Thursday, July 28, 2011

MSIH-BGU Prom! by blogger of the month Maayan Melamed

In March we had an MSIH/BGU Prom. Actually it was called Spring Formal but I much preferred prom. I even took couple of photo-booth pictures with my good friend L, which are romantically displayed on Facebook for those of you lucky enough to have access to the album. Justin has a nice description in his March blog, and even included a picture of me singing with the Astroblasts band. Singing a cover of “All of the Lights” was undoubtedly my highlight of the evening. But there was other entertainment, like the beautiful belly dancer seen in this photo, and a cello-classical guitar duo. Then there was dancing and other shenanigans. I also made a late-night Skype-on-iPhone call to my mom and passed the phone around to all of my friends. She loves them and wants to meet them all. The night inevitably finished at the Einstein club near campus and then we all headed home. Overall, a good time had by all. - blogger of the month, Maayan Melamed

Wednesday, July 27, 2011

Dietary Guidelines for Americans, My Way

I just saw this on BoingBoing.  Simple but true. 

This image was created by Adam Fields

The people who design government dietary guidelines are gagged by the fact that politics and business are so tightly intertwined in this country.  Their advice will never directly target the primary source of obesity and metabolic dysfunction-- industrially processed food-- because that would hurt corporate profits in one of the country's biggest economic sectors.  You can only squeeze so much profit out of a carrot, so food engineers design "value-added" ultrapalatable/rewarding foods with a larger profit margin.

We don't even have the political will to regulate food advertisements directed at defenseless children, which are systematically training them from an early age to prefer foods that are fattening and unhealthy.  This is supposedly out of a "free market" spirit, but that justification is hollow because processed food manufacturers benefit from tax loopholes and major government subsidies, including programs supporting grain production and the employment of disadvantaged citizens (see Fast Food Nation).

my first week of medical school, by August blogger of the month Avi Kopstick

Holy! I cannot believe it has only been one week since I was sitting at home, staring mindlessly at my laptop screen at 10 PM, and thinking “Oh shoot! My flight leaves at 1 PM tomorrow, and I haven’t started packing yet!” Really, it already feels as if I have lived in Beer Sheva my whole life. And my classmates? I’ve practically known them all since forever…

Okay, maybe I exaggerate (just a bit). Admittedly, the reason I procrastinated from packing for so long was precisely because I was so nervous about leaving the familiarity of Toronto, Canada, and traveling to Israel, a land and culture as different from mine own as maple syrup is from hummus. And while I’ve been to Israel before, usually I only stayed near Jerusalem or Tel Aviv and took small day trips to other, pleasant parts of the country. My previous visits did little to prepare me for Beer Sheva. Bum bum bummmm.
(Don’t say it’s hot. I’m not going to say it’s hot. Everyone who blogs on the MSIH First Year Blog talks about how hot it is… I’ve got to be different. Don’t want to fall into the same cliché. Don’t say it’s hot… Don’t say it’s hot…) OH MY GOD IS IT HOT HERE! And though it’s ironic to say, when North America is in the throws of one of the worst heat waves during the past century – Toronto was actually 4 degrees hotter than Beer Sheva throughout most of the days I have been here (face!) – it’s not necessarily the temperature that makes the weather so unbearable. Rather, it’s the SUN! In Toronto and any city like it, you walk down the street, the trees are there protect you, the skyscrapers are there to protect you, the billboards are there to sell you useless products and harass your eyes with meaningless images, but also to protect you… Beer Sheva is very low-built and spread out. When I walk from my apartment to Soroka Hospital, it’s just me and the sun, surrounded by unnecessary amounts of tan. I’m like some crunchy little bug, and it’s like an evil and oppressive megajerkface pushing down on my whole body, saying, “How do you like that?! Not so cool now, huh?!” (…Hmmm I wonder if I’m still suffering from jetlag.)

The only thing that may have hinted towards what I would encounter in Beer Sheva: I was, coincidentally enough, reading Dune, by Frank Herbert, on the flight over.  The story takes place on a desert planet, where all local inhabitants wear protective suits, called stillsuits, that collect all escaping body moisture – sweat and urine for instance – for reabsorption – through the mouth for instance… Anyway, in the end of the book it says, “The stranger might think nothing could live or grow in the open here, that this was the true wasteland that had never been fertile and never would be… What it needed was reshaping to fit it to man’s needs… the free-moving human population… an ecological and geological force of almost unlimited potential.”

 The minute I passed the sign that said Welcome to Beer Sheva (or something like that… I don’t know. It was all in Hebrew), I immediately recalled this passage. Beer Sheva, specifically Ben Gurion University and Soroka hospital, clearly only exists due to the incredible efforts of the local population. How else could you come across such a beautiful oasis amidst such arid conditions, if not by the incredible will of these people?

Actually, speaking of incredible people, I just noticed this post is getting a bit long. (I’ll be here all of August – so don’t worry, you’ll be able to hear a lot from me if you want.) And I should probably talk a bit about MSIH, the only thing you’re actually interested in (as opposed to the weather, which while it makes great small talk…). Honestly, we haven’t been exposed to too much of the program yet. I mean it hasn’t even been a week since we arrived! So um, ya: no, Dad, I am not a doctor yet. But we have been introduced to many of the personnel on the MSIH team. For instance, our super friendly Israeli student liaisons, who have been so helpful in showing us around the city and finding apartments to check ou. I have already had many dealings with most of the administrative team, and they have been so kind and efficient in helping me with visa applications and loans and signing up to be the first blogger…
Truth is that it is only due to these individuals that I even thought to open this blog post the way I did. And for the most part, I wasn’t even joking... I wish I was and that things were harder! Then at least I would have some more riveting blog drama, and I wouldn’t have to talk about the weather so much… On the contrary, we are thriving. We are having a great time with each other. We’ve had brunch as a group. We went swimming as a group. We go apartment hunting as a group. Just the other day, when the director of the school met our class, he asked us to tell him one interesting thing about ourselves. I told him that as an undergrad, I acted in many university plays and even stage-managed a production of Of Mice and Men. Upon hearing this, my new friend Lauren turned to me and said,“What?! I never knew this about you!” So I said, “Ummm, ya we’ve only know each other for like four days…” “Oh ya.” Guess it already feels like much longer… awwwww

… Oh ya, and we do three hours of ulpun – intensive Hebrew study – per day.

