Today is the last Friday of the month, which means it's also "Green Streets Day." The kids and I have participated in this initiative for the past several months. We've enjoyed finding our way to work and school/camp using 'people power.'

Green Streets Day (http://portlandgreenstreets.org/) is my favorite type of public/environmental health initiative: it is fun, it is fairly easy, and it costs nothing (or very little). It gets people out and about, exercising their bodies and minimizing their impact on the world. Portland Green Streets does an admirable job getting the word out...

"On Green Streets Day, we encourage people throughout Greater Portland to:

* Wear Something Green (shirt, pants, socks, whatever!)
* Get Around Green (walk, bike, bus, carpool, telecommute, etc.!)
* And then to Celebrate (by signing in for freebies, discounts, & raffle items from local businesses)!

We hold a region-wide party on that day, with each individual and institution - celebrating and encouraging in its own way.

So throw on something green for the last Friday of the month - and share a car ride, hop the bus, drive your bike, or put one foot in front of the other. And watch out - because you will not only do good, but feel good, too!"

I like this approach. The Portland Green Streets group wants us to enjoy our monthly person-powered commute. They aren't trying to make us feel guilty about the days on which we must use fossil fuels to get around. They simply want to help us experience an alternative.

My family and I experience this alternative regularly--especially the kids. We live close to our schools, the library, the town-sponsored summer camps and many of the playing fields. So my older kids (in seventh and tenth grade) walk and bike more often than not. Whenever possible, I accompany my second grader to school or camp along our neighborhood's wooded paths (we think she's still too small to go by herself). We chat, and occasionally take advantage of the free flowers that our friend sets out on her stone wall. Once we've gotten my daughter to her destination, I return home for my bike, and ride the two miles to my office.

There is nothing better than a bike ride on a beautiful day.

Unless it is a walk with one's second-grader on a beautiful day.

I know I'm lucky to be able to commute this way. Many people have odd schedules, or live too far away from their jobs or schools for this to be a viable option. My husband's job is forty minutes away in Lewiston, and though he has considered biking there, this simply hasn't been practical yet.

So the kids and I will carry the Green Streets torch for now, and we're happy to do it. Thanks to the Portland Green Streets group for making this monthly event something to look forward to. Our bodies and our world appreciate your efforts.

On July 8, the Portland Press Herald ran a story about a tragic 4th of July weekend motorcycle accident. A group of six motorcycle riders swerved to avoid a turning car, which they came upon suddenly after rounding a curve. Forty-three-year old Rochelle Plummer was thrown from her bike and killed. She was not wearing a helmet. Nor were four of the other five riders.

As a doctor, you might expect that I would have something to say about the lack of helmet wearing.

I do: it is stupid. People who ride motorcycles should wear helmets. I've seen too many people with head injuries not to believe this is important.

That being said, it legal in this state to ride without a helmet. Which is also stupid. But whether or not helmet wearing should be a law, right now it simply isn't. So people can chose to wear helmets or not. And many in Rochelle's group worked in public safety. They knew the risks.

So I was dismayed to read in the Press Herald sidebar:

INVOLVED IN ACCIDENT

ROCHELLE PLUMMER, 43, of Gray. Died in crash. No helmet.

Is it not enough that she died? Do we have to publicly pour salt in her family's wound?

It seemed a classic case of blaming the victim. Yet, when newspapers run stories about people who died for other reasons, they do not always feel the need to try and assign blame. Maybe we should. How about:

JOE SMITH, 56, of East Gish. Died of heart attack. Ate fatty foods. Never exercised.

Or perhaps we should start doing this for victims of crimes:

MELANIE PARKER, 23, of Way Up Yonder. Raped. Wore revealing clothing.

These could be taken to ridiculous extremes.

Obviously, there is a place for trying to understand why people die, or have their lives seriously impacted in some way. When we do this, we can potentially prevent harm from coming to others in the future. So the Press Herald is not remiss in commenting on a lack of helmet wearing. Perhaps their attention to the problem will someday lead to a change in Maine laws.

In the meantime, I wish they had not listed "No helmet" in their sidebar. We should let her family mourn her death without feeling the weight of public judgment.

She died doing something perfectly legal.

