decay is statistically an indicator of a child’s future health.

It’s also difficult to imagine the crushing domino effect that poor dental health has on a child, even at such a young age. Decay breaks down a child’s overall foundation of health and continues to erode physical health and self-esteem into adulthood.

Again, statistics tell the story: • Children who suffer from untreated decay often have more sinus and ear infections.

• Dental decay is linked to serious health conditions later in life, such as heart problems, stroke, and diabetes.

• Children in oral pain or who suffer from extensive tooth loss tend not to eat enough nutritious foods, affecting their immune system and healthy growth.

• Suffering from discolored and decayed teeth can affect a child’s self esteem and increase shyness, delaying their social development.

Tooth decay even carries a financial impact to society. More than a half million California children miss at least one school day a year due to dental issues, costing the state more than $30 million annually.

According to the Surgeon General’s report, children miss more than 51 million hours of school due to dental problems.

Taking action One answer to this growing health crisis in Sonoma County is to increase access to dental care through public-private partnerships—one of several key recommendations made by the Sonoma County Task Force on Oral Health in 2011. Santa Rosa Community Health Centers is building a dental clinic, scheduled to open later in 2013, that will

provide 18,000 dental visits per year. This addition to the five existing dental clinics for the uninsured and Medi-Cal patients in the county will lead to faster care for both adults and children.

But because the severest cases of tooth decay require surgery under general anesthesia, often hospitals are the only source of treatment—and unfortunately, one of the most expensive sources. PDI Surgery Center in Sonoma County was started in 2008 to address this gap, becoming the nation’s only nonprofit surgery facility specializing in pediatric dental treatment. PDI treats children with severe decay, mainly under the age of seven, often suffering from as many as 11 cavities or more. With more than 400 children on a waiting list as soon as PDI opened its door, the surgery center expanded with a second operating room later that year to double capacity. PDI’s service area has now grown from three to 30 counties, more than half of the counties in

Tooth decay is statistically an indicator of a child's future health.

California. To date, PDI has treated more than 8,300 children with diverse cultures and various backgrounds. PDI continues to receive 20 or more referrals on a weekly basis.

“The good news is, when Santa Rosa Community Health Center’s dental clinic opens, access for children to receive preventable care increases, hopefully giving children dental care before they need major dental surgery,” says Viveka Rydell, Executive Director of PDI Surgery Center.

As PDI continues to focus solely on treating children with severe cases of dental disease, a growing number of community resources are working on connecting more adults as well as children to routine, preventive dental care, including: Sonoma County Oral Health Access Coalition, First 5 Sonoma County, Taskforce on Oral Health, Mighty Mouth, Mommy and Me, Women Infants and Children, and Redwood Community Health Coalition.

Expanding access to care is one of five key initiatives the Sonoma County Public Health Department is pursuing in partnership with

DEnTAL HEALTH these community organizations and programs to improve dental health. Other initiatives include providing dental sealants to school aged children, promoting the application of varnishes in infancy and childhood, and educating the public about the importance of good dental habits. The fifth initiative, fluoridating the public water supply, although seen as the most wide reaching solution to the dental decay epidemic from a public policy standpoint, is highly controversial. [Editor’s note: Sonoma County’s Public Health Officer had just published a report about this at press time for this issue of Pacific Health Magazine. See Water Fluoridation: A boost or a threat to public health on page 10.]

In Sonoma County, Dr. Katherine Foster, a retired pediatrician, is part of a medical group that spends time with primary care providers and pediatricians, teaching doctors that dental health is integral to overall health, and should be part of a child’s wellness visit. She is helping to bridge the gap between the medical and dental communities. Dr. Foster is also a member of PDI Surgery Center’s board of directors.

Additionally, pediatric dental health began receiving national attention in 2012: The Ad Council and 35 different leading dental organizations joined together to create a national dental ad campaign aimed at reminding parents to brush their child’s teeth for two minutes twice a day. This is the first ever ad campaign focused on dental health. The ads share the importance of preventive care and taking control of a child’s dental health.

An estimated three million children are expected to gain dental benefits by 2018 through state health insurance exchanges as part of the federal Affordable Care Act— roughly a 5 percent increase over the number of children with private benefits currently, according to a report by the American Dental Association. More than one million California children will be added to Medi-Cal by 2014 and even more children will benefit through the expansion of employersponsored dependent coverage with dental benefits, also as a direct result of federal health reform.

For more information on PDI Surgery Center or other community resources for children’s dental health, visit: pdisurgerycenter.org.

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InTEgrATIVE MEDICInE

Acupuncture: EAST Meets WEST Embodied Ancient practice yields evidence-based health outcomes

D

r. Bill Prange’s own introduction to acupuncture came about much the same way it happens for so many people: out of desperation for help and relief.

“I had contracted hepatitis while on vacation in Mexico, lost considerable weight and strength for several months, and was unable to work. My doctors assured me that my lab results had become normal and there was nothing to do but rest. I was exhausted and feeling desperate,” he recalls. “A friend referred me to acupuncture, and, while I was phobic about needles, I was willing to take a risk. Twenty minutes after my first acupuncture treatment, I had a profound appetite and knew my recovery had begun.”

Dr. Prange was so impressed by the acupuncturist’s use of simple, non-invasive tools both to diagnose and to stimulate healing, he decided to study acupuncture while in the midst of earning his doctorate in clinical psychology. “I was young, and I saw an incredible opportunity to help others with this ‘new’ medical profession that is actually more than 5,000 years old!” he says.

Dr. Prange began his formal study in 198, 18 | Pacific Health Spring 2013

just three years after the California Medical Board legalized acupuncture, earning a doctorate in oriental medicine. He became the first acupuncturist to obtain privileges in a public hospital in California when Petaluma Valley Hospital accepted him in 199. He has been in private practice for more than 30 years (see drprange.com) and has helped launch integrative medical programs for Kaiser Permanente, Sutter Hospital, and Blue Shield of California.

For decades, acupuncture belonged to the realm of “alternative medicine” in the United States, relative to what might be considered (rather ironically) “traditional” medical care. Yet since its initial regulation in 19, the number of acupuncture patients has continued to rise steadily and significantly every year, according to the National Institutes of Health. Currently, a coalition of acupuncture and oriental medicine associations, institutions, health care professionals, and individuals are petitioning the federal government to include acupuncture as an “essential health benefit” under the Affordable Care Act, based on acupuncture’s track record of success and unparalleled safety as a low-tech, non-invasive, cost-effective system of care.

The following conversation with Dr. Prange explores some of the history, philosophy, science, and evidence surrounding acupuncture and its ascendance within Western health care and culture.

InTEgrATIVE MEDICInE How does acupuncture work?

Acupuncture involves the insertion of thin, solid, sterile needles in various patterns and combinations around the body.

These needles may then be enhanced by electrical stimulation, manual stimulation, or warming. The pattern or arrangement of needles around the body is important, and is designed to address the underlying problem as seen through the oriental model: an elegant and well-designed system of diagnosis and treatment based on more than 5,000 years of continuous study.

While there are thousands of outcome studies assessing acupuncture’s benefits for a wide variety of medical conditions, acupuncture does not conform well to placebobased, double-blind studies (where none of the participants or researchers know which participants belong to the control group versus the test group) since it is difficult to create “sham” or fake acupuncture.

