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'I would've retired years ago but I forgot where I work.'

My mother: Oh, there are some people in this place you wouldn’t believe. They don’t even know where they are

Me: Well, in Alabama, they could’t be there at all. If your memory slips too bad, you are considered too sick for assisted living and have to be moved out.

My mother: Well that makes sense.

Me: No, back to independent living. It is illegal to provide assisted living those with memory problems in Alabama

My mom and dad moved from Louisiana to Marietta Georgia after The Storm (on the Gulf Coast we now date everything by August 29, 2005. That’s the day Katrina made landfall in Louisiana). They were in Baton Rouge and were in their late 70s when the storm hit. They had their own home and could drive without too much effort to get necessary items and run routine errands. They had lived in their house for 53 years and were comfortable.

Post Katrina, their lives changed substantially. Baton Rouge almost doubled in size from the influx of New Orleans refugees. What was a simple chore (driving to the store) became a nightmare of left turns into rapidly moving oncoming traffic unimpeded by traffic lights. They were older people living in a first ring suburb in the sunbelt south. If you were older with failing reflexes you had to make the best of it. Without a car there was no food, no doctor, no post office.

They moved into an independent living community for older individuals in Marietta (by my sister). It is like what my kids used to call a college “wonder dorm,” only for older folk. Separate apartments, common areas for dining and socializing. Difference is that in college the turnover is dictated by the ebb and flow of college life. At the facility my folks are in, folks tend to stay. They stay, that is, until they lose their independence or they pass away. On my weekly phone calls I hear tales of which person is losing touch with reality. “Mr Soandso is grabbing everyone.” I’ll hear one week then two weeks later “Remember Mr Soandso, well they had to take him away.” Ambulances are a regular occurrence with the inevitable return of the resident just a little less functional than before he or she left. If only a little confused when they leave, they are a lot confused when they return. Soon, they are removed to another facility. My folks can’t help but wonder when the inevitable will catch up with them as well as they notice their memory slipping with age.

Why have we not come up with a better way? As I told my parents, in Alabama it is even worse because, with any type of dementia, regular assisted living is out. Alabamians have to move into a “specialty care assisted living.” There are only about 300 of those in the state with a total of 3000 beds. To quote a recent article:

The quality of care can vary significantly from one facility to another. The best assisted living facilities provide comfortable and healthy homes for patients in early and moderate stages of physical and mental decline. But inspection reports reveal that many fail to adequately staff facilities and train workers caring for patients – leading to falls, errors, abuse and even death.

In Alabama, we have 89,000 people living with dementia. With only 3000 beds, what happens to the rest of these folks? Some are admitted to the nursing home, losing their independence prematurely. In fact, the Alabama Medicaid crisis is precipitated in part by the $808 million spent annually on dementia care (about 20% of the budget). Most are cared for at home by a “volunteer” caregiver. In Alabama it is projected that 302,000 caregivers provide care for these folks. This is $4 billion of unpaid care with a huge toll on the caregiver’s health.

The baby boomers changed our society. We embraced the car. We became much more mobile. Little remained untouched. Boomers are now hitting their seventies. Inevitably they will lose their independence. Inevitably, many will lose their cognitive functions. Will they (and their caregiver children) demand better care for those who are aging out? For my sake I hope so.

Two weeks ago today I lost my lovely wife.  Coronary atherosclerosis. That is what the death certificate says. My family and I have received an outpouring of love and heartfelt sympathy from our community of twenty-five years. We will never be able to repay their kindness.

Danielle was a craftsperson when it came to her writing. She would work for hours (or days) to express a thought or concept in just the right way. Medical writing was a mystery to her with its passive voice and weasel words. Early in my career I tried to enlist her help with one of my “scholarly” articles. We soon reached an agreement that I would write what I needed and she would pretend to read it once published and say “that’s nice dear.”

This blog was a collaboration and was different. Our attempt was to write it for a layperson with an interest in health care, a passion for doing the right thing, and a desire to connect the dots regarding the flaws in our care delivery system. If we succeeded it was because of her. If we failed, I take the blame. I only hope I can continue and not embarrass myself too much without her contributions.

