0 CDC Diabetes And Prediabetes Risk Tests

The US Centers for Disease Control and Prevention (CDC) says that 25% of Americans with diabetes don’t know they have it, and that approximately 1 in 3 have prediabetes but only 7% of them know it. They developed these tests to help users learn whether they are at risk for prediabetes and type 2 diabetes.

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0 Carotenoids in Diet from Fruits and Vegetables May Help Prevent or Delay the Onset of ALS

Amyotrophic lateral sclerosis, better known as ALS, is a devastating degenerative illness that incapacitates its victims in a manner similar to those suffering from Alzheimer’s disease. At present, there is no known cure or effective treatment for the illness, believed to be the result of oxidative stress caused by decades of poor diet, stress, environmental toxins and poor physical conditioning. Researchers have now discovered that increased consumption of foods containing colorful carotenoids, particularly beta-carotene and lutein, may prevent or delay the onset of ALS.

Natural Sources of Fruits and Dark Leafy Vegetables Help Lower Risk of Developing ALS

ALS, or Lou Gehrig’s disease, is a progressive neurological disease that attacks nerve cells in the brain and spinal cord known to be responsible for the control of voluntary muscles. As the motor neurons degenerate, the muscles they control gradually weaken and waste away, leading to paralysis. A research team from the Harvard School of Public Health has published the results of their research in the Annals of Neurologythat builds on prior studies showing that carotenoids, the natural compounds that give fruits and vegetables their bright orange, red, or yellow colors, provide critical antioxidant support to help fight this devastating disease.

Scientists evaluated five large studies comprising more than one million participants to develop a basis for evaluation. Researchers reviewed food intake for the group and further broke consumption down to determine carotenoids eaten in the form of fruits and vegetables. Lead study author Dr. Alberto Ascherio noted “Understanding the impact of food consumption on ALS development is important. Our study is one of the largest to date to examine the role of dietary antioxidants in preventing ALS.”

Add Five to Nine Daily Servings of Fruits and Vegetables to Your Natural Food Diet

A total of 1093 cases of ALS were identified across the cohort of subjects. The team found that those with the highest intake of carotenoids from any source had the lowest risk of developing ALS. They also determined that individuals who consumed more carotenoids in their diets were more likely to exercise, have an advanced degree, have higher vitamin C consumption, and take vitamin C and E supplements. Participants with the highest dietary consumption of beta-carotene and lutein, most commonly found in dark green vegetables had a reduced risk of developing ALS.

Interestingly, the researchers found that diets high in lycopene, beta-cryptoxanthin, and vitamin C did not reduce disease incidence, and long-term vitamin C supplement intake was also not associated with lower ALS risk. Dr. Ascherio concluded“Our findings suggest that consuming carotenoid-rich foods may help prevent or delay the onset of ALS.” This study acts to support a large volume of prior works that reinforce the critical importance of a natural food diet consisting largely of fruits and vegetables to thwart diseases ranging from cancer and diabetes to Alzheimer’s disease and ALS.

0 The eyes look sunken and black This is why!

The eyes look sunken and black? This is why! - Lack of sleep is not a trivial matter that can be ignored. Sunken eyes indicate that you do not sleep well for a period of time. And trouble sleeping can cause a variety of health problems such as memory loss, high blood pressure and even diabetes. Before its too late, here are four medical cause why the eyes appear sunken, as reported Boldsky.

1. Unbalanced diet or extreme

If youre on an extreme diet to lose weight, you may begin to realize that your eyes look very haggard. When you lose the layer of fat in the face, the eyes will appear sunken. This is not a sign of good health. You should look for a more balanced way to weight loss.

2. dehydration

Loss of large amounts of water from the body also causes sunken eyes. Drink plenty of water every day, which is at least 8-10 glasses a day.

3. recovery

If you are recovering from serious illnesses such as dengue fever or malaria, you will have dark circles under the eyes and the eyes will look very concave. That means you need a lot of rest and a healthy diet to make eyes look healthy again.

4. Lack of vitamin

Malnutrition is responsible for the presence of dark circles under the eyes and sunken eyes. Lack of Vitamin C and K can make the eyes look sunken and tired. Even iron deficiency can make you look tired and dull.

Here are four medical cause for the eyes that look sunken. Remember, lack of sleep and dehydration is not a trivial problem that you can ignore. Health problems that might be simple if left unchecked can also be dangerous and life-threatening.

0 Aerobic exercise improves memory brain function and physical fitness

A new study conducted by researchers at the Center for BrainHealth at The University of Texas at Dallas published online in the open-access journal Frontiers in Aging Neuroscience found that engaging in a physical exercise regimen helps healthy aging adults improve their memory, brain health and physical fitness. This finding is significant considering that among adults 50 and older, "staying mentally sharp" outranks social security and physical health as the top priority and concern in the United States.

"Science has shown that aging decreases mental efficiency and memory decline is the number one cognitive complaint of older adults," said Sandra Bond Chapman, Ph.D., founder and chief director of the Center for BrainHealth, Dee Wyly Distinguished University Chair and lead author of the paper. "This research shows the tremendous benefit of aerobic exercise on a persons memory and demonstrates that aerobic exercise can reduce both the biological and cognitive consequences of aging."

For the study, sedentary adults ages 57-75 were randomized into a physical training or a wait-list control group. The physical training group participated in supervised aerobic exercise on a stationary bike or treadmill for one hour, three times a week for 12 weeks. Participants cognition, resting cerebral blood flow, and cardiovascular fitness were assessed at three time points: before beginning the physical exercise regimen, mid-way through at 6 weeks, and post-training at 12 weeks.

"By measuring brain blood flow non-invasively using arterial spin labeling (ASL) MRI, we can now begin to detect brain changes much earlier than before," said Sina Aslan, Ph.D., founder and president of Advance MRI and collaborator on the study. "One key region where we saw increase in brain blood flow was the anterior cingulate, indicating higher neuronal activity and metabolic rate. The anterior cingulate has been linked to superior cognition in late life."

Exercisers who improved their memory performance also showed greater increase in brain blood flow to the hippocampus, the key brain region affected by Alzheimers disease. Chapman pointed out that, using noninvasive brain imaging techniques, brain changes were identified earlier than memory improvements, implicating brain blood flow as a promising and sensitive metric of brain health gains across treatment regimens.

"Physical exercise may be one of the most beneficial and cost-effective therapies widely available to everyone to elevate memory performance," says Dr. Chapman. "These findings should motivate adults of all ages to start exercising aerobically."

Chapman cautioned that while physical exercise is associated with a selective or regional brain blood flow, it did not produce a change in global brain blood flow.

"In another recent study, we have shown that complex mental training increases whole brain blood flow as well as regional brain blood flow across key brain networks," Chapman said. "The combination of physical and mental exercise may be the best health measures to improve overall cognitive brain health. We have just begun to test the upper boundaries of how we can enhance our brains performance into late life. To think we can alter and improve the basic structure of the mature brain through aerobic exercise and complex thinking should inspire us to challenge our thinking and get moving at any age."

