Health for life

Ever since I was a teenager, Ive always struggled with that damn acne on my face.  Sometimes itll be really bad, other times itll clear up and Ill finally think Im growing out of it.  But it never fails to return.  Over the years, Ive experimented with just about everything under the sun to treat it (including the sun itself actually).  Just off the top of my head, and remember that this goes all the way back to the late 90s...

Stridex pads, Oxy pads, Swiss apricot scrub, probably 5 different types of Clearasil, all varieties of that white spot-treatment cream you put on at night...

More recently Ive tried the hippy route and experimented with different combinations of castor oil, grapeseed oil, jojoba oil, coconut oil, the cod liver oil / butter oil blend...

Ive tried washing it once a day, twice a day, after each meal, every other day, two days a week, once a week on Mondays at 8:00 am sharp... 

Ive also tried for as long as I can remember to find a dietary connection to acne.  First I thought it was dairy, then gluten, then alcohol, then carbs, then vegetable oils.  There were several occasions when I would eat super healthy for weeks and struggle with acne, then go out and party one night, stay up late and drink alcohol, and wake up the next morning with a face clearer than Id seen in weeks.  What gives??

Never mind the hair... focus on the acne.  It wasnt excessive, but it was just enough to be a problem.  I can remember this night specifically... it definitely ruined my confidence.  No one wants to deal with that.

In the end, after all those years of experimentation and wasted money, I ended up right back where I began... frustrated, confused, and clueless...

...until recently.  Ive been experimenting with something for several months now, since early November, that has worked extremely well for me.  It hasnt cleared up my skin completely, but its made a big difference.  I rarely break out anymore, but even when I do get the rare pimple here and there, itll be gone in just a day or two.  Its pretty incredible.

And youre not going to believe what it is.  Its so simple, so obvious in hindsight, that I cant believe I didnt figure it out sooner.  It might seem counter-intuitive at first, but it will all make sense when Im through with you.  Are you ready??  Heres the secret...

Do nothing.

You heard me.  Dont do anything.



I call it the Kunu Protocol.  Ive completely given up cleaning my face.  I dont use face wash, soap, cream, oil... I even avoid putting water on my face!  And yes, that means I shower less.  Those of you who know me in real life, have you noticed?  Didnt think so. 

The most recent picture of me from New Years Eve, with far less acne.  Cherish this selfie, you may never see another.

If you think about this for a minute, it actually makes sense.  Look at it from a historical perspective, as I like to do.
First... look at modern hunter-gatherers or even small-scale agriculturalists... people isolated from modern society.  They dont suffer from acne. According to the research of Weston A. Price, acne happens concurrently with the introduction of modern, processed food.  Its a disease of civilization.
Hence... humans likely never suffered from acne in hunter-gatherer times, accounting for nearly all of our 2.5 million years on this earth.
Did our ancestors use Clearasil?  Did they wipe their faces with Stridex pads?  Apricot scrub?  No.
Did they rinse their faces with water twice a day to keep them clean?  Doubtful.
Did they think about cleaning their faces at all??  I dont think so!

Look, Im no expert on the skin and acne, but this is what worked for me.  It just makes sense:  Stop dousing your face with chemicals and water, and let your skin do its thing with its natural oils.  Our faces werent designed for this beating! 

I know the Kunu Protocol isnt sexy.  Its not glamorous, nor exciting.  Youve probably never heard of it before, because it doesnt make anybody any money.  But the bottom line is it works.  Why not try it, you have nothing to lose!


What about you guys?  What are your thoughts on this minimalist approach?  And what skin care strategies have worked for you?

While the Disease Management Care Blog is pretty good at spotting current health policy silliness, its track record at predicting the future has been rather spotty.  Regular readers have undoubtedly forgotten this brazen attempt at 2012 health care augury, but the transparent DMCB uses to bury its mistakes.

So how did it do with its Ten 2012 Predictions?

