Health for life

Statins lower the rate of cataract by 20 percent, according to research presented at the ESC Congress today by Professor John B. Kostis from New Jersey, USA. The risk of cataract was reduced by 50 percent when treatment was initiated in younger individuals (in their 40s) and the duration of therapy was longer (e.g. up to 14 years).

Cataracts are the leading cause of visual impairment worldwide affecting more than 20 million people. Statins are among the most commonly prescribed medications. In the USA they are prescribed to 1 in 3 people over 45 years of age at a cost of $35 billion annually.

Professor Kostis said: "There is persistent concern among physicians and other health care providers about the possible cataractogenicity of statins.1 We theore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. To our knowledge this is the first meta-analysis on the topic."

The meta-analysis included 2,399,200 persons and 25,618 cataracts. The average duration of treatment was 54 months and average age was 61.

Using random effects meta-analysis, a statistically significant decrease in cataracts with statins was observed (odds ratios [OR] 0.80, 95% confidence interval [CI] 0.77-0.83, p<0.0001). Professor Kostis said: "This corresponds to an approximately 20% lower rate of cataracts with statin use compared to no statin use."

Absolute risk reduction was 1.4%+0.015% (95% CI 1.1%-1.7%, p<0.0001). Professor Kostis said: "This equates to 71 persons needed to treat (NNT) with statins to prevent one cataract (95% CI 59-91 persons)."

Meta-regression showed that younger people were more likely to benefit, with an OR of 0.50 for patients in their 40s and an OR of 0.90 for patients in their 70s. Professor Kostis said: "Our analysis shows that people in their 40s who use statins have a 50% lower chance of getting cataracts. For people in their 70s risk is lowered by just 10%. It is possible that the two processes (aging and statins) work in parallel or interactively."

The analysis showed an increase in benefit of statins with longer duration of treatment with the OR varying from 0.90 for a treatment duration of 6 months (a 10% reduction in risk) to 0.45 for a treatment duration of 14 years (a 55% reduction in risk).

There was no difference between studies by gender. Several sensitivity analyses confirmed the results.

Professor Kostis concluded: "This meta-analysis indicates a statistically significant and clinically relevant protective effect of statins in preventing cataracts. The effect is more pronounced in younger patients, and with longer use. Our findings dispel worries about the safety of statins when it comes to cataracts, and lends additional support to long term statin use."

Figure notes:

Extraction: Studies pertaining to removal of cataract by an operation; No Extraction: Studies where removal of cataract by an operation was not the endpoint; Clinical: Studies where the patient or a physician reported the presence of cataract; Opacities: Studies where an ophthalmologist reported the presence small areas of cloudiness in the lens of the eye unrelated to visual complaints by the patients.

A diet low in grains, beans and certain vegetables — combined with “anti-aging” supplements — improved blood vessel function, in a study presented at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology 2013 Scientific Sessions.

The blood vessel abnormality, or endothelial dysfunction, occurs when cells lining the interior wall of blood vessels malfunction. It’s a serious condition that’s often one of the first signs of heart disease.

Of the 200 51- to 86-year-old people in the study, 40 percent were women. All had risk factors for blood vessel disease and nearly three-quarters had endothelial dysfunction.

The diet restricted foods high in the sugar-binding protein lectin, generally regarded as a healthy nutrient. The restricted foods included grains, beans, fruit, poultry and plants belonging to the nightshade family, which includes tomatoes. At the same time, patients consumed plenty of leafy greens, shellfish and fish, olive oil and grass-fed animal protein, while taking supplements containing the antioxidant polyphenol from fish oil, grape seed extract and vitamins. Antioxidants are thought to slow cell aging.

“These findings represent a fundamental paradigm shift in how the diseases of the ‘Western Diet’ should be treated,” said Steven R. Gundry, M.D., lead author and medical director of the International Heart & Lung Institute at The Center for Restorative Medicine in Palm Springs, Calif. “Simple removal of ‘healthy’ lectin-containing foods, and taking a few inexpensive supplements, may restore endothelial function to normal, which in turn can reverse high blood pressure, diabetes and obesity.”

Despite the study’s findings, consumers shouldn’t eliminate tomatoes or other healthy foods from their diets, said the American Heart Association, which recommends consuming a diet with plenty of fruits, vegetables, whole grains and fish.

Im a little conflicted, lately.

I have a pretty good sense of humor, if I do say so myself. (You have to have a sense of humor to call yourself "The Angry Type 2 Diabetic" and still be able to handle every preachy a-hole out there thinking youre just bitter about your diabetes, and needing to get some anger management classes...) 


But... what exactly is OKAY as a diabetes joke? I find myself... somewhat at odds.

Lets see... at the "feather weight" level of jokes are erences to the things we do every day, and thats awesome. I think it definitely HELPS heaps when people can sort of join in with us on how we see the world... Whether its our struggles, or just things that make us go "hmmm..."


Then there are expressions, or tattoos that might encourage some mild debate... like "Sugar Free," and that can be okay, as well. This tattoo picture has provoked some argument and discussion in my Facebook diabetes group, and folks have gotten a chance to weigh in on the irony/misconception/message, however one might see it.

I kind of actually see it... as a way to tell The Sugar, aka Diabetes, that I am not its slave. (Lots of people HATE IT when diabetes is called "The Sugar," by the way. Dont be surprised if when you call it as such, objects go flying in your direction.)


