Guangzhou, China -- You may not have heard of Guangzhou, but it is a huge city in southeast China, two hours by car or rail north of Hong Kong--a bustling manufacturing and financial hub with a population of 13 million. The Pearl River Delta mega-city area, which includes Guangzhou, has a population of approximately 40 million, and encompasses Shenzhen (home of iPad production), Dongguan, Foshan, Jiangmen and Zhongshan.

The IMF Asia Team (myself; IMF President and Co-Founder Susie Novis; Lisa Paik, Senior Vice President, Clinical Education & Research Initiatives; and Daniel Navid, Vice President Global Affairs) conducted a series of events and meetings here last week to further enhance and extend our educational and research goals in China.

We began as guests at a wonderful dinner at the Dragon and Phoenix Restaurant at the Peace Hotel on the Bund in Shanghai hosted by Prof. Jian Hou along with Dr. Juan Du and the Shanghai Myeloma Center Team recipients of a 2012 research grant award. This center was really where myeloma diagnosis, treatment and research began in China with establishment of a laboratory for myeloma-protein testing--the essential first step in diagnosis.

We discussed ongoing projects and the potential for further collaboration. Exhausted, having just arrived in Shanghai, we had an early night before what turned out to be an adventurous trip south to Guangzhou.

There have been severe storms in the south of China which seriously delayed our flight, but we finally arrived safely. The Guangzhou International Multiple Myeloma Conference meetings were held at a new type of Chinese resort hotel about two hours outside the city--a huge Sheraton Hotel built in the form of an Indian lake resort that included a floating island in the middle of the lake and villas all around. Apparently, there are a number of these across the country, and they are very popular as holiday destinations. Many Chinese vacationers were checking in as we arrived.

Good Outcomes, New Research, Trial Collaborations

The first IMF meeting was with the Chinese Myeloma Working Group (CMWG), which is part of the International Myeloma Working Group (IMWG) and comprises the top Chinese myeloma experts brought together by the IMF with a focus on the coordination of myeloma care and research in China. We heard summary presentations of key study results from Shanghai, Beijing and Guangzhou. It was very impressive to see all the ongoing activities, including analysis of patterns of myeloma in Beijing. These included a median patient age of 59 years (younger than in the West), plus more frequent Immunoglobulin D (IgD) myeloma and high-risk disease with 17P- (P53 deletion) findings.

Despite that, outcomes are good, with median survivals of four years across the board. Important molecular and clinical trial research is going on in Shanghai. Special analyses of results with upfront versus delayed ASCT were presented from Guangzhou.

The broader focus was on new research and trial collaborations, including AMN trials incorporating both Kyprolis and Pomalidomide, which would allow the first introduction of these agents into China. The IMF also hopes to begin a trial with SQ Velcade, which is not yet feasible in China. It is hoped that the FREELITE test will be approved China within the next few months, and there was a lot of excitement among the myeloma MDs about the potential to soon have new access to this test for both diagnostic and response assessment.

This meeting was the followed by a reception/ dinner during which the IMF was presented with special lucky dragons as a token of appreciation.  Once again, pretty exhausted, the team retired to be ready for an early start the next day.

10 Steps to Better Care

The 3rd Annual Chinese National Myeloma Meeting, jointly hosted by the CMWG and IMF, began at 8:00 a.m. There has been great interest about the "10 Steps to Better Care," so I presented an overview to kick off the morning session. This was followed by an overview of FREELITE testing and then two presentations by Dr. Andrew Spencer, an IMWG member from Melbourne, Australia, who presented the whole range of current approaches to myeloma therapy, including detailed case discussions.

There was a comprehensive review of myeloma therapy in China from the Chinese experts--predominantly members of the CMWG.

On Sunday, May 19th the IMF joined with the myeloma team at Sun Yat-sen College of Medical Science to conduct a Patient Seminar. The local host was Dr. Juan Li, along with her colleague Dr. Gu (Grace Ku - English name).

Susie Novis presented background about the IMF and supportive care perspectives, which was greatly appreciated. This was followed by Prof. Wen-Ming Chen, who gave an overview about care in China. Then I presented the approaches to myeloma treatment in the U.S. in 2013.

