Older Bolder Life

Stronger | Leaner | Sharper | Longer - From Older Bolder Fitness

Medical Policy: A Slippery Slope if There Ever Was One – “Rational” Elder Assisted Suicide

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On a site dedicated to exploring health and wellness, it might at first glance seem a bit odd to find a link to a source talking about elder assisted suicide.

[As a quick aside, let me make my personal position crystal clear on the topic – I am against all forms and every practice of assisted suicide on moral grounds. Clearly adherents and supporters of the practice can put forth, at least on some level, cogent arguments, however, particularly in the context of the “elderly” as discussed in the links below, I find even the discussion abhorrent.]

That said, one of our goals here is to present occasional medical policy topics that have practical and current standing; given as to how media outlets such as the New Year Times have recently called attention to the issue, and physician friends have continued to report discussions along this line by entities ranging from local medical ethics committees to national professional association level, policy-articulating boards, I felt it reasonable to throw this out there.

Several months ago I was actually sent this link – Promoting ‘Rational’ Elder Suicide – by a physician friend; this friend (who shall remain nameless for obvious reasons) holds an appointment in a prominent American School of Medicine, heads his specialty department, and has served several stints on medical ethics boards for local centers as well as an ethics task force for his specialty nationally. He also happens to hold a JD in addition to his medical degree; of note, he never actually practiced law.

In his email he lamented that, for a variety of reasons, in his opinion we’re going to see a “significant push toward acceptance of assisted suicide for a an ever-enlarging spectrum of issues, including its routine use in the elderly who have outlived their resources, have diminished functional capacity and ability to meaningfully and consistently contribute to the greater society as a whole.”

Sober food for thought, and yet another reason to optimize one’s health and maximize one’s functional capacity for the long haul.

And back to more uplifting regular programming tomorrow…

the Older Bolder Life Vegetable Wednesday 5 December: Avocado Oil Roasted Leeks

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We dined with friends several weeks ago and the hostess served these simple yet delicious Avocado Oil Roasted Leeks with the meal. They were a perfect texture with a soft body complemented by just enough crispy browned edges, and what an amazing flavor.

We love leeks around our camp, using them in a number of soups and stews, as well as my wife’s favorite boeuf bourguignon recipe (I don’t think we’ve posted that one yet, I’ll make sure we get that done before the holiday week upcoming…)

These couldn’t be more simple to do, though with a two-hour cook time, you’ll need to plan ahead a bit. And by the way, our hostess had prepared these with a very nice olive oil, though we’ve since made them with avocado oil (both for taste preference and avocado oil’s much higher smoke point).

By the way, the oil remaining after cooking makes an amazing contribution to your next vinaigrette…

8 leeks, white and pale green sections, split lengthwise
1/2 cup good avocado oil (maybe a little more)
Good salt

Throw a rimmed baking sheet in the oven and preheat to 400.

Prep your leeks, minding to use only the white and the pale green stem sections; cut them in half lengthwise and wash thoroughly to remove the sand and grit. Take care to pat them as dry as you can after washing.

Now toss with the avocado oil and season generously with your favorite salt.

Pull the hot baking sheet from the oven, arrange the leeks cut side down on the hot sheet, then cover loosely with foil. Throw them back in the oven, reduce the heat to 300, and leave them alone for an hour and 20 minutes. Check at that point to see if they’re tender and lightly browned; they might need another 10-20 minutes.

Now remove the foil and turn the leeks cut sides up; turn the over up to 400 and slide the leeks back in until they’re golden brown and the tops (cut sides) look a little crispy.

Save that oil by the way, it’s great for roasting vegetables or making a flavorful vinaigrette…

Enjoy.

A Short Roundup on Plantar Fasciitis

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The Quick Backstory

As part of my own condition and wellness program, I’ve been walking 30 to 35 miles per week now for about five months, typically walking six of seven days per week and enjoying my time on the trails immensely.

About three weeks ago, pushing through a new facet of my resistance training, I tweaked my left sacroiliac joint and began to experience what typically was a nuisance mechanical lower back and left posterior pelvic pain about 25-30 minutes into a ninety minute walk.

Determined to push on through, I kept up my routine (minus the newer resistance component), monitoring my discomfort, without much difficulty. At one time I questioned whether or not I was having to adjust my gait significantly; I didn’t think so…

That all changed about ten days ago, when I seemingly woke up “out of the blue” with a fairly impactful left plantar fasciitis, which worsened impressively with that morning’s walk.

Those symptoms have sent me scrambling to review the current thinking in management of plantar fasciitis, which I’ve been implementing with reasonable success over the past ten days. My plantar fasciitis episode has clearly been multifactorial in origin (the gait pattern change above, shoes at the end of their functional life, slacking off on calf/leg/hip stretching over the past couple of months, and potentially even some terrain and trail changes altering foot stresses).

