Feb
01
2005

Black Widow Alert For Organic Produce

By | Health, Nutrition

Fresh fruit in winter has become the norm in supermarkets around the country. A significant amount of buyers seeks out organic produce for the lack of potentially noxious spray residues.
In the quest to combat insects that feast on their vines, growers of organic grapes nurture the black widow spider variety, which will prey on the vineyard pests in the sense of a biological pest control. Despite checks and handling measures to rid the grape bunches of spiders, more consumers have been spotting black widows on imported grapes. A Canadian Food Inspection Agency spokesman reported, that the numbers have been going up. The good news, however, is that bites have been infrequent, and more importantly, fatalities are extremely rare. Centers of the American Association of Poison Control recorded 13,000 bites in 1997 of which less than 1 % were fatal.
Nevertheless, the hazard is real, and people who are most at risk of suffering a fatal bite are children. Also the older patients who have a heart condition are at a high risk of severe complications. According to a recent study authored by Dr. A. Stibich, a dermatologist from the Newark-based University of Medicine and Dentistry in New Jersey, key signs of the toxin from a black widow bite are excessive saliva flow, tear flow, sweating, muscle tremors, a rapid heart beat and shock.

Black Widow Alert For Organic Produce

Black Widow Alert For Organic Produce

Medical treatment to deal with the symptoms and the pain is necessary. Most symptoms subside within two or three days.
For the consumer the most important message is caution. Black widows don’t only occupy fruit from the tropics, check out your organic grapes and look before you touch!

Reference: The Medical Post, December 14,2004, page5

Last edited December 7, 2012

Jan
01
2005

Doctor Recommended Diet Against Obesity

By | Diabetes, Health, Heart Disease, Nutrition, Weight loss

After overindulging over the holidays, new years resolutions often have diets and life style choices high on the list.
These concerns are not something new. Doctors have had concerns about heart disease, diabetes, bulging waistlines and elevated cholesterol. For over three decades there have been concerns that elevated insulin levels may be associated with heart disease, and the constellation of symptoms was called “syndrome X” and later the “insulin resistance syndrome”.

Most recently the evils that are associated with body fat have been called the “metabolic syndrome”.The problem has assumed epidemic proportions: by 2001, 30% of US adults were considered obese with a body mass index of over 30, and 50% were overweight with a body mass index over 25. The form of type 2 diabetes (the adult onset of the disease) is predicted to double in the next 20 years. Physicians are reporting that they are seeing increasing numbers of children who are obese and suffer of type 2 diabetes. The major concern with an accumulation of body fat is the area of the abdomen (think of the “apple shape” with fat around the abdomen). This visceral fat tissue is not just innocently sitting there stopping you from closing buttons and zippers. It is very metabolically active and the substances it releases are a threat to your health. These fat cells secret pro-inflammatory substances called “cytokines.”

They also form substances that influence blood-clotting, factors that increase insulin resistance, substances like angiotensin, which are signing responsible for high blood pressure as well. Among the host of damaging substances is also the C-reactive protein, which is recognized as a risk factor for heart disease.

Doctor Recommended Diet Against Obesity

Doctor Recommended Diet Against Obesity

There is only one solution: to reduce the risk, excessive weight has to be shed. A sensible diet to achieve that goal has to contain less saturated fat, more fiber, and low glycemic index carbohydrates. Proper dietary habits are only one part. The other as important measure is life style intervention, which includes 2.5 to 3 hours of moderate exercise per week.
Many of the current diets promise weight loss without compromising health. All of them promote weight loss, provided they are strictly adhered to.
The high protein diets (Atkins, Protein Power Plan) are useful for rapid initial weight loss, however due to the overload of protein long term use is highly questionable. Kidney dysfunction as a consequence is a threat to health and no benefit at all!
Moderate carbohydrate diets, moderate fat, as well as moderate protein will remain the answer for long-term life style changes. It is also of significance that the glycemic index of carbohydrates plays a major role. Food intake, which favors carbohydrates with a low glycemic index, is associated with less heart disease. It has also been documented that insulin levels are more stable. Low glycemic carbohydrates include most vegetables, beans, lentils, as well as fruit like apples, pears and oranges. In contrast, high glycemic carbohydrates result in a fast insulin release, which ultimately leads to insulin resistance. Among these items are potatoes, crackers and other flour products, rice, puffed or flaked breakfast cereals, and tropical fruit (papayas, pineapple, melons).

