Health for life

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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Older adults are often encouraged to stay active and engaged to keep their minds sharp, that they have to "use it or lose it." But new research indicates that only certain activities — learning a mentally demanding skill like photography, for instance — are likely to improve cognitive functioning.

These findings, forthcoming in Psychological Science, a journal of the Association for Psychological Science, reveal that less demanding activities, such as listening to classical music or completing word puzzles, probably wont bring noticeable benefits to an aging mind.

"It seems it is not enough just to get out and do something—it is important to get out and do something that is unfamiliar and mentally challenging, and that provides broad stimulation mentally and socially," says psychological scientist and lead researcher Denise Park of the University of Texas at Dallas. "When you are inside your comfort zone you may be outside of the enhancement zone."

The new findings provide much-needed insight into the components of everyday activities that contribute to cognitive vitality as we age.

"We need, as a society, to learn how to maintain a healthy mind, just like we know how to maintain vascular health with diet and exercise," says Park. "We know so little right now."

For their study, Park and colleagues randomly assigned 221 adults, ages 60 to 90, to engage in a particular type of activity for 15 hours a week over the course of three months.

Some participants were assigned to learn a new skill — digital photography, quilting, or both — which required active engagement and tapped working memory, long-term memory and other high-level cognitive processes.

Other participants were instructed to engage in more familiar activities at home, such as listening to classical music and completing word puzzles. And, to account for the possible influence of social contact, some participants were assigned to a social group that included social interactions, field trips, and entertainment.

At the end of three months, Park and colleagues found that the adults who were productively engaged in learning new skills showed improvements in memory compared to those who engaged in social activities or non-demanding mental activities at home.

"The findings suggest that engagement alone is not enough," says Park. "The three learning groups were pushed very hard to keep learning more and mastering more tasks and skills. Only the groups that were confronted with continuous and prolonged mental challenge improved."

The study is particularly noteworthy given that the researchers were able to systematically intervene in peoples lives, putting them in new environments and providing them with skills and relationships:

"Our participants essentially agreed to be assigned randomly to different lifestyles for three months so that we could compare how different social and learning environments affected the mind," says Park. "People built relationships and learned new skills — we hope these are gifts that keep on giving, and continue to be a source of engagement and stimulation even after they finished the study."

Park and colleagues are planning on following up with the participants one year and five years down the road to see if the effects remain over the long term. They believe that the research has the potential to be profoundly important and relevant, especially as the number of seniors continues to rise:

"This is speculation, but what if challenging mental activity slows the rate at which the brain ages?" asks Park. "Every year that you save could be an added year of high quality life and independence."

This is an engine. Now youre ready to drive!

Just when the Disease Management Care Blog thinks it has mastered the jargon of population health management, along comes another term that reminds it of how quickly the science is evolving.  "Simulation learning experiences" is a new addition to PHM parlance, thanks to this just-published JAMA article by the University of Colorados Eric Coleman.

While the phrase may be new, the underlying science isnt. As DMCB readers are aware, its one thing to transfer information to patients, its another thing to transfer skills. 

Dr. Coleman points out that a patient with diabetes, heart failure or asthma is not unlike a person just learning to drive.  While some classroom work on how an internal combustion engine works is a good idea early-on in the process, its not until the student takes "the wheel" of their glucometer, diuretic meds or peakflow meter that you can really know that they wont end up in a hospital (a.k.a. having an "avoidable admission").

Accordingly, individuals with chronic illnesses (and their layperson caregivers) need practice, rehearsal and role playing.  They need to test the care plan and make sure it comports, to any degree possible, with the home environment and the skills of the involved individuals.  Better to find out early about any obstacles, such as poor vision, low health literacy, cognitive impairment or low self-confidence.

Naturally, the traditional health system is ill-equipped to provide simulation learning experiences. There has to be dedicated space and the personnel who offer it to patients have to role-play, which can be very time consuming. Since each patient is ultimately unique with very different home circumstances, there is no one-size-fits-all approach

That being said, the DMCB suspects that as ACOs, integrated systems, provider networks, medical neighborhoods, managed care organizations and payers continue to evolve toward high value health systems, their hospital discharge planners, rehab-center case managers and transitions care managers will find that the "return on investment" from avoided re-hospitalizations, fewer unplanned ER visits and decreased redundant specialist visits will be more than enough to justify the cost.

And then theres the added bonus of the jargon that may warrant its own acronym of "SLE." The DMCB coyly suggests readers spring the term on an unsuspecting or clueless co-worker, boss, policymaker or doc who is all about "patient education."