Tips For Health

The Health Affairs Blog, organized by Chris Fleming, has an Inauguration Edition of the Health Wonk Review.  Think of it as a timely and linked summary of savvy insights from the best health policy bloggers that the web has to offer.  Theres a gold mind of information on health care costs, the mechanics of insurance and population health.

Enjoy!

Listen to public radio, read the national newspapers, surf the standard cable channels or listen to the mainstream commentariat and the message is the same: if only the U.S. would import the best of European-style health care, life-expectancy rates would increase, health care costs would decline and physicians like the Disease Management Care Blog would bask in the benevolent and enlightened management of the U.S. Department of Health and Human Services.

As the DMCB has pointed out before, comparative national data are not a slam-dunk, untangling unique non-medical cultural and economic impacts on population the U.S. is complicated and the U.S. in some instances, is getting its moneys worth.  Whats more, rising health care costs are a global phenomenon and there is no evidence that dropping European-style health care on the U.S. will blunt its overall cost inflation. As for the enlightened benevolence of HHS, just remember that their Board of Directors is Congress and that Taxmageddon promises that the SGR fix wont be pretty.

Yet, while DMCB readers may have a reason to be skeptical about the wisdom of of europhilism, what about the possibility that our beret-wearing, cobblestone-hopping, Audi-driving and cafe-sipping cousins across the Atlantic admire the U.S. system?  Impossible you say?

Think again.  The DMCB has personally been to Europe to share the good news about U.S. approaches to disease and management. The Care Continuum Alliance has an impressive international presence made up of organizations using elements of  disease management and population-based care. Many of the vendors sell millions of dollars worth of services in Europe. 

To drive the point home, heres recent and telling opening quote from a internationally published paper in Health Expectations on the topic of disease management:

Inspired by American examples, several European countries are now developing disease management programmes (DMPs) to improve the quality of care for patients with chronic diseases.

We had so much success with our Best Deals at CostCo question last week (nice work, everybody!), I thought wed try a similar one with TJs, with the intention of turning it into a larger article tomorrow. Here goes...

Wiki Commons Sprew

Q: What are the best deals at Trader Joes?

A: The Trader Joes in Brooklyn tend to be a tad crowded. (Think the Beatles at Shea Stadium.) Still, there are bargains to be had. My favorites are:

• Organic bananas
• Roasted red peppers
• Canned artichokes
• This insane olive tapenade my friend S. always brings with her
• WINE

In regard to that last one, Ive never found a better place to stock up on vino. The price-to-quality ratio is ludicrously good at TJs, and their house brand (Three Buck Chuck, holla!) is solid.

And with that, sweet readers, I throw it over to you. What are your favorite TJs buys?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

In honor of POTUS, were taking today to lect on the legislative branch.

Well return tomorrow. In the meantime, please enjoy Drunk History: Volume 5, with Will Ferrell, Don Cheadle, and Zooey Deschanel.

(Warning: Three or four bad words within.)

The DMCB goes through the details!

Even the Disease Management Care Blog has been overrun by the news cycle.  Snookis fecundity, Rushs misogyny and the close Ohio primary have been eclipsed by reports that electronic health records (EHRs) dont reduce unnecessary test ordering and that Medicares "Hospital Compare" web site doesnt reduce death rates. 

Knowing that the news medias word cannot be trusted, the DMCB steps up with a look at the details.

To summarize, both are observational studies that looked backwards in time at what happened after doctors offices started to install EHRs and after Medicare started their Hospital Compare web site.  Its been widely expected that EHRs would reduce duplicative and unnecessary x-ray studies and that Hospital Compare would "shame" hospitals into higher patterns of quality which would translate into lower death rates.  These studies show that may not be the case.

While observational studies are very useful at looking at patterns and associations, theyre less able to establish or rule out a direct cause-and-effect relationship.  Think about the "assocation" between the presence of white hair and heart attack, which has no cause-and-effect relationship.  Compare that to a similar "association" between high blood cholesterol levels and heart attack, which does have a cause-and-effect relationship.  Observational studies cant distinguish between the two. As a result, they are often counterintutive, prone to overinterpretation, require a lot of statistical jiggering and always leave some room for doubt.

So, with those caveats, proceed with caution......

Both studies are in the latest issue of Health Affairs.  The two studies abstracts are available here and here.

The EHR study looked at the National Center for Health Statistics 2008 "National Ambulatory Medical Care Survey." This data base contained information on 28,741 encounters with 1,187 primary care and specialist physicians.  The survey was detailed enough that the researchers were able to tell which encounters resulted in any "imaging study." That term collectively ers to an x-ray, ultrasound, MRI or a CAT scan. 

