What’s Your Plant Diversity Score?
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We speak often about the importance of dietary diversity, and of that, especially diversity of plants in one’s diet, but we’ve never really focused on it as a main feature, so that’s what we’re going to do today.
Specifically, you may have heard the advice to “eat 30 different kinds of plants per week”. But where does that come from, and is it just a number out of a hat?
The magic number?
It is not, in fact, a number out of a hat. It’s from a big (n=11,336) study into what things affect the gut microbiome for better or for worse. It was an observational population study, championing “citizen science” in which volunteers tracked various things and collected and sent in various samples for analysis.
The most significant finding of this study was that those who consumed more than 30 different kinds of plants per week, had a much better gut microbiome than those who consumed fewer than 10 different kinds of plants per week (there is a bell curve at play, and it gets steep around 10 and 30):
American Gut: an Open Platform for Citizen Science Microbiome Research
Why do I care about having a good gut microbiome?
Gut health affects almost every other kind of health; it’s been called “the second brain” for the various neurotransmitters and other hormones it directly makes or indirectly regulates (which in turn affect every part of your body), and of course there is the vagus nerve connecting it directly to the brain, impacting everything from food cravings to mood swings to sleep habits.
See also:
Any other benefits?
Yes there are! Let’s not forget: as we see often in our “This or That” section, different foods can be strong or weak in different areas of nutrition, so unless we want to whip out a calculator and database every time we make food choices, a good way to cover everything is to simply eat a diverse diet.
And that goes not just for vitamins and minerals (which would be true of animal products also), but in the case of plants, a wide range of health-giving phytochemicals too:
Measuring Dietary Botanical Diversity as a Proxy for Phytochemical Exposure
Ok, I’m sold, but 30 is a lot!
It is, but you don’t have to do all 30 in your first week of focusing on this, if you’re not already accustomed to such diversity. You can add in one or two new ones each time you go shopping, and build it up.
As for “what counts”: we’re counting unprocessed or minimally-processed plants. So for example, an apple is an apple, as are dried apple slices, as is apple sauce. Any or all of those would count as 1 plant type.
Note also that we’re counting types, not totals. If you’re having apple slices with apple sauce, for some reason? That still only counts as 1.
However, while apple sauce still counts as apples (minimally processed), you cannot eat a cake and say “that’s 2 because there was wheat and sugar cane somewhere in its dim and distant history”.
Nor is your morning espresso a fruit (by virtue of coffee beans being the fruit of the plant, botanically speaking). However, it would count as 1 plant type if you eat actual coffee beans—this writer has been known to snack on such; they’re only healthy in very small portions though, because their saturated fat content is a little high.
You, however, count grains in general, as well as nuts and seeds, not just fruits and vegetables. As for herbs and spices, they count for ¼ each, except for salt, which might get lumped in with spices but is of course not a plant.
How to do it
There’s a reason we’re doing this in our Saturday Life Hacks edition. Here are some tips for getting in far more plants than you might think, a lot more easily than you might think:
- Buy things ready-mixed. This means buying the frozen mixed veg, the frozen mixed chopped fruit, the mixed nuts, the mixed salad greens etc. This way, when you’re reaching for one pack of something, you’re getting 3–5 different plants instead of one.
- Buy things individually, and mix them for storage. This is a more customized version of the above, but in the case of things that keep for at least a while, it can make lazy options a lot more plentiful. Suddenly, instead of rice with your salad you’re having sorghum, millet, buckwheat, and quinoa. This trick also works great for dried berries that can just be tipped into one’s morning oatmeal. Or, you know, millet, oats, rye, and barley. Suddenly, instead of 1 or 2 plants for breakfast you have maybe 7 or 8.
- Keep a well-stocked pantry of shelf-stable items. This is good practice anyway, in case of another supply-lines shutdown like at the start of the COVID-19 pandemic. But for plant diversity, it means that if you’re making enchiladas, then instead using kidney beans because that’s what’s in the cupboard, you can raid your pantry for kidney beans, black beans, pinto beans, fava beans, etc etc. Yes, all of them; that’s a list, not a menu.