That being said, I believe the clinical benefit of acupuncture has been well established through conventional outcome studies.

What medical, physiological, or other principals is acupuncture based on?

The World Health Organization (WHO) produced a succinct summary on acupuncture in 1978, which still stands today. WHO identified 48 common medical conditions where acupuncture clearly demonstrated value. WHO stated that the main effect of acupuncture was due to “autonomic neural re-regulation,” which means that it stimulates the body to regain optimal balance between the fight or flight and rest and digest aspects of the nervous system.

Acupuncture may help the body let go of habituated stress patterns by stimulating specific reflexes throughout the body. My private practice is approximately one third supportive care for cancer (reduces side effects associated with chemo and radiation therapy and promotes recovery following treatment), one-third chronic pain, and one-third general medicine, which includes digestive issues, allergies, and sleep/mood disorders.

Is there evidenced-based data available on the effectiveness of acupuncture in the treatment of certain illnesses and conditions?

A great preponderance of clinical research indicates that acupuncture clearly works.

How often it works, how it works, and how to best study acupuncture are difficult questions. Scientifically measured effects occurring during acupuncture treatments on human and animal subjects include the following: • Reduction of pain through stimulation of endogenous opioid and monoamine systems (the body’s natural painrelieving systems).

• Increased blood fl ow and relaxation of smooth muscles through prostaglandin production.

• Vasodilation, rise in skin temperature.

• Elevated blood cortisol levels by stimulating adrenal response.

• Decrease in elevated cholesterol and phospholipids.

• Reduction of infl ammation through increased phagocytic and fibrinolytic activity; increased beta-globulins; impairment of leukocyte adherence to vascular cells.

• Decrease in blood pressure.

Likely mechanisms for the effects of acupuncture in western terminology include nerve conduction, circulation, the lymphatic system, electromagnetic flow through fascial planes, and interstitial fluid. Electric current has been measured along meridians not overlying single nerve trunks or muscle

A great preponderance of clinical research indicates that acupuncture clearly works. groups. Chinese medicine has more than 5,000 years of continuous study with its own view of factors affecting circulation of blood, lymph, and energy that is the basis of health.

Animal and human laboratory and clinical experience suggest that the majority of subjects respond to acupuncture, according to the National Institutes of Health.

Based on selected studies of acupuncture considered to have sufficient data, the NIH Office of Complementary and Alternative Medicine (CAM) has concluded there is clear evidence that needle acupuncture is efficacious for adult postoperative pain, chemotherapy nausea and vomiting, and probably for the nausea of pregnancy and for post-operative dental pain. There are

reasonable studies showing relief of pain with acupuncture on such diverse conditions as menstrual cramps, tennis elbow, myofascial (muscle) pain, and fibromyalgia.

In addition, ample clinical experience, supported by some research data, suggests that acupuncture may be a reasonable option for a number of clinical conditions.

Examples are postoperative pain and low back pain. Journals of oriental medicine always list current research publications.

Recent journals have described positive outcome studies specific to fertility, neuropathy, TMJ, Parkinson’s disease, dermatitis, and carpal tunnel, to name a few.

While acupuncture may have limited value in curing a progressed disease or significant injury, it may, however, serve an adjunctive role in several of these conditions by improving quality of life, reducing pain, and potentially improving immune status.

Acupuncture treatment may be useful in difficult conditions such as asthenic states (tired all the time, low energy), autonomic dysregulation disorders (anxiety, sleep disturbance, bowel dysfunction), and immune dysregulation disorders (recurrent infections and inflammations). In this way, acupuncture embodies its traditional role of improving health rather than treating disease, and can function well within a medically supervised program integrating prescriptive medications, physical therapy, and other tools of western medicine.

Why does it work?

The central issue, from the classical Chinese medical point of view, is not why acupuncture works, but rather how and when to use it. There are acupuncture traditions from China, Korea, Japan, and Europe all based on 5,000-year-old Chinese medical tradition. The dynamic balance that Chinese medicine equates with health manifests as the smooth and constant movement of blood, lymph, and energy (Qi).

When Qi, blood, or lymph stagnates, the processes of elimination and regeneration deteriorate, creating the basic condition underlying many forms of illness. The oriental model of health also embraces “shen” or “spirit,” which describes how thoughts and feelings live and move within our bodies. In fact, the Chinese did not separate mind and body. Their time-tested language of a holistic mind-body is precise, based on observation and touch.

Spring 2013 Pacific Health | 19

InTEgrATIVE MEDICInE Acupuncture accesses a series of energy flow pathways called meridians that traverse the body. These meridians frequently run in the clefts between muscle groups containing fascial layers, blood vessels, and neurovascular bundles. The acupuncture needle enters the meridian, activating or inhibiting the flow of Qi. Fourteen major pathways traverse the body from the top of the head to the tips of the fingers and toes. Many principal acupuncture points are located below the elbow and knee, where the Qi changes its polarity from Yin to Yang (negative to positive) and gathers force as it moves from the extremities toward the core. By eliminating congestion and activating circulation of Qi, acupuncture interrupts and reorganizes patterns of illness.

A western model of acupuncture incorporates a modern understanding of neuroanatomy within the classical Chinese model. Needles are placed in muscular trigger points, or motor points, of muscles to cause lengthening of the muscle and reduction of pain. They may also be placed in a segmental pattern along the spine to correspond with radicular symptoms of the extremities (that is, pain that radiates along nerves). An excellent knowledge of anatomy and physiology is required to practice acupuncture.

Describe a “typical” treatment session.

An acupuncturist takes a thorough patient history including diet, exercise, sleep patterns, daily stress, and concurrent medical treatment. Acupuncturists may then assess factors contributing to a patient’s health through physical examination, which may include palpation of pulses in the wrist and abdomen, identifying tender points throughout the body, and observing color of the face and tongue. Acupuncturists are interested in syndromes that organize patterns of symptoms rather than focusing on an identified disease or injury. For example, improving sleep and digestion may help someone recover from low back pain. Whereas western medicine prescribes a separate drug for each symptom, oriental medicine may offer one treatment that addresses many symptoms.

Needles are then inserted in a specific pattern and retained from one to 20 minutes, depending on the technique. A second series of needles may also be applied.

After acupuncture, the patient may receive 20 | Pacific Health Spring 2013

medicinal herbs or supplements, learn energy exercises (Qi Gong), or review dietary and lifestyle guidelines. It may take three to six visits before the practitioner is able to prescribe a course of treatment. Many patients receive a total of six to 12 treatments. Patients’ responses vary considerably, depending upon the severity of their symptoms.

The diagnostic language of oriental medicine frequently affirms the patient’s experience of how their illness feels. Unlike clinical laboratory results, oriental medicine describes the location where one may feel hot or cold, wet or dry, empty or full, tight or weak, etc. Patients usually feel deeply relaxed and may sleep during a treatment. After insertion of acupuncture needles, patients usually feel a few minutes of enhanced

The diagnostic language of oriental medicine frequently affirms the patient’s experience of how their illness feels. alertness followed by an extended period of deep relaxation. It is not unusual for a patient to experience profound rest both during and after treatment, with increased vitality the following day. While there are different schools and styles of acupuncture, the focus is the same: to help the body heal itself.

Are there any adverse side effects associated with acupuncture treatment?

The National Institutes of Health Consensus Statement on Acupuncture written in 1997 noted that one of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions.

Painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both of these have a potential for negative side effects, but are still widely used and are considered acceptable treatments. The incidence of medical malpractice among acupuncture

practitioners is below most health specialties, and is reflected in relatively low malpractice premiums.

What education, training, licensing, etc. is available and/or required to practice acupuncture?

A licensed acupuncturist (LAc) completes premedical prerequisites before entering 3,000 hours of formal study, which typically takes three to four years, and successfully passes a licensing exam. Some acupuncture schools require a bachelor’s degree for admission. While most acupuncturists are generalists, post-graduate studies are available in many specialties, including herbology, orthopedics, fertility, women’s health, sports medicine, and pediatrics.

While most acupuncturists work in private practice or in association with medical doctors or chiropractors, there are now more than 180 community acupuncture clinics in the United States where patients receive acupuncture in a group room while sitting in a reclining chair. This allows people to access low-fee treatments, which are particularly relevant for stress related disorders and addiction recovery.

What licensing or oversight body oversees the practice of acupuncture?

Acupuncture regulation is determined on a state by state basis, with California having some of the most stringent educational and licensing requirements in the nation. Acupuncture was first licensed as a medical practice in California in 1978. It is regulated by the California Acupuncture Board, which serves under the California Medical Board. Acupuncturists (LAcs) in California are licensed to diagnose, treat, and contract with insurances without a medical doctor's referral. California medical law allows acupuncturists to engage in the practice of acupuncture, electro-acupuncture, perform or prescribe the use of oriental massage, acupressure, moxibustion (a traditional Chinese medicine therapy using dried mugwort to stimulate circulation through acupuncture points), cupping (creating suction to promote blood flow), breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.

InTEgrATIVE MEDICInE How does a Doctor of Oriental Medicine compare to an MD? The OMD degree (Doctor of Oriental Medicine) and the DAOM (Doctor of Acupuncture and Oriental Medicine) are academic degrees that require significant postgraduate study of both oriental and western medicines – but does not expand the scope of practice beyond the LAc license, which excludes prescriptive medication and surgery. The MD has a much more rigorous study of science and western medical diagnostic techniques, and the scope of practice includes prescriptive medicine, surgery, and procedures within their area of specialty. In addition, the MD carries a heightened burden of defensible diagnosis.

Medical doctors, dentists, and podiatrists are also allowed to practice acupuncture after completing training as defined by their medical boards.

How would you characterize the western medical establishment’s regard for acupuncture? Has this changed over time while you’ve been in practice?

I personally see many more physicians as patients now than 10 years ago, and find that referring physicians have become more interested in my assessment. In 2000, more than 1,700 medical doctors in the US belonged to the professional association for medical acupuncture, with perhaps 3,500 physicians practicing acupuncture to some extent. Today, doctors are becoming familiar with acupuncture and acupuncturists, and, regardless of their understanding, the value of acupuncture is becoming apparent.

When I was studying to become an acupuncturist, many students had medical backgrounds, including several dentists and nurses who wanted to work with health and healing, rather than focusing on treatment of symptoms. The average student age was 40, equally divided between males and females. Today, more than 80 percent of acupuncture students are women, the average age is 32, and many are entering their first professional career. California now leads the nation with more than 12,000 practitioners.

What is the status of insurance coverage for acupuncture? Has this changed during the time you’ve been in practice?

Private insurance companies now offer policies that provide for acupuncture, as do

most HMOs. Medicare, however, still does not cover acupuncture. Most acupuncture offices operate on a cash basis, providing receipts that clients can submit for reimbursement. Insurance carriers were much more personal in the 1980s and 1990s, but I think this is generally true for most medical providers in private practice. Twenty years ago, I would call an insurance company and speak with a claims examiner who would prescribe a course of eight or ten treatments based on the patient’s condition. I would call or submit a summary of response after six treatments, and we would agree to a reasonable course of care. Today, it can be difficult to submit the right procedural and diagnostic codes and documentation to obtain payment. That being said, it is my impression that personal injury insurances and workers compensation insurance are pleased with the cost/benefit of acupuncture.

I am not sure how acupuncture will be defined within the Affordable Care Act. Acupuncture is not viewed as an essential service, and acupuncturists are not included within the health care workforce. Unfortunately, I anticipate inclusion of acupuncture may be contingent upon requiring a physician’s referral required prior to receiving care, which would remove the independent status of acupuncturists.

What are some of the biggest misconceptions you encounter about acupuncture?

New patients often think that the acupuncture needles, by themselves, will create the desired effect, similar to the effect of pain medication doing something to them.

However, acupuncture stimulates a homeostatic response in which the body relaxes, releases tension, and restores health. People are also surprised at how little acupuncture hurts, very different than hypodermic needles, and how peaceful they feel during the treatment.

Common Medical Conditions Helped by Acupuncture Addictions Allergies Anxiety Arthritis Asthma Bone Pain Cancer Support Colds and Flu Diabetes Depression Digestive Disorders Diarrhea Dizziness Fatigue Fertility gErD Headaches High Blood Pressure IBS (Irritable Bowel Syndrome) Immunity Infertility Migraines Menopause nerve Pain Acute and Chronic Pain PMS (Pre-menstrual Syndrome) Prostatitis PTSD (Post Traumatic Stress Disorder) Sciatica Shoulder Pain Sinusitis Sore Throat Smoking Cessation Sports Injuries TMJ Women’s Health Source: World Health Organization

Spring 2013 Pacific Health | 21

healthy aging

Rabbit Stew

Reconnecting With Your Inner (Younger) Athlete

By Jim Devore

B

The Rabbit Stew Boys L to R: John DeVore, Kent Beasley, Jim DeVore, Lad Allen, Mel Peterson, and Steve Bell

oys, you can’t have rabbit stew without the rabbits.”

That’s how our wizened and iconic coach, who was known for his quirky locker room talks, concluded his pep talk at our first practice. That was 1966, my senior year on the high school basketball team. I remember that moment as though it was yesterday. And so many more moments. The pep band blaring the theme to “Peter Gunn” as our Lancer team blasted onto the court, the raucous crowd, the pure adrenalin of going against the cross-town rival, the raw fitness of youth, the infrequent but always beautiful floating 15-foot jump shot that ripped the net, and, of course, my teammates, some of whom would remain lifelong friends.

That’s nice, you might say. We all have fond memories of days gone by. But get over it. You can’t recapture your youth.

You’re 63 years old. To that I say, “Really?”

When I first heard of something called the Senior Games coming to town and that there would be a three-on-three basketball tournament, I took less than 30 minutes to commit. I had not played competitively for 45 years, had absolutely no flexibility or speed, could barely touch the net—let alone dunk —and could only dream about nailing a 15-foot jumper. Perfect.

All it took was two calls and a trip to the sporting goods store and team “Rabbit Stew” was born. My brother, who was one year ahead of me in school, was a great athlete and could shoot lights out. He was all in. Check. My best friend and

22 | Pacific Health Spring 2013

teammate was a lot grayer but never one to shy away from a physical challenge. Check. Time to get some gear.

The young clerk could barely hold his smirk in check as he rang up my shiny new Michael Jordan Signature high tops and NBA Pro basketball. I was stoked. Just like the old days, I casually spun the round ball on my index finger in a cocky show of dexterity. Unlike the old days, the ball careened out of control and wiped out the entire bobble-head display on the counter. Time to start practicing.

