Health for life

Modern political discourse

The Disease Management Care Blog had a Hurricane Sandy choice: either a) leave day before that early A.M. hospital procedure and stay with friends who live close by, or b) stay at home and make the long trip in the wind and the rain to the hospital that same morning.  The DMCB spouse turned to repetitive education to help the DMCB make the right choice.

Does that learning tactic underlie Obamacare supporter Maggie Mahars approach to the latest Health Wonk Review?  Thats what the DMCB thought when it read Maggies posting.

To help the thousands of health orm realists who make up the DMCB readership, Hurricane Maggie repetitively retreads the cost-control talking points from orm architect Peter Orszag, surgeon Golden Boy Atul Gawande and the White House Office of Management and Budget  Rest assured, says Maggie, if you selectively counter the DMCBs fiction with facts, youll realize Washington DCs solutions are the right choice.

The DMCB isnt too sure about that.

Maggie doesnt argue health care costs arent rising, only that the increases are less than widely claimed.  She credits Obamacare.  The Disease Management Care Blog agrees that cost trends are moderating, but it also credits a lackluster economy.
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Maggie says be of good cheer, because the increased costs are delivering correspondingly better value for the health care dollar. The DMCB says value remains an inexact science that is ill-suited to simplistic nostrums and blunt force laws and regulations. The latest examples of this conundrum include mammograms and annual check ups.  There are plenty of others like this.

Maggie points to Massachusettss Atul Gawandes brimming optimism about Massachusetts leading the way with risk and performance contracting as a cost-control panacea.  The DMCB awaits the arrival of hard macroeconomic outcomes data that proves the experiment works.  It also points out that the Bay States recently passed cost control legislation speaks volumes on what that states leaders really think about the savings-success of Romneycare.

Last but not least, not everyone on the blue side of political spectrum shares Maggies optimism.

By the way, the DMCB has received a cost estimate from the unnamed hospital mentioned above. That institution is the flagship part of a nationally recognized integrated delivery system that is a basis for much of Maggie Mahars enthusiasm. The DMCBs planned procedure coupled with OR charges and an overnight stay will result in charges, prior to discounts and contracted rates, in excess of $100,000.

For those of us with a lingering doubt that our political classs health orm sound-bites, nostrums, talking points and pronouncements will cut through all those inconvenient facts, the DMCB recommends this catchy tune.  Youll feel a lot better:



Image from Wikipedia

Heres yet another reason to get off the couch: new research findings suggest that regularly breaking a sweat may lower the risk of having a stroke.

A stroke can occur when a blood vessel in the brain gets blocked. As a result, nearby brain cells will die after not getting enough oxygen and other nutrients. A number of risk factors for stroke have been identified, including smoking, high blood pressure, diabetes and being inactive.

For this study, published in the journal Stroke, Michelle N. McDonnell, Ph.D., from the University of South Australia, Adelaide and her colleagues obtained data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a large, long-term study funded by the NIH National Institute of Neurological Disorders and Stroke (NINDS) to look at the reasons behind the higher rates of stroke mortality among African-Americans and other residents living in the Southeastern United States.

"Epidemiological studies such as REGARDS provide an important opportunity to explore race, genetics, environmental, and lifestyle choices as stroke risk factors," said Claudia Moy, Ph.D., program director at NINDS.

Over 30,000 participants supplied their medical history over the phone. The researchers also visited them to obtain health measures such as body mass index and blood pressure. At the beginning of the study, the researchers asked participants how many times per week they exercised vigorously enough to work up a sweat. The researchers contacted participants every six months to see if they had experienced a stroke or a mini-stroke known as a transient ischemic attack (TIA). To confirm their responses, the researchers reviewed participants medical records.

The researchers reported data for over 27,000 participants who were stroke-free at the start of the study and followed for an average of 5.7 years. One-third of participants reported exercising less than once a week. Study subjects who were inactive were 20 percent more likely to experience a stroke or TIA than participants who exercised four or more times a week.

The findings revealed that regular, moderately vigorous exercise, enough to break a sweat, was linked to reduced risk of stroke. Part of the protective effect was due to lower rates of known stroke risk factors such as hypertension, diabetes, obesity and smoking.

