Here’s a warning shot across the bow for those workaholics and students who are chronically sleep deprived. I’ve mentioned in my slide show about the common cold, as well as my accompanying article, that there are a lot of preventive things you can do to fight off colds and flu viruses. And it may seem like common sense, but now it’s proven that getting less than 6 or 7 hours a sleep can dramatically increase your risk of infection. It’s a fascinating study which is addressed in an article from the New York Times. Here’s a good quote:
In a recent study for The Archives of Internal Medicine, scientists followed 153 men and women for two weeks, keeping track of their quality and duration of sleep. Then, during a five-day period, they quarantined the subjects and exposed them to cold viruses. Those who slept an average of fewer than seven hours a night, it turned out, were three times as likely to get sick as those who averaged at least eight hours.
Sleep and immunity, it seems, are tightly linked. Studies have found that mammals that require the most sleep alsoproduce greater levels of disease-fighting white blood cells— but not red blood cells, even though both are produced in bone marrow and stem from the same precursor. And researchers at the Max Planck Institute for Evolutionary Anthropology have shown that species that sleep more have greater resistance against pathogens.
So get your sleep!
Now that we are in the midst of flu season, there’s a lot of anxiety about vaccines and treatments. So it’s always good to be reminded of good old common sense practices to prevent infection in the first place. This week, esteemed British Medical Journal has published an excellent review article (link at bottom) which looks at those simple precautions — and yes, indeed, there’s excellent evidence that common sense works!
Their main conclusions for the most effective treatments:
- Thorough disinfection — 70% decrease
- Handwashing more than 10 times daily – 55% decrease
- Wearing masks — 68% decrease
- Wearing N95 masks — 91% decrease
- Wearing gloves — 57% decrease
- Wearing gowns — 77% decrease
- Handwashing, masks, gloves, and gowns combined — 91% decrease
Obsessive-Compulsives Are Right!
Let’s review those findings a bit. First, handwashing is extremely effective at reducing the spread of a virus. Unfortunately, it has to be done often — and correctly! As I discussed before, you need to wash with soap and water for 40-60 seconds or use alcohol-based gel for 20 seconds. I’m a big fan of those Purell-style alcohol gels; and it’s really not very practical to get someone to count to 60 every time they use soap and water. So stock up on alcohol gels!
It’s also important that your ayi is hand washing properly as well. I found a good website with PDF hand-washing instructions in multiple languages, including Chinese; print one that she can look at. This issue is another reason the alcohol gels are good; you can leave these plastic bottles all over the house and one squirt a few times a day is a lot more practical for an ayi (or anyone) than running to the sink with soap and water.
By the way, there’s little to no evidence that the antibacterial soaps do anything better than regular soap, so save your money.
Sorry, Cheap Masks Don’t Work Well
This review also reiterates what I mentioned before; that the cheap, regular surgical masks work a little bit, but not nearly as well as the N95 masks. And forget about layering; even wearing as much as 5 layers of the regular surgical mask wasn’t as good as N95!
The Take-Home Message (Literally)
But we have to be honest here; it’s not easy at all to wear masks all day, let alone gowns and gloves. But households with small children definitely benefit the most from more aggressive measures. In one Hong Kong study, if all family household members used masks and alcohol gel handwash within 36 hours of a family member’s viral infection, the risk of a family member getting sick was cut by 67%.
There’s a lot of evidence accumulating regarding which meats are good, or bad, for your health. We seem to understand the basics but it’s nice to start getting data to back up what common sense tells us.
A recent study did indeed suggest what many have thought — that a diet high in red & processed meat worsens heart conditions and causes early death, including from cancer. Published in March 2009, this huge study followed 500,000 people (!) and found that those who ate the red meat equivalent of one hamburger a day had a 30% increase in death over 10 years, mostly from heart disease and cancer. Sausage, cold cuts, and other processed meats also increased the risk. Eating white meats fish, chicken, turkey and other poultry decreased the risk of death by a slight amount.
By the way, red meat includes not just cows but also pork and lamb. But the American diet is mostly blamed on cows.
The issue seems to be the ratio of good fat and bad fat: I’m sure you’ve heard about the recent debate over the bad trans-fats versus the healthier cis-fats. Well, there’s a similar concept with the omega 3 and omega 6 fatty acids, which are components of cholesterol that you can only get from foods. Omega 3 is the good fatty acid; this is anti-inflammatory and can improve heart disease and cholesterol. It is found in flax oils; nuts such as walnut; and fruits like kiwi, as well as healthier animals and oily cold water fish such as salmon, mackerel and sardines. There are two sub-components of omega 3, EPA and DHA, which are considered more anti-inflammatory — and therefore, healthier — than the ALA component. In general, fish oils have more of the good EPA & DHA than the plant-based sources such as flax.