It’s not impossible to prepare for an athletic event after a four decade lay-off. It just requires training and consistency … and a lot of embarrassment. My program would consist of a series of small steps, each pushing me to a higher level of hoops fitness and skill. With my competitive juices starting to flow, my first task was teaching the two nine-year-old neighbor kids on my cul de sac a lesson. This really didn’t go well. The fact that they were barefoot and two feet shorter than me didn’t help my self-esteem as my errant shots bounced off a minivan parked nearby while the little twerps knocked down 3-pointers from outside the manhole cover right and left. Hey, nobody said it would be easy!

It took about four months of training, shooting and playing for me to feel ready. What didn’t take long was finding a number of basketball venues for practice. After a few weeks of shooting in the streets, I moved up to a neighborhood playground and eventually to some pick-up games at the

HEALTHy AgIng

Dr. Devore drives the ball past an opponent

YMCA and a local high school gym. I’ll be honest: this was tough. Early on, there was anxiety and much self-doubt when I started playing indoors. What am I doing trying to play full court with these young guys? But after a while, little by little I found myself running the floor like a real player. As one young smart aleck put it, “You are starting to suck less and less.” Gee thanks. But he was right. Like all pick-up games in every playground and every gym across America, there are unwritten rules for how teams are formed. There was one unforgettable moment back then when the guys were choosing sides: I was not picked last! With the theme from “Rocky” blaring in my head, I was thrilled. I was becoming a basketball player again.

So I’ve come up with five amazing and useful tips for any “senior” who wants to reconnect with his or her inner-athlete: Go for it. No matter how old you are or what condition you are in, you’d be amazed how your body will respond to training.

Imagine yourself getting strong and fit and lean and rippled with muscles and … well, maybe that is going too far but you absolutely can do this. Giddyup!

Pick a goal. Think of something that seems out of reach and make the commitment.

Just because you are getting older does NOT mean you can’t do something previously unimagined. Maybe your goal is as simple a walking around Spring Lake or perhaps a community 5k. Maybe it’s the “Pickleball” event in the Senior Games (whatever that is). Maybe it’s summiting Bald Mountain or Shasta or Half Dome. Try a short triathlon?

Getting out of the cart and walking 18 holes perhaps? Go for it.

Do it with a group. There is great joy in preparing for something exciting with buddies. The camaraderie and experiences you will share on your epic quest will help you keep motivated and moving forward.

Let’s be honest. There will be low points in your training when you are tired and sore and maybe even dejected. Sharing the tough moments with training partners will produce experiences and stories and friendships that last forever. Trust me on this, it’s true.

The pursuit of your chosen challenge will reward you with every bit as much excitement, exhilaration, and glory as you ever had in the old days. Yes, you are more mature but that does not mean you must sit back and get complacent. We all have more aches and pains and injuries and physical limitations to manage. Clearly you must pick a challenge that is possible given your medical condition. But don’t sell yourself short. You are capable of doing something big and amazing and yes, epic!

Here is the key to it all: always remember, “You can’t have rabbit stew without the rabbits.” * The 2012 Senior Games Basketball Tournament was held at Santa Rosa Junior College. Each team played in five-year age divisions, starting at age 50-55 all the way up to the over 75 division. It was an amazing and glorious thing to see the gym packed with competitors in colorful team uniforms, hard fought battles in every corner, and to hear the familiar sounds of refs and whistles and cheers and groans. There were rough words, intricate displays of teamwork, great athletic

plays, sloppy ball handling, bodies flying, and mad scrambles on the hardwood. And when it was over, there were exhausted, sweat-soaked, good-natured winners and losers, along with a few bad ones – just like after any basketball game. Yes, it all happened a little slower than in 1966 but this was real, intense, and very, very exciting.

For the record, the Rabbit Stew boys came in a disappointing third place. Here are our team stats: Muscle strains –  Hematomas –  nasty,  small Broken toes –  Ace wraps used –  Smiles & laughs – too numerous to count We hope to do better in all categories in this year’s tournament. ( * The author admits that the exact meaning of the famous “Rabbit Stew” quote is not completely agreed upon by his teammates.

He welcomes you to contemplate this further by email at James.Devore@stjoe.org.)

Learn more about the 2013 Wine Country Senior Games May 30-June 9 at winecountrygames.com

Dr. DeVore with future team recruit (and grandson)

About the author: Jim deVore, md is a family physician practicing in Santa Rosa since 1980 and is medical director of Annadel Medical Group. He is the author of White Coat Wrinkle, a book about the doctor-patient relationship. He has competed in marathons and triathlons for many years and continues to run the trails of Annadel State Park regularly with a group of buddies. By his own admission he is known for cajoling his friends and family into “one hare-brained adventure” after another. Most recently this has included backpacking along the Continental Divide in Colorado and in a remote section of the Mohave Desert. On his 60th birthday, he stood atop the Grand Tetons. Dr. DeVore has been married to his very patient and understanding wife (Sori) for 40 years who he hopes won’t be upset when she finds out his next big plan.

See, there’s this very big mountain in Africa and …

Spring 2013 Pacific Health | 23

MAkIng A DIFFErEnCE

Holistic nutrition Comes of Age Holistic Nutrition: A -Year Review with a Glimpse Forward Eating a yummy homemade dinner—such as a spring greens salad with a lemon artichoke heart dressing, fresh caught wild salmon with backyard dill and thyme sauce, and baked yam topped with yogurt and nutmeg—is an example of eating local, whole, fresh, colorful foods, ideally grown in soil enriched with manure and compost rather than fertilizer and pesticides. Sadly, current generations have not grown up eating real food grown and prepared the old-fashioned way. They’ve grown up in the midst of a culture littered with soda, Frosted Flakes®, cheeseburgers, French fries, and fake foods.

In 1989, when George H.W. Bush was president and Madonna was at the top of the charts, holistic nutrition was thought of as a quaint throwback to the days of our grandparents—a time when dinner was cooked from scratch instead of pulled out of the freezer, ready to heat n’ eat.

Let’s look at changes in our food supply in the past 20+ years that have contributed to the rise in obesity, diabetes, and premature,

D

R. ED BAUMAN, MEd, PhD, is the founder and president of Bauman College: Holistic Nutrition and Culinary Arts, located in Penngrove, right on the threshold of Northern California Wine Country. After studying traditional health and nutrition systems for more than  years, Bauman developed a model for holistic nutrition he calls Eating for Health (“It’s not another diet!”), an approach to nutrition and health that raises awareness about types and sources of foods, as well as eating habits.

Bauman has spent his entire career “exploring, tasting, learning and teaching about culturally diverse, delicious traditional healing foods.”

He started out as an organic farmer, then organized a food coop and opened a natural food restaurant in western Massachusetts, where he began teaching cooking from scratch. He came to California and founded Bauman College in , looking to create a sustainable culture of wellness within individuals, communities, and health care delivery systems. The state licensed vocational school promotes a comprehensive and integrative approach to holistic nutrition

24 | Pacific Health Spring 2013

chronic illness as well as three commercial nutrition food trends and the holistic nutrition counter points.

Trend #: Hidden Calories By 2009, US farmers were producing 3,900 calories a day more than they grew in the 1980s from corn, soy, and wheat. As farmers produced extra calories, the food industry figured out how to get them into the bodies of people who didn’t really want to eat 700 more calories a day than before.