For short-term dieters, it is an option to embark on any of the current diets without deleterious effects, no matter whether they are high-carb or low-carb. But at this point only the diets with moderate carbohydrates have shown to have some benefits on heart health.
Ultimately the wiser choice is to consume foods with a low to moderate glycemic index, by increasing the intake of vegetable proteins and oils and by choosing increased servings of vegetables and fruit instead of highly processed items. So, when you next walk through your supermarket, remember that most of the good stuff is in the periphery, namely the area where all the fresh, unprocessed or minimally processed foods are found.

More info about Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Metabolic Syndrome Rounds, Oct. 2004, Vol. 2, Issues 8, St. Michael’s Hospital, University of Toronto/On/Canada

Last edited October 27, 2014

Dec
01
2004

Nuts To Bust Gallstones Says Harvard

By | Gastrointestinal Disease, Nutrition, Prevention

Gallbladder problems rank fairly high among health problems in Canada: nearly 20% of women and 10% of men harbor gallstones.  According to the Canadian Liver Foundation certain racial groups have an even higher incidence: in the aboriginal population between 70 and 80% are affected. Statistics in the US would be similar.
Leaders in gallstone research at Harvard Medical School came up with new studies recently from the large scale Health Professional Follow-up and the Nurses Health study with respect to how eating habits influence the formation of gallstones.

Dr. Chung-Jyi Tsai and colleagues examined the relationship between nut consumption and the risk of gallstone disease. Men who consumed about 5 oz of nuts per week had a significant decrease in gallstone development than those who ate less than 1 oz per month. Women fared similarly. The 20-year study involving 80,718 female nurses found that women who consumed at least 5 oz of nuts per week had a 25% lower risk of developing gallstones requiring gall bladder surgery than those who rarely ate nuts or nut butter. It turned out that not all nuts have equal benefits. Peanuts decreased the risk only by 19%, peanut butter consumption decreased the risk by 15%, whereas other nuts lowered the risk for gallstones by 35%. Nuts offer this prevention due to a combination of fiber, unsaturated fatty acids, as well as magnesium and beneficial plant chemicals. Fats as “the good guys” in gallstone prevention may sound like a novel idea, but there are differences in fats: it is the monounsaturated fats and the polyunsaturated fats that are the winners. They are the ones that are found in nuts or vegetables, but not in meat.

Nuts To Bust Gallstones Says Harvard

Nuts To Bust Gallstones Says Harvard

The coauthor of the Harvard study, Dr. Edward Giovanucci, points out, that a diet that is high in saturated fat (the fat which prevails in meat products) and high in refined carbohydrates (bakery products, pasta, sugar) increases the risk of gallstones. It also depends on the dosage: those who consumed a diet high in insoluble fiber decreased the risk by 17%. So, what is the reason? Insoluble fiber acts like a broom that sweeps waste out of the intestinal tract faster than a diet that lacks fiber. It also reduces the bile acid secretion, increases insulin sensitivity and lowers triglycerides (harmful blood fat levels). The good news is, that you can get it all at a local supermarket. Nuts, tomatoes, squash, cucumbers, whole grains like cracked wheat (as opposed to flour), beans, apples, berries and pears are all good and inexpensive sources.

For more info on gallstones: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/gallbladder-disease/cholelithiasis/

Reference: National Review Of Medicine, November 30,2004, page 13

Last edited October 27, 2014

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Nov
01
2004

Flax Seed A Source Of Omega 3

By | Cancer, Diabetes, Heart Disease, High Blood Pressure, Men's Health, Nutrition, Vitamins and supplements, Women’s Diseases

Prevention has been gaining more momentum for public health as well as for the health conscious individual. Instead of looking at salvation from a slew of diseases like arteriosclerosis, high blood pressure, osteoporosis, Alzheimer’s, and the complications from diabetes in the form of super pills, prevention looks a lot more promising.
Flax seed has been around for several thousand years, but it has been making a name for itself as part of healthy eating.

