Wednesday, November 30, 2011

Insurance when you're laid off: What to ask for on your way out the door

Nobody wants a layoff notice, but critical insurance moves on your way out the door can help extend your health insurance (and other coverage) and save you thousands of dollars at a critical time. spelled this out today in an article titled "Insurance smarts during a layoff: 3 must-do moves."

Among the advice:
  • Ask for an extension of health care benefits. Ask for the employer to keep you covered for 3-6 months.
  • Negotiate with your employer to have them pay COBRA insurance premiums, which can be very expensive.
  • Convert group life insurance or group disability coverage to an individual plan, particularly if you're older.

Report: Health costs' rapid rise

The Commonwealth Fund has published a new report looking at state trends in health insurance premiums and deductibles from 2003 to 2010.

The upshot: employees' annual share of premiums increased by 63 percent over those 7 years (and premiums themselves rose 50 percent as well). In Washington state, for example, family health insurance premiums rose from $9,212 to $14,188 during that period. That's a 54 percent increase.

Not surprisingly, given stagnant incomes in recent years, premiums as a percentage of median household income during that time increased dramatically. In 2003, only a single state (West Virginia) had average premiums above 20 percent of median household income. Today, about half the states are in that category.

For a look at premiums (single and family) by state, here's a good interactive map from the report.

The report continues:
 At the same time, per-person deductibles doubled in large, as well as small, firms.
If premium trends continued at that rate, the researchers predicted, "the average premium for family coverage will rise 72 percent by 2020, to nearly $24,000."

Federal health care reform, passed in early 2010 but taking effect largely in 2014, offers the hope of some savings, the report says:
Health reform offers the potential to reduce insurance cost growth while improving financial protections. If efforts succeed in slowing annual premium growth by 1 percentage point, by 2020 employers and families together would save $2,161 annually for family coverage, compared with projected premiums at historical rates of increase.

The Next Step.

I have started typing this first sentence too many times to count now. Nothing seemed adequate enough to encapsulate my feelings as I read through all of your comments and emails regarding my post on Monday. I am beyond - truly - blown away. In the past two years, no post has received as much feedback, and I do not feel like any post has ever connected me to you more than this one. I am so very honored and sincerely touched by the outpouring of advice, wisdom and uplifting words. 

Just in the past two days I have come to several realizations. 

One wonderful email I got said, "Do not feel that your choices are between abandoning your business completely, or neglecting yourself and your family. Things are rarely that black and white." I am not ready to stop working at this point in my life or career. I enjoy being Mrs. I enjoy being Mommy. And I enjoy being Sheridan French behind my clothing line. Those are all parts of my pie that do create my balance, even if some pieces are bigger than they should be right now. {Awesome analogy from one of the anonymous posters by the way - you guys need to read the comments below. There are some seriously wise women reading this blog! I feel so honored.} IF I stopped working, I would fill my time with something else - art classes, interior design, something or other - because that is just who I am. I am a do-er. I like being busy. I have invested so much in every sense of the word into my line that I do not want to pull the rip cord just yet, only to fill my time with another activity. I love design and creating products when the headaches that go along with it are minimal, so that is where I need to sort things out. Adjust xyz to minimize the headaches. 

Whether that means finding some interns, not pursuing stores with such fervor, or solely switching to one area like accessories, I do not yet know. I will see 2012's orders and collection through regardless so I have time to think about what is the best way forward. I will, of course, keep you all posted on how things are developing.

The other, perhaps much more important thing I realized after all of the feedback, personal stories and insights, is that I love connecting with people. I love talking to people. I love listening and understanding what another person is going through, helping one another out in this amazing journey called life, being the support or outlet others may need and vice versa. THAT is my passion. I want to help everybody. The world is so big, yet so very small, and we are all connected. I wish I had a better way to pursue connecting with people... looking at other blogs, there are several with 5000, 7000, 20,000+ followers... I am so teeny tiny still. I don't feel like this is the best way for me to have a voice, as little fish get so lost in the big ocean. 

I had a long talk with a dear friend of mine yesterday afternoon and we discussed women like Oprah and Martha Stewart - they have amazing power and opportunity to connect, yet, as much as I love them both, in all honesty, I don't feel like I can personally identify with either of them. Oprah is not married, does not have children {albeit cute pups}, and lives a life that probably no housewife {ok maybe like 4 do} that watches her has. Martha Stewart's marriage was not successful and she has a practically estranged daughter that just wrote a tell-all book about her. I certainly cannot identify with celebrities. {Well, maybe Jennifer Garner. She's a cutie cute.} Obviously I am not judging anyone's life path or choices - each to their own - but MY wish is that we had a young woman to look up to and learn from that was in a public position like that of Oprah or Miss Martha, not just an actress or celebrity, that had successfully balanced marriage, children and a career. I want to TALK to her. Learn from her. Listen to her. Where is she? I would love to fill those shoes, even though I'm still practically a toddler compared to those ladies and really have no idea what I'm doing...but maybe that's the point. Do any of us? Oprah seems to have all the answers, yet I still do not. Martha makes perfect cakes and pies and handmade Easter decorations, but when I try to dye eggs, 14 of them end up broken and on the floor and Squish has just eaten half a jar of glitter. I want a real {?} normal {?} mother and wife to be talking to me. 

How do I do that? How do I reach 100,000 people? 1 million people? Just keep dreaming? Am I officially crazy to reach for the stars? Someone give me Oprah's former producer's number so I can pitch this to her, and in the meantime know I am sending massive, enormous hugs and thank you's to each and every one of you for your words, your thoughts and your insights into your own personal lives and experiences. Perhaps I will stop with clothing design. Perhaps I will move on to other things. Perhaps in one year's time I will decide to take a year off and see where God takes me. There is always so very much to learn. Thank you for teaching me. 

Colorado couple ordered to stop selling insurance in Washington state

A Colorado couple, Robert W. Ramlet and Patricia Ramlet, has been ordered to stop selling insurance in Washington state.

