The 'French paradox' rears its ugly head again. The reasoning goes something like this: French people eat more saturated animal fat than any other affluent nation, and have the second-lowest rate of coronary heart disease (only after Japan, which has a much higher stroke rate than France). French people drink red wine. Therefore, red wine must be protecting them against the artery-clogging yogurt, beef and butter.
The latest study to fall into this myth was published in the AJCN recently (1). Investigators showed that 1/3 bottle of red wine per day for 21 days increased blood flow in forearm vessels of healthy volunteers, which they interpreted as "enhanced vascular endothelial function"*. The novel finding in this paper is that red wine consumption increases the migration of certain cells into blood vessels that are thought to maintain and repair the vessels. There were no control groups for comparison, neither abstainers nor a group drinking a different type of alcohol.
The investigators then went on to speculate that the various antioxidant polyphenols in red wine, such as the trendy molecule resveratrol, could be involved. Even though you have to give animals 500 bottles' worth of resveratrol per day to see any effect. But there's another little problem with this hypothesis...
Ethanol-- plain old alcohol. You could drink a 40 oz bottle of malt liquor every night and it would probably do the exact same thing.
No matter what the source, alcohol consumption is associated with a lower risk of cardiovascular disease out to about 3-4 drinks per day, after which the risk goes back up (2, 3)**. The association is not trivial-- up to a 62% lower risk associated with alcohol use. Controlled trials have shown that alcohol, regardless of the source, increases HDL cholesterol and reduces the tendency to clot (4).
Should we all start downing three drinks a day? Not so fast. Although alcohol does probably decrease heart attack risk, the effect on total mortality is equivocal. That's because it increases the risk of cancers and accidents. Alcohol is a drug, and my opinion is that like all drugs, overall it will not benefit the health of a person with an otherwise good diet and lifestyle. That being said, it's enjoyable, so I have no problem with drinking it in moderation. Just don't think you're doing it for your health.
So does red wine decrease the risk of having a heart attack? Yes, just as effectively as malt liquor. It's not the antioxidants and resveratrol, it's the ethanol. The reason the French avoid heart attacks is not because of some fancy compound in their wine that protects them from a high saturated fat intake. It's because they have preserved their diet traditions to a greater degree than most industrialized nations.
I do think it's interesting to speculate about why alcohol (probably) reduces heart attack risk. As far as I know, the mechanism is unknown. Could it be because it relaxes us? I'm going to ponder that over a glass of whiskey...
* It may well represent an improvement of endothelial function, but that's an assumption on the part of the investigators. It belongs in the discussion section, if anywhere, and not in the results section.
** The first study is really interesting. For once, I see no evidence of "healthy user bias". Rates of healthy behaviors were virtually identical across quintiles of alcohol intake. This gives me a much higher degree of confidence in the results.
Guest Commentary: Obesity Trends - There is Hope
Laura Kimberly, MSW, MBE
Director of Special Projects
Jefferson School of Population Health
Recently at JSPH, two presenters at separate events referenced the CDC’s Behavioral Risk Factor Surveillance System obesity trend maps in their presentations. These maps track obesity rates over time and create a powerful visual demonstration of the sharp increases in states’ obesity rates since the 1980’s. The numbers are startling, and the associated costs, both fiscal and social, paint a grim picture.
Much has been written recently about the challenge of addressing rising rates of obesity in the United States, and the outlook tends to be gloomy. Well-intentioned interventions may enjoy isolated, short-term success, yet behavioral change with staying power seems elusive. However, at JSPH’s Health Policy Forum on May 12th, Karen Glanz, PhD, MPH, offered a note of hope. She discussed her work, which strives to make connections between academia and the community and to measure the impact of evidence-based interventions. She began by noting that the national vision for health, articulated in the Healthy People 2020 goals, includes an emphasis on creating social and physical environments that improve health for all, and she referenced T. R. Frieden’s health impact pyramid as a helpful framework for examining population health issues.
Dr. Glanz advocates for a social ecological approach to health promotion, and she pointed to several examples of interventions which have had a positive impact in the sphere of community and health system environmental interventions, and in legislation, regulation, and enforcement. In particular, Dr. Glanz discussed the success of tobacco control initiatives and was hopeful that our experiences with tobacco may help point us in the right direction as we develop strategies to address obesity.
She ended by cautioning that there is more work to be done and reminded us that we can’t assume causal relationships and shouldn’t always rely on randomized control trials as the gold standard when we do have access to natural experiments which can offer valuable insight. In addition, we need to reach disadvantaged populations and develop more practical tools.
All-in-all a sobering and immensely sensitive topic, but an area in which we can’t afford to throw up our hands. Do you think we can develop effective strategies to address rising rates of obesity? Please share your thoughts.
Director of Special Projects
Jefferson School of Population Health
Recently at JSPH, two presenters at separate events referenced the CDC’s Behavioral Risk Factor Surveillance System obesity trend maps in their presentations. These maps track obesity rates over time and create a powerful visual demonstration of the sharp increases in states’ obesity rates since the 1980’s. The numbers are startling, and the associated costs, both fiscal and social, paint a grim picture.
Much has been written recently about the challenge of addressing rising rates of obesity in the United States, and the outlook tends to be gloomy. Well-intentioned interventions may enjoy isolated, short-term success, yet behavioral change with staying power seems elusive. However, at JSPH’s Health Policy Forum on May 12th, Karen Glanz, PhD, MPH, offered a note of hope. She discussed her work, which strives to make connections between academia and the community and to measure the impact of evidence-based interventions. She began by noting that the national vision for health, articulated in the Healthy People 2020 goals, includes an emphasis on creating social and physical environments that improve health for all, and she referenced T. R. Frieden’s health impact pyramid as a helpful framework for examining population health issues.
Dr. Glanz advocates for a social ecological approach to health promotion, and she pointed to several examples of interventions which have had a positive impact in the sphere of community and health system environmental interventions, and in legislation, regulation, and enforcement. In particular, Dr. Glanz discussed the success of tobacco control initiatives and was hopeful that our experiences with tobacco may help point us in the right direction as we develop strategies to address obesity.
She ended by cautioning that there is more work to be done and reminded us that we can’t assume causal relationships and shouldn’t always rely on randomized control trials as the gold standard when we do have access to natural experiments which can offer valuable insight. In addition, we need to reach disadvantaged populations and develop more practical tools.
All-in-all a sobering and immensely sensitive topic, but an area in which we can’t afford to throw up our hands. Do you think we can develop effective strategies to address rising rates of obesity? Please share your thoughts.
Sweet Potatoes
We can measure the nutrient and toxin content of a food, and debate the health effects of each of its constituents until we're out of breath. But in the end, we still won't have a very accurate prediction of the health effects of that food. The question we need to answer is this one: has this food sustained healthy traditional cultures?
I'm currently reading a great book edited by Drs. Hugh Trowell and Denis Burkitt, titled Western Diseases: Their Emergence and Prevention. It's a compilation of chapters describing the diet and health of traditional populations around the world as they modernize.
The book contains a chapter on Papua New Guinea highlanders. Here's a description of their diet:
How was their health? Like many non-industrial societies, they had a high infant/child mortality rate, such that 43 percent of children died before growing old enough to marry. Surprisingly, protein deficiency was rare. No obvious malnutrition was observed in this population, although iodine-deficiency cretinism occurs in some highlands populations:
There was no evidence of coronary heart disease or diabetes. Average blood pressure was on the high side, but did not increase with age. Investigators administered 100 gram glucose tolerance tests and only 3.8 percent of the population had glucose readings above 160 mg/dL, compared to 21 percent of Americans. A study of 7,512 Papuans from several regions with minimal European contact indicated a diabetes prevalence of 0.1 percent, a strikingly low rate. For comparison, in 2007, 10.7 percent of American adults had diabetes (1).
I'm not claiming it's optimal to eat nothing but sweet potatoes. But this is the strongest evidence we're going to come by that sweet potatoes can be eaten in quantity as part of a healthy diet. However, I wish I knew more about the varieties this group ate. Sweet potatoes aren't necessarily sweet. Caribbean 'boniato' sweet potatoes are dry, starchy and off-white. In the US, I prefer the yellow sweet potatoes to the orange variety of sweet potato labeled 'yams', because the former are starchier and less sweet. If I could get my hands on locally grown boniatos here, I'd eat those, but boniatos are decidedly tropical.