Next week, emergency medicine! See you then.  - blogger of the month Avi Kopstick

Tuesday, July 26, 2011

Interview on Super Human Radio

Today, I did an audio interview with Carl Lanore of Super Human Radio.  Carl seems like a sharp guy who focuses on physical fitness, nutrition, health and aging.  We talked mostly about food reward and body fatness-- I think it went well.  Carl went from obese to fit, and his fat loss experience lines up well with the food reward concept.  As he was losing fat rapidly, he told friends that he had "divorced from flavor", eating plain chicken, sweet potatoes and oatmeal, yet he grew to enjoy simple food over time.

The interview is here.  It also includes an interview of Dr. Matthew Andry about Dr. Loren Cordain's position on dairy; my interview starts at about 57 minutes.  Just to warn you, the website and podcast are both full of ads.


Now this post is about leaving people, as in, leaving them after being with them for a few hours or a day, or even a few moments. How do you leave the person?

Besides saying goodbye and perhaps hugging and/or kissing them, how do they feel for having spent time with you?

Do you leave them feeling better than when you found them? Better than when you got together with them, uplifted and encouraged, or downtrodden and drained? Do you bring refreshment and joy to those you are with or do you bring total negativity and a spirit of complaint?

Is your conversation with them merely about you or do you take an active interest in them and what their interests are? Do you bore them with things they have no interest in or do you find common topics to talk about?

Most of all,are your words filled with chaste, lovable, virtuous, praiseworthy, true, topics or the opposite of these?

What spiritual gift do you bring to the presence of another? Is it a gift or a cursing of sorts?

You alone have the power, within your little member (the tongue) to lift a 300 pound person higher than when you found them!

You can bring a person up, who is down, inspire one who is discouraged, raise a depressed soul, bring a smile to someone so sad.

Remember you never know what another person my be experiencing in their life. What if you treated every person as if they were carrying the weight of the world on their shoulders, and you helped them carry it or you lifted it a bit? WOW!

Just as you have the power to lift and heal, your tongue can cut and hurt another and drain them. How do you want to use that power? I choose LOVE and lifting and leaving a person far better than when I found them!

Love from my sharing heART to yours! Muah! Bette Bliss

February sandstorms, by blogger of the month Maayan Melamed

You can get a better idea of what the sandstorm itself actually looks like from Claire in December, but when the second set hit in February, I was ready. The lack of exams this time made have made the storm slightly less awful, but I’d like to think that my prepared attire was what really made the difference. With an extra bonus of a drizzle, I think my umbrella was the cherry on this sundae. First years: take note when packing.  - blogger of the month Maayan Melamed

Monday, July 25, 2011

Re-investing in our hospital

By John Aldis, vice-president, corporate and post-acute services, chief financial officer, Rouge Valley Health System

As reported in the treasurer’s report at the Rouge Valley Health System (RVHS) 13th Annual General Meeting of Members, held on June 28, it has been another very successful year for us. Fiscal 2010–2011, the third and final year of the hospital’s deficit elimination plan has been our best yet. RVHS achieved an operating surplus of $8.9 million, which was $3.7 million better than planned.
Overall hospital revenues increased by 4.1%, while our operating costs climbed 2.6% compared to the previous year.

Driving our success this past year has been exceptional revenue performance and our continued focus on operating efficiencies and cost containment through our Lean management philosophy. As part of our operating plan, RVHS put a major focus on revenue enhancement this past year.

In addition to securing additional post-construction operating funds for new space and expanded programs as part of our Rouge Valley Ajax and Pickering (RVAP) redevelopment, the hospital received bonus funding for achieving wait time improvement targets in our emergency departments at both sites. And we attracted additional funding during the year for performing more CT and MRI scans, more surgical procedures targeted by the government for reduced wait times, and more priority program cardiac procedures than we had planned. Finally, the hospital also secured new funding from the Central East Local Health Integration Network to open a 20-bed transitional restorative care program at RVAP.
We have already re-invested some of our financial surplus directly into patient care. Approximately $1.3 million was spent on various quality of care improvement initiatives, staff education and training, as well as new furniture, equipment, and mattresses that will help reduce the risk and spread of hospital infections. In addition, RVHS will use part of last year’s surplus in the current year to accelerate investment in major capital equipment and renew our aging facilities’ infrastructure.

While our capital needs far exceed available funding, the hospital was able to invest close to $74 million in capital this year—most of which was related to completion of the RVAP redevelopment.
Fundraising is critical to our hospital’s financial well-being, and 2010–11 was no exception. The RVHS Foundation donated and transferred $687,000 to the hospital this year in support of much-needed capital purchases. Thank you to all donors, volunteers and Foundation staff. 

We continue to make the most of every dollar raised by aligning the Foundation’s fundraising goals and efforts with the strategic priorities of the hospital.

Rouge Valley’s working capital deficit continued to improve and ended the year at $31 million. Improved cash flow and prudent cash management has enabled RVHS to build up cash reserves through the year, reducing short-term borrowing needs and reliance on debt to fund minor capital expenditures.  
Rouge Valley continues to be a very busy place. This year, the hospital treated approximately 29,000 inpatients, provided 52,000 mental health, rehab and complex continuing care patient days, and registered 109,000 patient visits across our two emergency departments. On the outpatient side, we had 190,000 clinic visits and performed 16,500 day surgery cases.

