Is Meat Unhealthy? Part IX

Welcome to the last post in the series.  Time to summarize and wrap it up!

Respect

I respect each person's right to choose the diet they prefer.  This includes vegetarians and vegans, particularly because most of them make daily sacrifices to try to make the world a better place for all of us.  I'm an omnivore, but I sympathize with some of the philosophy and I often eat beans or lentils instead of meat*.

Our history with meat

Our ancestors have probably been eating some form of meat continuously for at least two hundred million years.  However, the quantity has waxed and waned.  The first mammals were probably largely carnivorous (insectivores).  Yet our primate ancestors went through a 60-million-year arboreal phase, during which we probably ate fruit, leaves, seeds, insects, and perhaps a little bit of vertebrate meat.  We only outgrew this phase in the last few million years, when we developed the tools and the brains to pursue prey more effectively.

During our 2.6 million-year stint as hominin hunter-gatherers, we ate an omnivorous diet, although we really have very little idea how much meat it contained (it probably varied by time and place).  Historical and contemporary hunter-gatherer cultures are all omnivorous, and typically eat significant to substantial quantities of meat, suggesting that our ancestors may have done the same.  Non-industrial agricultural populations eat as much meat as they can get, although they usually can't get as much as hunter-gatherers.

If there is such thing as a natural human diet, it is clearly omnivorous.

Meat, obesity, and chronic disease

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The Latest Health Wonk Review Is Up!

Happy Anniversary to the Health Business Blog. And what better way to celebrate the occasion than by hosting the Health Wonk Review.  David Williams' linked summary has the best of brainy health policy wonkery from around the web.

Enjoy! 

GET OUT OF YOUR OWN WAY

It is our time to get up to bat and before we are on the plate, we have mentally struck out and kick at the dirt in frustration for not hitting that ball as far as it could soar.  And so it goes with our life and the successes we could be enjoying if only the negative movie reel in our mind would sit down and shut up.  We get in our own way when it comes to reaching our fitness goals because we are too busy coming up with reasons why we are unable to make it happen.  Whether it stems from fear, frustration, laziness, depressed feelings or procrastination, our mind plays the biggest role in our ability to reach and maintain the fitness goals we desire.   

There is no easy way to achieve success without hard work and lots of sweat, and we all need to put in the effort to get where we want in life.  My Dad always told me, “it is a tough world out there”, and we do not need to make it harder on ourselves by playing negative mind games that keep us from creating a quality healthy lifestyle.  There is no perfect time or place to start taking care of our bodies and our minds.  The time is now and “negative Nancy or Ned” will need to take a back seat so that we can be successful with our attempt to reach our fitness goals.  There will be frustration along the way and that is part of life and the journey to get healthy.  Exercise will be hard and eating healthy will not always be one hundred percent, and that is called being human.  What matters is maintaining that positive mental focus and drive to reach your goals and not allowing thoughts talk you out of doing what needs to be done.  There is no amount of work, social life, family drama, laziness or whatever you allow to consume you that is more important than your health.  Once this is realized, it will be easier to stay on track with consistent exercise and eating healthy because the excuses will no longer be an issue.  You will finally be out of your own way and onto a new healthy you.  Time to hit the ball out of the park and Stay Healthy!

Thanks for stopping by my Blog, hope you enjoy the content, and if you have not become a follower yet, I would love to see your face on my friend's list, or if you want to receive my free updates, use the button below to select your feed preference. I look forward to responding to your comments and appreciate your shares.

Stay Healthy!

Darla 

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The Third Wave, Informatics, Quantum Mechanics and Health Care Reform

Schrödinger's cat

While the Population Health Blog continues to mull the promise vs. reality of Alvin Toffler's book on The Third Wave "Information" Age, it's been struck by the observation that any Wave's ideals are often applied to institutions.

It's a classic chicken vs. egg self-reinforcing feedback loop. For example, during the Second Wave, the industrial mindset gave rise to bureaucracies. 

Which prompts the PHB to wonder if the electronic health record (EHR) was the inevitable result of the Third Information Wave, or its intrusive invention?

Whither Biology in Health Care's Third Information Wave?

Yet, at the same time, the physician PHB has been struck by the emergence of biology-laced health reform jargon.  It's not unusual to read or hear that care delivery should have "organic" features (e.g., here and here) and resemble "ecosystems" (here and here).  Indeed, the intellectual underpinnings for integration is eerily close to complex 'living" entity, with a whole that is more than the sum of its semi-autonomous parts.  Think more organism than organization.