Instead, I eat potatoes, but I'm reluctant to recommend them whole-heartedly because I don't know enough about the traditional cultures that consumed them. I believe there are some low-CHD, low-obesity African populations that eat potatoes as part of a starch-based diet, but I haven't looked into it closely enough to make any broad statements. Potatoes have some nutritional advantages over sweet potatoes (higher protein content, better amino acid profile), but also some disadvantages (lower fiber, lower in most micronutrients, toxic glycoalkaloids).
I'm currently reading a great book edited by Drs. Hugh Trowell and Denis Burkitt, titled Western Diseases: Their Emergence and Prevention. It's a compilation of chapters describing the diet and health of traditional populations around the world as they modernize.
The book contains a chapter on Papua New Guinea highlanders. Here's a description of their diet:
A diet survey was undertaken involving 90 subjects, in which all food consumed by each individual was weighed over a period of seven consecutive days. Sweet potato supplied over 90 percent of their total food intake, while non-tuberous vegetables accounted for less than 5 percent of the food consumed and the intake of meat was negligible... Extensive herds of pigs are maintained and, during exchange ceremonies, large amounts of pork are consumed.They ate no salt. Their calories were almost entirely supplied by sweet potatoes, with occasional feasts on pork.
How was their health? Like many non-industrial societies, they had a high infant/child mortality rate, such that 43 percent of children died before growing old enough to marry. Surprisingly, protein deficiency was rare. No obvious malnutrition was observed in this population, although iodine-deficiency cretinism occurs in some highlands populations:
Young adults were well built and physically fit and had normal levels of haemoglobin and serum albumin. Further, adult females showed no evidence of malnutrition in spite of the demands by repeated cycles of pregnancy and lactation. On the basis of American standards (Society of Actuaries, 1959), both sexes were close to 100 percent standard weight in their twenties.
The Harvard Pack Test carried out on 152 consecutive subjects demonstrated a high level of physical fitness which was maintained well into middle-age. Use of a bicycle ergometer gave an estimated maximum oxygen uptake of 45.2 ml per kilogram per minute and thus confirmed the high level of cardiopulmonary fitness in this group.Body weight decreased with age, which is typical of many non-industrial cultures and reflects declining muscle mass but continued leanness.
There was no evidence of coronary heart disease or diabetes. Average blood pressure was on the high side, but did not increase with age. Investigators administered 100 gram glucose tolerance tests and only 3.8 percent of the population had glucose readings above 160 mg/dL, compared to 21 percent of Americans. A study of 7,512 Papuans from several regions with minimal European contact indicated a diabetes prevalence of 0.1 percent, a strikingly low rate. For comparison, in 2007, 10.7 percent of American adults had diabetes (1).
I'm not claiming it's optimal to eat nothing but sweet potatoes. But this is the strongest evidence we're going to come by that sweet potatoes can be eaten in quantity as part of a healthy diet. However, I wish I knew more about the varieties this group ate. Sweet potatoes aren't necessarily sweet. Caribbean 'boniato' sweet potatoes are dry, starchy and off-white. In the US, I prefer the yellow sweet potatoes to the orange variety of sweet potato labeled 'yams', because the former are starchier and less sweet. If I could get my hands on locally grown boniatos here, I'd eat those, but boniatos are decidedly tropical.
Instead, I eat potatoes, but I'm reluctant to recommend them whole-heartedly because I don't know enough about the traditional cultures that consumed them. I believe there are some low-CHD, low-obesity African populations that eat potatoes as part of a starch-based diet, but I haven't looked into it closely enough to make any broad statements. Potatoes have some nutritional advantages over sweet potatoes (higher protein content, better amino acid profile), but also some disadvantages (lower fiber, lower in most micronutrients, toxic glycoalkaloids).
It's the Sun, Stupid
Here is an article in the National Post by Lawrence Solomon that finally puts the conclusion in print: The sun effects the earth's climate.
"...solar scientists are increasingly conveying a clear message on the chief cause of climate change: It’s the Sun, Stupid. Jeff Kuhn, a rising star at the University of Hawaii’s Institute for Astronomy, is one of the most recent scientists to go public, revealing in press releases this month that solar scientists worldwide are on a mission to show that the Sun drives Earth’s climate. “As a scientist who knows the data, I simply can’t accept [the claim that man plays a dominant role in Earth’s climate],” he states."
...
"By comparing temperatures in Europe since 1659 to highs and lows in solar activity in the same years, the scientists discovered that low solar activity generally corresponded to cold winters. Could this centuries-long link between the Sun and Earth’s climate have been a matter of chance? “There is less than a 1% probability that the result was obtained by chance,” asserts Mike Lockwood of the University of Reading in the U.K., the study’s lead author."
"...solar scientists are increasingly conveying a clear message on the chief cause of climate change: It’s the Sun, Stupid. Jeff Kuhn, a rising star at the University of Hawaii’s Institute for Astronomy, is one of the most recent scientists to go public, revealing in press releases this month that solar scientists worldwide are on a mission to show that the Sun drives Earth’s climate. “As a scientist who knows the data, I simply can’t accept [the claim that man plays a dominant role in Earth’s climate],” he states."
...
"By comparing temperatures in Europe since 1659 to highs and lows in solar activity in the same years, the scientists discovered that low solar activity generally corresponded to cold winters. Could this centuries-long link between the Sun and Earth’s climate have been a matter of chance? “There is less than a 1% probability that the result was obtained by chance,” asserts Mike Lockwood of the University of Reading in the U.K., the study’s lead author."
The garden is in!
Here's our 24' x 14' garden, all planted:
Marilyn planted collard greens, kale, swiss chard, tomatoes, bell peppers, eggplant, asparagus, brussels sprouts, kohlrabi, dill, lettuce, chives, basil, parsley, and green beans. I just tilled, and will start harvesting in about a month. We'll have a second planting of spinach, kale, lettuce, cilantro later in the summer, for the cooler Fall weather.
this weekend's cooking
As you can see by my recent posts, I had some fun in the kitchen this weekend even though I didn't spend too much time in there as it was a good outside weekend. I don't want to spend much time in the kitchen this week as I have lots of work to do, and I wouldn't mind playing too, though work will probably win out, unfortunately.
So I made a big pot of bean "soup" to take care of my cooking needs for the week. I will still be making lunch for Marilyn (house mate) and Kenny (work collaborator), but I'll still save time by not doing additional cooking for myself. I plan to make micro-salads in the morning divided into 3 portions for brekky, lunch and dinner. That plus beans at lunch and dinner, plus whatever fruit I want to add should take care of me. I made a yummy fruit salad today. I'm addicted to the cheap strawberries we're getting right now.
I also made salsa and guacamole for Marilyn, and a nice easy veggie soup made with potatoes, canned tomatoes, peas, corn, onion, herbs, and ground sunflower seeds. This cooked up real quick in the pressure cooker. The soup is not as nutritious as Dr. Fuhrman likes (because of the potatoes) so I think I won't post it here. I think I can remember for next time.
Today's microsalad
This is a combination I've been having a lot lately because strawberries have been cheap and delicious! I vary the amount and type of greens so today's is just an example. Sometimes I used kale or cabbage instead of bok choy or lettuce. I also don't measure things out specifically, this is just what they came out to be when I weighed them.
Ingredients:
Romaine lettuce, 4.6 oz
broccoli, 1 stalk (peel the outer stalk layer)
cauliflower, 1/2 lb
spinach, 4 oz
bok choy, 8 oz
1 lb strawberries (big box)
6 oz blackberries (small box)
another fruit if you want, e.g., pear, apple, orange (peeled, deseeded, sliced)
juice of 1 lime
1 oz fresh squeezed orange juice
2 Tbsp seeds, grind if desired (e.g., flax which you need to grind, chia, hemp, sunflower)
Chop the veggies in a food processor using the s-blade. trim the strawberries, then chop them with the other fruit in a food processor. They will liquify but I like them chunky so I don't fully puree them. Do it to your desired chunkiness. Combine everything except the seeds in a large bowl. I then dish them out into 3 tupperware bowls to have with brekky, lunch and dinner. They are like dessert even though they are loaded with veggies! I wait to add the seeds until mealtime. It seems fresher that way.
