Later on, I had some spinach and more kolhrabi. I love kohlrabi.
Finger food
More weirdness on my part, but this is what I enjoyed eating today while watching football. During the packer game at noon, I had kohlrabi & carrot sticks, and sugar snap peas. I coated them in some lime juice and cilantro, but I think they are as good or better without the extra flavors--depends on my mood.
Halloween
I know I'm weird but I'm not the least bit attracted to Halloween candy. Here's what I was eating when the first kids dropped by my house (at left):
I was at the store today and they had fresh ripe mangos! We often have mangos at the store but never ripe, and they don't ripen well at home. So what I'm saying is, I hardly ever get a good fresh mango. But today I did, with strawberries and banana added in. It was so yummy. I doled out the candy (at right) to the kids, and did my part contributing to their poor health. I felt a little guilty. My fruit salad was followed by a delicious pomegranate:
Boy was that ever good--perfect ripeness.
this week's beans
This is a variation on my usual recipe. Today I harvest a brussels sprouts plant so used the leaves for my greens, and added the brussels sprouts. I also added a butternut squash and some parsnips. My eggplants are done for the season so that's gone from the recipe. Darn, I forgot to add the last 2 tomatoes from the garden. And I was going to add sage and forgot that. Oh well, they taste good.
2 lbs beans (1 lb Cannellini and 1 lb Lima from my Rancho Gordo selections)
>1 lb brussels sprouts greens
~2 lb mushrooms (oyster, shitake, crimini)
>1 lb onions
3/4 lb parsnips
3/4 lb brussels sprouts
>1 lb butternut squash, peeled
38 oz carrot juice (about a 5 lb bag juiced)several cups water
Soak the beans overnight, then cook them in water for a few hours. Juice the carrots, add to a 12-quart pot, start the heat going. Now I chop everything in a food processor, starting with the longest-cooking things and adding into the pot. Add water as necessary. The order is greens, onions, parsnips, squash and then mushrooms. By the time that's done, the first ingredients have been cooking for a while. Add the beans, and cook another 30-60 minutes depending on how tender you like it. Let cool. Pour into a gazzillion plastic bowls for freezing. This batch made 34 cups, which I doled out into 16 1.5-cup bowls and 10 1-cup bowls:
Here's a picture of them in the freezer, along with this week's smoothies:
That may be enough for 2 weeks. yeah!
Guest Commentary: Fitness for All
Michael Toscani, Pharm.D
Project Director
Jefferson School of Population Health
Obesity rates in the United States have reached epidemic proportions. The impact on our healthcare system in terms of type 2 diabetes and related cardiovascular disease will cost us billions in the next 10 years. One solution to this multi-factorial issue involves physical activity and exercise. However, there is a lack of consistent adherence to recommended physical activity guidelines.
Guidelines issued by the American College of Sports Medicine (ACSM) recommend 20 to 60 minutes of continuous aerobic activity three to five times a week, at 60% to 90% of your maximum heart rate. The ACSM also recommends doing resistance training two to three days a week. One set of eight to 10 exercises for major muscle groups (eight to 12 repetitions of each exercise) is ideal.
The second set of guidelines, from the U.S. Surgeon General, recommends that you accumulate 30 minutes of "moderate intensity" physical activity (such as walking, vacuuming, climbing stairs, and yard work) on most days – in two 15-minute bouts, three 10-minute bouts, or one 30-minute bout.
I’ve had the pleasure of being involved in a “Bootcamp” Fitness Class for the past 5 years. The creator of the program was a retired Major in the Marine Corps. His vision was to structure a variety of workouts that encompass the requirements of the guidelines but can be tailored for a wide group of participants at all levels of fitness. The group meets each day (M-F) from 6-7 AM at a local high school. All the workouts are outside, beginning with a 10-15 min warm up and ending with a cool down period. They are designed to offer a variety of training experiences and leadership opportunities for the participants. Participants work out at the level they are comfortable with.
A typical week is outlined below:
• Monday- Walk /run alternating speeds followed by abdominal core exercises
• Tuesday- Use a deck of cards (each suit corresponds to a different exercise designed to work large muscle groups, 2-14 reps each), 52 exercises
• Wednesday- Bike ride, run/walk or swim
• Thursday-Aerobic training and calisthenics/weight training using 4 corners of the workout area and fitness stations alternating periodically with a yoga class several months of the year.
• Friday- Leg exercises (squats, etc) combined with push ups, abdominal exercises and others selected by the group
Some of the results I have observed have been extraordinary for participants, who range in age from 35-65 years old. Some participants have many chronic medical conditions, including a renal transplant recipient and donor, lymphoma survivor, type 1 diabetes, hypertension, and dyslipidemias. Anecdotal results have included blood sugar and blood pressure reductions, normalized lipid profiles, weight loss, and improved cardiovascular fitness and a general sense of well being and confidence with continued participation for many months and years.
This approach and regimen is certainly not for all; however, the importance of having a “team fitness” approach undoubtedly improves attendance, adherence to fitness and dietary guidelines and could be a valuable piece of the complex puzzle of our health care system. Participants should always seek medical advice before engaging in these programs.
It would be great to see more randomized studies to test these observations and help provide more evidence to support individuals to achieve greater levels of fitness.
Hoo Rah !!!
Project Director
Jefferson School of Population Health
Obesity rates in the United States have reached epidemic proportions. The impact on our healthcare system in terms of type 2 diabetes and related cardiovascular disease will cost us billions in the next 10 years. One solution to this multi-factorial issue involves physical activity and exercise. However, there is a lack of consistent adherence to recommended physical activity guidelines.
Guidelines issued by the American College of Sports Medicine (ACSM) recommend 20 to 60 minutes of continuous aerobic activity three to five times a week, at 60% to 90% of your maximum heart rate. The ACSM also recommends doing resistance training two to three days a week. One set of eight to 10 exercises for major muscle groups (eight to 12 repetitions of each exercise) is ideal.
The second set of guidelines, from the U.S. Surgeon General, recommends that you accumulate 30 minutes of "moderate intensity" physical activity (such as walking, vacuuming, climbing stairs, and yard work) on most days – in two 15-minute bouts, three 10-minute bouts, or one 30-minute bout.
I’ve had the pleasure of being involved in a “Bootcamp” Fitness Class for the past 5 years. The creator of the program was a retired Major in the Marine Corps. His vision was to structure a variety of workouts that encompass the requirements of the guidelines but can be tailored for a wide group of participants at all levels of fitness. The group meets each day (M-F) from 6-7 AM at a local high school. All the workouts are outside, beginning with a 10-15 min warm up and ending with a cool down period. They are designed to offer a variety of training experiences and leadership opportunities for the participants. Participants work out at the level they are comfortable with.
A typical week is outlined below:
• Monday- Walk /run alternating speeds followed by abdominal core exercises
• Tuesday- Use a deck of cards (each suit corresponds to a different exercise designed to work large muscle groups, 2-14 reps each), 52 exercises
• Wednesday- Bike ride, run/walk or swim
• Thursday-Aerobic training and calisthenics/weight training using 4 corners of the workout area and fitness stations alternating periodically with a yoga class several months of the year.
• Friday- Leg exercises (squats, etc) combined with push ups, abdominal exercises and others selected by the group
Some of the results I have observed have been extraordinary for participants, who range in age from 35-65 years old. Some participants have many chronic medical conditions, including a renal transplant recipient and donor, lymphoma survivor, type 1 diabetes, hypertension, and dyslipidemias. Anecdotal results have included blood sugar and blood pressure reductions, normalized lipid profiles, weight loss, and improved cardiovascular fitness and a general sense of well being and confidence with continued participation for many months and years.
This approach and regimen is certainly not for all; however, the importance of having a “team fitness” approach undoubtedly improves attendance, adherence to fitness and dietary guidelines and could be a valuable piece of the complex puzzle of our health care system. Participants should always seek medical advice before engaging in these programs.
It would be great to see more randomized studies to test these observations and help provide more evidence to support individuals to achieve greater levels of fitness.
Hoo Rah !!!
Obesity and the Brain
Nature Genetics just published a paper that caught my interest (1). Investigators reviewed the studies that have attempted to determine associations between genetic variants and common obesity (as judged by body mass index or BMI). In other words, they looked for "genes" that are suspected to make people fat.