Now, a while back, the satirical, fake news publication, "The Onion," made an article making fun of Jay Cutler, a football athlete with Type 1 Diabetes... Lots of folks interpreted the article as though it was outright making fun of Type 1 Diabetes, when in fact, it seems they were really just trying to call Cutler a whiny bore... albeit, in a poorly thought out manner. They could have just erenced regular kids, NEVER mentioning diabetes at all, and still gotten the point across. (Me thinks those people, funny as they are sometimes, need a needle jab or two on the behind.) Clearly, this kind of humor is unacceptable... or is it? Is there a point when we can divorce our fears of losing our loved ones, or our own lives, so we can laugh at a joke? Yeah, on paper, this all seems good and well... in reality, Im gonna tell you to go f off with that joke. lol

Then theres jokes where people laugh... uncomfortably so. Like these ones... Or the ones where people joke about "falling limbs" from eating too much candy.  These types of jokes get most diabetics riled up... because they showcase a terrible misconception that we cant have sugar, or candy, or worse... that were all just going to lose life and limbs from even having as much as one bar too many. Youll find most diabetics standing up against these types of jokes, and I admit, they make me pretty crabby...




Theres also the "well intentioned" (or so I try to tell myself), yet still incredibly ignorant person wholl reply something along the lines of "Oh, thats just Type 2 Diabetes... Theres two kinds, you know." I think THAT makes me angrier than the joke itself, really. How is correcting one stereotype, by feeding another, suddenly acceptable in any way?

Then theres the McDonalds jokes... Im sorry... but if you cant laugh at a candy bar joke, Im not going to laugh at a Diabetes/McDonalds joke.

Was I supposed to laugh? *MY* bad.

My first attempt at a video presentation.  Check it!  And head over to You Tube and "like" it.  And comment!

Hugging a health insurer

Its an old conservative joke, but what is the one key difference between health insurers and terrorists? 

Answer: liberals only occasionally attack terrorists.

For the latest example of the continuing disdain for health insurers, check out this rather typical July 5 Washington Post article "Is this the end of health insurers?" After extolling one enlightened companys decision to self-insure its workers*, writer Sarah Kliff points out that hospitals can cut out the insurer middle man and offer the same service. The result, says the article, will be the wiser use of the premium dollars, lower costs and fewer coverage denials.

While the physician Disease Management Care Blog agrees that the health insurers have only themselves to blame for their bad reputation, it doesnt think that these companies are going to go away anytime soon.  Its not because, under Obamacare, U.S. citizens are now required to buy their product at any price.  Its not because they control hundreds of billions of dollars.  And its not because theyve had the ear of the political class for years.

The contrarian DMCB thinks theyll continue to stick around because they perform a two useful public services:

1. Keeping Providers From Going Belly Up: There have been too many examples of hospitals and physician organizations being unable to collect todays premium dollars and hold them as a promise to pay for tomorrows sickness.  Whether its not charging enough or being unable to say no, providers are vulnerable to running out of cash and being unable to cover their insureds health care bills.  The DMCB says its better to insulate hospitals and doctors from the perils of the underwriting cycle.  Insurers do that.

2. Keeping Providers From Going to the Dark Side: Assuming a hospital or physician organization can hold the dollars, pay for all that health care and end the year in the black, theres a good chance that theyll do it by ultimately employing the same tactics used by many mainstream insurers: denials of services based on determinations of "medical necessity."

*As an aside, self-insured companies dont always act in the their employees best interest.  Look at this infamous example and note that Cigna only "administered" the insurance plan on behalf of a self insured organization.

Health-conscious individuals understand the importance of Omega-3 fats for cardiovascular and brain health. Conversely, Omega-6 fatty acids from corn, safflower and soybean oil sources are known to lead to systemic inflammation and free radical proliferation when consumed in an unbalanced ratio with Omega-3 fats.

Were all aware of the past criticisms of "disease management." According to the critics, these for-profit vendors were in collusion with commercial insurers, relying robo-calls to blanket unsuspecting patients with dubious advice. Their claims of "outcomes" were based on flawed research that was never intended to be science; it was really intended to market their wares.  

But suppose the Disease Management Care Blog alerted you to:

1. A company that had developed a patient registry to identify at-risk patients who had not received an evidence-based care recommendation? Software created mailings to those patients that not only informed them of the recommendation but offered them a toll-free number to call if there were questions. Patients who remained non-compliant were then called by coordinators, who made three attempts to contact the patient and assist in any scheduling needs. If necessary, a nurse was available to telephonically engage patients and develop alternative care options.

If you think that sounds like typical vendor-driven telephonic disease management, youd be right.  Youd also be describing an approach to care that was studied by Group Health Cooperative using their electronic record, medical assistants and nurses.  When it was applied to colon cancer screening, a randomized study revealed each additional level of support progressively resulted in statistically significant screening rates.

Or how about.......

2. A major insurer that decided to use its claims data to identify its own "best practices" without waiting for any published evidence-based studies?  Since "strict experimental conditions cannot always be met," shortcuts like time-series analyses" and "propensity score approaches" will be used to "blur" the lines between feedback and evaluation, as well as the lines between provider and insurer?

If you think that sounds like an commercial insurer muscling into health care delivery while using quasi-experimental research shortcuts, youd be right.  Youd also be describing how Medicares Innovation Center is borrowing from the disease management industrys approach.  Its all here.

Lastly, theres......

3. A major insurer that decided to NOT to pay primary care sites enough fee-for-service or capitation, preventing them from hiring nurses who could provide coordinated care.  The insurer instead hired its own nurses and "embedded" them in the primary care sites while linking additional monthly payments of approximately $5 to pay-for-performance metrics.

If you think that sounds like a step away from the usual Patient Centered Medical Home, youd be wrong.  In this instance, having the embedded nurses did not get in the way of the sites achieving PPC-PCMH recognition. Whats more, compared to usual care in a prospective randomized study that was underwritten by the medical-home fans at the Commonwealth Fund, the embedded nurse approach resulted in better hypertension care, breast cancer screening and fewer emergency room visits.

Alas, disease management: to paraphrase The Bard, a rose still smells as sweet by any other name, especially if its used by Group Health, CMS and the Commonwealth Fund.

"Stand up, bend over and let me see that itchy rash!"

In another lesson on how its clinical world is changing, the Disease Management Care Blog recently witnessed a "virtual" computer-based video patient-physician office visit. The patient seemed to like the convenience, while the physician reminded the skeptical DMCB that most of any medical diagnosis is based on the patient history, not the physician examination. 

