Heatlh and Medical: October 2011

meetups and thoughts

My two nutritarian friends came into town on Friday and we had quite the feast:

I made sweet potatoes topped with black beans and greens etc and a dollop of soy yogurt (a recipe from the Fuhrman site). We made salad from Holly's lettuce and pear, my red pepper and a yummy salad dressing from the Fuhrman site. Holly made delicious stuffed mushrooms. Suz brought curried squash on brown rice. I got full eating all this great food. After our feast, we went on a walk at Olbrich community gardens, and then went, where else, to the co-op. That was interesting as we shared many food tips about all our favorite foods, as well as the ones we have to avoid (the cowgirl cookies are sometimes a challenge for me). I got a lot of new ideas from our discussions as we strolled through the store.

Some quotable quotes were "I'm an unethical vegan" and "I'm a vegan on weekdays."

Today I heard a great quote: "The best way to bring someone over to your cause is to have more fun than them." For me, the biggest difficulty about eating healthy is sometimes thinking that I'm missing out on what everyone else is eating. It's all in how you look at it. I just need to think of it as I'm the lucky one, having the most fun eating the best food. Along those lines, last weekend I was out on a walk at a conservancy and a group was roasting marshmallows over a fire and making s'mores. Well, you know how those nostalgic feelings can make you wish you were joining them. Today I was meditating in front of my fireplace (wow, is that ever easy to meditate in front of a fire!) and I was thinking about our ancestors roasting winter squash in their fire. Then I realized, our difficulties in eating healthy usually arise from nostalgia for eating the things we used to eat and drink with our family and friends. Maybe we just need to go back further in time. The last 50 years are a blip on the history of our people. Go back further, and we are talking sweets only on very special occasions. So just let your nostalgia go a little further back in time and you can imagine roasting squash instead of marshmallows, and relishing a good fruit instead of ice cream.

weekend cooking

It's fall and my food choices are changing with the season. It's winter squash time! Here's what I'm planning to try this week:

And that's just for lunch and dinner. I'm thinking sweet potatoes for breakfast. I made a huge pot of soup using veggies from the garden mostly. This has white lima beans, purple barley, onion, eggplant, collard greens, leeks, mushrooms, 2 cans of garden tomatoes, broccoli, and italian spices. I froze it into several containers to eat during the week. I still have some containers from my last batch of soup so I can have some variation. Here's my plan for the week--don't know if I will like it, I'll know tomorrow--brekky will be sweet potato topped with bean soup--I'm usually hungry after exercise class. Here's an example from today's lunch:

This also has banana, fresh ginger and cilantro. It tasted quite good.

Lunch and dinner will be salad (cabbage, spinach, lettuce, broccoli, cauliflower, seed mixture, vinegar) topped with squash, soup, apple, and pomegranate seeds, and probably some fresh ginger. The squash I'm hoping will be easy to prepare, just baking in the oven. I'll microwave it to heat it up. I have no idea what this will taste like, but I expect it will be pretty good. I mean, almost any mixture of veggies and fruit and greens tastes good.

Here's a quickie large salad I made tonight: cabbage, spinach, romaine, broccoli, then some pomegranate seeds, seed mixture, and fruit-infused vinegar.

Here's one of my most favorite treats. I ate this yesterday while making house mate's smoothies. It's just frozen mango, frozen blueberries, and a little d'angou pear vinegar (optional). I love this. It's easy to make thoroughly enjoyable food out of simple ingredients.

The Brain Controls Insulin Action

Insulin regulates blood glucose primarily by two mechanisms:

Suppressing glucose production by the liver
Enhancing glucose uptake by other tissues, particularly muscle and liver

Since the cells contained in liver, muscle and other tissues respond directly to insulin stimulation, most people don't think about the role of the brain in this process. An interesting paper just published in Diabetes reminds us of the central role of the brain in glucose metabolism as well as body fat regulation (1). Investigators showed that by inhibiting insulin signaling in the brains of mice, they could diminish insulin's ability to suppress liver glucose production by 20%, and its ability to promote glucose uptake by muscle tissue by 59%. In other words, the majority of insulin's ability to cause muscle to take up glucose is mediated by its effect on the brain.

Read more »

Guest Commentary: Grappling with Health Care Workforce Needs in the 21st Century

Patrick Monaghan
Director of Communications
Jefferson School of Population Health

In their opening remarks to “Creating the Health Care Workforce for the 21st Century,” Thomas Jefferson University President Robert L. Barchi, MD, and University of Delaware President Patrick T. Harker, PhD, fittingly set the table for the day’s discussions.

Dr. Barchi spoke of the millions of newly insured that have been entering the country’s healthcare system with the passage of the Affordable Care Act, and the need to develop creative approaches to extend the health care workforce in the face of the ongoing shortage of primary care doctors.