Thank you to our staff, who have done such a tremendous job in meeting the health care needs of the growing and aging populations of our east Toronto and west Durham communities.

Pathology on the brain, by Maayan Melamed

Our Passover break was somewhat in the middle of finals such that I studied (or pretended to a bit… I may have done some passive internet lecture listening) for pathology for a few days over vacation. I did get a day off with my family to visit the safari/zoo in Ramat Gan, and got to spend some time with the baboons. Now, as you can see here, these baboons have a bit of a posterior problem, and I had to wonder what the pathology was. Was it hyperplasia? Dysplasia? Cancer? At least half of these baboons had this problem, was there some sort of carcinogen in the baboon’s water in Ramat Gan that caused them to all be horribly afflicted?

A few days later we had a Q&A/review session for pathology, and I couldn’t help but send the professor an email with the picture and ask:

cleardotSat, Apr 30, 2011 at 6:35 PM
cleardotQuestion for review session

hide details Apr 30

Hi Dr.,

I know we generally deal with human pathology but I was at the safari in Ramat Gan earlier today and couldn't help but wonder what on earth is wrong with these baboons. Some sort of hyperplasia?


The professor was kind enough to respond:

cleardotMaayan Melamed
cleardotSat, Apr 30, 2011 at 10:57 PM
cleardotRe: Question for review session
cleardotImportant mainly because it was sent directly to you.

hide details Apr 30

Either hyperplasia or even a tumor. Most likely the former as baboons tend to have increased tissue growth in that area and is worse when inflamed.

He made sure that everyone in the review session got the pertinent information. These are some of the great global applications we get here at MSIH. - Maayan Melamed, July blogger of the month

Laser surgery for myopia early in life may create reading problems after 40

Shortsightedness, or myopia, seems to be endemic in urban populations. The National Institutes of Health suggests that myopia cannot be prevented, and that neither reading nor watching television causes myopia. I find that doubtful, as reading is a rather unnatural activity, and there is evidence that myopia is significantly associated with amount of reading at early ages.


Trying to avoid reading early in life would not be a highly recommended Paleolithic-mimicking choice, except for those who later decide to live among hunter-gatherers. (In spite of our romantic views of hunter-gatherer life, it is very rare to see an urbanite do this outside the context of anthropological studies.) Education requires a lot of reading, and without education in urban environments one is likely to end up suffering from other diseases of civilization. Diabetes, for example, is strongly and inversely associated with education level in urban environments.

Also, keeping up with friends on Facebook, without which life as we know it now could go on, requires a lot of reading and writing.

A different theory, often associated with Cordain, is that myopia is due to consumption of industrial carbohydrate-rich foods. Interestingly, according to Cordain and colleagues, myopia is typically accompanied by higher stature, a finding that is supported by empirical evidence. The idea here is that industrial carbohydrate-rich foods promote abnormal growth patterns during developmental stages, which arguably include abnormal growth of the human eye and its various structures.

Avoiding industrial carbohydrate-rich foods during developmental stages is feasible, but currently very difficult given public health policies that strongly promote the consumption of some of those foods, during development stages, as healthy choices (e.g., cereals). In part as a result of those policies, and also due to budget constraints (those foods tend to be generally cheap), industrial carbohydrate-rich foods are frequently served as meals in schools.

Okay, now to the main topic of this post. Let us say a person has myopia, should he or she fix it surgically?

As one ages, the ability to read at a short-distance (as in reading from books, or from a computer screen) goes down, because the ability to focus on short-distance objects becomes impaired. This phenomenon is called presbyopia, and is also associated with excessive reading. Therefore it could be called a disease of civilization as well. Most college professors at the level of Associate Professor and higher I know (that is, older folks, like me) have developed it, sometimes as early as in their late 30s.

In the general population, normally presbyopia sets in between 40 and 50 years of age, requiring the use of "reading glasses" afterwards … except for those with myopia. This is sometimes called the “myopia payoff of presbyopia”. People with myopia are often able to read well, without the help of glasses, after presbyopia sets in. The reason is that myopia essentially opposes presbyopia at short distances.

Someone with myopia will still have it after presbyopia sets in, and thus will have difficulty seeing at long distances, but will frequently be able to read well at short distances.

So, if you undergo eye laser surgery (the most common type) to correct myopia early in life, you may create reading problems after 40.

P.S.: A friend of mine who has been studying this tells me that eye problems in general are caused by avoidance of indirect sunlight. I am planning on looking into this more deeply in the future.

Friday, July 22, 2011

Global Health Corps Holds Training and Orientation at Yale

Medical Records in Shashemene clinic in 2006 (left) and in 2007 (right), after on-site mentors arrived

        Barbara Bush, ’04, is glad to be back at Yale in a new role – orchestrating orientation for the newest group of Global Health Corps’ (GHC) fellows. Founded two years ago, the GHC provides year-long fellowships for young persons from diverse backgrounds to work on the frontlines of the fight for global health equity.

The Yale Global Health Leadership Institute (GHLI) partnered with GHC in the planning of this year’s orientation. “GHLI also has a commitment to educate young professionals for leadership roles in health care systems around the world. Together, we hope to expand effective partnerships and train the next generation of leadership in global health,” said Elizabeth H. Bradley, Ph.D., faculty director, GHLI.

