Cookin' Good!

I’m feeling inspired!

I’m off today and digging into my pile of books, painfully aware of the gaps in my knowledge. I have a graduate degree. I’m a nurse practitioner. Yet I never had a class on nutrition and I learned even less about practical ways to help people make life-saving dietary changes. Just like doctors, I learned the basics of American medicine: prescriptions and proscriptions. Food was the province of dietitians. And I never met a single one in all my years in ambulatory care. If preventive dietary counseling is supposed to happen in a doctor’s office, consumers are screwed.

This morning, while checking out a course on plant-based nutrition, I stumbled on this:

PLANEAT.co.uk Trailer from planeat.co.uk on Vimeo.

These Brits, without any traditional financing, made an incredible, engaging film. For now, you can only watch it online; it costs $5.99. The best part of this little documentary gem, is that it features many professional chefs who cook only plant-based menus. Some of this food is very “high end,” beautifully presented, and would appeal to even die-hard foodies. I’ve never, ever seen anything like this level of creative, vegan food offered in my community. Many of the recipes in the film are posted on the movie’s web site for use by commoners, like me.

But there aren’t just chefs, there are ordinary people cooking lovely meals at home for friends and family. One is an Israeli scientist, now living in the U.S. Another is Ann Esselstyn, the wife of Dr. Esselstyn, the Cleveland Clinic surgeon and researcher who has done work on the impact of diet on advanced heart disease. You might think that Ann can’t possibly be ordinary. You would be wrong. There she was, in the family kitchen (with a well-worn toaster oven, no less), making lunch. She was so enthusiastic and had such ease working with some of her favorite foods, that she was infectious. Between making lunch, she recounted her own story. She had to invent recipes when her husband began to seriously change his lifestyle. Why? To paraphrase him: “I could tell people why they needed to change, but I couldn’t tell them ‘how to’. That is what Ann could do.” She became his partner, helping people learn how to cook tasty food so they could stick to the change. In the few moments she was featured, I learned some cooking tricks I’d never seen before! She doesn’t make fancy food, she makes practical food. In a kitchen just like mine.

When the film ended, I knew more than ever before that bringing nutritional solutions to people absolutely requires kitchen mastery. Eating is a sensual pleasure for most of us. Eating brings people together. Eating bad food, pulls people apart. You can’t get anyone’s attention if you make them feel as if they are going to be deprived of wonderful food for the rest of their lives. Who wants to live that way? Quality of life, not just surviving, is critical.

So, cooking and teaching go hand in hand. I have to know how to do both. Information without new skills guarantees failure. My own family thinks it’s impossible to eat a yummy plant-based diet. I must begin in my own kitchen, cooking delicious, wholesome food for friends and family. Because in the end, feelin’ good comes from cookin’ good!

Which first? Chicken or egg?

Ask a vegetarian / vegan which they gave up first, chickens or eggs, and you’ll likely get the answer: “chickens.” OK, and cows and pigs too, but let’s just stick to chickens for a moment. For me, the specter of brutalized chickens made it easy to give up flesh. But dipping a warm piece of buttered toast into a silky, shiny yellow yolk… that was heaven. And let’s be honest, terrible images of egg farms are pretty easy to suppress. So like most, I ditched “meat” and held fast to eggs and dairy.

Ah dairy. That’s an emotionally loaded food group for this Wisconsin girl. I always hated milk. It made me gag as a child. Loved ice cream though (it has sugar!). And cheese? You’d have to rip it from my cold dead hands. Whenever someone asked, “Are you gonna be a vegan?” The answer was immediate: “No. I absolutely cannot give up cheese.” Enough said. I did my part for animal cruelty and the environment. I gave up meat.

But it turns out that I had things a little backwards. Health was never at the top of my list of reasons for eating lower on the food chain. I knew that vegetarians had lower risk of heart disease but I didn’t change my diet to avoid disease. Like most people, I walk around in deep denial about disability and death. But my own aging and the constant exposure to the ravages of chronic illness in the clinic, has made the relationship between health and nutrition more prominent. My denial is being steadily chipped away.

I just finished the book “Healthy Eating, Healthy World”. This fast read is a well-written and researched overview of the interconnectedness of eating, planetary health, and human health and disease. Right up my alley! The author, Jim Hicks, was a management consultant who got interested in nutrition and set out to research a book on the subject. He ended up in a place he never expected to be: eating a vegan diet. He spent a lot of time with T. Colin Campbell, of “The China Study” fame and with Caldwell Esselstyn, the Cleveland Clinic surgeon who has done research on reversing heart disease with diet interventions. Dr. Esselstyn is also the father of “The Engine 2 Diet” guy Rip Esselstyn, who promotes a vegan diet that appeals to (he)men. You’ll see Rip’s approved foods on little seals pasted up all over the Whole Foods shelves. Much of the research done by Drs, Campbell and Esselstyn concludes that as bad as meat is for people, dairy is far worse. It has carcinogenic properties as well as increasing heart disease risk. So if you’re eating for health, you’d stop dairy first. Then eggs. And last …meat.

I immediately covered my eyes and began to sing the denial song … “la, la, la, la …” long and loud, to drown out this tidbit. I do not need to be this well informed. I have a terrible flaw: once I know something, I can’t un-know it and ignore the implications.

But now I know. So now what?

If you read this blog, you know that I’ve been eating at least a 99% vegetarian diet for three years (has it really been that long?). Over the last year, that diet has become really unhealthy. Yes, vegetarians can have unhealthy diets. One of my mainstays has become high fat dairy. Dairy replaced some of my salads and dark greens, which take more time to prepare, and soy protein. My LDL deteriorated and my overall feeling of well-being plummeted as my nutrition tanked. It’s been a multifactorial path that led me here …poor stress management, career dissatisfaction, and little exercise being big confounding factors. But when other things in life are gnawing at your immune system, it behooves you to be even more scrupulous about your nutrition. I have been anything but scrupulous.

I’ve reduced dairy intake in the last couple of weeks as I prepare for the 21-Day Kickstart Diet challenge. The cheese is nearly gone now but imagining giving it up for good is still really hard for me. With one benign colon polyp already removed, my risk of colon cancer is higher than average. It is a nasty disease and one I’d rather avoid. Dumping cheese to avoid chemo is a no-brainer. But it is also easy for the mind to lull you into believing that the risk isn’t really there as you opt for short-term pleasure. The decision to choose health is one we have to consciously make when the environment presents us with so many delicious and easily indulged in unhealthy options.

If a physician had told me 10 years ago to eliminate dairy, would I have made that choice? I don’t know. But I know what I’d do today.

Does anyone want my cheese?

The Other 1%

“If you have your health, you have everything.” So the old proverb goes. In 21st century America, health means you can afford the best pills and the latest medical interventions to prop you up as you hobble into old age. My job, as a health care practitioner, is to give you the props.

