Food Friday: Food Gifts

Tis the season to start firming up your holiday gift plans. To do this, remember that gift giving is supposed to be fun. It shouldn’t stress you out, or be unduly expensive. It should be personal. Finally, we all know the best gifts are home made. 

Here’s a list of ideas that should get you cooking on some fun food projects that will make great gifts. For more ideas, think of what you are really good at preparing. And, if you are still at a loss, then just consider what you might like to get ! 

Holiday food gifts divide themselves nicely into several categories: 

1. Baked goods, from cookies and cakes to fancy breads. You can even leave your cookie dough uncooked in a roll of waxed paper, and package them nicely for refrigeration. This is the so called “ refrigerator cookie “ which you can slice off as needed and “ bake” in the toaster oven. 

2. “Kits" for baked goods, cleverly packaged in, for example, a mason jar. Decorative recipe cards are included. 

3. Homemade candy, since it is a project to make. Brittles and toffees are classic, but truffles are highly prized. 

4. Candied or spiced nuts, since they are festive and because they are handy for entertaining. 

5. Other mason jar “ kits”, for soup, spiced hot drinks like chocolate, coffee, or chai. 

6. Spice mixes in nice containers. 

7. Preserved goods such as jam, jelly, and pickles. Of course if you live in the northern hemisphere it is not summer at Christmastime. Thus you will not have fresh fruit and vegetables to preserve. But you can still make preserves from other things, like wine ! You can make jelly from wine and even from balsamic vinegar. Plus, it only takes a few hot peppers to make some colorful hot pepper jelly. 

8. You can make infused oils and vinegars and use pretty bottles. 

9. Food kits can become more elaborate if you include equipment and table dressings. Consider a sushi themed basket with rice, seaweed, sushi rollers, pickled ginger, horseradish, chopsticks and dipping bowls. 

10. If you are super short on time, you can present someone a “ coupon “ for a dinner catered by you, or even just a batch of brownies. 

Food gifts are really fun to receive. This is especially true is you package them artfully and with care. Craft, fabric and even grocery stores have great materials for wrapping. I am partial  to unbleached parchment paper and plain brown cooking twine. You can add natural embellishments like pine cones, or evergreen twigs. You could even tie in a small wooden spoon. 

Whatever kind of gift you chose to give, just make sure that there is a little of you in it. 

Wellness Wednesday: Cold Weather Workouts

Now that the temperatures are dropping and the outdoors is frosty, there are a few cold weather tips you need for working out outside. 

• Chose safe routes. Avoid iced over rivers of uncertain stability. Winter roads can be icy. One winter run of mine a few years ago landed me in a CT scanner, since I slipped, fell and hit my head on the ice. All was well, but it was no fun and showcased my imprudence to all my friends in the emergency room. Plowed roads or snowpack can work well, but you still have to be on your guard for black ice. Despite your best efforts, you may fall and injure yourself, so always carry your cell phone or go with a buddy. Some have suggested a loop close to home so you are are never far if you have to limp back. 
• In your first excursions of the cold season, go for less time than you usually do, to see how you adapt. You can always work up gradually later. This is especially good advice if you have asthma or other medical conditions. 
• Don’t forget sunscreen, especially in bright snow white conditions. Likewise wear appropriate eye protection for sun, snow and ice .
• Warm up and cool down as always. However, in the case of cold weather, do it inside. 
• Dress in layers, so you can stay warm but not overheat and sweat too much. Start with a wicking layer, followed by insulation, and then a shell. Always include a hat, which adds warmth without bulk and can help prevent frostbitten ears if it has earflaps. Consider a neck gaiter to keep the mouth and nose warm. Absolutely wear gloves to prevent frostbite. 
• Check the forecast before you go, factoring in not only temperature but precipitation and windchill. Tell someone where you are going and when. 
• Have an indoors workout alternative if it is just too challenging out of doors, preferably an indoor alternative at home, such as a workout DVD you can do in your living room or basement. 
• Do not mix alcohol with any workout. Be aware that alcohol degrades decision making, and masks symptoms of hypothermia. 
• Know and recognize the symptoms of frostbite, whiteness, tingling and pain. Know, recognize and heed the signs and symptoms of hypothermia: shivering, confusion, fatigue and slurred speech. Hypothermia is medical emergency and must be corrected right away. 
• Avoid cold weather exercise in the face of dehydration, inadequate calories or sleep deprivation. These can limit your bodies ability to thermoregulate. 

Working out outdoors in the winter requires extra preparation and mindfulness. However, there are some major benefits: Winter workouts produces a bigger endorphin boost than working out in warm weather. You burn more calories in the winter and train a bit harder. And it is invigorating to be out in the weather, and the landscape is often stunningly beautiful. Getting outside in the winter is important for fitness, but it also improves attitude and mood as well. All in all, is it something you should add to this season’s workout mix. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

California and Oregon will soon allow pharmacists to screen patients and prescribed birth control pills. While the American College of Obstetricians and Gynecologists considers this a step in right direction, they believe they should be available over-the-counter, plain and simple. While it is true that low dose combination birth control pills can have medical complications in a very small percent of people, by and large their health benefits far outweigh their risks.

As most of you probably are already aware, hepatitis C has a new medical treatment which provides a cure in a very high percentage of people. However, hepatitis B has remained a challenge, and in particular, we have had to deal with the problem of vertical passage of the virus from mother to baby during pregnancy, labor and delivery. However recently at the meetings of the American Association for the Study of Liver Diseases, new research was presented. In the course of a randomized controlled trial, a drug called Tenofovir was shown to be able to reduce vertical transmission. 