1. Mitt Romney will win the Republican nomination and avoid discussing health care.  The DMCB got some of this right, but who would have predicted that the President would cleverly upend his opponents by embracing the term "Obamacare?"

2. A close election will hinge on an improving economy, not on Obamacare. In the end it wasnt really that close, but the DMCB was correct in foreseeing that Mr. Romneys candidacy would be undermined by dropping unemployment levels and the bottoming out of the comatose housing market.

3. The Supreme Court will rule Obamacare unconstitutional: Boy, the DMCB got that wrong.  But in its defense, few foresaw that SCOTUS would ignore the Affordable Care Acts statutory language and rule that a penalty was really a tax all along.

4. There will be no generalizable and published peer-review studies on the electronic record of the medical home that conclusively show that either saves reduces health care costs.  "Bingo!" says the DMCB.  It hopes 2013 is different and that a p value is < 0.05.

5. ACOs will not criticize CMS about the tardy delivery of claims data necessary to manage its assigned populations. The DMCB says the silence over this issue is deafening, which means either a) CMS has overcome its dismal track record on providing timely information or b) the ACOs are reluctant to go public with any concerns.  The DMCB has heard rumors that the latter is true.

6. Speaking of ACOs, their physicians will trump patient perences over savings.  The DMCB says the jury is still out on this, but time will tell if its call about this ACO Achilles heel is as important as it thinks it is.

7.  Health exchange deadlines will be pushed back. To the DMCBs knowledge, CMS is holding firm on the fall 2013 implementation date.  The DMCB takes some credit, however, for being among the first to spot this issue and bring it to its readers attention.

8. CMS will kick the Sustainable Growth Rate (SGR) down the road. "Bingo again!" says the DMCB.  It got his one right and looks forward to how Congress will deal with this in 2013.

9. Medical academics will increasingly turn to social media instead of print to make their mark on the scientific world. The DMCB believes this trend is continuing but has yet to reach a tipping point.

10. CMS Interim Administrator Tavenners status will remain in recess limbo.  OK, it wasnt all that hard to bank on continued partisan bickering, but the DMCB got this one right too.

Will the DMCB offer up predictions for 2013?  Stay tuned!

Ed is a 59-year-old father of three from Queens, New York. Though an avid golfer and fisherman, he struggled with his weight most of his life. Then, in the ‘90s, a complete lifestyle overhaul helped him drop almost 110 pounds, sending him from 287 to his current weight of 179. He’s never joined a gym or a diet program. This is his story.

(Incidentally, for transparency’s sake [and so I will not receive a beating from my mother], I will henceforth er to him as Dad.)

(Also, parts of this interview were edited for length.)

(Also also, thats not his real head in the pictures. But you knew that.)

KRIS: So Dad, when did you weigh the most?

DAD: I weighed 287 pounds in November of 1991.

K: Why do you think you were overweight? What are the reasons?

D: Well, I was always overweight. When I got out of high school I was about 195, and I slowly put on a lot of weight over the years until I got about to 250. It was my steady weight once I was out of the service.

K: And you’re 6-foot-1?

D: I’m 6-foot-1.

K: But you gained more weight after that.

D: I used to smoke. When I was 42, I quit smoking cold turkey and at the time I was about 255. I had trouble once I quit smoking pushing myself away from the dinner table, because there was no cigarette to end the meal. So I would hang around the table and eat just about anything that was left. Whether it was rolls, bread and butter, potatoes, spaghetti, meatballs - anything. And I put on another 32 pounds in that winter of ’91, and wound up at 287.

K: 287 was your top weight.

D: 287 was my top weight.

K: So, you were eating a lot of starches.

D: I was eating everything.

K: Did you have a particular food that you really kind of …

D: All food. I love bread and butters, pastries. Sunday was practically an all-day eating experience. I would go out to the bakery in the morning and pick up a bunch of rolls and pastries and sit down with the paper for an hour-and-a-half or so, eating continually, and then break for a couple of hours and then watch a couple of football games in the afternoon on Sunday and continue eating. So, there was a lot of eating and it was always two large meals, sometimes three.

