Baked Creamy Pasta

Pasta, the word itself attracts the kids. I can feed my kids everyday with them,they never get bored of it. When i chosed the kids delight-lunch box as theme for this weeks blogging marathon, i know one of my recipe will definitely go for pastas as i cook them atleast twice a week for my kids. I have hardly seen kids saying no to pastas,obviously pasta can be served with anything and am sure kids will love to see pastas in their plate for lunch.

Coming this baked creamy pasta, i used mascarpone cheese and low fat grated cheese for making it, this dish gets ready very quickly and gets vanished very quickly too. You can add any veggies of your choice to make it more healthier. Kids need calcium rich foods for their growth, adding cream and cheese makes this dish a calcium rich food also at the time you can feed easily even a fussy eater as this dish have pastas in it. My kids enjoyed thoroughly this baked creamy pasta for their lunch with grilled chicken and they just loved it.Check out the blogger running this 24th edition of blogging marathon here.

1packet Pasta (any variety,cooked as per instructions)

1tbsp Maida

1no Onion (chopped)

2cups Milk

3tbsp Mascarpone cheese

1/2tsp Pepper powder

3tbsp Bread crumbs

1/2cup Grated cheese

1/2tsp Thymn leaves

Salt

Olive oil

Heat the olive oil in a pan, add the chopped onions,thymn leaves and cook until the onions turns transculent.

Add immediately the maida,salt,pepper powder and roast it, now add the milk to it and cook until it gets thickens.

Finally add the mascarpone cheese,give a stir and put off the stove.

Add now the cooked pastas to the cheese mixture and toss everything well.

Preheat the oven to 350F.

Take a swallow baking pan,spread a layer of the pasta, top it with the grated cheese.

Again top the cheese with a layer of pasta and then with the cheese.

Now sprinkle generously the bread crumbs over it and bake for 15-20minutes.

Serve warm with your favourite meats or veggies.

Care Coordinators The Commonwealth Fund Shows Why ACOs Should Fund Them

In yesterdays post on the re-emergence of the "medical director" as a force to be reckoned with, the Disease Management Care Blog also mentioned care coordinators.   Theres a reason why they were prominent feature in The New York Times recent ACO article on Advocates success.

The DMCB defines care coordinators as credentialed non-physician medical professionals - usually but not always nurses - who have three responsibilities:

1) maximizing the "health insurance benefit"  - whats often lost is the reality that insurance coverage varies and is imperfect.  It takes time and effort to match a patients clinical needs with payments, networks and limits.  That includes fee-for-service Medicare.

2) enabling the patient to address "care gaps"  - and most DMCB readers understand that that is accomplished by enabling patient participation in and control of their care.

3) maximizing community resources  - there are a host of public and private services "out there," and its a full time job to help patients access them.

While well-meaning traditionalists will argue that letting nurses into the doctor-patient relationship is a risky proposition, check out this short article that just appeared in the Archives of Internal Medicine.  Michel Doty and colleagues tapped the Commonwealth Funds 2010 International Health Policy Survey of over 19,000 adults from 11 countries.  In it, they asked respondents about the involvement of a "care coordinator" and correlated it with self-reports on the use of health care services. 

While the odds ratios vary, having a care coordinator emerged as a strongly independent and statistically significant predictor of better appointment scheduling, access to test results, specialty care and follow-up after discharge.  Patients with access to that kind of care had odds ratios in the 0.50 range, meaning that they were about half as likely to report problems.

While the Archives article is based on self-reports, is retrospective, doesnt precisely define "care coordination" and there may have issues with how that gets translated across cultures and languages, the information is telling: having a trusted third party in the mix of care services can have a powerful impact on health care utilization that leads to decreased cost and higher quality.

Last but not least, while the authors point out that "care coordination" is a bedrock principle of the Patient Centered Medical Home (PCMH), they neglected to point out that this is also basis for population health management. 

Take it from the DMCB: medical directors have little reason to care if the care coordinator is on the PCMH payroll or offered by a third party population health management vendor, just so long he or she gets the job done, maximizes the benefit, engages the patient in self care and makes sure community resources are accessed. 

Another Reason Why There Was A Decline In U S Hospitalizations for Heart Failure

By now, many Disease Management Care Blog readers have become aware of this JAMA research study that used Medicare fee-for-service claims data to examine the nationwide rate of hospitalizations for chronic heart failure.  From 1998 to 2008, there was a counterintuitive 30% decline in the U.S. from a baseline rate of 2845 to a new rate of 2007 admissions per 100,000 person-years. 

The authors credit better care of heart attacks (damage from a heart attack to can lead to a flabby dilated heart), better prevention (such as more aggressive treatment of high blood pressure, which also causes heart damage) and a more "effective" medical system (such as better outpatient follow-up, use of alternate levels of care, flu shots prescriptions of ACE inhibitors and beta blocker medications).  The authors of the study think the numbers are remarkable because the U.S. population is getting older and healthier persons (without heart failure) seem to be signing up for managed care Medicare Advantage.

The DMCB is wondering about another possibility that has nothing to do with epidemiology or quality.  Rather, it could be the impact of Medicare payment rates on billing patterns.  After all, if heart failure is the leading Medicare inpatient diagnosis, shouldnt a decrease there have an impact on the overall hospitalization rate?

The DMCB explains:

When beneficiaries are discharged from a hospital, the bill (or the claim) submitted to Medicare is based on a "Diagnosis Related Group."  While the invention and logic of DRGs complicated, theyre important because the principal diagnosis determines the amount of the global payment for that hospitalization. While this may be overly simplistic, a discharge with a diagnosis of "heart failure" prompts Medicare to pay a hospital "X" dollars, while a diagnosis of pneumonia or kidney failure will render payments of "Y" and "Z" dollars, respectively.  In general, the more complicated the diagnosis, the greater the payment.

All well and good, but suppose the hospital has a patient with several concurrent problems and has a choice on which DRG to use?  As anyone who has taken care of hospitalized patients knows, there are usually multiple diagnoses present in any patient at one time.  Pneumonia may or may not have provoked the heart attack that led to the kidney failure that led to the leg swelling and the shortness of breath.  Given three simultaneous diagnoses, Medicare billing guidelines state that the hospital should use their best judgement to determine which DRG to bill. All things being equal, smart hospitals will probably use the DRG that renders the greatest payment.

The DMCB isnt saying that fraudulent billing (for example) accounts for the decrease in heart failure hospitalizations for Medicare. However, it knows some diagnosis related groups can be less remunerative than others and that in the last ten years, DRG payment rates have evolved and that hospitals have learned how to "code" more accurately and aggressively.  Based on the example at the bottom of this page, the DMCB wonders if some patients that were diagnosed with heart failure in 1988 would have been diagnosed with something more remunerative in 2007. 

In other words, there may have been the same number of hospitalizations involving the same patients with the same disease burden.  It was the case mix that changed?

The authors of the study to their credit cant discount the possibility:  They argue that if coding had changed there would have been a shift in the mortality rate of patients with heart failure:

"We were unable to determine whether the observed changes were due to changes by hospitals in medical coding; however, substantial up-coding or down-coding would likely result in changes to the coefficients of the CMS HF mortality model, and these coefficients remained stable from 2005 to 2008."

The authors may have a point, but that assumes the modeling - also based on claims - is trustworthy.

Of course, there is no way, based on Medicare billing claims alone, to determine whether measurement also played a role in the decline in heart failure admissions.  That would take an audit of the medical records themselves.

What Men Want Women to Know

Men Will Talk About Feelings

Was your guy raised as a traditional, stoic, mans man? If so, let me walk you through 18 relationship secrets, gathered from psychologists who study gender roles. Secret No. 1: It may be easier for your man to talk about feelings indirectly. Ask what hed do during a romantic weekend. Or what he thought the first time he met you. His answers will reveal how he feels and bring you closer.

Men Say "I Love You" With Actions

Some men per to express their feelings through actions rather than words. Your guy may say "I love you" by fixing things around the house, tidying up the yard, or even taking out the trash -- anything that makes your world a better place.

