Health for life

This week’s Ask the Internet question comes from right here at home, and addresses an issue many of us might be facing in our post-Christmas hazes.

Q: Two years ago, I received several bread mixes and a jar of chocolate sauce for Christmas. The breads were baked and eaten within a month, but the sauce still lingers in the bottom of my pantry. What should I do with it? What do YOU do with food-based Christmas gifts you don’t use and/or never intend to?

A: While the generosity and thoughtfulness of a food present is wonderful, there are zillions of pepperoni sticks and Jordan almonds that will go uneaten this year. What makes it tougher: many of them (see: chocolate sauce) would be of little use to a food bank.

So, readers – what’s your plan for this stuff? Will you re-gift? Will you bring the edibles to a party, or try to pawn them off at the office? Will they simply go in the garbage? Any and all suggestions are welcome in the comment section.

P.S. Good Christmas food stories are highly encouraged.

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

Todays question is ripped from the headlines. (Woo hoo! Timeliness!)

Q: A recent study on calorie labeling in fast food restaurants showed that it didnt affect what kids ordered. Though the research was only conducted in New York City and Newark, the results still kinda surprised me.

Readers of CHG tend to be pretty aware of nutritional guidelines. Would calorie labeling affect what you ordered from a chain?

A: On the rare occasions I visit fast food restaurants (mostly on the road), definitely. Some of those salads, man - why not just have the burger?

Readers, how about you?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

In 2004, the CDC published a study that found:

" ... the prevalence of overweight or obesity was 85.2% [among people with diabetes]."
- Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes

Given the strong correlation between weight and type 2 diabetes, the following documentary might be worth a watch.

PBS is currently broadcasting "Fat: What No One Is Telling You", a film investigating the issues surrounding the obesity epidemic.

From their website:

"With 66 percent of U.S. adults either overweight or obese, our girth is a serious public health issue. Yet many of us still view being overweight as a character flaw, a lack of self-control, or even a moral crime.

But does fat really equal failure? FAT: What No One Is Telling You explores the myriad psychological, physiological and environmental factors that can make it so tough to shed pounds and keep them off. In this documentary, Executive producer Naomi Boak and producer/director Tom Spain, both Emmy Award honorees, share new scientific knowledge about hunger, eating, and human metabolic operation. This film also explains our psychological responses to food, and shows how external pressures (such as oversized restaurant portions and the unending barrage of food advertisement) make fighting fat so difficult, both on the personal and national levels."

You can watch a preview here:



Check their site for local listing dates and times.
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Simple Organized Living started it. Then, Money Saving Mom picked it up. Today, Casual Kitchens Daniel puts his own twist on it. I think its officially a meme:

Q: What ten things DONT you spend money on?

A: Okay, here goes:

1. Beef (Thank you, chickens.)
2. Bottled water and soda (Thank you, tap.)
3. Lawn care (Thank you, Brooklyn concrete.)
4. Mayonnaise, radishes, scallops, cauliflower, and anise. (Thank you, food aversions.)
5. Name brand clothes (Thank you, lack of fashion sense.)
6. Cable TV (Thank you, Netflix.)
7. DVDs (Thanks again, Netflix.)
8. Books (Thank you, public library.)
9. A car (Thank you, feet.)
10. Kitchen gadgets (Thank you, limited cabinet space.)

Readers, fire away. This is a fun one.

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

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.

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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

Talk about a compelling story that went ignored.
In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.

Recall that portals are web-based entryways that on-line health consumers can reportedly use to access their records, request medications, correspond with their doctors, manage their health conditions, reduce health care costs, increase U.S. life expectancy, reduce our national dependency on jumbo-sized sugary drinks and fix everything else that ails the U.S. health system.

Unfortunately, facts have intruded.  After looking at fourteen randomized prospective trials, 21 observational, hypothesis-testing studies, five descriptive studies and six qualitative studies, the authors concluded...

 "...evidence that patient portals improve health outcomes, cost, or utilization is insufficient."

Ouch. 

In particular, any impact on diabetes care was short-lived or nonexistent, patients with heart failure had no meaningful improvement, blood pressure control did not improve and adherence to prevention recommendations were marginal.  One observational study found persons with heart failure were more likely to use the emergency room.  The only study that found any benefit involved a single randomized control trial that examined the impact of portals in the co-management of depression.

After looking at this review, depressed advocates of EHR portals may have to personally use their own portals to communicate with their docs health care medical neighborhood.