There are a number of gene variants that associate with an increased or decreased risk of obesity. These fall into two categories: rare single-gene mutations that cause dramatic obesity, and common variants that are estimated to have a very small impact on body fatness. The former category cannot account for common obesity because it is far too rare, and the latter probably cannot account for it either because it has too little impact*. Genetics can't explain the fact that there were half as many obese people in the US 40 years ago. Here's a wise quote from the obesity researcher Dr. David L. Katz, quoted from an interview about the study (2):
So, what do the genes do? Of those that have a known function, nearly all of them act in the brain, and most act in known body fat regulation circuits in the hypothalamus (a brain region). The brain is the master regulator of body fat mass. It's also the master regulator of nearly all large-scale homeostatic systems in the body, including the endocrine (hormone) system. Now you know why I study the neurobiology of obesity.
* The authors estimated that "together, the 32 confirmed BMI loci explained 1.45% of the inter-individual variation in BMI." In other words, even if you were unlucky enough to inherit the 'fat' version of all 32 genes, which is exceedingly unlikely, you would only have a slightly higher risk of obesity than the general population.
There are a number of gene variants that associate with an increased or decreased risk of obesity. These fall into two categories: rare single-gene mutations that cause dramatic obesity, and common variants that are estimated to have a very small impact on body fatness. The former category cannot account for common obesity because it is far too rare, and the latter probably cannot account for it either because it has too little impact*. Genetics can't explain the fact that there were half as many obese people in the US 40 years ago. Here's a wise quote from the obesity researcher Dr. David L. Katz, quoted from an interview about the study (2):
Let us by all means study our genes, and their associations with our various shapes and sizes... But let's not let it distract us from the fact that our genes have not changed to account for the modern advent of epidemic obesity -- our environments and lifestyles have.Exactly. So I don't usually pay much attention to "obesity genes", although I do think genetics contributes to how a body reacts to an unnatural diet/lifestyle. However, the first part of his statement is important too. Studying these types of associations can give us insights into the biological mechanisms of obesity when we ask the question "what do these genes do?" The processes these genes participate in should be the same processes that are most important in regulating fat mass.
So, what do the genes do? Of those that have a known function, nearly all of them act in the brain, and most act in known body fat regulation circuits in the hypothalamus (a brain region). The brain is the master regulator of body fat mass. It's also the master regulator of nearly all large-scale homeostatic systems in the body, including the endocrine (hormone) system. Now you know why I study the neurobiology of obesity.
* The authors estimated that "together, the 32 confirmed BMI loci explained 1.45% of the inter-individual variation in BMI." In other words, even if you were unlucky enough to inherit the 'fat' version of all 32 genes, which is exceedingly unlikely, you would only have a slightly higher risk of obesity than the general population.
Guest Commentary: Highlights from The Academy of Managed Care Pharmacy 2010 Educational Conference
Kellie Dudash, PharmD
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
The Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference was held last week in St. Louis, MO. The educational programming clearly reflected key contemporary issues in healthcare reform.
One of the most exciting presentations at the conference was an overview of a project that aims to demonstrate improved medication adherence for health plan members through pharmacy performance reporting and quality metric–focused interventions. The project is a collaboration between Highmark BlueCross BlueShield, Rite Aid Pharmacy, The Pharmacy Quality Alliance (PQA), CECity, and The University of Pittsburgh School of Pharmacy.
The literature indicates that poor medication adherence directly relates to increases in healthcare utilization and costs. Health plans usually tackle this issue by providing physicians with adherence reports for their patients at the population level. This study offers a novel approach by utilizing pharmacists at the point-of-dispensing to target non-adherent patients at the patient level.
The first phase of the project (2008) was rolled out in 50 Rite Aid Pharmacies in Western Pennsylvania. PQA-endorsed adherence measures for certain chronic conditions (heart disease, diabetes) were calculated for health plan members using Highmark claims data. CECity’s Lifetime™ platform translated the data into user-friendly electronic performance reports for Rite Aid pharmacists. The pharmacists could then compare the members’ adherence rates over time to those in their region and in all participating pharmacies.
Now that a system is in place to measure adherence in health plan members, phase two of the project (2010) will measure the impact of a psychosocial intervention on member adherence. Pharmacists in the intervention group will be trained in motivational interviewing techniques that will be used to motivate the non-adherent members. The primary outcome measured will be an increase in member adherence as measured by the PQA-endorsed adherence measures. Secondary outcomes include overall healthcare utilization calculated using member pharmacy and medical claims as well as member satisfaction with pharmacy services. The outcomes measured will be compared to health plan members in a control group in Central Pennsylvania who did not receive the intervention.
Currently, the data is only available at the pharmacy level. If they are able to measure data at the individual pharmacist level, exciting future directions for this project could include consumer reporting of pharmacist services and incentive reimbursement programs (pay-for-performance) for pharmacists.
As a profession, pharmacists have traditionally struggled with demonstrating the value of the cognitive services we offer. Retail pharmacists in particular are primarily rewarded based on prescription volume. It seems inappropriate to equate our professional value with hitting a target number that does not adequately account for the patient care services that go into each prescription.
I think most store managers would be open to rewarding pharmacists for cognitive services; but without easy to understand measures, the value of these services is consequently ignored. By creating a system to concretely measure the impact of pharmacists on improving patient outcomes, this pilot project is a step in the right direction.
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
The Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference was held last week in St. Louis, MO. The educational programming clearly reflected key contemporary issues in healthcare reform.
One of the most exciting presentations at the conference was an overview of a project that aims to demonstrate improved medication adherence for health plan members through pharmacy performance reporting and quality metric–focused interventions. The project is a collaboration between Highmark BlueCross BlueShield, Rite Aid Pharmacy, The Pharmacy Quality Alliance (PQA), CECity, and The University of Pittsburgh School of Pharmacy.
The literature indicates that poor medication adherence directly relates to increases in healthcare utilization and costs. Health plans usually tackle this issue by providing physicians with adherence reports for their patients at the population level. This study offers a novel approach by utilizing pharmacists at the point-of-dispensing to target non-adherent patients at the patient level.
The first phase of the project (2008) was rolled out in 50 Rite Aid Pharmacies in Western Pennsylvania. PQA-endorsed adherence measures for certain chronic conditions (heart disease, diabetes) were calculated for health plan members using Highmark claims data. CECity’s Lifetime™ platform translated the data into user-friendly electronic performance reports for Rite Aid pharmacists. The pharmacists could then compare the members’ adherence rates over time to those in their region and in all participating pharmacies.
Now that a system is in place to measure adherence in health plan members, phase two of the project (2010) will measure the impact of a psychosocial intervention on member adherence. Pharmacists in the intervention group will be trained in motivational interviewing techniques that will be used to motivate the non-adherent members. The primary outcome measured will be an increase in member adherence as measured by the PQA-endorsed adherence measures. Secondary outcomes include overall healthcare utilization calculated using member pharmacy and medical claims as well as member satisfaction with pharmacy services. The outcomes measured will be compared to health plan members in a control group in Central Pennsylvania who did not receive the intervention.
Currently, the data is only available at the pharmacy level. If they are able to measure data at the individual pharmacist level, exciting future directions for this project could include consumer reporting of pharmacist services and incentive reimbursement programs (pay-for-performance) for pharmacists.
As a profession, pharmacists have traditionally struggled with demonstrating the value of the cognitive services we offer. Retail pharmacists in particular are primarily rewarded based on prescription volume. It seems inappropriate to equate our professional value with hitting a target number that does not adequately account for the patient care services that go into each prescription.
I think most store managers would be open to rewarding pharmacists for cognitive services; but without easy to understand measures, the value of these services is consequently ignored. By creating a system to concretely measure the impact of pharmacists on improving patient outcomes, this pilot project is a step in the right direction.
this week's beans
Same as last week, only I used these beanss:
That's pinquitos and scarlet runner. Here they are before soaking:
Preparation is described in this post. I think I liked last week's more. But these are good with frozen sweet corn added to them.
sweet pea guacamole
Today I made sweet pea-avocado guacamole for housemate, and updated the recipe a bit. It was yummy!
Daily salad
I've been making great salads for my weekday meals. As I've posted before, on weekdays, I live on my bean soup from the freezer (made on the weekend) and salads. When I get tired of it, I'll do something else but for now I'm loving this. I make a big ole' salad every night and split it into three meals for the next day. Here's a post that describes this. The picture above shows one of the salads from last week. Here are typical ingredients used throughout the week this time of year (depends on what's fresh--right now, it's apples, pears, cruciferous veggies, greens, and pomegranates).
