Health science startup teams with Mayo Clinic on personalized nutrition


DayTwo, the world’s first provider of health improvement and disease prevention solutions based on gut microbiome research, is collaborating with the renowned Mayo Clinic in Minnesota to bring its first product, DayTwo Personalized Nutrition Solution, to early adopters in the United States.

Based on research from Israel’s Weizmann Institute of Science in Rehovot, Israel, showing that different people respond differently to the same food, DayTwo provides actionable health solutions for improving health and preventing disease by balancing blood-sugar levels in a personally tailored way.

As high blood sugar is linked to energy dips, excessive hunger, weight gain and increased risk for diseases such as obesity, diabetes and hypertension, balancing blood-sugar levels presents a significant health benefit.

The research generated an algorithm for predicting individualized blood glucose response to different foods based on gut microbiome information and other personal parameters. This algorithm was further developed by DayTwo and the Weizmann Institute, and predicts blood-sugar response to thousands of foods and meals.

The collaboration is managed by Dr. Heidi Nelson, director of the Microbiome Program at the Mayo Clinic Center of Individualized Medicine.

DayTwo CEO Lihi Segal says the collaboration is well aligned with the company’s U.S. launch targeting health-conscious and pre-diabetic individuals. “Providing our solution to U.S. consumers in a clinical trial setting with the Mayo Clinic allows us to calibrate our predictive algorithm for the U.S. market,” she said.

The Mayo Clinic will participate in Series A funding for DayTwo, which is registered in California and has offices in Rehovot.

Cures for age-old problems


When it comes to the health of boomers — those born between 1946 and 1964 —  there’s both bad news and good. The bad news is that, try as we might, this generation cannot stop the march of time and will increasingly face chronic medical issues that tend to develop with age, including heart disease, cancer and diabetes. 

The good news is twofold: Research demonstrates that boomers can significantly lower the risk of developing many of these health conditions by eating healthfully, staying physically active and avoiding tobacco. 

It also helps that scientists are pursuing a vast array of efforts to combat or treat these conditions. Here is a sampling of encouraging developments locally and in Israel that should give hope to boomers.

Heart disease

Heart disease risk increases significantly for those 45 and older, and it’s the leading cause of death for adults older than 60. The heart cannot regrow tissue damaged by a heart attack, but researchers are exploring how to help damaged hearts regenerate tissue, as well as creating materials to enhance heart function. 

At the Weizmann Institute of Science in Rehovot, Israel, Professor Eldad Tzahor and his colleagues were able to regenerate heart cells in mice by temporarily activating a protein involved in embryonic heart development. “Much more research will be required to see if this principle could be applied to the human heart,” Tzahor said in an Institute bulletin, “but our findings are proof that it may be possible.” 

Dr. Ronen Beeri, director of Hadassah Medical Center’s Cardiovascular Research Center, is collaborating with colleagues at Mount Sinai Hospital in New York to use gene therapy to replace failing heart cells. They are using viruses to transport specific genetic material into the heart cell.

A “cyborg heart patch” combining living tissue with integrated electronics has been created by Tel Aviv University professor Tal Dvir and doctoral student Ron Feiner. The material can expand and contract like human heart tissue, while regulating itself like a machine. “We expect this to move cardiac research forward in a big way,” Dvir said in a news release. He believes the patch, along with sensors, could be used to send data about the heart to a physician or even eventually to administer treatment, for example, by releasing anti-inflammatory drugs if it senses inflammation.

Here in Los Angeles, researchers at the Cedars-Sinai Heart Institute have identified a possible way to address a common but difficult-to-treat type of heart failure that occurs when the heart muscle is so stiff that the heart cannot fill with blood. Laboratory rats with hypertension and this specific type of heart failure regained heart-pumping function after receiving infusions of cardiac stem cells.

Cancer

Cancer is the second-leading cause of death in the United States, and 86 percent of cases in this country are diagnosed among those 50 years and older. A developing approach in cancer treatment called immunotherapy harnesses the body’s own immune system to fight the disease. 

At UCLA, investigators are testing an immunotherapy drug for advanced melanoma, the most aggressive and deadliest type of skin cancer. The drug “releases the brakes” on the body’s immune system, enabling it to recognize and attack cancer cells. UCLA is one of six national cancer centers comprising the Parker Institute for Cancer Immunotherapy, a collaboration launched this year to maximize the potential of cancer immunotherapy research. 

Weizmann Institute professors Yoram Salomon and Avigdor Scherz have helped to pioneer a new therapy for treating early-stage prostate cancer that involves using a laser in combination with a new drug, called TOOKAD Soluble. Patients receive the drug intravenously, then immediately undergo infrared radiation administered via thin optic fibers inserted into the cancerous tissue. The 90-minute procedure allows for treating large, deeply embedded cancerous tissues, and the minimally invasive approach appears to decrease side effects. 

At the Keck School of Medicine of USC, Dr. Gabriel Zada was among California’s earliest adopters and teachers of a new approach enabling the removal of deeply embedded (sub-cortical) brain tumors. The NICO BrainPath is a tool combining imaging and navigation technology with an instrument that’s about the width of a highlighter with a tip the diameter of a pencil tip. The instrument can gently spread brain tissue without damaging the cortex (gray matter) and brain fibers. “It’s a highly accurate way of finding and accessing deeper brain lesions while protecting all the important superficial layers,” Zada told the Journal. “Now we can get to tumors or blood clots in a safer way than we could before.” 

Type 2 diabetes

Boomers will be happy to learn that researchers at Ben-Gurion University of the Negev in Beersheba report that having a daily glass of red wine helps people with Type 2 diabetes moderately reduce cholesterol and improve cardiac health. Individuals with diabetes are at higher risk of cardiovascular disease and have lower levels of “good cholesterol.” Professor Iris Shai was principal investigator of the two-year trial, which also involved Harvard University and two European institutions.

Students in Hebrew University’s BioDesign program paired pressure-sensing socks with smartphones to reduce foot ulcers in diabetic patients.

Another challenge facing many people with diabetes is foot ulcers attributed to nerve damage that diminishes sensation in the feet. Members of the BioDesign: Medical Innovation program, created by The Hebrew University of Jerusalem and Hadassah Medical Center, developed an innovative way to address this problem. Hebrew University’s Danny Bavli and doctoral student Sagi Frishman, along with Hadassah’s Dr. David Morgenstern created SenseGO pressure-sensing socks. The machine-washable socks register pressure and send signals to a smartphone app that can alert patients to problems, helping them to avoid developing foot wounds.

Depression

In the past year, an estimated 6.7 percent of the U.S. adult population — or about 1 in 15 — had at least one major depressive episode, according to the National Institute of Mental Health. Depression affects around 6 million Americans ages 65 or older.

At UCLA, researchers are looking to the brain’s electrical system to develop and fine-tune treatment for depression. They are using an approach called neuromodulation, applying magnetic or electrical energy to modify the brain’s signaling processes. 

“Traditionally, we think of treating depression with chemicals that affect how individual nerve cells function,” Dr. Andrew Leuchter told the Journal. “The latest treatments … use a source of energy … to reset the mood regulating networks of the brain … and frequently restore normal moods in patients with depression.” 

One form of this treatment, called transcranial magnetic stimulation (TMS), involves placing an electromagnet on the scalp to pulse the brain’s mood-regulating area with electromagnetic energy. Leuchter says that about 60 percent of patients who failed to respond to antidepressant medication received “substantial benefit” when combining medication with this noninvasive treatment.

Researchers at Hebrew University found that targeting a certain type of brain cell, called microglia, may provide a new avenue for treating depression. Comprising roughly 10 percent of brain cells, microglia carry out immune system functions in the brain. Professor Raz Yirmiya and his team, along with researchers at the University of Colorado, Boulder, found that microglia also cause symptoms of depression in response to stress. Blocking the stress-response activation of these cells in mice halted their symptoms of depression. The findings, Yirmiya said in a media release, “suggest new avenues for drug research, in which microglia stimulators could serve as fast-acting anti-depressants in some … conditions.”

Alzheimer’s disease

Of the estimated 5.4 million Americans who have Alzheimer’s disease, all but about 200,000 of them are age 65 and older. According to the Alzheimer’s Association, the number of seniors with Alzheimer’s is projected to reach 7.1 million by 2025, a 40 percent increase over this year’s figure. 

By the time symptoms of Alzheimer’s appear, the patient may have been developing the disease for as long as two decades. At Cedars-Sinai, researchers are focusing on preventing the disease and detecting it early. The Cedars-Sinai Alzheimer’s Prevention Program includes an 18-month study looking at whether lifestyle changes can slow the buildup of amyloid plaque, the destructive brain plaque typical of Alzheimer’s, in patients with mild cognitive impairment or a family history of dementia. The program recommends lifestyle changes including eating a Mediterranean diet, exercising regularly, reducing stress and getting adequate sleep.

In addition, Cedars-Sinai researchers have developed optical imaging technology used in a device with potential to detect Alzheimer’s years before symptoms develop. The retinal imaging device detects amyloid plaques in the retina, which may precede the development of plaque in the brain.

Researchers at Tel Aviv University, the Technion-Israel Institute of Technology (Rambam Medical Center) and Harvard University are investigating the possibility of detecting Alzheimer’s via a blood test. They identified a specific protein found in high levels in individuals with cognitive decline. The next step will be to take these findings into clinical trials with the hope of eventually creating a “pre-Alzheimer’s test” to identify individuals who would benefit from early intervention measures.

Eye problems

The risk of severe eye problems increases significantly with age, especially in those older than 65. According to the American Foundation for the Blind, experts predict that rates of vision loss to double by 2030 because of the country’s aging population. 

Hebrew University Professor Uri Banin and graduate student Nir Waiskopf have developed an artificial retina that absorbs light and stimulates neurons. It is hoped that the wireless implant might be used in the future to create a prosthetic device to replace damaged retinal cells in those who are blind.

Bar-Ilan University researchers also are working on a way to help the blind to “see.” Professor Zeev Zalevsky, along with Sheba Medical Center professor Michael Belkin, have developed a prototype contact lens that processes digital images and translates them into tactile sensations. The cornea can feel these sensations, helping wearers form a picture of their physical surroundings. 

Also at Bar-Ilan, Dr. Yossi Mandel and researchers at Stanford University have developed a device that enables patients with glaucoma to monitor the fluid pressure inside their eyes using an implanted lens and a smartphone. The hope is that this technology will relieve the burden of visiting the ophthalmologist for frequent pressure tests, as well as provide a source of more frequent and reliable data.

Cartoon: Diabetes in California


Diabetes in Salinas: Why won’t a city world-famous for agriculture eat its vegetables?


