multiply the consumption of fresh vegetables

Most women who want to lose weight manglami magnesium deficiency.
Magnesium is useful to convert food into energy, instead of being fat. Therefore, eat more fresh vegetables buahdan or not in though. Once in a while, to stimulate your metabolic system, try the juice diet. How, in a day try to only eat or drink fruit juice or fresh vegetables.

Dissolve Away those Pesky Bones with Corn Oil

I just read an interesting document from the Gabriel Fernandez at the University of Texas. It is titled "High-fat animal model of diet-induced obesity associated with age and osteoporosis. I expect the usual" we eat rats industrial lard for 60% of calories and they are sick "paper, but I was surprised. From this introduction:

CO [corn oil] is known that bone loss, obesity, glucose tolerance, insulin resistance and thus promoting useful model for studying early stages in the development of obesity, hyperglycemia, type 2 diabetes [23] and osteoporosis. We have used the omega-6 fatty acid fortified foods as a source of fat commonly observed in contemporary Western diets are basically responsible for the pathogenesis of many diseases [24].

Only 10% of food such as corn oil (approximately 20% of calories), not containing added omega-3, on top of an otherwise poor nutrition laboratory, causing:

* Obesity
* Osteoporosis
* Replacement of bone marrow with fat cells
Diabetes
* Insulin resistance
* General inflammation
* Increased liver weight (may include fatty liver)

Hmm, some sounds familiar ... We can add to the findings that omega-6 are also various forms of cancer in rodents (1) promote.

Fat 20% less than the amount normally required to make the mice became ill. This leads me to conclude that corn oil is very good at making a mouse version of some of the most common aspect of the "diseases of civilization". This is very high in omega-6 (linoleic acid) with almost no omega-3.

Make sure you have a heart-healthy corn oil feeding you! This is done in the United States, cheap and even lower cholesterol!

Lindeberg on Obesity

I am currently reading Dr Staffan Lindeberg Food magnum works and Western diseases, recently published in English for the first time. Dr. Lindeberg is one of the world's leading experts on health and diet of non-industrial cultures, particularly in Papua New Guinea. This book contains references to 2034. It is also full of quotable statement. Here is what he said about obesity:

Middle age spread is a common phenomenon - assuming you live in the West. Few people are able waist [young] them to maintain after the age of 50 years. Usual explanation - lack of exercise and overeating - not fully consider the situation among the traditional population. People like this are not usually physically active as you can imagine, and they mostly eat large amounts of food.

Obesity is very rare in hunter-gatherers and other traditional cultures [18 references]. The simple fact is clear to all foreign visitors ...

Kitava study measured height, weight, waist circumference, subcutaneous fat thickness at the back of the upper arm (triceps skinfold) and upper arm with a circumference of 272 people aged 4-86 years. Overweight and obesity were absent and the mean [body mass index] is low in all age groups. ... There is no greater than around the waist around their hips.

... Circumference of the arm [usually shows muscle] Kitava only be reduced to negligible [compared with Sweden], shows that there is no malnutrition. It is clear from our study that the lack of food is an unknown concept, and that the surplus of fruit and vegetables regularly to rot or be eaten by dogs.

Kitava population occupies a unique position in the world in terms negligible effect that the Western lifestyle has been on the island.

The fat just Kitavans Dr Lindeberg found were two people who have several years of living outside the island, lifestyle, modern city, and returned Kitava for a visit.

I would recommend this book to anyone who has an academic interest in health and nutrition, and something of a background in science and medicine. This is a very good position, so much more valuable.

Student Health Insurance Quotes

If you are a fulltime student between the ages of 17 and 29, student health insurance may be right for you. In fact it may even be required of you. There are several options for student health insurance, you may look for private student health insurance on the open market, or you may opt for the student health insurance plan offered by the institution you are attending. Expect to pay more for private student health insurance of course, but generally these student policies carry greater benefits than those provided by the university.

Whichever you choose, even if your particular school does not require it, student health insurance is a great way to ensure academic success.
Student health insurance typically covers:

• Regular medical exams
• Payments for catastrophic care
• And emergency procedures

How do I get a student health insurance quote?

Nowadays it is really simple to get free quotes online. You merely have to provide some simple personal information in a completely secure fashion, to receive a free student health insurance quote.

You may be asked to provide:

• Weight/Height
• Tobacco usage history
• Your Address
• Phone number
• Gender
• Email address
• Date of birth

Today most colleges and universities, require health insurance. The good news is that as such most schools are affiliated with top heath insurance providers, and because of the relatively low-risk involved in this group - rates for student health insurance are generally low.

Private student health insurance is another option. Private student heath insurance is usually purchased by:

• Those who need a more specific kind of coverage
• Individuals with pre-existing medical conditions
• Students who are interested in spending a term studying abroad
• Or individuals who think that the coverage offered by the college or university does not fulfill their needs.

Private health insurance tends to be a little bit pricier but offers additional benefits that most university health plans do not - for example, dental, vision, and prescription coverage.

Comparing carriers

The easiest way to compare different carriers is online. Using online comparison tools you can quickly see which company offers the best benefits for you needs and budget. When you know your options, the better the chances that you will purchase the health plan with the most benefits at the best rates.

When getting any student health insurance quote, make sure you understand your policy thoroughly before purchasing. If you are unsure about anything that is or is not covered, speak to an agent or your schools benefits advisor.

Eligibility

Most insurance companies do not offer student health insurance to individuals with pre-existing medical conditions. Exclusions may be made for certain preexisting conditions.

Student health plans are generally available to individuals between the ages of 17 to 29. Depending on the insurance company and state, some other exclusions and requirements must be met in order to obtain student health coverage.

If you are interested in student health coverage do not hesitate to look for more information and obtain a free student health insurance quote online. Remember it is always important to know your options to make an informed decision about health insurance.

Medicare Supplemental Insurance Quotes

Medicare supplement insurance, also known as Medigap insurance, is a private health insurance option designed to provide additional benefits above those offered through Medicare Part A and Part B. When searching for Medicare supplement insurance quotes you will only have twelve possible options to consider. This will simplify the process as other types of health insurance have well over 100 different options. The available Medigap options have been structured by the federal government to provide additional health care coverage where it is most needed. By limiting the options, the confusion of choosing the right supplemental plan is greatly reduced.

If you are eligible for Medicare Part A, you are able to purchase a Medigap plan if you do so during the open enrollment period, which is the six month period immediately following your enrollment in Medicare Part A. You must also be enrolled in Medicare Part B to qualify for Medicare supplemental insurance. You are not obligated to purchase a supplemental plan during this open enrollment period, but failure to do so could cause problems later on if you change your mind or experience medical problems that would justify this additional coverage.

Make an informed decision about Medigap insurance

It is essential for you to be well informed when shopping for Medigap insurance coverage. Knowing your options and understanding the included benefits decreases the likelihood of later discovering that you are underinsured. A very helpful tool is to compare the different companies that offer this type of coverage. Differences between insurance companies can include:

• Participating provider network
• Premium charges
• Financial strength
• Customer Service history

Keep in mind that with this type of coverage it is really simple to compare rates because of the standardized polices. Even though policies have the same benefits (for example Plan F from Humana will have the same benefits as Plan F from Blue Cross) premium quotes may vary.

Which Medicare Supplemental Plan is best for you?

Before making any decision you should try to best determine and anticipate your likely future health care needs. Because different Medigap insurance plans provide different benefits, make sure you understand each one of these benefits and how they might relate to your health status. For example, if you are interested in benefits for preventive health care you should lean towards one of the policies that offer this benefit.

Once you decide which Medicare Supplemental Plan will best fit your needs, the next step is to find out which insurance companies offer this Plan so that you can compare their rates. Working with a health insurance broker that is licensed to sell Medigap insurance plans from multiple insurance companies is a great place to start. You will not pay an additional fee for the convenience of working with a broker because the premiums are determined by the insurance company and can’t be altered.

How do I get Medicare Supplement insurance quotes?

Getting a Medicare Supplement insurance quote online is now a simple and secure process. Keep in mind that sometimes personal information is required in order to provide you with your list of plan options. The information listed below should be sufficient enough for any broker to provide you with a quote:

• Your name
• Your age
• State of Residence
• Zip Code
• Medicare Part A and Part B enrollment
• Phone number

Medicare Supplement insurance quotes tips

Start your researching a quote requests at least 3 months in advance of becoming Medicare eligible. Rates are subject to change and could adjust slightly by the time that you are qualified to enroll in a Medigap plan. So, have a first choice and a second choice plan for back up.

Visit the Medicare.gov website to make sure that you are looking at all of the options available in your state. They have a very useful “Plan Locator” tool that will provide you with a comprehensive list.

Work with a licensed broker in your state that represents the majority of the insurance companies on the list you have obtained from Medicare.gov. If you can’t find an agent for all of your Plan options, you may need to contact the insurance carrier directly.

Purchasing process for a Medicare Supplemental Plan

Once you have chosen the right Medicare Supplemental Plan, you will need to complete the application and approval process. This can be simple if done timely and accurately.