1 head romaine lettuce
3-6 oz cauliflower
3-6 oz broccoli
red bell pepper (optional)
1 cup frozen sweet corn (optional; note: organic snow pac is the sweetest I've found)
1 pint cherry tomatoes (if they are local and fresh and ripe)
a few oz kale and/or purple cabbage
1 small-medium apple
1 small-medium pear (our local pears are very small but delicious)
1 kiwi
seeds from a whole pomegranate (about 100 g, or 3.5 oz)
once a week, a grapefruit peeled and cutup instead of the some of the other fruit
juice from an orange
juice from a lime
1-2 oz seed mixture
I chop the cruciferous veggies first (kale, cauliflower, broccoli, cabbage) and mix with the juice and seed mixture, to marinate a bit. Then chop up the lettuce and fruit, mix it all up together, and put it in my bowls for tomorrow's meals. For the lunch meal, I usually add 1/2 cup edamame. I eat the salads with sliced carrots and kohlrabi.
Seed Mixture
I've noticed when I eat whole sunflower and pumpkin seeds, they don't always fully digest. Um, how do I know that? I think you can figure it out. So I decided to grind my seeds. But not all of them need to be ground. Here's what I prepared today.
1/2 cup sunflower seeds
1/2 cup pumpkin seeds
1/2 cup hemp seeds
1/4 cup flax seeds
1/8 cup chia seeds
1/4 cup sesame seeds
1/4 cup walnuts or other nut, chopped (optional)
(I put in more of the ones I like better). I put the sesame and flax seeds in my vita-mix "dry" container, and they grind up nicely in about 5-10 seconds on high. Pour them out, then grind up the sunflower and pumpkin, but not as finely as the flax and sesame--because I like the texture of some small pieces. Put in the walnuts for a quick chop, add them with the hemp and chia seeds to the mixture, and stir it all up. Here's the result:
I store in the freezer. These are good to add to everything--salads, soups, steamed veggies, smoothies. In the salads, combined with orange, lime juice, or flavored vinegar, it makes a nice nutty little dressing.
Note, you can use any combination of nuts and seeds you want or have on hand. Here's a post I wrote about the nutritional content of nuts and seeds, and here are a couple of articles by Dr. Fuhrman on them: here and here.
Note, you can use any combination of nuts and seeds you want or have on hand. Here's a post I wrote about the nutritional content of nuts and seeds, and here are a couple of articles by Dr. Fuhrman on them: here and here.
"Greek" chickpea salad
I made a salad for a party and it was really good. I was going to use a recipe from the Fuhrman forums recipe site, but it called for spicy pecan vinegar and I didn't have any. Plus I thought of more things I wanted to add and just ended up changing the recipe. So it's different enough I can post it. But it was inspired by the Greek chickpea salad recipe, for those who have access and want to see it.
Here are the ingredients for a big batch that I split into a bowl for the party and a bowl for home. Halve the recipe if you want a smaller batch. Also, please note that these are somewhat random things I had in the kitchen. You don't have to follow this exactly! The main ingredients are chickpeas, romaine lettuce, some fruit, cucumber, nuts, pine nuts smashed in fresh-squeezed orange&lime juice, a little raw onion, and a little cilantro. The fruit can be whatever you want! I prefer the romaine lettuce over others because it holds up better in a dressing. You could try adding kale too.
2 cans unsalted cooked chickpeas, or 1 lb cooked dry chickpeas (soak overnight before cooking).
1/4-1/2 lb cherry tomatoes (optional--I only add fresh tomatoes if they are from my garden or one nearby)
1 small apple, peeled, cored, chopped
1 small pear, peeled, cored, chopped
1 kiwi, peeled, chopped
1/2 lb grapes, cut in half
1 cucumber, peeled, chopped
1 avocado, peeled, chopped
1 large head romaine or 2 small
1/2 fresh, mild onion
2-5 oz purple cabbage (as desired)
juice of 1 orange
juice of 1 lime
1 oz pine nuts, crushed, smashed or ground
1/4 - 1/2 cup brazil nuts, chopped
few Tbsps chopped cilantro
Mix the smashed pine nuts in the juice, or blend in a blender ( just smash and mix). Combine everything except the lettuce in a big bowl. Stir. Add the lettuce. Stir again. It's yummy.
I forgot to snap a picture. The guests loved it, so I'll be making it again and will snap a picture then.
today's lunch
I love some of the fruit that goes into housemate's smoothies, so I make a separate fruit bowl for myself. Today's has frozen mango (yum!), cherries (yum!), and blueberries. I ate it slowly with relish.
I also had some brazil nuts and a really simple salad. The salad was made from fresh, local spinach and greens, a little chopped fresh local onion, and cilantro. That's all! The greens were so good.
Current Housemate smoothies
I usually make a week's worth of smoothies for housemate at once, in 3-4 batches. Each batch makes 2 smoothies. I then freeze them, like so:
Add the date, nut, juice and water to the blender. I break open the supplements and pour the powder in, and put in the DHA. This is great because housemate won't swallow pills. I can't taste them in the smoothies. I put 2 portions since this will make 2 smoothies. Add the spinach on top and blend on high until smooth. Then add the fruit, and blend again until smooth. Pour into 2 glasses. Eat them now, or top with foil and put them in the freezer.
Each night, take one out and put it in the fridge. Take it out in the morning, stir with a tall spoon, add a straw and serve! Leave the foil on if your client is scared of a slight green color that can develop as the top layer is exposed to the air.
Here are the ingredients for one batch (2 servings).
650 grams (20 oz) fresh and/or frozen fruit. I like to include some sweeter fruits along with the less sweet but healthy berries. My favorite sweet fruits are bananas, pineapple, grapes, frozen sweet cherries, and fresh figs.
2-5 oz baby spinach
1/5-1 oz nuts and/or seeds: e.g., cashews, pistachios, walnuts, sunflower seeds, pumpkin seeds, hemp seeds, flax seeds, or seed mixture
0-2 medjool dates, pitted, or 2 Tbsp date syrup (optional, depends on how much sweet fruit you use and taste preferences of the customer)
1/2 cup pomegranate or cherry juice
1/2 cup fresh squeezed orange juice
supplements (DHA, gentle care vitamins, and osteo-sun)
This can be assembled in a variety of ways. If making 3-4 batches, you can combine all the fruit into a big bowl, like so:
Next assemble your dates, nuts, water and juice. Sometimes if I am making several batches, I might blend the dates, nuts and water ahead of time into a yummy nut date cream. I might make extra and enjoy my own treat of the cream over some fruit.
Here's everything ready for assembly for one batch. In this version, the dates, nuts, juice are combined into a mug:
Add the date, nut, juice and water to the blender. I break open the supplements and pour the powder in, and put in the DHA. This is great because housemate won't swallow pills. I can't taste them in the smoothies. I put 2 portions since this will make 2 smoothies. Add the spinach on top and blend on high until smooth. Then add the fruit, and blend again until smooth. Pour into 2 glasses. Eat them now, or top with foil and put them in the freezer.
Vomiting Causes,Cures,Effects,Home Remedies and treatment
Vomiting can be an unpleasant and exhausting experience, caused by a number of conditions. The term 'vomiting' refers to the forceful ejection of inside of stomach through the mouth. Popularly known as 'being sick' or throwing up’, vomiting is a reflex action caused by stimulation of vomiting center in the brain stem. Most vomiting is due to diarrhea, cholera or food poisoning. Vomiting can sometimes be caused by very serious diseases like diabetes.Vomiting Symptoms Causes:-
(1) Stomach irritation: Irritation of the lining of stomach is the commonest cause of vomiting.
A multitude of reasons may cause this:
Appendicitis
Gastritis
Peritonitis
Gastroenteritis
Ulcers (Gastric and Duodenal)
Tonsillitis (especially in young children)
Excessive drinking
Excessive intake of contaminated food
(2) Head injury
(3) Deliberate vomiting (by putting finger in the mouth)
(4) Motion sickness
(5) Certain diseases like meningitis, fever, whopping cough, jaundice
(6) Pregnancy (Morning sickness)
Vomiting Treatment Cures Prevention:-
Avoid solid foods as they will make you sicker and induce further vomiting.
Work back to normal diet over 3 to 4 days.
Suck ice cubes if you find it impossible to keep fluids down.
