Beauty Health for Life

How well does genetic make-up predict risk for type 2 diabetes? This recent review finds that genes arent a good predictor:

Predicting Risk of Type 2 Diabetes Mellitus with Genetic Risk Models on the Basis of Established Genome-Wide Association Markers: A Systematic Review, American Journal of Epidemiology, Online: September 2013

"In conclusion, [Genetic risk models] showed a low predictive performance for risk of type 2 diabetes, irrespective of study design, participants’ race/ethnicity, and the number of genetic markers included."

The researchers analyzed data from 23 studies and found that genetic testing was not as useful as conventional risk factors, e.g. weight and age, in determining risk for type 2 diabetes.

The National Institutes of Health (NIH) gives these conventional risk factors for type 2 diabetes:

• Age greater than 45 years
• Diabetes during a previous pregnancy
• Excess body weight (especially around the waist)
• Family history of diabetes
• Given birth to a baby weighing more than 9 pounds
• HDL cholesterol under 35 mg/dL
• High blood levels of triglycerides, a type of fat molecule (250 mg/dL or more)
• High blood pressure (greater than or equal to 140/90 mmHg)
• Impaired glucose tolerance
• Low activity level (exercising less than 3 times a week)
• Metabolic syndrome
• Polycystic ovarian syndrome
• A condition called acanthosis nigricans, which causes dark, thickened skin around the neck or armpits

NIH recommends that everyone over age 45 have a blood sugar (glucose) test at least every 3 years, more often if there is a higher risk for diabetes.
________

When: Fall, 1986

Where: A small suburban kitchen in Long Island, New York.

Who:

• Kris, a precocious, bespectacled eight-year-old who is already four feet taller than every single one of her peers.
• L, a Barbie-loving, bespectacled seven-year-old who is already much, much better at sports than her sister Kris.
• E, a somewhat adorable five-year-old who is already becoming the terror of his sisters and the neighborhood bullfrogs alike.
• Pa, a bearded, loving 37-year-old who’s already running out of culinary options, having been left to feed his children while his wife is stuck at work.

The kids are scattered all over the house. Pa calls them to dinner.

PA: Kids! Dinner!

KRIS: Coming!

L: Coming!

E: *mmph*

PA: E, please get He-Man out of your mouth and come to dinner.

E: Okay.

The kids assume their regular seats at the table. Pa places the evening’s meal in front of them.

L: What is this?

PA: It’s spaghetti squash and Texas Chainsaw Chili. Try it. You’ll like it.

KRIS: Are there hot dogs in it?

PA: No.

KRIS: Macaroni and cheese?

PA: No.

KRIS: But it’s SPAGHETTI squash?

PA: Yes.

KRIS: Okay then. (Tries it.) AUUUUUGHHH! THIS ISN’T SPAGHETTI!

PA: It’s a vegetable, Kris. It’s not really … Okay. Let’s move on. Take a bite of the chili, everybody.

L: I don’t wanna. It looks like guts.

KRIS: Yeah. Bug guts.

E: I’m scared Daddy.

PA: TRY. IT.

Each kid spoons a microscopic smattering of chili into their reluctant mouths. Each reacts with the same level of consummate revulsion.

KRIS: I want hot dogs.

L: I want Mommy.

E: I want He-Man.

PA: Okay, look. Nobody leaves the table until your plate is CLEARED.

L: What if we have to go to the bathroom?

PA: EAT YOUR DINNER.

E takes a few hesitant bites, then wolfs the remaining vittles. A similar plate-clearing takes L over an hour.

L: Done! Bye.

Three hours pass. Kris remains at the table, food untouched.

PA: Kris, it’s time for bed.

KRIS: But … but …

PA: It won’t kill you, my child. I promise. Eat it.

KRIS: Nooooooo.

PA: Okay then. Bedtime.

KRIS: (makes sure Pa’s back is turned, then whispers to still-full bowl) Never again, chili. Henceforth, you are my one true foe. Your evil shalt not pass these lips for the rest of time.

PA: Huh?

KRIS: Nothing. G’night, Pa!

Cut to 22 years later. Kris is sitting with The Boyfriend on their couch, watching The Biggest Loser and hoping – nay, praying – that Vicky falls into a vat of 80-calorie Banana Fudge Sundae pudding, never to return. Both Kris and TB are eating Cook’s Illustrated’s Easy Vegetarian Bean Chili.

KRIS: You know, I used to hate this stuff.

TB: What, reality TV?

KRIS: Well, that too. But mostly chili.

TB: Really? It runs through my veins. Like chunky, delicious blood.

KRIS: Once, I sat at a table for an entire night because I wouldn’t touch it.

TB: You’re weird.

KRIS: Thanks.

They resume eating the chili, and Kris wonders how she could have ever been so thick. As if to punctuate her deep, dark thoughts, The Boyfriend lets out a long, low fart. They both smile happily, thankful that life can be so good.

-fini-

Easy Vegetarian Bean Chili
Serves 4 – 6
Adapted from Cooks Illustrated Best 30-Minute Recipe.


CI Note: A combination of beans is better in this (kidney, black, pinto, whatever). Also, dont sub in anything for the pureed diced tomatoes, as the consistency is vital.

1 (28-ounce) can diced tomatoes
2 (15-ounce) cans beans (see note), rinsed
2-3 teaspoons minced chipotle chiles in adobo sauce
2 teaspoons sugar
salt and ground black pepper
2 tablespoons vegetable oil
1 onion, minced
3 tablespoons chili powder
2 teaspoons ground cumin
3 garlic cloves, minced
1-1/2 cups frozen corn, thawed
2 tablespoons minced fresh cilantro

1) Pour tomatoes and the accompanying juices in a food processor. Pulse 4 or 5 times, until its kinda chunky.

2) In a large saucepan, combine tomatoes, beans, chipotles, sugar, and 1/2 teaspoon salt. Stir and cover. Heat over high until it starts boiling. Drop heat to medium-low and simmer for the time being.

3) In a different large saucepan or Dutch oven, heat oil over medium heat. When very hot, add onion, chili powder, cumin, and 1/4 teaspoon salt. Stir. Saute until onions are soft and a little translucent, around 5 minutes, stirring occasionally. Add garlic. Stir. Saute until fragrant, 30 seconds to 1 minute. 

