Monthly Archives: February 2013

Floundering Over Seafood Choices?

Mercury.  PCBs.  Omega 3s.  Heart Healthy.  Industrial pollutants.  Wild caught.  Farmed.  Organic farmed.  Atlantic.  Pacific.  Domestic.  Asian.  South American.  It’ll make you live forever.  It’ll give you cancer.  Eat it at least three times per week.  Don’t have more than one serving per year.  It’s sustainable.  Eating it destroys the ecosystem.

I find the evening news to be a very poor place in general to catch comprehensive advice on whether a food has a net risk or net benefit, and I try not to fall hook, line and sinker for the bait thrown out to enhance tv ratings.  Trolling the internet is overwhelming.  There’s an ocean of information out there, some focused on health effects, some on environmental issues, some on economic or political concerns, and it’s up to the consumer to figure out how the scales tip overall.

Fish, in general, is good for you.  Problem is, fish can swim in polluted water and eat stuff that’s bad for you, hence becoming bad for you.  Certain farming practices with certain species of fish can be healthy and sustainable, and certain farming practices can be unhealthy for humans and cause environmental problems.  Certain wild (non-farmed) fishing practices can likewise have healthy/sustainable results or toxic results.

Unfortunately, there’s no consistent rule-of-thumb as to whether wild-caught or farmed is better. Domestic or imported, Atlantic, Pacific, or other source – each one has good and bad food choices.  Even different types of the same fish can vary significantly in safety and sustainability.

Most of the time, I try to use educated moderation when making food choices (see my recent post about eggs), but some of the seafood warnings are extreme enough for me to moderate my moderation and avoid certain items completely (e.g. I don’t feed my kids swordfish).  The Environmental Defense Fund collaborates with the Monterey Bay Aquarium and compiles data from government databases and scientific studies on seafood contaminants to maintain lists of fish that are relatively safe for humans and for the environment.  I tend to use the list on this page:http://apps.edf.org/page.cfm?tagID=17694 to judge safety.

Stopping by the local fish market, it used to make me feel like I was up the creek without a paddle if they were out of Alaskan wild-caught salmon, but after consulting the guide in the above link multiple times, I’ve caught on to which fish I can feed my family without having them grow extra arms out of their foreheads.  Tilapia seems to be a healthy choice, and when farmed in the U.S., it seems to be fairly environmentally responsible as well.  Calamari is on the healthy list (it’s like eating a tire, but it’s low in contaminates).  Halibut is currently on the safe list and is delicious, but it’s quite pricey.  Chunk light packaged tuna (low sodium) is on the healthy list, and mixes wonderfully with pesto sauce over pasta.

When in Boston, I will allow myself to indulge in a very occasional meal of grilled bluefish, and I am not worried that this will cause me to grow a third eye or to keel over.  But for now I’ll skip the bluefin tuna and walleye.  And I’ll try to stay hooked into reliable sources of information.

 

Thoughts from the Doc on College and Cholesterol – What’s in a Number?

My eldest son is now in the 2nd half of 11th grade, so a high percentage of thoughts in our household seem to revolve around college.  Where to apply?  What looks like a “good fit” on paper?  What’s it actually feel like when visiting?  Can he get in?  If colleges considered letters of recommendation from applicants’ mothers, I’m sure he’d be a shoe-in anywhere.  But the “holistic approach” to reviewing applications which every college and university currently claims to espouse notwithstanding, a lot of specific numbers come into play.

GPA.  Weighted GPA.  Class rank.  Standardized test scores.  The higher the aforementioned numbers in an entering class, the higher the college/university will be ranked.  And it will be ranked even higher when the number of applicants goes up and the percentage of students admitted goes down.

But what do those aggregate numbers actually say about a college?  And what do the individual numbers actually say about a student?  We all make inferences, whether fair or not, based on certain numbers.  Sometimes the inferences are accurate, and sometimes they aren’t.  They tend to be more accurate when more than one number is taken into account.  And even more so when more information is considered.  There’s a forest to discern from those trees.

When the nurse sticks a needle in the inside of your elbow and fills a few tubes with the red stuff, you’ll soon have a report filled with numbers.  “Good” cholesterol.  “Bad” cholesterol.  Blood sugar.  All kinds of data.  Very occasionally, one number by itself can give you a crucial, relevant, helpful piece of information.  But usually there’s a lot of contextual information that determines how a particular number should be interpreted.