Knowledge Is Power

A key element was the basic IMF approach for patients--"Knowledge Is Power"--giving myeloma patients the tools they need to get the best care. I summarized everything from basic testing to recommended treatment options. Then the Sun Yat-sen team presented local approaches and results.

This was followed by an extended Q&A session, with patients standing up to present their individual cases and questions/concerns.

Dr. Andrew Spencer accompanied us to the seminar and helped handle the questions, which was much appreciated and very helpful. As it turned out this was especially helpful since there were a whole series of questions about thalidomide maintenance (an area of research for Dr. Spencer). Patients routinely used ongoing thalidomide maintenance at a dosage of 200mg / day (or more) and, unfortunately, develop significant neuropathy. It was recommended to limit this type of maintenance to 9 to 12 months (based on the Australian data) and also to use doses of 50 to 100mg at the most.

After many emotional questions and answers the session drew to a close. Susie re-emphasized the need to keep patients informed and participate in decisions--really a new approach--openly accepted as a key perspective moving forward. And so to a wonderful Chinese lunch and a chance to further discuss especially difficult patient problems.

Our time in China came to a close with promises to stay in touch and establish further ongoing collaborations.

Exhaustion set in once again as our team prepared to move on to Australia and, ultimately, return home and plan for the future, assimilating all of our new experiences. There are great challenges-- but also great potential to improve outcomes for myeloma patients wherever they live!!

This trip would not have been such a great success without the dedicated help of the whole team, especially Lisa Paik, who helped arrange everything, and Dan Navid. As they say, "without them we would be nothing." A key additional team member is Danielle Loi back at the home office who helped support and coordinated from afar. Sincere thanks to Danielle!

Being interviewed by Sheila Dillon for BBC Radio this week was a great pleasure for me. Sheila is a food expert with an interest in the relationship between food and cancer.

A key question was the relevance of a U.K. book, "Food to Fight Cancer," by Richard Beliveau and Denis Bingras. This beautifully illustrated book summarizes the health benefits of everything from cabbage to chocolate! But the question is: can one really fight cancer with food alone? My answer quite simply was no! I stressed that one cannot eat one's way out of cancer.

In 2013, for myeloma in particular, there are many novel therapy approaches to treatment, which work extremely well: VELCADE, Thalomid, REVLIMID, plus new agents, POMALYST and KYPROLIS. These are the mainstays of treatment.

So what aspects of food are important? Eating "real food" is the most important step to healthy living. Avoid processed and fast foods as well as sodas, as I have discussed in previous blogs. Do not go overboard. There are only limited data to support the added value of particular healthy vegetables, fruits, herbal drinks, and juices.

In "The Blue Zones," a book by Dan Buettner about places in the world where people live to be over 100 years old, the diets are rather simple plant-based diets that include omega-3 fatty acids and usually some red wine with polyphenols. What is missing are the fast foods and sodas.

"That's all very well for people living in beautiful 'Blue Zones' with wonderful air and water, but what about us living in London or Los Angeles?" Sheila asked.

My answer is that we have to do the best we can to create our own "blue zones." Eating as healthfully as we can undoubtedly boosts our immune systems, as does reducing stress, getting exercise and sleep. As they say on Ikaria--the Blue Zone island close to Turkey--naps are OK!

But where does one get this kind of advice and specific help?

Unfortunately, doctors are really not trained in detailed nutrition and health as they should be! The focus is on disease. So

The personal stories of toxic exposures potentially linked to myeloma just keep on coming! I am grateful to all who shared them with me. And once again, the 9/11 compensation fund was in the news on January 30th.  The first 15 compensation awards were given out--but none to cancer patients. Sheila Birnbaum, the special master of the $2.8-billion fund, said she had not awarded money for cancer yet because she had not received completed applications. Of the 16,000 people who have registered, only 2,500 have submitted eligibility forms, and, of those, only 190 have submitted compensation forms and many lack documentation!