The Salinas Valley is world famous for producing healthful foods, but people here struggle with severe health challenges. As a physician seeing patients in exam rooms, I found it enormously difficult to help people—even those harvesting lettuce—to eat in healthy ways.

I decided to try a new approach—educating people before they develop serious health problems. That has meant offering five-week-long classes to groups of people in migrant education offices, school districts, low-income housing sites, senior centers, Head Starts, offices for CalWorks (the State’s aid program for needy families), and a farm labor camp.

We’re seeing such strong results—we’ve reached more than 400 people eager to prevent diabetes in the Salinas Valley—that we’re planning to offer more classes, in more places.

These classes are the product of my nearly 40 years of work here. I moved to Monterey County in 1976, from New York via Delano in the San Joaquin Valley, to work for the United Farm Workers. In 1980, I launched a career in health care, first as a nurse’s aide and then a nurse before I went to medical school and became a doctor. I returned to Salinas to do my residency training at Natividad Medical Center.

I love the Salinas area. Its physical beauty is striking, and it enjoys a rich diversity of cultures. Monterey County is more than half Latino—from recently arrived, indigenous language-speaking Oaxacan immigrants to U.S.-born Latinos—and includes communities like Seaside and Marina, with African-American, Vietnamese, Korean, Asian and Pacific Islander, and other populations, making the area feel like a microcosm of California. It’s been gratifying to see the local power structure change to represent the diversity of the communities. Salinas is a city, but it’s not so big as to be overwhelming. As John Steinbeck wrote in 1955, there’s “Always Something to Do in Salinas.”

In some ways, Salinas is quite healthy. The most recent major health assessment by the Monterey County Health Department found some good news:  decreased smoking rates, big declines in deaths from stroke and heart disease, and decreased overall mortality rates from diabetes. But the assessment also found large health disparities between Latinos and non-Hispanic whites covering everything from cancer screening to teen pregnancy to diabetes mortality and obesity.

These disparities had long bothered me personally, because I saw them in the exam room. I’ve devoted my career to public sector health care; my hospital, Natividad Medical Center, is one of just 21 public health care systems in the state. As a family physician, it was frustrating to realize that my curative work was often too little, too late. I was seeing obesity and diabetes at younger and younger ages; it was becoming an epidemic here, and Monterey County already had higher rates of diabetes than the state average. It was clear that people, particularly in the Latino population, needed earlier intervention and more robust education about their health.

So I decided five years ago to make the transition from seeing individual patients to focusing on public health, via Natividad’s foundation.

At first, I wasn’t quite sure how I wanted to work on prevention. I discovered quickly that for all the talk about prevention, there wasn’t much funding for it. One of the first things that got knocked out of the bill that became the Affordable Care Act was a sizeable part of prevention funding. And usually funders want to see quick results; that’s hard with prevention programs, since the outcome, if it’s good, is something that didn’t happen.

I started with a vision of a health promotion center. But I soon focused on a crucial aspect of health promotion: the prevention of diabetes. I had been struck by groundbreaking research from the National Institutes of Health and the Centers for Disease Control and Prevention that showed how simple measures—like walking 30 minutes a day and losing only 5 to 7 percent of body weight—could prevent diabetes in people with pre-diabetes. Indeed, measures like this outperformed a widely used diabetes medication.

I also knew we had to get out to communities, to communicate with people in familiar groups and settings. Our local community foundation—the Community Foundation for Monterey County—backed a program that we called “Five Steps to Prevent Diabetes,” and in fall 2012, we began the classes. They run once a week for two hours at a time, for a total of five weeks, at convenient times. During the harvesting season, scheduling can be tricky, so we try to offer many during the winter off-season. We also offer classes right after work, from 6 to 8 p.m.

Each class has a different topic—diet, physical activity, portions, diabetes—and we give homework that consists of exercises such as keeping a calendar of how many of cups of fruit and vegetables one eats in a day. People then share their progress—and obstacles—with the class and offer insights and solutions to each other, a strategy we’ve found to be especially powerful. We conduct the classes in English or Spanish, and we don’t use Power Points. Instead, we get people up and moving; they create model plates of food, they stretch resistance bands, and they jump rope. Seniors can participate in modified physical activities, such as chair exercises.

The idea is to teach easy and affordable strategies that people can use at home. We conduct testing of the participants before and after to evaluate progress. (We use validated United States Department of Agriculture and University of California, Davis questionnaires that are linguistically and literacy-appropriate). Starting with the first year of the class, we’ve seen significant improvement on most (and for the last two years, all) of the 13 measures we use, which include daily quantities of vegetables and fruits eaten and other behavior changes.

Over three years, we’ve modified the curriculum slightly to make concepts simpler, navigating some literacy challenges along the way. And we’ve seen—particularly in the case of a mother in our classes whose five-year-old child weighed over 100 pounds—how getting a whole family to improve its health together is crucial to making progress. (The mother reported the child was doing better, in conjunction with appropriate medical care.)

It’s important to recognize that change takes time. A young mother whose husband was diagnosed with diabetes reported that it took a year to make changes in the family diet that stuck. Eventually, though, the whole family was eating more healthfully, even eating tacos with lettuce-leaf wraps instead of tortillas.

I’ve been struck by just how avidly people want this information. Obesity and diabetes, which are often connected, have touched so many in this area that people are truly frightened by them. All of our class participants know someone with diabetes, and several report having family members with diabetes-caused amputations, blindness, neuropathy, and death. Families want what is best for their children and as a result are hugely motivated to keep the next generation healthy.

We just received funding for a fourth year for “Five Steps to Prevent Diabetes” from the community foundation, so we’re reaching out to new partners and trying to take the classes to other parts of the county and the Salinas Valley, such as King City. We’d also like to offer more in the indigenous languages that many workers in Monterey County speak; Natividad Medical Foundation has as project to teach indigenous language speakers to become interpreters who can work in health care, the courts, at the DMV, or in other settings.

We’re also learning how to encourage people to eat more of what is grown here. Part of the problem is price, since locally grown artichokes, berries, and exotic vegetables are often expensive. And many Salinas residents, because they’re familiar with agriculture, are very conscious about pesticides. In our classes at various food banks, food bank staff members told us that when they would send people home with free local produce, the recipients would sometimes throw it out if the fruits or vegetables were unfamiliar to them.

We discovered that many people don’t know what to do with some of the produce they and their neighbors help grow; they’re not used to having it in their diets in their countries of origin. But if you give them recipes or provide a cooking demonstration, they’re likely to use the produce. We conduct simple food demonstrations and give participants recipe cards.

We’ve been inspired to hear our participants’ reports. One Head Start mother from King City started her own vegetable and fruit garden. Several women at a labor camp in Soledad started a walking group, circling the expansive agricultural fields together at dusk. Another participant switched from white rice to brown rice or quinoa. Another substituted nopales for tortillas. Several tried recipes for baking instead of frying enchiladas or chicken. Others added more tomatoes, onions, and peppers to soups to increase their young children’s vegetable consumption. People love recipes for good local food; they know the goal is healthy living.

In the Salinas Valley, investment in prevention is paying off. And we’re confident that an even broader community health is attainable here.   

Dana Kent is a family physician working in Salinas, California, with the Natividad Medical Foundation, which supports Natividad Medical Center. This essay is part of Salinas: California's Richest Poor City, a special project of Zócalo Public Square and the California Wellness Foundation. 

New diabetes hope with AAT therapy


Israeli researcher Eli Lewis never forgot how a childhood friend with diabetes repeatedly injected himself with insulin shots. 

“I thought he was a hero,” said Lewis, director of the Clinical Islet Laboratory at Ben-Gurion University of the Negev in Israel. “I was blown away by his bravery.” 

As a post-doctoral fellow at the University of Colorado, Lewis thought of an idea that might help his friend. The lab was looking at how inflammation affected organ transplant rejection. Lewis realized inflammation and cell injury might play an unexplored role in type 1 diabetes, a disease in which the immune system destroys insulin-producing cells in the pancreas. More than 15,000 children are diagnosed with it each year, according to JDRF (originally known as the Juvenile Diabetes Research Foundation).

His idea evolved into clinical trials to test whether an existing drug — one replicating a substance naturally produced by the body — could eliminate the inflammation driven by cell injury that is involved in type 1 diabetes. Results of the trials, Lewis told the Journal by phone, “have been pretty striking.” 

Patients with type 1 diabetes who received treatment the soonest after diagnosis experienced the greatest benefits. About a third no longer showed any signs of diabetes — they were able to completely stop using insulin via syringe or other method to regulate their glucose levels. Those who were not “cured” were nonetheless able to forgo taking insulin at night. Treatments were limited to patients who had been diagnosed within one year, before damage to the pancreas is thought to be irreversible, Lewis said.

“One father of a child in the trial told me he couldn’t remember the last time he had a full night’s sleep,” said Lewis, referring to the father’s need to supervise his child’s nighttime insulin injections. 

Insulin enables the body to convert glucose (sugar) from food into energy. Normally, the body produces a substance called alpha-1 antitrypsin (AAT) that helps repair tissue and reduces inflammation, but AAT doesn’t function in patients with type 1 diabetes. 

The body naturally produces AAT in the liver. It has also been available in drug form for about 30 years as a treatment for a rare form of emphysema. The clinical trials demonstrated that when recently diagnosed patients received injections of functioning AAT in the form of the drug, they regained the ability to fight inflammation, Lewis said. 

“No other therapy was addressing the fact that when tissue is injured, it calls upon the immune system and inflammation [results],” he explained. “Our approach appeared to turn over a stone that had not previously been overturned.”

The three clinical trials were held at Ben-Gurion University, the Barbara Davis Center for Childhood Diabetes at the University of Colorado School of Medicine and the Joslin Diabetes Center, which is affiliated with Harvard Medical School. Patients received weekly doses of AAT for between eight and 12 weeks. Two new trials involving additional institutions are now starting to fine-tune timing and dosage.

Lewis says that AAT also shows promise as a therapy for people with type 1 diabetes who are beyond a year post-diagnosis. Islet cell transplantation is an existing alternative to insulin injection. In this treatment, after receiving injections of insulin-producing cells from a donor pancreas, a patient’s own pancreas regains its ability to produce insulin. However, the treatment loses effectiveness eventually because the transplanted cells are rejected and damaged by the body’s immune system in a matter of years. AAT seems to reduce the inflammation, allowing the new cells to remain effective indefinitely, according to pre-clincal trials. 

AAT therapy may also have some application in type 2 diabetes, although to a lesser degree. Metabolic mechanisms (those involved in converting food into energy) play the major role in type 2 diabetes, which accounts for 90 to 95 percent of diabetes cases, according to the Centers for Disease Control and Prevention. Nevertheless, Lewis said, inflammation may still play a role in type 2 diabetes. He cited a Swedish study that found half of patients with type 2 diabetes had decreased levels of AAT. 