The second fatty acid, omega 6, is also an essential nutrient which you need in small amounts, but it is considered the pro-inflammatory fatty acid.
It’s All About the Ratio
Up until the 19th-20th centuries, a human diet had a ratio of omega 6 to omega 3 that was probably 1:1 or 4:1, and heart disease was very uncommon. Things got severely out of whack in the 20th century with the immense uptake in industrialized cow factories in Western countries. The omega 6 is at least twice as high in these corn-fed cows, and many researchers feel this is a major reason for the rise of heart disease in the Western world. (China’s not too far behind!). Cows that are raised on the gigantic industrial farms and fed unnatural grains and corn have a higher omega 6:3 ratio than cows raised on traditional fields with grasses (4:1 versus 2:1). The Western diet has a omega 6:3 ratio estimated at 10:1 to 30:1!
So, What To Eat?
So, the key issue is to eat foods with more omega 3 than omega 6. As I said in the beginning, there’s good meat and bad meat. We’ve discussed the pros and cons, now it’s time for you to look at your diet and your health and see if you need to make changes. I think those people who already have heart issues and love their daily burgers or steaks, they really need to rethink this — it’s now clear that your diet may send you to an early grave. Some eating basics:
- White meat is better than red meat
- Lean red meat is healthier than fattier red meat
- If you love fatty red meat every day, try to cut back to 2-3 times a week
- Grass-fed meat usually is healthier than grain/corn fed
- Free range probably is healthier than mega-farm
Nasal congestion, whether from the common cold or flu, or chronic allergies, can be the most annoying symptom for many people. A runny nose is usually treated with over the counter nasal sprays such as oxymetazoline (Afrin), which works well for up to half a day; this medicine is good for 3-5 days maximum. Another medicine common in almost all combination pills (Tylenol Cold, Bufferin Cold…) is pseudoephedrine. This is called Sudafed in many countries. This pill is very effective at drying the sinuses — almost too effective, as people feel very dried out, also in the mouth. Still, it’s probably the most effective treatment for congestion.
But a healthier treatment is simple, inexpensive nasal saline. A seawater-type spray is very common in treating children and newborns, since the OTC medicine Sudafed isn’t considered very effective or safe for children under 24 months.
There’s also an even better way to use nasal saline; instead of a small spray, you can completely irrigate the nose with a small bottle (~200 cc each nostril) of warm salt water. Many people with chronic congestion from allergies, or repeated sinus infections, love this treatment and swear that it cuts down on their frequency of infections and need for medicines.
Buy One, Or Make One Yourself
One of my professors back in San Francisco, pulmonologist Dr KC Mehta, a few years ago became very wealthy simply by repackaging a small plastic squeeze bottle with some salt packets, and now his NeilMed Saline Rinse packages are in every American pharmacy (yes, I’m jealous). I don’t think NeilMed is available here in China, but there are many other versions available, both imported and local, in some (not all) expat pharmacies and local pharmacies and stores. They usually sell the bottle as well as pre-made salt packets. There’s also another style of bottle called a neti pot, which some find more comfortable.
You can also make your own system. All you need is a medium-size squeeze bottle (try Muji), or even a large 50cc medical syringe, or a bulb. The syringe or pick should be sterilized frequently or replaced every two to three weeks to avoid contamination and infection.
The recipe: Use a clean one-quart glass jar. Fill with warm (not hot) boiled tap or bottled water. Add 1 to 1 1/2 heaping teaspoons of non-iodized salt (usually not table salt, as it almost always has iodine which makes this less effective; pickling/canning salt is good). Add 1 teaspoon baking soda (pure bicarbonate). Mix and store at room temperature. Then, each time you pour out some into a small bowl and fill your syringe/bottle. You should throw away leftover solution after 1 week.
How often? Once or twice a day is best; twice a day is best for chronic problems.
“Fun For The Whole Family”?
OK, that was a little joke. Many people get grossed out thinking about rinsing their nose. It’s not for everyone, but it’s worth a try since it’s essentially free and has no major side effects. And anyone with chronic nasal issues or frequent colds here in Beijing should think about trying this as a daily routine.
This is definitely one of the top 10 issues that expats discuss, even before they arrive here. Yes, the air quality is an issue, but it’s important to review the facts as well.
Blue Air Days
First, subjectively and objectively, the air is definitely better than it was compared to a year ago. We’ve had a lot of clear days this year! The government stats agree; “blue air days” with a PM10 rating in their safe range under 100 are the best in over 10 years. But let’s talk about how relevant that really is. First, the government uses a “blue air” pollution index using an air particulate size of 10 micrometers (PM10). That’s a tiny particle, but one issue is that this PM10 is not what most countries use as a proper indicator of air pollution, using a smaller size of 2.5 micrometers. Why? Because this size is more easily inhaled deeper into the lungs and therefore probably causes more damage, so is a more accurate barometer of health risks. Also, the government cutoff of PM10 under 150 (or API under 100) as a “blue sky day” still would count in most other countries as unhealthy. The WHO 2005 Guidelines have 20μg/m3 as the cutoff. There’s a general consensus that, while no number is a safe number, a PM10 over 20μg/m3 starts to have health effects. Therefore, saying you have a “blue sky day” with a PM10 level still in the 90’s would be falsely reassuring.