"Our results confirm other research findings but our study has the distinct advantage of including larger numbers, especially larger numbers of women as well as blacks, in a national population sample so these provide somewhat more generalizable results than other studies," said Virginia Howard, Ph.D., senior author of the study from the School of Public Health, University of Alabama at Birmingham.

The researchers also looked at the data according to gender. After the researchers accounted for age, race, socioeconomic factors (education and income) and stroke risk factors, the results revealed that men who exercised at least four times a week still had a lower risk of stroke than men who exercised one to three times per week. In contrast, there was no association between frequency of exercise and stroke risk among women in the study. However, there was a trend towards a similar reduction in stroke risk for those who exercised one to three times a week and four or more times a week compared to those who were inactive.

"This could be related to differences in the type, duration, and intensity of physical activity between men and women," said Dr. Howard. "This could also be due to differences in the perception of what is intense physical activity enough to work up a sweat."

The results should encourage doctors to stress the importance of exercise when speaking with their patients, Dr. Howard said.

"Physical inactivity is a major modifiable risk factor for stroke. This should be emphasized in routine physician check-ups along with general education about the benefits of exercise on stroke risk factors including high blood pressure, diabetes and being overweight or obese," she said.

The study suggests that men should consider exercising at least four times a week.

REGARDS will continue to assess stroke risk factors to look for long-term patterns in the study population. "Findings from this study, including the current physical activity results, will ultimately help us to identify potential targets for immediate intervention as well as for future clinical trials aimed at preventing stroke and its consequences," said Dr. Moy.

Drinking two cups of hot chocolate a day may help older people keep their brains healthy and their thinking skills sharp, according to a study published in the August 7, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study involved 60 people with an average age of 73 who did not have dementia. The participants drank two cups of hot cocoa per day for 30 days and did not consume any other chocolate during the study. They were given tests of memory and thinking skills. They also had ultrasounds tests to measure the amount of blood flow to the brain during the tests.

"Were learning more about blood flow in the brain and its effect on thinking skills," said study author Farzaneh A. Sorond, MD, PhD, of Harvard Medical School in Boston and a member of the American Academy of Neurology. "As different areas of the brain need more energy to complete their tasks, they also need greater blood flow. This relationship, called neurovascular coupling, may play an important role in diseases such as Alzheimers."

Of the 60 participants, 18 had impaired blood flow at the start of the study. Those people had an 8.3-percent improvement in the blood flow to the working areas of the brain by the end of the study, while there was no improvement for those who started out with regular blood flow.

The people with impaired blood flow also improved their times on a test of working memory, with scores dropping from 167 seconds at the beginning of the study to 116 seconds at the end. There was no change in times for people with regular blood flow.

A total of 24 of the participants also had MRI scans of the brain to look for tiny areas of brain damage. The scans found that people with impaired blood flow were also more likely to have these areas of brain damage.

Half of the study participants received hot cocoa that was rich in the antioxidant flavanol, while the other half received flavanol-poor hot cocoa. There were no differences between the two groups in the results.

"More work is needed to prove a link between cocoa, blood flow problems and cognitive decline," said Paul B. Rosenberg, MD, of Johns Hopkins School of Medicine in Baltimore, who wrote an editorial accompanying the study. "But this is an important first step that could guide future studies."

"Plant sterols are present in various combinations in nuts, seeds and plant oils. As plant sterols are the equivalents of animal cholesterol, they can in principal influence metabolic processes, where cholesterol is involved," explained Marcus Grimm, Head of the Experimental Neurology Laboratory at Saarland University. "Because they also lower cholesterol levels, they are extensively used in the food industry and as dietary supplements."

High cholesterol levels have long been discussed to increase the risk of developing Alzheimers disease. "Studies have already shown that cholesterol promotes the formation of so-called senile plaques," said Grimm. These plaques, which are composed of proteins, particularly beta-amyloid proteins, deposit at nerve cells within the brain and are regarded as one of the main causes of Alzheimers disease.

The research team based at Saarland Universitys medical campus in Homburg collaborated with scientists from Bonn, Finland and the Netherlands to examine how the sterols that we ingest influence the formation of these plaque proteins. It was found that one sterol in particular, stigmasterol, actually inhibited protein formation. Stigmasterol is most readily found in soybean oil.