0 Medicares Expenses Increased by 0 4 Really And Its All Because of the Affordable Care Act

If youre the head of Google and you want to teach about the internet, North Korea is a swell place to visit.  If your goal is air travel safety, the 787 Dreamliner is the plane for you.  If you would like to get the puck from an opposing professional hockey player, saying "please" helps.  And if Medicare costs dip, the Affordable Care Act (ACA) obviously deserves the credit.

Writing on an HHS website, Richard Kronick and Rosa Po announce that 2012 Medicare expenditures per beneficiary grew only by 0.4% over the 2011 baseline.  They credit the ACAs value-based payment (VBP) system, attacks on fraud and abuse, reduced payments to Medicare Advantage plans, cutting hospitals payments and "innovation."

The Disease Management Care Blog isnt too sure about that.

1. This Kaiser Health News article notes the VPB program withholds 1% of hospital payments and uses that fund to award bonuses in what is really a zero sum game.  And this Health Affairs article suggests the overall financial impact of VPB on hospitals is quite minimal anyway. 

2. While there have certainly been some big fraud and abuse busts, theres plenty of reason to still be skeptical about the ability of Medicares ossified bureaucracy to catch up with the sophisticated criminal enterprises that are routinely fleecing billions from the U.S. taxpayer.

3. As for the one-time payment cuts to providers and insurers, the DMCB is confident that theyll figure out ways to get their money back.  They always do.

4. The innovations are in demonstration phase.  Its too early to tell.

In addition, the DMCB is surprised that Medicares 2012 insurance claims were ready to be rolled up and quantitated in early 2013. Check out this telling quote from the website:

"2010 and 2011 statistics are calculated on a calendar year incurred-basis. 2012 statistics are calculated on a fiscal year cash-basis, because calendar year incurred-basis data are not yet available." (bolding from the DMCB).

Last but not least, the DMCB believes the lackluster economy has probably had the biggest impact on consumers willingness to use their Medicare benefit.  While Kronick and Ro state" Medigap" insurance benefits have protected the beneficiaries from the financial pain of Medicares out-of-pocket expenses, the expense of using a hospital or seeing a doctor is more than the sum of all those medical bills.

Is the DMCB being too skeptical?  Perhaps, but this particular HHS spin is built on assumptions that are backed by associations that are biased by partisan loyalty.  Taxpayers deserve better.

Image from Wikipedia

0 The Dilemma of Medicare Coverage of Reasonable and Necessary Care and Why Its Important

If you get sick, health insurance should cover all the "stuff" necessary to make you better, right?

While that sounds good in principle, Uncle Sam has made it a lot more complicated than that.  As we continue to struggle with health orm, this New England Journal article on "Medicares Enduring Struggle to Define Reasonable and Necessary Care" is very timely.

According to Drs. Neumann and Chambers, Medicare has always covered medical services that are "reasonable and necessary." As new approaches, drugs and medical technologies have been released, youd think coverage would be based on an objective analysis of outcomes and cost effectiveness.

Youd be wrong.

Years of differing interpretations, patient advocacy, Congressional meddling, regulatory carve-outs and case law have generated a miasma of bureaucratic complexity that will guarantee the incomes of thousands of lawyers for years to come.

Not that CMS hasnt tried to be reasonable about "reasonable and necessary." According to the article, in 1989 CMS specifically proposed that the words "cost effective" could be used to assess new technology. That proved too controversial. It later tried "least costly alternative language" for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term "reasonable and necessary" could only be applied to medical services, not to the costs of those services.

How ironic. Even though CMS is making "value-based purchasing" judgements for hospital payments and costs can be factored in the coverage of preventive services, that still doesnt apply to new technologies and drugs.

The latest dysfunction is CMS pretzel logic of "coverage with evidence  development" approach to medical devices, essentially agreeing to coverage that is conditional on CMS evaluation of additional outcomes data.  Unfortunately, CMS ability to collect and interpret these kinds of data in the current political environment remains an open question.

Outside of Medicares cost travails, why is all of this important?

1) Medicares price tag was $509 billion in 2010, taking 12% of the federal budget. While there are other drivers of cost, such as aging, coverage arrangements, income, pricing, administrative costs and defensive medicine, technology could account from 38% to more than 65% of the current growth (inflation) in spending.  Medicares historic inability to control this does not bode well for future cost projections.

2) This is not a partisan issue and there are no partisan solutions.

3) Commercial insurers generally use Medicares coverage criteria to define their own benefit structure.  Medicares problems are everyone elses.

4) This is another reason why Medicare is banking on ACOs.  By delegating management and the associated risk of all these thorny coverage issues, theyre hoping ACOs can do within three years what CMS couldnt do in three decades. Well see.

0 Modern Climate Control Linked to Weight Gain and Obesity

(Article first published as Is Your Warm House The Reason You Can’t Lose Weight? on Technorati.)

We are all well aware that eating too much and insufficient exercise are important factors that determine our weight and drive the current obesity epidemic. Weight gain and loss is a product of many other lifestyle factors including stress, sleep and even the temperature of your house. A review published in the journal Obesity Reviews examines the link between reduced exposure to the cold and obesity in the UK and US.

We Burn More Calories When Cold

It’s not something we think a lot about when we’re sitting in our favorite easy chair in front of a warm fire in our well insulated house during winter. We can easily control our environment with a turn of the thermostat. In fact, the only deterrent to staying warm for most people is fear of the fuel oil or electric bill at the end of the month.

Historically, humans have lived in cold climates where they had to endure bitter cold for extended periods. Our body must burn calories at a much higher level to keep us warm during these times, and the increased metabolism helps to prevent overweight and obesity. This study review attempts to explain that seasonal cold helps to regulate energy balance and can help maintain normal body weight on a population level.

Indoor Temperatures Have Increased Over the Past Several Decades

Widespread access to central heating and air conditioning contribute to a restriction of the temperature variations experienced under natural conditions. Humans have evolved to acclimate to mild thermal stress, as our metabolic rate can easily adjust to differing temperature zones. When we’re cold, our heart rate and blood pressure increase as blood vessels close to the skin constrict in response to reduced temperatures.

The net effect is more calories burned for a longer period of time and this translates into lower body weight. Researchers have found that we experience a much smaller range of temperature variation than we did just 30 years ago. While this may not fully explain the skyrocketing overweight and obesity rates now seen across the US and UK, it does provide an important clue to how our environment can impact our ability to maintain a normal weight.

External Temperature Can Modify Our Fat Structure

Over the past decade, medical researchers have gained a much better understanding about the two distinctly different types of adipose or fat cells that we accumulate. White fat is metabolically active tissue that accumulates most commonly around the hips and mid-section of the body. Excess amounts of white fat are associated with inflammation, metabolic disease, heart disease and cancer.

