21. Supplements

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21. Supplements Herbal Remedies

supplementary
ie. not in text
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Working Definition

• A dietary supplement is a product taken by mouth
  that contains a dietary ingredient intended to
  supplement the diet.
• Includes vitamins, minerals, herbs or other
  botanicals, amino acids, enzymes, tissues from
  animal organs or glands, or a concentrate,
  metabolite or extract

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Vitamin and mineral supplements

• Necessity or a waste of money??
• What do you think
• (i) absolutely necessary (ii) in some dcases
  useful (iii) waste of my

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Herbal Remedies/Medicines - Food or Drugs?
"Been around for centuries with no reported
problems. Should be treated like foods, ie. don't
need labels, tests or restrictions on claims.
Give me easy access and keep the price down."
say proponents(and the producers).

"They contain many potent
ingredients. Need lots of tests, warning labels,
no unproven claims" say some pharmacists and
medical professionals (and the drug companies).
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The Rest of the World Knows
Chinese herbal medicine has been practiced
pre 0 AD. In countries of the EU some herbal
remedies are covered/ prescribed by government
health plans.
Since '78, Germany's Commission E (scientists
health pros) have researched 'herbals'
(usefulness safety) 200 of 300 have
been OK'd. Companies have 2-4 yrs to
'prove their claims'.
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and North America catches up
USA, 1994 - vitamins/minerals/supplements become
in between foods drugs many
'hormones' are OTC benefit claims are
eased little 'quality control'
prices drop users are happy but . Canada,
1997- started 'thinking about it' has Office
of Natural Health Products and advisory
panel to gov't Health Committee
'promising' new and comprehensive
regulations since 2002 www.hc-sc.gc gt A-Z index
gt Natural Health Products
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Where do supplements fit in?

• Categorized within foods not drugs, thus less
  rigorous regulation
• Manufacturers must demonstrate safety
• No rules re amounts or daily values
• Must list all ingredients
• Some substantiation of benefits needed

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The Practitioners - Understand
Herbalist - completely unregulated can get
referrals to persons with some
courses/experience Nutritionist - regulated in
QC, BC, NS many are registered
dietitians(RD/RDN, with Dietitians of
Canada) bachelors degree in nutrition intern
Naturopathic Doctor(ND) - use a variety of
'alternative therapies' regulated in BC,
MB, ON, SK(ABNB) should have 4yr
program after bachelors check
credentials Pharmacist - 4/5yrs B.Pharm.
experience(front line) but only relevant
courses since '95
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Conventional Alternative Complementary
Complementary Physician often Family
Medicine(MD) (bachelor 4yrs 1yr resid.
2yrs specialization) - many
'not on lists.!
Don't self-diagnose! Many 'alternative
practitioners' also do not have much diagnostic
training/experience. Also a certain number of
conventional doctors are not interested in/
knowledgeable about alternates, but
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Qualified Advice - Seek It
For all types of info see
www.canadian-health-network.ca
Canadian College of Naturopathic Medicine,
1255 Sheppard Av.,(East)
www.ccnm.edu North York, ON, M2K
1E2 1-866-241-2266
Dietitians of Canada,
480
University Av, Suite 604,
www.dietitians.ca Toronto, ON, M5G 1V2
[phone]
Canadian Natural Health Assoc.,
439 Wellington
St., Suite 5, www.natural-health.org
Toronto, ON, M5V 1E7 (416)
977-2642
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More
Canadian Naturopathic Assoc.,
(see Can. Coll.
of Natur. Med.), 1-800-551-4381

www.naturopathicassoc.ca
Canadian Assoc. of Herbal Practitioners,
1228 Kensington Rd., Apt.
400,
Calgary, AB, T2N 4P9 (403)
270-0936
National Institute of Nutrition,
408 Queen
St.(3rd floor), www.nin.ca
Ottawa, ON, K1R 5A7
[phone]
Canadian Complementary Medicine Assoc.,
8621 104th St., Edmonton,

