Posts Tagged ‘E. Coli’

Urinary Infections In Women

September 12, 2015

Andrew Siegel, MD    9/12/2015

shutterstock_femalebluepelvic

Bladder infections (a.k.a., cystitis) are common among women. Acute cystitis is a bladder infection that typically causes the following symptoms: pain/burning, frequent urination, and urinary urgency (“gotta go”). Additional symptoms that may occur are the following: urinating small volumes, bleeding and urinary incontinence (leakage). Microscopic inspection of urine usually shows bacteria, white blood cells and red blood cells.  80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common bacteria including Klebsiella, Proteus, and Enterococcus.

The occasional occurrence of cystitis is a nuisance and oftentimes uncomfortable, but is usually easily treated with a short course of oral antibiotics. When bladder infections recur time and again, it becomes a major source of inconvenience and suffering for the patient and it becomes important to fully investigate the source of the recurrence.

Bladder infections occur when bacteria gain access to the urinary bladder, which normally does not have bacteria present. The short female urethra and the proximity of the urethra to the vagina and anus are factors that predispose to cystitis.

For an infection to develop, the vagina and urethra usually have to be colonized with the type of bacteria that can cause an infection (not the normal healthy bacteria that reside in the vagina), these bacteria must ascend into the bladder, and these bacterial must latch onto bladder cells.

Offense and Defense

Whether or not an infection develops is based upon the interaction of protective mechanisms (“defense”) and bacterial factors (“offense”). “Defense” factors include the following:

  • An acidic vagina, which inhibits the growth of infection-causing bacteria while promoting the growth of “good” bacteria such as lactobacilli
  • The unique layer that protects the bladder lining
  • Immune cells in the urine that prevent bacteria from sticking to the bladder cells
  • The dilution action of urine production and the flushing effect of urinating

Bacterial “offense” factors include in following:

  •  Tentacle-like structures that promote the attachment of bacteria to bladder cells
  • The capability of bacteria to evolve and develop resistance to antibiotics

Bladder Infections in Young Women

Women aged 18-24 years old have the greatest prevalence of bladder infections and sex is usually a key factor, hence the term “honeymoon cystitis.”

The following are risk factors for bladder infections:

  • A new sexual partner
  • Recent sexual intercourse
  • Frequent sexual intercourse
  • Spermicides, diaphragms and spermicide-coated condoms (which can increase vaginal and urethral colonization with E. Coli)

Bladder Infections in Older Women

Cystitis is common after menopause, based upon the following factors:

  • Female hormone (estrogen) deficiency, which causes a change in the bacterial flora of the vagina such that EColi replaces Lactobacilli
  • Age-related decline in immunity
  • Incomplete bladder emptying
  • Urinary and fecal leakage (incontinence), often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra
  • Diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria)
  • Neurological diseases that impair emptying or cause incontinence
  • Pelvic organ prolapse
  • Obesity
  • Poor hygiene

Complicated Infections

A urinary infection is considered complicated if:

  • It involves the upper urinary tracts (kidneys)
  • You are pregnant
  • Bacteria are resistant to antibiotics
  • There is a structural abnormality of the urinary tract
  • It occurs in immune-compromised patients including diabetics
  • It occurs in the presence of a foreign body such as a urinary catheter or stone

If It’s Not an Infection, What Is It?

It is important to distinguish a symptomatic urinary infection from asymptomatic bacteriuria, urethritis, vaginitis, and Painful Bladder Syndrome (PBS)/Interstitial Cystitis (IC).

  • Asymptomatic bacteriuria, common in elderly and diabetics, is the presence of bacteria within the bladder without causing an infection. This does not require treatment, which is futile and promotes selection of resistant bacteria. It should be treated only in pregnant women, in patients undergoing urological-gynecological surgical procedures, and in those undergoing prosthetic surgery (total knee replacement, etc.).
  • Urethritis is an infection in the urethra
  • Vaginitis is a vaginal infection
  • PBS/IC is a chronic inflammatory condition of the bladder that can mimic the symptoms of cystitis.