The only good news is that there were some data that suggested that a substantial number of consumers liked using the portals.  But the DMCB likes channel surfing too, but that doesnt mean that the spouse agrees that its television-watching quality has improved or that the cost of all those premium channels is moderating.

The authors pointed out that it was difficult to isolate the impact of a portal vs. a portal plus care management.  To the DMCB, that means that portals are at best a means-to-an-end of enabling care managers to better communicate with their enrollees. 

To the thousands of DMCB readers, that is not a surprise.

In the meantime, the Feds and the NCQA have one more reason to re-examine their many cherished assumptions about health information technology and the stand-alone electronic record. The last time the DMCB looked, the federal government continues to extoll portals stand-alone virtues. The National Committee on Quality Assurance (NCQA) still includes two way communication for appointments, errals and prescription errals as a standard for the medical home.  Finally, the Feds promotion of the electronic health record (EHR) approves of portals as an option in meeting meaningful use criteria.

Image from Wikipedia

Are you helping your e-patients?

(The Disease Management Care Blog welcomes the Nursing and Physician Leadership Congress attendees.  By the way, heres the link it mentioned.)

The Disease Management Care Blog got to hear a compelling conference keynote presentation by Dave deBronkart, a.k.a. "e-Patient Dave."    Think of this as an ePost from the eDMCB about the eBusiness implications of ePatients.

By the way, a more suited moniker may be "Remarkable Dave." Hes survived Stage IV kidney cancer thanks to a an interleukin based treatment regime that he wouldnt have known about if it werent for his use of the internet.  Thanks to his laptop and a remarkable degree of determination, he was able to network with similarly "empowered, engaged, equipped and enabled" cancer patients.  Now a multi-year survivor, hes a go-to patient advocate for the Washington DC cognoscenti, is a co-founder of the Society for Participatory Medicine and a tireless advocate for acor.org.

While the DMCB could never capture the scope of e-Daves presentation in this blog, there were some insights that may be of use to the disease management and population health management service community:

The "Soup" of Information: As more medical information becomes available on-line, patients, families and friends will be "swimming" in social networks that will yield more insights about possible diagnosis and treatment options than an average physician could ever know about.  This is not about reading on-line content.  This is the two-way sharing of information in community networks of like-minded individuals who spend a lot of time and effort becoming experts.  They ultimately produce value, not consume it.

Population Health Management (PHM) Implications: ePatients with chronic conditions are going to be unlikely to settle for the recommendations in your pre-fab care plans.  Be prepared to accommodate new inputs that will complicate and enrich self-management.  If a e-patient asks about an unknown treatment option out of "left field," the best answer may be "dont know, well find out more and get back to you."

Under the Garbage Theres Gold: When you consider that as many as 1 in 5 romances start with an on-line dating service that involves hundreds of options and many poor fits before couples find each other, it should be no surprise that much on-line medical information is likewise ill suited to an individual  patients circumstances.  Thats OK, because if patients keep digging, theyll find that key piece of information that they really need.

PHM Implications: An emerging value proposition: being a trusted advisor and catalyzing ePatient information networking and mining.

Wisdom of Crowds on Steroids:  The best source of that information?  Other patients who, unlike many of their physicians, have a lot of time and motivation to do "deep dives" in personally relevant research that would otherwise take years to enter mainstream clinical practice.  Theyll also share their personal experiences with each other.

PHM Implications:  Have you thought about not only helping your patients find an on-line community but hosting one?

Vaccine Airheads: Yes, there is a lot of potentially harmful information on the web but much of it is the fault of the medical community.  The spurious link between vaccines and autism, for example, was the result of fraudulent research and faulty peer review.  Compare the "death rate from Googling" to the "To Err Is Human" death rate of 98,000 per year, and you get the picture.

PHM Implications: As you accommodate an on-line community, expect some crazy points of view.  Thats the price of doing business.

Jerks Google Also:  If a hateful (maybe a less provocative term would be difficult) patient is using the internet to torpedo a doctor-patient relationship, chances are theyd torpedo the relationship without Googling.  Use of the web is an innocent bystander.

Some other DMCB take aways:

There is ample research on shared decision making (plus a good article here) that shows that when patients get all the information they need, most not only choose wisely, they choose conservatively.  While some may chose the "wrong" option, thats the price of patient empowerment.  From a population-based level most of the curve shifts to the left. The good outweighs the bad.

Once again, we are witnessing the breakdown of "credentials" that separate knowledge-based professionals and self-trained amateurs.  This is a disruptive innovation that represents an important threat to "cognitive" physicians.

