Uncategorized – Page 33 – in thriver words

Make Your Salad More Salady

Instead of drenching your salad with dressing, why not make it more salady! When it comes to salads, it stands to reason that everyone would have different preferences. The question is, do those preferences make your salad more nutritious and satisfying or just more caloric?
salad
Some of us love salads. Some of us choose salads as a healthy choice on a restaurant menu. If you’re eating salad because you love it, just keep on chomping! If you’re eating salad to be healthy, it’s worth considering what’s in and on it.

While many of you were happily grilling burgers Labor Day, my friends and I were eating salad. Our holiday fare was a Caesar salad topped with grilled chicken. Okay, I guess the chicken was an homage to holiday grilling.

Anyway, one friend doesn’t really like Caesar salads. She says she prefers traditional salads with iceberg lettuce, carrots, tomatoes, cucumbers, onions, and cheese. Another argued that traditional salad has mixed greens, strawberries, blueberries, cranberries and pecans. That was laughingly characterized as a fruit salad by the hardcore traditionalists.

The great thing about serving salad at home is the components can be presented separately so that each family member can fill a bowl or plate with the combination they prefer. This presents a great opportunity for children to explore raw food, flavor combinations, crunchiness, and food groups. The dinner table is the perfect place to learn about food.
arugual
Any salad full of fresh vegetables is healthy. Adding fresh fruit, herbs, and raw nuts can be healthy too. When I eat salad, I tend to dig out the crunchy things first. If the crunch is provided by sugar snap peas, cucumbers, apples, yellow bell pepper, and carrots my bowl is healthier than if the crunch is provided by croutons, bacon, candied nuts, or fried tortilla chips.

Of course a salad can have croutons and still be healthy. The key is the proportion of raw vegetables, herbs, fruit and nuts to bacon, cheese, sweetened nuts & dried fruit, fried toppings, croutons & dressing.

Almost every pre-dressed salad has way more dressing than I prefer. And even when you order dressing on the side in a restaurant, the portion cup will most likely contain 2 to 2.5 ounces. A single serving of dressing is 1 ounce.

This double portion (and sometimes there are two of these cups on the side) may not seem like a big deal while you’re pouring it on your salad, but if you’re pouring Ranch Dressing you’re adding 290 calories to your vegetables. That’s only 10 calories less than two medium chocolate cupcakes with frosting.

To help keep calories in check, I sometimes choose cottage cheese instead of dressing or skip the dressing altogether. In a salad filled with berries and nuts, I’m often happy with no dressing at all. I’ve also been known to use vinegar and a little salt, but skip the oil. When I make dressing at home, I often start with yogurt or avocado instead of mayo or use vinegar, oil, and water in equal proportions.
peas
Once you’ve toned down the dressing, an easy way to keep the fat and calories down is to avoid any fried toppings. Some croutons are fried. If you opt for croutons, choose baked ones. If you’re gluten-free, the easiest thing to do is skip them. Substitute grilled chicken for fried chicken, and hold the bacon and fried wontons.

I’m not opposed to a wedge salad covered in bacon, bleu cheese and dressing. When properly chilled with perfectly crisp lettuce, they’re scrumptious. I just don’t think of it as a healthier alternative to a burger.

Reducing the amount of cheese in your salad can dramatically reduce the fat in your salad as well. This is why I think of making a healthy salad as keeping it more salady. The more flavor that is derived from fresh veggies and fruits instead of from things used to smother the veggies and fruits, the more salady it seems to me.

If you’re choosing salad as a meal, only vegetables and fruit with limited dressing may leave you feeling hungry soon after you eat. For a heartier salad, boiled eggs, black beans, chickpeas, avocado, tofu, and quinoa are some of my favorite additions.

Salad may be the most versatile entree that exists. The options are limited only by your imagination and the availability of ingredients. There’s a minimum of cooking required and fresh ingredients are encouraged. No wonder we love them. Now, if we can just bring ourselves to let them be more salady….

https://www.fatsecret.com/calories-nutrition/generic/cake-cupcake-chocolate-with-icing-or-filling?portionid=15043&portionamount=1.000

http://www.cooking2thrive.com/blog/salad-days/

What Makes a Grocery Store Great?

This week I’ve been wondering what makes a grocery store great? When I travel, I like to visit grocery stores. Not only do I want to see the food itself, I want to observe and absorb the culture. Funny thing is, I do not enjoy the grocery stores in my town. Why? Well, that’s what I’m exploring. I know it feels better to shop in some stores than others. Let’s figure out what makes that so.
grocery
Yesterday, I needed a few things in addition to groceries — potting soil, toilet paper, marbles. Wal-Mart seemed like a good place to get everything at one time. I crossed the river to an adjoining town to shop at the nearest Wal-Mart. But as I drove into the parking lot, I realized I didn’t want to be there. I didn’t want to go in that store. Without even pulling into a parking space, I drove out the other side of the parking lot and to a Kroger nearby.