Here's a picture of one bowl with a small spoon in it.
fruit salad
There is no specific recipe for fruit salad. It's just whatever delicious fresh fruits you want to cut up and serve in a bowl! This is the season for my favorite combination:
1 lb (box) strawberries
1 large banana
6 oz box fresh blueberries
1 ripe mango (for me in Wisconsin, it seems the best ones are the little yellow ones from Mexico. The big green/red ones come to us very unripe and mine usually rot as they ripe).
1 Tbsp fresh-squeezed orange juice (optional)
peel and cut the mango into small pieces. same with the banana. cut up the strawberries. combine everything in a big bowl. It is a taste of heaven.
This week's beans
This week will be busy and I need to spend less time in the kitchen, so I decided to make fancier beans, adding the healthy cooked vegetables Dr. Furhman recommends, and do less cooking each day.
Ingredients:
1 lb beans (this week it's some small whitish variety from Rancho Gordo)
juice from 5 lbs carrots--I noticed this was about 36 oz
2-4 cups water
1-2 onions (sweet vidalia are in season right now, yum)
2 parsnips (optional but good, I happened to have them)
1 lb shitake mushrooms, chopped (I left off the stems this time, though I might try next time since they cook for a while--maybe that will tenderize them).
Rinse the dry beans. Combine everything in a big pot the day or night before--add water to cover by a few inches. Let soak overnight in the fridge. Cook the next morning for 2-4 hours, until desired tenderness. Adding water as needed. These taste sweet and fantastic. As I said in another post, they are kind of like baked beans! Here's the big pot of cooked beans:
Here they are divided into 11 1-cup servings (minus 1 that I ate). I'll have these for lunch and dinner along with my micro-salads.
Each 1-cup serving as 206 calories, 11g protein (18% of calories), 40 g carbs (78%), and less than 1 g fat (4%).
JSPH Inaugural Commencement
TODAY, marks the inaugural commencement for our brand new School of Population Health. That's right---Population Health. A school whose mission is to prepare leaders with global vision to develop, implement and evaluate health policies and systems that improve the health of populations and thereby enhance, the quality of life.
We strive to fulfill this mission by providing exemplary graduate training in health policy, chronic care management, health care quality and safety, AND of course today, in public health.
Our nation stands today at a population health crossroad exemplified in part, by a new law----a law that is 10 weeks old. Whatever your politics, health care delivery in our country will never be the same. We have a lot of work to do!!! We must work hard to reduce the unexplained variation in health care services.
We must reduce disparities in how care is delivered. We must improve the coordination of care. We must improve the quality and safety of the care we deliver.
AND, we must put the patient at the center of all that we do.
Our school, in the great Jefferson University tradition, exemplified by these graduates here today, is preparing a new generation of leaders to meet these challenges. Men and women from a diverse background who now have the skills to go forth and to make a world of difference.
As the inaugural Dean, I am especially proud of the accomplishments of this class, and the support that they received from our faculty and our staff.
We strive to fulfill this mission by providing exemplary graduate training in health policy, chronic care management, health care quality and safety, AND of course today, in public health.
Our nation stands today at a population health crossroad exemplified in part, by a new law----a law that is 10 weeks old. Whatever your politics, health care delivery in our country will never be the same. We have a lot of work to do!!! We must work hard to reduce the unexplained variation in health care services.
We must reduce disparities in how care is delivered. We must improve the coordination of care. We must improve the quality and safety of the care we deliver.
AND, we must put the patient at the center of all that we do.
Our school, in the great Jefferson University tradition, exemplified by these graduates here today, is preparing a new generation of leaders to meet these challenges. Men and women from a diverse background who now have the skills to go forth and to make a world of difference.
As the inaugural Dean, I am especially proud of the accomplishments of this class, and the support that they received from our faculty and our staff.
salsa
This is simple and yummy. It makes a great soup too!
1 16-oz can tomatoes (or 1-2 tomatoes from the garden when available)
Small handful fresh cilantro, or to taste
chunk of zucchini, peeled, and cucumber, peeled. about 3" long each, or a few oz total
1-2 Tbsp red onion or scallions or any kind of onion (i.e., not much)
1/2 red or yellow or orange (or green) bell pepper
juice of 1/2 lemon (less or more to taste)
sweet corn (optional)
peas (optional)
Blend the tomatoes and zucchini/cucumber in a blender. Add in the lemon juice onion, bell pepper and cilantro and pulse to chop but not puree. If you want, add some sweet corn and/or peas.
You can make a double batch, eat a bowl for yourself as soup and serve up the rest to your guests with killer tostada chips (yes, I'm willing to poison my guests with their favorite foods), or you can make healthy chips by slicing and baking corn tortillas (unsalted); 5-10 minutes at 350 F works for me. Or eat with fresh veggies--peppers, celery, carrots.
Pastured Dairy may Prevent Heart Attacks
Not all dairy is created equal. Dairy from grain-fed and pasture-fed cows differs in a number of ways. Pastured dairy contains more fat-soluble nutrients such as vitamin K2, vitamin A, vitamin E, carotenes and omega-3 fatty acids. It also contains more conjugated linoleic acid, a fat-soluble molecule that has been under intense study due to its ability to inhibit obesity and cancer in animals. The findings in human supplementation trials have been mixed, some confirming the animal studies and others not. In feeding experiments in cows, Dr. T. R. Dhiman and colleagues found the following (1):
In a recent article from the AJCN, Dr. Liesbeth Smit and colleagues examined the level of CLA in the body fat of Costa Rican adults who had suffered a heart attack, and compared it to another group who had not (a case-control study, for the aficionados). People with the highest level of CLA in their body fat were 49% less likely to have had a heart attack, compared to those with the lowest level (2).
Since dairy was the main source of CLA in this population, the association between CLA and heart attack risk is inextricable from the other components in pastured dairy fat. In other words, CLA is simply a marker of pastured dairy fat intake in this population, and the (possible) benefit could just as easily have come from vitamin K2 or something else in the fat.
This study isn't the first one to suggest that pastured dairy fat may be uniquely protective. The Rotterdam and EPIC studies found that a higher vitamin K2 intake is associated with a lower risk of heart attack, cancer and overall mortality (3, 4, 5). In the 1940s, Dr. Weston Price estimated that pastured dairy contains up to 50 times more vitamin K2 than grain-fed dairy. He summarized his findings in the classic book Nutrition and Physical Degeneration. This finding has not been repeated in recent times, but I have a little hunch that may change soon...
Vitamin K2
Cardiovascular Disease and Vitamin K2
Can Vitamin K2 Reverse Arterial Calcification?
Cows grazing pasture and receiving no supplemental feed had 500% more conjugated linoleic acid in milk fat than cows fed typical dairy diets.Fat from ruminants such as cows, sheep and goats is the main source of CLA in the human diet. CLA is fat-soluble. Therefore, skim milk doesn't contain any. It's also present in human body fat in proportion to dietary intake. This can come from dairy or flesh.
In a recent article from the AJCN, Dr. Liesbeth Smit and colleagues examined the level of CLA in the body fat of Costa Rican adults who had suffered a heart attack, and compared it to another group who had not (a case-control study, for the aficionados). People with the highest level of CLA in their body fat were 49% less likely to have had a heart attack, compared to those with the lowest level (2).
Since dairy was the main source of CLA in this population, the association between CLA and heart attack risk is inextricable from the other components in pastured dairy fat. In other words, CLA is simply a marker of pastured dairy fat intake in this population, and the (possible) benefit could just as easily have come from vitamin K2 or something else in the fat.
This study isn't the first one to suggest that pastured dairy fat may be uniquely protective. The Rotterdam and EPIC studies found that a higher vitamin K2 intake is associated with a lower risk of heart attack, cancer and overall mortality (3, 4, 5). In the 1940s, Dr. Weston Price estimated that pastured dairy contains up to 50 times more vitamin K2 than grain-fed dairy. He summarized his findings in the classic book Nutrition and Physical Degeneration. This finding has not been repeated in recent times, but I have a little hunch that may change soon...
