Older Bolder Life

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Interesting Read: A Brief History of American Medical Insurance

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From time to time I’ll be sharing thoughts on medical policy and the medical insurance arena, both areas that anyone (certainly those of us, say, over 30) who wish to maximize wellness, function, and our longevity should, at least from a respectful distance, cast a wary eye toward.

There’s a lot to talk about in these areas, and of course the intricate realities of medical policy and the insurance world are at times deviously complex, maddeningly opaque, and almost always costly (both in human and financial terms) when you have an up-close and personal encounter with either, though particularly medical insurance.

To that end, I recently came across this (relatively) short read – A Brief History of American Medical Insurance – via an unlikely source, Hillsdale College’s Imprimis. Mr. Gordon doesn’t get everything right, though he’s much closer in presenting reality than most these days. Worth a read…

Much more to come in these two topic areas, with an eye to practical application for we consumers of health care.

Image via Imprimis.

the Older Bolder Life Friday Feast 7 September: Grilled Cumin Garlic Tahini Chicken

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Here’s a bit of a different spin on typical grilled chicken we had with friends a few months back – a Grilled Cumin Garlic Tahini Chicken.

Our daughter recently traveled to Jordan for her work as a photojournalist, and came back armed with several artisanal olive oils and spice mixtures, prompting an exploration of Jordanian and other Middle Eastern foods we’ve enjoyed tremendously of late.

We’ve always enjoyed tahini around our camp (even if used primarily in whipping up the occasional batch of hummus when entertaining company), and the nutty goodness of the ground sesame really comes through in this dish.

The fresh garlic, good cumin (get some fresh) and paprika, along with the fresh lemon juice combine very, very well the tahini, and caramelizing (gently) on grill makes the whole package even better.

If you’re a tahini fan, give this one a spin, it’ll likely end up in your rotation (it has in ours of late).

3-4 pound chicken, cut up
Good salt

7-8 garlic cloves, peeled, minced, mashed
1 tbsp fresh ground cumin
1 tbsp good paprika
1/3 cup tahini
1/4 cup fresh lemon juice (maybe just a bit more)
2-3 tbsp avocado or olive oil
Pinch of good salt, more to taste

Cut up your chicken, dust with good salt, and throw in the fridge for a couple of hours.

Mince the garlic, then grind into a paste with the side of your trusty chef’s knife, along with a pinch of good salt; transfer to a small bowl.

Now add the cumin, paprika, tahini, fresh lemon juice, and 2 tbsp of the oil you’ve chosen. Combine well, you’re looking for a thick paste something akin to a thinner peanut butter consistency. Add a tsp of fresh lemon juice or oil if you need to loosen it up; adjust the salt to taste.

Now slather the paste mixture over each chicken piece; it’s much more interesting to use your hands, rubbing it in and coating all surfaces well. Let the chicken sit at room temp for up to an hour.

Fire the grill.

Cook using your favorite routine for chicken; we start this one skin side down, and turn fairly frequently, moving the chicken to a cooler zone of the grill as the tahini-spice paste begins to caramelize. Rest the chicken when done for a few minutes, then serve either hot or cooled to room temp.

Enjoy.

Nutritional Ketosis Science Thursday: NK and Mitohormesis

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A few weeks ago I posted a link to this article – Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health – from none other than Jeff Volek (yep, one of the scientific heavy-weights in the ketosis world), VJ Miller, and FA Villamena.

[Citation: Journal of Nutrition and Metabolism. 2018; 2018: 5157645]

IMHO, for those interested in digging a bit deeper into a science behind why nutritional ketosis (NK) provides the hosts of benefits it does, this will go down as one of the landmark articles detailing in particular NK’s impact at the mitochondrial level.

Why does that matter? From the abstract (cited above) –

The free radical theory of aging proposes that reactive oxygen species (ROS)-induced accumulation of damage to cellular macromolecules is a primary driving force of aging and a major determinant of lifespan. Although this theory is one of the most popular explanations for the cause of aging, several experimental rodent models of antioxidant manipulation have failed to affect lifespan. Moreover, antioxidant supplementation clinical trials have been largely disappointing. The mitochondrial theory of aging specifies more particularly that mitochondria are both the primary sources of ROS and the primary targets of ROS damage. In addition to effects on lifespan and aging, mitochondrial ROS have been shown to play a central role in healthspan of many vital organ systems. In this article we review the evidence supporting the role of mitochondrial oxidative stress, mitochondrial damage and dysfunction in aging and healthspan, including cardiac aging, age-dependent cardiovascular diseases, skeletal muscle aging, neurodegenerative diseases, insulin resistance and diabetes as well as age-related cancers…

They go on to discuss the roll that reactive oxygen species (ROS) play in tissue/cellular damage (one of the principal driving forces of aging), the ‘built-in’ systems designed to mitigate ROS damage, and the lackluster results in large scale trials of antioxidants with regards to mortality and morbidity, with a possible exception being Alzheimer’s disease.

