Part 2: What do changes to Medicare mean?

With an understanding of what Medicare is, the question is why is there a call for changes to the system?  As with many issues currently facing our country, it has alot to do with money.  In a post of the New York Time’s Economix blog, Uwe Reinhardt overviewed Medicare’s costs:

“In 2009, Medicare is expected to cost the federal government about $480 billion. That represents over a fifth of total national health spending on personal health care, 13 percent of the federal budget and close to 3.5 percent of the country’s gross domestic product. These outlays are financed with a combination of payroll taxes (41 percent), general tax revenues (39 percent), premiums paid by the elderly (12 percent) and sundry other sources, including interest earned on a trust fund established for the program.”

With the large health care overhaul that President Obama pushed through Congress, health care costs in general have become a main political issue.  When it comes to Medicare the rising cost of coverage that is taken on by American’s tax dollars has been a growing issue.  What however does cuts to the system mean?  Of course, this answer is not simple.

The varying coverage received by the 45 million Americans under Medicare plans makes it even harder to understand what changes to the system would mean.  Already reports have come out accusing doctors of discriminating against patients who have Medicare insurance, which pays doctors lower rates.  Increased cuts to the system could mean even lower rates and further discrimination against people under medicare plans.  Suggested changes to Medicare would also charge higher premiums to all but the poorest of Medicare recipients placing a burden on people who may not have the money to cover their care.

Ultimately decreases in rates and rises in costs for beneficiaries seem likely to lead to decreased quality of care.  As many of the health care panels in Washington have decreed it is about fixing the entire health system not just Medicare.  Changes to one part of the system and not to all of it seem to lead to further problems.  The general consensus is that quick fixes such as higher premiums and lower rates would be detrimental while long term reform could be revolutionary.

Part 1: What is Medicare?

Understanding medicare is a monumental task.  Talks of increased cuts are constant but what does that mean for the 45 million people in the United States currently under the plan.  In a post of the New York Time’s Economix blog, Uwe Reinhardt summarized Medicare like this:

“The program now covers 45 million Americans 65 or older, as well as younger people with permanent disabilities[...]. About half of Medicare beneficiaries live at or below 200 percent of the federal poverty line (i.e., $20,800 annual income for a single person and $28,000 for a couple). Over a third of the beneficiaries are afflicted with three or more chronic conditions.”

That various parts of Medicare partially cover hospital expenses (Part A), outpatient preventative medicine (Part B), and prescription drugs (Part C, the newest edition to Medicare in 2003).  The care provided under Medicare can be fairly comprehensive, especially for those people participating in Part C Medicare coverage, which is both Part A and Part B coverage provided by a non-governmental insurance company.  And while care can be comprehensive, it can also fall short of realistic patient needs such as when a patient has Part A but not Part B and their hospital room is paid for but all doctors’ services must be paid out of pocket.

For a deeper understanding of who is covered and what services are covered visit Medicare.gov.  Next week we will look at Medicare costs and potential plan changes.

 1)   Its a pain reliever — Capsaicin, the ingredient in hot peppers that makes your mouth burn, can actually be used against pain.  It is an active ingredient in many topical arthritis creams and has been proven to have positive effects against:

• Pain disorders, including pain after surgery.
• Nervous system problems such as diabetic neuropathy, trigeminal neuralgia, and postherpetic neuralgia (shingles).
• Cluster headaches.
• Joint problems such as osteoarthritis and rheumatoid arthritis.
• Skin conditions such as psoriasis.
• Mouth sores due to chemotherapy or radiation.

 2)   It can help you lose weight — A 2010 study by the UCLA Center for Human Nutrition shows that “heat generated by peppers can actually cause your body to burn more calories and “oxidize” layers of fat.”  This is not a novel concept however.  For years Capsaicin has been thought to increase the digestive fluids in your stomach and aid in digestion.

 3)   It makes you feel good — And I’m not just talking to those people that like spicy food.  It has been shown that eating spicy foods (the spicier the better) increases serotonin levels in your brain and releases endorphins.  In effect eating spicy food can put you in a better mood!

 4)   It has antioxidant effects — Although not as thoroughly studied as some of the other benefits of capsaicin, the antioxidant effects found in the compound have been shown to reduce the oxidation of LDL (bad cholesterol) and therefore reduce the risk of heart disease.  Capsaicin is even considered to be able to decrease the risk of some cancers based on the lower rate of cancer in countries like India and Mexico where capsaicin is found in significantly higher levels in peoples’ diets.