What pulled me toward the other store?

Both are larger than I prefer, but the second store is smaller. Wal-Mart supercenters average 178,000 sq ft. Kroger Marketplace stores average around 100,000. I really prefer the footprint of The Fresh Market, Whole Foods, or Natural Grocers stores that average under 50,000 sq ft. From this I must conclude that size matters to me…in grocery stores.

As grocery store space expands, it rarely means more fresh produce, meat, or specialty flours. The added space is typically stocked with items that are boxed, bottled, fully prepared, or not food related. There’s nothing wrong with that. I just prefer shopping where fresh food is the focus.

I also like small shopping carts. Believe me, I can fill them with plenty of food. As a short person, tall, deep carts make it annoyingly difficult to reach small items hiding in the bottom near the back of the basket. Most grocery stores have both, but the store closest to my home does not.

When I walk into a store, it’s a pleasure to be greeted with a beautiful variety of produce, but two of my favorite stores (unfortunately, not in this town) have the produce located where it’s not visible from the door. Obviously, seeing produce immediately is not a big factor in a store making my favorites list. And from a practical standpoint, I’d rather stack easily bruised fruit on top of the staples in my basket. If I begin in the produce section, it ends up on the bottom where it’s more likely to get damaged.

More important than location is the variety and freshness of the produce offered. I’m okay with seasonal variations in selection, but only if there is a moderately predictable seasonal rotation or an easily accessed online list of what is currently stocked in a given store. Because stores in different neighborhoods are stocked differently, it sometimes takes visiting 3 or 4 locations to gather the vegetables I need for a recipe.

Once I find the produce I’m looking for, I’d like for it to be fresh enough to last a couple of days. Every other week, I get home to discover that the raspberries I couldn’t see in the bottom of the container are fuzzy or the prewashed sugar snap peas smell foul even though it’s not past the use by date. This recurring issue makes me dread what I’ll find next time I put away groceries.

This may not be true for everyone, but for me to think a store is great, it needs to offer a good selection of fresh meat, poultry, fish, and seafood that is unseasoned, unmarinated, and uninjected. I just want the raw ingredients, please. And I’d like a sell by date to give me an idea how long I have before it spoils.

Organic dairy products like plain yogurt with lots of active cultures and no gums or fillers, dairy alternatives without tons of sugar, high quality butter, and a wide selection of coffee improve my impression. Plenty of raw nuts, dried fruit without added sugar, and bulk spices make things even better.

Other than that, clear and accurate signs, efficient organization, and few empty spaces on the shelves go a long way toward a pleasant shopping experience. If I have to scour the health food section searching for gluten-free cereal amongst other whole grains, I will most likely skip it. I feel the same way about crackers, cookies, chips, and frozen food.

A final consideration is the ambience of the store. When I walk in, is it quiet and lit well but not garishly? Does it smell good? Are the aisles wide enough? Are there plenty of open checkout stations with friendly checkers? Does it feel more like a comfortable boutique than a herd-em-through warehouse? If so, I’ll enjoy being there.

If I could get a small, pleasant store with an adequate cold chain that offers a consistent variety of fresh fruit, vegetables, meat, poultry, fish, seafood, and easy to find gluten-free items that I can put in a small cart within 5 miles of my house, I’d be so giddy I wouldn’t know what to do. All of that together would truly make a grocery store great!

In the meantime, I’ll keep going to multiple stores to get what I need.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

https://retail-index.emarketer.com/company/data/5374f24d4d4afd2bb4446614/5374f2b24d4afd824cc15ebb/lfy/false/wal-mart-stores-inc-real-estate

https://www.walmart.com/

https://retail-index.emarketer.com/company/data/5374f24a4d4afd2bb4446582/5374f2834d4afd824cc15a0f/lfy/false/kroger-real-estate

https://retail-index.emarketer.com/company/data/5374f24d4d4afd2bb4446612/5374f29e4d4afd824cc15c99/lfy/false/natural-grocers-real-estate

https://retail-index.emarketer.com/company/data/5374f24e4d4afd2bb4446642/5374f2b34d4afd824cc15ed5/lfy/false/whole-foods-market-real-estate

https://retail-index.emarketer.com/company/data/5374f24e4d4afd2bb4446639/5374f2734d4afd824cc1587c/lfy/false/the-fresh-market-real-estate

Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?

It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.

But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.

Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

I’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

http://www.cooking2thrive.com/blog/get-know-food/

Here’s an Idea for an App

brain Here’s an idea for an app: Wouldn’t it be great if there were a smartphone app that could scan my tummy & tell me why it’s hurting? Is it a stomach virus, gluten exposure, FODMAP related, lactose intolerance, corn intolerance, salmonella, too much guar gum or carrageenan, natamycin, not enough fiber, too much fiber, the frequency of meals, or the fact that my sister is coming to visit? I’m willing to do whatever it takes to make it stop hurting. The problem is, it’s often difficult to determine what that is.

I was recently part of a team that reviewed a pilot research grant for a study of the effectiveness of an app vs traditional treatment. While we ultimately chose not to fund that particular grant, I see great possibilities in the future of apps to assist healthcare professionals with diagnosis and treatment of disease and chronic conditions, the physical manifestations of trauma, and mental health issues in general.

While the human element offers insight that may be missed by technology, it also brings inherent bias and inconsistency. In the 1960s, the Oregon Research Institute set out to study how experts rendered judgments. Lew Goldberg, a psychologist, developed a case study in which researchers gathered a group of radiologists and asked them how they determined from a stomach X-ray whether a patient had cancer.

The doctors indicated that there were seven major cues that they looked for. In an effort to create an algorithm that would mimic the decision making of doctors, the researchers created a simple algorithm in which the likelihood of malignancy depended on the seven cues the doctors had mentioned, all equally weighted.

Researchers then presented the doctors with X-rays from 96 different individual stomach ulcers and asked them to rate each one on a seven-point scale from definitely malignant to definitely benign. Without disclosing what they were doing, the researchers showed the doctors each ulcer twice with the duplicates mixed in randomly so that the radiologists wouldn’t notice the duplication.

All data were transferred to punch cards and sent to UCLA for computer analysis. When UCLA sent back the analyzed data, it became clear that this simple computer model was surprisingly good at predicting the doctors’ diagnoses. Even more surprising, the data showed that the diagnoses were all over the place. In spite of the fact that they were trained experts, the radiologists didn’t agree with each other. In fact, they often didn’t agree with themselves. Every single doctor had sometimes contradicted his own diagnosis when given a duplicate X-ray.

The researchers also found that clinical psychologists and psychiatrists deciding whether it was safe to release a patient from a psychiatric hospital wildly differed from each other in their determinations. Further, those with the least training were just as accurate in their judgments as those with more training.

The Oregon researchers then tested the hypothesis that the simple computer model they had designed might be better than doctors at diagnosing cancer. Turns out, the algorithm outperformed even the single best doctor in the group of doctors being studied.

What Goldberg came to realize was that doctors had a good theory of the cues to look for in diagnosing cancer, but in practice they did not stick to their own ideas of how to best diagnose. They tended to weigh things differently. As a result, they were less accurate than a computer model.

Given our current reliance on experts to diagnose, this research isn’t particularly reassuring; however, it does bode well for the inclusion of artificial intelligence in diagnostic procedures. That’s right, just the sort of technology that could be deployed by an app on my handheld device.
floating apps
Here’s an idea for an app

A decade ago, I attended the Game Developers Conference in Austin, Texas. There were sessions on massively multiplayer online (MMO) games, animation for video games, avatar development, and artificial intelligence in video games. I remember thinking as I sat through one of the sessions – the highest and best use of characters in a game who can learn from conflict would be to develop “games” or tools for families to learn to resolve conflict and improve communication.

If I create an avatar that behaves like me at first, but learns better ways to navigate specific situations, I can learn to improve my game, i.e., my life. With the distance of “playing” myself, I gain perspective. I still think there’s great potential for emotional and social growth applications.

Here’s an idea for an app

A couple of months ago, I spoke to the Trauma Institute & Child Trauma Institute in Northampton, MA about a new progressive counting method used to treat PTSD and the effects of childhood trauma. Essentially, the patient verbalizes their first chronological memory of trauma while the therapist counts. This process continues until the distress associated with that memory is resolved. Then the patient moves on to the next distressing memory and repeats the process.

I’m sure it’s a little more complicated than that, but my first thought was – I wonder if you can make a phone count out loud? If so, it seems like a lot of this could be done with a smartphone. Maybe you’d do a couple of sessions with a practitioner at the beginning and periodically thereafter, but the rest could be done in the safety and comfort of your own home. We need an app for that.

Well researched and well designed apps have the potential to propel us forward. Whether or not they include my ideas, I’m excited about their incorporation into medical and mental health practices.

http://www.ori.org/scientists/lewis_goldberg

http://www.ori.org/

http://psycnet.apa.org/record/1970-12828-001

http://michaellewiswrites.com/#top

http://www.childtrauma.com/

http://www.gdconf.com/

http://www.cooking2thrive.com/blog/make-it-easier-to-stick-to-your-eating-plan/