K: So you’re 42-years-old, you have three wonderful children and a lovely wife. Why do you decide to lose weight at that point? Why do you go on a diet?

D: Well, when I quit smoking I told the doctor I was worried about gaining a lot of weight. And he said, “Don’t worry. If you have the willpower to quit smoking, you can lose weight.” So I kind of took him at his word. And when I got up to 287, I couldn’t fit into most of my clothes anymore. I had outgrown extra large shirts and all my pants. My waistline was between 44 and 46 inches, and I was in XXL shirts. I felt huge. And I decided I had to do something about this, and I started on a diet in early 1992.

K: How did your weight affect your everyday life? Did you have limitations?

D: Well I was still relatively young…

K: Hee. Relatively.

D: Well, when you’re 59, 42 sounds great. I used to work on the car a lot, and it was difficult to get up and down, move around. You lose a lot of agility because you’re carrying this extra person, really. 287 is a good weight for two people. It’s just a huge amount of weight, and you just don’t feel right at all. I still did what I liked. I played some golf. I still went fishing. But everything was an extra burden. It was harder.

K: So what kind of changes did you make in your diet when you decided to start losing weight?

D: Well, I decided I was going to try to get by on 1500 calories a day. So, I was working at [redacted] at the time, and I used to eat practically non-stop all day there. I would come in with a couple of bagels and I’d say, “Well, I don’t have any butter on them, so it’s okay.” And then at break time I’d have something, and then go out for a full lunch. And then I’d have a snack in the afternoon. And then I’d go home and eat a big dinner. I was probably taking in about 5000 calories a day.

K: Wow.

D: I decided I was going to try to cut down to 1500 calories. To do that I cut out my snack in the car on the way to work – I forgot to mention that. And I cut it down to two rice cakes, which comes to 100 calories. And then at break time I’d have two more rice cakes. The caramel kind. Quaker.

K: Delicious.

D: Delicious. As rice cakes go, it doesn’t get much better than that. So, by the time lunch came around, I’d had 200 calories so far for the day. And I’d try to keep lunch between 500 and 600 calories, and then dinner about the same. And at night I’d have 100 calorie snack before I went to bed.

K: What did you have for lunch and dinner?

D: For lunch– maybe if I’d have a hamburger, it would be without cheese. Maybe a couple of hot dogs. No French fries. If I had a sandwich on a bagel, it would be a low-calorie meat like boiled ham. One slice of cheese for flavor, but not loaded up on cheese. Dinner in those days, we always had two vegetables, meat, and usually a piece of bread. And I cut almost all the butter out of my diet. We used to have spaghetti and meatballs every Tuesday night and I’d have two meatballs and some spaghetti, but instead of four or five slices of bread with butter, I cut it down to two slices of Italian bread with no butter. So, cutting back all around.

K: What kind of changes did you make to your exercise plan?

D: I just played golf. I wasn’t into walking for its own sake back then. I lost ten pounds a month for seven months. I went from 287 to 217 in seven months. It felt good.

K: How did you keep track of the calories?

D: I would read the labels on the food, and I also had a little booklet I bought at the checkout at the supermarket. It was a little pocket book that had about 30 or 40 pages, and it had a nice index of foods and calories in it. … Basically I was cutting about 35,000 calories a month out of my diet.

K: That’s a lot.

D: Yeah. Doing the math, I was losing 2-1/2 pounds a week.

K: Hunh.

D: Right. And that’s how I lost the weight. I strictly believe in counting calories and exercising for losing weight. I don’t think there’s any fad diets that work over any length of time.

K: Did you find you were eating less meat or more vegetables? It sounds like you definitely cut out the dairy part of it, but what about those two?

D: Well, I watched the quantities more than the types of food. But one thing I insisted on any diet is I had to have pizza once a week. Any diet I’ve ever been on because I absolutely love pizza. But it would be two slices. My days of three, four, five slices of pizza at a meal are over.