Electronic health records that rely on a walled garden to try to capture patients will lose.  Electronic health records that can accommodate the messy world of eDaves will survive.  Electronic records that can enable it will win.

The ePatient movements benefits outweigh harms, is self-enforcing and impossible to regulate.  That doesn mean that someone is going to try to do it.

One last closing insight from eDave: If you are reading this, think about what would happen if you developed a serious or life-threatening condition.  You would start searching the internet. 

You are already an ePatient.

Image from an HHS web site

Goin goin gone!

The Disease Management Care Blog recalls years ago when it was walking with some residents and students through a decommissioned wing of a hospital as a short-cut between patient floors.  Our footsteps echoed off the dreary beige tile while we chatted up the likelihood that we could get the next patient home this afternoon.  Then the  DMCB paused and took in the eerie fluorescent silence. "What you see around you," it mused, "is some valuable and unused capital."  The team then resumed the pace. Thats when the DMCB looked at the young docs and said "If we keep it up, theyll need to close another wing!" 

The fly in the ointment.  The monkey in the wrench.  The docs raised hand at a hospital board of trustees meeting.  Call it what you like, but sometimes our most cherished assumptions and best laid plans have a way of going all akimbo.  True to that tradition, curmudgeonly Dartmouth authors Stephen Rauh, Eric Wadsworth, William Weeks and James Weinstein examine the "illusion" of  expecting "lower costs" to come out the back end of a health system system after "quality" is put in the front end. 

The authors real focus is on hospitals and define "quality" as any intervention that reduces the utilization of health care services (versus other definitions). Despite the narrow view, the Disease Management Care Blog believes the article makes an important and yet obvious point: large and small health care organizations have rigid cost structures that cannot be flexed.  As a result, any increase in quality - such as reducing length of stay, admissions, readmissions or surgeries -  mostly results in additional dead space capacity, not bottom line savings.

Clinical improvement can reduce costs is in the general category of supplies and medications.  Unfortunately, those costs are at the margins.  Just because there are fewer readmissions wont mean all those expensive operating rooms. equipment, personnel costs and other administrative overhead will simply go away.  They dont.  Theyll be idle and cost just as much.

Some economists will argue that hospitals can take beds off line and furlough nurses.  Its also been pointed out that multiple health systems can regionally consolidate high-cost low-frequency services.
Unfortunately, the quarter to quarter business cycle facing the typical hospital administrator doesnt really accommodate that kind of wishful thinking.  The only way out is to find other revenue by either charging more or providing other services.

Despite many valiant attempts, the DMCB never managed to close another hospital wing.

Talk about a no win situation.  After seeing his "red line" go rudely unheeded, the President is facing the prospect of appearing weak if he does nothing or warmongering if he launches an attack.

Medical decision scientists ask: how did it come to this?

Mr. Obama is correctly admired for his "no-drama informed style of decision-making.  And good physicians, says medical science, should operate the same way.  According to this recent New England Journal article, consciously deliberative and logical approaches to diagnosis and treatment selection are far more reliable than the intuitive shoot-from-the-hip pattern recognition that used to rule the bedside.

Psychologists describe the latter as "Type 1" processing while the former is "Type 2."   Think George W. Bushs gut instincts over Iraqs weapons of mass destruction versus Barack Obamas disciplined rationality when he decided to attack the Bin Laden compound. He undoubtedly used the same methodology when he was pondering Syria.

But, thinks the Disease Management Care Blog, there are limits to brainy decision-making when the choices are overwhelmingly numerous.  In this retail business-oriented TEDTalk, Sheena Iyengar points out that dozens of options lead to procrastination followed by bad choices followed by low satisfaction. 

It can also apply to foreign policy. Given the vast array of pieces and potential moves on the Middle East chess board, little wonder that Mr. Obama would procrastinate for days saying he has "not made a decision," then apparently select an attack option disdained by even the New York Times and then engender even more second guessing by the very Congress that the President has repeatedly criticized as unreliable.

Ditto health care.  The downside to shared decision making is that an overwhelming number of testing and treatment options can lead befuddled patients to a "you decide, doc" mentality that leads the physician to regress to "Type 1" decision-making.

The DMCB isnt too sure how TEDTalks Dr. Iyengars suggested solutions can help the folks in the White House Situation Room, but the DMCB wonders if the national security staff shouldnt have done a better job of presenting the Commander in Chief with 1) a limited number of choices that were 2) more "concrete," as well as 3) arranged into categories with the 4) low complexity options offered first. 