Its most important components are its fiber content, the alpha-linoleic acid, and the lignans. Eating flax seed helps to mop up cholesterol in the bowel, and studies have shown a drop in the “bad” LDL cholesterol levels. Duke University is publishing results that show flax seed to be helpful in blocking prostate cancer. A publication going back to August 2001 in the Archives of Ophthalmology point out the fact, that the omega-3 fatty acids, which are contained in flax seed, reduce the risk of macular degeneration. The same omega-3 fatty acids also have a favorable influence in the glucose response after a meal, a fact that is important for the prevention of diabetes.

It has to be mentioned at this point, that flax seed oil does not have all the benefits, as the fiber has been removed, and some of the benefits get lost as a result of the temperature used with processing. Also, just eating a spoon full of flax seeds will not be the answer, as flax seed is not fully used during digestion (the seeds are simply excreted in a bowel movement). To unlock the benefits it is best, to grind the seed.

Flax Seed A Source Of Omega 3

Flax Seed A Source Of Omega 3

A coffee mill does the job well enough, and freshly ground seeds are better than the pre-ground variety that has been sitting around in the bin of a store for some time. Two teaspoons of ground flax seed mixed with some yogurt and fruit makes for a good starter in the morning or an easy evening snack. A slice of flax seed bread does not give you the benefits; remember that heat during cooking or baking destroys the key components.
The nice part about flax seed is the fact, that it is inexpensive, plentiful, has no adverse side effects*, and it is the ounce of prevention which is readily available to you.

More info on Omega-3: http://nethealthbook.com/news/inflammation-extinguished-omega-3/

Reference: The Medical Post, October 12, 2004, page 13

* Comments (added Aug.28, 2005): Despite the Duke University study cited above there are disturbing news from a 14 year follow-up prospective study that has been confirmed by other studies showing that there are side-effects. This study showed that in males there is a 2-fold risk of developing invasive prostate cancer when flax seed was the supplement used. As flax seed contains alpha-linolenic acid (=ALA) and fish oil contains eicosapentaenoic acid (=EPA), there are striking differences of action that have not yet been defined in more detail. The same study showed that over 14 years EPA (when mixed with DHA) lowered the risk of getting invasive prostate cancer by 26%. Until it is known more how flax seed works, it likely is wiser to to take a molecularly distilled EPA/DHA supplement daily as this also reduces the cardiovascular risk, but at the same time prevents cancer.

Last edited October 27, 2014

Nov
01
2004

The Mediterranean Diet Definitely Not A Fad

By | Health, Nutrition

Giacomo Castelvetro has first described healthy eating Mediterranean style in 1614. As an exiled Italian living in England, he tried to convince the English to eat a wider variety of fruit and vegetables and to prepare them in the same way he had eaten them in Italy. His attempt was a failure, however the same book has since been translated into English and published in 1989. In the meantime The Seven Countries Study by Ancel Keys in the 1950’s showed that the population of Crete in Greece had very low rates of heart disease, of certain cancers and a very long life expectancy, despite generous consumption of fat in the form of olive oil.

Despite a wide variation between all the 15 countries bordering the Mediterranean Sea, there are common characteristics: an abundance of vegetables and fruit are consumed, along with nuts and legumes. Cereal products are largely whole grain. Olive oil is the principal fat source, and fish, seafoods and poultry are eaten in moderation. Red meat is consumed rarely. Cheese and yogurt may be eaten, depending on the region.

The first clinical evidence supporting the health benefits of the Mediterranean diet came from the Lyon Heart Study. Patients who had suffered a heart attack were either assigned the diet designed by the American Heart Association or a Mediterranean style diet. After a follow-up of 27 months, the group eating the Mediterranean diet had a reduction of heart attacks by 73 % and a decreased mortality by 70% compared to the other group.

The Mediterranean Diet Definitely Not A Fad

The Mediterranean Diet Definitely Not A Fad

When the various foods of the Mediterranean diet are analyzed, the reasons for the health benefits become very clear. The fats, which are consumed, are heart-healthy monounsaturated fats like olive oil or fats that contain omega-3 fatty acids, which are found in fish (tuna, salmon, trout, sardines) or from plant sources (walnuts and other tree nuts and flax seed).