- Shop in the discount section of the supermarket. You don’t have shop exclusively there, but swing by that area, see what plants are available for next to nothing, and buy at least one of each. Figure out what to do with it later, but the point here is that it’s a good way to get suggestions of plants that you weren’t actively looking for—and novelty is invariably a step into diversity.
- Shop in a different store. You won’t be able to beeline the products you want on autopilot, so you’ll see other things on the way. Also, they may have things your usual store doesn’t.
- Shop in person, not online—at least as often as is practical. This is because when shopping for groceries online, the store will tend to prioritize showing you items you’ve bought before, or similar items to those (i.e. actually the same item, just a different brand). Not good for trying new things!
- Consider a meal kit delivery service. Because unlike online grocery shopping, this kind of delivery service will (usually) provide you with things you wouldn’t normally buy. Our sometimes-sponsor Purple Carrot is a fine option for this, but there are plenty of others too.
- Try new recipes, especially if they have plants you don’t normally use. Make a note of the recipe, and go out of your way to get the ingredients; if it seems like a chore, reframe it as a little adventure instead. Honestly, it’s things like this that keep us young in more ways than just what polyphenols can do!
- Hide the plants. Whether or not you like them; hide them just because it works in culinary terms. By this we mean; blend beans into that meaty sauce; thicken the soup with red lentils, blend cauliflower into the gravy. And so on.
One more “magic 30”, while we’re at it…
30g fiber per day makes a big (positive) difference to many aspects of health. Obviously, plants are where that comes from, so there’s a big degree of overlap here, but most of the tips we gave are different, so for double the effectiveness, check out:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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How To Avoid UTIs
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Psst… A Word To The Wise
Urinary Tract Infections (UTIs) can strike at any age, but they get a lot more common as we get older:
- About 10% of women over 65 have had one
- About 30% of women over 85 have had one
Source: Urinary tract infection in older adults
Note: those figures are almost certainly very underreported, so the real figures are doubtlessly higher. However, we print them here as they’re still indicative of a disproportionate increase in risk over time.
What about men?
Men do get UTIs too, but at a much lower rate. The difference in average urethra length means that women are typically 30x more likely to get a UTI.
However! If a man does get one, then assuming the average longer urethra, it will likely take much more treatment to fix:
Case study: 26-Year-Old Man With Recurrent Urinary Tract Infections
Risk factors you might want to know about
While you may not be able to do much about your age or the length of your urethra, there are some risk factors that can be more useful to know:
Catheterization
You might logically think that having a catheter would be the equivalent of having a really long urethra, thus keeping you safe, but unfortunately, the opposite is true:
Read more: Review of Catheter-Associated Urinary Tract Infections
Untreated menopause
Low estrogen levels can cause vaginal tissue to dry, making it easier for pathogens to grow.
For more information on menopausal HRT, see:
What You Should Have Been Told About Menopause Beforehand
Sexual activity
Most kinds of sexual activity carry a risk of bringing germs very close to the urethra. Without wishing to be too indelicate: anything that’s going there should be clean, so it’s a case for washing your hands/partner(s)/toys etc.
For the latter, beyond soap and water, you might also consider investing in a UV sanitizer box ← This example has a 9” capacity; if you shop around though, be sure to check the size is sufficient!
Kidney stones and other kidney diseases
Anything that impedes the flow of urine can raise the risk of a UTI.
See also: Keeping Your Kidneys Healthy (Especially After 60)
Diabetes
How much you can control this one will obviously depend on which type of diabetes you have, but diabetes of any type is an immunocompromizing condition. If you can, managing it as well as possible will help many aspects of your health, including this one.
