Tips from gaining health

Were switching the schedule around a bit this week, due to the gremlin that has taken up residence in my face. Wednesdays usual article is postponed until next week, replaced by this lovely recipe.

As this popular and highly rated Rosemary Chicken Salad recipe from Cooking Light is presented, it’s essentially a blank slate. I mean, its moist, it tastes good, and it uses up a bunch of leftover chicken, but no single flavor ever comes forward to assert itself as master and ruler of its subordinates. But theres a reason for that. A good reason. Nay – a really good reason.

And that reason? Is you.

Seriously, though. Recipes like this one are invaluable, because they allow the chef (a.k.a. you) near-infinite possibilities for improvisation. You can add nearly any ingredient you like to the original dish, because its highly improbable youll go wrong with your choices. Why not try:

• Celery
• Grapes
• Apples
• Dried cranberries
• Smoked almonds
• Raisins
• Cashews
• Pecans
• Walnuts
• Cayenne

Eggs, beans, oatmeal, polenta, and pasta salads are similarly inclined, in that they can be customized until the cows come home, with huge, gaping room for error. Well discuss more about the customization itself next week, but in the meantime, should you decide to whip this up, there are a few things to know:

1) My loathing for mayonnaise is surpassed only by my loathing of sinusitis, but it’s in here because the other flavors cover up the flavor and texture enough so I don’t ever have to taste, smell, or think about it.

2) The calculations are very different from Cooking Light’s, largely because I don’t include bread, and have changed the proportions of the original recipe a bit (less mayo, more yogurt).

In conclusion, go nuts with this thing. The salads the limit.

~~~

If this recipe looks tantalizing, man, youll like these:

• Autumn Apple Salad
• Golden Delight Egg Salad
• Potato Salad for Rainy Day People

~~~

Rosemary Chicken Salad
Serves 5
Adapted from Cooking Light.


3 cups (about 3/4 pound) roasted skinless, boneless chicken breasts or rotisserie chicken, chopped
1/3 cup chopped scallions
1/4 cup slivered or sliced almonds
6 tablespoons Greek low-fat yogurt
2 tablespoons light mayonnaise
1/2 tablespoon chopped fresh rosemary
1/2 tablespoon Dijon mustard
1/8 teaspoon salt
1/8 teaspoon freshly ground black pepper
Chopped: celery, grapes, apples, dried cranberries, smoked almonds, raisins, cashews, pecans, walnuts, cayenne (optional)

In a medium mixing bowl, combine chicken, scallions, almonds, yogurt, mayonnaise, mustard, salt, pepper, and chosen optional ingredients. Serve on whole wheat bread with mixed greens.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
134 calories, 5.1 g fat, 3.7 g fat, 0.7 g fiber, 18.5 g protein, $0.78

NOTE: These calculations are for chicken breasts, and no optional add-on ingredients.

Calculations
3 cups (about 3/4 pound) roasted skinless, boneless chicken breasts, chopped: 373 calories, 4.1 g fat, 0 g fiber, 78.3 g protein, $1.48
1/3 cup chopped scallions: 11 calories, 0 g fat, 0.9 g fiber, 0.6 g protein, $0.30
1/4 cup slivered or sliced almonds: 144 calories, 12.6 g fat, 3 g fiber, 5.3 g protein, $0.63
6 tablespoons Greek low-fat yogurt: 65 calories, 1.8 g fat, 0 g fiber, 8.5 g protein, $0.97
2 tablespoons light mayonnaise: 70 calories, 7 g fat, 0 g fiber, 0 g protein, $0.16
1/2 tablespoon chopped fresh rosemary: 1 calorie, 0 g fat, 0.1 g fiber, 0 g protein, $0.25
1/2 tablespoon Dijon mustard: 8 calories, 0 g fat, 0 g fiber, 0 g protein, $0.07
1/8 teaspoon salt: negligible calories, fat, fiber, and protein, $0.01
1/8 teaspoon freshly ground black pepper: negligible calories, fat, fiber, and protein, $0.01
TOTALS: 672 calories, 25.5 g fat, 3.7 g fiber, 92.7 g protein, $3.88
PER SERVING (TOTALS/5): 134 calories, 5.1 g fat, 3.7 g fat, 0.7 g fiber, 18.5 g protein, $0.78

A pair of University of Colorado Cancer Center studies published this month show that the milk thistle extract, silibinin, kills skin cells mutated by UVA radiation and protects against damage by UVB radiation – thus protecting against UV-induced skin cancer and photo-aging.