So, the dreadful task of completing all the paperwork seems to be the key to potential compensation, and staff advice is apparently available. Myeloma patients need to work through these details in as timely a manner as possible to take advantage of available compensation, as the fund expires in 2016! Current estimates are that over of $8.5 billion will be required to compensate the thousands of people potentially eligible--$6 billion more than the amount approved by Congress in 2010. Being at the front of the queue could prove to be quite important!

Many people have responded to my previous blogs on this topic, including Hardy Jones. Hardy documented the toxic pollution in his system by having his tissue levels tested and had extremely high mercury levels reduced with chelation therapy. His unwavering work to assess and document environmental pollution (he was featured in an NPR story in 2009) is applauded by all and can hopefully lead to meaningful protections and regulatory changes.  

Six months ago, cancer was added to the list of illnesses covered by the $3.4 billion World Trade Center fund. Now, as reported on December 19th in the New York Times, the New York City Health Department has completed a study that compares cancer rates among 9/11 responders with overall cancer rates for New York State. Myeloma is at the top of the list of cancers occurring at a statistically higher rate in 9/11 responders. Myeloma is occurring at a 3-fold increased rate: the rate being +185% versus the average for New York State. Thyroid cancer was at +102% and prostate cancer at +43%. All others were not statistically increased in this study.

The findings are controversial in part because it is very early to be assessing the ultimate risks--and therefore much too soon to be drawing conclusions for most cancers, the occurrence of which will increase over time. However, the early increase in myeloma cases is quite remarkable and suggests a particular susceptibility to the exposures at 9/11 sites.

The specific chemical identified by the Zadroga Act reviewers (6 months ago) was 1-3 butadiene, a chemical linked to rubbers and other  fumes present at the 9/11 sites.  The chemical 1-3 butadiene is metabolized in the body via an epoxy mechanism. A study which I published in 2009 (Leukemia article on DNA SNP) showed that myeloma patients are more likely to have a defect in this epoxy metabolism, and, therefore, are potentially more susceptible to the toxic effects.

So it seems that a story is coming together linking exposure, susceptibility, and early onset of myeloma in the 9/11 setting. More studies and follow-ups are needed, but these findings are plausible and satisfy elements of what are called the "Bradford Hill Criteria," used to link toxic exposures and the development of cancer such as myeloma. There is already "proof of principle" that several toxic chemicals can cause myeloma, including pesticides, solvents, and chemicals such as 1-3 butadiene.

With this knowledge, there is now an opportunity for early screening to diagnose any case as soon as possible and look toward even curative intervention.  Every cloud has a silver lining--in this case, the ability to understand the process and intervene early.

As I paged through the second edition of Dan Buettner's "The Blue Zones," pondering the benefits of goat's milk, beans, garden vegetables and the like, I suddenly noticed a sentence with the word "cookies" in it! His personal interviews with the centenarians from the Sardinian mountain regions were most revealing and interesting. Before heading off to visit the family mountaintop pasture, Dan "downed a dozen cookies with a few glasses of wine" with Tonino, the 75-year-old son of a centenarian. It turns out that "papassini," Sardinian cookies made with raisins, almonds, and jam from cooked red wine (saba), are very popular, especially at festivals and during holiday seasons. So right before Thanksgiving and the Christmas/New Year season, I learn that cookies may be okay after all! The recipe for papassini includes almonds (or walnuts), golden raisins, flour, eggs, vanilla powder, vegetable shortening, plus whole milk.

So do Sardinians live a long life despite eating cookies or are cookies actually part of the magic formula for life beyond 100 years?  Maybe, if they didn't eat cookies they could live to be 150 years? At this point, I am thinking that 100 years seem fine.  But, as I focused in on the individual stories of centenarians from "The Blue Zones" in Sardinia, Okinawa, California, Costa Rica, and the island of Ikaria in Greece, I appreciated the great diversity in factors contributing to long life. With regard to food, there are both similarities and differences. The major common feature is reliance upon a lean, plant-based diet. Herbal and medicinal teas are common. Red wine (Cannonau or Grenache) high in flavonoids is popular in Sardinia and Ikaria.  Fresh goat's milk and grass-fed sheep cheeses are also popular in both these blue zones. The high omega-3 fatty acids in these products may be especially important since fish is eaten, but is not a consistent staple across the blue zones.  There is liberal use of olive oil as well as frequent use of pork lard in cooking.  Of note, eggs often accompany beans, rice, and tortillas. Breads are whole grain.  Both sweet and traditional potatoes are used.  Meat-eating is definitely low, and is restricted mainly to pork, with less frequent beef reserved for holidays and festivals.