That 4-fold approach could help docs and patients too.  The DMCB looks forward to additional research in the area.

In the meantime, there is one additional medical rule that has withstood the test of time that may also be useful in dealing with Syria. The DMCB offers it up to business and politicians alike: primum non nocere.

Say hello to the CMS Administrator

Bowing to the implacably oppositional Republicans, President Obamas first selection for Administrator of CMS tendered his resignation and made way for second-in-command Marilyn Tavenner.  Whats more, instead of using a recess appointment, the White House has submitted her nomination to the U.S. Senate.

So who, asks the Disease Management Care Blog, is she?

According to this biosketch (scroll down, youll find her), Ms. Tavenner has a 25 year hospital administrator pedigree that includes being CEO at two Virginia Hospital Corporation of America hospitals (Chippenham and Johston Willis).  That part of her career culminated in her being the companys "President of Outpatient Services."  As the DMCB understands it, she entered the major leagues of public service in 2006 when Democratic Governor Tim Kaine tapped her as Virginias Secretary of Health and Human Resources.  Thanks in part to her links with Mr. Kaine, she later jumped to CMS, where she became the "Principal Deputy Administrator and Chief Operating Officer."  Unsurprisingly, her duties have included loyally defending the Affordable Care Act (ACA).  You can see her in action here on C-SPAN.

By the way, did the DMCB mention that Ms. Tavenner is a registered nurse?

She has an Virginia Commonwealth University BSN undergraduate degree and apparently climbed the HCA ranks one patient care unit at a time.  Somewhere along the line she also nabbed a Masters in Health Administration.

Four initial thoughts from the DMCB:

1. The new CMS nominee is another example of the emergence of nurses as go-to health leaders.  Not only does the public trust them, theyre able to bring a real-world understanding of hands-on patient care to the high falutin mix of operations, policy, politics and finance.  The good ones know how to deal with grumpy doctors and neutralize clueless administrators.  That being said, the physician DMCB cant help it and still wishes there was a doc at CMS helm. 

2. In its long career, DMCB has witnessed the Dark Side Transformation of many well-meaning physician or nurse administrators to a type that places profits over patients. Whats more, few have become hospital CEOs without making some enemies along the way.  Will any past foes come forward with unpleasant anecdotes from an otherwise forgotten past?  Stay tuned.

3. Despite lots of searching, the DMCB couldnt find much of a track record outside some speaking gigs and serving on some boards.  As far as it can tell, she has no peer-reviewed publications and her public statements have been pretty vanilla.  While that may impair Mr. Obamas foes ability to attack Ms. Tavenners record, the DMCB wants to know more about someone who is going to be leading the worlds largest health insurer.

4.  The absence of a track record doesnt mean that the nomination process isnt an opportunity for politically motivated mischief.  It remains to be seen how well Ms. Tavenner testimony holds up to the Republicans intense "gotcha" scrutiny and whether her nomination ultimately becomes a toxic partisan (re)hearing on the merits of the ACA.

Sweet readers! I ain’t got no recipe for you today, and I apologize. I’ve barely had time to go to the bathroom since arriving home, so cooking has been moved to the backburner. (Not literally speaking, because that would imply that I’ve cooked something. You see, here at CHG we try to use “literally” correctly, or we risk being severely pummeled by our mother.)
Anyway, our Italian honeymoon! It was great. Lots of art. And traffic circles. And domes. Boy, do they like domes over there.

The food, of course, was out of this world. Between myself and That Guy That I Married, we scarfed a silo’s worth of pasta, along with every known salami, prosciutto, capicola, and sopressata on the planet. This is to say nothing of the wine, which was plentiful and universally excellent.

Also? We ate horse. More on that in a minute.

First, a few observations, should you embark on your own journey:

1) Meats (cured and cooked), cheeses, pastas, wines, fruits, veggies, desserts, pastries, and sauces are absolutely, completely everything they’re cracked up to be. I gained almost six pounds, 90% of it in Pasta Carbonara.