A teaspoonful of bicarbonate of soda diluted in a teacup of water or milk can also be useful.
Take plenty of bland fluids - water, diluted milk or squashes but no aerated or alcoholic drinks
As the patient feels better, he can shift to semi solid diets like custards, soups, daliya etc.
Ginger tea can help with the nausea associated with vomiting and honey can soothe your throat.
DE8ADT6VCK9D
Cycling for better Health
Cycling is very enjoyable activity and beneficial for health and fitness,
Cycling Health Benefits:-
(1) First of all, Cycling is what's known as 'aerobic' exercise, improves the consumption of oxygen in the body. Increase heart rate and get us to breath heavily but not out of breath.
(2) This aerobic activity can burn up to 300 calories per 30 minutes. It’s really very effective in reducing depression and stress, boost confidence and leave with a high self esteem.
(3) Increase blood circulation and reduce the risk of high blood pressure, obesity, diabetes and heart diseases.
(4) Cycling on a daily basis will help minimize all of these heath issues whilst lengthening your lifespan at the same time. The physical benefits of cycling and the improvement to your health far out way the reasons for not doing so on a daily basis and should be looked at seriously to maintain a healthy life.
Cycling Risk Factors:-But also we have to prepare our self to prevent serious injury from cycling; to reduce the risk of serious injury is to use helmets.
Cyclist training is also extremely important, and acquiring knowledge on how to maintain your cycle is equally as important as learning how to ride in heavy traffic conditions. Defective breaks and low tyre pressure can quite often lead to accidents, and it is important that your cycle is in a road-worthy condition at all times.
"Training helps you to be confident in traffic and adopt a road position where you can be seen, communicate clearly with other road users and be aware of traffic movements”
Vacation
I'll be out of town until the beginning of November, so I won't be responding to comments or e-mails for a while. I'm going to set up a post or two to publish while I'm gone.
As an administrative note, I get a number of e-mails from blog readers each day. I apologize that I can't respond to all of them, as it would require more time than I currently have to spare. The more concise your message, the more likely I'll read it and respond. Thanks for your understanding.
As an administrative note, I get a number of e-mails from blog readers each day. I apologize that I can't respond to all of them, as it would require more time than I currently have to spare. The more concise your message, the more likely I'll read it and respond. Thanks for your understanding.
Guest Commentary: Awareness as a first step toward achieving population health
Valerie P. Pracilio, MPH
Project Manager for Quality Improvement
Jefferson School of Population Health
Recently, a number of colleagues and friends visited Philadelphia to celebrate the release of our latest book, Population Health: Creating a Culture of Wellness. As health care professionals, we are intimately familiar with the issues our system faces, and we are optimistic about the changes that are resulting from health reform efforts.
However, we still have a challenging road to travel to inform the public of the key issues and how they can be addressed at the population level. No mater what your position, I think we can all agree that achieving and maintaining health is our primary goal. By focusing on access to healthcare services when needed, good quality, safe outcomes when services are used, and avoiding the need for curative care, we can make great strides to improve health care.
The fact is, there is a strong army of individuals advocating for greater access, fewer barriers and better quality care, but the environment in which they are working presents a challenge. Population health is both a call to action and a solution. While individual patient needs are incredibly important, in this text we challenge you to broaden your perspective. We begin by providing background on the key issues and suggestions to achieve improvement. After all, awareness is the first step.
Just as we need to broaden our focus, we also need to recognize that developing population health strategies is not the work of individuals. The collaborative efforts of David B. Nash, JoAnne Reifsnyder, Ray Fabius and myself are a testament to that. At the book launch we had an opportunity to share what we learned while authoring and editing this text.
Dr. Nash highlighted the need for a book focused on population health and how the concept developed, JoAnne shared how we engaged key experts from a variety of fields to contribute, Ray mentioned the culture of wellness movement and how this book will help spread the message, and I highlighted the great work of our contributors, namely, Marty Romney and Henry Fader who were in attendance.
We also invited our colleagues to review the text and share their ideas about how we can turn strategies into solutions. We are at the tip of the iceberg, but we need YOUR help to improve population health!
How do you think can we can improve population health and create a culture of wellness? As always, we are interested in your comments.
Food = Health
This was a post from Darryl (aka "Nutritarian") from the Fuhrman forums about how changing your diet from the Standard American Diet to Dr. Fuhrman's plan will affect your health:
Here is what one might hope to achieve by really following Dr. Fuhrman's instructions:
First few weeks -- turning the ship around: Initial detoxification, improving cholesterol numbers, lowering of diabetic glucose levels, lowering of high blood pressure, etc. Some health conditions may resolve fairly quickly. Bowels start to work the way they are made to. Ability to taste and enjoy healthy food gradually develops.
Next few months - nutrient saturation: It takes quite a while for the body to readjust its complex physiology, so the entire system continues to work better and better as the months go by. The "healthy glow" develops, as phytochemicals diffuse through the body's nutrient-starved tissues. Detoxification is completed, excess inflammation resolves, immune system becomes stronger and more well-regulated. Weight moves toward ideal. Some kinds of health conditions may gradually resolve during this period.
Longer-term -- transformation: Ideal weight becomes just a normal part of life. As artery damage is gradually repaired, blood pressure works its way lower and lower until reaching extremely healthy levels. Nutritarian food just keeps tasting better and better. Skill for buying and preparing it develops to higher and higher levels. Tastes diversify, as one discovers more and more different wonderful-tasting vegetables, fruits, and legumes. Digestion and elimination become optimal, working exactly the way they are supposed to. Colds become mild and very infrequent. At the cellular level, the body's detoxification and anticancer mechanisms start functioning at maximal levels, gradually lowering (although unfortunately not eliminating) the probability of a cancer outbreak. Cellular damage that can lead to dementia and other premature degeneration later in life stops and perhaps is even reversed.
tomorrow's meals
Well, I'm back from vacation, and back to preparing meals for the week. First I went grocery shopping. Then I made smoothies for housemate. I haven't updated that post in a while. I make 8 smoothies at once, in 4 batches. Right now I'm using a lot of fresh seasonal fruit but soon will be back to frozen berries as the fresh fruit selections diminish. I put about 4 lbs of fruit in a big bowl. And I use fresh squeezed orange juice and water for liquid. Then I freeze them all as shown at the bottom of this post.
Next I made a giant pot of beans.
And then tomorrow's salads:
This has kale, broccoli, cauliflower, romaine, lime & lemon juice, sunflower, hemp, and chia seeds, apple, pear, pomegranate seeds, and kiwi.
Divide that into 3 bowls, add kohlrabi (yum) and carrot sticks. For the big lunch salad, I added edamame:
Breakfast is beans & salad; lunch is salad; dinner is beans & salad.
Maybe that sounds repetitive. I'll see. In the summer I had fresh corn on the cob at dinner, so I may have to come up with something else now that the season has changed. Or maybe I'll like this. I love the beans I made this week.
this week's beans
These are yummy!
You don't really need a recipe. The main ingredients are beans, carrot juice, vegetables of your choice, onions, and mushrooms (note that onions and mushrooms are great cancer fighting veggies). Here are the ingredients I used today, because of what is growing in my garden:
2 lbs beans (I randomly picked 1 lb lima and 1 lb tapiara from my Rancho Gordo selections)
>1 lb collards
1.5 lb mushrooms
>1 lb onions & shallots
1/2 lb eggplant
40 oz carrot juice
several cups water
I soaked the beans overnight, then cooked them in water while I was gone this morning--enough water to cover plus 3-4 inches above the beans. When I got home, I cooked everything else in the carrot juice and water. I let that cook for 2 hours probably, then added the beans. The beans are so creamy. Yum! Here it is in a 12-quart stock pot!
Of course, you can half the recipe. But I'm cooking for the whole week. After it cooled, and we ate some for dinner, I poured the rest into about 15 tupperware bowls to freeze for separate meals this week.