Filling the application

Your agent or broker that assisted you with selecting the right Plan will also be able to provide you with the necessary enrollment application. Every insurance company has their own application, so make certain that the application agrees with the insurance company that you have selected. These applications are usually quick and easy to complete and are just 2-3 pages in length.

The application can be delivered to your agent, who will submit it on your behalf. An initial premium payment may be required along with the application. Always make the check payable only to the insurance company.

Receiving Approval and ID Cards

If your application is completed properly, approval should only take 5-10 business days. You will receive notice of approval prior to receiving your insurance ID cards, which will typically arrive 2-3 weeks later. Your coverage will always become effective on the first day of the month following the date that your application was submitted.

Individual/Family Health Insurance Quotes

You have options when it comes to finding health insurance.

It is free for consumers to request health insurance quotes from licensed health insurance agents and brokers. A good health insurance agent will advise you on your private-market health insurance options from different insurance carriers and different plan types. They should understand your health, family and financial profile, and guide you towards a health plan that best serves your needs. Their job is to assist you in making the best health insurance decision for you and your family, and you should work with only the agents who have your interests at heart. You may speak to several agents to determine who can serve you the best.

What is the need for medical health insurance plans

These plans are necessary for people from all walks of life. In majority of the cases, it is known to all of us that, medical care is expensive and the costs related to medical care, hospitalization, medicine is growing upwards day-by-day. In this regard, the graph is in ascending order. Thus, the health insurance plan will certainly assist the concerned person financially. In third world countries and many other developing nations, Health Insurance plans helps the people, specially the poor and lower middle class people in a great extend and can act as a succor at the time when disease struck the family or any one of the members of the family. No one wants to fall ill. But, who knows what will happen to us.

Therefore, health insurance plan for everyone has emerged as the need of the hour. By this, one can protect himself from any sort of illness and related surgery, hospitalization, cost of medicine, etc. On the other hand, if you obtained a health insurance policy, then in case of medical expenses, a third-party, namely, the insurance company, or the employer, will pay for the said costs, if such provision exists. This can certainly relieves the amount of pain, anxiety and financial burden of the concerned person. Therefore, the necessity of the health insurance arises. As already described, who will pay your bills if you have a serious accident or suffering from a major illness Remember, we have to buy health insurance for the same reason for what we buy other kinds of insurance, i.e., to protect ourselves financially at the odd time. With health insurance, we protect ourselves including the family. As it is difficult to predict about the load of the medical bills, therefore, let the health insurance policy and the related Company thinks about it. In a good year, our costs may be low. But incase of illness, at certain amount of time, the higher medical bills can come across in front of us as a boomerang and then this will be covered by a third-party payer, not by us provided we opt for a health insurance.

What is an indemnity medical health insurance

The common form of health insurance is called as the indemnity insurance policy, which is also known as fee-for-service, in which the insurer pays for the cost of covered health care services after they have been provided with the bills and money receipts. In most indemnity insurance plans, the patient is free to choose his own doctor or hospital. However, some diseases are not covered by such plans. The person opting for insurance has to check it out before hand. Moreover, there is a certain time limit, for example, Mr. X has paid his first premium on the first day of the current calendar year. If he fall sick, say within fifteen days time of the first premium paid, then he may not get the coverage. The Insurance Companies thus goes for a thorough medical check-up of the person prior to issuing the health insurance policy to someone. Therefore, prior to opting for a health insurance, one must see all the rules and regulations attached to it, which may vary from companies to companies. What you have to do at the first hand is, read the concerned health insurance policy in details. Ask any queries which might disturb you to the representative of the concerned Insurance Company. You have to make your self sure that, you understand precisely what your policy does and does not cover. Thereafter, there is very little chance of coming across with unpleasant surprises at a later stage. Here is a checklist of some aspects, which are to be surely clarified prior to taking out a policy. The check list includes: i) whether the said policy cover only the treatment including operations ii) Is there any restrictions Because, many available policies in the market will often exclude different factors such as: treatment for alcohol and drug abuse; dental treatment/ surgery; HIV/AIDS-related illnesses; infertility treatment; normal pregnancy; cosmetic surgery to solely enhance appearance, etc. This list is not exhaustive and you should ask the insurer for details about your particular policy, iii) what is the coverage period , iv) what is the mode of payment of premium, renewal of policy, v) no claim bonus in case you renew the policy later, etc., and so on and so forth.

In todays competitive world, there are various types of health insurance, and more choices, than ever before. The Insurance Companies are competing with each other and every one of them has to survive. Therefore, many flexi plans are available for the people. You may be the first timer to buy a health insurance plan, or you may already have opted for a certain health insurance plan but want to consider changing plans. You may be a single person or a married one. You may want to cover both yourself and your wife, you may have children or without any issues, having old dependent parents; all this will be covered and answered by different plans available in the market. Help line numbers of the Companies or the Insurance agent will provide you assistance regarding how to choose a health insurance plan and which best meets the needs of you and that too as per your budget.

Moreover, the medical insurance document requires so many declarations from your end. You must declare everything on the application form, even if you think it is boring and unimportant on your part. Take some pain and fill-in-up all the information sought in the application form or any other form supplied by the Insurance Company. There should not be doubt in mind that, you are giving all true and accurate information as it forms the basis of the contract you make. If certain information is inaccurate or has been left out, or has been found incorrect later on, the insurer might refuse to pay your claim. In addition to this vital information, some other important aspects are as follows: the health insurance policies generally only cover you for disorders which have not affected you in the past. There are so many conditions attached to it. Any of your suffering, which is going on or has suffered from in the past, is known as pre-existing conditions. Most of the individual policies including some group policies generally not cover pre-existing conditions. Provisions are there that, some policies cover a pre-existing condition but only after a specific period of time has lapsed since your last treatment or visit to a doctor for the same condition. In this regard, the Insurance provision will allow you for a waiting period. For example, you might have a waiting period of between six months and two years before coverage begins. Therefore, make it doubly sure that, you checked your policy carefully to make sure if you can be denied coverage for a pre-existing condition.

Now, let us have a discussion about another important aspect, i.e. how to claim for a health care insurance. The health Insurance companies have to deal with thousands of claims every day. All the claims needs to be processed as per framed guidelines of the Company and subsequently passed for payment or to be denied, if does not meet the terms of the provision. Since, majority of the claims job is related with paper work, spot verification, etc. therefore often, it may take some time to release the fund. It is a very tedious job. Everyone seeks that; their claim should be cleared within a short span of time. Many smart companies give smart services to its customers. But, many other Companies, especially in country like India; some Companies are Govt. owned Corporations, which takes unnecessary time to settle claims. Whenever you want to make a claim, it is advisable to contact the insurer before you actually receive treatment, or going for hospitalization, if possible. Subsequently, the insurer can confirm the specifics of your cover and can also check that the treatment is within any relevant limits. Then, the company would provide you with the related information like whether you have to make payments first and then be reimbursed or whether the insurance company can make arrangements to pay directly to the Hospital against your bill. On your part, it is very vital that, paper work should be in order and complete in all forms after submitting the claim. Under any circumstances, you are not supposed to claim falsely. Otherwise, if you caught in such a situation, companies may file legal action against you. Dont forget to keep a full set of Xerox copies of all relevant papers with you.

Now, very particularly a question will come to our mind. This irksome question is, what kind of action can we take in case; the insurance company rejects a claim, which we feel as a valid claim In such a situation, if the company refuses the claim, the most advisable part is to insist for a reply in writing from the companys end. Moreover, re-submission of claim can be another solution. Many other matters of concerns can be settled across the table through discussions. For this, we have to ensure that, our problem has been told in clear language. In such cases, citing of Policy number, submission of all medical records such as test reports, prescriptions, cash memos of medicines, doctors records/advise, discharge certificate, etc. must be submitted. Moreover, copies of all earlier correspondences must also to be kept. But, if it is an injustice, dont hesitate to get the best service even with the help of Insurance regulatory Board and law of the land and also to protect our rights.

In the developed countries, both form of Health Insurances, i.e., private health insurance and public health insurance is present among masses. But, in a developing country like India, the private health insurance is more common among people rather than the public health insurance schemes. Many of the public health insurance schemes are very good on papers, but in reality, it is not reaching to the poor. In this regard, another answer can be the Community based health insurance (CBHI) programmes. This type of programme in rural or semi urban areas in India is an alternative arrangement to provide health insurance to the poor, i.e., low-income groups. In India, the Prime Minister has launched an universal health insurance scheme which is similar to CBHI as mentioned above, which can take care of the poor and downtrodden in the society provided it runs as per its policies and goals and reaching rightly to the target group. Moreover, the development of private health insurance can bring potential risks and benefits in terms of health care access for the clients including poor. Moreover, even the private health insurance market lacks development due to the want of regulatory decisions on the supply of health services and the demand for health insurance.