It worked pretty well.  Whats more, the literature suggests that this is not all that new,  there are studies that suggest high levels of patient satisfaction and a surprising willingness to pay for the service out of pocket.  Time will tell on whether this leads to comparable clinical outcomes at an acceptable cost.

But what has struck the DMCB most of all was a business model "dichotomy."  Talk to most policymakers about virtual office visits and youll discover that it is being hailed as another advance in increasing consumer-patient access to cost-effective care.  In other words, persons living in Faraway Montana will be able to discuss their rash with the expert Dr. Windowchat anywhere in the world.  The DMCB thinks of this as the "enlightened" side of "telemedicine."

While that may have merit, when the DMCB googles "virtual office visits," it finds a decidedly contrary business model: busy and computer-savvy suburbanites with the kind of disposable income who can pay out-of-pocket for the convenience of not having to sit in a waiting room.  From a health insurance perspective, this is quite compelling, since it substitutes a lower level of service for a population that is prone to overutilization.  The DMCB knows the doctors like it better when the insurers arent involved in a high cash-flow yes-Ill-take-VISA transactional business.  This is the "real" side of telemedicine.

The DMCB suspects this is one of those innovations that offers something for everyone: increased access for those with not enough of it and "disruptive" technology for a health care industry still locked into expensive and labor intensive one-on-one doctor-patient visits.  From all points of view, this form of telemedicines future is very bright.

Low levels of the "sunshine" vitamin D appear to increase a childs risk of anemia, according to new research led by investigators at the Johns Hopkins Childrens Center. The study, published online Oct. 10 in the Journal of Pediatrics, is believed to be the first one to extensively explore the link between the two conditions in children.

The researchers caution that their results are not proof of cause and effect, but rather evidence of a complex interplay between low vitamin D levels and hemoglobin, the oxygen-binding protein in red blood cells. The investigators say several mechanisms could account for the link between vitamin D and anemia, including vitamin Ds effects on red blood cell production in the bone marrow, as well as its ability to regulate immune inflammation, a known catalyst of anemia.

To capture the interaction between the two conditions, researchers studied blood samples from more than 10,400 children, tracking levels of vitamin D and hemoglobin. Vitamin D levels were consistently lower in children with low hemoglobin levels compared with their non-anemic counterparts, the researchers found. The sharpest spike in anemia risk occurred with mild vitamin D deficiency, defined as vitamin D levels below 30 nanograms per milliliter (ng/ml). Children with levels below 30 ng/ml had nearly twice the anemia risk of those with normal vitamin D levels. Severe vitamin D deficiency is defined as vitamin D levels at or below 20 ng/ml. Both mild and severe deficiency requires treatment with supplements.

When investigators looked at anemia and vitamin D by race, an interesting difference emerged. Black children had higher rates of anemia compared with white children (14 percent vs. 2 percent) and considerably lower vitamin D levels overall, but their anemia risk didnt rise until their vitamin D levels dropped far lower than those of white children. The racial difference in vitamin D levels and anemia suggests that current therapeutic targets for preventing or treating these conditions may warrant a further look, the researchers say.

"The clear racial variance we saw in our study should serve as a reminder that what we may consider a pathologically low level in some may be perfectly adequate in others, which raises some interesting questions about our current one-size-fits-all approach to treatment and supplementation," says lead investigator Meredith Atkinson, M.D., M.H.S., a pediatric kidney specialist at the Johns Hopkins Childrens Center.

Untreated, chronic anemia and vitamin D deficiency can have wide-ranging health consequences, including organ damage, skeletal deformities and frequent fractures, and lead to premature osteoporosis in later life.

Long known for its role in bone development, vitamin D has recently been implicated in a wide range of disorders. Emerging evidence suggests that low vitamin D levels may play a role in the development of certain cancers and heart disease and lead to suppressed immunity, the researchers note.

Anemia, which occurs when the body doesnt have enough oxygen-carrying red blood cells, is believed to affect one in five children at some point in their lives, experts say. Several large-scale studies have found severe vitamin D deficiency in about a tenth of U.S. children, while nearly 70 percent have suboptimal levels.

What do urine color and odor changes mean? How often should you go

Urine isnt something most people talk about. We barely give it more than a passing glance as it swirls out of sight down the toilet bowl. Yet changes in the urine – its color, odor, and consistency – can provide important clues about the status of your body. Your urine can reveal what youve been eating, how much youve been drinking, and what diseases you have.

"Urine and urinalysis have, for hundreds of years, been one of the ways physicians have looked at health," says Tomas Griebling, MD, MPH, vice chair of the urology department at the University of Kansas.
"From a historical view, urinalysis was one of the original windows into whats happening in the body," Griebling says. Thats because many of the substances circulating in your body, including bacteria, yeast, excess protein and sugar, eventually make their way into the urine.
Urine is an important part of the bodys disposal process. Its job is to remove the extra water and water-soluble wastes the kidneys filter out of the blood. "The urine is there primarily to get rid of toxins or things that would otherwise build up in the body that would be bad for the body," says Anthony Smith, MD, professor and chief of urology at the University of New Mexico.
When you notice that your urine has changed color, or theres a strange odor wafting up from the toilet, the cause might be something as harmless as what you had for dinner (which could have included beets or asparagus). It also might be a sign of a more serious condition, such as an infection or cancer.
Before you flush, here are a few urine changes to look out for, and what they might be saying about your health.

