Spicy Carrot-Celery Juice

If you have never juiced before, here is a recipe that does a great job of improving your health and the veggies are really easy to juice.  I have an Omega Juicer and I really like several things about it.  First, it is super easy to clean up. Second, with this juicer you can make enough juice to last you for 3 days without compromising the nutrients. It lasts longer because it doesn't rip your vegetables at high speed causing fast deterioration of the juice.  The slow rpm's of this juicer, at just 80 rpm's, allow the juice to hold its nutritional value longer. Slower machines produce less friction and less heat, preserving enzymes that can be destroyed by heat. Low RPM machines “masticate” or virtually chew the food to squeeze out the juice. High RPM centrifugal juicers spin juice through the air causing exposure of juice to lots of air and thus oxidizing the juice. Low RPM juicers don’t expose the juice to lots of air, reducing oxidation and preserving more of the nutrition in the juice Some juicers spin and shred at 14,000 rpm's-YIKES!! I also like my juicer because I can make soft serve ice cream out of my frozen fruits.  You can also make nut butter and homemade pasta. 

Juicing the greens with orange carrots makes an interesting color of juice. Matter of fact, if you google what color orange and green make it says a "Poopy" color-LOL. Well, you can decide for yourself what color it turned out to be.  If you double up on the carrots it will take on the orange color.

SUPERFOOD CUISINE - Cooking with Nature's Most Amazing Foods - BOOK REVIEW

SUPERFOOD CUISINE - Cooking with Nature's Most Amazing Foods is a beautiful hardcover book by Julie Morris, a natural food chef, writer, educator and advocate of whole, plant-based foods and superfoods for optimal health.  Julie includes 100 recipes, a vivid description of each superfood (including history, benefits, use and taste), and a convenient "pantry list" of what you need and where to find these special foods. She uses Navita Naturals 100% organic superfoods. I found I already had a lot of these superfoods in my pantry since I am a huge fan of Navita Naturals Raw products. If I counted correctly, about 46 of the 100 recipes are raw. The recipes I tried were easy, full of nutrients and super satisfying. Superfood Cuisine is the perfect Christmas gift. Get your holiday shopping finished early with the healthy gift that keeps on giving!!!

In chapter three Julie talks about 'The Need for Nutrient Density'.  She states that for the very first time in history, a yonger generation is showing signs of a shorter life expectancy than its parent generation.  Epidemic rates of terminal diseases such as heart disease, diabetes, cancer, osteoporosis, obesity - to name just a few - are at an all-time high, and rising.  She states the problem stems largely from our current Western diet.  We demonstrate a profound dependence on processed and refined (nutrient-void foods, which inundate our bodies with empty calories; a habitual craving for animal protein, with its high cholesterol-forming saturated fats and destructive acidic impact on our blood chemistry; and the almost unconscious consumption of refined sugars (such as high fructose corn syrup and excessive white cane sugar), whose omnipresence on supermarket shelves has contributed to the alarming spike in diabetes, among many other disease.  Our addiction to these foods is literally destroying us.  Because they often require more resources from the body just to digest than they give back in benefits, these foods can be classified as "antinutrients"  Instead of building us up, they actually break us down:  robbing our body of energy.  Modern studies point to the utilization of a whole-food, plant-based diet as one of the most promising ways to keep these serious - yet largely preventable - chronic disease at bay.  The World Cancer Research Fund has stated that simply by eating the right diet, a person can cut his or her cancer risk by up to 40% (a number thought to be on the conservative side by many estimates).

Superfoods are one of the easiest, most efficient ways to make significant beneficial changes to even the most risky of lifestyles, Small, powerful changes really do add up, and superfoods are one of the best ways to make an impact.  Superfoods are also super delicious! 

The recipes I created were: Mediterranean Vegetable Pizza, Kale & Black-Eyed Pea Stew, Pure & Simple Green Smoothie, Tater (Like) Tots and Hot Chocolate.  They all turned perfect and tasted so delicious. One superfood I used in the Green Smoothie was Lucuma Powder and it was so delicious. It is made by freeze-drying the Lucuma fruit, which is native to South America.  It has a sweet, maple-like taste, but is very low in sugars. Julie considers it her "secret ingredient" and I agree.

Below I have posted the recipes I created, a video where Julie shares her No Bake Brownies and an additional link so you can download 3 more recipes from her book + the introduction chapter from the book on her FACEBOOK page.  The 3 recipes you can download are Asian Tempeh Lettuce Cups, Cheesy Kale Crisps and Sacha Inchi Buckeyes - YUMMY!!
You can also purchase an autographed copy of her book at juliemorris.net.

 There's something about a pot of good stuff bubbling away on the stove that's always exciting.  Especially when that "good stuff" includes powerful ingredients providing a balanced array of minerals, protein and fiber.  Adding the kale at the very end of the cooking ensures that it's softened enough to be enjoyed, without destroying all of its nutrition through heat.  This is the kind of stew that eats like a meal.

KALE & BLACK-EYED PEA STEW

Printable Recipe

Makes 6-8 Servings

1 tablespoon coconut oil

2 cups white onions, diced (about 1 medium)

6 cloves garlic, minced

3 stalks celery, diced

1 red bell pepper, diced

1 tablespoon fresh oregano leaves, chopped

1/2 tablespoon fresh thyme leaves, chopped

1/4 teaspoon chipolte powder

1 tablespoon smoked paprika

3 cups vegetable broth

3 cups water

2 tablespoons wakame flakes, ground/crushed into fine pieces

3 cups cooked black-eyed peas

1 head kale, stems discarded and leaves chopped

1/2 lemon, juiced

fresh parsley, chopped, for garnish

In a large pot, melt the coconut oil over medium heat.  Add the onions and garlic and cook for 2 minutes, stirring occasionally.  Add the celery and bell pepper and cook for a few minutes loner.  Stir in the herbs and spices, cooking for about 30 seconds.  Add the vegetable broth, water, wakame flakes, and black-eyed peas.  Bring to a gentle simmer, and cook uncovered for 30 minutes, add more water if needed.  After the soup is cooked through, stir in the kale and keep over the heat for a minute longer - just enough to wilt the kale.  Add the lemon juice and turn off the heat.  Top with parsley and serve.