4) Pour tomato mixture into onion pot. Scrape browned bits with the back of your spoon, if you have em. Drop heat to medium-low and cook about 15 minutes, until chili has a more chili-like consistency. Stir occasionally.

5) After 15 minutes, add corn and cilantro. Stir. Heat until corn is warmed through. Salt and pepper to taste. Serve.

Approximate Calories, Fat, and Price Per Serving
For five servings: 292 calories, 7.9 g fat, $1.08

Calculations
1 (28-ounce) can diced tomatoes: 163 calories, 0 g fat, $1.89
2 (15-ounce) cans beans (see note), rinsed: ~680 calories, ~6 g fat, $1.50
2-3 teaspoons minced chipotle chiles in adobo sauce: 6 calories, 0.1 g fat, $0.30
2 teaspoons sugar: 33 calories, 0 g fat, $0.02
salt and ground black pepper: negligible calories and fat, $0.01
2 tablespoons vegetable oil: 247 calories, 28 g fat, $0.18
1 onion, minced: 46 calories, 0.1 g fat, $0.30
3 tablespoons chili powder: 71 calories, 3.8 g fat, $0.12
2 teaspoons ground cumin: negligible calories and fat, $0.02
3 garlic cloves, minced: 13 calories, 0 g fat, $0.12
1-1/2 cups frozen corn, thawed: 199 calories, 1.6 g fat, $0.60
2 tablespoons minced fresh cilantro: negligible calories and fat, $0.33
TOTAL: 1458 calories, 39.6 g fat, $5.39
PER SERVING (TOTAL/5): 292 calories, 7.9 g fat, $1.08

Smile Savers


Brushing, flossing, and eating right keep your teeth strong — and promote overall health

Make it tea for your teeth: Fruit drinks, sodas, and citrus juices (like orange) have sugar and acids that wear away tooth enamel. The better dental choice — as safe as just plain water — is tea without milk, lemon, or sugar.

Listen to your hygienist: In a two-week study of identical twins — one brushed and flossed, the other simply brushed — flossers developed significantly less plaque-causing bacteria than their brush-only siblings.

Spoon up some culture: In a new study, people who consumed at least 1/4 cup of yogurt or a lactic acid drink every day were less than half as likely to have serious gum disease. The magic ingredient? Probiotics, researchers believe.

Get plenty of fruits and veggies: The higher your consumption of folic acid from food (produce is a great source), the lower your risk of bleeding gums, research shows.

2 Twofers

With these, you burn calories and curb hunger

Cardio before meals: An aerobic workout cuts your hunger by lowering levels of ghrelin, an appetite-stimulating hormone. Count on about two hours benefit, including workout time. Weight training helps, too, but not as much. Not exercising at all leaves you hungriest.

A short walk: In a "gotta have chocolate" mood? Hit the sidewalk for 15 minutes. The walk will cut calories and — a study of chocolate lovers showed — curb your cravings as well.

Medicine Chest Must-Haves

These two can be lifesaving while youre waiting for the ambulance to arrive:

Aspirin (325 mg, not baby) to chew on in case you, a family member, or a guest has a heart attack

Liquid Benadryl in case of a life-threatening allergic reaction

4 Sleep Helpers

In 1896, GH advised insomniacs, "Upon retiring ... take a bowl of hot broth, like oatmeal gruel or clam soup." Our contemporary advice:

1. Chill, baby, chill. A cool bedroom lowers core body temperature, which initiates sleepiness. How cool? The ideal temp varies from person to person (and from husband to wife!), but try 65 degrees to start.

2. Hire a specialist — online. Cognitive behavioral therapy helps even longtime insomniacs sleep better. Try the online course developed by a Harvard researcher at cbtforinsomnia.com($25); also on CD.

3. Turn off appliances. Artificial light (from lamps, TVs, maybe even a glowing clock) can keep you up. But if its still not dark enough, try a sleep mask. The favorite in GHRI testing: Buckys 40 Blinks Mask ($13).

4. Practice tai chi. When researchers compared this Eastern meditative martial art with standard health education programs, tai chi won — heads down — in improving both sleep quality and duration.

Coffee Perks

Its fortunate our national java habit (the average coffee drinker downs three cups a day) turns out to be good for us. Coffee is rich in antioxidants, and (surprise) caffeine can also be a health booster. The brew has been linked to:

Lower risk of type 2 diabetes

Better memory and other cognitive functions

Reduced chances of non-melanoma skin cancer

Wider-awake days

But theres a trick to getting the most from your caffeine: Drink two ounces every hour or so through the morning and at lunchtime — then stop in early afternoon. Gulping a grande at breakfast may be followed by a crash later in the day

Move It!

Get one sweat every day; not a mere glow or perspiration, but a genuine, downright, old-fashioned ... sweat. (March 1916)

If youre sick of the gym, try a fun alternative that burns more calories than walking (246 calories per hour for a moderate pace). Ballet or swimming laps burns 422 calories; biking or playing Ping-Pong, 281.

Take a break. You may burn more fat when you divide a 60-minute workout into two 30-minute sessions with a 20-minute rest in between — and the boost may even continue post-exercise.

Get your hands dirty. Gardening gives you as much of a workout as walking or golf, a recent study reported. Plus: The weight-bearing motions involved in digging and pulling weeds can strengthen bones and muscle.

Add the #1 Veggie to Your Diet

Its kale — based on its contribution to daily nutrient recommendations, including beta-carotene, lutein, vitamins C and K, and folate, plus potassium, magnesium, and iron.

Spinach and collard greens are also stars.

Little Changes, Big Weight Loss

Cook pasta al dente. When you boil spaghetti for five minutes, its glycemic index is 38; after 20 minutes, it shoots up to 61. The higher the glycemic index, the sooner youll be hungry again.

Munch around the clock. A healthy snack mid-morning and mid-afternoon will keep you from overdoing itat lunch and dinner, for a net reduction in calories.

Keep a food diary. Recording meals and snacks ups your chances of weight-loss success. In fact, among a group of almost 1,700 dieters, diarists doubled their weight loss compared with non-writing folks.

