Cantaloupe, Listeria, and sea squirts, oh my

Grab your umbrella if you’re on the Pacific coast in a rainstorm, it might be raining Listeria monoctyogenes. Warming trends in the Pacific ocean are due to the change in the cold ocean currents. The deep current that brings cold water down from the Arctic and circulates warmer water north has been getting smaller. With a smaller current flowing, there is less heat exchange and the warmer ocean results in the harsh El Nino’ weather patterns every few years [6]. Listeria is the bacteria that has been in the news from cantaloupe related food poisonings.[16, 17] It can grow at refrigerator temperatures, so older leftovers should be reheated to steaming before eating. Cold lunch meat sandwiches can be a risk, especially to people with weakened immune systems or during pregnancy. The pregnant woman may not feel sick but the baby may be effected. [12 food safety info]Warming of the water in the Pacific ocean due to the change in the deep, cold currants has allowed the bacteria, Listeria, to flourish. While Listeria probably isn’t able to be carried by raindrops and an umbrella might not be necessary to protect yourself from that staying out of rain may become a better idea as our pollutants continue to add up. Toxic chemicals can evaporate and be in “acid rain” or “smog” and have been shown to damage plants and property. After the Japanese nuclear reactor incident this year, it was recommended to avoid skin contact with rain during times when radioactivity levels were detectable in the air.Smog levels, pollen count, and now ocean bacterial count might be needed. Listeria can be in the fish, algae, seaweed and the ocean water itself. Bird droppings from birds that ate the sickened fish may have dropped on a few cantaloupe or it might have gotten in the irrigation system. Listeria was a problem with air conditioning systems during their early introduction. Poorly maintained air conditioners could support the growth of Listeria. it likes a very watery environment that can be cool or warm – versatile bacteria. Dirty air conditioner (or humidifier) could be blowing microscopic droplets containing Listeria bacteria throughout a building. There isn’t a vaccination. The best way to stay healthy is to not have a weakened immune system. One in five people may die from it but they aren’t the younger, stronger, healthier individuals. Pregnant women are at risk for their baby’s sake more than their own risk of a severe case if infected.Why Cantaloupes – why are they the canary in this story?Imagine a nice warm, juicy, fragrant cantaloupe. Smell it in your mind, sweet and floral. Their rinds are so thin you could practically eat it whole. Membranes – weakened membranes, in a fruit so juicy, would leave it at risk to disease. It is a hungry world and so much juicy goodness is begging to be eaten. The orange color is a sign of vitamin A and the nutrient content is similar to sweet potatoes, carrots and other dark orange, red and green fruits and vegetables. Endless variety in nature may run out sooner then we realize, if the building blocks aren’t in the soil and toxins are found there instead.

Mitar Tarabic (1829-1899) predicted that the last great war would be fought with “cannonballs that do not kill, but that cast a spell over the land, the livestock and the people.” (Aftermath, 2010, L.E. Joseph) The cannonballs whizzing around may not be Listeria or radioactivity in rain. We have many chemical pollutants to choose from as our killing cannonballs.

The Food and Drug Administration regulates the safe use of chemicals in foods and products but the standards used have not addressed toxic effects that can be caused overtime at tiny doses. Drugs are evaluated for cancer risks, total toxic load (how much of the drug would kill a mouse for example) and for teratogenicity – whether it causes birth defects or not. What is not addressed is the research on excitoxins – the free amino acids that act as brain neurotransmitters  and messengers throughout the body – and estrogen like chemicals that have been linked to infertility and feminization of animals.

Today’s googling led me from three chemicals found to cause immunotoxicity in sea squirts to marine boat paint and creosote soaked boat dock pilings and lobster cages. Turns out that one of the three, TBTO, was widely used in marine boat poaint in a form that was very unstable. The current paint in less unstable but the TBTO is still allowed for use in the US in ships greater than 25 meters long. Do you think using it on a longer ship makes it safer for the environment or maybe just cheaper for the big boat owners, like say, the Navy, Army, Airforce, and Marines perhaps?

No, I don’t think bigger ships make toxin containing paint any safer than using it on little boats.

Back to sea squirts who live in the sea (with creosote and TBTO and copper sulfate).

I went straight to sea squirts on the long list of animals with research on health effects of chemicals. At the membrane level sea squirts are one of the most basic multi-celled organisms that also have cannabinoid receptors.

The endogenous cannabinoids (eCBs) are not just messenger chemicals but are also membrane building blocks and precursors for other important messengers like the eicosanoids. The eCBs building blocks are actually part of the cellular membrane wall and they can be quickly released in response to changes in calcium or glutamate levels in the cell fluid. Phospholipid and arachidonic acid are released from the membrane and combined into anandamide, an eCB, which might go on to signal changed activity as itself or it might be converted into an eicosanoid with a different message or it might be used to assemble membranes in a different cell (wound healing, baby building, normal breakdown and repair of individual’s cells, or growth of infection/parasitic use). However, if there are constant signals to help, heal, or flee (stress response) then the membranes get more and more “used up”. If the messengers are also the bricks and there are no more bricks coming in on the fertilizer truck the membrane can not be rebuilt. Agribusiness mainly fertilizes with a few nutrients – the basics to achieve growth but with little replacement of trace minerals or compost.

It turns out that compost is important for humic acid and other complex soil compounds that traditional farm dirt has in abundance. Crumbly and black and sweet smelling, farm soil is a good childhood memory. My recent month in a wetland mitigation project reminded me of the difference in soil quality and the impact that has on plants, insects, and small wildlife. The wetland project had five main sections and only one of them had really good dirt and it was the one with the most diverse flowers, insects and even had frogs (seeds were planted in all of them fairly equally but they didn’t all grow the same). There was growth in all of the sections but the creation of “wetland” vs sandy meadow was affected by the soil quality. Fertilizing is not allowed in the regulations – sounds too much like modern medicine – grow a wetland with sand and little water. We’ll see, but I think the buckthorn is winning.

Humic acid is a mixture of complex chemicals and contains amino acids, oils and aromatic chemicals. Another phrase of Mirat Tibarak’s prophecy states “when wildflowers have lost their smell”. Invasive plant control this summer taught me that problem is rampant. Herbs and flowers are fragrant from chemicals called terpenes that are commonly found along with the eCBs. The terpenes also have medicinal properties. Pine oil and lemon oil are examples of aromatic oil compounds.

Our climate may be warmer or colder or both and what exactly is the cause is not as important as recognizing and admitting that change is here. Doing nothing is choosing to do something – more of the same that got us in the mess in the first place.