Diagnosis and Treatment

The diagnosis of cystitis is by urinalysis and culture. A urine specimen is obtained after cleansing the vaginal area and collection of a mid-stream specimen. At times, catheterization is necessary to obtain a specimen. Dipstick is the fastest and least expensive means of screening for an infection, but it is not very accurate, whereas microscope exam is much more accurate. The definitive test is urine culture and sensitivity, which will demonstrate the type of bacteria, the quantitative count, and those antibiotics that are most likely to be effective.

Treatment is antibiotics to eradicate the bacteria. In the case of recurrent cystitis, it is important to do an evaluation to rule out a structural cause. This generally involves imaging, often an ultrasound (using sound waves to obtain an image of the urinary tract), and a cystoscopy (a visual inspection of the urethra and bladder with a flexible scope). This will check the entire urinary tract, including the kidneys and bladder. Findings may be a dropped bladder, a stone within the urinary tract, a urethral stricture (a narrowing in the channel leading out of the bladder that causes an obstruction), a urethral diverticulum (a pocket connected to the urethra), or a fistula (abnormal connection between the colon and bladder), etc.

 Antibiotic Options For Those With Recurrent Urinary Infections

  • Patient-initiated treatment: a short course of antibiotics when the symptoms first occur. It is useful to first test your urine using a dipstick (although not perfect, it is great for home screening) when the symptoms of cystitis arise. This has proven to be safe, economical and effective.
  • Sexual prophylaxis: A single dose of antibiotic just before or after sexual activity if the infections are clearly sexually related
  • Daily antibiotic prophylaxis: A single dose of antibiotic is taken on a prophylactic basis every evening or every other evening to prevent recurrent cystitis.

Pearls To Help Keep Cystitis At Bay

  • Stay well hydrated to keep the urine dilute: “The solution to pollution is dilution.”
  • Wipe in a top-to-bottom motion after urination or bowel movementsAt minimum, urinate every four hours while awake to avoid an over-distended bladder.
  • Maintain a healthy weight.
  • Urinate after sex.
  • If infections are clearly sexual related, an antibiotic taken before or right after sex can usually preempt the cystitis.
  • If you are diabetic, maintain the best glucose control possible.
  • Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause.
  • Methenamine: This chemical is broken down into formaldehyde, which can kill bacteria.
  • Cranberry extract: Cranberries contain proanthocyanidins that inhibit bacteria from adhering to the bladder cells. There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.
  • Probiotics such as Lactobacillus: These bacteria promote healthy colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.
  • D-Mannose: This sugar can inhibit bacteria from adhering to the bladder cells.
  • Estrogen cream: Applied vaginally, this can help restore the normal vaginal flora as well as uro-genital tissue integrity and suppleness.
  • Vaccination: Currently in research phases, the concept is an oral vaccine or vaginal suppository capable of providing immunity against the typical strains of bacteria that cause infections.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

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Bladder Infections In Women

March 16, 2012

 

 Bladder infections (cystitis) are relatively common occurrences among females.  Acute uncomplicated bacterial cystitis is an infection of the bladder that can cause burning, frequency, urgency, bleeding, urinating small volumes, incontinence, and pain (abdominal, pelvic, or lower back).  Lab studies usually show bacteria, white blood cells and red blood cells in the urine. 80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common pathogens including Klebsiella, Proteus, and Enterococcus.

 Cystitis occurs when bacteria that normally inhabit the colon gain access to the urinary bladder. While cystitis is common among the female population, it is rare among the male population.  Anatomical differences that promote cystitis in women are the short female urethra and the close proximity of the urethra to the vagina and anus, areas that are normally colonized with bacteria.  The occasional occurrence of cystitis—while a nuisance and oftentimes uncomfortable—is usually easily treated with a short course of antibiotics.   When bladder infections recur time and again, it becomes a major source of inconvenience and suffering for the patient, and it becomes important to fully investigate the source of the recurrence.