Color Changes
Urine gets its yellow color from a pigment called urochrome. That color normally varies from pale yellow to deep amber, depending on the concentration of the urine. Darker urine is usually a sign that youre not drinking enough fluid. "Your body needs a certain amount of fluid to function, so the body will hold on to fluid and the urine will become very strong and concentrated. When that happens, it will turn a darker color," Griebling says.
The opposite is also true. If your urine is very pale, it means that youre either drinking a lot of fluid, or youre taking a diuretic -- a drug that forces the body to get rid of excess water.
Urine can turn a rainbow of colors, and an unusual hue isnt necessarily cause for alarm. Certain medications can turn the urine fluorescent green or blue, carrots can tint it orange, vitamins can give it a yellow hue, and an inherited disease called porphyria can shade it the color of port wine.
Seeing red is typically a sign that there is blood in the urine, but before you panic, know that a little blood can produce a dramatic color change. "What I always tell patients is it takes one drop of blood to turn a toilet bowl red," Smith says.
That said, just a little blood in the urine can be a sign of something serious, like an infection or cancer, and it warrants a visit to your doctor or urologist. If youre seeing blood and your urine is also cloudy, theres a good chance youve picked up an infection, Smith says.

Odor Changes

Urine normally doesnt have a very strong smell. If you get a whiff of something particularly pungent, you could have an infection or urinary stones, which can create an ammonia-like odor. Diabetics might notice that their urine smells sweet, because of excess sugar. In the past, doctors would actually taste urine for this sweetness to diagnose diabetes.
Some foods can also change urine odor. Asparagus is among the most notorious. What people are smelling when they eat asparagus is the breakdown of a sulfur compound called methyl mercaptan (the same compound found in garlic and skunk secretions). If you catch a whiff of something after eating a plate of asparagus, it means that youve inherited the gene for the enzyme that breaks down mercaptan. Not everyone has this enzyme and, theore, not everyone can smell it.

How Often Do You Need to Go?

How often you need to go can be as important an indicator of your health as the color or smell of your urine. Most people take bathroom breaks about six to eight times a day, but you might go more or less depending on how much fluid you drink. If youre constantly feeling the urge to go and its not because youre not drinking extra fluid, causes can include:
• Overactive bladder -- involuntary contractions of the bladder muscle
• Urinary tract infection
• Interstitial cystitis -- a condition that causes the bladder wall to become inflamed and irritated
• Benign prostate enlargement -- growth of the prostate that causes it to squeeze the urethra and block the normal flow of urine out of the body
• Neurological diseases, including stroke and Parkinsons disease
• Diabetes
The opposite problem -- not going to the bathroom enough -- can occur when there is a blockage or infection. Or, it can be the result of bad bathroom habits. Some people -- especially teachers, surgeons, and anyone else who doesnt have time for regular bathroom breaks throughout the day -- tend to hold it in.
Delaying urination can be problematic, says Smith, who compares the bladder to a Slinky: It stretches and then contracts repeatedly, but eventually it can stretch too much to bounce back. "The bladder can develop a chronic overdistension…a chronic emptying problem," he says.

Developing Healthy Bathroom Habits

Take good care of your bladder, and it will thank you by helping you urinate regularly. To avoid having to make too many bathroom visits, stay hydrated, but not overhydrated. Drink whenever youre thirsty, but dont feel as though you have to adhere to the eight-glasses-a-day recommendation (unless you have kidney or bladder stones, in which case youll need to increase your fluid intake).
If youre getting up during the night to use the bathroom, stop drinking three to four hours before bedtime. Limit caffeine, which can irritate the lining of the bladder. Also watch your intake of alcohol, which can have similar effects.
Finally, dont hold it in. As soon as you feel the urge to go, excuse yourself from whatever youre doing and find a bathroom.

If youre interested in learning more about the latest U.S. health care cost trends, everything you need to know is in this article in the January 2013 issue of Health Affairs.

Or you could rely on the Disease Management Care Blog to point out the articles 7 most important points.  Use them to impress your colleagues and stymie your foes:

1) The data only go up to 2011; well have to wait another year before well know about 2012.

2) 2011 health care spending, as a percent of gross domestic product, remained at 17.9%.  The overall economy was slow and that took its toll on the health care sector.

3) That comes out to $2.7 trillion or $8,680 in health care spending per person.

4) While the percent remained stable, the economy experienced modest growth in 2011. The health care sector, thanks to an overall growth rate of 3.9%, kept pace. Prices for services grew less than the demand for services.  As we grow older, demand is likely to grow.

5) Medicare and private insurance grew faster than the economy, which was offset by Medicaid cost cutting by the states.

6) If the past is any guide, when the U. S. economy rebounds, health care spending is likely to accelerate and resume its march toward becoming 20% of GDP.

7) The relative stabilization of 2011 health care costs is independent of the Affordable Care Act.  Many of its important provisions (such as the mandate) dont kick in until 2014.

Dear readers, for those of you not living in the Northeast, let me tell you something I just learned: it is FALL! Sure, Utah was having snowstorms two weeks ago, but whatever. In my little world, the seasons just started changing, and hard.

When I told my boyfriend that I could see my breath this morning he was like, “Why are you so excited about it being freezing out?”

“I don’t know.” I thought for a moment. “I guess I really like November?”

It shouldn’t be too much of a surprise. Two weekends ago I texted a few friends a picture of the fall’s first Brussels sprouts at the farmers market, along with the word, “first!”

I know that summer is the season of produce bounty or whatever, and I have enjoyed it. I ate sweet cherry tomatoes like grapes, munched on every color of bell pepper, enjoyed berries and peaches and plums. It was great.

But fall is my favorite season for produce. The first few apples I saw just reminded me of late-winter apple fatigue, but now I’ve been making batches of spicy apple sauce that I’m frankly addicted to. I’m roasting sweet potatoes and sautéing broccoli and there’s a butternut squash on my kitchen table with a date with a (hopefully) sharp knife.

And then there are Brussels sprouts. O, Brussels sprouts, I love them so. I can’t tell how far into the popular consciousness their adoration has spread. It’s like a rumor, passed friend to friend, or admission to the Secret Brussels Sprouts Appreciation Society. “Have you tried roasted Brussels sprouts?” “If you brown them in a pan, they’re better than bacon.” “My mother used to steam them and they smelled like trash, but cooked hot and salty they’re— Oh, sorry, I’m drooling down my shirt.”