Men Take Commitment Seriously

Men have a reputation for being afraid to commit. But the evidence suggests men take marriage seriously. They may take longer to commit because they want to make sure they are onboard for good. In a survey of currently married men, 90% say they would marry the same woman again.

He Really Is Listening

When youre listening to someone talk, you probably pipe in with a "yes" or "I see" every now and then. Its your way of saying, "Im listening." But some guys dont do this. Just because a man isnt saying anything doesnt mean hes not listening. He may per to listen quietly and think about what youre saying.

Shared Activities Form Bonds

Men strengthen their relationships primarily through shared activities more than by sharing thoughts or feelings. For many men, activities like sports and sex make them feel closer to their partner.

Men Need Time for Themselves

While shared activities are important, men also need time for themselves. Whether your guy enjoys golf, gardening, or working out at the gym, encourage him to pursue his hobbies, while you make time for your own. When both partners have space to nurture their individuality, they have more to give to each other.

Men Learn From Their Fathers

If you want to know how a man will act in a relationship, get to know his dad. Some say men learn about their relationship role by watching and listening to their fathers. How they are with each other and how the father relates to the mother can predict how a man will relate to his wife.

Men Let Go Faster Than Women

Women tend to remember negative experiences longer and may have lingering feelings of stress, anxiety, or sadness. In contrast, men are less likely to dwell on unpleasant events and tend to move on more quickly. So while you may still want to talk about last nights argument, your guy may have already forgotten about it.

Men Dont Pick Up on Subtle Cues

Men are more likely to miss subtle signals like tone of voice or facial expressions. And they are especially likely to miss sadness on a womans face. If you want to make sure your guy gets the message, be direct.

Men Think About Sex ... A Lot

OK, so maybe this one is no secret. The majority of men under age 60 think about sex at least once a day, compared with only a quarter of women. And thats not all. Men fantasize about sex nearly twice as often as women do, and their fantasies are much more varied. They also think more about casual sex than women do. But thinking is not the same as doing.

Men Find Sex Significant

Its a myth that most men think sex is just sex. For many, sex is a very important act between two committed people. And just like most women, men find sexual intimacy to be most satisfying in the context of a committed relationship. One reason is that long-term partners know how to please one another better than strangers do.

He Likes It When You Initiate Sex

Most guys feel as though theyre the ones who always initiate sex. But they also like to be pursued and wish their partner would take the lead more often. Dont be shy about letting your guy know youre in the mood. Initiating sex some of the time may lead to a higher level of satisfaction for both of you.

Guys Arent Always Up for Sex

Men, much to many womens surprise, arent always in the mood for sex. Just like women, men are often stressed by the demands of work, family, and paying the bills. And stress is a big libido crusher. When a guy says, "not tonight," it doesnt mean hes lost interest in you. He just means he doesnt want to have sex right then.

Men Like Pleasing Their Partner

Your pleasure is important to your man. But he wont know what you want unless you tell him. Too many women feel uncomfortable talking about what they like and dont like. If you can tell him clearly in a way that doesnt bruise his ego, hell listen. Because he knows hell feel good if you feel good.

Guys Get Performance Anxiety

Most men get performance anxiety on occasion, especially as they age. Your guy may worry about his physique, technique, and stamina. If you can help him learn to relax and stay focused on the pleasures of the moment, sex will become less stressful.

Men May Stray When Needs Arent Met

If a man doesnt feel loved and appreciated in his relationship, he may turn elsewhere for satisfaction. For one man, that may mean burying himself in work. Another may develop a fixation on sports or video games. And some men cheat. To avoid this, partners need to work together to meet each others needs.

Hes Vested in You

Most men realize theres a lot to lose if a long-term relationship goes sour – not just each others company, but the entire life youve built together. If youre willing to work to strengthen your marriage, chances are your man will be, too.

10 Surprising Health Benefits of Love

Lower Blood Pressure, Fewer Colds, Better Stress Management Are Just the Beginning

“I need somebody to love,” sang the Beatles, and they got it right. Love and health are intertwined in surprising ways. Humans are wired for connection, and when we cultivate good relationships, the rewards are immense. But we’re not necessarily talking about spine-tingling romance.


“There’s no evidence that the intense, passionate stage of a new romance is beneficial to health,” says Harry Reis, PhD, co-editor of the Encyclopedia of Human Relationships. "People who fall in love say it feels wonderful and agonizing at the same time.” All those ups and downs can be a source of stress.




It takes a calmer, more stable form of love to yield clear health benefits. “There is very nice evidence that people who participate in satisfying, long-term relationships fare better on a whole variety of health measures,”
Most of the research in this area centers on marriage, but Reis believes many of the perks extend to other close relationships -- for example, with a partner, parent, or friend. The key is to “feel connected to other people, feel respected and valued by other people, and feel a sense of belonging,” he says. Here are 10 research-backed ways that love and health are linked:

1. Fewer Doctor’s Visits

The Health and Human Services Department reviewed a bounty of studies on marriage and health. One of the report’s most striking findings is that married people have fewer doctor’s visits and shorter average hospital stays.
“Nobody quite knows why loving relationships are good for health,” Reis says. “The best logic for this is that human beings have been crafted by evolution to live in closely knit social groups. When that is not happening, the biological systems ... get overwhelmed.”
Another theory is that people in good relationships take better care of themselves. A spouse may keep you honest in your oral hygiene. A best friend could motivate you to eat more whole grains. Over time, these good habits translate to fewer illnesses.

2. Less Depression & Substance Abuse

According to the Health and Human Services report, getting married and staying married reduces depression in both men and women. This finding is not surprising, Reis says, because social isolation is clearly linked to higher rates of depression. What’s interesting is that marriage also contributes to a decline in heavy drinking and drug abuse, especially among young adults.

3. Lower Blood Pressure

A happy marriage is good for your blood pressure. That’s the conclusion of a study in the Annals of Behavioral Medicine. Researchers found happily married people had the best blood pressure, followed by singles. Unhappily married participants fared the worst.
Reis says this study illustrates a vital aspect of the way marriage affects health. “It’s marital quality and not the fact of marriage that makes a difference,”. This supports the idea that other positive relationships can have similar benefits. In fact, singles with a strong social network also did well in the blood pressure study, though not as well as happily married people.

4. Less Anxiety

When it comes to anxiety, a loving, stable relationship is superior to new romance. Researchers at the State University of New York at Stony Brook used functional MRI (fMRI) scans to look at the brains of people in love. They compared passionate new couples with strongly connected long-term couples. Both groups showed activation in a part of the brain associated with intense love.
“It’s the dopamine-reward area, the same area that responds to cocaine or winning a lot of money,” says Arthur Aron, PhD, one of the study’s authors. But there were striking differences between the two groups in other parts of the brain. In long-term relationships, “you also have activation in the areas associated with bonding ... and less activation in the area that produces anxiety.” The study was presented at the 2008 conference of the Society for Neuroscience.

5. Natural Pain Control

The fMRI study reveals another big perk for long-term couples -- more activation in the part of the brain that keeps pain under control. A CDC report complements this finding. In a study of more than 127,000 adults, married people were less likely to complain of headaches and back pain.
A small study published in Psychological Science adds to the intrigue. Researchers subjected 16 married women to the threat of an electric shock. When the women were holding their husband’s hand, they showed less response in the brain areas associated with stress. The happier the marriage, the greater the effect.

6. Better Stress Management

If love helps people cope with pain, what about other types of stress? Aron says there is evidence of a link between social support and stress management. “If you’re facing a stressor and you’ve got the support of someone who loves you, you can cope better,” If you lose your job, for example, it helps emotionally and financially if a partner is there to support you.

7. Fewer Colds

We’ve seen that loving relationships can reduce stress, anxiety, and depression -- a fact that may give the immune system a boost. Researchers at Carnegie Mellon University found that people who exhibit positive emotions are less likely to get sick after exposure to cold or flu viruses. The study, published in Psychosomatic Medicine, compared people who were happy and calm with those who appeared anxious, hostile, or depressed.

