Healthcare, with emphasis on caring for actual health

Full disclaimer: I am neither Democrat nor Republican and I do not intend to promote or disparage either. This is a nonpartisan look at the highly politicized health care crisis facing the US and its proposed reform. It is, also, ultimately about food and other health choices and acting as a Food Renegade (thank you www.foodrenegade.com for Fight Back Fridays).

(And I promise a recipe for kohlrabi in my next post later today!)

An op/ed from Senator Tom Harkin (D-Iowa) (http://news.yahoo.com/s/ynews/20090625/ts_ynews/ynews_ts408) points to the key feature of the Obama administration's health care reform effort - reducing medical expenses by keeping people healthy. All politics aside, whether you see Obama as the answer to, or the author of, everything stupid - this approach to controlling health care costs is so common-sense it is genius. And is likely doomed to failure.

Legislation fails when it threatens the livelihoods of any group with enough power to make it fail. Here is a perfect example from Michael Pollan's Unhappy Meals (http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?pagewanted=2&ei=5088&en=7c85a1c254546157&ex=1327640400):

...a little-noticed political dust-up in Washington in 1977 seems to have helped propel American food culture down this dimly lighted path. Responding to an alarming increase in chronic diseases linked to diet — including heart disease, cancer and
diabetes — a Senate Select Committee on Nutrition, headed by George McGovern, held hearings on the problem and prepared what by all rights should have been an uncontroversial document called “Dietary Goals for the United States.” The committee learned that while rates of coronary heart disease had soared in America since World War II, other cultures that consumed traditional diets based largely on plants had strikingly low rates of chronic disease. Epidemiologists also had observed that in America during the war years, when meat and dairy products were strictly rationed, the rate of heart disease temporarily plummeted.

Na├»vely putting two and two together, the committee drafted a straightforward set of dietary guidelines calling on Americans to cut down on red meat and dairy products. Within weeks a firestorm, emanating from the red-meat and dairy industries, engulfed the committee, and Senator McGovern (who had a great many cattle ranchers among his South Dakota constituents) was forced to beat a retreat. The committee’s recommendations were hastily rewritten. Plain talk about food — the committee had advised Americans to actually “reduce consumption of meat” — was replaced by artful compromise: “Choose meats, poultry and fish that will reduce saturated-fat intake.” (Emphasis mine. Though the choice of italics here is not. I just can't seem to un-italicize it.)

So the question is, who's gonna hate this idea? Or more specifically, which group has something to lose and has the extraordinary means to kill the proposal?

On the one hand, private health care insurance companies are gonna love it because the healthier their insureds are, the less they will have to pay out in claims.

On the other...

Medical care in this country is primarily specialty care, which emerged very specifically from the 'sickness care' approach to health care. You want to fix what's broken? For whatever your issue, there is a specialist. New specialties pop up wherever advances in medicine occur - look at the evolution of interventional cardiology since the advent of angioplasty. And I'll tell you what, if I have a brain aneurysm - its a sure bet that I want the very highest-rated vascular neurosurgeon ready exactly when I need her. I selected the hospital to deliver my baby- even before I was pregnant - because it has the finest neonatal department in the area. Thankfully, I had a healthy baby, but should she have needed any critical care, it would have been instantaneously available.

This reform effort (right now, anyway) seems to lean toward placing greater emphasis on primary care, while moving away from emphasis on (far more expensive) specialty care.

My own personal demands for unfettered access to specialty care offers a peek at the problem, now that I'm looking at the issue. I learned earlier this week at my primary care doctor's office that she regularly performs PAP smears and skin cancer checks during routine physicals. I needed neither of these when I saw her because I continue to see my OB/GYN annually for an exam (even though I am done having children) and because just last week I had a dermatologist (actually some para-professional in the dermatology practice) map my moles (though I am extremely fair-skinned and I have burned like crazy over the years, I have yet to have any areas of concern). A little over a year ago, I had an echo-cardiogram at the primary care physicians' office to determine if my Mitral Valve Prolapse had advanced at all in the 20 years since I was diagnosed (glad we checked as it turns out I do not actually have Mitral Valve Prolapse at all). All of this points to the fact that at least some of my demand for specialists is utterly unnecessary. And that my health insurer paid out far more than was likely necessary for me to have these routine exams as specialty care costs are far greater (though only an additional $5 over my regular co-pay for me).