Dr. Harker spoke of the relationship between Thomas Jefferson University (TJU) and the University of Delaware, and how the two institutions can “show the country how coordinated care can be provided.”

With that, the one-day conference, focused on addressing the challenges of workforce development under health reform, was off and running. In a day filled with poignant talks and thought-provoking panel discussions, a highlight was former Pennsylvania Governor Edward G. Rendell’s keynote speech.

In his typically honest, disarmingly straight-ahead style, the former Governor expressed his concern over the competitive edge America has lost in science and technology; the need for the education of America’s youth to once again take center stage, and a call to return to the “can do” attitude that once made America the world leader in innovation, discovery, and scientific breakthrough. He spoke of the importance of the healthcare industry to the Greater Philadelphia region, and how conferences such as this one underlie how Philadelphia can serve as the point for an era of drastically improved healthcare in terms of quality, safety, innovation, and job creation.

Susan Dentzer, editor-in-chief of Health Affairs, spoke on the benefits of cultivating collaborative and coordinated care and the great responsibility vested in academic medical centers, such as TJU, to train tomorrow’s medical professionals to work collaboratively as a team, and the importance of reducing waste and medical error to cut costs and improve medical outcomes.

Joanne Conroy, MD, chief health care officer of the Association of American Medical Colleges, addressed the need for transformational change in the education of health care professionals, calling for “the right mix of physicians and essential health care providers with the right skills and training, in the right places.”

In one of two exceptional panel discussions, George W. Bo-Linn, MD, chief program officer for the Gordon and Betty Moore Foundation’s San Francisco Bay Area Program, underlined the importance of teamwork in healthcare, and how critical it is for health care professionals to engage their patients – or “persons,” as Dr. Bo-Linn prefers – in their own health care. “The current most widely unrecognized and largest workforce is patients and their families,” Dr. Bo-Linn declared.

The health care workforce for the 21st century will need to adapt to a health care system currently in reform, but the most basic tenet remains the same, surmised David B. Nash, MD, MBA, Dean of the Jefferson School of Population Health - “Patients, or persons, will remain at the center of all we do.”

Harvard Food Law Society "Forum on Food Policy" TEDx Conference

Last Friday, it was my pleasure to attended and present at the Harvard Food Law Society's TEDx conference, Forum on Food Policy. I had never been to Cambridge or Boston before, and I was struck by how European they feel compared to Seattle. The conference was a great success, thanks to the dedicated efforts of the Food Law Society's presidents Nate Rosenberg, Krista DeBoer, and many other volunteers.

Dr. Robert Lustig gave a keynote address on Thursday evening, which I unfortunately wasn't able to attend due to my flight schedule. From what I heard, he focused on practical solutions for reducing national sugar consumption, such as instituting a sugar tax. Dr. Lustig was a major presence at the conference, and perhaps partially due to his efforts, sugar was a central focus throughout the day. Nearly everyone agrees that added sugar is harmful to the nation's health at current intakes, so the question kept coming up "how long is it going to take us to do something about it?" As Dr. David Ludwig said, "...the obesity epidemic can be viewed as a disease of technology with a simple, but politically difficult solution".

Read more »

Blogs and meetups

This blog has very appetizing-looking and healthy recipes!

http://www.straightupfood.com/blog/

Yesterday I attended an excellent talk by John Allen Mollenhauer, a lifestyle coach. Wow, I'm tempted to hire him! His website is called Nutrient Rich. He has a free ebook called "Break Free of the Diet Traps!". I downloaded it and looked it over and found some helpful things in it.

Tomorrow I'm going to meet up with some nutritarian friends, yea!

And if I have time I'll attend the Whole Foods supper club on Thursday.

That's a lot of nutritarian socializing. Hopefully that will become the norm!

Checking in

I'm back to a busy busy schedule at work so it's hard to post on week days. How are you doing on the Pre-Thanksgiving Challenge? I overate 3 days on fruit and nuts, which is not good, but...I'm just observing it for now and letting myself learn the lessons I need to learn. I want healthy eating to be a choice, not an exercise in willpower. I usually feel like eating the most healthy foods in proper quantities. I guess I'm just letting myself be reminded of that through experience.

As I mentioned before, one of my goals for the challenge is to optimize my protein intake. I'm trying to get stronger at the gym and want to help that with my food intake. I'm monitoring my food intake with cronometer. Now this is just something fun I'm doing so don't feel you should have to do this also: Following Dr. Fuhrman's food plan will provide you with plenty of all your necessary nutrients. But it is instructive to see what foods have the highest protein. I can see where I can tweak to get more protein. For example, I can cut back my raw carrots a bit and replace them with sweet peas. I love peas so that's easy to do. The other thing that's very noticeable is that fruit has a lot less protein per calorie than green veggies (leafy or otherwise). But fruit has a lot of other healthy nutrients so it should be part of the diet. I find 1-1.5 lbs per day of fruit is a good amount for me. I've been eating veggie bean soup and also putting edamame in my salads every day. The combination of the soup, edamame, and lots of green veggies in the salads gives me about 14% protein which is good for building muscles. I could optimize it more but I love me carrots. Today I got some mediterranean pine nuts from Dr. Fuhrman. He recommends these and pumpkin seeds and sunflower seeds for optimal protein after a workout (along with beans and veggies). I'll add those in to next week's salads.

