Health for life

Getting a pet for the family can seem like such a wonderful idea – before you actually do it. But if you haven’t really thought through all the aspects of pet ownership, you can end up feeling that your pet is as much work as your children!

So before you rush out and bring home a whole bundle of trouble consider the following:
Before diving in, do your research: speak to a vet, an animal breeder, and friends who own pets before you settle on a particular animal. If you are thinking about getting a pet contact your local SPCA or vet and ask their advice.

• Who will look after the pet? If you have children under the age of 10 years, it is unrealistic to think that they can be independently responsible for a pet. You will be doing the bulk of the feeding, watering, cleaning, walking – unless you are prepared to remind every day.
• Can you afford to look after the pet? Pets are expensive – depending on the type of animal you get, there are food costs, vaccinations, beds and cages, grooming, flea and tick control, obedience classes, fences or gates around the house and vet care over the lifetime of the pet.
• Do you have to register your pet? Most local councils have regulations regarding the registration of dogs.
• How long will your pet live? Do you want to care for a pet when your children are older? And on the flipside, will your children be able to cope if there is an unexpected death in the family?
• Do you know what type of pet you want? And is it a practical choice? Some pets will be completely inappropriate for your family so make sure you’ve done your homework to discover the best pet for you.
• How much exercise will your pet need? And more importantly, does your family have the time and inclination to exercise a pet?
• Will you have to leave your pet alone a lot? If so, do you have to take any measures to ensure that it will be safe and secure?
• If you go away, who will care for your pet? Friendly neighbours are often happy to feed and walk pets but if you’re short on friendly neighbours (or your pet is a large dog who will bark for the whole seven days you’re away) then you need to consider either having someone move into your house to be a companion for your pet, or have your pet board away from home, which can be expensive.

This article was written by Ella Walsh for Kidspot. Sources include SA Government’s Parenting and Child Health.
_http://www.kidspot.co.nz/article+261+46+Owning-a-pet.htm

As with war, politics, and solving a Scooby Doo mystery, when it comes to saving cash and eating well, nothing is more important than having a plan. Grocery lists keep you from blowing dough on extraneous stuff. Price books give you the best possible food costs. Menu planners ensure you’re not scrambling to put dinner on the table, thus preventing dangerous bouts of crazy.

My own time-tested system combines a half-baked price book, hastily scrawled grocery lists, and yelling, “HON?! What are you in the mood for?” It works for now, but I’m thinking of going the pen-and-paper route. It’s working for Leigh, after all.

Fortunately, there are gazillions of downloadable menu planners, grocery lists, and price books all over the web. Unfortunately, many aren’t free, and involve some kind of weird sign-up or registration. Unless it’s for health insurance or Idol voting (Bowersox 4-evs), I hate doing that.

So, for your organizing pleasure, here are 36 free templates that’ll get you cooking. To know:

• There are no memberships or sign-ups required.
• All files are printable images, PDFs, or Excel spreadsheets.
• To make sure the sites were kosher, I downloaded/opened at least one form from each page. My computer has not virusized yet. (KNOCK ON WOOD.) Still, use at your own risk.
• Again: free.

If you’re craving more than a basic Word document, starred (*) entries go beyond the usual cells and tables. Their artsy graphic designs are Etsy worthy, and will look particularly cute hanging on your fridge.

Readers, if you know of any good templates/spreadsheets/whatever I missed, add ‘em in the comment section. Prettified ones will receive extra bonus points. (Meaning: a quiet “yay” in my small Brooklyn apartment.)

MULTIPLE RESOURCES
These websites include many different kinds of templates.

Better Budgeting
Basic weekly menu planner and weekly dinner planner, along with a grocery list organized by aisle.

Free Printable Grocery List
Dozens of grocery lists and menu planners, both blank and with pre-formatted checklists. Some have cute (but minimal) designs. Click on the sidebar and start printin’.

I’m an Organizing Junkie
Grocery list and weekly menu planner/grocery list combo. Formatted in boxes. A twist!

Keep and Share
Nice compilation of grocery lists for diet restrictions, including gluten-free, kosher, diabetic, lactose-free. Includes a pair of massive two-pagers, as well.

Mom’s Budget
Weekly and monthly meal planners, price logs, pantry inventories, and grocery lists in blue, green, orange, pink, and purple.

Money Saving Mom
Fourteen free downloads, including weekly, bi-weekly, and monthly menu planners as well as a master prep, ingredient, and shopping lists.


COMBINATIONS
Each of these single documents will do double-duty as say, a menu planner AND grocery list.

*A Feathered Nest
Menu planner/grocery list combo that’s super cute without being twee.

About.com
Weekly menu planner and shopping list.

*Carina Gardner
Anthropologie-esque weekly menu planner with a grocery list on the bottom. Nice! (Its the one pictured at the top.)

*Design Sponge
A weekly menu planner/grocery list combo, as well as blank and checklist-style grocery lists. Cute!

Organized Home
Weekly menu planner and shopping list

*The Project Girl
Menu planner and shopping list, with the best design out of everything here. Very pretty!

Saving Your Cents
Weekly menu planner and shopping list. Simple and clean. Use #1. (The others are already on this list.)


PRICE BOOKS
Excel documents unless otherwise noted.

Cheap Cooking
You have to do a little deleting here, but it should work otherwise.

It’s Your Money
A larger file requiring unzipping.

No Credit Needed
Uncomplicated and easy to figure out. My favorite of these options.

Organized Home
This one’s not an Excel spreadsheet. It’s a fill-in-the-blank-with-your-own-pen-style price book.


MENU PLANNERS

Busy Bee Lifestyle
Weekly planner with separate columns for kids and adults. With a picture of a bee! (Note: I like bees.)

*Disney Family Fun
Dinner planner only, but with a cute, kid-oriented design.

*From the Kitchen of…
Super fun weekly planner. Be aware that it’s a big file, and has to be unzipped. I don’t know why, but it reminds me a little of a Lynda Barry cartoon.

Home Life Weekly
Rainbow colored weekly planner.

The Home School Mom
Has one with a weekly activity planner on the side, and one without. Pretty basic.

Main Street Mom
Super, super basic design. But effective.

Meal Planning Mommies
Weekly plan with “I’m a meal planning mommy!” written across the top. Helpful if you forget who you are, not helpful if youre male.

Organized Home
Weekly menu planner made especially for notebooks.

*Petit Elefant
This one involves some re-sizing, but has a totally cute format and design.

Unclutterer
Available in spreadsheet or PDF form. Clean and efficient.

Vertex 42
Basic weekly, bi-weekly, and monthly menu planners in both portrait and landscape print styles.


GROCERY LISTS

Excel Template
Three printable spreadsheets of varying sizes, for general-to-specific shopping.

Mom Ready
Simple and straightforward checklist for your weekly trip.

Painted Gold
Simple blank list organized by department.

Pike’s Pickles
PDF files with both a blank list and formatted checklist.

Split Coast Stampers
Another checklist-style Excel spreadsheet. Also in PDF format if you scroll down a little further

Squawkfox
Landscape-style one-page checklist with many attractive boxes. Pretty thorough.

The Ultimatest Grocery List
Huge single-page checklist, with a massive bonus list for vegetarians! Maybe the best option if you’re looking for this kind of thing.

Vertex 42
Blank template organized by category. Handy.