But it turns out that many key features of blue zones are not food related.  It is important to realize that "The Blue Zones" are not idyllic paradises with individuals focused on their "best diet."  These centenarians, by and large, have endured many hardships in their lives and eaten what is available: often not enough.  Even when they have enough food in Okinawa, the centenarians stop eating when they are 80% full.  These are tough, decisive people doing their best to survive. There is an underlying faith that "God will provide" despite precarious circumstances. There is freedom from the financial and social pressures of modern society.  Elders are revered within the family and community. These are not "me" societies: it is all about the extended family. Time and deadlines are not important. Naps are okay and part of the pattern of life.

Dan Buettner and his diverse collection of experts have tried very hard to sort out the dietary, genetic, and social factors that can lead to long life. In Costa Rica, the centenarians are closely linked to the Chorotega Indians, but there may still be genetic diversity and strength from what locals call "mixed blood" in this blue zone.  Ultimately, the causes of longevity are clearly multifactorial.

And so, I came back to my starting question: what about the cookies? As I turned to page 238, I spotted another sentence with cookies in it: this time anisette cookies.  It turns out that, in Ikaria, they also love cookies, in this case, anisette cookies, which are remarkably similar to "papassini," using almond extract instead of crushed almonds.

So my final take-away is to rely on what Dan Buettner's team calls "Vitamin S" as a magic ingredient.  In this case, S is for Smile!  Centenarians and the rest of us, if we want to be like them, need to be happy, sociable, welcoming people always ready with a smile. If that smile, from time to time, combines with cookies and red wine, this can be a good thing!

In the October 28, 2012 issue of the New York Times Sunday Magazine, Dan Buettner discusses "The Blue Zones": places in the world where an unexpectedly high percentage of people live to be over 100 years old (or close). Dan has a newly updated book out on this topic, but the focus of the New York Times article is the story of a Greek-born war veteran who moved to the U.S. and, in his 60s, developed lung cancer (presumed terminal). Expecting to die very soon, he returned to his native island, Ikaria, a Greek island 30 miles off the west coast of Turkey. Now, 35 years later and approximately 100 years old, he is cancer free and living an active life on Ikaria.

The question is why?

To come up with an answer, Dan Buettner has zeroed in on a "Blue Zone," which is a cluster of villages high in the mountains of Nuoro province in Sardinia, which contains the highest concentration of men over age 100 anywhere in the world.

He has recruited a team of experts, including Dr. Gianni Pes (University of Sassari in Italy) and Dr. Michel Poulain, a Belgian demographer, to help assess and validate if "Blue Zone" residents are really living longer than expected and why. So it is possible to compare and contrast the diet and lifestyle of residents of Ikaria, including Stamatis Moraitis, the long-lived cancer survivor, with centenarians from Sardinia and the other "Blue Zone" regions.

A key common feature is the local variations on the "Mediterranean type diet." The residents of Ikaria drink a popular "mountain tea" made from dried herbs such as marjoram, sage, mint (fliskouni), rosemary and dandelion. Local honey is widely used, and old people start their day with a spoonful of honey.

The menu in Ikaria include goat's milk, two-to-four glasses of local red wine daily, lentils, garbanzos, potatoes, fennel and seasonal vegetables from the garden. Residents also enjoy fish three times each week and small portions of larded pork from the family pig. There is generous use of olive oil with meals, plus local sourdough bread made with stone-ground wheat.

So there you have it, "Mediterranean Real Food": but there is also what they do not eat! Very little refined sugar and white flour; no sodas. All of this is remarkably like the "Real Food" approach we have been discussing in recent weeks.