Eating Out
I ate out a lot while on vacation, though not in restaurants. :)
Saranac Lake, NY
Thunder Hole, Acadia National Park
Jordan Pond, Acadia
It was a little chilly this day so we ate in the "Taurus cafe". But we had a "table with a view" of Bar Harbor, Maine:
Otter Point, Acadia
Watkin's Glen, NY
Allegany State Park, NY
Greater Philadelphia Assoc of Health Underwriters-- GPAHU
Health Underwriters are the real sales force for insurance carriers across the nation. One of their largest membership organizations is here in Philadelphia--the Greater Philadelphia Assoc of Health Underwriters. I had the privilege of giving the plenary address to their entire 500 strong membership on Thursday, October 7th. I was asked to "sort out" health reform for them and to render my opinion about its implications in our marketplace. Well,no easy task for sure!!I told them my best understanding of the ACA is this---NO OUTCOME-NO INCOME---meaning, that we will face unprecedented levels of public accountability for what we do everyday as providers AND that we will come to be paid only after we achieve certain levels of outcome. Hence, No outcome--No income!!! This is a tough message--one filled with uncertainty and the possible erosion of professional autonomy too. Following my remarks, a leadership panel that included persons from Independence Blue Cross, Aetna, Cigna, United and Coventry made brief statements about their role and then we all took questions from a moderator. The insurance industry is clearly challenged by ACA and all of its implications. The carriers are in a watchful waiting mode, thinking about new markets and new opportunities too. GPAHU is an important part of the payment landscsape and the role of the broker under reform is still not clear. One thing IS clear---business as usual is out of the question!! DAVID NASH
Anti Aging Tips and facts-Wrinkles Symptoms-Causes-Treatment
We all have to believe fact of life is growing old. With old age we lose some of our physiological functions that hasten death. This loss occurs primarily within the cells in our bones, brain, heart and kidney. We have to aware from signs of aging and the correct way on how to slow them. Creases, Lines on the skin especially with old age at face, called Wrinkles. It’s one of the most Natural Part of Aging. Most of Young aged people’s skin also affected by this condition, if they are smoker or skin damaged by sun.Ultraviolet rays in atmosphere from sunlight, can damage collagen and elastin, which are very helpful our skin smoothness. Collagen is a protein that makes up a large part of your skin. The toxins in cigarette smoke stop your skin from producing as much new collagen. So we can say that smoking also causes wrinkles. As you get older, your skin gets thinner, more fragile and less stretchy, so it tends to wrinkle and crease. Some people wrinkle more than others. This can happen for different reasons.
Wrinkles Symptoms:-
(1) Deep formed lines.
(2) Crinkling crosshatch marks.
(3) Skin that is wrinkled may also have a tough, leathery appearance if the person has had a lot of exposure to the sun.
Wrinkles Causes:-
Wrinkles are also one of the major causes of skin aging.
Rapid weight loss can also cause wrinkles by reducing the volume of fat cells that cushion the face.
Other environmental factors, including cigarette smoke and pollution, particularly ozone, may hasten ageing by producing oxygen-free radicals. These are particles formed by many of the body's normal chemical processes in excessive amounts, can damage cell membranes and interact with genetic material, possibly contributing to the development of wrinkles and cancer.
(1) Deep formed lines.
(2) Crinkling crosshatch marks.
(3) Skin that is wrinkled may also have a tough, leathery appearance if the person has had a lot of exposure to the sun.
Wrinkles Causes:-
Wrinkles are also one of the major causes of skin aging.
Rapid weight loss can also cause wrinkles by reducing the volume of fat cells that cushion the face.
Other environmental factors, including cigarette smoke and pollution, particularly ozone, may hasten ageing by producing oxygen-free radicals. These are particles formed by many of the body's normal chemical processes in excessive amounts, can damage cell membranes and interact with genetic material, possibly contributing to the development of wrinkles and cancer.
Wrinkles Treatment:-
One of most common treatment and we can say Wrinkles Care Tips is,
To minimize skin wrinkling, stay out of the sun as much as possible. When you are outside, wear shielding clothing and use sunscreen. If you smoke, stop smoking.
Other effective options of wrinkles are, Chemical peels or laser resurfacing.
Botulinum toxin (Botox) may be used to correct some of the wrinkles associated with overactive facial muscles.
Tretinoin (Retin-A) or creams containing alpha-hydroxy acids may be recommended.
One of most common treatment and we can say Wrinkles Care Tips is,
To minimize skin wrinkling, stay out of the sun as much as possible. When you are outside, wear shielding clothing and use sunscreen. If you smoke, stop smoking.
Other effective options of wrinkles are, Chemical peels or laser resurfacing.
Botulinum toxin (Botox) may be used to correct some of the wrinkles associated with overactive facial muscles.
Tretinoin (Retin-A) or creams containing alpha-hydroxy acids may be recommended.
Blushing Definition- Cures and Treatments
What is blushing?
Blushing is a natural, involuntary reaction of the body in situations of anxiety or embarrassment, and it's often accompanied by sweating, mild to severe discomfort, and/or an inability to keep eye contact. Everyone blushes from time to time, but for some people it occurs too often, and becomes a key source of discomfort.
Blushing Facial Treatments Therapy:-
Surgical facial blushing Treatments; Drug Treatments; Psychological Treatment
Surgical facial blushing Treatments:-
ETS was one of the expected treatments for blushing, was responsible for diminished facial blushing with patients who applied it for palmar hyperhidrosis treatments. It isn't such a useful alternative for this particular condition. The compensatory sweat levels it acquires and the lot of fallouts are strong points against using ETS for facial blushing treatments.
Drug treatments:-
Robinol, Ditropan and Propanthelin together with a series of anticholinergic drugs are good choices for facial redness and excessive blushing. This offer more conservative approach. It can provide patients with good results. Some choose to combine the blushing treatment with drugs like Xanax. Other treatment methods may include bio feedback, although this has not been proven to be very effective. Anxiety medications, Beta-blockers and Clonidine are also used in facial blushing treatments.
Psychological Treatment:-
Continual facial blushing is such a painful cycle as you can blush just at the thought of the possibility and when you do blush you will bluish even more as soon as you know others notice it. It has been proven over and over that problem blushing is a mental issue; because it is triggered internally, most if not all external treatments don't work in the long term and simply delay and hide the real cause
Blushing is a natural, involuntary reaction of the body in situations of anxiety or embarrassment, and it's often accompanied by sweating, mild to severe discomfort, and/or an inability to keep eye contact. Everyone blushes from time to time, but for some people it occurs too often, and becomes a key source of discomfort.
Blushing Facial Treatments Therapy:-Surgical facial blushing Treatments; Drug Treatments; Psychological Treatment
Surgical facial blushing Treatments:-
ETS was one of the expected treatments for blushing, was responsible for diminished facial blushing with patients who applied it for palmar hyperhidrosis treatments. It isn't such a useful alternative for this particular condition. The compensatory sweat levels it acquires and the lot of fallouts are strong points against using ETS for facial blushing treatments.
Drug treatments:-
Robinol, Ditropan and Propanthelin together with a series of anticholinergic drugs are good choices for facial redness and excessive blushing. This offer more conservative approach. It can provide patients with good results. Some choose to combine the blushing treatment with drugs like Xanax. Other treatment methods may include bio feedback, although this has not been proven to be very effective. Anxiety medications, Beta-blockers and Clonidine are also used in facial blushing treatments.
Psychological Treatment:-
Continual facial blushing is such a painful cycle as you can blush just at the thought of the possibility and when you do blush you will bluish even more as soon as you know others notice it. It has been proven over and over that problem blushing is a mental issue; because it is triggered internally, most if not all external treatments don't work in the long term and simply delay and hide the real cause
tomorrow's meals
I’ve enjoyed all the fabulous local produce we got in Vermont, New Hampshire and Maine, but it was all gone by today (except the carrots, yea!), and I was hungry. So I admit I was looking forward to buying some California berries and pomegranates, Columbian bananas, and New Zealand kiwis at the Whole Foods in Portland, Maine—fortunately they also had a lot of local produce too, which I bought. My travel companion just got a small container of potato salad, and I asked her how she can resist buying and eating everything in sight. She said she prefers my salads to anything they prepare there. Now after preparing tomorrow’s feast, I think she’s right. These babies contain the following (from bottom of the bowl to top): kale, broccoli, cauliflower, purple cabbage, juice from a lime, bok choi, romaine lettuce, cucumber, kiwi, raspberries, strawberries, banana, chick peas, pumpkin seeds, sugar snap peas, celery, and carrots. Yum!
Total calories for the three meals will be: 1391, protein 66 g (19%!), total fat is 25g which comes out to 17% which might be a little low for me.
The Big Sleep
This blog usually focuses on diet, because that's my specialty. But if you want Whole Health, you need the whole package: a diet and lifestyle that is broadly consistent with our evolutionary heritage. I think we all know that on some level, but a recent paper has reminded me of it.