Creosote is leftover from making oil – it is tarry black goo that is painted or soaked into wood. Railroad ties are the most obvious example. The TBTO made cheap boat paint the protected against bacterial rot of the ship. Copper sulfate is used as an pesticide in Dutch Elm disease (I didn’t look into that one as much). All three caused reduced Natural Killer Cell activity and reduced phagocytosis in sea squirts. – The sea squirts weren’t able to protect themselves from infection or decayed/precancerous cells.

In investigating health I found mass die-offs in birds, bats, fish, insects, tress and sickened cantaloupe. Fish meals in Hawaii ahve also been recalled this summer due to Listeria.

Bento box meal recalled in Hawaii from 7-11 chain stores.

Quantum mechanics might suggest that we can make matter out of energy – something out of nothing – but I think it is more like making something slightly different out of something slightly similar but in a different form.

We can not make strong membranes and vitamin A out of potassium, nitrogen and phosphorus and neither can a cantaloupe. A cantaloupe that is also dealing with soil and ground water that is laced with TBTO, copper sulfate, and creosote might end up with a compromised immune system just like the sea squirt. They had less Natural Killer Cell activity and reduced rates of phagocytosis (ability for white blood cells to engulf and dispose of infected or decaying cells). Both effects have to do with apoptosis and the enzyme blast of death.
Yes, Virginia, we have cannabinoid rich membranes just like sea squirts and cantaloupes and if a bunch of toxins are around then the membranes can’t do their job properly and sickness develops. If the building blocks for the membranes aren’t in the fertilizer, then the plant doesn’t make strong membranes and our food supply for animals and humans doesn’t have as much membrane building blocks. Poor soils cause sickly plant growth and sickly insects and sickly animals and sickly humans.Decomposing plant material makes up the complex humic acid and rich soil that plants need to thrive and that insects, birds, and animals also need for survival. Substances found in rich soil that are not as common in sandy soil are aromatic and oil rich compounds – membrane building blocks.
Umbrellas won’t really help us. The invisible cannonballs are in ground water and eagle shells and human breast milk and our government seems to be voting to further reduce environmental standards daily. Is corporate profit worth sinking our planet in toxins and burning up our resources?
Burning up oil reserves for short term energy and short term profit may be adding to our world’s weak membranes because that huge ground oil reservoir of aromatic and oil rich compounds is being siphoned off and burnt up or turned into plastics. In the ground it was probably adding to the richness of soil by some seepage into the ground water but as plastics or burnt atmospheric waste it is no longer available to strengthen membranes in cantaloupe, sea squirts, or humans.Sweet potatoes and carrots can help build strong membranes and give vitamin A – if cantaloupe is leaving you a little leary. Otherwise heat to steaming and Listeria will be cooked – raw is the risk with lettuce and cantaloupe – we don’t heat them to the steaming point.

See my blogs, Membrane Building Foods and Feed your membranes to spell relief,
for more on eating defensively.

Didn't someone once say that a good fence makes good neighbors?
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Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

1.http://www.pesticideinfo.org/List_AquireAll.jsp?Species=1446&Effect=%27Immunological%27

PAN Pesticides Database – Chemical Toxicity Studies on Aquatic Organisms

Sea squirt (Styela plicata) Toxicity Studies – Toxicology studies from the primary scientific literature on aquatic organisms

Copper sulfate (anhydrous)       http://www.pesticideinfo.org/images/book16x16.gifShow Copper sulfate (anhydrous) studies for all species

Creosote       http://www.pesticideinfo.org/images/book16x16.gifShow Creosote studies for all species

Tributyltin oxide       http://www.pesticideinfo.org/images/book16x16.gifShow Tributyltin oxide studies for all species

***Effects for all three poisons include:

immunological Natural killer cell activity
Immunological Phagocytosis

Copper sulfate also had info on:
Immunological Antibody titres

2.http://www.inchem.org/documents/cicads/cicads/cicad14.htm

   This report contains the collective views of an international group of
    experts and does not necessarily represent the decisions or the stated
    policy of the United Nations Environment Programme, the International
    Labour Organisation, or the World Health Organization.

Concise International Chemical Assessment Document 14: TRIBUTYLTIN OXIDE (TBTO)