Asked why she lived past 90 years, an old lady on Ikaria said it was the clean air and wine. A 101-year-old woman just shrugged and said, "We just forget to die."

There may be a lot of truth in this. The island residents do not track time (no clocks), work in their gardens, socialize, drink wine, have naps and are happy to wake up each day. So, although food is definitely important, the impact of the whole lifestyle cannot be ignored.

I have the impression that rushing to the gym eating an energy bar is not going to replicate the long life on Ikaria no matter how much "Real Food" we add in. We need true lifestyle changes, plus every effort to eat as best we can!

A lawn chair, an old coffee table, an IBM typewriter, a ream of paper, and three people with very different backgrounds: that was the checklist of assets and experience that the International Myeloma Foundation had when it was born 22 years ago. Every day, no matter our triumphs or tragedies, I usually have a moment reflecting on where we began.

Comparing the IMF of today to the time of our founding, it is remarkable to me how far we've come...and how far we still have to go. Think of the maturing process of a young 22-year-old; how far he or she has developed since birth and yet still unsure of what the future will hold. That is how I feel about the IMF.

Like an infant, in our early days we were happy to have achieved something, anything. Following Brian Novis's diagnosis of myeloma, we had little idea of what lay ahead of us and lived day-to-day, thankful for every good one and knowing that they would become fewer sooner rather than later. Brian immediately understood that the main thing missing was information: information that patients could use and, sadly, information that most doctors and researchers didn't have.

As the idea of the IMF began to gel, we had few goals but great ambition. The first important achievement was the organization of the first international conference of myeloma experts. This meeting of 40 experts sharing ideas has evolved into a biannual international conference attracting thousands of clinicians and researchers. Additionally, since that time, the topic of myeloma has gone from being a peripheral concern at the annual meeting of the American Society of Hematology (ASH) to a highly anticipated forum and megaphone about the advances in myeloma treatment and research for thousands of doctors and researchers, and hundreds of thousands of patients and caregivers from every part of the globe.

The IMF seized on this opportunity to form a board of Scientific Advisors who, in 2001, met to publish the first ever management guidelines for myeloma. As many long-time IMFers well know, this initiative led to the creation of the International Myeloma Working Group (IMWG). This collection of internationally recognized experts is now the source of guidance and information for all with an interest in myeloma. We have now hosted three annual meetings of the IMWG, which has produced numerous management guidelines covering every facet of myeloma treatment.

Because of the achievements, clinicians have immediate, timely access to the best, most recent information to provide patients everywhere the best care possible. But that doesn't mean everyone has access to ideas yet.

The central idea that grew out of those early days was the value and importance of patient education. After attending that first clinical conference I began asking, "Why don't we have these kinds of gatherings for patients?" It had never happened before, so initially there wasn't much interest. But we persevered and held the first ever--for any disease group anywhere--Patient & Family Seminar in 1993. Since that time we have held hundreds of patient education meetings all around the world. This year alone we have hosted or co-hosted more than 45 patient meetings in 17 nations.

Also in 1993, we produced our first info packs, arguably the best information available for myeloma patients everywhere. In the early days we were busy at the copy machine churning out as many as we could afford. Today we produce more than 100 patient education booklets in at least 30 languages that are free to anyone who asks.

Looking back, we never could have imagined in 1990 the scope and range of programs that the IMF was capable of producing:

• A Hotline that takes thousands of calls per year, professionally staffed, and for most who call, the first optimistic words they hear about their myeloma diagnosis.
• An advocacy program that voices the concerns and needs of myeloma patients to policymakers.
• Research grants given to the best young and experienced minds in the field of myeloma.

In 22 years, the IMF is a mature, ever-growing organization that constantly seeks the input and direction from our members so, if there is a need, we do all we can to address it.

Over the years, I have been struck by the common hopes and fears of myeloma patients and caregivers everywhere. We all have simple, yet invaluable desires: to see our children graduate from school, to hold our grandchildren, to celebrate that important anniversary with our loved ones, to laugh with our friends, to hold hands on a peaceful walk in the woods. And in the simplicity of these desires, you experience what the core mission of the IMF is. We are here to serve every individual who has been touched by myeloma.