8. Faster Healing

The power of a positive relationship may make flesh wounds heal faster. Researchers at Ohio State University Medical Center gave married couples blister wounds. The wounds healed nearly twice as fast in spouses who interacted warmly compared with those who demonstrated a lot of hostility toward each other. The study was published in the Archives of General Psychiatry.

9. Longer Life

A growing body of research indicates that married people live longer. One of the largest studies examines the effect of marriage on mortality during an eight-year period in the 1990s. Using data from the National Health Interview Survey, researchers found that people who had never been married were 58% more likely to die than married people.
But Reis sees an emotional explanation. Marriage protects against death by warding off feelings of isolation. “Loneliness is associated with all-cause mortality -- dying for any reason,” he says. In other words, married people live longer because they feel loved and connected.

10. Happier Life

It may seem obvious that one of love’s greatest benefits is joy. But research is just beginning to reveal how strong this link can be. A study in the Journal of Family Psychology shows happiness depends more on the quality of family relationships than on the level of income. And so we have scientific evidence that, at least in some ways, the power of love trumps the power of money.

Nurture Your Relationships

To foster a loving relationship that yields concrete benefits, Aron offers four tips:

• If you are depressed or anxious, get treatment.


• Brush up on communication skills and learn to handle conflict.


• Do things that are challenging and exciting with your loved one on a regular basis.


• Celebrate each others successes.

Top 10 Links of the Week 12 11 09 – 12 17 09

Hey folks! I’m fully recovered from the Food Network marathon, so let’s get to the links. This week, it’s a ton of Christmas, the fall of Big Food (maybe), and BANANARCHY!

1) Planet Green: 25 Take-Out Treats You Really Can Make at Home
Would you like to bank money, eat delicious ethnic food, and save the environment at the same time? Make any one of these takeout recipes at home. It’s better for everybody, except maybe the delivery guy.

2) Gizmodo: Using Micro S’mores is Akin to Playing God
This is really real. And "gooeylicious." And for people without hands or muscles, presumably.

3) Washington Post: Sometimes a snack isnt just a snack. Its a slippery slope.
“A two-year study found that kids eat less junk food when their schools dont provide them with junk food.” Yeah, I know: “duh,” but it’s Ezra Klein’s ensuing argument that makes this piece a great read. How far should the government and our own employers go when it comes to keeping us healthy?

4) Consumerist: Study Shows High Fructose Corn Syrup May Cause Obesity, Diabetes, Heart Disease
Yeah, I know: “double duh.” But it’s nice to have science backing it up. SCIENCE!

5) Neatorama: Rich in Dextrose
Old print ads are just about my favorite things in the world. This one, a World War II-era page for Baby Ruth, claims the candy bars are “rich in dextrose and other wholesome ingredients.” Hee! I can’t wait until 50 years from now, when we’re giggling similarly about lycopene and xylitol.

6) New York Times: To Feed the Hungry, Keep the Can, Open a Wallet
You know that three-year-old can of artichokes sitting in the darkest, dustiest corner of your pantry? Don’t donate it to a food bank. Instead, a lovely cash gift would be much appreciated.

7) Boing Boing/AP: Monsanto seed biz role revealed
Monsanto’s in trouuuuuuuble. Make it douuuuuuuuuble.

8) Casual Kitchen: Why “Big Food” Isn’t Quite as Evil as You Think it is
If this doesn’t get you in, nothing will: “Its us. We are behind the curtain … Fattening and unhealthy foods are on our store shelves because we put them there.”

9) Chicago Sun-Times: Govt auditors say food-tracing program flawed
Hey! Have you ever wondered what the government does when there’s a outbreak of food-related illness? Me too. So this is reassuring: “A crucial part of the nations rapid-response plan … is seriously flawed, an independent watchdog agency has found … Nearly half the food manufacturers they surveyed that are supposed to register with the Food and Drug Administration failed to give the agency accurate contact information.” They don’t even have the RIGHT PHONE NUMBERS. My god. I hope the next link is cheerier, because otherwise I’m moving to Canada.

10) Urlesque: Bananarchy Gives D.C. Extra A-‘Peel’
In which two dozen people dressed as bananas bring joy and peace to all the land. Set to “Peanut Butter Jelly Time,” of course. Forget that FDA thing. America wins!

HONORABLE MENTION

Chow: Dinner Party for Beginners
I’m loving this simple tutorial series from Chow.

Culinate: Mixed-diet dinners - A pro offers suggestions for the cook
Supper tips for the veggie/omni family.

Double X: The Rise of the Kitchen Bitch (Ladies, it’s time to reclaim cooking)
I wholly object to Hanna Rosin calling Duff Goldman a “lovable jerk,” but otherwise, this somewhat all-over-the-place, yet still thought-provoking essay is worth a read. Especially if you like being angry before lunch.

Food Network: Sealed & Delivered - Recipes in a Jar
Need some last-minute Christmas gifts for your favorite foodie? These attractive and presumably tasty jarred recipes should fit the bill.

Salon: Cash and gumption - Food nonprofits to support
Excellent rundown of dozens of food philanthropies. Merry Christmas, everybuddy!

And finally, for your holiday pleasure/horror:

Sketchy Santas
Just look. You won’t be sorry.

(Photos from Neatorama [ad] and Sketchy Santas [sketchy Santa].)

Thank you so much for visiting Cheap Healthy Good! (We appreciate it muchly). If you’d like to further support CHG, subscribe to our RSS feed! Or become a Facebook friend! Or check out our Twitter! Or buy something inexpensive, yet fulfilling via that Amazon store (on the left)! Bookmarking sites and links are nice, too. Viva la France!

5 Ways to prevent mother to child obesity

5 Ways to prevent mother to child obesity - Since childhood, the childs diet should be monitored in order to maintain health and well-balanced weight. Mothers can prevent obesity in children, as reported by The Telegraph the following.

Do not make separate meals

Just because kids like picky eaters, do not create a separate menu for them. Instead, learn to make kids love all kinds of healthy foods that you cook yourself.

Always have vegetables and fruits

Best diet should contain healthy vegetables. Meanwhile, the fruit must also be at home as a snack for children and other family members. Avoid chips and other unhealthy foods as a snack.

Buying seasonal produce

In addition to less expensive, seasonal products obviously much fresher. You can also maximize the processing methods of healthy foods in various forms.

Cook fast and healthy

In addition to healthy food can also be cooked quickly. For example, make a salad or a healthy sandwich. If children are taught from childhood to love healthy food, until today they would still get used to eating them.

Involve children while cooking

You can also invite children to shop, cook, and involve them in all things while preparing food. That way, they will learn to recognize a variety of vegetables and want to eat them on a regular basis.

So many ways to prevent maternal obesity in children. The point is, get used to eating healthy foods so that the childs weight is always awake.

Honey Cinnamon Challah Bread Toast

I love to make bread toast with leftover stale breads usually or else ill turn them as breadcrumbs instead of trashing. Everytime while making the famous Jewish challah bread, i always want to make some bread toast with the leftover slices. Finally i have to say that my wish came true, yep i prepared this beautiful honey cinnamon bread toast for our breakfast during a weekend brunch with a loaf of leftover challah bread. If you dont have any idea about the Challah Bread, do check my 6 strand braided bread and my 4 strand braided Challah bread.

Every 3rd of the month,a bunch of food bloggers run the famous blogging marathon and today we are running our 25th edition, cant believe its our 25th edition and am very happy to be a part of this wonderful family, i just missed an edition coz of my operation last year else i have never failed any edition. Do you know few of the marathoners have organised something interesting secretly to celebrate this 25th edition and hope they will reveal it very soon. Coming to this weeks theme, i choosed breakfast on the run as this weeks theme.The remaining recipes am posting for the next two days will go for less than 30minutes of cooking time as the theme is to wrap the breakfast and go.Check out the Blogging Marathon page for the other Blogging Marathoners doing BM#25.