My patients have heart disease and most face continuing deterioration in their health. The devices in their chests sometimes shock them onto the floor. They swallow a long list of pills each day. They are obese. They try to do the right things: remember to take their pills, show up for their appointments, and maybe, sometimes, try to get healthier. Choosing better health often means trying the latest fad diet, swallowing the newest diet pill or buying Dr. Oz’s next miracle supplement. What they get is emptier pockets.

Every day I watch people of all ages and means stream through the doors of my hospital. If I were to count, probably half of them look like the people in Wall-E. Big, round, walking time bombs. Lurking inside them is the ultimate outcome of modern civilization -- heart disease, cancer, diabetes. Every one of those diseases is fueled by an unsound diet. While there is no silver bullet for excellent health, the statistics and the science are increasingly clear. If we could improve human nutrition there would be a profound reduction in illness burden and societal cost. No, expensive vitamins and supplements are not gonna do it. We have to alter, in a substantial way, what people eat every day. Few will want to do it. Even me. Especially me.

How in the world did I end up here, with a late-in-life obsession with nutrition? I’ve never been a “foodie”. I was never a devoted cook (ask my kids…my eulogy will not include raves about my cooking). If it’s not about the food, then it must be about … FEAR. That my family’s health is at risk, that I’ll end up sick from avoidable illness, or that my talents, however meager, won’t have been put to very good use.

I’ve been on a dietary roller coaster for more than 40 years. In the ‘70s, I hand-ground baby food for kids 2 and 3 (sorry number 1, you got Gerber’s Blueberry Buckle). As a young mom, I made all our bread -- whole wheat of course. I owned a copy of The Vegetarian Epicure and Diet for a Small Planet when only west coast kooks bought them. In the 90s I dabbled in “fringe” diets like Dean Ornish. He was holistic. He did yoga. His recipes were long, and time consuming and …well, not very good. I failed at any sustainable change. You eventually had to cook and we’ve established that I’m not a kitchen goddess. You ate weird food too, like tofu. You stuck out like a sore thumb the minute you shared a meal. I gave up.

But like a karmic cycle, here in my 60s I’m back to The ‘60s. Like “liberals” who’ve become “progressives,” the V word has a new name too -- “plant based”. It’s the same thing those fringe folks wrote about so long ago only now there’s no commune to sustain our resolve. And it’s still hard. And I might give up.

Yet I seem to be stumbling towards a calling. I feel ill-equipped for the task. I don’t know how to help people make transformative change in their food habits. I’m barely managing my own personal transformation, which is a rocky road at best. I’m aiming to become one of the 1%. No, not Mitt’s, but Bill (the Big Dog) Clinton’s. That’s how many self-professed Vegans lived in the U.S. in 2009. Many days I don’t want to go there. It will definitely sound the death-knell for my dating life. But I seem pulled to this new thing, to the possibility that I might be able to help people avoid or reverse chronically ill health. That I might be able to dodge the diabetes that has stalked my own family.

I can’t continue to turn a blind eye to what passes for “health” care. I feel inauthentic. It’s taking a personal toll. But entering this new world is a struggle. Finding a personal and professional support system is a challenge. If I make a transition, I have no idea what it will look like or if I can be self-supporting. Too often, I feel alone and on the fringe even though I know there have to be others out there who are like me. For now, I’m educating myself and searching for the spiritual and emotional courage to move into an unknown future with all the vulnerability that comes with that. Until then, I’m teetering on the bleeding edge of the 99%.

The Vegetarian Faces the Mirror

My naked reflection stared back: “Face it,” she glared. “You’re fat. Inside, you look just like that meat you won’t eat, with yellow or white greasy stuff embedded in your muscles and vessels.” “Thank’s for that repellant visual,” I mumble, as I cocoon myself in the towel. The cruel reality is that I’ve become a fat, miserable vegetarian.

I’ve complained for months about my weight, while I sneak another biscotti like a closet alcoholic. Compared to the Average American, I look small. But there are onerous drum beats compelling me to wake up:

1. My undies have become an abdominal garrote
2. My bra is so tight I can’t deep breathe
3. My knees creak, groan, and shoot pain when I climb stairs
4. I’m perpetually fatigued
5. And …I’m experiencing some unpleasant female miseries best left unsaid

Today, I’m declaring war…on myself. Like any war, a multi-pronged offensive is in order. Eliminate stress eating. Learn how to sleep. Exercise and …Google for a miraculous elixir that will reverse the metabolic penalty of aging. How hard is that? Overwhelmingly hard. I’m discouraged. I’m guilt-ridden. Ashamed. I swore I’d never get this way again and yet, here I am.

OK, so I have to fight on many fronts. But I can’t attack every one at once. My stress would skyrocket, then I’d eat more, my stress would soar, then I’d eat even more …you see how that works? So, I’m starting with nutrition, betting it will have the most impact on my well-being.

(My drug of choice)

Work is an eater’s minefield. Home to stressed nurses, we continually display heaps of salty/fatty/sweet comfort food. I grab whatever fits my hand. None of it is healthy. I often skip lunch. At dinner, I rely on high fat protein sources (luscious full fat cheese …eggs …nut butter) or dark chocolate. I’m addicted to processed, poor quality vegetarian food. I need to detox. And I dread it.

Last week I started eating my way through the pantry and fridge, saying a fond, tearful farewell to the soon-to-be forbidden foods. I have a deadline, April 2, when the next 21-day Vegan Kickstart Program begins. I signed up. I have the app. I’m cleansing my mind to prepare for the challenge. I can do this! (I hope).

This weekend I shopped. I read labels. It made my head hurt. Dairy and eggs are embedded in everything, often as unpronounceable chemical additives. This is going to be harder than I imagined. I’ll have to cook. And plan. Oh dear.

Surely I can manage 21 days of this. That’s not forever. I don’t intend to become a full-time vegan. I want to lose weight and gain energy. Hopefully, eating plant-based will feel less daunting. At the least, I’ll Kickstart my health again. But the true test is in 3 months. On my 64th birthday, I want to take a deep breath, face the mirror, and get a well-earned “atta girl” from the face staring back.

It Starts With The Gas

A rule of thumb for adults with aging parents: When the elderly forget to turn off the gas, start shopping for assisted living.

Today, I left on the gas.

This morning I cooked (of all the ironies), the last of my eggs. I slid them onto my plate, put the sauté pan in the sink, ate, cleaned up …and left. Three hours later, I returned to make a nice cup of tea. There, simmering away, was that incriminating, barely visible blue flame. Above me hovered the dementia fairy, whispering softly, “This is how it starts, you know.”

Does it? Is this how it starts? Was this an aberrance? Just a reflection of my chronic distractibility? Or an ominous sign?

Back at my desk, I worried, wondered, did a quick once-over of my mental status. Can I still calculate? (yes, faster than when I was 50, or 30, for that matter). Do I lose things? (oh boy, we probably shouldn’t discuss that). Do I forget more? (let’s avoid this too). How is my decision-making? (pretty damn good; I resigned from Match.com, permanently). Can I learn new things? (yes; I’ve adopted all things Apple and my devices and I are doing quite fine together).