Biology: Not Incompatible but Synergistic

And before you assume that the healthcare paradigm of binary silicon-based electronics is  incompatible with complex carbon-based life forms, recall that DNA has been recast as a computer, and life has been defined as a DNA software system. Is networked machine intelligence in a large regional delivery system all that different than the chromosomes and enzymes that enable me to type this blog?

It seems that the "biology" of "information technology" is not cognitive dissonance, but a perfect, if ironic, window into where health care is headed.

Enter Statistics

And since software is ultimately about information, "medical informatics" has - by definition - moved front and center. Assuming it is "patient-centric," success in our Third Information Age is less about collecting patient anecdotes than their associated data: assembling and using of means, standard deviations, p < .05 significance, associations, predictors, regressions, known-unknowns, unknown-unknown Black Swans, artificial intelligence and "big data" inputs. Little wonder, then, that the informatics underpinnings of "population health" are increasingly being used by policymakers and has captured the attention of the entities such as the Institute of Medicine, and The White House.

Statistics on Steroids: Quantum Mechanics and What We Don't Know

Quantum mechanics is bubbling up into popular media (from photography to leadership). Health care - from the atomic level  of molecular biology to the societal level of public health - has not been immune.

Mix quantum mechanics with some Triple Aim, and Heisenberg's "Uncertainty" over position vs. momentum tells us that the more intense the statistical measurement of health care quality and cost, the greater the complexity, impreciseness and chaos. 

If so, it may be that the best that health system architects will ever be able to do is define the range of probabilities, risk and uncertainty that underlie cost, quality and care. 

Which leads the PHB to......

Risk as the Coin of the Healthcare Realm

Insurers are masters at measuring and monetizing (and, when necessary, avoiding) health risks. They understand the inherent uncertainties of health care. In the PHB's estimation, the quantum sophistication of the Information Age is going to lead the next level: managing uncertainty.

The Bottom Line: Outcomes vs. Risk Management

As health informatics and analytics grow, health care's imprecision will become better defined. We'll understand that not every patient with diabetes will be known to have diabetes, not every patient known to have diabetes will have a test for diabetes and collecting all individual tests for diabetes will never tell us what's really going on for the universe of diabetes.  The idea that we can use the health system to attain 100% measurement or perfection is about as real as the quantum state of Schrödinger's cat.

OK, What About the Real World?

While quantum mechanics already has some real world applications, it's too early to predict how risk, uncertainties and probabilities will factor into the future of health reform.  But the PHB confidently predicts that patient outcomes will be less a function of diabetes control, rehospitalization rates, medication compliance or satisfaction. 

Instead, it will be about understanding the determinants of a lower risk of diabetes complications, a lower chance of rehospitalization, a greater likelihood of medication compliance and a higher probability of satisfaction.  Quantum mechanics tells us that when measurement causes these well-managed probabilities to "collapse" out of their "quantum" state, the measurements will look better.

All that remains is determining the best combination of buyers, payers, insurers, providers and government necessary to achieve that.

It starts with the risk.  Complex health systems that adapt to that fundamental paradigm shift will win.

Image from Wikipedia

We Do Science Interview

I recently did an interview with Laurent Bannock, an expert in sport and exercise nutrition.  His podcast We Do Science has rapidly become quite popular, due to Laurent's credibility and the interesting guests he interviews.  We covered body composition, metabolically healthy obesity, the relationship between BMI and mortality, calorie counting, body fat regulation, and other related topics.

If you've already listened to several of my interviews and are starting to find them repetitive, you might enjoy this one because we cover some new ground.  Laurent was a gracious host.  Follow the link below to listen:

Neurobiology of Obesity, with Stephan Guyenet

Food Reward Friday

This week's lucky "winner"... the Cinnabon cinnamon roll!!!

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PUSH THROUGH THE PAIN

I am not talking about pain that does not feel right when performing an exercise but what I am referring to is the emotional and mental pain that will enter each of our lives through differing circumstances.  Whether we are suffering crisis from a family member being ill, a death, divorce, or financial strain due to a job loss, these types of stressful situations can cause us to not take care of ourselves as we place health and fitness on the back burner.  We get so wrapped up in the pain of the event with our minds consumed, our emotional banks drained, and the energy to even put one foot in front of the other feeling like an impossible task. The burden feels heavy and the world can seem bigger than we are.  It will be in these moments where taking care of ourselves through exercise and eating right is even more important, and often times pushing through the pain even when we do not want to will be what keeps us healthy emotionally and physically.