Yet another encouraging recommendation about exercise in pregnancy has been released. According to the American College of Obstetricians and Gynecologists, nearly half of US women gain too much weight while they're pregnant. We all know that women who gain too much weight in pregnancy are very uncomfortable. However they also have higher rates of miscarriage, premature birth, stillbirth, and babies with birth defects. They’re also more likely to have heart problems, sleep apnea, gestational or pregnancy associated diabetes, preeclampsia also known as toxemia, and abnormal blood clots. They are at higher risk for cesarean section. So there are ample reasons to find ways to control this weight gain. 

The new memo released by ACOG advises pregnant women to exercise regularly and more often than they currently do. The memo states that while walking is the best exercise, jogging, Pilates, yoga, cycling, swimming, and other forms of exercise are perfectly acceptable. ACOG cautions against contact sports such as skiing, and other specialized sports such as scuba diving.

More good news: it appears that breast-feeding for two months or more reduces a gestational diabetic’s risk of developing type II diabetes later in life by 50 %. Moreover, the risk of diabetes lessens as the patients breast-fed longer.

Finally, here is some good news that initially sounds a lot like bad news. Since 2010, there has been a significant increase in the number of women under age 26 who have received a diagnosis of early-stage cervical cancer. In the next age group, 26-34, the numbers were unchanged. What changed for the younger age group? The answer is the availability of insurance. One of the features of the ACA, The affordable care act, was to allow children to stay on their parents insurance plans through the age of 26. Most likely the increase in diagnoses came from increased compliance with recommended screening, i.e. pap smears. Once again, we are reminded that appropriate screening leads to early diagnosis, which leads to less invasive treatments, fewer complications, and higher rates of cure. 

Stay tuned for more breaking news from the world of OB/GYN next week on Medical Monday.

Food Friday: After Thanksgiving

How was your thanksgiving ? Not flawless ? That's ok. Take this time to decide how to make the rest of this weekend worthwhile. 

Our family and friend group has a leftover party every Thanksgiving Friday. Pies are featured as well. Turkey soup and turkey pot pie are great options. 

Consider this time, your leftovers, your pies, friends and family and be grateful.

Wellness Wednesday: Holiday Wellness

Here are just a few tips to make this most intense part of the holiday season less stressful, more relaxing and more celebratory. 

1. Take a look at your calendar from now until New Years. Make sure you are neither overbooked, nor forgetting about events that are meaningful to you. Make sure the schedule is realistic and that your family members are all on board with the plan. 

2. Take a hard look at your budget and stick with it for your Holiday expenditures. A great source of holiday stress is financial. Reduce costs by decorating with natural elements, entertaining pot luck, and by making or baking homemade gifts. Consider also gifts of outings. For example, give a certificate good for “one Sunday afternoon walk in the park with me”. 

3. Ramp up the consistency of your workouts. You will feel better about yourself and avoid the Holiday weight gain. 

4. Be choosy about your indulgences. Eat slowly and savor your treats. Drink ample water through the day, and be sure to consume the sights and sounds of the season, not just the tastes. Consider being the amateur event photographer of the family. It takes your appreciation of the season far beyond the food. 

5. Relatives coming from out of town ? Make a sound plan for their accommodations. A little advance planing can save a lot of stress. 

6. Anticipating stressful interpersonal encounters ? Plan ahead and adjust your attitude. Try to see the good in everyone. Blessed are the peacemakers. 

7. Bon chic, bon genre - This is a French saying meaning that if you dress well, you bring your best self forward. Dress to present yourself thoughtfully, and to indicate your respect, enthusiasm and cheer. Never dress to impress. Dress to delight and to put others at ease. 

8. Consider the deeper meaning of the season. This is, of course, the best way to put the shine on the season. 

Happy Holidays from Dr. Gina 

A very nice reference for more reading : 

http://www.clevelandclinicwellness.com/Features/HealthyHolidayCelebrations/Pages/introduction.aspx#

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Happy Monday on this short week ! This week in honor of Thanksgiving I plan to apply the filter of gratitude to the news that I feature. Let’s see how this works out. 

The LA Times recently reported on the actual C Section rate in the US ( 33%)  as compared to the theoretical ideal of 15 %. An ACOG (American College of Obstetricians and Gynecologists) spokesman indicated that this discrepancy was largely about risk tolerance of the involved parties. Gratefulness filter: Le’t be glad we live in a place where C sections are readily available to those who need them. 

Findings coming out of the African American Cancer Epidemiology Study indicate that black women with the healthiest diets were 34 % less likely to develop ovarian cancer that their counterparts who ate the most unhealthy diet. Gratefulness filter: Diet is an easy factor to modify !

Findings presented at the American College of Rheumatology indicate that Denosumab was superior to Zoledronic Acid ( Zometa) at restoring low bone density due to osteoporosis. Gratefulness filter: This is great news for all with low bone density ! 

The Supreme Court rejects the case against Planned Parenthood. Justices Scalia and Thomas dissent. Gratefulness filter: Let is be glad we live in a country that respects free speech of differing parties, that observes due process and the rule of law. 

About 10 % of all new mothers suffer from post partum depression. New York is rolling out a ambitious program which will require that all expectant and new mothers will be screened for depression. Gratefulness filter: Thank goodness awareness is increasing about this important and treatable problem. 

Rhode Island has a new state mandate requiring HPV vaccine for youngsters. Nearly three quarters of seventh graders received it by the start of the school year. Gratefulness filter: Thank goodness we have a way to prevent cervical cancer. 

Count your blessings this week and stay tuned for more news from the world of OB/Gyn next week on Medical Monday ! 

Food Friday: Fruit Muffins 2.0

Fruit muffins were originally an attempt to use up borderline fruit and to make regular muffins (Fruit muffins 1.0) more healthy. They have since become a family favorite. 

You may not need to make fruit muffins before Thanksgiving but you will most definitely need to make them afterwards. That is why I am giving you the recipe this week. You see, you will have left over items from Thanksgiving, and most likely you will make soup out of these premium ingredients. It follows therefore that you will need muffins to go with your soup.