As there is an emphasis on natural foods, the diet is extremely low in trans fatty acids (hydrogenated fats), which are known to increase the risk for cardiovascular disease. As more than 300g of vegetables per capita are consumed daily, the contents of antioxidants and other beneficial plant chemicals is much higher when compared to Western diets. There are many individual components of the Mediterranean diet that contribute to the reduction of disease and in particular of heart disease. It also is apparent, that it is not one single food or nutrient, but all the interactive effects of all the nutrients that are responsible for the health benefits.

The practical application does not mean deprivation and starvation, but a move away from processed fats (margarine), baked goods (donuts, muffins, pastries), and high saturated fat snacks and trans fats (chips, crackers, cookies, pies). Food choices move towards those of fresh fruits and vegetables, nuts, fish, and olive oil. Portions or servings have to be adequate to maintain a healthy weight.

Mediterranean food is not the heaping plate of pasta with an afterthought of vegetables nor the super-size fast food pizza with pepperoni and cheese, but foods that incorporate the fresh food rather than the fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Low amounts of alcohol, especially red wine can make a meal enjoyable, which means one drink per day for women, and two drinks per day for men. And after dinner go for a walk! What Castelvetro tried to teach us in his writings back in 1614 is still true today.

More info on Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Patient Care Canada, September 2004, Vol.15, No.9

Last edited October 27, 2014

Nov
01
2004

Not All Vitamins Prevent Cancer

By | Cancer, Nutrition, Prevention, Vitamins and supplements

Even in the recent past, vitamins were looked at as an essential weapon to prevent illness, however, a large study by the Cochrane Hepato-Biliary Group at the Centre for Clinical Intervention Research at Copenhagen University has come up with disappointing evidence.

A large evidence-based analysis was performed involving a population of 170,525 persons who were enrolled in randomized trials. They received a regimen of antioxidant supplementation that included beta-carotene, vitamin A, vitamin C, and vitamin E daily or on alternate days for 1 to 12 years, along with selenium every year for 2 to 4 years.
All trials reported the separate or combined incidence of cancer of the esophagus, colon, pancreas, stomach or the liver.
Results showed that beta-carotene alone, the most widely tested antioxidant for cancer prevention, did not have substantial cancer-fighting properties in gastrointestinal cancers. The devastating blow is the fact that beta-carotene in combination with vitamin A and vitamin C significantly increased mortality! Recent studies examining vitamin C show, that it can be an antioxidant, but it also can be a pro-oxidant (the less desirable quality). Trials involving selenium very clearly showed that it might have beneficial effects on the incidence of gastrointestinal cancers.
Following these news it would be a grave mistake to assume, that fruit and vegetables with their built-in antioxidants, micronutrients, dietary fiber and beneficial plant-chemicals have fallen off grace.

Not All Vitamins Prevent Cancer

Not All Vitamins Prevent Cancer

The truth is, that fruit and vegetables typically contain safe levels of vitamins. Most studies have reported that adequate intake of fruit and vegetables are indeed associated with a low incidence of cancer.
The study, however, clearly points out the pitfalls of vitamin supplementation.
-“The more the better” does not apply when it comes to taking vitamins.
-Antioxidants according to this study are not as beneficial for cancer prevention as was thought of in the past.
– Only vitamin C and selenium held up to the scrutiny of the evidence-based researchers with regard to having preventative effects regarding the above named gastrointestinal cancers.

Reference: The Lancet, Vol. 364, Number 9441, pg.1219-28,  October 2, 2004

Last edited December 7, 2012

Oct
01
2004

Hamburger Disease – A Sizzling Problem

By | Infectious Disease, Nutrition, Prevention

One of the many strains of the bacterium E. coli (type 0157:H7) became famous after a 1982 outbreak of bloody diarrhea across the U.S. The infection could be traced back to contaminated hamburgers sold by a fast food chain. Canada also had some smaller food-related outbreaks, but a large disastrous outbreak occurred in Walkerton, Ontario. In this case the culprit was cow manure that was washed into surface water. The water was not optimally treated at the local water works and then consumed by the local community. It is important to know, that infection with E. coli bacteria can be spread in various ways as shown in this table.