Eat s...l...o...w...l...y. In one study, women who took half an hour to eat a pasta lunch consumed almost 70 fewer calories than those who scarfed it down in nine minutes.

Stop the music! People spend longer at the dining table when theres background music — any tempo or volume.

Watch out for sneak eating. "I just want a taste" (of pie, ice cream, pizza...) can add about 25 calories per mouthful.

Sip Gingerly

Beyond quelling nausea, ginger also eases menstrual cramps. To brew your own relief, peel 1 inch of fresh ginger root, cut into fine rounds, and put in a saucepan. Cover with 2–3 cups of water and simmer for 15 minutes. Strain, pour into a pretty cup, and sweeten with honey.

If Only It Were That Simple... an excellent and never-failing cure for nervous headache is the simple act of walking backward. (July 1896)

Better Bones

1. Do An Upward Dog: Yoga postures can ward off — and help correct — the dreaded dowagers hump that can occur with age. In a six-month study, even people who already had serious curves in their upper backs improved with yoga classes three times a week.

2. Follow a Big (Low-) Fat Greek Diet: Women who eat Mediterranean-style — consuming plenty of fish and olive oil, and limiting red meat — have the greatest bone density, researchers recently found.

3. Eat Like Popeye: Spinach, along with other fruits and veggies, promotes the best acid-base balance in your body for keeping bones strong.

Dont Bar Chocolate

If youre worried about weight gain, indulging may be a solution. A study found that women who put their favorite snacks on the no-no list actually ate 40 grams more of them when given the chance than those who didnt set such strict limits. (In the case of dark chocolate, that would be 180 extra calories.) The payoffs associated with as little as half an ounce a day: Lower blood pressure

Less-stiff arterial walls

Lower bad LDL cholesterol

Inhibited formation of blood clots

Reduced stress hormones

As a nutritionally minded blogger, I normally advocate fresh, whole, prepared-from-scratch meals in modest proportions.

But, dude. The Super Bowl’s coming.

With the possible exception of Thanksgiving, no other event requires Americans to consume their body weight in onion dip. Nor can I think of another quasi-holiday where quesadillas are designated as health food. Sure, your party of choice might have a token crudite platter buried behind the wings, but essentially, Super Bowl Sunday is to diets what Lawrence Taylor was to Joe Theismann’s leg. (Caution: this video might kill you.)

Yet, us weight-conscious folks need options come February 3rd. And that’s where Lightened Seven-Layer Taco Dip comes in. I got the original dish straight off AllRecipes last year, but subbed in reduced-fat and fat-free ingredients, which saved 30 calories and 4 grams of fat per serving. Fortunately, there were so many loud, proudly competing flavors nobody could tell the difference. I’m making it again this year. And while the initial expenditure might look daunting (see Calculations below), just know three things:

1) With 56 servings, this is a hulking behemoth of food. It is the Mount Kilimanjaro of taco dips. If it was people, it’d be William “The Refrigerator” Perry bear-hugging John Goodman. Last year, my friends N and I barely put a dent in it, and they once downed a Ben & Jerry’s Vermonster by themselves.

2) There are ways (WAYS!) to save a little extra dough. This year, I’m going to buy ingredients on sale, make my own taco seasoning (total cost: about a quarter) and shred a block of Kraft Cheddar with my grater. Depending on how much I buy the block for, it will probably run $0.50 to $1.00 less than a bag. Good times.

3) I live in Brooklyn. Even when bargain priced, everything is more expensive here. Except maybe Chinese food.

If you’re interested in keeping it extra-healthy, the dip can be paired with self-baked tortilla chips or possibly celery. (Which, eat quickly, because people will inevitably bogart the veggies for their hot wings.)

On a final note, the rest of this week is being dedicated to Sunday’s game. Tune in tomorrow for some pigskin-appropriate links, and then again on Wednesday for a monster list of cheap, healthy Super Bowl fare. After that, it’s Thursday’s Football Favorites of the Week. Friday is anyone’s guess, but there are seven lonely leftover jalapenos sitting in my fridge. Suggestions are most definitely welcome.

Lightened Seven Layer Taco Dip
56 servings (seriously)
Adapted from All Recipes.

1-oz. package taco seasoning mix (or make your own )
16-oz. can fat-free ried beans
8-oz. package fat-free cream cheese, softened
16-oz. container fat-free sour cream
16-oz. jar salsa
1 large tomato, chopped
1 green bell pepper, chopped
1 bunch chopped green onions
1 small head iceberg lettuce, shredded
6-oz. can sliced black olives, drained
2 cups reduced-fat shredded Cheddar cheese (or shred your own 8-oz bar)

1) In a medium bowl, mix taco seasoning thoroughly with ried beans. Transfer it to a large platter or bowl, spreading it out on the bottom

2) In a separate medium bowl, mix sour cream and cream cheese. Pour it over ried beans and spread.

3) Pour salsa over sour cream/cream cheese mixture. Spread out. Then, layer with: tomato, bell pepper, onions and lettuce. Finish with cheese and sprinkle olives over everything.

Approximate Calories, Fat, and Price per Serving
36 calories, 1 g fat, $0.25

Calculations
1 (1 ounce) package taco seasoning mix: 45 calories, 0 g fat, $0.25
1 (16 ounce) can fat-free ried beans: 385 calories, 0 g fat, $0.89
1 (8 ounce) package fat-free cream cheese, softened: 218 calories, 3.1 g fat, $2.69
1 (16 ounce) container fat-free sour cream: 336 calories, 0 g fat, $1.20
1 (16 ounce) jar salsa: 123 calories, 0.7 g fat, $1.50
1 large tomato: 22 calories, 0.2 g fat, $1.00
1 green bell pepper: 24 calories, 0.2 g fat, $0.50
1 bunch chopped green onions: 32 calories, 0.2 g fat, $0.79
1 small head iceberg lettuce: 45 calories, 0.5 g fat, $0.99
1 (6 ounce) can sliced black olives: 80 calories, 6 g fat, $1.49
2 cups reduced-fat shredded Cheddar cheese: 720 calories, 48 g fat, $2.50
TOTAL: 2030 calories, 58.8 g fat, $13.80
PER SERVING (TOTAL/56): 36 calories, 1 g fat, $0.25

Study Highlights:

- Eating foods with more fiber was linked to a lower risk of first-time stroke.
- Every seven-gram increase in total dietary fiber was associated with a 7 percent lower risk of first-time stroke.
- The results reinforce the importance of a diet that includes at least 25 grams of fiber daily.

