Tips from gaining health

Sweet readers! Thanks very much for being so patient with us last week while we got drunk on Jagermeister worked on work-stuff. It was fun doing the wayback recipe thing - I hadnt looked at some of those in quite awhile, and it made me want lassis.

I had a different post set up for today, but instead, my entire body has been possessed by a zombie demon a nasty case of hives. So, instead of going to work and bringing home the bacon (mmm...bacon) like a boss, Im sitting at HOTUS computer, awaiting a swift and merciful end to my pain callback from the doctor. Its very exciting, unbelievably itchy, and also kind of weird, because this has never happened before, and I dont have any allergies, as far as I know.

And now theres one on my face. ARG.

Considering the circumstances, I figured this was as good a time as any to broach the subject of allergic reactions, especially since todays dish, Peanut Dipping Sauce from Catherine Walthers Soups + Sides, should not be eaten by those with an aversion to nuts (doy). For those without allergies, its an easy, relatively inexpensive sauce that pairs well with satay, vegetables, and dumplings, and makes for a nice changeup to straightforward soy sauce. One batch lasted us three different meals, and Id make it again right now if I wasnt furiously attempting to scratch my elbow off my body.

Anyway, back to that allergy thing. Its a topic weve covered only briefly here on CHG, but a very important one, since it affects the way some buy, prepare, bathe in, and consume food. I know several people with dairy issues, one or two with severe peanut allergies, and I grew up with a girl who was allergic to sugar. At the time, her condition seemed inconceivable and tragic (NOTE: I was eight), but now similar immune system reactions are pretty commonplace.

Happily, there are more foods and food products available for folks with allergies, though there can always be more. Well hit that topic in tomorrows Ask the Internet, but in the meantime: Do you have any food allergies yourself, or have loved ones with shellfish, nut, soy, or similar issues? How do you cope?

And with that, Im off to find a spiky hairbrush, so I may vigorously remove my epidermis. Happy Monday!

~~~

If this looks dang tasty, you will also find mucho happiness with:

• Aromatic Noodles with Lime-Peanut Sauce
• Chicken Fried Rice
• Peanut Butter and Jelly Oatmeal

~~~

Peanut Dipping Sauce
Serves 6
Adapted from Catherine Walthers Soups + Sides


6 tablespoons natural creamy peanut butter
½ cup light coconut milk
1 tablespoon soy sauce
1 tablespoon brown sugar
2 teaspoons fresh lime juice
1-2 teaspoon grated ginger
1/2 to 1 teaspoon sriracha sauce (optional)

Mix everything thoroughly in a small bowl until smooth. Add more of any ingredient to taste as needed.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
110 calories, 8.7 g fat, 1 g fiber, 3.9 g protein, $0.30

NOTE: These calculations are without sriracha.

Calculations
6 tablespoons natural creamy peanut butter: 540 calories, 48 g fat, 6 g fiber, 21 g protein, $0.62
½ cup light coconut milk: 75 calories, 7 g fat, 0 g fiber, 1.5 g protein, $0.85
1 tablespoon soy sauce: 8 calories, 0 g fat, 0.1 g fiber, 1 g protein, $0.09
1 tablespoon brown sugar: 34 calories, 0 g fiat, 0 g fiber, 0 g protein, $0.01
2 teaspoons fresh lime juice: 3 calories, 0 g fat, 0 g fiber, 0 g protein, $0.13
1-2 teaspoon grated ginger: 2 calories, 0 g fat, 0 g fiber, 0 g protein, $0.10
TOTAL: 662 calories, 52 g fat, 6.1 g fiber, 23.4 g protein, $1.80
PER SERVING (TOTAL/6): 110 calories, 8.7 g fat, 1 g fiber, 3.9 g protein, $0.30

Sweet readers! I apologize for being kind of AWOL this week. (No Wednesday article! Ack.) Wedding planning is starting to really kick in, and our world is slowly being consumed by strapless bras and canapés. How did people do this before Excel spreadsheets?

Still, it’s a strong round of links this week with various tutorials, a coupla neat new sites, and a dashing finale. (Hint: The Old Spice Guy is involved.) Enjoy!

1) Wise Bread: 50 Healthy Foods for Under $1 a Pound
Wise Bread wins. They just do. (Pic from Natalie Dee.)

2) Washington Post: Kentucky town of Manchester illustrates national obesity crisis
If you’ve ever wondered how obesity affects and why it prevails in small towns, this moving, in-depth account of Manchester is the piece to read. The line about the intersection will tell you just about everything.

3) Casual Kitchen: Knowing When Not to Be a Food Snob
Sadly, the anonymity of the interwebs often means we foodies come off like raving packs of Comic Book Guys. (“Worst. Recipe. Ever.”) When do we hold back? When is it okay to unleash our inner elitists? Dan uses a fairly recent piece by Ratio guy Michael Ruhlman to discuss.

4) Surviving and Thriving: A big meal plus leftovers for less than a buck. (Hint: Let others do most of the cooking.)
Donna Freedman waxes poetic about potlucks. Most helpful? This gem: “Deviled eggs are a big hit because everybody loves them and nobody likes to make them.” Truer words, never spoken.

5) Urlesque: Annoying Cooks on the Web – a Field Guide
The title is a tad misleading; it should really be “15 Reviewers You Meet on Community Recipe Sites.” My favorite, and the one that makes me most crazy: The Ingredient Switcher. To wit: “I hated this recipe! I followed the instructions to a T but instead of white flour I used cornstarch and I swapped the honey for chili powder. It was terrible"

6) New York Times: Hungry Girl Offer a Real Take on Diet Foods
NYT’s (first?) profile of Lisa Lillien echoes a running theme in almost all HG articles. The author is clearly wary of her endorsements and use of processed foods, but has to maintain a respectful tone out of deference to Lillien’s bagillions of followers. Despite that, it’s still one of the better Hungry Girl pieces I’ve seen.