Readers, whatchoo got? The comments are open!

~~~
If you like this article, you might also enjoy:

• Cheap Healthy Good’s Ultimate Guide to Kitchen Equipment
• Information Central: 32 Free Food Charts, Checklists, and Wallet-Sized Guides
• Pantry of the Gods

The great Wayne Gretzky once famously observed that he achieved ice hockey prowess because he made a habit of skating to where the puck was going, not where it is.  That important lesson may have been lost on countless health care executives who, now that the Department of Health and Human Services has told us what an "Accountable Care Organization" (ACO) is, are furiously skating to fill out this application.

The Disease Management Care Blog suggests they also think about where this ACO puck could go.  Listen to the ACO zealots and its easy to believe that the triple aim will become manifest and providers will rolling in shared savings moolah in less than 18 months.

Regular DMCB readers know better.  They know that Medicares ACOs have no track record and that the ACO-like models have had a checkered experience.  As data on the Medicares ACOs come in, it is quite possible that we may discover a penalty box where a) shared risk translates to shared losses, b) the Feds are fickle partners, c) the correlation between cost inflation and quality is implacably positive and d) only a few hospital-physician alliances have the kind of non-generalizable culture necessary to make ACOs financially viable.

In other words, this is not going to be a preordained power play. By the time they get there, ACOs could find the puck went somewhere else. 

The DMCB humbly suggests that that somewhere else could be a post-ACO world.  That’s why the DMCB suggests that no organization’s long-term ACO strategic planning is complete without serious contemplation of why they should not follow the herd and plan on a 3rd quarter where:

The Bubble Bursts?  The hangover of lost millions in misallocated capital and human resource investments could preoccupy key partners and hobble lead competitors for years to come.  This has important implications for future business relationships, mergers and acquisitions and growing market share.

The Ascendancy of Physician Groups.  As hospital-physician arrangements unravel, the larger  independent physician-owned practices left behind could fill the vacuum with an array of contained, discreet and non-global commercial insurer payment arrangements that are based on 1) a level playing field and 2) what both sides value.  That is, of course, assuming these practices dont run afoul of any market dominance scrutiny by the FTC.

Federal Retrenchment:  Despite any prior deals on the SGR, a perfect storm of entitlement non-orm, rebounding cost inflation and the lack of any new innovative ideas forces CM to cut rates. The impact on physician participation in Medicare is anyone’s guess, but the new urgency to control costs means physicians will 1) have one more business reason to seek the efficiencies of larger groups and 2) be even less willing to take on additional practice costs that ranges from hiring to technology.

Should provider organizations skate toward this post-ACO world?  The DMCB suggests its not unreasonable.  Time will tell if they win this game.

When we eat, we make glucose available to our cells for energy and other processes. Insulin helps that glucose enter our cells. But when cells reach a certain satiety point, insulins signaling ability lessens, possibly protecting the cell from an influx of too much glucose. This process may be at the root of insulin resistance.



A study that appeared in the February 21 issue of Nature described a link between the presence of glucose, fats, and other nutrients in the bloodstream ... and the action of an enzyme called O-linked beta-N-acetylglucosamine transferase (OGT). When nutrient levels are high, OGT travels out of the cell nucleus to the cell membrane. There it works to dampen insulin signaling by attaching glucose-containing molecules to key proteins of the intercellular insulin signaling pathway.

Not surprisingly, the particular sugar molecule it attaches is called O-linked beta-N-acetylglucosamine (O-GlcNAc). And the amount of O-GlcNAc is related to how much glucose is in the bloodstream.

Knowing the specific enzymes and sugars involved in insulin resistance can lead to the development of specific drugs that target these molecules. This type of research can also help us to understand how overnutrition can bring about insulin resistance, a condition which often leads to diabetes.

Although drug therapy that targets these molecules may not be available for a while, diet therapy is available today. Learning how to feed our bodies just what they need, but not more than they need, can improve the action of insulin ... reducing the occurrence of insulin resistance and lowering the risk for type 2 diabetes.
________
For the study:
Phosphoinositide Signalling Links O-Glcnac Transferase To Insulin Resistance

News article (ScienceDaily):
Novel Link Between Excessive Nutrient Levels And Insulin Resistance Uncovered

The Disease Management Care Blog remembers when it was first introduced to an electronic health record (EHR).  After many days of learning how to document, link, retrieve, order, manage, view, bill, sign-off and close patient encounters, it asked about retrieving summary statistics on its patient population.  It wanted to know how many if its patients with high blood pressure were under control and how many of its patients with heart disease had low cholesterol levels. 
The practice administrator looked at the DMCB like it was crazy.

That was when the DMCB realized that the purpose of its EHR had less to do with quality, costs, coordination and everything to do with perpetuating the "hamster wheel" of one-on-one primary care.  Prior to the EHR, it averaged about 4-5 patient visits per hour.  After the EHR, that didnt change.  Neither did its HEDIS® measures, patient satisfaction rates or professional well-being.  The only thing that increased was its cumulative billing amounts.  No wonder the DMCB has been an unrepentant EHR skeptic.  It concluded that the purpose of the EHR is to perpetuate the dysfunctions of one-on-one care.

Articles like this, however, may change the DMCBs mind.  Jennifer Frankovich, Christopher Longhurst and Scott Sutherland describe how they tapped their local EHRs multi-year database to assess the outcomes of a cohort of patients that was similar to one of their own.  After analyzing how prior patients under similar circumstances fared, they decided that it would be a good idea to treat their patient with a blood thinner.  The patient ended up doing OK.

1.  Normally, a physicians expertise is built over the course of many patient encounters.  Thats called "clinical wisdom."  Being able to compact years of an institutions collective experience from an EHR into a spread sheet is not only a step in the right direction, its using the EHR to build an institutional body of wisdom.

2. This is another case study on the important distinctions between observational data bases (imperfect but locally relevant and readily available) and pristine evidence-based prospective randomized clinical trials (the gold standard for collecting evidence that is often lacking).  The latter is the standard of care and the enemy of the good; the former is quite useful and, as this case shows, often good enough.

3.  Last but not least, this is a good example of "applied" "population health management" in which a virtuous cycle of measurement can drive the local standard of care.  Its not only true for patients with obscure and rare diagnoses but for those with common, chronic and expensive conditions.  Want to reduce the burden of obesity?  Understand what really works for diabetes?  Tackle the costs associated with hypertension?  Assembling and using an electronic data base like this will make it possible.

The DMCB is looking forward to when future EHRs can perform at this level everywhere all the time.

When looking at blood lipid profiles, doctors tend to stress LDL cholesterol to their patients, but high LDL levels alone dont necessarily indicate high risk of heart disease.  It turns out, further research has uncovered that there are in fact two types of LDL.  You have pattern A LDL, which is large and fluffy, and you also have pattern B, which is small and dense.  The large, fluffy type is not associated with an increased risk of heart attacks, while the small, dense type very much is.  People with these larger LDL particles tend to have normal levels of other risk factors:  they typically have high HDL and low triglycerides.  People with small LDL experience the opposite:  they typically have low HDL and elevated triglycerides.  These two types of LDL clearly exhibit the exact opposite effect in terms of cardiovascular health, so why are we still so concerned with LDL?  Well, probably because doctors dont normally test for LDL particle size.  Maybe they should hop on that.

The discovery that there are two very different types of LDL has far-reaching implications, most notably in the saturated fat debate.  For years, the USDA Dietary Guidelines have stressed to us that we should reduce saturated fat and cholesterol intake because they raise LDL levels.  So what if they raise LDL levels?  Do they raise pattern A or pattern B LDL?  Research shows, saturated fat in the diet tends to raise the benign, large, fluffy pattern A LDL.  This study from Sweden shows that people who consume more milk fat (whole milk, cheese, butter, etc.) have predominantly large, fluffy LDL.  This study from UConn and this one out of Mexico both show that consumption of eggs, which are high in both saturated fat and cholesterol, result in the non-atherogenic large, fluffy LDL.  This of course makes evolutionary sense as well.  It is estimated that hunter-gatherers consumed at least 10-15% of their calories from saturated fat.  The Dietary Guidelines say we should keep it under 10%.  Maybe the USDA should actually read research instead of making recommendations that will sell more processed foods made from corn and soy.



My advice:  pay no attention to your overall LDL level and dont fear saturated fat or cholesterol.  Your total LDL number is meaningless unless you know which type of LDL you predominantly have.  Even if your doctor doesnt check for LDL particle size, though, there is still a good way to predict which type of LDL youve got.  If your HDL is high and your triglycerides low, youre probably safe regardless of your LDL count because its going to be the large and fluffy pattern A.  If your HDL is low and your triglycerides high, then youre in trouble, even if your LDL level isnt high.  In the end, it looks like total LDL just isnt all that important of a predictor of heart disease.  If youve read this and my previous blog post, you have to wonder...  why is everyone so concerned about cholesterol??