6nos Challah bread slices (slice them as bit thick)

2cups Milk

3nos Eggs

1tsp Cinnamon powder

Honey /Agave syrup (as per need)

Butter or oil for toasting

Beat the eggs with cinnamon powder, honey and keep aside.

Dip a bread slice in the milk and dip immediately to the egg mixture until the bread gets well coated with the egg mixture.

Heat enough butter or oil in a pan, drop immediately the egg coated challah bread slice to the hot butter or oil and toast it on both sides until they get well toasted.

Serve it with honey or else with agave syrup.

Exercise Timing Important for Weight Loss

(Article first published as Exercise Tips That Drive Weight Loss and Burn Fat on Technorati.)

The body is an amazingly efficient metabolic machine which stores excess caloric energy for use in times of famine. Unfortunately our genetically programmed survival mechanism leads to failure for the majority of people trying to lose weight. Information published in the American College of Sports Medicine provides encouragement to those who use exercise as a catalyst to drop excess weight.

Professional athletes load up on fast burning carbs before they train, as this provides the necessary energy they need to perform at a competitive level. Research indicates that people who don’t eat before exercising burned significantly more body fat, and for a longer period of time than those who ate prior to exercise. Carbohydrates are the body’s perred source of energy, and when carbs are not readily available, fat is burned instead.

This information is important for individuals interested in sustainable weight loss. Many people believe they need to eat prior to exercise, as this provides fuel for training. In effect they’re simply burning the calories just eaten, and never turn up their fat burning metabolism, unless they exercise intensely or for an extended period. Research sheds an important light on the proper steps to follow to maximize the weight loss effect from each exercise session.

Tip 1: Carb Fast Prior to Exercise to Burn Fat

Fat burning in the body shifts into high gear when energy from a recent meal is limited and you begin to exercise. The body must find an energy source and shifts to your fat reserves. Eating a meal high in carbohydrates will cause your body to focus on burning existing calories, and a full stomach actually encourages fat storage, even during exercise.

Carb fasting before exercise will provide weight loss results for many people, but it’s important to note that is may not be for everyone, especially those individuals with poorly controlled blood sugar or diabetes. If fasting of any type is not an option, eating 3 or 4 smaller meals per day will work better to control blood sugar spikes. Avoid processed carbohydrates or any type of food which breaks down to glucose quickly, including fruits, sweetened beverages and juices.

Tip 2: Use Protein to Increase Metabolism
Protein is your friend when trying to lose weight. Proteins are very difficult for the body to break down, and theore don’t provide an easy source of energy, forcing the body to break into its fat reserves for fuel. Research from the Medicine and Science in Sports & Exercise journal demonstrates that whey protein eaten 30 minutes before exercise boosts the fat burning metabolism for up to 24 hours after the workout ends.

Tip 3: Choose High Intensity Interval Exercise to Drive Weight Loss

Choosing the right type of exercise is essential to maximizing the fat burning potential of a training session. While aerobic exercise is important for its heart healthy benefits, high intensity interval training is optimized for metabolizing fat. Resistance exercises which train the muscles in short bursts at high intensity for 1 to 2 minutes per repetition help to build fat burning muscle. We have evolved with this ‘fight or flight’ type of exercise, and it’s the key to priming our fat burning furnace.

Exercise is the catalyst to successful weight loss, and improving the efficiency of each training session will step our metabolism into overdrive, burning stored fat for energy. While it’s possible to lose weight without exercise, most people understand that a reduced calorie diet and regular exercise are necessary for permanent weight loss. Get the most health and weight loss benefits from exercise by coordinating meal timing and food choices with high energy resistance training.

Consuming Omega 3 Fats from Fish and Supplements Lowers Mortality by One Third

Health researchers have known for some time that eating fish regularly provides health benefits to help protect against cardiovascular disease, stroke and overall mortality. The primary long-chain fats, DHA and EPA have been shown to improve innate immune response by stimulating the effectiveness of B cells to lower systemic inflammation. Until recently, scientists have not been able to determine the impact of omega-3 fats on risk reduction for specific diseases or decline in mortality.

Researchers from the Harvard School of Public Health and the University of Washington, publishing the results of a study in the Annals of Internal Medicine have found that older adults who have higher blood levels of omega-3 fatty acids, commonly found in fatty fish and seafood, may be able to lower their overall mortality risk by as much as 27 percent and their risk of dying from heart disease by about 35 percent. Older individuals with the highest levels of omega-3 fats in their blood lived an average of 2.2 years longer than those with lower levels.

Eating Fatty Fish or Fish Oil Supplements Dramatically Lowers Risk from a Fatal Heart Attack

The study is regarded as the first to assess how serum blood levels of DHA and EPA omega-3 fats relate to total mortality and specific causes of mortality in a general population. Study author, Dr. Dariush Mozaffarian commented “Although eating fish has long been considered part of a healthy diet, few studies have assessed blood omega-3 levels and total deaths in older adults… our findings support the importance of adequate blood omega-3 levels for cardiovascular health, and suggest that later in life these benefits could actually extend the years of remaining life.”

To conduct their study, researchers examined sixteen years of data from about 2,700 U.S. adults, aged 65 or older, who participated in the Cardiovascular Health Study. All participants were healthy at the start of the study, and during follow up each had blood drawn, underwent physical exams and diagnostic testing, and were questioned about their health status, medical history, and lifestyle. Blood samples were tested for all omega-3 components (DHA, EPA and DPA) at the study outset and during follow up.

Eat Fatty Fish Three Times a Week or Supplement Daily to Slash Hear Disease Risk Factors

After adjusting for demographic, cardiovascular, lifestyle, and dietary factors, the scientists found that all three fatty acids combined were associated with a significantly lower risk of mortality (27 percent). When broken down by type, the researchers found that high DHA blood levels were associated with a 40 percent reduction in death from coronary heart disease. EPA and DPA were most strongly linked with lowered risk for stroke death and EPA significantly reduced non-fatal heart attack risk.

The team determined that the largest benefit was increasing omega-3 fat intake from a very low level to 400 mg per day. Dr. Mozaffarian concluded “The findings suggest that the biggest bang-for-your-buck is for going from no intake to modest intake, or about two servings of fatty fish per week.”Past research studies have determined that all individuals with no risk factors for heart disease should consume fatty fish three times per week or supplement with 1,200 mg fish oil daily. Those with multiple risk factors should increase intake to 2,400 mg combined EPA/DHA daily to minimize heart disease risk and extend lifespan.

Saturday Throwback Dr Veg Love or How I Learned to Stop Worrying and Love Seasonal Produce

Every Saturday we post an older piece from CHG’s archives. Today’s article comes from August 2007. Thems was good times.

I’ll be honest: when I started researching this article, I assumed 90% of it would focus on cash. Specifically, I thought the money saved from buying in-season fruits and vegetables would far outweigh any other benefit.

Man alive, was I wrong.

Between Google and Nexis, it took approximately 2.2 seconds to discover that snagging chronologically-appropriate produce has massive political, nutritional, emotional, and environmental perks. What’s more, it tastes better. And that’s gotta count for something.

So, without further ado, nine reasons you should raid crops from the seasonal section:

It costs WAY less. Simple economics here: an abundance of anything lowers its price. Plus, because in-season produce is often grown domestically, overseas transportation costs are cut. All told, this means you can save between 10% and 50% on beans, greens, and all the in-betweens. Need proof? Check your berry section, where writer Briony Harmer notes, “strawberries in November … will cost nearly three times more than what you would have paid in June."

It tastes better. When fruits and vegetables are imported off-season, they’re often harvested prematurely, because that way they hold up better in transit. Once the food arrives here, it’s then sprayed with ethylene gas to ripen it artificially. By the time it reaches grocery stores, you’ll see decent color, but the flavor blows. See for yourself: eat a plum tomato in winter, and write down your thoughts. Try another one at the end of the summer. Odds are, the winter tomato will taste like air in comparison.