7) The Kitchn
10 Things to Eat When You Return From Vacation
Quick, Easy Ways to Get More Vegetables Into My Diet?
You think you’re so cool, don’t you, The Kitchn? “Blah blah blah here’s another positive, incredibly helpful and thoughtful post with a bunch of pictures that put Ansel Adams to shame blah blah blah.” Yeah, we getcher point. Punks.

8) Kitchen Myths
Oodles of Alton Brown-type cooking myths, busted in no-nonsense style, presented ing Internet-circa-1996 style. I give this three Bill Clinton heads out of a possible four.

9) Marketplace: Farmers Market Guide – 20 Cities, Coast to Coast
Ooo … handy!

10) Bargaineering: How to Dry Fresh Herbs
Just in time! We inherited our friends’ CSA shipment this week, and it came with the most enormous bag of tarragon you’ve ever seen in your whole puff. Anyone for some Tarragon Pops?

HONORABLE MENTION

Jim’s Pancakes
Oh, yay! It’s amazing what you can do with a little food dye and some hungry children.

The Kitchn: Zucchini At Your Door? 12 Recipes to Help Eat It Up
Again? Again with the practical deliciousness? Harrumph.

Promo Machine UK: Discount Design - 23 Fantastically Vintage Coupons
Who wants $0.07 off a box of Life cereal?

Village Voice: Americans Getting Too Fat for Theater Seats
Hey! We’re still fat! Whee! On a related note: Has anyone seen Twilight: Eclipse? My sister and I have three questions:

1. Why are these two supernatural, smokin’ hot dudes fighting over The Most Boring Woman in the World?
2. Why is being turned into a vampire so bad? You live forever, receive awesome powers, and still get to have sex. I don’t see the downside here.
3. Where was the eclipse?

AND ALSO

New York Times: On Facebook, Telling Teachers How Much They Meant
God, I love this story. Mr. Leogrande, this one’s for you.

BoingBoing: Goodbye Old Spice Guy
I will miss you most of all. SWAN DIVE!



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!

You can wreck your back in any number of ways, but a few major offenders stand out: Not stretching, not paying attention to your movements, and years of wear and tear, says Nick Shamie, MD, associate professor of orthopedic neurosurgery at UCLA and a spokesman for the American Academy of Orthopaedic Surgeons.

Here are five habits that put your spine at risk and simple strategies to stop them before the damage is done.
Back Wrecker #1: Weekend Warfare

"Most often, I see people who injured themselves during a weekend basketball game or a round of golf," Shamie says. "These people think theyre athletes, but dont train like the pros, and as a result, their backs suffer."

Tackling those "Honey Do" lists at home can also set you up for injury, especially if you were idle for most of the week. Cleaning out the garage, bending over a workbench, or spending hours in the yard or garden can be just as hard on your back as anything you do on a playing field.

"Like any other part of the body, the back is likely to be injured if you havent warmed up or stretched," Shamie says.

Prevent it: "The only preventive solution Ive found for back pain is exercise," says Michael Hisey, MD, orthopedic surgeon and president of the Texas Back Institute in Denton, Texas. "The fix is to stretch and strengthen your core muscles."

The obliques -- the abdominal muscles on your sides -- are especially important for back stability, Hisey tells WebMD.

Hiseys tip: Get an inflatable exercise ball. Use it in your workouts and sit on it, instead of a chair, to engage your abs.
Back Wrecker #2: Poor Lifting Technique

"Improper bending and lifting causes back injury; thats all there is to it," says Dan McMackin, a spokesman for UPS.

Prevent it: Engage your abs to help support your back. Here are the basic principles that UPS uses for safe lifting, according to McMackin:

    * Bend your knees and keep your back straight. Dont bend at your waist.
    * Keep the object close to you. The farther away you hold it from your body, the more it stresses your back.
    * Never hold an item higher than your armpit or lower than your knees.
    * Dont move something that weighs more than 20% of your body weight.
    * Dont pivot, twist, or turn while lifting. Point your feet at the item youre lifting and face it as you pick it up. Change direction with your feet, not your waist.

Back Wrecker #3: Absentmindedness During Daily Activity

Simple tasks like taking out the trash or washing the dishes can get your spine bent out of shape if your body isnt ready.

Back Wrecker #3: Absentmindedness During Daily Activity continued...

"The movement doesnt necessarily have to be exaggerated or involve a heavy object," Hisey says. "You can hurt your back grabbing a paperclip off the floor or loading the dishwasher."

And if your mind is running on auto-pilot instead of focusing on what youre doing, you could be in trouble.

"At UPS, weve seen a higher proportion of injuries occur at the end of the shift, due to fatigue of the mind and body," McMackin says.

Prevent it: Train yourself to keep your core muscles engaged.

A simple way to do that is to pull your navel toward your spine and imagine youre wearing a corset that pulls the sides of your abs inward. Doing that throughout the day -- and especially when lifting or bending -- strengthens and supports your back, says Esther Gokhale, author of 8 Steps to a Pain-Free Back and owner of Ester Gokhale Wellness Center in Palo Alto, Calif.
Back Wreckers #4 and #5: Commuting and Computing

You sit, and you sit, and you sit some more -- at work, while driving, and in front of the TV. And your back doesnt like it. Heres why.

Your discs are spongy and cushion the vertebrae in your spine, but discs have poor blood supply, Hisey says. When you move, fluid circulates through the discs. When you sit still, the fluid is wrung out, so youre depriving discs of nutrition, he says. Spending so much time behind the wheel of a car or sitting in front of a computer adds mileage to our discs, which leads to stress in your back.