The survey also told the researchers if the ordering physician used a EHR with electronic access to 1) past high dollar test results (a typed report that describes a radiologists interpretation of what the x-ray, CAT or MRI looks like) or 2) the images themselves ("click" and the x-ray itself appears on-screen).

The authors next used regression modeling that yielded "odds ratios" to ascertain if there was any statistical association between the likelihood of physicians ordering an imaging study and access to 1) results or the 2) images. Regression modeling  allowed the authors to statistically account for or isolate any imbalances in patient or physician characteristics that could also tilt imaging frequency in one direction or another. 

The results?  The authors knew something was up when they saw the raw data: physicians with EHR access to results or the images were MORE likely to order an imaging study.  18% of encounters with access resulted in an imaging study, while 12.9% of visits without access resulted in an imaging study. 

The association held up statistically when regression accounted for and statistically neutralized known patient (for example, age, gender or type of insurance) and practice (for example, spciality, private practice or income source) factors.  The odds ratios (likelihood) for test ordering were increased at 1.71 and 1.78 if access to results and the images were present, respectively.  In other words, the likelihood of ordering an imaging test was increased by between 70%-80% if an EHR was in the mix.

The DMCB cant say its surprised.  One business proposition of commerically available EHRs is that their configuration enables test ordering by making it a few "clicks" away with all the necessary documentation.  The authors point out that decision support at the point of care may blunt the physicians increased tendency to use their EHRs to over-order tests.  The DMCB points out that if the docs dont figure this out soon, radiology benefit management programs will continue their relentless expansion.

The second study looked at Medicares much ballyhooed Hospital Compare.  Readers may recall that this is Medicares web-based system that pubicly compares hospitals on their quality of care for the key "big three" high frequency and high expense conditions of heart attack, heart failure and pneumonia.  The reporting system was implemented in 2005 and, if it was supposed to work as intended, it should have ultimately led to a decreased in national death rates for three three conditions.

Not exactly.

The authors examined approximately 18 million Medicare admissions and death rates for the "big three" conditions as well as stroke, intestinal bleeding and hip fracture from 2000-2008.   Readmissions and patients who were enrolled in Medicare Advantage at anytime were excluded from the analysis.  The authors used "time series design,""nonlinear quadratic trends" and regression modeling with a comparison to the parallel trends to the non Hospital Compare conditions of stroke, hemorrhage and hip fractures. In case youre interested, risk adjustment was used to account for patient severity.

The authors found that while there was a drop in death rates from 2000-2008, the overall trends - except for heart failure - were well established before the implementation of Hospital Compare and simply continued their downward trends.  The overall adjusted relative risks for heart attack, heart failure and pnsumonia were .97, .92 (significant) and 1.01.  When the trends were adjusted and compared to the other three non-reported diagnoses, there appeared to be a slightly increased relative risk for pneumonia at 1.07.  Last but not least, there was no evidence in the analysis that patients tended to shift toward any of the higher performing hospitals.

The DMCB cant say its surprised here either.  When patients are being hospitalized, theyre not about to check with Hospital Compare first and the hospitals and their doctors were already working hard to optimize their care protocols.

But, based on the caveats described above, these studies are not conclusive.  Time will tell and, alas, more studies are needed before well know if were getting our moneys worth from the EHR and Hospital Compare.

Its a new year. Maybe youve resolved to hold your meals to a new standard. If so, you might want to check out the National Heart, Lung and Blood Institutes (NHLBI) Menu Planner.

It lets you select a daily calorie limit and plan your meals with drop-down menus. The planner keeps a running tally of your total calories, fat, and carbohydrates ... and lets you know when youve exceeded your calorie limit.

Its easy to use, although for what it provides in ease it lacks in depth. The food choices are limited. (Where are the nuts? Has anyone seen the nuts?)

A better tool for analyzing your food intake can be found on the USDAs MyPyramid Tracker site. For example, an entry of "pizza" in the search box returns 66 items, where the NHLBIs Menu Planner fails to list pizza at all.

Both sites are worth a visit, though. While youre at the NHLBIs site, dont miss their Portion Distortion Interactive Quiz:

A common genetic variant that affects 1 in 3 people significantly increases the risk of colorectal cancer from the consumption of red meat and processed meat, according to a study presented today at the annual American Society of Human Genetics 2013 meeting, the largest gathering of human geneticists in the world.

In addition to identifying a gene that raises risk for colorectal cancer from eating red or processed meat, the study — the first to identify the interactions of genes and diet on a genome-wide scale — also reveals another specific genetic variation that appears to modify whether eating more vegetables, fruits and fiber actually lowers your colorectal cancer risk.