Fruit muffins 2.0 is a flexible recipe. You will see a lot of variations and there are a lot of workable substitutions. 

Adjust your shelf to the upper third of the oven and preheat to 350 degrees F. 

Equipment

• Two cupcake tins each holding 12 cupcakes.
• Unbleached cupcake papers, usually available at a natural food store

Ingredients

• 3 1/2 cups whole wheat pastry flour or whole wheat flour fine grind ( use white if you must but the result is less rich.. you may need more flour too) 
• 2 teaspoons baking powder
• One half teaspoon salt
• One and 1/2 half teaspoons baking soda
• 1/2 cup butter, or one half cup coconut oil can be substituted
• 1 1/2 cup sugar, can be cut to 1 1/4 cup
• Two eggs
• 4 tablespoons lemon juice (equals one quarter cup)
• Six bananas
• or 3 bananas +3 cups mixed fruit such as strawberries, diced fresh apple, dried cranberries.
• Zest of one orange if you have it

Most baking recipes like this one proceed along a typical pattern:

• Cream the liquid ingredients first starting with the butter in the sugar by themselves.
• Add eggs at this stage and whip mixture until fluffy. 
• Add the lemon juice and whip again. 
• Mix in all the fruit and the zest. 
• Whisk together the dry ingredients so they are thoroughly mixed. 
• Stir or fold them thoroughly into the wet ingredients. 
• Scoop with a large ice cream scoop into the muffin papers. 
• Bake 19 -24 minutes ( usually 23) until golden and slightly firm, and passing the sharp knife test. 

Transport in their tins to serve warm to happy friends and family, or to crabby ones and watch their mood improve. These are great served with cold milk. 

Have fun cooking this week. Clean , decorate, cook, and forget perfection. Make cooking a fun group activity. Make it healthy with selected treats and family traditions. Get along with everyone as best you can. Most of all, be grateful. 

Wellness Wednesday: Nature and Health

Tonight I attended the Banff Mountain Film Festival as I have done almost every year for the last 20 years. This film festival is a celebration of mountain culture and the outdoor lifestyle.

Mountain culture means a certain thing to me, my family and my friends. Understanding what this means can shed some light on what it means to be healthy. 

I could say it means high adventure like ice climbing, parasailing, and extreme skiing. I could say it means having a community where fitness is highly valued. I could say it means being outdoorsy. I could say it means being active in the environmental community. But it is not exactly just these things. 

It is a little but of each of these things. But mostly it is this: it is connecting WITH  people IN nature. We know from the social sciences that being connected to others is critical to health and wellness. We also know that immersion in nature is critical to our well being. Numerous studies have demonstrated that exposure to or immersion in nature improves the following: 

• mental health

• immune system resistance

• reduced stress

• reduced anxiety 

• reduced anger

• reduced fear

• increased positive mood

• increased feelings of unity with others, more sense of community

• more concern over helping others 

• enhanced social interactions 

For children, exposure to nature has been associated with the following:

• reduced stress levels, increased fitness 
• reduction in ADHD symptoms 
• enhanced student performance on tests of critical thinking 

The data on the subject of nature and health are fascinating, overwhelming and encouraging. Check some out for yourself: 

University of Minnesota

Health Promotion International

National Wildlife Federation

American Public Health Association

Stanford University via Science Alert

The Lancet

University of Washington

Norwegian University of Life Sciences

No matter where you live, be it city or country, this is important for you to know. You and your family need your time in nature, no matter the season, no matter whether you live in the mountains. coast, desert or plain.

You should keep an eye out for any outdoor film festivals in your area as they are sure to inspire. Our local festival out of Banff is sponsored in part by National Geographic. I was intrigued by their stated interest which was the intersection of “science, adventure and storytelling” . Go out and get some for yourself. 

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

The HPV vaccine has recently been vetted at the European Medicines Agency (EMA, the equivalent of the FDA). The EMA concluded that the benefits of Cervarix and Gardisil outweigh the risks. CDC (Center for Disease Control) Director Tom Frieden estimates that increasing the HPV vaccination rate to 80% would prevent 50,000 cases of cervical cancer in women.

Echoing results from last week, a study published in the Journal Hypertension has shown that those who had high blood pressure in pregnancy double their risk to develop the condition later in life. For diabetes, the risk quadruples.

Our largest and most foundational study on postmenopausal hormone therapy, the Women's Health initiative, (2002) was noteworthy for the fact that overall “estrogen plus progestin hormone replacement therapy" increased risk of "heart disease and breast cancer”.

Well the devil is always in the details, and sometimes angels too. It turns out that age makes a big difference the development of heart disease risk. If you “unpack" the data, you will see that women between the ages of 50 and 59 actually had a protective benefit to using hormone therapy, while women over 60 did not have the same advantage. Is interesting to remember that in this study all study participants  had never before taken any postmenopausal hormone replacement therapy. Therefore those who were 60 and older entering the study were beginning their hormone therapy approximately 10 years after the onset of menopause. Some researchers believe that it is that block of time after menopause but before initiation of hormone therapy in which silent atherosclerotic developed. If this is true then cardiovascular disease manifesting during the course the study would not really have been caused by the hormone replacement under study. Optimistic speculation leads us to wonder if women over 60 would do as well as their younger counterparts if they're hormone therapy has been started at the onset of menopause. It would be nice to know whether or not it is the youth of the women that caused them to do well with hormone therapy in their 50s or the fact that they started their hormone therapy immediately after the beginning of menopause.

It is interesting to note that age at the beginning of the study did not affect a woman's risk of breast cancer. Use of "estrogen plus progestin hormone replacement therapy” was and is clearly associated with increasing risk of breast cancer. (The same cannot be said for those who are able to use estrogen alone as their hormone therapy.) The lead investigator in this most recent study, Dr. Joanne Manson, indicated that "for every 1000 women per year not using hormone therapy, about 3 develop breast cancer” versus 4 out of “every 1000 women” using combined estrogen plus progestin hormone therapy.