In country like India, the insurance business is still a monopoly of the private Insurance Companies. In fact, for all practical purposes, the only medical insurance policy available for the people in India is the Medi-claim policy. This policy is available through the subsidiaries of the General Insurance Corporation (GIC) of India. Moreover, in India, the government has some schemes meant for its employees such as the ESIS (Employee State Insurance Scheme) and the CGHS (Central Government Health Scheme), etc. After the economic liberalization in India, many foreign Insurance companies entered in to Indian market. They also cover the health insurance sector under its various schemes. In India, now-a-days, many employers provide medical insurance as a standard perquisite to many of their employees, through the group insurance schemes, where the premium is less than a personal insurance policy. The premium is either paid by the Employer or deducted from the medical benefits enjoyed by the employee. In many cases, the employer pays a part of the cost. Not all employers, however, offer health insurance to its employees. Therefore, it is a fact that, in India, health care is still lagging specially with regard to poor and lower middle calls category.

Therefore, once again it is a repetition that, the insurance business in India is still a monopoly. The question arises to the common man is, whom to insure, only to himself or some or all the members of the family; and how much amount to insure for each one of them. Obviously, this is a very confusing situation. This situation is not the same in countries like USA. In USA, there are a wide variety of medical insurance schemes available for the citizens. A person can choose a policy from the health maintenance organization (HMO) or from preferred provider organizations (PPO). But, this brings confusion to all most all the policy buyers. Therefore, one has to be very careful at the time of buying a policy. It is a very simple matter that, once money has been spent for treatment, it should be realized through the Insurance policy. But, the insurance company will be more happy in case of low reimbursements from their part and receiving higher premiums from your end, you have to be very careful to choose the right policy and therefore to take guidance from all Help Lines and also from the Professional Agents. Health to all is still a distant dream in developing countries like India. By opting for health insurance policies, you can protect yourself and your family members from odd situation of life arising out of illnesses, etc.

Medical health insurance

Life is precious. We dont know what will happen to us in near future and we are also unaware about what type of problem may disturb us at what point of time Remember, distress and calamities will not come to us with prior intimation. There is no alert message or danger alarm in this regard. Therefore, we have to act as a pro-active person and therefore, as a matter of fact the only answer to it is buying an insurance policy. Today, in this article we will not peep into medical health insurance as a whole, but we will see only a segment of it, i.e., Health insurance.

Health insurance is nothing but a plan, for which you have to pay previously in the form of a premium. This will provide medical services or medical indemnities for medical health insurance care, which are in need at the time of illness or disability. For this, a voluntary plan has to be opted. This voluntary plan may be commercial or non-profit subject to the nature of the plan. There are various options available such as individual plan as well group insurance plans. A person can act as the main prosper and may include his family members and near and dear ones. In case of compulsory group health insurance plans, these are usually related to social security plans.

Now, lets see into historical aspect of medical health insurance. Most probably, for the first time during the period 1883-84, a compulsory accident and sickness insurance plan was introduced in Germany at the initiative of Otto von Bismarck. Later on, many countries find it very suitable and effective. Thereby, countries like Great Britain, the erstwhile Soviet Union, France, etc. adopted this unique system of health insurance plan after the First World War. In Great Britain, the Government declared the National Health Insurance Act in the year 1946, which came into effect with most comprehensive compulsory medical care plan. Under this plan, individuals were allowed to obtain free medical attention from any doctor, who is a participating member in the National Health Service. Later on, on the basis of this plan, many countries including Europe and Asia designed and adopted several kinds of health insurance plans. The United States is the only nation without some form of comprehensive national health insurance.

Handicap on Gathering the Local Public health Data

Health is something real important. That is why; we need to maintain it well, or if it was possible, we should be able to improve it. For some reasons, some of us want to improve the lever of the local health.


Surely, to be able to improve it, we should make sure that we could get many kinds of information about the local public health. But somehow, that efforts might not as smooth as it was planned.



There are some handicaps on the field. Gathering the local public health data wasn’t as easy as it was planned. In facts, for some privacy reasons, the local community prefers the keep the information.

Gathering the Necessary Data

Improving the health love of the local community is something that should be done. To be able to do that, the program should have some supporting data. The data must be complete.

More importantly, the data that contains of local public health data should be valid. This is necessary so the programs could be done perfectly. Without the valid data, it would be a bit difficult to determine the perfect programs.

There are many kinds of local public health data that should be gathered to support the program. The data of the age, sickness, pattern of sexual behavior and many other supporting data are important.

The Important of the Availability of the Local Health Data

For some reasons, there are many kinds of things that should be done to deliver the perfect health improvement program. There are many factors that determine the success of the program.

First of all; we should collect all data that we needed to determine the perfect program. The most important data that we should gather is the local public health data. Without it, we couldn’t determine the perfect data.

It would be extremely important to have the perfect data. Without the perfect data, the programs wouldn’t have the perfect direction. That is why, the valid data is important in this program.

California HIPAA Dance (Redux)

Another change for HIPAA in California.

Blue Shield of California, in response to Anthem's proposed premium payment arrangement (which is apparently not going to be fully implemented), has taken the following action with regard to HIPAA plan enrollments in California.

Effective 3/2/10, PPO enrollments from HIPAA plans will no longer offer any date of the month not before application receipt date. Now, 1st or 15th of the month following approval of the application.

Book Review: S.P.E.E.D.

This book was sent to me by Matt Schoeneberger, who co-authored it with Jeff Thiboutot. Both have master's degrees in exercise science and health promotion. S.P.E.E.D. stands for Sleep, Psychology, Exercise, Environment and Diet. The authors have attempted to create a concise, comprehensive weight loss strategy based on what they feel is the most compelling scientific evidence available. It's subtitled "The Only Weight Loss Book Worth Reading". Despite the subtitle that's impossible to live up to, it was an interesting and well-researched book. It was a very fast read at 205 large-print pages including 32 pages of appendices and index.

I really appreciate the abundant in-text references the authors provided. I have a hard time taking a health and nutrition book seriously that doesn't provide any basis to evaluate its statements. There are already way too many people flapping their lips out there, without providing any outside support for their statements, for me to tolerate that sort of thing. Even well-referenced books can be a pain if the references aren't in the text itself. Schoeneberger and Thiboutot provided appropriate, accessible references for nearly every major statement in the book.

Chapter one, "What is a Healthy Weight", discusses the evidence for an association between body weight and health. They note that both underweight and obesity are associated with poor health outcomes, whereas moderate overweight isn't. While I agree, I continue to maintain that being fairly lean and appropriately muscled (which doesn't necessarily mean muscular) is probably optimal. The reason that people with a body mass index (BMI) considered to be "ideal" aren't healthier on average than people who are moderately overweight may have to do with the fact that many people with an "ideal" BMI are skinny-fat, i.e. have low muscle mass and too much abdominal fat.

Chapter 2, "Sleep", discusses the importance of sleep in weight regulation and overall health. They reference some good studies and I think they make a compelling case that it's important. Chapter 3, "Psychology", details psychological strategies to motivate and plan for effective weight loss.

Chapter 4, "Exercise", provides an exercise plan for weight loss. The main message: do it! I think they give a fair overview of the different categories of exercise and their relative merits, including high-intensity intermittent training (HIIT). However, the exercise regimen they suggest is intense and will probably lead to overtraining in many people. They recommend resistance training major, multi-joint exercises, 1-3 sets to muscular failure 2-4 days a week. I've been at the higher end of that recommendation and it made my joints hurt, plus I was weaker than when I strength trained less frequently. I think the lower end of their recommendation, 1 set of each exercise to failure twice a week, is more than sufficient to meet the goal of maximizing improvements in body composition in most people. My current routine is one brief strength training session and one sprint session per week (in addition to my leisurely cycle commute), which works well for me on a cost-benefit level. However, I was stronger when I was strength training twice a week and never going to muscular failure (a la Pavel Tsatsouline).

Chapter 5, "Environment", is an interesting discussion of different factors that promote excessive calorie intake, such as the setting of the meal, the company or lack thereof, and food presentation. While they support their statements very well with evidence from scientific studies, I do have a lingering doubt about these types of studies: as far as I know, they're all based on short-term interventions. Science would be a lot easier if short-term always translated to long term, but unfortunately that's not the case. For example, studies lasting one or two weeks show that low glycemic index foods cause a reduction in calorie intake and greater feelings of fullness. However, this effect disappears in the long term, and numerous controlled trials show that low glycemic index diets have no effect on food intake, body weight or insulin sensitivity in the long term. I reviewed those studies here.

The body has homeostatic mechanisms (homeostatic = maintains the status quo) that regulate long-term energy balance. Whether short-term changes in calorie intake based on environmental cues would translate into sustained changes that would have a significant impact on body fat, I don't know. For example, if you eat a meal with your extended family at a restaurant that serves massive portions, you might eat twice as much as you would by yourself in your own home. But the question is, will your body factor that huge meal into your subsequent calorie intake and energy expenditure over the following days? The answer is clearly yes, but the degree of compensation is unclear. Since I'm not aware of any trials indicating that changing meal context can actually lead to long-term weight loss, I can't put much faith in this strategy (if you know otherwise, please link to the study in the comments).

