Insulin Resistance Strongly Predicts Cardiovascular Disease Risk

I recently came across a very interesting paper by the research team of Gerald Reaven, an endocrinologist at Stanford.  He has long been one of the leading researchers studying insulin resistance, the metabolic syndrome, and their association with obesity.  Reaven's research, and that of many others, suggests that insulin resistance is a central part of the constellation of metabolic disturbances that are so common in affluent nations*.  We also have good reason to believe that it contributes to cardiovascular risk.

All the way back in 1998, Reaven's group published a paper that should raise the eyebrows of anyone interested in cardiovascular health (1).

Read more »

Free Webinar - Building Bridges between Transportation and Health

Building Bridges between Transportation and Health


Meeting Description:

This webinar will discuss the connection between transportation and health and give insight into the specific process one community used to fund programs and how the programs are implemented from start to finish. It will also highlight how advocacy and community organizing are used to move projects forward.

To register click here

Date:
Wed, Jun 3, 2015

Time
02:00 PM EDT

Duration
1 hour

Host(s):
American Public Health Association

Moderator:  Megan Wier, MPH
(Lead Staff, Health, Transportation and Equity at San Francisco Department of Public Health)

Speakers:

Leslie Meehan, AICP
(Director of Healthy Communities, Nashville Area Metropolitan Planning Organization)

Leslie will provide an overview of the process used to incorporate health into transportation planning, policy, funding, data collection and measurement in the greater Nashville region.  She will provide information on how the MPO evaluates and prioritizes projects by health and equity, and how health data is used to predict population-level changes in health outcomes from increased active travel.

Scott Bricker
(Executive Director, America Walks)
Scott will discuss advocacy and community organizing as tools to move projects forward. He will provide examples of communities that have improved walkability and active transportation through organized efforts.

"Generative" Health Care Leadership, Governance and Boards of Directors

Time to get "generative!"

Thanks to bout of troublesome weather, the Population Health Blog has been stranded somewhere in the U.S. air-travel network. Undaunted by bitter loss of an upgrade and the prospect of a late arrival, it bravely used the down time to dig into the highly interesting book Governance as Leadership: Reframing the Work of Nonprofit Boards by Richard P. Chait, William Ryan, and Barbara Taylor.

While written for "nonprofit board members," the PHB believes the insights are applicable to just about any board of directors or other leadership group of an organization that is grappling with uncertainty. And given the uncertainty in health care, Governance is "must" reading for the leadership as well as the board of any hospital, physician-group, health system or provider organization.

Pointing to years of academic research, consulting experience and common sense, the book describes three "modes" of governance:

1. Type I Fiduciary, which relies on process and uses standing committees to ask (for example) if assets are being effectively deployed.  Think "data."

2. Type II Strategic, which relies on content and uses ad hoc committees to ask (for example) how strengths align with future opportunities.  Think "information."

3. Type III Generative, which relies on "cues," "framing" and "narratives" to ask less about the solution and more about the problem.  Think "insight."  
  
Boards are naturally inclined toward Type I and II governance. According to the authors, that's a mistake that can foster zero-sum thinking and the triumph of personal influence over group meaning.

Instead, when all three types are used at the right time for the right issues, they become synergistic and can create a tangible competitive advantage for the organization.  The best time to turn to Type III governance is when there is an issue that is ambiguous, salient, high stakes, contentious and irreversible.  The authors compellingly describe how present "cues and clues," can be used to "reframe" facts into new patterns.  As a result, the past can be re-narrated to imagine a new future.

Governance uses the example of the compelling insight that broken windows isn't the result of, but can lead to high crime rates.  That, in turn, led to the creation of "community policing."  The PHB would offer the health industry insight that the "problem" wasn't getting physicians to better care for persons with diabetes, but getting persons with diabetes to be better engaged in self-care.

You get the idea.

 The authors readily admit that Type III Governance is a "wilderness" that is an "outside-the" or "black" box that is non-linear, vague and subjective.

It seeks "sense" or meaning and creates multiple choices, not a single fix.  It generates insight and creativity, not mission setting, strategy development or problem solving.  It gets you to the drawing board.  It frames the problem.  It generates the hypothesis. 