In 2006, the two sold two life insurance policies in Washington state without being licensed as insurance agents here.

Tuesday, November 29, 2011

Another Simple Food Weight Loss Experience

Whole Health Source reader Sarah Pugh recently went on a six-week simple food (low reward) diet to test its effectiveness as a weight loss strategy, and she was kind enough to describe her experience for me, and provide a link to her blog where she discussed it in more detail (1). 

Consistent with the scientific literature and a number of previous reader anecdotes (2), Sarah experienced a reduction in appetite on the simple food diet, losing 15 pounds in 6 weeks without hunger.  In contrast to her prior experiences with typical calorie restriction, her energy level and mood remained high over this period.  Here's a quote from her blog:
Well, it looks like the theory that in the absence of nice palatable food, the body will turn quite readily to fat stores and start munching them up, is holding up. At the moment, the majority of the energy I use is coming from my insides, and my body is using it without such quibbles as the increased hunger, low energy, crappy thermo-regulation or bitchiness normally associated with severe calorie restriction.
I can't promise that everyone will experience results like this, but this is basically what the food reward hypothesis suggests should be possible, and it seems to work this way for many people.  That's one of the reasons why this idea interests me so much.

Read more »

Special Issue of Health Services Research Provides Forum for Diverse Research in Global Health

Leslie Curry, MPH, PhD, research scientist, Yale Global Health Leadership Institute

A special Yale-sponsored issue of the journal Health Services Research (HSR) dedicated to global health issues came out in December. This edition of HSR, which is the first issue dedicated entirely to global health, points out the importance of having a forum for researchers, health care workers and academicians to showcase potential interaction between health services research, field and global health topics. Many of the disciplines and frameworks of health services can be helpful in global health efforts, particularly in the ongoing health systems strengthening work. This special issue of HSR publishes outstanding work in several critical areas of global health and illustrates the value of diverse disciplines in addressing key research questions in this field.

An introductory article written by Yale faculty provides an overview of how the evolution of global health from its roots in international health to its current focus on health systems strengthening provides many opportunities for social scientists to make meaningful contributions to the field. Whereas international health generally focused on low- and middle-income countries, emphasized bilateral cooperation, and attracted researchers from medicine and public health, the field of global health encompasses a much broader vision.

The featured papers tackle several pressing issues in the organization, delivery and financing of health care in highly diverse international settings. The issues include patient satisfaction and catastrophic health expenditures in health systems reforms; health care consumer preferences in post-conflict settings, national policy decisions to adopt universal health insurance; racial disparities in childhood insurance; and features of hospital organizational culture that influence hospital performance. Together, the papers involve data from multiple countries and continents.

The special issue is accessible online now:

Monday, November 28, 2011

Maintaining an Audacious Hope

I’m an undergraduate student at Columbia, who completed the Fundamentals of Global Health class offered by faculty at the Mailman School. This confirmed my interest in the field of global health and I was therefore delighted when, last semester, I had the opportunity to study abroad in Kenya.

The program, which focused on health and development, taught us a lot about East African culture and current events, and how different health and development organizations operate within that context.

One issue that struck me regularly through my time in Kenya was the disconnect between government and the day-to-day realities faced by many people. For example, Kibera, the largest slum in East Africa, is in Nairobi, the capital. In fact, Kibera may be the largest slum in Sub-Saharan Africa, but slum populations tend to be hard to count. Estimates for Kibera range from 200,000 to 500,000 people. One group estimated 1,000,000. However, the Kenyan government does not recognize Kibera as a human settlement and marks it as forest on official maps.

This leaves hundreds of thousands of people without rubbish collection, electricity, or access to clean water that the government is supposed to provide. The fact that three Kenyan officials summoned to the International Criminal Court in The Hague to face charges of crimes against humanity during the widespread violence following the last elections continued to hold positions as government ministers during my stay also jarred with me.

That being said, it was a fascinating time to be in Kenya, because things are seemingly beginning to change. A new Constitution was passed last year, paving the way for a highly functional and beneficial government when it is fully implemented. The uprisings in the Arab world are encouraging Kenyans to believe that that they too have the power to hold their government accountable, and people are beginning to find their voice and call for an end to corruption. Kenyans are also beginning to unify as a nation, instead of each identifying first as the tribe of which they are ethnically and culturally a part. Everyone seems tired of the problems and, aware of the underlying causes, are ready to work to make things better.

Change comes slowly however. Many services, especially in the health sector, remain significantly supported by bilateral funding or foreign NGOs. Though there is talk about sustainability and a time when programs will be entirely run and funded by Kenyans, most people suggested to our study abroad group that this would not be anytime soon. Problems of governance, a lack of natural resources, limited infrastructure, and high disease burden are obstacles that are not going to be easily or quickly overcome.

Buses in Kenya are often decorated, and many of them have signs on the front or back. The bus shown here was one of my favorites. Using the name of the book by then-Senator Obama, this sign is indicative of the phenomenon of Kenyan identification with our president. It is also indicative of the hope that so many Kenyans have in the face of their continuing challenges.

- Devon Welsh
Student, Columbia University

To Work Or Not To Work?

Ladies, let’s pretend we are sitting one on one over a warm cup of tea right now. It is time for a heart to heart as I need a big dish of good advice, some personal experiences and the like.

Several times a year since I started my clothing line I have thought about stopping. Every time – up until now – it has been more of a fleeting thought in a moment of stress and after a day or a week, the desire to stop working fades. This time, it is different. I feel like I have reached the point of being truly overwhelmed, and I feel like I am missing out on being a mother by choosing to dedicate so much time to my business. I absolutely will not hire full-time help to take care of my children (yet if I keep having babies at this rate and end up with 5 or 6, that might be a different story ;), as that is not a choice I have any desire to make right now, yet I cannot hire someone to run my business for me at this point. My involvement will always be very, very high and labor and time intensive. So, why do I feel like I am drowning? Read on.