It’s better for the Earth (probably). The expert consensus is that an average pound of produce travels about 1500 miles. Imported off-season crops can raise that number significantly since they’re coming from all over the world. That scrumptiousness has to be shipped somehow, and it’s usually via truck, train, plane, or boat, all of which consume energy and add to pollution. To give some perspective, in England, “importing just a kilogram of strawberries from America is the equivalent of running a 100 watt light bulb for a week.” Buying seasonal produce can help offset the waste.

(That is, unless you buy this alarmingly convincing article from the New York Times, which pokes some pretty big holes in the transportation argument. Still, it concedes, “the connection between lowering food miles and decreasing greenhouse gas emissions is a no-brainer.”)

It’s healthier. Off-season fruits and veggies tend to lose their nutritional punch over time, since they’re shipped long-distance for weeks and months. As the London Observer reports, “freshly dug potatoes have about 21mg vitamin C per 100g which falls to 9mg after three months of storage.”

What’s more, that produce may not have started out on equal footing to begin with. A 2002 Japanese study found that Vitamin C and carotene are “significantly influenced by the cropping season,” meaning that a carrot grown in winter is missing half the carotene it would have had in the summer. For some reason, spinach, tomatoes, carrots, and broccoli are particularly affected by this, while “sweet peppers, celery, and kiwifruit [are] fairly stable.”

It’s less poisonous. You probably won’t croak eating off-season produce from abroad, but there’s a good chance it harbors more toxins than its in-season counterparts. Why? Well, according to the BioDiversity Project, “Many countries have neither the pesticide regulations nor the labor safety practices that are the law in the U.S., so theres no telling what is on or in your imported fruits and vegetables.” That added flavor you detect? It’s the bitter taste of uncertainty.

It’s in better condition. “Handling and storage … is one of the main problems in the deterioration of produce. From the way the grower packs it, to the loading and off-loading in the truck yard, to the handling in the markets, it all contributes to knocks and bruises that will quickly affect the quality of the produce,” says the Canberra Times. If you’ve ever flown cross-country, you can relate: the further something travels, the worse shape it’s in when it arrives at its destination.

It can be frozen or canned for future use. Imagine having a sweet, delicious blueberry in the middle of March. Now imagine that same piece of fruit hasn’t lost an iota of vitamins, minerals, or flavor because it was iced right after being picked. NOW imagine you’re not spending $6 on a pint of blueberries from the farthest corners of the planet, because you bought it for $2 six months ago and had the forethought to shove it in your freezer. Okay, you’re done imagining. Pat yourself on the back and eat a blueberry.

It’s politically correct (and not in an annoying way). This is a bit difficult to summarize, but I’ll give it a shot: essentially, Third World farmers make more (but not a lot of) money importing specialized off-season produce to richer countries than by growing food for themselves. According to Briarpatch, this not only “threatens the extinction of [their] local crops,” but leads to hunger and “[slavery] to international commodity prices.” Meanwhile, local farmers are hosed by big-name suppliers who purchase cheaper goods from abroad. Buying seasonally benefits everyone more in the long-run.

It’s a mental trigger for the good times. BabyFit.com’s Rebecca Pratt makes a fabulous point: “[Food is] tied to the special days and seasons of our lives: sweet, luscious watermelon paired with the memory of filies and fireworks; fragrant hearty soups that temper winter’s chill; sweet young vegetables that accompany spring’s first warm day.” Think about it: on Christmas, do you crave gazpacho? When Easter rolls around, do you drool over the light, airy taste of parsnips? Food is key to socialization, and in-season fruits and veggies can play major parts in our memories.

Of course, none of this information is any good unless you know what produce is ripe at which times. The guides at Food Network, Nutritiously Gourmet, and Cornell University are all good places to start. Consumo felice!

Sources:

• “Buy Organic and Locally Produced Foods,” BioDiversityProject.org.
• Dowden, Angela. “The food thats travelled 35,000 miles to reach your plate,” The Daily Mail (London). September 2005.
• Harmer, Briony. “How to become a vegetarian without increasing grocery bills,” Essortment.com. 2002. essortment.com/food/vegetarianincre_skfk.htm.
• “How Food Finds its Way to Your Plate,” Talk of the Nation. NPR Radio. November 2006.
• Lempert, Phil. “The squeeze and sniff test: Tips on how you can pick out fresh fruits and vegetables,” SupermarketGuru.com. April 2002. supermarketguru.com/page.cfm/287.
• McWilliams, James E. “Food That Travels Well,” New York Times. August 2007.
• Monks, Helen. “How to buy food that doesnt cost the Earth,” The Independent (London). April 2006.
• “Pass the fresh test,” Canberra Times (Australia). August 2006.
• Pratt, Rebecca. “Seasonal Foods Exceptional Flavor & Nutrition that Fits in Your Budget,” Babyfit.com. babyfit.sparkpeople.com/articles.asp?id=669.
• Ross, Alicia and Beverly Mills. “Save Money: Buy in Season.” Dallas Morning News. July 2007.
• “Seasonal Vegetables in Temperate Countries,” Food & Fertilizer Technology Center for the Asian and Pacific Region. January 2001. agnet.org/library/pt/2001002/
• Watson, Julia, “Eat To Live: Buy seasonally, eat healthily,” UPI. Jaunary 2006.
• Wiebe, Nettie. “Whos cooking the food system? Globalization & the struggle for food sovereignty,” Briarpatch. February 2007.

Causes of Obesity Food Variety

So I had this new idea today while sitting in class.  We were talking about food palatability and how modern food is "hyperpalatable"... this just means that it is extra salty, extra fatty, extra sweet, and overall just more pleasing to eat than food of the past.  (Ive talked about this before 1, 2, 3, 4).  And I started thinking... there are like a million different reasons why Americans are so obese.  Why dont I start exploring each one individually on my blog??  So that is what I will be doing.  Starting now.  Maybe ironically NOT starting with hyperpalatability of food... although its a related topic.  Today our cause of obesity is unconventional, one you probably havent thought of.  And you all know how much I like bringing you a fresh perspective and new way to think about something.  So without further ado...

Cause of Obesity #33162:  Food Variety

Why do we eat?  Is it because were hungry?  Partly.  But there are other reasons too.  Dont even act like you dont know... boredom, convenience, stress, depression, happiness, celebration, social pressures, societal expectations, just because its meal-time...  the list really does go on and on.  Because of this, researchers have divided eating into two categories:  homeostatic and non-homeostatic eating (1).

Homeostatic eating:  eating is driven by a true need for energy
Non-homeostatic eating:  eating is driven by factors other than a need for energy

Pretty simple really. 

So how does variety fit into this?  Easy.  You can only eat so much of one food.  In fact, variety in food is one of the major factors driving how much you eat, whether you notice it or not.  There are even diets designed for weight gain based around this principle... take the cafeteria diet for example.  Allow humans (or rats) easy access to a high variety of food and theyll gain weight.  In contrast, give someone a restrictive diet that lacks variety and they inevitably eat less and lose weight.

Diets With Excessive Variety
Examples.  Take this 1994 study, which put 10 men in a metabolic ward for 7 days with unlimited access to a wide variety of palatable food, including the following:  "English muffins, French toast, pancakes with syrup, scrambled eggs, chicken pie, cheeseburgers, margarine, white sugar, various cakes and puddings, apples, jelly beans, Doritos, M and Ms, apple juice, 2% milk, sodas and several other foods." (2).  These men ate, on average, a whopping 1,544 calories over their estimated needs!  :-o!  They gained an average of 5.1 pounds in just one week.

There are also two similar studies done in Pima Indians, which is a population known to be susceptible to easy weight gain.  One was done with Pima men (3), the other with Pima women (4).  The results, as you would expect, showed that they overate and gained weight at a similar clip to that first study.