Danielle was a healthy, fit, active women who unfortunately had a terrible predisposition to cardiac disease and no sensation of cardiac pain. In other words, no “warning signs.” She did not smoke, was not overweight, and ate mostly vegan. Her “coronary atherosclerosis” would have been as much of a surprise to her as it was to the rest of us. Here are my thoughts, at two weeks out:

  • Disease occurs randomly. Being adopted, she had limited knowledge of her family history.Had she known that that was a possibility, there are only a couple of things she could have done to change the outcome.This is true for many people who suffer from illness and disability. Victim blaming serves no purpose and is an incorrect response. This we all need to stop.
  • That being said, risk factor mitigation only makes good sense. Eat right (a diet low in fats and animal protein, high in fiber, and minimize processed components), exercise daily, avoid cigarette  smoke and alcohol in excess. While it didn’t save her life (nor any of us eventually) this type of living likely gave her 10-15 years she would not have had. And gave us that time as well. We all need to try and live in harmony with our bodies.  As a community we need to provide these opportunities.  Farmers’ markets, community gardens, and bike paths all contribute and should be supported.
  • Human connections are very important. What I learned of Danielle after her death was how important her friendship was to many people. I cannot count the number of people who have come up to me to say that at a vulnerable time she reached out and help him or her through the rough patches. As a primary care physician I am brought in at times of crisis. We need people like Danielle who will take an interest and have a serious discussion about concerns with folks who are vulnerable. Things like this prevent crisis. Please reach out to someone who seems distress and ask them what can be done to help them. While churches can serve that purpose, activities involving the arts, informal interactions within the community at open air markets and dog parks, for example, are where such interactions take place. As a community we need to build in these opportunities for casual interaction.
  • Illness, random or otherwise, in America is expensive with insurance and cost-prohibitive without it. We are very fortunate that we had health insurance through my employer and enough money to cover incidental costs.  Without insurance, the hospital would be able to put a lien on my house if I didn’t have the money. While the ACA is not perfect, it is what we have at this time. President Obama has made it so that, at least in those states that have expanded Medicaid, bankruptcy for medical bills is much less common. Please support the Medicaid expansion.

Enough rationality. For those who know us, I miss her every day in ways both big and small and I know you do as well. For those who did not have the opportunity, hug someone and go back to helping us continue the fight.

Aloha, Danielle.


The car and the industries that supports the car have a lot to answer for:

  • 71% of parents of school-aged children walked or biked to school when they were young, whereas only 18% do so now.

  • +6.3 pounds = the difference in weight between the average person living in the most sprawling county in the US vs. the most compact (Geuga County, Ohio vs. New York City, New York)

  • The odds of having high blood pressure were 29% lower for residents of compact cities.

  • 65% of the adult population in the United States is overweight, and almost one in three is obese. Over the past 25 years, the portion of children, age 6 to 11 who are overweight has doubled, while the portion of overweight teens has tripled. 15% of teenagers 6-19 are now overweight.

Here is Mobile, as an extra added bonus, we have the oil used to run those cars in the waters to our south. As evidenced by the Deep Water Horizon oil spill, that is not necessarily a good thing. The infrastructure to process that oil has ended up on the gulf coast (it followed Big Oil) and that isn’t necessarily a good thing either as we in Mobile are finding out.

1) Mobile is going to allow the Canadians to bring the tar sands down by rail and pump then under (and hopefully not into) the bay to subvert Keystone. Canadian National Railroad (CN) and ARC Terminals (a company in Midlands) have partnered to ship heavy Canadian tar sand oil to Mobile. ARC Terminals bought the old Mobile Asphalt storage facility on Blakeley Island (across the river from Mobile and where the trains stop). They will rail heavy Canadian oil down to Mobile, offload either in Chickasaw or on the Mobile side of the river where it will travel under the river to the Blakely side, be stored until a barge can come to take to Pascagoula, Baton Rouge, Houston or some other Gulf Coast refinery. Blakeley Island is essentially now a toxic waste dump, where we have been shipping and storing crappy stuff ever since Alcoa built the alkali pits in 1930 (that are apparently still so toxic they can’t support life after 50 years).  The Canadian toxic waste will almost certainly end up in the Bay as does the other toxic materials following a hurricane or other storm surve event. If we are really unlucky we can have a massive oil spill when a boat anchor tears into the pipeline. Why tar sands? Really cheap oil which becomes really cheap gasoline.