 A urinary infection is considered complicated under the following conditions:  if it involves the kidneys; if it occurs during pregnancy; if the bacteria are highly resistant to antibiotics; if there is a structural abnormality of the urinary tract; if it occurs in immune-compromised patients, including diabetics; in the presence of a “foreign body” such as an indwelling urinary catheter, urinary stent or urinary tract stone.

 For an infection to develop, there has to be vaginal colonization with pathogenic bacteria (bacteria that can cause an infection and not the normal healthy bacteria that reside in the vagina); movement of these bacteria into the bladder; and finally, attachment of the bacteria to the cells that line the bladder.  Whether or not an infection develops is based upon the interaction of female protective mechanisms (“defense”) and bacterial virulence factors (“offense”). “Defense” factors include an acidic vagina, which inhibits the growth of the type of bacteria that cause infections while promoting the growth of “good” bacteria such as lactobacilli; the presence of a mucopolysaccharide layerthat protects the bladder lining; and immune cells present in the urine that block the adherence of bacteria to the bladder cells.  Additionally, the dilution action of urine production and the flushing effect of urinating can wash out bacteria before they have a chance to latch on to the lining of the bladder.  Bacterial “offense” factors include fimbriae, tentacle-like structures that promote attachment to the bladder lining cells and the capability of bacteria to evolve and develop resistance to antibiotics.

  Women aged 18-24 years old have the greatest prevalence of acute uncomplicated bacterial cystitis and sexual activity often is a factor in bacteria finding their way into the urethra and bladder, hence the term “honeymoon cystitis.”  The following are risk factors for cystitis: a new sexual partner; recent sexual intercourse; the use of spermicides, diaphragms or spermicide-coated condoms. Spermicides can change the vaginal “environment” and promote the presence of different bacteria from the normal flora. Being overweight can play a role in promoting cystitis because it is more difficult to maintain good hygiene under these circumstances.

  Cystitis also occurs with increased prevalence in the post-menopausal population, based upon changes that happen because of estrogen deficiency.  As a result of low levels of estrogen, there is a change in the normal bacteria (flora) of the vagina in which E. Coli replaces lactobacilli.  Topical estrogen cream has been shown to reverse vaginal colonization with E. Coli and helps prevent cystitis.  Other factors are an age-related decline in immunity; incomplete bladder emptying; and the not uncommon occurrence of urinary and fecal incontinence often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra.  The presence of diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria), neurological diseases, pelvic organ prolapse, obesity and poor hygiene further increase the prevalence of cystitis among older women

 It is important to distinguish a symptomatic urinary infection from asymptomatic bacteriuria, urethritis, vaginitis, and Painful Bladder Syndrome (PBS)/Interstitial Cystitis (IC).  Asymptomatic bacteriuria is the presence of bacteria within the bladder without causing an infection.  Asymptomatic bacteriuria does not require treatment, since treatment is most often futile and achieves nothing but selection of a resistant organism—in other words, by unnecessarily exposing bacteria to an antibiotic environment, bacteria can evolve and adapt to become modified in such a way that the antibiotic is no longer effective. Asymptomatic bacteriuria needs only to be treated in pregnant women and in patients undergoing urological-gynecological surgical procedures.  Urethritis is an infection in the urethra; vaginitis is a vaginal infection; and PBS/IC (Painful Bladder Syndrome/Interstitial Cystitis) is a chronic inflammatory condition of the bladder that can mimic the symptoms of cystitis.

 The diagnosis of cystitis is on the basis of urinalysis and culture.  A urine specimen is obtained after cleansing of the vaginal area with an antibacterial wipeand collection of a mid-stream voided specimen. At times, catheterization is necessary to obtain a specimen.  Dipstick is the fastest and least expensive means of screening for an infection, but it is not very accurate and fraught with false positives and negatives.  Microscopy is much more accurate, seeking the presence of bacteria, white blood cells and red blood cells.  The definitive test is urine culture and sensitivity, which will demonstrate the bacteria responsible for the infection, the quantitative bacterial count, and those antibiotics that are most likely to be effective.