It will not be easy and I share this personally as I am currently struggling with my father being gravely ill and rapid decline in health.  During sleepless days and nights of course I focus more on my nutrition and get in my exercise when I can, but do seek out exercise as being therapeutic and stress relieving. Studies have shown that exercise is directly linked to decreased depression and stress, which is why it is so important not to neglect this very important part of our life.  Our bodies are made to move and doing that helps prevent a spiral down into dark mental places.  All of us will experience pain in our life and that is unfortunately a part of this journey, and it will always be how we respond to the circumstances that will keep us healthy.  Journaling is another great way to feel comfort through painful situations, and if necessary a great counselor, and I am all for talking to God and prayer. The Blog is an outlet of expression for me and sharing my feelings with you also provides healing and hopefully a comfort for others going through a painful life episode. 

Life will not play fair that is a fact and we need to prepare ourselves by being healthy and happy to begin with.  Being fit helps us to cope better during emotional stress. Today is always the day to take the steps necessary to become your best YOU in all aspects.  Life is short, a gift, and taking it for granted is not only a shame, but will lead to a life of illness and unhappiness.  When the painful things in this life come knocking on your door, will you be ready physically, emotionally and spiritually?  Will you have the strength to push through the pain?

I dedicate this Blog to my wonderful father who is a fighter, and my beautiful mother who stands strongly by his side and for 55 years.  Thank you for blessing me with life, faith and love.

My Beautiful Parents

Me and My Fabulous Father

Thanks for stopping by my Blog, hope you enjoy the content, and if you have not become a follower yet, I would love to see your face on my friend's list, or if you want to receive my free updates, use the button below to select your feed preference. I look forward to responding to your comments and appreciate your shares.

 

                                                                                        

mHealth Apps to Monitor Recently Discharged Patients

After knee surgery: how do you
monitor this patient at home?

The "this paper" link in the original post directed readers to the wrong web site.  It's been corrected and the PHB apologizes for the error)

While the Population Health Blog is tantalized by the prospect of healthcare consumers using mHealth apps to lower costs, increase quality and improve care, it wanted to better understand their real-world value propositions. 

Are app-empowered patients less likely to use the emergency room?

Do they have a higher survival rate? 

Do they have higher levels of satisfaction?

In other words, where's the beef?

That's when this paper caught the PHB's search engine eye. It's a report on using an app to monitor post-operative patients at home.

This was a "feasibility study" involving a Canadian cohort of home-based post-operative patients who had gone through either reconstructive breast or knee (anterior cruciate repair) surgery. In order to qualify, patients had to be between age 18 years and 75 years, not using tobacco and able to speak English.  Once the app was activated, patient were asked about pain, their recovery and satisfaction (using a 1 to 4 scale).  They also used the app to take pictures of the surgical site. 

To maintain confidentiality, there were no patient identifiers linked to any images and a "locked down" subscriber identify module (SIM) was used. Data was encrypted on the server and the device.

Three surgeons participated and were responsible for reviewing their patients' data on a daily basis.  The app flagged any measure that was unexpectedly out of range for expedited review.

Instruction on use of the app took between 30 and 45 minutes. Patients were loaned a smartphone or a tablet, along with an instructional booklet.  At the end of the 30 day period, the smartphone or tablet had to be returned.

38 breast patients were approached at 33 agreed to participate.  40 orthopedic patients were approached and 32 agreed to participate.

Results?

The mean number of log-ins over the 30 days ranged from 19 to 24, with greater use in the first half of the month. Over 2000 photos were generated. Based on the pain and recovery scales, two early infections were identified and one was treated over the phone with antibiotics with subsequent improvement. On a 1 to 4 scale, the overall level of satisfaction was 2.7 to 3.9.

The PHB's take?

It would appear that the science on using apps to address specific outcomes in narrowly defined populations is still in its infancy.  While the Triple-Aim potential of mHealth is high, we're just beginning to understand how an app would work in the real world, say.... monitoring the outpatient status of recently discharged surgery patients.

That's why this particular study was interesting. It would appear handhelds or tablets can be used in the post-operative setting, that patient satisfaction is high and that, with symptom monitoring and imaging, an early wound infection can be identified and managed early.