I don’t have time to delve into plantar fasciitis comprehensively here this week, though I thought it might be useful to post a few useful videos and references now, and we’ll come back and deal with PF in more detail at a later time.

A Few Very Useful Plantar Fasciitis Links and Vids

How to Treat Your Plantar Fasciitis Naturally – Dr. Phil Maffetone and team; very well done, downloadable PDF

Plantar Fasciitis – Fix Your Feet! from the StrategicAthlete, good vids included

How to Cure Plantar Fasciitis – October 18 post on Mark’s Daily Apple

2 Stretches to Heal Plantar Fasciitis – video by Brad Kearns; note his explanation re: bent vs straight knee is reversed, but otherwise well done and core essential stretching

Plantar Fasciitis from MobilityWOD/Kelly Starrett; very well done…

More to come; don’t waste another day if you’re suffering from PF and haven’t made any progress in your rehab and recovery.

the Older Bolder Plan to PreGame Your Holidays: Seven Essentials

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Now’s the time to proactively take some simple, readily attainable steps to make the upcoming holiday weeks something to savor and enjoy instead of “simple surviving”.

There’s nothing to follow that falls into the rocket-science level of thought, and while no doubt some of our readers are holiday season ninjas, handling the stress and frenzy of the holidays without batting an eye or breaking a sweat, there’s a useful pearl or two below for the rest of us.

Simplify (Everything)

Everything should be made as simple as possible, but not simpler.
– Albert Einstein

A trusted mentor years ago sat back in his chair as we sipped coffee after an early morning breakfast, and said something close to this, “…if there’s one thing I could impart to you from all the time we’ve spent working together, it would be to simplify your life. Simplify, simplify, simplify…”

My friend was also a physician, and we’d recently left busy, successful practices to together start a new practice model, the first of its kind for our specialty in the entire state (Utah) at the time. I don’t remember all the precise details of our conversation, but I’d been complaining about all the seemingly endless onslaught of ‘must do’ tasks that our new startup engendered, and how it was impacting time with my young children and my other love, fly fishing.

The call to simplify of course fits perfectly with the tsunami of activities we all face during the holiday window at year’s close. I personally find the call to simplification quite liberating, opening the door to not pursue perceived perfection (events, food, gifting, and so on) but think out of the box, uncouple from (at least some) burdensome traditions, and engage with friends and family in the moment.

One easy way to simplify? Put down your damned phone, and take a several week hiatus from social media. Watch out, you’ll probably find that social media isn’t doing anything useful for you, and never go back…

Creatively Meal Plan and Cook Ahead

For many aspiring primal and ancestral eaters, the holidays present a particular challenge when it comes to making optimal choices to fuel their bodies for the activities of the day. Carb bingeworthy, insulin-spiking treats seem to pop up everywhere, and many feel undue peer or family pressure to participate.

One simple practice that’s revolutionized the way my wife and approach our meals is to plan out our menu a week or ten days at a time. I like to do this at a time during the day when my creative and planning processes are firing on all cylinders (somewhat ironically, that’s almost always in a fasted state for me). Thinking through our favorite meals in the rotation and planning their timing according to our schedules (and even the weather forecast) shuffles all the “what should we eat decision making” into one convenient window, and saves significant time (and stress) during the week.

Our adult daughter from Montana is joining us for the week around Christmas; she’s been keto now for several weeks, and we’ve already planned out a deliciously tasty and largely keto compliant menu for her stay. Yep, there’s one not-quite-keto dessert planned, but we’ll be 97% on target (give or take a percent) otherwise.

Easy peasy, and I’ll even cook Christmas Eve’s Boeuf Bourguignon a few days ahead (it only gets better).

Cling to Your Wellness Routines, Especially Exercise and Sleep

I know, I know, this one is easier said than done, particularly if you’re in a part of the country where winter has already locked the countryside in its icy grip. Be uncompromising about your regular workouts, and perhaps it’s now time this month to treat yourself to that extra yoga class or extended hour or two in the gym/on the slopes/on the road.

Most of us, given the drastically shortened day length in December (solstice on the 21st!), feel the circadian tug to sleep longer this time of year. Don’t fight it, and there will be an event or two this month that you need to forgo to recharge your own sleep batteries.

Just do it.

Shift Mental Gears on Gifting

Probably the most cherished Christmases we experienced with both of our children at home were the years we decided as a family to hand-make all gifts. The first time we did this our kids were late-elementary school age, and we were amazed at how creative they were, and how invested they became in the process.