“This could be a future direction for research,” he said.

It will take at least two years for AAT to receive Food and Drug Administration approval as a treatment for type 1 diabetes. However, some physicians have been using it in the meantime as an off-label treatment. This practice involves using a drug approved for one condition (in this case, a rare form of emphysema) for a different condition (in this case, type 1 diabetes).

Lewis described a family in Israel who obtained AAT in this manner. Soon before beginning the first clinical trial, he heard from a father who had learned about the AAT study online and whose son who had diabetes. The man’s daughter also had just been diagnosed. At that time, however, the clinical trial hadn’t yet started, and neither child qualified, as one had been diagnosed too long ago, and the other was too young.

“The father was very persistent and got his doctor to use the material,” Lewis said. “The treatment was completely effective for his daughter. She no longer needs insulin. The father now says that he only has one child with diabetes.” 

Being American is bad for your health


“Americans are sicker and die younger than people in other wealthy nations.” 

That stark sentence appears in the January 2013 issue of the Journal of the American Medical Association, and it comes from the authors of a landmark report – “Shorter Lives, Poorer Health” – on differences among high-income countries.

You probably already know that America spends more on healthcare than any other country.  That was one of the few facts to survive the political food fight pretending to be a serious national debate about the Affordable Care Act.

But the airwaves also thrummed with so many sound bites from so many jingoistic know-nothings claiming that America has the best healthcare system in the world that today, most people don’t realize how shockingly damaging it is to your wellness and longevity to be born in the U.S.A.

This is made achingly clear in the study of the “U.S. health disadvantage” recently issued by the National Research Council and the Institute of Medicine, which was conducted over 18 months by experts in medicine and public health, demography, social science, political science, economics, behavioral science and epidemiology. 

Compare the health of the American people with our peer nations – with Britain, Canada and Australia; with Japan; with the Scandinavian countries; with France, Germany, Italy, Spain, Portugal, Austria, Switzerland and the Netherlands.  Side by side with the world’s wealthy democracies, America comes in last, and over the past several decades, it’s only gotten worse.

With few exceptions – like death rates from breast cancer – we suck.  Our newborns are less likely to reach their first birthday, or their fifth birthday.  Our adolescents die at higher rates from car crashes and homicides, and they have the highest rates of sexually transmitted infections.  Americans have the highest incidence of AIDS, the highest obesity rates, the highest diabetes rates among adults 20 and older, the highest rates of chronic lung disease and heart disease and drug-related deaths. 

There is one bright spot.  Americans who live past their 75th birthday have the longest life expectancy.  But for everyone else – from babies to baby boomers and beyond – your chances of living a long life are the butt-ugly worst among all the 17 rich nations in our peer group.

In case you’re tempted to blow off these bleak statistics about American longevity by deciding that they don’t apply to someone like you – before you attribute them to, how shall we put it, the special burdens that our racially and economically diverse and culturally heterogeneous nation has nobly chosen to bear – chew on this: “Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health (e.g., higher infant mortality, higher rates of chronic diseases, lower life expectancy) in the United States than in other high-income countries.”  And by the way, “the nation’s large population of recent immigrants is generally in better health than native-born Americans.”

Why are we trailing so badly?  Some of the causes catalogued by the report:

The U.S. public health and medical care systems:  Our employer- and private insurance-based health care system has long set us apart from our peer nations, who provide universal access.  The right loves to rail against “socialized medicine,” but on health outcomes, the other guys win.

Individual behavior: Tobacco, diet, physical inactivity, alcohol and other drug use and sexual practices play a part, but there’s not a whole lot of evidence that uniquely nails Americans’ behavior. The big exception is injurious behavior.  We loves us our firearms, and we don’t much like wearing seat belts or motorcycle helmets. 

Social factors:  Stark income inequality and poverty separate us from other wealthy nations, who also have more generous safety nets and demonstrate greater social mobility than we do.  In America, the best predictor of good or bad health is the income level of your zip code.

Physical and social environmental factors: Toxins harm us, but our pollution isn’t notably worse than in other rich nations.  The culprit may be our “built environment”: less public transportation, walking and cycling; more cars and car accidents; less access to fresh produce; more marketing and bigger portions of bad food.

Policies and social values:  To me, this is the richest, and riskiest, ground broken by the report, which asks whether there’s a common denominator – upstream, root causes – that help explain why the United States has been losing ground in so many health domains since the 1970s: 

“Certain character attributes of the quintessential American (e.g. dynamism, rugged individualism) are often invoked to explain the nation’s great achievements and perseverance.  Might these same characteristics also be associated with risk-taking and potentially unhealthy behaviors? Are there health implications to Americans’ dislike of outside (e.g., government) interference in personal lives and in business and marketing practices?”

My answer is yes, but I’d plant the problem in recent history and politics, not in timeless quintessentials.  Since the 1980s, in the sunny name of “free enterprise,” there’s been a ferocious, ideologically driven effort to demonize government, roll back regulations, privatize the safety net, stigmatize public assistance, gut public investment, weaken consumer protection, consolidate corporate power, delegitimize science, condemn anti-poverty efforts as “class warfare” and entrust public health to the tender mercies of the marketplace. 

The epidemic of gun violence has been fueled by anti-government paranoia stoked by the gun manufacturers’ lobby, the NRA.  The spike in consumption of high-fructose corn syrup has been driven by the food industry’s business decisions and its political (i.e., financial) clout.  In the name of fiscal conservatism, plutocrats push for cuts in discretionary expenditures on maternal health, early childhood education, social services and public transportation.  The same tactic that once prolonged tobacco’s death grip – the confection of a phony scientific “controversy” – now undermines efforts to combat climate change, which is as big a danger to public health as any disease.

More accidents may be shortening our lifespans.  But we’re not getting sicker by accident.


Marty Kaplan is the Norman Lear professor of entertainment, media and society at the USC Annenberg School for Communication and Journalism.  Reach him at martyk@jewishjournal.com.

Israeli company testing insulin pill for diabetes treatment


Some people diagnosed with Type 2 diabetes can manage their disease with diet and exercise. Others must turn to insulin injections and other medical interventions to control their blood sugar levels. But diabetes is a progressive disease — even if medication isn’t needed at first, it may be needed over time, according to the American Diabetes Association (ADA).

And while most people with Type 2 diabetes would like to avoid insulin shots, they are a daily reality for many diabetics.

That’s where the promise of a new insulin pill comes in. Israeli company Oramed Pharmaceuticals Inc. just received an Israeli patent for an oral insulin capsule — what researchers have called “the holy grail” of diabetes treatment.

Diabetes is a metabolic disorder in which a person has high blood sugar, either due to the body not producing enough insulin (Type 1) or because the cells have developed a resistance to the body’s own insulin (Type 2). (Some women develop gestational diabetes during pregnancy and are at risk for Type 2 diabetes.) Left untreated, diabetes can damage nerves and blood vessels, and lead to complications such as heart disease and stroke. Other health problems can include kidney failure and vision loss. 

By 2030, there will be 366 million people worldwide affected by diabetes, the World Health Organization estimates. More than 25 million Americans currently have diabetes, and by 2034, this number could increase to 44 million, the ADA reports. Americans’ increasing obesity, sugar-laden diets and lack of exercise don’t help.

Injectable insulin was first given to people in 1922. Over the years, there have been numerous attempts to find a needle alternative, including an inhalable version. But various problems — including possible lung cancer and low profitability — forced inhalable insulin off the market, while research continues. Diabetics are hopeful the Food and Drug Administration (FDA) will approve Generex’s Oral-lyn inhalable, which uses a mist spray.

There are two main obstacles to creating an insulin pill: One is that insulin is a protein and, in a pill form, it would be broken down by enzymes in the stomach, much the way protein in food is, so insulin would never reach the bloodstream. The second is that the insulin molecule is too big to pass through the stomach or intestine wall.

“Imagine the intestine wall is a tennis net, and when you take a Tylenol, it’s like a small ball that passes through the net and reaches the bloodstream,” Oramed CEO Nadav Kidron said. “But if the ball is bigger than the hole in the wall, it will never reach the circulation and will have no effect,” he said.

He should know. His mother, Miriam Kidron, studied the disease for 35 years at Hadassah University Medical Center in Jerusalem. At 70, Kidron is a unique woman: the great-niece of Rabbi Abraham Kook, Israel’s first Ashkenazi chief rabbi, she went into the army and then got a master’s degree in pharmacology and a doctorate in biochemistry at Hebrew University. She researched diabetes at Hadassah while raising four children in Jerusalem (she now has 13 grandchildren). 

In 2006, she went to her son and said, “We have a breakthrough.”

Their new capsule has both an enteric coating, which prevents it from being dissolved in the stomach, and an anti-protease that prevents the pill from being dissolved by enzymes.

The technology, which received Israeli patent approval in May, has the potential to be used for flu vaccines, among other injectable medications.

A lawyer and MBA who worked with Israeli startups and the nonprofit world, Nadav Kidron, 38, and Miriam Kidron founded Oramed in 2006; Hadassah is a partner. The drug is entering phase 2 of its FDA trials, and Oramed hopes to have the capsule on the market by 2015 in the United States, and earlier in countries such as China and Russia.

Oramed is one of several companies in the race for the cure. Danish pharmaceutical giant Novo Nordisk is spending $2 billion on a pill, but its research in the United States is only at phase 1 of FDA trials. A handful of smaller companies searching for an insulin pill include Philadelphia’s Diasome Pharmaceuticals and Diabetology Ltd. in the United Kingdom.

But competition doesn’t bother Miriam Kidron. “Personally, at the end of the day, I am not afraid,” she said, noting that there will probably be a few options. “There is no one medication good for 100 percent of the population.”

Analysts believe the market for a successful pill is from $5 billion to $10 billion.

But it’s not the money that excites her. “Money is not my motivation. My children are all married [except Nadav], and I have what I need. Maybe if it was 50 years ago,” she mused.

What really drives the Jerusalem grandmother is simple: “I will be happy when people will have oral insulin.”

Roots, reality and Israel’s 60th


It is a proud and glorious week as Israel, her 7.2 million citizens and millions of friends around the world celebrate the 60th anniversary of Israel’s birth as a modern, democratic nation.

This week, world leaders will join us in joyful ceremonies; flags will fly, anthems will play and the progress Israel has made toward the fulfillment of the ideals and aspirations of an ancient people in their modern state will be lauded.

The joy will be tempered by memories of loss and by the challenges and threats that continue as a daily part of Israeli life those same 60 years later. But in all, it will be a visible celebration of human achievement that can bolster hope in a difficult part of the world. It will be the stuff of ceremonies and tableaux, visible, stirring and meaningful.