They focus a large part of discussion on the mitochondrial free radical theory of aging, which (as complex as it is) is discussed in detail, leading to presentation of the key concept of mitochondrial signaling and mitohormesis –

Apart from generating detrimental oxidative damage, ROS have numerous crucial biological roles in signaling and stress response (reviewed in [33-35]). Emerging evidence suggests that oxidative stress might promote longevity and metabolic health through the concept of mitochondrial hormesis (mitohormesis). The mitohormesis theory hypothesizes that low levels of oxidative stress induced by either caloric restriction, exercise [36], or other stimuli may trigger adaptive responses that improve overall stress resistance, probably through increased endogenous antioxidant defense, which may eventually reduce chronic oxidative damage [37] and subsequently achieve lifespan extension…

The Take Away

While part of the paper details the ongoing search for and testing of pharmacologic agents which induce mitohormesis, the authors clearly reference studies and the science supporting nutritional ketosis, calorie restriction, and exercise (among others) as potential drivers of mitohormesis.

NK’s ability, when properly executed, to induce / encourage these types of adaptive changes at the cellular level is quite impressive, and should lead most to take a more serious look at using NK as an intermittent tool to improve their health.

The paper happens to be extensively referenced, and for those who want to dig deeper into NK, there are several weeks of additional reading and pondering to do…

the Older Bolder Life Vegetable Wednesday 5 September: Grilled Southwestern Cauliflower Steaks

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Even thought the calendar has turned to September, it’s still prime time grilling season for most of us around the country; if you’ve not tried grilling cauliflower, give these Grilled Southwestern Cauliflower Steaks a spin.

I know, I know, there are probably hundreds of recipes for grilled cauliflower floating around out there, but this is one of our favorites given the southwestern spice flavors.

This is another of those recipes that’s so ridiculously easy it’s almost child’s play (don’t tell anyone that) yet unique and tasty enough to serve when entertaining.

Don’t forget to save the cauliflower florets you trim away as you carve the “steaks”, the trim is perfect for a salad or stir fry. Some recipes out there call for microwaving the cauliflower for 2-3 minutes before grilling it, but we’ve never added that step and it turns out perfectly every time.

Inspired by several different recipes, include one from Serious Eats.

2 medium heads cauliflower, trimmed, cut as per below
3 tbsp EVOO or avocado oil

Spice rub
1 generous tbsp ground turmeric
2 tsp mild chile powder
2 tsp ground cumin
2 tsp good salt
1 tsp powdered ginger
1 tsp garlic powder
1 tsp fresh ground black pepper
1/4 tsp onion powder

Garnish
2-3 tbsp fresh cilantro or parsley, finely chopped
Pickled red onions

Mix the spice rub ingredients well, set aside.

Remove the green leaves from the cauliflower and slice off the root/base so the cauliflower can sit flat on your cutting board.

Slicing vertically, trim several inches off one side of a cauliflower head, then slice as many 3/4-inch thick slices as you can obtain from each head. You want the slices to more or less remain intact, with the peripheral florets still “connected” to the core/stalk so they’ll stay together on the grill. (Save the trimmed florets for a salad or stir fry…)

Brush the “steaks” with your oil of choice, dust/coat well with the spice mixture, and set aside at room temp while you fire the grill. (Alternatively, shake the oiled steaks one at a time in a large resealable bag with the spice mix.)

Grill over direct head for 3-4 minutes per side; you’re looking to develop a bit of char here without burning the spices. Then move to an indirect heat zone and cook until as tender as you’d like, we like these will a bit of residual crunch (somewhere between 13-15 minutes typically).

Best served hot/warm, and garnish with the chopped cilantro or parsley and maybe those pickled red onions…

Enjoy.