Primary care physicians (largely represented by the somewhat powerful American Medical Association) will likely support of the focus on wellness rather than sickness care. It just makes sense to have your health care hubbed in one office and to see your same doctor once a year for a complete physical. If and when the need for additional expertise arises, you then see a specialist with the advanced education, training and experience to most effectively address your condition.

Specialists (who are not nearly as cohesively represented in the halls of Congress as primary care physicians for complicated reasons that combine the AMA's generalist focus and punishing anti-trust laws) will say that specialty care IS quality care and any shift away from our current system is a danger to patients. Specialists will point to patient frustration and outrage over managed care efforts in the past. And, it's true, patients commonly had to dance to get a referral from a primary care doc, in many cases delaying necessary specialty care because the patient had to schedule a visit to the primary care physician first and only after that appointment occurred could the patient schedule the appointment with the specialist. "Managed care" as we know it did not enhance patient care. It did enhance health insurers' profit margins because it financially rewarded primary care docs for two things: 1) seeing more patients in less time and 2) restricting access to specialists and tests. Both points worked directly against patients and against quality, timely health care. People are unlikely to embrace any suggestion of a return to this failed system.

Add to that Senator Harkin's comment:

"As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health." (Emphasis mine.)

Sure, Americans spend a staggering $40 billion a year on weight-loss products. But we spend twice that on cigarettes.

Is education the answer? I know my kid learns about healthy eating in school every year. And then lunches in the school cafeteria that boasts selling 125 pounds of french fries each week. There is always a gaping chasm between what people know and what people do with that knowledge. (My favorite example is this: while studying in 1994 to be a Red Cross Certified HIV/AIDS educator, the group of students in this class - all there with the shared goal of reaching out to the community to help people protect themselves from a deadly disease - would step out at each break time to inhale deadly-disease-causing carcinogens.)

Most of us have had the power all along to protect ourselves from many preventable debilitating and deadly illnesses. Will new legislation aimed at ultimately reducing our national debt inspire us to act for our own personal selves and our families in ways that we never have before?

Not likely. What is likely is that we - the health care consumers - will be responsible for killing this health care reform proposal. We are trained to respond to high cholesterol with a 'pass me a magic statin pill and another double cheeseburger, please'. In September 2001, the New England Journal of Medicine reported that as many as 90% of the cases of Type II Diabetes in women was preventable and reversible with healthy eating and other lifestyle changes. Yet, between 1990 and 2005, the prevalence rate doubled causing the CDC to chacterize Type II Diabetes as an epidemic. In November 2007, The National Institutes of Health noted that while it was traditionally seen as an adult-onset condition "type 2 diabetes is increasingly diagnosed in children in parallel to rising obesity rates." Type 2 diabetes is just one example, but it might be tough to find a more dramatic one. Have you seen the 'living with diabetes' magazines - yes, more than one - in the checkout lanes at the grocery store? 90% preventable type 2 diabetes has become its own industry.

What is it going to take to get us to change? What needs to happen to get us to act in our own self-interest health wise?

Check the ACLU's completely un-subtle message about what lengths our government could possibly go to if we move to a universal health care program http://aclu.org/pizza/images/screen.swf
It is frightening to think that it just might take this Orwellian level of intrusion into our personal lives to make us seek our own wellness. I hope there is an answer before 1984 arrives.

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(I know the ACLU is considered a crazy left-wing organization. But the link below was sent to me by a strident right-winger -defined for these purposes as believing all Democrats are evil morons- friend of mine with the subject line: Ordering Pizza in an Obama World. So that makes this whole post 'fair and balanced' for sure!)