“When you have a cell affected by UV radiation, you either want to repair it or kill it so that it cannot go on to cause cancer. We show that silibinin does both,” says Rajesh Agarwal, PhD, co-program leader of Cancer Prevention and Control at the CU Cancer Center and professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences.

The first study, published in the journal Photochemistry and Photobiology worked with human skin cells subjected to UVA radiation, which makes up about 95 percent of the sun’s radiation that reaches Earth. The Agarwal Lab treated these UVA-affected cells with silibinin. With silibinin, the rate at which these damaged cells died increased dramatically.

“When you take human skin cells – keratinocytes – and treat them with silibinin, nothing happens. It’s not toxic. But when you damage these cells with UVA radiation, treatment with silibinin kills the cells,” Agarwal says, thus removing the mutated cells that can cause skin cancer and photo-aging.

Specifically, the study shows that pretreatment with silibinin resulted in higher release of reactive oxygen species (ROS) within the UVA-exposed cells, leading to higher rates of cell death.

The second study, published this month by the same authors in the journal Molecular Carcinogenesis shows that instead of beneficially killing cells damaged by UVA radiation, treatment with silibinin protects human skill cells from damage by UVB radiation, which makes up about 5 percent of the sun’s radiation reaching Earth.

Again, remember Agarwal’s suggestion that the prevention of UV-induced skin cancer can happen in two ways: by protecting against DNA damage or by killing cells with damaged DNA. With UVA, silibinin kills; with UVB, it protects, in this case by increasing cells’ expression of the protein interleukin-12, which works to quickly repair damaged cells.

“It has been 20 years of work with this compound, silibinin,” Agarwal says. “We first noticed its effectiveness in treating both skin and solid cancers, and we now have a much more complete picture of the mechanisms that allow this compound to work.”

Agarwal and colleagues continue to test the effectiveness of silibinin in cancer prevention and treatment in cell lines and mouse models, and are working toward human trials of silibinin-based therapeutics.

A University of Eastern Finland study showed that low serum vitamin D levels are a risk factor for pneumonia. The risk of contracting pneumonia was more than 2.5 times greater in subjects with the lowest vitamin D levels than in subjects with high vitamin D levels. The results were published in Journal of Epidemiology and Community Health.

The follow-up study carried out by the UEF Institute of Public Health investigated the link between serum vitamin D3 and the risk of contracting pneumonia. The study involved 1,421 subjects living in the Kuopio region in Eastern Finland. The serum vitamin D3 levels of the subjects were measured from blood samples drawn in 1998–2001, and these data were compared against reported cases of pneumonia in hospital records in the same set of subjects in 1998–2009. The results showed that during the follow-up, subjects with serum vitamin D3 levels representing the lowest third were more than 2.5 times more likely to contract pneumonia than subjects with high vitamin D3 levels. Furthermore, smoking constituted a significant risk factor for pneumonia. The risk of contracting pneumonia also grew by age, and was greater in men than women. At baseline, the mean serum D3 concentration of the study population was 43.5 nmol/l, and the mean age of the study population was 62.5 years.

Earlier research has shown that vitamin D deficiency weakens the immune defence system and increases the risk of mild respiratory infections. This University of Eastern Finland study was the first one to establish that vitamin D deficiency also increases the risk of contracting pneumonia in the ageing general population. According to the researchers, this finding supports earlier observations on the diverse role of vitamin D in the body, and it also calls for further research on vitamin D deficiency as a public health issue. In northern latitudes, there is enough sun exposure to maintain sufficient vitamin D levels in summer, but not during the winter season, and vitamin D supplementation is often required.