It’s purely my opinion, but I’d argue anywhere, anytime that the best gifts we can give are gifts from the heart, markedly personal, and (keeping with my theme) often beautifully simple. Don’t shop just to “shop and find the perfect gift”. This might just be the year when you buy/make gifts in batches (ornaments, a primal/paleo/ancestral food treat – get creative here, candles, and so on…).

Be a Crafty Scheduler: Who, When, and Where

For many, time demands escalate dramatically during the holiday season, sometimes to the point of being ludicrous. We try to approach social demands during the holiday pragmatically; there are events that are ‘must do’, we try and make those as fun as possible and invest time wisely.

There are, however, always a flock of event invitations, some no doubt by winsome folks and worthy organizations, that for what ever reason, that don’t resonate with you or present a conflict or unnecessary drain of time, effort, or holiday cheer. Don’t hesitate to say ‘no thanks’; saying no can be very empowering, gets easier the more you do it, and you need to be making the best choices with your time you possibly can. Choose the best (over the good and not so good) for you and yours this season.

Make This Month Fun

It’s amazing to me how many people look and feel stressed and harried this time of year. Seeing someone, a couple, or a group of friends, talking, laughing – obviously having real fun – is something of rarity it seems.

Have a friend or family member who always make you smile and laugh? Make a special effort to spend time with them in the next few weeks. Carve out time every week to do something you really enjoy, crank up your favorite music, and invest time with people you care about and love.

Cultivate a Sense of Gratitude

There’s a remarkable body of scientific work that’s been collected detailing the health benefits related to perceiving a sense of gratitude. We’ll delve into the science of gratitude, and its impacts on human physiology and the human psyche in detail in coming months; here’s a decent recent summary with links to pertinent research if you’re skeptical.

For many this time of year invokes a spiritual connection; if you’re one of those, embrace it, and revel in the time of celebration and fellowship. (We’ll spend some time this next year looking at the impressive health benefits of spiritual practice…)

For some, looking at life through a lens of gratitude and appreciation isn’t one that they understand well, nor is it one they’ve practiced often. It doesn’t matter, your gratitude capacity grows markedly with repeated use; start flexing those gratitude muscles today, and keep it up through the busy holidays (and beyond).

the Older Bolder Life Salad Sunday 2 December: Broccoli Caesar

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Back in late August I shared about how much we love a great Caesar salad around our house, though we struggled for years to find a dressing recipe we truly loved and could make at home without an advanced food degree or pestering our friend Chef Libby to work her magic.

Though not a new concept, we’ve been making this Broccoli Caesar as often as a traditional Caesar of late; the cruciferous crunch is delicious, especially when topped with this Homemade Caesar Dressing with Avocado Oil Mayo you’ve prepped in your own kitchen.

The shaved Parmesan is always a great touch – that nutty, salty Parmesan flavor is essential in our book, and the toasted walnuts will make you forget there’s not a crouton in sight…

One recipe Homemade Caesar Dressing with Avocado Oil Mayo

2 medium to large heads of broccoli
1/4 head Napa cabbage (more to taste)
Good salt to taste

Shaved Parmesan
Fresh lemon zest
Freshly ground (coarse) or cracked black pepper

Optional: Toasted Walnuts

Trim any rough, darkened ends from the broccoli stems, and remove the florets as close to the dark green flower buds as you can, then trim or break into bite-sized segments, placing in a large bowl. Now slice the stems into thin rounds, starting with narrow stalks that held the florets.

When trimmed down to the main stems, peel the tougher outer layers off, exposing the more tender inner cores, then slice crosswise into narrow discs and add to the florets.

Slice thinly/shred the cabbage (add more if you like) and stir into the broccoli pieces.

Now pour the dressing over, salt to taste, stir to coat, and let rest in the fridge for 10-15 minutes.

When ready to serve, stir once more, topped with shaved Parmesan, the lemon zest, and the pepper. Add toasted walnuts if desired.

Enjoy.

Inquiring Minds Want to Know (Links and Stuff) 1 December 2018

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Topics and Articles That Caught Our Eye this Week

Dietary Fat: From foe to friend? – A nifty work from Science featuring two heavyweights in the research world battling to correct decades of misinformation – Drs. David Ludwig and Jeff Volek. If you read nothing else today – read this one.

The Case for a Low-Carb Diet is Stronger Than Ever. (A summarized lay version of the above by one of the co-authors, Dr. Ludwig)

Fasted Workouts: When They’re More Effective (and How I Incorporate Them) – a very useful blog post from one of the masters, Mark Sisson. I’ve been doing fasted workouts now (typically multiple per day) for very nearly a year now and have found he practice extraordinarily useful.

Simply Seeing and Smelling Food Preps the Liver for Digestion. If you’ve been paying attention to your body’s responses over the years, you knew this was true. Here’s the actual paper from Cell the article was based on.

Simple, functional resistance training built muscle mass in the elderly.