2) Mobile is allowing the  building of an oil pipeline through (well OK, close to) our water supply. A terminal formerly known as 10 Mile terminal, now known as “Mobile Terminal” and owned by a subsidiary of Plains All America Pipe Company, is in Magazine Point. It currently has a pipeline that goes to Liberty Mississippi (which, as my daughter would say, is a “wide spot in the road” near Louisiana).  They offload oil from everywhere into their tanks and pipeline it to Liberty and from there I presume to the refineries. They want to create a direct pipeline to the Pascagoula refinery for regular crude oil shipped in from Venezuela and other countries. They have permission to acquire property by eminent domain and likely had no clue that Big Creek Lake was actually “Mobile Drinking Water Reservoir.” THEIR not-so-heavy crude will possibly end up in Big Creek Lake if not rerouted (yes, this is the same company that owns the pipeline and the responsibility for the massive oil spill in Mayflower, Arkansas).  Why offload in Mobile?  Once finished,  they can put oil in the pipeline and pick any refinery on the gulf coast based on capacity. Ensures cheap gasoline.

So, cheap gasoline has health aspects for all Americans. In addition, we are turning our town into a toxic waste dump to keep everyone else’s gas cheap. I guess what I’m asking is not to make either cars or gasoline illegal but to make its use safe, legal, but rare. Admittedly, a selfish goal on my part.

mban1414lWe have a new Publix in town and so I am now an unwilling target of the Publix-Walmart price wars.  Where I grew up, the Winn Dixie was our neighborhood store. My parents bought a house in the “first tier” suburbs in Baton Rouge and a suburban-type shopping center had sprung up to service the neighborhood when I was about 6 or 7. Before that, our shopping was done at the A&P “over by campus”  but we had no brand loyalty and the convenience of local trumped almost everything else. By the time I was 8, I was able to ride my bike to the store and bring home a half gallon of milk after a mandatory stop at the TG&Y. I don’t recall my mother price shopping much although I do remember when “store brands” became an option and we children had to argue for value over volume when it came to things like Pop-tarts. When we went and visited my mother’s family in the rural town of Pontchatoula, we would go shopping at Bohning’s for a very different experience. In that store, many of the staff knew my mother (even though she had been away for over a decade) and the visit was an important part of the store experience. At least for my mother it was, to be honest I was a little (well, OK, a lot) bored.

For many today, grocery shopping is a very different experience, mostly as a consequence of Walmart. In 40 metro areas in the United States, Walmart accounts for over 50% of the traditional grocery market and nationally it accounts for 25% of sales. This is problematic in two ways. One is that they are forcing out the last vestiges of personalized service such as I had experienced at Bohnings. Much worse, however, is the impact on the food chain

The real effect of Walmart’s takeover of our food system has been to intensify the rural and urban poverty that drives unhealthy food choices. Poverty has a strong negative effect on diet, regardless of whether there is a grocery store in the neighborhood or not, a major 15-year study published in 2011 in the Archives of Internal Medicine found. Access to fresh food cannot change the bottom-line reality that cheap, calorie-dense processed foods and fast food are financially logical choices for far too many American households. And their numbers are growing right alongside Walmart. Like Midas in reverse, Walmart extracts wealth and pushes down incomes in every community it touches, from the rural areas that produce food for its shelves to the neighborhoods that host its stores.