8.7.1  Immunotoxicity
      A large number of well-conducted studies have shown that TBTO
    causes depression of immune functions dependent on the thymus. Results
    from a number of short-term studies are listed in Table 1. Subchronic
    and chronic studies (Vos et al., 1990) are summarized in detail below
    and are listed in Table 1. The chronic study conducted by Vos et al.
    (1990) shows effects on thymus-dependent immune responses at a dose lower than that at which any other toxic effects have been observed.
    The Vos et al. (1990) study also establishes that weanling animals are
    more sensitive than adults to the effects of TBTO. For example,
    following subchronic exposure, the LOAEL in weanling rats was 0.25
    mg/kg body weight per day, whereas the LOAEL in aged rats was 2.5
    mg/kg body weight per day. The NOAELs were 0.025 and 0.25 mg/kg body
    weight per day, respectively. Data from Buckiova et al. (1992) and
    Smialowicz et al. (1989) also show that exposure of mice  in utero
    and exposure of rat pups prior to weaning cause effects at exposures
    lower than those required for the same effects in adult animals.
         In a subchronic immunotoxicity study (Vos et al., 1990; a
    companion to the chronic study summarized below), aged (1-year-old)
    male Wistar rats were exposed for 5 months to the same diets used in
    the principal study. Based on the authors’ statement from the chronic
    study (see below), estimated compound intake was 0, 0.025, 0.25, or
    2.5 mg/kg body weight per day. End-points were the same as some of
    those evaluated in the chronic study.
         Compound-related effects occurred only in the high-dose group and
    consisted of significantly decreased thymus weight (39% lower than
    controls,  P < 0.01), impaired resistance to  Trichinella spiralis
    (indicated by increased recovery of adult worms from the small
    intestine [780% higher than controls;  P < 0.01] and number of
    larvae in muscle [80% higher;  P < 0.001]), and impaired resistance
    to  Listeria monocytogenes (indicated by approximately 300% increased
    splenic bacterial count;  P < 0.05).
*** Immunotoxicity is not addressed in approval of use of this chemical – only carcinogenicity and lethal dose information is given – for mice. It may not be a problem for humans since it hasn’t been tested for that. (sarcasm)
*** didn’t read it word for word but this popped out during my skim:
Food consumption was slightly increased in all dose groups in males throughout the study (p value not reported).  ***subtext to me  – chemical that may increase appetite and weight gain possibly. The previous link mentioned depressed thymus – aka increased hypothyroidism
Statistically significant decreases in survival occurred in treated mice of both sexes. In males, survival after 18 months was 67, 52, 42 and 42% in the control and low-, mid-, and high-dose groups, respectively (p < 0.05, all doses). The overall survival of the low-dose males (52%) was within the range of the controls (45-78%). Because the difference in survival between the low- dose and control males became apparent late in the study (beginning at 15 months) and was marked at termination (54% vs. 71% in controls), the decreased survival in the low-dose males is considered treatment-related. Survival in females at 18 months was 59, 48, 40 and 27% in the control and low-, mid- and high-dose groups, respectively (p < 0.05, except for the low-dose group). No information on causes of death was available. Other treatment-related effects included significantly decreased food consumption and increased absolute and relative liver weights in females at the high dose.
*** High does are assoc with poor weight gain and shorter life. Offspring had poor weight gain at higher doses in the mothers.
“Based on decreased thymus weight, the LOAEL for parental toxicity is 2.95 mg/kg-day in males and 3.43 mg/kg-day in females. The NOAEL for parental toxicity is 0.29 mg/kg-day in males and 0.34 mg/kg-day in females.”
“Actual weight gain was 4.5% higher, 1.8% lower, and 26% lower than controls at the low-, mid- and high-dose, respectively. Adjusted weight gain (excluding uterus) was 5.5, 22.2 and 69.4% lower than controls at the low-, mid- and high-dose, respectively.”
*** – yes lower dose mice gain more weight – these were pregnant but it’s a clue. What is more disturbing  is how hard the pregnancy was on the mice at the higher doses – subtracting the uterus left them 69.4% lighter than the controls and the low dose mice actually lost weight compared to controls as well so the average size of the uterus from that group of mice was 10% larger than the  control group’s.
*** Organic chemistry of earth science – increasing acidity of rain and ground water may be triggering a change in soil conditions towards sequestering minerals.
From chapter 14:
Soil humic substances contain higher amino acid concentrations: roughly 500 nM/mg for soil humic acids and 150 nM/mg for soil fulvic acids. Hydrogen bonding appears to play a role in molecular aggregation.
Soil humic substances have core structures that are highly aromatic (20 to 70% of total C) The shape of humic substances is strongly influenced by pH. At low pH, humic and fulvic molecules are fibrous. At neutral pH, these fibers tend to mesh together to form a sponge-like structure. This mesh structure is capable of trapping smaller molecules. For example, fatty acids and acyclic alkalenes, which are found in most humic and fulvic acids, may be simply trapped rather than bonded to the molecular backbone. Under alkaline conditions the structure becomes plate-like. (pg 612) Aquatic humic substances are primarily aliphatic whereas soil humic substances are primarily aromatic. This observation in itself does not exclude derivation of aquatic humic substances from soil (since leaching may preferentially remove aliphatic-rich molecules), but the difference is consistent with soil humic substances being derived primarily from higher plants (which are rich in aromatic molecules such as lignin and tannins), and aquatic humic substances being derived primarily from algae and zooplankton (which are poor in aromatic molecules). (pg 612)
Dependence on pH
Figure 14.31 shows the effect of pH on the adsorption of humic acid on Al2O3: the extent of adsorption is greatest at a pH of about 3 and is generally greater at low pH than at high pH. This pH dependence arises because the availability of hydrogen ions in solution will affect the charge on a solid
surface in contract with that solution. At pH below the isoelectric point of a mineral, mineral surfaces
will be protonated and will carry a positive charge; at higher pHÕs the mineral surface will bear a negative charge. Furthermore, dissociation and protonation of organic functional groups, which will affect the extent of adsorption through the mechanisms discussed above, is pH dependent (pg 624)
THE WORLD OF ORGANOTIN CHEMICALS: APPLICATIONS, SUBSTITUTES, AND THE ENVIRONMENT
John M. Batt, Director – Product Stewardship, Additives Division, ATOFINA Chemicals, Inc.
In the marine antifoulant (MAF) paint market, tributyltin is used as a biocide in
paint formulations. These paints are then used to protect the underwater surface
area of a ship’s hull against barnacles, algae, etc. in order to avoid increased fuel
consumption and premature dry-docking. Triorganotins were introduced for this
application 30 to 40 years ago. Originally, tributyltin oxide (TBTO) was freely
dispersed in what were called Free Association Paints (FAP). These paints had
uncontrolled, rapid leaching rates of the biocide.
Polar oceans key to temperature in the tropics (6-17-10)

7. http://www.ontariogenomics.ca/outreach/episode-8-brood-14-fact-sheet

CAN CROWS BECOME VIOLENT FROM A DIET OF COPPER SULFATE-LACED CICADAS?

***this was a TV show plot explanation – I don’t think cicadas that ate copper sulfate laced nutrients (from Dutch Elm Disease treatment of tree roots) would hatch well  for the crows to be able to eat them, probably and short term craziness in the crow would be less likely then gradual weakening of the immune system and eventual death from infection.

8. http://www.ontariogenomics.ca/

The Ontario Genomics Institute (OGI) is a private, not-for-profit corporation focused on using world-class research to create strategic genomics resources and accelerate Ontario’s development of a globally-competitive life sciences sector.

9. http://www.whygenomics.ca/

“Genomics is our best weapon in the battle against world hunger, disease, and environmental challenges.”
***If we are only focused on one question – how gene manipulation can save the world – then we may miss out on saving the world.

9.1. http://www.ontariogenomics.ca/outreach/episode-8-brood-14-sceince-society

10. http://geochange.er.usgs.gov/sw/changes/natural/elnino/

 “During an El Niño, the trade winds are too weak to cause upwelling of nutrient-rich waters off the coasts of Ecuador and Peru. Generations of South American fisherman thus have recognized these conditions by the disappearance of their standard catch, commonly during December and January, every three to seven years. Because of the near coincidence in timing between these conditions and Christmas, the fishing communities have called the phenomenon “El Niño”, for the Christ child. The geologic record suggests that El Niño conditions have been a part of earth’s climate for at least several thousand years.”