A recent study has shown that only about half of women visited the dentist during pregnancy. Dental care in pregnancy is critical since many oral and tooth diseases have a direct impact on the pregnancy including increased risk of preterm labor.

Former Republican representative from Georgia Phil Gingrey has criticized the recent US Preventive Services Task Force (USPSTF)  recommendations on mammography citing the differing recommendations of the USPSTF, the American Cancer Society, and the American College of Obstetricians and Gynecologists. He has urged for more time to study the basis of these differing recommendations, so that we can "analyze the research and arrive at a medical consensus”. He has introduced a bill entitled “Protect Access to Life-saving Screenings”, (PALS). This bill would place a two year moratorium on the USPSTF recommendations.

I am all for this and I dare say a great deal of unpacking the data will be necessary here. What will be important in the conversation is identifying the “harms" of screening. And please don't talk to me or the breast cancer survivors in my life about fear of and pain from mammograms, which have been cited by the USPSTF as harms. Besides this, it will also be imperative to study endpoints, not only survival, meaning and lack of death, but years of life. It seems like a subtle distinction but it seems to have been lost on the US Preventive Services Task Force thus far.

Support has come out for treatment of subclinical hypothyroidism (low thyroid) in pregnancy. A new study presented at the International Thyroid Congress has shown that treatment with synthroid or Levothyroxine in pregnancy for those with subclinical hypothyroidism “was associated with decreased low birth weight and Apgar scores". It was not however associated with a significant decrease in miscarriage. This will probably tip the wobbling scales in favor of universal thyroid testing in pregnancy. 

Any study recently published in the December issue of Obstetrics and Gynecology has shown that yoga is safe even late in pregnancy. Study participants were put through various yoga postures and measurements were taken of heart rate, blood pressure and other vital signs for mother and or baby. Although mothers often opted for various modifications of their poses, no ill effects were found.

In more happy news, the United Nations and the World Bank jointly issued a report Thursday noting that maternal death rates have dropped 43% worldwide since 1990. This is attributed to better access to higher quality health and sex education services.

Stay tuned for more news from the world of OB/GYN and women's health, next week on Medical Monday.

Food Friday: Wild Rice Stuffing

You will not believe the ingredients for this recipe. When you assemble the ingredients, it looks like you're going to make a salad. But the result is as hefty and savory as the Thanksgiving turkey itself.

This recipe is best made by crowd since there are a lot of ingredients to prepare. Additionally it is best to start a day ahead. On Thanksgiving day, ingredients should be prepped two or three hours ahead of when the turkey will be done. Finally, be advised that this stuffing does not actually stuff the turkey. It is much safer, much quicker, and just as delicious to bake the stuffing in its own separate pan, which incidentally, is anything ovenproof, such as metal, glass, or ceramic.

For cooking you will need at least two large frying pans, prep bowls, and a big bowl for mixing.

Budget at least one cup of stuffing for each guest. This recipe makes at about 8 cups.

Ingredients

• At least 4 cups of cooked wild rice, cooked the day before
• 2 cups dried fruit soaked overnight in the wine of your choice, and minced. Our favorites are craisins, dried pears, dried apples, or dried plums. 
• One cup sliced or slivered almonds, toasted carefully on a metal pan under the broiler. Be careful since they go from perfect to burnt in a few seconds.
• Two tablespoons minced garlic
• Two onions diced 
• One generous bundle of parsley chopped
• Two bundles of green onions chopped
• 2 cups celery chopped
• One green apple and one red apple, diced
• Zest and juice of one orange
• 2 cups mushrooms, sliced if desired
• 1/4 cup dried spice of your choice; See my recipe for "family spice" below
• About 2 cups strong turkey or chicken broth
• Olive oil to sauté
• Kosher salt and freshly ground pepper to taste

Directions

As a general rule, you will begin sautéing the ingredients one by one or in groups from hard to soft. That is to say, you cook the ones that take the longest first. Cook each of these until they are almost perfectly done. Sauté the minced garlic, onions and celery in olive oil. Go slowly enough so that they caramelize and do not burn. Set these aside and sauté the apples. Add green onions and parsley and sauté these. Set aside. Sauté the mushrooms until slightly browned. Salt and pepper each batch lightly as you go. You can always add more at the end.

Mix all of this with the rice, the dried fruit, the flavored wine, the almonds, the zest and juice of the orange, and the spices. Mix everything thoroughly. Adjust seasonings. Press the mixture evenly into the pan or pans. Moisten everything lightly with the broth. Do not feel compelled to use all of the broth. 

At first, you will be cooking the pan with foil on top at 375° to finish cooking the ingredients and blend all the flavors. This will take somewhere between 30 and 45 minutes. The mixture should end up moist but not soupy. In the last 15 minutes you will want take take the foil off and watch carefully to brown the top. 

Serve beside the turkey or separately. Once served, refrigerate promptly. It reheats very well.

Family spice

• Two parts ground rosemary
• Two parts thyme
• One part basil
• One part tarragon
• One part of oregano

Happy cooking ! 

Wellness Wednesday: Gratitude is at the Center of Wellness

Most people think of gratitude as a feeling. Actually, it is a practice. Did you know that there is a science of gratitude?

Major academic centers the world are investing in gratitude. Gratitude is studied as a part of a relatively new branch of Psychology called Positive Psychology. A landmark study in the Journal of Personality and Social Psychology, 2003, volume 84 number 2, entitled “Counting Blessings versus Burdens: an experimental investigation of gratitude and subjective well-being in daily life." This research suggested that”...a conscious focus on blessings may have emotional and interpersonal benefits”.