Time to adjust

When the Disease Management Care Blog recently visited Capitol Hill to advocate on behalf of tort orm, it couldnt help but notice that one Congressmans office wall was festooned with multiple pics of him with former Presidents Bush and Clinton. Their open-necked shirts and silly grins were quite the contrast with a single White House holiday portrait with a stiffly smiling Mr. and Mrs. Obama.

That particular photograph was hung off to the side.

Which is why the DMCB was not at all surprised by The New Yorker report about our Presidents remote and sterile governance style.   While we can take some comfort in his fact-driven decision making, the no-drama Obama methodology of coolly processing the underlying legal, policy and political strengths and weaknesses is quite a contrast from the messy, interpersonal, shifting, intuitive and maddening style of his two predecessors.

So it should also be little wonder that Mr. Obamas methodology can lead to remarkably legalistic decisions like trying Mr. Khalid in civil court, giving the EPA jurisdiction over CO2, signing the Dodd Frank legislation and embracing the Affordable Care Act (ACA). In each case, dissent was just a factor to be considered, disagreement a matter of misinterpretation and the decision the final product of reasoned judgment.

Which brings the DMCB to the Supreme Courts rude intrusion over the constitutionality of the ACA.  The DMCB thinks that a watershed moment in this POTUS-SCOTUS narrative was when the President berated the Supremes to their faces during the 2010 State of the Union address. While there may have been some political theater involved, it seems Mr. Obama was also genuinely annoyed that his manifest logic hadnt prevailed. After all, since his decision-making is so right, the judges must have been so wrong.

Unfortunately, many of Mr. Obamas supporters have taken that attitude to a whole new style of hubris. When the ACA passed and the Tea Partiers registered their initial objections over notions of constitutional liberty, they were dismissed as either wacky radicals or dullards incapable of understanding the enlightenment of a supremely rational system. Even when conservative lawyers began to swarm in the lower federal courts, the consensus was that theirs was poorly conceived long-shot that was motivated by bad ideology.  Even when the contrary lower court opinions began to accumulate, The Obama Posse et al showed no second thoughts.

What a difference three days makes. If the SCOTUS observers reports are any guide, the ACA opponents are within credible striking distance of overturning the mandate and gutting the entire law.

Which leads the DMCB back to Mr. Obamas holiday photograph.  As the SCOTUS imbroglio plays out, it is times like this when Presidents pause, lect, reconsider and adjust.  This is a time when doubt, second-guessing and what-did-I-get-wrong steps in.  Smart people learn from it and become better decision-makers.

While a gauge of that will not necessarily be a new informality portrayed in pictures on Capitol Hill office walls, the DMCB and other voters will be watching to see what the President and his supporters have learned from this. The DMCB will be on the look-out for a more flexible and nuanced accommodation of contrary points of view that may not fit with a scrubbed lawyerly and political calculus.

The DMCB thinks that will be the true measure of our 44th President. Whats more, thatll be how many other messy, interpersonal, shifting, intuitive and maddening Americans decide to vote for or against him this fall.

Oats may deserve the well-earned status of "super grain", according to research presented at the American Association of Cereal Chemists International annual meeting, being held this week in Albuquerque, NM. World-renowned grain researchers presented compelling data to support the important role that oats can play in improving diet quality and supporting human health.

YiFang Chu, Ph.D., PepsiCo R&D Nutrition, shared new data about antioxidants in oats (Avena sativa L.) and their role in human health. In the session, "Antioxidants in Grains and Health: Is there a Linkage?" Chu emphasized that oats are a nutritious whole grain with evidence to show that oats are even more complex than previously thought. They possess a wide spectrum of biologically active compounds including carotenoids, tocols (Vitamin E), flavonoids and avenanthramides – a class of polyphenols.

"The polyphenols, avenanthramides, are unique to oats and have been widely used in skincare products because of their anti-inflammatory and anti-itching effects," says Chu. "As scientists continue to link inflammation to chronic diseases, they are also investigating whether bioactivities produced by the polyphenols in oats can be as beneficial from within the body as they are on the skin." There are over 25 different biologically active avenanthramides in oats that look similar chemically, but behave differently. Theore, adds Chu, "compared to the bioactive compounds identified in other grains—like wheat and rye—oats may be more bioavailable and possess more anti-inflammatory properties."