When I launched the move to eating real food (and began discovering what that really means), I ran to the doc and had my blood work done and urged my hubby to do the same. We expected that his cholesterol numbers would be higher than ideal. They were 4 years ago and nothing about his diet or lifestyle has changed in any way since. He still plays full-court basketball 4 -5 times per week and (until recently) still polishes off more frozen pizzas (with milk shake chasers) than anyone has a right to. He went from 234 total cholesterol to 226. His doctor said that he was probably a little higher than she would prefer, but dismissed the reading as 'not a concern.'

My numbers came back in the normal range (total cholesterol count 189). But the person who called me with the results used an alarming tone when she said "Your LDLs are high and you need to get that number down." When I received the paperwork in the mail, everything was all printed in regular fonts until you got the the LDL count, which was highlighted, bolded and underlined with the word "HIGH" bookending the number 117. Mine are HIGH at 117; my husband's at 160 are of 'not a concern'.

I am confused. (He is nine years older than I am. And he's a guy. You would think...well, at least I thought...well, I don't know what I thought, but I know that these responses were unexpected and a little inexplicable. )

So, I picked up The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will) by Michael Ozner, MD (a board-certified cardiologist). Dr. Ozner contends that a healthy cholesterol reading should not exceed 150 - with LDL below 70 and triglycerides below 100. (Given that, my reading IS high. And my hubby's is dangerously high.) And 150? Have you ever even heard of someone with 150 cholesterol?

Then, I had a great chat with my doctor this morning during my physical. She explained that the overall number is not very useful. Rather, the HDL to LDL ratio is important. Also the triglyceride number is important. Beyond that, though, the numbers are assessed against the overall health and family history of the individual. Neither of us has any heart disease in our personal or family histories. Neither of us is overweight or has diabetes or smokes.

All of which makes our numbers not overly important, but, apparently not unimportant either. She recommended getting all of our cholesterol numbers within the boundaries of what is considered healthy. How? First: add fish oil and back off of simple carbs. Dr Ozner's recommendation? Exercise and follow a Mediterranean diet.

Backing off the simple carbs is a chief aim of this whole real food effort for us. In three months, I go back to get tested again. I wonder what difference three months can make. Lucky for me, the local farmers' market opens this week.

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Dr Ozner lists "the top foods that have been shown to have a favorable impact on cholesterol, by lowering the "bad" LDL cholesterol or by raising the "good" HDL choleserol...:
* Fruits and vegetables
* Olive oil
* Oatmeal
* Nuts (especially almonds and walnuts)
* Beans
* Cold water fish
* Red wine
* Cinnamon
* Whole grains
* Soy protein
* Plant sterol and stanol spreads

Am I the only one who did not know this?

This is definitely what I am talking about when I say I am "learnin' stuff."

After reading that the Red Brandywine Tomato plants I received at the Chicago Botanic Garden were 'heirloom', which means 'can be reproduced from own seeds', I was a little confused. I knew that the tomato seedlings I bought from the local garden center were 'hyrbids' as the plastic labels that surrounded their peat cups told me so. What I did not know was what I read when I peeked into Wikipedia for more information:

...most authorities agree that heirlooms, by definition, must be open-pollinated. They may also be open pollinated varieties that were bred and stabilized using classic breeding practices. While there are no genetically modified tomatoes available for commercial or home use, it is generally agreed that no genetically modified organisms can be considered heirloom cultivars. Another important point of discussion is that without the ongoing growing and storage of heirloom plants, the seed companies and the government will control all seed distribution. Most, if not all, hybrid plants, if regrown, will not be the same as the original hybrid plant, thus insuring the dependency on seed distributors for future crops. (Emphasis mine.)

"the seed companies and the government will control all seed distribution" sounds frightening. What is gained by this? And, most importantly, what is lost?

What was planted in the White House garden?

It all leads to more questions for me. More stuff to learn.

Cook. And if you can, plant a garden.

Pollan's Rule of Thumb #8. Cook. And if you can, plant a garden.