Brown fat is a thermally active type of tissue that actually burns calories for energy and is associated with a higher metabolic rate and lower weight range. Researchers from the Obesity Reviews study found that when people spend more time in a climate controlled environment they produce less brown fat and metabolize fewer calories at rest. This was found to result in a tendency to gain weight, especially when coupled with a sedentary lifestyle.

The researchers concluded "Research into the environmental drivers behind obesity, rather then the genetic ones, has tended to focus on diet and exercise -- which are undoubtedly the major contributors. However, it is possible that other environmental factors, such as winter indoor temperatures, may also have a contributing role. This research theore raises the possibility for new public health strategies to address the obesity epidemic." The bottom line is to caully control calories and remain physically active. Be mindful that external environmental factors also contribute to your ability to successfully lose weight.

0 Active Compounds in Green Tea and Red Wine Halt Alzheimer’s Disease Progression

Alzheimer’s disease is characterized by an unnatural accumulation of amyloid plaque aggregates around nerve synapses that block the transmission of electrical and chemical transmitters that allow the brain to retain a high level of cognitive function and to store and retain memories. Millions of middle aged and older Americans suffer from some stage of Alzheimer’s disease, as the illness continues to escalate at an epidemic rate. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease.

Green Tea and Red Wine Extracts Impede Amyloid Formation to Prevent Alzheimer’s Development

The past decade has uncovered a small handful of natural, bioactive compounds that easily cross the blood-brain barrier where they have been found to alter the progression of Alzheimer’s disease. Researchers from the University of Leeds in the UK have determined that natural chemicals found in green tea and red wine may disrupt a key step of the Alzheimers disease pathway. Publishing in the Journal of Biological Chemistry, scientists have identified the process which allows harmful clumps of protein to latch on to brain cells, causing them to die.

Scientists understand that amyloid proteins in the brain clump together to form toxic, sticky balls of varying shapes. These amyloid balls latch on to the surface of nerve cells in the brain by attaching to proteins on the cell surface called prions, ultimately causing nerve cells to malfunction and die. Study co-author Dr. Jo Rushworth commented "We wanted to investigate whether the precise shape of the amyloid balls is essential for them to attach to the prion receptors, like the way a baseball fits snugly into its glove.”

Supplement Daily with EGCG and Resveratrol to Slow Disease Progression

The team wanted to determine if it was possible to prevent the amyloid balls from binding to prions by manipulating their shape and stop the cells from dying. Scientists formed amyloid balls in a test tube and then added them to human and animal brain cells. Study authors concluded "When we added the extracts from red wine and green tea, which recent research has shown to re-shape amyloid proteins, the amyloid balls no longer harmed the nerve cells.”

Researchers determined that the bioactive compounds in green tea and red wine (EGCG and resveratrol) distorted the shape of the amyloid balls, preventing them from binding with prions and disrupting cellular function. Complimentary studies have also determined that curcumin, the active compound in the curry spice turmeric, crossed the delicate blood-brain barrier to halt the advancement of dementia. Health-minded individuals should consume green tea and red wine or take standardized supplements regularly to help prevent the initial development and progression of Alzheimer’s disease.

0 SEMOLINA AND OATMEAL PANCAKE

When your everyday oatmeal breakfast becomes boring, mix it up with these  pancake!  Youll certainly love this savory pancake, packed with the nutrition of a bowl of oat  and semolina

Made with semolina and rolled oat, flavored with chopped onion, cilantro and sliced green/red chili, these pancake are easy to make, scrumptious to eat and a little healthier twist to a standard breakfast recipe.

SEMOLINA & OATMEAL PANCAKE
Yield    :     4 pancakes

1/2 cup semolina
1/2 cup rolled oat
1/4 cup chopped onion
1 tomato chopped
2 red/green  chili finely sliced
1/2 tsp cumin seed
1 cup milk
1/2 cup hot water
1/4 cup chopped cilantro
1/4 tsp hing (optional)
METHOD

Dry roast semolina for 2-3 minutes, keep aside.

Combine rolled oat and hot water.

In a mixing bowl, place semolina, rolled oat mixture, onion, tomato, hing, cumin, salt and cilantro.

Gradually add the milk to form into pouring consistency batter.  Let sit for 15 minutes.

Grease a heavy bottom pan, pour 1/4 cup of batter, drizzle oil around the pancake, cook for 1-2 minutes.

When it starts to brown, flip over and cook the other side,  repeat with the rest of the batter.

Serve hot with spicy chutney.
  _http://treatntrick.blogspot.com/2013/02/semolina-and-oatmeal-pancake.html

0 Of Intellectual Enclaves and Self Reinforcing Media Crossing The Health Care Reform Divide

Watch for and report any
contrary opinions!

Theres an interesting Saturday Essay in The Wall Street Journal that describes the self-perpetuating socioeconomic-neighborhood enclaves that separate Americas "haves" and "have nots."  Its turning out that zip code is not only associated with health, its becoming associated with destiny.

Not only fascinating, says the Disease Management Care Blog, but the essay reminds it of the pernicious twin intellectual enclaves in the health care debate.  While the progressive-liberals and the market-oriented conservatives in D.C. remain stuck in their closed information loops, the political process has been boiled down to the Supreme Courts nine lawyers and vague threats to unilaterally "repeal Obamacare."   Yikes, says the DMCB, the Dark Knights Joker had it right: we deserve a better class of politician criminal.

And if you think Newt is being wacky over the media bearing some responsibility, check out this NPR interview with the author of the book The Information Diet.  Unrepentant lefty Clay Johnson points out that the news outlets are becoming less of a solution and more of a problem.  By serving pre-digested and ined reports that cater to our pre-existing biases, organizations like CNN, Fox, The New York Times and The Wall Street Journal are creating an epidemic of intellectually obese brains that are hooked on the sugar and fat of what wed like to know, not what we should know.

Which is why the DMCB steeled itself, stepped outside its right-of-center comfort zone and sat through this C-SPAN broadcast of pro-Obamacare Jonathan Gruber being lobbed softballs by the fawning attendees at a Seattle Town Hall.  It makes for a spirited retread of the merits of enlightened central government, the villainy of the health insurers and the intrusion of politics, even as Dr. Gruber characterizes opponents as either 1) uneducated or 2) mistaken.  Thats why hes written this comic book designed to help both classes of simpletons.

The DMCB suspects its readers wont need to order a copy.

+++++++

As an aside, the Penn State graduate DMCB sadly notes the passing of Joe Paterno, the recently fired Penn State football coach. Despite his legendary stature, even "JoePa" was no match for the toxic Sandusky scandal.  It wasnt too long afterwards that Coach Paterno was diagnosed with what was eumphemistically characterized as a "treatable" form of lung cancer.  Occasional news reports since then described an increasingly frail 85 year old man struggling with the side effects of his cancer treatment.