And when reality is recreated, it can ultimately achieve a far richer level of down-stream buy-in.

How can Type III Governance be leveraged?

First of all, governing boards and their management teams must collaborate in this.  Boards have a particular role to play because they have the three "P's" of power, a plurality of multiple perspectives and a position of a more distant ("10,000 foot") vantage point.  Boards can work with their management teams by either acting as 1) sounding boards that foster generative thinking by asking, probing and identifying the cues, framing the data and renarrating the past or by 2) initiating generative thinking by focusing on ambiguous or problematic issues among themselves and their colleagues.

Be prepared to tackle sensitive subjects and dealing with multiple perspectives that is less about fixed unanimity and more about the sense of a "collective mind". Resist succumbing to notions or fostering groupthink.

Use retrospective questioning (to discover unknown strengths, flaws and patterns in the past) and dominant narratives (that create a meaningful bridge from the past to a portray a desired future) to gain greater understanding.

Embrace the generative mode early on the "elephants in the room." A otherwise unaddressed "big issue" will evolve over time and default processes and solutions will recast the situation as a planning or strategic challenge.

Use mindful deliberation without formality or rank that focuses less on creating the solution than on defining the problem.

To increase the chance of success, boards need regular exposure to inside-facing culture of the organization as well its outward-facing environment. That means having unfiltered access to the cues/clues inside (the "factory floor") and outside (with customers or other stakeholders). While there is a risk of board members or senior leaders running amok over established lines of authority, the risk to any organization is ultimately greater if they're confined to the boardroom or the C-suite. 

Generative thinking will feel more like "play" or a "retreat" than a meeting.  That's good.

Use tools like

Counterfactuals: What is it about the budget or the assigned FTEs that explains our goals?
Hypotheticals: If the company ceased to exist, where would its customers go?
Intuition: Is there a hunch about the next five years?
Catalytic questioning: Is there a headline we'd like to see?

Governance makes for interesting as well as fun reading. The authors avoid complex jargon and sprinkle their text with some insightful examples. While readers may struggle with the details of installing "generative" thinking into their leadership "workflows," the idea of using this template to harness the creative juices of a leadership group or a board is exciting stuff.

Fluffy Carob Banana Ice Cream

It's about time I posted another banana ice cream recipe on here! Especially since I practically live off this stuff. A life without 'nana ice cream is not a life worth living. That is why you simply have to give this a try if you haven't already. Before I first tried this I had myself convinced that I absolutely hated bananas and that my feelings toward these yellow little fellas were never going to change. But it all changed as soon as I:

a. Learnt to wait for those beautiful specks to appear, meaning the bananas were fully ripe and ready to eat.

b. Sliced them, froze them and gave them a good ol' blend.

(I now like (love) raw bananas as well but it's been a long process.)

So have a go at it and let me know what you think! Cheers!

Naked.

Dressed.

Behind the scenes.

Fluffy Carob Banana Ice Cream

Ingredients:

- 330 g frozen banana coins (about 3 medium sized bananas)

- 50 ml or a little less than 1/4 cup unsweetened almond milk

- 1 tbsp carob powder

- 1 pinch pure vanilla powder

Toppings:

- Fresh berries, raw cacao nibs, quinoa pops or whatever you like

How to:

1. Place all ingredients except for the almond milk in a powerful food processor or blender.

2. Process on high until all of the frozen banana coins have reduced to tiny pieces, this usually takes around one minute.

3. Stop to scrape down the sides with a spatula if necessary, then blend on high again and slowly pour the almond milk, little by little, into the food processor while blending (through the hole on the lid).

4. Once you've added in all of the almond milk, the mixture will eventually turn into a fluffy, wonderfully creamy ice cream! Spoon it all up in a bowl, top with whatever you desire and serve immediately! You may have to scrape down the sides a few more times but be patient and you'll end up with the most delicious treat ever :)

Predictions for a 50% Health Care Economy

Health care costs too much.  Having to pay more for doctors, hospitals and pills is threatening national security, undermining our industrial competitiveness, leading to underinvestment in vital infrastructure and exacerbating economic inequality. As we devote more and more of our individual household budgets, business revenues and national treasure to healthcare, it these excess costs will "crowd-out" our ability to pay for other worthy stuff.