Losing Fat With Simple Food-- Two Reader Anecdotes

Each week, I'm receiving more e-mails and comments from people who are successfully losing fat by eating simple (low reward) food, similar to what I described here. In some cases, people are breaking through fat loss plateaus that they had reached on conventional low-carbohydrate, low-fat or paleo diets. This concept can be applied to any type of diet, and I believe it is an important characteristic of ancestral food patterns.

At the Ancestral Health Symposium, I met two Whole Health Source readers, Aravind Balasubramanian and Kamal Patel, who were interested in trying a simple diet to lose fat and improve their health. In addition, they wanted to break free of certain other high-reward activities in their lives that they felt were not constructive. They recently embarked on an 8-week low-reward diet and lifestyle to test the effectiveness of the concepts. Both of them had previously achieved a stable (in Aravind's case, reduced) weight on a paleo-ish diet prior to this experiment, but they still carried more fat than they wanted to. They offered to write about their experience for WHS, and I thought other readers might find it informative. Their story is below, followed by a few of my comments.

Read more »

The Runner-Up(s)

Jan and Jerry. Here is their report:

Afunny thing happened when I took my brother Jerry under my wing to help himlose weight...I lost weight too! He ended up losing more than 40 pounds on the"greens and beans" diet. And he got off his diabetic medications! Ilost only a few pounds but I reached a milestone weight that has been eludingme for a good long while.
Jerrydutifully texted me his weight and his blood sugar reading every morning. Thatgesture, I believe, helped him to keep his weight and health goals first andforemost in his mind. Those daily texts also provided him with accountability. I taught Jerry the acronym G-BOMBS (aka GOMBBS) to remind him what foods to eatevery day. It is such a simple but powerful and effective concept...eat thesesix foods and regain your health. It's all about greens, beans, onions,mushrooms, berries, and seeds! And teaching Jerry about healthy eatinghelped to reinforce the information for me.
Thisis not to say that it was all easy...there were temptations and slip-ups andother obstacles along the way. Accountability and keeping it simple....that'sthe combination that led to a successful outcome.
Weboth have more weight to lose and this six-week challenge was a great start.Thanks, Barb!

And the winner is...

Diane Watkins!

Oh, this was soooooo hard! I don't like being a judge and selecting a single winner. So many people did really well. Congratulations to all of you. Here is Diane's final report:

I discovered the Eat to Live program in June and immediatelyembraced it. I did extremely well the first 3 weeks, then found it difficult tocontinue. We were traveling a lot with my husband’s work and I found itdifficult to find the foods that I needed in restaurants, which was our usualway to eat on the road. So, I was looking for help staying on the diet when I found yourchallenge. This was exactly what I needed to help me adjust to the ETLlifestyle. I chose to set my goals as learning to organize my food and life tofit the Eat to Live program and staying on the program throughout the 6 weeks,specifically healthy eating at every meal and every snack.
I feel that I have met these goals, although I am still learning andevolving. I found it easiest to get into a pattern of eating that supportsthese healthy eating goals. While the foods eaten change, the pattern hasstayed the same. I eat a fruit salad and fruit juice for breakfast, a largegreen salad for lunch, and a homemade bean or lentil and vegetable soup orsteamed vegetables for dinner. I sometimes add beans or a sweet potato to thelunch salad to keep me from getting hungry again before dinner, but I usuallyeat my beans in the dinner soup. I also have a green juice in the afternoon,when I have time to make it in the morning, and green tea or water during theday. I will occasionally snack on some homemade low-fat hummus with snow peas,nappa cabbage or other vegetables. I’ve discovered a few excellent no-oil saladdressing recipes. My favorite is tangerine juice, lemon or lime, and vinegar.The hardest part of the challenge is to not eat late at night, when my husbandhas his late night snack.
I wake up each morning hungry, for the first time in my life. I wasnever much of a breakfast eater in the past. And I am usually ravenous by dinnertime. But I can honestly say that I have not had any problems with cravings,which is also unusual. The fruit satisfies my sweet tooth; but I am used toeating a lot of salt. I will admit that I cheated a few times in the beginning,adding salt to my soup, but I have gradually adjusted my salt addiction and amdoing better now. I am slowly getting healthy. Although I have a long way to go totruly regain my health, I can honestly say that I am a lot better off now thanI was only 6 weeks ago. I have a heart arrhythmia and an autoimmune diseasethat have severely limited my movement and energy levels in the past. Gettingmy health back is my priority right now, because I had truly lost it. I need toturn that around quickly. I believe that the Eat to Live program is my bestchance of regaining a healthy body. The autoimmune disease manifests itself in very painful skin lesionsthat make my life difficult. The Eat to Live program these past 6 weeks hashelped, I have only had one new lesion in the last 6 weeks, and the old lesionsseem to be improving, although not fast enough to suit me. It seems to me thatimprovement is directly related to my consumption of green juice. The more Idrink, the better they get. I also had a bad episode of A Fib during the challenge. This is notunusual, actually only having one is probably a great improvement. In the past,I have had bad episodes regularly, sometimes weekly, so one in 6 weeks is animprovement. I have increased my nut and seed consumption and that seems tohave helped. My blood pressure is good, without medication and I have more energythan before, with the exception of the week of the A Fib episode. I have alsolost some weight, although I promised myself I wasn’t going to concentrate onmy weight during this challenge. I wanted good health to be my goal.
I have made quite an improvement, although I still have a ways togo. I will be joining you on your next challenge and look forward to a lifetimeof healthy eating. I appreciate your running this challenge and supporting us.The Vitamix has been a nice incentive, and I do need one; but I know that I ama winner either way. I really feel that a Vitamix would help me drink more vegetablejuices and this challenge has only intensified my longing for one. I have beenmaking juice in my regular blender, but I have to strain it. The entire processtakes a lot of time that I don’t really have in the mornings. The fruit juiceis easier, since I can drink it without straining, and it seems to blend a lotfaster. I have been struggling to figure out how to afford a Vitamix, we arevery strained financially and It doesn’t fit into our budget. I am putting iton my Christmas list, however, in the hope that we might manage it. My husbandand I talked about getting one for my birthday, which is only a few days away,but decided that we just couldn’t make it happen right now. Thank you for this challenge and your support.

October 21 Special Conference

The Jefferson School of Population Health is all fired up this week as we head toward our long planned special joint conference with our colleagues at the University of Delaware entitled "Creating the Healthcare Workforce of the 21st Century". This conference will be held on our campus in center city Philadelphia in the Hamilton Building between 10th and 11th streets in the Connelly auditorium.

The day is devoted to addressing the key policy question---what kind of healthcare workforce will our nation need to help fulfill the promise of health reform?. Among the luminaries who will be presenting are Susan Dentzer, the Editor in Chief of HEALTH AFFAIRS, Dr Joanne Conroy, a key leader from the AAMC in Washington DC, former Governor of PA Ed Rendell, and Dr George Bo-Lin, the CMO of the Intel foundation in California. It is an amazing line up for sure.

There will also be two panel discussions with many other regional leaders as we tackle some tough questions about, for example, the role of nurse practitioners in the future, the appropriate supply of primary care doctors, the need for interprofessional education in the health professions and related subjects.

I hope you will join us for this amazing event. You can register directly at the following address...http://www.delawarehsa.org/conferences/kbpc.php We look forward to seeing you there!! DAVID NASH

Guest Commentary: JSPH's Academic Programs are Thriving

Caroline Golab, PhD
Associate Dean for Academic and Student Affairs
Jefferson School of Population Health

This September, the Jefferson School of Population Health (JSPH) welcomed 185 new and returning students to a combination of on-site, off-site, and online courses – an 80%increase in enrollment over September 2010. And this is only our third year of operation!

In addition to our PhD program in Population Health Sciences and our Master’s degree and certificate programs in public health, health policy, healthcare quality & safety, and chronic care management, we introduced two new degree programs – a Master of Science in Healthcare Quality and Safety Management (MS-HQSM) and a Master of Science in Applied Health Economics and Outcomes Research (MS-AHEOR). We have also developed programs in healthcare risk management, scheduled for debut in fall 2012.

The MS-HQSM, offered in cooperation with the American College of Physician Executives (ACPE), is designed specifically for physician leaders and addresses the national need for executive leadership in healthcare quality and patient safety. It equips physician leaders with tools, methods, knowledge, and strategies necessary for this task. The MS-AHEOR builds on Jefferson’s more than twenty years of experience and expertise in health outcomes research. It meets the growing need for professionals to evaluate and measure health outcomes (both physical and humanistic) and to ascertain economic consequences of health care interventions by determining optimal clinical effectiveness, comparative effectiveness, and economic value.

The 2011-2012 academic season also represents our second year of asynchronous online course delivery to a national audience. The introduction of online programs followed an extensive period of preparation that included adoption of a nationally recognized rubric (Quality Matters) and development of a mandatory comprehensive faculty training program (CATS) to assure excellence in online course design and instruction. Often to their surprise, both students and faculty have discovered that online learning provides exceptional opportunities for increased collaboration, community building, and enhanced learning outcomes – all items near and dear to our educational mission.