2) These are three of the best pasta dishes I’ve ever had the pleasure of shoving down my gaping maw:

Rigatoni Carbonara at Dino & Tonys in Rome

Pappardelle with Wild Boar Ragu in Montepulciano

Macaroni, Marscapone Cheese, and Some Kind of Mystery Meat at Al Duomo in Verona

3) At home, we eat 90% vegetarian. Abroad we ate: octopus, boar, horse, donkey, chicken, pork, beef, sardines, anchovies, swordfish, rabbit, shrimp, and all kinds of fish. Regarding the horse and donkey, they’re both traditional meats of the Veneto region. (No, really.) We were a little hesitant at first, but figured it had already been cooked, so what the heck? With apologies to Secretariat, the results were surprisingly delicious.

4) Italian breakfasts are five-minute affairs consisting of espresso, some kind of sweet bread (meaning “chocolate croissant,” not “turkey pancreas”), and the worst fruit juice you’ve ever had in your life. I don’t understand how the same country that created Valpolicella wine could not master a halfway decent OJ. Get on it, Berlusconi!

5) Lunches are 30-to-60-minute affairs consisting of a sandwich, pizza, or some combination of meat, cheese, and bread. Not a bad way to live.

6) Dinners are two-hour affairs consisting of several courses: antipasti (usually cured meat and cheese), primi (some kind of amazing pasta), secondi (some kind of amazing meat), verdure (side veggies), dolci (dessert), and espresso and/or an aperitif to top it all off. At home, we’re pretty good at taking our time during meals. Even so, it took a few days to get used to the long, leisurely Italian suppers.

7) Speaking of those aperitifs, meals are generally ended by one of two beverages: limoncello (pictured) or grappa. We did not partake of the former, but did attempt the latter, which contained enough pure alcohol to strip a car.

8) More on the alcohol: While Italians offer a plethora of excellent regional wines, ordering a beer means you’re getting Peroni, or the occasional Moretti. While both are pretty good, we were craving good ol’ stouts and hefeweizens by Week 3. (In related news, we should be punched.)

9) This is Florence’s Central Market, a.k.a. Kris’ Personal EuroDisney. Picture this stall, multiply it by 100, and fill each with a different kind of food – cheese, tripe, fruit, vegetables, spices, chickens, rabbits, pig skulls, etc. I would have happily stayed there instead of our B&B, even though the owners offered free Nutella.

What heaven looks like in my head

10) Did you know walnuts are found in the middle of squishy tree fruits? Me neither! We discovered this when we locked ourselves out of our mountaintop B&B for 8-1/2 hours and were forced to forage for dinner.

11) During those same 8-1/2 hours, this magnificent chicken took a very real liking to me.

Mah Italian boyfriend

12) His girlfriends retaliated by pecking at our rental car.

Not pictured: a Mercedes Benz with hen dents

13) Italians do not use ice in their drinks. Ever. Hmph.

14) The greatest French fries/roasted potatoes in the world are located at a family-run Osteria in a miniscule town called Villa D’Aiano. It takes about 40 hours to reach, and no one speaks much English, but they must make their tubers with magic and unicorns. It’s the only way to explain them.

15) It is not a myth: Italian people are very fashionable, super tan, and extremely hot. Seriously, it’s like a whole country filled with Monica Belluccis. I have no idea how they are able to shove themselves into Armani pants when so much fresh pasta is available.

That’s all I can think of right now. Expect to see a few Italy-inspired recipes in the coming weeks, though. I promise, if I can find that Marscapone and Macaroni dish, it’ll go up a.s.a.p.

In the meantime, thanks for tolerating this, sweet readers! And if you have any memories of wonderful vacation food, please add ‘em in the comment section. It’s good to be back!

In George Romeros campy movie Land of the Dead, the zombies undergo a very worrisome change. While they used to just pathetically stumble around looking for brains to eat, they organize and make menacing plans. The living survivors, holed up inside the fence at the former city of Pittsburgh, have a fight on their hands.

Maybe its the Halloween season, but the recent slew of late night walking dead horror has inspired the Disease Management Care Blog.  Its entered sweeps for a cameo appearance in AMCs cool zombie series.  Its assessed the relative merits of the undead staggering vs. running, being loners vs. in packs and being wrathful vs. both hungry and wrathful.  The DMCB has also discovered one key commonality of this fearsome species: while maximum head trauma undoes the undead, more of them just keep coming and coming. That DMCB thinks that, despite the spouses advice to the contrary, is an important lesson.