"Diet is a modifiable risk factor for colorectal cancer. Our study is the first to understand whether some individuals are at higher or lower risk based on their genomic profile. This information can help us better understand the biology and maybe in the future lead to targeted prevention strategies," said lead author Jane Figueiredo, Ph.D., Assistant Professor of Preventive Medicine at the Keck School of Medicine of USC.

"But we are not saying that if you dont have the genetic variant that you should eat all the red meat youd like," Figueiredo added. "People with the genetic variant allele have an even higher increased risk of colorectal cancer if they consume high levels of processed meat, but the baseline risk associated with meat is already pretty bad."

Weve all heard reports about how certain foods may lower or raise the risk for certain diseases, such as cancer. But how our personal genetic variations modify the effects of diet on disease has not yet been thoroughly investigated, said senior author Ulrike Peters, Ph.D., M.P.H, of the Fred Hutchinson Cancer Research Centers Public Health Sciences Division.

The researchers systematically searched the more than 2.7 million genetic sequences for interactions with consumption of red and processed meat. The study looked at 9,287 patients with colorectal cancer and a control group of 9,117 individuals without cancer.

The risk of colorectal cancer associated with processed meat was significantly higher among people with the genetic variant rs4143094, the study shows. This variant is located on the same chromosome 10 region that includes GATA3, a transcription factor gene previously linked to several forms of cancer. The transcription factor encoded by this gene normally plays a role in the immune system, but carries this genetic variant in about 36 percent of the population.

The researchers speculate that the digestion of processed meat may promote an immunological or inflammatory response that may trigger tumor development. The GATA3 transcription factor normally would help suppress the immunological or inflammatory response. However, if the GATA3 gene region contains a genetic variant, it may encode a dysregulated transcription factor that impacts its ability to suppress the response.

But other genetic vatiants may be beneficial: On chromosome 8, another statistically significant diet-gene interaction was found in variant rs1269486. For people with this variant, eating your fruits and veggies may be even better for you when it comes to colorectal cancer risk, the research shows.

The study is part of an ongoing collaboration among multiple institutions worldwide, the international NIH-funded Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO).

"GECCO aims to continue to discover additional colorectal cancer-related variants by investigating how genetic variants are modified by other environmental and lifestyle risk factors, including biomarkers as well as how they influence patient treatment response and survival," Peters said, emphasizing how much further research is required to uncover the specific mechanisms by which genes modulate the intake of certain foods on colorectal cancer risk.

Colorectal cancer is a multi-factorial disease attributed to lifestyle, environmental and genetic causes, and the third leading cause of cancer death in both men and women across most racial groups. Over 30 genetic susceptibility alleles for colorectal cancer have been pinpointed throughout the genome. They include rare variants that have a strong impact on risk and common variants that are low risk.

"Colorectal cancer is a disease that is strongly influenced by certain types of diets," Figueiredo said. "Were showing the biological underpinnings of these correlations, and understand whether genetic variation may make some people more or less susceptible to certain carcinogens in food, which may have future important implications for prevention and population health."

It’s been a sweet seven days over at headquarters (Note: my futon), between a Lifehacker link and post on the most excellent Get Rich Slowly. But the week is never complete without ... THE LINKS!

From Get Rich Slowly

1) Get Rich Slowly: How to Use a Food Dehydrator to Preserve Your Harvest
Clear, informative, extensive post on the wide world of dried fruits and veggies. I swear, Kris’ summary of methodology, practical uses, and advantages will convince you to buy a dehydrator by the time the article is over.

2) Eatocracy: The Great Lunch Swap
I love this idea: co-workers Tommy and Callie made lunch for each other for three days, and it was a total, raging success. Are you converting from takeout to brown-bagging your office meals? This is a faboo way to ease into it.

3) stonesoup: 18 tips for minimising your food costs
If you’re just starting out on this whole frugal food journey, this excellent rundown on the basics of eating cheaply/healthfully is a must-read. Bonus cauliflower/chickpea recipe at the end!

4) The Oregonian: Nurturing the Next Crop of Farmers
Neat piece on the new generation of young farmers. Inspired by the Michael Pollans and locavore movements of the world, they’re overcoming legislative obstacles to learn about the harvest.

5) The Kitchn: Good Ways for Couples to Share Food Responsibilities?
Wise Bread had a really good piece on this a few weeks ago, and this extensive comment thread only adds more to the discussion. Great for those couples A) just starting out, or B) experiencing an unequal division of labor. Most important: if you feel you’re shouldering all the responsibility, SAY SOMETHING, or suffer the resentment-filled consequences.