The Carb Conundrum That Really Isn’t (Part 2)

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Yesterday I shared an interesting email from a physician friend lamenting the widely varying recommendations about carbohydrate consumption discussed in the medical and lay press these days.

We agreed to spend thirty minutes on the phone together to allow me to present a simple collection of five suggestions to him; the discussion focused on the following. (I’ll be delving into the established science in each of these areas in later posts; to do so here and now would simply be too much to cover…)

You Say Low Carb, I Say Thoughtful, Careful, Smart Carb

The longer I personally live what most would call a ‘Primal Lifestyle’, the more I feel we’re probably mischaracterizing the optimal approach to carbohydrates in a healthy diet.

We’re not carb-phobic, or carb avoiding. Quite the contrary.

What we’re really talking about here is a Thoughtful, Careful, Very Intentional Carbohydrate approach (some even frame it as Smart Carbs), selecting nutrient-dense, fresh, insoluble fiber-rich, whole sources of carbohydrate, and avoiding (like the plague) highly refined and processed carbohydrate sources, like sugars, just about all grains, legumes, and overly sweet fruits.

One of my mentors early on challenged me to eat 30 to 50 grams of healthy carb vegetables a day (as part of a rational eating plan) and then argue that I didn’t find my hunger sated and energy needs met handily; I issued the same challenge to my friend…

Clearly for those who have existed and struggled as carb-fueled, binge and crash several times a day machines, there’s a transition journey, though for most it’s a molehill and not a mountain to cross.

Is Restoring Insulin Homeostasis the Key? (Yep, It Is.)

I reminded my friend of the critical and varied roles that insulin plays in the human body, in addition to one of its principle tasks, that being the storage of excess ingested nutrients, most commonly as stored fat. There’s no question that high carb diets chronically elevate insulin levels, keeping fat locked in storage, and over time, lead to development of insulin resistance, which among a myriad list of undesirable effects, makes it much, much harder to drop excess body fat.

Chatting about this, we found we both share a particular interest in insulin’s effects on brain metabolism and aging (here’s an interesting read on some probable mechanisms in the brain).

Thoughtful, Careful, Smart Carb: Embrace the Good, Out with the Bad

A few weeks back I wrote –

There are several foods, ironically centerpieces of the typical American diet, that contribute more to the damaged and deranged health of the population than anything else – sugar, grains, and the highly-oxidized, polyunsaturated, industrially-processed vegetable and seed oils being the worst of all.

Eating a SAD diet, these three categories often make up the preponderance of calories consumed, despite the hard science record that carbs are the principle driver in determining body composition and that excess glucose (yep, we’re looking right at you grains and sugars) is the root culprit fostering the obesity epidemic and the flood of disorders (i.e. T2DM, heart disease) that walk hand in hand with it.

This isn’t a carb-phobic approach – it’s sweeping the crap carbs out of your diet, and replacing them fully with nutrient-dense, fiber-rich, healthy carbs at levels that make sense physiologically.

I reminded my friend that dialing in optimal, quality carbohydrate intake goes hand in hand with consuming moderate amounts of quality proteins, which contributes impressively to satiety, along with consumption of healthy, appropriate fats.

Thoughtful, Careful, Smart Carb Brings Out the Fat Burning Beast

We talked briefly about the growing body of data suggesting that fats (and some of their metabolic derivatives, i.e. ketone bodies) very well may be the body’s preferred, most efficiently utilized fuel for anaerobic activities (the stuff we humans do for the vast majority of our days).

This is an enormous subject, and far too vast to cover in a few paragraphs (or a thirty minute conversation on the phone). Having just read it myself, I suggested my compadre grab a copy of Nora Gedgaudas’ most recent book Primal Fat Burner for a detailed, recent review of the science behind this growing and most interesting line of thinking.

Training your body to become fat adapted opens doors of (metabolic) flexibility that are truly game changing.

Thoughtful, Careful, Smart Carb Works for the Long Haul

Finally, my friend and I agreed that we’d both journeyed down various diet paths only to find these altered eating routines unsustainable over time.

Eating a thoughtful, careful, very intentional carbohydrate approach, coupled with high-quality, moderate protein consumption, and liberal enjoyment of tasty, healthy fats simply tastes good, one of, if not the most critical feature for longterm eating plan compliance.

Not only that, this type of eating plan is based on simple, easy to understand, almost common-sense principles that allow anyone to intuitively navigate the vast sea of food choices we face every day.