SUPERFOOD TIP:

Using smoked ingredients like chipotle powder and smoked paprika add an impressive depth of flavor to recipes without compromising nutrition through overcooking. 



Pure & Simple Green Smoothie, Pg. 221
(made with frozen mango chunks, banana, lucuma powder, spinach leaves, chlorella powder, water and stevia)



Hot Chocolate, Pg. 230
 (made with cacao powder, mesquite powder, maca powder, palm sugar and either cashew or almond milk)

Mediterranean Vegetable Pizza, Pg. 136

(This is a pizza more by architecture than by detail.  The crust is a high-protein, cracker-like flatbread boosted with super seeds; the sauce is a savory olive spread rich in minerals and healthy fats; and the vibrant topping boasts copious amounts of flavorful cooked vegetables)

 

                          No-Bake Brownies (By Julie Morris)

Download 3 free recipes + the introduction chapter from the book via Superfood Cuisine on  facebook
@greenjules on twitter
Website juliemorris.net (can purchase signed copy here)

A Controversial Proposal about Complementary Medicine

A controversial proposal about complementary and alternative medicine (CAM) will be the hot item today and tomorrow at the annual meeting of the College of Physicians and Surgeons of Ontario. Since the College regulates medical practice in Ontario, this isn't a Mickey Mouse discussion!

The College felt it had to create a policy because patients in Canada, like those in the U.S., were voting with their feet - and money - for CAM:

In increasing numbers, patients are looking to complementary medicine for answers to complex medical problems, strategies for improved wellness, or relief from acute medical symptoms. Patients may seek advice or treatment from Ontario physicians, or from other health care providers.

The proposed policy explicitly recognizes a patient's right to decide on the course they want to follow:

Patients are entitled to make treatment decisions and to set health care goals that accord with their own wishes, values and beliefs. This includes decisions to pursue or to refuse treatment, whether the treatment is conventional, or is CAM.

In my psychiatric practice, I heard more than once from patients that their other physicians pooh-poohed psychiatric treatment, especially psychotherapy, with terms like "magic," "witch doctor" and "rent-a-friend." From that experience, I especially liked the way the Ontario College insists that physicians conduct themselves with civility:

The College expects physicians to respect patients' treatment goals and medical decisions, even those with which physicians may disagree. In discussing these matters with patients, physicians should always state their best professional opinion about the goal or decision, but must refrain from expressing personal, non-clinical judgements or comments...about the therapeutic options, or the patient's health care goals or preferences unless those are explicitly requested by the patient.

The fact that many physicians and physician organizations complained bitterly that this standard would "muzzle" them demonstrates the need for making civility and common courtesy an ethical expectation!

The Canadian medical community was especially vehement in its criticism of the way the original draft discussed standards of evidence for CAM. In the eyes of the critics, the College was setting a lower bar of evidence for CAM compared to allopathic medicine. Here's the key passage from the original draft:

Reasonable expectations of efficacy must be supported by sound evidence. The type of evidence required will depend on the nature of the therapeutic option in question, including, the risks posed to patients, and the cost of the therapy. Those options that pose greater risks than a comparable allopathic treatment or that will impose a financial burden, based on the patient’s socio-economic status, must be supported by evidence obtained through a randomized clinical trial that has been peer-reviewed.

To my reading, this statement was entirely reasonable. It's a small percentage of medical practice that's based on rigorous randomized controlled trials. The term "sound evidence" requires explication, but it's the best we can claim for much of what we physicians do. The wording of the revised proposal being discussed in Toronto today makes it clear that the same standard of evidence should be applied to "conventional" and "complementary" medicine. But to my reading it retains an appropriately skeptical view of just how solid the evidence is for what is conventionally done:

Any CAM therapeutic option that is recommended by physicians must be informed by evidence and science, and it must:

• Have a logical connection to the diagnosis reached;
• Have a reasonable expectation of remedying or alleviating the patient's health
condition or symptoms; and
• Possess a favourable risk/benefit ratio based on: the merits of the option, the potential interactions with other treatments the patient is receiving, the conventional therapeutic options available and other considerations the physician deems relevant.

Physicians must never recommend therapeutic options that have been proven to be ineffective through scientific study.

I applied these standards to myself with regard to my treatment many years ago of a patient with trichotillomania (compulsive hair pulling). The literature recommended medication and stated that hypnosis did not work. But my patient didn't want to take medication, and liked the concept of hypnosis, despite what the literature said. We agreed that it seemed relatively risk free, and tried it.

It worked. I didn't see the patient again until 20 years later, when the symptoms recurred. A brief repeat of the hypnosis did the job again. (For a more extensive discussion of the case, see here.) I believe the Ontario College would conclude that the treatment met their standards. I had done the hypnosis, but I hadn't recommended it!

If I were in Toronto today I'd vote to approve the College's proposal. Without demeaning "conventional" medicine it implicitly recognizes the degree to which conventional practice rests on uncertainties. And without using the term "placebo effect" it allows for the provision of interventions - "conventional" and "complementary" - that may well derive their efficacy from the placebo mechanism.

(The proposal being considered by the Ontario College of Physicians and Surgeons can be found on pages 248-275 of the agenda for today's meeting. If you're especially interested in the topic, you can read the original policy statement draft here. A summary of the Canadian Medical Association's criticism of the original draft is here.)

Learning from Massachusetts Health Reform

The Blue Cross Blue Shield Foundation of Massachusetts has just published a report on the first five years of Massachusetts health reform. The report provides valuable lessons about how U.S. society can learn to improve access and set limits on costs. It's crucial for us to understanding the learning curve for health reform. Reforming the health system isn't primarily an intellectual challenge. The difficulties are mainly in our own psyches, and among the different players on the health care chess board.