6) Money Saving Mom: Is Organic Milk Worth the Extra Price Tag?
We use milk exclusively for cereal over here, so these 124 comments are a bit of an education (especially Amber’s at #11). Unscientific, but most interesting: some women claim organic milk/meat postpones their daughters’ periods a few years (meaning: past third grade).

7) Salon: How to never make the same-old, same-old salad again
Sick to death of lame greens and droopy tomatoes? Francis Lam ensures you’ll never suffer a weak salad again with this thorough, knows-what-he’s-talking-about how-to.

From Real Simple.

8) Real Simple: 22 Quick, No-Cook Recipes
Oo! Nice, heat implement-free compilation of easy recipes.

9) Huffington Post: Stop Drinking Bottled Water Now!
Fab, graphic-happy poster explains why bottled water drains our wallets and environment. Print and hang!

10) Chow: What the *&@#%!$ Should I Do with All This Summer Fruit?
We started with a trip to the dehydrator. We’re ending with a trip to the freezer. Solid step-by-step on freezing your berries, melons, stone fruits, and … uh, other stuff.

HONORABLE MENTION

Chicago Tribune: Homemade Pickles in Just an Hour
Sixty minutes to a better burger.

Esquire: Food for Men – Chinese Food
Ever wonder how to get the authentic stuff at Chinese restaurants? Only John Mariani knows for sure. (Okay, and millions of lovely Chinese people, too.)

Holy Cool: 15 Cool and Creative Ice Cube Trays
Ooo! Great birthday gifts for summer babies.

New York Times: Healthy Department Revamps Restaurant Inspection Website
Noo Yawkuhs! Restaurants are receiving letter grades for cleanliness now. Blissful ignorance is no more.

Slashfood: Vegetarian Grilling Taste Test
Quorn always loses these things. And Morningstar Farms always wins.

AND ALSO

Gawker TV: The Best Little League Player in the Country is a Girl
Baseball pitcher Chelsea Baker, age 13, has a 65-mph fastball. She hasn’t lost a game in four years, and pitched two perfect ones, including an All-Star game. This year, she struck out 127 batters in 60 innings. Beautifully shot and edited, this piece highlights her knuckleball and ponytail in all their glory.



Thank you so much for visiting Cheap Healthy Good! (We appreciate it muchly). If you’d like to further support CHG, subscribe to our RSS feed! Or become a Facebook friend! Or check out our Twitter! Or buy something inexpensive, yet fulfilling via that Amazon store (on the left)! Bookmarking sites and links are nice, too. Viva la France!

This time last year, I took an unexpected swim in Lake George and hung out with some Vermont syrup tappers made of pantyhose. As one who will stop for anything that catches my eye along the roadside, weird and kitschy New England-in-the-fall excursions seem to becoming a tradition and rife with inspirado.

A couple of weekends ago CB and I visited his parents in the great state of New Hampshire, where we lived free and ate garden-fresh vegetables (rather than the alternative). On the way back through Massachusetts, we strolled through a pumpkin spice-hyacinth-clean laundry-mountain spruce-cookie-scented, fake-snowy Bavarian Christmas village with a country crafts food court and animatronic bluegrass band.

We also bought enough squash for me to start my own roadside stand.

I can get squash in New York. But there they were, all orange and green and yellow, beckoning me from the side of the road. Since we had a car, for once I was able to buy more than I could carry. So I scooped up two sugar pumpkins for pie, two butternut squashes for soup, a Long Island cheese squash, and a buttercup squash—the latter two because they were new to me and pretty.


And they were cheeeeeap. For six squashes, I spent a grand total of $7. The farmer at my local market has reasonable prices compared to most in the area, but yay!

It took me a whole day to bake, puree, and freeze my bounty, and now I’m ready for whatever new-and-exciting squash recipes come my way. And snacking on roasted squash seeds. Scanning the InterWebs for inspirado, only a few clicks through the blog reader unearthed the perfect recipe to kick off Squash Season: Savory Kabocha Pie from The Kitchn.

Practice my pie crust technique on a savory squash and tofu pie that would be amazing for brunch or a light lunch? Okay, whoever is reading my thoughts: Swiss bank account, cottage on the Isle of Skye, lifetime supply of handspun alpaca.

From my roadside bounty, I chose the buttercup squash. It was recommended as a substitute for kabocha; weighing in at just over 2 lbs, it was the right size, and I couldn’t wait to try it.

Buttercup squash is a small, squat, dark green squash looks very similar to a kabocha. The sweet flesh is ideal for a variety of recipes and is interchangeable with its butternut and kabocha cousins.

In the pie at hand, the buttercup squash combines flawlessly with the tofu to make a rich and creamy filling without being heavy; and the sweetness is nicely balanced with the savory garlic and onions. Rosemary has an almost woodsy scent, and makes a lovely addition, though take care not to overdo it. Too much makes the filling bitter. Sage or thyme would be equally delicious.