The political dimensions of the Affordable Care Act are becoming more zombie-like with each passing week.  According to the Kaiser Health Foundation, public support for health orm has not only remained stubbornly underwhelming, it has just taken a recent downturn.  While its too early to tell if this is bad news or statistical variation, theres no denying President and his allies are being forced to fight one-on-one with undead employer pessimism, oppositional Republicans and the CLASS Acts failures, while more ever more issues slowly stumble closer.  And who can blame the living Dems for their post-apocalyptic anxiety? It was only yesterday that the ACA was a signature achievement and the world was a wonderful place of Congressional majorities, fawning media support and supreme self-confidence.

While supporters of health orm may take comfort in the notion that the zombies have been unorganized and are attacking the margins, the DMCB worries that the Kaiser poll slide may portend a worrisome Romero-esque development: unable to grasp the details if the Affordable Care Act, Americans support for it was always based less on the underlying policy and more on the President himself.  A slip in support, theore, has less to do with the laws merits and more with a shift in what people fundamentally think about Mr. Obama.

With just over a year until the elections, thats a scary thought for this Halloween. It seems the folks inside the White House fence have a fight on their hands.

What happens when you mix health care entrepreneurship with the increasing role of remote connectivity? Thats what the Disease Management Care Blog thought when it talked to former disease management maven Chris Selecky about a new business venture called "Health Tech Hatch" (HTH).

HTH hasn’t gotten off the ground yet.  When it does later this summer, it’ll offer aspiring health tech entrepreneurs the real-world discipline and business savvy of industry veterans. The good news is that start-up costs for promising apps, devices or other cool technology innovations are lower than ever before, component "platforms" are readily available and venture capital interest in eHealth is growing exponentially. HTH pairs those ingredients with networking, intellectual capital, crowdsourcing, business planning, pilot programs and strategic advice that can make the difference between a shot at funding versus withering on the vine.

How can HTH make money?  Chris imagines via her company participating in any outside funding, sharing in the revenue from any future premium services, sponsorships, future consulting engagements and getting an equity stake. Yes, HTH has competition, but its niche is focused in health care, technology and the business of patient-consumer engagement.

This is further evidence, says the DMCB, of the rapid evolution of health care.  Just when we think we have population health management, the medical home, telehealth, the electronic health record, accountable care and health system "alignment" figured out, companies like HTH keep threatening to blow holes in our best laid plans using stuff like handheld devices and even greater levels of self care.

Revolutionary or evolutionary, the concept is intriguing.  Stay tuned!

In his PDF book, "Eat Stop Eat" Brad Pilon makes the following statement:

"While you may find this guideline overly simplistic at first, the truth is there is NO normal or perfect way to eat for weight loss. This is the great fallacy behind most diet books. The fact is, and always will be, it is calorie restriction that causes weight loss."

I am amazed that this statement is so amazing to me. I hope you are getting the double whammy that is in that statement. It does not say you have to count calories, he says you have to restrict them... in other words: eat less. I know. I know. Whats so unusual about that? Everybody knows that! If you want to lose weight you have to eat less. Point made. Point taken. Lose the food, lose the weight.

I have spent so much time trying to figure out what to eat to lose weight that this simple truth somehow whizzed right over my head. Brads statement brought it down in front of my eyes. I dont like to think of myself as "simple minded" but, darn, maybe I am. I worked hard to find a style of eating that would help me lose weight and what I really needed was a style of not eating. Oh my.

The "double" part is that eating "low carb" or "low fat" or "high protein" is not the point. The point is less food. What my mother used to say. All this time, Ive been avoiding it, but it turns out she was right. It is the one thing that works. Just eat smaller portions. It is not even important how much smaller, just smaller than what youve been eating. You dont need "guidelines" from someone else. Just make your portions smaller than what you usually eat. Start where you are and trim a little off the contents of the plate. Drink plenty of water, too.

Surprise. You dont need to fill up all the spaces in your stomach. Once it becomes a habit, it will not seem unusual or strange to you.

I think the thing I feared was not having food to eat. Or eating less. Or being deprived. Somehow. I know... I feared "hunger." Is that possible? Yes, I think it is. I feared being hungry. I dont know why... and Im not even interested in finding out why. Im just glad that Ive already discovered that "hunger" is nothing to fear!! That is the major lesson I learned from fasting. It is not the overpowering, all consuming, scary thing that I seemed to think it was. Hunger. Wow.  Starvation? Yes, that should be feared and worked against. But, simple ordinary every day hunger? What is there to fear in that. It is almost silly. Funny.

I worked so hard to avoid the fact of simply eating less that I went round in circles over and over again. I did not think I could control the quantity of food that I eat in a session, so avoided attempting something at which I believed I would fail. I believed I could not simply eat smaller portions and be satisfied. I was used to dealing with the eating machine which is the antithesis of portion control. The eating machine is portion out of control.