As I see it, the key aspect of Massachusetts health reform is the process by which it came about. Prior to passage of the 2006 law, there were several years of discussions, reports, conferences, committee meetings, and more. From this combination of education, argument and deliberation, what emerged was a consensus that government, employers, and individuals had to share responsibility for making things better. And, at least as important, all that interaction created some trust among the key parties and a culture of civility that is all-too-lacking in the pathetic national non-dialogue on federal reform. The term "Obamacare" is a symptom of the lack of dialogue and civility.

In terms of shared sacrifice: individuals accepted a mandate that we be insured; employers accepted a requirement that they provide insurance or pay into a state pool; and the state accepted responsibility for subsidizing low income folks and for creating a mechanism - the Connector - to administer the new forms of insurance that were made available.

Massachusetts has reduced its uninsured population to 1.9%, compared to the shameful national average of 16.3%. The cost of the subsidized insurance has gone up 3% per year, significantly lower than the national average. Approval of the 2006 law has remained steady at two thirds of the adult population.

Massachusetts explicitly chose to tackle coverage before squaring off with cost. The five year report documents that coverage is relatively "solved." Now the state is turning its attention to cost.

It looks to me as if we're approaching the cost problem the way we approached coverage - with LOTS of talk. We've had multiple reports, all of which say much the same thing - that providers with market clout get paid high prices without delivering comparably superior outcomes, that the entire system has a great deal of waste, and that cost escalation is strangling the businesses, public agencies, and individuals, who pay for care. As I wrote back in March, Massachusetts is the jawboning capital of the western world (see here).

Wise psychotherapists understand that dealing with the resistance to change is the hard part of the work. Once resistances have been dealt with, things get easier. And the late management guru Tony Athos described Japanese management style in the same way - LOTS of process to bring about consensus and then much smoother implementation than we see with our "process-lite" U.S. approach.

I believe, and hope, that what we're seeing in Massachusetts now with with regard to health care costs is creating the human and social infrastructure we need to get a grip on costs. The next report, five years from now, will reveal whether this is true or not.

(The five year report, written by my former colleague Alan Raymond, is very readable. If you're interested in learning more about Massachusetts health reform, take a look.)

Zeke Emanuel on Health Reform

Zeke Emanuel provides an excellent piece of public education about the potential for improved quality of care and cost savings in a recent New York Times blog post. The piece will be especially informative for folks who don't understand how fragmented the U.S. care system has become and how fee-for-service reimbursement promotes the fragmentation. Emanuel concludes, correctly, that there's substantial potential for improving care for patients with chronic illness, and that these improvements can achieve savings for the health system.

But I think Emanuel makes two mistakes in the piece. Both come from misinterpreting the psychological underpinnings of health reform.

First, after describing very lucidly how bundled payments provide financial support for coordination among caretakers, he explains that "the idea is to force all of a patient's care providers to work together." But "force" is the wrong verb here, and it reflects a mistake medical managers make all too often.

Collaborating with colleagues actually makes practice more enjoyable as well as more effective. Working together in ways that help our patients is intrinsically satisfying. When those in charge assume we clinicians have to be "forced" to do something, we buck them. When they facilitate what good clinicians want to do, we do it with pleasure. The idea of global payments is to "allow" and "support" collaboration, not to "force" it!

Second, Emanuel correctly notes that improved care coordination can produce much more savings than malpractice reform. But apart from the question of how much savings a reduction in defensive medicine might produce, the climate of litigation has a corrosive impact on the psychology of medical care and the doctor-patient relationship. In ethics discussions with medical students, residents, and practicing physicians, the first question is typically - "what does the law say - what happens if I'm sued?"

The spectre of malpractice litigation creates a sense that patients and society are potential enemies. Health reform requires collaboration between doctors, patients, and the wider public. Malpractice reform is crucial not just for whatever money it might save for the health system, but for the potential that reform will reduce the degree to which physicians feel under attack.

Heart-Healthly Plant-Based Thanksgiving Recipes

I want to wish you all a very happy and healthy Thanksgiving!!  I hope you enjoy my holiday recipes. The menu is Holiday Wellington, Wild Rice Cornbread Stuffing, Mashed Potatoes with Mushroom Gravy, Sourdough Bread, Tender Green Bean with Mushroom & Lemon Peel, Spinach Almond Salad, Homemade Whole Cranberry Sauce, Vegan Pumpkin Pie & Sparkling Cranberry Juice. This meal is designed to keep your heart healthy, your energy up, taste fabulous and be packed with delicious plant-based nutritious ingredients like kale, sweet potatoes, spinach, apples, green beans, pecans and cranberries just to mention a few.  What a yummy feast of thanksgiving. I have a lot to be thankful for, and one is that I can share my food and nutrition ideas with all of you. You can do a lot of the preparation for this meal ahead of time and finish on Thanksgiving day. Have an absolutely wonderful time with your family and friends.  Please email me if you have any questions at all on the recipes. Stay happy and healthy:)

Holiday Wellington
Adapted from Morgan's Holiday Wellington  Little House of Veggies
Printable Recipe
(Serves 8)

(2) Homemade pastry dough recipes (see recipe below)
1 bunch of kale, washed, trimmed & chopped
8 oz. sliced baby Bella mushrooms
3 yellow onions, sliced
1 large sweet potato or Yam, peeled &amp sliced
1 ½ cups vegetable broth
1 recipe for sage quinoa (see below)
Red pepper flakes

To Make:
• Start the caramelized onions first. Peel and slice all 3 onions. In a skillet or pot, heat 1 Tbsp of coconut oil over medium high heat. Add the onions, along with a pinch of salt and pepper. Sauté for about 3-4 minutes, stirring occasionally. Add in 2 Tbsp. vegetable broth and continue to cook until the onions are darker in color (slightly brown) and have a sweet taste and very tender texture. While the onions are caramelizing, preparing the rest of the ingredients for the Wellington.
• Start by prepping all of your different ingredients keeping them all separate from each other. Heat a large skillet over  medium heat.
• Start with the kale. Heat 1 Tbsp. vegetable broth in the pan. Add the chopped kale, and a pinch each of salt, pepper, and red pepper flakes. Sauté until softened, about 5 minutes. Remove the kale from the pan and set aside on a plate.
• Add another 2 Tbsp. of vegetable broth to the pan. Add the sliced mushrooms, and a pinch of salt and pepper. Sauté about 5 minutes until the mushrooms are softened. Remove from the pan and set aside on a plate.
• Add 2 Tbsp. of vegetable broth to the pan, and add the yams/sweet potatoes. Add a pinch of salt and pepper and sauté 5 – 10 minutes until tender, but not mushy. Remove from pan and set aside on a plate.