You can use any crust you like, but I branched out and made the whole-wheat crust recommended in the recipe. It was hearty and dense but tender and flaky, standing up to the earthy flavors of the filling more than would a simple white flour crust. Give it a try; it’s worth the effort.

If you’re feeling ambitious, you might make two crusts at once and freeze one for later. A frozen pie crust will keep for several months, and give you a head start on your holiday baking—or make this dish that much easier when you want to make another immediately, which I assure you, you will. I did (with a butternut: equally amazing).

Next time I hit the road (soon), I’ll be looking for more food I’ve never tried and flannel-wearing robots that sing and play the banjo. Let me know if you have a line on any.

~~~

If this article tickled your fancy, sidle on over to:

• Pumpkin Orzo with Sage
• Vegan Pumpkin Pie
• Butternut Squash Gnocchi

~~~

Savory Buttercup Squash Pie
Serves 8.
Adapted from Savory Kabocha Pie from The Kitchn (crust adapted from Brother Ron Pickarskis Friendly Foods).


Crust
1 cup whole-wheat pastry flour
1/2 cup unbleached, all-purpose flour
2 tbsp olive oil
1/4 tsp salt
1/4-1/3 cup ice water

Filling
2 lb buttercup squash, seeded, baked, and mashed
1/2 tbsp olive oil
1 small onion, diced (about 1 cup)
3 cloves garlic, minced
14 oz silken tofu, mashed
1 tbsp fresh rosemary leaves, finely chopped
1 1/2 tsp salt
Freshly ground pepper, to taste
2 tbsp arrowroot powder dissolved in 1 tbsp water

For the Crust
1) Mix whole-wheat pastry flour, all-purpose flour, and salt in a small bowl. Pour olive oil in a separate bowl. Place both bowls in freezer for at least 1 hour.

2) In a food processor or with a pastry cutter, combine flour and hardened oil until it forms a coarse meal. Leave a few pea-sized pieces of hardened oil for a flakier crust. Drizzle the water to the flour mixture, using only enough to form a dough. Take care not to overwork the dough, or it will become tough.

3) Turn out the dough onto a lightly floured surface and roll into 1/16"-thick circle. Caully place dough in a 9" pie pan. Trim and crimp edges as desired. Place crust in rigerator until you are ready to fill.

For the Filling
1) Preheat oven to 350º F.

2) Slice squash in half and scoop out seeds. Place sliced side down on greased baking sheet and roast in oven for 15-25 minutes until a fork easily pierces the skin. Allow to cool, then scoop out flesh, mash, and set aside. Leave oven on at 350º F.

3) In a large saucepan, heat olive oil and sauté onions and garlic about 7 minutes, until the onion is translucent. Stir in squash, tofu, rosemary, salt, and pepper. Cook until warm. Dissolve arrowroot in water and stir into mixture to thicken filling.

4) Pour the filling into pie crust and bake for 30 minutes.

5) Serve warm with salad or soup for brunch or lunch. Keep a back up for yourself.

Approximate Calories, Fat, Fiber, and Protein per Serving
222.5 calories, 9.3g fat, 9.2g fiber, 14.3g protein, $.43

Calculations
1 cup whole wheat pastry flour: 440 calories, 20g fat, 16g fiber, 12g protein, $0.64
1/2 cup unbleached, all-purpose flour: 227.5 calories, 0.5g fat, 1.5g fiber, 6.5g protein, $0.10
2 tbsp olive oil: 240 calories, 28g fat, 0g fiber, 0g protein, $0.16
1/4 tsp: negligible calories, fat, fiber, protein, $.02
2 lb buttercup squash: 416 calories, 0g fat, 32g fiber, 0g protein, $1.00
1/2 tbsp olive oil: 60 calories, 7g fat, 0g fiber, 0g protein, $0.04
1 small onion: 10 calories, 0.05g fat, 0g fiber, 0g protein, $0.12
3 cloves garlic: 12 calories, 0g fat, 0g fiber, 0g protein, $0.04
12 ounces firm tofu: 375 calories, 19g fat, 24g fiber, 96g protein, $1.20
1 tbsp fresh rosemary leaves: negligible calories, fat, fiber, protein, $.04
1 1/2 tsp salt: negligible calories, fat, fiber, protein, $.02
Freshly ground pepper: negligible calories, fat, fiber, protein, $.02
2 tbsp arrowroot powder: negligible calories, fat, fiber, protein, $.02
TOTALS: 1780.5 calories, 74.5g fat, 73.5g fiber, 114.5g protein $3.40
PER SERVING (TOTALS/8): 222.5 calories, 9.3g fat, 9.2g fiber, 14.3g protein, $.43

With integral the rigid activities further sweat-generating regimens that most weight loss programs have, more again further people are enticed to halt owing to a better alternative, irrecoverable the trouble of exerting too much effort.