13. http://mauidish.com/breaking-maui-foodie-news/possible-food-listeria-contamination-7-eleven-bentos-recalled/ Possible Food Listeria Contamination 7-Eleven Hawaii Bentos RECALLED, by Jen Russo on July 7, 2011 – 11:12 am

14. http://www.inchem.org/documents/cicads/cicads/cicad62.htm#1.2

Concise International Chemical Assessment Document 62, Coal Tar Creosote

“Aquatic invertebrates and fish bioaccumulate creosote components, as has been demonstrated mainly for PAHs by field monitoring studies at creosote-contaminated sites, relocation experiments, and laboratory or microcosm studies. Generally, PAH profiles in insects and crayfish were close to that found in sediments, whereas fish had greatly altered ratios for low/high-molecular-weight PAHs. Bioconcentration factors (BCFs) in connection with creosote exposure have rarely been reported. However, BCFs for PAH components from creosote-contaminated sediments have been estimated to range from 0.3 to 73 000.”  *** Creosote has many compounds including benzene, fluorene, and fluoranthene

7.5.3 Endocrine disruption

“A coal tar creosote (partial specification: 15 PAHs) has been examined in vitro for estrogen receptor-mediated activity using competitive ligand binding assays and reporter gene assays (Fielden et al., 2000). Creosote was found to bind to the mouse estrogen receptor, bind to the human sex hormone-binding globulin, and elicit partial agonist activity in reporter gene assays in transiently transfected MCF-7 cells (human mammary carcinoma-derived cells). The mouse competitive ligand binding assay (using uterine cytosol from female ICR mice) resulted in an IC50 value (displacement of the labelled ligand from the estrogen receptor) of 135 mg/litre creosote (compared with 7 µg/litre for 17beta-estradiol). Based on these values, it was estimated that creosote has a relative estrogenic potency of 0.000 165 and contains approximately 165 mg/litre of estradiol-equivalents. In the assay with human cells (human pregnancy serum), creosote displaced approximately 50% of the ligand at a concentration of 220 mg/litre; however, an IC50 value could not be determined, because full displacement curves could not be obtained due to the insolubility of creosote at higher concentrations.”

8.2.2.1 Non-cancer effects

Women (281 cases, 216 controls, USA) occupationally exposed to dusts that were primarily wood- and agriculture-related were found to have an increased risk of infertility (OR = 2.87, CI = 1.05–7.88); however, there were no data available to establish an association with the wood preservatives (PCP, creosote, formaldehyde, chromium, or arsenic) commonly used (Smith et al., 1997).

*** That effect may in part be due to the fluorine and fluoanthene and increased thyroid inhibition.

“An increase in susceptibility to infectious disease has been demonstrated in eastern oysters (Crassostrea virginica) exposed to 0, 15, and 30% dilutions of the WSF generated from Elizabeth River sediments. The mean total PAH concentration in this sediment was 2.4 g/kg dry weight. The mean concentration of aromatic compounds in the WSF (more than 100 compounds) was 4.08 mg/litre, with naphthalene, acenaphthene, 2-methylnaphthalene, phenanthrene, fluorene, dibenzofuran, 1-methylnaphthalene, and carbazole being the predominant compounds (concentrations ranging from 0.15 to 1.51 mg/litre). Exposure to these fractions for 56 or 68 days enhanced pre-existing infections caused by the protozoan parasite Perkinsus marinus (Dermo) and increased the oysters’ susceptibility to experimentally induced infection in a dose-dependent manner (Chu & Hale, 1994).”

 Bad Food, Good Wrap, The Boston Globe, Stephen reucroft and John Swain (4-25-2000)

CDC says 18 deaths tied to listeria in cantaloupe, AP Online, (10-4-2011) BY Mary Clare Jalonick

“FDA Commissioner Margaret Hamburg said Tuesday that the agency is still investigating the cause of the outbreak. Officials have said they are looking at the farm’s water supply and possible animal intrusions among other things in trying to figure out how the cantaloupes became contaminated. Listeria bacteria grow in moist, muddy conditions and are often carried by animals.”

17. http://www.highbeam.com/doc/1G1-268415671.html ADH Reports Case Connected to Multi-State Outbreak of Listeriosis Linked to Whole Cantaloupes from Jensen Farms, Colo.., States News Service  September 29, 2011

18.http://www.ncbi.nlm.nih.gov/pubmed/12043163 Zh Mikrobiol Epidemiol Immunobiol. 2002 Mar-Apr;(2):81-3. [Opportunistic bacteria detected in cultivated mussels].[Article in Russian] Beleneva IA, Maslennikova EF.Institute of Marine Biology, Far East Branch, Russian Academy of Sciences, Vladivostok, Russia.

“As many as 8 Listeria monocytogenes strains, 12 Pseudomonas aeruginosa strains and 5 Staphylococcus aureus strains were isolated from mussels Mytilus edulis, grown on special installations in the Trinity Bay of the Gulf of Peter the Great, the Sea of Japan. The isolated cultures proved to be highly resistant to a number of antibiotics. Many strains displayed DNAase and haemolytic activity. The cultures of L. monocytogenes, S. aureus and P. aeruginosa also had high lipase, protease and lecithinase activity. The organism of the mussels seems to be a confinement for these bacteria under study. “
Mar Pollut Bull. 2011 Feb;62(2):382-7. Epub 2010 Oct 13., Incidence and characteristics of Staphylococcus aureus and Listeria monocytogenes from the Japan and South China seas.,  Beleneva IA, .A.V. Zhirmunsky Institute of Marine Biology, Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia. beleneva.vl@mail.ru

20.  http://news.yahoo.com/scientists-bacteria-spreading-warming-oceans-142213062.html
Scientists: Bacteria spreading in warming oceans By DON MELVIN – Associated Press | AP – Tue, Sep 13, 2011

 21. http://www.highbeam.com/doc/1G1-225623023.html Study data from Technical University of Munich update understanding of Listeria.

Biotech Week May 12, 2010  ***study on laying hens, organically fed vs standard feed groups comparing their amount and types of Listeria and Enterococcus infection. Levels of pathogen infections were similar but the amount of antibiotic resistant strains were fewer in the organically fed chickens.