On July 11, Dr. Bradley presented to GHC fellows about health systems strengthening. Using GHLI’s work in Ethiopia and Liberia as examples, Dr. Bradley discussed “the science of improvement” as contributions to global health systems strengthening efforts. When Ministry of Health officials in Ethiopia and Liberia decided to decentralize the health systems in their countries, GHLI faculty and staff focused on how they could help translate the government policies into practice in hospitals and health centers around the country. As part of the Ethiopia Hospital Management Initiative (EHMI), GHLI worked together with the Clinton Health Access Initiative to place on-site mentors in 16 hospitals across Ethiopia. The EHMI program, now entering its 7th year, also facilitated the establishment of a “CEO” model of hospital leadership, and created a Master’s of Hospital Administration program at two Ethiopian universities to train newly appointed health care executives.

The program grew out of improvements made at the local level. In Sheshemene, the medical record was redesigned to be more complete and locally relevant, and registration was centralized and computerized to prevent bottlenecking among patients. Evaluation of the projects showed tangible quality improvement across the participating hospitals.

During the talk, one GHC fellow in the audience asked how the team members dealt with any negative reaction from the hospital staff or managers. “It starts with listening,” responded Dr. Bradley. “You cannot go in and try to change everything right away. You need to learn how the system is working currently and from there find ways to accommodate people and create incentives.”

Nina Gumkowski, GHLI Intern

Thursday, July 21, 2011

10 things your homeowners insurance DOESN'T cover

Surprise: Here are 10 things a typical homeowners policy doesn't cover:
  • Damage due to animals or rodents.
  • Mold, mildew or dry rot.
  • Earthquakes -- including earth movement, landslides, etc.
  • Slow leaks.
  • Flooding: You have to buy a separate flood insurance policy to be covered for floods, tidal surges and tsunamis.
  • Intentional damage.
  • Foundation settling and cracking.
  • Volcanoes: Damage from tremors caused by the eruption generally isn't covered, but removal of ash deposits -- or damage from them -- often are covered.
  • A home business: If you operate a home-based business, you might be uninsured and not even realize it. Your homeowners policy may provide a limited amount of coverage for business-related personal property in the home, but don't wait until you have a loss to find out if you're covered. Talk to your agent.
  • A second residence on the property: Most homeowner policies don't cover a second residence.
Here, on the other hand, is a list of what is covered under a typical homeowners policy.

Need help with insurance problems?

If you live in Washington state, we can help with insurance questions and problems. (We're the state agency that regulates insurers, agents and brokers. We get tens of thousands of calls a year from consumers.)

What kind of help? Here are a few examples of recent cases we've handled:

-We helped a dentist get paid when one insurer didn't process a claim because it didn't have the medical codes from the primary insurer. We looked up the codes (on the primary insurer's website; not so hard), provided them, and passed along a friendly reminder about the legal requirements for timely claims processing. The insurer processed the claim the next day.

-We helped another consumer get a life insurer to pay out the proceeds -- more than $250,000 -- on his mother's annuity policy.

-We helped a consumer after an insurer found him 100 percent at fault for an accident. We reviewed their investigation and discovered that they'd failed to get statements from key players (the other driver, for one, and a police officer witness who happened to be sitting beside the road when the accident occurred).  We asked the company to contact the two. Result: they reversed their decision, finding the other driver 100 percent at fault for the accident.

-We helped a homeowner expedite and settle a disputed home repair claim for more than $145,000.

Need help? Call us at 1-800-562-6900 or see

(And if you live in another state, here's a handy map with contact info for your own state's insurance regulator.)

Wednesday, July 20, 2011

Weight Gain and Weight Loss in a Traditional African Society

The Massas is an ethnic group in Northern Cameroon that subsists mostly on plain sorghum loaves and porridge, along with a small amount of milk, fish and vegetables (1, 2).  They have a peculiar tradition called Guru Walla that is only undertaken by men (2, 1):
Read more »

Health insurance exchanges: Who's doing what?

The Kaiser Family Foundation has put together handy maps illustrating what each state is doing in terms of setting up health insurance exchanges. The maps are sortable by actions, status, etc.

Exchanges are new marketplaces where consumers will be able to comparison shop for health insurance.

Lava Lamp Belly - Lactose Intolerance

Back in High School, I remember explaining to my doctor that my stomach felt like a lava lamp each and every day. He laughed at my explanation, but it was the truth! Each day I had pockets of gas painfully churning inside me due to all of the dairy products I was consuming. Luckily, he suggested a week off of dairy products only to find that I was indeed lactose intolerant. Lactose intolerance, also called lactase deficiency, means you aren't able to fully digest the milk sugar (lactose) in dairy products. It's usually not dangerous, but symptoms of lactose intolerance can be uncomfortable.

The problem behind lactose intolerance is a deficiency of lactase — an enzyme produced by the lining of your small intestine. Many people have low levels of lactase, but most don't experience signs and symptoms. Only people with both low lactase levels who also have associated signs and symptoms have, by definition, lactose intolerance.

Being diagnosed with lactose intolerance was devastating for me at that age, but I've learned to make healthier decisions with dairy free options as well as obtaining important nutrients from natural foods.

Interestingly enough, there are three types of lactose intolerance:

1. Normal result of aging for some people (primary lactose intolerance) 

Normally, your body produces large amounts of lactase at birth and during early childhood, when milk is the primary source of nutrition. Usually your lactase production decreases as your diet becomes more varied and less reliant on milk. This gradual decline may lead to symptoms of lactose intolerance.

2. Result of illness or injury (secondary lactose intolerance) 

This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, surgery or injury to your small intestine. It can occur as a result of intestinal diseases, such as celiac disease, gastroenteritis and an inflammatory bowel disease like Crohn's disease. Treatment of the underlying disorder may restore lactase levels and improve signs and symptoms, though it can take time.

3. Condition you're born with (congenital lactose intolerance) 

It's possible, but very rare, for babies to be born with lactose intolerance caused by a complete absence of lactase activity. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. Infants with congenital lactose intolerance are intolerant of the lactose in their mothers' breast milk and have diarrhea from birth. These babies require lactose-free infant formulas.