Like many friends and colleagues, the DMCB wondered if the "stress" of his ignominous departure was the real cause of his death.  According to this Psychosomatics case series of 43 lung cancer patients based on used of the Hospital Anxiety and Depression Scale, baseline depression was associated with a poorer 6 month survival, but not overall survival. 

In other words, they die sooner.
 
Image from Wikipedia

0 Lentil Soup with Sausage Brown Rice and Spinach Things Are Looking Up

Today on Serious Eats: Swiss Chard and Turkey Sausage Over Polenta. So simple. So seductive delicious.

Painful things I have done recently (SPOILER ALERT):

Dislocated and/or broke my left pinky toe on a door frame. That’ll teach me to ... uh ... walk.  

Read the entire Lord of the Rings series. Fellow nerds! Hear my call! Why did no one tell me the books were butt-awful? Sweet bejeezus, Tolkien dedicated entire CHAPTERS to whether Frodo and Sam should take a left at the scary-looking rock, and exactly two pages on the death of Gollum, destruction of the ring, and collapse of Mordor. By the ancient sword of Elendil, Charles *freaking* Dickens would been like, “This needs fewer words, old chap.” 

Admitted my English degree has been fairly useless. With apologies to the Bronte sisters, Jane Eyre does not prepare you for the intricacies of expense reports. 

Watched Precious. “Hm,” I thought halfway through the film, “The only thing that could possibly make this more depressing is if they gave Precious AIDS.” (ten seconds pass) “Aaaaand there you go.” 

Threw out my old music cassette tapes. Oh, man. Here’s something they don’t tell you when you move: Carrying 90 boxes up a flight of stairs isn’t the hardest part. It’s chucking beloved, but outdated and useless possessions, like Open Up and Say ... Ahh!, the 1988 multiplatinum classic from Poison. Every rose has it’s thorn, indeed.

A very enjoyable thing I did recently: 

Ate Double Lentil, Sausage, Brown Rice, and Spinach Soup from the stupendous Kalyn’s Kitchen. Speaking of which, Kalyn just published her Top 10 Recipes of 2010, which you should gaze upon immediately.

HOTUS and I had guests for the first time at our new apartment. As it turns out, it’s impolite to starve company, so thus, the soup. And it tasted good. Real good. So good, there was slurping. From guests! Even my sister liked it, and she hates food.

I made two medium-sized changes to Kalyn’s original recipe: I substituted water in for part of the chicken broth, and used a combination of salt, pepper, garlic powder, and paprika for Spike Seasoning, which I couldn’t find in Brooklyn. Also of note: Kalyn and I both used a 3.5-quart slow cooker. If you don’t own one, she includes instructions to adapt the recipe for the stovetop at Kalyn’s Kitchen. (They’re not included here).

A wonderful thing I have recommenced recently: 

Blogging. Its good to be back, sweet readers.

~~~

If this recipe floats your boaty, these will surely make you gloaty. (Sorry.):

• Pasta with Turkey Sausage and Broccoli Rabe
• Slow Cooker Pork Chops, Apples, and Sweet Potatoes
• White Bean and Kale Soup with Turkey Sausage

~~~

Double Lentil, Sausage, Brown Rice, and Spinach Soup
Serves 6.
Adapted from Kalyn’s Kitchen.

1/2 medium onion, diced small
1 carrot, peeled and diced small
2 stalks celery, diced small
1 tablespoon olive oil
3 cloves garlic, minced
1 teaspoon dried thyme
A few shakes each: kosher salt, freshly ground black pepper, garlic powder, paprika
3 links pre-cooked chicken or turkey sausage, chopped into 1/3-inch pieces
1 (15-ounce) can petite dice tomatoes, undrained
2 (15-ounce) cans chicken broth
2-1/2 cups water
1/4 cup brown or green lentils
1/4 cup red lentils
1/4 cup long-grain brown rice
4 cups chopped fresh spinach
2 tablespoons balsamic vinegar

1) Heat olive in large skillet over medium high heat. Add onion, carrot, and celery. Saute until ever-so-slightly softened, about 4 minutes. Add garlic, thyme, salt, pepper, garlic powder, and paprika. Saute an additional 2 minutes.

2) Pour onion mixture into crockpot. Add sausage, tomatoes, broth, water, and all lentils. Stir to combine. Cook on high 3 hours.

3) Add rice and spinach. Stir to combine. Cook 1 more hour.

4) Add balsamic vinegar. Stir to combine. Cook 15 minutes. Serve, with crusty bread and “Parmesan cheese if desired.”

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
226 calories, 7.8 g fat, 7.3 g fiber, 15.5 g protein, $1.72

Note: Calculations are for Chef Bruce Aidells Chicken & Apple Sausage from CostCo., since the numbers were easily available online. I personally used a different, yet similar brand, the label of which I cant remember, and is currently buried under two feet of garbage.

Calculations
1/2 medium onion, diced small: 23 calories, 0.1 g fat, 0.8 g fiber, 0.5 g protein, $0.17
1 carrot, peeled and diced small: 25 calories, 0.1 g fat, 1.7 g fiber, 0.6 g protein, $0.08
2 stalks celery, diced small: 17 calories, 0.2 g fat, 2 g fiber, 0.9 g protein, $0.25
1 tablespoon olive oil: 199 calories, 13.5 g fat, 0 g fiber, 0 g protein, $0.13
3 cloves garlic, minced: 13 calories, 0 g fat, 0.2 g fiber, 0.6 g protein, $0.20
1 teaspoon dried thyme: 3 calories, 0.1 g fat, 0.4 g fiber, 0.1 g protein, $0.12
A few shakes each: kosher salt, freshly ground black pepper, garlic powder, paprika: negligible calories, fat, fiber, and protein, $0.03
3 links pre-cooked chicken or turkey sausage: 480 calories, 30 g fat, 1.5 g fiber, 42 g protein, $4.34
1 (15-ounce) can petite dice tomatoes, undrained: 70 calories, 0 g fat, 3.5 g fiber, 3.5 g protein, $1.69 (ugh, I know)
2 (15-ounce) cans chicken broth: 67 calories, 0 g fat, 0 g fiber, 13.1 g protein, $1.33
2-1/2 cups water: negligible calories, fat, fiber, and protein, $0.00
1/4 cup brown or green lentils: 119 calories, 0.5 g fat, 14.7 g fiber, 12.4 g protein, $0.37
1/4 cup red lentils: 119 calories, 0.5 g fat, 14.7 g fiber, 12.4 g protein, $0.37
1/4 cup long-grain brown rice: 171 calories, 1.3 g fat, 1.6 g fiber, 3.7 g protein, $0.18
4 cups chopped fresh spinach: 28 calories, 0.5 g fat, 2.6 g fiber, 3.4 g protein, $0.86
2 tablespoons balsamic vinegar: 20 calories, 0 g fat, 0 g fiber, 0 g protein, $0.20
TOTALS: 1354 calories, 46.8 g fat, 43.7 g fiber, 93.2 g protein, $10.32
PER SERVING (TOTALS/6): 226 calories, 7.8 g fat, 7.3 g fiber, 15.5 g protein, $1.72

0 Diet and Lifestyle Determine Mid Life Weight and Disease Risk

(Article first published as Evolved Dietary Changes Lead to Weight Gain and Chronic Disease on Technorati.)