Vitamin K2
Cardiovascular Disease and Vitamin K2
Can Vitamin K2 Reverse Arterial Calcification?
Getting the garden ready
We got a lot of early spring crops in our garden that just grew back with the weeds: spinach, dill, mustard greens, kale, chives and mint. But it's time to plant, so I harvested a bunch of them, then Marilyn weeded the garden, and I tilled it:
Now we are ready for planting, yea!
Lest I give the impression I do a lot of yard work, I will admit this is one of the few tasks I do in the yard. I also turn over the compost and spread it in the garden twice a year (did that yesterday). And I harvest the produce. This tiller is a great piece of equipment, even though it uses gasoline and pollutes. It makes life so much easier and does a much better job than we can do with a pitchfork. Our garden has grown to 24' x 14'. It's great!
Easy no-bake "Baked beans"
This is one of those accidental inventions. I was saving time by preparing my beans the night before and then cooking the next morning. And when they were done, they looked and tasted like baked beans! with no added sugar!
Ingredients:
Juice from 5 lbs of carrots
1-3 cups water
1 lb (16 oz, 453 g) white or yellow beans
1 medium onion
2 parsnips (optional)
The night before: Rinse the beans. Juice the carrots and add to the beans. Add water to cover with an inch or two on top. Chop the onion and add. Peel and chop the parsnips and add. Let them soak overnight in the fridge. Next morning: put on the stove and cook for 2-4 hours, to desired tenderness. You'll probably need to add 1-2 cups water. The carrot juice makes them look orange, just like baked beans:
The carrot juice and parsnips make them nice and sweet. Yum! The parsnips even look kinda like those blobs of bacon you get in the canned beans, but they don't taste like it! (which for me is a good thing).
Note: you can make this with any other kind of beans and just call the result "sweet beans" or something. I think I'll be making this a lot.
Guest Commentary: Public Health will Benefit from Health Care Reform Legislation
Rob Simmons, DrPH, MPH, CHES, CPH
Director, MPH Program
Jefferson School of Population Health
After over a year of national debate and discussion, earlier this spring President Obama signed into law The Patient Protection and Affordable Care Act and its accompanying law, the Health Care and Education Reconciliation Act of 2010. Whatever one’s view of the law’s global impact on health care in the US and the cost for the provision of such care, it is very clear that public health and health promotion will be positively impacted by the new law.
Some of the highlights of the new health law include:
• Expanded prevention benefits in private insurance policies, Medicare, and Medicaid that cover annual wellness visits, a personalized prevention plan, and evidenced-based health screening services with no deductibles and co-pays
• Risk reduction services including weight management, nutrition services, physical activity incentives, and smoking cessation
• Grants to small businesses to provide worksite-based wellness programs and services
• Chronic disease prevention and management services in such areas as diabetes control and obesity prevention
• Public health infrastructure and workforce recruitment and retention programs
• Training for mid-career public and allied health professionals
• Expansion of community health centers and a national health service corps
• Oral health public education campaign and demonstration projects
• Increased emphasis on breastfeeding
• Nutrition labeling of standard menu items in all chain restaurants
• Enhanced drug coverage for seniors by closing the “donut hole” for Medicare Part D
• Increased grants for college education that will help to expand the public health and healthcare workforce and increase its diversity
The public health provisions of the new law did not receive much media attention compared to other components of the health reform law. Yet, they will provide much-needed services for public health and preventive health that have been reduced over the past decade. Speaking as a member of the public health community, it could not have come soon enough.
Director, MPH Program
Jefferson School of Population Health
After over a year of national debate and discussion, earlier this spring President Obama signed into law The Patient Protection and Affordable Care Act and its accompanying law, the Health Care and Education Reconciliation Act of 2010. Whatever one’s view of the law’s global impact on health care in the US and the cost for the provision of such care, it is very clear that public health and health promotion will be positively impacted by the new law.
Some of the highlights of the new health law include:
• Expanded prevention benefits in private insurance policies, Medicare, and Medicaid that cover annual wellness visits, a personalized prevention plan, and evidenced-based health screening services with no deductibles and co-pays
• Risk reduction services including weight management, nutrition services, physical activity incentives, and smoking cessation
• Grants to small businesses to provide worksite-based wellness programs and services
• Chronic disease prevention and management services in such areas as diabetes control and obesity prevention
• Public health infrastructure and workforce recruitment and retention programs
• Training for mid-career public and allied health professionals
• Expansion of community health centers and a national health service corps
• Oral health public education campaign and demonstration projects
• Increased emphasis on breastfeeding
• Nutrition labeling of standard menu items in all chain restaurants
• Enhanced drug coverage for seniors by closing the “donut hole” for Medicare Part D
• Increased grants for college education that will help to expand the public health and healthcare workforce and increase its diversity
The public health provisions of the new law did not receive much media attention compared to other components of the health reform law. Yet, they will provide much-needed services for public health and preventive health that have been reduced over the past decade. Speaking as a member of the public health community, it could not have come soon enough.
Malocclusion Posts Translated into German
It's nice to see on my website statistics program that Whole Health Source has a solid international following. As commonly as English is spoken throughout the world however, there are many people who do not have access to this blog due to a language barrier.
A gentleman by the name of Bertram has translated/summarized my series on the causes and prevention of malocclusion (misaligned teeth) into German. His site is OriginalHealth.net, and you can find the first post here, with links to the subsequent 8. It looks like an interesting site-- I wish I could read German. Thanks Bertram!
A gentleman by the name of Bertram has translated/summarized my series on the causes and prevention of malocclusion (misaligned teeth) into German. His site is OriginalHealth.net, and you can find the first post here, with links to the subsequent 8. It looks like an interesting site-- I wish I could read German. Thanks Bertram!
Intervew with Chris Kresser of The Healthy Skeptic
Last week, I did an audio interview with Chris Kresser of The Healthy Skeptic, on the topic of obesity. We put some preparation into it, and I think it's my best interview yet. Chris was a gracious host. We covered some interesting ground, including (list copied from Chris's post):
- The little known causes of the obesity epidemic
- Why the common weight loss advice to “eat less and exercise more” isn’t effective
- The long-term results of various weight loss diets (low-carb, low-fat, etc.)
- The body-fat setpoint and its relevance to weight regulation
- The importance of gut flora in weight regulation
- The role of industrial seed oils in the obesity epidemic
- Obesity as immunological and inflammatory disease
- Strategies for preventing weight gain and promoting weight loss
spring food
The produce at the co-op has changed with the spring season and it is wonderful. The fresh strawberries from California have been cheap and delicious. They really taste better this time of year. This is one fruit you should buy organic (see this post from diseaseproof.com). I've been buying these as often as I can get to the store, because the season (when it's really good) is temporary. I've been eating them with blackberries which have also been good.
I've also been enjoying sugar snap peas, and local spinach and lettuce greens and arugula. We had local asparugus but that is gone again. But the California asparagus is good right now. Sadly, the local carrots disappeared from the store a few days ago. We get them about 9 months of the year, so that's good. I bought some California carrots and they tasted like chlorine even though they are organic. Yuck. So I think I'm done with eating raw carrots for a while. Maybe I'll juice them and add them to beans. We've also had morel mushrooms for a couple of weeks. Those were great! I'm still trying to adjust my tastes to like shitake mushrooms because Dr. Fuhrman says they are way more nutritious than the white button, cremini and portabella. So I welcomed the morel mushrooms. I just got some fresh California zucchini today--I'll see how that tastes this week. The bok choy, kale, and collard greens are usually wilted by the time we get them here in Wisconsin. But today's baby bok choy looked good so I bought several. I can't wait to get kale and collards from our garden, or locally--those are much better. It's fun watching the California, Florida, and local produce start to come in with the spring/summer season. You can tell when it's fresh and abundant because they are cheaper and often on special. I used to think that meant there was something wrong with them, but I had it all wrong--that's when they are best.