K: So it was a portion control issue.

D: It was portion control. I believe you have to have things you like. You just can’t be continually eating rice cakes. Once in awhile you have to treat yourself.

K: Are there any other big changes you made to your lifestyle? You mentioned you had quit smoking.

D: That was it. It was seven months at ten pounds a month, and it just worked out.

K: At this point, when you were losing 70 pounds, did you ever consider joining a gym or Weight Watchers or anything?

D: No. I’m not a joiner. I don’t like the crowd aspect of joining things. I can’t see myself at a gym.

K: Okay. So you stopped at 217, but you still lost around 40 pounds after that.

D: No. What happened was, over a period of about 12 or 13 years, I slowly put on about 20 pounds. A pound one year, a couple of pounds the next, and when we went on vacation to Spain, when I came back, I was 237.

K: Were you really?

D: Well, I was 217, and over those years I gained 20 pounds. So, I said, “This is not good. I’m well into my 50s, and I’m only 13 pounds from being 250 again.” So I decided it was time to start a diet again. And the first couple of months I lost quit a bit of weight, as you do on most diets. Maybe 15 or 16 pounds. And then I decided … I want to change my lifestyle so I don’t have to constantly be worried about losing all this weight and then putting it back on. … So, I would start losing, get down three pounds a month, two pounds a month. Sometimes there would be something special going on, like a vacation, and I might put on a couple of pounds or only lose a pound or break even that month. But slowly, over the course of a couple of years, I got down to my low weight, which was 179, which is about where I am now.
K: What about your eating habits now?

D: [On] weekends [I eat] two meals a day instead of three. I have brunch and dinner – maybe a light snack during the middle of the day. … And then it’s certainly a more structured environment at the office, and I think it’s easier to lose weight. I bring in some dry cereal in the morning. I like dry cereal because I think you get more flavor out of it, and I think it takes longer to eat. … And then I have a little snack in the middle of the morning. Always 100 calories or less. At lunch I have either a sandwich or soup.

K: But we’re not talking pastrami with mayonnaise.

D: No. … And then in the evening a normal meal. And I have my pizza once a week, and on the weekends I eat two good meals each day. I mean, they’re hearty meals. Sometimes I go for pancakes. Sometimes I go for Polish food. Whatever I feel like – but only two meals. … [Also] I do a lot of walking. I walk about 30, 35 miles a week. So, that helps, too.

K: Whoa.

D: Well, I get off the subway in the morning, about a mile from the office. I leave the house a little earlier to do that. In the afternoon I walk to a different station, and another mile. And then at lunchtime, whenever I can, I walk up to the promenade in Brooklyn, which is almost another mile to and from – a mile each way. So, just in those four things, I’ve already walked four miles for that day. And on the weekend I play golf and I go fishing at night. I always walk a mile or two. And it adds up quickly. It doesn’t have a lot of stress on my joints. At my age, I’m not into – I never was a jogger. I never saw somebody jogging who was smiling, so I figured it can’t be too pleasant an experience. They always look kind of pained. So … it’s kind of a lazy man’s exercise, but what I don’t have in quality, I make up in quantity.

K: Okay. So were your diets difficult to maintain? Did you ever feel deprived or anything?

D: Well … when I’m into a diet, it becomes a way of life. … Once you get used to it, it’s fine. … And this latest one, where I altered my lifestyle and still had big meals when I feel like it - it’s almost a guilty pleasure you don’t have to pay the price for all the time.

K: So it’s easier now.

D: It’s easier in that I kind of changed the way I manage my intake. I don’t go to the bakery and sit at the breakfast table for two hours anymore either. That doesn’t happen. And I don’t eat those massive quantities of pizza. I went from having pizza twice a week to having it once a week. So, it’s definitely a cutback, but that’s okay. I still get my pie.

K: What have been the benefits of the weight loss?