Our diet has changed radically over the past century and has become a significant cause of disease and illness as animal based foods account for a quarter of our calories. Processed foods which didn’t exist 100 years ago make up more than 60% of our present diet while naturally healthy vegetables and fruits provide less than 5% of our daily energy.

The food we eat influences our genes and is the leading cause of the rampant rise in heart disease, cancer, diabetes, dementia and obesity seen today. It’s possible to prevent and even reverse the damage from a poor dietary lifestyle by eating naturally high nutrient density foods.

A Diet of Processed Foods Leads to Illness

We need both calories and nutrients to survive. Modern food manufacturing techniques have removed most of the nutrition from the processed foods which represent such a significant portion of our calories. Vitamins, minerals and a host of essential nutrients provide the fuel we need to neutralize free radicals, facilitate DNA repair, counteract carcinogens and provide an effective immune response. After decades of nutrient deficiency our natural reserves are depleted and the stage is set for the onset of chronic disease often leading to a shortened lifespan.

Children Develop a Taste for Junk Food Early in Life

Many children are fed a diet of processed junk food from an early age and they quickly develop a taste for salty, sugared and fried foods. The instinct to eat vegetables, fruits and meats in their natural form is erased as their taste buds become satiated with a ined diet impregnated with artificially manufactured chemicals which are more pleasing to the taste.

An analysis reported in the Journal of the American Dietetic Association indicates that 800 of 2200 calories consumed by a typical child each day are attributable to solid fats and added sugar. These macronutrients are commonly known as `empty calories` as they provide scant nutrients and contribute to the growing childhood obesity problem. Children who acquire the taste for junk food early are much more likely to develop weight problems in later life and suffer from early onset chronic illness.

A Natural Food Diet Reverses Disease Progression

The vast majority of children and adults eat less than a quarter of the fruits and vegetables they need to provide minimal protection against disease. Include a minimum of five and optimally ten or more servings each day of fresh vegetables and leafy greens, berries, nuts, seeds, lean protein sources and protective monounsaturated fats. Prepare foods raw or minimally cooked and avoid overheating as this quickly removes nutrients. The human body has an amazing capacity to repair and reverse the effects of a poor diet. Health conscious people view natural foods as medicine which leads to a long and healthy life.

0 What Is The Difference Between Pay for Performance and Accountable Care Organizations

Wheres that evidence?

The Disease Management Care Blog has occasionally wondered about the difference between pay for performance (P4P) and accountable care organizations (ACOs).  While the latter involves a more explicit transfer of risk, it thinks the underlying logic for both is ultimately the same: better quality performance should translate into less sickness, fewer specialist physician visits and reduced hospitalizations which, in turn, should save money that can be shared with the providers.  Assuming thats true, the possibility of getting that kind of money should prompt physicians to prevent, coordinate, counsel, immunize and screen instead of treat, er, ignore, not immunize and hustle out the door.

Unfortunately, a recently published Cochrane Review says otherwise. 

The DMCB likes CRs because they are state-of-the-art and highly disciplined reviews of the worlds scientific medical literature.  In this instance, after an exhaustive examination of every published paper on the topic of P4P, the authors conclude....

"....there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care."

The DMCB will be the first to argue that academic, rigorously conducted, randomized and controlled clinical trials are not the final answer when it comes to managing the subtle complexities of physician behavior change.  The DMCB has run into some very smart and passionate physician leaders who have few doubts about the real world links between P4P, increased quality and reduced cost.

That being said, given the commonalities between P4P and ACOs, no one should assume that ACOs are going to succeed based on any notions of "evidence" that the promise of savings will translate into a changed physician workforce.   Cochrane says it just aint there.

0 Green Kitchen Chickpea Cutlets and Non Meat Proteins

Green Kitchen is a bi-weekly column about nutritious, inexpensive, and ethical food and cooking. Its penned by the lovely Jaime Green.

When it comes to humanely raised food, meat is a big question. If youve seen Food, Inc. (which Kris has written about before) or read Fast Food Nation or The Omnivores Dilemma, youre familiar with the cruelties of the industrial livestock industry. The animals suffer, the workers are mistreated, food safety is a joke, the health value of the meat plummets, and the negative environmental repercussions are epic.

But okay, farmers market meat is usually humanely raised on small-scale farms that are a bajillion times better than factory farms. Sadly, it’s also hella pricey, and this website is not called Worthwhile Expenses Healthy Good. Of course, we should support small operations so they can grow and thrive, but there’s an alternative: non-meat protein.

When you cant buy from a local farmer, non-meat protein is a solid alternative on every level. It will save you money. It almost always will be healthier. It will be better for the planet, having required less energy to produce.

So: non-meat protein! Yay! Nearly all supermarkets have some tofu and mock-meat cold cuts these days, which is spectacular. Still, even the most enthusiastic vegetarian gets tired of tofu, and have you looked at the ingredients on a box of fake ham? There are a lot of them, and I dont know what most of them are. The solution: DIY.

Take these chickpea cutlets, for example. Adapted from inimitable vegan cookbook Veganomicon, they’re healthy, cheap, homemade, and DELICIOUS. (Meat-eating boyfriend-approved!) They’re also packed with protein (thanks, legumes), and a cousin of seitan, the hearty vegan protein Leigh and I have both written of.

A couple of recipe notes: You can bake the cutlets or pan-fry them, and instructions on both methods are below. The pan-fried are a little juicier and tastier than the baked, but thats what fat does for your food. The baked cutlets (I made two of each) were still totally delicious.

Also: one cutlet is a good, albeit slightly small portion. Depending on what else you serve, hungrier or larger folks may want one-and-a-half. The recipe makes four. I ate them with roasted root vegetables (love you, parsnips!) and broccoli, because there is nothing green at the greenmarket right now, and that just doesnt work for me.