This week's updates
I'm not spending as much time in the kitchen as I have a new obsession: road and mountain biking. This week, some days were mostly raw, with micro-salad for brekky and lunch, and cabbage salad for lunch and dinner, along with fruit and seeds in various forms (frozen, or fresh strawberries) for extra treats. Other days I had micro-salad for breakfast and lunch, and cooked veggies for lunch and dinner.
There were several good posts on Dr. Fuhrman's Disease proof blog the last few weeks. For example, a quick overview of what foods to eat (health-promoting) and what to avoid (disease-promoting); junk food desensitizes the brain; refined carbs increase heart disease risk; and several good posts by Emily Boller with success strategies and interviews. Also, there's a great radio interview with Dr. Fuhrman here.
cooked veggies
I don't use recipes much, so this is just an example of what I made today from food in my fridge.
Ingredients:
1/2 medium eggplant, peeled and chopped
1 small (or bigger) onion, chopped
1 16-oz can tomatoes
4-8 oz shitake mushrooms
1 bunch kale, chopped
brussels sprouts, 12 oz in this case
1 parsnip, peeled and chopped
1 Tbsp sunflower seeds + 1 Tbsp sesame seeds, ground
1/4 cup raisins (I'm guessing--I added an unripe white peach instead and didn't like it, so next time I will try raisins or an apple)
1 cup beans
1/2 tsp each of some spices--I tried cumin, garam masala, and curry (felt like an Indian flavor)
fresh herbs if you have them--right now, it's cilantro, chives, and dill
1 Tbsp flavored vinegar (e.g., spicy pecan, or pomegranate balsamic)
Combine everything in the pressure cooker except the raisins, beans, ground seeds, and tomatoes. Cook for 2 minutes at high pressure, let set for a few minutes before letting out pressure (cooks them longer). Then add the raisins, beans, and tomatoes--also helps cool it down. It's pretty good. I'm not sure what spices work best, was just experimenting.
Breakfast micro-salad
Here's a salad I made several times this week. It was so filling I often spread it out to lunch even though it has under 500 calories.
Maybe it doesn't look the greatest but it takes a longer time to eat if you don't chop it down with the food processor. I like it both ways.
Ingredients:
Lettuce and/or spinach, 5-10 oz
cauliflower and/or broccoli (optional), 0.5-1.5 lbs
Fresh herbs if you want (e.g., chives, dill, cilantro), optional, I just do this when I have some in the garden
lime juice, from one lime
fresh berries if in season, otherwise frozen (16 oz)--This time of year it's fresh strawberries and blackberries, very yummy. But I don't shop every day so other days it's frozen cherries and blueberries or banana, etc.
1 orange, peeled
1/2 cup edamame (optional)
1 Tbsp seeds (e.g., sunflower, chia, flax, hemp) (optional)
I chop everything except the seeds, edamame and lime in the food processor. I grind the seeds in the coffee grinder, juice the lime, and add them. You can chop the edamame in the food processor too.
ice cream????
Sometimes I like my "ice cream" chunky. Here's some frozen mango, banana, and cherries topped with 1 Tbsp sunflower seeds. It was yummy. Frozen fruit tastes great. And without blending them, you get to taste the flavors separately.
Guest Commentary: Let's Get Moving
Laura Kimberly, MSW, MBE
Director of Special Projects
Jefferson School of Population Health
Prevention and wellness seem to be two of the health care reform buzzwords of the moment. Yet some of the efforts currently underway across the country indicate that a tremendous amount of energy is being devoted to thinking about the future and how best to create healthy communities where people thrive.
As we all know, physical activity is an important component of wellness, particularly in the face of rising rates of obesity and other associated chronic conditions. On May 3rd, the U.S. National Physical Activity Plan was released by an expert panel, including representation from the Centers for Disease Control and Prevention, the American College of Sports Medicine, the American Heart Association and the American Cancer Society.
Philadelphia was the first city to formally endorse the plan, and on May 11th JSPH hosted an event entitled Moving Philadelphia! Creating Healthier Communities. The campus green was abuzz with exhibitors and physical activities for children and adults, including an outdoor spinning class, followed by presentations on physical activity and the built environment.
On behalf of Mayor Michael Nutter, Dr. Don Schwarz, Deputy Mayor for Health and Opportunity and Health Commissioner for the City of Philadelphia, presented a proclamation declaring May 11, 2010 Moving Philadelphia Day.
In his keynote address, Dr. Schwarz discussed Philadelphia’s high rate of obesity and the many hidden costs associated with obesity and chronic conditions. He offered a particularly compelling example: at Children’s Hospital of Philadelphia, children too large for the CT scan machines in the hospital must be transported to the city’s zoo to use scanners designed for large animals. Dr. Schwarz noted the link between low physical activity levels and the built environment, stressing that communities must be made safer and more accessible to encourage recreation. To this end, as part of a Comprehensive Streets Plan, Philadelphia is working hard to increase bicycle and pedestrian traffic and reduce reliance on cars.
Other noted speakers included Allison Kleinfelter from the National Coalition for Promoting Physical Activity and Founder and CEO of achievABILITY, who discussed the U.S. National Physical Activity Plan in detail, and Richard Killingsworth, Senior Advisor at Nemours Health and Prevention Services, who explored the impact of the built environment on health and wellness. Both speakers issued a call to action, not just to policy makers and other key leaders and decision makers, but also to local grassroots organizations and to each and every individual. The push for change must come from each of these levels if we truly want to get our country moving!
What do you think about physical activity and the environments in which people live? Can we get people moving? To learn more about the U.S. National Physical Activity Plan, please visit http://www.ncppa.org/resources/plans/.
Director of Special Projects
Jefferson School of Population Health
Prevention and wellness seem to be two of the health care reform buzzwords of the moment. Yet some of the efforts currently underway across the country indicate that a tremendous amount of energy is being devoted to thinking about the future and how best to create healthy communities where people thrive.
As we all know, physical activity is an important component of wellness, particularly in the face of rising rates of obesity and other associated chronic conditions. On May 3rd, the U.S. National Physical Activity Plan was released by an expert panel, including representation from the Centers for Disease Control and Prevention, the American College of Sports Medicine, the American Heart Association and the American Cancer Society.
Philadelphia was the first city to formally endorse the plan, and on May 11th JSPH hosted an event entitled Moving Philadelphia! Creating Healthier Communities. The campus green was abuzz with exhibitors and physical activities for children and adults, including an outdoor spinning class, followed by presentations on physical activity and the built environment.
On behalf of Mayor Michael Nutter, Dr. Don Schwarz, Deputy Mayor for Health and Opportunity and Health Commissioner for the City of Philadelphia, presented a proclamation declaring May 11, 2010 Moving Philadelphia Day.
In his keynote address, Dr. Schwarz discussed Philadelphia’s high rate of obesity and the many hidden costs associated with obesity and chronic conditions. He offered a particularly compelling example: at Children’s Hospital of Philadelphia, children too large for the CT scan machines in the hospital must be transported to the city’s zoo to use scanners designed for large animals. Dr. Schwarz noted the link between low physical activity levels and the built environment, stressing that communities must be made safer and more accessible to encourage recreation. To this end, as part of a Comprehensive Streets Plan, Philadelphia is working hard to increase bicycle and pedestrian traffic and reduce reliance on cars.
Other noted speakers included Allison Kleinfelter from the National Coalition for Promoting Physical Activity and Founder and CEO of achievABILITY, who discussed the U.S. National Physical Activity Plan in detail, and Richard Killingsworth, Senior Advisor at Nemours Health and Prevention Services, who explored the impact of the built environment on health and wellness. Both speakers issued a call to action, not just to policy makers and other key leaders and decision makers, but also to local grassroots organizations and to each and every individual. The push for change must come from each of these levels if we truly want to get our country moving!
What do you think about physical activity and the environments in which people live? Can we get people moving? To learn more about the U.S. National Physical Activity Plan, please visit http://www.ncppa.org/resources/plans/.
Sometimes You Just Get Lucky
I went fishing last Saturday on Fidalgo island with some friends.
That's a picture of the trophy minnow I caught after a full day of fishing. I'm thinking about having it mounted.