While the population health management service industry has a successful track record when it comes to chronic heart failure, diabetes and asthma, the Disease Management Care Blog thinks, after a quick scan of the literature, that there are fewer studies of its impact on hypertension.

 A recent Morbidity and Mortality Weekly Report (MMWR) reminds us that thats a problem.

The National Health and Nutrition Examination Survey(NHANES) performs interviews and physical examinations of a representative sample of U.S. households.  This particular report on the prevalence and treatment of high blood pressure was based on a sample of 20,811 individuals from four 2-year survey cycles that were performed from 2003 to 2010.

Extrapolating from the sample, 66.9 million persons or 30.4% of the U.S. populationn have high blood pressure. Of this population, just over half (54% or 35.8 million) have uncontrolled hypertension.  Of these persons, 31 million (or 88%) had been seen by a health care provider in the preceding year. The prevalence of uncontrolled hypertension among those hypertensives with Medicare was 52%. Not having health insurance or having seen a health care provider in the past year increased the risk of untreated and uncontrolled high blood pressure.

Whats more, the DMCB discovered control of hypertension doesnt appear to be getting better over time.

The good news is that the treatment of high blood pressure is not all that complicated and that team-based non-physicians can play an important role.  Patients should be engaged on weight control, a DASH diet, restricting salt, exercise and moderating alcohol intake. Medication therapy can be individualized and tailored to meet mutually agreed-upon goals and to minimize any barriers.  Check out this MMWR table and youll see erences to "lifestyle counseling," "self monitoring," "self-management education."

Given the looming shortage of primary care care settings and the coming influx of newly insured persons, the DMCB believes population health management will need to be part of the solution.  In addition to the established science, the industry 1) understands the importance of risk stratification, 2) can be bolted onto accountable care arrangements and 3) understands that optimal outcomes are somewhere between 46% and 100% control.

Hopefully, given the relative dearth of high quality studies, this opportunity will be accompanied by ongoing studies of outcomes.

I dont really care for Valentines Day.

You know how it goes. The heavy pressure on that romantic aspect of our lives, that may or may not, live up to "Sense and Sensibility" expectations. The courting, the chocolates, the flowers, the glittery stuff. The "proposals" and declarations. Bah. Humbug. It was enough to make some of my dearest friends... joyfully declare their mood of choice for the holiday, by getting creative on Facebook...

(I have to admit, since I also dislike romance novels, I thoroughly enjoyed this little creation.)

So... though I do the usual, quiet penance at home with the husband, I cant say I focus very much on Valentines Day. I certainly dont think of walking away with any sort of "wordless Wednesday lessons," if you would. Whats to learn? Materialism? Impossible-to-live-to expectations? Yeah, so one would think. (I dont even have any kids, so I cant make this post about them! lol)

Often, though, life quietly speaks to us in its own way... especially when our hearts are open, and not just open to diamonds, or chocolates, and other distractions and materialisms, but open to whats TRULY being expressed... by fate? God? The universe? Your own inner self? Perhaps. But, maybe... Just maybe... Valentines Day needs to be a bit more "selfish" than it already is, you see. Valentines Day should be about the one love that actually matters more than almost any love out there: self love. Yes, not the kind of self love that goes around expecting what can I get from others... but the kind of self love that goes around expecting what can I get from MYSELF. 

The little image, above... the heart made of wholesome food. That was IT. That was all Valentines Day had to give me, yesterday. And it gave me a LOT; more than I could have imagined. A random posting of sorts, shared by a stranger, with entirely different intentions.

Food is love.

For me, food has always been love (even though I sort of dislike food). Just, perhaps, not the right kind of love.

Like any other person struggling with binge eating, and disordered eating, I tend to, unwittingly, look for love in food. I tend to want to FEEL things from the food I eat -- comfort, enjoyment, numbing of bad feelings, friendship, avoidance of issues, appeasing of bad memories, etc, etc. Often, Ive tried, again and again, to replace the love that others would not give me, or the missing attention from parents... with food, or bury whatever awful life traumas, underneath it.

Often, this is termed "When Food is Love."

Recently, though, Ive been quietly asking myself... what if I can just change that definition around? What if food can still be love, but, from a different angle?

The image above gave me the answer. It almost literally screamed it:

"You can do more than just THINK youre getting emotional support from food... you can actually LOVE YOURSELF with food. Good food. Quality food... HEALTHY FOOD. To show yourself love with proper nourishment is the purest form of self love... Be very selfish with it. Do not abuse it, and do not entrust it to just any food. Treasure it."

When we thoroughly manage our health and give ourselves quality foods that make us FEEL healthy, able bodied, and able minded, capable of taking on the world, of thinking, and making proper decisions... When we give ourselves foods that dont just fuel our bodies, but make our hearts sing because they are wholesome and tasty, and FULFILLING, and in more than just temporary emotions we might feel... But also in HEALTHY emotions we may anticipate because weve put effort into making such meals, and invested in ourselves, as we would in our children... We are literally, feeding ourselves love. We ARE our children. We ARE our loved ones.

Its not a diet, its not a "healthy lifestyle..." It is SELF LOVE. It is simply... Loving Yourself.  

Work on loving yourself, today. Youll be glad you did.

After my self-revealing experience (see my last post: "Placing My Trust") where I discovered that I had placed my trust in the experience of eating rather than in Jesus, Ive been doing more observing. What I have since noticed is that I not only use binging (unscheduled eating) to assuage my feelings of fear, I have similar trust issues during regular meals. I suppose that would be obvious to others, but was still another revelation to me.

I consider myself to be a "big eater." I like my meals to be on the large side. I often have seconds. I noticed on Saturday when I tried out a new buffet restaurant, that in the middle of my second medium sized plateful my body suddenly signaled that I was full and I could not eat another bite. I then paused and felt confused. I did not know what to do with the rest of the food on the plate. I didnt know what to do. I tried to be aloof and stop eating, but I could not keep from finishing the plate. I then got a piece of pound cake, too.

I did not actually notice that the trust issue had showed up again until I had finished eating, paid my bill, drove home, and walked into my front door. I had been thinking about what happened on my trip home and when I walked in the door it dawned on me that I had not trusted or obeyed my bodys very clear message to me.

When the full feeling hit, I really did feel confused. I could see that I was really full, but could not respond to that feeling with trust, and just stop eating. I allowed me to ignore my body message, ignore what was good for my health, and continue eating, by desire or force of habit, I guess. I dont have this one quite figured out, yet, but I know I need to address this issue. I have seen it many times before.

I have had the experience of reaching the full point, putting my eating tools down, stating that I was completely full, waiting while my companion/s went on eating and talking, and then picked up my tools and started eating again. I just could not leave food on my plate. It was as if the food was starring at me. Perhaps, I was the one doing the starring.

This response is emotional, and very strong inside me. It is not logical and Ive often felt defeated by it, but Ive not found my way around it... yet. I know there has to be a way to deal with this, and it seems, in my mind, to be a trust issue, too. I think it could also be habit. I think I may need some kind of "permission" to actually rely on my bodys message of "Im full" in a new way.

I am not sure a plan to simply "stop" when the full signal goes off will work, but that appears to be the thing that would make the most sense. I have actually tried that in the past with very little success. I would like to respond to the full signal as if it were the final truth in the matter. I realize how odd this sounds but I know that when it comes to emotion, logic does not always enter in.

A picture of a childhood incident has popped into my mind two or three times as Ive been discussing this. I kind of did not want to share the incident because Ive shared it before and it is "boring" to me, now, but I also think it may be significant to this discussion so here is the incident:

I was sitting in a high chair eating a bowl of oatmeal. My mother was standing at the kitchen sink doing dishes. I was old enough to feed myself so my mother had left that to me as she went about doing her business. I had eaten all that I wanted and was playing in my food. My body had told me that I was full and I did not want any more food, so I had just moved on to this new activity. I was happily copying what my mother was doing. She was wiping plates in a circular motion, so I started to stir my food in a circular motion as I washed my dish. I felt I was doing what she was doing and I enjoyed this play.  I really did not want any more food and felt happy to just be with her doing what she was doing.

She turned her head, saw me stirring my unfinished oatmeal and became irritated. She, with very angry body language, stopped what she was doing, wiped her hands, came over, sat down and started forcing food into my mouth. I was suddenly frightened of her. I remember kind of backing up in my chair when I saw her anger and I just opened my mouth as she started shoveling the food in. As the heaping spoonfuls of food were shoved into my mouth, I would let it come out and kind of drip down my chin, I did not want to eat this food, I was full. She scraped my face with the spoon and shoveled that in too. Over and over again. My skin was starting to feel sore from the scraping. She was doing this caully and not intentionally hurting me, but the sheer force of her intention was frightening. I remember deciding that I should remember to clean my plate and eat all my food so I did not have to experience this violation again. I decided to eat all the food on my plate in the future so she would never be angry with me for not eating, ever again.