As a proud Israeli, I will join that celebration here in Los Angeles, but not just the pomp and circumstance. That’s just the tip of the iceberg, if you will, or the part of the tree that lives above the ground. My celebration will seek that which is not so easily seen: the roots of a tree that give it life and stability; the underwater bulk of an iceberg that makes it massively powerful. You see, from my perspective, Angelenos and most of the people of the world see only the smaller, more visible part of the Israeli experience and reality.

What they don’t see are the roots that modern Israeli society has grown outward to connect with the rest of the world; what they don’t feel is the massive impact that Israeli companies have on the global economy; what they don’t know is how often in their everyday lives they are touched by modern Israel through the research, innovation and creativity that are the larger output of the total Israeli endeavor each day.

Most Angelenos “touch” Israel literally dozens of times each day; they just don’t know it. Be it the ingenuity of the Intel team in Israel that created the dual-core processor architecture now driving all of the PCs and Macs, the prominence of the Israeli software that safeguard our Internet connections, the major Israeli contributions to the very invention and continued development of cellphone technology or the ubiquity of Israeli software in the creation of voice mail boxes, instant messaging and customer service programs, there is “Israel Inside” almost everywhere; we just don’t know it, but it benefits us all every day.

There are hundreds of Americans alive today — and tens of thousands of others around the world — because of the ingenious “camera-in-a-pill” designed by Israel’s Given Imaging. This brilliant diagnostic imaging device is but one of many Israeli contributions helping better diagnose disease, just as Copaxone, a leading drug used to treat multiple sclerosis, is but one of many Israeli advances in treating disease. Ask any neurologist or endocrinologist about the level and quality of medical research being conducted in Israel today — in stem cells, diabetes or in neurodegenerative diseases — and they will tell you that Israelis are leaders in these fields and more, often in collaboration with Americans.

This is the work of Israelis; it should be the hallmark of our first 60 years and the legacy upon which our future is conceived and built. In a part of the world where many nations are blessed with enormous mineral wealth, our country has had but one natural resource: the curiosity, ingenuity and determination of our nation — immigrants from more than 180 countries — to create first a national homeland and then a society dedicated to making the world a better place. And, we do this despite our ongoing geopolitical and security challenges.

It’s time for the world to pay almost as much attention to Israeli organizations — like Save a Child’s Heart, which provides free treatment for Third World children with life-threatening heart ailments, or to the millions of lives saved by Israeli ingenuity with water conservation and irrigation — as it does to the violence in our region that we would hope to end forever.

As Israel turns 60, it is time for Americans to look below the surface and see the roots that now connect us — all of us, every day — by the way the diversity and creativity of the Israeli people and its extraordinary economy become integrated with Los Angeles and the world. Now is the time for Americans to see the larger part of Israel that is either submerged or obscured from view by the smoke of the conflict — the everyday reality of daily life in Israel that exists beyond the images of conflict.

Here, Angelenos and Americans will find an Israel where more people get up each day and go to work trying to make the world a better place, than get up each day and do anything related to the conflict with our neighbors. The number of people who are involved with basic and applied scientific research, biotech, biomed and health care research and product development is far greater than the number of people involved with security — the number of people working in Israel’s high-tech industry alone exceeds the number of people in the military.

These Israelis are adding value to the world every single day. These Israelis are what root us to the rest of the world; they are the bulk of that which we create; they are what we hope the world will come to see and appreciate about Israel, as we begin our seventh decade.

Jacob Dayan is consul general of Israel in Los Angeles.

Local diabetes fighter goes global with Discovery Health Channel documentary


Dr. Francine Kaufman has seen the incidence of diabetes skyrocket in the last 30 years. The pediatric endocrinologist is director of the Comprehensive Childhood Diabetes Center at Childrens Hospital Los Angeles, and she says the disease’s local increase is part of a worldwide phenomenon.

In Los Angeles, the number of adults with diabetes stands at about 600,000, or 8.6 percent of the population, up from 6.6 percent in 1997. Nationally, 20.8 million children and adults — about 7 percent of the population — have diabetes. Worldwide, more than 180 million people are estimated to have diabetes, a number expected to double by the year 2030.

The author of “Diabesity: The Diabetes-Obesity Epidemic that Threatens America and What We Must Do To Stop It,” Kaufman has been on the front lines of fighting these escalating numbers as a clinician, researcher and a former president of the Diabetes Association of America.

Now Kaufman is turning to the small screen to bring attention to this global epidemic in a one-hour, commercial-free Discovery Health documentary narrated by actress Glenn Close, “Diabetes: A Global Epidemic,” on Sunday, Nov. 18.

Kaufman spent six months visiting every continent except Antarctica to explore the challenges of diabetes as well as the success stories. Logging about 150,000 air miles, she visited clinics, met with government officials and spoke directly with patients.

“There’s a common theme: Diabetes can potentially devastate people’s life anywhere, both the countries with tremendous resources and the countries with almost no resources,” Kaufman told The Journal. “It knows no boundaries.”

Diabetes is an inability of the body to use or produce insulin, a hormone that regulates blood sugar. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. Ninety percent of people with diabetes worldwide have Type-2 diabetes, which is largely the result of excess body weight and physical inactivity. Lifestyle changes can delay or prevent its development, which is why Kaufman is so passionate about the issue.

Kaufman’s journey began in December 2006 in Capetown, South Africa, during the 19th World Diabetes Congress. Traveling to the city’s outskirts, she saw the poor living in shacks that lacked running water or electricity. She visited a residential hospital where children receive care because their families cannot provide it. While some don’t believe in Western medicine, others suffer due to unreliable insulin delivery or a lack of resources to refrigerate the perishable animal hormone.

At each destination she visited, Kaufman found cultural factors that impact diabetes:

  • In Los Angeles, she focused on the largely Latino patient population, whose genetics and dietary customs pose problems. “I was raised on rice, beans, tortillas, meat and cheese,” explains one woman, whose weight had once reached more than 300 pounds.
  • In India, a country with a history of starvation, the populace largely perceives obesity as a sign of health and wealth. Street vendors sell fried foods on every corner, and the bikes that Kaufman had seen on her previous visit have been mostly replaced by scooters and cars. The cultural practice of bare feet poses particular challenges because diabetics often lose sensitivity in their feet. As a result, small cuts can go unnoticed until they become infected or gangrenous.
  • In Australia, a country associated with physical fitness, Kaufman learned that citizens are now more likely to watch sports than participate in them. And the country’s Aboriginal population, whose bodies are hardwired to store calories, have an astounding 50 percent prevalence of diabetes.

    However, Kaufman also saw some successes.

  • In Helsinki, Finland, the government’s proactive approach to prevention showed that those at high risk of developing diabetes could decrease their risk by 58 percent. Peka Puska, director general of the National Public Health Institute, told Kaufman, “We have to change the environment so the healthy choice is the easy one.”
  • In India, Kaufman visited a comprehensive clinic that treats 100,000 patients and addresses every aspect of diabetes care. In one location, patients see specialists such as dentists, dieticians and opthalmologists, and can purchase items including medication, food and special shoes.

“I would love to be able to replicate that in Los Angeles,” she said.

While Kaufman did not visit Israel as part of the documentary, she said she was there last month for a symposium hosted by D-Cure, an Israeli nonprofit organization that funds diabetes research and collaborates with research projects around the globe.

“With its focus on healthcare and technology, Israel is likely to emerge as an international player in finding solutions [to the diabetes epidemic],” Kaufman said.

At the same time, Israel’s rate of diabetes is 7.8 percent.

“It’s a struggle there like it is for all of us from cultures that intermingle nourishing with nurturing,” she said. “It’s hard to overcome how we were raised, where our grandparents were starving, and overweight was a sign of health.”

Whatever a nation’s specific challenges relating to diabetes, the disease is universally devastating when not managed, Kaufman said. She does, however, have the prescription.

“To manage it, you need a government that can give resources; a health care system that is focused on it; the environment in which you live supporting a healthy lifestyle; and, ultimately, your own personal choice of whether you’re going to do everything you can to combat this or not.”

“Diabetes: A Global Epidemic” will air on Discovery Health, Nov.18, 9 a.m. For more information, see http://health.discovery.com/centers/diabetes/diabetes.html and

http://www.d-cure.org/English/

A healthy hut — lighter side of Sukkot cooking


As you look forward to Sukkot, you may have a few lingering thoughts from the reflection and retrospection of the High Holidays. Perhaps you promised to treat your body to more healthful, nutritious food. Or maybe your new goal is to take time out to observe Jewish holidays, or to just relax with friends over a good meal.

This can be a frustrating set of goals, since it often seems as though celebrating the Jewish holidays through food while still eating healthfully are irreconcilable endeavors. Cheesy blintzes, creamy kugel and schmaltz are hardly lean cuisine. However, a growing number of new cookbooks are oriented towards the more health conscious Jewish cook. One such book is Nechama Cohen’s “Enlitened Kosher Cooking,” published just this year.

Founder of the Jewish Diabetes Association, Cohen took her personal plight of cooking Jewish food as a diabetic and extended it through the work of her organization, whose goal is “to educate and guide individuals facing the challenges of managing diabetes within the framework of a Jewish lifestyle.”

To this end, her book not only contains hundreds of recipes that meet low-carb, low-sugar and low-fat dietary needs, but also contains a useful set of appendices with health reference information, and a holiday-by-holiday guide to her recipes.

This Sukkot, try her Etrog Compote. Or, if you would rather make a dessert with the etrog’s (citron’s) modern counterpart, I recommend the Luscious Lemon Ice Cream. At once tangy and creamy, its refreshing taste is sure to please anyone you have welcomed into your sukkah.

Another great dish is the Baked Spinach-Cheese Delight.
Due to the recent FDA warning, I used 3/4 cups frozen spinach instead of fresh. A healthier carb alternative to quiche crust, the triangles of bread also give the dish some textural variety. I used challah for a dash of Jewishness. Don’t fill the dish with much bread — it expands considerably while baking. I also halved the amount of cheese to make it even healthier, sprinkling it on the top where it is the most flavorful. As with the kugel, I recommend adding herbs to taste; this time I used dill, basil, and some ground pepper.

With both healthier versions of traditional Jewish dishes and other healthy recipes of non-Jewish food, this book appeals to a wide range of Jewish (and non Jewish) palates. While sometimes Cohen’s aim for simplicity and accessibility leaves dishes slightly unseasoned, this book is certainly a worthy primer for the cook uninitiated into the ways of more healthful cooking
(For the main course, one of the dishes Cohen suggested was the “Enlitened Mock Noodle Kugel.” Made with spaghetti squash to reduce the carbs and calories, this dish lacks the unmistakable toothsome quality of traditional kugels, but is quite tasty nonetheless.)