Most of those calories enter our mouths in ready-to-eat foods with processed corn and soybeans, vegetable oil, and high-fructose corn syrup.6 Corn contributes 554 calories a day to America’s per capita food supply, and soy another 257. Add wheat (768 calories) and rice (91 calories) and you can see there isn’t a whole lot of room left in the American stomach for any other foods.8 About a third of all our calories now come from what is known, by common consent, as junk food.6 Eating foods with more calories and less nutrients is a recipe for fatigue, weight gain, and blood sugar instability. and culinary arts by training and preparing individuals for careers as Nutrition Consultants, and Natural Chefs. Bauman is also the President of the Board of Directors of the Palm Drive Health Care Foundation.

Bauman has long asserted the need to shift to organic, non-genetically-modified, whole foods. However, he cautions, because each person has unique genetic tendencies, needs, tastes, and tolerances, one size does not fit all when it comes to proper nourishment. People need differing amounts of healthful foods and nutrients to achieve optimal wellness in a fast paced, stress-filled, toxic world. Similarly, our individual metabolisms must continually adapt to changes in seasons, situations, climate, health, and age. For example, Bauman notes, the nutrient depleted Standard American Diet that many of us ate as children will not nourish us sufficiently as aging adults to protect us from diet and lifestyle related preventable illness.

This article is adapted from Nutrition Essentials for Everyone (), a Bauman College workbook Bauman and colleague Jodi Friedlander, MS, NC, developed to accompany an evidence-based, whole food community course. that Bauman believes would be a terrific addition to patient education in clinics, hospitals, and even as an online resource to help reduce medical costs and improve health outcomes.

making a difference

Trend #2: Plant Species Vanishing from Our Food “Humans have eaten some 80,000 plant species in our history. After recent precipitous changes, three-quarters of all human food now comes from just eight species, with the field quickly narrowing down to genetically modified corn, soy, and canola.” 6 “Garden seed inventories show that while about 5,000 non-hybrid vegetable varieties were available from catalogs in 1981, the number in 1998 was down to 600.” 6 The loss of plant varieties affects us in several ways. Large corporations own the seeds that grow the plants that most people eat. These are altered to create greater crop yields, greater shelf life, and to be more pest resistant. This may sound good, but often these plants are less tasty, less juicy, and are more allergenic. As a backyard gardener, I love to grow heirloom fruits and vegetables that are native to my region and are far more delicious and nutritious than lifeless commercial varieties. Compare a home grown, heirloom tomato or Gravenstein apple to an import. The native varieties win hands down. More plant choice widens our taste, appreciation, and desire to cook rather than be cooked for.

Trend #3: Diet-Disease Connection Today, heart disease causes at least 40 percent of all US deaths. During the 60-year period from 1910 to 1970, the proportion of traditional animal fat in the American diet declined from 83 percent to 62 percent, and butter consumption plummeted from 18 pounds per person to four per year. During the same period the percentage of dietary vegetable oils in the form of margarine, shortening, and refined oils increased about 400 percent while the consumption of sugar and processed foods increased about 60 percent since the 1950’s when our parents started feeding us food products rather than whole food.5 “An American born in 2000 has a 1 in 3 chance of developing diabetes in his lifetime; the risk is even greater for a Hispanic or African American. A diagnosis of diabetes subtracts roughly 12 years from one’s life and living with the condition incurs costs of $13,000 a year.” 9

Evidence and Approaches Over the past 20 years, published research

increasingly demonstrates that food is the primary promoter of health and the main protector from disease. This has given the public and the medical profession a muchneeded wake up call. In 1990, Dr. Dean Ornish published findings in The Lancet, the leading medical journal in the United Kingdom that a low fat, vegetarian diet, combined with yoga and emotional support, reversed cardiovascular disease in 84 percent of participants who followed his program for one year. T. Colin Campbell of Cornell University reported the first batch of results from a large study in China that noted urbanites, who ate a diet higher in saturated fats and animal protein, had higher incidences of mortality and morbidity than rural people, who ate a plantbased diet with limited amounts of animal protein.

Diet programs have grown like mushrooms on a damp and shady log. For weight loss, Dr. Robert Atkins promoted a high protein, low carbohydrate, low-calorie diet, augmented with an array of dietary supplements, known as the Atkins Diet. Dr. Barry Sears introduced the Zone Diet, while the concept of food combining was widely touted by Harvey and Marilyn Diamond in their book, Fit for Life. The Blood Typing Diet, put forth by Dr. Peter D’Amato, suggested which foods to eat or avoid, depending one’s blood type O, A, B, or AB. Conflicting evidence during this time proved confusing to consumers and health providers. In the past 20 years, diet wars have been launched and persist, whereby proponents jockey for market share and ideological supremacy through books and nutrient programs. Beyond the hubbub of these debates, however, is one common denominator: people needed to eat more fresh whole foods and minimize their intake of processed and refined foods. This consensus pre-dated author Michael Pollan’s concise dictum: “Eat food. Not too much. Mostly plants.”8 The dietary supplement industry has grown in the past 20 years and is now showing signs of change as products are available online, at convenience stores, in grocery stores, and through health care professionals.

Certified Nutrition Consultants and Natural Chefs provide individual guidance for consumers who seek to identify needs

and make cost-effective diet and lifestyle decisions to restore balance. Food is the foundation, while herbs and supplements work best to deal with special needs and health issues. Attitude is the crown of creating and maintaining healthy habits.

The following are elements of Holistic Nutrition.

Farmers’ markets have been the brightest star on the holistic nutrition, whole food, and sustainable agriculture horizon. Following the passage of the Farmer-to-Consumer Direct Marketing Act of 1976, active U.S. farmers’ markets have grown from about 350 to well over 3,500 today, or an average of 75 per state. 6 Buying food out of doors, in the midst of a market place with growers standing proudly behind the fruits of their labor, brings the message of people, food, culture, and community together in a vibrant way that is fun, healthy, and socially uplifting.

Organic standards have been carefully hammered out, only to be watered down by large stakeholders in the food and farming business.

“The paper trail of organic standards offers only limited guarantees to the consumer. Specifically, it certifies that vegetables were grown without genetic engineering or broadly toxic chemical herbicides or pesticides; animals were not given growth-promoting hormones or antibiotics. ‘Certified organic’ does not necessarily mean sustainably grown, worker-friendly, fuel-efficient, cruelty-free, or any other virtue a consumer might wish for.” 6 Sustainable Nutrition—In January 2010, Michael Pollen was on the Oprah Winfrey Show discussing the whole foods movement and explaining how the overconsumption of processed food is a detriment to health and ecology. Increasingly, consumers are reading labels, eschewing food chemicals, and spending their food money at farmers’ markets. The success of Whole Foods Markets® around the country, for example, proves that a viable market for an organic alternative exists. There is also a burgeoning interest in organic farms, backyard gardens, food co-ops, slow foods, and home cooking. Consumers are calling for reasonably priced, local, seasonal, and fresh foods. This collective power is opening the way for fast food restaurants, such as Wendy’s®, to emphasize fresh, never frozen burgers and salads. Retailers such as Spring 2013 Pacific Health | 25

making a difference Costco®, Wal-Mart®, and grocery chains are stocking organic food with labels that state where the food came from. This also creates a conflict among shoppers. Should they buy cheaper organic foods at a super store, or support their community farmers? Holistic nutrition advocates supporting small local farmers when possible, lest they disappear like the birds and the bees that once buzzed and chirped in our back yards.