There's currently no way to boost your body's production of the lactase enzyme. People with lactose intolerance usually find relief from signs and symptoms by reducing the amount of dairy products they eat and using special products made for people with this condition.

1. Eat fewer dairy products 

This is the best bet for people with lactose intolerance to reduce their signs and symptoms. There is an argument that those who avoid milk will end up being deficient in multiple nutrients including (but not limited to) calcium, B Vitamins, protein, Vitamin D, copper and zinc. This is plain silly and if you're eating a balanced diet there's no need for milk. The line of reasoning has been created by those in the dairy industry with the main threat being a decrease in calcium consumption. Calcium is found in many other foods, such as almonds, book choy broccoli, canned salmon, kale, milk substitutes (oat, almond, rice, hemp or soy milk), oranges, pinto beans, rhubarb, spinach or tofu.

2. Experiment with an assortment of dairy products
Not all dairy products have the same amount of lactose. For example, hard cheeses, such as Swiss or cheddar, have small amounts of lactose and generally cause no symptoms. You may well be able to tolerate cultured milk products, such as yogurt, because the bacteria used in the culturing process naturally produce the enzyme that breaks down lactose.

3. Watching out for hidden lactose
Milk and lactose are often added to prepared foods, such as cereal, instant soups, salad dressings, nondairy creamers, processed meats and baking mixes. Check nutrition labels for milk and lactose in the ingredient list. Also look for other words that indicate lactose, such as whey, milk byproducts, fat-free dry milk powder and dry milk solids. Lactose is also used in medications. Tell your pharmacist if you have lactose intolerance.

4. Use caution if you choose to eat dairy products
It may not be necessary to completely avoid dairy foods. Most people with lactose intolerance can enjoy some milk products without symptoms. You may even be able to increase your tolerance to dairy products by gradually introducing them into your diet.

5. Consume probiotics

Probiotics are living organisms present in your intestines that help maintain a healthy digestive system. Probiotics are also available as active or "live" cultures in some yogurts and as supplements in capsule form. Probiotics can be found in many fermented foods such as sauerkraut, raw kombucha tea, miso or tempeh. These are sometimes used for gastrointestinal conditions such as diarrhea and irritable bowel syndrome. They may also help your body digest lactose. Probiotics are a safe and easy way to help lactose intolerance as well as keep your digestive system healthy.

6. Use lactase enzyme tablets or drops
Over-the-counter tablets or drops containing the lactase enzyme may help you digest dairy products. You can take tablets just before a meal or snack. Or the drops can be added to a carton of organic milk. Not everyone with lactose intolerance is helped by these products. I keep Lactaid pills with me wherever I go just in case I'm out and a food contains a little dairy.

Are you lactose intolerant?
The signs and symptoms of lactose intolerance usually begin 30 minutes to two hours after eating or drinking foods that contain lactose. Common signs and symptoms include:
- Diarrhea
- Nausea
- Abdominal cramps
- Bloating
- Gas

Symptoms are usually mild, but they may sometimes be severe. Let me know if you have any questions regarding lactose intolerance (I'm pushing over 15 years now). I would love to share some dairy-free alternatives with you or hear some of your own below!
Keep it fresh!
- Lauren

Tuesday, July 19, 2011

Health Care Administrators Present Cost- Saving Innovations to U.K Visitors

At the Yale-SEPT International Healthcare Management Programme session last week, a panel of three health care administrations from Connecticut and New York presented cost-saving innovations that have been implemented in local health management systems.

The first panel member to speak was Gayle Capozzalo, executive vice president, strategy and system development, Yale-New Haven Health System (YNHHS). She explained how the YNHHS – which encompasses three hospitals in diverse demographic regions of the state – was charged with cutting costs that would have resulted in lost jobs. Instead, they hired consultants to observe the hospital staff and determine what changes could be made to increase productivity. Their discoveries – including the fact that more than 50 percent of nurses’ time was wasted on administrative duties – led to an overhaul of procedures, implementation of more efficient technology and standardization of the shift change process. Although administrators faced some resistance to change, staff time is now more productive and patient satisfaction has increased.

Next, on the panel was William Gillespie, senior vice president and chief medical officer of Emblem Health, a not-for-profit health care provider. Mr. Gillespie shared with the audience that Emblem Health is faced with the question of how a health insurer can add value during this time of health care reform. He explained that health care providers need to be patient advocates; helping people coordinate their care and navigate through the sea of information received during medical treatment. Emblem Health’s began by designating nursing personnel, clinical advisors and social workers to assist patients who are transitioning from in-patient to home care. These advisors develop personal relationships with patients and help insure that there are no oversights in a patient’s care. The program has resulted in a reduction in preventable hospital readmissions, saving both money and manpower.

The third panelist was Steven Merz, vice president of administration, Yale-New Haven Hospital (YNHH). Mr. Merz discussed an issue that YNHH faced regarding the care of mentally unstable patients throughout the hospital. The costs of behavioral health services are largely not covered by insurance. Add to those costs, the numerous hours spent by staff trained to service medical and surgical issues trying to assist patients with mental health issues while still trying to keep a safe environment for other patients on the floor. Patients in need of behavior health care were being caught in the middle -- they couldn’t stay in the hospital because insurance wouldn’t pay, and they had nowhere else to go. So, YNHH created Behavioral Intervention Teams. The teams are comprised of psychiatrists, nurses and social workers who accompany the medical and surgical team on rounds to observe patients from admission, essentially upending the consultation process. After a month, the new progress of this innovation was reviewed and revealed that in cases where the behavioral team was involved; there was a significant reduction in the length a patient stay and there haven’t been any denied days by the insurance companies. The team’s involvement also affords each patient better integration between physical and mental health care provision.