Eating more fiber may decrease your risk of first-time stroke, according to new research in the American Heart Association journal Stroke.

Dietary fiber is the part of the plant that the body doesn’t absorb during digestion. Fiber can be soluble, which means it dissolves in water, or insoluble.

Previous research has shown that dietary fiber may help reduce risk factors for stroke, including high blood pressure and high blood levels of low-density lipoprotein (LDL) “bad” cholesterol.

In the new study, researchers found that each seven-gram increase in total daily fiber intake was associated with a 7 percent decrease in first-time stroke risk. One serving of whole wheat pasta, plus two servings of fruits or vegetables, provides about 7 grams of fiber, researchers said.

“Greater intake of fiber-rich foods – such as whole-grains, fruits, vegetables and nuts – are important for everyone, and especially for those with stroke risk factors like being overweight, smoking and having high blood pressure,” Diane Threapleton, M.Sc., and Ph.D. candidate at the University of Leeds’ School of Food Science & Nutrition in Leeds, United Kingdom.

Researchers analyzed eight studies published between 1990-2012. Studies reported on all types of stroke with four specifically examining the risk of ischemic stroke, which occurs when a clot blocks a blood vessel to the brain. Three assessed hemorrhagic stroke, which occurs when a blood vessel bleeds into the brain or on its surface.

Findings from the observational studies were combined and accounted for other stroke risk factors like age and smoking.

The results were based on total dietary fiber. Researchers did not find an association with soluble fiber and stroke risk, and lacked enough data on insoluble fiber to make any conclusions.

The average daily fiber intake among U.S. adults is lower than the American Heart Association’s recommendation of at least 25 grams per day. Six to eight servings of grains and eight to 10 servings of fruits and vegetables can provide the recommended amount.

Most people do not get the recommended level of fiber, and increasing fiber may contribute to lower risk for strokes,” Threapleton said. “We must educate consumers on the continued importance of increasing fiber intake and help them learn how to increase fiber in their diet.”
In the United States, stroke is the fourth leading cause of death, killing more than 137,000 people annually. Among survivors, the disease is a leading cause of disability.

In addition to following a nutritious diet, the American Heart Association recommends being physically active and avoiding tobacco to help prevent stroke and other heart and blood vessel diseases.

It doesnt do away with fingerstick testing entirely, but Medtronics Guardian® RT continuous glucose monitoring system, approved by the FDA on August 10, is a step in that direction.

From Medtronics Press Release:

The Guardian® RT System records as many as 864 glucose readings during a three-day period using a disposable glucose sensor that connects to a transmitter and communicates to a monitor using radio frequency. The sensor measures glucose in the interstitial fluid found between the body’s cells, and is typically discarded and replaced by the patient after three days of use. Glucose measurements are relayed every five minutes from the transmitter to the monitor, which displays the glucose values on its screen.

The monitor described above is actually a small screen on a portable pager-like device. The glucose sensor is a tiny electrode that must be inserted under the skin but is good for up to 288 glucose readings a day, for three days. Fingersticks are still needed twice a day to calibrate the glucose sensor, and to verify a possible hypoglycemic or hyperglycemic condition. The System is intended for management of either type 1 or type 2 diabetes, for those over 18 years of age.

________
For Medtronics press release:
Medtronic Announces FDA Approval Of Real-Time Continuous Glucose Monitoring System

For Medtronics product information:
Guardian® RT Continuous Glucose Monitoring System

Thinking about an ER visit.....

As part of a research requirement that it had to fulfill prior to medical school graduation, the young Disease Management Care Blog conducted a patient satisfaction survey. To its surprise, the DMCB discovered patients cared less about high touch primary care and more about access to high tech specialists.

It naturally ignored the income implications and became a general internist.

Fast forward to its job as a Medical Director in a not-for-profit physician-led managed care insurance plan.  No matter how much we "polished" the primary care network, emergency room utilization remained persistently high.

The CEO naturally ignored the DMCBs conclusion that there was little that could be done and assigned another medical director to the task.

Fast forward to Uncle Sams Healthcare Fantasy Land, where ACOs and medical homes caring for patients with universal insurance will, thanks to the enlightened efficiencies of primary care, save gazillions of dollars by steering patients away from emergency rooms and hospitals.

All three scenarios came together when the DMCB read some research by group of Philadelphia docs who wanted to better understand why patients with low socioeconomic status kept ending up in emergency rooms and hospitals.

Best of all, to do this, they used a novel methodology: they found some patients and.... asked!

Their report appears in the latest issue of Health Affairs.

64 hospitalized patients with low socioeconomic status were approached to participate in a "qualitative" research interview (heres one example of how its done). The patients were selected because they had been hospitalized via the ER multiple times, were between the ages of 18-64 years, were uninsured or on Medicaid, lived in a poor ZIP-code region of the city. 24 said no, leaving 40 subjects who agreed to have their interviews recorded. A rigorous analysis followed, with two "coders" who listened to the recordings and independently developed themes or ideas. They then circled back to the patients for confirmation.

Two themes emerged:

1) Convenience/Access: Even if they have access to primary care, the emergency room and inpatient setting remains the more convenient option.  Thats because walk-in is available 24/7 and all testing as well as specialty care is available during a one-time visit.  Zero dollar primary care co-pays dont make up for the hassle, time and expense of calling ahead for appointments, arranging transportation (even if vouchers through Medicaid are available) or being erred for separate testing as well as specialty consultation.

2) Technology: Based on personal experience with their primary care docs, the emergency rooms and hospitals were perceived to have more technically proficient providers who were better able to achieve the correct diagnosis and render the correct treatment in a timely fashion.

A subset of patients seemed to come from chaotic life circumstances. Those patients found hospitals offered what the researchers described as "respite" and social "support."