Naturally, it'll take a study involving a control group to better understand the true value of an app like this.  Based on this feasibility study, the PHB is looking forward to reading about it in the not too distant future.

Image from Wikipedia

Can High-Fiber Foods Fight the Metabolic Syndrome?

The metabolic syndrome (MetSyn) is a cluster of signs including abdominal obesity, insulin resistance, high blood pressure, and blood lipid disturbances.  MetSyn is the quintessential modern metabolic disorder, and it affects about one third of Americans.  Many MetSyn diets recommend eating high-fiber foods, and research on the role of the gut microbiota in body weight and health tends to support this recommendation.  Yet these diets are complex, so it's difficult to attribute positive effects to the high-fiber foods specifically, and some people have questioned the benefits of dietary fiber.  Do high-fiber foods really improve MetSyn and promote weight loss?

The study

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Sweet Potato Chocolate Spread

What if I told you that 2 tbsp of this spread provides you with all the vitamin A you need in a day? Sounds too good to be true? Well it isn't. Other than being delicious, sweet potatoes are packed with this super important nutrient that keeps your eyes in good condition and your skin beautifully radiant. Plus this recipe is so simple and quick to make and only requires five ingredients! No excuses!

Ingredients:

2 medium-sized, peeled sweet potatoes (380 g)

3 tbsp melted cacao butter or coconut oil

10 dates (100 g)

2 tbsp cacao or cocoa powder

Pinch of salt


How to:

1. Cube the sweet potato and steam until entirely soft and easy to pierce with a fork, approximately 15-20 minutes.
2. Transfer the cooked sweet potato to a medium-sized bowl, add the remaining ingredients and blend with a hand blender until smooth. This could also be done using a food processor.
3. Spoon up the chocolate spread in a mason jar or any airtight container of your choice and store in the fridge.

Enjoy this spread on peanut butter sandwiches, your oatmeal or eat it straight from the jar with a spoon! (That's what I do...)

Chocolate love from Tilda ♥

Is Meat Unhealthy? Part VIII

Health can be defined as the absence of disease, and that is the lens through which we've been examining meat so far.  However, most of us have a broader view of health that also includes optimal growth and development, physical and mental performance, well-being, fertility, immunity, robustness, and resilience.  What role does meat play in this broader view of health?

Non-industrial cultures

One of the things I keep coming back to in this series is the strong natural affinity that our species has for meat.  Every culture that does not prohibit meat consumption for religious reasons (e.g., Indian Hindus) seeks and eats meat avidly.

A key fact that stands out from my recent conversations with anthropologists is that hunter-gatherers and subsistence agriculturalists place a high value on meat, even if they already have regular access to it.  Here's an excerpt from a paper by Kim Hill, Magdalena Hurtado, and colleagues (1):

Observations of the exchange rate between other foragers and their agricultural neighbors indicate that meat is worth much more than carbohydrate calories (e.g., Hart 1978; Peterson 1981). Hart, in his study of exchanges of meat and casava between Pygmy foragers and neighboring agriculturalists, found that approximately four and one half times as many calories of casava were exchanged for each calorie of meat given. In addition, it appears that almost everywhere in the world meat calories from domestic animals are probably expensive to produce relative to plant calories, and yet subsistence farmers continue to use at least some of their "cheap" plant calories to produce "expensive" animal calories (see Harris 1985 for discussion)

Why do humans around the globe value meat so much?  This strongly suggests that we've evolved an affinity for meat because eating it provides a reproductive advantage.  In other words, meat may increase our "Darwinian fitness".

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The Latest Health Wonk Review Is Up

Peggy Salvatore at the Health System Ed blog hosts the latest version that's been aptly titled the Valentine Edition of the Health Wonk Review: For Health Policy Lovers Everywhere. The aw shucks PHB is there with other blogging luminaries who are embracing topics that run from the cells of women to health-worker strikes.

REASONS DO NOT ACHIEVE RESULTS

The truth about health and fitness is that we either want it or we don’t.  Let’s face it, we can all come up with reasons not to exercise today or pack our coolers with healthy food to have on hand.  All the reasons in the world are excuses that will eventually catch up to us in the form of illness or injury.  That also is the truth.  What we need to understand is that our lifestyle is our medicine, and that includes what we eat and how we move and rest our bodies.   We can’t continue to walk around in a state of un-health and believe that this is an acceptable existence.  Looking and feeling our best is what we all want, dream about, and talk about, but the action to make it happen never seems to occur.  Look at what is flooding our magazines, commercials, and television shows when it comes to getting healthy.  We need to be living the reality shows of achieving our best body not sitting in front of the tube with our chips watching other people taking action to get healthy. 