5) It helps your ulcers — Despite the myth that ulcers are caused by spicy foods, capsaicin may actually be able to kill bacteria that ulcers are caused by in effect preventing or curing ulcers altogether.  This fact does not negate that many people do get indigestion or heartburn from spicy food and should still take precautions when eating foods they know to upset their digestion.

Gym and fitness center memberships are more and more commonly being covered by employee benefits.  Lots of employees sponsor health fairs and weekly fitness classes at their offices.  Lunch and learns, which teach employees about different healthy living topics, are monthly occurrences at many offices.  All of these health and fitness benefits provided by employers are great for creating healthy employees.

However what happens when an employee has high blood pressure, off the charts cholesterol or is overweight and weekly group classes at the office aren’t enough?  Many of you probably answered that they’re doctor prescribes them a pill to lower their blood pressure or cholesterol, or that they will be sent to a nutritionist to help them eat better.  Some doctors however are taking a novel approach which is now being covered by some insurance companies, prescribing a personal trainer.

While still a very new concept and only covered by a few insurance companies personal training as a cure to common health problems is an up and coming prescription.  In Chicago doctors are prescribing a nine-week class that comes with a two month membership and access to a personal trainer at the Swedish Covenant Hospital’s Galter LifeCenter.  Galter LifeCenter is a medical fitness center, a growing fitness concept that treats fitness and personal training as a way to prevent and treat chronic illnesses.

Facilities such as these are often connected to hospitals making it easy for patients in the hospital to go from hospital treatment to medical fitness center treatment.  Prescriptions for personal trainers are still slow in being covered by insurance companies but facilities such as the Galter LifeCenter are providing examples to make it more common.  Keep in mind however that prescription personal trainers are not for those of us looking to lose a few extra pounds.  Prescription personal training is for people with true medical problems that can be treated through exercise.

Contact your insurance company for information about exercise and personal training coverage on your plan.

A selection of energy drinks in a cold drink display.

Waking up in the morning, the first thing many people think to do is get some caffeine in their system but that doesn’t necessarily mean putting on a pot of coffee anymore. The rise in popularity of energy drinks in the past decade has lead to the consumption of caffeine and other stimulants in new ways.

Energy drinks are not defined by the FDA but they are typically considered to be beverages with high levels of caffeine and other stimulants such as guarana and taurine. The recommended intake of caffeine per day is 300 mg. The average cup of coffee has 80 to 100 mg of caffeine, a cup of tea 40 mg, a Coca Cola 35 mg, and a Red Bull 80 mg. Energy drink companies are not required to list the amount of caffeine in their products which is why you will find companies such as Monster listing that their product contains 2500 mg of “energy blend”, which contains caffeine as well as other stimulants. Aside from caffeine ingredients such as taurine are listed in mgs but it is still not clear what the recommended daily intake of taurine is or what the side effects of taurine are.

Because the effects of taurine, guarana and other stimulants isn’t fully known, let’s focus on caffeine. Caffeine has been credited as an appetite suppressant, a diuretic, a calorie burning stimulant, and a performance enhancer when consumed before exercise. On the downside high levels of caffeine have been linked to insomnia, nervousness, restlessness, irritability, nausea or other gastrointestinal problems, fast or irregular heartbeat, muscle tremors, headaches, and anxiety (Mayo Clinic). Even more frightening is the trend to mix energy drinks and their high levels of caffeine with alcohol which leads to drinkers believing they are less drunk then they are and often over-drinking or taking part in activities they should not be doing when so intoxicated (WebMD).

With the increased use of energy drinks by not only adults looking for a jolt but also young people, there is great concern for understanding how much is too much. A morning cup of coffee is one thing but when 1 energy drink can max out your daily caffeine intake caution should be used.

With nearly 15 years of experience in the food industry, chef Vickie Kirlick of Traveling Gourmet in the New York metro area has learned a trick or two.  As a personal chef she uses her knowledge on a daily basis to cook for specialized diets from vegan to low cholesterol to specialized medical diets.  We got the chance to sit down with chef Vickie and gain some of her knowledge.  Here are five useful secrets from a personal chef.

1) One of the best staples in the culinary pantry are canned legumes.  The possibility of uses are almost endless…

2) Many people eat too much animal protein and most people don’t know what a serving of meat protein is.  It is actually only 3 ounces which is the size of a deck of playing cards.