People are becoming increasingly aware of the benefits of local foods. When available, they tend to be healthier, better for the environment (using less petroleum to reach us), and sometimes even cheaper. According to Packaged Facts (www.packagedfacts.com), sales of locally grown foods in the United States are expected to rise from about $4 billion in 2002 to $7 billion by 2011.

This time of year, many of us buy local foods through farmers' markets and farmshares. These are an invaluable resource, and one we would not want to do without. Of course, it isn't always possible to predict what might be available through these venues. And then there is the convenience factor: we have grown spoiled by the ability to buy a head of lettuce at 10 pm on a Tuesday night at the nearby supermarket. Needless to say, our 10 pm supermarket lettuce is far less likely to be grown in state. Until recently, local farmers simply have not had the capacity to provide supermarkets with the volume they need to keep us supplied with produce.

Bowdoinham's newly established "Locally Known" (www.locallyknownfoods.com) group is hoping to keep us supplied with fresh, local 10 pm supermarket lettuce. Locally Known greens come from fields cultivated by Atlantic Organics, a farm located near Merrymeeting Bay. According to an article in Monday's Boston Globe:

At full capacity, Locally Known expects to harvest about 60,000 pounds of greens each week, including spinach, arugula, and baby kale. The produce will supply retailers such as Whole Foods, Trader Joes, and Hannafords.

It is exciting to have an increasing number of options for purchasing local produce.

It is also particularly timely, given the recent flooding in the Midwest. It is estimated that upwards of 10% of the farmland supplied by the Mississippi River is currently underwater. This has already forced corn prices up (now at an all-time high of $8 a bushel), and will likely have the same effect on soybeans and wheat. According to the World Bank, food prices have already risen 83% worldwide in the last three years. This is thought to be related to supply-decreasing weather problems in the world's major food-producing regions, coupled with increasing global demand. This has lead to scarcity and rioting in many areas of the world.

While we have yet to experience food-related rioting here in the United States, we have felt the impact of rising food prices. And there is a chance that scarcity may at some point become an issue in the future. Obviously, it is not always feasible to rely on someone in other parts of the country (or the world) to raise our food. It makes sense to support efforts such as Locally Known, and get to know other local growers through farmshares and farmers' markets.

When possible, it also makes sense to learn how to grow our own food--and teach our children how to grow food as well--whether at home or through community and schoolyard gardens.

The more self-reliant we are, the better off we will be.

My daughter and I picked up our first share of the season at New Elm Farm in Freeport yesterday. We arrived early and thus had a few minutes to chat with Cordelia (the owner). Cordelia told us that she has twice as many farmsharers as last year, and ended up having to turn people away. Despite this, she won't likely make money this year. She calls it her "labor of love." I told her that I've had to view my medical practice the same way:).

We noticed that their strawberries are starting to ripen, and Cordelia said she hoped to be able to have some for each of the farm sharers next week. We always associate strawberries in Maine with the fourth of July, so this was exciting news.

This week our farmshare included:

* 8 radishes
* 3 shallots
* 3 heads of bok choy
* 2 heads of lettuce
* 1 bunch of kale
* 1 bag of mesclun mix

Cordelia also let Sophie cut some flowers (cosmos, daisies and irises) and select a morning glory to plant at home.

Last night we made the following with our farm share bok choy, inspired by a recipe from How to Cook Everything Vegetarian (Mark Bittman; Wiley Publishing, 2007):

Bok Choy & Broccolini with Sun Dried Tomatoes

1 head of bok choy, thoroughly washed
1 head of broccolini, thoroughly washed
3 tablespoons of extra virgin olive oil
1 tablespoon minced garlic
1 cup low sodium organic vegetable broth
2 tablespoons of capers, drained and rinsed
1/4 cup pitted olives, drained, rinsed and chopped
1/4 cup sun dried tomatoes in oil, drained, rinsed and chopped
1/2-1 tablespoon of balsamic vinegar

freshly ground sea salt
freshly ground pepper

Separate bok choy stems from leaves. Separate broccolini stems from florets. Cut stems into 1/2 inch pieces. Heat oil over medium-high heat in stainless steel pan. Add garlic and saute for 1 minute. Add broccolini stems. Saute for 3 minutes, then add bok choy stems. Saute for 3 minutes, then add broccolini florets. Once the stems and florets are slightly tender, add bok choy leaves and broth. When greens are tender, add capers, olives and tomatoes. Cook until most of broth is evaporated. Add balsamic vinegar, salt and pepper to taste. Serve warm.