Walmart has made it harder for farmers and food workers to earn a living. Its rapid rise as a grocer triggered a wave of mergers among food companies, which, by combining forces, hoped to become big enough to supply Walmart without getting crushed in the process. Today, food processing is more concentrated than ever. Four meatpackers slaughter 85 percent of the nation’s beef. One dairy company handles 40 percent of our milk, including 70 percent of the milk produced in New England. With fewer buyers, farmers are struggling to get a fair price. Between 1995 and 2009, farmers saw their share of each consumer dollar spent on beef fall from 59 to 42 cents. Their cut of the consumer milk dollar likewise fell from 44 to 36 cents. For pork, it fell from 45 to 25 cents and, for apples, from 29 to 19 cents.

So, I looked critically at the Walmart ad in our local paper and it struck me that the savings of $36 on a $150 basket was a little artificial. Sure, they have great prices at Walmart on Coca-Cola Cherry Vanilla Soda ($1.50 cheaper than Publix).  Also, if I bought 4 different boxes of sugary cereal with the word “clusters” in the title every time I went shopping I would certainly like to save a dollar on every box. Given that 32% of Mobilians suffer from obesity, I hope we are learning to make better selections. For example:

There, saved you an extra $50. Go and spend it on local produce at a farmer’s market (if you need to find one near you, click here)..

My wife, Danielle Juzan, has a local political blog called “Bear Left.” She recently posed some questions for our mayoral challenger (one Sandy Stimpson), found here.  That got me thinking of what questions I would like to ask candidates for Mayor of Mobile. As a health professional, my only questions would be about health:
Gentlemen, Alabama is #45 in United Health Care Ranking and Mobile County is #45 in the state. Mobilians are more likely to be disabled than the rest of the state. From CDC data  6.5% of Mobilians have had a stroke (highest in the country, mean 2.5%), 31.4% have limited mobility (mean for US 18%), 14% require equipment for mobility (mean for US 18%). Among other diseases, the self-reported prevalence of diabetes is estimated to be 13% (US median 8%), self-reported hypertension 36% (US median 34%), self-reported coronary artery disease 11% (US mean 6%), arthritis 33% (US mean 26%). In the Gallup-Healthwise wellbeing survey, we came in very close to the bottom (#3 from there, in fact).

My question for you, Mayor Jones, is that you have had 8 years to attack our health problems and things have gotten worse, not better. I served on your transition team and we identified these exact problems 8 years ago. Most of the problems I cited above are a direct result of obesity, sedentary lifestyle, and tobacco use. With the exception of the poorly enforced tobacco ordinance (to my eyes, as one who frequently dines in downtown Mobile), what have you done to alleviate the problems of obesity and encourage physical activity? Please cite specific examples of how the solutions we identified eight years ago have been implemented.

My question for you, Candidate Stimpson, is as follows. A sickly workforce is going to be unattractive to companies looking to start up here in Mobile, no matter how small. Predictors of wellness are not numbers of hospital beds (of which we have too many) or numbers of heart surgeries done (also too many) but numbers of people who wake up every day not in pain, able to work. This requires not just “bike paths” but access to quality primary care (of which we don’t have enough), walkable neighborhoods (of which we are woefully lacking), high quality food (Mobile is not lacking food deserts), and safe places for activities for our children so that they will learn healthy behaviors. Clearly our Mayor has not taken advantages of the last 8 years to accomplish this. What concrete tasks will you commit to so that 4 years from now we will have reduced our obesity to below 25% and the number of sedentary individuals to below 25%?

Mobile, the city in which I live, received quite a distinction this past week:

MOBILE, Alabama — This is one of the worst places to live in the country, according to an analysis by 24/7 Wall St., a financial news website.  The website ranked Mobile as the 3rd most miserable city in the country.

Only the Huntington and Charleston areas of West Virginia are worse, according to the analysis, which drew on the Gallup-Healthways Well-Being Index for its data.