3) Easiest way to de-seed a pomegranate:  Cut the pomegranate in half across the middle of the fruit.  Hold the fruit cut side down with one hand over a large bowl.   Take a wooden spoon in the other hand and hit the rind of the pomegranate with several HARD whacks!  The seeds and juice will fall into the bowl with very little pith attached.

4) The more colors (vegetables and fruits) a person consumes, the healthier their diet.

5) The pressure cooker is an invaluable piece of equipment for the cook who wants to eat healthy but has little time to spend in the kitchen.  Meats, fish, grains, soups, vegetables and desserts can be prepared in as little as half the time it would take to cook by conventional methods.  Foods retain more of their water-soluble vitamins and minerals when cooked in a pressure cooker as compared to cooking on top of the stove or in the oven.  Plus foods can be prepared in the pressure cooker with out the use of additional fat.

As a bonus here is a seasonal pressure cooker recipe from chef Vickie’s recipe book.  Bon appetit!

Autumn Quinoa Serves 4

1/4 cup pecans, roughly chopped

1 cup quinoa rinsed and drained

1 teaspoon olive oil

1 teaspoon ginger, minced

1/2 cup carrots, small dice

2 cups low-sodium chicken broth

1/4 cup orange juice

1/2 cup dried cranberries

In the pressure cooker, over medium heat, lightly toast the pecans and set them aside.  In the cooker heat the olive oil and stir in the ginger and carrots,  Add the quinoa, chicken broth, orange juice and cranberries.

Lock the lid in place, bring to high pressure.  Stabilize the pressure and cook for 9 minutes.  Release the pressure.  Remove the lid and stir in the reserved pecans.  Serve.

This can be cooked in a conventional 2 quart saucepan.  Once the quinoa, broth, juice and cranberries are added, bring to a boil.  Lower heat to a simmer and cover.  Simmer for 20 minutes.  Allow the quinoa to rest for 5 minutes before serving.

Calories 270 Total Fat 9 g  Sodium 317 mg  Total Carbohydrate 48 g Dietary Fiber 5 g  Sugars 15 g  Protein 8 g

Iron has more meaning in being healthy than just “pumping iron”. Eating iron filled foods or getting plenty of iron from a supplement is key to being and feeling healthy. Two-thirds of the iron in your body is found in hemoglobin, the protein in your red blood cells that carries oxygen to your body.

A simple blood test at your doctor’s office can determine if you have an iron deficiency. A lack of iron can lead to fatigue and a decreased immune system. Extreme iron deficiency is called Anemia.

So if our bodies are lacking iron and we’re tired and getting sick, how do we turn it around? Start eating iron rich foods! But of course its slightly more complicated than that. There are 2 types of iron, heme and nonheme. Heme irons are better absorbed in your blood stream but are primarily found in meat proteins ie chicken livers, oysters, beef, etc. Since meat is a no go zone for many vegetarians, and others on low meat diets we have a slew of foods that contain nonheme iron. Yes, nonheme iron is not absorbed as easily into the blood stream but it can be found in so many foods ie oatmeal, soybeans, spinach, raisins and it still contains that much needed iron.

Iron deficiency can effect your energy levels and immune system. While these aren’t extreme effects they can impact your day to day life. However, having a healthy amount of iron in your body is easy to do. So take that supplement or go eat a steak and be good to yourself!

Last Wednesday NYC mayor Michael Bloomberg threw out a new tactic in the war against obesity asking the US Department of Agriculture to ban the purchase of soda or other sugary drinks using food stamps.  This tactic to limit sugary drinks and sodas is nothing new, after Mayor Bloomberg unsuccessfully tried to impose a tax on the drinks earlier in the year.

Already there are supporters on both sides of the debate.  Proponents of the ban say that sugary drinks and soda are an easy way to cut calories and improve overall health.  The Department of Agriculture already prohibits the purchase of cigarettes and alcohol using food stamps so for many high calorie and overly processed foods and drinks seem like a logical next step.

On the other side of the aisle those opposing the ban specifically targets low income New Yorkers and minorities.  Many supermarkets in low income areas do not tend to provide the healthy alternatives that proponents are suggesting and if they do they are at a significantly higher cost.