So, I want to make sure you’ve heard. When steamed or boiled, Brussels sprouts are gross, deserving of their putrid reputation. But roasted or sautéed, browned and salted just right, they’re— Oh, sorry, I’m drooling down my shirt again.

Beyond that, Brussels sprouts are also a good source of Vitamin A, Vitamin C, Thiamine, Folate, Iron, and fiber. They come into season (at least in the Northeast and other similarly climated regions) in mid-October, and last past the frost. Their relatives include cabbage, collard greens, broccoli, and kale, and they do indeed look like tiny cabbages (or brains). They grow on stalks, and sometimes you can buy them that way at the farmers market, and it looks CRAZY.
And that was Brussels sprouts fact-time! Yay!

My go-to Brussels sprout recipe, and what originally converted me to their cult, is Heidi Swansson’s Golden-Crusted Brussels Sprouts. The cheese is superfluous but the method is perfection – cook halved sprouts with oil and salt, sautéing until they’re carmelized and browned. Crispy outsides, melty insides, addictive throughout. I served them as a side dish when I cooked Thanksgiving at my mom’s house a couple of years ago (everything but the bird), and converted my family in one go.

Sometimes, though, I just don’t have the patience to make sure the cut sides are browned, to find the right balance between thorough cooking inside and out. (Cooking Brussels sprouts too slowly lets the insides steam, giving you that nasty, almost horseradishey flavor.)

(You can also roast these babies in the oven – tossed with oil and salt, laid out on a baking sheet, shaken around once in a while, until browned and delicious. But I’m still living in the land of No Gas to the Kitchen, and a meager few toaster oven-roasted Brussels sprouts is just not enough for my fix.)

So here’s my new favorite way to cook Brussels sprouts – it gives you the pan-sautéed flavor without any of the finicky work.

You shred some sprouts. You heat oil in a pan. You sautee them until they’re done.

Oh, you wanted an actual recipe? Okay. Enjoy. Welcome to the club.

~~~

If you think this looks good, yer gonna love:

• Chopped Salad
• Escarole and White Beans
• Roasted Brussels Sprouts

~~~

Golden Shredded Brussels Sprouts
serves 2-3


1 lb Brussels sprouts (3-4 cups shredded)
1/8-1/4 t salt
dash of red pepper flakes (optional)

Note: if increasing recipe, cook in batches – an overfull pan of sprouts will steam rather than brown.

1) Trim ends and loose leaves off of sprouts. Cut (lengthwise) into thin shreds.

2) Heat olive oil in a wide sauté pan over medium-high heat. Add sprouts and toss with salt and red pepper.

3) Sauté until sprouts are browned in places, about ten minutes.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
129 calories, 7.5g fat, 5.6g fiber, 5.2g protein, $1.51

Calculations
1 lb Brussels sprouts: 132 calories, 0.9g fat, 11.7g fiber, 10.4g protein, $3.00
1/8-1/4 t salt: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
dash of red pepper flakes: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
TOTALS: 258 calories, 14.9g fat, 11.7g fiber, 10.4g protein, $3.02
PER SERVING (TOTAL/2): 129 calories, 7.5g fat, 5.6g fiber, 5.2g protein, $1.51
PER SERVING (TOTAL/3): 86 calories, 5g fat, 3.9g fiber, 3.5g protein, $1.00

It’s been our BME (Best. Month. Evah.) here at CHG (Cheap Healthy Good), both in terms of traffic (over 450,000 pageviews!) and comments (whee!). Thank you, sweet readers, both old school and new wave. Here’s hoping we can keep the streak alive. (Crap! I mentioned the streak! Somewhere, Joe DiMaggio is tut-tutting me all classy-like.) One more article coming tomorrow, and then it’s on to April.

MARCH RECIPES

Banana Oatmeal Muffins
Broccoli with Roasted Red Peppers
Chickpea Cutlets
Curried Apples and Acorn Squash
Dal with Rice and Ginger
Rice Pudding
Salsa Couscous Chicken OR Moroccan Chicken
Vegetarian Chili
White Bean Dip


MARCH ARTICLES

Remember when we fed the Husband-Elect for $25 that one week? Thems was good times. There’s even a clip of our Early Show appearance here! We ended the whole deal with The $25 Food Project Finale: Recipes, Conclusions, and an Exit Interview

Our greatest bombs were documented in CHG Hall of Shame III: Return of the Breadi.

Leigh asked and answered: HOW Old is that Oatmeal? When to Clean Out the Pantry.

Then, she exclaimed mightily, "I Want to Be a Tofu Butcher!"

There was that two-part series on the Junk Food Tax, starting with Reasonable Public Health Measure or Evidence of a Nanny State? and ending with Reader Ideas, Opinions, and Solutions.

Oh, and hey: Need a Weekly Meal Planner, a Grocery List, or Price Books? We Have 36 of ‘em.

Ask the Internet, was ever-so-lovely, as always. We inquired about the following:

• $25 Grocery List from Scratch?
• CSA Reviews, Ideas, and Experiences?
• Fast Breakfast for Students?
• Food Funny?
• Hominy Recipes?

For more Cheap Healthy Goodness…

1) Have your say!
We love reading creative comments and participating in thought-provoking discussions. There’s even a fabulous Ask the Internet column, where readers can write in with various inquiries and/or offer helpful suggestions. Sweet.

2) Spread the word!
Like us? Link to us! Refer us to a bookmarking site! (We have StumbleUpon and Digg buttons now!) Or just talk us up to your mom. That’s nice, too.

3) Behold our social networking!
Subscribe to our feed, join our Facebook page, or check out our Twitter … thing. They’re super fun ways to kill time, minus the soul-crushing frustration of Bejeweled.

4) Buy from our Amazon Store!
If you click on the Amazon widget (lower left hand corner) and buy anything from Amazon (not just what we’re advertising on CHG), we get a small commission. And that’s always nice.