The overseas production process is a nightmare, deadlines are never met on time, delays ensue and delivery guarantees are broken. The process of weaving fabric is sheer chaos, dealing with monsoons and all sorts of other tropical climate natural disasters that create circumstances out of my control that, again, cause delays. I never thought I’d get so into the Weather Channel. Religious holidays are an extremely regular occurrence in Indonesia, leading to full weeks on end off of work, not just a day here and there as it typical Western practice.

On top of that, there is the sheer volume of marketing that has to be done to actually get retailers to pay attention to you. Give you a first glance. Emails, phone calls, markets, newsletters, follow up emails, phone calls and newsletters. Constant research. Constant contact. It’s always push push push. Then creating the look book, website, arranging the photo shoots for all of that in the first place, participating in the shoots. Soon there will be the entire website aspect I have to deal with. Taking and processing orders, shipping, returns, customer service, packing boxes, emails to respond to, not to mention this poor blog that so desperately needs my attention and sweet readers that reach out to me that I simply do not have the time to email back, which just breaks my heart. There are a million things and it is never ending, and all of this, I am pretty much doing on my own. I have been beyond fortunate to have a few very kind hearted people help me over the past two years and generously contribute their time and energy, yet 99% of the time, I am running things by myself. Just me.

Then couple all of that with the fact that my line is a small collection created by a young girl, a mother with no official training in fashion design but rather just degrees in business, trying to manage the company out of her house while raising two children, young children, with number three on the way to soon bring the numbers to three babies under three years old… I am not sure how much longer I can last. We are always told that if we want it all, we can have it all, yet I am not sure I do want it all anymore. Doing it all is, well, hard.

{This is where you start thinking of the great advice you're going to give me here in a bit…}

It has always been a dream of mine to be a successful clothing designer, among other things. I do feel to some extent I have already achieved a bit of that success, going from 7 stores in year one to 22 stores in year two, but I cannot dedicate the time or energy to the business that I typically would if I did not have children at this point in my life. As a result of pulling myself in what feels like thousands of different directions for my business, I sacrifice time I could give to so many other areas of my life, namely my family and myself.

I posted something like this last year and got several responses. Most actually said to keep working. Don’t quit. Don’t give up. That I would regret it and soon “just” be a mom with no career or identity of my own to speak of. I do understand that and fully appreciate that angle. I am not saying I disagree, BUT, I also have to consider that this dream of mine was a dream I had before I got married. Before I had babies. When I needed to fill my life with something…but now, something else has filled my life. Something more amazing and wonderful than anything any job could ever give me.

Often I resent the work I have to do because the truth of the matter is, I do not have as much time as I would like for my husband, for my children, for myself, for my other interests like painting, drawing, running, photography, just flat out spending time with my sweet girlfriends that I so very rarely get to see. I honestly cannot tell you the last time I sat down to just watch tv. Just read a magazine. Just go on a walk. Looking at for 4 minutes every morning is my “me” time. Every spare moment of my life is FULL trying to mark things off of my to do list. And I am exhausted.

The big snag for me is this though: I hate quitting. I just do not do that. I push myself ridiculously hard in every area of my life. I exercise until my heart is beating out of my chest and sweat is burning my eyes. I woke up in 5th grade at 4am to go study with my grandfather before school so I could make an A+ on my history test…and I graduated senior year with a 4.2 GPA from a very academically rigorous school thank you very much ;) But you see what I mean? I am PROUD that that is a personality trait of mine - that I do something until the best I can do is achieved - yet I have not done that with my line yet. I know it has tons of potential. I know I can keep growing it. I have not reached the level I will be satisfied with as far as business goes. I don’t want to just stop. It’s not in me. I don’t know HOW. But I feel like I have to…something’s gotta give.

I am trying to figure out some sort of balance, a word that has no good definition as I have come to realize. Do I just do clothing and stop trying to expand into other lines? Or do I just focus on purses, as I am very passionate about the songket fabric and the process and craftsmanship of it? Or does balance for me actually mean that I do indeed stop working right now, so that I can focus on what I feel are more important parts of my life? Will I feel like my Masters is going to waste? Perhaps I can use it to super-educate my children and sweet Squish will just know who Pavlov is by the time he’s 4. Will I miss my work once it’s gone? If I put it on the back burner now and want to pick it up in the future, will it be too late, and will I lose the desire to work full stop? Is this line of work even the best path for me? Should I quit worrying about myself so much and make what I personally feel is the best decision for my children? Is the grass always greener on the other side? I don’t know. I just don’t know what to do.

Has anyone struggled with this before? What did you ultimately decide? Did you regret stopping your work, or shutting down your business? Did you feel like you entered a world where it was truly no longer about you, and you did not have your own life or experiences? If so, was that ok? If you did not stop working and had the option to, do you wish you had? 

The Light at the End of the Tunnel (and a few spots along the way)…by blogger of the month Ross Green

Hello again! I’d first like to apologize for my lack of consistency in posting this month. Like I’m sure I’ve said a few dozen times before, finals are REALLY soon now! Last Thursday we completed our Bacteriology (I guess that’s what that quiz was…) quiz for the semester, and starting a week from today we have our other 5 exams! To add to the hectic feeling right now (‘tis the reason, right?!), we have group presentations in our Introduction to Global Health course this week, 2 Microbiology lab reports to complete, and Global Health module presentations to present as well! On a lighter note, there were also entertaining things that occurred this past week and a half as well, I promise!

About a week and a half ago 5 of my classmates and I decided to try something new on a Thursday night. We hopped in a couple of cabs, took the usual 22 shekel ride over to the BIG, and played some pool (or Snooker as they call it here in Israel). I must say, we had a great time! We had a few beers, played a few rounds, and basically just spent a few hours unwinding from the stressful week that we were finally able to put behind us! I’m not sure if it was because we were in Be’er Sheva, or Israel just has its own rules, but the balls we played with were much smaller than we were used to AND the table was much larger! It was crazy, but these new “obstacles” made it quite entertaining. To put it lightly, we were not professionals that night, and yes a few balls did fly off the table during our games. Overall it was a fun experience that we will definitely try again (and hopefully we’ll play better too).

