Monday, February 27, 2012

Sushi: More Than Just Raw Fish

Japanese cuisine has worldwide popularity and nothing is more synonymous with Japanese food than sushi. The term sushi is associated with raw fish dishes that we see as healthy culinary art forms that taste great! The forms and traditional types vary greatly. Raw seafood is the foundation for dishes that are consumed and stand on their own merit. Many presentations also include rice, nori (dried seaweed paper) and numerous other ingredients such as vegetables and some seafood that may already be cooked. It is not limited to raw fish and rice. Condiments such as soy sauce, wasabi paste, a distinctive cousin to horseradish, tofu, soy beans, eggs and mayonnaise are often components to some dishes.  

Fish is a wonderful source of high quality lean protein. It is low in saturated fats, cholesterol, and carbohydrates. Salmon, mackerel, herring and tuna are rich in omega-3 fatty acids which are linked to many health benefits. Tofu, soy beans, nori, the dried seaweed wrapper commonly used in “rolls”, are all excellent nutrient sources of minerals, calcium, vitamin D, folic acid and antioxidants. Not all ingredients are limited to raw fish. Shrimp, eel, geoduck, crab are often cooked before they are featured in a roll. The wide array of creative rolls and styles seems endless with something to suit any taste. One must be thoughtful about some of the ingredients in some contemporary rolls like cream cheese, fried foods, mayonnaise, soy sauce that greatly increase the calories, sodium and fat contained in your dish. Overall the benefits of enjoying sushi and sashimi are diverse and outstanding.

The risks of eating sushi are very low but are worthy of consideration. The general contamination of seafood with mercury is virtually unavoidable. Unfortunately this neurotoxin contaminates all open waters of rivers, lakes and ocean. Some caution should be exercised in choices of fish variety and quantities consumed by those who are at greatest risk by mercury consumption. Women, who are pregnant, nursing or planning to get pregnant, young children, elderly or people who have a compromised immune system, should limit their consumption of seafood to only 12 ounces per week. Some species of seafood are likely to have higher mercury levels such as tuna, swordfish, shark and mackerel. This does not mean they need to be avoided entirely but consumed in limited quantities emphasizing variety with other kinds that may be lower in mercury content such as salmon, trout, crab and shrimp.  

There are other risks of undercooked or raw seafood which remain low if products are handled and stored properly. There are FDA guidelines for the industry which include freezing fish for precise amount of time to kill parasites. Still poor handling or dishonest vendors can provide tainted food that is contaminated with bacteria or parasites. The most common symptoms from eating contaminated raw fish are nausea, vomiting, diarrhea, abdominal pain, headache and fever. One must rely on a reputable dealer and trust your restaurateur to provide sanitary products of high quality. Although eating raw seafood is simply of greater risk than cooked fish, experts agree the health benefits outweigh the risks.

Enjoy the nutritional benefits of a wonderful culinary art with thoughtfulness and peace of mind. Strive for variety and eat sensible portions. 

Thursday, February 23, 2012

Pertussis: The Preventable Epidemic

Pertussis, also known as whooping cough is the only vaccine-preventable disease that is on the rise. After 1940 when Pertussis vaccine became available till 1980, there was a steady decline of this deadly childhood disease in the United States. If you thought pertussis was history, think again. Since 1980 the number of cases in the U.S. has risen to more than 3 million a year. More cases are being reported among adults and adolescents who experience a milder but just as stubborn form of the disease as infants. Since pertussis initially resembles other common colds the disease is probably under reported.

Babies under the age of one year get the infection from those who are closest to them. Family members, friends, caregivers are usually the source. We have only recognized in recent years, the role of adults around the infant to be a potentially dangerous reservoir of the disease. Adults are susceptible to pertussis, because the vaccine you received as a child wanes over five to ten years. If one member of a household has it, there's a 90% to 100% chance that other susceptible household members will catch it.

The vaccine is administered at 2, 4 and 6 months of age. A fourth dose is administered between 12 and 18 months, and a fifth after age 4. Teens need another booster shot between 11 and 18 years of age. All adults should have a single adult booster of Tdap (tetanus, diphtheria, and acellular pertussis) vaccine. Even when your baby is vaccinated, he or she may not be fully protected until they have received at least 3 doses of the infant pertussis vaccine. In order to create a “cocoon of safety” around your infant, those in close contact with the baby should receive a single dose of Tdap.  

The infection is spread easily through mucus droplets broadcast by profound coughing and sneezing. It can take 3 weeks or more to develop symptoms after exposure to the infection. You can give it to others until you've been treated with antibiotics for five days, or until you've been coughing for 21 days. The swelling and inflammation to airways is actually caused by toxins secreted by the bacteria. After 21 days of the infection the bacteria will die off but have already released their damaging toxins. Early recognition and treatment is important to minimizing the effects and preventing spread of the acute infection to others. Pertussis (whooping cough) causes spells of coughing that make it hard for a child to eat, drink, or breathe. The cough is often followed by a "whooping" sound as the person gasps for air, which is how the condition got its name. Some historians referred to the disease as the “100 day cough”. Serious side effects from the coughing fits are common in children. The choking and gasping can be fatal in children under one year of age. The disease is most serious in infants, especially those too young to get the vaccine or not fully protected. Babies with whooping cough are often hospitalized. With older kids and adults, the disease is milder and can cause several weeks of exhausting coughs. Although rarely fatal in adults and older children, time loss from school and work is substantial.

Early detection is important in limiting the spread of the disease. Appropriate antibiotic therapy for the person suffering with the condition and their close contacts needs to be started as soon as possible. Late recognition and treatment fails to change the course of the disease. Many weeks of coughing in the affected individual will continue even if the spread is limited. Testing specimens from a nasal swab can be helpful in identifying pertussis only in the first couple weeks. Many patients do not seek medical evaluation till later. The results of testing also causes further delay. Precise recognition can be difficult. Treatment is often started in the context of clinical symptoms and known outbreak in the community.

This punctuates the importance of prevention and a proactive approach to immunizations of both children and adults in our community. The best way to help protect babies against pertussis is to get infant vaccinations in a timely fashion. Adolescents and adults should have a single dose of Tdap booster.