I somehow managed to get on the press list of the Annals of Internal Medicine. That means they send me embargoed papers before they're released to the general public. That journal publishes a lot of high-impact diet studies, so it's a great privilege for me. I get to write about the studies, and publish my analysis at the time of general release, which is the same time the news outlets publish their stories.
One of the papers they sent me recently is a fat loss trial with an interesting twist (1; see below). All participants were told to eat 10% fewer calories that usual for two weeks, however half of them were instructed to sleep for 8 and a half hours per night, and the other half were instructed to sleep for 5 and a half hours*. The actual recorded sleep times were 7:25 and 5:14, respectively.
Weight loss by calorie restriction causes a reduction of both fat and lean mass, which is what the investigators observed. Both groups lost the same amount of weight. However, 80% of the weight was lost as fat in the high-sleep group (2.4/3.0 kg lost as fat), while only 48% of it was lost as fat in the low-sleep group (1.4/2.9 kg lost as fat). Basically, the sleep-deprived group lost as much lean mass as they did fat mass, which is not good!
There are many observational studies showing associations between insufficient sleep, obesity and diabetes. However, I think studies like that are particularly vulnerable to confounding variables, so I've never known quite what to make of them. Furthermore, they often show that long sleep duration associates with poor health as well, which I find highly unlikely to reflect cause and effect. I discussed one of those studies in a post a couple of years ago (2). That's why I appreciate this controlled trial so much.
Another sleep restriction trial published in the Lancet in 1999 showed that restricting healthy young men to four hours of sleep per night caused them to temporarily develop glucose intolerance, or pre-diabetes (3).
Furthermore, their daily rhythm of the hormone cortisol became abnormal. Rather than the normal pattern of a peak in the morning and a dip in the evening, sleep deprivation blunted their morning cortisol level and enhanced it in the evening. Cortisol is a stress hormone, among other things, and its fluctuations may contribute to our ability to feel awake in the morning and ready for bed at night.
The term "adrenal fatigue", which refers to the aforementioned disturbance in cortisol rhythm, is characterized by general fatigue, difficulty waking up in the morning, and difficulty going to sleep at night. It's a term that's commonly used by alternative medical practitioners but not generally accepted by mainstream medicine, possibly because it's difficult to demonstrate and the symptoms are fairly general. Robb Wolf talks about it in his book The Paleo Solution.
The investigators concluded:
Keep your room as dark as possible during sleep. It also helps to avoid bright light, particularly in the blue spectrum, before bed (4). "Soft white" bulbs are preferable to full spectrum in the evening. If you need to use your computer, dim the monitor and adjust it to favor warm over cool colors. For people who sleep poorly due to anxiety, meditation before bed can be highly effective. I posted a tutorial here.
1. Nedeltcheva, AV et al. "Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity." Annals of Internal Medicine. 2010. Advanced publication.
* The study was a randomized crossover design with a 3 month washout period, which I consider a rigorous design. I think the study overall was very clever. The investigators used calorie restriction to cause rapid changes in body composition so that they could see differences on a reasonable timescale, rather than trying to deprive people of sleep for months and look for more gradual body fat changes without dietary changes. The latter experiment would have been more interesting, but potentially impractical and unethical.
I somehow managed to get on the press list of the Annals of Internal Medicine. That means they send me embargoed papers before they're released to the general public. That journal publishes a lot of high-impact diet studies, so it's a great privilege for me. I get to write about the studies, and publish my analysis at the time of general release, which is the same time the news outlets publish their stories.
One of the papers they sent me recently is a fat loss trial with an interesting twist (1; see below). All participants were told to eat 10% fewer calories that usual for two weeks, however half of them were instructed to sleep for 8 and a half hours per night, and the other half were instructed to sleep for 5 and a half hours*. The actual recorded sleep times were 7:25 and 5:14, respectively.
Weight loss by calorie restriction causes a reduction of both fat and lean mass, which is what the investigators observed. Both groups lost the same amount of weight. However, 80% of the weight was lost as fat in the high-sleep group (2.4/3.0 kg lost as fat), while only 48% of it was lost as fat in the low-sleep group (1.4/2.9 kg lost as fat). Basically, the sleep-deprived group lost as much lean mass as they did fat mass, which is not good!
There are many observational studies showing associations between insufficient sleep, obesity and diabetes. However, I think studies like that are particularly vulnerable to confounding variables, so I've never known quite what to make of them. Furthermore, they often show that long sleep duration associates with poor health as well, which I find highly unlikely to reflect cause and effect. I discussed one of those studies in a post a couple of years ago (2). That's why I appreciate this controlled trial so much.
Another sleep restriction trial published in the Lancet in 1999 showed that restricting healthy young men to four hours of sleep per night caused them to temporarily develop glucose intolerance, or pre-diabetes (3).
Furthermore, their daily rhythm of the hormone cortisol became abnormal. Rather than the normal pattern of a peak in the morning and a dip in the evening, sleep deprivation blunted their morning cortisol level and enhanced it in the evening. Cortisol is a stress hormone, among other things, and its fluctuations may contribute to our ability to feel awake in the morning and ready for bed at night.
The term "adrenal fatigue", which refers to the aforementioned disturbance in cortisol rhythm, is characterized by general fatigue, difficulty waking up in the morning, and difficulty going to sleep at night. It's a term that's commonly used by alternative medical practitioners but not generally accepted by mainstream medicine, possibly because it's difficult to demonstrate and the symptoms are fairly general. Robb Wolf talks about it in his book The Paleo Solution.
The investigators concluded:
Sleep debt has a harmful impact on carbohydrate metabolism and endocrine function. The effects are similar to those seen in normal ageing and, therefore, sleep debt may increase the severity of age-related chronic disorders.So there you have it. Besides making us miserable, lack of sleep appears to predispose to obesity and diabetes, and probably sets us up for the Big Sleep down the line. I can't say I'm surprised, given how awful I feel after even one night of six hour sleep. I feel best after 9 hours, and I probably average about 8.5. Does it cut into my free time? Sure. But it's worth it to me, because it allows me to enjoy my day much more.
Keep your room as dark as possible during sleep. It also helps to avoid bright light, particularly in the blue spectrum, before bed (4). "Soft white" bulbs are preferable to full spectrum in the evening. If you need to use your computer, dim the monitor and adjust it to favor warm over cool colors. For people who sleep poorly due to anxiety, meditation before bed can be highly effective. I posted a tutorial here.
1. Nedeltcheva, AV et al. "Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity." Annals of Internal Medicine. 2010. Advanced publication.
* The study was a randomized crossover design with a 3 month washout period, which I consider a rigorous design. I think the study overall was very clever. The investigators used calorie restriction to cause rapid changes in body composition so that they could see differences on a reasonable timescale, rather than trying to deprive people of sleep for months and look for more gradual body fat changes without dietary changes. The latter experiment would have been more interesting, but potentially impractical and unethical.
hotel food prep
I'm on vacation and preparing my meals in hotel rooms. Yep, I'm such a fanatic, I haven't eaten in a restaurant yet. Well, I just don't think restaurant (healthy) food tastes as good as my own, thanks to the fabulous local produce I've been getting. Anyway, who has time to eat in restaurants when there is hiking, biking and kayaking to be done? Here's how I do it. Clean off a desk, or bathroom counter or kitchen counter, depending on what's available. Set out the bowls and utensils. I find most useful a chopping knife, smaller paring knife, can opener, and lime squeezer thingie (second picture below). The apple corer is not really needed.
I use an electric cooler to keep my produce cool (see this post). On this trip, I've been lucky to find outstanding locally grown produce in Maine, Vermont, and New Hampshire: all kinds of lovely varieties of apples, as well as kale, lettuce, spinach, broccoli, cabbage, cherry tomatoes, and carrots! As one store employee said, the carrots taste like candy! I've been calling them carrot candy. So of course, I've based my salads on these. I layer the bottom with the cruciferous veggies: kale, broccoli, cauliflower, cabbage (whatever I happen to have on this day), and squeeze lime on that. That will marinate overnight at the bottom of the salad (I make the meals at night for the next day so we can get up early and go!):
Then I add the spinach and lettuce. Then fruit: apples, maybe an orange, cherry tomatoes, maybe a grapefruit. I scored 5 small pomegranates at a fantastic co-op in Vermont, so have been eating pom seeds in my salads for the last 5 days. They add great flavor! I just added the last one tonight. I haven't come across many fresh berries so haven't bothered with those. Then I add a can of beans and 1 oz of seeds or nuts:
Today and yesterday were heavy exercise days, so I also added a can of Dr. Fuhrman's soup. It added a nice flavor. Then I top with carrots. These I eat for dessert when I'm done with the meal, because they are like candy!