To Assemble the Wellington:

Using a rolling pin, roll out dough on parchment paper to a 17” x 14” rectangle. Begin layering the ingredients on the pastry dough. Once all ingredients are layered, roll up very gently and fold and close up all open ends. Put in a baking dish and bake at 350 degrees for about 1 hour. Brush with olive oil when you have about 10 minutes left to help brown. Remove from oven and allow to cool for 10-15 minutes before slicing.

Sage Quinoa
1 cup uncooked quinoa
2 cups vegetable broth
½ Tbsp poultry seasoning

Put all ingredients in a pan and bring to a boil. Simmer with lid for 25 minutes until all liquid is well absorbed.

Pastry Dough (For Wellington & Pie)

Printable Recipe
(Makes 1 pie)

1 1/3 cups unbleached white flour, whole wheat pastry flour or white whole wheat
¼ cup coconut oil
Dash salt
¾ cup water

Put flour and salt in bowl and stir. Spread pieces of the coconut oil around on top of the flour and cut into flour with either a pastry cutter or a fork. Add water all at once and stir into a ball. Dough will be a bit sticky. Flour board and top of pastry ball. Roll into desired shape.

Wild Rice Cornbread Stuffing
Printable Recipe

Wild Rice Cornbread Stuffing By Rachel Spurr, posted on The Kind Life

Serves 6-8

Ingredients
• 2 tbs olive oil
• ¼ onion
• 1 rib celery, cubed small
• ½ apple
• 1/2 tsp rubbed sage
• 1/8 tsp black pepper
• 1/8 tsp sea salt
• 3 cups vegan corn bread, pre-cooked
• 1/2 cup wild rice, pre-cooked
• 2 tbs pecans
• 2 tbs fruit sweetened dried cranberries
• 1/2 tsp poultry spice
• 3/4 tsp sea salt
• 2 tbs parsley
• ½-1 cup vegetable broth

Steps
1. Add the first 7 ingredients to a sauce pan and cook 10-15 minutes or until apples and celery begin to soften.
2. Meanwhile, crumble precooked vegan cornbread into a large bowl.
3. Add wild rice, pecans, dried cranberries, poultry spice, sea salt and parsley.
4. Mix in sauteed mixture, stirring well.
5. Adjust seasonings as desired.
6. Add vegetable broth.
7. For a moisture dressing, more vegetable broth can be added.
8. Place in a well oil pyrex dish or casserole.
9. Bake covered at 350 for 1 hour, uncovering in last 20 minutes of cooking.

Wild Rice
1 cup wild rice
3 cups water

Bring to a boil and simmer until all liquid is gone about 40-50 minutes. Remove lid and fluff with fork. Simmer longer if there is still any additional liquid. Keep lid off until use.

Vegan Cornbread for Stuffing
1 cup cornmeal
1 cup white whole wheat flour
½ tsp. sea salt 4 tsp baking powder
1 Tbsp maple syrup
1 flax egg (make with 1 Tbsp ground flax seed & 3 Tbsp water)
1 cup almond or cashew milk  (make cashew milk by blending 1/4 cup cashews with 1 cup water)

Preheat oven to 425 degrees. Sift together all dry ingredients. Stir all liquid ingredients together and add to dry ingredients. Beat until smooth, but do not overbeat. Bake in a greased 8-inch square pan for 20-25 minutes. Cool and break into pieces to use for stuffing.

Mashed Potatoes & Mushroom Gravy
Printable Recipe

Mashed Potatoes
6 Russet potatoes scrubbed well (leave skins on)
1 recipe cashew cream
Salt and pepper to taste

• Cut up potatoes and place in pan. Cover with water and bring to a boil. Lightly salt water. Boil until potatoes are soft.

• Drain potatoes and place in bowl in preparation for mashing.
• Add 1 cup cashew cream (recipe below) and salt and pepper to taste.
• You can top with a little Earth Balance Butter if desired before serving.

Cashew Cream
½ cup cashews (soak in water for 30 minutes and then drain)
Enough water to make 1 cup with the cashews

After soaking cashews, drain water and then add enough water with the cashews to equal 1 cup. Blend well until smooth and creamy.

Mushroom Gravy
Makes 3 1/2 cups

3 ½ cups vegetable broth, divided
1 cup chopped white onion
4 cloves garlic, finely chopped
 8 oz. sliced mushrooms
2 tsp. dried thyme
1 tsp. dried rosemary
¼ cup apple cider vinegar
2 tbsp Coconut Aminos, Bragg’s Liquid Aminos or Tamari
3 tbsp nutritional yeast
 2 tbsp arrowroot powder or flour
¼ tsp ground black pepper

• In a large skillet over medium-high heat, bring ½ cup broth to a simmer.
• Add onion and garlic and cook for about 4 minutes or until onion is translucent.
• Stir in mushrooms, rosemary and thyme and continue to cook about 2 minutes or until mushrooms release their liquid and start to become tender.
• Add apple cider vinegar and cook 1 minute, stirring constantly. Stir in remaining 3 cups broth and bring to a simmer.
• Meanwhile, in a small bowl, whisk together coconut liquid amino or Bragg’s, yeast and arrowroot powder.
• Add mixture to skillet about 1 tsp at a time, whisking constantly to make sure paste dissolves.
• Bring to a boil and boil 1 minute, stirring constantly. Add pepper and serve.
Mushroom Gravy adapted from Whole Food Market

Whole Cranberry Sauce
Printable Recipe

1 (12 oz.) bag fresh whole cranberries
6 packets stevia (1 1/2 tsp.)
1/3 cup maple syrup (grade B)
½ lemon (juiced)

Add all ingredients to sauce pan. Simmer 10 minutes. Add juice of ½ lemon. Refrigerate to thicken.