Thanks to advances in medicine and the treatment, especially within the past 14 years, myeloma patients are living significantly longer with a vastly improved quality of life. We can envision a day when myeloma will become a chronic disease, something that Brian could never conceive.

In 2002, I was honored to testify before the U.S. Senate on behalf of all cancer patients to advocate for funding for the National Institutes of Health (NIH) and the National Cancer Institute (NCI). I described to the senators a situation that is far too familiar to too many of us: "Brian's doctor said he had three to five years to live. Our family and friends hoped and prayed that he was wrong, that we would be able to raise a family and have a long and happy life together. We were wrong--the doctor was right. Brian died in 1992, just four years after his diagnosis at the age of 37. Our life together, however brief, was happy. And even though we never had children we did create a family. Our family became the International Myeloma Foundation. A family comprised of patients, family members, caregivers, and friends."

Much like a parent who nervously, but confidently, anticipates a productive life for their 22-year-old child, I am confident, not nervous, that as our 22-year-old idea continues to mature we will make significant contributions with our core mission and programs.

Looking back on the past 22 years, I realize that together we have created so much more than a family. We have helped create a loving and caring community. A community of hundreds and thousands that can trace its birth to a lawn chair, a coffee table, an IBM typewriter, a ream of paper, and three people with very different backgrounds.

My life was deeply touched this fall by three special, hardworking couples: Karl and Lorraine Vollstedt, Howard and Teresa Martinson, and Harold and Sue VanDuyn. Each went out of their way to welcome me into their local myeloma support group community.

With the help of myeloma survivor Barb Davis, Karl and Lorraine are co-leaders of the Stillwater, Minnesota Multiple Myeloma Support Group. I met them when I attended my first ever support group meeting five years ago.

I am fond of telling anyone who will listen that the education I received—and the friendships I made there—helped save my life.

After a number of years, Karl is still alive and kicking. Myeloma and advancing years have taken their toll on Karl. And Lorraine recently had both knees replaced, along with a painful foot surgery. But you wouldn't know it by talking with them—two of the most positive, upbeat people I have ever met

Lorraine was kind enough to invite me to stay with them during my recent visit north. I was scheduled to speak to a myeloma support group in Minneapolis, but I set up my schedule to allow me to spend a couple extra days with Karl.

We drove into the city for a tour of Target Field, the new Minnesota Twins' ballpark. We visited a homeless center there, too; Karl is a member of their board of directors.

And speaking of homeless shelters, my new friends and support group leaders, Howard and Teresa, in Spokane, Washington, also help to run a shelter in nearby Coeur d'Alene, Idaho.

What?  Like dealing with their own cancer and helping other patients and caregivers—doesn't keep them busy enough? Amazing!

I met Howard and Teresa—and our third couple, Harold and Sue—in Dallas at the IMF's Support Group Summit. Harold had just introduced himself when he started bragging-up their hometown of Grand Rapids, Michigan. They invited me up to speak to their group and I eagerly accepted.  Even thought Grand Rapids is the state's second largest city, there wasn't a support group for myeloma patients anywhere to be found nearby. So of course, this energetic couple started one ten months ago.

With the help of the IMF, the new, fledgling group is already amazingly successful.  Over 40 patients, caregivers and family members somehow squeezed into a room in the world famous Gilda's Club to hear my story on Monday. And Harold was right! Grand Rapids was a very impressive city, with new medical and research buildings rising everywhere.

But it's the people that make Stillwater, Spokane and Grand Rapids so special. Everyone I met was warm and helpful.

Harold only recently recovered from a stem cell transplant, and some of his counts haven't recovered.  But like Karl and Lorraine, you wouldn't know it!  Harold may be the patient face of the new group, but Sue pulls everything together.  She's the organizer.

Isn't that always the case?  Behind most every helpful myeloma survivor, there is a dutiful caregiver that helps monitor their medications, gets them to appointments on time and helps emotionally hold things together.