In addition to avenanthramides, oats and oat products have many bioactive compounds that may provide health benefits. Oats and oat-containing products that meet a minimum level of oat beta-glucan are allowed to bear a Food and Drug Administration-approved health claim for cholesterol-lowering benefits. Studies also suggest oats can enhance satiety and may also help reduce the risk of other chronic conditions.

It’s the second full week of 2010. By now, you may be ten or eleven days into a resolution diet. You’re probably feeling really good about your progress. Chances are you lost a little weight. There’s a possibility you noticed a physical change already. You might even be thinking (and justifiably so): “I am the greatest person alive! Besides Eddie Vedder, I mean.”

Sadly, this may also have crossed your mind: “If eat one more salad, I’m going to set my face on fire.”

Sweet baby Jane, I hear you. When I began to change my eating habits, salads made up a big chunk of my diet. Office lunches were never-ending parades of the Caesar varietals (with light dressing, natch), and I got real tired, real fast of baby spinach. Then, I learned to cook and life got exponentially better. (Exponentially! That’s a lot.)

Anyway, once I started puttering around the kitchen, I realized the following:


With a creative topping, you can turn five ounces of pedestrian grilled chicken into a succulent celebration, a flavoral fooferaw, or even a scrumptious shindig. (Or any other gratuitously alliterative party.) Think of the meat as your canvas, and the accompaniment as your pretty rainbow paint of rainbows.

Take Gail Simmons’ Tomato and Avocado Salsa from Food & Wine, for example. You can use it as a dip for chips or veggies, sure. (The Super Bowl’s coming up, after all.) But on plain poultry, it becomes something else entirely: a tasty, filling, healthy dinner. Like almost all salsas, the recipe is staggeringly easy to make and constitutes a solid serving of vegetables. For $1 and 100 extra calories, that ain’t too shabby.

This week, when you’re choking down another round of Romaine, stop. Grab an avocado and a few grape tomatoes, grill a slice of chicken, and treat yourself to Tomato and Avocado Salsa. It’ll make the next few months a lot easier to stomach.

~~~
If you like this recipe, you might also dig:

• Guacamole-Bean Dip Mashup
• Mango Salsa
• Tomatillo Guacamole

~~~

Tomato and Avocado Salsa
Serves 4.
Adapted from Food & Wine.

1 1/2 cups grape tomatoes, halved or quartered
1 Hass avocado, diced small
1/4 cup onion, chopped small
1/2 small jalapeno, seeded and minced
1/8 cup cilantro, chopped
1/8 cup fresh lime juice
Kosher salt and freshly ground pepper

1) In a medium bowl, gently combine all the ingredients. Salt and pepper to taste. Stir again to combine. Serve on meat, chicken, fish, chips, cheese, or … anything, really.

NOTE: If you’d like a less chunky salsa, chop the tomatoes and avocado even smaller.

Approximate Calories, Fat, Fiber, and Price Per Serving
4 servings: 100 calories, 7.4 g fat, 3.7 g fiber, $1.04

Calculations
1 1/2 cups grape tomatoes, halved or quartered: 45 calories, 0 g fat, 0.1 g fiber, $2.50
1 Hass avocado, diced small: 322 calories, 29.5 g fat, 13.5 g fiber, $0.99
1/4 cup onion, chopped small: 13 calories, 0 g fat, 0.6 g fiber, $0.08
1/2 small jalapeno, seeded and minced: 9 calories, 0 g fat, 0.3 g fiber, $0.05
1/8 cup cilantro, chopped: negligible calories and fat, 0.1 g fiber, $0.25
1/8 cup fresh lime juice: 10 calories, 0 g fat, 0.2 g fiber, $0.25
Kosher salt and freshly ground pepper: negligible calories, fat, and fiber, $0.03
TOTAL: 399 calories, 29.5 g fat, 14.8 g fiber, $4.15
PER SERVING (TOTAL/4): 100 calories, 7.4 g fat, 3.7 g fiber, $1.04

Why do different insurers pay different amounts for the same service?  While Medicaid and Medicare are notorious for their take-it-or-leave-it fee schedules, competing commercial insurers payment rates for vary considerably across providers, even within the same region.