I confess, I’ve adopted some memory crutches:

1. Stash stuff in the same place. Always. Do not get creative about where to put cars, keys, earrings, candy you vow not to eat. If I take a risk and discover a better place for something, it’s likely to become part of my inaccessible mental cold storage locker. I haven’t lost my car yet, but I have “misplaced” it.
2. Make a list. Or ten (and remember where you put them.) I hate lists…but keeping track of work, home, things that matter, is far too challenging without them (thank you Siri for helping with this miserable task).
3. Stop multi-tasking. OK, this is impossible, especially at work. But when I try to manage multiple mental streams, something inevitably floats away. “Where was I?” has become my mantra.

But even with my little tricks, there is no denying that my mind is different. I’ve always been easily distracted but as I age, that has magnified. Focus is harder to maintain. I bore more easily too (thus, the distractibility). My mental discontent seems to be increasing. My mind is interested in more things than I can reasonably explore. And that just makes the forgetting worse.

But please, please let there be an up-side.

Well, one “plus” is that as we lose focus, researchers increase their focus on us. How come? For the usual reasons: money. When Boomers worry, corporations see dollar signs. As a group, we are scared to death of aging, dementia, frailty and dependence. If you want to develop a market, figure out how to soothe us (just make sure we remember your pitch). To find a niche, the hucksters need data. What are our old brains really like anyway?

Well, for starters, we are losing things (and not just our keys). “Fluid Intelligence” peaks in your 20s. Genetics influence it. This underlies our capacity to solve abstract problems that rely little on experience. But the gain is in “Crystallized Intelligence” which takes off in our middle years. It builds on experience and education. Inductive reasoning and judgment depend on this kind of intelligence. We elders actually seem to get much better at utilizing past experience to assess complex problems with moral, cultural, or political dimensions. Maybe we get wiser, even as we forget to turn off the gas.

Beyond the usual memory tricks, there are ways to shore up the aging brain. The continuous pursuit of learning can buy you 10 extra years of brainpower as compared to your peers. Your joints might creak, but your brain will be younger, more vibrant. Challenge your mind: Read, write, do puzzles (Words With Friends anyone?), take classes, use your computer. Men, especially, seem to benefit from computers (is it the lure of porn, even for old guys?). But beyond the obvious, here are some other ways to keep a fit brain: stay connected socially; seek out support from loved ones; volunteer; attend meetings about things you care about; manage stress to maximize a sense of control over your life.

The benefit extends beyond yourself. A decline in cognitive functioning exacts a huge cost: on the health care system, on society, on families. At a time when our species faces so much uncertainty, so many risks, we will need more than technical skill from the young’uns to save us from ourselves. We will need judgment, wisdom, a moral compass. If my mind goes too soon, my community can’t benefit from my well-developed intelligence. So I’ll keep writing, and reading, and trying to beat my friends’ Words.

Then maybe I’ll remember where I stashed that candy.

Shooting Up With Paula

Today, 7,300 people 20 or older will learn that they are diabetics. Three years ago, the hugely popular cooking queen Paula Deen also got the word. Paula went home to think about it. She told her immediate family and no one else. Paula was just feeling too private to share.

I know, getting hit with a serious health diagnosis can rattle you to the core. You pretend it isn’t real. You wonder how you caught this thing. But when you begin treatment, it’s hard to avoid the reality. Your change in health begins to define you. You take medicine twice a day, maybe more. You may have to give yourself shots. In the case of a diabetic, you must begin to eat differently if you want to stem the advance of the disease. Surely Paula woke up. After all, she has something pretty damned important to stick around for. Something far more important than protecting her health records. Paula is a BRAND. A high fat, high sugar, food-hawking multi-media brand. And that brand is worth millions.

Now Paula was confronted with a bit of a complication. As she struggled with her personal health, she surely realized that her brand reinforced all the things that promoted diabetes. But did she challenge herself to adapt her style to reduce the risks inherent in her food? Nope. But I suppose that expecting Paula to reflect on her lifestyle, to take responsibility for her negative impact on other people’s health, is like expecting Royal Dutch Shell to reduce drilling when they noticed the Arctic melting. Shell didn’t stop. And Paula kept cookin’.

Suddenly, three years in, Paula decides to come out of the kitchen closet. What provoked her sudden desire to reveal all? How about a promotional gig with Novo Nordisk, one of the largest purveyors of diabetic drugs. Suddenly, Paula is giving interviews, pushing a web site, and speaking on behalf of the drug, Victoza, a Novo Nordisk injectable (did I mention that she gets the drug for free?). She’s a one-woman diabetes educational machine. She’s telling everyone about her disease.

What is the meaning of all this? Who the hell cares about Paula Deen? I care. Because Paula Deen is a cultural icon, like it or not. It matters what she says and does, to millions of people, most of them women.

I think Paula was too embarrassed to take any responsibility for herself and her devoted fans. She was utterly clueless about what to do and too stupid to make the connection between what she ate and those shots she gave herself every day. She admitted that she didn’t want to tell anyone until she could offer something positive. But even if you give her the benefit of the doubt, it is hard to avoid the conclusion that Paula is a self-centered, unethical fraud. Paula has almost certainly gotten the best diabetes care money can buy. She knows damn well where diabetes comes from. Yet when an interviewer asked her how people develop diabetes Paula answered: Age, genetics, race and (mumble, mumble) lifestyle. No mention of obesity. Forgot to say that high carb, high fat food is lethal. Emphasized that her cooking was fine, “in moderation” (she really did say that). Seriously? Should any diabetic eat Paula’s food in moderation? Not if they like legs, eyes and kidneys -- and I don’t mean the kind you fry in butter and cover in cheese. But rather than risk her millions, she found an easy out -- promote drugs and even better, get paid for it!

You just know that Paula’s fans won’t abandon her. They’ll run to their physicians and nurse practitioners and ask about that new drug Paula is using (which is very expensive). They will ignore any diet teaching that challenges their beloved Paula since Paula says that her crap is fine, “in moderation.” They will continue to serve this poison to their families, ensuring that their kids will get to hear those terrible words: “you have diabetes.” Then they’ll blame it all on genetics. In 2010 there were 1.9 million new diabetics. And now Paula has 1.9 million new customers.

The Cardiologist Eats Tofu

I corner him to introduce him to a new staff member. He grabs my arms and stares intently into my eyes. We are about to play a game. “Guess what I had for dinner last night.” He has been asking me this a lot lately, since he found out I’m a vegetarian. I’m ready for him. “White bean and kale soup.” I’m smiling, ready for my praise. He always has white bean and kale soup. “Nope.” He’s loving this. I’m wrong. He enjoys it a lot when I’m wrong. “OK, what was it?” He lets go of my arms, “A nice bed of fresh cooked spinach with tofu on top and some kind of sauce. My wife made it. It was great. We are now going to eat vegetarian two days a week.”