For example, a blood sugar level twice the upper limit of normal must be a big problem, right?  Well, what if it had been three times the limit two hours ago?  Or what if the blood sample had been taken from a vein that had an IV running into it that had sugar in the IV fluid?  Might those circumstances not influence a doctor’s evaluation and interpretation of that one particular number?

An actual visit to a college campus helps a person see beyond the numbers as he meets students, hears how the school presents itself in an information session, and observes the interactions within the buildings and on the grounds.  Reading an essay and holding an interview with a student helps a school go beyond the numbers as the admissions representative sees how a student expresses himself, and the school gets a glimpse of how the student interacts with others.  The numbers can then be integrated back into the pictures to provide more contextually complete representations.

In general, doctors need not to react just to specific numbers, but to take into account the entire clinical picture.  Contextual clues can help guide which numbers and laboratory data to check, and can help indicate an erroneous lab value.   A doctor needs to look at a total cholesterol level, then look at the breakdown of cholesterol subtypes, and factor in her patient’s weight, medical history, and family medical history in order to decide how to interpret that lab data.

I would like my son either to go to a college or university that sees him as more than just a GPA and ACT score, where people care about his development as a person, or I’d like him to figure out a way to find a sub-community of peers and mentors who look beyond the numbers if he ends up in an overall impersonal, numbers-driven environment.

I would hope that people find themselves with doctors who look at them as whole people, who take the time to explain the numbers, and figure out what they mean within the context of the whole person.  Or, I would hope that they can find a medical advocate who can teach them, and empower them to communicate beyond the numbers with their own physicians.  My ears are open if you need me, and I am currently taking on clients in the southern and central parts of Oakland County if you know of someone there who could use my help – just send them to peek at www.practicalmedicalinsights.com.

People are more than numbers.

Weighing in on Risks

(Note: I began writing this post before the International Olympic Committee decided that ping-pong was a more Olympics-worthy sport than wrestling.  There is now a Keep Wrestling in the Olympics page on Facebook which you can follow if you are interested, or you can visit www.TheMat.com)

All three are very athletic, and I’m sure they’d be pretty good, and they’ve all begged, but I don’t let my kids play football.  Flag football is fine.  So are neighborhood impromptus.  But not official-school-team football where you have 250-pound kids running into 130-pound kids.

It’s not that I’m afraid of my kids’ getting hurt.  Well, yes it is, but it’s a little more complicated.  Given the paragraph above, you might be surprised to hear that my youngest son, who just turned 12, is a wrestler.  For the past few months, I’ve been delightedly watching him compete in tournaments with our local youth wrestling club, and he’s moved up from “novice” (first-year wrestlers only) to “open” since he’s doing so well.

Have you ever watched a high school or college wrestling match?  It doesn’t have the theatrics of professional wrestling.  Instead, it has remarkably strong individuals using incredible force and twisting maneuvers in order to get their opponents off-balance, onto the floor, and into specific positions or “pinning” them on their backs.  It’s actually really exciting.  And it’s really exciting to watch my baby do it.  At least, it is when he’s in the better position, which so far he’s been in the vast majority of the time.  But I did NOT like it when an opponent had a hold of my child’s foot in what looked like a really unnatural position.

So how did an “absolutely-no-football” mom become an enthusiastic wrestling mom?  It actually wasn’t much of a transformation.  My boys are competitive athletes.  They run track and cross country.  They’ve played basketball.  They ride bikes.  They climb trees.  They know how to skateboard.  They’ve learned martial arts.  We hike in national parks.  We do not live a life free from risk.  There is no such thing.  If you hide inside your whole life, that brings it’s own set of dangers.

I look at data.  A doctor’s job is to look at data and assess risks.  To weigh the risks of doing one thing with the risks doing a different thing, or of doing nothing.  I did this with every patient, I help elucidate this for every client, and I of course do it with my family.

Virtually every sport carries a not-insignificant risk of injury.  Different sports have different rates of different types of injury.  One of the most dangerous aspects of high school and collegiate wrestling has been trying to lose a lot of weight quickly in order to “make weight” (since there are weight categories in wrestling, and you get to wrestle someone smaller if you drop into a lighter category, but of course becoming dehydrated and malnourished is a pretty stupid way to prepare for a battle of strength).  There are now rules in place (at least at the high school level) that limit how low each wrestler is allowed to go in weight.