From the wonderful/hibernating vegan blog, Yeah, That Vegan S***, I got the idea to dip these cutlets in agave nectar, and oh my goodness was it good! Also great: honey, a squeeze of lemon juice. Maybe a sandwich with an herbed mayo? (Sorry, Kris.) Honey mustard? BBQ sauce? Go mad. Anything youd dress chicken with would work.

~~~
If you like this recipe, you might also like:

• Roasted Chickpeas
• Sweet Potato and Chickpea Puree
• Veggie Burgers

~~~

Chickpea Cutlets
Makes 4 cutlets.
Adapted from Veganomicon by way of Yeah, That Vegan S***

1 cup chickpeas
2 tablespoons olive oil
½ cup vital wheat gluten
½ cup oatmeal, food-processed to breadcrumb consistency (or ½ c plain breadcrumbs)
¼ cup vegetable broth or water (I used Better than Bouillon)
2 tablespoons soy sauce
2 garlic cloves, pressed or grated
½ teaspoon lemon zest
½ teaspoon dried thyme
½ teaspoon paprika (I used hot, and it was great)
¼ teaspoon dried sage
Olive oil or cooking spray for baking or pan-frying

0) If you will be oven-baking these, preheat your oven to 375.

1) In a medium bowl, combine chickpeas and olive oil. With a big spoon and/or fork (plus a little muscle), mash them together until all the chickpeas are broken apart.

2) In a separate small bowl, combine dry ingredients: gluten, oatmeal, thyme, paprika, sage.

3) In another small bowl, combine wet ingredients: broth, garlic, lemon zest.

4) Dump both dry and wet ingredients into the chickpea mixture. Knead about 3 minutes or so, "until strings of gluten have formed."

5) Divide your dough into quarters. Flatten each piece until its a patty roughly the size of your flat hand.

TO PAN-FRY: Heat a large skillet over medium heat and coat lightly with olive oil. Cook cutlets about 12 to 15 minutes, flipping once halfway through. When finished, they should be browned and patty-esque in texture.

TO BAKE: Grab a baking sheet and lightly oil or coat it with cooking spray. Then, "brush both sides of each cutlet with olive oil" (or spray with cooking spray – you get the idea here). Pop in the oven for 20 minutes. Flip once and bake 8 or 10 more minutes. When finished, they should be browned and patty-esque in texture

Approximate Calories, Fat, Fiber, and Price per Cutlet
246 calories, 8.2g fat, 3.8g fiber, $0.65

Calculations
1 cup chickpeas: 286 calories, 2.7g fat, 10.6g fiber, $.50
2 tablespoons olive oil: 239 calories, 27g fat, 0g fiber, $.24
½ cup vital wheat gluten: 280 calories, 0g fat, 0g fiber, $.82
½ cup oatmeal: 150 calories, 3g fat, 4g fiber, $0.15
¼ cup vegetable broth: 1 calorie, 0g fat, 0g fiber, $.05
2 tablespoons soy sauce: 18 calories, 0g fat, .3g fiber, $.21
2 garlic cloves: 10 calories, 0 g fat, 0.1 g fiber, $0.10
½ teaspoon lemon zest: negligible calories and fat, 0.1g fiber, $.50
½ teaspoon dried thyme: negligible calories, fat, and fiber, $.02
½ teaspoon paprika: negligible calories, fat, and fiber, $.02
¼ teaspoon dried sage: negligible calories, fat, and fiber, $.02
TOTAL: 984 calories, 32.7g fat, 15.1g fiber, $2.63
PER CUTLET (TOTAL/4): 246 calories, 8.2g fat, 3.8g fiber, $0.65

0 Saturday Throwback 11 Things Dwight K Schrute Taught Me About Food and Frugality

Every Saturday, we post a piece from the CHG vault. Today, we salute the end of the 2010 television season with this feature from October 2007. Beets. Bears. Battlestar Galactica.

Hardworking. Alpha Male. Jackhammer.

A renowned beet farmer, volunteer Sheriff’s Deputy, and Assistant to the Regional Manager at the Dunder-Mifflin Paper Company Scranton branch, Dwight K. Schrute embodies all these enviable qualities, and then some. (He’s also merciless and insatiable.) Yet, the goose-bating, martial arts-trained Schrute makes cultural contributions that go far beyond his multiple jobs.

Of course, I er to his insights.

Our lives can only benefit from Schrutes somewhat obtuse, yet priceless aphorisms. Especially the ones about food. And cooking. And saving money.

So read on, dear … uh, readers. Learn from our fair farmer, and one day you, too, may join the DWIGHT ARMY OF CHAMPIONS.

DWIGHT SAYS: “Michael always says ‘K-I-S-S. Keep it simple, stupid.’ Great advice. Hurts my feelings every time.”
DWIGHT MEANS: Fresh, simple ingredients are the best way to a cheap, healthy meal.
In other words, eat food. Not too much. Mostly plants. Fruits, vegetables, whole grains, legumes, dabs of dairy, healthy fats and lean meats are the building blocks of delicious dinners and happy digestive systems. In the long run, they cost less and taste better than pre-packaged stuff, too.

DWIGHT SAYS: “My grandfather left me a 60-acre working beet farm. I run it with my cousin Mose. We sell beets to the local stores and restaurants. It’s a nice little farm ... sometimes teenagers use it for sex.”
DWIGHT MEANS: Buy local.
Not only does it support neighborhood farmers (who need security to keep randy kids away), but food that’s shipped from nearby tastes better, is better for you, and is easier on the environment. See here for more.

DWIGHT SAYS: "First rule in roadside beet sales, put the most attractive beets on top. The ones that make you pull the car over and go, Wow, I need this beet right now. Those are the money beets."
DWIGHT MEANS: Knowing how food is marketed is vital to saving cash.
There’s a reason grocery stores put expensive, good-looking food at eye level. It’s the same mentality behind placing pricey victuals in gigantic, showy displays. When you go food shopping, don’t forget to look at the top and bottom shelves - beyond what’s immediately apparent. You’ll spend less. (Also: Stick to the perimeter of supermarkets, shop from the circular, only use coupons for stuff you’d buy anyway, keep a price book, etc.)

DWIGHT SAYS: “Studies show that more information is passed through watercooler gossip than through official memos, which puts me at a disadvantage because I bring my own water to work.”
DWIGHT MEANS: Bottled water is a big, wet cheat.
Packing a thermos from home, using the cooler at the office, or simply gathering H2O from the tap can conserve up to $600 per year, depending on how often you buy bottled. (See here, here, and here for more.)

DWIGHT SAYS: “Yes, I have decided to shun Andy Bernard for the next three years, which Im looking forward to. Its an Amish technique; its like slapping someone with silence. I was shunned from the age of 4 until my 6th birthday, for not saving the excess oil from a can of tuna.”
DWIGHT MEANS: Save leftovers, or suffer the terrible consequences.
Whether it’s excess mashed potatoes or those last two slices of pizza, try to pack your extras away. It’ll keep your portion size down, make a delicious office meal the next day, and put your lunch money back where it belongs – in your pocket.

DWIGHT SAYS: "Oh you know that line on the top of the shrimp? Thats feces."
DWIGHT MEANS: Don’t play around with food safety.
Yeah, I think this ones pretty self-explanatory.