In 2011, when I last wrote about our misery in this space, we were #14 (actually we were 174/188 and now we are number 183 but apparently 3rd most miserable sells more ads). I don’t like the way this trend is going. I pointed out last time that our selling point (low overhead) was not what people were buying. Hitting #3 got the new media attention, but the local commenters are still not convinced:

The report is weighted towards health, and mental health. Mobile’s health issues are bad ,in part, because Mobile has not invested in healthy municipal infrastructure like walking trails, usable accessible parks, and outdoor activities that require physical action. Yes…Many Mobilians are fat and overweight from a lack of exercise and unhealthy fried foods saturated with fats. With unhealthy foods and a lack of exercise, people don’t “feel good about themselves.”  [More importantly} according to the report Alabama has the 8th lowest tax rate in America. I guess you missed the following:

” 8. Alabama
> Taxes paid by residents as pct. of income: 8.2%
> Total state and local taxes collected: $13.28 billion (25th lowest)
> Pct. of total taxes paid by residents: 68.0% (21st lowest)
> Pct. of total taxes paid by non-residents: 32.0% (21st highest)

I was contacted by a local news media outlet for a comment …ok, I have to confess that after reading comments like the one above I contacted them and offered my opinion…and was asked for my thoughts (found here)

I elected to focus on how easy it would be to improve our physical fitness. Why?

The results of that survey, Perkins said, made it clear that Mobilians suffer from poor mental and physical health in large part because the city’s built environment is not conducive to being active. Access to healthy foods in poor neighborhoods is also poor, he said.

In otherwords, if you believe the Canadian government we might make it back up to to 174:

The body responds positively to physical activity, which impacts the musculoskeletal, cardiovascular, respiratory and endocrine systems. This results in positive health outcomes, including reduced risk of cardiovascular disease and several cancers, as well as other health conditions.

There are many benefits of physical activity for individuals’ health and wellness, including:

  • Better overall health
  • Improved fitness
  • Better posture and balance
  • Positive self-esteem
  • Healthy weight and weight control
  • Improves your mood
  • Helps you sleep better
  • Reduces the risk of falls
  • Stronger muscles and bones
  • Increased energy
  • Relaxation and reduced stress
  • Continued independent living in later life

My wife told me a Ukranian “joke”

A Ukrainian caught a goldfish and was promised to get anything he wanted – but with the condition that his neighbor gets twice as much.

“So if I’ll get a house, my neighbor gets two?” he asks.


“And if I ask for a cow, my neighbor gets two cows then?”

“You are right.”

“Then I want to lose one eye,” he finally wished.

I live in Mobile, Alabama. Though we are the longest continuously settled city on the Gulf, we spend a lot of time looking with envy towards Birmingham, Tuscaloosa, Atlanta, and mostly New Orleans. So much so, in fact, that there was a little teeny bit of schadenfreude when Katrina hit and left us relativly unscathed. It is now 7 years later and New Orleans has rebuilt herself. She is a major economic force on the Gulf Coast and demands respect. Meanwhile, Mobile is still struggling.  New Orleans school system, not functioning prior to Katrina and completely destroyed by Katrina and the aftermath, has recovered to a great extent. The New Orleans health care system is in the process of refocusing care delivery where it is needed (though the state of Louisiana is doing its best to screw it up under the guise of “improving care”). Granted, there are still problems (such as violent crime) but we in Mobile are once again looking to New Orleans and saying “Why can’t we be that cool?”
As a physician I interact with many folks in the course of my day. I have a vested interest in improving the built environment so that my patients will be able to walk and/or bicycle to where they need to go (Our Walkability Score 38, New Orleans 55, National average 43). I want my patients to have access to healthy foods (55% of our restaurants are fast food restaurants as opposed to 44% in New Orleans). I don’t want to spend the rest of my time here reflecting wistfully on what might have been so I am going to offer a list of things we (and others in a similar fix) can do to make where we live a better place.
  • Buy and live local and encourage others to do the same – for example, one  New Orleans neighborhood away from the French Quarter is cool because it includes Magazine Street, a shopping district that goes on for several miles and has some very nice, locally owned shops. After Katrina, a Whole Foods relocated to that area. It relocated because of Magazine Street, not the other way around. If everyone picked out 3 LOCAL businesses and spent $50 a month there, we could create destinations for bike rides and walking.
  • Put some there, there – New Orleans is a unique, European-style city that happens to be in Louisiana. Every community needs to strive to create a sense of place. Mobile has some very unique features (Mobile Bay, many historic districts, the third largest river delta) that we have not made an effort to make user friendly. Rather than hide our assets from visitors as well as our own citizens, we need to put money into infrastructure development.
  • Embrace diversity – What New Orleans has is that it is an international city, not really a part of Louisiana. The world is a big place and European-Americans are becoming more and more of a minority. Europeans all live near and visit other countries with regularity. Even if we do not do so, we can’t afford to be seen as intolerant and parochial in our understanding of the world. Support public education in the broadest sense, not just to teach the 3 R’s but to force us all to look at the world through other peoples’ eyes.
  • Embrace environmentally friendly living – New Orleans is fortunate (not done intentionally) that the French Quarter (really dating back from Spanish times) was spared urban renewal. This is a unique built environment that was designed pre-car and people actually live there (I did when in medical school). Americans tend to be car focused. In a recent article, long commutes were linked to poor physical and mental health. Being able to walk or bike to work allows exercise to occur without special effort or gym memberships and provides for additional time for additional physical activity. Seek out opportunities to reduce your energy footprint and better health will follow, not only for you but for your family and neighbors as well.