At breakfast Tuesday, Harold started rattling-off examples of all the new myeloma friends the couple had made since starting their group.  Right back at you, Harold!  I hope I make the list.  I can't imagine having better friends than Karl, Lorraine, Howard, Teresa, Harold and Sue!

Three exceptional patient/caregiver teams and support group leaders.  Six exceptional friends.

Funny how a cancer like multiple myeloma can bring out the best in people, isn't it?

Feel good and keep smiling!

Pat

After the teleconference on "10 Steps To Better Nutrition," numerous comments, questions, and helpful suggestions came into the International Myeloma Foundation (IMF). It is clear that many details about food and drinks are of great interest. So I will start with some of the recurring themes.

Are some cookies okay?

The answer is yes! It is important to understand about acrylamide and some other aspects of cookies. Let me again refer you to the Mayo Clinic nutrition article plus the National Cancer Institute's "Fact Sheet: Acrylamide in Food and Cancer Risk." Acrylamide is a toxic chemical which is produced by high temperature cooking (above 248°F [120°C]) when asparagine, an amino acid (in proteins), binds with sugars in whatever is being cooked. So keep temperatures low and avoid excessive browning or burning: these are key to keep acrylamide low. Preparative pre-cooking can also be important, such as the use of coating with olive oil before cooking meat. Likewise blanching potatoes before frying can be helpful in reducing acrylamide. So what about cookies? It is definitely possible to have cookies with low acrylamide. For example, lightly baked, fully organic oatmeal cookies or shortbread cookies can be options. Obviously, one needs to separately consider the sugar content and calories: nothing is simple these days!

Talking about sugars, let me switch to the number one area of questions and comments:

What about sodas? Are there some safe options there?

On the teleconference call on Thursday, October 11th, I cautioned that quite a number of processed and packaged foods and drinks can contain toxic chemicals, hormones, antibiotics, and some can even contain dangerous fungus or bacteria.

So what can one do to stay healthy? My strong recommendation is to eat "Real Food" and carefully selected drinks. I also recommended that you stay above the fray of the often confusing and controversial discussions about which chemical or hormone is toxic or not. Just do your best to avoid chemicals or processes which are in dispute and potentially dangerous. Read labels and make a commitment to maximize the amount of "Real Food" in your diet. If you can't go to a Farmer's Market or don't have one close by, check at your local store- many are now stocking organic food (Time Magazine, October 2012). Another option is to see if fresh, local, organic produce can be delivered (Fresh Direct) or perhaps friends or neighbors can help.

What is best with regard to sodas?

The main point is to do your best to avoid:

• Artificial sweeteners: Sucralose (Splenda®) and Aspartame (Nutrasweet® and Equal®
• Caramel coloring chemicals: 4-methylimidazole (4MI)
• Excess sugar, especially high-fructose corn syrup
• Also, bisphenol A from plastics and phosphate preservatives

A recent editorial in the New England Journal of Medicine (this and another article are linked as references from the teleconference page) highlights the need to restrict soda intake, because of the high-fructose corn syrup, to reduce the risk of developing obesity, diabetes, and/or a range of other ailments.

A useful website source is "Rodale" (Where Health Meets Life), which highlights 8 healthy sodas. Go to the site to get full details. The sodas and healthy drinks are:

• Fizzy Lizzy, a carbonated fruit juice drink
• Reed's Light extra ginger brew
• Virgil's Root Beer
• Bionade, which comes in a range of fruit flavors
• Oogave, a certified organic soda with multiple flavors
• Kombucha fermented tea
• Hot Lips cranberry or pear soda
• Steaz sparkling green tea

These are options if you feel like having a soda or a healthy drink! Another option, in response to a question posed, is simply to add some natural pomegranate juice into sparkling water, which can produce quite a delicious drink. Pomegranate is an ancient and healthy fruit, which contains many active ingredients, such as antioxidants and polyphenols. Claims have been made that it is helpful for a variety of medical conditions and have been taken seriously enough to lead to several ongoing trials. Pomegranate is a good fruit- just how good, we don't know yet!

So this is perhaps enough information for now. I will be back again soon to discuss additional topics of particular interest or concern. In the meantime, don't forget to read the labels!