22. http://www.highbeam.com/doc/1G1-139036416.html  Orca Bay recalls crab legs: USDC detects Listeria contamination.(United States Department of Commerce )

“The risk of listeriosis can be decreased in ruminants by feeding good quality silage with a low pH. Spoiled or mouldy silage should be avoided, as well as silage from the superficial few inches exposed to air.”
Amazon Link – textbook

24. http://books.google.com/books?id=NZsS6tbSAFYC&pg=PA637&lpg=PA637&dq=listeria+wild+animals&source=vrt&ots=3sGFgl_eS2&sig=TEOjD7TVh-EpR4VmFYpfdJWK6rM&hl=en&ei=Dj6NTvePIYS2tweWhfWJDA&sa=X&oi=book_result&ct=result&resnum=11&sqi=2&ved=0CHsQ6AEwCg#v=onepage&q=listeria%20wild%20animals&f=false
Elliot T. Ryser, Elmer H. Marth, Listeria, Listeriosis and Food Safety, (page 637)

“Listeria spp can be recovered from non-plolluted environments and the source of this bacterium may very well be from avian species, especially seagulls.[99]”

25. http://www.highbeam.com/doc/1G1-144294853.html Winter wellness: answering your body’s need for nurturance: pamper yourself with herbalist Karyn Sweet.(DEPT.> herbal healing)

New Life Journal February 1, 2006 | Sweet, Karyn

Essential oil of oregano, active compound carvacrol.

Oregano means “joy of the mountain” in Greek–let it bring some joy into a cold mountain day. It is a warming herb that can add delicious taste to Italian sauces while soothing the digestive tract and preventing free radical damage. A compound of oregano oil called carvacrol is a powerful antiseptic and so can be used as a gargle to soothe sore throats or mouth inflammations. In aromatherapy, the essential oil is used as a treatment for bacterial and fungal infections. Research has found that it is as effective against bacteria such as listeria, staphylococcus, and E. coli as conventional antibiotics. Use of the diluted essential oil may alleviate toothache, gum infections, athlete’s foot, psoriasis, or eczema. Oregano’s antiseptic properties can be enjoyed by grinding it into soap and its anti-inflammatory properties can be released in homemade salves and oils. Furthermore, oregano’s use as an expectorant makes it particularly useful during these winter months. Add a strong infusion to the bath and relax in the warm water while the winds blow cold outside. ”

Talking about trauma with kids; PTSD, neural mapping, EMDR and reframing

/This article was originally posted on March 21, 2011. It is still important to have open conversations with children about traumatic events or other information they may find confusing, troubling or frightening. EMDR therapy can be helpful for adults with PTSD./
We all need comfort and we gain it from sharing our burdens, talking about troubles and letting out worries. Listening is more important than talking – let kids talk to you about trauma – we don’t know what they are thinking or are worried about until we let them talk it out. Don’t worry too much about “how to talk about it“, pause, listen, and accept – “yes, there are worries but we’ll stick together and work through it“, is a strong message for all of us to hear.
Children and all of us have “hot” emotional memories centered in the amygdala and milder long term factual memories stored more generally throughout the neocortex. Electrical activity of the brain can be recorded and associated with the topic being considered. The amygdala centered emotional memory can be tied to smells, sounds, places or people and can be unexpectedly triggered leaving the person with panic attack type symptoms unique to the individual’s memories of the early traumatic event.

Neural connections in the brain can be flexible or can be linked together in behavior patterns that might be described as being a bit like playing with a line of toy dominoes. The designers spend hours placing the dominoes in line, each the perfect distance and angle from the last, carefully balanced on end and poised for any slight shock to send the entire chain tumbling down. Emotional memories may be triggered by something like a car door slamming shut. A toddler memory may be submerged regarding something as trivial as mom and dad fighting over who has to carry in the groceries and the car doors were slammed shut violently. To a toddler the words may not mean as much as the tone and the violent sounds. A description of brain cell connections without the dominoes analogy is available on ScienceDaily: Brain pattern flexibility and behavior, (ScienceDaily)

 

After the event, immediately, and maybe later that day, the next day, the next week – the toddler may pester with questions of what is wrong and what did I do to cause that fight? The child’s world is centered around themselves – natural while young but prone to self blame. The memory can be stored with feelings of “I caused that arguement – I am a bad person – I don’t deserve attention or explanation” and so on. If their worries are left unanswered or are denied as real then the hot memory is ignored and is left unprocessed, instead it is pushed down and forgotten at the daily level. A car door slamming with a combination of shouting voices might trigger a panic attack though.

 

The hot memory can be toned down and moved to long term storage if time is allowed to discuss the event – and more than once. It might pop up in the toddler’s chit chat daily, and then weekly, monthly, and maybe even over the years if it was bad enough triggering event. Once the connection is made though, (negative event associated with a negative symptom) and discussed, usually the power of the slamming/shouting sound is reduced and similar events in the future may not trigger a panic attack or it might  be a milder reaction.

 

Children are absorbing knowledge and building their neural pathways – good habits and bad habits are learned by watching the people they love and trust. Spending a few minutes whenever possible to listen to children share their worries allows them to move the memories from the ‘hot’ button zone of the amygdala, to the mellower long-term storage of the neocortex.

 

Symptoms of PTSD, Post Traumatic Stress Disorder, can be effectively reframed  and reduced using cognitive therapy techniques like EMDR. A problem or trigger event is visualized and then a state of deep relaxation is reached and the memory is discussed or pondered with guidance from the therapist. New insights from the perspective of the adult framing of the situation can be considered and then the relaxation method is repeated using the new perspective.  The neural maps of the traumatic events can be reached  from a deeply relaxed state of theta waves. EMDR, attempts to help the patient reach the theta state with rapid stimulation of the right side then left side of the brain, either visually with a moving hand or object, or with sound or a vibration buzz in the palm of the hand. Children under seven are already living in this more meditative level of consciousness. In the zone – flow time – playing like a child – we could all use a little relaxed theta time these days and a chance to free a little worry from the hot zone of the amygdala.

 

The world is changing but denying reality never solves problems it only pushes them down to a submerged hot zone. When we talk about our troubles then we can look for solutions and change. Denying problems, denies a chance for change.

 

Art therapy can be a useful way to give children and anyone freedom to explore feelings – color to feel not to produce. Playdough and other free form play can help reach a relaxed state where gentle talk about hot topics can be released  as they surface. Picking at the problem with needling questions may not be as quick as open ended play time. Adults may find a walk or bike ride their ticket to free flow brain time.