The presence of Medicaid insurance had little to do with the attitudes described above.

The DMCBs take:

While subjective qualitative research is viewed with disdain by researchers, policymakers and journal editors, occasionally, good studies like this comes along.  This article sheds important light on a potential Achilles heel of accountable care organizations (ACOs) as well as the patient centered medical home (PCMH).

That Achilles heel? Just because you build it, these 40 patients - and millions who live in poverty like them - wont come.

Whats more, they are making rational decisions.

The authors point out that system solutions include co-locating multiple services (primary care, labs, x-rays and specialists), improving the quality of primary care and, when possible, mitigating any social challenges. The DMCB agrees, but is unaware of any ACOs or medical home initiatives that, outside of the usual process measures, specifically address these patients special concerns.

The DMCBs suggestions:

Advocates for ACOs and the PCMH need to get real, lower expectations and recognize that a key solution to the problem of health care overutilization by persons in poverty is to stop politicians and health care leaders from medicalizing poverty. 

That being said, one possible solution for ACOs and PCMHs serving fragile patients with poverty is high intensity biopsychosocial intervention.  It sounds expensive but full time community-based care management with low case loads and lots of physician support may help ameliorate some of the dysfunction.  Its probably less expensive than all those hospitalizations.

Finally, this may be an opportunity for nimble population health management service providers.  If any are already out there serving this population, the DMCB would like to know about it.

Image from Wikipedia

Happy belated Thanksgiving, Gentle Readers! Hope your festivities were fun and delicious. Mine were joyous and pie-filled, just as I dreamed they would be.

My body is reacting to all the friendship and gratitude by purging any built-up toxins through my facial orifices. Translation: I have a cold. And this cold wants soup.

A while back, reader and all-around good sort Chris wrote in to ask “When vegetarians/vegans are feeling under the weather, what sort of comfort foods do they like? I would love to learn how to make a flavorful broth (maybe something with ginger and onions, good for colds?) to help my sick veggie buds.”

Chris, first let me apologize for taking so long to get to your request, but as they say, necessity makes us get off our arses when we’d rather lay on the couch and watch Mythbusters reruns. Secondly, you’re a good friend.

I’ve found that most people (and plants) don’t like to eat much when they’re feeling peaked, and, as your spokesveg-in-residence, vegetarians and vegans are no different. A no-fuss soup of broth is soothing on a sore throat; noodles and one or two vegetables add a little substance.

If you are nursing someone else, like to prepare ahead for emergencies, or are strong enough to chop through the rheum, make your own Homemade Vegetable Stock for a healthy, inexpensive recuperative concoction.

If you need sustenance immediately and haven’t the strength for washing carrots, go canned broth or bullion. There is no shame, only sodium, which drinking lots of fluids will take care of. Since this cold hit right after a major holiday, my freezer was empty, and I reached for vegetable bullion cubes.

You may have noticed from articles past that I like spicy food, especially garlic. Good news! Garlic is great for colds. My favorite snorky-sinus soother is a garlicky broth soup with noodles and a green vegetable like broccoli, bok choy, or kale. These crucifers are high in vitamins A, C, and K and minerals manganese and folate—just what a recovering immune system needs.

Toss in a little ginger, crushed red pepper, or hot chili paste for sinus-clearing heat, and you’ve got a fast, easy soup that will put you or your favorite vegetarian/vegan back on the path to mixing with the general population.

Thanks, Chris, for writing with your query. Readers, do you have any favorite soup or comfort food recipes that pick you up when you’re feeling down? If so, sing out in the comments. And give us a shout if you have any questions or post ideas. The suggestion box is open 24-7, including holidays.

Now rest up and get healthy. The holiday food onslaught coming.

~~~~

If this post floats your boat, paddle on over to:

• Vegetarian Miso Soup
• Low-Down Curried Root Soup
• Cheap Healthy Sick: 10 Easy Nutritious Foods for When You’ve Contracted the Plague

~~~

Fast, Easy Garlic and Chili Soup with Broccoli
Makes about 3 servings


4 cups cold water + 2 vegetarian bullion cubes (“not chicken”, etc.)
OR
4 cups rich vegetable stock
3 cloves garlic, coarsely chopped
1 tsp hot chili paste or crushed red pepper flakes
2 cups broccoli, chopped (frozen or fresh)
2 oz. Korean style somen noodles (or thin noodle of choice)

1)  Pour stock or cold water into medium saucepan and set heat to high. Add garlic and bullion (if using) to pot and bring to boil.

2) Add broccoli to boiling water and cook for 2 minutes. Add noodles and stir in hot sauce. Continue to cook on high heat for 3 minutes, until noodles and broccoli are tender.

3) Ladle into soup bowls and allow to cool for a couple of minutes, breathing in the spicy broth. Feel the relief in your sinuses.

Approximate Calories, Fat, Fiber, Protein, and Price per Serving
126 calories, 2.17g fat, 4g fiber, 4.6g protein, $.52

Calculations
2 vegetarian bullion cube: 60 calories, 6g fat, 0g fiber, 0g protein, $0.62
3 cloves garlic: 12 calories, 0g fat, 0g fiber, 0g protein, $0.04
1 tsp hot chili paste: 0 calories, 0g fat, 0g fiber, 0g protein, $0.02
2 cups broccoli: 82 calories, 0g fat, 10g fiber, 8g protein, $0.66
2 oz. Korean style somen noodles: 225 calories, 0.5g fat, 2g fiber, 6g protein, $0.21
TOTALS: 379 calories, 6.5g fat, 12g fiber, 14g protein, $1.55
PER SERVING (TOTALS/2): 126 calories, 2.17g fat, 4g fiber, 4.6g protein, $.52


Fast, Easy Garlic and Ginger Soup with Bok Choy
Makes about 3 servings


4 cups water + 2 vegetarian bullion cubes (“not chicken”, etc.)
OR
4 cups rich vegetable stock
3 cloves garlic, coarsely chopped
2” piece fresh ginger, coarsely chopped
2 cups bok choy (about 1 small head), washed and chopped
2 oz. Korean style somen noodles (or thin noodle of choice)

1)  Pour stock or cold water into medium saucepan and set heat to high. Add garlic, ginger, and bullion (if using) to pot and bring to boil. Reduce heat to medium and simmer about 5 minutes to allow ginger time to infuse broth. Return heat to high and bring again to a boil.