"Stigmasterol has an effect on a variety of molecular processes: it lowers enzyme activity, it inhibits the formation of proteins implicated in the development of Alzheimers disease, and it alters the structure of the cell membrane," explained Dr Grimm. "Together, these effects synergistically reduce the production of beta-amyloid proteins." The research team has been able to confirm the positive effect of stigmasterol in tests on animals.

Overall, the researchers were able to demonstrate that the various plant sterols influence different cellular mechanisms and theore have to be assessed individually. "Particularly in the case of Alzheimers disease, it seems expedient to focus on the dietary intake of specific plant sterols rather than a mixture of sterols," explained Dr Grimm. In future studies, the research team wants to determine which other cellular processes in the brain are affected by phytosterols.

Research has also indicated that stigmasterol may be useful in prevention of certain cancers, including ovarian, prostate, breast, and colon cancers. Studies have also indicated that a diet high in phytoesterols may inhibit the absorption of cholesterol and lower serum cholesterol levels by competing for intestinal absorption.

Ever since The Glorious Return of Gas to My Oven, I have been making good use of my fully functional kitchen. Ive been boiling water on the stovetop for tea, marvelling at how quickly the kettle whistles. Ive roasted a chicken (you know, what with eating meat again). Ive baked two versions of Chickpea Cake and even broiled salmon when my fish-allergic boyfriend was out of the house. But my favorite thing to do, the thing I missed most in my ovens time off, is to roast broccoli.

I am a full believer in the power of oil, salt, and high heat to transform almost any vegetable into a delicacy. Sauteed Brussels sprouts, roasted root vegetables or cauliflower, even oven-roasted kale – these methods all move their produce from tasty enough healthy choices to mouth-watering heaven, as if heaven is a thing you eat. And broccoli perhaps benefits from this treatment best.

This is a variation on Ina Gartens recipe, which I learned by way of The Amateur Gourmet (where it is called, accurately, The Best Broccoli of Your Life). It is rich and hearty, a little sweet from caramelized edges, good and salty from... salt. Its also super easy – you toss broccoli with salt and oil and throw it in the oven. Set it and forget it, basically. And then, after all that zero hard work, you get something amazingly, addictively delicious that is also, lest we forget, broccoli.

This weekend I took my dear broccoli to a new level, by way of a little greenmarket desperation curiosity. While strolling through with my friend J. for eggs, onions, and heavy cream (my new obsession) – the only good things to find in a February farmers market – I saw something intriguing between the onions and ten kinds of potatoes: Jerusalem Artichokes. They are neither Israeli nor artichokes, but rather knobby little roots that I conveniently – thank you for writing seasonal recipes, fellow foodbloggers – had read about just a few days before. (You can swing by that very Marks Daily Apple post for more history of the sunchoke, and a couple more recipe ideas.)

Lets see. Roasted sunchokes, roasted broccoli. Creamy and nutty, toothsome and savory. Roasted, roasted. In my fridge, in my fridge. It obviously took a great feat of culinary inspiration and general genius for this combination to be conceived. (Thanks for sending me to college, mom!)

Note: Make sure to dry your broccoli and sunchokes THOROUGHLY. Id even recommend not washing the broccoli. Its going to be in a hot oven for a long time – anything bad on theres gonna get killed, and anything that doesnt get killed in the oven is some sort of superpowerful freak germ that was going to get you anyway.

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If this looks nice, youll surely appreciate:

• Broccoli-Cheddar Soup
• Broccoli Quiche
• Broccoli with Roasted Red Peppers

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Roasted Sunchokes and Broccoli
Serves 4
Adapted from Ina Garten/The Amateur Gourmet and Marks Daily Apple.


1 ½ lb broccoli (about 5 cups of florets)
1 lb sunchokes (about 4 cups sliced)
2 T olive oil, divided
salt to taste

1) Preheat oven to 400. Line two baking sheets with aluminum foil.

2) Chop broccoli into florets. (Put the stems aside for another use.) Toss in a large bowl with 1 T oil and a sprinkle of salt. Spread in a single layer on one baking sheet. Sprinkle with a little more salt if you like.

3) Slice or quarter sunchoked into relatively uniformly sized chunks, a little less than an inch thick. Toss in your large bowl with the remaining 1 T of oil and a sprinkle of salt. Spread on a single layer on the other baking sheet, ideally with each piece lying flat on a cut side (for optimal browning).