Naturally, insightful Population Health Blog readers know the real story is more complicated than that. Inflation-adjusted costs of other "stuff" that comprise much of the U.S. economy have dropped. As the denominator has gotten smaller, the health care numerator appears relatively bigger.  More on that here. 

What's more, as society has benefitted from lower energy, housing, transportation and food costs, consumers are better able to choose to shift resources toward the health care that they want, which further fuels its growth. 

Plus, there's the observation that government subsidies have a significant impact. Our elected officials are advancing their constituents' wishes, right?

Right now, it appears that health care is costing just under 20% of the U.S. gross domestic product (GDP). Between our

1) appetite for more health care,

2) cheap robots doing everything else for us and

3) the inability of government bureaucrats to resist ever more meddling....

the PHB suspects that the percent of GDP going toward the medical-industrial complex is destined to hit 50%.

The provocative PHB asks if that's such a bad thing.

If 50% of all persons disabled or retired, the other 50% of us can look forward to the happy prospect of being gainfully employed thanks to taking care of them. 

If that's our future, the PHB has some other predictions:

1. 50% of all parking space acreage (for our Google Cars, naturally) will be devoted to the disabled.  The rest of us will benefit from longer walks, with a 50% greater likelihood of achieving our 10,000 per day step quota.

2. 50% of primary care providers won't be physicians.  But 100% of all those non-physicians will have slept in a Holiday Inn last night!

3. For those primary care physicians who remain in practice, 50% of their income will be thanks to the burgeoning science of tattoo removal, botox and dermal fillers.

4. 50% of all wheelchairs and bedside commodes will be of the "jumbo" variety.

5. 50% of all medicines will have dire "black box" warnings.  Likelihood that patients will actually take them will be decreased by 50%.

6. Automated decision support will thwart the ability of lawyers to sue doctors.  Following a path of least resistance, the legal community will respond with a 50% increase in lawsuits in other growth areas of the economy, such as robotic cars and pillow manufacturing.

7. Despite automated decision support, 50% of all providers will still detest their electronic record system.  The other 50% will loathe it.

8. 50% of all mental health counseling will be automated. Not kidding!

9.  When health systems finally grasp the impact of handhelds and apps, there will be a 50% increase in desk-top PC recycling.  Chances that DC's "meaningful use" criteria will recognize this soon enough are 50-50.

10. Growing traffic on the PHB's blog will lead to a 50% increase in its vast web-site related income. There is a 100% chance, however, that the PHB Spouse will not be suitably impressed.

Image from Wikipedia

LEAN UP NATURALLY

The best part about getting healthy and achieving a lean body is that each of us already have what it takes to make that happen.  Also, it does not cost lots of money nor does it require anything special, not even a gym membership.  We can achieve a lean body naturally and that happens with how we live.  Our lifestyle determines what are body will look and feel like.





Being consistent with eating healthy, exercise, staying hydrated and getting plenty of rest will create a lean physique naturally.  It starts with our shopping lists and the foods we are buying to maintain the body we have.  If we are buying crap then we will create a body of crap.  I know that sounds bluntly harsh, but the truth can sting when it hits us between the eyes.  The same goes for exercise and guaranteed if you are not moving and taking care of that body with a regular fitness program, it will let you know through injury or stiffness.

We can lean up naturally by purchasing healthy foods and eating at home most of the time.  Nothing special about that and no extra dollars except our normal grocery bill filled with healthy food instead of fake food.  This way we know what and how much we are eating and at a cost saving.  Eating healthy even 80% of the time will result in weight loss and an overall leaner look.  Also, reducing alcohol consumption to no more than 1 to 2 times per week will make this happen even faster.  Drinking plenty of water and considering that an essential nutrient will also hasten the lean up process.

Get up and move that body!  No gym membership required and much can be accomplished with a brisk walk for at least 30 minutes several times per week. Add in a few push ups, squats, crunches and stretching and you have a complete at home program that will yield a tone physique.  Achieving a lean body is not complicated or expensive and I challenge anyone on that statement.  It is in our daily choices, will power and the want to be our best healthy self that controls what we are in the physical sense.  We all have the ability, but the choice is always up to each of us.