Then I clean up my mess and try to make it as spotless as possible, and tip the room cleaners, because I don't want hotels to start banning food. The main evidence of my food prep is the trash bin, a pretty dirty washcloth. and all the towels are used (but they aren't dirty).
Then I enjoy my meals in nature's restaurants, like this one:
Potatoes and Human Health, Part III
Potato-eating Cultures: the Quechua
The potato is thought to have originated in what is now Peru, on the shores of lake Titicaca. Native Peruvians such as the Quechua have been highly dependent on the potato for thousands of years. A 1964 study of the Quechua inhabitants of Nuñoa showed that they obtained 74% of their calories from potatoes (fresh and chuños), 10% from grains, 10% from Chenopodia (quinoa and cañihua), and 4% from animal foods. Total energy intake was 3,170 calories per day (1).
In 2001, a medical study of rural Quechua men reported an average body fat percentage of 16.4% (2). The mean age of the volunteers was 38. Body fat did increase slowly with age in this population, and by age 65 it was predicted to be about 20% on average. That's below the threshold of overweight, so I conclude that most men in this population are fairly lean, although there were a few overweight individuals.
In 2004, a study in rural Quechua women reported a body fat percentage of 31.2% in volunteers with a mean age of 35 (3). Body fat percentage was higher in a group of Quechua immigrants to the Peruvian capital of Lima. Among rural women, average fasting insulin was 6.8 uIU/mL, and fasting glucose was 68.4 mg/dL, which together suggest fairly good insulin sensitivity and glucose control (4). Insulin and glucose were considerably lower in the rural group than the urban group. Blood pressure was low in both groups. Overall, this suggests that Quechua women are often overweight but are in reasonably good metabolic health.
Rural Quechua are characteristically short, with the average man standing no more than 5' 2" (2). One might be tempted to speculate that this reflects stunting due to a deficient diet. However, given the fact that nearly all non-industrial populations, including contemporary hunter-gatherers, are short by modern standards, I'm not convinced the Quechua are abnormal. A more likely explanation is that industrial foods cause excessive tissue growth in modern populations, perhaps by promoting overeating and excessive insulin and IGF-1 production, which are growth factors. I first encountered this hypothesis in Dr. Staffan Lindeberg's book Food and Western Disease.
I don't consider the Quechua diet to be optimal, but it does seem to support a reasonable level of metabolic health. It shows that a lifetime high-carbohydrate, high glycemic index, high glycemic load diet doesn't lead to insulin resistance in the context of a traditional diet and lifestyle. However, there is some evidence for overweight in women. Unfortunately, I don't have more detailed data on other aspects of their health, such as digestion.
Potato-eating Cultures: the Aymara
The Aymara are another potato-dependent people of the Andes, who span Peru, Bolivia and Chile. The first paper I'll discuss is titled "Low Prevalence of Type II Diabetes Despite a High Body Mass Index in the Aymara Natives From Chile", by Dr. Jose Luis Santos and colleagues (5). In the paper, they show that the prevalence of diabetes in this population was 1.5%, and the prevalence of pre-diabetes was 3.6%. The prevalence of both remained low even in the elderly. Here's a comparison of those numbers with figures from the modern United States (6):
That's quite a difference! The prevalence of diabetes in this population is low, but not as low as in some cultures such as the Kitavans (7, 8).
Now to discuss the "high body mass index" referenced in the title of the paper. The body mass index (BMI) is the relation between height and weight, and typically reflects fatness. The average BMI of this population was 24.9, which is very close to the cutoff between normal and overweight (25).
Investigators were surprised to find such a low prevalence of diabetes in this population, despite their apparent high prevalence of overweight. Yet if you've seen pictures of rural native South Americans, you may have noticed they're built short and thick, with wide hips and big barrel chests. Could this be confounding the relationship between BMI and body fatness? To answer that question, I found another paper that estimated body fat using skinfold measurements (9). That study showed something similar to what was found in the Quechua: men were relatively lean, but women developed excess fat mass with age.
Back to the first paper. In this Aymara group, blood pressure was on the high side. Serum cholesterol was also a bit high for a traditionally-living population, but still lower than most modern groups (~188 mg/dL). I find it very interesting that the cholesterol level in this population that eats virtually no fat was the same as on Tokelau, where nearly half of calories come from highly saturated coconut fat (10, 11). Fasting insulin is also on the high side in the Aymara, which is also interesting given their good glucose tolerance and low prevalence of diabetes.
Potato-eating Cultures: the Irish
Potatoes were introduced to Ireland in the 17th century. They were well suited to the cool, temperate climate, and more productive than any other local crop. By the early 18th century, potatoes were the main source of calories, particularly for the poor who ate practically nothing else. In 1839, the average Irish laborer obtained 87% of his calories from potatoes (12). In 1845, the potato blight Phytophthora infestans struck, decimating potato plantations nationwide and creating the Great Famine.
There isn't much reliable information on the health status of the Irish prior to the famine, besides reports of vitamin A deficiency symptoms (13). However, they had a very high fertility rate, and anecdotal reports described them as healthy and attractive (14):
Starting nearly a century ago, a few eccentrics decided to feed volunteers a potato-only diet to see if it could be done. The first such experiment was carried out by a Dr. M. Hindhede and published in 1913 (described in 15). Hindhede's goal was to explore the lower limit of the human protein requirement and the biological quality of potato protein. He fed three healthy adult men almost nothing but potatoes and margarine for 309 days (margarine was not made from hydrogenated seed oils at the time), all while making them do progressively more demanding physical labor. They apparently remained in good physical condition. Here's a description of one of his volunteers, a Mr. Madsen, from another book (described in 16; thanks to Matt Metzgar):
Just yesterday, Mr. Chris Voigt of the Washington State Potato Commission embarked on his own n=1 potato feeding experiment as a way to promote Washington state potatoes. He'll be eating nothing but potatoes and fat for two months, and getting a full physical at the end. Check out his website for more information and updates (18). Mr. Voigt has graciously agreed to a written interview with Whole Health Source at the end of his experiment. He pointed out to me that the Russet Burbank potato, the most popular variety in the United States, is over 135 years old. Stay tuned for more interesting facts from Mr. Voigt in early December.
Observational Studies
With the recent interest in the health effects of the glycemic index, a few studies have examined the association between potatoes and health in various populations. The results are all over the place, with some showing positive associations with health, and others showing negative associations (19, 20, 21). As a whole, I find these studies difficult to interpret and not very helpful.
Anecdotes
Some people feel good when they eat potatoes. Others find that potatoes and other members of the nightshade family give them digestive problems, exacerbate their arthritis, or cause fat gain. I haven't seen any solid data to substantiate claims that nightshades aggravate arthritis or other inflammatory conditions. However, that doesn't mean there aren't individuals who are sensitive. If potatoes don't agree with you, by all means avoid them.
The Bottom Line
You made it to the end! Give yourself a pat on the back. You deserve it.
In my opinion, the scientific literature as a whole, including animal and human studies, suggests rather consistently that potatoes can be a healthy part of a varied diet for most people, although women in cultures that rely heavily on potatoes do gain excess fat mass with age. Nevertheless, I wouldn't recommend eating nothing but potatoes for any length of time. If you do choose to eat potatoes, follow these simple guidelines:
The potato is thought to have originated in what is now Peru, on the shores of lake Titicaca. Native Peruvians such as the Quechua have been highly dependent on the potato for thousands of years. A 1964 study of the Quechua inhabitants of Nuñoa showed that they obtained 74% of their calories from potatoes (fresh and chuños), 10% from grains, 10% from Chenopodia (quinoa and cañihua), and 4% from animal foods. Total energy intake was 3,170 calories per day (1).
In 2001, a medical study of rural Quechua men reported an average body fat percentage of 16.4% (2). The mean age of the volunteers was 38. Body fat did increase slowly with age in this population, and by age 65 it was predicted to be about 20% on average. That's below the threshold of overweight, so I conclude that most men in this population are fairly lean, although there were a few overweight individuals.