Tender Green Bean with Mushroom

& Lemon Peel

Printable Recipe

1 Portobello mushroom sliced
2 tbsp yellow onion diced
¼ tsp oregano
1 tsp olive oil
Salt & pepper

Steam:
1 pound green beans
¼ cup water

Sauce:
Juice of ½ lemon
2 tbsp Vegenaise (grape seed oil)
1/8 tsp dried dill
Rind of 1 lemon (use a lemon zester to produce long thin slices)

• Cook mushroom, onions and oregano in olive oil and season with salt and pepper. Cook until mushrooms look soft and turn color. Remove from pan.
• Add ¼ cup water to pan you cooked the mushrooms in. Add green beans and simmer with lid until all water has disappeared. Remove green beans and place in bowl.
• Mix sauce well and blend with green beans.
• Add mushroom mixture. Add rind of lemon and enjoy.

Spinach Almond Salad
Printable Recipe

1 (10 oz.) bag fresh baby spinach
1 medium Granny Smith Apple
¾ cup toasted slivered or sliced almonds
1 cup fruit juice sweetened dried cranberries

• Place spinach in bowl.
• Slice apple very thin and add to spinach.
• Toast almonds in oven for 300 degrees for around 8-10 minutes and cool. Stir several times while cooking.
• Add cooled toasted almonds to spinach.
• Add cranberries and toss.

Dressing:
¼ cup maple syrup (grade B)
1/3 cup olive oil
¼ tsp salt
3 Tbsp apple cider vinegar
1 Tbsp dried onion or 1/8 small onion chopped finely

Place all ingredients in a blender bottle and shake well. Just before serving, pour dressing over salad mixture and toss.

Sourdough Bread

Adapted from: The Complete Bread Cookbook by Kaufman
Printable Recipe

1 cup sourdough starter (see recipe below)
½ cup lukewarm water
2 tbsp maple syrup (grade B)
3 Tbsp soft Earth Balance Butter
1 cup white whole wheat flour
1 cup unbleached white flour
1 tsp sea salt

• In a large mixing bowl, combine 1 cup starter, water. Maple syrup and butter. Beat well with a wooden spoon until thoroughly blended.
• Add 1 cup whole wheat flour. Mix well. Then gradually add remaining flour until a soft but firm ball is formed. Turned out onto a floured board and knead for 10 minutes until the dough is smooth.
• Turn into a warm greased bowl. Cover and set aside in a warm place until doubled in bulk, about 1 hour.
• Punch down with a wooden spoon, cover and let rise again until doubled in bulk.
• Turn out onto a floured board and knead for 5 minutes. Shape into a ball. Place in a well-greased and lightly floured ovenproof 1½ quart round bowl, or if desired, shape into a loaf and bake in a well greased 9-inch loaf pan.
• Cover and set aside in a warm place until doubled in bulk.
• Make a crisscross on top of round loaf.
• Bake in a preheated 400 degree oven for 35 to 40 minutes or until done. Tap loaf; when it sounds hollow it is done.
• Cook on wire rack.

Sourdough Starter
2 tsp instant yeast
1/3 cup lukewarm water
1 cup lukewarm water
2 tsp maple syrup (grade B)
1 cup unbleached white flour or white wheat flour

• Sprinkle dry yeast over 1/3 cup lukewarm water. Add maple syrup and stir.
• Cover and let stand for 5 minutes until the mixture begins to foam. Add 1 cup lukewarm water, and flour. Beat well with a whisk or beater until well blended.
• Pour into a large wide-mouthed jar. Cover lightly with lid and let stand in a warm place for 2 to 3 days until the starter is a bubbly foaming mass.
• After a day or two the liquid will rise to the top, mix gently with wooden spoon to blend. Use 1 cup of the starter at a time for your sourdough bread recipe.
• After using 1 cup replace with ½ cup flour, ½ cup water and let sit at room temperature for a few hours and then place back in refrigerator with lid on. You can pour off the liquid if it has been sitting in the refrigerator for days without use.
• When ready to use again, add ½ cup flour, ½ cup water, and stir with wooden spoon.  Let sit to warm up and get bubbly. Use 1 cup for recipe and replace with ½ cup flour and ½ cup water. Let sit at room temperature for a few hours and then place back in refrigerator with lid on.
• Repeat this process and you will continually have a sourdough starter ready to use.
• If the sourdough starter ever stops creating bubbles, begin with step 1 in a new jar and repeat process.. Enjoy!!
Adapted from: The Complete Bread Cookbook by Kaufman

Vegan Pumpkin Pie

Printable Recipe
(Makes 1 pie)

1 (14 oz.) can 100% Pumpkin
½ tsp sea salt
1 tsp ground cinnamon
½ tsp ground ginger
¼ tsp ground cloves
1 cup cashew cream (see recipe below)
½ cup maple syrup (grade B)
1 tsp vanilla
4 packages stevia (1 tsp)
2 tsp (Orgran) No-Egg (natural egg replacer) plus 4 tbsp water
1 pastry dough pie crust

• Mix pumpkin, salt, and spices together. Add cashew cream, maple syrup, vanilla and stevia.
• In a small bowl mix 2 teaspoons of the (Orgran) No-Egg replacer with 4 tbsp water. Mix well and then add to pumpkin mixture.
• Place in whole wheat pastry and cook at 425 degrees for 15 minutes. Then turn oven down to 350 and continue to cook for an additional 40-50 minutes. Watch carefully to not over-brown the crust.
• Top with non-dairy whipped topping.