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Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. Terrorism, and talking to kids about catastrophic mass violence, guidance sheets from The National Child Tramatic Stress Network [nctsnet.org/trauma-types/terrorism]
  2. by Carol Boulware, MFT, PhD, “EMDR Therapy, EMDR Therapists, EMDR information, PTSD,” [emdr-therapy.com/].
  3. by Carol Boulware, MFT, PhD, “EMDR-Breakthrough Therapy for Overcoming Anxiety, Stress,Trauma and Self-Sabotage,” [emdr-therapy.com].
  4. by Carol Boulware, MFT, PhD, “Do I Have Anxiety Needing Therapy?” a discussion about anxiety and PTSD focused on adults [emdr-therapy]
  5. The National Child Traumatic Stress Network [nctsnet.org/]
  6. Trauma and Your Family – a guidance factsheet from The National Child Traumatic Stress Network pdf: [nctsn.org]
  7. by Tanya Anderson, PTSD in Children and Adolescents, Great Cities Institute, GCP-05-04, November, 2005  pdf: [uic.edu]
  8. This website is a non-profit 12 step based program for the Adult Children Of Alcoholic (or Dysfunctional) Families. PTSD and neural mapping aren’t discussed but the symptom list includes similar problems: The Laundry List – 14 Traits of an Adult Child of an Alcoholic (or Dysfunctional Family) ,  [adultchildren.org]

Alp Luachra, an old name for edematous malnutrition

Alp Luachra is a Celtic fairy with a pet newt. It was considered dangerous to fall asleep near a stream. Alp Luachra might climb into the victim’s mouth along with his pet newt. They would live in the stomach and gobble up nutrients while the rest of the accursed person shriveled away. No matter how much the victim would eat they would eventually starve – because Alp Luachra leeches all the nutrition away. I learned of him from my new book, Tarot of the Celtic Fairies. The picture on the Tarot card does resemble edematous malnutrition with a very round belly and thin, starved looking arms and legs. Maybe it does exist outside of the tropics. (The 9 of Cauldrons card from  Tarot of the Celtic Fairies 14)

Kwashiorkor, (that rare tropical form of malnutrition in toddlers weaned from breast feeding too rapidly, and/or from lack of introduction of insects to the diet at the appropriate stage), has been in the news. An insurance billing watch dog group found an increased use of the diagnosis code for kwashiorkor/malnutrition in a group of California hospitals. Prime Healthcare Service’s response to the allegations that a diagnosis of malnutrition was used to increase reimbursement states that the facts were distorted in order to mislead the public and gain concessions. It continues that the “relevant (i.e., where the diagnosis affected reimbursement) malnutrition rate at all Prime Healthcare hospitals was 3.6%,which is much less than the rates referenced in the article. For example, their relevant malnutrition rate at Huntington Beach hospital was 5.3% rather than the 39% reported by California Watch.”

That seems reasonable to me. It continues to review the disturbing prevalence of malnutrition and their screening program that Prime Healthcare hospitals use for improving patient care and decreasing morbidity and mortality rates a nutritional screening for their elderly patients is part of their routine care.

Published studies estimate that up to 15% of ambulatory elderly patients, up to 44% of homebound elderly patients, up to 65% of hospitalized elderly patients, and up to 85% of nursing home patients are malnourished. Hajjar, R.R., Kamel, H.K., Denson, K., Malnutrition In Aging, The Internet Journal of Geriatrics and Gerontology, Volume 1, Number 1 (2004); Chen, C.C-H, Schilling, L.S., Lyder, C.H., A Concept Analysis of Malnutrition In The Elderly, Journal of Advanced Nursing, Volume 36(1) (2001).

** Prime Healthcare sounds like a good place for dietitians to work. A nutrition screening by a Registered Dietitian is vital for quality preventative health care. A multidisciplinary team allows a thorough assessment from multiple viewpoints – a stethoscope or a microscope or a little Celtic sparkle – who knows the health solutions that teamwork can bring. However, I was just reading about albumin on RD411, an information website, today [16]. I learned that low albumin is not considered useful to tell if a patient is malnourished because it is easily influenced by many factors besides dietary protein intake. However, at the same time I learn that it is associated with increased mortality and morbidity – so I am left to assume that  I needn’t consider the elderly person with an albumin of 7 or 8 as ‘malnourished’ but just to consider them at increased risk of morbidity and mortality instead. The recommendation is to continue dietary calculations as normal, but instead of pouring another Health Shake to add to the malabsorbtion mess I would rather consider what is causing the shift in fluid and what might be better absorbed than what we already have been trying.

In research by Yi-Chia Huang et al, the elderly Taiwanese population had an intake range of 573.9 to 3191.9 kcal/day and no association between functional status and intake could be made.  Intake of at least 55 grams protein per day was associated with better function but higher levels of protein intake again could not be correlated to improved status. [7] In cases of malabsorption we can pour in 3000 calories per day and there will be no guarantee that it will be more helpful than 573. It would probably be more harmful than low intake. Anything that passes through the body has to be brought into safe balance with the chemical needs of the intestinal lining. Magnesium is a buffer that is taken from the bones to “fix” over acidic conditions. High protein, dairy and sugar intakes add to acidic conditions and coffee, carbonated beverages, black tea, and fruit juices can be very acidic. For strong bones try choosing an herbal or green tea and pass on the extra large glass of pop or milk and the triple shot of alcohol too probably.

There is controversy over using just the albumin level for a diagnosis of malnutrition and it is true that short term edema – puffiness – will cause low albumin levels while puffy. With less fluid in the blood and more fluid in the spaces between cells and organs there will be less albumin. It is a blood protein that acts a little like a sponge to attract and keep fluid around it but where the fluid goes it is also attracted to follow. Circular paths are the way of nature. The albumin level that remains low for months – rather than during an acute week of an illness – I would strongly consider the possibility that an underlying malnutrition problem is the cause of puffiness and low albumin, the reasons for the initial malnutrition can vary but once the poor absorption starts the problems picks up pace and the body deteriorates from feeding on itself – there isn’t a newt but there is a brain, heart and lungs as long as the fingers, toes and remaining peripherals hold out (reminder Buerger’s vasculitis disease [15]).

One lab test can be supported by other labs and observed signs and symptoms of health or weakness. Several studies have found that assessing frailty factors seems more correlated with a variety of quality of life factors and improved surgical recovery rates than BMI. More than 3 of 5 of the following – unintentional weight loss, weakness, self-reported poor energy, slow walking speed, and low physical activity  was found associated with risks of falls and fractures. Hand grip strength, and calf muscle to fat area, mid arm circumference, sarcopenia were mentioned as measurements of improved muscle mass with improved health status. Sit ups and leg lifts or just a walk in the woods – better muscle mass is associated with longer life.

Based on the sensitivity of the autoimmune gut and my review of kwashiorkor research, I would surmise that a gluten free, lactose free, low calcium to magnesium ratio with an increase in glucosamine and other essential sugars (super starches) and plenty of B vitamins, C, A, zinc, selenium might help the catabolic patient with edema. We need to provide building blocks that readily make a strong glycocalcyx to reduce the leakiness of the intestinal lining.