Through curriculum development and consultation, JSPH will continue to support the College within a College (CwiC) program for 50+ first- and second-year medical students enrolled in Jefferson Medical College. A co-curricular activity partially funded through a HRSA grant, CwiC enables these JMC students to complete six credits toward a Master of Public Health (MPH) degree in conjunction with their medical education. The goal of this initiative is to encourage medical students to complete coursework for the MPH degree prior to their graduation from Jefferson Medical College.

For the fifth year, we have successfully recruited and obtained funding to support fourteen Fellows as part of the Greater Philadelphia Albert Schweitzer Fellowship Program. The mission of the Schweitzer Fellowships is to encourage students in various health-related professions to become “leaders in service” and, by their example, to inspire others in addressing the health needs of underserved communities.

Finally, as the new School year starts, we are already planning next summer’s Global Health Academy, a four-week summer didactic and hands-on experience for high school students. Successfully launched this past summer under the guidance of Jefferson faculty and outside experts, students from local high schools studied major challenges to global health – everything from infectious diseases, natural disasters, water shortages, and healthcare delivery systems to the international resources, agencies and technologies that respond to these challenges. We believe it’s never too early to find and nourish future leaders in population health.

Pre-Thanksgiving Challenge!

Hi everyone,

We had so much fun doing the 6-week challenge, let's do another one! Sorry I don't have a vitamix to offer this time. Let's just share our successes and struggles, inspire each other, and win good health.

Here's my idea. From Oct. 14 (tomorrow) until Nov. 23 (day before Thanksgiving) is 40 days which is 2 days shy of 6 weeks. Let's try to eat healthy for the next 40 days, and then we can each decide for ourselves how we want to celebrate on Thanksgiving. Maybe you want to splurge a little or a lot, on healthy food or a few bites of the traditional stuff. It can be guilt-free if you plan something reasonable, and eat healthy for the next 40 days, right?

Let's think of goals for ourselves and send in updates when we feel like it. I'm trying to get stronger at the gym, so in addition to eating only healthy foods and not overeating (my forever top two goals), I will try to eat the foods Fuhrman recommends for building muscles: edamame, sunflower seeds, mediterranean pine nust, beans and...I'll have to check his latest post to make sure I got them all.

okay, let's go.

ps, I'll post the winner of the last challenge on the weekend.

Good night!

Diabetes Affects Kidney

Tips to control Diabetes and retain a healthy kidney:

Did you know...Diabetes affects the kidney? Diabetic nephropathy is one of the significant specific complications of diabetes. Around 30 to 50 percent of people with kidney failure are diabetics.

Uncontrolled high blood sugar for long span of time produces functional and later structural changes in the kidneys. But what is unfortunate is that the changes occurring in kidneys are not clinically observable to the treating doctor. The symptom the patient show until the kidney function is harshly affected and the disease has reached an irreversible phase.

Urine test is one trendy way of detecting early kidney damage in diabetes through Presence of albumin leak in urine is called albuminuria of proteinuria.

Albumunuria is a symptom of early diabetic kidney disease. In routine urine examination will identify albuminuria. However, as there are no symptoms this is not given any clinical importance and often goes unnoticed without medical care. Aggressive treatment should start at this time and the progression of the kidney damage could be delayed or arrested.

Routine exam of urine will detect albumunura. However, there is another sensitive test for detection of micro abluminuria. This test detects minute amounts of albumin leaked into the urine (microabluminuria).

Microabluminuria is a sign of early abnormalities of the blood vessels and a forerunner of atherosclerosis (hardening of arteries). Therefore occurrence of albuminuria is sign to aggressive treatment of cardiovascular risk factors.

Research has shown that sufficient and long-term control of blood sugar, blood pressure and dietary changes can help in preventing kidney disease. However, the efforts should start early in the life of people with diabetes. New drugs used for treatment of hypertension are called angiotension-converting enzyme inhibitors. These agents were originally invented and used for treatment of hypertension. But they were found to be helpful in preventing kidney disease in persons with diabetes, particularly in patients who have albuminuria.

Other than the specific diabetes kidney disease, people with diabetes are also more prone to urinary tract infections. Chronic recurrent urinary tract infection is more common due to high blood sugar levels. Diabetes can also affect the nerves supplying the urinary bladder and produce abnormal bladder function. This can lead to deficient urinary evacuation and urinary retention. Therefore avoidance of infections also helps in preventing kidney damage in diabetes.

So, remember, if you are a diabetic then have urine test for albumin periodically to detect kidney disease.