Local food adds value and leaves a lighter carbon footprint than conventional food shipped 1,500 miles to market. Holistic nutrition is evolving into sustainable nutrition, where people make diet and lifestyle choices that are good for the economy, ecology, and their health. Shopping for value rather than price and convenience shows a new level of awareness and social responsibility.

What’s Ahead Whole food nutrition is making in-roads into the mainstream and exceeding the growth of commercial foods. Public schools in California and across the country were

26 | Pacific Health Spring 2013

mandated to implement nutrition and physical activity programs by 2010. Nonnutritive sugar—such as diet sodas and candy—are being removed from growing numbers of schools. The Garden to School movement is taking off across the country, with farmers contracting to grow organic food for the schools and children seeing once again that their food comes from a garden or pasture, not a supermarket or feedlot. In this way, children are learning about holistic nutrition.

A local, sustainable culture of renewal is underway, fed by the desire by many to recover a natural vitality in food that had been lost. I am glad that the seeds planted over 20 years ago, tended by committed human beings, have led to the change in the awareness and behavior we are witnessing today. As more people understand that good nutrition is not a diet fad or magic bullet, Eating for Health will be one way to bring us back to health.

For more information: baumancollege.org

References: 1. Atkins, R. (2002). Dr. Atkins’ New Diet Revolution, Revised Edition. New York: M. Evans and Company 2. Campbell T C. et al. (2006). The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health. Dallas: Texas, Ben Bella Books, Inc. 3. D’Adamo, P. and Whitney, C. (1996). Eat Right 4 Your Type: The Individualized Diet Solution to Staying Healthy, Living Longer and Achieving Your Ideal Weight. NY: GP Putnum’s Sons.

4. Diamond, H and Diamond, M. (1987). Fit for Life.

Springfield, Illinois: Charles C. Thomas Publisher.

5. Fallon, S. (1999). Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats. Washington, DC: New Trends Publishing.

6. Kingsolver, B, Kingsolver, C and Hopp, S. (2009).

Animal, Vegetable, Miracle: A Year of Food Life (P.S.). NY: Harper Collins, Publishing 7. Ornish, D. (1990). “Can You Prevent—And Reverse— CAD?”, The Lancet, 336, 129-133.

8. Pollan, M. (2009). In Defense of Food: An Eater’s Manifesto. NY: Penguin Publishing, 9. Pollan, M. (2007). The Omnivore’s Dilemma: A Natural History of Four Meals. NY: Penguin Publishing, 10. Sears, B. (1995). The Zone: A Dietary Road Map to Lose Weight Permanently: Reset Your Genetic Code: Prevent Disease: Achieve Maximum Physical Performance. NY: Harper Collins, Publishing 11. Ungoed-Thomas, Jon. The Sunday Times, London, October 28, 2007. Retrieved from http://www.timesonline.co.uk

nUTrITIOn & HEALTH

For Physicians: HEALTHY EATING Supports Wellness & Prevents Disease

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elping patients understand and embrace good nutrition from healthy food sources represents one of the most proactive and cost-effective interventions physicians can incorporate to improve outcomes. The following are Dr. Ed Bauman’s recommendations for physicians: Become better educated about the difference between S.O.U.L. (seasonal, organic, unrefined, and local) food and food that is conventionally grown and nutritionally compromised from seed to table.

Be aware of how a whole foods approach to nutrition such as Eating for Health differs from the USDA food pyramid and the Academy of Nutrition and Dietetics MyPlate model. Eating for Health emphasizes fresh, local, natural, organic (when possible) whole foods. MyPlate does not distinguish between natural, whole foods and packaged, refined foods. Dietetic menus in institutional settings tend to rely on refined foods to feed patients based upon heart, lung, and cancer association standards.

The Academy of Nutrition and Dietetics (formerly the American Dietetics Association) endorses enriched foods, calling these “functional foods” or “medical foods.” Even ice cream can qualify now by adding folic acid or probiotics or fiber. Whole food nutrition advocates getting nutrients from plants grown in pesticide-free soil and optimal conditions. Healthy eating is plant-based, fresh, natural, and best when homemade. doctors can work hand-in-hand with certified nutrition consultants or registered dietitians to teach patients how to improve their diets, lifestyles, and attitudes. However, giving healthy eating advice is less effective without also engaging patients and their significant others with follow up support. In group settings, for example, patients retain more and benefit most through social learning. They have time to ask questions and gain a better understanding of what they can do to live longer and feel better, particularly in conjunction with their medical regimens.

Since costs associated with chronic illness are second only to military expenditures in this country, physicians can directly impact health care costs by supporting their patients’ ability to make healthier dietary choices.

Patients—and even health providers themselves—may still choose processed, adulterated or junk foods but they cannot claim ignorance about the consequences. Handson food demonstrations, with samples of simple healthy meals and snacks awaken people’s innate appreciation for real food and remind them what they have been missing if they regularly eat pizza, burgers, and take-out food.

By combining healthy eating and medicine under the same roof, patients can receive cutting-edge, preventive medical care and evidence-based health education. Dr.

Dean Ornish has validated this approach through a series of scientific studies at the Preventive Medicine Research Institute, demonstrating that integrative changes in diet and lifestyle can: • Reverse heart disease • “Turn on” health-promoting genes and “turn off ” disease-promoting genes • Lengthen telomeres, the ends of chromosomes that control aging • Slow, stop, or reverse the progression of earlystage prostate cancer • Support heart and prostate health programs.

Bauman College offers activity-based, nutritional wellness programs that can be designed and implemented at hospitals, businesses, senior centers, and assisted living facilities to bring affordable nutrition information to lowincome, under-nourished, and chronically ill adults and families. People love learning how to eat well on a few dollars day and enjoy their favorite ethnic dishes made without excess calories or food additives.

Sources: http://www.pmri.org/research.html • Bauman, E and Friedlander, J. Nutrition Essentials for Everyone.

Bauman College Press. Penngrove, CA 

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nUTrITIOn & HEALTH

Eating for Health™ Guidelines

tips on eating for Health . Increase intake of local, seasonal, fresh, organic foods. . Drink plenty of purified water each day, about / cup ( ounces) every hour. To determine the total amount you need, divide your weight in half and drink that many ounces of water. . Read labels and avoid foods with artificial ingredients. . Decrease intake of refined and artificial sugars, white flour products, unnatural fats, added hormones, preservatives, colors, and antibiotics. . Diversify sources of proteins, fats, and carbohydrates. . Ingest  gram of protein per kilogram (. lbs.) of normal body weight. . Eat protein by ten in the morning and - more times during the day. . Eat protein to curb sugar cravings. . Minimize caffeine intake to mg or less ( cup black tea,  cups green tea, or / cup coffee or espresso). . Eat more monounsaturated fat (olives, avocados, almonds) than saturated fat (animal, dairy, coconuts) or polyunsaturated oils (soy, corn, sunflower). . Decrease consumption of glutinous grains (wheat, rye, oats, barley) to prevent digestive disturbance and inflammation. © Bauman College. Reprinted with permission.