I have recalled this incident many times before and thought I had dealt with it, but clearly my current eating actions still seem to be related to it and this decision of mine. I feel kind of weepy and tears are welling up in my eyes, so I guess I need to process this information until I find the break through. I remember a technique that Pastor James Chapman once taught me in a counseling session with him.

He showed me a way to think of a certain emotional response as an adult rather than as a child. If I step back and take on the parental adult role of counseling a child, I would probably tell that young girl that it is completely OK to stop eating when your body says it is full.

Stepping back to observe this scene with me as an older child that I can talk to, along with me as an adult standing side by side, watching me as a baby with my mother, I ask "adult me" what I would say to this child to comfort and help her gain understanding of it.

As I look back as an adult I recognize my mothers response. She was busy and had a lot on her mind. She may have had an appointment of some kind that she needed to get to and she wanted to finish these two chores (doing the dishes and feeding the baby) so she could move on to the next important thing. As I think about this, I realize that she may have been pregnant at the time, too. Maybe she was in pain and wanted to just sit down and rest. I have a younger brother who is three years younger than me, but there was also a baby that did not live in between my birth and his. So if I was anywhere from a year to eighteen months old, that would have been right during the time that she was either pregnant or had recently lost my baby sister.

Any one of those things would account for her short tempered actions. As I think about this and compare my older sisters babyhood to my babyhood, it is as if we were from two different families. There were four years between her birth and mine, and no babies that I know of between us, so she had four years of being the baby of the family. There was one very tragic event that happened between the time she was born and I was born, though. My oldest brother, Terry, had drowned two years before I was born. That was a stressful life changing event all on its own. So my mother (and father) had really gone through a lot, already. I also know that when I was born, my mother got pneumonia, and when I was about a month old, I got whooping cough. Near that time my father also had opened a small restaurant/cafe down town which was failing, causing additional stress in the family.

So what I might say to a toddler/child living through this would be something like: "Im so sorry that happened to you. That must have been very scary for you and you did the only thing you could think of. You made a decision that would help you avoid this kind of confrontation in the future. That was not only brave and thoughtful it was clearly the logical choice based on trying to manage a situation that a toddler should not have to manage.You lived through it, and made a plan for the future, too. Good job!

Sometimes we have to be patient with our adults. They are not perfect and your mom was definitely going through some tough times, then. Think about this: she did not beat on you, or yell at you. Look at what she did. She made sure you had enough to eat. She made sure you did not go without something essential to your health. Yes, it could have been done with a little more patience and tenderness, but your mom usually was very patient and soft spoken which is probably why it surprised and frightened you when she was less than her usual quiet self. You were barely a toddler when you made that life-long-lasting decision out of a seemingly dire situation. At least "dire" to a toddler.

Think about other toddlers that you know. They are pretty small. Do you think that letting toddlers make life long decisions is the best way to handle any situation? When you were a toddler, did you know that? No. You didnt. You used all the intelligence and information you could muster in that instant and in your baby mind, you did what you needed to do to survive. There was no one else there to help you, so you did what you needed to do. What a great kid you were, but dont you think that is too much responsibility for a toddler to have to take on? Why is that? Because toddlers cannot see the big picture. Toddlers are too young to be making major life-long decisions on their own. You would not leave that kind of thing up to a baby, now, and you dont have to leave that decision in the hands of the "toddler then," either.

That was a great solution, at that time, but that decision which helped so much in the past is no longer valid for your present reality. It is time to make a new decision about being full. Do you think it might be OK, for you, now, as a sixty-three year old woman, to give yourself permission to leave left overs on your plate? It probably would be OK for you to give yourself permission to leave the food alone whenever you, in your adult mind, can see that you are full.

Picture yourself getting the "full" signal and looking at your plate. First, relax. You are OK. You dont have to eat even one more bite. Being full is a perfectly valid response to having eaten your fill. Notice... this is YOUR fill and no one else has the right to decide whether you are full or not. 

Wow. That last sentence touched me deeply. I began to really cry and then remembered there is a little more to the story that I had forgotten. I remember telling my mother that I was not hungry. I was full, but she completely disregarded me and my state. This battle of wills was not going to be won by the toddler. My mother had reached her last straw and this little girl was not going to get her own way. My mother forced her way on me. She forced me to eat. Every. Last. Drop. No food escaped by dripping out of my mouth. She caully scraped that up too, and made me eat it. She was so angry and determined. She had become a force to be reckoned with. I was angry at this violation of me and so very frightened by her behavior, I never wanted to go through that again. I believed she was angry because I had not finished my food, but that may not really be the case. I believe she was angry because her plan had been side tracked. She may have been frustrated with her life and my childlike playing was just the last straw for her on that morning.

Wow. My mother was like that. Most of the time she was gentle and patient, but aloof. She did not hug us, nor kiss us, nor cuddle us. (She was raised that way, too.) She did not sit next to us on the couch. She never put her arm around us or even patted a hand. She rarely carried on a conversation with me, directly. She was always busy and preoccupied, and if she decided something was going to be a certain way, it was. This reminds me of the hair incident when I was about eight years old.

She wanted to give me a Shirley Temple hairdo. This was probably 1958 and Shirley Temple hair does had gone out of style before I was born, but she wanted me to have that stupid banana curl job on my head. I was completely embarrassed at the thought of it. I told her over and over that I did not want it. I begged her not to do that to me. I cried and begged some more. She told me over and over that it would be cute and I would look good. I knew I was going to end up looking and feeling like a putz. I already had to wear these horrible sturdy green shoes she bought for Susan and me, and also had to wear my sisters old clothes. I was not going to wear that hair do too.

She forced me to sit still in the chair while she did my hair. I gave in and folded my arms and waited, but I did not give up. I knew that I was not going to wear that hair out of the house. I knew I could not stop her from doing this, but I was not going to wear it, either. (By the way, my hair was very hard to style, it was not easy for her to make my thick straight hair look like it had curls.) Anyway. She finished fixing my hair and walked out of the room, I presume, to get some hair spray to keep it that way. As soon as she left, I took my hands and ran them through my hair pulling out all of her work. Then I sat there and waited. I knew I was going to be spanked but, frankly, my dear, I did not give a you-know-what. I would rather take a beating than to walk out the door with that hair do. When she walked back into the room, the other you-know-what, hit the fan. She yanked me out of that chair, began beating my bottom with her hand, and informing me that she would NEVER do my hair again. She never did it, again, either. I was on my own in the hair department after that.

There was the snow pants incident, too. She wanted me to wear them (My sister did not have to wear them.) I used. So she let me go to school that year without them. The next year I was wiser and wanted them because it was so cold without them. She used to get them for me. I knew I was screwed and I walked to school from then on with cold legs and feet. That was when all little girls wore dresses to school, so no matter the temperature my legs were bare in the ice and the cold. Pants were not introduced in high school until the year after I graduated in 1968. Snow pants were the only long pants that little girls were allowed to wear to school.

You know, not until this writing, did I ever fully recognize that my mother and I had battled like that. With her and me it was often a battle of wills and however it ended, "the decision was always final." When Mom made up her mind, or I had forced her to do something my way, she never changed her mind. She never gave in. She never repented. And she never forgave. She never said anything, either, but I knew what was going on. Looking back on this makes me feel really sad. I wish it had not been so difficult for both her and me.

I guess I must have been hard for her to raise. Drawing the line and taking a stand was not an every day occurrence, for sure, which is probably why I never noticed it before -- but I knew how to do it. I think she may have given in to me, much more than I realized before. But not until this writing did I recognize how much she resented that, too. In fact, I think she actually gave up addressing me directly -- although that could also simply have been her MO. I had not realized that, either. I know it must seem odd that I did not notice that, but Ive never looked at this in this way before. Perhaps that is why she used to say that it was easier to raise boys. Ha. Now I understand that statement.

I had not realized that I got my "draw the line" and "do battle" stance from dealing with her. I knew it was there, I just did not know where it came from. It was just, you know, part of me. I remember the foreman at the paper in Salt Lake City giving me a complement that I was both proud of and embarrassed by. He said with admiration in his face and a chuckle of pride in his voice, "You dont take s**t from anyone." I knew he was right. But, I also did not know what to do with that information.