Uwe Reinhardt tackles this mystery in a just-published article in Health Affairs.  Not only is this “price discrimination” untidy, says he, it’s also been unfairly credited as being evidence of “cost shifting.”

It turns out that there are some credible studies that show that as public payer fee schedules get squeezed, commercial insurers seem to pay more.  Yet, in order for a cause and effect to be present, that would mean that providers are not acting in their own economic self interest and are waiting on Medicare and Medicaid before bargaining with their local managed care plans. To Dr. Uwe, that seems suspect.  That would mean commercial insurers have little negotiating leverage which would also mean that the U.S. cannot rely on them to control costs.  Yikes.

Compounding this untidiness are the big swings in the costs of goods and services in an opaque market that seems better suited to upside price gouging and not downside discounting. This is not only hurting the uninsured, the dysfunction is now reaching into the pocketbooks of the middle class.  No wonder Americans are grumpy about the cost of health care.

Dr. Uwe’s suggestion? An “all payer” system.  Not to be confused with a “single payer” system involving some sort of Obamaesque Price Czar, all payers would negotiate prices with all providers in regional blocks across counties, regions or even states.

Some of the European countries use this approach and so, by the way, does the state of Maryland.  The role of government would presumably be limited to brokering a yearly Big Meeting between representatives of both camps; in fact, government could make sure all parties agree to prices that are indexed to the GDP.  The result?  Patients would benefit from an average price applied equally to all, insurers would know they’re paying their fair share and best of all, hospitals would get a fair price for their services.

The DMCB likes the approach but suspects that politicians would be tempted to meddle by showing favoritism.   It would per to see it implemented at the state level while the Feds are kept at arms length.  It should be limited to hospitals at first.  Depending on how things work out, it could be tested on a trial basis involving physicians, such as the Patient Centered Medical Home.

Sam, over on the chat board, recommended rubbing petroleum jelly on your feet to protect them, as well as wearing comfortable socks that are "Not too tight in the ankles! Dont ever impede your circulation." This is great advice.

Foot problems are common complications of diabetes. Managing blood glucose is the best way to prevent them. But conscientious foot care ranks up there with BG control as necessary for staving off effects of nerve damage and poor circulation ... conditions at the root of foot problems for people with diabetes.

The National Diabetes Education Program (NDEP) list these tips:

- Check your feet every day.
- Wash your feet every day.
- Keep the skin soft and smooth.
- Smooth corns and calluses gently.
- Trim your toenails each week or when needed.
- Wear shoes and socks at all times.
- Protect your feet from hot and cold.

For more tips along with more specific care instructions, visit the NDEPs Foot Care site.

There are lots of reasons one might want to avoid dairy. One might be allergic. One might be vegan. One might be omnivorous but per dairy from happy, grass-fed cows, which can be expensive or hard to come by. One might be lactose intolerant and rationing those pricey lactase pills.

Or one might like that experimenting with non-dairy versions of usually-dairy meals can lead one to delicious dishes one might never have eaten otherwise.

A little of column A, a little of column B.

I ended up at creamed kale the other night by an internet/culinary odyssey – my original plan for cold sesame broccoli was thwarted by the fact that it was about thirty degrees outside, and maybe five cooler in my apartment. Next thought: cream of broccoli soup, but Leigh already has us covered there. So what else is in my fridge? Kale! Cream of kale soup? Creamed kale? I love creamed spinach – is creamed kale a thing?

Thank you, internet, because you showed me that it is.

(Have I ever mentioned how much I owe the internet for my cooking? Other people have cookbooks; I have a netbook and WiFi.)

I read a few recipes, and started to get an idea of how one might make creamed kale at all; creamed spinach, love of my life, has always come to me frozen in a little cardboard box. I eliminated recipes that called for whisking flour into broth, to keep things totally grain- and gluten-free. I found a recipe calling for a cashew cream for the sauce. That sounded intriguing, and while I didn’t have any cashews, I’ve been working through a bag of slivered almonds (after some unsuccessful almond meal pancake attempts) that could do with being polished off.