AB, T6E 4G6
[phone]
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The DIN Drug Identification Number
In Canada all OTC and prescription drugs,
including vitamins minerals, must show on
the label a) expiry date, b) amt of
active ingredient, c) DIN which indicates
approval by Health Canada based upon
extensive tests of effectiveness and
safety. Traditional herbal medicines(THMs) also
can have a DIN based on historical support
by 2 recognized herbal compendia and no
requirement for proof of safety or efficacy.
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An Informative Label - or Ignore
Directions
Expiry date
Unit weight
Other Ingredients
Active Ingredients
DIN
Plus a 'function' claim address /
telephone
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Active ingredient GLA

• Gamma Linolenic acid (an essential fatty acid)
• Present in corn oil, olive oil
• A polyunsaturated C18 Fatty acid

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Structure of GLA

• An omega-3 and an omega-6 PUFA (p. 369 text)

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Would you buy evening primrose oil?

• Yes, no , maybe?

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What the Mayo Clinic says

• high quality evidence for its use in most
  conditions is still lacking

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Marketing Hype - Beware!
Clinically Proven Quality
Extract Guaranteed Potency Essential
Naturally Occurring Pure
Highly
Concentrated Maximum Absorption Special Extract
Scientifically Standardized
Nutritionally Comprehensive
Independent testing often indicates up to 30 of
products contain little(or no) 'active'
ingredients, especially in USA.
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Reliable Info - It's a Jungle out There!
The Healing Power of Vitamins, Minerals and
Herbs' by Reader's Digest('99) consult. ed. Joe
Schwarcz (ISBN
0-88850-678-3)
Some interesting
health-related websites with lots of
archived info and useful web links 1)
www.wellnessletter.com(articles on gt70 'herbs')
2) www.tvo.org/yourhealth
3) www.cbc.ca
gttelevisiongtnewsworldgthealthmatters Also

4) www.canoe.ca/HealthHerb
al
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Supplements - a Growing Market
In Canada(2007) - 4 billion and growing at
20/yr 40 vitamins, 20 minerals, 20 herbs,
20 others Out-of-control in some areas, eg.
see KidzHerbs (for ages 4
and up)
Time Out/ Sweet
Lullaby -"to sleep/relax naturally",
contains St. John's wort
Straight
A's - "helps children think straight"
contains
ginkgo/ginseng
Allergy Schmallergy - "to help
with allergies" contains
echinacea


also available in lollipops for your
lunch!
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OTHERS - not Vitamins,
Minerals, Herbs
Acidophilus, bee products(pollen, royal jelly),
carotenoids, coenzyme Q, creatine, DHEA other
steroids, evening primrose other lipoic acids,
fish oils, flaxseed, glucosamine, HGH(human
growth hormone), 5-HTP(hydroxy tryptophan)
other amino acids, kelp, soy isoflavonoids, shark
cartilage
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DHEA - the 'Precursor' Hormone
Dihydroepiandrosterone - conc'n drops to 10 by
age 70
Ads build muscle, ? immune system, ? cell
damage, relieve stress, reduce fat.

Known rats don't have much and human trials
very inconclusive. Prescription only in
Canada but OTC in USA. No quality control.
Side effects, especially in women when
used in excess.
Avoid
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Melatonin - the 'Fountain of Youth'?
From pineal gland regulates body 'biorhythms'
concn. with age.
Ads anti-aging, sleep control, boosts immune
system, reduces oxidative cell damage.
Known seems to be
effective for 'jet-lag', may assist drugs
against cancer, vascular damage,
Parkinsons. No apparent side effects. OTC in
USA, prescription in Canada.


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Ponce de Leon ?
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Glucosamine - it's 'Natural'!
Produced in joints as 'precursor' for cartilage
repair
Ads move again without pain Known prescribed in
Europe for arthritis relief slows
cartilage deterioration relieves joint pain no
known serious side effects.