We made out a little better the next day.
Here are two of my other hunter-gatherer adventures for those who are interested:
Foraging
Hunting
That's a picture of the trophy minnow I caught after a full day of fishing. I'm thinking about having it mounted.
We made out a little better the next day.
Here are two of my other hunter-gatherer adventures for those who are interested:
Foraging
Hunting
Saturated Fat and Insulin Sensitivity, Again
A new study was recently published exploring the effect of diet composition on insulin sensitivity and other factors in humans (1). 29 men with metabolic syndrome-- including abdominal obesity, low HDL, high blood pressure, high triglycerides, and high fasting glucose-- were fed one of four diets for 12 weeks:
The paper that's typically cited by people who wish to defend the idea that saturated fat impairs insulin sensitivity is the KANWU study (3). In this study, investigators found no significant difference in insulin sensitivity between volunteers fed primarily SFA or MUFA for 12 weeks. You wouldn't realize this from the abstract however; you have to look very closely at the p-values in table 4.
One of the questions one could legitimately ask, however, is whether SFA have a different effect on people with metabolic syndrome. Maybe the inflammation and metabolic problems they already have make them more sensitive to the hypothetical damaging effects of SFA? That's the question the first study addressed, and it appears that SFA are not uniquely harmful to insulin signaling in those with metabolic syndrome on the timescale tested.
It also showed that the different diets did not alter the proportion of blood fats being burned in muscle, as opposed to being stored in fat tissue. The human body is a remarkably adaptable biological machine that can make the best of a variety of nutrient inputs, at least over the course of 12 weeks. Metabolic damage takes decades to accumulate, and in my opinion is more dependent on food quality than macronutrient composition. Once metabolic dysfunction is established, some people may benefit from carbohydrate restriction, however.
- A diet containing 38% fat: 16% saturated (SFA), 12% monounsaturated (MUFA) and 6% polyunsaturated (PUFA)
- A diet containing 38% fat: 8% SFA, 20% MUFA and 6% PUFA
- A diet high in unrefined carbohydrate, containing 28% fat (8% SFA, 11% MUFA and 6% PUFA)
- A diet high in unrefined carbohydrate, containing 28% fat (8% SFA, 11% MUFA and 6% PUFA) and an omega-3 supplement (1.24 g/day EPA and DHA)
The paper that's typically cited by people who wish to defend the idea that saturated fat impairs insulin sensitivity is the KANWU study (3). In this study, investigators found no significant difference in insulin sensitivity between volunteers fed primarily SFA or MUFA for 12 weeks. You wouldn't realize this from the abstract however; you have to look very closely at the p-values in table 4.
One of the questions one could legitimately ask, however, is whether SFA have a different effect on people with metabolic syndrome. Maybe the inflammation and metabolic problems they already have make them more sensitive to the hypothetical damaging effects of SFA? That's the question the first study addressed, and it appears that SFA are not uniquely harmful to insulin signaling in those with metabolic syndrome on the timescale tested.
It also showed that the different diets did not alter the proportion of blood fats being burned in muscle, as opposed to being stored in fat tissue. The human body is a remarkably adaptable biological machine that can make the best of a variety of nutrient inputs, at least over the course of 12 weeks. Metabolic damage takes decades to accumulate, and in my opinion is more dependent on food quality than macronutrient composition. Once metabolic dysfunction is established, some people may benefit from carbohydrate restriction, however.
Guest Commentary: Employer-Based Wellness Programs - Is There A Long-Term Benefit?
Neil I. Goldfarb
Associate Dean for Research
Jefferson School of Population Health
Last Thursday, the Jefferson School of Population Health hosted Dr. Dee Edington, University of Michigan Health Management Resource Center, as the 19th annual Grandon Lecture speaker. Dr. Edington is one of the nation’s leading researchers on health and wellness programs. Many of us prepared for Dr. Edington’s visit by reading his latest book, Zero Trends: Health as a Serious Economic Strategy. Among Dr. Edington’s key recommendations: “keep the healthy people healthy,” and focusing with patients on the message of “don’t get worse,” is more feasible and likely to have more impact than telling them to lose 50 pounds or make other dramatic changes in lifestyle.
The School’s Employer Research Interest Group had the opportunity to spend some private time with Dr. Edington discussing his work and exploring future directions for our own research initiatives in the employer wellness space.
One of the key questions that continues to trouble me is whether employer-based wellness programs are cost-saving, from a societal perspective, i.e. a growing body of evidence demonstrates the potential of wellness initiatives to help employers achieve a “zero trend” in their health-related spending, but does this translate into lifetime savings from a societal perspective?
Dr. Edington concurred that employers are focused on avoiding costs during the employment years; what happens, from a cost perspective, once employees retire and hit Medicare is of little concern (to them). I certainly would not argue against any programs that extend years of productivity or quality of life, but unless we change our approach to delivering high-cost, often-unnecessary, services toward the end of life, today’s big push in wellness may lead to tomorrow’s budget-busted Medicare program.
Implementing and evaluating wellness programs is just one of several topics covered in our College for Value-based Purchasing of Health Benefits, a training program for employee benefit managers that we have offered since 2004 in collaboration with the National Business Coalition on Health and the HealthCare21 Business Coalition of Tennessee (www.cvbp.org). We will offer the College for the 14th time in Philadelphia this summer, July 19-21, with a special parallel track for pharmaceutical industry account managers and others who work routinely with employers. For more information, please contact me at neil.goldfarb@jefferson.edu.
Associate Dean for Research
Jefferson School of Population Health
Last Thursday, the Jefferson School of Population Health hosted Dr. Dee Edington, University of Michigan Health Management Resource Center, as the 19th annual Grandon Lecture speaker. Dr. Edington is one of the nation’s leading researchers on health and wellness programs. Many of us prepared for Dr. Edington’s visit by reading his latest book, Zero Trends: Health as a Serious Economic Strategy. Among Dr. Edington’s key recommendations: “keep the healthy people healthy,” and focusing with patients on the message of “don’t get worse,” is more feasible and likely to have more impact than telling them to lose 50 pounds or make other dramatic changes in lifestyle.
The School’s Employer Research Interest Group had the opportunity to spend some private time with Dr. Edington discussing his work and exploring future directions for our own research initiatives in the employer wellness space.
One of the key questions that continues to trouble me is whether employer-based wellness programs are cost-saving, from a societal perspective, i.e. a growing body of evidence demonstrates the potential of wellness initiatives to help employers achieve a “zero trend” in their health-related spending, but does this translate into lifetime savings from a societal perspective?
Dr. Edington concurred that employers are focused on avoiding costs during the employment years; what happens, from a cost perspective, once employees retire and hit Medicare is of little concern (to them). I certainly would not argue against any programs that extend years of productivity or quality of life, but unless we change our approach to delivering high-cost, often-unnecessary, services toward the end of life, today’s big push in wellness may lead to tomorrow’s budget-busted Medicare program.
Implementing and evaluating wellness programs is just one of several topics covered in our College for Value-based Purchasing of Health Benefits, a training program for employee benefit managers that we have offered since 2004 in collaboration with the National Business Coalition on Health and the HealthCare21 Business Coalition of Tennessee (www.cvbp.org). We will offer the College for the 14th time in Philadelphia this summer, July 19-21, with a special parallel track for pharmaceutical industry account managers and others who work routinely with employers. For more information, please contact me at neil.goldfarb@jefferson.edu.
Baby's Not Born as "Blank Slate" says Study
As Dennis Prager always says, studies either prove what we already know or they're wrong. In this case, this study proves what Christians have always taught: We are born sinners, or as the study says "the difference between good and bad may be hardwired into the brain at
birth."
birth."
healthy black bean salad
Despite all the healthy stuff in here, my guests enjoyed it too. I brought this to a potluck tonight.