"The discs in your spine are nourished by motion," Hisey says. "So sitting still is hard on your back and neck, and can do long-term damage." Studies have also shown that sitting puts more pressure on your spine than lying down or standing up.

"The worst posture is sitting and leaning forward," Shamie says. This makes you lock your pelvis and flex your spine, putting pressure on the front of the vertebrae, where your discs are. The more you arch forward and exaggerate the curve of the spine, the more pressure youre putting on your discs. "This uneven pressure on a disc puts it at high risk of rupture," Shamie explains.

Prevent it: Youre going to sit. So try these tactics to lessen its impact on your back:

    * Get up and move at least once every 20 minutes, unless youre driving. Set your screen saver to remind you; make a habit of going for a drink of water; when you answer the phone, stand up to stretch and change positions.
    * Keep your spine properly aligned by holding reading material at eye level (when sitting or standing) rather than bending over. Dont lean over a desk or table to work. Whenever possible, your spine should be straight.
    * Choose a chair that supports your back. Adjust the chair so that your feet stay flat on the floor. If the chair doesnt support your lower backs curve, place a rolled towel or small pillow behind your lower back. Remove anything from your back pockets, especially a wallet, if youll be seated for long periods of time because this puts your spine out of alignment.

Gokhale suggests doing the following exercises to help lengthen your spine:

    * Get on your hands and knees. Reach your left arm straight ahead and straighten your right leg behind you. Use your stomach muscles to stabilize. Hold for 5-10 seconds and slowly return to starting position. Switch arm and leg. Repeat 3-5 times on each side.
    * Sit tall, lengthen your spine, and let your shoulders relax. Concentrate on squeezing your shoulder blades together, keeping your arms hanging at your sides. Hold for 3-5 seconds, then release. Repeat 10-20 times.

 If All Else Fails

The experts interviewed for this story all told WebMD that most back pain should abate with in 48 hours with a nonprescription pain reliever. But in some cases, your pain could require urgent care.

You need immediate attention if you suffer any loss of bladder or bowel control with your back pain, Hisey says. This is associated with a disc thats pressing on nerves and the faster you relieve the pressure, the faster the function returns.

"Most back pain wont radiate below the waist," Shamie says. "If you feel pain in the thighs or knees, you likely have a disc herniation causing nerve compression." Seek medical attention to ensure there isnt more serious damage.

If your back pain keeps coming back, see a medical professional. You may have begun to rupture a disc or have another injury that could require treatment. "The older you are, the quicker you should get to a specialist.

Research published in the prestigious journal Diabetes Care (published by the American Diabetes Association) suggests that two ounces of nuts consumed daily when substituted for ined carbohydrate foods can prevent diabetes and the deadly complications caused by the disease. Researchers found that nuts eaten as part of a healthy diet can lower serum blood glucose and lipids to lower long-term blood sugar control as measured by the HbA1C blood test. Grab a big handful of almonds, walnuts, pecans or macadamias to ward off diabetes and metabolic syndrome, devastating conditions currently evolving to threaten human health and longevity.

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

Spend an afternoon perusing family-oriented frugality blogs, you’ll discover there are a few recurring themes. Among them: yard sales, thrift store shopping, a widespread love of free shampoo, and of course, weekly menu planning.

Menu planning, it’s argued, will streamline evenings in the home. Ma and Pa are saved money, time, and mounds of frustration because they know what the brood’s having for dinner days ahead of time. There’s no scrambling in the kitchen or supermarket, since both shopping and cooking are ined to a science. Kids (sometimes) get to have a say in what they eat, too, which makes the whole thing a family activity rather than merely a parental chore.

All in all, it’s a fantastic strategy. Even better, EVERYBODY can use it.

See, while weekly menu planning for non-families is a rare topic around the blogosphere, it’s just as monumentally helpful for post-collegiates, office workers, struggling singles, and young couples. It even offers extra benefits, mostly involving time management. Like:

• You’re saved from 8pm post-work dinner freakouts, because dinner is ALWAYS planned.
• Ingredients are guaranteed to be on hand.
• Cooking goes much faster, since you go in knowing how to prepare a meal (by instinct or through print-out recipes).
• You eat healthier, as home-cooked meals are generally much more nutritious than calorie-laden takeout or heat-and-eat dinners (Hot Pockets, Hungry Man, etc.).
• Grocery shopping goes waaaaay faster. You go in knowing exactly what you want, and don’t have to blow an extra half-hour wandering around. Case in point: last night, using my weekly menu plan, I did all my shopping in 59 minutes, door to door, WALKING. In that time, I hit two stores, the further of which is about a half-mile away. Woo!
• Extra trips to the grocery store are mostly eliminated.
• You can plan for leftovers for office lunches. This is huge, personally speaking, because turkey sandwiches get tired 40,000 times in a row.
• You always have food for those bag lunches (the night before, no less), saving you $30 per week, or around $1500 per year.
• For budgeting purposes, you can pretty much estimate the cost of your bill to the dollar.
• There’s less food waste, because you’re buying only what you need.
• It allows for variety during the week, since you’ve got all the ingredients on hand anyway.

But how to begin? How do you organize this stuff? How do you create a weekly menu and grocery list without it taking a billion, gazillion years?

The answer: I don’t know. Everybody has their own system, based on what works best for them. But here’s what The Boyfriend and I do currently:


STEP 0
Create a new word document
This is what you’ll be typing, cutting, and pasting to. It’s much easier than writing everything down, and at the end, you can print out the grocery list, weekly menu, and recipes all at once.