It may work for you, try it but inform
your doctor some people need gt1g (!) for
'relief'
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Herbal Remedies - Remember
These materials contain physiologically active
compounds not all of which are known. They are
not patentable so there is no incentive by the
suppliers to do research. Because of their great
popularity there will be good 'studies' over time
mainly from medical schools.


Meanwhile gtgtgt
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Herbal Remedies - some Observations
can't cure only alleviate
chronic conditions
NB. frequent use of 'minor effect'
and 'may help'
be aware of 'side effects
avoid
if there are 'special conditions', eg. pregnancy
avoid excess dosages and long duration
the species and
parts of plant are important
there are many serious interactions with

conventional medicines

keep up-to-date
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'Herbals' - Something for Everyone
A cornucopia! 121 listings in Tyler's
Honest Herbal A Sensible Guide to the Use
of Herbs and Related Remedies
(4th ed),
Steven Foster Varro
Tyler Tyler's Herbs of Choice The
Therapeutic Use of
Phytomedicines,


J. Roberts V. Tyler
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the Top Ten(2000) - in the USA
Aloe Vera(external) - exudate/ gel from
leaves, great for minor skin problems
Aloe latex (internal) - juice of
crushed leaves, possible 'digestive
aid (cramps for many!)
Cranberry - minor urinary tract infections,
especially women recommended 16 oz/day
of undiluted juice(3000 berries!)

Echinacea - immune booster ? don't take
constantly tincture loses potency more
quickly
but is more effective
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Echinacea - only 3(of
9) species
..angustifolia ..pallida
. purpurea
Purple Coneflower
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the Top Ten (continued)
Garlic - blood thinner may ?cholesterol
'fights' minor infections it's the sulfur
compounds that do it so raw is best !
Worshipped by the Egyptians and used
by pyramid builders for strength/endurance.
Ephedra(Ma Huang) - contains ephedrine(adrenaline
like) ?? for bronchial problems (used in
China since 3000BC) potent stimulant,
??blood pressure(weight loss?) abused in
US(28 deaths in '98), illegally peddled in
fitness centres. Avoid it!

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Garlic in 4 thieves vinegar

• 1720 Marseilles. Plague killed 60 of
  population
• 4 thieves robbed the dying, but did not get ill
  (boosted immune system?)
• Rubbed their bodies with mixture of cider vinegar
  and garlic
• le vinaigre des quatre voleurs

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4 thieves vinegar

• Available in California

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the Top Ten - more
Ginkgo - aids memory loss in elderly(increase
blood flow to the CNS) maybe helps
general circulatory disorders BUT doesn't
make you smarter Ginseng(panax) - immuno
stimulant affects pituitary/ adrenal
glands ? anti-stress(?) OTC 'tonics'
contain more alcohol than ginseng
Goldenseal - immuno stimulant
antibiotic qualities (sinus infections,
nausea, warts, cold sores/ shingles)
'single' applications not prolonged use
Saw palmetto - fatty
acids/phytosterols relieves prostate
enlargement and urinary problems. Truth
does not solve prostate problems!
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Supplements DrugComplications
Anticoagulants avoid before surgery
gingko biloba !!!
Antidepressants - ephedra, ginseng, kava,
melatonin, St. John's wort
Antihypertensives -
ephedra, garlic, ginseng, goldenseal,
hawthorn, licorice
Diuretics - aloe vera, dandelion,
ephedra, ginseng, glucosamine,
hawthorn, licorice
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The Latest trendssome dangerous))
Kava kava - ceremonial/social drink in S.
Pacific trendy anti-stress remedy
(sedative, muscle relaxant,
intoxicant) skin problems

St. John's wort - for mild (NOT major)
depression some side effects (sun
sensitivity) many active compounds
with care!