    Treatment of cystitis is based upon antibiotics to eradicate the bacteria. In the case of recurrent cystitis, it is important to do an evaluation to rule out a structural cause. This generally involves imaging—often an ultrasound (using sound waves to obtain an image of the urinary tract)—and a cystoscopy (a visual inspection of the urethra and bladder with a flexible scope).  This will check the entire urinary tract, including the kidneys and bladder.  Findings may be a (cystocele) dropped bladder, a stone within the urinary tract, a urethral stricture (a narrowing in the channel leading out of the bladder that causes an obstruction), a urethral diverticulum (a pocket connected to the urethra), or a fistula (abnormal connection between the colon and bladder).

    After treatment of the acute infection, it is important to make changes in order to help minimize recurrent episodes of cystitis.  After urination or a bowel movement, it is important to wipe in a top-to-bottom direction to avoid bringing bacteria from the anus up towards the urethra.  It is also important to remain well hydrated to keep the urine from becoming very concentrated:  “The solution to pollution is dilution” applies well to urinary infections.  It is important to urinate on a regular basis over the course of the day, utilizing the natural flushing effect of urination to wash out the bladder and keep it from becoming over-distended.  Many workers such as nurses and teachers do not have the time to empty their bladders during the course of their days, and they often end up predisposed to cystitis.  It is very important to urinate after sexual activity to help flush out any bacteria that may have been introduced into the urethra and the bladder.

   One option for the management of recurrent cystitis is the self-administration of a short course of antibiotics when the cystitis symptoms first occur.  It is useful to first test your urine using a dipstick (although not perfect, it is great for home screening) when the symptoms of cystitis arise. This has proven to be safe, economical and effective.  Alternatively, a single dose of antibiotic can be administered just before or after sexual activity if the infections are clearly sexually related.  Another possibility is a single dose of antibiotic administered on a prophylactic basis every evening or every other evening to prevent recurrent cystitis.  Methenamine is converted to formaldehyde in the urine and can help prevent recurrent infections. Cranberries, lingonberries, and blueberries contain proanthocyanidins that inhibit the adherence of bacteria fimbriae to the bladder cells, acting as anti-adhesives and helping to prevent bacteria from attaching onto bladder cells and causing an infection.  There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.  Estrogen cream applied vaginally can help restore the normal vaginal flora and thus help prevent cystitis.  Probiotics promote healthy bacteria colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.

   In summary, bladder infections in females are common, annoying, but rarely serious.  They are very treatable, and those who suffer with recurrent infections can be nicely managed.

                      Pearls To Help Keep Cystitis Away

  • Wipe in a top-to-bottom motion after using the bathroom
  • Stay well hydrated to keep the urine dilute
  • At minimum, urinate every four hours while awake to avoid an over-distended bladder
  • Maintain a healthy weight
  • Urinate after sexual activity
  • If infections are clearly sexual related, an antibiotic taken pre or post-sexually can usually preempt the cystitis
  • If you are diabetic, maintain the best control possible
  • Topical estrogen can be helpful for the post-menopausal female
  • Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause; if none are found, there are a number of means of managing recurrences, including self-diagnosis/self-treatment; daily antibiotic prophylaxis; daily methenamine; cranberry extract; probiotics

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

To view my educational video on bladder infections:

 

E. Coli Contamination Of Our Food

July 16, 2011

Fecal bacterial contamination of our foods is an increasingly prevalent problem and one that has received a significant amount ofpublicity—to wit, numerous disturbing reports on E. Coli 0157:H7 contamination of hamburger meat resulting in recalls. The astonishing and frightening lead articles on the front page of the October and December 2009 New York Times by investigative reporter Michael Moss cannot help but make us question whether we ever really want to eat another hamburger again. He won the Pulitzer Prize for his article entitled, “The Burger That Shattered Her Life,” describing the horrible E. Coli illness linked to the consumption of Cargill ground beef by a young woman.