Chapter 6, "Diet", is a very brief discussion of what to eat for weight loss. They basically recommend a low-calorie, low-carb diet focused on whole, natural foods. I think low-carbohydrate diets can be useful for some overweight people trying to lose weight, if for no other reason than the fact that they make it easier to control appetite. In addition, a subset of people respond very well to carbohydrate restriction in terms of body composition, health and well-being. The authors emphasize nutrient density, but don't really explain how to achieve it. It would have been nice to see a discussion of a few topics such as organ meats, leafy greens, dairy quality (pastured vs. conventional) and vitamin D. These may not help you lose weight, but they will help keep you healthy, particularly on a calorie-restricted diet. The authors also recommend a few energy bars, powders and supplements that I don't support. They state that they have no financial connection to the manufacturers of the products they recommend.

I'm wary of their recommendation to deliberately restrict calorie intake. Although it will clearly cause fat loss if you restrict calories enough, it's been shown to be ineffective for sustainable, long-term fat loss over and over again. The only exception is the rare person with an iron will who is able to withstand misery indefinitely. I'm going to keep an open mind on this question though. There may be a place for deliberate calorie restriction in the right context. But at this point I'm going to require some pretty solid evidence that it's effective, sustainable, and doesn't have unacceptable side effects.

The book contains a nice bonus, an appendix titled "What is Quality Evidence"? It's a brief discussion of common logical pitfalls when evaluating evidence, and I think many people could benefit from reading it.

Overall, S.P.E.E.D. was a worthwhile read, definitely superior to 95% of fat loss books. With some caveats mentioned above, I think it could be a useful resource for someone interested in fat loss.

From Wall Street Journal "The Wellpoint Mugging"

A very interesting article from the Wall Street Journal.

The Wellpoint Mugging

Some parts of the article are quite telling.

He ought to subpoena California's political class because Wellpoint's rate hikes are the direct result of the Golden State's insurance regulations—the kind that Democrats want to impose on all 50 states. Under federal Cobra rules, the unemployed are allowed to keep their job-related health benefits for 18 to 36 months. California then goes further and bars Anthem from dropping these customers even after they have exhausted Cobra. California also caps what Anthem can charge these post-Cobra customers.

This next one hits home for me as one of the leading Anthem HIPAA producers in California. While I know that Anthem is taking losses on the guaranteed-issue side, I also am confident that my book of Anthem HIPAA business (which apparently is #2 in the state of CA right behind e-healthinsurance)is not creating losses. Yes, the whole pool is losing money and Anthem has been covering almost 80% of it for several years (same with MRMIP). However, I always strive to do proper case development before I pick the appropriate HIPAA plan for a client and find I have a fairly even spread between my three California major medical carriers. And no, Anthem has not invited me to lunch for my high HIPAA production LOL!

This explains why Anthem lost $58 million in California on its post-Cobra customers in 2009. If WellPoint didn't raise premiums amid these losses, it would soon be under assault from its shareholders, if not out of business.

The company presented its findings to California insurance commissioner Steve Poizner last November, who had a month to review the proposed increases and never objected. But recently amid the White House campaign, Mr. Poizner has joined the chorus claiming to be "skeptical" of the increases and demanding that Anthem postpone them while he conducts a review. Anthem has done so.

More HIPAA Dancing

I have learned that Anthem Blue Cross California has again changed its position with regard to HIPAA enrollments.

Apparently they have backed off of the "no premium" with application design (which virtually guaranteed a 60-day minimum gap in coverage) and will allow premium submission with the application in the near future.

The current no premium program was only in effect on the HMO HIPAA plans, not the PPO HIPAA plans. Anthem had indicated a desire to have a unified HIPAA application with no premium pre-payment possible. Apparently this has been scrapped and HIPAA applicants will soon be able to pre-pay premiums for both HMO and PPO HIPAA plans with Anthem Blue Cross CA.

phil heath Kai Greene Branch Warren after the 2009 Mr Olympia video phil heath met rx

phil heath



video of phil heath Kai Greene and Branch Warren after the 2009 Mr Olympia, phil heath was unlucky at the 2009 mr olympia due to some illness going into the mr olympia bodybuilding contest.

but aspect to see phil heath pushing for the 2010 mr olympia title and in much better condition then the 2009 mr olympia contest.

phil heath is wearing a met rx t-shirt in the video not sure if phil heath is still sponsored by met rx or not now.

Part Deux: Is The California Individual & Family Health Insurance Market In Critical Condition?

Having recently watched the "bi-partisan" meeting in Washington and many videos on youtube, I wonder if the problem is "un"-fixable.

Speaker Pelosi, in a recent youtube video answering questions on the meeting, pointed out two things which are absolutely of concern. 1, our health insurance system is employer-based in design and function. 2, there are many more people not covered under the employer-based system who choose to remain on the sideline than those who participate in the non-employer health insurance market.

I won't go through the numbers again since they are covered under part one of this topic below. Suffice to say, nearly two-thirds of those who should participate in the health insurance market in California for individual & family coverage do not. No employer-sponsored health plan, whether fully insured or self-funded, could operate at a participation level of 33% or less. Employer plans require 75% of all eligible employees to participate. I have worked in the past for employers who made it mandatory to buy a health plan through their fsa/cafeteria plan unless one had a valid waiver (so as not to mess up participation).

With rare exception, most every vlog I have seen, including the grilling of Anthem/Wellpoint CEO Braly in Washington, have had a nasty, negative tone. While it is without doubt that people are upset by the rate changes and popular press, there are implications to this notwithstanding the fact that my study below shows that even with the "massive" rate increase, Anthem prices below most of the other California carriers for like coverage (including 2 not-for-profits).

Now here's your "inside scoop" for the day, dear readers. I have it on good authority that a very large health insurance company in California (which shall remain anonymous), in the last six months, approached the state regulatory agency/ies to review the option of cancelling the individual & family market product and bailing out. To be clear as to what is at stake....

IN THE LAST SIX MONTHS, ONE OF THE LARGEST HEALTH INSURANCE COMPANIES IN CALIFORNIA ADDRESSED TO A STATE REGULATORY DEPARTMENT THE POSSIBILITY OF NO LONGER SELLING HEALTH INSURANCE TO INDIVIDUALS & FAMILIES IN CALIFORNIA.

The writing is on the wall across the spectrum of carriers. Sales of new plans are flat. HIPAA plans have been reformated to high deductibles and expensive HMO plans to stem the bleeding in that pool. Programs like Tonik for individuals and BeneFits for small group have experienced less-than-stellar sales.

The only two PPO programs (non-HIPAA) that are selling at all right now are SmartSense by Anthem and VitalShield by Blue Shield. Even in those cases, the sales of new plans is not keeping up with the cancellation of existing subscribers.

Anthem has launched three new product portfolios for IFP in the last six months--Core Guard, Clear Protection, and coming April 1, Premier. I will be curious to see whether or not new enrollments in these plans (lower cost) will overtake defections off of coverage as is the current trend.

Until and unless this trend shifts, the IFP market is going to be chaotic at best. Continuous premium increases will become the norm, and this in turn will drive more people off of coverage which will create a repetitive cycle.

So, Dave, you ask, what is your solution to the problem?

Well, I see two choices.

One, like Speaker Pelosi mentioned, mandate coverage and penalize those who do not participate. Increase participation to as close to 100% as possible, guarantee-issue health insurance coverage with no pre-existing conditions problems and create an incentive (tax or othewise) for people to participate in addition to a penalty.

Two, and this is one I may favor over the first one, kill off all non-employer coverage plans and go to a single payer exchange for coverage (with a mandate or incentive). The exchange could offer compliant private plans from carriers that wish to offer them and/or public plans like Medicare/FEHB or other plans designed under federal mandates. Allow carriers to sell private plans outside of the exchange to those who can qualify and wish to purchase outside of the exchange.

Make the exchange available to those who cannot obtain employer-sponsored coverage and do not wish to or cannot purchase a private plan outside of the exchange. Also, provide that any employer under 20 employees (2-19) who chooses the exchange over the group plan must pay a penalty per employee to the exchange, and any company over 20 employees must either provider group coverage or pay a payroll tax penalty per employee to the exchange.

Magnesium and Insulin Sensitivity

From a paper based on US NHANES nutrition and health survey data (1):

During 1999–2000, the diet of a large proportion of the U.S. population did not contain adequate magnesium... Furthermore, racial or ethnic differences in magnesium persist and may contribute to some health disparities.... Because magnesium intake is low among many people in the United States and inadequate magnesium status is associated with increased risk of acute and chronic conditions, an urgent need exists to perform a current survey to assess the physiologic status of magnesium in the U.S. population.

Magnesium is an essential mineral that's slowly disappearing from the modern diet, as industrial agriculture and industrial food processing increasingly dominate our food choices. One of the many things it's necessary for in mammals is proper insulin sensitivity and glucose control. A loss of glucose control due to insulin resistance can eventually lead to diabetes and all its complications.

Magnesium status is associated with insulin sensitivity (2, 3), and a low magnesium intake predicts the development of type II diabetes in most studies (4, 5) but not all (6). Magnesium supplements largely prevent diabetes in a rat model* (7). Interestingly, excess blood glucose and insulin themselves seem to reduce magnesium status, possibly creating a vicious cycle.