After I recover from the image of him eating tofu, I lavish him with the strokes he’s looking for. “Your wife is wonderful. You are a lucky man. I think I’d like your wife. And I’m proud of you for eating tofu.” He smiles. Then he says, “We had steak the night before that,” and walks away.

OK, I get it. He isn’t going to give up his steak. But I take heart that the cardiologist is eating less meat. You’d think that choice would be a no-brainer for a guy who spends his life mending hearts, but it isn’t.

Still, he’s proud that he’s doing the right thing. Even if his wife is the instigator, he’s agreed to participate in this experiment of hers. He’s not alone either. In Mark Bittman’s column today he reveals that Americans are eating less meat. And can you believe it? One of the predicted 2012 health trends identified by a social science research company called The Values Institute at DGWB is:

“The Rise of the “Flexitarians.” They predict that in the pursuit of health, more Americans are going to adopt a flexitarian diet, markedly reducing the amount of meat they eat without adopting a totally vegetarian diet. They attribute the promotion of Meatless Monday meals as a contributor to the trend.

Small changes add up. For my cardiologist, it’s two vegetarian meals a week. That’s one more than last year. Maybe, with encouragement, he’ll lead his patients to Meatless Monday too. Here’s to the Rise of Flexitarians!

My Vegetarian Hypocrisy Revealed

“So,” my son said, with a snarky tone, “you eat eggs but not chickens. What’s the difference?” Fueled by a glass of wine, I gave a smart-ass response that made little sense. One of my daughters-in-law mounted a more intelligent defense on my behalf, but the encounter left me feeling conflicted and a bit ashamed.

Let me see if I can do better. “Why eggs but not chickens?”

1. Egg production stresses the environment less. One hen makes lots of eggs. One fryer makes …one fryer. Who knows if that’s true, but it feels right. Oh, and I like eggs.
2. I’m not a vegan. I like eggs.

The truth: There is little moral or environmental justification for eating eggs and avoiding eating chickens. Veganism without question has the lowest environmental footprint. It is even the “in” diet these days. Bill Clinton converted. Venus Williams is giving it a try. Mark Bittman, who can teach you how to cook and eat everything, advocates a vegan lifestyle “until dinner” in his New York Times column. All of them revolutionized their diet when their impaired health didn’t respond to traditional American interventions like drugs, a low fat diet, or exercise.

After watching “Forks Over Knives,” I started exploring a plant-based diet more seriously. Many sources pointed to evidence that a well-planned, mostly home-cooked, vegan diet provides optimum health. Yes, we are physically suited to an omnivorous diet. Psychologically, most humans are capable of killing animals to eat. But we humans also possess intellectual and spiritual capabilities. These help us formulate personal values to constrain our physical and psychological urges.

Here are three of mine:

I value the earth’s health because a sick planet dooms my grandchildren. Unfettered exploitation of resources is suicidal and stupid. I’m neither.

I value my health because I dread suffering pain and disability on my way to my grave. Heart disease, diabetes and cancer all bring suffering. They are all strongly linked to diet.

I value humane treatment of those less powerful than me. Videos like this from PETA, make it impossible for me to ignore the lives of the animals whose bodies occupy the center of most American’s plates.

If I’d asked my son last night to justify eating meat, he would have said that he likes meat and does his part to support sustainable farming. He buys organic, pastured, local, and (maybe) humanely raised meat. Like most modern, conscientious omnivores, when he eats at home he focuses on animal husbandry rather than environmental burden or nutritional research. And when eating out, no questions asked. For now.

But I’m prone to ethical shapeshifting too. By eating eggs, however they’re raised, I promote the untimely and unpleasant death of a hen. I can’t hide from that. And after watching a video clip of dairy practices recently, I’m more uncomfortable than ever with eating cheese. I adore cheese. It’s one of my core protein sources. But each time I pick up a block of cheese, it gets harder to ignore the life of the cow who produced it or its contribution to my bad cholesterol.

We are all living an elaborately constructed “middle way.” Some of us lie closer to the vegan endpoint …my ideal. Conscientious omnivores emphasize sustainable livestock practices and organic meat as the goal. We all want health -- for ourselves, for the planet -- and we each strive to get there without compromising our most deeply held values or the quality of our lives.

No, I’m not “all in.” My son’s right. I’m a hypocrite. Processed food, eggs, dairy, sugar …I eat them all, and my health and well-being reflect that. I eat junk when I’m stressed. I trade off healthful food for speed and ease. I’ve become adept at elegant rationalizations for my behavior. But my consciousness is rising again and with that, my guilt. I struggle. That’s why I can’t give my son a very satisfying answer to his question. I know he was baiting me. He disapproves of my lifestyle. I’m a pain in the ass to feed at family gatherings. He wants me to stop my craziness and make everyone’s life easier. So he points out my hypocrisy in hopes that I’ll eat …a nice chicken pot pie. Instead, he makes me think harder, and I creep ever closer to my ideal. I hope he’ll edge closer to his too.

Just Put Down Your Fork! Obesity and the Health Care Debate

I like Bill Maher. I do. He supports PETA. He encourages vegetarian diets. He's rich. OK, so the last one is no reason to like him, but it's important to this post.

Recently on "Real Time", he got into a rant with Arianna Huffington about the role of personal responsibility in fueling health care costs. I'm sympathetic to the argument. It goes something like this: Obesity is creating an alarming rise in health care costs. Where there is obesity, there is diabetes, heart disease, kidney disease among others. We can lower health care costs by lowering our forks, giving up junk food, and using some old-fashioned will power to control our eating. The underlying premise is that obesity is primarily the result of overeating. As a health care practitioner, I like the simple elegance of that solution. A lot.

But there's more here than meets the eye. Really.

We're flooded with obesity statistics every day, usually accompanied by photos of fat people with their eyes conveniently covered by black bars. Or we get only their backsides. But if you want to see how large we're all getting, you don't need the media to tell you. Stroll through your workplace, the mall, your local grocery store. Look around at your fellow movie-goers. We are surrounded by fat people. What's worse, we don't even know who is fat any more. May I direct you to Match.com? Check out people's descriptions of their body type. Pay special attention to those who self-identify as "about average" or a "few extra pounds". Now look at the pictures. Often they are substantially overweight ("average") or morbidly obese ("a few extra pounds"). Uhhh, I thought average meant that they were not fat, not "toned", not "thin" ...just kinda in the middle, you know? Average. Then again, recall your stroll through your familiar haunts. What do most people look like? Yup. Big. Bigger than they used to be. Obesity is the new "average".

I'm biased. A "weight-ist", if you will. You probably are too, but won't own up to it. I absorbed a distaste for overweight people from my mother who had strong opinions about such things. I'm in my 60s. I remember when significantly overweight people stuck out in a crowd. The Conventional Wisdom of the time was that "those people" had no self-control. They were the poster children for the Deadly Sin of Gluttony. We felt little guilt for deriding them.