4) Cook broccoli and sunchokes for 30-40 minutes, until golden brown (or a little darker). Half-way through, swap them between the top and bottom racks, and stir/move around the veggies, adding salt if desired.

Approximate Calories, Fat, Fiber, Protein, and Cost Per Serving:
211 calories, 7.5g fat, 5.4g fiber, 6.2g protein, $1.41

Calculations:
5 cups broccoli: 155 calories, 1.7g fat, 11.8g fiber, 12.8g protein, $3.00
4 cups sunchokes: 438 calories, 0.1g fat, 9.6g fiber, 12g protein, $2.50
2 T olive oil: 252 calories, 28g fat, 0g fiber, 0g protein, $0.12
1 t salt: 0 calories, 0g fat, 0g fiber, 0g protein, $0.02
TOTALS: 845 calories, 29.7g fat, 21.4g fiber, 24.8g protein, $5.64
PER SERVING (TOTALS/4): 211 calories, 7.5g fat, 5.4g fiber, 6.2g protein, $1.41

Youve just had an A1C (hemoglobin A1C) test. The result was 7.5%. What does that mean? How does that relate to the average blood glucose readings you take at home? If preliminary results from the ADAGE trial hold, that A1C lab result may be reported as average glucose, in the familiar mg/dl reading, beginning next year.

The ADAGE study is a clinical trial being conducted at a number of centers across North America, Europe, and Africa. Its goal is to confirm the relationship between HbA1C levels and average blood glucose. Preliminary findings, reported at the 2007 ADA Scientific Sessions, are showing that relationship is closely correlated, for both type 1 and type 2 diabetes. This could lead to results of an A1C test being reported as A1C-Derived Average Glucose (ADA-G).

What Is HbA1C?

Hemoglobin A1C is that portion or percent of total hemoglobin that has glucose attached to it. In people without diabetes, about 4% to 6% of their hemoglobin is glycosylated. Red blood cells that contain the hemoglobin circulate in the bloodstream for 3 or 4 months before being broken down and replaced. During that time the RBC can bond, irreversibly, to glucose in the bloodstream. Thus, A1C readings higher than about 6% indicate higher than normal amounts of glucose roaming the bloodstream in the past 120 days.

Using the Conversion Table from the ADAs 2005 Position Statement on Standards of Medical Care in Diabetes, the 7.5% A1C reading at the beginning of this post would equate to an average blood glucose of about 188 mg/dl:


If this change happens, instead of receiving a 7.5% HbA1C, you might receive a result such as 188 mg/dl ADA-G. Improved calibration of lab machines that measure glycosylated hemoglobin are also in the offing. These changes may make lab results easier to interpret leading to improved blood glucose management.
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Statins -- the popular class of cholesterol-lowering drugs used widely to prevent recurrent heart disease or stroke as well as risk for having a first cardiac or stroke event -- appear to cause few side effects, according to new research reported in Circulation: Cardiovascular Quality and Outcomes.

Researchers conducted the largest meta-analysis on statin side effects to date, reviewing data from 135 previous drug studies to evaluate the safety of the seven statins on the market. They concluded "as a class, adverse events associated with statin therapy are not common."

Researchers noted that simvastatin and pravastatin, the generic names of the brands Zocor and Pravachol, were found to have the best safety profile in the class. This is particularly true when patients were prescribed low to moderate doses of those statins, said Huseyin Naci, M.H.S., the studys lead author and a doctoral candidate at the London School of Economics and Political Science and research fellow at Harvard Medical Schools Department of Population Medicine.

Researchers also noted a 9 percent increased risk of diabetes among statin users. But according to a previous landmark study, 250 patients need to be treated with a statin for one case of diabetes to be diagnosed.

"I am concerned that patients may misunderstand this small increase in risk and stop adhering to their medications," Naci said. The proven ability of statins to significantly cut the rate of death and hospitalization in patients who have heart disease outweighs the "small increase in diabetes risk," he said.

Researchers reviewed trials published between 1985 and early 2013, which included almost 250,000 patients. On average, the trials lasted a bit longer than a year. Some compared one statin to another, while others compared a statin to an inactive placebo, which is often called a sugar pill or dummy pill.

The study also found that statins were not linked to an increase in cancer risk. However, the drugs were associated with a typically reversible increase in liver enzymes, which Naci said still resulted in a very low rate of actual liver toxicity in statin patients.