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With these pills dominating the market today, who needs to emotions those abs and biceps and do some dieting if there is an easier way to lose weight?

With an estimated 60% of the American cats that are over considered as obese, these �wonder� drugs are definitely reaping millions of dollars in the United States alone.

Now, the questions are: is there any gospel regarding the manufacturers' claims that these aliment pills can ultimately promote guidance destruction? Are they really forcible in articulation people evade weight? and if that is the case, do these pills also help those people maintain their ideal weight and predomination any fat dividend in the body?

In reality, there are diet pills that can entirely make a person shed off those else pounds. These diet pills contain certain substances that were being clinically further scientifically proven to be very effective.

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Find diet pills that effectively suppress your appetite. It does not necessarily mean that you bequeath skip meals but you will not just feel hungry every considering and accordingly. This is because obesity generally happens to kinsfolk who are fond of in-between meals, which actually initiates fat calorie intake.

3. The calorie stopper

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These substances are known as �phaseolus vulgaris.� This is familiar to create an enzyme that bequeath efficiently control any unessential calories in the habit. The enzyme responsible for this delightful employment is known as �alpha-amylase.�

4. The metabolic enhancers

It is best to choose diet pills that presuppose the so-called �lipotropic elements� that are influential in eliminating fats from the habitus. It functions like a sweeper that effectively sweeps excess fats outside the body.

These lipotropic elements are effect in vitamin C, chitosan, alpha lipoic acid, and pullulating festivity extracts.

5. The water-retention breaker

Effective cuisine pills are those that contain diuretics. These are elements that avert the retention of wet power the body during the weight bereavement regimen.

All of these factors are, indeed, clinically proven and effective in losing weight. Though, it must be kept in expectation that diet pills alone are not sufficient to insure finest weight loss. Hence, positive is pastoral important to do some exercises.

Theore, with exercise again the right diet pills, you are definitely on your way to a healthier, slimmer you.

FreeMoneyFinance is the host of the latest Cavalcade of Risk.  This insurance and enterprise risk management summary offers up some of the best bloggery on data sharing, health care policy, workers comp and, last but not least, an unusual type of life insurance claim.

For your learning pleasure. 

A HEALTHY LIFE Interdisciplinary research at the University of Copenhagen explains why moderate exercising is more motivating than hard training. The findings have just been published in Scandinavian Journal of Public Health.

Last year, a research team monitored just over sixty moderately overweight – but healthy – Danish men for 13 weeks in their efforts to get in better shape. The men who exercised 30 minutes a day lost an average of 3.6 kg. during the three months, while weight loss was 2.7 kg. for those exercising for a full hour. By means of qualitative interviews based on ethnological expertise, the researchers have now approximated the test subjects by, e.g., identifying the cultural barriers in relation to training and change of entrenched habits.

"The qualitative data offer a possible explanation for the surprising biological data. The subjects in the test group that exercised the least talk about increased energy levels and a higher motivation for exercising and pursuing a healthy everyday life. They take the stairs, take the dog for an extra walk or cycle to work. In contrast, the men who exercised for one hour a day, after training, felt exhausted, demotivated and less open to making a healthy change. We are thus seeing that a moderate amount of exercise will significantly impact the subjects daily practices," says Astrid Jespersen, ethnologist and associate professor at the Faculty of Humanities.

Give me your tired, your poor, your wilted herbage straining for the trash can, the rotting use of your crisper drawer. Send these, the yellowing, long-forgotten to me, I will make them into awesome pesto!

That’s what your food processor is saying right now, if it were also the statue of liberty.

Talk about eating and cooking in environmentally friendly ways often comes back to the same ideas – eat local, eat unprocessed, eat happy meat. These are awesome ideas – they connect your kitchen to lovely, independent farms, shortening the distance from the soil to your fridge – but they are also sometimes difficult ideas.

Not everyone has access to greenmarkets. Not everyone has the education or skills to choose or prepare unprocessed foods. Not everyone can afford local, free-range, grass-fed, ethically raised meat. It’s sadly easy to sigh in resignation when we can’t manage those good choices and lose sight of a good choice every single one of us can make.

Do not waste food.

You know what makes a box of Dunkaroos an even less worthwhile investment of raw materials, industrial production, and your dollars? Not eating them! Want to completely negate any power for good contained in that conventionally grown midwinter Peruvian tomato? Throw it out! Wasting food is the surest way to guarantee that its environmental impact is all for naught. It’s also a suire way to waste your money, too.