That said, I reminded him of a key point mentioned in yesterday’s post – the key imperative is paying careful, thoughtful attention to what your own body is telling you, and adjusting your approach to fit your own unique, (very likely) evolving physiology.

As noted above, we’ll be delving into each of these areas in more detail here on the blog over the next few months.

The Carb Conundrum That Really Isn’t (Part 1)

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Here’s part of an interesting email from a friend who has recently decided it’s (past) time to reshape his approach to food, starting moving again, and drop the 80 or so excess pounds he’s been carting around for the past decade.

As a way of background, he’s a physician (orthopaedic surgeon), busy family guy, still helps when he can with his parent’s ranch two hours away, is an avid hunter, and loves to cook and eat.

…I appreciate your time on the phone last week, and I’ve read through some of the sites you suggested, though clearly there are conflicting positions as to the roll carbohydrates play in the typical American’s diet, particularly those of us who are above our ideal body weight and in our 40’s or older.

I get that the traditional medical/nutritional establishment, as a larger collective, still touts various carbohydrates as the foundation of the food pyramid (even though they’ve more or less moved on from that construct), but even a cursory search of food plans to lower carbs yields what appears to be highly anecdotal recommendations that are all over the map.

Your simple explanation of a lower carb, moderate protein, higher fat approach makes sense on one hand, though what the hell is one to make of the no-carb carnivore stuff being waved around today? Or the high carb recommendations still flooding the sports medicine literature, particularly at the elite level and in the endurance disciplines. Or the high carb, high protein regimens that come out of the power lifting / body building worlds? Not to mention those choosing the vegetarian or vegan roads, of course neither of which are so carb-phobic.

For a guy still in practice today, this all presents something of a conundrum – actually two to deal with. One, recommending that patients lose weight as I sit on the stool next to them with my panniculus hanging over my belt rings a bit hollow. And two, dispensing specific nutritional advice to patients puts me on the hook in a way, and I damn sure want to engage personally with an approach that’s physiologically/scientifically sound.

You know where I’m coming from, and with your health success personally and study over the past few years, would you mind steering me to some solid, evidence-based data to incorporate here?

My wife and I have tried and failed with a number of different approaches, like The Zone, South Beach, Weight Watchers, and even some crazy thing she bought for over a grand that had us drinking meal replacement shakes twice a day that tasted like dirty socks soaked in dishwater with a sprinkle of Nestle’s Quick stirred in. We need something that is geared for the long haul that still lets us enjoy good food. We’ve both had enough of running out of energy two hours after eating and reaching for what must be the wrong snacks to reach the next meal…

Let’s Start With Some Simple Points about Food (and Life) to Agree On

Those of you who have chosen to amble down a food plan path different than that of the Standard American Diet (SAD) have heard some variation of the comments / questions levied by my friend above.

You also know that what initially might appear to be confusing for some – for example the differing carb intake recommendations my friend pointed out above – often comes into much sharper focus as one digs a bit deeper and separates the science from the noise AND takes an honest appraisal of one’s own health, unique physiology, and approach to food.

That said, I quickly responded to my friend and commended him for several things.

One, simply choosing to get started, drawing that line in the metaphorical sand, and deciding to make a change is a critical step.

Two, there’s no question that excess body fat isn’t your friend. As a busy orthopaedic surgeon making his living (for the most part) replacing hips and knees that have worn out, he understands this better than most. The obesity epidemic impacts the morbidity of his arthroplasty patients, their implant longevity, and eventual return to function (link), among other things.

The list could go on and on, but just for example’s sake, excess belly fat increases your risk of an early death, abdominal obesity increases cancer, cardiovascular, and all cause mortality, and can severely impact quality of life (including sexual function).

Three, the current SAD approach to nutrition clearly isn’t a workable longterm plan for health and wellness. Looking for proof? Explosion in adult obesity over the last 40 years? Check. Explosion in childhood obesity over the last 40 years? Check. Skyrocketing rates of T2DM, hypertension, auto-immune diseases over the last 40 years? Check. (Frankly, go to an area shopping center and people watch for 20 minutes…).

And four, I agreed with him that there is a tremendous amount of noise out there about carbohydrates and their role in human nutrition. That duly noted, there are good scientists, physicians, and health advocates telling the truth about carbohydrates around, and some diligent personal research and careful thought is called for here, as is the imperative of paying attention to what your own body is telling you (as evidenced by the simple fact that my friend’s current approach to food clearly wasn’t working by what he’d described).