Cooking is already a love for me, so that was a quick win in this effort. Gardening is newer to me and my experiences so far have been less than successful. Part of the problem is that the very best place on my property to grow things would be the front yard. Of course, this is suburbia and front yards are not used for vegetable gardens. My whole (un-jumbo) backyard is shaded by a huge maple tree, the house itself and a wall of deciduous pine trees.

The south-facing side of my house has a 3 x 9 garden area that gets the most sun (other than the front yard), though I cannot confirm that it is the full sun that the 6 tomato plants I have there have requested.

I purchased 4 tomato seedlings at home and garden store. Two of the tomato seedlings I picked up at the Chicago Botanic Garden this past weekend. They were just giving them away. These two are heirloom variety Red Brandywine Tomatoes. Because it is an heirloom variety (according to the instruction sheet given with the plants) it can be reproduced from its own seeds. Also because it is an heirloom variety, it is not typically found in grocery stores (the thin skin does not make for successful transportation.

New to gardening, I was unaware that every tomato plant could not be reproduced with its own seeds.

In addition to my 6 tomato plants, I have a few cucumber plants, one green bell pepper plant, two different kinds of strawberry plants (one pictured above - with some baby strawberries!) and one heirloom zucchini plant (also a gift from the Chicago Botanic Garden).

So in 50 - 80 days, I should have quite the harvest if the plants get enough access to the sun they need and I can keep the chipmunks from treating the area as a buffet until then. (the little creeps have already eaten 8 of 9 sunflower seedlings).

Meanwhile, I can take advantage of the numerous farmers markets in the area. The one in my very own hometown launches June 25.
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Got this recipe for Home Fries from from Rachael Ray:

Heat oven to 500 degrees (525 of your oven can)
Slice one baking potato (per person) in half and then in quarters and then into slices, lay flat on baking pan
Smash garlic (as much as you like) and distribute chunks among the potatoes
Chop fresh rosemary and sprinkle over potatoes
Drizzle olive oil over potatoes and hand-toss until all is mixed together.

Bake for 20 minutes or so (until your whole house smells like a holiday)

I served these with corn on the cob and some homemade burgers with lots of delicious garden toppings (red onion, tomato. fresh basil).

Doesn't get any fresher

I am lucky to live near the Chicago Botanic Garden (and luckier still that my mother gifted me with a membership to this amazing place!). Each Saturday and Sunday, a local chef demonstrates cooking with just-picked ingredients from your garden.

Yesterday a chef from a restaurant in Glen Ellyn, IL called Glen Prairie made Organic Tomato Gazpacho for the audience. (The picture shows everything the chef used yesterday, plus also a guy in a hat.)

Here is the recipe:

5 each Roma Tomatoes (rough chopped)
2 each Cucumber (seeded, peeled and chopped)
1 each large Red Pepper (seeded, cored and chopped)
1 each Celery Stalk (chopped)
5 each Green onions (chopped)
2 cloves Garlic (chopped)
1 tsp Worcestershire sauce
1 tsp Tabasco (or to taste)
1 oz Olive Oil
1/4 cup Sherry Vinegar
2 ea - 8 oz cans tomato juice or V8

In your blender or food processor, combine first 6 ingredients. Sprinkle with salt and pepper. Combine oil, vinegar, tomato juice (or V8) and Tabasco. Blend into vegetables until smooth. Serve in large bowls or mugs. Serves 6 to 8.

For garnish: 1 tbsp creme fraiche or sour cream, halved grape tomatoes and scallions

Everyone in the audience gets samples. The soup was fantastic. The chef suggested it the day before you plan to serve so all the ingredients can "marry" in the fridge.

Plus I picked up two Red Brandywine Tomato seedlings and some nasturtium seeds (dosed with some wormy fertilizer) to add to my home garden.

Pierogi triumph


The pierogi were not nearly as much work as I first thought. I followed the dough recipe exactly, including the part where all of it is hand-prepped (including the kinda icky part where the raw egg is mixed into the flour). But I was in for the full experience and while it was a little gunky, I would most certainly do it again.