More on that:
How To Prevent And Reverse Type 2 Diabetes
Note: In the case of Type 1 Diabetes, the above advice will (alas) not help you to prevent or reverse it. However, reducing/avoiding insulin resistance is even more important in cases of T1D (because if your exogenous insulin stops working, you die), so the advice is good all the same.
How do I know if I have a UTI?
Routine screening isn’t really a thing, since the symptoms are usually quite self-evident. If it hurts/burns when you pee, the most likely reason is a UTI.
Get it checked out; the test is a (non-invasive) urinalysis test. In other words, you’ll give a urine sample and they’ll test that.
Anything else I can do to avoid it?
Yes! We wrote previously about the benefits of cranberry supplementation, which was found even to rival antibiotics:
❝…recommend cranberry ingestion to decrease the incidence of urinary tract infections, particularly in individuals with recurrent urinary tract infections. This would also reduce the [need for] administration of antibiotics❞
Read more: Health Benefits Of Cranberries
Take care!
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Real Self-Care – by Pooja Lakshmin MD
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As the subtitle says, “crystals, cleanses, and bubble baths not included”. So, if it’s not about that sort of self-care, what is it about?
Dr. Lakshmin starts by acknowledging something that many self-help books don’t:
We can do everything correctly and still lose. Not only that, but for many of us, that is the probable outcome. Not because of any fault or weakness of ours, but simply because one way or another the game is rigged against us from the start.
So, should we throw in the towel, throw our hands in the air, and throw the book out of the window?
Nope! Dr. Lakshmin has actually helpful advice, that pertains to:
- creating healthy boundaries and challenging guilt
- treating oneself with compassion
- identifying and aligning oneself with one’s personal values
- asserting one’s personal power to fight for one’s own self-interest
If you’re reading this and thinking “that seems very selfish”, then let’s remember the “challenging guilt” part of that. We’ve all-too-often been conditioned to neglect our own needs and self-sacrifice for others.
And, while selfless service really does have its place, needlessly self-destructive martyrdom does not!
Bottom line: this book delivers a lot of “real talk” on a subject that otherwise often gets removed from reality rather. In short, it’s a great primer for finding the right place to draw the line between being a good-hearted person and being a doormat.
Click here to check out Real Self-Care and “put your own oxygen mask on first”!
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Eggs: Nutritional Powerhouse or Heart-Health Timebomb?
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Eggs: All Things In Moderation?
We asked you for your (health-related) opinion on eggs. We specified that, for the sake of simplicity, let’s say that they are from happy healthy backyard hens who enjoy a good diet.
Apparently this one wasn’t as controversial as it might have been! We (for myth-busting purposes) try to pick something polarizing and sometimes even contentious for our Friday editions, and pick apart what science lies underneath public perceptions.
However, more than half (in fact, 60%) of the subscribers who voted in the poll voted for “Eggs are nutritionally beneficial as part of a balanced diet”, which very moderate statement is indeed pretty much the global scientific consensus.
Still, we’ve a main feature to write, so let’s look at the science, and what the other 40% had in mind:
Eggs are ruinous to health, especially cardiometabolic health: True or False?
False, per best current science, anyway!
Scientific consensus has changed over the years. We learned about cholesterol, then we learned about different types of cholesterol, and now we’ve even learned about in some instances even elevated levels of “bad” cholesterol aren’t necessarily a cause of cardiometabolic disorders so much as a symptom—especially in women.
Not to derail this main feature about eggs (rather than just cholesterol), but for those who missed it, this is actually really interesting: basically, research (pertaining to the use of statins) has found that in women, higher LDL levels aren’t anywhere near the same kind of risk factor as they are for men, and thus may mean that statins (whose main job is reducing LDL) may be much less helpful for women than for men, and more likely to cause unwanted serious side effects in women.
Check out our previous main feature about this: Statins: His & Hers?
But, for back on topic, several large studies (totalling 177,000 people in long-term studies in 50 countries) found:
❝Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.❞
Egg whites are healthy (protein); egg yolks are not (cholesterol): True or False?