STEP 1
Make a quick grocery list of what you need
What groceries are running low? What foods do you eat regularly from week to week? This is my most recent list:

Cereal
Cumin
Deli ham or turkey (for lunches)
Eggs
Fruit (for breakfast and lunch)
Meat (general)
Yogurt (for lunches)


STEP 2
Brainstorm the dinners you want to eat this week
New dishes? Old favorites? Seasonal experiments? Whatever you’re in the mood for, list ‘em here, with special attention paid to food you need to use up before it goes bad. This is also a good time to take a cursory glance at your local online circulars. Entire menus can be built around loss leaders (biggest bargains).

This week, our dinner list includes:

• Chickpea and Bread Soup from the Kitchn
• Spinach Rice Casserole from Tammy’s Recipes
• Brunch Clafouti from Serious Eats
• Spiced Chicken with Tangerine Sauce from Cooking Club
• Curry Cauliflower Soup with Honey from Sunday Nite Dinner
• Pasta with veggies
• Turkey burgers with rice and frozen veggies

For the sake of convenience, cut and paste each new recipe IN ITS ENTIRETY into your document. That way, you can print it up and consult it when you’re cooking.

(Note: I cook a lot of new dishes for both Serious Eats and CHG, so chances are your list will be a lot less complicated.)


STEP 3
Make a rough menu
Based on what you have in the fridge, what you’re planning for the week, and what you usually have, create a weekly menu. Take care to note when you won’t be home for a meal. Yours can be simple or complex, but I might start off pretty low-key until you get the hang of it. Heres ours:

WEDNESDAY
Lunch: sandwich, leftovers yogurt, Kix, fruit
Dinner: Spinach Rice Casserole with leftover Irio

THURSDAY
Lunch: Leftover casserole, salad, fruit, yogurt
Dinner: The Boyfriend OUT; Me - Chickpea and Bread Soup w/asparagus

FRIDAY
Lunch: Leftover soup and/or casserole or sandwiches, fruit, yogurt
Dinner: Both OUT @ comedy show

SATURDAY
Brunch: Brunch Clafouti
Dinner: Both OUT @ friends’ house for dinner

SUNDAY
Brunch: Omelets, toast, and fruit
Dinner: Spiced Chicken Breast w/tangerine Sauce and Cauliflower-Honey Soup

MONDAY
Lunch: Leftovers, crackers, fruit
Dinner: Pasta with veggies

TUESDAY
Lunch: Sandwiches, popcorn, fruit
Dinner: Turkey burgers with rice and frozen veggies

(Note: 90% of our weekday breakfasts consist of cereal [or homemade whatever], so we don’t list them. Also, we keep our beverages limited to coffee, beer, and water. This way, we’re always awake, tipsy, and hydrated, just the way we like it.)


STEP 4
Add additional ingredients to the grocery list
Now that you have a concrete menu, add your new needs to the foods you listed in STEP 1. Mine are at the bottom here, for the recipes I plan to make:

Cereal
Cumin
Deli ham or turkey (for lunches)
Eggs (for Clafouti and otherwise)
Fruit (for breakfast and lunch)
Meat (general)
Yogurt (for lunches)
2 15-oz. cans chickpeas (for Chickpea Soup)
4 cups beef stock (for Chickpea Soup)
2 cups low-sodium chicken stock (for Cauliflower Soup and Tangerine Chicken)
3/4 a baguette (for Chickpea Soup)
9 or 10 ounces fresh spinach leaves (for Casserole)
1 1/2 cup fresh fruit (for Clafouti)
4 boneless skinless chicken breast halves (for Tangerine Chicken)
1/2 cup tangerine juice (for Tangerine Chicken)
2 tangerines (for Tangerine Chicken)


STEP 5
Go through circulars (thoroughly this time)
Now that you have a general plan, comb your online (or paper) circular for sale items corresponding to your list. If you have coupons, this is a good time to see if there are any good discounts.

One more thing: if you see something you love but don’t need on mega-sale, go for it. For example, I don’t NEED red peppers this week, but I use them frequently for salads, pastas, and whatnot. So, I’ll probably pick up a few because $1.99 is a good price. If beans were on sale, I’d be all over that, too. But they’re not. Boo.

This week, this was on sale from my list:

SUPERMARKET #1
Chicken Breast - $1.69/lb (for Tangerine Chicken)
Bananas – 2lb/$1 (for breakfasts/lunches)
La Yogurt – 2/$1 (for lunches)
Oranges – 8/$2 (for breakfasts/lunches)
Red Peppers - $1.99/lb (for whatever)

SUPERMARKET #2
Cantaloupe - $0.99/ea (for breakfasts/lunches)
Blueberries - $1.99/6oz (1-1/2 cups for Clafouti)
Eggs – 2/$3 (for Clafouti and otherwise)


STEP 6
Finalize the list
Okay, stocks weren’t on sale. Neither were tangerines, chickpeas, baguettes, cold cuts, or spinach. So now, I assign them to a grocery store that I think will have the lower price.