I opted for the Cheese & Potato Pierogi Filling (on page 462 of Strybel's book) with a topping of carmelized onions. This was cry-worthy good food.

I love absolutely everything my Vita-Mix can do, but the Cheese & Potato filling recipe has to be the single most delightful that has ever been mixed in mine. Here's the recipe: Cook 1 lb potato in skins until tender, peel under cold running water, and mash well or grind together with 1/4-1/2 lb. farmer cheese. (The proportion of potatoes to cheese is a matter of preference and may be varied according to taste.) In 2 tablespoons butter lightly brown 2 finely chopped onions and add to mixture... Salt & Pepper to taste. A dash or two of paprika and/or homemade herb pepper will provide added zest. (I could not find any farmer cheese, so I opted for cottage cheese.)

Here is the dough recipe and instructions for cooking as they appear on page 457 in Polish Heritage Cookery by Robert and Maria Strybel:

Sift about 2 1/2 cups flour into breadboard. Sprinkle with 1/2 teaspoon salt. Make a volcano-like crater in the flour mound and deposit 1 egg into it. Work ingredients into a dough, gradually adding about 1/2 cup cold water in a thin stream. (Some Polish cooks prefer lukewarm or even hot water.) Knead dough on floured board until firm and smooth, roll it into a ball, and let it rest 10 minutes or so beneath a warm inverted bowl. Take 1/3 of the dough at a time (leaving the rest beneath the bowl) and roll out thin. With glass or biscuit-cutter cut dough into circles. Place a spoonful of filling on each circle slightly off-center, fold in half and press edges together with fingers, crimping to ensure a tight seal. Drop small batches of pierogi into a fairly large pot of salted boiling water, making sure not to crowd them. When boiling resumes, reduce heat to a slow boil and cook about 10 minutes. Test one to see how well dough is cooked. Remove to a colander with slotted spoon and rinse lightly with cold water. Serve hot with topping of choice or let them cool and then fry them in butter to a nice golden brown. ...makes 25-30 pierogi or roughly 4 servings.

For the soup which helped balance this dinner, I fell back on the whatever-vegetables-I-have-in-my-house vegetable soup.

And, of course, there was corn-on-the-cob. As there will be for three more nights. (Picture of corn above from www.pickyourown.org/freezingcorn)

St. Hyacinth and his pierogi!


Who knew the Polish say 'St. Hyacinth and his pierogi!' when surprised? I like it!

I am learning a lot on this, my first ever, Fight Back Friday, (www.FoodRenegade.com) about traditional foods from reading Polish Heritage Cookery by Robert Strybel. In this 1993 book (again 1993!), Strybel (again, like Michael Pollan and Pat Edwards, a journalist) includes a 33-page Forward that covers everything from how Polish Cookery developed (including the influences of 'forcible Russification and Germanization'), the contradictory findings of different diets' effects on cholesterol levels and the sometimes deceptive practices of the food industry. The author describes his book as a "fairly complete compendium of Polish cookery spanning the past two centuries."

I am delighted that I overlooked the book's front cover images of the crispy whole pig and the spiral of sausage that looks like it may have been one of the poor pig's final acts of digestion.

On page 19, Strybel writes: "...and despite the huge upsurge in consumption of 'lo-cal' and 'diet' products over the past decade, overall obesity in America has not declined." Of course, 16 years later the 'diet' industry's growth shows no sign of lagging and obesity rates have experienced their own huge upsurge.

On page 22, Strybel writes: Good nutrition is constantly stressed throughout this book. There is a colossal difference between balanced, common-sense eating habits and all the trendy, pseudo-diet and quasi-health innovations the advertisers try to foist on an unsuspecting public...The general rule of thumb, therefore, is to stick to real, natural foods refined as little as possible..."

'Good nutrition is constantly stressed throughout the book' and there are more than 40 variations on the pierogi in the recipe section? I am feeling significant Polish pride.

Tonight's menu: pierogi with some vegetable soup or stuffed cabbage. "Smacznego!" (Polish translation of 'bon apetit!')