D: Well, I’m a lot more agile. I can, despite my bones starting to creak and stiffen up a little, I can get up and down relatively easily. I have a bad back, and the weight loss certainly helps my agility and my mobility. And of course, with all the walking, I can walk a pretty good distance. I walked to your office tonight from Downtown Brooklyn, which is about four miles. I did that in a little over an hour, so that’s a good pace. Good for someone my age.

K: Okay. So here’s a question: Grandma, your mom, was a big woman.

D: Yes.

K: Did you ever look at her and say to yourself, “That can’t happen to me when I’m that age”? Was that part of it at all?

D: Well, what I did notice – my mother lived to 88.

K: Oh yeah. I missed that.

D: There’s that. But I noticed that you don’t see a lot of big, old fat guys. They tend to die off relatively early. And I’ve been blessed with pretty good blood pressure and a good heart from what I understand, a strong heart. So, I didn’t want to make it any worse. I wanted to have a long, happy, healthy retirement, and part of that was not being overweight.

K: And with Grandma, she lived until 88, but she was not mobile for the last …

D: Listen, if I can get to 83 and suddenly not get too mobile…

K: Good point. So, for the diet and the lifestyle change, what was your support system like? Did anyone help you?

D: No.

K: Oh no.

D: Well, people say positive things. “Oh, you look great.” “Oh, you lost weight.” That’s certainly – that’s supportive. So, it’s a positive thing that you’re doing and people remark on it. And a lot of people have trouble losing weight, [but] you know, I guess for me, it hasn’t been … extremely difficult to do. But for some people it’s a real struggle, and I understand that. Positive feedback is always appreciated.

K: Got it. What are your plans for the future?