Reasons will not change how we look or feel and in fact will only make us feel and look worse if continued as a lifestyle.  Our first step to change this reality of reasons, is to own that we are doing that.  If you are coming up with reasons to stop by the fast food or restaurant, skip out on the workout, and party hardy until the break of dawn, it is time to stand in your own truth and ask why.  Looking at the truth can sometimes piss us off, cause us to throw our hands up with a profound “f” word salute, and that is normal.  It will be in that frustrated moment of anger or other emotion that will open the mind to what in the hell am I doing with my life and body.  It will be that slap in the face that will cause us to get serious about a healthy lifestyle becoming our medicine. 

The only person responsible for replacing reasons with action is you and me.  It is time to rearrange the priorities in our lives because no person is too busy to take care of their health.  Everyone can have their fittest body at any age and I will take on any backlash for making this statement.  A healthy fit body is obtainable and realistic for all of us and should be the goal while we are living this life.  Dependence on prescribed drugs to pseudo fix health issues is way out of hand, and although certain medications are needed for a small percentage of medical issues, I am addressing the general populous that continue to accommodate their “reasons” and unhealthy way of life.  Living a healthy lifestyle is not a half in and half out scenario either because occasional effort equals occasional results.  We want so much to change but are not willing to give the effort and this is the bottom line.  Results can and will happen, but the choice is up to you.

I dedicate this Blog to my husband, friend, love and support in my life.  

Happy Valentine’s Day Babe and I Love You Forever and a Day

Thanks for stopping by my Blog, hope you enjoy the content, and if you have not become a follower yet, I would love to see your face on my friend's list, or if you want to receive my free updates, use the button below to select your feed preference. I look forward to responding to your comments and appreciate your shares.

Stay Healthy!

Darla 

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Health impact assessment of a roundabout?

I've done health impact assessments on all types of proposals. The smallest was of a specific health facility. The biggest was of a population plan for several hundred thousand people. 

This is the first time I've seen an HIA of a roundabout though. The process scales to any size!

The End of Power Health Care?

Corporate titans enjoying
the good old days.

While Moses Naim's The End of Power devotes only a few pages to medicine, it's still provocative and worthwhile reading for anyone involved in the delivery of health care.

As the Population Health Blog understands it, the book's central thesis is that traditional "power" is being disrupted by the three modern trends of "more," "mobility" and "mentality."

We live in an unprecedented era of more (relative) widespread wealth, have an astonishing ability to move goods, services, information and ourselves around the globe (mobility) and are far less likely to adopt the cultural and intellectual assumptions and norms of established society (mentality).

Despite the depressing narrative of the "elite 1%," the irony is that governments and corporations have far less ability to command and control the 99%. This has big implications for world affairs, democracy and U.S. power.

Wow.

Big themes like this naturally prompt the excitable Population Health Blog to speculate about the implications of Naim's more-mobility-mentality for health reform in the United States.

It should be no wonder that policymakers, politicians, academics and regulators are promoting a large and concentrated i.e. powerful version of healthcare delivery.  These cognoscenti argue that huge integrated delivery systems, accountable care organizations and regional providers can "rationalize" health care with standardized protocols, less variation, efficient service lines, alignmment of incentives, optimum capital deployment and assumption of insurance risk.

Mr. Naim cautions that the power-play may not succeed. The PHB extrapolates:

1. While pundits can argue whether the Affordable Care Act's insurance options are as good as they should be, we're devoting a lot of wealth toward health care. More individuals have higher levels of resources to put into their care than they've ever had before. And they know it.

2. While that wealth is being tempered by out-of-pocket expenses, network exclusions, service limitations and other trade-offs, consumers still have relatively abundant choices on not only when, but where to see that doctor, have that surgery or take that pill.  By the way, information is not only cheaper (thanks to the internet) but no longer monopolized by the health professions. 

3. Whether it's a one-on-one recommendation to have a procedure or a proposal to build a new hospital wing, gone are the days when a professional expert's opinion was automatically accepted. Stakeholders are demanding evidence, seeking justification, asking for alternatives and are relishing the "gotcha" moments.

Where do these healthcare versions of more-mobility-mentality take us? Greater access to resources means higher expectations. Mobility means consumers will use exercise choice to cross country, state or even national borders to access care when they choose to do so.  And mentality translates into higher levels of individual consumerism.