The more experienced cook can use the recipes as a jumping-off point for experimentation. You might just find a few dishes even your bubbe would have enjoyed, and a few others that the rest of us could learn to cherish as much as their less lean counterparts. What better way to welcome people into your sukkah than with some healthy new favorites?

Baked spinach-cheese delight

Nonstick cooking spray
2 whole eggs
2 egg whites
3/4 cup 1 percent milk or low-fat, low-carb soymilk
3 slices day-old light bread, cut into small triangles
1 cup fresh spinach, finely chopped, or 3/4 cup frozen spinach
1/2 cup shredded Parmesan cheese

Preheat the oven to 350 degrees. Line bottom of an 8-inch Springform pan with baking paper and spray with non-stick cooking spray.

In a medium bowl, whisk the eggs and egg whites until frothy.

Add the milk, spinach and cheese. Stir to blend.

Pour into the prepared pan.

Immerse the dried bread triangles in the mixture. After they are coated with the mixture, raise one point of each piece with a fork so that they peek out at the top.

Bake uncovered until lightly browned, about 20-30 minutes. Remove from the oven and cool.
Loosen the edges by cutting around the outside with a knife. Remove from the pan and place on a heatproof plate.

Serve hot or at room temperature.

Makes six servings.

Luscious lemon ice creamam

1 (4 ounce) container light whipped topping
4 egg whites
2 eggs, separated
Sugar substitute equal to 1 cup sugar, divided
1/4 cup lemon juice

Beat whipped topping until stiff.
In a separated bowl, beat egg whites together with half of sugar substitute. In another bowl, beat egg yolk with other half of sugar substitute. When thick, fold in lemon juice. Fold all three mixtures together until well blended.

Freeze.

Pistachio variation:

For a delectable pistachio-flavored ice cream, omit the lemon juice and add 1 teaspoon almond extract, 1/3 cup chopped pistachios and two to three drops of green food coloring.

Makes eight servings.

Do Day School Health Programs Make the Grade?


Twenty parents from the Emek Hebrew Academy in Valley Village have come on a chilly winter evening to hear Dr. Francine Kaufman, a national expert on diabetes and childhood obesity, talk about promoting children’s health. Although the school has 455 families, Rabbi Sholom Strajcher, the school’s dean, is not discouraged by the modest turnout.

“We have to change the culture…. It’s a challenge,” he said.

Strajcher (pronounced Striker) tells the group he’s been overweight since childhood.

“When I was growing up, no doctor or teacher ever mentioned my weight,” he said. “I am reaping the result of all those years.”

He is not alone. In fact, Strajcher’s students are even more likely to struggle with weight issues. According to the Institute of Medicine, an agency under the National Academy of Sciences, more than 9 million U.S. children above the age of 6 are considered overweight or obese. The litany of health consequences associated with obesity — diabetes, cancer and heart disease, to name a few — might result in today’s children becoming the first generation in American history with a lower life expectancy than their parents. For children born in 2000, their lifetime risk of developing diabetes exceeds 30 percent.

Many can name factors contributing to these alarming trends: An increase in sedentary activities, such as television and computers; greater demand for convenience foods; advertisements targeting kids with high-fat foods, and an environment that discourage walking and physical activity. Given the breadth of the problem, solutions require action on all levels of society — from government and business to schools and families. Jewish day schools, which may not see their role in the equation, have been slow to address these concerns.

But some have begun to take action.

Let’s Get Physical

At Jewish day schools, the demands of a dual curriculum coupled with limited outdoor space can cause physical education to take a back seat. This is decidedly not the case at Valley Beth Shalom (VBS) Day School. When Head of School Sheva Locke joined the Encino school four years ago, one of her first priorities was instituting an athletic program. The school now employs an athletic director and two full-time coaches who supervise physical education classes and activities at recess and lunch.

The athletic department also runs an extensive after-school team sports program. Kindergarteners through third-graders can join in a Junior Sports Club, while fourth- through sixth-graders can participate in competitive sports, including basketball, soccer, football and volleyball — and 98 percent of them do. The teams compete in the San Fernando Valley Private School League. VBS provides transportation to off-site games to make participation easier on parents and children.

“The focus was on getting as many children as possible to participate and to play,” Locke said. “The problem solving and goal setting that goes along with having a physical fitness program is equally as important.”

During the school day itself, VBS provides physical education twice a week, a figure fairly standard in the day school world. For students who don’t participate in after-school physical activities, that amount is woefully inadequate, according to physician Fran Kaufman, professor of pediatrics at USC’s Keck School of Medicine and head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital of Los Angeles.”

“Kids should be active for 60 minutes each day,” she said.

The state of California requires that children in first through sixth grade have a minimum of 200 minutes of physical education time per 10 days of school, which averages 20 minutes per day. In seventh through 12th grade, the time requirement doubles. (According to the California Center for Public Health Advocacy, 51 percent of school districts reviewed failed to meet the state’s minimum requirement for physical education time.)

Those numbers fall far short of the 60 minutes daily recommended by Kaufman and the USDA’s Dietary Guidelines for Americans. And as Emek’s Strajcher points out, not all of that time involves being active.

“Even when kids are supposedly playing, how much of that time is spent waiting for a turn?” he asks.

At Maimonides Academy in West Hollywood, instructor Alan Rosen has designed a unique program where lessons on character and values are integrated into physical education. On the play area used by the elementary school students, circles painted on the blacktop list such values as responsibility, humility, effort and cooperation. The words are incorporated into songs and games, and are referred to in the course of regular physical activities.

“If it’s important, you find the time,” said Maimonides’ principal, Rabbi Karmi Gross. “Physical activity doesn’t have to be divorced from what else is being done.”

By the Book

Inside the classroom, the content and amount of wellness-related curriculum varies from school to school. An informal survey taken by the Bureau of Jewish Education of Los Angeles on nutrition education garnered responses from only 10 schools out of more than 30. Of those, half had no “formal” nutrition curriculum, and relied primarily on teacher-generated materials.

Because health is not a subject for which the state requires standardized testing, public school districts vary in the degree of emphasis they give the topic. Los Angeles Unified School District specifies knowledge and abilities that students are expected to master in grades four, seven, and high school.

In both public and private schools, a dedicated health class is generally taught in middle school. Seventh graders at Abraham Joshua Heschel Day School in Northridge take a health and life sciences class that focuses on the physiology and biology of the human body. An eighth-grade nutrition unit includes a screening of the school version of “Super Size Me,” in which the filmmaker traced his odyssey eating McDonald’s fare exclusively three times a day for one month, and how his body suffered as a result.

“We talk about individual choices and about society, and we discuss where responsibility lies,” said science teacher Liz Wenger. “We look at how society is changing the way we eat, such as not eating at home as much, and eating larger quantities and higher fat foods.”

The students calculate their own caloric intake and use a calorimeter to measure the amount of food energy in various foods. They also build pumps to replicate the heart and use stoppers to illustrate cholesterol build-up.

VBS employs a full-time nurse whose duties include teaching health-related lessons to all grade levels. At Milken Community High School, ninth graders take a class, designed with input from a health educator and a rabbi, which explores physical, social and emotional health as well as sexuality and tobacco, drug and alcohol abuse.

Ess, Ess Mein Kind

Learning about nutrition doesn’t necessarily translate into action. Most of the schools interviewed expressed concerns about the food they provided to students, not only through formal meal programs, but also informal means such as class parties or incentives.

Eating can be an emotionally charged issue given its integral role in Jewish practice. The ubiquity of food is illustrated in the oft-repeated definition of Jewish holidays:

They tried to kill us. We survived. Let’s eat.

“Every time we celebrate, we celebrate with food — and there’s nothing wrong with that,” said Emek’s Strajcher. The question is what kind of food and how much. He said that traditionally, when students began to learn the aleph-bet (Hebrew alphabet) in school, the rebbe would put a drop of honey on each letter so that the children would associate learning with sweetness. Even in the synagogue itself, congregants throw candy for auf-rufs (engagements), bar mitzvahs and other celebrations.

Some parents are troubled by the amount of sugary snacks given to their children.

Kaufman noted that packaged kosher snacks can be some of the worst offenders in terms of saturated fat content.

Last year, Emek parents formed a committee and worked with the school’s caterer and a nutritionist to improve the healthfulness of school lunches. Parent Amy Leibowitz, who spearheaded the committee, said it was a challenge to satisfy nutritional, budgetary and kashrut considerations simultaneously. The results included adding fruit and salad, subtracting dessert, serving foods that are baked instead of fried, serving leaner, lower-salt meat, and making water available at mealtimes. She said that classes now celebrate all the month’s birthdays at one time to limit the influx of sugary treats.

Maimonides also revised its lunch program, and modified the practice of using food as an incentive. Instead of giving Israeli chocolates as rewards, principal Gross now gives Israeli postcards.

“We’re not yet where we want to be,” he said. “But we’ll eventually get there.”
Vending machine soft drink sales — a tempting source of revenue for some schools — will likely decline due to a decision announced in May by the nation’s largest beverage distributors to discontinue selling beverages with more than 100 calories to schools. It is estimated that the practice will affect 87 percent of the public and private school market.

As schools grapple with decisions regarding food policies, Emek’s Strajcher says that they can look to Judaism for a model of dietary self control.

“Kashrut [shows us that] when it comes to food, there has to be a certain discipline,” he said.

And as Eileen Horowitz, principal at Temple Israel of Hollywood, noted, “The [mission] for a Jewish school is teaching how to make good choices. That applies to how we talk to a neighbor as well as what we put in our mouth.”

Just Do It

Some administrators cited the challenge of fitting in adequate time for physical activity and comprehensive health education on top of an already full dual curriculum.

“There’s tremendous pressure for time,” acknowledged Dr. Roxie Esterle, Heschel’s associate head of school. “It’s a very full day and it gets fuller and fuller,” she said, mentioning computers and technology as examples.

Secular schools also struggle with these issues. A recently released national report found that the No Child Left Behind Act of 2001 was threatening physical education time because subjects that are not tested — including physical education — receive lower priority. In Los Angeles, 68 percent of high school students failed to meet recommended levels of physical activity according to a 2005 study by the CDC.

Yet, practicality dictates that schools take action on this issue: The California Department of Education states that healthy, active and well-nourished children are more likely to attend school and are more prepared and motivated to learn. The 2006 Shape of the Nation Report, issued jointly by the National Association for Sport and Physical Education and the American Heart Association, recommends that schools across the country “make physical education instruction the cornerstone of a comprehensive school physical activity program that also includes health education, elementary school recess, after-school physical activity clubs and intramurals, high school interscholastic athletics, walk/bike to school programs and staff wellness programs.”