Last Friday morning 4 of us traveled by bus to visit the children of Save a Child’s Heart. This foundation works to help children living in underdeveloped countries who are in need of heart surgery. Utilizing the services of fantastic cardiac surgeons here in Israel, these children and their mothers are flown in and given a place to sleep at this house just outside of Tel Aviv until their procedures are finished and they have fully recovered. When we visited last week there were only three children, all of which were there a couple months ago when I visited for my first time. The three of them were all from Angola, and were 5, 7, and 17 years old. It was a fairly quiet day, since it was raining just before we arrived, but mostly because the last time we visited there were close to ten children running around. This week’s visit revolved around a little piece of technology known as an iPhone. When we walked in and I saw that Erikson (the 5 year old that I spent a lot of time with the previous visit) was still here, I thought it would help him remember me if I showed him a picture of us that I took during our last visit. I pulled up the picture, smiled, and showed it to him… his face lit up! I was so happy and thought he was remembering all of our time spent last time playing soccer, making paper airplanes and playing music and dancing around the house. I was fooled, because from that exact moment on I realized that his face lit up because of my phone and not because I was there again (well, maybe slightly because of me too…)! He took it from my hands, we sat down at the couch, and two hours flew by with him not losing a second of iPhone playing time! I must say that it was pretty amazing watching him (and his friend Antonio, age 7) navigate perfectly on such a complex device. I could tell that this was NOT his first time using one, but it was pretty amazing watching him speed by from one picture to another, zoom in and out, and open up different games (Mom, I found a new technology tutor for you!). It ended up being a great time, mostly because he didn’t stop smiling until we attempted to leave (yes, with my phone… I don’t think he realized that), but when it comes down to it that’s exactly why we were there!

This last weekend was Thanksgiving. Unfortunately I am unable to write about the amazing dinner that my class put together Friday night (maybe next month’s blogger can begin with this), but I spent the weekend in Jerusalem and had my own amazing experience. For my first year of college I lived here in Israel on a program called Nativ. This program brings American students in their first year of undergraduate studies to Israel to study and volunteer. Every year on Thanksgiving they have a big dinner and invite all of the old participants of the program who are in Israel to join. Along with myself there were 7 other people from my year alone that attended this reunion dinner! The rest of them have either made Aliyah (moved to Israel) and joined the Israeli Army, or are studying here for graduate studies. Along with the 8 of us, there are few more people from my class that were unable to attend but are also here in Israel! It’s pretty amazing how many of us ended up back her for one reason or another, and it was great seeing all of them again, some for the first time since we parted ways 4 years ago! It was a nice experience to celebrate an American holiday in the middle of Jerusalem, but if any of you have been there (if you haven’t please go!) you would know that it’s not such a big surprise, since more people speak English on the streets than Hebrew! The rest of the weekend was spent with two of my best friends who started the army just a few days ago. We had a nice and relaxing time together, and traveled back to Be’er Sheva before they hopped on a bus and headed to their base.

Now, it’s crunch time! I hope you enjoyed reading my entries to this blog, and that they gave you a little light into what goes on here in the life of a first year medical student in Be’er Sheva! Thanks for reading! - blogger of the month Ross Green

Triglycerides, VLDL, and industrial carbohydrate-rich foods

Below are the coefficients of association calculated by HealthCorrelator for Excel (HCE) for user John Doe. The coefficients of association are calculated as linear correlations in HCE (). The focus here is on the associations between fasting triglycerides and various other variables. Take a look at the coefficient of association at the top, with VLDL cholesterol, indicated with a red arrow. It is a very high 0.999.

Whoa! What is this – 0.999! Is John Doe a unique case? No, this strong association between fasting triglycerides and VLDL cholesterol is a very common pattern among HCE users. The reason is simple. VLDL cholesterol is not normally measured directly, but typically calculated based on fasting triglycerides, by dividing the fasting triglycerides measurement by 5. And there is an underlying reason for that - fasting triglycerides and VLDL cholesterol are actually very highly correlated, based on direct measurements of these two variables.

But if VLDL cholesterol is calculated based on fasting triglycerides (VLDL cholesterol  = fasting triglycerides / 5), how come the correlation is 0.999, and not a perfect 1? The reason is the rounding error in the measurements. Whenever you see a correlation this high (i.e., 0.999), it is reasonable to suspect that the source is an underlying linear relationship disturbed by rounding error.

Fasting triglycerides are probably the most useful measures on standard lipid panels. For example, fasting triglycerides below 70 mg/dl suggest a pattern of LDL particles that is predominantly of large and buoyant particles. This pattern is associated with a low incidence of cardiovascular disease (). Also, chronically high fasting triglycerides are a well known marker of the metabolic syndrome, and a harbinger of type 2 diabetes.

Where do large and buoyant LDL particles come from? They frequently start as "big" (relatively speaking) blobs of fat, which are actually VLDL particles. The photo is from the excellent book by Elliott & Elliott (); it shows, on the same scale: (a) VLDL particles, (b) chylomicrons, (c) LDL particles, and (d) HDL particles. The dark bar at the bottom of each shot is 1000 A in length, or 100 nm (A = angstrom; nm = nanometer; 1 nm = 10 A).

If you consume an excessive amount of carbohydrates, my theory is that your liver will produce an abnormally large number of small VLDL particles (also shown on the photo above), a proportion of which will end up as small and dense LDL particles. The liver will do that relatively quickly, probably as a short-term compensatory mechanism to avoid glucose toxicity. It will essentially turn excess glucose, from excess carbohydrates, into fat. The VLDL particles carrying that fat in the form of triglycerides will be small because the liver will be in a hurry to clear the excess glucose in circulation, and will have no time to produce large particles, which take longer to produce individually.