Diets That Lack Variety
But what if we restrict our variety?  Well Ive written about this before in a post called "Does Sugar Make You Fat?" (5).  In one study in which the participants consumed nothing but a sugary beverage in unlimited quantity, the obese subjects rapidly lost weight.  One subject lost 200 pounds in 255 days.  In another study, the subjects ate nothing but fruit and nuts experienced the same results.  There are plenty more examples of this, like the guy who ate nothing but potatoes (6).  Use your Google machine.

Think about some of the more successful weight loss diets out there, specifically the ones that get you to lose weight without counting calories.  Paleo diet - restricts grains, legumes, and dairy.  Vegan diet - restricts meat and dairy.  Atkins diet - restricts carbohydrates.  30 bananas a day diet - restricts all non-banana foods.  One of the main reasons these diets work is because they inherently lack variety.  You can eat all the food you want and still lose weight, because you can only eat so much of one particular type of food.

The Modern Cafeteria Diet Food World. 
Now think about the food environment we live in today, compared to just 25 years ago before the obesity epidemic.  We live in a globalized world; the amount of variety at your fingertips is unprecedented.  If you live in or near a city, you are just minutes away from any of the following... Mexican restaurants, Chinese restaurants, Thai restaurants, Sushi bars, hibachi, Panera, steakhouses, Italian restaurants, burger joints, fast food, gas station food, sandwich shops, 24-hour diners, bakeries, Starbucks, Dunkin Donuts, all-day breakfast restaurants, chocolate shops, Indian restaurants, liquor stores, pizza shops, and all of the others Im forgetting.  There are like 200 different types of potato chips at the grocery store, theres a whole aisle devoted to it...  Aint nobody got time for that!  Whatever you want to eat, you can have it in just a moments notice.  We essentially live in a cafeteria diet world.  Do you think this has something to do with the obesity epidemic?  I think so.

I  mean just the other day for lunch, I ate enough sushi to feed a family of four... Why?  I hadnt had sushi in weeks; I was craving it.  There are just too many other foods to keep me occupied, just too much variety.  And boy was I stuffed...  but then I had a piece of my girlfriends apple pie.  See what I did there???  Stuffed on sushi, but theres still room for something else!!  Good ol variety nipped me in the butt again.


With so much variety, we cant just free-eat anymore and stay thin.  The more variety were given the more food were driven to eat.  And Im sorry... I love variety, probably more than the average person.  I know damn well that variety is the spice of life. As cliche as it is, you know its true.  But I think this beloved variety is making us fat.

What are your thoughts, readers?  

Exercises to Prevent Heart Attacks

Heart disease may be a leading cause of death, but that doesnt mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take. 

An inactive lifestyle is one of the major risk factors for heart disease. Fortunately, its a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits. Taking steps for preventing heart disease and all cardiovascular diseases means making smart moves now that will pay off the rest of your life.

Anyone at any age can take advantage of simple steps to keep their heart healthy. Weather you are in 20s or 60+ here’s what you can do to prevent heart disease.

Healthy diet

First of all you need to choose a healthy eating plan. The food you eat can decrease your risk of heart disease and stroke. Choose foods low in saturated fat, trans fat, cholesterol, sodium and added sugars and sweeteners. Eat plenty of fruits and vegetables, fiber-rich whole grains, fish, nuts, legumes and seeds. Also try eating some meals without meat. Select fat-free and low-fat dairy products and lean meats and poultry. Limit sugar-sweetened beverages and quit smoking.

Physical exercise: What Type of Exercise Is Best?

Cardiovascular or aerobic is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the bodys ability to use oxygen. You can slowly work up to at least 2½ hours (150 minutes) of moderate-intensity aerobic physical activity like brisk walking every week.

Or  you can indulge in a vigorous intensity aerobic physical activity such as jogging or running or a combination of both for an hour and 15 minutes (75 minutes) of  every week. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help your blood pressure and improve your breathing. Other aerobic exercises include: walking, jogging, jumping rope, bicycling, skiing, skating, rowing, and aerobics.

Additionally, on two or more days a week you need muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest shoulders and arms). Strengthening exercises are repeated muscle contractions. They help tone muscles, improve strength, and increase your metabolism.

So, now you know what to do, but before you start any exercise program ask your doctor. Your doctor can help you find a program that matches your level of fitness and physical condition. Your exercise session should include a warm-up, a conditioning phase, and a cool-down.

Warm-up helps your body to adjust slowly from rest to exercise. It reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature.

Conditioning follows the warm-up. All the benefits of exercise are gained and calories are burned during this phase. 

Cool-down is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean taking rest right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to slowly decrease the intensity of your activity.

When you start any exercise program maintain a moderate level not too heavy exercise, always maintain a good posture. Keep your back straight; do not curve or slump your back. Make sure your movements are controlled and slow. Avoid quick, jerking movements. Do not bounce. Do not hold your breath during these exercises. 

Choose an activity that you enjoy. Youll be more likely to stick with an exercise program if you enjoy the activity. Add variety. Develop a group of several different activities to do on alternate days that you can enjoy. Use music to keep you entertained. Find an exercise "buddy". Plan to exercise at the same time every day (such as in the mornings when you have more energy). If you exercise regularly, it will soon become part of your lifestyle.

Here are some simple exercise you can do.

Ankle pumping. Sit on the floor with your feet straight out in front of you. Keeping your heels on the floor, lift your toes up as far as you can. Hold for a count of five.

Knee straightening. Raise your foot to fully straighten your knee out in front of you. Hold for a count of five. Lower your foot to the floor. Repeat on other side.

Hip bending. Lift one knee up toward the ceiling. As you lower this knee, raise your other knee. Alternate each leg as if you were marching in place (while sitting.)

Overhead reaching. Raise one arm straight over your head, with your palm facing away from you. Keep your elbow straight. Slowly lower your arm to your side. Repeat with other arm.

Shoulder touching. Sit with your arms at your sides and your palms facing up. Bend your elbows until your hands are touching your shoulders. Lower your hands to your sides.

Single arm lifts. Sit with your arms at your sides, fingers pointing toward the floor. Raise one arm out to your side, keeping your elbow straight and your palm facing down. Slowly lower your arm to your side. Repeat with your other arm.

Shoulder shrugs. Keeping your back straight, lift your shoulders up and forward toward your ears. Release your shoulders down and back in a smooth circular motion.

Arm circles. Sit with your arms at your sides, fingers pointing toward the floor. Raise both arms out from your sides (about 1 or 2 feet from your body). Keeping your elbows straight and your palms facing toward you, rotate your arms in small circles.

Single shoulder circles. Bending one elbow, put your fingertips on your shoulder. Rotate your shoulder and elbow clockwise, then counter clockwise. Repeat with each arm.

If you have chest pain or pain anywhere else in the body, do not allow the activity to continue. Performing an activity while in pain may cause stress or damage to the joints. If you experience chest pain, significant breathlessness, or dizziness, you should stop exercising and let your doctor know about your symptoms. 

References:

1) http://www.heart.org

2) http://www.webmd.com/heart-disease/guide

Another Randomized Controlled Clinical Trial Proves Outsourced Population Health Care Management Works Hypertension

Heres another high quality randomized controlled clinical that confirms the benefits of outsourced care management.

Margolis and colleagues accessed Minnesotas HealthPartners electronic records to identify all patients who had had two sequential primary care clinic blood pressure readings that were more than 140 systolic or 90 diastolic.  These patients with hypertension were asked by letter and then phone calls to participate in the research trial.  Those who agreed were rechecked by research assistants who re-measured the blood pressures to confirm the hypertension.

16 clinics participated. 8 were assigned to the intervention group. 8 served as comparison (control) "usual care" clinics that relied on usual physician care.

In the intervention clinics, a pharmacist interviewed each patient and sought agreement to lower the blood pressure by 5 points. The patients received a home BP monitor that transmitted data to AMCHealth six times a week. The pharmacist and patient met by telephone every 2 weeks. Based on the BP monitoring and the telephone interviews, the pharmacist used a standardized medication algorithm to adjust medications until control was achieved for 6 weeks.  Telephone calls were then reduced in frequency to monthly.