Given that Judaism mandates the care of our bodies, Jewish day schools have an imperative to address these issues.

“If you’re not healthy, it’s hard to serve God with fullness,” Strajcher said. “Your soul can only do what it needs to do when your physical self is intact.”
He hopes to spare his students from facing the weight issues that have plagued him since childhood, and from the dire consequences which may result.

“If this is preventable and we can do something about it, it’s our obligation to do so,” he said.

Health Report Card for Schools

To determine how well your school promotes wellness, here are some questions to ask:

  1. How much physical education time is allotted?
  2. Is the physical education instructor certified?
  3. Are children actively engaged during physical education and recess?
  4. Does the school offer after-school activities or team sports?
  5. Do health lessons address nutrition and physical activity?
  6. What is the content of school lunches, and who determines this?
  7. Are fresh fruits and vegetables offered daily?
  8. Does the school have a policy on desserts and snacks?
  9. Is there a vending machine on campus? What does it offer?

Wanted: A General in the Obesity War


Obesity is the fastest growing health threat in this country, currently on track to overtake tobacco as No. 1.

The Centers for Disease Control and Prevention estimates that 30 percent of American adults older than 20 (more than 60 million people) are obese. The percentage of youths ages 6-19 who are overweight has more than tripled since 1980 to more than 9 million.

The lifetime risk of Type II diabetes is headed toward 30 percent for boys and 40 percent for girls, putting these kids at greatly elevated risks for debilitating health problems, like kidney and heart disease, amputation and blindness.

Locally, more than half the adults in Los Angeles are either overweight or obese, while 21 percent of the children are overweight, with an additional 19 percent at risk of becoming overweight.

And while Jews are far from immune, obesity is not an equal opportunity affliction — African American and Latino communities have obesity rates triple that of whites, and poorer Americans are almost 50 percent more likely to be obese than wealthier Americans.

The seriousness of the problem has begun to attract considerable attention both inside the public health community and beyond. Our state and local governments have been active in responding to this epidemic — from Gov. Arnold Schwarzenegger’s Obesity Task Force and his tireless cheerleading for more physical activity to the Los Angeles Unified School District’s (LAUSD) healthy beverage initiative, which notably brings healthier food and drinks to schools without diminishing snack revenues.

The nonprofit sector has also mobilized through a variety of projects that empower kids to lose weight by making smart diet and lifestyle choices, and through innovative organizations like Students Run L.A., where young Angelenos train for the L.A. marathon. Forward-thinking foundations have pitched in some of their considerable resources to fight obesity.

Meanwhile research/advocacy organizations like the Center for Food and Justice at Occidental College have expanded their missions to address obesity, noting that many of the same families at risk for hunger are also at the greatest risk for obesity.

So why the need for another alarmist editorial when we already find some of our best and brightest organizations fighting obesity? The answer lies in the dual nature of the epidemic.

At one level, obesity is an extraordinarily uncomplicated problem. According to Dr. Francine Kaufmann, head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, obesity is on the rise because we simply take in more calories in food then we expend in energy. Yet finding a correspondingly simple solution has proved maddeningly difficult.

Reversing the tide requires taking on, in a coordinated manner, the variety of factors responsible for the epidemic, from unhealthy diets, insufficient exercise, reliance on automobiles, inadequate nutrition education, excessive junk food, scarcity of fresh produce to many other complicated, interrelated causes related to the way we now live. And while many of these causes are being addressed individually, success in fighting this disease requires a strategy that coordinates the present multiplicity of approaches.

To introduce this higher level of strategizing, we are proposing the creation of a joint county, city (and, if possible, LAUSD) obesity coordinator. The office would be modeled on the city’s AIDS coordinator’s office created by Mayor Tom Bradley, but would include the county to take advantage of its public health and health care resources and the LAUSD as one of the country’s largest educational institutions, while also leveraging the bully pulpit available to the mayor.

Following the successful AIDS coordinator model, the obesity coordinator would have various responsibilities:

• Education/Public Health. The coordinator would create an education campaign, leveraging the city and county media infrastructure, as well as the school system and a prevention program targeted at encouraging healthier food and lifestyle choices.

• Policy/Coordination. The obesity coordinator would spearhead the development of county-citywide obesity policies to ensure that governmental and nongovernmental responses to obesity are adequately coordinated.

• Analysis. The coordinator would analyze the efficacy of existing programs and facilitate long-term studies of the current approaches to identify and consolidate around the most successful ones.

• Programs. Following on the pioneering work of the food policy organization, California Food Policy Advocates, we would encourage the obesity coordinator to explore creative solutions, including programs to introduce green grocers into neighborhoods that currently lack access to quality fresh produce. These programs would require minimal capital (possibly leveraging new markets tax credits and other innovative financing sources) to help create and capitalize local businesses that sell fresh fruits and vegetables.

We believe that the Jewish community has a role to play in the campaign to appoint an obesity coordinator and to win the battle against obesity. Generating the political will to create an empowered obesity coordinator will require pressure from many communities, including our own.

In addition, many existing institutions can participate in this fight, from Koreh L.A., The Jewish Federation’s reading in public schools program that could incorporate obesity education curriculum, or Mazon, the anti-hunger effort, which could expand its mission to confront the obesity epidemic through its network of food banks.

Ultimately, this is a complicated and long-term problem that will require the kind of effort deployed against AIDS and smoking.

The appointment of an obesity coordinator would enable more effective cooperation and strategic management of our resources and hasten the day when we turn around this burgeoning affliction.

Brian Albert and Tanya Bowers are members of the New Leaders Project, which was founded in Los Angeles in 1990 and links Jewish values with a commitment to civic activism.

This op-ed piece is the first of three by members of
the New Leaders Project (NLP), a Jewish civic leadership training program of the Jewish Federation’s Jewish Community Relations Committee. Participants researched three pressing issues — education,
housing and health — and presented their proposed solutions to a panel of community experts.

Q and A With Dr. Francine R. Kaufman


 

Obesity has reached record rates among children and adults, bringing with it increased risk for developing diabetes and related health problems. In addition to the more than 18 million Americans currently living with diabetes, another 41 million are considered prediabetic, and are likely to develop the disease unless they take action.

In her new book, “Diabesity: The Obesity-Diabetes Epidemic That Threatens America — And What We Must Do to Stop It” (Bantam), Dr. Francine R. Kaufman describes how reversing these trends requires efforts from all levels of society.

The immediate past president of the American Diabetes Association and the head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, Kaufman spoke with The Jewish Journal about the magnitude of the problem, its causes, and strategies for changing the course of this epidemic.

The Jewish Journal: How have rates of obesity and diabetes changed over recent years?

Dr. Francine R. Kaufman: There’s been such a huge increase that we’re now calling it an epidemic. And it’s not only affecting adults, but also children. The number of overweight children has tripled since 1970. Cases of Type 2 diabetes among children have grown from a negligible number in the early 1990s to about 25 percent of new cases today.

JJ: Why are we seeing so much weight gain among children and adults?

FK: Our lifestyles have markedly changed: The amount of physical activity has markedly diminished in the community setting, in homes and in schools. The amount of sedentary behaviors — such as television, computers, video games and instant messaging — has markedly increased. And the quality and quantity of food is markedly different.

JJ: You advocate applying the strategies used by the anti-tobacco movement to purveyors of fast food and junk food. Where does personal responsibility fit in?

FK: The fundamental difference between the anti-tobacco campaign and this issue is that everyone has to eat but no one has to smoke. In both cases, personal responsibility is important. People need to be concerned about their health and motivated to get active and eat appropriate amounts of quality food.

However, there are lots of people who don’t have the option to make these healthy choices. It’s not realistic to expect a woman who’s on welfare, has three kids and is working two jobs to go to the Whole Foods store — which she can’t afford — and have the luxury to cook this wonderful meal — which she doesn’t have time to do — and then go exercise with her children.

We have to be able to fit healthy behaviors into our daily lives rather than segment them out. Our work places, our communities, our schools and our faith-based organizations must allow us to make healthy food choices and engage in physical activity.

For example, it’s not easy to be healthy at most workplaces. Employee cafeterias offer fare that’s high in salt, fat and sugar. Vending machines sell sodas, candies and chips. Stairwells are dingy and hard to access. It doesn’t have to be this way. Workplaces could [offer incentives to] employees to be active, serve healthy snacks in their cafeterias and vending machines or subsidize employee gym memberships.

JJ: In your book, you describe how your Grandma Sadie, who eventually developed diabetes, grew up undernourished in Russia. Her diet changed when she came to American and was exposed to abundance for the first time. How does your grandmother’s experience parallel the experience of our society?

FK: In Los Angeles, there are still a lot of new immigrants who [don’t] have an abundance of food like we see here. After starving or having tremendous food insecurities, they come here and overindulge. My Grandma Sadie hid food. If she went to a restaurant, she took home all the rolls and the sugar. She couldn’t shake the mentality of scarcity.

The grandmas of my patients have tremendous impact on the health of their children and their children’s children — just like Sadie did for us. They don’t want to limit the amount of food their grandchildren can have and don’t understand why they should.

Also, many children in this country live in communities where all they see are liquor stores, convenience stores and fast food restaurants. It’s not the equivalent of living on the Westside. It’s hard to find a grocery store in some parts of town. The quality of the produce is not equivalent. The produce is more expensive and people have less money to spend.

JJ: These are formidable obstacles…

FK: I think there’s movement afoot to address these problems: The federal government, originally led by Health and Human Services Secretary Tommy Thompson, has promoted the message. Congressional leaders have become aware that we need to improve the health status of America. Locally, I chaired a task force for the Los Angeles County Board of Supervisors, who are putting the recommendations into action. And Los Angeles Unified School District’s ban on selling soft drinks was a clarion call to the nation.

JJ: So there’s hope.

FK: I’m very hopeful. There is positive change. We have to make these changes. If not, diabetes will devastate us. In 2002, diabetes cost the nation $132 billion. One in three children born in the year 2000 will develop diabetes in his or her lifetime. The New England Journal of Medicine just published and article projecting that this generation will not live as long as the previous one because of obesity-related diseases.

 

A Walk in Rick Orlov’s City Hall


Rick Orlov of the Los Angeles Daily News, long known as the
dean of City Hall reporters, is that rare media type who has no enemies. That’s
because he’s long had a reputation for being an old-fashioned straight shooter
who honors secrets not only in print, but also in hallway gossip.

“He’s a person you can trust,” Richard Riordan remarked once
when he was mayor. “He’s not some young person trying to prove himself with a
gotcha.”