Nina Gumkowski, GHLI Intern

Monday, July 18, 2011

Health insurance rate requests now public

Individual and small employer health insurance rate requests are now public. See the complete filings received since July 1, as well as a summary for each request.

Several health insurers filed rate requests prior to July 1, but have voluntarily made their filings public. They include: Asuris Northwest Health, Kaiser Foundation Health Plan, and Regence BlueShield.

Insurance Commissioner Mike Kreidler proposed the legislation (HB 1220) making health rates public on behalf of the consumers who contact his office, demanding to know what's driving their higher premiums. State law prevented him from sharing the information that insurers use to justify rate requests - even after the rate was approved.

The new law makes most individual and small employer health insurance rate filings public shortly after they're received. This includes how much of the requested rate will be spent on medical claims, administrative costs and profit. Also, the public will see if their rate change includes any benefit changes.

Kreidler's office is building an interactive web tool where the public can search rate requests, post comments, and sign-up to get an e-mail when their health plan requests a change and a decision is made. The new tool is scheduled to go live early this fall.

U.K. visits U.S. to Examine Health Care System

 Elizabeth H. Bradley, Ph.D., faculty director of the GHLI and Patrick Geoghegan, OBE, chief executive, South Essex Partnership University NHS Foundation Trust, are joined by physicians, nurses and health care providers from the United Kingdom as part of a week-long session held in July at Yale.

      Last week, the Yale Global Health Leadership Institute and the South Essex Partnership University National Health Service (NHS) University Foundation Trust (SEPT), is holding an executive management training session at Yale. Members of the NHS will examine the U.S. health care system and learn from Yale faculty. This year’s session is of particular importance with the U.K. in the midst of a major health care reform that aims to transform the NHS into a more competitive and increasingly privatized system. At the same time, recent American health reform has been aimed at eliminating disparities and moving toward the provision of increased, if not universal, access. “With current re-evaluations taking place in both the U.S. and U.K. health care systems, this session comes at a crucial time to provide insight and dialogue on major health care issues and methods for both countries,” said Elizabeth Bradley, Ph.D., faculty director of the Yale Global Health Leadership Institute.

Dr. Bradley opened the sessions on Monday with a talk entitled Health System Change: Competition and Collaboration. She focused on three features that must be considered for policy making: quality, efficiency and access. Dr. Bradley also explored the pros and cons of competition and collaboration, and discussed the conditions under which each is the optimal approach.

The U.S. health care market allows for fairly unregulated competition in an effort to achieve Pareto optimality – a state of market equilibrium where no one can be made better off without making someone worse off. However, this efficiency is only possible under certain conditions, all of which the country is unable to sustain or control. In contrast, the National Health Service favors collaboration, which allows for less money to be devoted to marketing, provider incentives and organizational profits but encourages integration of care services. Dr. Bradley highlighted the fact that competition and collaboration can coexist in the health system. Competition might most appropriately be applied in places where product is a commodity and consumers can readily judge quality or where unequal distribution is acceptable. Collaboration could be successfully applied where output and outcomes can be monitored and sanctions are possible for poor performance.

Dr. Bradley wrapped up her presentation with some comments on the current health care reform occurring in the U.S. While the need for change is clear, reform on the federal level faces many obstacles due to the size and diversity of the country’s population. Where health care reform seems to be taking form most quickly is at the state level. Here, populations are smaller, potentially making it easier to delegate resources to necessary areas.

Nina Gumkowski, GHLI Intern

Hematology lab safety protocols, blogger of the month Maayan Melamed

This was definitely one of the highlights of the semester. During a hematology lab, there was a crackdown on safety protocols. H bravely biked quickly home and brought back several pairs of close-toed shoes, including several house slippers. To be extra safe, he made sure to don the proper safety equipment to demonstrate to the class. The man-goggles are for style and in case he can fit in a man-swim.

Dietary protein does not become body fat if you are on a low carbohydrate diet

By definition LC is about dietary carbohydrate restriction. If you are reducing carbohydrates, your proportional intake of protein or fat, or both, will go up. While I don’t think there is anything wrong with a high fat diet, it seems to me that the true advantage of LC may be in how protein is allocated, which seems to contribute to a better body composition.

LC with more animal protein and less fat makes particularly good sense to me. Eating a variety of unprocessed animal foods, as opposed to only muscle meat from grain-fed cattle, will get you that. In simple terms, LC with more protein, achieved in a natural way with unprocessed foods, means more of the following in one's diet: lean meats, seafood and vegetables. Possibly with lean meats and seafood making up more than half of one’s protein intake. Generally speaking, large predatory fish species (e.g., various shark species, including dogfish) are better avoided to reduce exposure to toxic metals.

Organ meats such as beef liver are also high in protein and low in fat, but should be consumed in moderation due to the risk of hypervitaminosis; particularly hypervitaminosis A. Our ancestors ate the animal whole, and organ mass makes up about 10-20 percent of total mass in ruminants. Eating organ meats once a week places you approximately within that range.

In LC liver glycogen is regularly depleted, so the amino acids resulting from the digestion of protein will be primarily used to replenish liver glycogen, to replenish the albumin pool, for oxidation, and various other processes (e.g., tissue repair, hormone production). If you do some moderate weight training, some of those amino acids will be used for muscle growth.

In this sense, the true “metabolic advantage” of LC, so to speak, comes from protein and not fat. “Calories in” still counts, but you get better allocation of nutrients. Moreover, in LC, the calorie value of protein goes down a bit, because your body is using it as a “jack of all trades”, and thus in a less efficient way. This renders protein the least calorie-dense macronutrient, yielding fewer calories per gram than carbohydrates; and significantly fewer calories per gram when compared with dietary fat and alcohol.