DWIGHT SAYS: “In the wild, there is no health care. In the wild, health care is, ‘Ow, I hurt my leg. I cant run. A lion eats me and Im dead.’ Well, Im not dead. Im the lion, youre dead.”
DWIGHT MEANS: Eating smart and modestly will save your money and your life.
Obesity contributes to heart disease, diabetes, and cancer – all difficult and expensive illnesses to treat. (See Get Rich Slowly’s The High Cost of Being Fat.) Plus, it makes it very difficult to run away from lions.

DWIGHT SAYS: “Whenever I’m about to do something, I think, ‘Would an idiot do that?’ And if they would, I do not do that thing.”
DWIGHT MEANS: Find a food anti-idol.
Imagine your most extravagant friend. You know, the high roller - the one that doesn’t think twice about his finances. For what does he dole out the most dough? If he’s anything like my big-spender buds, it’s food. Learn from his bad example and try to use good judgment when buying groceries, ordering out, or settling down for a restaurant meal.

DWIGHT SAYS: [to Tobys daughter] “Hello, tiny one. YOU ARE THE FUTURE!”
DWIGHT MEANS: Teach your children well.
When it comes to eating and budgeting, kids learn largely from the examples set by their parents. Whether it’s having dinner together or serving more vegetables, changing a bad habit or starting a few good ones will benefit them for life.

DWIGHT SAYS: “When you are ready to see the sales office, the sales office will present itself to you.”
DWIGHT MEANS: Honest change can not come until one is truly ready.
If you’re looking to cut costs or make a switch to simpler foods, you must first commit yourself to the idea, and then be ready to follow through on the behaviors. Think of it like smoking: every single person on Earth can warn you to stop, but until you want to, there’s no chance.

DWIGHT SAYS: “I do not fear the unknown. I will meet my new challenges head-on, and I will succeed, and I will laugh in the faces of those who doubt me.”
DWIGHT MEANS: You don’t know unless you try.
So you’d like to make more money, cook more wholesome meals, lose a few pounds. What’s stopping you? Don’t let the fear of failure keep you from reaching your dreams - gastronomic, economic, and otherwise.

(Catch more of Dwight on The Office every Thursday on NBC.) Photos from Flickr and Buddy TV.

0 Exercise Does a Body – and a Mind – Good

We’ve heard it time and time again: exercise is good for us. And it’s not just good for physical health – research shows that daily physical activity can also boost our mental health. But what actually accounts for the association between exercise and mental health?

A new article in Clinical Psychological Science, a journal of the Association for Psychological Science, explores whether certain psychosocial factors may help to explain the benefits of daily physical activity for adolescents’ mental health.

Karin Monshouwer of the Trimbos Institute in the Netherlands and colleagues at Trimbos and VU University Medical Center specifically wanted to examine two existing explanations for the link between exercise and mental health. The self-image hypothesis suggests that physical activity has positive effects on body weight and body structure, leading to positive feedback from peers and improved self-image, and ultimately improving mental health. The social interaction hypothesis, on the other hand, holds that it’s the social aspects of physical activity – such as social relationships and mutual support among team members – that contribute to the positive effects of exercise on mental health.

Monshouwer and her colleagues surveyed over 7000 Dutch students, ages 11 to 16. The adolescents completed validated surveys aimed at assessing their physical activity, mental health problems, body weight perception, and participation in organized sports. The researchers also gathered data on the adolescents’ age, gender, and socioeconomic status; whether they lived at home with their parents; and whether they lived in an urban area.

The researchers found that adolescents who were physically inactive or who perceived their bodies as either “too fat” or “too thin” were at greater risk for both internalizing problems (e.g., depression, anxiety) and externalizing problems (e.g., aggression, substance abuse). Adolescents who participated in organized sports, on the other hand, were at lower risk for mental health problems.

Confirming both the self-image hypothesis and the social interaction hypothesis, adolescents’ body weight perception (i.e., “too heavy,” “good,” or “too thin”) and sports club membership each partially accounted for the relationship between physical activity and mental health, even after taking adolescents’ backgrounds into account.

These results suggest that certain psychosocial factors – body image and social interaction – may help to explain at least part of the connection between physical activity and mental health. The researchers acknowledge, however, that other factors, such as the physiological effects of exercise, are probably also at work.

“We think that these findings are important for policymakers and anyone who works in healthcare or prevention. Our findings indicate that physical activity may be one effective tool for the prevention of mental health problems in adolescence,” says Monshouwer.

Monshouwer and her colleagues hope that future studies will be able to examine similar questions while following participants over time. Such longitudinal studies could help researchers to understand how physical activity type and context might influence the relationship between exercise and mental health.

0 Overeating impairs brain insulin function can lead to diabetes and obesity

New research from Mount Sinai School of Medicine sheds light on how overeating can cause a malfunction in brain insulin signaling, and lead to obesity and diabetes. Christoph Buettner, MD, PhD, Associate Professor of Medicine (Endocrinology, Diabetes and Bone Disease) and his research team found that overeating impairs the ability of brain insulin to suppress the breakdown of fat in adipose tissue.

In previous research Dr. Buettners team established that brain insulin is what suppresses lipolysis, a process during which triglycerides in fat tissue are broken down and fatty acids are released. When lipolysis is unrestrained, fatty acid levels are elevated, which can initiate and worsen obesity and type 2 diabetes. The current study is published online in The Journal of Biological Chemistry. The first study was published in the February 2, 2011 issue of Cell Metabolism.

"We are interested in understanding why people who eat too much eventually develop diabetes. Our recent studies suggest that once you overeat, your brain develops insulin resistance. Since brain insulin controls lipolysis in adipose tissue by reducing sympathetic nervous system outflow to adipose tissue, brain insulin resistance causes increased spillage of fatty acids from adipose tissue into the blood stream," said Dr. Buettner.

Increased fatty acids induce inflammation and that, in turn, can further worsen insulin resistance, which is the core defect in type 2 diabetes. Fatty acids also increase glucose production in the liver which raises blood glucose levels, Dr. Buettner explained. "Its a vicious cycle and while we knew that this can begin with overeating, this study shows that it is really the brain that is harmed first which then starts the downward spiral."

In this study, researchers fed rats a high-fat diet comprised of 10 percent lard for three consecutive days. This increased their daily caloric intake by up to 50 percent compared to the control rats that were fed a regular low fat diet. The researchers then infused a tiny amount of insulin into the brains of both groups of rats that they had shown in earlier studies to suppress release of glucose from the liver and fatty acids from fat tissue. They found that overeating impaired the ability of brain insulin to suppress glucose release from the liver and lipolysis in fat tissue. Similarly, short-term overeating in humans is known to produce comparable insulin resistance which could be explained by brain insulin resistance.

"When you overeat, your brain becomes unresponsive to these important clues such as insulin, which puts you on the road to diabetes. We believe that what happens in rats also happens in humans" said Dr. Buettner.