But Ive been fasting for 24 hour periods for a while now so I know I can do it and love it. Not that every time I try it, it is successful. Just today I was going to do a spur of the moment fast, but I petered out later and ate. But ESE is flexible and I know I can do it tomorrow and if I prepare for it, I will do it.

Fasting has shown me there is a different way to approach food and eating. You do know those are two different things. Food. And eating. Food is simply a substance. Eating is an act that is performed. If you want to lose weight, you have to eat less.



The other day I had gotten out one of my mothers old dessert dishes (picture above). I dont remember what for. But as I walked across the floor I stopped and looked at the size of this tiny dish that had the name "dessert dish." It fit in the palm of my hand. I thought about the gargantuan bowls of ice cream I used to eat when I was a kid. I remember my Dad teasing that I would "make a good step mother" because I served everyone large portions. They never used them. And here in my hand was this tiny little cut glass dessert dish. If every dessert I had would fit in that small dish, I would probably be thin.

It is almost as if the size of the bowl creates the size of the person.

I was recently watching episodes of the BBC program call "Supersize vs. Super Skinny" where one humongous person and one tiny person swapped meals for a certain amount of time in what they call their feeding clinic. They have to sit across the table from one another, after preparing a meal from a day in their own food diary, and then when they sit down to eat, they trade meals. The big person eats the small persons meal and the small person eats the big persons meal for a few days in a row. 

They are both flabbergasted at what the other one eats and they have conversations about this experiment as they do it. Often the big person quickly eats the little persons meal and then sits and watches the tiny person struggle to eat their gigantic portions of food which they almost never finish. Each one feels responsible for the other ones discomfort. When they see how the other person has to struggle to do what they do on a regular basis, they begin to realize what they have been doing to themselves. The big person realizes just how unrealistically large their portions are. The thin person realizes that the tiny meals they eat are not enough for an adult to live on.

The supersize person gets a trip to America that the skinny person does not get. They go to visit a person who can be as much as a couple hundred pounds larger than they are for the purpose of seeing, for themselves, what the effects of continuing to pack on the pounds does to a human body. The people they visit often have many ailments and they often are not doing anything to curb their appetites and lose weight, although not all of them are like that. They suffer from immobility, pain, seeping legs, high blood pressure, diabetes, sleep apnea and all kinds of weight related problems. They often need help, just to go to the bathroom. This is the "wake up" call for the English participant. They get to be up close and personal with what it really means to continue doing what they are doing. It works. They get it.
 
From having watched many episodes this feeding clinic exercise seems to help the overly slim or super skinny person get in touch with their hunger, which for whatever reason, got turned off sometime in the past. When they return to the show about 8 weeks later they look more normal sized and not so skinny, even though they worked hard, ate lots, and put on about 3 pounds they look like theyve put on 15 or 20. The fat person also looks different. They often lose quite a bit of weight and feel very good about themselves and they look good too.  But... a year later the formerly super skinny person now looks like a normal human being, the fat person looks like a smaller fat person. Sometimes the "one year later" show has three of the participants back and very often it is two of the ormed super skinnies, and one of the somewhat smaller fat people. Makes me wonder if the fatties got lost somewhere, or put their weight back on again, so they are not on the show. They never say anything like that. You just never see them again.

All of these prove that we have perceptions about food and eating that show up as body size. Sometimes they are easy to change and sometimes they are not. I find that the twice weekly fasting has taught me some things about me that I did not know before. For one thing, I can now skip a meal and not have a cow. In fact, it really is rather simple and very easy to skip a meal, or two, or three in a row, and not die. It does not make me sick. I dont get light headed. I dont feel faint. I dont get tired. In fact, just the opposite happens. I feel lighter on my feet, awake and alert and, dare I say it: happy. I still know where my next meal is coming from. Im not starving. I dont go into starvation mode and my metabolism is not harmed in any way. Studies on fasting prove this is true. (You can read about it in ESE.)

You wont go into starvation mode until about 72 hours of not eating. The body also knows how to maintain your metabolism. If it is not getting food to run on, it uses the storage of fat. A fat belly really is like a pantry for the body to feed itself, but if you keep eating continually, it never gets the opportunity to use up the one year supply of food on your back. This makes it very hard to lose weight and very easy to pack on more pounds. It is not the style of eating that needs to be changed. It is the style of not eating!!