We had this dish with a French lentil and fresh herb soup, followed by (store-bought) organic strawberries that had been lightly marinated with balsamic vinegar and just a dash of fresh pepper. Delicious!

My neighbor Mary is the author of the "The Frugal Family's Kitchen Book." She is also a regular blogger. So I was not surprised to see her featured in this week's Portland Press Herald, discussing ways to keep costs down in the kitchen.

Mary is quoted as saying,

"What is really funny now is listening to people with all these exciting new tips that are as old as my mother's."

It is funny--and a bit sad. We are a nation of extremes. When we are flush with cash (and oil, and food), we forget to be mindful. Then things shift, and we feel scared...and we decide to be frugal again.

The thing is, most of us still have plenty. We do not need to revert back to eating "Spam," as seems to be a recent trend. We can find delicious, nutritious foods that are not costly. Bulk grains...legumes...seasonal produce: it is possible to eat well when costs are up. We do not need to feel scared. We just need to pay attention to what we are putting into our mouths--and the mouths of our families.

Something we should probably be doing anyway.

Yesterday's Press Herald contained an editorial suggesting that Maine was jumping the gun in requiring stricter standards for lead in toys. Apparently, a law taking effect later this year will require that toys sold in Maine contain less than 90 parts per million of the substance. The Press Herald is concerned that this legislation is premature, and that Maine would do better to wait for the federal government to set its own strict standards and means of regulation.

I have mixed feelings about this stance. I do agree that we would do better to have uniform legislation, rather than asking manufacturers to comply with numerous different state laws.

On the other hand, lead is dangerous. And it is especially dangerous to a very vulnerable (and voiceless) group: our children.

Here is the skinny on lead, taken from an article I wrote for the Parent and Family Newspaper in 2000:

"Lead poisoning can cause 'damage to the brain and nervous system, behavior and learning problems (such as hyperactivity), slowed growth, hearing problems and headaches' (from www.hud.gov). Pregnant women with high lead levels in their blood may not only pass these problems along to their babies, but they may become sick during pregnancy. Non-pregnant adults are not immune either. They may suffer from memory loss, an inability to concentrate, nervous disorders, high blood pressure, muscle and joint pain, stomach or bowel problems and difficulty getting pregnant. Some of these issues may resolve when a person’s lead level comes down, while others, like mental retardation, are more permanent in nature."

Scary stuff, eh?

Given that we've likely been exposing our kids to leaded toys for years--and that we've previously acknowledged the danger of lead by outlawing its use in paint and gasoline--I don't think it makes sense to wait any longer. And perhaps by taking a stand now, we will be encouraging the government (and manufacturers) to take action more quickly. The California emissions standards certainly have a had an impact on the way automakers approach clean air.

Maine is doing its part for clean air, too. In another May 28 article, the Press Herald reported that our state is joining ten other states (including New Hampshire, Massachusetts, Connecticut and Rhode Island) in a lawsuit against the Environmental Protection Agency. The lawsuit wants the EPA to be tougher on smog. In March, it lowered the maximum concentration of ozone from 84 parts per billion (ppb) to 75 ppb. According to an EPA advisory board, this is not adequate--they recommended a limit of 60 to 70 ppb, a limit necessary to protect (again) our most vulnerable (and still largely voiceless) citizens: children, elderly, and those with respiratory problems.

Ozone is particularly troublesome for Maine and other New England states, because we end up being exposed to smog from our more industrial and urban southern neighbors. Levels skyrocket in the summer, causing our public health officials to release repeated advisories against exercising outdoors. That can't be good for a state (or a country) struggling with obesity.

So I applaud Maine for addressing the lead and ozone issues. Sure, we could have waited. But as is always the case when dealing with unpleasantness, someone has to take a stand. When it comes to our health--and the health of our children--that someone might as well be us.

Anecdotally we've observed that after being together for a while, many people end up looking like their dogs.

Or their spouses.