In a 1993 trial, a low-magnesium diet reduced insulin sensitivity in healthy volunteers by 25% in just four weeks (8). It also increased urinary thromboxane concentration, a potential concern for cardiovascular health**.

At least three trials have shown that magnesium supplementation increases insulin sensitivity in insulin-resistant diabetics and non-diabetics (9, 10, 11). In some cases, the results were remarkable. In type II diabetics, 16 weeks of magnesium supplementation improved fasting glucose, calculated insulin sensitivity and HbA1c*** (12). HbA1c dropped by 22 percent.

In insulin resistant volunteers with low blood magnesium, magnesium supplementation for four months reduced estimated insulin resistance by 43 percent and decreased fasting insulin by 32 percent (13). This suggests to me that magnesium deficiency was probably one of the main reasons they were insulin resistant in the first place. But the study had another very interesting finding: magnesium improved the subjects' blood lipid profile remarkably. Total cholesterol decreased, LDL decreased, HDL increased and triglycerides decreased by a whopping 39 percent. The same thing had been reported in the medical literature decades earlier when doctors used magnesium injections to treat heart disease, and also in animals treated with magnesium. Magnesium supplementation also suppresses atherosclerosis (thickening and hardening of the arteries) in animal models, a fact that I may discuss in more detail at some point (14, 15).

In the previous study, participants were given 2.5 g magnesium chloride (MgCl2) per day. That's a bit more than the USDA recommended daily allowance (MgCl2 is mostly chloride by weight), in addition to what they were already getting from their diet. Most of a person's magnesium is in their bones, so correcting a deficiency by eating a nutritious diet may take a while.

Speaking of nutritious diets, how does one get magnesium? Good sources include halibut, leafy greens, chocolate and nuts. Bone broths are also an excellent source of highly absorbable magnesium. Whole grains and beans are also fairly good sources, while refined grains lack most of the magnesium in the whole grain. Organic foods, particularly artisanally produced foods from a farmer's market, are richer in magnesium because they grow on better soil and often use older varieties that are more nutritious.

The problem with seeds such as grains, beans and nuts is that they also contain phytic acid which prevents the absorption of magnesium and other minerals (16). Healthy non-industrial societies that relied on grains took great care in their preparation: they soaked them, often fermented them, and also frequently removed a portion of the bran before cooking (17). These steps all served to reduce the level of phytic acid and other anti-nutrients. I've posted a method for effectively reducing the amount of phytic acid in brown rice (18). Beans should ideally be soaked for 24 hours before cooking, preferably in warm water.

Industrial agriculture has systematically depleted our soil of many minerals, due to high-yield crop varieties and the fact that synthetic fertilizers only replace a few minerals. The mineral content of foods in the US, including magnesium, has dropped sharply in the last 50 years. The reason we need to use fertilizers in the first place is that we've broken the natural nutrient cycle in which minerals always return to the soil in the same place they were removed. In 21st century America, minerals are removed from the soil, pass through our toilets, and end up in the landfill or in waste water. This will continue until we find an acceptable way to return human feces and urine to agricultural soil, as many cultures do to this day****.

I believe that an adequate magnesium intake is critical for proper insulin sensitivity and overall health.


* Zucker rats that lack leptin signaling

** Thromboxane A2 is an omega-6 derived eicosanoid that potently constricts blood vessels and promotes blood clotting. It's interesting that magnesium has such a strong effect on it. It indicates that fatty acid balance is not the only major influence on eicosanoid production.

*** Glycated hemoglobin. A measure of the average blood glucose level over the past few weeks.

**** Anyone interested in further reading on this should look up The Humanure Handbook

Anthem: The Tale of the Tape in California

I was curious about the impact of the now-delayed Anthem Blue Cross rate increase on premium levels. I could only think of one way to find out, so I ran quotes on myself in Gilroy for four comparative coverage plans from the four California health carriers. Kaiser and Blue Shield are not-for-profit, so they should win, right? The results may surprise you!

The rates below include the Anthem rate increase scheduled for March 1, 2010.

1500 Deductible HSA Plan (or closest match)

#1 Anthem Blue Cross Lumenos 1500 HSA...............$243.00
#2 Health Net CA 2500 HSA (closest).................$246.00
#3 Blue Shield CA 1800 HSA (closest)................$311.00
#4 Kaiser 1500 HSA..................................$349.00

3500 Deductible Traditional PPO (or closest)

#1 Health Net Value PPO 4000 (closest)..............$179.00
#2 Anthem Blue Cross 3500 PPO.......................$224.00
#3 Kaiser 3000 Plan (closest).......................$277.00
#4 Blue Shield CA Essentials 3000 (closest).........$352.00

$0 Deductible PPO/HMO RightPlan Clone with Comprehensive Rx (or closest)

#1 Anthem Blue Cross RightPlan 40 PPO...............$358.00
#2 Health Net NetFirst PPO..........................$383.00
#3 Kaiser HMO (closest match).......................$457.00
#4 Blue Shield CA Active Start 35...................$504.00

1500 Deductible HMO Plan

#1 Kaiser 30/1500...................................$365.00
#2 Anthem Blue Cross HMO (w/1500 deductible)........$654.00
#3 Health Net HMO 40................................$670.00
#4 Blue Shield CA Access+ HMO.......................$798.00



I have not included the SmartSense plans, nor the the Core Guard and Clear Protection plans offered by Anthem. However, those three portfolios all price even more favorably against the in-state competition.

Anthem Agrees To Delay Rate Increase in California

On Saturday (2/13) Anthem agreed to hold off on the March 1 rate increases until May 1 at the soonest. This will give time for independent actuaries and auditors to determine if the increase in rates is appropriate.

Anthem to delay insurance rate hike amid criticism

Anthem Answers Sebelius

Anthem President and CEO of Consumer Business, Brian Sassi, addressed his response to Ms. Sebelius regarding her inquiry concerning Anthem rate increases in California.

Click here to read Mr. Sassi's letter

How to Review Your Homeowners Insurance Renewal Statement

For most of us, our home is our single largest and most important investment. Many of us have poured thousands of dollars and countless hours into maintaining, improving and (hopefully) paying off our homes. Many people own their homes free of any mortgage. These assets are pure equity. Certainly its worthwhile to invest 15 minutes a year to be sure it's properly insured.

Thankfully, the insurance company offers you a perfect reminder and opportunity in sending out your annual renewal statement. Even if your insurance is paid by your mortgage company as part of your impound account, the insurance company still mails you a statement of renewal every year to update you with your current coverage limits and deductible.

Here's a few important steps you can take to be sure that HOME SWEET HOME is properly protected.

1. Check the basics. Check your name, address and any other description of the insured property. Make sure there's been no change of vesting or ownership that needs to be updated. Check your address to be sure no numbers are transposed.

2. Check the mortgagee clause. Here's where you can be sure that the current mortagee on your home is listed correctly. Check the lender, address and your loan number. Be sure there's no old information there. Maybe you had a HELOC (Home Equity Line of Credit) or a second mortgage that no longer applies. Be sure to get them removed.

HEADS UP: Whenever you have a significant claim, the mortgage company will be one of the payees on your claim settlement check. Just that alone can be an inconvenience. But it becomes a major hassle when one of the institutions listed no longer has a vested interest in your home. The insurance company is bound by contract to include the mortgage company on all settlement checks beyond a stated threshold.

*3. Check the coverage on your home (dwelling or building). This is without question the single most important coverage to examine, consider and adjust whenever necessary. Having been an agent during the two raging firestorms in San Diego, CA in this decade, I can tell you that underinsured homes are just NO FUN! Two of my clients lost their homes in the 2003 fires and fortunately they were both adequately insured. (we call all our homeowner clients once a year to review their coverages and suggest improvements and adjustments) But I can tell you that there were literally hundreds of people in the area that were not so fortunate. Many were underinsured by over $100,000! Contractors were giving rebuilding bids on homes for $400,000 with insurance policies with limits less than $300,000. See if that doesn't tweak your financial well-being just a little. Here's the solution.

Get an accurate rendering of the square footage of your home. Check county records, take a look at zillow.com, call your favorite Realtor, or get a tape measure and do your thing. Usually you don't include the garage in this calculation. Once you get your square footage, then you need to determine the building cost per square foot in your area for a home like yours. Call a local contractor for a quick estimate or you can call your insurance agent. Average costs in San Diego run about $200 per square foot. With that, a 2000 square foot would take about $400,000 to rebuild. Custom homes can be significantlly more. For a more complete discussion of this, check out: How Much Homeowners Insurance Do You REALLY Need?

Your contents coverage is usually 75% of the amount you have on your home. For example, if you have $400,000 on your home, you'll have an additional $300,000 to cover your personal property (furniture, clothing, dishes, TV, collections, shoes, tools, etc) Usually this is enough, but think through it anyway. If you have antiques, art, collections of any kind then you may need more. Ask your agent for help if you need to.