More than 50 years later, the belief still sticks: you're fat because you can't control yourself. Like every belief, this one is partly true. I overeat. Sometimes, I'm compelled ...like many people, I can slip into "emotional/stress eating". But is the secret to conquering obesity just exercising more willpower? Getting a grip? Perhaps, for some of us. But I don't think an epidemic emerged from a sudden inability to put down our forks. Especially among the poor, minorities, and the middle class.

Which leads me to three broader food-related issues that undermine our health and cost us money: 1) the poor quality of our food supply, 2) the near absence of people's ability to cook from scratch, and 3) the unavailability in most families (especially elderly and one-person families) of someone who has the time and/or energy to make a fresh, healthy meal. If we can't address these three, complex systemic issues we won't get very far trying to impose incentives for "healthy behavior" or for providing more efficient care to large numbers of people who have chronic conditions.

"Food, Inc.", a documentary on how our food is raised, concocted and engineered, is currently playing in our area. Go see it. It presents a visually compelling link between our consumption of food-like substances and the cost and quality of our health. I came to tears watching a lower middle class working Hispanic family shop for food. Two bottles of soda were cheaper that a bunch of broccoli. They had two children to fill up and with the cost of the father's medications, not enough money to buy the food that would avert further deterioration. One young daughter was perilously close to a diabetes diagnosis. The mother knew what she should be eating, but she couldn't afford it. They all worked 16 hour days, with no time or energy left for cooking at the end of the day. Three out of four of them were overweight or obese. This is not their fault. They want to do the right thing. The system conspires against them.

If you think this is a problem of poverty alone, you're wrong. While obesity declines as income and education climb, it remains higher than we can afford. And all those lovely kitchens in McMansions, are for show, not daily use. Those families eat out. A large proportion of adults my age are on multiple medications for high blood pressure, high cholesterol and depression (which is linked to poor cardiac health). Most of these illnesses are partially fueled by the hidden, unhealthy ingredients in food, the things we didn't eat 50+ years ago because they didn't exist. As an example, this week a study was released that revealed that the average American woman eats 22 teaspoons of sugar a day, almost all of it "hidden". Her healthy limit should be, at most, 6 teaspoons -- half that if she is sedentary. Flavored fat-free yogurt, a common health and weight loss food, contains the entire sugar budget for the day. Yogurt, for crying out loud.

So as you ponder your position on the health care reform debate, perhaps you need to challenge your biases. That's hard. For me, for you, for Bill Maher, who unlike most of us can afford to play the food game by "New Rules". But think about that Hispanic family, your co-workers, maybe your own family members ...and how difficult it is for all of them to buy, prepare or eat a high quality diet. Think about the cost of our heralded cheap food. Face the dirty secret that the decline in food costs almost directly mirrors the increase in health care costs. Then ask yourself who's to blame. Not so simple, is it?

The Big Bugs Among Us

Yeah, I know, I've been silent a long time. But I'm gearing up again for a spurt of activity. Sooo much data is released every day that deeply worries me. I can't ignore it while I go about my mundane chores.

This blog is dedicated to health, broadly interpreted. I'm a health care professional. Since childhood I've been deeply influenced by the health care culture. Over the last year, I've switched to a primarily vegetarian diet which has had a profound impact on my health, my understanding of nutrition, and my opinion of American eaters and the dominant food culture. So I've become increasingly sensitive to emerging information on how our contaminated, processed, nutritionally vacant food chain compromises our health. I have grandchildren. And I'm scared shitless over the impact our food sources have on their long-term health.

A top story on MSNBC right now, just fueled my fear.

The story recounts investigative reporting from Prevention magazine: Concerns Growing Over Superbugs in Our Food. Bottom line: a growing proportion of the animal protein in our country is causing outbreaks of MRSA (an antibiotic resistant bacteria) and/or seeding our bodies for future eruptions of the disease. The incidence of workers in factory farms and processing plants with this illness in also increasing. And most worrisome, MRSA is recurrent -- once you get it, you are likely to have repeated outbreaks, each one more resistant to treatment than the last. MRSA can be lethal. It is unwise to dismiss it as 'just a skin infection'.

The story offers a list of ways to protect yourself. One of them is switching to organic meat. However, in my view, that's just trying to soothe meat-eaters into thinking that organic means "safe". But, if that organic meat is finished in a CAFO or processed in plants where contaminated meat was processed, or if it is butchered by workers who've been infected at other plants, then the organic label is less protection than people imagine. Regulation won't protect you: no one regulates the exposure to MRSA promulgated by the food industry.

The meaningful switch is another one suggested by the list: avoid or minimize your exposure by using non-animal sources of protein as much as possible. All the meat eaters I know will be jumping onto their soap boxes, throwing verbal epithets at me, and extolling the virtues of meat, insisting that they will eat what they damn well please, thank you very much. I support free will, OK? But informed eaters can't continue to ignore the increasing flood of information on the risks of eating 'food' supplied by the American industrial food complex -- and that includes the organic and natural food industry, which is increasingly being industrialized, with unanticipated consequences.

We need to eat lower on the food chain, period. We need to attempt to verify our food sources whenever possible, be deeply skeptical of food in restaurants, and take seriously the impact of food on health. The risk is highest for children. At the least, we need to feed our children differently than we eat. We must be vigilant about their exposure to contaminants, possible allergens in processed foods, and minimize their consumption of food that is low in nutrient value. Allergies are increasing in children and I have no doubt whatsoever that this is directly related to the amount of processed food they eat. If you wait for studies to identify the risks, it will be too late for your children. No one wants to fund those studies or take on the food industry, whose campaign contributions have bought them protection from deep scrutiny.

Read the article online. Consider the benefits of a conservative approach to your food choices. Your children will one day thank you!

Passion Redux - RFK, Jr. Rocks!

We know I have a thing about passion. I can't help myself. I have it in abundance ..and am profoundly moved by it in another person. Last night, I spent 2 hours in the presence of a deeply commited and passionate man: Robert F. Kennedy, Jr. I'm still feeling buoyed by the experience.

This man epitomizes what it means to be an engaged citizen. His intellectual range is enormous -- environmental pollution, voter fraud, children's health, constitutional law, to name a few. He can articulate fact-based positions on each and every one of these, with humor and depth. I was mesmerized as he described entrepreneurial initiatives that could significantly alter the way we use energy. He deftly walked through the true cost of faux "free-market" capitalism as practiced by Republicans since Reagan. He argued cogently for why true partriotism and democracy are dependent on an informed citizenry, and how at-risk we are with a toadying Beltway press. He described the machinations of K Street lobbyists who occupy posts in key government regulatory agencies, where they work tirelessly against the public interest.

It was enough to make me give up on Democracy. Let's be honest: the Democrats embrace the culture of D.C. influence peddlers as much as their Republican cohorts. Liberals like me, count on the influencers having values and an agenda that meshes with mine. Somehow, that seems like a naive mindset to hold, given the peril we find ourselves in today. While it was immensely reassuring to know that people like Bobby are out there working tirelessly on our behalf, we have an individual obligation to hold our elected representatives' feet to the fire. To make them live up to their promises. This is not a time for incremental change -- that will be lethal. Our problems require substantive and transformative change. Whether or not our new President has the cojones to proceed fearlessly and boldly, remains in question. But I know where I stand. And where Bobby stands. And where the grassroots stands that helped elect the current administration. Much like the '60s, when activists brought down a president and ended a war, we will only get the change we need if we mobilize the people, put pressure on Congress and the President, and insist that they work in the public interest.