Living in a largely Dominican neighborhood means a lot of nice things for me, culinarily, not the least of which is the prevalence of cheap cilantro in the supermarket. It is not local, it is not seasonal, but it is 99 cents a bunch, and tempting to pick up to throw on sautés and in omelets and such.

But let’s be honest – more times than not, that 99-cent bunch of delicious, delicious cilantro sits in my crisper drawer until it is yellow and wilted, and it ends up not in my mouth but in my compost.

This time, I resolved to do it differently. Not to remember to use any of the cilantro for its intended purpose, of course, but to salvage it once it had gone forsaken.

A while back I’d seen a recipe online for cilantro pesto that specifically addressed this forsaken cilantro issue. No surprise, my interest was piqued. What’s that, you say? Pesto can be made with nasty, wilted cilantro? And does not require billion-dollars-a-pound pine nuts? Please, go on!

And go on this recipe did! Cilantro + oil + nuts = pesto! My cilantro wasn’t so much wilted as yellowing (with, okay, a couple of rotten leaves), but I overcame my squeamishness, pulled out the gross stuff, and was left with about two cups worth of usable greenery. “Usable” not really as it was, but hopefully the alchemy of pestoization (yes, that’s a proper use of the Italian root word) would be enough.

And so, dear reader, it was.

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If this looks good, youll surely adore:

• 156 Cheap, Healthy Recipes for Ten Common Leftover Herbs
• Gingered Carrot Soup with Lime and Cilantro
• Pesto

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Cilantro Pesto
inspired by The Lazy Localvore.
makes about 6 one-tablespoon servings
(quantities are flexible for two reasons – one, so you can suit the recipe to your taste; two, because who knows how much of your languishing cilantro will be salvageable.)


2-3 cups cilantro leaves (& little stems)
1-2 T olive oil
1/8-1/4 cup slivered blanched almonds (or other nut)
1/8-1/4 t salt
dash of garlic powder

Put cilantro, almonds, salt, and garlic powder into bowl of food processor. Process, streaming in olive oil as you go. Pulse until it is a thick paste, with nuts chopped finely but not pulverized. Adjust seasonings to taste.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
60 calories, 5.7g fat, 0.7g fiber, 1.1g protein, $0.22

Calculations
3 cups cilantro leaves: 18 calories, 0g fat, 1g fiber, 1g protein, $0.99
1.5 T olive oil: 189 calories, 21g fat, 0g fiber, 0g protein, $0.12
1/4 c slivered blanched almonds: 155 calories, 13.3g fat, 3.3g fiber, 5.7g protein, $0.15
1/4 t salt: 0 calories, 0g fat, 0g fiber, 0g protein, $0.01
dash garlic powder: negligible calories, fat, fiber, and protein, $0.02
TOTAL: 362 calories, 34.3g fat, 4.3g fiber, 6.7g protein, $1.29
PER SERVING (TOTAL/6): 60 calories, 5.7g fat, 0.7g fiber, 1.1g protein, $0.22

Todays question comes from reader Sara A.:

Q: Are there any good vegan cabbage recipes? It is super cheap year round, but I have trouble finding a way to make it palatable. It always turns out very bland.

A: Good question, Sara. Being inexpensive, relatively hearty, and surprisingly high in both Vitamins C and K, cabbage doesnt get nearly enough play as it should. Fortunately, there are a number of vegan/vegetarian applications (along with bacony ones) for the veggie, especially if you look to international cuisines. Here are five examples:

Beet and Cabbage BBQ Slaw
Hot and Sour Cabbage Soup
Napa Cabbage and Red Onion Slaw
Red Cabbage and Apples
South Indian Cabbage

Readers, how about you? What are your favorite cabbage recipes? Fire away.

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

CHG’s No-Cook Month continues. Next week: no-heat food ideas!

Have you ever been to Las Vegas in the summer? I have. The year was 2007 and it was 102°F outside. My friend S. and I were supposed to walk the strip, but we didn’t want to become human rotisserie chickens.

This week, with all due respect to the Silver State, New York is making Nevada look like Fargo. It’s 405°F in the sun. My eyes are sweating. I’m pretty sure I saw a group of elderly Russians wrapped in towels and beating themselves with sage leaves in the backyard.

Turning the oven on right now would be crazy. Like, seriously crazy. Not the HAHAHA-GIRL-YOU-SO-CRAZY crazy, but the Shutter-Island-was-based-on-my-life-story crazy. I’m honestly thinking of extinguishing the stove’s pilot lights, as if A) it would make a difference, and B) we’d ever be able to light them again.