Much more recent research since then has also underscored the physical health benefits of gratitude. Most of us understand by now that the mind and body are connected on a neurophysiologic level, and while it is fascinating, it is no surprise that a mental practice such as gratitude could go on to have concrete benefits to physical health. 

What is gratitude, the practice?

Prof. Robert Emmons, the author of”Gratitude Works !" recommends establishing a full on gratitude ritual. These can include the following:

Gratitude Works!: A 21-Day Program for Creating Emotional Prosperity

$14.88

By Robert A. Emmons

Buy on Amazon

• Make a resolution or vow to practice gratitude. 
• Make a plan to practice gratitude. 
• Have a morning gratitude ritual. Examples would be glancing over your gratitude journal or meditating for a few minutes about what you are grateful for. 
• Adopt the physical habits of gratitude such as smiling and making eye contact, saying hello,, saying please and thank you, and making a physical gesture such as handshaking if appropriate.
• Send written expressions of gratitude such as emails and thank you notes in paper.
• Place objects or other visual cues in your house, office, or where you can see them to remind you of something for which you are grateful.
• Keep a gratitude journal. Make it brief but make it regular. If you keep it by your bed you can glance at it first thing in the morning.
• Go out of your way to remember good times.

What will a practice of gratitude do for you?

There is an enormous body of science from a variety of sources that indicate the following effects of gratitude:

• Stress reduction
• Improvement of a immune function as measured in the bloodstream.
• Better recovery from loss, i.e. Better resilience
• Higher levels of life satisfaction.
• For students,better grades.
• It makes you a better friend to others.
• Improved sleep.
• Strengthens interpersonal relationships
• Improves team functioning 
• Greater alertness
• Greater enthusiasm
• Greater goal attainment.
• Lower levels of depression
• Enhanced capacity for empathy
• Improved self esteem
• Reduced aggression
• Decreased loneliness
• Greater tendency to act with generosity and compassion
• Increased energy.

Gratitude

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By Oliver Sacks

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This is not just new age foo foo nonsense. Institutions such as Stanford, Harvard, and Penn, not to mention Google have thrown serious money, time, and entire departments into the pursuit of the evidence based effects of gratitude.

So this Thanksgiving, capitalize on this most important of national holidays. Find your gratitude, and keep it going. 

References and Additional Reading: 

Pass the Gratitude: Recipe for a happy Thanksgiving, From Huff Post Los Angeles

In praise of gratitude, from the Harvard Mental Health Letter

Seven scientifically proven benefits of gratitude that will Motivate you to Give Thanks Year-round from Forbes

Expanding the Science and Practice of Gratitude, From the Greater Good Science Center at the University of California, Berkeley

Why gratitude is Good for You, From the Stanford Social Innovation Review

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

Happy Monday ! This week, in addition to reading the news and doing your normal workweek, you get to start seriously preparing for the holidays.  Enjoy the process !

Postpartum depression is in the news again, and this is a good thing. “ Shots” blog by NPR ( National Public Radio ) has run a story about a woman, Paige Bellenbaum,  who went through this. She has since recovered and has become an activist on the subject, and helped to write a bill in New York “ aimed at educating more families on the symptoms of maternal depression.” The bill also promotes screening through the Pediatrician's office. Early treatment for postpartum depression is, of course, more effective. 

Research findings presented at the NCI ( National Cancer Institute’s) annual conference underscored that increasing parity ( the more children you have ) reduces risk of ovarian cancer. The first child reduces the change of this cancer10% and each subsequent birth reduces it 8% more. While no one would decide the number of children they wanted based on this, it is interesting and may spur further research about how ovarian cancer comes into being the first place. Hopefully this will ultimately yield clues on how to prevent and treat this awful disease. 

New research published in the Journal of Diabetes Care indicates that women with central obesity (higher levels of abdominal fat) are more likely to develop pregnancy associated diabetes here. Of course it is also known that women who get gestational ( pregnancy associated diabetes) are more likely to get Type 2 Diabetes later in life. Moral of the story: Get in good shape and at your correct weight before pregnancy and in-between each delivery. 

Also hot on the trail of gestational diabetes (GDM), s study presented at the Conference of the Society for Endocrinology indicates that women who are sedentary in the first trimester are more likely to get GDM. They defined sedentary as sitting more than 6.5 hours per day. Has anyone ever tried a standing desk ? Personally I think the best thing at work is to alternate siting and walking about at frequent intervals. Also naps, mid afternoon. Wouldn’t that be cool ? 

The CDC ( Center for Disease Control) reports that half of pregnant women are gaining too much weight in their pregnancy. IOM ( Institute of Medicine ) recommendations indicate women with a normal BMI ( body mass index) gain about 18.5 an 24.9pounds. Smaller women should gain more and larger women should gain less. 

Wow this week's news sure had some common themes. 

To help you stay in the know very quickly, don’t miss Medical Monday.

Food Friday: Carbohydrate Intolerance

“ Hey wait, I thought food Friday was supposed to be a celebration of good food and eating !” Of course it still is. I just want to talk a little bit about how to understand your own metabolism and to leverage it for your health and for your enjoyment. Bear with me for a little science.

Carbohydrate or carbs is a term we hear frequently in popular media. But what exactly are they? A carbohydrate is a compound that contains carbon, hydrogen and oxygen. These molecules are linked together in such a way as to store energy. In their simplest form, they are sugars like glucose. When they are linked together like Legos they become starch, which is really just a storage form of glucose. 

Glucose is the body's principal energy source, its fundamental fuel. But as with most things,too little or too much is a problem. A young, healthy, non-pregnant body will manage its fuel very efficiently. The silent internal workings of the body's physiology will keep circulating levels of glucose within a close ideal range, even during periods of dietary excess and periods of dietary scarcity. The main regulators here are insulin and glucagon. Insulin is a pancreatic hormone that brings glucose from the circulation into the cell where it can be used for fuel. Glucagon has the opposite effect. When blood sugar levels go low, though lack or food or periods of high demand, glucagon goes into action and mobilizes stored starch to be broken down releasing glucose into the bloodstream. 