If people end up physically resembling other creatures simply by spending time with them, it seems reasonable that over time they might begin acting like them, too. Which is what medical researchers are now verifying. Apparently infections are no longer limited to viruses. We now have social infections: namely, obesity and tobacco abuse. In a July 2007 New England Journal of Medicine article, we learned that obese people who spend time with other obese people are likely to continue being obese. An article published in yesterday's New England Journal of Medicine found that the same was true of people who smoke.

According to Drs Christakis and Fowler, of the 12,067 people studied as part of the Framingham Heart Study:

* Smoking cessation by a spouse decreased a person's chances of smoking by 67%.
* Smoking cessation by a sibling decreased the chances by 25%.
* Smoking cessation by a friend decreased the chances by 36%.
* Among persons working in small firms, smoking cessation by a coworker decreased the chances by 34%.

This is good news and bad news. Bad news because it means we must now take into consideration an obese or tobacco-addicted individual's entire social network when offering treatment.

Good news because it means we must now take into consideration an obese or tobacco-addicted individual's entire social network when offering treatment (which, fortunately, organizations such as Maine's Center for Tobacco Independence are already doing).

Good or bad, the concept of social connections impacting one's health is not really even 'news.' In family medicine (as in other primary care and related specialties), we have always been trained to take the needs of the family into consideration, even as we seek to treat the individual. In preventive medicine and public health, we look for ways to improve the health of the community, as a way to indirectly impact the health of individuals. These are two slightly different ways of acknowledging the same idea: that we humans are actually connected to one another. And we are connected to our environments. For better or for worse. As John Muir once said, "When we try to pick out anything by itself, we find it hitched to everything else in the Universe."

Instead of picking out--and picking on--obese and tobacco-addicted individuals, let's find out who they are hitched to. Let's continue to talk about tobacco-free Maine communities, and try to 'love the smoker,' though we may 'hate the smoke.' Let's work with people within the context of their lives, as we seek to solve these social infections.

Then maybe we can figure out how to keep people from looking like their spouses.

And their dogs.

I'm so relieved.

We no longer have to drink eight glasses of water a day. An recent editorial in the online version of the Journal of the American Society of Nephrology has laid that urban myth to rest. Its authors (Drs Negoianu & Goldfarb) found that there is no clear evidence behind this long held recommendation.

Now I can keep doing what I've been doing: drinking when I'm thirsty. And telling my patients to do the same. Only now I don't have to feel guilty about it.

I stopped drinking (and recommending) 64 daily ounces of water several years ago. I had heard this health tidbit early on in my medical career, though I had never seen a good study to back it up. Yet my colleagues in the nutrition field were always touting water's benefits, and it seemed reasonable enough. So ever the dutiful doctor, I passed along the advice. And I took it myself. During residency, I would carry a water bottle in the pocket of my white coat, and sip from it while going over charts or sitting in lectures. As a runner (and a breast-feeding mother, at the time), this was probably a good idea.

But after a while it became clear that large amounts of water are not a good idea in every situation. My water-obsessed patients often showed up bloated and edematous. The ones with heart disease occasionally noted that their blood pressures went up along with their water intake. Once I was no longer a busy resident (and my babies were weaned) I actually started to get headaches when I drank too much water--not to mention that I was constantly in the bathroom. So I began to question the previously sacrosanct notion that excessive hydration is healthy.

Of course, other healing traditions have questioned this notion for decades--if not centuries. In the worlds of macrobiotic nutrition and Traditional Chinese Medicine, too much water is thought to unbalance the body. We've known about the dangers of over-hydration in the Western medical world as well. Of recent interest was a 2005 study printed in the New England Journal of Medicine. This study found that found Boston Marathon runners who drank too much water were at risk for potentially harmful hyponatremia (low sodium levels): "The strongest single predictor of hyponatremia was considerable weight gain during the race, which correlated with excessive fluid intake." Hyponatremia can cause a myriad of significant problems, including brain swelling and death.

There is no need for hyponatremia, or dehydration, for that matter. Our bodies known what we need, as long as we are willing to listen. When we are thirsty, we can drink. When we are not, we can stop.

And we will stop needing to run to the bathroom every ten minutes to rid ourselves of excess fluid.

Which is, itself, quite a relief.