D: Retire, fish, golf, sex, drugs, rock and roll. Not necessarily in that order.
~~~

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Every Saturday, we post a piece from the CHG archives. This one comes from March 2009. Enjoy!

Up until a few years ago, the list of foods I loathed was a long one. It included, but wasn’t limited to: spaghetti squash, broccoli, asparagus, red cabbage, ginger ale, cauliflower, radishes, lentils, beans, Brussels sprouts, fennel, eggplant, anise, scallops, figs, and of course, the dreaded mayonnaise. The list goes on (and on), but you get the idea: growing up, I wasn’t exactly a daring eater.

I still hate mayo. I will ALWAYS hate mayo. George Clooney could serve me mayo wrapped in chocolate bacon on a gold-plated re-issue of Who’s Next, and I would throw it back in his face. But my opinion’s changed on most of those other foods. These days, I’ll gladly scarf a floret of cauliflower. Brussels sprouts hold a special place on my dinner table. And eggplant? Well, eggplant is my favorite thing ever, aside from the panda song from Sifl and Olly. (In fact, you could say I’m drunk on eggplant mystery.)

Granted, part of it is just me aging. At 31-years-old, my palate’s matured a little, and my tastes now lean more toward savory than sweet. The other part, though, can be directly attributed to recent changes in my lifestyle.

See, a few years ago, I resolved to learn to cook, to eat healthier, and to better manage my money. As it turned out, vegetables and legumes were vital to making this work, since they’re exponentially cheaper than meat and much more nutritious than most starches. So, I had to confront my fears. I had to expand my produce repertoire beyond corn, carrots, corn, and carrots.

These strategies helped. I learned to tolerate, and even love, a lot of foods I had longstanding issues with. Try ‘em for yourself, and please add your own suggestions to the comment section.

Make it unrecognizable.
Case study: Eggplant
Seedy, mushy, and horrifically purple, eggplant appealed to me about as much as a drug-free colonoscopy. Then, in 1997, my friend H hid it in her homemade tomato sauce. And … revelation. Soon, I was on to eggplant dips, eggplant pastas, and finally, plain ol’ broiled eggplant. The trick was getting the image of the vegetable out of my head, and forcing me to associate it with otherwise good food. I suspect it would work beautifully with any vegetable that could be pureed or furtively included in a sauce (butternut squash, bell peppers, etc.).

Use it in a recipe with foods you love.
Case study: Brussels sprouts
As far as I was concerned, Brussels sprouts were tiny, bitter cabbages that masochists ate when they ran out of bigger bitter cabbages. Little did I know that slathering them in Parmesan would provide a delicious gateway into healthier, simpler preparations. See also: Red Cabbage (ew) with Honey (nice), Apples (yay!), and Bacon (king of cured meats). Its actually quite scrumptious.

Try it in an ethnic dish.
Case study: Broccoli
Broccoli: looks like trees, tastes like butt, right? Yeah, I used to think like that, too. But in high school, Ma ordered Chicken and Broccoli from our local Chinese joint, Da How. Suddenly, it was broccoli: looks like trees, tastes like HEAVEN (with garlic and brown sauce). Sometimes, a food is more appealing when its paired with flavors you’re not necessarily accustomed to. Like bean sprouts on top of Pad Thai. Or peas stuffed in a samosa. Or tomatillo sauce spread across an enchilada. Pick a cuisine and start experimenting.

Cook the best-reviewed recipe you can find featuring that food.
Case study: Cauliflower
Most aggregate recipe sites like Epicurious, Food Network, and All Recipes have sophisticated rating systems with which home cooks can evaluate any dish. If you’re feeling ambitious, plug an ingredient into one of their search engines. Then, prep the recipe with the best overall reviews. For example, Ina Garten has a Cauliflower Gratin that’s received an average of five stars from 132 people (which is outstanding). I’ve tried it myself, and without exaggeration, it changed the way I felt about cauliflower. I just … I just didn’t know it could taste that good. Now, stuff like Roasted Garlic Cauliflower and Curried Cauliflower Soup with Honey are making regular appearances in my mouth.

Understand you don’t have to eat it the way your Ma (or Pa) prepared it.
Case study: Spaghetti Squash
Across the country, millions of Irish-Americans loathe vegetables because growing up, produce was boiled beyond recognition and then forced by threat of death into their reluctant maws. But take heart, my freckled brethren! It doesn’t have to be this way. Did you know carrots can be roasted? And broccoli rabe, sauteed? And spaghetti squash, combined with red sauce, mozzarella, and pine nuts to create something COMPLETELY DELICIOUS? It’s true. So, love your Gaelic Ma. Embrace her. Call her often. Just … try to forget her cooking. It’ll make this whole process much easier.

Try a dish with a subtler incarnation of that food.
Case study: Tarragon
This one’s a little difficult to explain, so here’s an example: I despise anise. Even thinking about its black licorice flavor makes my tongue curl. Recently though, I discovered a White Bean and Tarragon Soup that I quite like. Tarragon, like fennel, possesses traits similar to anise, but it’s much, much subtler. In the soup, it was complemented so well by the other ingredients, I didn’t even taste the hate. Maybe Ill feel the same way about anise someday. Think of this principle like salsa: you start out mild, and work your way up to medium and hot varieties.

Give it just one more shot.
Case study: Beans
For some inexplicable reason, I always assumed I hated beans. As a kid, they looked funny to me. And in my six-year-old brain, funny-looking food = bad food. It wasn’t until I grew up, sacked up, ate one and didn’t throw up, that they became a regular part of my diet. (Okay, hummus helped.)

If you truly hate it, let it go.
Case studies: scallops, figs, radishes, mayo
Scallops will never be my thing, no matter how fresh they are, how well they’ve been prepared, and how many times I try them. Figs, radishes, mayonnaise – still disgusting, as well. (Which, did I mention I hate mayonnaise? I did? Oh, good.) Sometimes, a certain food just won’t do it for you. And it’s okay. Just move on to the next one.

And that’s it. Readers? Suggestions?

~~~

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Every Saturday, we post a piece from the CHG archives. This one comes from June 2009.