Dr. Buettners team plans to investigate methods of improving brain insulin function that could restrain lipolysis and improve insulin resistance.

0 If I Had identified Then Food and monetary recommendation for the College Bound Also a Story

As summer attracts to an in depth, gazillions of monumentally stoked 18-year-olds square measure getting ready to go away the warmly cozy, cozy heat of their hometowns for four years in cinderblock lecture halls. however faculty isn’t all reading, studying, and periodically authorship 25-page papers on Federal Communications Commission v. Pacifica (1978). It’s conjointly occasion to work stuff out – like a way to seriously manage your adult life for the primary time.

Fortunately for this journal, that adjustment amount has a lot of to try to to with frugalness, food, and health. highschool grads everyplace can before long be budgeting and preparation for themselves, and also the initial months won’t be straightforward. I know, as a result of once upon a time (the year forty five BC) i used to be there.

Looking back, i feel I did okay. Still, there square measure quite few CHG-type things I would like I had glorious before I left home. Like…

How to feed myself capably and frugally. My folks were glorious suppliers and good cooks WHO fed U.S.A. rounded meals from birth through late adolescence. however somehow, when seventeen years, I neer picked informed straightforward ideas like, “eat a vegetable, doofus,” or “an all-mozzarella stick diet can bankrupt, then KILL YOU.” If I had paid attention or done any analysis, the road to healthiness may need been a neater and cheaper one.

How to cook. In my tiny faculty city, it had been ritual for college kids to eventually move out of the dorms and into run-down off-campus housing (owned by a landowner WHO worked nights because the anti-Christ). Of the eight youngsters WHO shared one room my junior year, only 1 knew what she was doing. the remainder people bought expensive food from the native superstore and/or created do with no matter she (note: me) might collect from her night job at the friedcake search. on lection, associate degree elementary grasp of basic preparation skills might have saved each time, money, and much of friedcake symptom.

How to avoid shopping for negligible junk. each semester, I subsisted entirely on some hundred greenbacks earned over summer or winter breaks. it had been only enough for textbooks and food. Yet, I still bought fourteen loads of useless crap for no alternative reason than I might. Once, it had been try of vintage jeans. over again, a Phish album (which, ew). And another time? I blew $7 on a ampoule of coloured mud from a neighborhood tchotchke search. To repeat, I spent SEVEN greenbacks ON YELLOW DIRT. I would like I had scan a finance book at that time, or perhaps had any clue regarding maintaining a budget. At the terribly least, I wouldn’t have bought any beaker soil.

How to scan nutrition labels. Oh man. what percentage muffins did i feel contained solely 220 calories, once it had been truly a lot of like 660? Duh.

How to care regarding my body within the right means. this is often a tough subject, as a result of on the total, universities square measure sadly rife with intake disorders. an excessive amount of self-scrutiny will land one in Bulimiatown, and deficient can build the Freshman fifteen look like a fond memory. So, I’ll say this: I would like I had spent less time worrying regarding my weight (which no one cared regarding 0.5 the maximum amount as I did), and longer investment in my health (which … it wouldn’t have hurt to hit the athletic facility once or twice). Negative body pictures square measure endemic to young women – in America particularly, and applying my energies the right means (to intake right and exercise vs. stressing out regarding my butt) would have helped American state greatly down the road.

I might conjointly add “how to fancy cheap beer” to the present list, however I truly learned that half quite quickly. And it still wasn’t 0.5 as valuable because the single best lesson I gleaned from my folks throughout college: specifically, there arent any second possibilities with universe cash.

Let American state justify.

Back within the spring of (DATE REDACTED), i used to be accepted to the same semi-affordable public establishment in upstate the big apple, wherever the seven-month winters were matched in intensity solely by my ought to GET THE CRAP faraway from HOME. I idolized my Long indweller folks (and still do), however the prospect of living four hundred miles faraway from them excited this womb-to-tomb girl to without stopping. So, I sent the “yes” letter, got my friend assignment, and spent the remainder of the summer earning textbook funds at the native Wendy’s fryolator.

For the foremost half, Ma and Pa were improbably confirmative. Besides creating the obligatory visits to Bed, Bath, and on the far side for girly-blue shower caddies, they conjointly offered to pay my tuition till my sister entered college, 2 years thus. Being sensible folks and savvy people, theyd one condition: I had to keep up a three.0 average.

“No downside,” i believed. “Bs square measure straightforward.” I’d breezed through highschool (for the foremost half - damn you, Physics), and wasn’t intimidated by the prospect of a better, tougher education. later, after I entered college within the fall, I devoted most of my time to … um … not assignment.

It went fine for the primary few weeks, till I received a string of fairly awful grades on papers and tests. Those metallic element (and in one or 2 cases, Ds) were each enormously mortifying and a heavy warning sign for my stupid (drunk) ass. So, I prune on the surplus, buckled down, and soon, most of my category marks had morphed into semi-respectable BS and B-minuses.

Except Basic prowess.

Though the category was tutored by the sweetest man alive, I didn’t perceive a damn factor. Nor did I build any effort to, whatsoever. I incomprehensible a vacant minimum of 1 category per week, neer scan the fabric, and doubtless took a combined total of 3 pages of notes. on lection, I’m stunned the {professor|prof|academician|academic|faculty American statember} didn’t hurl me out a window, content perspective 1st.

By the tip of the semester, I somehow force a C-minus out of the air (note: my butt). it had been higher than I due, however still brought my overall measure all the way down to a grand ol’ a pair of.99. (Seriously! A a pair of.99! I didn’t even recognize that was possible!) once my folks saw, I expected them to gush, “2.99! however that’s theore near a three.0! We’ll pay your tuition FOREVER.” To my then-consternation and their unending credit, that didn’t happen.

“Kid,” they aforementioned, “we asked for a three.0. Here’s the bill.”

My juvenility (and let’s be honest - new love of low {cost|low-cost} beer) cost American state upwards of $4,000, that I finally finished paying off last year, when over a decade of interest had accumulated. (P.S. I neer got below a three.3 again.)

But you recognize what? I’m glad it happened. I’m glad Ma and Pa stuck to their guns, as a result of it tutored American state the 3 of the foremost valuable things I’ve ever learned:

1) There arent any second possibilities with universe cash.
2) There arent any second possibilities with universe expectations.
3) My folks don’t fiddle, ever.

Thanks to that inglorious a pair of.99, I pay bills on time. I don’t miss deadlines. I attempt to exceed what individuals raise of American state. Sure, most of it’s out of sheer terror of the implications, however i favor to assume I learned a microscopic smattering of responsibility on the means. (Note: It’s largely the phobia.)

Readers, however regarding you? whether or not you visited faculty, your own flat, or a wedding, what food/health/economic things did you want you knew before exploit home? cause dem stories (and I promise next week, there’ll be a writing with real analysis and actual learny-type things).