In the end, my list looks like this:

SUPERMARKET #1
Chicken Breast - $1.69/lb (for Tangerine Chicken)
Bananas – 2lb/$1 (for breakfasts/lunches)
La Yogurt – 2/$1 (for lunches)
Oranges – 8/$2 (for breakfasts/lunches)
Red Peppers - $1.99/lb (for whatever)
2-15 oz. cans chickpeas (for Chickpea Soup)
2 tangerines (for Tangerine Chicken)
1/2 cup tangerine juice (for Tangerine Chicken)

SUPERMARKET #2
Cantaloupe - $0.99/ea (for breakfast and lunch)
Blueberries - $1.99/6oz (1-1/2 cups for Clafouti)
Eggs – 2/$3 (for Clafouti and otherwise)
Cereal
Cold cut ham or turkey (for lunches)
4 cups beef stock (for Chickpea Soup)
2 cups low-sodium chicken stock (for Cauliflower Soup and Tangerine Chicken)
3/4 a baguette (for Chickpea Soup)
9 or 10 ounces fresh spinach leaves (for Casserole)

(Note: I get cumin in bulk from an ethnic grocer on the walk home, so it’s not included here.)

~~~

And that’s it. Now, after only 40 minutes of planning, I have an exact grocery list AND menu for the whole week. Plus, I’m guaranteed to save money on sale items, prepare healthy foods, and have plenty to bring to the office. And that’s good for everyone involved.

Readers, how about you? Do you menu plan? What’s your plan like? How might you change this one? Fire away in the comments section.

Looking through the MRI

In a prior posting, the Disease Management Care Blog was reminded that the U.S. health care system  is exceptionally complex and non-linear. Thanks to its many overlapping, contradictory, shifting and often non-medical inputs, it defies the simple logic of a single-cause-leading-to-a-single-effect. If economics is the dismal science, health care economics is its dubious spawn.

However, that doesnt mean that multiple coordinated inputs combined with some good luck wont push the health care weather vane in the right direction. For the latest example of this fundamental truism, check out David Lee and Frank Levys Health Affairs article The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause.

By way of background, medical imaging has been a high profile issue for policy makers and a headache for insurers because, until recently, the rate of costly "high dollar" imaging studies has been growing much faster than other medical costs.  It has been blamed as one technology-laden driver of health care inflation.  In the meantime, physicians have pointed to a variety of causes (and, by the way, left others unmentioned).  

In this study, the authors examined 10 years worth of insurance claims for advanced imaging MRI and CAT scans from two multi-state commercial insurance plans and another smaller single state plan.  These data were then pooled with a 5% national random sample of imaging claims from Medicare beneficiaries.  The authors also interviewed radiologists, health administrators, radiology benefit managers and physician recruiters.

The results?  From 2000 through 2005, CT scans grew at a whopping rate of 14.3% but then slowed to 1.4%. MRI slowed in the same periods from 14% to 2.6%. At the same time, starting salaries for radiology specialist physicians significantly declined.
 
What happened?  According to the authors:

1. An industry sprung up.  In another example of the adage that "need is the mother of invention," companies that prior authorize imaging studies for medical necessity (for example) were hired by many commercial insurers.  They had an impact.

2. Skin in the game. Deductibles, co-insurance and co-pays made consumers think twice about agreeing to a study that was going to result in some out-of-pocket spending.

3. Unilaterally imposed fee reductions. Medicare cut the amount it paid for CAT and MRI studies performed in freestanding centers and physicians offices. Hospitals were left untouched.

4. Glow in the dark.  Media reports on the amount of radiation prompted patients to worry about the long term impact of all those x-rays.

In other words, there was no single lever. Instead, the reduction of high utilization of pricey imaging was due to the confluence of at least four mutually reinforcing trends.

As further evidence of the overlapping trends that extended beyond simple cause-and-effect, Medicare never relied on prior authorization, didnt alter the out of pocket testing expenses for beneficiaries and left the payments for hospital-based imaging untouched. Yet Medicare saw an across-the-board reduction. MRIs dont involve ionizing radiation (they use relatively harmless magnets), but their overall rate went down in concert with CAT scans..

This has important implications for other laudable policy targets.  Based on this experience, waiving out of pocket costs alone are unlikely to increase the use of preventive health care services. Simply paying for the medical home may not make that big a difference.  Quoting the DMCB may not be enough to convince your skeptical friends.  So on and so on.

The obvious implication for the population health management service companies is that if theyre going to have a significant impact, the likelihood of a successful outcome is far greater if it is implemented concurrently with other supportive interventions.

The human body is well adapted to deal with short-term stress, but if it remains on orange alert for an extended period of time, you can grow vulnerable to some serious health problems. Heres how major systems respond to your worries.

NERVOUS

The "fight or flight" response begins here: When youre stressed, the brains sympathetic nerves signal the adrenal glands to release a chemical variety pack, including epinephrine (aka adrenaline) and cortisol. Persistently high levels of these chemicals may impair memory and learning, and up your odds for depression.

ENDOCRINE

Stress hormones trigger the liver to produce more blood sugar, to give you that kick of energy in the moment of perceived danger. But if the "danger" youre concerned with is a long-term dilemma and youre already at risk for type 2 diabetes, bad news: Elevated glucose levels may turn you into a card-carrying diabetic.

RESPIRATORY

At high-stress moments, you may find yourself breathing faster, feeling short of breath, or even hyperventilating. Over the long term, this strain on the system can make you more susceptible to upper-respiratory infections (so if youre considering a career in air-traffic control, you might want to stock up on Emergen-C).

CARDIOVASCULAR

Momentary, acute stress, like, say, when youre walking down the aisle to get married, will make your heart beat faster and blood pressure rise. Long-term stress, like unwelcome pressure from the folks to produce offspring, can cause narrowing of the arteries and elevate cholesterol levels, upping your chances of heart disease, heart attack, and stroke.

REPRODUCTIVE

Stress can lengthen or shorten your menstrual cycle, stop it altogether, or make your periods more painful. High levels of stress make bacterial vaginosis (BV) more likely and, during pregnancy, may increase the chance of your babys developing asthma or allergies later in life. Bring on the prenatal yoga.

IMMUNE

Short-term stress can actually boost the immune system, helping your body fight infection. Ongoing stress, however, turns things in the other direction, possibly slowing wound healing, leaving you more susceptible to infection, and worsening skin conditions such as eczema, hives, and yes — acne.

DIGESTIVE

Extreme stress isnt unlike the morning after a bender. It can cause dry mouth, indigestion, nausea, and gas, and it stimulates the muscles of the intestines, possibly causing diarrhea or constipation. Have these symptoms chronically, and you may increase your risk for irritable bowel syndrome, severe heartburn, and ulcers.

MUSCULOSKELETAL

Muscles tense to deal with what your body perceives as danger. No one whos pulled an all-nighter with only PowerPoint for company will be surprised that constantly tight muscles can cause headaches and neck, shoulder, and back pain. Chronic stress may also increase your likelihood of developing osteoporosis.

Last week, Bristol-Myers Squibb decided to halt development of its promising new diabetes drug, Pargluva^TM (muraglitazar).

You may recall the news last September when an FDA advisory panel recommended the drug for approval. You may also recall an article in the Journal of the American Medical Association (JAMA) a month later that warned of Pargluvas link to increased risk for heart attack and stroke.