Instead of protocols with less variation, patients will want the care to be personalized. Service lines will be judged less on efficiency than on local notions of value. Provider incentives based on "outcomes" and "upside risk" will have zero value proposition for their wealthy, mobile and skeptical customers.  Capital won't necessarily flow toward non-performing assets and year-end savings won't materialize just because policymakers wish it so.

Accountable care organizations and integrated delivery systems will still have huge competitive advantages. That being said, their chances competing successly against smaller competitors and access to capital will be increased if

1) their protocols are flexible,

2) variation is not only welcome but warranted,

3) patients have a good reason to choose their service lines,

4) incentives are broadened, and

5) this new and different level of complicated risk is realistically priced.

And that's assuming that the health provider policymakers, politicians, academics, regulators and CEOs realize that they're not quite in charge anymore.

Asian Salmon

Like anyone, I get bored of eating the same meals all the time and look for ways to add flavor to meals, while still keeping them healthy.  Right now, I'm hooked on this Asian Salmon dish that I've made several times now.  If you try it, please let me know what you think.  The recipe below is for one meal, so make more marinade if you're feeding your whole family.  

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40-Day Fat Loss Challenge (Day 14 Update)

It's time to check in and update my progress for the 40-Day Fat Loss Challenge I entered at my gym. For my body fat percentage, I'll use my trainer's caliper measure since I won't have access to the machine until the 40 days is up.  The machine measured about the same as my trainer anyway.  My goal is to lose at least 1% body fat each week so that at the end of the 40 days (nearly 6 weeks), I'll have gone from 24% down to 17%.  I'm on track for that now, but would love to get closer to 15%.  

PROGRESS

Day 1:  24% body fat (112.4 pounds)

Day 7:  22.4% body fat (110 pounds) 

Day 14: 21% body fat (109.4 pounds) 

(These numbers reflect what I weigh when I weigh-in at the gym mid-morning.  My weight below I take first thing in the morning when I wake up, so it's slightly lower.) 

Below is a picture of where I'm at as of Day 13.  I didn't take a good "Day 1" picture, so the "start" is from December, but it's a good representation of me on Day 1.  

You're not going to notice a dramatic difference week by week, but over many weeks, and then a couple or few months, you definitely will.  If there's one thing I've learned it's to be patient, take it one day at a time and TRUST THE PROCESS.  If you look carefully, you'll see my arms and tummy are leaning out a little 

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Creamy Dreamy Peanut Butter-Blueberry Sundae

Ice cream:

- 3 ripe bananas, sliced and frozen (300-330 g)

- 3-4 tbsp almond milk

- 1 heaped tbsp Arctic Berries Blueberry Powder

- 1 pinch vanilla powder or extract

Peanut Butter Sauce:

- 1 tbsp peanut flour (or peanut butter)

- 1 tbsp almond milk

- 1 pinch sea salt

Optional:

- Toppings such as mulberries, coconut chips or raw cacao nibs

How to:

1. Start by making the peanut butter sauce: in a small bowl combine the ingredients for the sauce with a fork until you're left with a thick yet runny sauce. Set aside while you make the ice cream.
2. Place all the ice cream ingredients except for the almond milk in a food processor or high speed blender and blend on high*. Blend for approximately 60-90 seconds or until the frozen banana slices have all been broken down to tiny pieces. Stop to scrape down the sides if necessary.
3. Carefully remove the top cap from your blender and slowly pour in the almond milk while blending. Blend on high until smooth and again, stop to scrape down the sides if you need to. Be patient and don't add more liquid unless you really have to. The ice cream will be much creamier and not as runny this way.
4. Spoon the ice cream up in two bowls and drizzle generously with the peanut butter sauce. Top with whatever you desire and eat immediately before it melts! (And feel free to just have it ALL for yourself. That's what I did.)

*I find this the most effective way to get a creamy, completely smooth ice cream but if it seems too complicated to you, simply place all the ice cream ingredients in the blender/food processor and blend until smooth.

Berry-Boosted Blueberry Jam (Naturally Sweetened)

There's something oddly comforting about jam. That sweet, slightly sour taste adds another dimension to basically any carb-y meals. On top of a steaming hot bowl of oatmeal is how we usually enjoy our jam here in Sweden but I have always loved to spread a thick layer of raspberry preserves on top of a crispy, golden brown slice of toast. Mhm. And I know I just said raspberry even though this recipe specifically calls for blueberries. Confession: I didn't like blueberries as a kid. I loved spinach but not blueberries. Yes, I was weird. Moving on.