One more thing. I know my mother resented my father, because she used to talk about him behind his back, all the time. As much as fifteen years after he had passed away, she was still talking bad about him like he was in the next room. Their relationship was not all one sided. My Dad had done some things that I find really harsh. I found out that both Susan and I told her we were tired of hearing it. I remember saying to her, that he was my father and I loved him, and that he had been dead for 15 years, when was she going to let go and forgive him? She just started to quietly cry. That was when she told me that Susan had said the same thing to her. I felt sad for her pain.

I had not realized that she resented me, too, or, at least, did not know what to do with me. She was often stern in odd places, but that is another story. I knew I did not trust her but I was never sure why I did not trust her. (Some incidents come to mind but that is for another time.) Perhaps that is why we did not have "conversations"... I remember being about 14 or 15 the first time she actually said anything to me in a conversational sort of way. Oddly enough, I dont recall what was actually said, I just remember being kind of flabbergasted that she had actually spoken to me like I was a person and I remember the exact place in the house that it happened, too.

Most of my life I was "the victim" and I did not understand that, either. Anyway. I am really quite pleased to have remembered and recognized these things. I would never want anyone, including me, to think less of my mother. I still love her and miss her. She taught me some good things, too -- we did not have these stand offs all the time, which is probably why the ones I have mentioned stand out in my mind. She encouraged our creativity and wanted us to be independent. She taught me to cook. She is the one who taught me about God, too. Even though it was the Mormon way, which I later gave up for the truth, it was she, who taught me that God was important, and that prayer works. She really was an amazing woman.

Nobody has "June Lockhart" for a mother. Not even June Lockharts kids. June played the mother in the TV series "Lassie" when I was growing up. I remember wishing that she could be my mother. She spoke to Timmy with sympathy and understanding and treated him like he was a valid human being with authentic thoughts.  I thought she was a little sappy, too, but I really envied Timmy. I say that June Lockharts kids dont have that mother, either, because that was a role in a play and she only had to be Timmys mother for 30 minutes once a week. Somebody else wrote every word she spoke. Anybody can be a perfect angel of a mother for 30 minutes once a week if they have a script!  LOL The rest of the time she is a human being with all the faults and foibles of any other human being -- and no script and no director to say "cut" do over -- just like my Mom.

Im not sure where this revelation will take me in my eating adventures but I hope that I will be able to give myself permission to be full and enjoy the feeling, the next time it occurs. I will have to exercise these new muscles and learn what it is like to actually leave behind any food that I am too full to eat. I kind of like those words, "Too full to eat." Im happy with that.

Im also afraid that all this may have no consequence. What if the next time I feel full, I simply do what Ive always done? I suppose I will have to walk through that one, too -- maybe every time I eat, until I get it down pat.

To sum up where I am, I feel like now I have the "why" and all I need is the "what" as in what can I do with this information that will end up giving me the desired result which is to stop eating after Im full? I think I need to get back into my book and see what the expert says.

I really do have the right to be full... and act like it without fear! 

So odd that all this "stuff" got attached to food.

Thank you, Lord for opening my eyes.

(I just ate dinner, and am feeling nice and full. What an unusual feeling. Ive never experienced it so well, so fully, so deeply and so long before. Amazing.)

Be back soon,

Marcia

Now that 2011 is gone, this is a good time for the Disease Management Care Blog pause and take stock. How is it doing?

It likes to think of itself as a unique ongoing journal club on the organization, delivery and financing of health care.  If the DMCB was soup, thered be three ingredients:

1) reliance, whenever possible, on peer-reviewed and published evidence,

2) a physicians "real world" experience and

3) a ready dash of skeptical humor.

The DMCB must be doing something right.  Despite a narrow mix of medical science, economics, effectiveness and policy, the DMCB has attracted a relatively large and elite readership.  If youre reading this, that means you. 

Sophistication

When it looks at the ISPs of its many return visitors, the DMCB sees dozens of academic institutions, big and small name news media outlets, publishing houses, trade associations, information technology businesses, Congress, CMS, the White House, state government, foundations, commercial insurers, hospitals, health care consulting organizations and population management service providers. Many are household names.

It doesnt stop there. The DMCB has been contacted by and gotten to know folks from all levels in the health care industry.  Based on those conversations, it knows this a smart group.  The author of this blog is a better person for it.

The DMCB knows each regular visitor, twitter follower and Google subscriber has been earned one person at a time. It knows its elite readers are knowledgeable, active or interested in health policy, population health management, the patient centered medical home or primary care. These are not casual readers.

And you have a lot of company:

According to Google Analytics mix of ISP addresses and cookies, DMCB Ver. 2011 had 29,000 unique visitors with 42,000 visits. A third were repeat (defined as more than one) visits.  While there is no definition of a "regular" reader, the number of visitors with more than 50 DMCB "hits" in 2011 numbered 5153. There were 786 visitors with more than 200 hits. 

The DMCB also has 416 Twitter followers.  According to TweetReach, the DMCB regularly reaches almost 1500 persons with its tweets.  Depending on re-Tweets, that number can exceed 7000. 

There are also 466 Google RSS subscribers. 

These 2011 numbers suggest there are thousands of persons that regularly read the DMCB.  Every individual visitor, follower and subscriber returned or opted-in based on the DMCB content and only the DMCB content. There is no marketing, emailing or use of any services to promote the DMCB. It doesnt have the advantage of a sponsoring institution or explicit link to a big-name business. And its readership continues to slowly grow.

The DMCB Web Juggernaut

The DMCB is regularly lected and linked in many prestigious web outlets, include HealthHombre, Health Affairs, KevinMD, Forbes, and many sister blogs. Its also appeared in the web sites of USAToday, Wall Street Journal, the Washington Post, Dartmouth Atlas, Business Week and the National Review. Its also been linked in the intranet web sites of many insurers, provider organizations, and health information tech companies.

And, by the way, according to YouTube, the DMCBs videos to date have had 33,486 views.

As testimony to its growing web presence, the DMCB is on the first page when the term "disease management" is Googled.  The DMCBs growing web traffic has ironically made its "Comments" section a target by spammers with links to its dubious medical web sites.  With only one unobtrusive Google "Ad" that generates pennies per click, it still got a check for $100 (prompting the derision of the DMCB spouse, but thats another post).  The DMCB has also been offered - and used - cash to provide link backs.  It also had one complaint lodged over copyright infringement over an image (the post has since been removed, with apologies).  Simply put, folks are paying attention.

Last but not least, the DMCB is proud of its four 2011 peer reviewed publications in Population Health Management, Self Care and the Journal of Comparative Effectiveness Research.

And a thank you....

... to the readers who have commented or emailed with feedback, comments and insights.  To the readers who use their precious time and keep coming back.

Sweet readers! Hi there. It’s Kris. And I have a favor to ask yis.

First, some background: We’re all about life changes at the CHG Mansion lately. HOTUS and I are still cleaning up from the wedding. I started a new job last week. We’re buying a car, even though I’ve driven exactly once since 2004. Our cat barfed.

And now, the latest, most unexpected (but happy) development: we’re moving right after Thanksgiving.

As they say in France, LES YIKES.

Among many other fabulous things, this means theres not much time to blog, much less pack, much less see the new Harry Potter. (Crap!) Leigh and Jaime are taking up some of the slack, but we’re gonna need backup. So, I was wondering if any of y’all would be interested in providing it. With guest posts, I mean.

If you’re not interested, no worries. We’ll catch up over a few drinks later.

If you are interested, yay! I kiss you.

Here are the details: We’re looking for fun, original, grammatically sound recipe posts and CHG-esque articles. They can be personal accounts, experiments, Top 10s, or anything really, as long as the topics generally adhere to CHGs usual subject matter (cheap n healthy food). Also, taking a look at this Guest Submission Guideline post from Get Rich Slowly might be a good idea.

In return, we can offer you a fair amount of publicity for your own blog, website, small business, or backwoods militia. Our RSS feed is up over 10,000 these days, and we’re getting between 4,000 and 5,000 hits off of various search engines and links daily. So there’s that.

Should this sound like a fun idea, shoot me an e-mail at


to discuss a potential post, as well as a few blogging rules and regulations (formatting, recipes instruction rewrites, etc.). We’ll take the best ideas and run with ‘em, and see how it all ends up.

If you don’t receive a reply within a few days, I apologize, and will hopefully get to everybody as soon as possible. In the meantime, thank you for being more wonderful than an evening with Ina Garten, Tina Fey, and Eddie Vedder combined.

Now, off to clean up some cat barf.

Sweet readers! The links are coming a little later today, but first: Leigh and I wrote an opinion piece for CNN. Its here: Want Healthy Kids? Learn How to Cook.

In related news, Husband-Elect and I will be appearing tomorrow morning on CBS The Early Show to discuss the $25 Food Project. We are super excited, and currently in desperate search of things to wear.

See you back here in a few hours.