"Although the benefits of statins clearly outweigh risks at the population level, individualizing such benefits and risks is more difficult," he said. "This brings into sharp focus the importance of identifying the individuals who stand to benefit the most from statin therapy.

Although the risk of developing diabetes is low, what this risk would amount to over time is simply not known based on the existing evidence," Naci said.

If New York Citys Mayor Michael Bloomberg has his anti-obesity way, the Big Apple will begin banning the restaurant and concession sale of sugary beverages that exceed a volume 16 fluid ounces as early as March of 2013.  The Disease Management Care Blog suspects there is one big reason why Hizonner is deploying brute force in this battle of the bulge, this confrontation of the calories, this attack on adiposity:

It works.

Contrast the approach of simply outlawing obesogenic drinks with kinder and gentler approaches, like those based on education (food labeling and warnings), economic incentives (fat taxes), appeals to self-interest ("youll look and feel better!") or enculturation (starting with food choices in our schools cafeterias).  They all have their role, but lets face it: we dont heed labels, hate taxes, find life-style changes difficult, are suckers for the food industrys marketing and ultimately like the taste rush of corn syrup.  Take a stroll through Manhattan and its pretty obvious we have a problem.

The Big Apple is doing this for our own public health good.

This lesson prompts the Disease Management Care Blog to ponder the largest threat to the success of the "accountability" movement in health care.  By "aligning" economic interests, offering savings-based "gain-sharing," leveraging decision support and enculturating physicians into "systems" of care imbued with best practices championed by physician leadership, we believe our collective taste for high cost testing, technology and pharmaceuticals will fade faster than the flab on The Biggest Loser.

Is that so?  Maybe not, and so the DMCB offers up two observations:

1. Assuming physicians are people and patients have their self-interest at heart, the likelihood that our appetitite for over-testing, the latest tech and brand name drugs will be blunted by electronic health record decision-support warnings, the promise of some savings-based future bonus, appeals at staff meetings to do the right thing or an expectation that physician culture will change is about as realistic as a successful John Edwards White House run in 2016.

2. And assuming that none of that works, the likelihood that future local and national politicians will use the same public health logic and announce a Bloomberg-esque "ban" of some high cost low value tests, technology and drugs is almost certain.

You read it here first.

Image from Wikipedia   

The Transportation Security Administration (TSA), a division of the US Department of Homeland Security, has enlisted new security measures for airline travel as a result of the threat to several passenger flights originating from the UK this morning.

As of this morning, the TSA is now "prohibiting any liquids, including beverages, hair gels, and lotions from being carried on the airplane."¹ They advise transferring these items from carry-on to checked baggage.

Some exceptions were listed on their website:

The following items are permitted to be carried aboard the aircraft:

• Passengers traveling with infants may bring baby formula.
  
• Prescription medicine that matches the passenger’s name.
  
• Essential non-prescription medicines such as insulin are permitted.
  
  - TSA, New Security Measures

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¹ Statement By Homeland Security Secretary Michael Chertoff Announcing A Change To The Nations Threat Level For The Aviation Sector

Photo compliments CNN.

Spring makes me want to dig in the dirt and make green things grow. I begin to picture a fire escape container garden with trellising bean vines and hanging tomato plants. But two things prevent me from making this yearly urban-farming fantasy a reality: my tiny New York City apartment gets no direct sunlight, and I’m terribly absentminded. So I water my low-light houseplants and leave the food growing to the pros.

Plus, the best part about buying fresh produce is chatting up the farmers at the farmers’ market. My neighborhood market draws the same group of upstate New York and eastern Pennsylvania farmers every year, and they become a part of our community. The Morgiewicz family supplies the majority of my vegetables from April through Thanksgiving, and the folks Breezy Hill Orchard from rock the best stone fruit I’ve ever put in a pie.


But even that can’t beat spending a day on a farm, seeing firsthand where your food comes from. Such was my weekend when I trekked south for the 16th Annual Piedmont Farm Tour sponsored by Carolina Farm Stewardship Association in April. The tour brought together 40 farms across Orange, Alamance, and Chatham counties in central North Carolina, on the eastern edge of the state’s Piedmont region.