True and False, respectively. That is to say, egg whites are healthy (protein), and egg yolks are also healthy (many nutrients).
We talked a bit already about cholesterol, so we’ll not rehash that here. As to the rest:
Eggs are one of the most nutritionally dense foods around. After all, they have everything required to allow a cluster of cells to become a whole baby chick. That’s a lot of body-building!
They’re even more nutritionally heavy-hitters if you get omega-3 enriched eggs, which means the hens were fed extra omega-3, usually in the form of flax seeds.
Also, free-range is better healthwise than others. Do bear in mind that unless they really are from your backyard, or a neighbor’s, chances are that the reality is not what the advertising depicts, though. There are industry minimum standards to be able to advertise as “free-range”, and those standards are a) quite low b) often ignored, because an occasional fine is cheaper than maintaining good conditions.
So if you can look after your own hens, or get them from somewhere that you can see for yourself how they are looked after, so much the better!
Check out the differences side-by-side, though:
Pastured vs Omega-3 vs “Conventional” Eggs: What’s the Difference?
Stallone-style 12-egg smoothies are healthy: True or False?
False, at least if taken with any regularity. One can indeed have too much of a good thing.
So, what’s the “right amount” to eat?
It may vary depending on individual factors (including age and ethnicity), but a good average, according to science, is to keep it to 3 eggs or fewer per day. There are a lot of studies, but we only have so much room here, so we’ll pick one. Its findings are representative of (and in keeping with) the many other studies we looked at, so this seems uncontroversial scientifically:
❝Intake of 1 egg/d was sufficient to increase HDL function and large-LDL particle concentration; however, intake of 2-3 eggs/d supported greater improvements in HDL function as well as increased plasma carotenoids. Overall, intake of ≤3 eggs/d favored a less atherogenic LDL particle profile, improved HDL function, and increased plasma antioxidants in young, healthy adults.❞
Enjoy!
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The Sweet Truth About Diabetes
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There’s A Lot Of Confusion About Diabetes!
For those readers who are not diabetic, nor have a loved one who is diabetic, nor any other pressing reason to know these things, first a quick 101 rundown of some things to understand the rest of today’s main feature:
- Blood sugar levels: how much sugar is in the blood, measured in mg/dL or mmol/L
- Hyperglycemia or “hyper” for short: too much sugar in the blood
- Hypoglycemia or “hypo” for short: too little sugar in the blood
- Insulin: a hormone that acts as a gatekeeper to allow sugar to pass, or not pass, into various parts of the body
- Type 1 diabetes (sometimes capitalized, and/or abbreviated to “T1D”) is an autoimmune disorder that prevents the pancreas from being able to supply the body with insulin. This means that taking insulin consistently is necessary for life.
- Type 2 diabetes is a matter of insulin resistance. The pancreas produces plenty of insulin, but the body has become desensitized to it, so it doesn’t work properly. Taking extra insulin may sometimes be necessary, but for many people, it can be controlled by means of a careful diet and other lifestyle factors.
With that in mind, on to some very popular myths…
Diabetes is caused by having too much sugar
While sugar is not exactly a health food, it’s not the villain of this story either.
- Type 1 diabetes has a genetic basis, triggered by epigenetic factors unrelated to sugar.
- Type 2 diabetes comes from a cluster of risk factors which, together, can cause a person to go through pre-diabetes and acquire type 2 diabetes.
- Those risk factors include:
- A genetic predisposition
- A large waist circumference
- (this is more relevant than BMI or body fat percentage)
- High blood pressure
- A sedentary lifestyle
- Age (the risk starts rising at 35, rises sharply at 45, and continues upwards with increasing age)
- Those risk factors include:
Read more: Risk Factors for Type 2 Diabetes
Diabetics can’t have sugar
While it’s true that diabetics must be careful about sugar (and carbs in general), it’s not to say that they can’t have them… just: be mindful and intentional about it.