2) Add bok choy to boiling water and cook for 1 minute. Add noodles. Continue to cook on high heat for 3 minutes, until noodles and broccoli are tender.

3) Ladle into soup bowls and allow to cool for a couple of minutes, breathing in the fragrant broth. Take relief in your renewed breathing capabilities.

Approximate Calories, Fat, Fiber, Protein, and Price per Serving
109 calories, 2.17g fat, 1.3g fiber, 2.7g protein, $.50

Calculations
2 vegetarian bullion cubes: 60 calories, 6g fat, 0g fiber, 0g protein, $0.62
3 cloves garlic: 12 calories, 0g fat, 0g fiber, 0g protein, $0.04
2” piece fresh ginger: 12 calories, 0g fat, 0g fiber, 0g protein, $0.12
2 cups bok choy: 18 calories, 0g fat, 2g fiber, 2g protein, $0.52
2 oz. Korean style somen noodles: 225 calories, 0.5g fat, 2g fiber, 6g protein, $0.21
TOTALS: 327 calories, 6.5g fat, 4g fiber, 8g protein, $1.51
PER SERVING (TOTALS/2): 109 calories, 2.17g fat, 1.3g fiber, 2.7g protein, $.50

No-Cook month continues on CHG! We’ve already tackled 13 Ways to Cook Without an Oven, so today, we’re brainstorming the dishes themselves; food that doesn’t require any heating implement to create. There’s no baking, roasting, grilling, or crockpotting involved whatsoever. All you need is a knife, a cutting board, and a stomach.

Fortunately, it’s July, which means we can take full advantage of summer produce. Tomatoes, peppers, eggplant, zucchini, yellow squash, blueberries, raspberries, cherries, corn, melons, plums, nectarines, peaches, herbs, and leafy greens are either here or about to arrive. And that equals wicked variety, massive nutritional value, and low, low prices. Excellent.

So, without further ado: 18 no-cook meal ideas. And Im sure there are some I missed. Readers, what would you add to this list? What did I forget? (For now, we’re looking for ideas, not specific recipes. That’s next week.)

Appetizers
Rather than rifle through entrees, why not focus on the hors d’oeuvre chapter of your favorite cookbook? Perhaps some proscuitto-wrapped cantaloupe would sate your salty-sweet craving. Maybe Greek Salad Skewers can fill your grumbly stomach cavity. And who’s ever turned down a mozzarella and tomato stack? No one, my friends. No one.

Canned fish
Come August, the prospect of a mayonnaise-slathered tuna sandwich isn’t exactly appetizing. But with a little lemon juice, a few herbs, and a dollop of olive oil, canned seafood like tuna, salmon, and sardines can be kept light and fresh as the day it was pulled mercilessly from the sea. Try this Alton Brown recipe and see.

Ceviche and tartare
We mentioned marinating seafood in citrus juice in our Ways to Cook Without an Oven piece, and the idea hasn’t become any less viable over the last two weeks. If you have a few extra bucks, grab a lemon, some quality shrimp, and start soaking.

Cold soups
You’ve heard of Gazpacho, the tomato-and-cucumber-based concoction Lisa Simpson pushes on barbecues, but did you know there are hundreds of fruit and veggie soups requiring only a food processor and a basket of produce? A Google search for “cold soup recipes” yielded 1,230,000 results. Get browsing.

Crostini / bruschetta
While most recipes in this genre call for toasted bread, you can fudge it with a super-crusty baguette, a little rubbed garlic, and some olive oil. Honestly, the additional toppings are usually so tasty, no one will complain. (P.S. If you’ve ever wondered what the difference was, check this post from Foodblogga.)

Dessert
Sorbet, granita, simple whipped creams, various balls (hee), frozen pies, no-bake cheesecakes, ice cream treats, trifles … I could go on, but I’m all drooly now. So I’ll let the Kitchn and their 25 No-Bake Summer Desserts roundup take over.

Dips and spreads
Hummus, tapenades, and pestos are not just stunningly simple to make at home. They’re inexpensive, highly edible with pita chips or crudite, and eminently spreadable on sandwiches or wraps. Plus, you don’t even need a food processor. Just grab your potato masher and dub the dips “rustic.”

Fruit and fruit salad
Pedestrian cantaloupe-n-honeydew salads may understandably cause some egregious eye-rolling. But, as previously discussed, with warm weather comes a tremendous variety of in-season fruits. Whether they’re eaten whole or chopped and mixed in some sublime concoction, there are few healthier, less expensive options for summer.

Guacamole
Two avocados + 1/3rd a red onion + a small tomato + one lime’s worth of juice + a handful of chopped cilantro + salt and pepper = a dip that’ll be devoured in ten minutes.

Marinated vegetables
With a little vinegar and oil, vegetables are surprisingly simple to marinate yourself, as demonstrated in these Zucchini, Mushroom, and Cucumber Salads. If you’re not in the mood, a jar of roasted red peppers will do the trick just as well.

Salads (green)
You CSA people know what I’m talkin’ ‘bout. When the thermometer reads like a radio dial, there’s nothing quite like stuffing your face with a pile of leaves. If you can accent those greens with additional veggies - tomatoes, cucumbers, carrots, what have you – all the better. And healthier.

Salads (non-green)
Of course, non-stop lettuce marathons can become tiring after a while. So why not spruce up your dinner with a bean or bread salad? There are gazillions of options online, but I particularly enjoy this Black-Eyed Pea dish from Martha Stewart and Moosewood’s Summer Panzanella.

Salsa
What simple condiment can top chips, be stuffed in a burrito, and perk up chicken breast? If you said “chocolate” … ew. If you said “salsa,” you win! Cheap, low in fat and calories, and high in various nutrients, salsa is the superfood that keeps on giving. (Especially if you’re a tad prone to indigestion.)