Exciting news!  I am the new Sports Nutrition Expert and freelance writer on the subject for About.com.  My page is dedicated to the newbie exerciser, fitness enthusiast, or seasoned athlete wanting all the current information on nutrition as it relates to health and fitness. Come by for even more great reads by yours truly and I look forward to hearing from you here on Stay Healthy Fitness.

As always, thanks for stopping by my Blog and I look forward to reading and responding to your comments.  Do not forget to subscribe to get all my free updates!

             DON'T MISS MY FREE UPDATES

Stay Healthy!
Darla

Sports Nutrition Expert and Writer

Vegas' Healthcare Lessons: A Field Trip Report

The Population Health Blog spent the last week in Vegas exploring the actuarial, medical, predictive, economic, social and quality dimensions of an important part of the property and casualty insurance industry.

If memory serves, this was the fourth time it was there.  And a lot has changed over the last few years

Naturally, the PHB's commitment to lifelong learning shielded it from Sin City's too-numerous -to-count temptations.  Being in windowless conference rooms from 7 AM to 6 PM prevented it from the succumbing to The Strip's scintillating jewelry displays, blinka-blinka light pollution and siren call of unfavorable risk-transfer arrangements (a.k.a. "gambling").

Plus, having the spouse for company helped, even though she vetoed perfectly reasonable entertainment options like this and this.  As a consequence, the PHB limited itself to an evening show and a variety of interesting eateries. The good news is that, as a result, the field trips outside the meeting venue gave it some time to compare the "old" and today's "new" Vegas to derive some healthcare lessons:

Old Vegas:

Small hotel lobbies, walls, winding walkways.

New Vegas:

Open hotel atriums, mirrors but still winding walkways

Lesson: You don't have to give away the keys to the business to give the consumer the impression of transparency. While healthcare has a long way to go on truly transparent pricing, the PHB suspects there will be a lot of mirrors and winding walkways between where we are now and where we want to go.

Old Vegas:

Rooms at $250 per night

New Vegas:

While rooms on The Strip can be $300 per night, that's comparatively less in inflation adjusted dollars, plus there are remote controlled curtains for the floor to ceiling windows and one, if not two, flat screen TVs.

Lesson: Consumers are expecting more quality at less cost. Healthcare remains an economic outlier.

Old Vegas:

Computerized slot machines

New Vegas:

Computerized insights on the users of the slot machines

Lesson: Knowing background, revenue/cost determinants and risk preferences of your customers is critical.  In healthcare, we call this "big data."

Old Vegas:

Illusionists, Carrot Top, The Osmonds, Elton John and Cirque

New Vegas:

Illusionists, Carrot Top, The Osmonds, Elton John and Cirque in over the top stages and elaborate auditoriums.

Lesson: If you have a winning formula, stick to it and do it better. Even though health insurers may get in the way, more patients will seek you out.

And finally.....

Old Vegas:

Some homeless people

New Vegas:

More homeless people. 

Lesson: The economy recovery is failing the most vulnerable. 

Image from Wikipedia

Healthy Vegan Chocolate Mousse (Low-Carb Alternative!)

Blogging just got so much more exciting - I've finally begun to grasp the very basics of Adobe Lightroom which makes my pictures look a teeny bit more professional and I don't have to be embarrassed about posting them anymore. Half a year after getting my camera hehe. You know what they say, better late than never!

This obviously calls for a celebratory (and nowadays rare) new recipe by yours truly. Apologies for taking so long but here it is, my vegan chocolate mousse recipe! It's vegan (duh), can be made low-carb and tastes absolutely d-e-l-i-c-i-o-u-s if I may say so myself. Although the recipe calls for fresh berries, I could highly recommend squeezing some passion fruit over this beauty as well since chocolate and passion fruit were made for each other (we all know it).

Hopefully it won't be long before the next recipe and if so, please give me remind me of what a lousy blogger I am and I will get to it immediately. Pinkie swear!