This proposal is consistent with moves towards making NYC a healthier place including the ban on trans fats in restaurants and the requirement that restaurants display the calorie counts of the items on their menus.

South Beach, Atkins, macrobiotic, raw, vegan, and now gluten-free. All of these are diet trends that have risen to fame in the last 15 years. Promising to help us drop the pounds and feel more fabulous than ever with little to no effort, we often find years later that there may be a downside to these trends. Atkins left many Americans with soaring cholesterol. Vegan diets left Americans protein, calcium, and iron deprived. Now the removal of wheat, barley, and rye seen in gluten-free diets may be taking more away from us than just our pasta.

Let’s start with the benefits. As a recent Daily Beast article promotes, the celebrity approved removal of gluten from your diet can lead to a decrease in sinus problems, tiredness, and acne, not to mention weight loss. These benefits are not a revelation however. For decades doctors have been promoting this diet to their patients suffering from the autoimmune disorder, celiac disease.

Celiac disease is a condition where peoples’ bodies cannot properly process gluten, specifically when it comes into contact with the small intestine. While people who do not suffer from celiac disease may also see some physical improvements once going on a gluten free diet, there may also be negatives due to improper nutrition.

It turns out that gluten-free eating removes a good deal of prebiotic fibers from your diet. These prebiotic fibers promote the absorption of calcium, strong healthy bones, and lower intestinal cancer factors, to name just a few. As the Jackson Siegelbaum Gastroenterology website explains “Prebiotics [...] are the necessary plant fibers that contain both oligofructose and inulin.  These two fibers are the main nourishment for the good bacteria that reside in the gut. [...] Wheat and wheat products provide over 80% of the prebiotics that North Americans ingest.”

People suffering from Celiac Disease who need to remove gluten from their diets are usually aided by dietitians who inform them of how they will need to adjust their diets to continue to get proper nutrition. As a person removes such large portions of prebiotic fibers from their diet they must either take a supplement or replace the wheat that they would be eating with other high prebiotic fiber foods such as raw chicory root, raw Jerusalem artichokes, and raw dandelion greens.

It is not that gluten-free eating is an unhealthy diet. Quite to the contrary, gluten-free living provides many people relief from pain and physical problems every year. The greater problem is the immediate desire to try diet trends without all the information necessary to enter into a new lifestyle choice. Gluten-free diets can be a wonderful healthy way to lose weight and possibly take care of some other physical problems such as acne or tiredness. At the same time however, the help of a doctor or dietitian is always the best way to enter into any new eating regimen.

A commonly thought of source for vitamin C

Everyday many of us wake up, take a shower, get dressed eat breakfast, and pop a few multivitamins. Vitamins have become such a basic part of our lives that we can’t buy any kind of food without finding that its been enriched with Vitamin C, D, Calcium, Iron. While Calcium and Iron aren’t technically vitamins, we do find them in many multivitamins and supplements.

“Know Your Vitamins” will be an ongoing series that takes a look at all the supplements we put in our body. Yes, your doctor is telling you its good for you, but why? And if you don’t take that multivitamin, what would happen? And for that matter where in nature can you find these vitamins because the pilgrims had to be getting along without the vitamin and supplement aisle in their local CVS somehow.

First up, Vitamin C. Vitamin C is often best known for its cold preventing and shortening abilities. An even bigger role it has however is in the growth and repair of body tissue including your skin, muscles, and blood vessels. Vitamin C is responsible for all this because it is directly linked to both the production and function of white blood cells; that army of cells that fights the bad and promotes the good within your body. Other benefits seen from the intake of Vitamin C are a reduce in cataracts and their severity and the reduction of free radicals inside your body.

Just like your mother told you when you wouldn’t drink your orange juice, not enough Vitamin C can lead to an increase in colds. What mother didn’t tell you was that it could also lead to poorly healing wounds and an increased possibility of respiratory infections. In the extreme, Vitamin C deficiency leads to scurvy, a disease that presents symptoms of easily bleeding and bruising, hair and teeth loss, and joint pain and swelling. However, seeing as few of you reading this are swashbuckling pirates or long-voyaging sailors, I’d say you’re safe from that.

Since Vitamin C is not produced or retained by our bodies, daily intake is very important. While supplements are readily available, all fruits and vegetables contain some level of Vitamin C. Common foods with some of the highest concentrations include rose hip, which is found in many teas, blackcurrant, red pepper, parsley, kiwifruit, and broccoli.