I must say I'm very pleased with this recipe. It's thick, just like jam is supposed to be. Don't want any of that runny, slimy stuff, no thank you. So it's thick, packs a punch of blueberry flavour only rounded off by a hint of vanilla. I even got my mom hooked on it so now it's a battle against time to have as much as possible for myself before she eats it all up!

Also, I finally got to use a jar from the collection featured throughout this post. To say that I have an obsession with jars is an understatement. This recipe makes one small jar but if you feel like you're likely to finish it soon after making, feel free to double the recipe. You could probably even freeze some for later if you wanted to, even though I haven't tried this myself yet.

Finally I want to point out that this jam is even more nutrient-dense than your average Homemade-healthy-jam all thanks to the Arctic Berries powders! I added some of the blueberry powder and some of the sea buckthorn powder in this but combine them however you want for your own personal touch! Hope you enjoy the recipe!

Berry-Boosted Blueberry Jam

-1/2 lb (225 g) frozen or fresh blueberries

- 6-8 fresh dates (75 g)

- 1/2 tsp pure vanilla powder

- 1/2 tbsp  any Arctic Berries Powder (I used the Sea buckthorn and blueberry powders)

- 1 tbsp chia seeds

How to:

1. Place the blueberries in a small sauce pan and slowly thaw them over medium heat.
2. Meanwhile, pit the dates and put them in a small bowl. Blend the dates with a hand blender until smooth and set aside.
3. Once the berries start to release their juices, bring it up to the boil and let boil for about a minute.
4. Remove the blueberries from the heat and stir in the date paste, vanilla powder and Arctic berries powder(s). If the date paste feels very dense and hard to incorporate into the berry mixture, start by transferring a few tablespoons of blueberry juice into the bowl with the date paste and mix the two to make it a bit looser in consistency.
5. Lastly, stir in the chia seeds and make sure they're evenly divided throughout the jam.
6. Spoon the jam up in a glass jar, seal it and let sit on the countertop to cool off before putting it in the fridge.

My favourite way to eat this jam - thinly spread on top of a rice cake.

Best Granola Ever (no oil!)

Prepare yourselves for the crunchiest, sweetest, most delectable granola ever! Though you could never tell from how they taste, these caramel-ly clusters are 100% refined sugar-free and contain no added syrups or oils whatsoever! That's just how we do it around here. ;)

The added nutrient-boost from the sea buckthorn powder gives this granola an extra umph, a je-ne-sais-quoi that is hard to beat. I know that I'm going to add this beautiful orange powder to many more recipes from here on out and after tasting this granola, I hope that you are as well.

Sea Buckthorn & Buckwheat Granola

1 cup raw buckwheat groats (175 g)

1/2 cup quinoa pops (15 g)

1/2 cup raw almonds (75 g)

14 dates, pitted (160 g)

2 tbsp Arctic Berries Sea Buckthorn Powder

2 tbsp water

How to:

1. Pre-heat the oven to 130C.
2. Chop the almonds coarsely and pale them in a large bowl along with the buckwheat groats and quinoa pops.
3. In another, smaller bowl, blend the pitted dates, water and the sea buckthorn powder with a hand blender until completely smooth.
4. Transfer the date paste into the bigger bowl and mix well with the grains and almonds until you have a chunky 'dough'.
5. Bake in the oven for 35 minutes. Remove to stir around every ten minutes to prevent the clusters from burning!
6. To make sure the clusters stay crunchy, leave them in the oven overnight to dry out, preferably with the oven lamp on.
7. Store in an airtight container and enjoy on top of your smoothies, oatmeal, banana ice ream or anything really!

PROGRESSION IS WHAT GETS YOU THERE

No one starts at the top and sometimes you can get to the top of your fitness game, and injuries or other issues occur that send you right back to the beginning step.  I speak from experience when it comes to being knocked down from an injury and although the setback was difficult, I never gave up.  When it comes to our exercise programs, we can put so much pressure on ourselves to do too much too soon, and with that come discouragement and frustration.  When we approach our fitness and nutrition programs with a progressive attitude, it is a more realistic way of adopting a healthy lifestyle.  Progressive simply means starting where you are, accepting where you are, doing what you can, mastering what you are able to do, and then moving forward to the next level of whatever type of exercise program you have enlisted yourself.  It also means forgetting any comparisons to others because they are not you, and your program is your program.  The comparison game can cause us to get off track with our progressive program and being on alert to squelch our inner competitive nature will be important, especially when we are “newbies” to fitness. 