I am glad that Prime Healthcare has had to stand up for malnourished patient’s rights – the right to a diagnosis that is accurate. An albumin of 7 or 8 is tragic and just because it is from excessive dilution due to malabsorption/mal-retention and not due to lack of protein in the diet – doesn’t mean it isn’t leading to cell starvation. Just because we don’t quite understand edematous malnutrition and don’t seem to know how to stop it, doesn’t mean that it doesn’t exist and isn’t killing people in a very costly and agonizingly slow way.

Names matter and the tropics and kwashiorkor is simply where the problem was studied most. Edematous malnutrition is a better name for the condition in my opinion than protein calorie malnutrition. Over the long term edema means that the cells aren’t being well fed or well detoxified. During edema the movement of fluid is reduced and the movement of nutrients and toxins is slowed. Over the long term edema leads to dysfunction and malnourishment. If the fluid in our toilets backed up regularly we would expect the plumber to repair it not just measure the dysfunction. Puffy abdomen and ankles = overflowing waste = better call a doctor on the Prime Healthcare team in case malnutrition is involved (and remember to ask for a referral to a Registered Dietitian); maybe repair is still in the future but recognition is at least a first step.

Kwashiorkor occurs on the same diet as marasmus malnutrition but the children have different metabolic reactions. Recent infection may be associated with the kwashiorkor susceptible population. Their intestinal lining lacked glucosamine and excess fluid movement both directions was the result. An enzyme deficiency for the conversion of glucose or galactose into glucosamine seemed to be a significant difference between the two groups of children and aldosterone levels were also abnormal in the kwashiorkor children but not the maramus group. Edematous malnutrition exists outside of the tropics.
Glucosamine supplements may be crucial for heart disease and other leaky membrane problems (dementia). Zinc and selenium are low in heart disease and B6 and all of the B vitamins are essential for cell growth and energy demands. Vitamin C is also depleted rapidly. Our “health supplement shakes” and complete feeding formulas are not based on ratios that the critically ill can tolerate – they are more harmful than helpful. We need research and development of an isotonic formula with high levels of beneficial nutrients and low levels of a few things that add to the body burden .

In the meantime more magnesium, B complex, zinc, selenium, iodine, glucosamine, taurine, vitamin C, and beta carotene rich dark green and deep orange fruit and vegetables may be helpful to the chronically ill and obese. Mushrooms, aloe vera, fenugreek, slippery elm powder and ginger also have essential sugars – super fiber for building a strong glycocalyx. The intestinal lining is an organ that protects and nourishes our bodies for miles – literally – do we want junk food littering the way or a strong yet fluid, free-form matrix of super starches, trace mineral ions lighting up the place and plenty of strong white blood cells patrolling for trouble.  Cancer wouldn’t stand a chance – or at least reduced chance.

***11-7-11 BTW I figured out what’s happening with the leaky membrane problem – its complicated – call me or read the [bazillion words, “Cantaloupe, listeria, and sea squirts, oh my,” Oct. 5, 2011]

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 /Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./
  1. Olubukola O. Nafiu et al., “The Association of Body Mass Index to Postoperative Outcomes in Elderly Vascular Surgery Patients: A Reverse J-Curve Phenomenon,” Anesthesia & Analgesia 112, no. 1 (January 1, 2011): 23 -29.
  2. Ian M Chapman, “Obesity paradox during aging,” Interdisciplinary Topics in Gerontology 37 (2010): 20-36.
  3. S L Miller and R R Wolfe, “The danger of weight loss in the elderly,” The Journal of Nutrition, Health & Aging 12, no. 7 (September 2008): 487-491.
  4. Ian Janssen, “Morbidity and mortality risk associated with an overweight BMI in older men and women,” Obesity (Silver Spring, Md.) 15, no. 7 (July 2007): 1827-1840.
  5. Kristine E. Ensrud et al., “Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures,” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62, no. 7 (July 1, 2007): 744 -751.
  6. Meei-Fang Lou et al., “Nutritional status and health outcomes for older people with dementia living in institutions,” Journal of Advanced Nursing 60, no. 5 (December 2007): 470-477.
  7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)
  8. Matteo Cesari et al., “Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study,” The American journal of clinical nutrition 83, no. 5 (May 2006): 1142-1148.  (free article)
  9. H K Vincent, K R Vincent, and K M Lamb, “Obesity and mobility disability in the older adult,” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 11, no. 8 (August 2010): 568-579.
  10. Heppenstall, et al, “Frailty: dominos or deliberation?,” N Z Med J. 2009 Jul 24;122(1299):42-53. http://www.nzma.org.nz/journal/122-1299/3710/.
  11. Fred Chau-Yang Ko, “The clinical care of frail, older adults,” Clinics in Geriatric Medicine 27, no. 1 (February 2011): 89-100.
  12. Stephane M Schneider et al., “Lack of adaptation to severe malnutrition in elderly patients,” Clinical Nutrition (Edinburgh, Scotland) 21, no. 6 (December 2002): 499-504.
  13. Lilian Liang et al., “Nutritional issues in older adults with wounds in a clinical setting” 1: 63-71.
  14. McElroy, Mark, Tarot of the Celtic Fairies, artwork by Eldar Minibaev, (2010, Lo Scarabeo, Via Cigna 110 – 10155 – Torino- Italy _www.loscarabeo.com_ (I hope this will be viewed as a brief extract and recommendation rather than copyright infringement.  I find Tarot cards a meditative cognitive therapy aid – solitaire for the brain.)
  15. http://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/ ***I discussed it in my article Vasculitis – Withering from Within.The main cause of this type is smoking and the best treatment is to quit smoking. Smoking depletes oxygen and antioxidants and magnesium – malnourishment from within – second best to quitting smoking would be of course to replenish with extra vitamin C and magnesium supplements and foods and some oxygen would help also vitamin A foods – supplements have not been helpful but the food has helped . . . carrots, peaches, sweet potatoes, tomatoes, broccoli and V8, mangos, apricots and cantalope.
  16. http://www.rd411.com/index.php?option=com_content&view=article&id=393:albumin-as-an-indicator-of-nutritional-status&catid=105:professional-refreshers&Itemid=400
  17. see my previous blogs Angelina please don’t risk the knife, and We are what we eat, for more Bibliography on kwashiorkor, insects and perimenopause.
  18. see my previous blogs on the glycocalyx and Electrolytes R Us, for more on leaky membranes and hydration.
  19. http://www.highbeam.com/doc/1G1-250812435.html . “Prime Healthcare Services Review of State Health Data Confirms Normal Malnutrition Rates Among Its Medicare Patients; Recent Studies Debunked.(Clinical report).” PR Newswire. PR Newswire Association LLC. 2011. HighBeam Research. 9 Apr. 2011 http://www.highbeam.com.