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More 'New' Finds
Grape seed extract -
popular in Europe potent anti-
oxidant(proanthocyanidins/pycnogenols or PCOs)
potential against cardiovascular
degeneration also rheumatoid arthritis,
allergies no side effects reduces
computer eye-strain!
Soy isoflavones - phytoestrogens, ie.
anti cancer properties, LDL reducers get
100mg/day flavones in 3 'servings' of soy
products. Tofu everyone!
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Recent rulings/results
Kava/kava banned in Germany, Canada,
Singapore. Implicated in liver damage.
Ephedra Banned in USA 2004 Increasing
implications for heart attacks/strokes. HC
issued voluntary recall 2002 .
St. Johns wort NIH(US) study(double blind)
found no more effective than placebo for
major depression. Ginkgo study in JAMA(US)
found no measurable memory improvement.


Stay tuned !
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2008 Warning

• More than 60 incidents including strokes, heart
  attacks, irregular heart beat, seizures in Canada
  last year from ephedra use

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Miracle supplements!!

• Can you imagine developing a compound which
  actually addresses the core reason why we gain
  weight, become diabetic, feel exhausted or
  prematurely old? Leading scientists at the U. of
  Toronto have made what may be one of the greatest
  discoveries of our time

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PGX (PolyglycopleX)

• You could feel good about eating again!
• Non habit forming!
• Stimulant free!

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Globe Mail Ad. March 22/08

• PGX will change your life!
• A unique combination of natural fibres
• Will prevent or correct insulin resistence
• Once blood sugar is under control, no messages
  sent out from the brain

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How does this work?

• PGX reduces the glycemic index of food
• Brings erratic and uncontrolled blood sugar
  levels back under control

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Glycemic Index

• Measures the potential foods to raise blood
  glucose levels, which in turn trigger a release
  of insulin, which then may be followed by a
  dramatic decrease in blood glucose
• All carbohydrates are not created equal!!

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Factors affecting the Glycemic Index

• Type of carbohydrate (simple or complex)
• Method of preparation
• Fat and fibre content

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Scale of Glycemic Index

• 55 or less (low)
• 55-70 (moderate)
• Above 70 (high)
• Sucrose is 65, white bread is 71

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Some generalities

• All vegetables and beans are very low (15)
• Bakery products such as donuts are high
• Breads vary greatly multi-grain and high grain
  are low, white bread baguette is high (95)
• Cereals such as bran, oat bran, muesli are
  low-medium rice krispies, corn flakes are high
• Pasta is low rice is high
• Peanuts are low dates are high
• Milk is low ice cream is high

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White bread vs. whole grain bread

• Same caloric value, but white has high GI vs. low
  for whole wheat
• Difference whole wheat contains more soluble
  fibre!

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What is important

• Consider the whole meal, rather than the GI of
  individual foods (too complicated)
• Beans, lentils, fresh vegetables, whole wheat
  bread are all good choices
• Imp. for diabetics
• Still controversial concepts too complex
• Glycemic load amount of carbohydrate x GI

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A balanced diet

• Use food with low or medium glycemic index
• Eat regularly
• Lots of fruits, vegetables, grains and legumes

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Causes of Insulin resistance

• Poor eating habits!
• Genetic disposition
• Result blood sugar levels spike and fall
• Type II diabetes looms

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What is in PGX that makes it work?

• Natural factors-actually Soluble fibre swells
  up when water present gives full feeling
• Take at mealtime with plenty of water
• Soluble fibre long known to be beneficial
• Gramma called it Roughage Fibre facts and
  Fallacies, Robert L.Orey (1991)ACS

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Soluble fibre and glucose levels

• It is known that soluble fibre dissolves 20-200x
  its weight in water and becomes a viscous gel.
• Nutrients can be trapped inside the gel and are
  shielded from the digestive enzymes
• Thus sugar is absorbed into the bloodstream more
  slowly, preventing spikes in glucose levels

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Soluble fibre chemically

• Consists of pectins, hemicelluloses and gums
• Highly viscous in water

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Solid Science

• It appears that the science behind PGX is solid
• Just a question of and convenience

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Soluble fibre in common foods

• Apples! (1 per day!)
• Raisins, figs, prunes, blueberries, oats, dried
  beans, peas, citrus fruits

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Your choice

• PGX powder, tablets, granules to be sprinkled on
  cereal (31.99 tax for 120 tablets), PGX
  shakes
• Fresh or dried fruit on a daily basis

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Weight loss supplements

• Who is most likely to use them?
• Women vs men?
• Age profile?
• Are they dangerous?