'

Serves: 2

Ingredients:

- 300 g silken tofu

- 2 tbsp cocoa or cacao powder

- 1 tbsp mesquite powder (could possibly sub for lucuma powder or omit)

- 25 g 80-90% dark chocolate

- 5-6 dates (50-60 g depending on how sweet you like it) or 3 tbsp erythritol for a low-carb free version

Toppings:

- Fresh strawberries and blueberries

- Coconut chips or cacao nibs for crunch

How to:

1. Place all ingredients in a medium-sized bowl and blend until entirely smooth. Scrape down the sides with a spatula to make sure that no unblended pieces remain.

2. Top with berries and a sprinkle of coconut chips or cacao nibs if you wish and serve immediately or keep in the fridge for a couple of days at most.

Food Reward Friday

This week's lucky "winner"... Hardee's Most American Thickburger!!

Read more »

Recent Interviews

Here are two recent interviews I'd like to share with readers:

Danny Lennon of Sigma Nutrition

Danny Lennon is an evidence-based nutrition coach who publishes a podcast called Sigma Nutriton Radio.  We had a nice conversation about why we overeat, including energy homeostasis and the personal economics of food choice.  The podcast has a high production value.  You can listen to the interview here.

Angelo Coppola of Latest in Paleo

Angelo Coppola and I hit it off recently due to our mutual interests in gardening and self-reliance.  We recently had a nice conversation about hunter-gatherer dietary patterns, the personal economics of food choice, US diet history, legumes and the Paleo diet, and how much meat we should eat.  You also get to hear a personal story about the only existing video of me as a child (that I'm aware of).  This one also has a high production value.  You can listen to it here.

Zucchini Noodles with a Zesty Broccoli Dressing

Sometimes it just so happens that you throw a bunch of ingredients in a bowl, blend them up and end up with some unexpected awesomeness you didn't see coming. I'd like to think that was the case with this dish so I'm going to share the recipe with you even though I've only made it once. This is a perfect side dish to go with anything really, and makes for a nice, refreshing addition to any meal. Because you just can't go wrong with zoodles. Yum. Let me know if you give it a try!

Serves: 2

Zucchini Noodles:

- 2 large zucchinis

Dressing:

- 200 g broccoli florets (about small head)

- 100 g silken tofu

- 1 tbsp lime juice

- 3 tbsp unsweetened plant-based milk

- 1-2 handfuls fresh basil leaves

- 1 1/2 - 2 tbsp sweet white miso paste

How to:

1. Peel (optional) the zucchinis and spiralize them to make zoodles or make 'zagliatelle' t´ribbons using a carrot peeler.
2. Steam the broccoli until just cooked through.
3. Place all the ingredients for the dressing in a bowl and blend with a hand blender until fairly smooth. This would probably work even better in a real blender so go for that if you, unlike me, have access to one.
4. Dress the zoodles/zagliatelle in the broccoli sauce and add some fresh basil leaves on top for decoration!

MAKE IT HAPPEN

How simple that sounds but it really is a choice.  The weekend is upon us and all the excitement of what that means to each of us: a break from work, social drinking, parties, indulgence in unhealthy foods, and plain slacking off from our goals of living a healthy lifestyle.  It is almost as if the weekend turns us into different people ... the "Jekyll and Hyde" of fitness and health exposed.







I admit to letting my hair down a bit on the weekend, and especially a little more this Sunday and Monday to celebrate Mother's Day and my Fabulous 51 Birthday.  However, I do not agree with plunging completely into the dark side of forgetfulness of living a healthy life, and not being able to exemplify what that means not only to me but those I teach and motivate on the daily. Moderation is knowing how to moderate.  A treat day does not need to turn into a cheat weekend because I guarantee that guilt and feeling like crap will come knocking at the door.

It is really OK to enjoy indulgences in life and that is called living and being realistic.  It is a wise healthy person that knows how to do so in moderation, without guilt, and getting right back on healthy track the next meal, or next day. Studies have actually shown that mixing up the nutrition and throwing in an occasional quality splurge day can benefit the body similar to muscle confusion when the exercise program is changed.  If you have been hardcore depleting your body of much needed nutrients and your muscles are screaming for some glycogen or blood sugar, a cheat meal or day can benefit both physiologically and psychologically. When you shock your system with a high influx of calories at one time, the body's metabolism will show an increase and you'll kick start your 'furnace' into high gear once again.