We cannot rely on the press to keep us well-informed. We must do the work ourselves. Think critically. Dig up the facts. Read relentlessly. Be a patriot. Be inspired.

Then, we will get the country we truly deserve.

Thanks to Kevin McCarrison, from UMKC, for the great photo!

Pigs and MRSA

Nicholas Kristof has a column today on the spread of MRSA (a potentially lethal, drug resistant bacterial infection) among people who live or work around factory-farmed pigs. This is yet another example of how our food chain has run amok. As Kristof notes, we've done a good job in the U.S. of providing cheap food. But the pricetag is far bigger than the one presented at the checkout. Increasingly, we're uncovering "farming" practices that put our health at risk -- animal waste that permeates and contaminates aquifers, overuse of antibiotics which manifests as drug resistance in humans, "meat" that has an entirely different nutritional profile than the meat eaten by our grandparents and great-grandparents -- the list of evolving hazards is long, and growing longer.

Most people I talk to about these issues are in deep denial about the quality of their food. If it's cheap and shrink-wrapped, then it's fine by them. As a group, Americans seem hell-bent on defending to the death their need to eat food that kills them and despoils the planet.

Hopefully, information like the kind in Kristof's article, information that has only recently been published in the mainstream press, will begin to challenge people's assumptions about the desirability of the foods they eat. We need to wake up and break the back of the factory farming industry in this country if we're going to significantly improve the environment and our personal health. A real test of our resolve to bring change, is soon to come: the Obama administration's new budget is attempting to reduce or eliminate subsidies for large agribusiness. This move is absolutely essential to fostering the resurgence of family farming; illuminating the true cost of the mass-produced food, especially meat, that we eat; managing our federal deficit, and addressing climate change. But be prepared. If you want a healthier food supply, you're going to have to fight for it ...and pay dearly.

The Professionals' Conscience

The President is about to piss off a whole lotta people, but I'm not one of them.

An anonymous source has leaked that President O is going to eliminate a rule that my nemesis GW issued right before he left office. The rule speaks to an issue that has infuriated me for a long time: the "right" of health care professionals to refuse to provide care that violates their conscience. Check out the arcane details of the proposed rule recision here.

What's with this "I can't fill a birth control pill RX because it violates my conscience" crap? OK, you're a pharmacist who is against birth control? Then don't become a pharmacist. Become a chemist instead. You a nurse who doesn't want to pull the plug on a vegetative patient? Don't work in an ICU, nursing home, subacute facility or hospice. Work in a pediatrician's office that doesn't face these ethical dilemmas.

Seriously, can you imagine a cop who had issues of conscience with arresting speeders? Or a science teacher who refused to teach zoology because it included sexual reproduction? Hey, if you oppose educating people on the biology of sex, become a damn math teacher.

It is absurd that people put themselves in professional situations that, by definition, require you to violate your beliefs, and then bitch because they have to do things they find reprehensible. Grow up. Pick another profession for crying out loud. I started out my nursing career in oncology. I repeatedly had to administer treatments to people that I thought were not being well-served by their physician, who were not being given sufficient information to make informed decisions. From my perspective, I was inducing unnecessary suffering. It made me nuts. You know what I did? I left oncology. I'm free to say whatever I please and I don't violate my fundamental principles.

All you "conscientious objectors", get over yourselves.

The Path Away from an Omnivorous Lifestyle

Evidence continues to accumulate that eating substantial amounts of meat is detrimental to health, the environment, and possibly to global social stability, as valuable land and water resources are rapidly depleted to support vast numbers of animals.

Last year, after deciding to limit my meat-eating, I began to shift to a primarily plant-based diet. After joining Weight Watchers to get off some pesky pounds, I discovered that filling up with fruits, vegetables and legumes left me less hungry, a lovely benefit! I lost a substantial amount of weight, and so far (fingers crossed!), I’m maintaining my weight even as I experiment with adding more whole grains and complex carbohydrates to my diet. I believe that limiting animal protein has been instrumental in my success and overall physical well-being. Mark Bittman, celebrity foodie, shares my experience (see his new book, Food Matters).

As my diet continues to evolve, I find myself in early 2009, rarely eating meat and seafood. I don’t miss it, which is somewhat surprising. I’ve always enjoyed meat and poultry and never intended to stop eating it entirely. But over time, the desire to eat meat has dwindled. As a consequence, I’ve had to learn new ways to cook, which has led to discovering wonderful foods and recipes that I never would have tried before. I’ve expanded my horizons and added much more diversity to my eating experiences. Certainly America’s increasing ethnic diversity has made the shift easier. More food cultures are available to us all now — Mediterranean, East Indian, Asian, African — many of which have strong vegetarian traditions. I’ve learned to appreciate simple foods, fragrant spices, and new cooking techniques. In many ways, eating mostly plants challenges one’s creativity and educates the palate.

Not unexpectedly, people have noticed the change. I’m the only one in my social network who eats this way so I tend to stand out. For some, I’m a pain in the neck as I sort through what is available to eat from a table laden with the Standard American Diet (SAD) — which is dominated by factory farmed meat, highly processed/refined carbohydrates, and high fat, salty, and sugary “foods” (and “sad” it is, for it is the root cause of diabetes, obesity, heart disease, and immune disorders). But for more open-minded folks, I’ve been a curiosity, a source of education as they tasted my weird food and discovered some things they didn’t know they’d like. As I’ve answered questions about why I eat this way, a few have made small changes of their own.

But among those closest to me, there has been abundant criticism, teasing, and sometimes outright hostility regarding my choices. I work hard not to pound my family and friends over their choice to still eat meat. They know that I wish they’d eat less meat for the sake of the planet’s future and their children’s health. They think that if the meat is humanely raised, then they have done enough, for they’ve posed the problem as an animal rights issue. They cannot yet see that it is impossible to feed the world on humanely raised, grass fed, pastured animals. There isn’t enough space to do it. Period. We have to significantly limit our intake, regardless of the meat’s origins. In their children’s lifetimes, if not in their own, meat will become a very costly commodity, much as it was when my grandparents were young.

My friends and family are socially conscious, intelligent, caring people. They have progressive values and try their best to live by them. Yet eating as much meat as they please is a line they’ve drawn in the sand, a way to demonstrate to me and themselves, that they are free and relatively affluent Americans. They are very in-your-face about it too. They take every opportunity to remind me how much pig they eat and take great pride in updating me on how much their children enjoy meat. Their mantra is “I love meat, I’m going to eat as much as I want, and no one is going to get me to change that” (a long mantra, I know).