“A big part of it is, you don’t play favorites,” Orlov said
recently over lunch at Pete’s Café & Bar, the new downtown hangout for
local pols. He’s covered City Hall for the Daily News since 1988; I worked with
him there in the early ’80s, when he was city editor. “I always remember what
an editor told me when I started out: ‘These people are not your friends,'”
Orlov added.

Orlov, 55, was born in Chicago and spent his early years in
the Midwest. His parents, both children of Russian Jewish immigrants, met in Los
Angeles during World War II at a Hillel-sponsored dance; his father was in
the Navy and his mother was a UCLA student. When he was 11, Orlov’s family
moved to Encino, where his father managed an insurance office, and his
religious training ended.

“Up until then, I had been in Hebrew school studying for a
bar mitzvah and we attended temple regularly,” Orlov said. “But when we came
here, my father got in a fight with the rabbi at our new temple, and since his
own religious background was minimal, our family became fairly secular. We had
Passover seders … but most of the rest was abandoned.”

Orlov, who’s a bachelor of the old-fashioned,
married-to-his-work newspaperman type, is such a City Hall institution that for
years no one complained about his lighting up cigarette after cigarette in full
view of the mayor and various councilmembers and their aides. Puffing away in
office buildings has, of course, long been illegal, but Orlov’s chainsmoking
habit apparently was tacitly OK’d under some sort of grandfather clause. It’s a
moot point now, since he gave up the cigs (and lost 30 pounds) after he was
diagnosed with diabetes a couple years ago.

“When they cut off your toes it gets your attention,” said
Orlov, who now gets around with a duck-headed cane and a handicapped parking
pass. He can still drink, which is fortunate, as a key technique of his
schmoozey style of information gathering is his endearing willingness to buy
everyone a round.

Another newspaper tradition he’s kept up is open cynicism
about the grandstanding and ineffective ways of local politicians, particularly
the L.A. City Council.

“They came out against Proposition 187, so you knew it would
pass,” he said. “And then there’s the war in Iraq. They were against the
Patriot Act, and there’s a lot of things to dislike about the Patriot Act, but
I can’t believe anyone in Washington cares what the L.A. City Council thinks.”

Over the years, Orlov has seen City Council demographics
change along with those of Los Angeles.

“When I came to City Hall in 1988, five of the 15 council
members were Jewish and the Bradley administration had a strong presence from
the Jewish community in staff jobs, contributors and political advisers. Today
I think the only Jewish members are Wendy Greuel, Jack Weiss and, through
conversion for marriage, Jan Perry,” he said about the African American.

“Councilman Bernard Parks counts a number of advisers from
the Jewish community, as does Councilman Antonio Villaraigosa and Councilman
Dennis Zine,” Orlov continued. “Mayor James Hahn does not seem to have the same
level of Jewish support that went either to Richard Riordan or Tom Bradley.
Hahn’s tried to inherit it, but he’s had a hard time.”

Much of the Jewish community, Orlov noted, was split between
Hahn and Villaraigosa in the mayoral election. “That was primarily due to
Riordan’s backing of Villaraigosa,” he noted, “as well as from Jewish leaders
like Eli Broad. I’m not sure it has made much of a difference on the council as
far as its policies, since it remains a heavily Democratic body that is
generally more liberal in its policies than the city’s population, and, as in
the past, composed of activists on social issues.”

Even if he hadn’t had to cut back his drinking, which used
to extend to Friday evening boozefests at the Daily News press office in City
Hall, Orlov finds local politics these days not only less Jewish, but less
colorful. “The Riordan administration was more fun because they were so
unprofessional politically,” he said. “Riordan would just say whatever was on
his mind, whereas [Mayor James] Hahn has been around politics since he was 5
years old.”

We drove back to the underground City Hall parking garage,
and I was impressed by the Dean of City Hall’s prime parking space. Rick
smiled.

“It’s that whole Deandom thing,” he said.  

Preteen Advocate Educates Nation About Diabetes


At first glance, Emma Klatman’s summer vacation sounds like that of a typical 11 year old. She attended summer camp and traveled to Washington, D.C. Instead of merely a participant at camp, however, Klatman was a featured speaker. And in our nation’s capitol, she came not to sightsee but to lobby legislators.

Klatman serves as the American Diabetes Association’s (ADA) 2003-2004 national youth advocate. Her duties entail promoting research and public policies relating to diabetes, and visiting diabetes summer camps to involve other children in the fight against the disease.

“Emma acts as an ambassador on behalf of all children with diabetes,” said Stewart Perry, chair of the ADA’s National Government Relations and Advocacy Committee. “She puts a face on diabetes in children.”

Perry accompanied Klatman on her recent legislative visits in Washington, D.C., where she urged Sen. Dianne Feinstein (D-Calif.) and aides to Sen. Barbara Boxer (D-Calif.) and Rep. Diane Watson (D-Culver City) to increase funding for research and to insure that diabetes medications be covered under Medicare.

Adapting to her new role like a pro, Klatman presented her case to a supportive Feinstein as the senator walked from her office to a hearing.

“People don’t want to talk to kids when they’re in a hurry, but she did,” Klatman said.

Klatman’s interest in acting (she also attended the Youth Academy for Performing Arts this summer) and a natural poise gives her the confidence to lobby effectively. In one instance, she pulled out her “finger stick” and pricked her finger to show what it’s like to check blood sugar — a constant necessity for those with diabetes.

Visiting diabetes summer camps for children in Illinois, Missouri and Wisconsin, Klatman told the young campers that they can also be advocates, whether by helping other children understand how to manage their disease or by contacting a legislator about important issues. She said this enables children to “gain self-esteem and think that you really make a difference.”

Perry said that youth advocates like Klatman can be more effective than adults in showing children that they “can live a normal, happy, healthy life with diabetes if they take care of themselves.” Her example, he said, shows “this is what you’re capable of — what you can aspire to be.”

Klatman was diagnosed with Type 1 diabetes at the age of 7. She is one of the more than 13,000 American children annually diagnosed with Type 1 diabetes (previously known as juvenile diabetes), which involves a failure by the body to produce insulin. With overweight and inactivity increasing among U.S. children, more cases of Type 2 diabetes are now being seen in children and adolescents. In the past, Type 2 diabetes was considered an adult disease.

Prior to her diagnosis, Klatman experienced symptoms typical of diabetes — she was drinking and urinating frequently, felt constantly hungry and often fatigued. It was at a Purim celebration at Temple Beth Am that her parents realized something was seriously wrong. Her father, Chris Klatman, recalled noticing that Emma appeared peaked, and assuming that she needed something to eat. He bought her more hamantashen and soda, which only served to further elevate her blood sugar. A trip to the doctor quickly confirmed diabetes, and Emma’s life changed from that day forward.

Today, she wears an insulin pump, a blue plastic device that resembles a slightly oversized pager, which is attached to a tube under her skin. The pump automatically administers insulin throughout the day and Klatman presses a button to inject additional insulin based on the food she consumes. She must check her blood sugar levels at least six times a day by pricking her finger and placing a drop of blood in a small device called a glucose meter. Like all people with diabetes, Klatman must keep tight control of blood sugar levels since low levels (hypoglycemia) can lead to loss of consciousness and high levels (hyperglycemia) can eventually cause kidney, nerve, blood vessel and eye damage.

“Sometimes I get so mad that I have to test 10 times a day and I’m not like most kids…. I have something to worry about and they don’t,” Klatman said.

But she said the process has become routine, and even generates admiration among her peers.

Klatman is quite matter-of-fact about her disease and her ability to accomplish her goals. With her youth advocate duties involving monthly travel, she said, “I’ll have to work twice as hard with school, but I’m capable.”

In some ways, Klatman’s illness seems to take a greater toll on her parents, who believe research — particularly stem cell research — may hold the key to the cure for this and other diseases. Until then, her mother, Carol Eisner, noted, “As parents, we’re never relaxed. We really deal with life with Emma test by test.”

While Emma said she can eat anything, her mother elaborates that “eating is never, ever the same…. It’s like keeping strictly kosher: Every single bite that goes into your mouth has thought behind it. For every morsel [you need to ask]: How many carbohydrates does this have and how many units of insulin do I have to give myself for this?”

Because of the frequent need for diabetics to monitor blood sugar levels, one of the ADA’s top priorities involves insuring that children with diabetes be allowed to check glucose levels and inject insulin where and when they need to at school, rather than being forced to walk a distance to the nurse’s office or another isolated location.

Perry talks about other barriers children with diabetes may encounter in schools. “They’ve been told they can’t play football. They can’t be cheerleaders. They can’t go on field trips,” she said. “We want kids with diabetes to be treated no differently than any other kid — not segregated and not discriminated against.”

Emma reflected on what having diabetes means to her.

“I don’t like to refer to myself as a diabetic. I refer to myself as someone with diabetes. It’s something that [requires me to do] more in my life. But I’m still Emma.”

For more information on diabetes, e-mail nya@diabetes.org  or call 1-800-342-2383.

Doctor Helps Kids Deal With Diabetes


Ask just about any of Dr. Francine Kaufman’s pediatric patients about her and the superlatives will start to fly.

“Fran is one of the busiest people I know … yet she’s still able to find time for me and make me feel like the only child in the hospital,” said 15-year-old Katie Zucker.

Chris Paonessa, 14, calls Kaufman his “mentor and role model.”

“She’s not just my doctor, she’s my friend,” noted college student Lupe Pena, a patient of Kaufman’s for 15 years.

The compliments come despite the fact that Kaufman, a pediatric endocrinologist and the head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, is often the person who delivers the devastating news to children that they have diabetes. It is Kaufman who orchestrates their transition from having a carefree childhood to one dramatically altered by the constant need to monitor diet, measure blood sugar and administer insulin.

If there’s such thing as a typical doctor, Kaufman surely doesn’t fit the mold. First, as Zucker noted, “She’s the only doctor we know who comes to work in stilettos and a miniskirt.”

While doctors are cautioned not to get too involved with their patients, Kaufman has invited several of them to stay at her home for periods ranging from days to years. One became a member of the family, whom Kaufman refers to as her “near son.” Another currently lives with the Kaufmans during the week while attending college.

Kaufman’s quest to eradicate diabetes extends beyond her direct work with pediatric patients. Among other things, she is a professor of pediatrics at the Keck School of Medicine at USC, the president of the American Diabetes Association (ADA) and lead researcher on two National Institutes of Health (NIH) diabetes studies. That’s in addition to being the wife of a Cedars-Sinai pediatrician and mother of two grown sons.

Kaufman was honored by the ADA as their 2003 Woman of Valor at a tribute dinner on Feb. 6. Along with physicians nationwide, she is alarmed at the increasing number of children diagnosed with Type 2 diabetes, which used to be known as adult-onset diabetes.

“Twenty-five percent of new onset diabetes in children is Type 2,” Kaufman noted.