This will end up leading to excess triglycerides hanging around in circulation, long after they should have been used as sources of energy. High fasting triglycerides will be a reflection of that. The graphs below, also generated by HCE for John Doe, show how fasting triglycerides and VLDL cholesterol vary in relation to refined carbohydrate consumption. Again, the graphs are not identical in shape because of rounding error; the shapes are almost identical.

Small and dense LDL particles, in the presence of other factors such as systemic inflammation, will contribute to the formation of atherosclerotic plaques. Again, the main source of these particles would be an excessive amount of carbohydrates. What is an excessive amount of carbohydrates? Generally speaking, it is an amount beyond your liver’s capacity to convert the resulting digestion byproducts, fructose and glucose, into liver glycogen. This may come from spaced consumption throughout the day, or acute consumption in an unnatural form (a can of regular coke), or both.

Liver glycogen is sugar stored in the liver. This is the main source of sugar for your brain. If your blood sugar levels become too low, your brain will get angry. Eventually it will go from angry to dead, and you will finally find out what awaits you in the afterlife.

Should you be a healthy athlete who severely depletes liver glycogen stores on a regular basis, you will probably have an above average liver glycogen storage and production capacity. That will be a result of long-term compensatory adaptation to glycogen depleting exercise (). As such, you may be able to consume large amounts of carbohydrates, and you will still not have high fasting triglycerides. You will not carry a lot of body fat either, because the carbohydrates will not be converted to fat and sent into circulation in VLDL particles. They will be used to make liver glycogen.

In fact, if you are a healthy athlete who severely depletes liver glycogen stores on a regular basis, excess calories will be just about the only thing that will contribute to body fat gain. Your threshold for “excess” carbohydrates will be so high that you will feel like the whole low carbohydrate community is not only misguided but also part of a conspiracy against people like you. If you are also an aggressive blog writer, you may feel compelled to tell the world something like this: “Here, I can eat 300 g of carbohydrates per day and maintain single-digit body fat levels! Take that you low carbohydrate idiots!”

Let us say you do not consume an excessive amount of carbohydrates; again, what is excessive or not varies, probably dramatically, from individual to individual. In this case your liver will produce a relatively small number of fat VLDL particles, which will end up as large and buoyant LDL particles. The fat in these large VLDL particles will likely not come primarily from conversion of glucose and/or fructose into fat (i.e., de novo lipogenesis), but from dietary sources of fat.

How do you avoid consuming excess carbohydrates? A good way of achieving that is to avoid man-made carbohydrate-rich foods. Another is adopting a low carbohydrate diet. Yet another is to become a healthy athlete who severely depletes liver glycogen stores on a regular basis; then you can eat a lot of bread, pasta, doughnuts and so on, and keep your fingers crossed for the future.

Either way, fasting triglycerides will be strongly correlated with VLDL cholesterol, because VLDL particles contain both triglycerides (“encapsulated” fat, not to be confused with “free” fatty acids) and cholesterol. If a large number of VLDL particles are produced by one’s liver, the person’s fasting triglycerides reading will be high. If a small number of VLDL particles are produced, even if they are fat particles, the fasting triglycerides reading will be relatively low. Neither VLDL cholesterol nor fasting triglycerides will be zero though.

Now, you may be wondering, how come a small number of fat VLDL particles will eventually lead to low fasting triglycerides? After all, they are fat particles, even though they occur in fewer numbers. My hypothesis is that having a large number of small-dense VLDL particles in circulation is an abnormal, unnatural state, and that our body is not well designed to deal with that state. Use of lipoprotein-bound fat as a source of energy in this state becomes somewhat less efficient, leading to high triglycerides in circulation; and also to hunger, as our mitochondria like fat.

This hypothesis, and the theory outlined above, fit well with the numbers I have been seeing for quite some time from HCE users. Note that it is a bit different from the more popular theory, particularly among low carbohydrate writers, that fat is force-stored in adipocytes (fat cells) by insulin and not released for use as energy, also leading to hunger. What I am saying here, which is compatible with this more popular theory, is that lipoproteins, like adipocytes, also end up holding more fat than they should if you consume excess carbohydrates, and for longer.

Want to improve your health? Consider replacing things like bread and cereal with butter and eggs in your diet (). And also go see you doctor (); if he disagrees with this recommendation, ask him to read this post and explain why he disagrees.

Saturday, November 26, 2011

A Brief Response to Taubes's Food Reward Critique, and a Little Something Extra

It appears Gary Taubes has completed his series critiquing the food reward hypothesis of obesity (1).  I have to hand it to him, it takes some cojones to critique the entire field of food reward research, particularly when you have no scientific background in it, and have evidently not read a single paper on food reward itself.  As of 2012, a Google Scholar search for the terms “food reward” and “obesity” turned up 2,790 papers.

The food reward hypothesis of obesity states that the reward and palatability value of food influence body fatness, and excess reward/palatability can promote body fat accumulation.  If we want to test the hypothesis, the most direct way is to find experiments in which 1) the nutritional qualities of the experimental diet groups are kept the same or at least very similar, 2) some aspect of diet reward/palatability differs, and 3) changes in body fat/weight are measured (for example, 2, 3, 4, 5, 6, 7, 8, 9).  In these experiments the hypothesis has both arms and one leg tied behind its back, because the most potent reward factors (energy density, sugar, fat) have nutritional value and therefore experiments that modify these cannot be tightly controlled for nutritional differences.  Yet even with this severe disadvantage, the hypothesis is consistently supported by the scientific evidence.  Taubes repeatedly stated in his series that controlled studies like these have not been conducted, apparently basing this belief on a 22-year-old review paper by Dr. Israel Ramirez and colleagues that does not contain the word 'reward' (10).