There are a lot of upper extremity injuries in wrestling.  There are a lot of blown-out knees in football.  As awful as these are, they wouldn’t stop me from allowing my kids to reap the benefits of the sports – teamwork, physical fitness, accountability, commitment, sportsmanship, etc..  But the knee and shoulder injuries don’t scare me as much as potential high-velocity collisions or the long-term effects of repetitive head injuries.

Here’s my thinking:  Wrestling has weight classes.  It’s really not possible in wrestling, outside of heavyweight, to have a huge weight differential, but in football it’s quite possible for someone to be run into by someone who outweighs him by a factor of two.  Football, by its nature, involves full-speed body collisions, while wrestling is more of a steady-force-pushing kind of thing.  Yes, there are take-downs in wrestling that involve hitting the floor, but the rates of concussions differ significantly between the two sports.  Also, football practice involves repetitive collisions, and while each impact may be less than what is needed to cause a concussion, a cumulative high volume of sub-concussion head trauma is showing in current research to have long-term effects on the brain.  Again, no sport is totally free of this (cross country or track runners can certainly collide), but I can’t ignore how much of it there is in football.

For now, I am accepting the risks of wrestling because I see how much my son loves it, how much he loves learning the techniques and strategy, how strong he is becoming, and how good it makes him feel about himself.

Risks and benefits.  Different for every individual.  What risks are you willing to take for what benefits?

Scrambled Messages

A snow day on Friday, followed by a blissfully not-over-scheduled weekend, allowed for three days in a row of being able to do a little better than cold cereal for breakfast.  Homemade whole grain waffles on Friday, scrambled eggs topped with chili and arugula on Saturday, slowly cooked oatmeal with cinnamon, vanilla, a touch of honey, and a dollop of low-fat vanilla ice cream and fruit garnish on Sunday.  I love the luxury of morning cooking time!

But the whole breakfast thing can be a little confusing, health-wise.  Are eggs “good for you” or “bad for you?”  My ancestors in New Jersey and Philadelphia grew up on eggs.  They’re full of protein.  Good for you.  At some point, the health effects of cholesterol were noted.  Eggs contain cholesterol.  Bad for you.  Researchers later figured out that dietary cholesterol itself didn’t necessarily affect your blood cholesterol level as much as saturated fat.  Eggs only have a gram or two of saturated fat each.  Not really bad for you in moderation.  More research that eggs help raise “good” cholesterol.  Good for you.  Recent study out of Canada that says eggs are second only to smoking in association with heart disease.  Bad for you.

The studies conflict.  But none of the studies are “prospective, double-blind, placebo-controlled” studies (the gold standard of science).  There are laboratory studies, and there are correlational observation studies.  The results of lab studies might not hold out in real life.  The correlations observed in real-life observational studies (such as the Canadian study showing higher consumption of egg yolks in people with higher levels of cardiovascular disease) might not be cause-and-effect, but might actually both be effects of a third factor (i.e. an entirely different cause).

So what, pray tell, are we supposed to do?  This type of situation rears its head frequently.  If I took every study to be ultimate truth, I’d end up starving to death in a sea of confusion and fear.  So here’s how I decided to deal with eggs:

I buy a lot of eggs.  My family eats a lot of egg whites, and a few yolks.  There are lots of nutrients in the yolks.  There is cholesterol and saturated fat in the yolks.  The yolks lend a richness to the flavor of egg dishes and baked goods.  The whites are full of protein, have some other nutrients, and are a good binding agent in baked goods.  If I’m making a banana cake that’s going to feed 15 people and the recipe calls for 3 eggs, I go ahead and use whole eggs.  If I’m making scrambled eggs for my family of 5, I’ll use 4 or 5 whole eggs and an additional 12 to 15 whites.  When I make egg salad, I use a similar ratio to what I use in a scramble.  And we’ll have that type of egg meal maybe once or twice a week, and maybe a whole grain waffle or pancake meal (which will use a total of 2 or 3 eggs in the whole batch) once a week.

So we get protein from the whites, some of the nutrients and rich flavor from the yolks, and not a lot of the fat or cholesterol.  If enough research is done to show overwhelming evidence of either the danger or the benefits of consuming egg yolks, I won’t have to feel guilty for either having poisoned my family or having completely deprived them of essential nutrition.  Eggcellent!