Bird Flu Infection

Avian influenza (Bird flu)

Bird flu is an infection caused by bird influenza (flu) virus. It is occur naturally in birds. Wild birds carry the viruses in their intestines, but generally do not get sick from them. However, bird flu is very infectious among birds and can make some domestic birds, including hens, ducks, and turkeys, very sick and kill them.

Humans and Bird flu:

There are several subtypes of type A influenza viruses. These subtypes vary because of certain proteins on the surface of the influenza A virus hemagglutinin(HA) and neuraminidase (NA) proteins. There are 16 different HA subtypes and 9 different NA subtypes of flu A viruses. Various different combinations of HA and NA proteins are possible. Each combination is a different subtype. All known subtypes of flu A viruses could found in birds. When we talk about human flu viruses we are referring to those subtypes that occur widely in humans. There are only three known A subtypes of human flu viruses (H1N1, H1N2 and H3N2); it is likely that some genetic parts of current human influenza A viruses came from birds originally.

Human Symptoms:

Bird flu symptoms in humans have ranged from typical flu-like symptoms (fever, sore throat, cough and muscle aches) to eye infections, severe respiratory diseases (such as acute respiratory distress), pneumonia and other severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection

Spread of Bird Flu:

Infected Birds shed flu virus in their nasal secretions, saliva, feces. Susceptible birds become infected when they contact with contaminated excretions or surfaces that are contaminated with excretions. It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been experienced to continue beyond one person.

Deal with Bird flu:

Studies suggest that the prescription medicines approved for human flu viruses should work in preventing bird flu infection in humans.

Flu viruses can become resistant to these drugs, so these medications may not always work. Further studies are needed to prove the effectiveness of these medicines. People should avoid contact with infected birds and should be careful when handle cooking poultry.

day 42!

This is the last day of the 6-week challenge! Congratulations! I'm eager to choose a winner for the vitamix, but I should give people at least a few days to send in their progress reports. Send them to bwhitney@chi-squared.org. Here's my progress report:

My goal was to eat only healthy food and don't overeat. I started the challenge early so mine lasted 48 days. I misbehaved 5 days out of 48. On four of those days, I overate on fruit and nuts. On one day, I ate some unhealthy food too (darn it!). So I achieved my goals for 43 days out of 48. That's good but I think I can do better. I'm ready for the next challenge! My goal for that challenge is to optimize my protein as I'm trying to get stronger at the gym. And of course, to eat only healthy food and don't overeat.

I think I will start a short Oct. challenge, and then do monthly challenges until it gets old.

MIstakes are good--haha, that typo was not intentional

My kid friends that were visiting and a dream I had last night reminded me that kids learn almost entirely from making mistakes. As the 6-year old was shaking my salad to stir it, I could see the future, and sure enough, there was a spill. I dreamed I was in a car with a teenager and he took this turn too tight and I could see the future and we rolled over--very slowly, nothing dangerous, but how were we going to explain this to the person we borrowed the car from? I thought, what a weird dream. Then I thought, kids learn from making mistakes. So do we all. So let's proceed with our learning.

Hey, I just noticed that my previous post was my 1000th post! Isn't that something.

Day 41, winding down!

I've started getting updates from people on how they did. The stories are inspiring, and they are not without their struggles. It will be fun to share them with you. You will see the many different goals and victories and obstacles and it's all good because we are just trying to achieve better health.

I've thought more about my weekend splurge. I realize I have just been using visitors as an excuse. When I think about each time I did this in the last year, none of my visitors expected me to eat their food. Most were more interested to try my food than have me prepare theirs. Last night, the kids visiting me helped me with my food prep, and they were astounded that I was planning to eat all that salad in one day. I gave them an apple and they made their own fresh squeezed orange juice. One of the girls said, "I wished I didn't like chocolate like Barb". So you see, they like me to be this way. I just used them as an excuse. There was no pressure. Boy the excuse machine is so clever!

Today I saw some nice looking home-made oatmeal raisin cookies at a talk, and thought "I could restart tomorrow!" Oh boy. The first few days are always tough because of that one. Then I thought, maybe I could make some of my own nutritarian oatmeal raisin cookies. Another interesting thing I realized today is that I wanted those cookies only about 15 minutes after hearing this nightmarish health story from a friend, due completely to diet. You'd think that would be more of a deterrent, wouldn't you?

In some ways, this journey we are on is very easy--the food is good, we feel great eating this way, our health and energy goes up. There is no rational reason on earth not to eat this way 100% of the time. So then why is it so hard sometimes? I don't know. Because we are social. Because we don't react well to forbidden foods. Because sugar, fat and salt are addictive and excite our pleasure centers and taste really good and call to us---the funny thing is, even after we have lost our taste for it. Oh, I guess smokers go through this too. They physical addiction wears off long before the psychological.

Is it Day 40?