Ingredients:
1 lb dried black beans (I was out, so used Rancho Gordo vaquero beans--they are black and white), or 2 cans
1 bunch kale, frozen
juice of 1 lime
flavored vinegar (optional)
1 stalk broccoli
1-2 cups cauliflower
1 red bell pepper
fruit--10 oz frozen or fresh mango, or apple, orange, pear in any combination, maybe 12-16 oz total
some cilantro and/or chives
10 oz bag of frozen corn
1 tsp cumin
1/2 tsp cinnamon
Cook the beans if dried (soak overnight first, cook for a few hours), drain. Add the corn which will thaw the corn and cool the beans. Remove the kale from the freezer and crinkle right away with your hands (shatters into small pieces so save chopping time!). Add the lime juice and some vinegar to the kale. Chop the rest of the ingredients in a food processor, combine everything in a big bowl. Serve and enjoy!
I forgot to take a picture of the final product but here's the beans and the corn before draining:
and here's the veggies after chopping in the microprocessor:
Then they were all combined. It was good and filling!
Guest Commentary: Reducing Health Care Disparities Through HIT
M. Chris Gibbons, MD, MPH
Associate Director, Johns Hopkins Urban Health Institute
Assistant Professor, Public Health and Medicine
Johns Hopkins Medical Institutions
Over the past decade a rapidly expanding body of literature has demonstrated the existence of disparities in health and health care. While consensus has not emerged regarding the causes of disparities, they are generally thought to be related to sociocultural, behavioral, economic, environmental, biologic, or societal factors.
To effectively address disparities, several authorities have suggested the need for greater information technology research and investments. As information technology plays an ever-increasing role in Americans' economic and social lives, the potential health implications of these findings need to be more clearly evaluated because the prospect that some people will be left behind in the information age could leave some groups less able to take advantage of cutting edge innovations and thereby increase rather than decrease disparities.
Recent advances in the computer sciences and information technology fields have spawned several methodological advances in the biological and molecular sciences. In like manner, the behavioral and population sciences may be on the verge of a similar information technology–based scientific revolution. New eHealth solutions may soon permit the real-time integrative utilization of vast amounts of behavioral-, biological-, and community-level information in ways not previously possible. Technology may also function as an interventional agent to help treat disease and address disparities, not just as an analytic agent to enhance our understanding. As such, we may one day be able to deliver high quality care to anybody, anytime, anywhere, and significantly reduce or even eliminate disparities in the process.
To access a podcast of Dr. Gibbon's recent presentation at the Jefferson School of Population Health, please visit the following link and click on the 'download' button on the right side of the page: http://jdc.jefferson.edu/hpforum/46/
Associate Director, Johns Hopkins Urban Health Institute
Assistant Professor, Public Health and Medicine
Johns Hopkins Medical Institutions
Over the past decade a rapidly expanding body of literature has demonstrated the existence of disparities in health and health care. While consensus has not emerged regarding the causes of disparities, they are generally thought to be related to sociocultural, behavioral, economic, environmental, biologic, or societal factors.
To effectively address disparities, several authorities have suggested the need for greater information technology research and investments. As information technology plays an ever-increasing role in Americans' economic and social lives, the potential health implications of these findings need to be more clearly evaluated because the prospect that some people will be left behind in the information age could leave some groups less able to take advantage of cutting edge innovations and thereby increase rather than decrease disparities.
Recent advances in the computer sciences and information technology fields have spawned several methodological advances in the biological and molecular sciences. In like manner, the behavioral and population sciences may be on the verge of a similar information technology–based scientific revolution. New eHealth solutions may soon permit the real-time integrative utilization of vast amounts of behavioral-, biological-, and community-level information in ways not previously possible. Technology may also function as an interventional agent to help treat disease and address disparities, not just as an analytic agent to enhance our understanding. As such, we may one day be able to deliver high quality care to anybody, anytime, anywhere, and significantly reduce or even eliminate disparities in the process.
To access a podcast of Dr. Gibbon's recent presentation at the Jefferson School of Population Health, please visit the following link and click on the 'download' button on the right side of the page: http://jdc.jefferson.edu/hpforum/46/
Traditional Preparation Methods Improve Grains' Nutritive Value
Soaking or Germinating Grains
The most basic method of preparing grains is prolonged soaking in water, followed by cooking. This combination reduces the level of water-soluble and heat-sensitive toxins and anti-nutrients such as tannins, saponins, digestive enzyme inhibitors and lectins, as well as flatulence factors. It also partially degrades phytic acid, which is a potent inhibitor of mineral absorption, an inhibitor of the digestive enzyme trypsin and an enemy of dental health (1). This improves the digestibility and nutritional value of grains as well as legumes.
I prefer to soak all grains and legumes for at least 12 hours in a warm location, preferably 24. This includes foods that most people don't soak, such as lentils. Soaking does not reduce phytic acid at all in grains that have been heat-treated, such as oats and kasha (technically not a grain), because they no longer contain the phytic acid-degrading enzyme phytase. Cooking without soaking first also does not have much effect on phytic acid.
The next level of grain preparation is germination. After soaking, rinse the grains twice per day for an additional day or two. This activates the grains' sprouting program and further increases their digestibility and vitamin content. When combined with cooking, it reduces phytic acid, although modestly. Therefore, most of the minerals in sprouted whole grains will continue to be inaccessible. Many raw sprouted grains and legumes are edible, but I wouldn't use them as a staple food because they retain most of their phytic acid as well as some heat-sensitive anti-nutrients (2).
Grinding and Fermenting Grains
Many cultures around the world have independently discovered fermentation as a way to greatly improve the digestibility and nutritive value of grains (3). Typically, grains are soaked, ground, and allowed to sour ferment for times ranging from 12 hours to several days. In some cases, a portion of the bran is removed before or after grinding.
In addition to the reduction in toxins and anti-nutrients afforded by soaking and cooking, grinding and fermentation goes much further. Grinding greatly increases the surface area of the grains and breaks up their cellular structure, releasing enzymes which are important for the transformation to come. Under the right conditions, which are easy to achieve, lactic acid bacteria rapidly acidify the batter. These bacteria are naturally present on grains, but adding a starter makes the process more efficient and reliable.
Due to some quirk of nature, grain phytase is maximally active at a pH of between 4.5 and 5.5, which is mildly acidic. This is why the Weston Price foundation recommends soaking grains in an acidic medium before cooking. The combination of grinding and sour fermentation causes grains to efficiently degrade their own phytic acid (as long as they haven't been heat treated first), making minerals much more available for absorption (4, 5, 6, 7). This transforms whole grains from a poor source of minerals into a good source.
The degree of phytic acid degradation depends on the starting amount of phytase in the grain. Corn, rice, oats and millet don't contain much phytase activity, so they require either a longer fermentation time, or the addition of high-phytase grains to the batter (8). Whole raw buckwheat, wheat, and particularly rye contain a large amount of phytase (9), although I feel wheat is problematic for other reasons.
As fermentation proceeds, bacteria secrete enzymes that begin digesting the protein, starch and other substances in the batter. Fermentation reduces lectin levels substantially, which are reduced further by cooking (10). Lectins are toxins that can interfere with digestion and may be involved in autoimmune disease, an idea championed by Dr. Loren Cordain. Grain lectins are generally heat-sensitive, but one notable exception is the nasty lectin wheat germ agglutinin (WGA). As its name suggests, WGA is found in wheat germ, and thus is mostly absent in white flour. WGA may have been another reason why DART participants who increased their wheat fiber intake had significantly more heart attacks than those who didn't. I don't know if fermentation degrades WGA.
One of the problems with grains is their poor protein quality. Besides containing a fairly low concentration of protein to begin with, they also don't contain a good balance of essential amino acids. This prevents their efficient use by the body, unless a separate source of certain amino acids is eaten along with them. The main limiting amino acid in grains is lysine. Legumes are rich in lysine, which is why cultures around the world pair them with grains. Bacterial fermentation produces lysine, often increasing its concentration by many fold and making grains nearly a "complete protein", i.e. one that contains the ideal balance of essential amino acids as do animal proteins (11, scroll down to see graph). Not very many plant foods can make that claim. Fermentation also increases the concentration of the amino acid methionine and certain vitamins.
Another problem with grain protein is it's poorly digested relative to animal protein. This means that a portion of it escapes digestion, leading to a lower nutritive value and a higher risk of allergy due to undigested protein hanging around in the digestive tract. Fermentation followed by cooking increases the digestibility of grain protein, bringing it nearly to the same level as meat (12, 13, 14, 15). This may relate to the destruction of protease inhibitors (trypsin inhibitors, phytic acid) and the partial pre-digestion of grain proteins by bacteria.