More tomorrow on clarifying my buddy’s carb conundrum.

the Older Bolder Life Salad Sunday 26 August: Homemade Caesar Dressing with Avocado Oil Mayo

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As the summer heat drags on here in Northeast Texas, we find ourselves reaching more and more often for a cool salad topped with a tasty and chilled grilled protein.

My wife and I love a good Caesar, and have played around for years looking for a Homemade Caesar Dressing that tasted like a great Caesar should and yet didn’t require an advanced food science degree to pull off.

Thanks to several friends, including Chef Libby in Austin, we’ve settled on this amalgam of several good recipes, which is build around a cup of a healthy and tasty avocado oil (or good olive oil) mayo made right in our / your own kitchen.

If smashing anchovies and garlic into a paste with the back of a spoon doesn’t sound like your cup of tea, track down the very reasonable substitute anchovy paste, though we agree with the many traveling this road before us that the real thing packs a bit more funky, umami punch, and just tastes better.

Most recently we’ve been topping Caesars with either a Cajun-spiced grilled chicken or shrimp, though Judy’s salmon, grilled and chilled, is tough to beat too.

2-3 small garlic cloves, minced
1-2 small anchovies
1 cup freshly made avocado oil mayo
2 tbsp freshly squeezed lemon juice
1 and 1/2 tsp Worcestershire sauce
1 tsp good Dijon mustard
1/4 tsp good salt (or to taste)
1/4 tsp freshly ground black pepper

1/2 cup freshly grated Parmigiano-Reggiano cheese

This one is a piece of cake to pull together.

Mash the minced garlic and anchovies into a smooth paste in a small mixing bowl; whisk in the next 6 ingredients until smooth and creamy. Stir in the freshly grated Parmigiano-Reggiano (I’ll sometimes add a bit more) and adjust the salt and pepper to taste.

Stir into that masterpiece of a Caesar salad you’ve built and go to it.

Enjoy.

the Older Bolder Life Friday Feast 17 August: Grilled Gochujang Skirt Steak

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When were up in Montana a few weeks ago, I brought along about five pounds of skirt steak for a celebratory fajita dinner. We have a family favorite, Texas-inspired version we’ve been making for years (recipe later perhaps), and ended up making the entire bundle of skirt using that old recipe.

I’d actually intended to do a pound or two using this Grilled Gochujang Skirt Steak recipe a friend shared with us a few months back, though didn’t grill this one up until we were back in Texas settled into our routine again.

We’re using gojuchang more and more in the kitchen these days. If you’re not familiar, it’s the umami-laden, thick, crimson red, Korean fermented chile paste that’s most often sold in the little red tubs in our neck of the woods. For those watching their soy intake, most brands include fermented soy in the mix. Note occasionally a bit of glutinous (sticky) rice has been ground in to thicken the mixture, and some even include additional sweeteners (an ingredient we prefer not be included).

This blistering summer we’ve typically been eating thinly-sliced, grilled skirt steak (both warm and cold) over a big-assed salad, but it makes for a great taco (tortilla or lettuce) along the lines of what we talked about in last Friday’s Grilled Southwestern Lamb Shoulder Tacos.

You’ll want to try this in your rotation next week…

2 pounds skirt steak, trimmed, cut into 8-ounce pieces

1/3 cup (generous) gochujang + more for the table
1/3 cup (generous) avocado oil (or EVOO)
1/3 cup (generous) rice vinegar (seasoned if you have it)
2-3 tbsp tamari, coconut aminos, or soy sauce
1/2 sweet onion, grated

To serve
Warm tortillas or lettuce leaves
Your favorite taco fixin’s

Trim your skirt steaks and cut into roughly 8-ounce pieces.

Combine the gojuchang, oil of choice, rice vinegar, tamari/aminos/soy sauce, and the grated onion in a small bowl and mix well. Pour into a large resealable bag, add the meat and goosh it around so every surface has been coated with the marinade.

Into the fridge it goes for at least an hour, overnight is better.

When ready to cook, drain the skirt steak, and grill over medium-high heat 2-3 minutes per side. Remember skirt cooks really quickly as it’s so thin, and we like ours medium rare…

Pull, let rest for 10 minutes or so while you’re getting the rest of the goods ready, then slice thinly across the grain and go to it.

Enjoy.