When we become overweight or pregnant or older, this process works less well. In particular, the cells do not respond as well to insulin. I am not speaking of diabetics here. This tendency is true of everyone. When we do not process our blood glucose efficiently, specifically when we become less sensitive to our own insulin, we are said to be carbohydrate intolerant.

A vicious cycle can then ensue. When we cannot bring glucose from the bloodstream into the cell by the action of our insulin, the concentrations of glucose in the bloodstream becomes abnormally high. This leads to the formation of fat in our tissues and in particular our arteries. This of course, leads to cardiovascular disease.

Under these circumstances, our insulin levels also become chronically high in an attempt to bring the blood sugar down. This is called hyperinsulinemia, and it is thought to be a precursor of type 2 diabetes. Moreover, hyperinsulinemia alone is associated with “ Metabolic Syndrome” , the unholy quartet of hypertension, obesity, high cholesterol ( or triglycerides) and glucose intolerance. 

How can you short-circuit this vicious cycle? Well, no one can avoid aging if they're lucky, and many people choose to become pregnant. Avoiding obesity is the best way to avoid carbohydrate intolerance because, as you have no doubt gathered by now, obesity leads to carbohydrate intolerance, and carbohydrate intolerance leads to more obesity, a vicious cycle. That is one of the reasons why it is so hard for people to lose weight once they have become obese. It is far easier to avoid obesity in the first place than it is to correct it after the fact.

But there are many obese people who are intent on losing their weight and getting healthy. Here's the good news for them, and for the rest of us wanting to prevent these problems. If we minimize sugars and simple carbohydrates (like starch) in our diet and keep a steady intake of meals and snacks with high quality fruits, vegetables, proteins and fiber, our blood sugar levels will trend toward the steady and normal, both necessary to avoid the development of carbohydrate intolerance.

If we add steady increasing levels of physical activity every day and, as a result develop increased exercise tolerance and increased muscle mass, we will have synergistically increased our metabolic rate. We will feel more energetic, and as a result be more active. A virtuous cycle will set in! 

Here's the real newsflash: I am asking all my patients to pay more attention to food. In fact, I am almost certainly asking them to eat better food, in greater quantities, more frequently. In fact I would be thrilled if all of my patients made healthy food a lifelong hobby. Sourcing high quality food, searching for recipes, trying new things, and entertaining with healthy recipes is a lot of fun.

So with the holidays approaching, do not worry. Get excited about finding some great healthy recipes. And maybe plan a frosty family walk outside on your Thanksgiving morning, or between dinner and pie. 

Wellness Wednesday: How to Start Your Fitness Routine

There are people out there who experience lasting fitness breakthroughs. They all have to start somewhere. This week's post is about how you can start your fitness regimen. 

How do you break out of your rut? By creating a new rut. A lot of people have good intentions and a lot of people have brute force discipline. But that's not really what it takes.

What does it really take? It takes a good set up. You have to set yourself up for success.

As with any goal, your goal of starting fitness needs to be SMART.  

SMART means: 

• SPECIFIC
• MEASURABLE
• ATTAINABLE 
• RELEVANT
• TIME BOUND 

1. Specific- Decide what you are going to do. I suggest beginners either go to a class at an accredited health center, gym or, as a lower cost alternative get a selection of appropriate fitness DVDs for home use. One great regimen is every other day at the gym interspersed with every other day at home with a DVD. Always take at least one or two days off a week. On those off days you may do gentle yoga to perpetuate your habit and stay limber. 

Being specific also means that you know exactly what you are going to wear and exactly what you are going to do to start the workout. For me, this means coming home from work, changing into my exercise clothes, turning on my DVD player, grabbing a glass of ice water, and then putting on my workout shoes. By then, the workout is as good as done. I do it the same way every time to create and reinforce a habit loop.

2. Measurable-Consult with your doctor about how many days a week you should work out. I suggest no less than three and no more than six, preferably 5 to 6 days per week. When you are a beginner the duration of your exercise should be no more than 30 minutes and possibly closer to 20.

Very importantly decide on a method of recording your exercise episodes. This can be as simple as making a mark on the calendar or as complicated as using a fitness tracker on your smart phone. Don't make a big deal out of the recording, just do something simple and quick. Then your exercise becomes measurable.

3. Attainable-Make sure the first three months of your workout are easy. Your workouts should be so easy that they provoke nothing more than some light breathing. They should not hurt, burn, or exhaust you. The first three months of what you do is simply to let your body and your mind adjust to the idea of regular exercise. You are building a habit. You will almost certainly want to modify the routines you see in the easiest of your DVDs, but this is perfectly okay. 

4 Relevant-The first three months of your fitness workout should focus on light cardio and light resistance combined. This is the most relevant form of exercise according to current Sports Medicine evidence. You do not want to undertake long distance running or powerlifting or anything so specialized or extreme.

5 Time bound-You know your schedule. Carve out precisely 30 minutes for a 40 minute work out getting yourself five minutes on either side to change clothes. Know exactly where the workout is going to be placed in your day for the entire next week. Be realistic… you have 30 minutes. Everyone does, but this might mean you need to be more efficient overall, and there is nothing wrong with that. It also might mean that you have to cut things out, Such as Facebook, Pinterest or even Big Bang Theory.

You really want it. You know it will make you feel good. You know it will enhance your health. You know it will set a good example for your family. I'm here to tell you that fitness is not hard. In fact, it's fun and satisfying. Take these SMART steps today and start your fitness routine.

Medical Monday: Weekly News Update in Obstetrics and Gynecology

Good Monday.