Accompanied by my best friend Angela and her hubby Jesse, who live in Pittsboro, in Chatham county, my boyfriend CB and I got to take a peek at four farms in two days despite thunderstorms and tornadoes. We met farmers and talked to sustainable agriculture enthusiasts; we dined at restaurants that served locally sourced produce, dairy, and meats; we made friends with a few animals; and we marvelled at compost—twice.


Our first stop on Saturday was Harland’s Creek Farm in Pittsboro, a certified organic farm that produces flowers, vegetables, herbs, and pastured poultry. Harland’s Creek provided a tour brochure so guests could wander the grounds at their leisure.

Their flowers and herbs are grown in a formal parterre garden of raised, geometrically shaped beds, which reminded me of photographs of English country estates. The stunning historic farmhouse added to the illusion. As we pinched off tiny bits of herbs to smell and taste for identification (fennel and lemon balm or was that lemon verbena?), CB made fast friends with a pair of cats. It would be a recurring theme for the weekend.


Next up was Aryshire Farm, also in Pittsboro, which we visited after waiting out the thunderstorms. We were lucky to be farmer Bill Dow’s last tour of the day, and gratefully slogged through red clay mud to see and hear about his certified organic pear, apple, and peach orchard, blueberry bushes, and vegetable terraces. About halfway through the tour, we were joined by a group of beer-drinking senior citizens who enjoyed themselves as much as we did, but perhaps for different reasons.

Dow grows primarily lettuces and greens for local restaurants, working directly with chefs to produce the produce they want. "Id never heard of rapini before I started growing it," he quipped. Rapini, mizuna, arugula…he plants what they serve.


He also asks the chefs who visit his farm to bring their waitstaff with them, since as he puts it, "Theyre the ones talking to the people who eat the food."

Dow explained how he prevents erosion and conserves water on farm. By building terraces on the gently sloping land, water that would normally wash down the hillside is trapped and used by the plants at each level. And he distributes organic fertilizer (manure and compost) from the back of a beat-up old pick up truck that it is the envy of teenagers county-wide.

In late fall, he plants cover crops, like red clover, that are turned into live mulch in the spring. He pointed to the clover tops that were just starting to turn pink explaining that they were most nitrogen-rich and ready to be turned. He then walked over to a small three-sided shed, that housed a small tractor, hand tools, ropes, and buckets. He pulled out a garden hoe, much like one you might use in your backyard garden, except the handle was nearly as long as he was tall.


“The Dutch are better than us in two things: art and gardening.” He then demonstrated that with this Dutch-made, long-handled implement, you could turn the soil or break up weeds without stooping and hurting your back. He offered the hoe for one of our party to try. She passed her brewski to her husband and marveled at its ease of use.

As the tour wrapped, Dow’s dog Kate joined our posse and made fast-friends with CB. She followed him back to the car where we said our goodbyes, but not before Dow offered us a terrace for lease. The four of us looked at each other in contemplation. CB and I quickly said no; but I suspect we may be hearing about Angela and Jesse’s farm-fresh rapini in seasons to come.

Sunday, we set out for central Orange County to visit Avillion Farm, a fiber farm in the small Orange County burg of Efland. A fiber farm raises sheep, goats, and/or rabbits for their fleece which is spun into yarn or thread for knitting, weaving, crocheting, and countless other fiber arts. I’m a knitter/stitcher, so I just had to see the fuzzy animals, which Avillion had in abundance: adorable sheep, goats, and bunnies at every turn. More friends for CB.


Another self-guided tour, we learned from posted signs that, while Shetland sheep and Angora rabbits produce Shetland and Angora wool respectively, Angora goats produce mohair. We also saw a demonstration of vermicomposting of the rabbit poo and cleaned up at a homemade foot-powered hand washing station made of recycled water cooler jugs. It was well worth the hour drive north, and I managed to avoid spending my life’s savings on yarn.

With daylight on our side, we made one last stop: at McAdam’s Farm, also in Efland. A former tobacco farm, McAdams is a conventional farm that produces strawberries, flowers, produce, and raises beef cattle. Howard McAdams is the fourth generation of his family to work the land, making the switch from tobacco in 2000.

McAdams took us on a tour of his produce and strawberry fields, explaining just how labor intensive a crop of strawberries can be. Depending on soil quality and climate, the planting window can be as little as a week, and they must be replanted every year to ensure a healthy, productive crop.