Cashew Cream
½ cup cashews (soak in water for 30 minutes and then drain)
Enough water to make 1 cup

After soaking cashews, drain water and then add enough water with the cashews to equal 1 cup. Blend well until smooth and creamy.

Non-Dairy Whipped Topping
Printable Recipe

1 (13.66 fl. Oz.) Coconut Milk-refrigerate overnight
3 packets stevia (3/4 tsp)
¼ tsp xanthum gum (optional)
2 tsp maple syrup (Grade B)
1 tsp vanilla

Open coconut milk and scoop out all the solid portion and place in whipping bowl. Discard liquid portion. Add stevia and xanthum. Whip until fluffy. Add maple syrup and vanilla. Continue to whip. Store in refrigerator until ready to use.

Public Altruism about Health Care is Alive and Well

Four days ago I discussed Medicare beneficiaries who think about Medicare in terms of future generations and the common good, not just in terms of their own care. That post was triggered by my reaction to hearing this aphorism:

The true meaning of life is to plant trees under whose shade you do not expect to sit.

This morning's Boston Globe included an obituary that made the same point. It told about Paul White, who died at 61 of kidney cancer, after eight years of illness. Here's the relevant passage:

In a life curtailed by cancer there was much to curse, but Mr. White was more apt to speak optimistically about how chemotherapy gave him more time with his five granddaughters and how experimental treatments would provide a foundation for patients he would never meet.

"He just felt he was doing his part," his daughter said. "He kept talking about, 'I'm doing this for the next generation.' I can hear him saying that: 'I'm the guinea pig for the next generation.'"

I've been looking to see if any surveys of Medicare beneficiaries suggest what proportion is moved by concerns about the commons. I haven't yet found what I'm looking for, but I'd predict that it's a substantial number.

The Globe also included this letter to the editor:

Five ways to cut spending on Medicare - from a beneficiary

WHEN SPENDING less on Medicare is suggested, it seems that many people, especially Democrats and those over 65, protest loudly. However, there are ways that Medicare could spend significantly less money without denying anyone medical care that is of value. As a Medicare beneficiary myself, I offer five concrete proposals.

1) Make generic drugs the default for covered prescriptions.

2) Let Medicare negotiate with drug companies on the cost of drugs.

3) Let the Medicare Independent Payment Advisory Board identify medical services that provide little or no benefit, and let Medicare refuse to pay for them, or require significant copayments.

4) For surgery or other major interventions for which there are medically reasonable alternatives, do not pay for those interventions unless patients are fully informed about their alternatives, including no intervention at all.

5) Give providers significant protection from malpractice claims if they can document that patients were well informed before a treatment decision was made.

Congress has made if difficult or impossible for Medicare leadership to take any of these reasonable steps to control Medicare costs. Enacting these reforms could significantly cut Medicare costs with no downside for patients or their doctors.

Jack Fowler

Brookline

The writer is senior scientific adviser for the Foundation for Informed Medical Decision Making. His views here are his own.

Voices like Paul White and Jack Fowler can make an important contribution to our national political dialogue. There's no way to deal with the country's long-term economic health without dealing with Medicare. If enough Americans speak as Paul White and Jack Fowler did it will become harder to argue for the politics of selfishness that our anti-tax zealots are so eager to promote.

Mitt Romney on the Veterans Health System

By temperament I'm an optimist, but Republican pronouncements on health care, like Mitt Romney's proposal for privatizing the Veterans Health system, challenge that stance. Paul Krugman has a powerful op ed on this latest piece of Republican disinformation in today's New York Times.

The Veterans' care system was radically reengineered in the 1990s. It now consistently outperforms the private sector on measures of quality and cost. As Krugman points out, that violates Republican theology. When facts and faith collide, something has to give. Romney isn't dumb, so the differential diagnosis is (1) faith in markets that is so strong he'll deny facts or (2) garden variety political duplicity - (i.e., expeditious lying).

(See this piece in yesterday's Daily Kos for details about the VA program and the Republican knee-jerk assault on public programs.)

Do Medicare Beneficiaries Only Think About Themselves?

This week I spoke with a friend about my conviction that U.S. political process needs a voice from Medicare beneficiaries advocating for a progressive and sustainable approach to Medicare. I told him that although I don't have survey data to draw on, I believe that many of us folks in the Medicare generation are worried about the impact of runaway Medicare costs on future generations. We're not all like the belligerent elders in the AARP advertisement who warn politicians - if you want my vote, don't touch my Medicare.

My friend responded with an aphorism I'd never heard before:

The true meaning of life is to plant trees under whose shade you do not expect to sit.

I do a lot of walking in the woods and love trees, so the aphorism moved me.

I went back to Erik Erickson, to review his interpretation of the stages of life. I discovered that I misremembered his schema. I mistakenly thought Erickson named the healthy approach to aging "generativity." Erickson actually posits that as the virtue for adulthood. "Wisdom" is what he ascribes to the successful 65+ folks. It's opposite is despair.

Erickson may have been on target when he formulated his views 50 years ago, but I think he's wrong for the present. "Wisdom" as he conceptualizes it involves reflecting on the meaning of one's life. That sounds passive and somewhat narcissistic. What I see, and experience, in the Medicare set, is much better described as a quest for "generativity." The question many pose for themselves is - what can I contribute to the world at this phase of life?

Current political dialogue offers two choices for Medicare policy - "don't touch Medicare" or "tinker with the mechanics - raise the age of eligibility or replace Medicare with a voucher to buy insurance."

No one is talking about a cooperative enterprise in which Medicare moves to sustainability via patients and clinicians cooperating to create a more caring, less technological, approach within an overall budget that doesn't saddle the next generations with crushing debt.

There's more than enough money in our current expenditure to provide excellent care for beneficiaries. The way I make the point to knowledgeable friends is to ask - imagine what Medicare would be like if it was guided by the best clinicians from a population-oriented program like Kaiser Permanente!