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. Increase consumption of gluten-free grains (rice, corn, millet, quinoa, buckwheat, amaranth), which are mineral rich and easy to digest. . Increase consumption of leafy (e.g. kale), crunchy (e.g. broccoli) and starchy (e.g. yam) vegetables to provide abundant minerals. . Eat three portions of vegetables in a meal to  serving of protein and  serving of fat for pH balance. . If body temperature is cold, eat more proteins, essential fatty acids, seaweeds, and warming spices such as ginger and cayenne. . If body temperature is warm, eat more cooling foods, such as fruits, vegetables, and green herbal teas and spices like mint, rosemary, lemongrass, and rooibos. . Determine a diet direction according to your metabolic tendency: building if metabolism is fast, cleansing if metabolism is slow, or balanced if metabolism is neither fast nor slow. . Add booster foods to the diet to increase energy, detoxification, and antioxidant activity. . Undertake a simplified diet or fasting program seasonally, including colon cleansing and increased spiritual practice. . Enjoy your food and let others eat in peace.

nUTrITIOn & HEALTH

it’s official now:

organic really is Better The biggest study into organic food found that it is more nutritious than ordinary produce and may help to lengthen people’s lives.

The evidence from a four-year European study led by Newcastle University, still the largest such study to date, ended years of debate and is likely to overturn government advice that eating organic food is nothing more than a lifestyle choice. The study found that organic fruit and vegetables contain as much as  percent more antioxidants, which scientists believe can cut the risk of cancer and heart disease, our biggest killers. They also had higher levels of beneficial minerals such as iron and zinc.

Researchers grew fruit and vegetables and reared cattle on adjacent organic and nonorganic sites on a -acre farm attached to Newcastle University, and at other sites in Europe. They found that levels of antioxidants in milk from organic herds were up to  percent higher than in milk from conventional herds.

As well as finding up to  percent more antioxidants in organic vegetables, researchers also found that organic tomatoes from Greece had significantly higher levels of antioxidants, including flavonoids thought to reduce coronary heart disease.

In , a -year study by the University of California comparing organic tomatoes with those grown conventionally found double the level of flavonoids—a type of antioxidant thought to reduce the risk of heart disease. Other studies show organic milk having higher levels of omega- fatty acids, thought to boost health.

Like other studies, the results show significant variations, with some conventional crops having larger quantities of some vitamins than organic crops. But researchers confirm the overall trend that organic fruit, vegetables, and milk are more likely to have beneficial compounds. Identified compounds found in greater quantities in organic produce include vitamin C, trace elements such as iron, copper and zinc, and secondary metabolites, which are thought to help to combat cancer and heart disease.

Sources: Ungoed-Thomas, Jan. . The Sunday Times, thesundaytimes.co.uk/sto/ Bauman, E and Friedlander, J.  Nutrition Essentials for Everyone. © Bauman College

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yOU ArE WHAT yOU EAT

H E ALTHY RE C I PE S

Revitalizing Breakfast Whether you start your day with the full-bacon-and-eggs-monty, coffee and juice only, or somewhere in between, these recipes demonstrate delicious, healthy ways to boost your breakfast routine for better nutrition.

Flax meal muffins

Citrus Breeze Tonic A bright and refreshing tonic for a spring or summer morning. ingredients ½ cup lemon verbena leaves 2 cups filtered water 2 medium oranges 1 medium ruby grapefruit

½ cup frozen grapes ¼ cup fresh cranberries 1 tsp ground flaxseeds 1 tsp raw honey

Directions:

A tasty and hearty gluten-free muffin perfect for a quick breakfast or mid-morning snack. ingredients ¾ cup brown rice flour ¾ cup buckwheat flour ½ cup ground flaxseed ½ cup date or palm sugar 1 tsp baking soda ½ tsp ground cinnamon ¼ tsp ground nutmeg ¼ tsp salt

½ cup raisins or chopped prunes 2 eggs ¼ cup grape seed oil ½ cup unsweetened applesauce 1 cup buttermilk, yogurt, almond or coconut milk

Directions: 1. Preheat oven to 375º. Line a 12-cup muffin tin with unbleached paper liners and set aside. In a large bowl, whisk together brown rice flour, buckwheat flour, flaxseed, sweetener, baking soda, cinnamon, nutmeg, salt and dried fruit.

2. In a second large bowl, whisk together eggs, oil, applesauce and buttermilk. Add flour mixture to buttermilk mixture and stir until just combined.

3. Spoon batter into prepared muffin tins and bake until golden brown and a toothpick inserted in the center of a muffin comes out clean, about 30 minutes. Cool muffins in pan for 5 minutes before transferring to a wire rack to finish cooling.

Recipe provided with permission by Barbra Cohn, NE, adapted by Ed Bauman, PhD

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1. In a saucepan, combine water and lemon verbena leaves and bring to a boil. Lower heat and simmer for 15 minutes.

Drain and allow to cool.

2. Juice oranges and grapefruit and put in a blender.

3. Add frozen grapes, cranberries, lemon verbena tea, ground flaxseed and honey. Blend until smooth. Serve immediately.

yOU ArE WHAT yOU EAT

H E A LTHY RE CI P E S

Poached eggs with wilted greens, shiitakes and caramelized onions

Root n’ Tuber HOME FRIES Potatoes aren’t the only spuds to consider when making home fries as this recipe demonstrates. ingredients 2 T ghee or olive oil 2 medium red potatoes, 1 large onion, diced medium dice 1 medium rutabaga, ½ cup parsley, roughly medium dice chopped 1 large parsnip, medium dice Sea salt & pepper to taste 1 medium yam, medium dice Directions:

Poaching eggs is hands down the best and easiest way to prepare eggs for optimal flavor and nutrient value. The runny yolk is considered the perfect sauce; smooth, luxurious and perfectly balanced. ingredients 2 T ghee or olive oil 1 medium onion, sliced thinly 3 cloves of garlic, minced 2 cups shiitake mushrooms, sliced 3 medium cloves garlic, diced 1 lb of baby spinach

1. Put cubed rutabaga, parsnip, yam and red potatoes to a large pot and cover with filtered water. Add a generous teaspoon of sea salt and bring water to a boil. Parboil roots for 12 minutes and then remove from heat. Drain and set aside.

2. To a large sauté pan, melt butter and olive oil over medium heat. Add onions and a pinch of sea salt and sauté until softened, about 5 minutes.

3. Gently add in root vegetables and sauté over low to medium heat until lightly browned, skins are crispy and fork tender.

Season with sea salt and pepper and toss in chopped parsley.

Serves 4

Feta or other crumbly cheese (optional) Poached eggs 1 tsp light vinegar (rice wine, white wine, or apple cider) 4 large free-range chicken eggs Salt and black pepper to taste

Directions:

1. Add 1 T of ghee or olive oil to a heated sauté pan and caramelize onions on low heat until golden and sweet.

2. Meanwhile in another large sauté pan, melt remaining ghee or olive oil and quickly sauté garlic. Add mushrooms and continue sautéing.

When mushrooms release some of their own liquid add spinach leaves and 1 T of water. Cover pan and allow spinach to wilt.

3. Remove pan and squeeze ½ lemon over spinach. Stir vegetables together adding salt and pepper to taste.

4. Poach Eggs: Bring unsalted water to a high simmer in a 10" skillet with 1 tsp of vinegar. It is important that the water is at a steady simmer without boiling. Make sure there is enough water (2-3") in the poaching pan to cover eggs.