Hamburger Disease – A Sizzling Problem

Hamburger Disease – A Sizzling Problem

The symptoms of infection usually present themselves after an incubation period of 3 to 8 days in the form of abdominal cramps, diarrhea that can also be bloody, and vomiting. Unfortunately, a more severe form can occur in 2 to 10% of patients due to the toxic substances of the bacterium. The dreaded form of “hamburger disease”, is medically known as hemolytic uremic syndrome, and children are at the highest risk, along with older adults or those with immune suppression (AIDS patients, cancer patients). The disease is life threatening, requires blood transfusions, dialysis and life-support therapy in an intensive-care unit setting.

Hamburger disease is caused by:
Contact with livestock (or feces)
Human-to-human contact
Consumption of non-chlorinated contaminated water
Consumption of insufficiently cooked ground beef, salami, unpasteurized milk, even vegetables like
lettuce or alfalfa sprouts that have not been washed.

Prevention is of utmost importance, and fortunately a lot of it is common sense about food safety and safe food-handling practices:

Hints to prevent Hamburger disease:
Wash your hands after handling animal and livestock after using the washroom and after changing diapers.
Wash your hands before and after preparing or eating food and handling raw meat.
Never put raw meat in contact with cooked meat and disinfect areas of meat preparation like
counters or cutting boards.
Make sure all the pink color is gone from cooked meats, and juices after cooking should never
be bloody!
Drink only pasteurized milk, fruit juices or ciders.
Never drink water from untreated sources (creeks, ponds).
Practice strict hand hygiene when dealing with persons who have diarrhea, especially when changing diapers of children with diarrhea.

Besides prevention, vigilance is important: if any case of E. coli infection has been found, the local health units have to be notified, so the source of infection can be found and further spread can be prevented.

More info on food safety: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/food-safety/

Reference: The Canadian Journal of Continuing Medical Education, September 2004, Vol.16, Nr.9, pg.49.

Last edited January 4, 2015

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Sep
01
2004

Calcium Prevents Kidney Stones

By | Health, Nutrition

Forget what your grandmother may have taught you about kidney stones. In the past there may have been a bias towards thinking that calcium may be one of the causes of kidney stones. But Dr. Curhan and collegues from the Channing Laboratory, Department of Medicine, Brigham and Womens’ Hospital, Boston, MA put this question to the test. Other food factors were also examined in this Nurses Health Study II, which was published recently in the Archives of Internal Medicine (in April of 2004) and reviewed by The Medical Post (Aug. 24, 2004 edition).

I have summarized the results in the bar graph below. What is shown is the cumulative risk for developing kidney stones in a population of 96,245 nurses aged 27 to 44 over eight years without a history of kidney stones in this prospective study. At the same time detailed records were kept regarding food and health habits. The risks between the highest and the lowest quintile regarding various food groups were computed, which is an accepted way to tease out the effects of the food group studied.

Calcium Prevents Kidney Stones

Calcium Prevents Kidney Stones

Dr. Curhan and his collegues found that calcium protects from getting kidney stones as does meat. Sugar is a risk for stone development. Fluid intake has a protective effect as uric acid and other stone forming substances are kept in solution preventing kidney stone formation. Phytates that are found in soybeans, beans and peas have a protective effect. The control value of the study was the average risk for the population, which was set at 1.0 meaning that there is no added risk to develop kidney stones.

Relative risk of developing kidney stones from exposure to different foods in younger nurses

Calcium Prevents Kidney Stones1

Study shows Calcium To Prevent Kidney Stones

Conclusion: Contrary to popular belief calcium and meat as well as phytones have a protective effect against the development of kidney stones. Fluid intake is protective as well. On the other hand sugar is a risk factor for kidney stones, a fact that seems to not be generally known.

More info on kidney stones: http://nethealthbook.com/abdominal-pain/left-upper-abdomen/kidney-stone-renal-calculus/

Ref.: 1. Dr. G.C.Curhan et al., Arch Intern Med 2004 Apr 26; 164 (8), pp. 885-91  2. The Medical Post, Aug. 24, 2004, p.17

Last edited October 26, 2014

Aug
01
2004

Too Much Fat Fuels Metabolic Syndrome

By | Heart Disease, High Blood Pressure, Hormones, Nutrition, Obesity

In a review article for physicians from the St. Michael’s Hospital of the University of Toronto (see reference below) Dr. Monge outlined some of the newer human research where links were found between the lining of the blood vessels and the hormones produced by fat cells that lead to the complications of the metabolic syndrome. In obese people there is a cluster of conditions such as high blood pressure, high blood sugar, high cholesterol, lipid abnormalities and high insulin levels, which is known as “metabolic syndrome”. Another name that was used for this condition in the 1990’s was “syndrome of insulin resistance”.