This increase is tied to the rise in childhood obesity, now considered an epidemic, and Kaufman is concerned about the poor eating habits and lack of physical exercise among school-age children.

“We’re seeing too many kids who are gaining too much weight,” she said.

To address this problem, Kaufman chaired the Los Angeles County Task Force on Children and Youth Physical Fitness, which recommended policies to support physical activity and healthy eating among children. She was one of the driving forces behind the Los Angeles Unified School District’s policy to prohibit soft-drink sales at middle and high schools starting January of next year (they are already banned in elementary schools).

At Childrens Hospital Los Angeles, her team is involved in NIH multicenter studies to see how lifestyle modifications can impact children with Type 2 diabetes, and whether diabetes can be prevented in the relatives of those with the disease.

She has collaborated on diabetes initiatives with Secretary of Health and Human Services Tommy G. Thompson, who flew in from Washington, D.C., to present Kaufman’s Woman of Valor Award. Saluting her work nationally and in such locations as Israel, Ecuador and Mongolia, Thompson said Kaufman has “the courage and the drive to make a difference in the lives of millions, not just here but around the world.”

When Kaufman sees a need, she fills it. One of the biggest challenges for diabetics is keeping the level of their blood sugar stable, especially at night. Kaufman came up with the idea of using uncooked cornstarch to formulate a patented food bar that reduces the incidence of hypoglycemia by promoting gradual and consistent absorption of glucose. For some patients, it has eliminated the need to wake up during the night to snack or test their blood sugar.

To help children understand the nature of diabetes, Kaufman helped develop a CD-ROM game called Life Adventure Series. And when she noticed that patients were having difficulty calculating the dosage of insulin they needed, she designed a simple slide card that matches blood sugar numbers and corresponding insulin dosages.

With all her roles and accomplishments, Kaufman’s direct impact on her patients is perhaps the most dramatic.

As Paonessa, who has successfully completed a marathon said, “She made me believe that everything is possible, even with diabetes.”

The Life Adventure Series: Diabetes CD-ROM is available
free of charge to children with diabetes and their parents. For information,
visit www.starbright.org/projects/diabetes/order.html

A Forkful of Trouble


Turkey, potatoes and gravy, candied yams — all the foods you love to pile on your plate come Thanksgiving. But you might want to check your blood sugar before you take another helping of mashed potatoes, because if you are one of the many American Jews at risk for diabetes, that extra forkful could spell a whole lot of trouble.

"I’m an Ashkenazi Jew, a meat-and-potatoes guy," said Los Angeles County Supervisor Zev Yaroslavsky, who was diagnosed with Type II diabetes in January 2001. "All of these things are off my diet now. No potatoes, not even a french fry."

It is no small irony that November is home to both Thanksgiving, our nationally recognized day of gluttony and sloth, and National Diabetes Month. Diabetes, which affects 17 million Americans, is on the rise in the United States. According to Health and Human Services Secretary Tommy Thompson, the number of people with diabetes in the United States has risen by nearly 50 percent during the past decade.

The impact of diabetes in the Jewish community is significant. "The prevalence in the Jewish community is greater than in other Caucasian populations," said Dr. Riccardo Perfetti of Cedars-Sinai Medical Center.

Dr. Francine Kaufman, head of endocrinology at Childrens Hospital in Los Angeles and president of the American Diabetes Association, said that lack of exercise at Jewish day schools is compounding the problem.

Diabetes results when the pancreas cannot create enough insulin, which helps the body convert glucose (a sugar) into fuel. Any additional sugar in the bloodstream, from either sweets or complex carbohydrates (like potatoes or white rice) aggravates the condition and increases the risk of fainting or stroke.

Type I diabetes, once known as juvenile diabetes, is rare and tends to be diagnosed at birth or in childhood. The more common Type II diabetes comprises 90 percent to 95 percent of all cases, and can go undiagnosed in many cases.

Although Yaroslavsky’s mother and "everyone on that side of the family" had had diabetes, he didn’t think it could happen to him. He dismissed the symptoms — extreme thirst, fatigue, frequent trips to the bathroom — as the combined result of stress from his busy schedule and age. Yaroslavksy might never have realized he had the disease if not for a bad cold, which led to a routine blood test.

The doctor told him that with diet and exercise he could manage the diabetes and live a normal life, but "if I didn’t, I could have any one of the following: amputation, kidney failure, heart failure, stroke or blindness," Yaroslavsky said.

So he changed his dietary and exercise habits, increasing his jogging routine, and is following a diet of whole-grain bread, chicken, fish, salads and some vegetables and fruits.

Yaroslavsky has no self-pity for the loss of his favorite foods. He calls it "a win-win situation."

"The diagnosis of diabetes will probably add 10 to 15 years to my life, because without it, I would have been eating the junk I ate before and not thinking about the consequences," he said.

Kaufman and Perfetti attribute the large increase in diabetes cases to a lack of physical activity — "God forbid we take the stairs," Kaufman said. She added that when it comes to exercise, schools are the worst culprits, including Jewish ones.

"In schools across the country, there are not enough physical activities to meet the needs of the students," Kaufman said. "Jewish day schools are the same or even worse, because they demand such a high level of academics. I would think that with the root of our religion being the reverence of life, we would stress taking care of our body as being just as important as academics."

Exercise can make a difference in the treatment of diabetes, Kaufman said, noting that one of her patients, Steve Eidelman, a Beverly Hills High School senior diagnosed with Type I diabetes, plays varsity tennis and even ran a marathon in Rome last summer.

In his spare time, Eidelman helps promote responsibility and activity among newly diagnosed youth. "If you are responsible," he said, "there is no reason you cannot control your diabetes.

A number of promising studies are underway to find a cure for both types of diabetes. Perfetti is working on one involving engineering a man-made gene to promote insulin production. He hopes to begin testing on human subjects some time in the next year.

Kaufman is chairing two multicenter clinical trials for the National Institutes of Health: one aimed at diabetes prevention, the other to determine the best treatment for the growing number of children with Type II diabetes.

Both physicians agree that the increase in the disease is a battle that can be won, if more people pay attention to their eating habits, and if they move away from their sedentary ways.

Coping on Two Continents


Since being diagnosed with diabetes in 1997, two developments have brought 14-year-old Cesar Chavira closer to leading a life like that of his Hollywood High peers: an insulin pump, which provides a continual dosage that lasts all day, and the Sponsorship for Adolescents with Diabetes, which has paired him up with a diabetic mentor.

The good news for other local diabetic teens is that now the Tel Aviv/Los Angeles Partnership — an agency of the Jewish Federation of Greater Los Angeles — will help Dr. Beverly Daley, creator of Sponsorship, extend her crusade. Co-sponsored by the Federation, Children’s Hospital of Los Angeles, the Bob Shapell School of Social Work at Tel Aviv University and the Ministry of Social Welfare of Tel Aviv, the Partnership’s new exchange program provides Daley an avenue to consult with Israeli researchers, who already operate a mentorship program patterned after her brainchild.

“The reason the Jewish Federation selected the program to be part of the Partnership is because of its potential for building Jewish identity,” says Daley. “There are many young adults who have become so assimilated that they’re participation in Jewish life is marginal.”

Ever since pursuing her doctorate at USC, Daley has led a tireless campaign to understand and combat diabetes.

“Diabetes is an insidious disease,” says Daley. “It’s a leading cause of death and disability here and in Israel, often leading to cardiovascular disease, kidney disease, blindness.”

Daley adds that teens are especially vulnerable to the disease’s psychologically traumatic aspects, as they must undergo a complex daily routine of insulin shots, blood-sugar-level monitoring and special diet and exercise patterns.

In 1986, with Children’s Hospital, Daley launched Sponsorship for Adolescents with Diabetes, using Alcoholics Anonymous and Big Brothers/Big Sisters as templates. Daley enlisted “young professionals with diabetes in their 20s or 30s … to serve as role models and educate and inspire the teen-agers. What we’re hoping to achieve with the kids is the self-esteem and the optimism that comes from realizing that diabetes does not stand in the way of their goals.”

Three months ago, Daley paired Chavira with Andy Leisner, an advertising manager at Cycle World magazine.

“We get along very, very well,” Chavira says of his mentor, whom he views as a big brother. “I don’t have very many friends, so to have a friend like Andy is totally cool.”

Chavira especially appreciates Leisner’s perspective on living with diabetes.

“There should definitely be more programs like this,” says the teen. “It would definitely benefit many people.”

Maria Traferro agrees. At age 13, she spent a year in Daley’s program, going to Magic Mountain and the movies with mentor Kristina Keefe. Five years later, Traferro still gets together with Keefe, and, despite their age difference, the 18-year-old considers her adult patron “a very good friend. I look up to her and admire her…. [She’s] helped me realize that I’m capable of taking care of myself.”

And while Keefe, a graphics business entrepreneur, originally participated with the intention of inspiring a teen, the experience has inspired her as well.

“I was always hesitant in public with my diabetes,” says Keefe. “Being with Maria, we sit down at a table, shooting up with our insulin, testing our blood sugar. So that was a big help for me.”

One person who values Daley’s program is Jerry Rogoway, the Partnership’s project committee chair. As a youth, he watched his grandfather die from diabetes. And now that medical advances help keep the devastating effects of diabetes at bay, Rogoway knows that teens must find the key to living with the disease.

“When juveniles are diagnosed,” says Rogoway, “they feel that their life is over. A program such as this one lets them know that, even though there are restrictions, they can live a generally normal life.”

Keefe says: “The neat thing about the program is that the kids and the adults can see that it’s not just about diabetes. It’s about developing friendships. Sometimes diabetes doesn’t even come up in conversation. It’s more about the kids seeing that you’re out there, living your life, and that diabetes doesn’t have to be all consuming.”

In 1988, Daley officially established the Sponsorship with grants from the Diabetes Research and Education Foundation and the American Diabetes Association. Surprisingly, since that time (Tel Aviv University notwithstanding), a diabetic mentorship, to Daley’s knowledge, has never been implemented elsewhere.

“I’m disappointed because we really would like to be a model for other centers,” says Daley. “But I’m just ecstatic that it’s finally happening in Israel … One of the most prominent features of society in Israel is community support. This program complements that cultural value.”

So far, there has been no shortage of volunteers in Tel Aviv. Unfortunately, it’s been a different story locally. Daley has found plenty of interested Jewish teen-agers around Los Angeles but few Jewish professionals willing to befriend them.

“I cannot say it enough,” says Daley, urging prospective mentors to apply. “We need a strong response.”

For more information on the Sponsorship for Adolescents with Diabetes, contact Dr. Beverly Daley at (323) 669-2490 or bdaley@chla.usc.edu.