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The findings

• 15 of adults per year use them
• Women are 2x as likely as men to try them
• Highest use among ages 18-34
• Some are definitely dangerous

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Hydroxycut

• burns fat, builds muscles,and dramatically boost
  metabolism
• Findings it does none of the above
• 23 reports of serious illness in users-1 death,
  seizures, hepatitis other liver damage
• FDA warning out-manufacturer withdrew a long
  list of weight loss products from the market

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Hydroxycut-withdrawn form market June 2009
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Weight loss aids

• Often herbal and include ephedra
• 1994 law in USA deregulated supplements
• No Canadian regulations either
• Public is asking for reforms to protect
  consumers

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Summary on Supplements

• Univ.California Wellness letter July 2009
• In general, be skeptical about claims
• Legitimate use of fish oils for those with heart
  disease Vit D for all Calcium for
  postmenopausal women folic acid for pregnant
  women-reduces risk of spinabifida and neural tube
  disorders (NTDs) in newborns

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New Products on the market!

• Belllifestyle ad (Ottawa Citizen 22/6/09)
• Master Herbalist cures for just about
  everything
• Anxiety, stress, chronic fatigue, depressed
  moods, eating disorders use 66 Calming chronic
  Stress
• Etc,etc.BEWARE..no documented proof

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Other Belllife herbals
66
Also cures for

• Skin disorders, hearing loss, cancer, chronic
  nerve pain, arthritis( use shark cartilage),
  incontinence, loss of virility (men), loss of
  desire (women), high cholesterol, migraines,
  snoring, sleep apnea, allergies, high blood
  pressure, carpal tunnel syndrome
• WOW!!!

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Use of Multivitamins

• As insurance policy for general population
• Highly recommended for expectant mothers-June
  2009 study shows multivitamins aid infant birth
  weight

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10 foods to consume AOAP

• Salmon
• Yogurt (probiotic)
• Skim milk
• Spinach
• Carrots
• Whole grains (bran, oats)
• Legumes (beans, chickpeas etc)
• Blueberries
• Almonds
• Broccholi

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Mayo Clinics list

• Almonds, Apples, blueberries, Broccoli, red
  beans, salmon,spinach, sweet potatoes, vegetable
  juices, wheat germ

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Food safety

• Bacterial contamination is most dangerous
• Listeria outbreak-August 2008
• Maple Leaf foods Toronto
• Symptoms of Listeriosis fever, chills, nausea,
  diarrhea, headaches-can be lethal in people with
  compromised immune systems (elderly,pregnant
  women etc)

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Minimizing risk from Listeria

• Avoid soft cheeses, smoked fish, all deli meats,
  raw milk
• Heating kills it-pasteurization of milk, cooking
  meats thoroughly
• Keep food out of the danger zone (4-60oC).

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Sources of Listeria

• From uncooked fruits and vegetables
• Soil,water, sewage, silage,human and animal feces
  
• Many people carry it without getting ill
• Onset of illness can be from 12 hours to 3 months
  after infection
• More dangerous than salmonella

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Sept 6, 2008 source identified

• 2 Meat slicing machines in processing plant
• Typical of this bacteria-can hide in nooks and
  crannies of equipment
• 19 deaths in Canada
• Prime Minister orders public inquiry

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Another case for food irradiation!

• Would kill Listeria !!

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End of course!!!

• Review next class
• evaluations