If approved, Pargluva would have become the first marketed drug in a relatively new class of compounds called glitazars. These drugs not only lower glucose, but can improve cholesterol levels. Both of these benefits were documented in a study appearing in this months Diabetes Care which pitted Pargluva against a similar drug, Actos (pioglitazone).

In light of possible health risks associated with Pargluva, the FDA last year requested more information on the drugs cardiovascular safety profile. Bristol-Myers Squibb decided that the time required to run additional safety trials, up to 5 years, would not be worth the effort - given the diabetes drugs projected to become available in the coming years.

________
For Bristol-Myers press release:
Bristol-Myers Squibb Announces Discontinuation Of Development Of Muraglitazar, An Investigational Oral Treatment For Type 2 Diabetes

For the Diabetes Care, May 2006 study (abstract only):
Improvement of Glycemic Control, Triglycerides, and HDL Cholesterol Levels With Muraglitazar, a Dual (/) Peroxisome Proliferator–Activated Receptor Activator, in Patients With Type 2 Diabetes Inadequately Controlled With Metformin Monotherapy

For our September 2005 post:
New Diabetes Drug Gets FDA Panel Backing

For our October 2005 post:
Pargluva^TM on Hold

Some news summaries:

New Drug Helps with Diabetes Control (Reuters)

Bristol Drops Diabetes Drug (New York Times)

Making her CHG debut, please welcome todays guest blogger, Amy Dickenson. Amy is an actor, writer, producer, and mom to the cutest baby girl in the five boroughs.

Forty. Forty is the new 30, right? Well, in my house, 40 is starting to look like the new 60. My gorgeous husband and I have recently been diagnosed with high blood pressure and high cholesterol—hypertension and hypercholesterolemia, to be fancy, like certain cheeses which I love and will never be able to eat again.

Photo: Jami Dwyer via Flickr

Let’s jump in the Crisco Time Machine. It all started 18 years ago when our courtship took a decided slant toward biscuits slathered in butter and jam. Have you ever tasted butter? It’s like a miracle married to a unicorn wrapped in a rainbow. Much like its cousin, bacon, which is a miracle married to a unicorn dipped in chocolate, butter’s not so good for your arteries. But it was the early ‘90s and we didn’t know about cholesterol and vegetables back then. Did we?

Back in the time machine to August 2010. My cholesterol is 254. WHAT? I am not a high-falutin’, pin-stripe-wearin’ banker chugging scotch, smoking stogies, eating aged porterhouse steaks with my big wig partners, guffawing over “that deal” that made “lots of money” while flashing my newly laminated AARP card. I am a working mom. I eat veggies. I make sure my family gets a salad at least once a day. So, what gives? And why is my husband’s blood pressure 180/2 million?

My husband (let’s call him Adam) and I do not agree all the time (shocking) but we do agree on one thing: We want to be around for our baby daughter’s graduation from college. And her wedding. And her babies. And their graduations from college. Even if she doesn’t get married or go to college, we want to be around to lament those things.

She is worth all the broccoli in China. And I know they have tons, because, let’s face it, nobody ever eats that side of bright green buried under the General Tsao’s chicken. I imagine the Great Wall as an agricultural implement built to contain the cruciferous invaders from the steppes of central Asia. They must love it as much as I do.

Photo: La Grande Farmers Market via flickr

Our daughter, however, loves broccoli (a secret point of pride), and for now, she needs us to make it for her. Time to act.

Adam’s doctor put him on the First Line Therapy diet. Mine gave me a prescription cholesterol reducer, a pharmaceutical of the most common side effects reported are headache, muscle pain, abdominal pain...variety.

One of the scariest side effects I read about is birth defects. Since Adam and I are “not not trying” to have another baby, the meds are sitting on my desk, looking forlorn while I debate whether to take it. Or I could give this First Line Therapy diet a try too.

Adam and I are fly-by-the-seat of our pantsers, not planners. I love to cook, but I have been known to open the freezer at 5 pm and stare blankly for three minutes before I reach directly above it for the takeout menus. (OK, the restaurant numbers are in my cell phone.)

How do two nonplanners plan to be healthy, live longer, and learn about nutrition on a diet that requires grocery shopping in advance of the moment we might need said ingredients?
I started by reading the cute little binder Adam got from his doctor. It has menus, recipes, and tips like pretty much every other diet book. I thought, “Hmmm. This looks really great.” And I said to Adam, “Babe, this is really great.” And then I put down the book and we ordered chicken ceasar wraps with feta from Zorba’s. Because you can have fat-free feta on this diet. (Zorba’s doesn’t have fat-free anything.)

Oh I needed a PLAN. I gave myself a goal of meal planning for three days. My mind can grapple with Sunday, Monday and Tuesday just fine. I didn’t want to get too ambitious and hope for a week.

First Line Therapy (FLT) is basically the reduced-carb, high-veggie, lean protein, healthy fat diet that we have all read about, tried, and maybe succeeded at. It’s similar to the South Beach approach or the Mediterranean diet…or Weight Watchers if you do it right.

You aim for a set number of calories per day within a certain set of food groups. For instance, Adam can eat 2000 calories a day, and this is how they break it down:

Servings per Day
3–4 “Category 1” veggies (the green leafies, the zucchinies, the tomatoes, the peppers, etc.)
2 legumes
1 dairy
3 concentrated proteins
2 fruits
4 healthy oils
1 nut
1 grain
1 “Category 2” veggie (the yummy orange ones)

You can read more about FLT here, where people are dangerously perched on two-wheels or here, where they weigh giraffes. I per the giraffes.

Among the many challenges of embracing FLT is that it’s kinda pricey. They recommend you eat what they call “medical food,” which includes Ultra Meal 360 Plus shakes with delicious "Selective Kinase Response Modulators,” twice a day and take a variety of supplements. You can indulge in medical chalklate, medical chalkberry or medical chalknilla flavored shakes, which you mix with cold water. Or you can get purse-friendly bars in flavors approximating fudge or apple cinnamon. (We have yet to try the apple cinnamon bars or strawberry shake flavors.) If there is a cookie variety, they are holding out on us.

“Medical food,” in combination with the cost of fresh produce, was looking a little forbidding until we looked at our daily Starbucks intake—$10 easy for both of us, which adds up to over $3600 a year. If we cut that out, along with our takeout habit, we could maybe swing this thing.

I comparison shopped at our local grocery store vs. the health food store vs. the farmer’s market. A head of lettuce at our grocery store costs around $3. I never used to buy a head of lettuce that I’d have to cut up and WASH and spin and hang to dry. It’s like doing laundry. Especially when have these cute little plastic boxes of cut up, triple-washed lettuce. But, they’re $4.99 a box. And, if truth be told, we usually throw away about 1/3 of it when the purple leafy things get all slimy. Hmmm… I see savings in my salad spinner.

The farmer’s market had locally grown lettuce for (drum roll please) $2! And it doesn’t come in those plastic shells which I always feel guilty about buying and tossing. So, not only am I supporting local growers, I can get my green on too? I’m sold. Or least sold on Wednesdays. Because that’s the only day the farmers market comes to my area.

To fill out the week, I decided to go for Romaine hearts at my grocery store, saving roughly $4 a week. Over a year, that’s $200. Which means I can buy those fancy Omega-3s FLT recommends we take. Or the “Medical food,” which is $50 a canister for 14 servings. OUCH, but remember the lettuce. Remember the lettuce!