What’s amazing about this dish isn’t that it tastes like it’s made with dairy – it doesn’t. It’s saltier, more savory and complex, and, to be fair, not as smoothly creamy. But, and maybe even more excitingly, this dish is amazing in its own right. It scratches the creamed spinach/kale itch – hot, creamy, savory comfort food, totally addictive despite being packed with super-healthy greens – but without pretending to be something it’s not. The sauce is nutty and has a hint of oniony taste, not quite cream but just as good.

And I can save my lactase pills for the Seabrook Farms creamed spinach hanging out in my freezer. Maybe in February, when local greens are truly, totally gone. Late November? Still total bounty.

~~~

If you like this recipe, you might also enjoy:

• Kale with Mushrooms and Polenta
• Potato Leek Soup with Kale
• Vegan Ginger Cookies

~~~

Vegan Creamed Kale
(adapted from Whole Foods)
Serves 4


1 bunch kale, torn into smallish pieces (5-6 cups, torn)
1 medium yellow onion, diced
2 cloves garlic, minced
1 tablespoon margarine
1/2 cup vegetable broth (I used Better than Bouillon)
dash salt
1/3 cup unsweetened soy milk
2 tablespoon soy creamer (or more milk)
1 tablespoon lemon juice
1 teaspoon soy sauce
1/3 cup blanched, slivered almonds (or ½ cup whole raw almonds, or cashews)
1 tablespoon nutritional yeast
1/8 teaspoon red pepper flakes
1/8 teaspoon nutmeg
a few grinds of black pepper

1) Steam kale until bright green and tender, about four minutes. (You can also blanch it.)

2) Drain kale and rinse under cool water.

3) Melt 1 T margarine in a sautee pan over medium-high heat. Add onion and a dash of salt, and sweat until translucent, about five minutes. Add garlic; cook one minute more.

4) Combine onion mixture, broth, creamer, milk, lemon juice, soy sauce, almonds, nutritional yeast, red pepper flakes, and nutmeg in food processor or blender, or use an immersion blender, to puree smooth. Taste and adjust seasonings as needed.

5) Return mixture to sautee pan and simmer over medium-low heat until it thickens slightly, stirring often, about ten minutes.

6) Stir in kale and cook, tossing often, until kale is cooked and sauce is thickened to your liking, 5-10 minutes more. Top with ground black pepper.

Approximate Calories, Fat, Fiber, Protein and Price per Serving:
155 calories, 8.6g fat, 4.2g fiber, 7.2g protein, $0.83

Calculations
1 bunch kale (5-6 cups, torn): 184 calories, 2.6g fat, 7.4g fiber, 12.1g protein, $1.50
1 medium yellow onion: 42 calories, 0.1g fat, 1.8g fiber, 1.2g protein, $0.50
2 cloves garlic: 9 calories, 0g fat, 0.1g fiber, 0.4g protein, $0.04
1 T butter: 102 calories, 11.5g fat, 0g fiber, 0.1g protein, $0.13
½ cup vegetable broth (Better than Bouillon): 2 calories, 0g fat, 0g fiber, 0g protein, $0.05
dash salt: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
1/3 c + 2 T unsweetened soy milk: 35 calories, 2g fat, 1g fiber, 3.5g protein, $0.45
1 T lemon juice: 8 calories, 0g fat, 0.1g fiber, 0.1g protein, $0.07
1 t soy sauce: 4 calories, 0g fat, 0g fiber, 0.6g protein, $0.02
1/3 c blanched, slivered almonds: 207 calories, 17.8g fat, 4.4g fiber, 7.6g protein, $0.33
1 T nutritional yeast: 27 calories, 0.3g fat, 1.7g fiber, 3g protein, $0.19
1/8 t red pepper flakes: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
1/8 t nutmeg: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
a few grinds of black pepper: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
TOTALS: 619 calories, 34.4g fat, 16.6g fiber, 28.6g protein, $3.32
PER SERVING (Totals/4): 155 calories, 8.6g fat, 4.2g fiber, 7.2g protein, $0.83