Dietary fat is easily stored as body fat after digestion. In LC, it is difficult for the body to store amino acids as body fat. The only path would be conversion to glucose and uptake by body fat cells, but in LC the liver will typically be starving and want all the extra glucose for itself, so that it can feed its ultimate master – the brain. The liver glycogen depletion induced by LC creates a hormonal mix that places the body in fat release mode, making it difficult for fat cells to take up glucose via the GLUT4 transporter protein.

Excess amino acids are oxidized for energy. This may be why many people feel a slight surge of energy after a high-protein meal. (A related effect is associated with alcohol consumption, which is often masked by the relaxing effect also associated with alcohol consumption.) Amino acid oxidation is not associated with cancer. Neither is fat oxidation. But glucose oxidation is; this is known as the Warburg effect.

A high-protein LC approach will not work very well for athletes who deplete major amounts of muscle glycogen as part of their daily training regimens. These folks will invariably need more carbohydrates to keep their performance levels up. Ultimately this is a numbers game. The protein-to-glucose conversion rate is about 2-to-1. If an athlete depletes 300 g of muscle glycogen per day, he or she will need about 600 g of protein to replenish that based only on protein. This is too high an intake of protein by any standard.

A recreational exerciser who depletes 60 g of glycogen 3 times per week can easily replenish that muscle glycogen with dietary protein. Someone who exercises with weights for 40 minutes 3 times per week will deplete about that much glycogen each time. Contrary to popular belief, muscle glycogen is only minimally replenished postprandially (i.e., after meals) based on dietary sources. Liver glycogen replenishment is prioritized postprandially. Muscle glycogen is replenished over several days, primarily based on liver glycogen. It is one fast-filling tank replenishing another slow-filling one.

Recreational exercisers who are normoglycemic and who do LC intermittently tend to increase the size of their liver glycogen tank over time, via compensatory adaptation, and also use more fat (and ketones, which are byproducts of fat metabolism) as sources of energy. Somewhat paradoxically, these folks benefit from regular high carbohydrate intake days (e.g., once a week, or on exercise days), since their liver glycogen tanks will typically store more glycogen. If they keep their liver and muscle glycogen tanks half empty all the time, compensatory adaptation suggests that both their liver and muscle glycogen tanks will over time become smaller, and that their muscles will store more fat.

One way or another, with the exception of those with major liver insulin resistance, dietary protein does not become body fat if you are on a LC diet.

Friday, July 15, 2011

Owner of auto glass companies sentenced in $1.6 million fraud case

A Burien auto glass company owner has been sentenced to jail for a billing scheme that's believed to have cost insurers more than $ 1.5 million.

Michael Alan Perkins, 44, pleaded guilty to three counts of first-degree theft in King County Court July 1. He was sentenced to 9 months in jail, with 30 days of the sentence converted to 240 hours of community service.

Investigators for state Insurance Commissioner Mike Kreidler are recommending a total of more than $1.6 million in restitution to the companies. The court will decide the amount at an upcoming hearing.

Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., both run out of Perkins' Burien home. The glass shops overbilled insurers, including State Farm, Allstate and MetLife insurance companies.

An investigation by Kreidler's office's anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found more than $1.5 million in deceptive billing by Perkins' companies between September 2005 and December 2009. Read the full release.

Thursday, July 14, 2011

Bringing Balance to the Workplace Through Yoga

Babies are born yogis. When we were younger we were all able to pull our toes up by our ears and simply laugh. Then we grew, we aged, we got injured and we began carrying stress on our back, shoulders, and neck. Our bodies became tighter, muscles grew stiff and we lost our balance.

Yoga helps create a sense of union in body, mind and spirit. It brings us balance.

The Physical benefits: Creates a toned, flexible, and strong body. Improves respiration, energy, and vitality. Helps to maintain a balanced metabolism. Promotes cardio and circulatory health. Relieves pain. Helps you look and feel younger than your age. Improves your athletic performance.

The Mental benefits: Helps you relax and handle stressful situations more easily. Teachesyou how to quiet the mind so you can focus your energy where you want it to go - into a difficult yoga pose, on the tennis court or golf course, or in the office. Encourages positive thoughts and self-acceptance.

The Spiritual benefits: Builds awareness of your body, your feelings, the world around you, the needs of others. Promotes an interdependence between mind, body, and spirit. Helps you live the concept of "oneness."

Yoga in the workplace has the added benefits of boosting energy, reducing work related stress, relieving office chair back pain, all of which add up to happier employees and increased productivity. But for the most part, the evidence of the benefits of yoga is anecdotal. They range from the simple "I can touch my toes again" to "it helped me handle my stress." A former student and corporate client in West Patterson said, “I enjoy yoga at the office because it is convenient. By practicing it in the work environment, I can relate the relaxation techniques to my job. I find that I am a better employee when I practice yoga, I can ‘go with the flow’, rather than waste time and energy fighting changes. Especially in today’s business environment, the pace is fast and ever changing.”

The great thing about yoga is, you don’t have to be able to touch your toes to do it. Anyone can do yoga-no matter how young or old you are, whether you're a couch potato or a professional athlete. Size and fitness level do not matter because there are modifications for every yoga pose. The idea is to explore your limits, not strive for some pretzel-like perfection.

If you work in the Metro Park area, you can check out a class at Metro Park Wellness located at 99 Wood Ave South, Iselin, NJ. Classes are offered on Monday, Wednesday and Thursday at 12:15 – 1:00pm and 1:15 – 2:00pm on the 8th Floor. It's a $10 drop in and yoga mats are provided. Simply wear comfortable clothing that allows you to move. Just remember one thing: the purpose of yoga isn’t to tie you in knots; it’s to untie the knots you already have and bring balance back to the body.

Keep it Fresh!