 

 

Averting a Snow Day Crisis With a Connection to Actual DocThoughts

Snow day!  Kids slept in.  In our kitchen, making waffles, my boys happily complaining that it was too bad the snow day hit on a day they had jazz band, but they’d take the snow day anyway.  Wait a minute.  Jazz band.  Band.  Instruments.  “Uh, Mom, do we have rehearsal this Sunday?”  “Yes.  Why?”  “Because our instruments are at school.”

Crud.  This really hadn’t been an expected snow day, so I couldn’t legitimately yell at my boys for not planning ahead (not that doing that would help the situation anyway, even if it had been “their fault”).  Think.  Think.  Phone call to high school office – no answer.  Quick phone call to friend who teaches at the high school to see if anyone’s usually there on snow days.  She said theoretically someone from the custodial staff should be there, so we should try to see if any door to the building is open and catch one of the custodians to let us into the band room, and if we couldn’t get in, she has a key to the building and could go up there with us to let us into the school to look for a custodian.

Sent my high schoolers to try to get in (the main roads had been plowed by this time).  As they were trying a door, a custodian was leaving through another door and yelled to them that everything was now locked and the alarms were on so no one could get in today.  My boys tried to yell back to let him know what was happening, but they must not have been loud enough (surprising for a couple kids who can be plenty loud when they are of the opinion that their parents are being unreasonable), because the custodian got into his car and left.

Crud.  Called teacher friend again to tell her about the situation and to ask if there are generally people in the building on Saturdays, so that we could try again tomorrow morning.  She said that the fitness center should be open, but that the athletic area was locked from the rest of the building, and the alarms would be set.  She suggested emailing the principal in case he checked his email and could contact someone from the custodial staff to meet us there and help us during fitness center hours.

Zipped off an email to the principal.  Hoped he would see it.  Thought some more.  Checked to see what was up on Facebook.  Saw a post that talked about how snow days were decided.  Clicked to read the full article.  There was a quote from the superintendent.  The superintendent……. maybe he would be in his office?  Zipped him an email, and then called his office – he answered his phone!  I explained our predicament.  He said he’d call me back in a minute.  Phone rang a minute later, and our superintendent told me that the head of the district’s custodial staff would meet us at the east doors in 15 minutes to let us in.

Disaster averted.  Instruments retrieved.  And in the meantime, the principal had emailed back that there would be someone in the building Saturday morning who could help, so even if we hadn’t been saved today, the situation could have been fixed tomorrow.  Thank you emails were sent to everyone involved.  Snow day has been enjoyed to its fullest, with a houseful of teenage boys (and one 12-year-old, but I’ll count him as an honorary teen).

So here’s where Doc Thoughts come in.  It’s easy to panic, but panic doesn’t get you anywhere.  When you take a deep breath, you can think of people who might be able to help you, and even if they can’t help you directly, they probably know someone who can.  I had a new client this week who was referred to me by someone I had just met earlier that day, who realized that this person was in a state of crisis and could use my help.

How many steps to link any actor to Kevin Bacon?  How many steps to find someone who can help you?  Networking works.  We all know people.  A large part of what I do professionally is figuring out who to go to and where to get the right information to help people.  Sometimes it takes a few steps, but I get there.

Breathe.  Think.  Make a couple calls.  Send a few emails.  Someone likely will be able to unlock the door for you.

 

Corrected Cornbread Recipe

As promised, here is my cornbread recipe.  I’m writing it this morning so you’ll have time before the big game to pick up a few ingredients you might not have on hand.  It’s made with whole grains, and has way less saturated fat than standard recipes.  It does have sugar, but not a ton.

First, preheat your oven to 425 degrees.

Next, line a 9×13 (or 9×11) inch baking pan with unbleached parchment paper.  (*Note – using parchment paper makes for ridiculously easy clean-up, and it saves you from using any unnecessary grease/oil/butter/etc. to keep stuff from sticking.  It really is a marvelous invention.)

Then in a large mixing bowl, stir together:

1 cup whole wheat pastry flour (Bob’s Red Mill (local folks – it’s cheap at Hiller’s) and Aarowhead Mills are two good brands) – whole wheat pastry flour is ground really fine, and works very well in cakey things, cookies, etc., but it has more fiber and protein than white flour, and is a bit more flavorful.