Only 2 more days of the challenge?! Let's see, we started on a Thursday, so it will end on Wednesday! Well, you can start sending me your progress report whenever you are ready. Send it to me at bwhitney@chi-squared.org. Let me know if it's okay to post it. I think people will enjoy hearing how others did. It's especially helpful to learn how you solve your problems, and how you learn from your mistakes.

I started my challenge a week early so I suppose I could say I finished it on Friday. I suppose that's a good thing because I unexpectedly stumbled on Saturday, with my desire to eat my guests' food. For 6 weeks, I behaved quite well except for a couple of days on my vacation when I overate nuts and fruit, and then on last Thursday when I did the same. But on Saturday, I wanted to eat everything they ate, just because they were eating it, even though I didn't like the taste. Can someone explain that one to me? I stumbled last summer with visitors too. I have visitors again today but I'm okay. I'll have to be more cautious next time.

Besides being busy with the visitors, on Sunday I did food prep, biking in the outstanding weather, and harvesting the garden. I made a nice soup from garden produce and beans, which I'll have all this week along with my salads. I harvested a bunch of greens and brussels sprouts from the garden and froze them. It was a fun day. And it was very fun with the visitors. Then today was back to work and exercise and more visitors tonight. whew. So I'd better get back to them.

Should we do a new challenge? I'm thinking monthly challenges might be easier chunks to handle--for one thing easier to count the days, and a month might seem more doable for accomplishing a goal.

Guest Commentary: International Collaboration with Universidad CES, Medellín, Colombia

Rob Simmons, DrPH, MPH, MCHES, CPH
Director, MPH Program
Jefferson School of Population Health

This past August, I had the opportunity to spend three weeks in Medellín, Colombia at Universidad CES representing the Jefferson School of Population Health (JSPH). CES is an acronym for the “City of Eternal Spring” in English and is an indication of the temperate climate of Medellín, Colombia’s second largest city with a population of over 4 million. Universidad CES was founded 34 years ago by a group of Colombian physicians who wanted to establish a private, health science university with an emphasis on medical, dental, mental and veterinary medicine, and allied health education. Universidad CES has three large clinical entities in the region, including a major hospital in downtown Medellín, and has expanded its undergraduate and graduate education programs in the biosciences, physical therapy, public health, and most recently, health law. Enrollment currently stands at approximately 2700 students.

Universidad CES is considered the top university in the health sciences in Colombia and served as host to representatives of the US CDC Center for Global Health during my visit. Similar to the JSPH, one of its areas of focus is health care quality and safety, and CES holds an annual conference for health care professionals in South and Central America each fall.

In 2008, I had the opportunity to visit Universidad CES for a day and shared information about Thomas Jefferson University and our plans for a new school of population health. Over the past two years, the Jefferson School of Population Health has returned the favor and has hosted Dr. Julián Osorio, the Dean of the CES Medical School, Dr. Oscar Saldarriaga, its Director of International Relations, and one of its medical students. In the interest of collaboration, I was asked to come to Medellín to provide training and technical assistance for program directors and faculty.

During my stay at Universidad CES, I provided training on the infusion of public and community health education and practice in their medical education, presented an overview of the US public health and healthcare systems, provided a framework and resources for expansion of their global health prevention initiatives, and met with researchers on preventive health research opportunities in Colombia and the Americas.

At the conclusion of my visit, we discussed future collaborative opportunities between Universidad CES and Thomas Jefferson University and, particularly, the Jefferson School of Population Health. These could include student and faculty exchanges, collaborative research opportunities, and joint professional education symposia in-person and via satellite in both Philadelphia and Medellín. David Nash, JSPH Dean, has been invited to be the keynote speaker at one of CES’s annual international conferences on Quality and Safety in the future. I look forward to working with Universidad CES and helping build future collaborative health initiatives between our two universities.

The Case for the Food Reward Hypothesis of Obesity, Part II

In this post, I'll explore whether or not the scientific evidence is consistent with the predictions of the food reward hypothesis, as outlined in the last post.

Before diving in, I'd like to address the critique that the food reward concept is a tautology or relies on circular reasoning (or is not testable/falsifiable). This critique has no logical basis. The reward and palatability value of a food is not defined by its effect on energy intake or body fatness. In the research setting, food reward is measured by the ability of food or food-related stimuli to reinforce or motivate behavior (e.g., 1). In humans, palatability is measured by having a person taste a food and rate its pleasantness in a standardized, quantifiable manner, or sometimes by looking at brain activity by fMRI or related techniques (2). In rodents, it is measured by observing stereotyped facial responses to palatable and unpalatable foods, which are similar to those seen in human infants. It is not a tautology or circular reasoning to say that the reinforcing value or pleasantness of food influences food intake and body fatness. These are quantifiable concepts and as I will explain, their relationship with food intake and body fatness can be, and already has been, tested in a controlled manner.