(The aphorism comes from the title of a book Wes Henderson (1928-2003), a third generation Canadian, wrote about his father Nelson. It's the advice Nelson gave Wes when Wes graduated from high school.)

A Heart Healthy/Plant-Based Thanksgiving Feast

Check out my Plant-Based Thanksgiving Feast Class coming up on November 16th.  Holiday Wellington,  Homemade Cranberry Sauce, Mashed Potatoes with Mushroom Gravy, Pumpkin Pie, Wild Rice Stuffing, Spinach Salad, Tender Green Beans with Mushroom & Lemon Peal  and 100% Whole Wheat Sourdough Bread. I will post the recipes for this heart healthy and yummy meal soon. 

Sister Margaret McBride Speaks Out

Fundamentalist certainty is an understandable, but dangerous, stance in a world that William James famously described as a "one great blooming, buzzing confusion." Believing that our "truths" are true for all, and that disagreement is iniquity, is simpler than dealing with the diverse views of seven billion fellow humans.

Last year Sister Margaret McBride was excommunicated for her role at St. Joseph's Hospital in Phoenix in allowing an abortion to be done to save a pregnant woman's life. In her first public comments since Bishop Olmsted pronounced her excommunication, she told the Arizona Republic (by email):

"My journey over the past year has led me in many directions, but ultimately to a new understanding of forgiveness and mercy...Whether we are talking about my situation, the state of the church or society in general, I believe that forgiveness and mercy are extremely important for each of us...

Our important mission to our community has not changed. This is an extraordinary place with people from every religious background doing the impossible every day. At the heart of St. Joseph's is still our commitment to caring for the poor and ill in our community. Each employee is an inspiration to me every day in carrying out the mission of the Sisters of Mercy," (McBride's religious order, which is active in education, health care and social service worldwide).

According to the article, "sources" report that Sister Margaret has "resolved" her excommunication by going to confession.

Here's my guess about what "resolved" means.

When I did my psychiatry training in Boston, we learned which priests were likely to absolve depressed patients for "sins" like masturbation and which were likely to reinforce what we saw as pathological guilt.

I hope that Sister Margaret has been absolved and recognized as a good Catholic by a wise priest!

(For previous posts on St. Joseph's Hospital and Sister Margaret McBride, see here, here, here, here, and here.)

Cleaning Your Healthy Home

Years ago I had to come up with a solution to not be breathing all of those store bought chemicals. A cleaner that would kill germs without hurting me and my family and leave my home sparkling clean. I have tried a lot of store "green" solutions that are expensive and I haven't liked them either. I am also not fond of having my house smell like vinegar. So, I did a lot of research and came up with a few solutions that I have been using for the last 6 years & love! These cleaners you can make for less than $1.00 per bottle.  Here they are: First the disinfectants: streak free, they smell great and clean everything from kitchen counters, floors, mirrors, toilets to floors, walls, etc.. The first cleaner consists of hydrogen peroxide - 3% (mixed 50/50 with water), tea tree oil, lemon oil and lavender oil. I haven't suffered from sinus discomfort for over 6 years since I started using this solution, and my home is sparkling clean. I also love the aroma therapy as I am cleaning. Any spray top will fit the 32 oz. brown, round peroxide bottle. You can find these round type peroxide bottles at Walgreens. Also, you will need to find a nice spray top that will make cleaning easy. I like the Home Depot spray bottles you can get in the cleaning section.  They are high quality and will cost around $3.79  You can find Rubbermaid bottles at Target, but my favorite are the ones at Home Depot.  You will  need 70% rubbing alcohol for the 2nd cleaner.  Cleaning with both the peroxide cleaner and the rubbing alcohol cleaner are economical and earth friendly. You will also need the essential oils listed below. You can buy them on iHerb or get them at your health food store.  The oils will last you for what seems like forever. Important: Keep peroxide cleaner in the dark brown peroxide bottle to preserve strength.



Lemon oil, tea tree oil and lavender oil are all great additions to your healthy cleaners.

 
Hydrogen peroxide kills bacteria, mold, mildew and fungus. It is non-toxic, which is safer for pets and children.

Tree oil turns out to be one of the most useful of all essential oils, especially as an antiseptic. The antiseptic, germicidal, antifungal, antibacterial immune-boosting qualities of Tea Tree oil make it applicable to a wide range of health conditions. In addition, the antiseptic benefits of the oil allow its use as a natural cleaner and disinfectant within the household environment.

Lemon oil is a wonderful disinfectant as well. It is believed that inhaling lemon oil helps in increasing concentration and alertness - we can all use that!!

As a disinfectant, lavender is effective against the bacteria causing diphtheria, pneumococcus, staphylococcus, and typhoid. Lavender oil is moderately antifungal but because it is so well tolerated, it can be applied directly on the skin, such as for athlete's foot or other fungal skin infections. It is soothing to the nervous system and a great tension reliever! We can all use that too:)

70% rubbing alcohol has antiseptic qualities that enable it to kill bacteria. It can also remove oils and grit from hard surfaces. Cleaning with isopropyl rubbing alcohol is both economical and earth-friendly.

The other cleaner I use is just plain baking soda. I put it in a container that has holes in the top and sprinkle it in my sinks and in my toilet bowl. I also clean my stainless steel pans with it. You can find the clear containers in a lot of grocery stores and even The Dollar Store. I purchase the larger size baking soda which is a super value. It is a great cleaner because it has scrubbing power without scratching surfaces, and it can deodorize and has antiseptic and disinfectant properties as well. Baking soda (or bicarbonate of soda, as it is also known) is a naturally occurring material, present in most organic life forms. It can be "made" from sodium carbonate, or soda ash. The soda ash is dissolved in a carbon dioxide rich solution, and sodium bicarbonate (baking soda) precipitates out.


You can also make your own cleaning towels from cotton t-shirts.   Below you will find the recipes for the cleaners and directions on how to make the cotton white cleaning towels from materials you probably already have.

Enjoy good health in your home!