~~~

In the meantime, hello everyone from CNN! If you’re visiting the blog for the first time, welcome! We’re so happy to have you. Bathroom’s on the left. If you’re a longtime reader, we love you! We’re not kidding. Its a little scary.

To get an idea of what CHG is all about, our FAQ and mission statement are good places to begin. To go a little deeper, these six posts give a pretty solid overview of what we do here:

1. Spend Less, Eat Healthier: The Five Most Important Things You Can Do
2. Dr. Veg-Love, Or How I Learned to Stop Worrying and Love Seasonal Produce
3. The Circular Game: Decoding Your Supermarket Weekly
4. How to Tell if a Recipe is Cheap and Healthy Just by Looking at it
5. Weekly Menu Planning for Singles, Couples, and Working People
6. Relax, Frugal Eater: A Measured Approach to Lifestyle Changes

Our master article directory of over 135 similar pieces can be found here. We also post one or two frugal, healthy, and delicious recipes per week, which are compiled here. Theres something like 300 right now, and we’re always adding to the list. Here are ten fairly simple favorites to get you started:

• Asparagus, Mushroom, and Parmesan Frittata
• Baked Apples
• Egg Drop Soup
• Honey-glazed Roasted Carrots
• Indonesian Curried Bean Stew
• Light(er) Macaroni and Cheese
• Pumpkin Orzo with Sage
• Roast Chicken with Two Lemons
• Sweet Lassi
• Wacky (Chocolate) Cake

Hope you’re enjoying the blog so far. We’d love to hear from you if you have suggestions, and best of luck with your cooking!

Change in Weight More Important Than Where You Start

Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds.

In fact, the nationwide study found that people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years.

They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

On the other hand, those who started out as very obese in their 50s and whose weight continued to increase were the most likely to die during that period.

Overall, the results suggest that about 7.2 percent of deaths after the age of 51 are due to weight gain among obese people, at least among the generation in this study, said Hui Zheng, lead author of the study and assistant professor of sociology at The Ohio State University.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time,” Zheng said.

While some extra weight seemed protective in this study, Zheng cautioned that these results applied only to people over 50. His previous research, published in Social Science & Medicine, suggests that being overweight may not be helpful for younger people.

“Our other research suggests that the negative effect of obesity on health is greater for young people than it is for older people, so young people especially shouldn’t think that being overweight is harmless,” he said.

This new study was published online this month in the American Journal of Epidemiology. Co-authors are Dmitry Tumin, doctoral student, and Zhenchao Qian, professor, both in sociology at Ohio State.

The researchers used data from the Health and Retirement Study, a nationally representative survey of Americans born between 1931 and 1941. This study analyzed 9,538 respondents who were aged 51 to 61 when the survey began in 1992. They were re-interviewed every two years until 2008, and the researchers had information on how their body mass index (BMI) changed at each interview and whether they died at any point before December 2009.

Body mass index measures weight relative to height and is often used to evaluate obesity.

Zheng and his colleagues classified respondents into six groups, depending on their BMI at the beginning of the study and how it changed over the 16-year period they were surveyed.

While slightly overweight people (BMI of 25 to 29.9) whose weight was steady had the highest survival rate, those who moved from overweight to obese (BMI 30 to 34.9) were close behind.

“This suggests that among overweight people at age 51, small weight gains do not significantly lower the probability of survival,” Zheng said.

The third highest survival rate among the six groups was normal weight individuals (BMI of 18.5 to 24.9) whose weight increased slightly, but stayed within normal range.

Next came the Class I obese (BMI of 30 to 34.9) whose weight was moving upward.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time.”

Next to last were normal weight individuals who lost weight. Although the study attempted to control for illnesses among those studied, it may be that many of these individuals dropped weight because of illness.

The most obese individuals (BMI of 35 and over) who continued to add weight had the lowest survival rate of the six groups.

There weren’t enough people who started out as overweight and obese and lost weight to include in this analysis, Zheng said.

“We can’t really evaluate the effectiveness of planned weight loss on mortality. Even in the normal-weight people in this study, there was no way to tell whether weight loss was planned,” he said.