1. Increasing the reward/palatability value of the diet should cause fat gain in animals and humans

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Day 36

I had an interesting experience today. We have a family visiting us and, well, you can fault me for this, but I just decided to give them the foods they like. Weird thing #1 was grocery shopping and buying all this stuff I used to buy in my previous life, over 6 years ago--cereal and milk and ham and cheese and bread and cookies and ingredients for a spaghetti dinner. Trying to remember what the ingredients were, and searching for this stuff was as confusing as when I was first learning where the tofu and tempeh was. I made the dinner just like I did before I changed my diet, with no regard to health. Weird thing #2 was cooking meat, and then not being able to test it to verify I had the right flavorings. But I was told it was good. How can you go wrong with lots of fat and salt and meat and seasonings and cheese and butter? It is easy to cook this way. The bread was drenched in garlicy butter. Of course, that was a hit. One of the girls just wanted the garlic bread and noodles without the sauce--drenched in butter and parmesan cheese. Weird thing #3 was my reaction to the food. Part of me wanted to eat it. I know the spaghetti sauce tasted really good and I wanted some, but I don't want to eat animals. I know the garlic bread tasted really good but at the same time I was grossed out by the greasiness of the butter and it does have an overpowering smell. Wierd thing #4 was cleanup. Boy did that take a lot of soap. I was thinking, it would be good if you could do a similar cleanup to your blood vessels after eating this.

Unfortunately, a reaction to all of this was that I overate on my foods. I didn't eat regular meals at mealtimes, just ate randomly. I ate too much fruit, too many nuts, too much essene bread, a few turkish figs (they were good), what else, carrots, some cabbage, edamame with d'angou pear vinegar and chopped walnuts (that was good). I made a nice ice cream from a banana, cherries, walnuts and grape juice. I discovered that frozen mangos and peanut butter is a nice combination. Maybe that was weird thing #5. ha. Okay, so I have something to work on in my next challenge: Dealing with visitors. This was a problem for me several times this past year. Well, tomorrow is a good opportunity to get started. I get to watch them eat my old diet all day long. I will behave. I can do this.

Day 35

Quick post before going observing (I'm an astronomer...).

My oatmeal (see yesterday's preview) turned out awful. The food warmer must be hotter than a slow cooker, not colder. The oatmeal was burnt! yuck. so I threw that out.

I nibbled on carrots, sugar snap peas and a little fruit while making lunch and dinner. Oh, here's something that turned out great: I took some beans and grains from the freezer--a batch of just beans and some kamut, barley and wild rice cooked up, bland on it's own--and added a mashed baked sweet potato (which I decided later probably wasn't needed), some curry powder, cinnamon, and sliced grapes. This was great! curry powder, cinnamon and grapes is a great combination and will turn a bland dish into a yummy curry dish.

Then had big salads with the usual local and garden produce: massaged kale, cabbage, lettuce mix, spinach mix, jicama (okay, that was from Mexico), yummy yummy asian pears! (from California), yummy kiwi berries (from California), red bell pepper, sunflower, pumpkin seeds, walnuts, d'angou pear vinegar. okay, that wasn't such a local salad after all except for the greens.

gotta run, see you tomorrow!

Day 34 of the Challenge

wow, only 8 days left! Then we start a new one because I'm in a groove and want to stay there! I'm not perfect, but I'm doing pretty good. Today's foods were similar to yesterdays. I made a big salad from kale, cabbage, salad mix, spinach, D'angou pear vinegar, sweet red pepper, jicama (part of one), 2 nectarines, walnuts, pumpkin seeds, hemp seeds. That was divided into 3 bowls for the 3 meals. Then two small bowls of beans and greens from the freezer, and a baked sweet potato and baked beets. Then I had some carrots and part of an asian pear when I got home. Oh my gosh, asian pears are yummy! I heard someone rave about them on the Fuhrman forums so I bought some and they have a very interesting flavor, almost honey like or vanilla like. I put the rest of the asian pear into tomorrow's oatmeal. Check out my new toy! And it was only $10:

Here it is next to a coffee mug for scale:

I was thinking for a while that it would be nice to find a small slow cooker to cook oatmeal in. Well, I was shopping the other day and came across this cute food warmer. It's meant for dips and things and it says it's not a slow cooker, only a warmer. But you don't really have to cook oatmeal so I figure it will work. We'll find out tomorrow! Oh, I should add cinnamon to it. It's got a little under 1/2 cup oats (41 g), 4 chopped walnut halves (9 g), and a small handful of raisins (10 g). But I'm getting ahead of myself.

Today's food totaled 1503 calories; protein 53 g (11%), fat 22 g (13%), carbs 298 g (76%), fiber 75 g.

Time to get some shut-eye. I exercised hard today and I'm sleep deprived.

Heatlh and Medical