5. Poach eggs for about 5 minutes, or until whites are firm. Salt and black pepper to taste.

6. Remove from water with a slotted spoon and place on spinach.

7. Serve on organic, sprouted whole grain toast.

Serves 4

Recipes from the Flavors of Health Cookbook: your Guide to eating for HealthTM

By Dr. Ed Bauman and Chef Lizette Marx () Bauman College Press

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PUBLIC HEALTH

Understanding Concerns About Community Water Fluoridation

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By Patricia Dines

he claims for community water fluoridation are certainly appealing. We’d all surely like to believe that putting a material into our shared water supply could improve everyone’s dental health; save us more money than it costs; and harm no people, pets, livestock, crops, wildlife, or ecosystems.

Unfortunately, there is a body of scientific evidence that contradicts this idyllic scenario. Among the many public opponents to fluoridation of public water supplies are thousands of top scientific experts, dentists, doctors, former public health ministers, Nobel Laureates, and more. Many of them were formerly proponents of community water fluoridation (CWF) until they reviewed the science and saw that their positions needed updating. Many industrialized countries have rejected this practice.

The scientific method requires a willingness to re-examine our premises in light of the evidence. Surely we only want to add a chemical to everyone’s water if this is the best option and there is incontrovertible evidence of its  percent safety and efficacy.

Does CWF really meet those standards?

eight Key Facts about Community Water Fluoridation Note: This article, with citations and links to further resources, is available online at patriciadines.info/PHMF.html. ) the use of fluoride compounds in dentistry is fundamentally different from CWF. Knowledge and beliefs about the first do not automatically apply to the second.

With the former, scientifically tested, pharmaceutical grade fluorine compounds are applied to specific people’s teeth by their informed choice, in controlled and supervised doses.

In the case of CWF, an entire population is exposed via the water supply, without their consent, to uncontrolled and unmonitored doses of different fluorine compounds—usually hydrofluorosilicic acid known to be contaminated with toxics and with no testing and approval by the U.S. Food and Drug Administration (FDA). ) Fluoride’s primary mode of action is known to be topical, not systemic. The benefits of fluoride are realized when applied directly to tooth surfaces, not through ingestion. Even the Centers for Disease Control and National Research Council agree with this. ) Both fluoridated and non-fluoridated regions have seen the same overall decline in tooth decay over the past  years.

Some non-fluoridated countries have experienced even lower decay rates. ) Studies have not proven public water fluoridation to be safe and effective. In , the British government’s Final Fluoridation Study (conducted by York University and nicknamed “The York Review”) was touted as “the study to end all studies into fluoridation” and was expected to confirm the claimed benefits of CWF. Instead, its systematic review found that none of the studies purporting to demonstrate the safety and effectiveness of water fluoridation met their grade A criteria—defined as “high 32 | Pacific Health Spring 2013

quality, bias unlikely”—and committed basic data analysis errors such as failing to make double-blind assessments or adjust for confounding factors.

York Professor Trevor Sheldon said, “Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation.” ) no minimum daily requirement is set for fluorine. It is not an essential nutrient; there is no such thing as a fluorine deficiency.

This is clearly stated by the U.S. FDA, U.S. Public Health Service, and the National Academy of Sciences Institute of Medicine (IOM), which indicates that its  report is being used incorrectly to claim otherwise. ) many Americans are already exposed to fluoride amounts beyond safe levels through dental products, food, soda, tea, pharmaceuticals, pollution, and pesticides. Children can go over the threshold just in the way they brush their teeth, for instance, using too much toothpaste, failing to rinse thoroughly, or swallowing toothpaste. ) many studies have connected fluoride to health threats, even at common u.S. exposure levels. These include significant increases in thyroid tumors, bone cancers, bone fractures, arthritislike symptoms, decreased fertility, lower IQ, and dementia-like effects. Excess fluoride also causes dental fluorosis, a condition where fluoride disturbs dental enamel, leading to permanent stains and/or pitting, and reflecting damage happening to bones throughout the body, according to experts. In ,  percent of America’s children had fluorosis, a dramatic increase from fewer than  percent in the s. People with compromised nutrition are also more vulnerable to excess fluoride. ) Fluorine compounds are essentially drugs that produce a range of responses, can cause harmful side effects, and require dosage limits and individualized treatment. they are not suitable for everyone. For example, infants and kidney patients are directed not to ingest fluoridated water. But removing fluorine from water is difficult, requiring expensive whole-house reverse osmosis systems that are especially inaccessible to community water fluoridation’s primary target audience: low-income people and children.

Additional information and links to the sources referenced in this article are available online, including a link to “A Response to Pro-Fluoridation Claims,” from The Case Against Fluoride, by Dr. Paul Connett, et al. Dr. Connett, a chemistry professor at St. Lawrence University, believed that CWF was effective until he looked at the science contradicting it. He is now the director of the Fluoride Action Network. © Copyright Patricia Dines, 2013. All rights reserved About the author: patricia dines has been an independent freelance author, journalist, and public speaker for more than 25 years, covering health and environmental issues.

It’s Time to Join

PFMC!

The Pacific Foundation for Medical Care is the physician network of choice for selfinsured employers throughout Sonoma County and California.

Our members are paid promptly, at rates well above Medicare, and we offer friendly local service from our main office in Santa Rosa. Why not join us today? – Dan Lightfoot, MD Empire Eye Doctors, Santa Rosa President, PFMC

Pacific Foundation for Medical Care To learn more about PFMC, or for a membership application, visit pfmc.org or call Kathy Pass at 707-525-4281

Pacific Foundation for Medical Care

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3510 Unocal Place, Suite 108 Santa Rosa, CA 95403

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SANTA ROSA, CA PERMIT NO. 470

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In the first quarter of 2013, more than two dozen Sonoma County providers joined the Pacific Foundation for Medical Care physician network. Why? Because they—along with more than 8,000 of their colleagues across California—know that PFMC offers prompt payment at competitive rates for thousands of local patients.

Adding your name to the list below is as simple as calling our office in Santa Rosa. Just contact Kathy Pass at 707-525-4281 or kpass@rhs.org. For more details, visit pfmc.org.

• Yulia Rozen MD, Anesthesiology, Santa Rosa • Jon Portnoff MD, Cardiovascular Disease, Ukiah • Helena Longin MD, Dermatology, Santa Rosa • Pooja Sherchan MD, Endocrinology, Santa Rosa • Michelle Mertz MD, Family Practice, Santa Rosa • Aruna Jayaraman MD, Gastroenterology, Santa Rosa • Stewart Allen MD, Internal Medicine, St. Helena

• Guy Delorefice MD, Internal Medicine, Santa Rosa • Benjamin Meyer MD, Internal Medicine, St. Helena • Barbara Anna Hayes MFT, Marriage Family Therapy, San Rafael • Anna Joyce MFT, Marriage Family Therapy, Santa Rosa • Patricia Stenger MFT, Marriage Family Therapy, Santa Rosa • Andreas Sakopoulos MD, Thoracic Surgery, St. Helena

Pacific Foundation for Medical Care 3510 Unocal Place #108, Santa Rosa, CA 95403 707-525-4281 • www.pfmc.org A nonprofit organization dedicated to improving patient access to physicians

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