Zheng noted that the study took into account a wide variety of demographic and socioeconomic factors that may play a role in both weight and mortality among Americans. The researchers also controlled for whether the respondents smoked, whether they had a variety of chronic illnesses and even how they rated their own health. The results stood even after all of these factors were taken into account.

Why is being slightly overweight protective for older people?

“It is probably because the older population is more likely to get illnesses and disease, especially cancer, that cause dangerous weight loss,” he said. “In that case, a small amount of extra weight may provide protection against nutritional and energy deficiencies, metabolic stresses, the development of wasting and frailty, and loss of muscle and bone density caused by chronic diseases.”

Younger people are less likely to get many of the diseases that afflict older adults, which is one reason extra weight is not good for them, he said.

But Zheng said the main message for everyone, including older adults, is that packing on the pounds, especially if you’re obese, can be hazardous to your health.

“Continuing to put on weight can lower your life expectancy,” he said.

A new study has found that many people who stopped taking cholesterol-lowering statin drugs were also taking an average of three other drugs that interfered with the normal metabolism of the statins.

The other drugs can contribute to a common side effect of taking statins - muscle pain – and often led people to discontinue use of a medication that could otherwise help save their life, researchers learned.

The interactions of many drugs with statins have been known of for some time, researchers said, but are not being adequately managed by physicians and pharmacists, who could often choose different medications or adjust dosages to retain the value of statin drugs without causing this side effect.

The research, done as part of a survey of more than 10,000 current and former statin users, found that use of medications which interfere with statin metabolism almost doubles the chance that a person will discontinue statin use due to muscle pain.

The issue is of growing importance because statin drugs are some of the most widely used medications in the world, proven to lower LDL, or “bad” cholesterol, and decrease the risk of heart attacks, heart disease, strokes and death. About 20 million people in the U.S. now take statins, and new guidelines have just been issued to further expand the types of health conditions for which statins may be of benefit. Based on those guidelines, the number of statin users could increase to more than 30 million.

The findings were published in the Journal of Clinical Lipidology by scientists from Oregon State University and four other universities or research institutes.

“We’ve known for some time of many medications that can interact with statins, but only now is it becoming clear that this is a significant contributor to the side effects, and often the reason some patients stop taking statins,” said Matt Ito, a professor in the OSU College of Pharmacy and president of the National Lipid Association, which funded this study.

“This issue is something physicians, pharmacists and patients all need to be more aware of,” Ito said. “There’s a lot we can do besides discontinue use of these valuable medications. You can change dosages, use drugs that don’t cause interactions, use different types of statins. Patients need to be proactive in understanding this issue and working with their health care providers to address it.”

Persons who have problems taking statins should discuss options with their physicians or pharmacists, Ito said, and not assume the drug has be to discontinued. A Medscape web site at http://erence.medscape.com/drug-interactionchecker also can help individuals learn more about possible interactions between statins and the full range of medications they may be taking.

Statins are usually well-tolerated, but in the recent survey, a muscle-related side effect was reported by 29 percent of participants. In former statin users, 62 percent of the people said that side effects, mostly muscle pain, were the reason they stopped taking the drugs.

There are many drugs that can interfere with statin metabolism, increase systemic exposure to the statin and raise the risk of this muscle pain, the researchers said in their report. This can include some common antibiotics, cardiovascular drugs, and others taken for treatment of cancer, mental health, HIV treatment and other conditions.

These interactions are not always adequately considered by physicians and pharmacists, however. One recent report found that as many as 20 percent of significant statin-drug interactions were missed in 64 pharmacies.

Besides drug interactions, statin side effects are also more common in women and associated with increasing age, history of cardiovascular disease, and some other conditions. Statin discontinuation has been associated with increased cardiovascular morbidity and death.

If youre having difficulty keeping your resolution to exercise 30 minutes a day, 5-days-a-week, then youre going to like this study.

Researches put young men through some very brief, but strenuous, workouts and found their sensitivity to insulin (and so their blood sugar levels) improved:

Extremely Short Duration High Intensity Interval Training Substantially Improves Insulin Action In Young Healthy Males, BMC Endocrine Disorders, January 2009

A total of 16 men, average age 21, underwent 6 sessions of exercise over 14 days.

A session of exercise consisted of:

• 30 seconds of cycling as fast as possible
  
• 4 minutes of rest
  
• The above repeated 4 to 6 times

An exercise session lasted 17 to 26 minutes, but only 2 to 3 minutes of that was actual exercise.

Compared to before training (baseline):

• Postprandial glucose levels declined 12% (measured by AUC: Area Under the Curve)
  
• Postprandial insulin levels declined 37% (AUC)
  
• Postprandial free fatty acid levels declined 26% (AUC)
  
• Insulin sensitivity improved 23% (measured by Cederholm index)
  
• Aerobic cycling performance improved 6%

The authors concluded:

"The efficacy of a high intensity exercise protocol, involving only ~250 kcal of work each week, to substantially improve insulin action in young sedentary subjects is remarkable. This novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to time consuming traditional aerobic exercise regimes."

________

A study due in the upcoming July 15 issue of the American Heart Association journal Circulation will be reporting that: ¹

"Greater adherence to the prudent pattern [of eating] may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women."

What did the researchers define as a "prudent pattern"?

"High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores lected high intakes of red meat, processed meat, ined grains, French fries, and sweets/desserts."

It was a large prospective evaluation of the diets of 72,113 women who participated in the Nurses Health Study. They were followed for 18 years.

The prudent diet reduced risk of cardiovascular death by 28% when compared to the Western diet. It reduced risk of all-cause death by 17%.

The Western diet increased risk of cardiovascular death by 22%, cancer death by 16%, and all-cause death by 21%.

These findings are similar to those reported earlier this year in the same journal.² In that study, the diets of 9,514 participants of the ARIC cohort (Atherosclerosis Risk in Communities study) were evaluated over the course of 9 years. Those men or women who ate a Western pattern - high in meat and fried foods - had a higher risk of developing metabolic syndrome. Metabolic syndrome is a constellation of risk factors for heart disease. These include insulin resistance, diabetes, hypertension, high blood lipids, high uric acid levels, and obesity - especially weight carried around the waist.

________
¹ Dietary Patterns And Risk Of Mortality From Cardiovascular Disease, Cancer, And All Causes In A Prospective Cohort Of Women, Circulation, 2008

² Dietary Intake And The Development Of The Metabolic Syndrome. The Atherosclerosis Risk In Communities Study, Circulation, 2008

The Basics of a Healthy Diabetes Diet

Contrary to what you may have heard, there is no "diabetes diet," per se -- and thats good news! The foods recommended for a diabetes diet to control blood glucose (or blood sugar) are good for those with diabetes -- and everyone else. This means that you and your family can eat the same healthy foods at mealtime. However, for people with diabetes, the total amounts of carbohydrates consumed each day must be monitored caully. Of the different components of nutrition -- carbohydrates, fats, and proteins -- carbohydrates have the greatest influence on blood sugar levels. Most people with diabetes also have to monitor total fat consumption and protein intake, too.


To keep your blood sugar levels in check, you need to make healthy food choices, exercise regularly, and take the medicines your health care provider prescribes. A dietitian can provide in-depth nutrition education to help you develop a personalized meal plan that fits your lifestyle and activity level, and meets your medical needs.
Learn the ABCs of a Diabetes Diet

The goal of nutrition for people with diabetes is to attain the ABCs of diabetes. The A stands for the A1c or hemoglobin A1c test, which measures average blood sugar overthe previous three months. B is for blood pressure, and C is for cholesterol. People with diabetes should attain as near as normal blood sugar control (HbA1c), blood pressure, and healthy cholesterol levels.
Alcohol and Diabetes

Use discretion when drinking alcohol if you have diabetes. Alcohol is processed in the body very similarly to the way fat is processed, and alcohol provides almost as many calories as fat. If you choose to drink alcohol, only drink it occasionally and when your blood sugar level is well-controlled. Its a good idea to check with your doctor to be sure drinking alcohol is acceptable.