Though it might seem intuitive, determining a recipe’s cost and nutritional value can get pretty complicated, pretty quickly. Ingredient prices can add up before you know it, and a combination of fats, meats, and cheeses will take a toll on your calorie count without even registering on your radar. And sometimes, even the most harmless-looking dishes, like All Recipes’ Greek Pasta Salad with Shrimp, Tomatoes, Zucchini, Peppers, and Feta, can run you $2 and 42 grams of fat per serving.

So, how can you tell if a dish is good for you, just by looking at it? How can you avoid the pitfalls of secretly fatty and financially unsound food? How can you err on the side of caution when it comes to cooking?

Look no further, sweet readers. We’ve got you covered. If your recipe source doesn’t give a nutritional breakdown and you’re unsure of the potential cost, these tips will help you decide whether the money/waistline expenditures are worth the trouble. If you have any suggestions, be sure to include them in the comment section.

DO choose your source wisely. Man, I love Paula Deen. Her food looks stupendous and she’s endlessly entertaining – like Yo Gabba Gabba if it was a charmingly cackley southern woman. That said, her concoctions might not be the best choice for those concerned about weight. If you know you’re looking for healthier recipes, sources like Everyday Food, Cooking Light, and Eating Well will generally be more helpful than the Neelys or the Two Fat Ladies. Likewise, reproducing a dish from Grant Achatz’s Alinea cookbook will probably run you a pretty penny compared to the average Cook’s Illustrated meal. Starting your search with a website, cookbook, or blog aimed at your requirements is half the battle.

DO check the number of servings. Once you have a recipe in mind, before you do anything else, check how many people it’s supposed to sate. Fourteen ounces of flank steak does little damage split among eight eaters, but can destroy diets if it’s meant only for two.

DO read the ingredient list caully. After the serving size, the ingredients are the most important determinant of the cost and nutritional value of a recipe. Scan the rundown, look for a few keywords (many of which are listed below), and be extra aware of extravagant or difficult-to-find foods for your area, which will drive up the price.

DO consider recipes with one or two out-of-the-box ingredients. In small doses, odds are it/they won’t break the bank, and you can incorporate new flavors into your repertoire. Lemongrass? Meyer lemons? Lemon basil? Sure, why not?

DON’T dismiss a long list of ingredients outright. Lighter foods like Bon Appetit’s Turkey Chili with Beans frequently require multiple, inexpensive spices and flavorings to make up for the absence of fat. While their sheer number can seem pretty intimidating, don’t fret. Oftentimes, these foods can be found right in your pantry for minimal cost.

DO count the number of ingredients already in-house. Speaking about that pantry, recipes based on dry goods will usually be cheaper than ones requiring a trip to the supermarket. Look for meals that use rice, beans, pasta, and other staples as jump off points, and go from there.

DO opt for whole food ingredients. If it can be found in the outer aisles of your supermarket, it’s probably a good start to a meal. Fresh fruits, veggies, and lean meats give recipes more bang for the buck, and almost guarantee a healthier overall experience. Fewer preservatives and extra-excellent flavor are just bonuses.

DON’T choose recipes made from processed food. The less ingredients are handled by humans, the better. Why? Well, in general, heavily processed and pre-cut edibles are more expensive and worse for you than the aforementioned whole foods. Semi Homemade-style meals may be convenient, but when you’re sacrificing money, nutrition, and taste, is it worth it?

DO watch out for lots of meat and cheese. In moderation, neither of these is anything to fear. But prices and calories rise when a meal centers on multiple cups of frommage or large cuts of beef or pork. Instead, search for recipes where meat and cheese are add-ons instead of the main event. You’ll save all around.

DO calculate about 12 or 13 grams of fat per tablespoon of butter or oil. When doing a cursory scan of any recipe, I take extra care to check the total cooking fat. If there’s a lot, but it can be easily reduced (like in sautés), I keep going. If there’s a lot, but the amount is set in stone (as in some baking), I move along to the next dish.