Sampler plates
A pal of mine had his bachelor party a few weeks ago, meaning three ladyfriends and I were left without our various menfolk. So? We had a ladies’ barbecue. We assembled lots of crudite, a few bowls of fruit, assorted olives, many jars of Trader Joe’s dip, some fine cheeses, and several kinds of crackers, breads, and pita chips. And we ate it. And it was AWESOME. (Note: the wine helped.)

Sandwiches, wraps, and pitas
(Hey! Another personal anecdote!) The last few Mondays, Husband-Elect and I dined on prosciutto, skim-milk mozzarella, roasted red peppers, and incredible olive bread procured from a nearby grocery store. We dubbed it “Favorite Sandwich,” and it’s just the thing for sweltering summer nights. You might be tempted to relegate similar cold sandwiches and wraps to lunchtime, but take it from me: don’t.

Slaws
What was your first reaction to the word “slaw”? Was it like mine? Was it “Ew! Cole slaw. Gross. I always give that to my brother. He’ll eat anything except rusty hubcaps. And even then, if you slather it with enough mustard, it’s a possibility.” But I digress. The world of slaws extends well beyond mayo-soaked iceberg lettuce. Let Leigh’s Jicama Mango Slaw be your inspiration, and then slice and julienne your way to glory.

Smoothies, lassis, parfaits, and enhanced yogurts
Remember this post about your favorite smoothies, where you gave 30 stupendous suggestions for tricking out your yogurt drinks? Man, those were the good ol’ days. But seriously, folks. Trumped-up yogurts are filling, frequently nutritious, and infinitely customizable.

Soaked noodles
Though I’ve never attempted it myself, various online sources swear you can soak noodles in very hot tap water to a satisfying al dente doneness. It takes a little longer than boiling, but if you’re dead set against oven use, it’s an option.

BONUS SECTION

If you’d like to incorporate cooked foods without using your own kitchen, think of using prepared and pre-cooked from supermarkets, restaurants, big box stores, and other large, pointy buildings where you might acquire edibles. For example:

• Hit up your local Chinese joint for a pint of white or brown rice.
• Grab a rotisserie chicken at CostCo.
• Find a salad bar and stock up on a variety of veggies.

These options might cost more than you would normally spend, but the spared sweating will make them worth the purchase.