Another way to test the hypothesis is to see if people with higher food reward sensitivity (due to genetics or other factors) tend to gain more fat over time (for example, 11, 12, 13, 14, 15, 16).  In addition, studies that have examined the effect of palatability/reward on food intake in a controlled manner are relevant (17, 18, 19, 20, 21, 22), as are studies that have identified some of the mechanisms by which these effects occur (reviewed in 23).  Even if not all of the studies are perfect, at some point, one has to acknowledge that there are a lot of mutually buttressing lines of evidence here.  It is notable that virtually none of these studies appeared in Taubes's posts, and he appeared largely unaware of them. 
Read more »

Thursday, November 24, 2011

What are you thankful for?

I am thankful for...

my family
my health
my eyes to see my children with
my hands to touch and arms to hug with
my legs to walk and run and play and jump with
my heart to feel
my ability to learn and laugh and love
my intelligence
the roof over my head
the food in my stomach
the water in my bathtub
the shoes on my feet
the blankets on my bed
all of the blessings in my life
that have nothing to do with
insignificant material things
but instead are the most simple
that we so often take for granted

enjoy every bite of your feast today
{and remember to include others in your prayers}

happy thanksgiving!

Wednesday, November 23, 2011

Commissioner Kreidler on health care reform, the individual mandate, and rate transparency

Commissioner Kreidler was interviewed by host Austin Jenkins on TVW's Inside Olympia program this morning to discuss health care reform, health insurance costs, and his successful push to release confidential rate information from health insurers.

On the federal Affordable Care Act: "While this act is not perfect, it is the best thing that we have going right now to get our hands around a very serious problem for this country of ours...People are really being hurt...The current system is broken."

On the individual mandate to buy health coverage, starting in 2014: "If you have people opting in when they're sick and out when they're well, it just plain won't work."

On health care exchanges: "It's going to be a lot like online shopping that a lot of people are familiar with. And that's going to be a huge advantage over what we have now."

Gift Guide :: In My Dreams

I have learned a lot about myself through the course of this blog, one of those things being: I am a complete failure when it comes to creating practical gift guides. One look at Tiffany's ring selection and I'm a goner. {FYI, go to Jewelry, Rings, View All, then Sort By: Price High to Low, and girlfriend you are in for a TREAT! Hello 12-carat, D color, round brilliant diamond in platinum for $2 million, it's me, Sheridan, won't you be mine? Ok ok I'll settle for the 13-carat rectangular fancy yellow diamond illuminated by a small halo of round brilliant diamonds for a cool $675,000.} See what I mean? Ok I have to go look at the rings again...and while I do I'm imagining myself wearing that Oscar de la Renta gown...having a great conversation with my new imaginary crystal zebra clutch {she's my new bff} and eating some chocolate almond butter, of course...brb...The guide details are below!

So, I will do some good guides this year - reasonable, realistic ones - but for now I shall start with an "In My Dreams" Gift Guide because, as we all know, it sure is fun to dream.

As Lewis Carroll said - probably my FAVORITE quote of all time ever ever ever - 

"Sometimes I've believed as many as six impossible things before breakfast."

Additional flood warnings in WA

After overnight rain in parts of the state, the National Weather Service has issued another flood warning, including:

The Nooksack River at North Cedarville (Whatcom County)
The North Fork of the Stillaguamish near Arlington (Snohomish County)
The Deschutes near Rainier (Thurston County)
The Chehalis at Porter (Grays Harbor County)

Minor flooding is expected at some of those locations today or tonight. The Chehalis River at Porter was close to flood stage at 8:45 this morning.

See the link above for details.

Update: (11:41 a.m.) Another warning's been issued, including some other area rivers. The upper reaches of most rivers crested this morning or will crest this afternoon, with crests moving downstream through Thursday.

Tuesday, November 22, 2011

Most Wanted :: Red Pant Suit

So simple. So pretty. So un-maternity...I'm jealous.
Does she have the most perfect shade of brunette hair or what? 
Oh so chic. 

Flood warning issued for parts of Lewis, Thurston, Pierce counties

The National Weather Service has issued a flood warning for the:
  • Newaukum River near Chehalis (reaching flood stage this evening, continuing through Weds night or Thursday)
  • Chehalis River near Doty (this evening)
  • Chehalis River at Centralia (late tonight)
  • and the Chehalis River near Grand Mound. (late tonight)
"Minor to moderate flooding is expected along the Chehalis and Newaukum Rivers beginning this evening," the weather service says.

In addition, a flood watch remains in effect for the lower reach of the Chehalis River in Grays Harbor County, where the NWS says flooding is possible starting late Wednesday.

Up to 4 inches of rain has fallen in the Chehalis River Basin during the past 24 hours. Another 2-5 inches is expected from now through Wednesday night. For more details, including specific roads and areas likely to flood, click the link above.

Here's the critical part, from our perspective: Flood damage is not covered under a standard homeowners insurance policy. If you want coverage against flooding -- and your lender may require it if you live in a flood-prone area -- you'll need to buy extra coverage.

For most homeowners, that means going to the National Flood Insurance Program, a federally run insurance plan that's sold by local agents. But the coverage takes 30 days before it goes into effect. Flood season is long in the Pacific Northwest. If you think you're at risk -- and see the red "One-stop flood risk profile" box check your flood risk and get an estimate of premiums -- definitely consider flood insurance. And don't delay.

Update: (12:02 p.m.) A new alert has been issued for minor flooding along the Puyallup River near Orting and the Deschutes River near Rainier.

Two warranty companies ordered to stop selling in Washington

We issued a cease and desist against Charter Warranty Services of Detroit, MI and TracGuard Services of North Miami, FL, ordering both to stop selling protection products in our state without a license.

Both companies were selling motor vehicle service contracts and protection products guarantees but had not registered with us. In Washington state, all motor vehicle service contract and protection product providers must register with our office.

If they fail to do so, they're required to get a certificate of authority to act as an insurer and get an agent or producer license in order to sell their products.

Don't recognize these two companies, but still wondering if you should get a warranty on your next big purchase? We can help. See if the company is registered before you buy a policy.

And consider these helpful tips on negotiating a price and what to ask before you buy.