DON’T rule out all fatty ingredients. Nuts, olives, avocados and certain oils aren’t low-fat foods, but they’re healthy ones because of the vitamins and minerals they offer. Relatively inexpensive and often pivotal to a dish’s overall flavor, they should be incorporated into any diet in moderation.

DO look for words like: baked, roasted, steamed, grilled, or sautéed. These cooking techniques tend to use less fat than others while still producing flavorful foods. Steaming and boiling are good keywords as well.

DON’T choose recipes with the words: fried, au gratin, cream sauce, bisque, bacon-wrapped, or lard. Each of these terms implies one thing: fat. If you’re serious about watching your weight, there are lighter recipes for certain dishes (Spaghetti Carbonara, etc.), but straight-up lobster bisque will do a number on your numbers.

Confusing? Maybe. Do-able? Definitely. With some practice, these rules will get easier to use. And in the end, you’ll have no problem telling the difference between the recipe you really want and the recipe you thought you wanted.

Readers, fire away in the comment section.

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EHR portals at work?

The Disease Management Care Blog had this thoughtful reply logged onto its "Follow-Up" post on the topic of EHR patient portals. Logged by Rebecca M Coelius MD, Medical Officer for Innovation at HHS/ONC, the DMCB recognized that this was important enough to warrant its own separate page.

While we wish that the results were more conclusive and positive, the Office of the National Coordinator for Health Information Technology (ONC) applauds the meta-analysis and the recent upswing in articles on patient portals and other patient-facing technologies. The number of patients and caregivers who desire greater participation and transparency in their healthcare makes continued research in this area vital. Yet, in a close read of the full Annals of Internal Medicine meta-analysis article and in many of the studies it cites, there were unquestionably statistically significant positive clinical outcomes, as well as positive patient experiences, associated with certain patient portal functions.

The ONC does not believe that Health IT alone is a panacea, or that meeting the form of Meaningful Use, while not embracing the new functions the technologies it enables, is likely to result in measurable improvements. The study authors caution that it was case management that tipped the utility of portals from unclear or small to more substantial, but it is important to note that the case management activities happened via the portal itself. This is a perfect example of Health IT as an enabler of new ways of reaching and caring for patients; we would not separate the two concepts.

To the study’s described limitations, we offer two significant additions. First, the definition of a patient portal remains loosely specified, so it is difficult to make conclusive statements about the entire category. The meta-analysis did attempt to list which functions were present for each study, but half of the studies that looked at patient outcomes gave only a partial description of portal features, and a deeper assessment of the quality of functions and their relevance to the outcomes measured was not present for any study.

A more illustrative future approach would be to evaluate individual functions of portals for impact on patient participation in their care and specific health outcomes, and then ask what design principles and organizational contexts were necessary to make that function successful. For example, the impressive OpenNotes project demonstrated that patients with access to provider notes had a better understanding of their health and condition, improved recall of their care plan, and increased likelihood of taking medications as prescribed. In a New England Journal of Medicine study on weight loss interventions, over twice the number of patients in the remote support intervention groups (telephone, website access, and e-mail support) lost more than 5% of their weight versus the control group. Secure messaging and the ability to view personal health information are two cornerstones of portal functionality within Meaningful Use.

Second, more than 10% of these studies are ten years old, and over a third were published five or more years ago. We understand the necessity of adequate numbers for meta-analyses, but statistical significance does not necessarily confer relevant insights. Technology, and patient perences and capabilities for using technology have fundamentally changed over the study time periods included, not to mention the maturation among health-care organizations themselves and the expectations of patients.

The very premise of the patient portal is a rapidly ageing one. As the ONC articulated in a 2013 Health Affairs article, there are shifting attitudes related to the traditional roles of patients and providers, and exploding demand and penetration of smartphones, health and wellness apps, and connected devices. We are moving the conversation from engaging people with our existing healthcare system through “portals”, to using technology to move outside our system to reach them every day where health truly happens. What we need to measure and incentivize in the future is not the value of portals, but the value of delivering the right information and intervention to the right person, at the right time, through the right interface based on an individual user’s context.