Fecal bacterial contamination of livestock is viewed by the government and meat suppliers as acceptable and a given at certain levels. However, even a small amount of contamination—a collateral effect of what animals are fed and how they are raised—can make us very ill, or in some instances, even cause death.  If we buy ground beef off the shelves of a supermarket, what we actually get is an amalgam of various grades of meat from different parts of cows and different slaughterhouses, both nationally and internationally. One hamburger may represent a composite of up to 1000 cows! The more cows and the more slaughterhouses involved in the ground beef, the greater the risk of fecal contamination.  There exists strong potential for bacterial E. Coli contamination during every single step of beef processing. And so it would seem that the only way for us to get a hamburger that originates from one cow and dramatically reduce our potential for E. Coli exposure is by purchasing a cut of beef and having our butcher grind it up for us—I’m told brisket makes for an amazing burger.

A company called Beef Products, Inc., came up with the “clever” concept of using the lowliest waste products of the beef carcass—fatty slaughterhouse trimmings with no functional value, typically used for pet food and cooking oil—as a means of keeping the cost of hamburger meat as low as possible. This company conceived the novel idea of treating the fatty trimmings with ammonia to kill the bacterial contaminants, particularly E. Coli and Salmonella, prevalent because of the low grade and quality of beef remnants used. The ammonia works no differently than it does for household cleaning, the alkalinity of the ammonia causing bacterial death. Unfortunately, the ammonia has not proven to be a failsafe measure of sterilization, and there have been numerous instances of bacterial-contaminated beef; plus, who wants to be consuming ammonia, a product that truly belongs on our bathroom floors! Beef Products’ meats are widely used in fast food restaurants, including McDonalds and Burger King, as well as in the ground beef sold in supermarkets and used in the federal school lunch program. School lunch officials allow hamburgers served in schools to contain 15% of the product, which serves to bring the price down. Some customers have complained about the ammonia-like taste and the pungent odor of their beef. Ammonia is not listed as an ingredient on the label, but is referred to by the moniker “processing agent.” A former USDA microbiologist, G. Zirnstein, commented that the beef product is a “pink slime that I do not consider to be ground beef, and I consider allowing it in ground beef to be a form of fraudulent labeling.”

E. Coli 0157:H7—a type of bacteria that is responsible for hemorrhagic colitis and a myriad of other health problems, even including death—is often contracted by the consumption of contaminated beef, although it can also occur by eating spinach and apple juice contaminated from the fecal run-off from farms that raise cattle. E. Coli 0157:H7 is a product of two factors—the corn that the Industrial Food Complex feeds cattle and the feedlot where the cattle are raised. Cows are hard-wired to eat grass, but since corn is cheap, convenient and every kernel contains a big dollop of starch (corn has been bred to contain more carbohydrates and less protein), it will make for bigger and fatter cattle. We all know how too many “carbs” make us humans fat, and the same is true for other mammals. These literally obese cattle will get to slaughter faster and yield beef that is well-marbled with saturated fat that commands a higher ranking on the USDA beef hierarchy and translates into more dollars and profits for the industry. The beef from grass-fed cattle is different than that from corn-fed cattle, essentially being less marbled with saturated fats, healthier, and less likely to be contaminated with E. Coli and other such bacteria.

Since the digestive system of ruminants like cattle did not evolve for the digestion of large quantities of corn, their consumption of corn—as opposed to grass, the staple of a ruminant mammal’s diet—changes the bacterial content of the cow’s stomach, allowing for the emergence of E. Coli. Under circumstances of a grass diet, stomach acidity results in the death of most of the bacteria within a cow’s stomach. Cattle raised on grass on real ranches via traditional pasture farming lead a much different life from cattle raised on feedlots, which are the large industrial factories where most cattle are raised in over-crowded and contaminated environments. These animal factories are known as CAFOs (Confined Animal Feeding Operations). It is to some extent similar to the difference between living leisurely in an affluent suburb on a large piece of land, versus a crowded, infested, and dangerous inner city environment. Cattle raised in feedlots stand in very filthy and over-populated conditions, ankle-deep in manure, with their hides caked with excrement, overfed with starch-rich corn and further fattened by their limited availability to move around. The use of antibiotics in the feed is, in fact, an attempt to neutralize some of this fecal contamination.