Once you delve into the research on traditional grain preparation methods, you begin to see why grain-eating cultures throughout the world have favored certain techniques. Proper grain processing transforms them from toxic to nutritious, from health-degrading to health-giving. Modern industrial grain processing has largely eschewed these time-honored techniques, replacing them with low-extraction milling, extrusion and quick-rise yeast strains.
Many people will not be willing to go through the trouble of grinding and fermentation to prepare grains. I can sympathize, although if you have the right tools, once you establish a routine it really isn't that much work. It just requires a bit of organization. In fact, it can even be downright convenient. I often keep a bowl of fermented dosa or buckwheat batter in the fridge, ready to make a tasty "pancake" at a moment's notice. In the next post, I'll describe a few recipes from different parts of the world.
Further reading:
How to Eat Grains
A Few Thoughts on Minerals, Milling, Grains and Tubers
Dietary Fiber and Mineral Availability
A New Way to Soak Brown Rice
The most basic method of preparing grains is prolonged soaking in water, followed by cooking. This combination reduces the level of water-soluble and heat-sensitive toxins and anti-nutrients such as tannins, saponins, digestive enzyme inhibitors and lectins, as well as flatulence factors. It also partially degrades phytic acid, which is a potent inhibitor of mineral absorption, an inhibitor of the digestive enzyme trypsin and an enemy of dental health (1). This improves the digestibility and nutritional value of grains as well as legumes.
I prefer to soak all grains and legumes for at least 12 hours in a warm location, preferably 24. This includes foods that most people don't soak, such as lentils. Soaking does not reduce phytic acid at all in grains that have been heat-treated, such as oats and kasha (technically not a grain), because they no longer contain the phytic acid-degrading enzyme phytase. Cooking without soaking first also does not have much effect on phytic acid.
The next level of grain preparation is germination. After soaking, rinse the grains twice per day for an additional day or two. This activates the grains' sprouting program and further increases their digestibility and vitamin content. When combined with cooking, it reduces phytic acid, although modestly. Therefore, most of the minerals in sprouted whole grains will continue to be inaccessible. Many raw sprouted grains and legumes are edible, but I wouldn't use them as a staple food because they retain most of their phytic acid as well as some heat-sensitive anti-nutrients (2).
Grinding and Fermenting Grains
Many cultures around the world have independently discovered fermentation as a way to greatly improve the digestibility and nutritive value of grains (3). Typically, grains are soaked, ground, and allowed to sour ferment for times ranging from 12 hours to several days. In some cases, a portion of the bran is removed before or after grinding.
In addition to the reduction in toxins and anti-nutrients afforded by soaking and cooking, grinding and fermentation goes much further. Grinding greatly increases the surface area of the grains and breaks up their cellular structure, releasing enzymes which are important for the transformation to come. Under the right conditions, which are easy to achieve, lactic acid bacteria rapidly acidify the batter. These bacteria are naturally present on grains, but adding a starter makes the process more efficient and reliable.
Due to some quirk of nature, grain phytase is maximally active at a pH of between 4.5 and 5.5, which is mildly acidic. This is why the Weston Price foundation recommends soaking grains in an acidic medium before cooking. The combination of grinding and sour fermentation causes grains to efficiently degrade their own phytic acid (as long as they haven't been heat treated first), making minerals much more available for absorption (4, 5, 6, 7). This transforms whole grains from a poor source of minerals into a good source.
The degree of phytic acid degradation depends on the starting amount of phytase in the grain. Corn, rice, oats and millet don't contain much phytase activity, so they require either a longer fermentation time, or the addition of high-phytase grains to the batter (8). Whole raw buckwheat, wheat, and particularly rye contain a large amount of phytase (9), although I feel wheat is problematic for other reasons.
As fermentation proceeds, bacteria secrete enzymes that begin digesting the protein, starch and other substances in the batter. Fermentation reduces lectin levels substantially, which are reduced further by cooking (10). Lectins are toxins that can interfere with digestion and may be involved in autoimmune disease, an idea championed by Dr. Loren Cordain. Grain lectins are generally heat-sensitive, but one notable exception is the nasty lectin wheat germ agglutinin (WGA). As its name suggests, WGA is found in wheat germ, and thus is mostly absent in white flour. WGA may have been another reason why DART participants who increased their wheat fiber intake had significantly more heart attacks than those who didn't. I don't know if fermentation degrades WGA.
One of the problems with grains is their poor protein quality. Besides containing a fairly low concentration of protein to begin with, they also don't contain a good balance of essential amino acids. This prevents their efficient use by the body, unless a separate source of certain amino acids is eaten along with them. The main limiting amino acid in grains is lysine. Legumes are rich in lysine, which is why cultures around the world pair them with grains. Bacterial fermentation produces lysine, often increasing its concentration by many fold and making grains nearly a "complete protein", i.e. one that contains the ideal balance of essential amino acids as do animal proteins (11, scroll down to see graph). Not very many plant foods can make that claim. Fermentation also increases the concentration of the amino acid methionine and certain vitamins.
Another problem with grain protein is it's poorly digested relative to animal protein. This means that a portion of it escapes digestion, leading to a lower nutritive value and a higher risk of allergy due to undigested protein hanging around in the digestive tract. Fermentation followed by cooking increases the digestibility of grain protein, bringing it nearly to the same level as meat (12, 13, 14, 15). This may relate to the destruction of protease inhibitors (trypsin inhibitors, phytic acid) and the partial pre-digestion of grain proteins by bacteria.
Once you delve into the research on traditional grain preparation methods, you begin to see why grain-eating cultures throughout the world have favored certain techniques. Proper grain processing transforms them from toxic to nutritious, from health-degrading to health-giving. Modern industrial grain processing has largely eschewed these time-honored techniques, replacing them with low-extraction milling, extrusion and quick-rise yeast strains.
Many people will not be willing to go through the trouble of grinding and fermentation to prepare grains. I can sympathize, although if you have the right tools, once you establish a routine it really isn't that much work. It just requires a bit of organization. In fact, it can even be downright convenient. I often keep a bowl of fermented dosa or buckwheat batter in the fridge, ready to make a tasty "pancake" at a moment's notice. In the next post, I'll describe a few recipes from different parts of the world.
Further reading:
How to Eat Grains
A Few Thoughts on Minerals, Milling, Grains and Tubers
Dietary Fiber and Mineral Availability
A New Way to Soak Brown Rice
The Message of the Gospel is Not "Behave!"
This is a great post from "The Gospel-Driven Church". The author captures a great distinction that is WORTH meditating on and working out in our own lives/faiths/churches. Here's one excerpt:
"I believe many Christians in America would be satisfied if "the culture"Quoting from Michael Horton's Christless Christianity:
just stopped using pornography and drugs and alcohol and stopped
aborting babies and started "acting right." As far as I can tell, that
would be a Win. But it's not a win. A land where everybody acts
right and is on their best behavior, where peace reigns and social decay
is no more and the poor are helped and the hungry are fed, but Christ
is not worshiped as the sole supreme satisfaction in all the universe,
is a big fat FAIL."
"What would things look like if Satan really took control of a city? Over
half a century ago, Presbyterian minister Donald Grey Barnhouse offered
his own scenario in his weekly sermon that was also broadcast
nationwide on CBS radio. Barnhouse speculated that if Satan took over
Philadelphia (the city where Barnhouse pastored), all of the bars would
be closed, pornography banished, and pristine streets would be filled
with tidy pedestrians who smiled at each other. There would be no
swearing. The children would say, “Yes, sir” and “No ma’am,” and the
churches would be full every Sunday . . . where Christ is not preached.
There
is a great difference between “being good” and the gospel. Some call it
moralism. Moralism, in fact, blinds us from the gospel by giving us
something of “the real thing” ensuring that we miss out on the true
gospel all together. We must remember that Christ came first not to make
bad people good but to make dead people live. If we forget that, our
Christianity will turn out to be Christless."
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