Wherever you are in your fitness program and especially with eating healthy, learning how to moderate splurges will make or break the success of reaching goals.  How you think about what you are eating is important because eating healthy should be a lifestyle and not looked upon as a punishment or burden. This type of thinking will lead to resentment of adopting a healthy lifestyle and the rebel within will eventually revolt and return to those foods that created the state of un-health in the first place.

YOUR CHOICE

Healthy foods not only taste good but are great for you.  Gravitate towards foods in their rawest forms, especially produce.  Enjoy the textures and tastes of vegetables, fruits, and raw nuts.  Indulge in lean proteins on the grill like salmon and chicken breast.  Stay away from processed junk, soda and basically those foods that do not support a healthy lifestyle.  Alcohol should be kept to a minimum or eliminated altogether.  Drink water over soda or sugared processed juices. Don't allow this fast paced society and marketing of "fake foods" pull you down a road of illness and obesity.  Enjoy those things minimally and in moderation and get back on track with what eating is really supposed to be ... HEALTHY!

MAKE IT HAPPEN AND STAY HEALTHY!

I dedicate this Blog to my beautiful Mother and friend.  Thank you Mom for blessing me with your love and support.  I love you dearly and wish you a very Happy Mother's Day.

Every Day is Mother's Day

Darla Leal, Fitness Expert and Fit at 50

 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.

             DON'T MISS MY FREE UPDATES

Vegan Sweet Potato Burgers

These past couple of weeks I've been completely stuck in a dinner rut, unable to get out. Or rather, I've been too lazy to cook any proper meals, making hummus and rice cakes my go-to din din companions for better or worse. So today was finally the day to put an end to the dreary repetitiveness and get my ass in the kitchen to actually cook, and not just blend things together and hope for the best.

You see, there was this sweet potato that had been sitting in the fridge for almost a week, glaring at me each time I neglected to acknowledge its existence, giving me a hard time for not putting its beautiful, sweet flesh to good use. So, I pondered. Sweet potato brownies (I'll probably never be able to top Deliciously Ella's, so no), sweet potato pie (come on Tilda, 'tis not the season), sweet potato gnocchi (been there, failed that) or ... sweet potato burgers! Yes, I'd gladly watch your metamorphosis into a burger, sweet potato o' mine.

I got so excited over these burgers, I even went ahead and made my own whole grain spelt buns! Sadly, there won't be a recipe for those as they were a disappointment but I'll try my luck again sometime in the future. As for now, I suggest you either find a better bun recipe on your own, or go buy some from the store. I won't judge. (But the sweet potato might o_o)

Now, time to stop with this nonsense and get down to business. The recipe's right here below, enjoy!

Vegan Sweet Potato Burgers

Burgers:

- 1 medium sweet potato (200 g peeled)

- 1/2 can chickpeas (120 g)

- 1/4 cup quinoa flakes (could sub for oats but then you may have to start with a little less than 1/4 cup)

- 1 tbsp sweet miso paste (you can omit the miso paste if you don't have any but it really takes away from the flavour...)

- 1/4 small bell pepper, finely chopped

- 1 tsp onion powder

- 1 tsp garlic powder

- Salt and pepper to taste

Condiments:

- 4 buns of your choice (bonus points if you make your own.)(I did.)

- Avocado

- Thinly sliced vegetables of your choice such as tomatoes, lettuce, red onions etc.

How to:

1. Start by peeling and chopping the sweet potato into large cubes. Steam until it's soft enough to pierce with a fork (15-20 min).
2. In a large bowl, mash all of the ingredients together with a fork until everything sticks together nicely. Blend with a hand blender for a smoother consistency. (Though I highly recommend keeping the chunks!)
3. Form 4 big or 6 small patties with your hands.
4. Fry the burgers in a non-stick pan or a spoonful of coconut oil over medium to low heat until the patties have a nice colour on both sides, approximately 5-10 minutes on each side.
5. Serve immediately and with all the toppings your heart desires! (That is, stuff as much avocado as you possibly can in there. So worth it.)