A new study presented at the annual meeting of the American Society of Anesthesiologists suggested light meals during labor may be safe for most women. Ordinarily we would like to restrict intake to clear liquids nothing at all depending on the risk level of the woman. The main concern here is the risk of aspiration which means inhaling food particles from the stomach into the respiratory tract. Pregnant women are at increased risk for aspiration compared to non-pregnant women due to  the pressure from the baby and the relaxation of the esophageal muscles. Moreover, women are often nauseous during labor, increasing risk. The highest concern comes if the patient needs to go to cesarean section. In this instance she needs to be on her back with only a slight tilt, and this increases the risk of aspiration even further. It is unfortunate that the lay reporting makes it sound like we fear that women might aspirate during normal labor. Our concern is mostly having to do with the chance that they will go to cesarean section on a full stomach. 

Shots Blog on NPR covered this interesting tidbit: Babies and mothers exchange cells each others circulation during pregnancy labor and delivery, And they are maintained in circulation thereafter. These are believed to have implications for cancer and auto immune diseases that affect women. It is unclear whether these are beneficial, harmful, or both, depending on the circumstances. 

We know that when people have more testosterone in their system that they are more assertive or aggressive. But we are now finding is that the converse is also true. According to a study published in the Proceedings of the National Academy of Sciences, our testosterone levels rise in response to assertive behavior such as the use of power in a work situation. Study noted that this is especially true in women.

Did you know that tobacco use before pregnancy and in pregnancy is associated with cleft palette and congenital heart defects? The CDC's National Center on Birth Defects and Developmental Disabilities performed a meta-analysis which indicated that 6% of oral clefts and 1.4% of non-syndromic heart defects are attributable to maternal smoking in the first trimester. 

Yet another study underscores the fact that drinking alcohol increases a woman's risk of breast cancer.

Got cold sores? Don’t feel bad. The World Health Organization estimates that half of the world’s population under 50 does too. 

Stay tuned for more news from the world of obstetrics and gynecology, Next week on Medical Monday.

Structure Sunday: The Structure is Changing !

As of today, I have done precisely one year of regular blogging four days per week. Medicine, Fitness and Nutrition lend themselves to easily written useful blog posts, and they are also easy to illustrate. Structure Sunday, however, is rather bookish. It requires more thought, and is probably worth more in the long run, but it is not as easy or convenient to read. 

For this reason, I am going to streamline down to three blog posts per week, continuing all on schedule except Structure Sunday. This energy and this material is going to go toward books. I have several planned or partly written, and with some allotted days to work on them, they will come to completion. When this type of longer material is put in book form, only people who want these longer pieces will get it. 

I would love to know what you think about the change ! 

I am also curious about any subject you would like to see become books. 

Finally, do you prefer your ebooks as Kindle or Ibooks ? 

Looking forward to your feedback, 

Dr. Gina 

Food Friday: Trick or Alternative Treats

Ever wonder what you could give out instead of just candy ? I have worked on this challenge before at Easter when filling eggs, but have not until now considered what alternatives I could do at Halloween. 

First of all your Halloween alternative offerings should not break the bank. Secondly they should be age specific. In my family and group of friends, everyone from young children to old adults go out for the holiday, usually in costume. Halloween has always been a big holiday for our family, but especially since our youngest child was born on that day 22 years ago. When he was tiny he used to think the whole town came out for his birthday. 

I am for a strategy where you actually hand out the treat rather than have people take it from an unattended bowl on your porch. You will see why when you see my list of alternatives. Some are definitely age specific. Plus you ought to get to know your neighbors.

I think it is important to have some candy at Halloween. Always choose something that is wrapped so that the parent or child can be sure that has not been handled. You might think that the candy would get cherry picked out. This will not be the case if you were the one doing the handing out. Moreover, at Easter, I have found that some of the other non-food items are actually more popular than the candy.

Here's the list:

• Tiny boxes of raisins
• Trinkets you've purchased for cheap at the thrift store
• Interesting buttons purchased by the jar at garage sales or thrift stores
• Tiny spools of thread purchased by the bag at the fabric store
• Craft items such as decorative pipe cleaners or pom-poms
• Glass “Jewels”, meaning the pretty glass rocks you put in the bottom of a vase of flowers, Usually available at the dollar store in a selection of sizes and colors.
• Stickers
• Glow bracelets usually available at the dollar store.
• Poems quotes or sayings written decoratively and in tiny envelopes
• My favorite: beads, especially large ones.
• Tiny rolls of ribbon
• Tiny toy soldiers or animals 
• Office supplies such as decorative clips, rubber bands, tip erasers, or pencils
• Tea light candles

Basically I pick things I would like to get. Speaking of me, as you can see from the picture, I am still working hard on my costume. Guess who I am going to be.  

Have a safe happy Halloween. 

Wellness Wednesday: The Wellness of Being Yourself

My new T shirt 

As most of you know I recently returned from my alma mater, nerd nation, the mothership, Stanford University. Here is a group of misfits so diverse and enthusiastic that they just might save the world.

Wikipedia defines nerds as follows:

Nerd (adjective: nerdy) is a descriptive term, often used pejoratively, indicating that a person is overly intellectual, obsessive, or lacking social skills. They may spend inordinate amounts of time on unpopular, obscure, or non-mainstream activities, which are generally either highly technical or relating to topics of fiction or fantasy, to the exclusion of more mainstream activities.[1][2][3]

The Wiki goes on further to add the following:

"Nerdy" interests[edit]

Some interests and activities that are likely to be described as nerdy[by whom?] are:

• Intellectual, academic, or technical hobbies, activities, and pursuits, especially topics related to science, mathematics, engineering, linguistics, economics, literature, sociology, geography, mythology, history, and technology.[citation needed] (See below)
• Hobbies, games, and activities that are described as obsessive and "immature", such as trading cards, comic books, fantasy and science fiction novels, television programs and films, role-playing games, tabletop games, and video games and anime.[citation needed] (See below)
• Interest in the fine arts, non-mainstream music such as classical, progressive rock, techno, or folk music, hobbies (i.e., collecting), or other "obscure" interests.[citation needed]
• Heavy obsession with a topic that would otherwise be mainstream (such as a popular TV show or a sport).[citation needed]

Reality Is Broken: Why Games Make Us Better and How They Can Change the World

$14.79

By Jane McGonigal

Buy on Amazon

Jane McGonigal writes convincingly in her book “Reality is Broken" that the gaming community is full of people with great capacity to focus, as well as a passion for adventure and righting wrongs. She proposes to harness this energy for good and not just for gaming. This nerdy passion for adventure and justice combined with an intense capacity for focus was just what I saw at Stanford.