5) Remember: when a neighborhood kid drops an empty Papa John’s pizza box on your front stoop, it’s within your rights to pelt him with water balloons.
Oh, Brooklyn.

Low levels of vitamin D may be associated with longevity, according to a study involving middle-aged children of people in their 90s published in CMAJ (Canadian Medical Association Journal).

"We found that familial longevity was associated with lower levels of vitamin D and a lower frequency of allelic variation in the CYP2R1 gene, which was associated with higher levels of vitamin D," writes Dr. Diana van Heemst, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands, with coauthors.

Previous studies have shown that low levels of vitamin D are associated with increased rates of death, heart disease, diabetes, cancer, allergies, mental illness and other afflictions. However, it is not known whether low levels are the cause of these diseases or if they are a consequence.

To determine whether there was an association between vitamin D levels and longevity, Dutch researchers looked at data from 380 white families with at least 2 siblings over age 90 (89 years or older for men and 91 year or older for women) in the Leiden Longevity Study. The study involved the siblings, their offspring and their offsprings partners for a total of 1038 offspring and 461 controls. The children of the nonagenarians were included because it is difficult to include controls for the older age group. The partners were included because they were of a similar age and shared similar environmental factors that might influence vitamin D levels.

The researchers measured levels of 25(OH) vitamin D and categorized levels by month as they varied according to season. Tanning bed use, which can affect vitamin D levels, was categorized as never, 1 times per year and 6 times per year. The researchers controlled for age, sex, BMI (body mass index), time of year, vitamin supplementation and kidney function, all factors that can influence vitamin D levels. They also looked at the influence of genetic variation in 3 genes associated with vitamin D levels.

"We found that the offspring of nonagenarians who had at least 1 nonagenarian sibling had lower levels of vitamin D than controls, independent of possible confounding factors and SNPs [single nucleotide polymorphisms] associated with vitamin D levels," write the authors. "We also found that the offspring had a lower frequency of common genetic variants in the CYP2R1 gene; a common genetic variant of this gene predisposes people to high vitamin D levels.

These findings support an association between low vitamin D levels and familial longevity." They postulate that offspring of nonagenarians might have more of a protein that is hypothesized to be an "aging suppressor" protein. More research is needed to understand the link between lower vitamin D levels, genetic variants and familial longevity.

Results of the PREDIMED study, aimed at assessing the efficacy of the Mediterranean diet in the primary prevention of cardiovascular diseases, have been published in The New England Journal of Medicine. They show that the Mediterranean diet supplemented with extra-virgin olive oil or tree nuts reduces by 30 percent the risk of suffering a cardiovascular death, a myocardial infarction or a stroke.

The study has been coordinated by the researcher Ramon Estruch, from the Faculty of Medicine of the UB and the Hospital Clínic -- affiliated centres with the health campus of the UB, HUBc -- and has had the collaboration of the professor Rosa M. Lamuela and her team from the Natural Antioxidant Research Group of the Faculty of Pharmacy -- located at the campus of international excellence BKC -- which determined the biomarkers of Mediterranean diet consumption.

The research is part of the project PREDIMED, a multicentre trial carried out between 2003 and 2011 to study the effects of the Mediterranean diet on the primary prevention of cardiovascular diseases. The study was funded by the Carlos III Health Institute by means of the cooperative research thematic network (RETIC RD06/0045) and the CIBER of Physiopathology of Obesity and Nutrition (CIBERobn).

A total of 7,447 people with major cardiovascular risk factors participated in the study. They were divided into three dietary intervention groups: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts (walnuts, almonds, hazelnuts), and a low-fat diet (animal and vegetable). A dietician visited the patients every three months and they attended dietary training group sessions, in which they received detailed information about the Mediterranean and the low-fat diet, and the food included in each one. Moreover, they were provided with shopping lists, menus and recipes adapted to each type of diet and each season of the year.

During the study, those participants who followed any of the two types of Mediterranean diet received freely extra-virgin olive oil (one litre per week), and nuts (30 grams per day; 15 grams of walnuts, 7.5 grams of almonds and 7.5 grams of hazelnuts).

After five years, it has been proved that participants who followed any of the two types of Mediterranean diet showed a substantial reduction in the risk of suffering a cardiovascular death, a myocardial infarction or a stroke.

According to the researchers, the results of PREDIMED study are relevant as they prove that a high-vegetable fat diet is healthier at a cardiovascular level than a low-fat diet. The authors state that the study has been controversial as it provides new data to reject the idea that it is necessary to reduce fats in order to improve cardiovascular health.

Hopefully, these results will provide new erences to prevent cardiovascular diseases. In addition, the design and methodology used can be easily transferred to the biomedical sector.

Even organic foods not stored, prepared or cooked in plastic containers can contain these contaminants

While water bottles may tout BPA-free labels and personal care products declare phthalates not among their ingredients, these assurances may not be enough. According to a study published February 27 in the Nature Journal of Exposure Science and Environmental Epidemiology, people may be exposed to these chemicals in their diets, even if their meals are organic and foods are prepared, cooked and stored in non-plastic containers. And children may be most vulnerable.

"Current information we give families may not be enough to reduce exposures," said Dr. Sheela Sathyanarayana, lead author on the study and an environmental health pediatrician in the University of Washington School of Public Health and at Seattle Childrens Research Institute. She is an assistant professor of pediatrics at the UW School of Medicine and an attending physician at Harborview Medical Centers Pediatric Environmental Health Specialty Unit.

Phthalates and bisphenol A (BPA) are synthetic endocrine-disrupting chemicals. Previous studies have linked prenatal exposure to phthalates to abnormalities in the male reproductive system. Associations have also been shown between fetal exposure to BPA and hyperactivity, anxiety, and depression in girls.