The problem occurs in the slaughterhouse where the more manure on the animal, the greater the risk of fecal contamination upon processing the animal. Cattle often arrive with smears of feedlot feces on their hides and when the knife is brought to the flesh, the meat can get exposed to bacterial contaminants that are present in the cow feces. Ground beef, in particular, lends itself to contamination because its constituent parts are often the lower quality parts of the cow that are more likely to have fecal contact. There is additional risk of E. Coli contamination at the gutting station, where the intestinal tract—where E. coli resides—is separated from the rest of the animal.

So what to do? There are a number of possible solutions. We can cook our hamburgers so that they are so well done—ala hockey pucks—that bacteria don’t have a fighting chance. We can forego meat and become vegetarians or vegans. We could select certified organicallyraised beef that has far less chance of contamination. In the ideal world, certified organic beef is derived from a ranch that maintains a record of breeding history and veterinary care rendered to its cattle. The cattle do not receive hormones or antibiotics, are fed organic grains and grasses, have unrestricted outdoor access, and are treated in a humane fashion. Alternatively, we can purchase meats from local farmers or at farmers markets. Or we can go to a reliable butcher and pick out a nice cut of meat and have him grind it in front of us. Or we can try the DIY (Do It Yourself) approach and raise a few head of cattle in our backyards (try getting a town or city permit for this one!).

Nullius in verba (take nobody’s word for it): I hate to throw a fly in the ointment, but is organic really organic, or is it mere semantics? Are organic livestock pasture-based? Prior to June 2010, at which time more stringent rules went into effect, the requirement for organic dairy producers was the following: organically-raised livestock had to have access to pasture. Theoretically, this might mean that a farmer permitted his cattle pasture time for 10 minutes each day—a mere romp in the field allowing for the label “organic.” This was a loophole allowing some dairies to feed their animals almost exclusively a diet of grain feeds. The new regulations state that cows must now graze on pasture for a major portion of the grazingseason—a minimum of 120 days mandated by law—and must get at least 30% of their food from pasture during the grazing period.These new rules also apply to beef cattle, with the exception that the 30% requirement is suspended during the 4-month period when the animals are fattened prior to slaughter. Ahhh . . . yet another disturbing loophole in the quest for truly grass-fed cows!

In New York City there are now several Shake Shack restaurants where, in contradistinction to your typical fast food restaurant, you can get what seems to be as close to a healthy burger as you possibly can. Right off their menu is the following: whole-muscle, no-trimmings, fresh-ground, antibiotic-and-hormone-free, source-verified-to-ranch-of-birth, choice-or-higher-grade Black Angus beef. Sounds like a great option when that carnivorous craving strikes!

And now a little aside on American-grown poultry exported to Russia and Europe, according to a New York Times report by Michael Schwirtz in January 2010. Russia’s view is that American poultry is fatty, tasteless and raised on chemicals. From Russia’s perspective, the critical issue is that American companies use chlorine to disinfect the poultry after slaughter. Russian health officials feel that the chlorine method is unsafe and outlawed it in 2008, as had the European Union previously. The Russian government imposed a ban on the importation of American chicken, purportedly because US companies have been remiss in adhering to Russia’s new food safety regulations. Prime Minister Putin stated that the USA was not ready to observe Russian poultry standards. Yikes, so we use chlorine to disinfect our chickens, just as we do to decontaminate our pools and our standards are not good enough for Europe and Russia!

 Another healthy alternative chosen by many is to buy kosher meats. Kosher foods—prepared in accordance with Jewish dietary laws and requiring certification—have really come into their own in this era of food fears engendered by numerous reports of food contamination, food allergies, and the dubious provenance of many ingredients. Forty percent of the food items sold at supermarkets now bear the kosher imprint and only fifteen percent of those who buy kosher do so for religious reasons. The vast majority of those who buy kosher, including an increasing number of non-Jewish people, do so because of the perceived high quality, purity of ingredients and healthiness, thought of in a similar vein as local and organic foods. Is kosher food actually any healthier or safer than non-kosher food? The honest answer is that we just don’t know.

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is: www.promiscuouseating.com. It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.  It is also available on Amazon Kindle.