The research assistants reassessed the participants blood pressures at 6, 12 and 18 months.

Over 14,000 patients were identified and 2020 agreed to be screened. 450 met criteria for persistently elevated blood pressures. 228 were cared for in the intervention clinic and 220 were cared for in the usual care. The mean age was 61 years, 45% were women, 82% were white and 48% had a college degree. The average blood pressure was 148/85.

Both groups had a similar frequency of follow-up visits. 380 patients had completed both 6 and 12 month follow-up visits with the research assistants. 

The proportion of patients with controlled BPs at both visits in the intervention clinics was 57.2% vs. 30% in the control clinics. If those patients lost to follow-up were counted as blood pressure "failures," the success rate was 48.5% vs. 25.1%. Both sets of measures were statistically significant.  The relative proportions held up at 18 months.

Unsurprisingly, intervention patients were taking more medications over the duration of the study and at 6 months were statistically more significantly more likely to report that they were taking them. 

Six patients in the intervention group vs one in the control group had "events" related to low blood pressure, dizziness and loss of consciousness.

The cost, based on pharmacist time, was $1350 per patient.

The Disease Management Care Blogs take:

This adds to a growing body of evidence that non-physicians working under clinical protocol side-by side with busy primary care physicians can achieve control of a chronic condition - in this instance, hypertension.  This is a core attribute of population health.

Another piece of good news is the emergence of the electronic health record as a means to identify patients who are program candidates.  Now thats "meaningful."

The bad news:

The cost was $1350.  It is unlikely that those direct costs were mitigated by hypertension-related "savings" within the same fiscal year.  On the other hands, thinks the DMCB, the use of other types of non-physicians with or without IT-based decision support and higher throughput could lessen that cost.  The DMCB is sure that the population health service providers are already on it.

Even with state of the art population health, the rate of hypertension control was ultimately 50%.

A small excess of participants experienced an excess of treatment side effects.  While this may be the inevitable consequence of more aggressive treatment, it could expose the program to liability.

This was Minnesota: we dont know if this would work in, say, Los Angeles.  This needs to be tested elsewhere.

Image from Wikipedia

The Latest Cavalcade of Risk is Up

The latest Cavalcade of Risk is hosted by Jason Hull of Hull Financial Planning. Pointing out that this is more than just a board game, Jason summarizes and links a series of blogs dealing with the latest insights on managing and anticipating risk. The DMCB is included, so you know its good stuff.

Enjoy!

Are Your Blood Sugars High in the Morning

Two common reasons for this are the Dawn Phenomenon and the Somogyi Effect:

Dawn Phenomenon

Every human being experiences the Dawn Phenomenon. While we sleep, usually around 3-8 AM, glucose is released in response to the stimulus of some hormones in order to repair and maintain our body. These hormones are growth hormone, cortisol, glucagon, and epinephrine (also called adrenalin), which are also known as counterregulatory hormones, since they have the opposite effect of insulin: they cause glucose levels to rise.
- About.com - The Dawn Phenomenon and the Somogyi Effect

Somogyi Effect

The Somogyi Effect happens when your blood glucose levels are high in the morning due to hypoglycemia (low blood glucose levels) overnight. [Low blood sugars can occur when there is extra insulin in the body.] This is also called rebound hyperglycemia, since your body reacts to low blood glucose levels by increasing the release of glucose from muscles, liver and fat, theore causing hyperglycemia.
- About.com - The Dawn Phenomenon and the Somogyi Effect

How Can You Tell the Difference?

• If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.
  
• If the blood sugar level is normal or high at 2 a.m. to 3 a.m., its likely the dawn phenomenon.
  - A-Z Health Guide from WebMD: Dawn phenomenon and the Somogyi effect

What Can You Do?

Once you and your doctor determine the cause, there are a number of options. These include changing the time, the type, or the amount of insulin you take, making adjustments to your evening snack, or switching to an insulin pump.

________
Resources:
About.com - The Dawn Phenomenon and the Somogyi Effect

A-Z Health Guide from WebMD: Dawn phenomenon and the Somogyi effect

WebMD - Diabetes: Morning High Blood Sugar Levels

CoQ10 Can Lower High Blood Pressure to Prevent Congestive Heart Failure

Reporting in the journal Biofactors, researchers found that patients with congestive heart failure that were supplemented with the active form of coenzyme Q10 (ubiquinol) improved ejection fraction by 39%. Ejection fraction is a critical marker of heart function used to determine the volume of blood pumped by the heart through the vascular system.

CoQ10 is essential to convert nutrients to energy and power the cellular engine, and natural production in the body declines with age. Extensive research explains how you can benefit from daily supplementation with this powerful co-enzyme to restore healthy energy balance and prevent age-related heart disease.

CoQ10 Improves Quality of Life for Heart Failure Patients

The study conducted at the East Texas Medical Center and Trinity Mother Francis Hospital focused on patients with advanced congestive heart failure that were classified as Stage IV, the most severe form of the disease. Patients were supplemented with 580 mg of the ubiquinol form of coenzyme Q10 daily to increase plasma blood levels by a factor of four.

The researchers found “the improvement in plasma CoQ10 levels is correlated with both clinical improvement and improvement in measurement of left ventricular function.” Prior to CoQ10 supplementation, most of the participants were considered critically ill and confined to bed or a wheel chair. After a regimen of ubiquinol, patients typically improved two classification levels (Stage IV to II or III to I) and were able to carry on a productive lifestyle.

CoQ10 Improves Blood Vessel Elasticity to Lower Blood Pressure

Hypertension is a serious problem that affects as many as one in three adults in the US today. High blood pressure is closely associated with coronary artery closure due to plaque formation and arterial stiffening as the normally elastic vessels require more pressure to fully circulate blood to the body. The result of a study published in the journal Nutrition and Metabolism found that coenzyme Q10 supplemented along with other potent antioxidant nutrients (vitamin C, vitamin E, and selenium) significantly increased small and large arterial elasticity that led to lower blood pressure and risk of a heart attack.

Subjects in this study received 60 mg of CoQ10 for a period of six months along with moderate amounts of the other nutrients. In addition to improved arterial elasticity, researchers found a significant decline in HbA1C blood sugar control and an increase in protective HDL cholesterol levels. The authors of the research concluded that the CoQ10 nutrient antioxidant cocktail “has beneficial effect on glucose and lipid metabolism, blood pressure and arterial compliance in patients with multiple cardiovascular risk factors.”

It comes as no surprise to most alternative health-minded individuals that nutrients obtained from natural sources exert a powerful influence on human health. Adults will want to supplement with 50 to 100 mg per day (higher amounts may be necessary for existing cardiovascular disease) of the ubiquinol form of co-enzyme Q10 to maintain optimal health, energy and protection from age-related diseases of the heart.

The Latest Health Wonk Review Is Up!

Theres a heartfelt Health Wonk Review over at Peggy Salvatores Health Talent Transformation Blog. The HWR is linked summary of the best health policy insights from around the blogmos.  Health orm remains a moving target and Peggys assembled something for everyone.

Enjoy!

The Chameleon Like Quality Of HDL Cholesterol

This is an older study (2001) but it addresses an evolving topic - the "chameleon-like" quality of HDL cholesterol - sometimes anti-inflammatory, sometimes pro-inflammatory:

HDL and the Inflammatory Response Induced by LDL-Derived Oxidized Phospholipids, Arteriosclerosis, Thrombosis, and Vascular Biology, 2001

The development of fatty streaks in arteries results in part from an inflammatory response, one that involves the oxidation of phospholipids in LDL cholesterol.

HDL is “good” or anti-inflammatory when:

"In the sense that normal HDL can prevent the formation of or inactivate these inflammatory LDL-derived oxidized phospholipids, normal HDL is anti-inflammatory."

HDL can become pro-inflammatory during an acute-phase reaction:

“In contrast, during an acute-phase [AP] reaction, AP-HDL favors the conversion of LDL to the proinflammatory [mildly-oxidized]-LDL.”