Compared to blueberries, which are mostly at eye-level, strawberries are close to the ground; so harvesting is backbreaking work. That explains the popularity, among farmers at least, of pick-your-own strawberry patches, and why berries come at such a premium.

McAdams uses conventional farming methods, like black and white plastic mulch, along with chemical herbicides and pesticides to keep unwanted plants and critters at bay, and commercial fertilizers to enrich the sandy, coarse soil. He explained, laughing, that his land, unlike much of the surrounding rich red clay was great for tobacco but not that great for vegetables.

Angela made this trip an extra special experience. She is not just my best friend since high school; she is also an incredibly active member of the vibrant sustainable agriculture community of Chatham County. She is the manager of the Pittsboro Farmers’ Market and has been a champion of organic, local food since I can remember.

She asked so many great questions of the farmers, showed us the organic student farm used by the Sustainable Ag program at Central Carolina Community College, and took us for some amazing local fare. Every restaurant we visited, even the greasy-spoon diner and the burgers-and-fries sports bar, boasted local produce, meats, and dairy products.

A stand out was the Saxapahaw General Store in the tiny former-mill-village of Saxapahaw, in Alamance county. A combination restaurant/biofuel gas station, it’s a green oasis where you can fill up your converted minivan with cooking grease and your belly with maybe the best mac and cheese ever to pass these teeth.

In the weeks since my return to the big city, I’ve been thinking about the cost of food, particularly conventional versus organic produce, and I think I get it even more than I did before. Neither are easy to cultivate, and both are subject to the whims of weather, pests, and proper planning. In two days I saw vastly different farming methods in action and met the hard-working people behind them. It was suddenly plain to me why, organic or not, berries are so very expensive, and why organic produce comes at such a premium. Hearing Dow describe spreading manure from the back of a pick up truck with a shovel made me laugh in the moment—as CB said, “I’ve never met an unfunny farmer,”—but now I realize just what it means.

Farming takes commitment and passion, no matter what the scale. Dow is connected to his crops—he knows every plant and tree—and his reward is great, though his output is smaller than a conventional farm. McAdams takes a more business-like approach to his farm, focusing on the big picture of managing a mid-sized operation, and he clearly takes pride in carrying on his family’s legacy.

I’ll also remember how much time and sweat and pollen goes into raising food the next time I start planning my imaginary kitchen garden. This was one of the most eye-opening and delightful trips I’ve ever taken to my home state. My only regret is that I dont have a picture of farmer Dow showing off his superior Dutch hoe.

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If this flight tickled your fancy, flutter this way:

• A Confession and A Prayer to Remain Tailess
• Organic Foods: When to Splurge
• The CHG Guide to CSAs

The latest Cavalcade of Risk is up at David Williams Health Business Blog. Dave has summarized and linked the web sites of writers with insights about personal, business, insurance and enterprise risk.  This particular edition is heavy on health policy, which makes it doubly interesting.

Worth a look here.

Enjoy!

Low dose aspirin may ward off cognitive decline in elderly women with a high risk of cardiovascular diseases such as heart disease and stroke, conclude researchers from the University of Gothenburg in Sweden who write about their five-year study in a paper published 3 October in the online journal BMJ Open.

In their introduction, corresponding author Anne Börjesson-Hanson and colleagues explain that many studies have looked at the effect of non-steroidal anti- inflammatory drugs (NSAID) on cognitive decline and dementia, but few have looked at the effect of aspirin on these conditions.

Yet, while researchers have proposed that inflammation might be important in the development of cognitive decline and cardiovascular diseases, and low dose aspirin is widely prescribed to prevent cardiovascular disease, no study has yet examined the effect of aspirin on cognitive function in people at high cardiovascular risk.

For their study, the researchers followed 681 women aged between 70 and 92 for five years. 129 of the women were already taking aspirin at daily doses ranging from 75 and 160 mg, and after undergoing baseline assessments, 601 were classed as having high cardiovascular risk.

Over the study period, the participants underwent more tests of cognitive and thinking skills, including one commonly used in the UK to diagnose dementia, the Mini Mental State Examination (MMSE).

The results showed that while the MMSE scores for the overall group fell over the five years of the study, it fell less for those women taking aspirin.

But although other tests of memory and thinking showed a similar pattern, those results were not statistically significant.