Here is my 3-day plan:
Breakfast: a medical food shake, plus 2 eggs – anyway you like ‘em
Snack: fruit with a nut butter (Almond butter is pricey, but a little goes a loooong way. Plus, you can only have 1 tbsp.)
Lunch: here’s where the planning kicks in…yesterday’s dinner leftovers
Snack: another fruit
Dinner: a recipe from Adam’s cute binder and a salad
Snack: another medical food (This stuff is pricey.)*

Sunday’s dinner was turkey chili from the book (surprisingly delicious); Monday’s dinner was salad with grilled chicken breast; and Tuesday’s dinner was turkey and bulgur with peas (also yummy).

Not only did we have plenty of chili for lunch, I actually froze two servings for another day. The bulgur recipe looks like it might be another loaves and fishes story. I have never cooked bulgur, which I had to get at my health food store, but it was only $4 for a bag that will last me until the Buffalo Bills win a superbowl.**

Now I have to take a deep breath because today is Wednesday. And I have to plan again. But I did it THREE DAYS in a row. And I think I can, I think I can, I think I can… I talked to my doctor about Adam’s FLT diet, and he asked how it was going. “Well, it’s challenging, figuring out how to cook and plan and get all the food groups in.” He said, “That’s what it is. It’s practice.”

Hmmm... Practice. I can do that.


*According to the American Heart Association, in 1995, the last yearly figures they publish, there were 1,460,000 angiograms performed at an average cost of $10,880 per procedure. This resulted in 573,000 bypass surgeries at an average cost of $44,820, and 419,000 percutaneous transluminal (balloon) coronary angioplasties (PTCAs) at an average of $20,370 each. The total bill in 1995 was $50 billion, or $137 million per day―$5.7 million per hour. The total annual cost of cardiovascular disease in the United States, including medications and disability, is approximately $274 billion per year. And that was in 1995. When we were slathering butter on our biscuits. Good grief.

**Adam and I proudly hail from Buffalo, NY.

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How to Lose Weight and Keep It Off: 10 Rules to Live By
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Why Weight Maintenance Is Harder Than Weight Loss, and How to Help It Along

The Disease Management Care Blog is still waiting to be listed in the CMS "clear accurate information is essential in times like these" Op-Eds & Blogs web page.  Will the CMS mandarins find favor with this particular DMCB post and include it with the other insightful masterpieces theyve linked, like "Health Reform Helps Many" and "Public Service Recognition Week?"

Probably not, says the DMCB.  Its not because the DMCB is again linking this report showing how CMS seems to be incapable of delivering disease management services to its fee-for-service enrollees.  Its not because of this report revealing how Medicares Hospital Compare isnt having much of an impact on outcomes.

Its because the DMCB is bringing up the inconvenient truth of this independent evaluation of Medicares Premier Hospital Quality Incentive Demonstration. This demo tested whether pay for performance can increase the quality of care for acute heart attack, chronic heart failure, pneumonia, heart bypass surgery and total knee as well as hip replacements.  33 measures for these conditions were collected from 252 participating hospitals. The hospitals that scored in the top measurement deciles received bonus payments, while those that were underperforming were hit with a payment penalty.

Think of it as "pay-for-performance" for hospitals.

After excluding hip and knee surgery (where mortality rates are very low), the researchers were interested in measuring whether the Premier Incentive Demo was associated with one of the most important outcomes of all: lower death rates. Based on 6 million patients worth of data from 2002 through 2009, the researchers found that there was no difference in overall 30-day mortality rates for all of the four conditions compared to non-demo hospitals (11.8% vs. 11.7%). In addition, mortality rates for the individual conditions of heart attack, heart failure and pneumonia were no different either. For heart surgery, there was a slight excess of deaths in the Premier group (4.1% vs. 3.3%).

These results are quite a contrast from this Premier press release that estimates that the Demo "saved an estimated 6500 heart attack patients." The DMCB suspects that that particular number was derived and extrapolated from prior studies linking less tobacco cessation or greater aspirin use to improved death rates.

It seems the math may have been wrong. And it was that same math that led the architects of the Affordable Care Act to establish the Medicare Hospital Value-based Purchasing Program ("Hospital VBP"). As the DMCB understands it, its just now getting underway.

Egads.

Go to this particular HHS web page and youll find that the Department....

"...monitors and evaluates programs to assess efficiency and responsiveness and to ensure the effective use of information in strategic planning, program or policy decision making, and program improvement."

Hopefully, the leaders at HHS will be doing precisely that by reexamining its assumptions and its ability to achieve real value with the Hospital VBP.

When youre in the midst of a week of high-90s days, as New York City is now, it is very easy and tempting to have all meals catered by The Messrs Ben and Jerry.

“Theres no cooking,” you say. “Im saving electricity and gas by not turning on my stove! And ice cream has dairy and protein and dark chocolates antioxidants!”

I cant find it in my heart to counter any of those arguments, mostly because ice cream is so dang delicious. But whats one of the cardinal rules of eating green? Make it yourself!

Lucky for us, with our hotness, frugality, and environmental consciousness, there are plenty of frozen treats that can be made simply, cheaply, and to healthy and delicious effect. Even without a real ice cream maker.

Id like to introduce you to my new favorite thing: my $1.74 clearance shelf popsicle mold.

In the last few weeks weve been through many adventures. Coconut milk and maple syrup. Arnold Palmers (thats lemonade and iced tea, my boyfriends brilliant idea). Strong Earl Grey, coconut milk, and a little simple syrup. Pureed honeydew melon and mint. The possibilities for healthy, delicious, homemade pops are nearly endless, and Im looking forward to a summer of popsicle experimentation.

(And yes, these are all entirely no-heating-up-your-kitchen, because you can make simple syrup in the microwave: 1 part water, 1 part sugar, microwaveable measuring cup; microwave until the sugar is dissolved, 2-3 minutes, stirring every so often.)

But so far – my favorite – the biggest hands-down, most glorious success: Cherry Chocolate "Ice Cream" Popsicles.

Food processor “ice cream” recipes abound on the internet, usually featuring frozen fruit, heavy cream, and sugar. Lately, Ive been sort of obsessed with substituting coconut milk – a rich, lactose-free stand-in full of healthy fats - which tastes good just about any way you can conceive to use it. I find you don’t need the extra sugar, either, since the frozen fruit provides enough sweetness.

Variations on the food processor/fruit/coconut milk idea are infinite. Try changing the fruit. If youre down with dairy, use regular cream. If your fruit is tart or your sweet tooth is strong, add a little simple syrup. A flavorful honey might bring some magic to, say, a peach variation.

This particular mixtures creaminess gives a great texture to the popsicles but also makes it a little trickier to remove. Leave pops out at room temp for five minutes, or run the molds under warm water. Pull the sticks *gently*. If they dont come out, give them some more time. If you’re not down with that, the recipe can be served like ice cream, either straight out of the food processor or after 20 minutes or so to firm up in the freezer.

Granted, the end product isnt quite ice cream, but its delicious, healthy, cheap, and puts a little less strain on the planet. Which is important to keep in mind, even when that damn planet and her damn seasons are putting so much strain on us.