Dr. Monge pointed out that blood vessel health depends on the fine balance between two opposing forces. On the one hand there is a system that leads to blood vessel spasm, blood clotting, growth promoting, inflammation causing and oxidizing. On the other hand there is a system that is responsible for blood vessel relaxation, growth inhibition, blood clot dissolving, inhibiting inflammation and antioxidant activity. Complex changes occur in our metabolism when we put on pounds and accumulate too much fat. It is important to realize that fat is not just sitting there, but is composed of highly active fat cells that respond to insulin and growth factors and in turn produce a number of hormones and factors that affect the cells that are lining the blood vessels. Inflammatory cytokines are produced by fat cells that attack the blood vessels by producing atheromatous plaques, causing them to accumulate fat again and help in the processes that lead to rupture of the plaques.

Too Much Fat Fuels Metabolic Syndrome

Too Much Fat Fuels Metabolic Syndrome

The end result is that the deadly interplay between the fat cells and the endothelial cells lining the blood vessels tips the balance between the two systems mentioned above to the point where heart attacks and strokes suddenly occur.

There are two complex pathways that are involved in this process and that are linked to what was stated above. One crucial aspect of this involves nitric oxide, a small molecule that is normally produced by the endothelial lining cells and that is needed for normal circulation of the heart muscle, skeletal muscles and internal organs. This protective system is where much of the derangement of normal metabolism occurs with regard to the metabolic syndrome.

Dr. Monge pointed out that with these newer insights into the complex metabolic changes associated with the metabolic syndrome in obese people, there will be very practical results in the near future. Anti-inflammatory medications are already being utilized and some of the anti-diabetic medications have been shown to reduce the risk of heart attacks. It is hoped that sensitive tests will be developed to measure the hidden endothelial dysfunction at a time when preventative steps are still effective or early intervention can be done.

More info on the metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: Metabolic Syndrome Rounds (April 2004): J.C. Monge “Endothelial Dysfunction and the metabolic syndrome”

Last edited Oct. 26, 2014

Aug
01
2004

Citrus Fruit Peel Lowering Cholesterol

By | Anti-aging medicine, Heart Disease, Nutrition

New research from London/Ontario in cooperation with the U.S. Department of Agriculature has shown that in hamsters cholesterol can be reduced by about 35% through a diet that contains compounds derived from orange peel.

A development company (KGH Syndergize, London/Ont.) under the lead researcher, Dr. Elzbieta Kurowska (PhD), has identified the active compounds in the peels of oranges or tangerines that are having cholesterol lowering properties. They are a group of substances known under the name of “polymethoxylated flavones” (PMFs) and have the advantage that they have no side-effects. They are naturally occuring and have been part of the food chain that our bodies are used to.

The research results were recently published in the Journal of Agricultural and Food Chemistry, which is a peer-reviewed journal of the American Chemical Society.

The animal and cell line experiments showed that the liver cell metabolism of cholesterol is changed so that bad cholesterol (LDL cholesterol) is lowered, but the good cholesterol (HDL cholesterol) is unaffected. When hamsters were fed a diet with 1% PMFs their LDL blood levels were lowered by 32% to 40%.

Citrus Fruit Peel Lowering Cholesterol

Citrus Fruit Peel Lowering Cholesterol

The experiments were so successful that there is now a human trial on the way where the longterm effects of PMFs on LDL levels is being followed. Dr. Kurowska cautioned that drinking orange or tangerine juice would be having many beneficial health effects. But in order to get the cholesterol lowering effect that you can achieve with the citrus peel PMF supplement you would have to consume about 20 cups of orange or tangerine juice every day.

Reference: The Medical Post, Vpl. 40 (June 22, 2004): page 18

Last edited December 8, 2012