Why breastfeeding is best for your baby

By Dr. Karen Chang, Chief of Paediatrics, Rouge Valley Centenary

It’s no secret that breastfeeding is widely considered the recommended method of choice to feed infants by leading organizations like the Canadian Paediatric Society, the American Association of Paediatricians and the World Health Organization (WHO).
It’s recommended that mothers try to breast feed their babies for a minimum of six months. It’s even better for the baby if they can continue for longer than that.

The advantages of breastfeeding are too numerous to mention in their entirety, but some of them include:
  • It’s a great way for mothers and babies to bond;
  • Babies who are breastfed continue to receive antibodies via breast milk. This helps to prevent the baby from developing diseases and infections.
  • Reduces a baby’s chances of developing atopic dermatitis, including eczema;
  • Breastfeeding helps to decrease instances of Sudden Infant Death Syndrome (SIDS);
  • Decreasing an infant’s chance of developing allergies;
  • It’s most easily absorbed by the baby’s stomach;
  • Breast-fed babies are rarely constipated compared to babies fed with formula;
    It’s always at the right temperature;
  • Decreases necrotizing enterocolitis, a severe inflammatory disease that affects at-risk premature infants and newborns; 
  • And finally, it's convenient and inexpensive. 

Many breastfeeding moms can also attest to how breastfeeding has helped them to lose weight because of all the calories they’re giving to the baby. It’s also known to help contract the uterus back to its normal size.
While the benefits of breastfeeding are numerous, it’s no easy task. For many women and their babies, breastfeeding can be a challenge – far from the image that many mothers have of immediately mastering this task. Remember that this is a learned activity, many mothers and babies don’t get it on their first try.

Some babies don’t latch on right away, while some mothers experience pain when they are breastfeeding. Many mothers are delayed in getting their milk, which can be a challenge. And once you and your baby finally master breastfeeding, it can also be a challenge to wean the baby off of the breast and transition to formula.
Remember that help is available, and if you’re having difficulty breastfeeding, you don’t need to go through it alone.

Breastfeeding Support
But remember that there are supports available. Many hospitals, including Rouge Valley Health System, recognize the nutritional benefits of breastfeeding. As a result, they have provided supports such as lactation consultants, who help to teach breastfeeding mothers how to breast feed and assist them through any challenges they may be experiencing.
Our lactation consultants see patients, both in hospital and on an outpatient basis. They also run daily breastfeeding classes for mothers in the hospital, as well as provide education for staff. Our Lactation Consultants will also begin to see patients in our Newborn Follow-up Clinic at Rouge Valley Centenary.

Our Lactation Consultants can be reached at:

* Rouge Valley Ajax and Pickering:
905-683-2320 ext. 1597
* Rouge Valley Centenary: 416-284-8131 ext. 4530

Toronto Public Health and Durham Region Public Health also offer breastfeeding clinics in the community. 
If you’re experiencing difficulty breastfeeding, you can speak with your paediatrician, or take advantage of the many breastfeeding supports and resources currently available, both in your community and online.

RVHS Resources
·         Rouge Valley Health System Breastfeeding Clinics:
-Rouge Valley Ajax and Pickering, 905-683-2320 ext. 1597;
-Rouge Valley Centenary, 416-284-8131 ext. 4530.
·         Rouge Valley Health System Maternal Newborn Program

Community Resources
·         Toronto Public Health:
·         La Leche League Canada -
·         Breastfeeding Inc. from Dr. Jack Newman -

Monday, November 21, 2011

Wind warning for tonight

The National Weather Service is predicting gusts of up to 60 miles per hour in parts of Washington state tonight, including San Juan County, western Whatcom County, western Skagit County and the Admiralty Inlet area.

The day after windstorms, we often get a wave of calls from people with toppled trees, debris-damaged cars, etc.

To help, we put together this list of typical questions, including:

Am I covered if my car was damaged by falling tree limbs?
My yard is covered with branches and debris. Will my insurer pay the cleanup costs?
My boat sank from strong winds. Am I covered?
My business' awning was damaged by the wind. Can I file a claim?

Be careful out there.

Pit Bulls :: The Nanny Dog

Rich or poor, American parents used to know exactly what pit bulls were famous for. Being great with kids.

Our sweet Pit Bull, Emmaline, is nothing short of amazing. When I decided to adopt her from the Humane Society, boy did I hear about what a terrible idea it was. From friends, from family, you name it, everyone had an opinion on her: How could I? I was about to have a child, and to bring such a vicious dog breed into our home? Was I crazy? Here she goes again, going against the grain. As always, I did my research, made my own decision, and adopted her anyway despite the negative feedback I was getting from every angle. I cannot ever imagine having another dog for the rest of my life. Below is a great, short article that gives a brief history of Pit Bulls and brings to attention that the breed has become very misunderstood and misrepresented. Please, please read in order to educate yourself on this wonderful dog, a breed that used to be known as the Nanny Dog. 

There are few things quite as obnoxious as rich parents. Be it a $3000 stroller or Louis Vuitton diaper bag, the well off don't want their little angels to be seen with anything average middle class rug rats might have, let alone a child who might be, gasp, POOR! So is it now, so ever has it been in America. 


In America, one dog breed historically became known as the dog for people who are afraid of dogs. One dog breed achieved such a rock solid reputation with children that for 150 years it was known as America's "Nanny Dog." One dog breed became so trusted that despite the fact that no Kennel Club or Association recognized it, despite the fact that it could be found on the poorest farms and bleakest city neighborhoods with kids who didn't know where their next meal was coming from, the super-wealthy acquired them in droves because they were simply the safest, most tolerant breed to have around their progeny.

Rich, poor, and everything in between, until recently, Americans agreed that there were only a CERTAIN TYPE of people who owned a Pit Bull...