4. Look at your Personal Liability Coverage. This is the coverage you need when you get sued. Little Johnny runs across your front yard and trips on one of your sprinklers and ruins his chances to become America's Next Top Model and his parents sue your for $250,000. Make sure you don't scrimp here. It's not too expensive to get $500,000 or even $1 Million of liability coverage. If you have $100,000 or less, you could be setting yourself up for a mess just waiting to happen. Put a really big checkbook between your assets and someone who sees an injury as a lifetime paycheck. You might even consider a Liability Umbrella.

5. Check your 'special limits'. This is a REALLY BROAD subject that I just can't do justice to here in this post. Simply stated, there's limits on many things such as cash, computers, cameras, jewelry, furs, goldware, silverware, tools, etc. Call your company and ask for a review. You can increase many of these limits for just a few dollars a year. Sometimes the available increase isn't enough. That's the perfect time to consider a Personal Articles Floater (or it's called many different names) It's a policy that's designed to place stated amounts of coverage on many items from jewelry, business tools, iPods, hearing aids, cameras, musical instruments and on and on. If you have more than 'the average Joe' of ANYTHING, then check this out FOR SURE!

6. Check your deductible! This can be a tremendous cost-control tool in your insurance spending. Simply stated: The larger your deductible, the greater your savings. Usually you can save close to $100 per year just by going from a $500 deductible to $1000. Pick the largest number you can stand without losing sleep at night and ask your agent or company the savings you'd realize by changing. If you have a $250 or smaller deductible, it's definitely time to change it UP! Keep in mind that you usually hit a point of 'diminishing returns' once you get to $4000 or more. This means that you'll save less and less for each additional $1000 you choose. It might make sense to go from $1000 to $2000 if you save $85 a year by doing so, but not from $5000 to $6000 if you only save another $21 by making that jump.

Monitoring your insurance costs and coverages can result in a lot of savings AND peace of mind. Be sure you keep notes and file your thoughts and changes from year to year. These recoreds will make your annual call quicker and easier each year.

Feel free to contact me anytime if you have questions.

Till next time...

It's a Good Life !

Dennis Volz Insurance Agency
10783 Jamacha Bl, Suite 1, Spring Valley, CA 91978
OFFICE: (619) 670-1000 - FAX: (619) 670-1121

eMail:Dennis@DennisVolzInsurance.com

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Saturated Fat and Insulin Sensitivity

Insulin sensitivity is a measure of the tissue response to insulin. Typically, it refers to insulin's ability to cause tissues to absorb glucose from the blood. A loss of insulin sensitivity, also called insulin resistance, is a core part of the metabolic disorder that affects many people in industrial nations.

I don't know how many times I've seen the claim in journal articles and on the internet that saturated fat reduces insulin sensitivity. The idea is that saturated fat reduces the body's ability to handle glucose effectively, placing people on the road to diabetes, obesity and heart disease. Given the "selective citation disorder" that plagues the diet-health literature, perhaps this particular claim deserves a closer look.

The Evidence

I found a review article from 2008 that addressed this question (1). I like this review because it only includes high-quality trials that used reliable methods of determining insulin sensitivity*.

On to the meat of it. There were 5 studies in which non-diabetic people were fed diets rich in saturated fat, and compared with a group eating a diet rich in monounsaturated (like olive oil) or polyunsaturated (like corn oil) fat. They ranged in duration from one week to 3 months. Four of the five studies found that fat quality did not affect insulin sensitivity, including one of the 3-month studies.

The fifth study, which is the one that's nearly always cited in the diet-health literature, requires some discussion. This was the KANWU study (2). Over the course of three months, investigators fed 163 volunteers a diet rich in either saturated fat or monounsaturated fat.

The SAFA diet included butter and a table margarine containing a relatively high proportion of SAFAs. The MUFA diet included a spread and a margarine containing high proportions of oleic acid derived from high-oleic sunflower oil and negligible amounts of trans fatty acids and n-3 fatty acids and olive oil.

Yummy. After three months of these diets, there was no significant difference in insulin sensitivity between the saturated fat group and the monounsaturated fat group. Yes, you read that right. Even the study that's selectively cited as evidence that saturated fat causes insulin resistance found no significant difference between the diets. You might not get this by reading the misleading abstract. I'll be generous and acknowledge that the (small) difference was almost statistically significant (p = 0.053).

What the authors decided to focus on instead is the fact that insulin sensitivity declined slightly but significantly on the saturated fat diet compared with the pre-diet baseline. That's why this study is cited as evidence that saturated fat impairs insulin sensitivity. But anyone who has a basic science background will see where this reasoning is flawed (warning: nerd attack. skip the rest of the paragraph if you're not interested). You need a control group for comparison, to take into account normal fluctuations caused by such things as the season, eating mostly cafeteria food, and having a doctor hooking you up to machines. That control group was the group eating monounsaturated fat. The comparison between diet groups was the 'primary outcome', in statistics lingo. That's the comparison that matters, and it wasn't significant. To interpret the study otherwise is to ignore the basic conventions of statistics, which the authors were happy to do. There's a name for it: 'moving the goalpost'. The reviewers shouldn't have let this kind of shenanigans slide.

So we have five studies through 2008, none of which support the idea that saturated fat reduces insulin sensitivity in non-diabetics. Since the review paper was published, I know of one subsequent study that asked the same question (3). Susan J. van Dijk and colleagues fed volunteers with abdominal overweight (beer gut) a diet rich in either saturated fat or monounsaturated fat. I e-mailed the senior author and she said the saturated fat diet was "mostly butter". The specific fats used in the diets weren't mentioned anywhere in the paper, which is a major omission**. In any case, after 8 weeks, insulin sensitivity was virtually identical between the two groups. This study appeared well controlled and used the gold standard method for assessing insulin sensitivity, called the euglycemic-hyperinsulinemic clamp technique***.

The evidence from controlled trials is rather consistent that saturated fat has no appreciable effect on insulin sensitivity.

Why Are We so Focused on Saturated Fat?

Answer: because it's the nutrient everyone loves to hate. As an exercise in completeness, I'm going to mention three dietary factors that actually reduce insulin sensitivity, and get a lot less air time than saturated fat.

#1: Caffeine. That's right, controlled trials show that your favorite murky beverage reduces insulin sensitivity (4, 5). Is it actually relevant to real life? I doubt it. The doses used were large and the studies short-term.

#2: Magnesium deficiency. A low-magnesium diet reduced insulin sensitivity by 25% over the course of three weeks (6). I think this is probably relevant to long-term insulin sensitivity and overall health, although it would be good to have longer-term data. Magnesium deficiency is widespread in industrial nations, due to our over-reliance on refined foods such as sugar, white flour and oils.

#3: Sugar. Fructose reduces insulin sensitivity in humans, along with many other harmful effects (7).

As long as we continue to focus our energy on indicting saturated fat, it will continue distracting us from the real causes of disease.


* For the nerds: euglycemic-hyperinsulinemic clamp (the gold standard), insulin suppression test, or intravenous glucose tolerance test with Minimal Model. They didn't include studies that reported HOMA as their only measure, because it's not very accurate.

** There's this idea that pervades the diet-health literature that all saturated fats are roughly equivalent, all monounsaturated fats are equivalent, etc., therefore it doesn't matter what the source was. This is beyond absurd and reflects our cultural obsession with saturated fat. It really irks me that the reviewers didn't demand this information.

*** They did find that markers of inflammation in fat tissue were higher after the saturated fat diet.

Poizer Asks For Temporary Halt To Anthem Rate Increase

California Insurance Commissioner Steve Poizner has sent a strongly-worded communication to Wellpoint/Anthem requesting that they hold off on the proposed 3/1 rate increase until 5/1 so that an independent actuary retained by the DOI can review Anthem's payout ratios.

Additionally, the Obama Administration has expressed serious concerns about such a large rate increase in California.

A link to Mr. Poizner's letter here.

Is The California Individual & Family Health Insurance Market In Critical Condition?

With the recent LA Times article and notifications to approximately 800,000 CA residents by Anthem Blue Cross of California, the future of individual & family health insurance coverage is looking bleak. Anthem announced a rate increase for March 1, 2010 ranging between 30-39% on many private health plans.

I received information just yesterday that Aetna has now laid off the IFP staff support for northern California (and I supposed SoCal as well). The last time Aetna laid off people in these positions, they exited the market in California.

First a look at some "interesting" numbers and how they relate to this issue.

California population (2009) - 36,900,000 (probably 37,000,000 by now)

# California residents covered by private health plans - 2,100,000
# California residents on average uninsured - 6,000,000
# California residents covered under Group/Medicaid/Medicare - 28,800,000

Those numbers tell us a lot about what is going on. IFP (Individual & Family Plan) represents an average enrollment of 6% of the total population, and 7% of the total insured population of California. 76% of the total population is covered under an employer-sponsored health plan, Medicaid or Medicare and 93% of the total insured population is covered under an employer-sponsored health plan, Medicaid or Medicare.

Sadly, the uninsured population is nearly three times as large as those who have private health insurance.