An acute-phase reaction can be the result of an infection, or it may be a chronic acute-phase reaction - such as the low-grade systemic inflammation associated with being overweight.

This link between HDL and LDL, and their pro-inflammatory nature during an acute-phase reaction, “probably evolved to protect against infection, particularly in the young, and appears to be activated in susceptible mouse strains by an atherogenic diet.”
________

Caffeine in Beverages

Since its been shown that caffeine can increase blood glucose and make cells more resistant to insulin after a meal, I thought it would be helpful to post the caffeine content of some common beverages and chocolate.

Click the link to the right for a table distributed by the American Beverage Association. It lists the caffeine content of drinks manufactured by several companies, including Coca-Cola, Pepsi, Royal Crown, and Snapple.

Note that energy drinks (8.4 oz. can) typically contain the amount of caffeine found in a cup of coffee. Some not listed:

• Impulse - 88 mg.
  
• Naughty Boy - 80 mg.
  
• Red Bull - 80 mg.
  
• V - 78 mg.

Click here for a table compiled by Kansas State Universitys Research and Extension Program. It lists the approximate caffeine content of some common coffee and tea beverages, and chocolate.

Note that the caffeine values for coffee and tea apply to 5 oz. servings. A coffee mug typically holds 8 oz. Take-out cups can be 16 oz. or more.

Speaking of take-out coffee, about 10 years ago, the Center for Science in the Public Interest (CSPI) published the table below which drew attention to the caffeine content of Starbucks brewed coffees:



Starbucks doesnt divulge caffeine content on their website. But an article from Newhouse News Service (NNS) in 2003 reported finding "anywhere from 259 to 564 milligrams of caffeine" in 16 oz. Starbucks samples. They contacted a Starbucks rep:

"Lara Wyss, spokeswoman for the Seattle-based Starbucks Coffee Co., said in a statement that "many variables contribute to caffeine levels in coffee from cup to cup," including type of bean, roast, brewing method, grind and coffee maker. Starbucks customers can expect an average of 200 milligrams of caffeine per 8 ounces, she added."

That equates to 300 mg. caffeine for a Starbucks 12 oz. "tall", and 400 mg. for a 16 oz. "grande". Quite a jolt.

Reasons not expect cause weight gain

Will not be surprised to increase your weight when you eat more calories higher or take exercise less
But youll notice when you find an increase in weight and you did not change your lifestyle The same calories and the same effort if youre surprised we invite you to follow-up article to know the reasons behind it:

- Sleep deprivation:
There are two counts of sleep problems and weight gain. The initial problem intuitive When the watchful late is only natural that the hungry and eat snacks which means more calories.
The second problem: to deprive you of sleep leads to hormonal changes increase the sense of hunger and increase your appetite when you eat do not feel you are hungry!!

Stress and tension:
When life demands intensify resist our bodies to stay alive .. Secretion of the stress hormone "cortisol" which is responsible for the increased appetite .. It thus becomes the stress and tension associated with eating high-calorie foods .. Which provides a fertile environment for weight gain

Some medications cause weight gain:
Psychiatric drugs and drugs used to treat migraines and medicines for diabetes and pressure drugs may cause weight gain. Consult your doctor before changing your medication.

Questions Surrounding Avandia� and its Effect on Bone

A small study to be published in an upcoming issue of the Journal of Clinical Endocrinology & Metabolism found that postmenopausal women who took Avandia^® (rosiglitazone) at 8mg/day for 14 weeks had greater reductions in hip bone density than women in a control group:

• - Total hip bone density fell in the Avandia group by 1.9%
  
• - Total hip bone density fell in the placebo group by 0.2%

Leading authors to conclude:

"Short-term therapy with rosiglitazone exerts detrimental skeletal effects, by inhibiting bone formation."

A reduction in bone density could increase the risk of fractures. That wont be welcome news to women with diabetes who already experience an increased risk of fractures - a finding reported by this journal last year.

Reuters reported:

"Morgan Stanley said in a note that an osteoporosis warning was now "very likely" to be added to the drugs label."

________
Avandia study, free author manuscript (pdf):
The peroxisome-proliferator-activated receptor-gamma agonist rosiglitazone decreases bone formation and one mineral density in healthy postmenopausal women: a randomized, controlled trial

Avandia study, abstract:
The peroxisome-proliferator-activated receptor-gamma agonist rosiglitazone decreases bone formation and bone mineral density in healthy postmenopausal women: a randomized, controlled trial

Reuters news summary:
New study fuels bone fears over Glaxos Avandia

JCEMs diabetes and bone fracture study, abstract:
Risk of Fracture in Women with Type 2 Diabetes: the Women’s Health Initiative Observational Study

Healthy SkinHealthy Skin Six Simple Summer Skin Tips

Beautiful skin is healthy skin. Dr. Susan Evans, a renowned Beverly Hills dermatologist, offers practical advice for all skin types.
With ongoing climate changes (hello, heat wave!) and the ever-present penetrating rays from the sun, how do you take care of your skin?  With so many seasonal variances, is it possible to maintain a healthy year-round glow?
Throughout the year, within my clinical practice, I see a variety of unique seasonal skin concerns. I usually begin with identifying each individual’s skin type and then determine the best approach.
On a recent CNN segment, I talked about the sun and tanning. Sure, everyone wants to look great with healthy glowing radiant skin, especially in the summer. But did you know the majority of all premature aging is due to sun damage?

Here are six simple summer skin tips that will get you help you achieve that glow and look your best:

1. The best way to protect yourself this summer and keep your skin looking great is to use sunscreen everyday. Use a sunscreen that is a combination sunscreen and moisturizer (your skin surface needs extra lubrication in the summer months). You need to nourish your skin with healthy vitamins and anti-oxidants, so that while you are protecting your skin from the sun, you also  receive long-term benefits.
2. Make sure you drink plenty of water to stay hydrated. Eat plenty of fruits and salads to keep your skin looking firmer, and your digestive track healthy.
3. For any skin type, make sure to cleanse your skin daily! In your morning and evening routine, you want to make sure you wash off the toxins on your skin. Look for a cleanser that is gentle to your skin. Look for cleansers with AH and BH acids or papaya-based products. The papain enzyme within papaya helps to remove dead skin cells and encourage new skin growth.
4. Wear lip balms that are moisturized to your skin for the summer, with a minimum of 15 SPF. Lip balms without sun protection should be avoided because the “gloss” may attract the harmful UV rays.
5. Make sure you exfoliate your skin two to three times a week to remove unwanted dead skin that may be clogging your pores.
6. Use a toner right after cleansing your skin. Toners help restore the pH balance to your skin, which makes your skin surface less susceptible to unwanted bacteria growth.

If You Have Oily Skin
Carry around a blotter to remove the oil from your skin throughout the day. Look for products with BHA to keep the pores clean. Once a week, follow up with a clay mask. At night, after cleansing, use an oil-free moisturizer to help soothe the skin, and keep the skin moisturized while you are sleeping! Look for products that are alcohol-free, in order to avoid overdrying your skin.
If You Have Dry Skin
Make sure you moisturize daily, especially right after the shower. Your moisturizer should be left on to allow penetration and absorption into deeper layers of your skin. Follow this routine twice a day. Make sure you avoid artificial moisturizers since they are not adding value to your skin care routine!  Look for a scrub or cleanser with AHA, that breaks down the dead skin and doesn’t allow the moisture to get in. Look for a toner that is gentle to your skin, like rose water. Once the dead skin is removed, the moisturizer is easier to penetrate. Use a hydration mask, at least once a week.
If You Have Normal Skin
If you have normal skin, then you are lucky! You want to keep your skin protected and moisturized throughout the day. Look for a scrub or cleanser with AHA or BHA and cleanse twice a day. Use a lighter moisturizer for the summer months — something that will not clog up your pores.
Follow these skin care tips and may you achieve that healthy summer glow.