From a different list of reading:
7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)

Excerpt from Conclusions section:
“There were approximately 36% of functionally dependent subjects who consumed energy less than 75% of the Taiwan RDNA in our study. The elderly with functional dependence might have more difficulties in accessing food. However, we could not find an association between energy intake and functional status. This might be due to large variations of energy intake among individuals ranging from 573.9 to 3191.9 kcal/day.
Consistent with Payette and Gray-Donald [24], the elderly had sufficient mean protein intake, but these authors’ association between protein intake and serum albumin concentration was not found. Morgan et al. [6], however, indicated a positive relationship between protein intake and serum albumin concentrations. It is worth noting that the association was valid only up to protein intake of 55 g/day. Since our subjects had a varied protein intake ranging from 23 g/day to 122 g/day and half of the subjects had a protein intake .55 g/day, the dietary protein intake might no longer have an effect on serum albumin concentration. Another possibility was that chronic conditions play a determinant role in affecting the albumin concentration.”

***Note on vitamin D – The chronically ill may have depressed 25-D levels because they have elevated 1,25 D levels resulting in more than enough of the active hormone for preventing fractures even though the vitamin level seems insufficient for the average person.

The enzyme to activate the vitamin to the steroidal hormone is made by white blood cells as part of the stress/inflammation response and in some cancer cell strains. An active D level above 45 means the bones are losing calcium stores. My five year 1,25-D average, while actively avoiding vitamin D foods, supplements and much time in the sun, was 59 pg/ml and my five year average 25-D was 20 ng/ml. The range was 51-71 pg/ml, 1-25-D and 8.0-26.7 ng/ml for 25D. Ex: 3-31-2009 25-D of 9.0 and 1-25D of 53 pg/ml. If I spend a day on the beach I am hurting two days later from the calcium that is drawn out of the bones – muscle spasms, fatigue and irritability symptoms primarily for me but ringing in the ears and a twitching eyelid have been reduced with magnesium. B vitamins and zinc tend to be involved to – magnesium rich foods would provide those as well as iron and iodine only if it was grown in iodine rich soil.

Kwashiorkor Bibliography

  1. http://www.ajcn.org/content/89/2/592.long ***Reduced production of sulfated glycosaminoglycans occurs in Zambian  children with kwashiorkor but not marasmus also good –
  2.  http://www.icmr.nic.in/ijmr/2009/November/1128.pdf  Tahmeed Ahmed, Sabuktagin Rahman and Alejandro Cravioto, Oedematous malnutrition,  Indian J Med Res 130, November 2009, pp 651-654
  3.  http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.htmlWilliams, L., Jewett, C., and Doi, S. K., Hospital chain, under scrutiny, reports rare illness (The Press Enterprise Local News)
  4. http://www.pe.com/localnews/opinion/editorials/stories/PE_OpEd_Opinion_D_op_27_ed_primehealth.1816fbc.html  Shady billing? (The Press Enterprise)
  5. http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illness.html
  6. Prime Healthcare Should Be Denied New Hospital Licenses Until Federal, State Investigations into Extraordinarily High Septicemia, Malnutrition Rates and Risk to Patients are Complete.Business Wire. Business Wire. 2011. HighBeam Research.
  7. http://online.wsj.com/article/SB10001424052748703293204576106072340020728.html  Marcel Dicke, Arnold Van Huis are professors of entomology at Wageningen University in the Netherlands.  (2-19-11, The Wall Street Journal, pC3)  The Six-Legged Meat of the Future
  8. http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2010.00705.x/abstractEffect of Diabetes Mellitus on Protein–Energy Wasting and Protein Wasting in End-Stage Renal Disease, Nazanin Noori1, Joel D. Kopple1,2Article first  published online:13 APR 2010DOI: 10.1111/j.1525-139X.2010.00705.x
  9. http://www.ncbi.nlm.nih.gov/pubmed/19121473  Semin Nephrol. 2009 Jan;29(1):39-49. Causes and prevention of protein-energy wasting in chronic kidney failure. Dukkipati R, Kopple JD. Division of Nephrology and Hypertension, Los Angeles Biomedical  Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
  10. http://www.ncbi.nlm.nih.gov/pubmed/19121477 Semin Nephrol. 2009 Jan;29(1):75-84. Nutrition support for the chronically wasted or acutely catabolic chronic kidney disease patient.Ikizler  TA.Department of Medicine, Division of Nephrology, Vanderbilt University School of  Medicine,Nashville, TN 37232-2372, USA.
11. http://www.ncbi.nlm.nih.gov/pubmed/16129200Am J Kidney Dis. 2005 Sep;46(3):387-405. Multinutrient oral  supplements and tube feeding in maintenance dialysis: a systematic review and meta-  analysis. StrattonRJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, Elia  M.Instituteof Human Nutrition, University of Southampton, UK.

12.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891019/?tool=pubmed New Insights into the Role of Anabolic Interventions in Dialysis Patients with Protein Energy Wasting Jie Dong and T. Alp Ikizler1 Curr Opin Nephrol Hypertens. Curr Opin Nephrol Hypertens. 2009 November; 18(6): 469–475.doi: 10.1097/MNH.0b013e3283 31489d.

 “Economic Implications of Nutritional interventions It is also important to assess the impact of nutritional supplements not only in terms of changes in nutritional parameters, but to extrapolate these observations to potential improvements in hospitalization, mortality, and cost-effectiveness. In a recent study, Lacson et al showed that a hypothetical increase in serum albumin concentration in the order of 2 g/L in 50%  of the United States dialysis population would be associated with  projections of approximately 1400 lives saved, approximately 6000 hospitalizations  averted, and approximately $36 million in Medicare cost savings resulting  from a reduction of approximately 20,000 hospital days over one year[68]. This is a reasonable estimation since 2 g/L increase in serum albumin is the average improvement reported in most nutritional intervention studies.”

***The above paper is suggesting that giving them growth hormones  and other anabolic steroids along with protein will help them to stop catabolizing and start building albumin. They have had success with the strategy, but wouldn’t magnesium plus protein (ideally combined within the same magnesium foods) be cheaper than hormones and protein?