As I have identified before, I am a runner. I run to keep physically fit, to keep weight off (I am also an eater), and to clear my mind of extraneous materials as I dodge cracks in the sidewalk. I ran a race today and although it was unseasonably warm I did all right.

To set a race up takes a lot of effort and infrastructure. This particular race benefited the L’Arche community.  People volunteered willingly to help control traffic, hand out water, offer band aids and fruit to the runners, and in general make the runners feel welcome and supported. Turns out that racing itself is not nearly as important as training for a race. The act of training provides an opportunity to participate in “vigorous intensity aerobic activity.” For adults, in addition to strength training the CDC recommends:

2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week or 1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week or an equivalent mix of moderate- and vigorous-intensity aerobic activity.

In addition the CDC points out the the more time you spend exercising, the greater the benefits are.

Human beings are designed to be physically active. People who are physically active get fewer heart attacks,have less hypertension, less diabetes, less colon cancer, less depression, and less anxiety. At these races, there are very few people who do not routinely participate in physical activity and they look healthy for the most part. In my clinical practice, on the other hand, I see a lot of folks who have led sedentary lives and are often afraid to begin exercising. The CDC recommends that those starting a program do so in doable chunks, 10 minutes or so at a time. In additions, they recommend a gradual increase over time:

If you want to do more vigorous-level activities, slowly replace those that take moderate effort like brisk walking, with more vigorous activities like jogging

For those of you who are physicians seeing patients with chronic illnesses, instead of adding another pill try an exercise prescription. Exercise prescription involves a planned or structured physical activity regimen given to an individual or group that includes specific recommendations for the frequency, intensity, and type of exercise. Write it out as you would a pill to lower cholesterol (it is almost as effective).

I often offer may patients the opportunity to begin a trial of exercise rather than adding another pill or potion and write them a prescription. Sometimes, it even works.

I live and practice in Mobile, Alabama. Alabama is ranked #2 in the supersizing of America with 31% of our adults in the obese range and 14% of our children. The Trust for America’s health, who compiled the above data, lists some policy opportunities to reverse the trend (should we in Alabama chose to). These include:

  • Support obesity- and disease-prevention programs through the new health reform law’s Prevention and Public Health Fund
  • Align federal policies and legislation with the goals of the forthcoming National Prevention and Health Promotion Strategy.
  • Expand the commitment to community-based prevention programs
  • Continue to invest in research and evaluation on nutrition, physical activity, obesity and obesity-related health outcomes and associated interventions.

I was reminded of the ranking of our state by a future medical student who is very interested in healthy eating and obesity prevention, and he met with me to call my attention to Wholesome Wave, a program designed to inexpensively deliver fruits and vegetables to low-income patients.

Obesity is a huge (no pun intended) problem without an easy fix. In my conversation with Will, we talked at length about how the problem is a mixture of diminished opportunity to purchase and eat healthful  foods combined with limited opportunities to participate in physical activities.Programs such as this are a start but need to be combined with biking, walking, and other means of burning calories.