The researchers compared the chemical exposures of 10 families, half who were given written instructions on how to reduce phthalate and BPA exposures, handouts developed by the national Pediatric Environmental Health Specialty Units, a network of experts on environmentally related health effects in children. For five days the other families received a local, fresh, organic food catered diet that was not prepared, cooked or stored in plastic containers

When the researchers tested the urinary concentrations of metabolites for phthalates and BPA, they got surprising results. The researchers expected the levels of the metabolities to decrease in those adults and children eating the catered diet.

Instead, the opposite happened. The urinary concentration for pthalates were 100-fold higher than the those levels found in the majority of the general population, The comparison comes from a study conducted by the National Health and Nutrition Examination Survey (NHANES), a program of studies managed by the Centers for Disease Control and Prevention and designed to assess the health and nutritional status of adults and children in the United States. The concentrations were also much higher for children as compared to the adults.

Then, the researchers tested the phthalate concentrations in the food ingredients used in the dietary intervention. Dairy products—butter, cream, milk, and cheese—had concentrations above 440 nanograms/gram. Ground cinnamon and cayenne pepper had concentrations above 700 ng/g, and ground coriander had concentrations of 21,400 ng/g.

"We were extremely surprised to see these results. We expected the concentrations to decrease significantly for the kids and parents in the catered diet group. Chemical contamination of foods can lead to concentrations higher than deemed safe by the U.S. Environmental Protection Agency," said Sathyanarayana.

Using the study results, the researchers estimated that the average child aged three to six years old was exposed to 183 milligrams per kilogram of their body weight per day. The U.S. Environmental Protection Agencys recommended limit is 20 mg/kg/day.

"Its difficult to control your exposure to these chemicals, even when you try," said Sathyanarayana. "We have very little control over whats in our food, including contaminants. Families can focus on buying fresh fruits and vegetables, foods that are not canned and are low in fat, but it may take new federal regulations to reduce exposures to these chemicals."

The Department of Health and Human Services (HHS) has launched a "Million Hearts" campaign that is designed to prevent a million heart attacks and strokes in the next 5 years.  You can read about it in the New England Journal here or in Circulation here.  There is also more detail here at the HHS gov web site.

The campaign is crafted to address the "ABCS" a.k.a. aspirin, blood pressure control, cholesterol control and smoking in the U.S. population. The Feds propose to 1) consolidate just how ABCS will be specifically measured in any population, 2) remind and help manufacturers as well as users of EHRs that they can be tasked to addressing ABCS, 3) initiate a "pharmacist-led campaign.... (to) facilitate counseling about hypertension control," 4) launch an anti-tobacco marketing and community-based campaign, 5) push for food labeling in restaurants and 6) increase the measurement of sodium and fat consumption.  Details are in this table.

"Bravo!" says the DMCB.  When it reads about Million Hearts, its clear that the Feds are identifying population-based strategies, basing their interventions on demonstrated needs, increasing awareness of health risks, using patient-friendly education, helping consumers make the right choices and figuring out how to assess outcomes on an ongoing basis with a feedback loop.

If you agree on the DMCBs assessment of what the Feds are up to, you also agree that theyve they have launched a huge population health improvement (PHI) initiative.  The DMCB isnt making that up: if you compare the Care Continuum Alliance description of PHI here with the fundamentals of Million Hearts, youll see that the overlap is almost 100%.

Whats different is that the Feds are also using Million Hearts to 1) further justify the Affordable Care Act and the EHR meaningful use initiative, 2) leverage some potent government entities like AHRQ, CDC, CMS and the FDA, 3) distribute hundreds of millions in community grant money, 4) create a coalition that includes The Y, AHA, Walgreens, some professional pharmacy associations and AHIP, and 5) say some nice stuff about Mrs. Obamas childhood obesity program.  

All that makes perfect sense from a governmental as well as political process, but its still PHI.

"A hearty welcome to the fold!" says the DMCB.  HHS has finally decided to give millions of Americans access to PHI that combats atherosclerotic heart disease.  Better late than never, but based on what we know about the science of PHI in multiple other settings and assuming the government can pull this off, the DMCB is confident that a million lives being saved is within reach.  

When accountability fails

"Accountability."  Everyone wants it, right?

While its one thing for health care providers to be "accountable" for costs, its another for them to actually make money at it.  The Disease Management Care Blog is continuously amazed at how many physicians and administrators believe that dollops of "primary care," "prevention" and "wellness" will empty hospital beds and cause insurance money to appear like the morning dew on a windshield of a physician specialists BMW. 

Believe that and the DMCB has an ORD-SFO United Airlines upgrade "departure management card" it would like to sell you.

If the DMCB could do only one thing to reduce costs within one fiscal year for a health care system , it wouldnt be PCPs, wellness or prevention. Instead, it would place one vastly overpaid case manager in every emergency room in the network.  His or her job would be to find alternative levels of care for persons that dont really need to be in the hospital and begin discharge planning for those who do.

The second thing the DMCB would do is implement predictive modeling.  Thats why its immodestly tooting its horn and suggesting research like this is so important.  In this web first publication, Chris Hollenbeak, Mark Chirumbole, Benjamin Novinger, Frank Din and your humble DMCB examined the baseline demographic data and medical conditions that can predict the likelihood of a future high cost hospitalization within a Medicaid population.  Armed with knowing which of its patients are at risk ahead of time is a critical level of intelligence for any newly "accountable" hospital, clinic, IPA, PHO or IDN.  By reaching out to high risk individuals prior to any crisis, physicians and administrators can engage these patients in outpatient settings and keep them away from the emergency room.

The good news is that the art and science of predictive modeling is within reach of most data bases, desk-top computers, statistical software packages and trained analysts.  The bad news is that interpreting and executing on that information remains a daunting challenge. 

Health systems like HealthCare Partners is a good example of how it can work well.  As this "accountability" movement in health care evolves, the DMCB will undoubtedly learn about other good examples. 