I’m mystified about the aggressiveness of many meat-eaters. What about having a “near vegetarian” in their midst triggers their need to extol the virtues of a meat-based diet? What logic might persuade them to be open to changing their habits? I recognize that a diet that is 80% plant based isn’t for everyone. Mark Bittman offers a compromise by eating “vegan until dinner”, when he then eats anything he wants. His impetus was both his health (his doctor wanted him to become a vegan!) and his increasing awareness of the environmental burden of his lifestyle. By making his changes, he dramatically improved his health while significantly reducing his reliance on meat, seafood and dairy. It hasn’t been very hard for him either. While I wish he would save meat for a couple of days a week, his solution is certainly more progressive and responsible than the lifestyle of the majority of Americans.

Perhaps one day, those of us who are forgoing meat, will not be perceived as a threat or an anomaly. But whatever a person's reasons for avoiding or minimizing meat, today I’m making a free and conscious choice, trying to bring my values and lifestyle into greater alignment. The time may come when devoted meat-eaters will be forced into change by economic and environmental circumstances. I don’t look forward to the uproar that will ensue!

Dig It!

OK, I know ...it's been forever since I posted. Life has gotten away from me. The election, holidays, work ...you know how it is. But I'm home sick so it seemed like a good time to post something that I discovered on Facebook today. Yup, Facebook. I was badgered into getting a page there by one of my sons.

So, I'm checking out "Causes". The younger generation seems to have invented a way to proselytize one another about favorite charitable causes and other activist attention-grabbers. I found one that resonated and signed a petition, which I'd like you all to consider as well. This particular initiative is one that has been pushed by Michael Pollan and Alice Waters, two people I respect immensely.

Here it is: Eat The View!




The goal is to get President Obama to dedicate a portion of the White House grounds to growing an organic garden. It would feed the White House and any leftover produce would go to food pantries in the Washington, D.C. area. Seems that Eleanor Roosevelt insisted on a Victory Garden during WWII ...which became a model for all Americans. Given the current economy, people could certainly save money by growing some of their own food ...and they would likely be healthier as well.

So if you have the time and inclination, please sign the petition and push for this great idea. Spring is nearly here. Let's push for full employment for gardeners!

Electronic Graveyards

From National Geographic:

Maybe your basement has a collection of dead electronics -- all those old CRTs, cell phones, laptops. Or maybe you've attempted to recycle them by giving them to charity. A few things might have been sneaked into that 'bulky waste pickup' that the city has each year. But I'm betting that you have no idea what happens to this stuff, even if you have tried to do the right thing. I sure didn't.

The January 2008 issue of National Geographic got ...well, graphic...in its expose of e-trash. It was chilling.

June is the wet season in Ghana, but here in Accra, the capital, the morning rain has ceased. As the sun heats the humid air, pillars of black smoke begin to rise above the vast Agbogbloshie Market. I follow one plume toward its source, past lettuce and plantain vendors, past stalls of used tires, and through a clanging scrap market where hunched men bash on old alternators and engine blocks. Soon the muddy track is flanked by piles of old TVs, gutted computer cases, and smashed monitors heaped ten feet (three meters) high. Beyond lies a field of fine ash speckled with glints of amber and green—the sharp broken bits of circuit boards. I can see now that the smoke issues not from one fire, but from many small blazes. Dozens of indistinct figures move among the acrid haze, some stirring flames with sticks, others carrying armfuls of brightly colored computer wire. Most are children.

Regardless of where you dispose of your e-junk, much of it generated in the U.S. ends up in undeveloped countries where poor families and their children attempt to salvage whatever might bring cash in the marketplace. Gold, copper, silver and other valuable metals are embedded in our junk. Getting it out releases toxins and carcinogens when the salvage operation is a low-tech fire tended by children and women. We don't see that though. We just line up to buy the latest gadget, mindless about what happens to the old one.

How vast is the problem? Estimates are 50 million tons a year, worldwide.

In the United States, it is estimated that more than 70 percent of discarded computers and monitors, and well over 80 percent of TVs, eventually end up in landfills, despite a growing number of state laws that prohibit dumping of e-waste, which may leak lead, mercury,
arsenic, cadmium, beryllium, and other toxics into the ground. Meanwhile, a staggering volume of unused electronic gear sits in storage—about 180 million TVs, desktop PCs, and other components as of 2005, according to the EPA. Even if this obsolete equipment remains in attics and basements indefinitely, never reaching a landfill, this solution has its own, indirect impact on the environment. In addition to toxics, e-waste contains goodly amounts of silver,gold, and other valuable metals that are highly efficient conductors of electricity. In theory, recycling gold from old computer motherboards is far more efficient and less environmentally destructive than ripping it from the earth, often by surface-mining that imperils pristine rain forests.

As always, the European Union is ahead of us. They've implemented regulation to encourage green design and take-back programs while also requiring manufacturers to implement recycling. While some of their trash slips through the current safety net, they are at least aggressively confronting the problem. In the U.S. though, the epicenter of the largest consumer society on the planet, we do nothing. The Congress hasn't ratified the Basel Convention, calling for stronger recycling and manufacturing oversight. Instead, we've lined up with Haiti and Afganistan in dragging our feet. Kyoto Treaty anyone? The EPA is pondering a certification program for recyclers, a market-based solution. Typical Bush/Republican preference for minimizing corporate responsibility.

On the other hand, there is a bright spot, however small. A company in Tampa, Creative Recycling Solutions, has made a big bet on electronics recycling. Their multi-million dollar plant is one of only 3 plants in the U.S. that can recapture usable materials from our tossed out gear. Currently, his operation isn't cost-effective, only moral. But if the U.S. implements certification and if states and municipalities move toward tighter standards, he's well-positioned to succeed.

In case you're thinking that none of this is your problem -- what happens in Ghana and China, stays there -- think again. A chemist at the University of Ohio decided to test jewelry made in China to see what was in it. Lo and behold, he found ... lead, high levels of it. The chemical fingerprint also showed that the lead was mixed with metals that likely came from electronic trash. Hmmm. What goes around, comes around. Wondering what else is in all those made-in-somewhere-else toys and things you're buying that no one has looked for yet?

So, what's a person to do? Throw up your hands and face defeat? Become a Luddite? Nah. There are some things to do.

• Before you drop off your junk on e-recycling day, find out where its going to end up. Don't assume it will be reused or recycled.
• Don't give your stuff to charities like Goodwill or Disabled Veterans. Despite their good intentions, e-trash given to charities often ends up overseas.
• Lobby your municipality or company to get a contract with a recycler like Creative Recycling Systems. They work with any size organization.
• Stop and think about whether or not you need the next generation of gadget. If you decide you do, make a plan for disposing of your old one before you acquire the new one. When HDTV becomes the standard by 2009, an estimated 25 million TVs will be affected. You're likely to own one of them. Figure out how to dump that obsolete one now.
• Raise awareness. Let friends and colleagues know what really happens to their old cell phone, TVs and computers. Kids are dying and pollutants are getting back into our own consumer goods because we choose to ignore the burden our consumption creates.
• An election is coming, remember? National candidates need to be reminded of the need to ensure the EPA implements that certification system. Lobby legislators to ratify the Basel Ban, which calls for green design and take-back programs.
• And remember, local solutions can have an impact. Get your city government to implement tougher standards for local recyclers. It'd be a start and help out guys like Joe Yob at Creative Recycling.