In 2004, a study in rural Quechua women reported a body fat percentage of 31.2% in volunteers with a mean age of 35 (3). Body fat percentage was higher in a group of Quechua immigrants to the Peruvian capital of Lima. Among rural women, average fasting insulin was 6.8 uIU/mL, and fasting glucose was 68.4 mg/dL, which together suggest fairly good insulin sensitivity and glucose control (4). Insulin and glucose were considerably lower in the rural group than the urban group. Blood pressure was low in both groups. Overall, this suggests that Quechua women are often overweight but are in reasonably good metabolic health.
Rural Quechua are characteristically short, with the average man standing no more than 5' 2" (2). One might be tempted to speculate that this reflects stunting due to a deficient diet. However, given the fact that nearly all non-industrial populations, including contemporary hunter-gatherers, are short by modern standards, I'm not convinced the Quechua are abnormal. A more likely explanation is that industrial foods cause excessive tissue growth in modern populations, perhaps by promoting overeating and excessive insulin and IGF-1 production, which are growth factors. I first encountered this hypothesis in Dr. Staffan Lindeberg's book Food and Western Disease.
I don't consider the Quechua diet to be optimal, but it does seem to support a reasonable level of metabolic health. It shows that a lifetime high-carbohydrate, high glycemic index, high glycemic load diet doesn't lead to insulin resistance in the context of a traditional diet and lifestyle. However, there is some evidence for overweight in women. Unfortunately, I don't have more detailed data on other aspects of their health, such as digestion.
Potato-eating Cultures: the Aymara
The Aymara are another potato-dependent people of the Andes, who span Peru, Bolivia and Chile. The first paper I'll discuss is titled "Low Prevalence of Type II Diabetes Despite a High Body Mass Index in the Aymara Natives From Chile", by Dr. Jose Luis Santos and colleagues (5). In the paper, they show that the prevalence of diabetes in this population was 1.5%, and the prevalence of pre-diabetes was 3.6%. The prevalence of both remained low even in the elderly. Here's a comparison of those numbers with figures from the modern United States (6):
That's quite a difference! The prevalence of diabetes in this population is low, but not as low as in some cultures such as the Kitavans (7, 8).Now to discuss the "high body mass index" referenced in the title of the paper. The body mass index (BMI) is the relation between height and weight, and typically reflects fatness. The average BMI of this population was 24.9, which is very close to the cutoff between normal and overweight (25).
Investigators were surprised to find such a low prevalence of diabetes in this population, despite their apparent high prevalence of overweight. Yet if you've seen pictures of rural native South Americans, you may have noticed they're built short and thick, with wide hips and big barrel chests. Could this be confounding the relationship between BMI and body fatness? To answer that question, I found another paper that estimated body fat using skinfold measurements (9). That study showed something similar to what was found in the Quechua: men were relatively lean, but women developed excess fat mass with age.
Back to the first paper. In this Aymara group, blood pressure was on the high side. Serum cholesterol was also a bit high for a traditionally-living population, but still lower than most modern groups (~188 mg/dL). I find it very interesting that the cholesterol level in this population that eats virtually no fat was the same as on Tokelau, where nearly half of calories come from highly saturated coconut fat (10, 11). Fasting insulin is also on the high side in the Aymara, which is also interesting given their good glucose tolerance and low prevalence of diabetes.
Potato-eating Cultures: the Irish
Potatoes were introduced to Ireland in the 17th century. They were well suited to the cool, temperate climate, and more productive than any other local crop. By the early 18th century, potatoes were the main source of calories, particularly for the poor who ate practically nothing else. In 1839, the average Irish laborer obtained 87% of his calories from potatoes (12). In 1845, the potato blight Phytophthora infestans struck, decimating potato plantations nationwide and creating the Great Famine.
There isn't much reliable information on the health status of the Irish prior to the famine, besides reports of vitamin A deficiency symptoms (13). However, they had a very high fertility rate, and anecdotal reports described them as healthy and attractive (14):
As far as fecundity is concerned, the high nutritional value of the potato diet might have played a significant role, but little supportive evidence has been presented so far... What is known is that the Irish in general and Irish women in particular were widely described as healthy and good-looking. Adam Smith's famous remark that potatoes were "peculiarly suitable to the health of the human constitution" can be complemented with numerous observations from other contemporary observers to the same effect.Controlled Feeding Studies
Starting nearly a century ago, a few eccentrics decided to feed volunteers a potato-only diet to see if it could be done. The first such experiment was carried out by a Dr. M. Hindhede and published in 1913 (described in 15). Hindhede's goal was to explore the lower limit of the human protein requirement and the biological quality of potato protein. He fed three healthy adult men almost nothing but potatoes and margarine for 309 days (margarine was not made from hydrogenated seed oils at the time), all while making them do progressively more demanding physical labor. They apparently remained in good physical condition. Here's a description of one of his volunteers, a Mr. Madsen, from another book (described in 16; thanks to Matt Metzgar):
In order to test whether it was possible to perform heavy work on a strict potato diet, Mr. Madsen took a place as a farm laborer... His physical condition was excellent. In his book, Dr. Hindhede shows a photograph of Mr. Madsen taken on December 21st, 1912, after he had lived for almost a year entirely on potatoes. This photograph shows a strong, solid, athletic-looking figure, all of whose muscles are well-developed, and without excess fat. ...Hindhede had him examined by five physicians, including a diagnostician, a specialist in gastric and intestinal diseases, an X-ray specialist, and a blood specialist. They all pronounced him to be in a state of perfect health.Dr. Hindhede discovered that potato protein is high quality, providing all essential amino acids and high digestibility. Potato protein alone is sufficient to sustain an athletic man (although that doesn't make it optimal). A subsequent potato feeding study published in 1927 confirmed this finding (17). Two volunteers, a man and a woman, ate almost nothing but potatoes, lard and butter for 5.5 months. The man was an athlete but the woman was sedentary. Body weight and nitrogen balance (reflecting protein gain/loss from the body) remained constant throughout the experiment, indicating that their muscles were not atrophying at any appreciable rate, and they were probably not putting on fat. The investigators remarked:
The digestion was excellent throughout the experiment and both subjects felt very well. They did not tire of the uniform potato diet and there was no craving for change.In one of his Paleo Diet newsletters titled "Consumption of Nightshade Plants (Part 1)", Dr. Loren Cordain referenced two feeding studies showing that potatoes increase the serum level of the inflammatory cytokine interleukin-6 (22, 23). However, one study was not designed to determine the specific role of potato in the change (two dietary factors were altered simultaneously), and the other used potato chips as the source of potato. So you'll have to pardon my skepticism that the findings are relevant to the question at hand.
Just yesterday, Mr. Chris Voigt of the Washington State Potato Commission embarked on his own n=1 potato feeding experiment as a way to promote Washington state potatoes. He'll be eating nothing but potatoes and fat for two months, and getting a full physical at the end. Check out his website for more information and updates (18). Mr. Voigt has graciously agreed to a written interview with Whole Health Source at the end of his experiment. He pointed out to me that the Russet Burbank potato, the most popular variety in the United States, is over 135 years old. Stay tuned for more interesting facts from Mr. Voigt in early December.
Observational Studies
With the recent interest in the health effects of the glycemic index, a few studies have examined the association between potatoes and health in various populations. The results are all over the place, with some showing positive associations with health, and others showing negative associations (19, 20, 21). As a whole, I find these studies difficult to interpret and not very helpful.
Anecdotes
Some people feel good when they eat potatoes. Others find that potatoes and other members of the nightshade family give them digestive problems, exacerbate their arthritis, or cause fat gain. I haven't seen any solid data to substantiate claims that nightshades aggravate arthritis or other inflammatory conditions. However, that doesn't mean there aren't individuals who are sensitive. If potatoes don't agree with you, by all means avoid them.
The Bottom Line
You made it to the end! Give yourself a pat on the back. You deserve it.
In my opinion, the scientific literature as a whole, including animal and human studies, suggests rather consistently that potatoes can be a healthy part of a varied diet for most people, although women in cultures that rely heavily on potatoes do gain excess fat mass with age. Nevertheless, I wouldn't recommend eating nothing but potatoes for any length of time. If you do choose to eat potatoes, follow these simple guidelines:
- Don't eat potatoes that are green, sprouting, blemished or damaged
- Store them in a cool, dark place. They don't need to be refrigerated but it will extend their life
- Peel them before eating if you rely on them as a staple food
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