Is the medical establishment waking up to Lifestyle Treatment for Alzheimer’s? Short answer – kinda…

Gene recombination in Alzheimer’s.

Our Recipes from the Week

Thai-Inspired Celery Salad

Cajun Buffalo Cauliflower with Blue Cheese Crumbles

Puerco Guisada

the Older Bolder Life Friday Feast 30 November: Puerco Guisada

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As we turn the corner from late fall into early winter, here’s one to help you beat back the crush of winter’s hand – Puerco Guisada, a south Texas / Mexico inspired take on the spicy ‘meat in gravy’ stew (carne guisada) gracing every worthy taco stand from Austin to the southern border in Texas.

One might certainly argue this dish is traditionally made with beef (carne guisada) – and you can certainly do that by exchanging the pork with a cut of chuck or bottom round – though the pork version seems a tad lighter and sweeter to us.

This puerco guisada is another one of those recipes that are so simple they’re child’s play, thought there are a couple of caveats to note. Flavors are dramatically improved by actually browning the meat in the oil up front; if you overcrowd the meat it steams and doesn’t brown. Browning in two or three batches works wonders and leaves a hoard of those tasty browned ‘pan crispins’ behind to scrape up and flavor the stew.

The other caveat pertains to the peppers; jalapenos and serranos can very dramatically in their heat level. Cut off a small chip of the pepper and touch it to your tongue to get an idea about the heat; the last two jalapenos I picked out of the bin were searingly hot, so we left out the serranos on that batch (even though they add a slightly different heat and flavor pattern).

This Puerco Guisada makes for a killer bowl of spicy goodness standing alone (with a few toppings of course) and it makes a mouth-watering taco or burrito too. We’ve even been known to use it to make a puerco guisada huevos rancheros for breakfast when special company is in the house.

4ish pounds of pork shoulder or loin, trimmed, cut into 3/4-inch cubes
4 tbsp avocado oil
1 large sweet onion, diced
2 jalapeno peppers, stemmed, seeded, and diced
2 serrano peppers, stemmed, seeded, and diced
6 garlic cloves, minced
14-oz can diced tomatoes with liquid or 3 fresh tomatoes with seeds and core, diced
2 tbsp ground cumin
2 tbsp good chili powder
2 tsp (preferably Mexican) oregano
1/2 cup chopped cilantro or more
2 bay leaves
2 cups of water
1 bottle cerveza (Corona or Negro Modelo for the spirit of things)
Optional: 1 tbsp masa if needed for thickening

In your trusty dutch oven, heat 1/3 of the oil over medium high heat and brown 1/3 of the meat; remove to a plate and repeat to brown all the meat.

Add a splash of oil if needed, and sauté the onions and peppers until soft; then add the garlic, and cook, stirring now and again, for another couple of minutes.

Now add the pork back to the dutch oven, along with the tomatoes, cumin, chili powder, oregano, bay leaves, water and beer. Stir until well combined, turn up the heat and bring to a gentle boil, stirring frequently.

Now turn down to a simmer and let it go low and slow for 4 to 5 hours, stirring once an hour; you’ll notice the pork begins to tenderize and break down a bit, thickening the mixture as the water cooks off. (You can always add the masa at the end to thicken it more, though we never do.)

Traditionally this would be served steaming hot in a big bowl, sprinkled with grated cheese, maybe a few chopped fresh peppers, cilantro, and fresh or pickled onions. The possibilities are endless as noted above.

Enjoy.

Keto Thursday: Digging into the History Behind Today’s Nutritional Ketosis

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Over the past few weeks I’ve been spending a portion of my research time digging into the history of nutritional ketosis.

As most nutritional ketosis advocates know, formal discussion of NK in modern medical literature appears to have first been reported by Guelpa and Marie in 1911, two Parisian physicians who noted that fasting had consistent, demonstrably favorable impacts in epilepsy.

Perhaps even more interestingly, fasting is reportedly the only therapeutic measure against epilepsy documented in the Hippocratic collection (disclosure – I haven’t read all the Hippocratic collection), and there’s even a purported reference to fasting for a child with an apparent seizure disorder during Jesus’ time (Mark 9:14-29, KJV).

For those with an interest, I’ve listed below several more current references / links which are fairly easy, if not lengthy, reads. I certainly can’t vouch for the absolute accuracy of the information reported therein, though if you read through all you’ll note the consistencies.

History of the ketogenic diet (Epilepsia, 2008)

History and Origin of the Ketogenic Diet (Chapter two of Epilepsy and the Ketogenic Diet, pp 31-50)

The Origin (and future) of the Ketogenic Diet Part 1, Part 2, and Part 3 (Robb Wolfe’s team)

Do ketogenic diets have a place in human evolution? (Break Nutrition, 2017)