I returned from nerd nation inspired and encouraged. However I also found myself with a number of questions. Have I had enough faith in myself and the world? Have I tried enough new things ? Have I developed myself to my fullest potential? Have I done enough to make the world a better place ?

There is the temptation for these questions to become very heavy. However, in nerd nation, there is the acknowledgment that everyone is unique and that everyone has something unique to contribute. It was provocative nonetheless to meet a considerable selection of people who are doing things that could actually change the world, and by change the world I mean things like discover life on other planets or cure cancer. It is even more provocative to consider that most of these nascent accomplishments were not that hard. Rather than coming from brute force of mind, they came from unencumbered creative thinking, an environment supportive of trial and error, and steady efforts in a collegial team environment. 

On balance the visit was more empowering than daunting. This is where the connection to wellness becomes evident. I have written before about the connection between wellness and creativity. I have also written about the connection between learning and wellness. There is clearly a connection between wellness and altruism. I write now to encourage all of us to have a little more faith, a little more creativity, maybe some continuing education, maybe a little travel to get us out of our own heads, and more drive to make the world a better place.

Get your nerd on people.

Medical Monday: Weekly News Update in Obstetrics and Gynecology

Good Monday !

I am returning from a great five days back at Stanford with our son Forest, who is now also an alumni. We attended “ Classes without Quizzes” and enjoyed ourselves immensely. We learned about numerous things, including a little about the way the brain functions during early language development, the latest in nutrition research, and a MMOG, yes, a massive multiplayer online game called EteRNA which has become a powerful tool in the design of tiny RNA machines which may be used to treat disease. We also took a yoga Piyo Hip Hop Fusion class, went on a pro multi-ethnic eating tour and saw tons of old friends. 

So now we return inspired, excited to move the needle forward in everything we do, including Medical Mondays ! 

Flibanserin went on sale this last Saturday. Flibanserin is of course the pill to treat low libido in women. It goes by the name Addyi. Does anyone know how to pronounced this ? Someone got paid to think of that name, you know. I can’t wait to see the commercials. For some real information about this drug, please see my prior post HERE. 

This week, in a 2000 word opinion piece in the New York Times, a political scientist Courtney Jung, criticized breast feeding activists for putting too much pressure on women to breastfeed. She states broad based research indicates the benefits of breastfeeding are  “ modest”. Could this op ed have anything to do with the fact that she is releasing a sensational new book called “Lactivism” next month ? Imagine running a 2000 word ad for your upcoming book in the New York Times. I wonder if they even paid her for her ad.

Her subtitle includes many of us: 

How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy

I am just going to go out here on a limb and disagree and say that I do not think breastfeeding is bad policy. I guess I’m kind of a rebel that way. 

The American Academy of Pediatricians has come out saying that "no amount of alcohol is safe for unborn babies". The new guideline “identifies prenatal exposure to alcohol as the leading preventable causes birth defects and intellectual disabilities in children.” It was previously thought that "a small amount" of alcohol is okay in pregnancy. According to the CDC (The Centers for Disease Control), about 10% of women self-report that they drink alcohol in pregnancy. So in my simplistic mind this means that if women comply with this recommendation, 10% of the entire next crop of babies could be significantly developmentally better off than the last group. Wouldn’t this have staggeringly good effects on the population ? 

The American Cancer Society has revised its recommendations for mammograms once again stating that they should start at age 45 in a patient of average risk, and go to every other year at the age of 55, provided that the woman is expected to live at least 10 more years. The purpose here is to "eliminate false positives and over treatment’.

Has anyone ever considered asking the question, How bad is the badness of a false positive? And what do they mean by overtreatment? Do they mean biopsies which turn out to be benign or do they mean lumpectomies or mastectomies? Most physicians do not consider a biopsy to be a treatment. Most patients consider a benign result a great relief. I have never heard of a patient saying ”Doctor, my biopsy was benign. It looks like I really didn't need that biopsy after all ”. If biopsies were taken out of the “over treatment “ calculations would there really be any unnecessary “treatments” left to lament ?

The American College of Obstetricians and Gynecologists (ACOG) has maintained their stance on mammograms every one to two years from the age of 40 forward. It also recommends a clinical breast exam annually. The American Cancer Society is dropping their recommendation for an annual clinical breast exam since it has not"been shown to save lives.” They say nothing about whether it extends lives. Is important for readers to know that there are many studies designed to determine whether or not a certain intervention prevents death in the course of the study. Preventing death is the same thing as saving life, no matter if you die at one year or ten years after treatment.  Studies geared to show an interventions ability to save life do not necessarily have the power to show it extends life. ACOG keeps its position on mammograms and clinical breast exams because earlier more frequent mammograms and clinical breast exams are associated with earlier diagnosis and longer life after breast cancer. 

I had better stop writing since there is steam coming out of my keyboard and my ears again. 

Stay tuned for more news from the wacky world of OB/GYN next week on Medical Monday. 

Structure Sunday: The Structure of Travel

Travel should do at least three things:

Connect you with good people​

Educate you

Inspire you.

My post will again be brief due to the fact that I am traveling. Prepare well,  do these three things​, and take lots of pictures. Then your journey will be a success.