Thusly, we must find alternate ways to cook our food; methods that won’t further warm the kitchen, but will prevent us from a month of non-stop raw vegetables. (Which? Isn’t too bad, all considering.)

In no particular order, here are a few suggestions, along with a plethora of recipe links for dinner ideas.

THE OBVIOUS

Grills and Hibachis
While firing up the ol’ Thermos may seem like a given for cooking meats and veggies, simple baking is also a distinct possibility. Pizzas, breads, and even cakes are possible with a few briquettes and some clever technique. Alas, grilling isn’t possible for some apartment dwellers, so we must make do with other methods of cookery. Like, say …

Slow cookers
God’s gift to the easily over-heated kitchen, slow cookers generate little warmth outside their immediate vicinity. Not to mention, they’re easy to clean, use minimal power (important on potential brown-out days), and work wonders on cheap meats and tough vegetables (though soups, stews, desserts, breakfasts, and drinks are not out of the question). Recipes abound.

Rice cookers
I did not believe in the power of the rice cooker before moving in with Husband-Elect. Now, I have seen the light. Trustworthy and more versatile than you think, these standalone appliances are solid options for those who want grains without the 30-minute stovetop time. Some RCs emit steam, but the effect can be easily remedied by pointing the stream in the general direction of a window.

Toaster ovens
Want a pizza bagel? How about a quesadilla? Maybe some homemade croutons? If it can be baked, it can be toaster ovened. This tiny facsimile of a grownup oven will make you feel like a summertime gourmet, without the accompanying sweat stains. Bonus: it only uses about half the energy of its big brother.

Microwave
Try this. Then tell me you can’t cook in a microwave. Long considered a tool for reheating, defrosting, and making quick potatoes, the microwave, when operated correctly, can be a powerful force for good food. It uses even less power than the toaster oven and produces no heat outside its six walls, to boot. The only disadvantage: you can’t take it camping.


THE LESS OBVIOUS

Lemons and Limes
For many, summer equals seafood, and preparing it ceviche-style means you never have to jack up the temperature. You simply marinate fish in citrus juice, which both cooks and flavors the flesh. Made well, it is delicious – an outside-the-box delicacy for your next dinner party. (Obligatory warning: only buy fresh, sashimi-grade seafood for ceviche. Otherwise … disaster.)

George Foreman Grills
A few months after graduating college, I threw a small dinner party for Ma and Pa, using my George Foreman Grill to cook the main course. In retrospect, the salmon odor stuck around the apartment for a few days longer than I would have liked. But the fish? Came out perfectly. Lesson: while it’s a pain to clean and lower-fat claims are dubious at best, you could do worse for a few bucks. And how can you not love this face?

Waffle Irons and Electric Griddles
Beyond your standard flapjacks and Belgians lies a world of bacon, Philly Cheesesteak Sandwiches, more bacon, fajitas, and more bacon. Your imagination (and electric bill) are your only limits.

Hotpots
Remember college, when there was no better meal than macaroni and cheese made at 3am in your dorm? Okay, so your tastes may have changed since then. But for young professionals, frequent travelers, and folks without ovens/stoves, the humble hotpot is still a viable option for boiled foods. Just dont let the RA see you.


THE NOT OBVIOUS AT ALL

Nothing
If you have some extra cash lying around, why not try some raw meat? Tartare, sashimi, sushi, and carpaccio don’t necessitate any cooking whatsoever, and could make for a fancy Sunday meal. As with ceviche, just make sure you buy top-of-the-line products, or risk a gastrointestinal riot

Car engines
Yes, you will undoubtedly use a lot of gas. But when you’re on the road and there’s nothing else for miles, it’s a fun experiment. And you’ll always be able to tell loved ones about the time you made hot dogs under the hood.

Hot Boxes
Best for crockpot-esque meals, a hot box is an insulated enclosure in which you place a pot of already-boiling food. The vessel sits and simmers for hours, and by the end of the day, you have a meal. While it takes some planning, it’s fantastic for cutting way, way back on energy expenditures.

Solar Ovens
Employed around the world as alternatives to fuel-powered ovens, solar cookers require three things: El Sol, ingenuity, and a few bucks for assembly. Cooking might take a little longer than you’re used to, but there are scores of recipes with which to experiment.

Readers, what did I miss? How do you cook when the oven isn’t an option? What’s your favorite use for any one of these items? Let us know in the comment section.

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If appealing this article you find, other articles appealing you may find as well, Yoda:

• Feeding a Group on Vacation
• Last Minute Little Dinners for One
• Little Meals for One

(Photos courtesy of University of Oklahoma [sun], Amazon [rice cooker], Wise Bread [car engine], and Goldsmith Learning [George Foreman].)