And that’s it. Readers, what would you add? I’d love to hear.

~~~

If this post tickles your fancy, you might also want to peruse:

• 10 Ways to Eat Less Meat
• 156 Cheap, Healthy Recipe Ideas for Ten Common Leftover Herbs
• Cheap, Healthy Zucchini and Eggplant: 134 Recipes

Male pattern baldness is linked to an increased risk of coronary heart disease, but only if its on the top/crown of the head, rather than at the front, finds an analysis of published evidence in the online journal BMJ Open.

A receding hairline is not linked to an increased risk, the analysis indicates.

The researchers trawled the Medline and the Cochrane Library databases for research published on male pattern baldness and coronary heart disease, and came up with 850 possible studies, published between 1950 and 2012.

But only six satisfied all the eligibility criteria and so were included in the analysis. All had been published between 1993 and 2008, and involved just under 40,000 men.

Three of the studies were cohort studies - meaning that the health of balding men was tracked for at least 11 years.

Analysis of the findings from these showed that men who had lost most of their hair were a third more likely (32%) to develop coronary artery disease than their peers who retained a full head of hair.

When the analysis was confined to men under the age of 55-60, a similar pattern emerged. Bald or extensively balding men were 44% more likely to develop coronary artery disease.

Analysis of the other three studies, which compared the heart health of those who were bald / balding with those who were not, painted a similar picture.

It showed that balding men were 70% more likely to have heart disease, and those in younger age groups were 84% more likely to do so.

Three studies assessed the degree of baldness using a validated scale (Hamilton scale). Analysis of these results indicated that the risk of coronary artery disease depended on baldness severity, but only if this was on the top/crown of the head, known as the vertex.

Extensive vertex baldness boosted the risk by 48%, moderate vertex baldness by 36%, and mild vertex baldness by 18%. By contrast, a receding hairline made very little difference to risk, the analysis showed.

To compensate for differences in the methods of assessing baldness in the studies included in the analysis, the authors looked at four differing grades of baldness: none; frontal; crown-top; combined.

Once again, this indicated that the severity of baldness affected the risk of coronary heart disease.

Men with both frontal and crown-top baldness were 69% more likely to have coronary artery disease than those with a full head of hair, while those with just crown-top baldness were 52% more likely to do so. Those with just frontal baldness were 22% more likely to do so.

Explanations for the reasons behind the association vary, but include the possibility that baldness may indicate insulin resistance, a precursor to diabetes; a state of chronic inflammation; or increased sensitivity to testosterone, all of which are involved directly or indirectly in promoting cardiovascular disease, say the authors.

But they conclude: "[Our] findings suggest that vertex baldness is more closely associated with systemic atherosclerosis than with frontal baldness. Thus, cardiovascular risk factors should be reviewed caully in men with vertex baldness, especially younger men" who should "probably be encouraged to improve their cardiovascular risk profile."

Todays question comes from a new membership! Yay!

Wiki Stu pendousma

Q: I just joined CostCo, mostly to get their super-solid eye exam/contact lens deal. But, while Im there, Id like to join the wonderful world of bulk shopping. What products are bargains?

A: From a cursory glance (and, admittedly, some prior shopping with my dad), I figured:

• contact lens solution
• canned tomatoes
• vanilla extract
• cinnamon
• peppercorns
• chicken broth
• cat food
• oatmeal (in canisters, not packaged)
• CostCo brand block cheese
• Sabra hummus

Readers, how about you? What are worth buying at big box stores like Sams Club, CostCo, and BJs?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

The British Dental Health Foundation believes new scientific research presented is a further indication of a possible link between pancreatic cancer and gum disease.

The latest research, presented in the journal Gut, found one of the bacterium key in the development of gum disease was associated with a two-fold increase in risk for pancreatic cancer. The study also discovered those with non-harmful oral bacteria had a 45 per cent lower risk of pancreatic cancer.

Although researchers cannot confirm whether gum disease contributes towards a higher risk of developing pancreatic cancer, the research is a further indication of a potential link between the two diseases.

Previous research has also drawn an association between bacteria responsible for gum disease and pancreatic cancer, although in both cases it remains unclear whether the presence of particular types of bacteria are a cause or effect of pancreatic cancer.

The papers corresponding author Dominique Michaud, epidemiologist at Brown University, commented: "This is not an established risk factor. But I feel more confident that something is going on. Its something we need to understand better."

Co-lead author Jacques Izard, of the Forsyth Institute and Harvard University concurred. He said: "We need to further investigate the importance of bacteria in pancreatic cancer beyond the associated risk."

Pancreatic cancer accounted for 7,901 deaths in 20104, while only four per cent of people in England survived the disease for more than five years. Given these statistics, Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, believes any link between the two diseases should provide a timely reminder about the importance of good oral health.

Dr Carter said: "This research provides further ammunition to the growing belief these two diseases could be related.

"There is no escaping the fact poor oral health has some role to play, as a number of studies are now starting to show. What we must remember is oral health is relatively simple to maintain. The Foundations three key messages - brushing your teeth for two minutes twice a day using a fluoride toothpaste, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend - are a great starting point for maintaining good oral health.

"If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease. If any of these symptoms persist, your dentist may be able to help you."

(Women of course should keep on consuming fish or fish oil supplements. In addition to all the benefits listed below:

Regular use of fish oil supplements, which contain high levels of the omega-3 fatty acids, EPA and DHA, was linked with a 32 percent reduced risk of breast cancer.

In the first population-based study in women of childbearing age, those who rarely or never ate fish had 50 percent more cardiovascular problems over eight years than those who ate fish regularly. Compared to women who ate fish high in omega-3 weekly, the risk was 90 percent higher for those who rarely or never ate fish.)

The report about the Omega-3 very strong connection to prostate cancer is very disturbing, although personally, that risk is in the past. Nevertheless, for almost all males, a risk-reward calculation should be made of the risk vs.the benefits of Omega-3 consumption. Because, while the risks are great, so are the rewards.

Heres what I wrote in 2008:

Jons Health Tips: Eating Fish

I eat a lot of fish – mostly salmon, but lots of other fish as well. However, I avoid swordfish and tuna, especially tuna steaks and albacore because of high levels of mercury, and tilapia because of high levels of omega-6. I eat fish because its healthy and I like it, and when I’m eating fish I’m not eating meat. I supplement my fish consumption with fish oil or flaxseed oil on days that I do eat meat.

My daughter, who is a pediatrician and vegetarian, also uses flaxseed oil and gives her 3 children fish oil supplements.

Here’s why: (see link above for details on each of these)

Fish reduces asthma and allergies

Eating fish may explain very low levels of heart disease in Japan

Eating Fish May Prevent Memory Loss and Stroke

A diet rich in fish and omega-3 oils, may lower your risk of dementia and Alzheimer’s disease, according to a study published in the November 13, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology. People who ate fish at least once a week had a 35-percent lower risk of Alzheimer’s disease and 40-percent lower risk of dementia.

Oily fish can protect against rheumatoid arthritis

Eating fish and foods with omega-3 fatty acids linked to lower risk of age-related eye disease

The evidence of health benefits has grown even stronger since then. Here is a small sampling:


1. There is mounting evidence that omega-3 fatty acids from fish or fish oil supplements not only help prevent cardiovascular diseases in healthy individuals, but also reduce the incidence of cardiac events and mortality in patients with existing heart disease. A new study, published in the August 11, 2009, issue of the Journal of the American College of Cardiology, extensively reviews data from a broad range of studies in tens of thousands of patients and sets forth suggested daily targets for omega-3 consumption.

2. Omega-3 Fatty Acids=Reduced Risk of Colon Cancer

3. Omega-3 fatty acid kills neuroblastoma cancer cells

4. New research has shown for the first time that omega-3 in fish oil could "substantially and significantly" reduce the signs and symptoms of osteoarthritis.

5. Eating at least two servings of oily fish a week is moderately but significantly associated with a reduced risk of stroke, finds a study published on bmj.com today. But taking fish oil supplements doesnt seem to have the same effect, say the researchers.

And most important:

6. Older adults who have higher levels of blood omega-3 levels—fatty acids found almost exclusively in fatty fish and seafood—may be able to lower their overall mortality risk by as much as 27% and their mortality risk from heart disease by about 35%, according to a new study from Harvard School of Public Health (HSPH) and the University of Washington. Researchers found that older adults who had the highest blood levels of the fatty acids found in fish lived, on average, 2.2 years longer than those with lower levels.

Earlier this year, researchers reported finding insulin being produced in an organ other than the pancreas:

"Researchers at Rhode Island Hospital and Brown Medical School have discovered that insulin and its related proteins are produced in the brain, and that reduced levels of both are linked to Alzheimers disease."

The amounts were low. But the idea that Alzheimers Disease (AD) could be a form of diabetes specific to the central nervous system prompted additional study. Subsequently, a supportive follow-up report was published in November that described a link between the progressive nature of AD and the availability of insulin and insulin-like growth factors - the lower the quantity of insulin and functioning insulin receptors in the brain, the more advanced was the stage of AD.

The type of diabetes described here as associated with Alzheimers Disease (coined "type 3 diabetes" by researchers) is not the same as type 2 diabetes, which affects approximately 18 million Americans. Type 2 diabetes is characterized by higher than normal levels of blood glucose (throughout the body) which result from malfunctions in the production or utilization of insulin made in the pancreas.

A connection between the two disorders may exist, but has yet to be clarified. If a relationship can be shown, the possibilities for therapies that could target both type 2 diabetes and Alzheimers Disease are promising.

________
For press release on "brain insulin" finding:
Researchers discover link between insulin and Alzheimers

For some summaries of the recent study:
Evidence Grows That Alzheimers Is A Type Of Diabetes
and
Alzheimers Disease May Be Type 3 Diabetes

For the abstract and review article:
Review of insulin and insulin-like growth factor expression, signaling, and malfunction in the central nervous system: Relevance to Alzheimers disease

Impaired insulin and insulin-like growth factor expression and signaling mechanisms in Alzheimers disease - is this type 3 diabetes?