Group plans (employer-sponsored) flourish in California. The plans are heavily mandated by benefit and also represent a true actuarial "pool" of risk. Carriers require 75% of all eligible employees to participate, thereby spreading the risk across a large and balanced company population. I have heard over the years that actuarily, group plans tend to run 20% using major benefits, 30% using some benefits and 50% using no benefits in any plan year.

While group plans will certainly experience rate increases due to health care costs, they are often minimized by mandated participation. So long as the actuaries do their job, group tends to be more stable.*

Individual plans have few if any mandates and there is no participation requirement. As such, plans react to utilization of benefits and increases in health care costs on a more radical scale than employer-sponsored group plans.

Also, plan benefit levels are continuously being adjusted to keep the utilization in check. Lower deductibles give way to higher deductibles, first-dollar benefits give way to services under deductibles first, co-insurance splits continue downward (Health Net has plans 50/50),and so on.

When I first started in health insurance in California, then Blue Cross of California (now Anthem) had a very impressive set of PPO plans. $10, $20, $30 and $40 co-pay plans with no deductible, low out-of-pockets and 80%-90% coinsurance levels. They also covered all normal benefits including maternity. The $40 co-pay plan was so inexpensive that it became a loss-leader. The plans were retired around 2000 to make room for plans with lower co-insurance levels, deductibles and higher out-of-pockets. This trend has continued since.

The bottom line is that slowly but surely IFP will become undesireable to consumers and carriers. Carriers will bleed money on accelerating health care costs and consumers will hate the plan designs. Every year the IFP carriers introduce "new" plans, all of which are stripped-down from the preceeding plan designs. Carriers will continue to retire plans that are no longer profitable (see Anthem Share PPO plans and Blue Shield Spectrum PPO plans). At the rate things are going, IFP plans in a few years will be completely catastrophic coverage with little or no preventive care, generic only drug benefits and deductibles in the 10-20,000 range. Oh, and you can pretty much forget about maternity on PPO plans in a few years, too.

HMOs will continue to offer richer and stronger benefits (with access restrictions), however, they will eventually price so high as to be unaffordable for many consumers.

* the exception was the major rate increase in the Lumenos HSA plans a couple of years ago for group. This was due to an actuarial error in terms of anticipated benefit utilization. Lumenos group HSA plans offer free no-cost preventive medicine. The utilization by the traditional 50% who normally don't use benefits in a plan year as almost 100% which totally blew the curve. Rates were increase between 25-39% at the first Lumenos plan anniversary to compensate.

Cal-COBRA under ARRA

I have just received information from multiple sources that the ARRA extension through 2/28 for subsidy to 15 months does now apply to Cal-COBRA as well as federal COBRA.

The Body Fat Setpoint, Part IV: Changing the Setpoint

Prevention is Easier than Cure

Experiments in animals have confirmed what common sense suggests: it's easier to prevent health problems than to reverse them. Still, many health conditions can be improved, and in some cases reversed, through lifestyle interventions. It's important to have realistic expectations and to be kind to oneself. Cultivating a drill sergeant mentality will not improve quality of life, and isn't likely to be sustainable.

Fat Loss: a New Approach

If there's one thing that's consistent in the medical literature, it's that telling people to eat fewer calories does not help them lose weight in the long term. Gary Taubes has written about this at length in his book Good Calories, Bad Calories, and in his upcoming book on body fat. Many people who use this strategy see transient fat loss, followed by fat regain and a feeling of defeat. There's a simple reason for it: the body doesn't want to lose weight. It's extremely difficult to fight the fat mass setpoint, and the body will use every tool it has to maintain its preferred level of fat: hunger, reduced body temperature, higher muscle efficiency (i.e., less energy is expended for the same movement), lethargy, lowered immune function, et cetera.

Therefore, what we need for sustainable fat loss is not starvation; we need a treatment that lowers the fat mass setpoint. There are several criteria that this treatment will have to meet to qualify:

1. It must cause fat loss
2. It must not involve deliberate calorie restriction
3. It must maintain fat loss over a long period of time
4. It must not be harmful to overall health
   

I also prefer strategies that make sense from the perspective of human evolution.

Strategies: Diet Pattern

The most obvious treatment that fits all of my criteria is low-carbohydrate dieting. Overweight people eating low-carbohydrate diets generally lose fat and spontaneously reduce their calorie intake. In fact, in several diet studies, investigators compared an all-you-can-eat low-carbohydrate diet with a calorie-restricted low-fat diet. The low-carbohydrate dieters generally reduced their calorie intake and body fat to a similar or greater degree than the low-fat dieters, despite the fact that they ate all the calories they wanted (1). This suggest that their fat mass setpoint had changed. At this point, I think moderate carbohydrate restriction may be preferable to strict carbohydrate restriction for some people, due to the increasing number of reports I've read of people doing poorly in the long run on extremely low-carbohydrate diets (2).

Another strategy that appears effective is the "paleolithic" diet. In Dr. Staffan Lindeberg's 2007 diet study, overweight volunteers with heart disease lost fat and reduced their calorie intake to a remarkable degree while eating a diet consistent with our hunter-gatherer heritage (3). This result is consistent with another diet trial of the paleolithic diet in diabetics (4). In post hoc analysis, Dr. Lindeberg's group showed that the reduction in weight was apparently independent of changes in carbohydrate intake*. This suggests that the paleolithic diet has health benefits that are independent of carbohydrate intake.

Strategies: Gastrointestinal Health

Since the gastrointestinal (GI) tract is so intimately involved in body fat metabolism and overall health (see the former post), the next strategy is to improve GI health. There are a number of ways to do this, but they all center around four things:

1. Don't eat food that encourages the growth of harmful bacteria
2. Eat food that encourages the growth of good bacteria
3. Don't eat food that impairs gut barrier function
4. Eat food that promotes gut barrier health

The first one is pretty easy: avoid refined sugar, refined carbohydrate in general, and lactose if you're lactose intolerant. For the second and fourth points, make sure to eat fermentable fiber. In one trial, oligofructose supplements led to sustained fat loss, without any other changes in diet (5). This is consistent with experiments in rodents showing improvements in gut bacteria profile, gut barrier health, glucose tolerance and body fat mass with oligofructose supplementation (6, 7, 8).

Oligofructose is similar to inulin, a fiber that occurs naturally in a wide variety of plants. Good sources are jerusalem artichokes, jicama, artichokes, onions, leeks, burdock and chicory root. Certain non-industrial cultures had a high intake of inulin. There are some caveats to inulin, however: inulin and oligofructose can cause gas, and can also exacerbate gastroesophageal reflux disorder (9). So don't eat a big plate of jerusalem artichokes before that important date.

The colon is packed with symbiotic bacteria, and is the site of most intestinal fermentation. The small intestine contains fewer bacteria, but gut barrier function there is critical as well. The small intestine is where the GI doctor will take a biopsy to look for celiac disease. Celiac disease is a degeneration of the small intestinal lining due to an autoimmune reaction caused by gluten (in wheat, barley and rye). This brings us to one of the most important elements of maintaining gut barrier health: avoiding food sensitivities. Gluten and casein (in dairy protein) are the two most common offenders. Gluten sensitivity is widespread and typically undiagnosed (10).

Eating raw fermented foods such as sauerkraut, kimchi, yogurt and half-sour pickles also helps maintain the integrity of the upper GI tract. I doubt these have any effect on the colon, given the huge number of bacteria already present. Other important factors in gut barrier health are keeping the ratio of omega-6 to omega-3 fats in balance, eating nutrient-dense food, and avoiding the questionable chemical additives in processed food. If triglycerides are important for leptin sensitivity, then avoiding sugar and ensuring a regular source of omega-3 should aid weight loss as well.

Strategies: Micronutrients

As I discussed in the last post, micronutrient deficiency probably plays a role in obesity, both in ways that we understand and ways that we (or I) don't. Eating a diet that has a high nutrient density and ensuring a good vitamin D status will help any sustainable fat loss strategy. The easiest way to do this is to eliminate industrially processed foods such as white flour, sugar and seed oils. These constitute more than 50% of calories for the average Westerner.

After that, you can further increase your diet's nutrient density by learning to properly prepare grains and legumes to maximize their nutritional value and digestibility (11, 12; or by avoiding grains and legumes altogether if you wish), selecting organic and/or pasture-raised foods if possible, and eating seafood including seaweed. One of the problems with extremely low-carbohydrate diets is that they may be low in water-soluble micronutrients, although this isn't necessarily the case.

Strategies: Miscellaneous

In general, exercise isn't necessarily helpful for fat loss. However, there is one type of exercise that clearly is: high-intensity intermittent training (HIIT). It's basically a fancy name for sprints. They can be done on a track, on a stationary bicycle, using weight training circuits, or any other way that allows sufficient intensity. The key is to achieve maximal exertion for several brief periods, separated by rest. This type of exercise is not about burning calories through exertion: it's about increasing hormone sensitivity using an intense, brief stressor (hormesis). Even a ridiculously short period of time spent training HIIT each week can result in significant fat loss, despite no change in diet or calorie intake (13).