By the end of the study, 41 of the participants developed dementia, but the rate was no different between those on aspirin and those who werent.

In discussing the possible limitations of their study, the authors say they cant rule out that people with incipient cognitive decline might be less likely to take aspirin anyway.

They conclude that low-dose aspirin treatment "may have a neuroprotective effect in elderly women at high cardiovascular risk".

Simon Ridley, Head of Research at Alzheimers Research UK, says in a press release:

"The results provide interesting insight into the importance of cardiovascular health on cognition, but we would urge people not to self-medicate with aspirin to try to stave off dementia."

He points out the study found no benefit from aspirin on overall dementia rates, and that previous trials investigating potential benefits of drugs like aspirin for dementia have been negative.

"We know that keeping our heart healthy through regular exercise, a healthy diet, not smoking and keeping our blood pressure and cholesterol in check, can help to reduce the risk of dementia," says Ridley, adding that research into risk factors for cognitive decline must nevertheless become a top priority in the UK because of its increasingly aging population.

A few weeks ago, I was having dinner with a friend who works with computers. After our fries were finished, we started talking about his job. “Here’s the thing,” he said, “and I think it happens with a lot of different occupations. When you work with clients, they want your work to be quick, cheap, and thorough. And you kind of have to tell them to pick two.”

“Why can’t they expect all three?” I wondered.

He phrased his response caully. “Well, you have other clients who demand your time. And competition is always pretty fierce.” He sipped his Guinness. “And it’s kind of the natural order of things, you know?”

“Explain.”

“Um, well. Think of it like this: If they want it done fast and cheap, the standard of work isn’t going to be very high. If they want it done fast and right, they’re going to have to fork over money for the extra manpower. And if they want it done cheap and right, it’s gonna take awhile.”

"Like a triangle."

"Yep."

“So getting all three is impossible?”

He shook his head. “Nope. You can get a little of everything if you’re willing to compromise. It’s kind of that sweet spot in the middle.”

“But getting people to compromise is tough.”

“Always.”

I nodded. The triangle idea made sense in a work context. And, when I though about it, it started to make sense in other contexts, too. “You know, it’s kind of like finding a New York apartment, except the parameters change a little.”

“Okay." More Guinness. "Go on."

“If you want a place that’s cheap and in a great neighborhood, it’s going to be a rat-infested hellhole.”

“Like your old place.”

“Right,” I continued. “And let’s say you have kids, and you want a place that’s cheap and nice. It’s going to be a gabillion miles from any subway stop. That’s why all our friends end up in Jersey.”

He finished my thought: "And you have to be making Derek Jeter-caliber money to live in a nice place in a good neighborhood."

"Right. Jeez. That guy."


Later that night, I tried to apply the idea to Cheap Healthy Good. And it got harder. Because heres the thing:

• People say you can buy cheap and healthy food, but it wont taste any good.
• People say you can buy delicious, healthy food, but it will cost a bagillion dollars.
• People say you can buy cheap, delicious food, but it will give you ten successive heart attacks.

I disagree with all of those conclusions. Like my friend, I believe that compromise is key to maintaining balance between the cheap, the healthy, and the good. I believe this is possible:



Paying a little more will get you healthier, scrumptious-ier food. Adding a little butter wont cost you much, and will keep food from tasting like lawn scraps. And actually preparing it yourself – not a ten-course State dinner, but yknow, a casserole – will cost less and give you a good chance of making it into your 80s.

(Of course, adding "time" or "effort" into the equation would be a logical extrapolation of this theory, but it turns the 2D drawing into a much-harder-to-understand 3D pyramid, which would simultaneously blow my mind and tax my pitifully scanty knowledge of graphic design to its breaking point, so well ignore it for now and get back to ruminating.)

So there you have it. The CHG Triangle of Compromise. Its exists to remind us of three things:

• We need not engage in extreme, black-and-white thinking when it comes to eating inexpensively, healthfully, and well.
• Compromise is the key to eating inexpensively, healthfully, and well.
• I am bad at Photoshop.

Readers, what think you? If you have any geometrically-based theories, Id love to hear em.

~~~

Like this? Youll love:

• Fear Itself
• Musings of a Healthy Cooking Teacher
• Trading Butter for All the Broccoli in China: Getting Healthy Takes Practice