The systems that rely on vague notions about primary care, fail to understand the role of case management and ignore the business case for predictive modeling will form the bad examples.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes. If you have diabetes, youre up to 4 times more likely to have heart disease or suffer a stroke.

The National Diabetes Education Program (NDEP) developed a campaign entitled "Be Smart About Your Heart. Control the ABCs of Diabetes." to help reduce CVD and other diabetes complications.

The campaign focuses on three critical factors:

• Blood glucose - As lected in your A1C
  
• Blood pressure
  
• Cholesterol

And recommends the following tests:


If you have diabetes, know someone who has it, or are a diabetes educator, the NDEP has free educational materials. Theyre available in English, Spanish, and 15 Asian and Pacific Islander languages. They include record forms for keeping track of test results. You can download the materials at:
Be Smart About Your Heart. Control the ABCs of Diabetes.

Hi,

I am still on track and losing small amounts of weight every day, although, I am at 322 and have five more pounds to get back to my new low of 317. I am disappointed that my cheat week was so very impactful to my weight, but I am happy that I have been slowly heading in the down direction again. It is rather encouraging to me to see even a small reduction (quarter to half pound) every day. I like bigger jumps down but a jump down is a jump down. I think that by the beginning of my next six-day period I should be completely back on program, again.

Trading in Your Health for Convenience: I read those words on one of Dr. Mercolas articles and they just suddenly struck me because they are so true. At least for me. And I think for many of the friends that I talk to who desire to lose weight but struggle with it. When I suggest to someone that eating more fresh raw vegetables, not eating grains and processed foods, and eating more simply cooked protein will help them to lose weight, control their blood sugars, and regain their health to an amazing degree, I nearly always get that "deer in the headlights" look.

The idea of not eating from a box of manufactured food just seems like crazy thinking to them. I remember feeling that way too, a long time ago. Ive come to believe that the only way out of the box is to simply step out and begin. Then I think, well who am I? I struggle to eat right, but the more I do it, the easier it gets. The more fresh raw salads and veggies that I eat, the more they seem to resh me and I like the way they affect my health statistics (my weight numbers, my blood sugar numbers, my blood pressure numbers, etc.)

I think that the main objection people have to healthy eating is really the "C" word: convenience. It is so easy to open a box or sealed bag, reach in and drag out an extruded "something" and eat, that we choose that which is "easier" over having to go to the trouble of washing veggies, cutting, examining, and preparing them before we even get close to eating. We let our health go out the window in exchange for quick and easy.

I think that the word "healthy" is not even "real" for some. When we are on the run it is not easy to slow down enough to do something different -- to do what is healthy and right for our bodies. What we are really exchanging is our future health. We are exchanging "easy now" for "problematic later." We dont have to keep doing that. If we were willing to take just a little time right now and give it to eating right, our futures would improve.

From the reading that Ive done it seems perfectly clear to me that eating fresh raw vegetables and simply cooked animal protein will not only normalize blood sugars and high blood pressure, but it will delay or eliminate cancer, too. Who knows how many other things like heart attacks and strokes are also affected by how we feed ourselves? I am beginning to get the idea that things like arthritis, fibromyalgia, and attention deficit disorder are also all related to the manufactured food weve been eating.

I read about a school in Appleton, Wisconsin that eliminated canned pop and candy machines from their school, and started to feed the kids salads and good healthy foods plus water to drink at lunch. The behavior of the kids changed. They went from acting like hoodlums to acting like normal kids. The kind we used to remember from long ago, or see in the movies. They became more like the kids from the Cleaver family. Normal, American kids. They no longer needed police presence on the campus because the kids were all behaving -- naturally. They are no longer carrying weapons or committing suicide. Those numbers have gone down to ZERO!! Doesnt that say something about the affect that good food or bad food has on us? (Read about the Appleton school here: http://www.feingold.org/PF/wisconsin1.html)

What is good for the kids is also good for us adults. We truly are what we eat.

When I made the change to fresh raw vegetables my daily statistical numbers began to improve immediately. My blood sugars, while they are not yet normal, are much closer to normal than they were. My blood pressure, while not yet normal is much closer to normal than it was. My weight, when I eat right, comes down. Eating right means eating the things that God prepared for us. Fresh. Raw. Vegetables. An already healthy person can eat fruit, too, but, I am a diabetic which means my health had deteriorated and I need to not eat fruit until my body can handle it.

I need to nearly eliminate grains, too, if I want to see blood sugar numbers that normalize. I allow one cheat meal, and one cheat item during the week which is a far cry from "cheat" items at every meal. I dont have to completely eliminate all the things Ive grown to love -- I can have them once or twice a week. If that is not "moderation" I dont know what is. I know that when I stay on the program (six-days of fresh raw veggies and protein, with a one-hour cheat meal on day seven and one "cheat" item some time during the week) my health statistics begin to be good. It brings balance to my body. It adds healthy time to my future.

The change is a big one. Going from eating the standard American diet, to eating fresh food as God prepared it really is a very big change. It is also very worth while. I think it is worth the time it takes to cut up a few veggies if it means not having to lie in a hospital bed at some later time in my life. What is it worth to you? What is your goal? Look at what you are eating and you will see where you will end up.

Priority. What are our priorities? What can we exchange for what? If "health" is a high priority then it seems that eating Gods food must be a priority. It always boils down to "what are you putting in your mouth right now?" We really are what we eat -- one meal at a time.

Love you much,

Be back soon,

Marcia

Am running my third week of blogging marathon from today with an incredible theme meatless dishes, pick any non vegetarian dish and make it as vegetarian or vegan, sounds interesting and challenging na. Seriously I loved making meatless dishes with their vegetarian or vegan substitutes. You will be wondering how this tandoori tofu steak will tastes, trust me they are just wow. Even my younger one who dont like that much tofu enjoyed thoroughly his platter when i served him with some veggies for dinner. This dish tastes fantabulous even they are served as startes, a crowd pleaser definitely.