Face it. The reality is that if we are going to get serious about our e-trash, the manufacturers aren't the only ones who'll pay. The cost will find its way back into our next computer or cell phone. But the consequences of ignoring the problem are increasingly grim.

Lap Bands R Us

The Diabetic Quick Fix

Here it is. The lap band. The billboards advertising them, the TV ads, they never actually show you one. Cute little suckers, aren't they? You just pinch them around the stomach, fill them full of water to restrict the space you can dump food into, and you're good to go.

I'm a nurse practitioner. I have patients with them. Yup, they work. At least, for awhile. Diabetes improves. But in my experience, diet, nutrition, and lifestyle are unchanged. Same with other types of obesity/bariatric surgeries. I have patients who had gastric bypass 10 or more years ago, a more drastic approach to weight loss. Guess what. They are obese -- again. They are chronically ill. Some of them have even had a second procedure, to no avail.Without personal change, will improvements gained through surgery be sustainable? I have my doubts.

Typical of Western medical approaches, we do not address the underlying issues. Maybe we're sick because:

1- Our food supply is polluted and nutrient deficient
2- Our eating knowledge base -- how to cook, what and how much to eat -- is full of holes or empty
3- Our culture values quantity over quality -- in food, in housing, in income, in material goods -- which in turn leaves us fat, stressed, chronically time-crunched, in debt, and unhappy

As everything and everyone around us grows larger, as we feel less and less control over our lives and health, passive solutions like a lap band offer the ultimate cure. Good grief.

We're facing an election. Health care reform is on the top of the agenda. So a study like this that promises relief for millions of people, can provide a peek into what needs to be reformed. While this was an Australian study, American doctors and health care institutions (who stand to make a shitload of money off surgical solutions) are lining up to extol the virtues of this possible 'cure'.

If lap bands can be a solution to diabetes, then let's take a closer look at the study, OK? On the face of it, people who had surgery did much better than everyone else. Here's the glitch: the study compared a lap bad to 'usual care'. For you non-medical people, 'usual care' is the fucked up management you get in the current health care system. What you get when you go to the doctor and s/he tells you, "sorry, you have diabetes". Right this minute, in clinics and doctor's offices across America, "Usual Care" is handing you a pamphlet on diabetes (usually written by a drug company), a glucose meter for 'free' (provided by the folks who want your money for supplies), writing you one or more prescriptions, signing you up for an hour with a diabetic educator (maybe), and wishing you luck. In other words, 'Usual Care" is crappy care, plain and simple.

In the world of the lap band-aid, no one pays to teach people who have diabetes or who are at-risk, how to eat. No one shows you how to shop for and cook healthy food. No one works with individuals and families long-term to help them sustain changes or develop healthier eating habits. Obesity is a family problem, not just an individual one. It's also a food-chain problem, where we subsidize high-fructose corn syrup and processed foods at the expense of fruits, vegetables, and healthy grains. The recently passed farm bill did almost nothing to encourage the growth of locally grown, affordable organic vegetables or healthier school lunches. We're going to grow the same junk and rave about how lucky we are to have cheap food.

The cost of a lap band is at least $15,000; other obesity surgeries cost even more. Sometimes health insurance covers it. Sometimes not. When is the last time an individual or insurer invested this kind of money in a 2 yr program to reduce obesity, diabetes and heart disease? Short answer: never.

In the NBC video the lead researcher states that an adult cannot lose over 20 pounds and keep it off. Unless of course, a surgeon puts in a lap band (wanna bet he's a surgeon?). Bullshit. Granted, it is much, much harder for morbidly obese adults to lose weight and keep it off. But the study participants were overweight, not morbidly obese. We, as a country, have made no effort from a public health perspective, to look at the system that creates and nourishes obesity (no pun intended). That system includes schools, family farms, industrial agribusiness, processed food purveyors, the goddamned Food Pyramid ...I could go on, but you get the idea. This is a cultural, societal problem and while lap bands may be a stop-gap, and necessary for some, we're in a world of hurt if we don't invest in systemic solutions. At the least, we need to help families learn how to feed their kids to fend off the obesity epidemic. How 'bout that?

As for classifying a lap band as 'first line treatment for diabetes', God help us.

Sleeping With Men …An Unintended Consequence

I’m all for sleeping with men, really I am. At least for 30 minutes or so. And I’d like them to be around in the morning. But in-between, I’d like to sleep alone thank you very much. Now the evidence is in: Sleeping the night with a man, can have unexpected consequences ...that may not be so good for women. It’s a dirty little secret too. Many of us have moved out ...of the bed, or the room... though it seems few of us are telling anyone about it. C’mon, tell the truth. You secretly wish he'd sleep elsewhere, but be around for on-demand cuddling, don't you. For men though, either you’re in or you’re out, so to speak.

As is often the case with coupling, men often appear to benefit more. They are healthier and happier if they are married, regardless of the state of the relationship. Women? Not so much. Maybe it’s because we don’t sleep. Surely you’ve read the headlines on sleep deprivation and poor quality sleep. The list of bad outcomes is long and getting longer: depression, obesity, high blood pressure, cardiac disease, poor performance, memory problems …not to mention crankiness, homicidal tendencies, and sleep-walking through sex.

I don’t know about you, but I can’t sleep worth a damn with someone else in the bed. I want to, I really do. I have fantasies about how lovely it would be...I go through spells of craving company. But then reality intrudes. I toss. I turn. I lie there and fret. I feel guilty.

I have motherhood to thank, it seems. Until my first son was born you could have put an air-raid siren outside the bedroom door and I would have slept through it. Now? I can hear the freakin’ cats breathing. I’ve tried tossing them out, but they scratch at the door and howl, which is no improvement. Tossing out a man is even more complicated. They rant and accuse you of disloyalty, frigidity, and disinterest. Nope. I just want a good night’s sleep. Repeatedly.

Who decided we were supposed to sleep together anyway? Can’t we just have rotating conjugal visits — your bedroom on weeks 2 and 4 and my bedroom on weeks 1 and 3? We could post a calendar so we’d know when to clean the sink, change the sheets, and freshen the candles for ‘visitation week’. Just so it’s understood that there is none of this staying-the-night stuff.

I'm leaning toward the Victorian Solution — big houses with separate bedrooms for husband and wife and all the privacy you'd ever need. Free of Victorian morality, we can have plenty of sex…tip-toe down the hall, spontaneous, illicit-feeling sex, which can be the best kind. Maybe coupling in the 21st century would improve if we incorporated His and Hers Victorian-style retreats. We all might have better sex, better memories, fewer heart attacks ... and less guilt!