- Type 1 diabetics will need to carb-count in order to take the appropriate insulin bolus. Otherwise, too little insulin will result in hyperglycemia, or too much insulin will result in hypoglycemia.
- Type 2 diabetics will often be able to manage their blood sugar levels with diet alone, and slow-release carbs will make this easier.
In either case, having quick release sugars will increase blood sugar levels (what a surprise), and sometimes (such as when experiencing a hypo), that’s what’s needed.
Also, when it comes to sugar, a word on fruit:
Not all fruits are equal, and some fruits can help maintain stable blood sugar levels! Read all about it:
Fruit Intake to Prevent and Control Hypertension and Diabetes
Artificial sweeteners are must-haves for diabetics
Whereas sugar is a known quantity to the careful diabetic, some artificial sweeteners can impact insulin sensitivity, causing blood sugars to behave in unexpected ways. See for example:
The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis
If a diabetic person is hyper, they should exercise to bring their blood sugar levels down
Be careful with this!
- In the case of type 2 diabetes, it may (or may not) help, as the extra sugar may be used up.
- Type 1 diabetes, however, has a crucial difference. Because the pancreas isn’t making insulin, a hyper (above a certain level, anyway) means more insulin is needed. Exercising could do more harm than good, as unlike in type 2 diabetes, the body has no way to use that extra sugar, without the insulin to facilitate it. Exercising will just pump the syrupy hyperglycemic blood around the body, potentially causing damage as it goes (all without actually being able to use it).
There are other ways this can be managed that are outside of the scope of this newsletter, but “be careful” is rarely a bad approach.
Read more, from the American Diabetes Association:
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The SharpBrains Guide to Brain Fitness – by Alvaro Fernandez et al.
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We say “et al.” in the by-line, because this one has a flock of authors, including Dr. Pascale Michelon, Dr. Sandra Bond Chapman, Dr. Elkehon Goldberg, and various others if we include the foreword, introduction, etc.
This is relevant, because those who contributed to the meat of the book (i.e., those listed above), it makes the work a lot more scientifically reliable; one skilled science writer might make a mistake; it’s much less likely to make it through to publication when there are a bevy of doctors in the mix, each staking their reputation on the book’s content, and thus having a vested interest in checking each other’s work as well as their own.
As for what this multidisciplinary team have to offer? The book covers such things as:
- how the brain works (especially the possibilities of neuroplasticity), and what that means for such things as memory and attention
- being “a coach not a patient”; i.e., being active rather than passive in one’s approach to brain health
- the relevance of physical exercise, how much, and what kind
- the relevance (and limitations) of diet choices for brain health
- the relevance of such things as learning new languages and musical training
- the relevance of social engagement, and how some (but not all) social engagement can boost cognition
- methods for managing stress and building resilience to same (critical for maintaining a healthy brain)
- “cross-fit for your brain”, that is to say, a multi-vector collection of tools to explore, ranging from meditation to CBT to biofeedback and more.
The style is pop-science without being sensationalist, just communicating ideas clearly, with enough padding to feel casual, and not like a dense read. Importantly, it’s also practical and applicable too, which is something we always look for here.
Bottom line: if you’d like to be given a good overview of what things work (and how much they can be expected to work), along with a good framework to put that knowledge into practice, then this is a great book for you.
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What is silicosis and what does research say about it?
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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.
Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.
Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.
But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.
The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.
Silicosis in modern industries
Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.
The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.
The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.
A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.
An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.
Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.
In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.
In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.
However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.
A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.
The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.
Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”
Silicosis symptoms and treatment
Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.
Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.
There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.
Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.
Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.
In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.
Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.
Research roundup
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.
Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.
However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”
The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.
The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.
“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.
Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.
The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.
The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.
“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.
Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.
“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.
A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.
These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.
The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.
“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”
Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.
From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.
Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.
At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.
The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.
“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”
Additional research
Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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