PURCHASE ESSENTIAL OILS FROM iHerb (Click on links below)
Aura Cacia Lavender Essential Oil $8.21
Aura Cacia Lemon Essential Oil $3.95
Aura Cacia Tea Tree Essential Oil $5.98

 Anti-Bacterial Household Cleaner #1 (Peroxide)
Printable Recipe
Start with a 32 oz. peroxide bottle. You will need to remove half the liquid and then fill the part that has been removed with water. You will now have 16 oz. of peroxide and 16 oz. of water in the bottle.

Add: 10 drops of lemon oil (lemon is an antibacterial, deodorizer and disinfectant)
Add: 10 drops of tea tree oil (tea tree is an antiseptic, antibacterial, antiviral and antifungal)
Add: 5 drops or of lavender (anti-bacterial, anti-fungal and for scent purposes)

Shake before using.  This cleaner is safe on any surface and even cleans mirrors.
 
Anti-Bacterial Household Cleaner #2 (Rubbing Alcohol)
Printable Recipe
1/4 cup 70% rubbing alcohol (anti-bacterial)
Add:  5 drops lavender essential oil (anti-bacterial, anti-fungal and for scent purposes)
Add:  3 drops of liquid dish soap

Add all ingredients to spray bottle and then add water to the 25 oz. mark.
This cleaner is safe for your granite countertops and throughout your home, including mirrors. Shake before using.

Cotton T-Shirt Cleaning Towels
You will need:
 Cotton T-Shirts that you are no longer using.  I like white ones, but you can actually use any color.


Plain white t-shirt.



Start by cutting off the sleeves.



Cut off the bottom seam.



Measure the length and cut across the middle.



Cut off the top section of the t-shirt.



Even out the sides.

Cut  into 4 pieces and enjoy your new cleaning towels.

Union Health Plans and Health System Ethics

On November 1 I blogged about how much I looked forward to meeting the next day with union leaders responsible for overseeing union health plans.

As I'd anticipated, the union leaders evinced a strong sense of solidarity with the insured population and, at the same time, a strong sense of the economic realities of the insurance fund. I presented a diagram I've often used to convey my view of the ethical framework that - ideally - patients, clinicians, purchasers and other stakeholders would use in their dealings with the health system:The idea that we should approach the health system committed to both fidelity to the needs of the individual and stewardship of the resources available for the care of the group was intuitively obvious to the group, as did the metaphor of numerator and denominator that I also like to use::Bringing about a health "system" that is more effective, equitable and efficient in a nation of more than 300 million and a bitterly divided national political process requires won't happen without multiple local initiatives. Oregon, Massachusetts and Vermont show what individual states can do.

The union leaders taught me that union health plans can make important contributions to the national learning curve. Unions are about solidarity on behalf of shared interests. As a population we should be solidly unified on behalf of achieving the best health we're capable of. Sadly, we're not. Union health plans provide a venue in which substantial components of our population are committed to the well-being of each person and, at the same time, to being realistic about how much resource can be devoted to health care. What they learn and demonstrate can help us all.

Can We Afford High Cost Pharmaceuticals?

I'm in New Orleans, to meet tomorrow with a group of union leaders who oversee union health plans. They will have read, or at least - I hope - glanced at "Setting Limits Fairly," the book in which Norman Daniels and I presented the "accountability for reasonableness" framework for curbing unsustainable health care costs.

I'm excited at the prospect of working with union leaders. For them the constituency in the health plans they oversee are fellow union members, not impersonal "covered lives," the unfortunate insurance jargon term for you and me. And they know where the health plan funds come from - their own contributions and, perhaps, contributions from their employers, which could otherwise go into wages.

In advance I proposed four premises for the discussion:

1. Resources are finite.
   


2. There are more potentially valuable things that health care can offer than we can pay for.
   


3. Organizations like unions that provide health insurance will have to learn to work with questions like "how much is life worth?" in a thoughtful and constructive manner.
   


4. High cost pharmacy is a prime area where tough decisions will have to be made.

We'll use two drugs as examples that ultimately require us to acknowledge "how much is life worth?" as a real question. Provenge is a new immunotherapy for minimally symptomatic metastatic prostate cancer not responsive to hormone therapy. It extends median survival for 4.1 months at a cost of $93K. Cerezume is a biologically engineered form of the deficient enzyme in Gaucher's disease. It can produce significant improvements in quality of life for $150K - $250K per year.

In emotional terms, life is priceless. But in economic terms, it isn't.

I'll make the point that avoiding questions about the value of health interventions is a major reason we're in the mess we're in now. We won't solve the cost dilemma until we learn to think in terms of both numerator (my needs and desires) and denominator (the insured population's needs and desires). I'll make the further point that this kind of learning is more emotional than cognitive. And it takes time, so a long term strategy is necessary.

Union health plans, which are likely to have a high degree of solidarity among the insured population, are a promising venue for thinking this way. I hope we'll be able to probe health care costs as "our problem" rather than as something "they" are forcing on us.

I'll write more after I meet with the union leaders.

myPennMedicine: Giving Patients Access to their Online Medical Records

Penn Medicine patients now have access to their online medical records through myPennMedicine. Currently, Penn Medicine is the only health system in the region to offer patients this online health management tool. It gives patients the ability to submit routine requests for prescription refills, referrals or appointments as well as view lab results, medication lists and health summaries without having to pick up the phone.

Learn more about myPennMedicine and register to win a free iPad

Penn Medicine Wants You to Stay Healthy: Get Your Flu Shot Today!

Vaccination is the best protection against contracting the flu. The Centers for Disease Control and Prevention (CDC) recommend that everyone six months of age and older get vaccinated against the flu as soon the 2011-2012 vaccine becomes available.

“Every flu season, different flu viruses develop and spread,” says Charles Schwartz, MD, PennCare® for Kids. “The flu can affect people differently based on their body’s ability to fight infection.”

That is why yearly vaccination is critically important for protection against the flu. Penn Medicine has received its supply of flu vaccine and mist and the staff urges you to make an appointment today.

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