Now that I'm back Maayan Melamed, July blogger of the month

Now that I’m back home…

Let’s go backwards from where I sit now, comfortably on my family’s couch, enjoying the deciduous suburbs. I got off the plane just after 5am, brought my dog Jerry through the agricultural checkpoint, and rolled down with him and two suitcases to meet my mom and boyfriend, both very happy to see me. The plane ride was long, but it was very reminiscent of the group flight, visiting some other classmates who were on the same plane, then wishing everyone a good summer. There were about 8 of us on the train to Tel Aviv, laughing and decompressing from our stressful day. Some of us had moved, I had been cleaning and preparing for a subletter, and we all had finished our last exam of first year in the morning.  
                It’s hard to believe that I have successfully completed my first year of medical school (grade just got in, last bead of sweat wiped off forehead). I’m not quite sure where to begin, so I think the best approach is through a picture collage of my first year in pieces starting this month and moving backwards. Hope you enjoy! - Maayan Melamed

Wednesday, July 13, 2011

Simple Food: Thoughts on Practicality

Some people have reacted negatively to the idea of a reduced-reward diet because it strikes them as difficult or unsustainable.  In this post, I'll discuss my thoughts on the practicality and sustainability of this way of eating.  I've also thrown in a few philosophical points about reward and the modern world.
Read more »

Monday, July 11, 2011


Just in case you didnt know this already, I have an application that is available on Ipone, Ipad and Ipod touch.

It is called SUPERFOOD HD and is an incredible raw resource for over 60 super foods, their properties and nutrients as well as over 300 recipes!

Here is the link to Superfood Hd facebook page;

Superfood on iTunes

Here is the link to iTunes:

JuiceIt Hd

Yes! Did you see something new? JuiceIT Hd was just "born on the apple store a couple weeks ago! Go check it out!

Thank you for checking it all out and I send you the wish for incredible and amaZING health!

Love from my superfood, juice loving heart to yous! Muah,Bette

Love from my superfood, juice loving heart to yours! Muah,Bette

Planking, by Maayan Melamed, July blogger of the month

I’ll start my section of the blog with a picture soon before we left Beer Sheva. Shortly before exams, my fellow students and I become rather obsessed with the phenomenon of “planking,” which we would often endeavor to do instead of studying. Here you can see S, my study partner, during a short study break, performing a rather impressive plank on the BGU campus. You can see her perfect form, toes pointed, arms back, face down: impeccable. I think this reflects the attention to detail that we at MSIH pursue in our studies and our lives. This same perfection is applied to endocrinology and anything else we put our minds to. That is the sentiment that I wish to imbue upon my contribution to this blog. Enjoy, readers. - Maayan Melamed, July blogger of the month


"You'd be happy too if you could eat what bugs ya!" says the frog as he smiles with a fly on his outstretched tongue. (talking with his mouth full....hahaha).

Is this statement true? If something is bugging us emotionally and we eat to fill it, as in, to seek "comfort", does it work? Are we happy? Is it a comfort or does it simply dull down the emotions, numb us out to them?

 Only to feel it, yet again, when the next wave hits but now we have the added body burden of the food we ate, how stinkin lousy we feel,the damage we have done to our bodies and for many, the guilt that often joins hands with that.
(umm let us disappear that real fast...)

Why do we eat when we are under emotional duress?

Well, maybe for that exact reason and more.
To numb, to not feel, to FEED a need. To feed a need; that is kind of like putting on ten layers of clothes on a hot summer day when we needed to put on our bathing suit and go swimming in a cool ocean. (ok ok I tried with this analogy, but you get it?)
We need one thing that is so good for us and healthy, and we do quite the opposite, that beats us up! (hmm back to the drawing board for our self love work).

Some might eat when under duress because it is something they can CONTROL. Life gets so out of their control sometimes that they know the ONE thing they have the power But, do we really have power over food if we are a slave to it and it is our master, it leads us????

We all see people who are literally eating themselves to death, a slow suicide. We feel for the kids starving to death and our heart aches but we also have this opposite side of the coin as well. People eating large amounts of food, that isnt truly feeding the body nutrients, that usually leads to disease and death. This is the hard reality.

Well what do we do when emos hit? Ask ourselves: what is the need here? What do I need in this moment? Does my body need a beating or a hug? What will best help me to deal with this emotional upset? How can I feed my body so as to best support what is happening?

A raw eating plan, the next raw food is the very anecdote to being able to be better able to handle these emotional times better and better. The other food choices only lead to worse and worse emotional upsets and the cycle goes on and on.
Juicing with greens is a great way to reset the body and reduce cravings!
Please check out our new app on iTunes:

JuiceIt Hd  for great juicing ideas!

WHEN are we going to STOP this chaotic cycle and love ourselves to health, love ourselves to wholeness, love ourselves ENOUGH as created by our God to LOVE life in joy, peace and happiness??

When are we going to stop beating ourselves and love ourselves, our bodies and our life? Eye opening questions for sure!!!

I assure you, it isnt the food. It is the mastering of loving oneself enough and this gives you the desire for the BEST. The best faith, the best life, the best food, the best friends, the best one can have in this life.

YOU (yes I am talking to YOU) are enough, you DO enough, YOU have enough, YOU ARE LOVED, YOU ARE, you simply ARE and you deserve all He has given YOU and all that is on its way to YOU!!

Write a list of all it would benefit you to be raw, stay raw, be healthy, lose weight and GET YOUR LIFE BACK. I imagine that list will be powerful.

OK here is your POWERFUL REASON WHY to do this! Here is why we you WANT to stop this cycle now.

In fact, this will be the title at the top of your page.

MY POWERFUL REASON WHY I want to take care of ME by eating life sustaining foods that truly feed my body dense nutrition. Why raw for ME? What is my powerful reason why?

I am happy to support you in reaching your health goals, using this powerful tool as well as many others! Contact me at for a free consultation that will prove invaluable to your health!

Love, from my raw food loving heart to yours! Muah! Bette B.