Anecdotally, many people have had success using intermittent fasting (IF) for fat loss. There's some evidence in the scientific literature that IF and related approaches may be helpful (14). There are different approaches to IF, but a common and effective method is to do two complete 24-hour fasts per week. It's important to note that IF isn't about restricting calories, it's about resetting the fat mass setpoint. After a fast, allow yourself to eat quality food until you're no longer hungry.

Insufficient sleep has been strongly and repeatedly linked to obesity. Whether it's a cause or consequence of obesity I can't say for sure, but in any case it's important for health to sleep until you feel rested. If your sleep quality is poor due to psychological stress, meditating before bedtime may help. I find that meditation has a remarkable effect on my sleep quality. Due to the poor development of oral and nasal structures in industrial nations, many people do not breathe effectively and may suffer from conditions such as sleep apnea that reduce sleep quality. Overweight also contributes to these problems.

I'm sure there are other useful strategies, but that's all I have for now. If you have something to add, please put it in the comments.


* Since reducing carbohydrate intake wasn't part of the intervention, this result is observational.

The California HIPAA Dance

For those who have been following the near-hourly updates on my HIPAA insurance page, the one word I would use to describe the recent activity is--CHAOS.

Anthem Blue Cross initiated what has essentially become a "you-know-what contest" between the two Blues concerning their respective HIPAA portfolios.

The chronology is as follows:

Fall, 2009 - Anthem retires the Share PPO portfolio (retired plans do not need to be offered in the HIPAA mirror of plans)

Jan 11,2010 - Anthem Blue Cross announces a complete HIPAA portfolio overhaul, replacing the 1500 and 2500 Share plans with HMO plan. DOI-registered PPO plans remain the same (5000 and Basic 1000)

Jan 15, 2010 - Anthem closes new enrollments on the 1500/2500 at end of business day

Jan 18, 2010 - Blue Shield CA advises an impending change to the HIPAA products, but cannot comment until 1/22

Jan 22, 2010 - In response to the Anthem HIPAA portfolio change, Blue Shield closes the Spectrum PPO portfolio and eliminates the Spectrum PPO 1500 and 2000 from the HIPAA portfolio. New plans will be available effective Mar 2, 2010 and include an HMO plan, 5500 PPO, 5000 PPO and 4000 HSA-compatible PPO

Jan 25, 2010 - Anthem indicates that a new enrollment requirement applied to the HMO plans will go into effect on Feb 8 in regard to the PPO plans as well (DOI plans). This new requirement will, in effect, guarantee that all Anthem Blue Cross HIPAA enrollees will experience a minimum 30- to 60-day gap in coverage between expiration of group (COBRA/Cal-COBRA) and enrollment in the HIPAA plan.

Please stay tuned to my blog and HIPAA page for further updates as information becomes available.

The Body Fat Setpoint, Part III: Dietary Causes of Obesity

What Caused the Setpoint to Change?

We have two criteria to narrow our search for the cause of modern fat gain:

1. It has to be new to the human environment
   
2. It has to cause leptin resistance or otherwise disturb the setpoint
   

Although I believe that exercise is part of a healthy lifestyle, it probably can't explain the increase in fat mass in modern nations. I've written about that here and here. There are various other possible explanations, such as industrial pollutants, a lack of sleep and psychological stress, which may play a role. But I feel that diet is likely to be the primary cause. When you're drinking 20 oz Cokes, bisphenol-A contamination is the least of your worries.

In the last post, I described two mechanisms that may contribute to elevating the body fat set point by causing leptin resistance: inflammation in the hypothalamus, and impaired leptin transport into the brain due to elevated triglycerides. After more reading and discussing it with my mentor, I've decided that the triglyceride hypothesis is on shaky ground*. Nevertheless, it is consistent with certain observations:

• Fibrate drugs that lower triglycerides can lower fat mass in rodents and humans
  
• Low-carbohydrate diets are effective for fat loss and lower triglycerides
• Fructose can cause leptin resistance in rodents and it elevates triglycerides (1)
• Fish oil reduces triglycerides. Some but not all studies have shown that fish oil aids fat loss (2)
  

Inflammation in the hypothalamus, with accompanying resistance to leptin signaling, has been reported in a number of animal studies of diet-induced obesity. I feel it's likely to occur in humans as well, although the dietary causes are probably different for humans. The hypothalamus is the primary site where leptin acts to regulate fat mass (3). Importantly, preventing inflammation in the brain prevents leptin resistance and obesity in diet-induced obese mice (3.1). The hypothalamus is likely to be the most important site of action. Research is underway on this.

The Role of Digestive Health

What causes inflammation in the hypothalamus? One of the most interesting hypotheses is that increased intestinal permeability allows inflammatory substances to cross into the circulation from the gut, irritating a number of tissues including the hypothalamus.

Dr. Remy Burcelin and his group have spearheaded this research. They've shown that high-fat diets cause obesity in mice, and that they also increase the level of an inflammatory substance called lipopolysaccharide (LPS) in the blood. LPS is produced by gram-negative bacteria in the gut and is one of the main factors that activates the immune system during an infection. Antibiotics that kill gram-negative bacteria in the gut prevent the negative consequences of high-fat feeding in mice.

Burcelin's group showed that infusing LPS into mice on a low-fat chow diet causes them to become obese and insulin resistant just like high-fat fed mice (4). Furthermore, adding 10% of the soluble fiber oligofructose to the high-fat diet prevented the increase in intestinal permeability and also largely prevented the body fat gain and insulin resistance from high-fat feeding (5). Oligofructose is food for friendly gut bacteria and ends up being converted to butyrate and other short-chain fatty acids in the colon. This results in lower intestinal permeability to toxins such as LPS. This is particularly interesting because oligofructose supplements cause fat loss in humans (6).

A recent study showed that blood LPS levels are correlated with body fat, elevated cholesterol and triglycerides, and insulin resistance in humans (7). However, a separate study didn't come to the same conclusion (8). The discrepancy may be due to the fact that LPS isn't the only inflammatory substance to cross the gut lining-- other substances may also be involved. Anything in the blood that shouldn't be there is potentially inflammatory.

Overall, I think gut dysfunction probably plays a major role in obesity and other modern metabolic problems. Insufficient dietary fiber, micronutrient deficiencies, excessive gut irritating substances such as gluten, abnormal bacterial growth due to refined carbohydrates (particularly sugar), and omega-6:3 imbalance may all contribute to abnormal gut bacteria and increased gut permeability.

The Role of Fatty Acids and Micronutrients

Any time a disease involves inflammation, the first thing that comes to my mind is the balance between omega-6 and omega-3 fats. The modern Western diet is heavily weighted toward omega-6, which are the precursors to some very inflammatory substances (as well as a few that are anti-inflammatory). These substances are essential for health in the correct amounts, but they need to be balanced with omega-3 to prevent excessive and uncontrolled inflammatory responses. Animal models have repeatedly shown that omega-3 deficiency contributes to the fat gain and insulin resistance they develop when fed high-fat diets (9, 10, 11).

As a matter of fact, most of the papers claiming "saturated fat causes this or that in rodents" are actually studying omega-3 deficiency. The "saturated fats" that are typically used in high-fat rodent diets are refined fats from conventionally raised animals, which are very low in omega-3. If you add a bit of omega-3 to these diets, suddenly they don't cause the same metabolic problems, and are generally superior to refined seed oils, even in rodents (12, 13).

I believe that micronutrient deficiency also plays a role. Inadequate vitamin and mineral status can contribute to inflammation and weight gain. Obese people typically show deficiencies in several vitamins and minerals. The problem is that we don't know whether the deficiencies caused the obesity or vice versa. Refined carbohydrates and refined oils are the worst offenders because they're almost completely devoid of micronutrients.

Vitamin D in particular plays an important role in immune responses (including inflammation), and also appears to influence body fat mass. Vitamin D status is associated with body fat and insulin sensitivity in humans (14, 15, 16). More convincingly, genetic differences in the vitamin D receptor gene are also associated with body fat mass (17, 18), and vitamin D intake predicts future fat gain (19).

Exiting the Niche

I believe that we have strayed too far from our species' ecological niche, and our health is suffering. One manifestation of that is body fat gain. Many factors probably contribute, but I believe that diet is the most important. A diet heavy in nutrient-poor refined carbohydrates and industrial omega-6 oils, high in gut irritating substances such as gluten and sugar, and a lack of direct sunlight, have caused us to lose the robust digestion and good micronutrient status that characterized our distant ancestors. I believe that one consequence has been the dysregulation of the system that maintains the fat mass "setpoint". This has resulted in an increase in body fat in 20th century affluent nations, and other cultures eating our industrial food products.

In the next post, I'll discuss my thoughts on how to reset the body fat setpoint.


* The ratio of leptin in the serum to leptin in the brain is diminished in obesity, but given that serum leptin is very high in the obese, the absolute level of leptin in the brain is typically not lower than a lean person. Leptin is transported into the brain by a transport mechanism that saturates when serum leptin is not that much higher than the normal level for a lean person. Therefore, the fact that the ratio of serum to brain leptin is higher in the obese does not necessarily reflect a defect in transport, but rather the fact that the mechanism that transports leptin is already at full capacity.