Short, 24-hour fasts for one, two, or even three days in a week gives your body the chance to go into fat burning mode. In between you can eat what you normally eat but in a responsible manner. Brad suggests that you eat more fruit and vegetables, which will replace a lot of processed foods. If you are conscious enough to be eating more fruit and veggies you probably are already not eating as much sugar and starchy foods. Brad says that the key to making this work for you is "self control." You cannot eat like a sumo wrestler and expect to look like a super model. On the days you eat, eat sensibly. Eat enough. And then move on.

So the new thing for me in this is the dessert dish. Now I know what size a dessert should be for a normal sized human being. With the combination of 24 hour fasts, and in between, sensible eating, I should be able to speed up the weight loss thingy. 

Wonder what people will think when I bring my dessert dish with me as a reminder for myself that I can have dessert as long as it fits in my dessert dish? I picture holding it up and saying (more to myself than to anyone else), "As long as it fits in here, I can eat it. If it does not fit in here, then I dont eat it."

I guess Ill find out.

Be back soon,

Marcia



 

Alcohol is thought to be responsible for 34,000 deaths in the UK each year because of the damage it does to the body, plus many more deaths due to the indirect effect of alcohol on others.

Alcohol is a sedative hypnotic drug that depresses the central nervous system, making you feel more relaxed.
Most adults in the UK drink alcohol moderately and on a social basis and derive a lot of pleasure from doing so.
However, about one in five men and one in seven women regularly drink more than the Department of Health suggests is strictly safe for good health. This is up to two to three units of alcohol a day for women and up to three to four units of alcohol a day for men, to a maximum of 14 units a week for women and 21 units a week for men. A unit of alcohol is equivalent to half a pint of ordinary strength beer, a small glass of wine or a single pub measure of spirits.

Short-term effects of alcohol

The short-term effects of alcohol are dependent on the amount consumed and can vary enormously from person to person and from one situation to another.
The main effect is on the brain, which can result in:

• Slurred speech
• Loss of coordination
• Unsteadiness when standing or walking
• Impaired attention and judgement
• Loss of inhibition
• Sleep

Relatively low doses of alcohol relax the user, make them more talkative and animated. Larger doses lead to uncoordinated movement, impaired decision-making and sedation.
The depressive effects of alcohol on normal brain function - especially those causing impaired judgement - are the main reasons its always best to avoid alcohol when driving and never to exceed the limit.

Long-term effects of alcohol

The cumulative effects of excessive alcohol consumption, especially when associated with a poor diet, affect every part of the body. The two main sites of damage are the liver and the nervous system.
The liver may become progressively damaged through a condition known as cirrhosis, which may lead to liver failure, liver cancer and death.
The nervous system may be damaged at many levels. Damage to the brain can interfere with intellectual function, and increase the risk of anxiety and depression, confusion and dementia.
Damage to the peripheral nervous system can lead to loss of balance, impotence, numbness of the feet and hands, tremor and blindness.
Alcoholism is also implicated in diabetes, inflammation of the pancreas, internal bleeding, weakening of the heart, high blood pressure and stroke. Alcohol intake during pregnancy is harmful to an unborn baby.

Symptoms of alcohol addiction

When someone becomes dependent or addicted to alcohol, they:

• Develop a strong sense of compulsion to drink
• May drink shortly after waking to reduce feelings of alcohol withdrawal
• Develop a reduced capacity to control how often and how much they use
• Organise their lifestyle around drinking

Books about alcohol and addiction

Alcoholics Anonymous - Big Book (AA Services, 2002) - a seminal book, originally published in the 1930s, for people who suffer from alcohol addiction and who want to stop drinking.
Lets Drink to Your Health! (Nick Heather and Ian Robertson, 1996) - useful advice to enable people to change their drinking patterns; a drinking diary and tips for drinking less are included.
Alcoholism: The Facts (Donald W Goodwin, 2000) - a classic text on alcoholism. Written in a clear and lively style, the book is aimed at those who have alcohol problems and the people who share their lives.
Dying for a Drink: What You and Your Family Should Know About Alcoholism (Anderson Spickard and Barbara R. Thompson, 2005) - a self-help book for people who have alcohol problems and their families.
The Easyway to Control Alcohol (Allen Carr, 2009) - a self-help guide by best-selling author on addictions and how to overcome them.
Drinking: A Love Story (Caroline Knapp, 1997) - Knapp offers insights not only about alcoholism, but about life itself and how we learn to cope with it.