1 cup whole grain corn flour (Bob’s Red Mill makes it) – you can substitute whole grain corn meal if you can’t find the corn flour (but locally they carry it at Hiller’s and at Natural Food Patch, and sometimes at Westborn).  The corn flour gives it a really rich, cakey taste and texture, but if you prefer a sandier, crunchier texture then use a medium grind whole grain cornmeal instead.

3 teaspoons aluminum-free, double acting baking powder

1/2 teaspoon baking soda

Then add in:

2 eggs

1/4 cup canola oil

1/4 cup honey or maple syrup or agave syrup

1-and-1/4 cup low-fat buttermilk (the stuff from Trader Joe’s is really good) (*Note – If you substitute something else for the buttermilk, reduce the amount to one cup, skip the baking soda, which is only there to work with the acidity of the buttermilk, and add an extra full teaspoon of baking powder instead.  If you want to make it dairy-free, you can substitute a can of creamed corn, but that adds some extra sugar, so you can reduce the honey/maple syrup/agave syrup.  Or use soy milk or whatever substitute you usually do.)

Optional – some thawed frozen corn  (make sure they’re thoroughly thawed or warmed, otherwise they’ll affect the baking and you’ll end up with little raw spots)

Stir together just until smooth, put into the parchment-lined baking pan, and bake in the 425 degree oven for about 25 minutes.

Enjoy!   And enjoy the game, commercials, and (hopefully) chili!

Correction

I can’t believe no one caught me yet on my mistake!  I misspoke – I said there wasn’t saturated fat in the cornbread, but it is made with two eggs, so there IS saturated fat from those, and there is a tiny amount in the canola oil and low-fat buttermilk (the Trader Joe’s brand I mentioned only has 1% fat).  But it’s way less than if it were made with the butter or shortening that standard recipes call for, and if you use egg substitute it knocks the saturated fat level close to nothing.

Sorry about that!  I have fixed the post.  And once again, enjoy the Superbowl!

 

The Cornbread

As promised, here is my cornbread recipe.  I’m writing it this morning so you’ll have time before the big game to pick up a few ingredients you might not have on hand.  It’s made with whole grains, and has way less saturated fat than standard recipes.  It does have sugar, but not a ton.

First, preheat your oven to 425 degrees.

Next, line a 9×13 (or 9×11) inch baking pan with unbleached parchment paper.  (*Note – using parchment paper makes for ridiculously easy clean-up, and it saves you from using any unnecessary grease/oil/butter/etc. to keep stuff from sticking.  It really is a marvelous invention.)

Then in a large mixing bowl, stir together:

1 cup whole wheat pastry flour (Bob’s Red Mill (local folks – it’s cheap at Hiller’s) and Aarowhead Mills are two good brands) – whole wheat pastry flour is ground really fine, and works very well in cakey things, cookies, etc., but it has more fiber and protein than white flour, and is a bit more flavorful.

1 cup whole grain corn flour (Bob’s Red Mill makes it) – you can substitute whole grain corn meal if you can’t find the corn flour (but locally they carry it at Hiller’s and at Natural Food Patch, and sometimes at Westborn).  The corn flour gives it a really rich, cakey taste and texture, but if you prefer a sandier, crunchier texture then use a medium grind whole grain cornmeal instead.

3 teaspoons aluminum-free, double acting baking powder

1/2 teaspoon baking soda

Then add in:

2 eggs

1/4 cup canola oil

1/4 cup honey or maple syrup or agave syrup

1-and-1/4 cup low-fat buttermilk (the stuff from Trader Joe’s is really good) (*Note – If you substitute something else for the buttermilk, reduce the amount to one cup, skip the baking soda, which is only there to work with the acidity of the buttermilk, and add an extra full teaspoon of baking powder instead.  If you want to make it dairy-free, you can substitute a can of creamed corn, but that adds some extra sugar, so you can reduce the honey/maple syrup/agave syrup.  Or use soy milk or whatever substitute you usually do.)

Optional – some thawed frozen corn  (make sure they’re thoroughly thawed or warmed, otherwise they’ll affect the baking and you’ll end up with little raw spots)

Stir together just until smooth, put into the parchment-lined baking pan, and bake in the 425 degree oven for about 25 minutes.

Enjoy!   And enjoy tomorrow’s game, commercials, and (hopefully) chili!