~~~

If you like the idea of this, you might also enjoy pondering:

• Plums With Orange and Mint
• Strawberry Mousse
• White Sangria

~~~

Chocolate Cherry “Ice Cream” Popsicles
Serves 4, at least by my popsicle molds.

8oz frozen cherries
½ c canned coconut milk (a type with emulsifiers, like guar gum, will actually do you better)
1/3 c dark chocolate chips (vegan, if thats your style)

1) Put cherries and coconut milk into bowl of food processor. Process until smooth and ice creamy.

2) Add chocolate chips, and process until mostly broken up and dispersed. (A renegade full chip never hurt anyone.)

3) Pour into molds. Freeze at least 4 hours.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
132 calories, 7.2g fat, 1.7g fiber, 1.2g protein, $0.81

Calculations
8oz frozen cherries: 147 calories, 0g fat, 2.7g fiber, 1.3g protein, $2.40
½ c coconut milk: 111 calories, 12.1g fat, 0.6g fiber, 1.1g protein, $0.50
1/3 c chocolate chips: 268 calories, 16.8g fat, 3.3g fiber, 2.4g protein, $0.37
TOTAL: 526 calories, 28.9g fat, 6.6g fiber, 4.8g protein $3.27
PER SERVING (total/4): 132 calories, 7.2g fat, 1.7g fiber, 1.2g protein, $0.81