Progression is what will get us to the next level of fitness without injury and with a healthy body and mind.  For example, you want to master a pull-up and for the very first time you try to lift yourself on the bar, you are stuck.  The pull-up is one of the hardest body weight exercises to perform and to believe your first time out you will be able to accomplish one is unrealistic.  Those who can do one or more pull-ups have been doing this exercise for years and have built the strength in their back muscle to the point of being able to perform the exercise.  A great way to start the journey of being able to perform a pull-up is to modify the movement using a leg spot, bench spot, a Gravitron, TRX straps, or having a spotter help lift a portion of your bodyweight as you pull up.  As you are consistent in your modification of the pull-up exercise over time, you will be able to “progress” to performing the exercise without assistance.  Another great example is long distance running.  I for one would not be able to bust out a marathon like I have been doing it for years without proper training and starting from the beginning.  It truly is all about persistence, patience and progress. 

Progression can also be applied to implementing healthy foods into our nutrition.  Begin slowly by eliminating one thing like soda, and replacing it with more water intake or herbal tea.  Over time and as unhealthy foods are eliminated and replaced with healthy food choices, you will be able to progress to a 80% to 20% clean eating program without feeling deprived.  Life is already hard enough without making a healthy lifestyle feel like a burden with unrealistic expectations.  Applying the “progression principle” to our workouts and daily food intake creates a positive outlook mentally and physically.  We all like to feel accomplished with our programs and to celebrate every moment we take steps that lead us closer to our goals.  The good news is that progression is what will get you there.

Stay Healthy ~ Darla 

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Maintenance of Certification (MOC) Update: A Health Reform Lesson

The 1967 Corvair. A non-PHB version

Long ago, when the Population Health Blog was courting the future PHB spouse, our unspoken understanding was that if the PHB liked its unsafe-at-any-speed 1967 Corvair, it could keep its unsafe-at-any-speed Corvair.

The sweet perfume of our relationship more than made up for the odor of car exhaust, unsightly blemishes, noisy rattles and rusted floorboards.

Cracking the windows, touches of spray paint, the AM radio volume knob and care where you placed your feet also helped.

It wasn't until courtship turned to relationship that the spouse's true thinking began to manifest itself.

That's why, years later, the PHB was unsurprised by President Obama's disavowal of his you-can-keep-your-health-plan assurances. Substitute Federal minimal essential benefit requirements, narrow networks and unaffordable premiums for spousal safety demands, mocking eye-rolling and intrusive hints about the merits of a new car, and readers should understand the PHB's acquiescence.

So the PHB shrugged off the notification that its life-long American Board of Internal Medicine (ABIM) specialty credential wasn't really a life-long credential.  

Enter maintenance of certification or "MOC."

More background can be found here, but, briefly, the sweet perfume of accomplishment was overcome by the MOC stink of intrusive, unproven as well as expensive documentation, education and testing renewal requirements.

Thousands of the PHB's physician colleagues were less submissive about the matter in print and on-line. There were also competitive threats, lawsuits, online petitions, and websites. The American Medical Association weighed in. And then state medical societies, which have a vital interest in serving their membership, began to sound the alarm.

And it paid off. 

While the PHB would have predicted that the academics populating the ABIM leadership were about as likely as Mr. Obama or the PHB spouse to change their minds, they've issued a "we got it wrong and sincerely apologize" announcement. 

As a result, many of their documentation requirements are on hold, the test is being revamped, fees are being reduced and the education options are being broadened.

Good for the ABIM and good for the practice of internal medicine.

This kind of mea culpa is a good first step in engaging the opposition and is likely to turn many critics into allies. More importantly, this is a great example of the impact of grass roots activism and the advocacy of organized medicine.

If this can happen in this corner health care, perhaps there are other areas of health reform where a well placed apology might be a good first step.

The magnanimous PHB is also happy to admit that, in retrospect, the spouse was right about the Corvair. At one point, highway snow was blowing up into the passenger compartment.  At 60 miles an hour.  Seriously.

Since then, it has gotten to like and keep lots of other stuff.  It makes having to pay so much for its own heath insurance a little more tolerable.

Image from Wikipedia