Diabetes and Glycemic Index

For years, researchers have tried to determine what causes blood sugar levels after meals to soar too high in those with diabetes. Potential culprits have included sugar, carbohydrates, and starches, among other foods. The glycemic index is a ranking that attempts to measure the influence that each particular food has on blood sugar levels. It takes into account the type of carbohydrates in a meal and its effect on blood sugar.

Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. People who eat a lot of low glycemic index foods tend to have lower total body fat levels. High glycemic index foods generally make blood sugar levels higher. People who eat a lot of high glycemic index foods often have higher levels of body fat, as measured by the body mass index (BMI).

Talk to your doctor, a registered dietitian, or a diabetes educator and ask if the glycemic index might work to help gain better control of your blood sugar levels.

The glycemic load takes into account the effect of the amount of carbohydrates in a meal. Both the type of carbohydrate and the amount have an effect on blood sugar.
Eating Right With Diabetes

If you have diabetes, its important to eat right every day to keep your blood sugar levels even and stay healthy. Heres some easy tips:

    * Be sure to eat a wide variety of foods. Having a colorful plate is the best way to ensure that you are eating plenty of fruits, vegetables, meats, and other forms of protein such as nuts, dairy products, and grains/cereals.
    * Eat the right amount of calories to maintain a healthy weight.
    * Choose foods high in fiber such as whole grain breads, fruit, and cereal. They contain important vitamins and minerals. You need 25 to 35 grams of fiber per day. Studies suggest that people with type 2 diabetes who eat a high fiber diet can improve their blood sugar and cholesterol levels. Similar results have been suggested in some studies in people with type 1 diabetes.

Serving Sizes and Diabetes

Be sure to eat only the amount of food in your diabetes meal plan. Excess calories result in excess fat and excess weight. In people with type 2 diabetes, excess body fat means less sensitivity to insulin. Weight loss in overweight and obese people with type 2 diabetes helps improve blood sugars and reduces those risk factors which lead to heart disease. Your dietitian can help you determine the appropriate serving sizes you need, depending on if you need to maintain your weight, gain weight, or lose weight, and if you have high or low blood sugar levels.

    * In women with gestational diabetes, its important to eat multiple meals and snacks per day as recommended.
    * Do not skip meals.
    * Eat meals and snacks at regular times every day. If you are taking a diabetes medicine, eat your meals and take your medicine at the same times each day.

Note: If you are taking some of the newer diabetes drugs, some of these tips may not apply to you; ask your health care provider the tips you should follow.
The Sweet Truth about Food and Diabetes

You might have heard that, as a person with diabetes, you shouldnt have any table sugar. While some health care providers continue to promote this, many -- realizing that the average person lives in the real world and will probably indulge in a bit of sugar every now and then -- have adopted a more forgiving view. Most experts now say that small amounts of sugar are fine, as long as they are part of an overall healthy meal plan. Table sugars do not raise your blood sugar any more than similar amounts of calories from starches, which is found in many foods that we consume. It is important to remember that sugar is just one type of carbohydrate.

When eating sugar, keep these tips in mind:

    * Read food labels. Learn how to determine how much sugar or carbohydrates are in the foods that you eat.
    * Substitute, dont add. When you eat a sugary food, such as cookies, cakes, or candies, substitute them for another carbohydrate or starch (for example, potatoes) that you would have eaten that day. Make sure that you account for this in your carbohydrate budget for the day. If it is added to your meal for the day, then remember to adjust your insulin dose for the added carbohydrates so you can continue to maintain glucose control as much as possible. In other words, readjust your medications if you do add sugars to you meals.
    * Sugary foods can be fattening. Many foods that have a lot of table sugar are very high in calories and fat. If you are watching your weight (and many people with diabetes must), you need to eat these foods in moderation!
    * Check your blood sugar after eating sugary foods and talk to your health care provider about how to adjust your insulin if needed when eating sugars.
    * Ultimately, the total grams of carbohydrates -- rather than what the source of the sugar is -- is what needs to be accounted for in the nutritional management of the person with diabetes.

Diabetes Diet Myths

Before you start a diabetes diet, get the facts. So many people believe that having diabetes means you must avoid sugar and carbohydrates at all cost, load up on protein, and prepare "special" diabetic meals apart from the familys meals. Wrong! Most individuals with diabetes can continue to enjoy their favorite foods, including desserts, as long as they monitor the calories, carbs, and other key dietary components and keep a regular check on their blood glucose levels.

Get the facts and start enjoying the foods you love on a diabetes diet.

What Is the TLC Diet for Diabetes?

People with diabetes who have abnormal cholesterol levels will likely be placed on a diet known as a "TLC" diet. The TLC diet will help reduce the intake of cholesterol-raising nutrients. As part of this diet you may be asked to lose weight and increase physical activity levels -- all of these are components that will help lower bad LDL cholesterol. Looking at food labels will help you become more knowledgeable about your intake of fats and cholesterol.

Specifically, the TLC diet calls for the following:

    * Total fat consumption should be 25%-35% or less of total calories eaten per day.
    * Saturated fats should be less than 7% of total calories eaten in a day.
    * Polyunsaturated fats (from liquid vegetable oils and margarines low in trans fats) should be up to 10% of the total calories per day consumed.
    * Monounsaturated fats (derived from vegetable sources like plant oils and nuts) should be up to 20% of total calories per day eaten.
    * Carbohydrates should be 50%-60% of total calories per day eaten
    * We should eat 20-30 grams of fiber per day. These can be derived from oats, barley, psyllium, and beans.
    * The amounts of protein in the diet should equal about 15%-20% of total calories eaten per day.
    * Cholesterol content of the diet should be less than 200 milligrams per day.

How Much Fat Is Acceptable on a Diabetes Diet?

People with diabetes have higher than normal risk for heart disease, stroke, and disease of the small blood vessels in the body. Controlling blood pressure and limiting the amount of fats in the diet will help reduce the risk of these complications.

Limiting the amounts of saturated fats, increasing the amount of regular exercise, and receiving medical treatment can lower bad LDL cholesterol. This has been repeatedly shown in medical studies to help people with diabetes reduce their risk of heart disease and reduce the risk of death if a heart attack does occurs in a diabetic person.

Artificial Sweeteners and Diabetes

Artificial sweeteners can be added to a variety of foods and beverages without adding more carbohydrates to your diabetes diet. Using non-caloric artificial sweeteners instead of sugar also greatly reduces calories in your favorite foods.

Keep in mind that foods with artificial sweeteners are not necessarily zero carbohydrates foods. Many have carbohydrates; theore, you must read the food labels to determine the gram amounts per serving that these have in order to take into account the effect that these carbohydrates have on your glycemic control. Foods labeled with artificial sweeteners can affect your blood sugar.

As long as you are aware of the content of carbohydrates you can adjust your meal or medication to maintain blood sugar control. "Sugar free" means no sugar has been added, but you must remember these foods still contain carbohydrates which does affect your blood sugars.

Examples of artificial sweeteners you can use include:

    * Aspartame
    * Acesulfame-k
    * Saccharine
    * Sucralose
    * Other non-nutritive sweeteners

Pregnant or breastfeeding women should avoid saccharine, and people who suffer from phenylketonuria should not use aspartame. People with phenylketonuria are unable to metabolize phenylalanine, an amino acid thats a common part of many proteins.

Some artificial sweeteners -- such as xylitol, mannitol, and sorbitol -- have some calories and do slightly increase blood sugar levels.

The American Diabetes Association cautions that eating too much of any artificial sweetener can cause gas and diarrhea.