You’ve probably heard recently about the US Embassy’s air monitor, which is on top of their Chaoyang building and takes hourly PM2.5 readings which are put onto their Twitter page, and which is now accessible through the non-Twitter site iphone.bjair.info. This is a mildly sensitive issue as it often reports a higher number than the government’s PM10 readings. But, it is important to realize that you cannot compare them apples-to-apples, since the measuring sizes aren’t the same, and the government figures are an average of the multiple Beijing weather stations. Plus, the PM2.5 number is about equivalent to 50% of the PM10 number (i.e., a PM10 of 100 = a PM2.5 of 50). But for me personally, the Embassy numbers are relevant since I live and work in their neighborhood.
Can I Jog Outside Or Not?
OK, enough of the intro. In real life terms, there is definitely a risk from air pollution to your health. The underlying damage seems to be the tiny particles getting sucked deep into your lungs and initiating an inflammatory response — and long term exposure has a dose-response increase in chronic bronchitis, lung cancers, and atherosclerotic heart disease. It has been studied extensively, and I have links below to a couple of the best articles. In one recent New England Journal of Medicine study, every 10 microgram per cubic meter decrease in PM2.5 levels increased life expectancy by 0.6 years. Other studies have shown a similar effect; long term exposure to higher levels of particulates can reduce life expectancy by 0.6 to 1.3 years. (read the article and review, linked below).
What level is safe? Well, the WHO Air Quality Guidlines say the average PM10μg/m3 number should be under 20 μg/m3 to stop the increase in mortality. In 2005 (see the above table), Beijing’s average was over 100 μg/m3.
So, how does this affect your daily life? I think you should read these scholarly reviews yourselves, then occasionally monitor the published numbers and make your own conclusions and decisions, especially if you and your children plan to live here more than a few years. If you like to jog and bike, you should avoid all main and ring roads and avoid the worst days, but you certainly shouldn’t stop exercising outside, since the overall benefits far outweigh the risks.
I think one take-home concept is that air pollution is a pro-inflammatory disease, and that you should be extra aware of having an optimum anti-inflammatory lifestyle and diet. That includes the obvious things like not smoking, and exercising at least 150 minutes per week. Your diet should focus on fruits and vegetable, grains, beans, and good fats. But you could also consider supplements and herbals proven to be anti-inflammatory (usually meaning the same as “anti-oxidant”). That includes vitamin C but also omega 3 fatty acids found in some fish, as well as coenzyme Q10 and others. I personally have a daily regimen of 1 gram omega 3 supplement, as well as CoQ10, as well as a morning smoothie including spirulina. I strongly recommend people think about these types of proactive health measures, not just for air pollution but for overall health.
What About Indoor Pollution? And Air Filters?
Yes, the levels inside your house can also be dangerously high. It’s not just the outdoor pollution; there are many indoor pollutants as well that can build up. That’s why it’s important to open your windows, usually in the mornings (not overnight! Particulate levels are worst overnight) to clean out your house air. This brings up another perennial expat topic; air purifiers. I personally think they are useful, and I have one in my bedroom going 24/7. But not every doctor is convinced that it makes a big long-term difference. You can start to read more information at the US EPA’s Indoor Air website. We’ll leave the fun topic of “which filter is best?” for a later post & discussion…
Resources: A must-read is a 2008 article in Urbane China magazine, written by United Family Hospital ER Dr. Chickering. It’s a PDF file; article called “Air Supply” starts on page 29. Print it and show it to family and friends! You can also check out my previous post on air pollution.
- Daily Air Quality Forecasting Map – interactive graphs, from AMFIC
- Real-time Pollution Monitor – from the US Embassy’s Twitter feed
- Daily Pollution Index (China EPA) – all major cities
- Air Quality And Health – an FAQ from the WHO
- WHO Air Quality Guidelines – the 2005 update, a large PDF file. Great data and info.
- LiveFromBeijing – an excellent environmental blog with good resources and data
- “Seeing Through The Smog” — a big PDF file. It’s a great review, from the Wilson Institute. They have a great collection of PDF articles from their China Environment Series.
- The World Bank: Cost Of Pollution in China – The 2007 report; a large PDF file to download. Read chapter 2, starting page 42, Health Impacts of Ambient Air Pollution
- Pollution & Life Expectancy in the US – an excellent, free New England Journal article (PDF file) from January 2009, plus the editorial and a fascinating interactive map – Pollution & Life Expectancy in US Cities