US News and World Reports offers another opinion. They found 22 experts

including nutritionists and specialists in diabetes, heart health, human behavior, and weight loss

who reviewed and rated 25 diets in seven categories, including short- and long-term weight loss, ease of compliance, safety, and nutrition.

The winner, as identified by the experts, was the DASH diet, rated 4.1 out of 5 (lots of vegetables, fruits, low in fat). The loser, the Paleo diet (eat only what cave men eat) was only rated 2.0 out of 5. The website offers a feature where readers can identify with a YES or  NO whether or not the diet worked for them. Although liked by the experts, the DASH diet has only been tried by 1600 readers and only 24% found it effective. By contrast, the Paleo diet had been tried by 30,000 folks with roughly the same amount of weight loss. The winners, based on readers clicking YES were the Vegetarian, the Vegan, and the Eco-Atkins (#10, #14, and #17) which had 93% self reported success by over 40,000 readers.

Fad diets tend to work in the short run by limiting food choices and forcing participants to select lower calorie options. This is reflected in the number of people who reported losing weight with the “bad diets.” This weight tends to come back as people revert to old habits hence the ongoing problem of obesity. On the other hand, losing weight is more than choosing healthy foods. Losing weight is always ultimately about burning more calories than you take in. The DASH diet is a healthy long term diet and, for example, would work even better if it included actual dashes. The Paleo diet to be effective would have to include participation in activities only a cave man might do. As to what that might be, you’ll have to use your imagination.

Our neighborhood lost a local doughnut shop and I feel oddly compelled to “weigh” in. When we moved here 20 years ago, the local Krispy Kreme (built in the retail factory model of the 1960s) was a place to take the kids that served coffee and provided hours of entertainment as they (we) watched the yeasty donuts come out of the intricately timed warming component, move through the frying station (took about a minute a side) and through the glazing waterfall. As an added plus, a hot Krispy Kreme doughnut tastes like nothing else.

Why are they closing? Per their web site, they are going to a strategy of “factory stores, doughnut and coffee shops and satellite units.” I suspect they were unable to convert this to a coffee shop in a cost-effective manner, and with the construction of a new factory store in town the location is unneeded.The company has a growth strategy to bring doughnuts to multiple sites to an area through new technology that can create HOT DOUGHNUTS with minimal infrastructure and the company has an app to make consumption of HOT DOUGHNUTS even easier. From the web-site:

With Hot Light Online you can map your nearest Krispy Kreme location from your phone and get alerts when the neon glow of “Hot Now” is activated in your area. So look up, download or tweet your way to find a hot Krispy Kreme doughnut near you with any of the following free options.

Now the downside. Each of the tasty glazed morsels has 200 calories, 110 from fat (per the company’s nutritional info). Although the company reports a serving size of 1 (one) doughnut, they are most commonly purchased by the dozen meaning that the average consumer purchases between 24 and 36 hours worth of calories if you get the simple glazed. In addition to the 2400 calories you’ve consumed (after eating  “just one more” times 12), you will also get 72% of the day’s requirement of calcium and 48% of the iron.

Krispy Kreme expanded too rapidly in the early 2000s but has recently righted themselves financially and has turned a profit for 12 straight quarters. They have selected a new CEO, Kenneth May, who

…is a highly respected business leader with more than 25 years of operational, retail, supply chain and brand experience.  As part of a successful career with FedEx Corporation, he served as President and Chief Executive Officer of FedEx Kinko’s Office and Print Centers, and led the integration of Kinko’s into FedEx.

I should wish them the best, but won’t. It concerns me that to increase profit, they are looking to increase sales of these little fat bullets through innovative marketing techniques. For me, these were an annual treat and now they will be less so but then again, I am not in their target demographic. To be honest I would rather hang at a locally owned shop such as Serda’s, Cream and Sugar, or even a Starbucks and spend my money on good coffee and skim milk. I encourage you to do the same.