America's Nanny Dog is the victim of a smear campaign that has turned common sense upside-down and robbed us of our historical memory. The dogs that we trusted with our children's lives are now deemed too vicious to live among us. The dogs that in two World Wars were the symbol of the United States military itself are now ordered off its bases.* The Pit Bulls haven't changed at all. Only the owners have.
By Y.W. Grossman, June 2, 2011

*FYI: Sgt. Stubby, a Pit Bull, was the first decorated American war dog. He served in 17 battles during WWI and was given rank in the United States Armed Forces. Sgt. Stubby was the inspiration for the U.S. Military K-9 Corps. 

 Our darling Emmaline.

Emmaline loved being next to my stomach when I was pregnant with Squish, and once he was born she would hardly let him out of her site. She is the exact same way with Munchkin now.

The truth of the matter is this: any animals can be dangerous. Dogs can be dangerous. Big dogs can be more dangerous. Big dogs owned by bad people are SUPER DANGEROUS. Period. It is not the dog - it is the human. When I was speaking with the Humane Society about Emmaline, {her name was actually Prayer when I adopted her}, they said something that really stuck with me. Pit Bulls were known as Nanny Dogs because they can be trained to do anything to the max. Families trained them to LOVE to the max. But they can also be trained to FIGHT to the max... Until death. These days they are bred for "gameness," a quality akin to bravery, which, unfortunately, makes them the best for fighting. I won't get overly graphic because the stories are heart-breaking and beyond disgusting, but in my research, I came across Pit Bulls that had ammonia poured in their eyes or in their wounds to instill anger and aggression, or some with four broken legs still trying to fight, because they were simply obeying their owners and doing what they were trained to do. 

I don't know if any of you watch the Dog Whisperer, but Cesar Millan used to take his Pit Bull Big Daddy everywhere he went. Daddy died in 2010. He helped Cesar train whatever dog was in question. As he says, "Aggression is not a breed issue. IT IS A HUMAN ISSUE." Search both National Geographic and YouTube for wonderful videos of Cesar Millan rehabilitating aggressively trained Pit Bulls.

The loyalty of one Pit lover at a time, one day at a time, can change the minds of many and erase the myth that they are inherently vicious. 

Fiscal responsibility is good for patient care

Operational Sustainability Plan is about maintaining and improving our ability
to invest in patient needs in our hospital

By John Aldis, Vice-President,
Corporate & Post Acute Services, and Chief Financial Officer, RVHS

Our hospital is investing in the current and long-term health care needs of our communities in west Durham and east Toronto.

This of course, is what we should be doing. But it’s important to remember that our organization has not always reinvested in direct patient care, replaced equipment or maintained facilities at the level required.  So we are still playing catch up.

The fact that we now can, and are, investing in our hospital is the result of clear financial plans supporting our Strategic Plan-On-A-Page, collaboration and teamwork, and a “can do” culture of accountability we have cultivated over the last three to four years.

In that time, Rouge Valley Health System (RVHS) has moved from having zero cash on hand and being stalled on investment – for even basic needs such as boilers and roofing – to generating the operating surpluses that we so desperately need to maintain facilities and invest in current and future patient needs.

Fiscal 2011/12 marks the first year of our Operational Sustainability Plan (OSP), the logical evolution of our successful Deficit Elimination Plan (DEP), which lived up to its name and was successfully completed in March 2011.  The OSP will help guide us through the next three years; building on the platform we built with our DEP.  In alignment with our Strategic Plan On-A-Page and our Patient Declaration of Values, the OSP will allow RVHS to increase our regular annual investment in capital needs and fund additional major capital items, including big ticket medical and diagnostic equipment, information systems, and facilities infrastructure.

- But what does that mean for patients? -
An example of what this means to patients, is the accelerated purchase of our new Magnetic Resonance Imaging (MRI) scanner at Rouge Valley Ajax and Pickering hospital campus.  We were able to fund the MRI upfront, while the RVHS Foundation collects on the pledges from its tremendous fundraising campaign over the next few years. Without the cash reserves we have accumulated over the last three years and stronger working capital position, our patients and their families would have waited longer for in-hospital MRI in their community.

The OSP will allow us to continue to invest in new equipment, technology, and our facilities, as well as expand our services to care for more patients, as our communities continue to grow in east Toronto, Pickering, Ajax and Whitby.

There are always risks and challenges, especially in these financially constrained times. But we are taking a proactive approach to financial risk management, as part of our OSP. The plan has specific risk mitigation plans built in and gives us the ability to adjust and protect our financial stability if actual events are worse than we planned, or invest even more if events turn out to be more favorable.

Our critical success factors are:
·      Reaching for the top – that is, achieving top-quartile performance in the many areas in which we are measured provincially. We will achieve this by benchmarking against the best in all that we do, such as: minimizing infection rates, reducing wait times, improving patient outcomes, and finding ways to reduce our costs through continuous Lean-based performance improvements;
·      Further ingraining Lean as our management philosophy and approach to innovation and constant improvement for patients;
·      Enhancing and sustaining our revenue streams, such as parking, retail operations, outpatient diagnostic and other revenues, and better access to insurance-covered private rooms; and
·      Anticipating risks through proactive financial management and fiscal accountability – to make sure our patients continue to get the highest value for their tax dollars.

For more on the OSP, take a look at my presentation to hospital leaders at both hospital sites in September and October at our Leadership Forum. 

- Major Capital Plan -
Complementing the Operational Sustainability Plan is our three-year Major Capital Plan (MCP). This plan provides a road map for our major capital investments between 2011 and 2014.

The MCP selection process, carried out as a team with all areas of the hospital, identified 83 items worth about $57.3 million. Of that, already 37 items worth about $20 million have been approved by our management and Board of Directors, including:
·      Cardiac catheterization lab replacement;
·      Intensive care unit patient central monitoring equipment;
·      Mental health unit renovations;
·      Information technology infrastructure; and
·      27 facilities infrastructure repairs/replacements.

Our ability to continue to invest in more items on our Major Capital Plan is directly linked to our success in implementing the Operational Sustainability Plan. We have outperformed our Deficit Elimination Plan over the last three years working as one team, inspired and involved.  I have no doubt we will execute our Operational Sustainability Plan with the same zeal.