Do You Have Any Idea How Close the Affordable Care Act Came to Being Toast?

I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out.

I also expected the four liberal justices to support both the individual mandate as well as the entire law.

About everyone expected Roberts and Kennedy to vote alike.

If Roberts had gone with

New Study: Is a Calorie a Calorie?

A new study in JAMA led by Dr. Cara B. Ebbeling and colleagues purports to challenge the idea that all calories are equally fattening (1).  Let's have a look.  When thinking about the role of calorie intake in body fatness, there are basically three camps:

1.    Calories don’t matter at all, only diet composition matters.
2.    Calories are the only thing that matters, and diet composition is irrelevant.
3.    Calories matter, but diet composition may also play a role.

The first one is an odd position that is not very well populated.  The second one has a lot of adherents in the research world, and there’s enough evidence to make a good case for it.  It’s represented by the phrase ‘a calorie is a calorie’, i.e. all calories are equally fattening.  #1 and #2 are both extreme positions, and as such they get a lot of attention.  But the third group, although less vocal, may be closest to the truth. 
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The Supreme Court Ruling on Health Care, Its Impact on Medicaid, and 29 Republican Governors--Be Careful You Might Get What You Wish For

Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable.

Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income

The Supreme Court's Decision on the Affordable Care Act

In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts' vote saved the ACA."On to the elections.

How to Look 10 Years Younger - 3 Anti Aging Traps to Avoid

If you are trying to look 10 years younger or more, there is no shortage of information or products to help you achieve your goal. Nowadays, it seems everywhere you turn there is some new product or cosmetic procedure claiming to remove wrinkles, restore elasticity, bring back radiance... the list goes on and on. But before you try that breakthrough product or visit that hot new medical day spa there are 3 anti aging traps you need to know about. Fall into one of these, and no matter what products you are using, you could be undermining your results without even knowing it. Anti Aging Trap #1- No Passion for Anti Aging or Complete Acceptance of the Aging Process "Passion for anti aging?" you say. "Of course I have passion for anti aging. Why do you think I spend hundreds of dollars on products and procedures?" Let's make one thing clear- passion for anti aging and looking 10 years younger has nothing to do with how many products you buy or how many visits you schedule with your plastic surgeon. Passion for anti aging starts in the brain: For example: Every morning when I wake up, the first thing on my mind is anti aging. I am constantly researching, studying, putting test ideas into practice to stay and feel younger and more vibrant. I thoroughly enjoy it and a day doesn't go by without me thinking about anti aging and trying to look 10 years younger. Now I know everyone doesn't or even can't wake up with anti aging on the brain. There are kids to get off to school, jobs to go to, bills to pay; the list goes on and on. But to really achieve any level of anti aging, you do have to have some passion for it. Why? Because passion for anything, whether it be looking 10 years younger, losing weight, or getting a promotion starts in the brain. The moment you set your mind to achieve something your brain immediately goes into overdrive coming up with ideas to bring this plan to fruition. Passion is the fuel which drives this process. The more passionate you are about an idea, the higher the probability that you will achieve what you desire. Unfortunately, anti aging or trying to look 10 years younger or more quickly loses momentum. This is because many people feel there are only a few options to truly stay youthful. Once they start to age, they believe the only options they have are plastic surgery or Botox. Which brings us to the next anti aging trap: Anti Aging trap #2- Overloading On Plastic Surgery and Cosmetic Procedures I recently met a 48 woman who was obviously addicted to plastic surgery. Her face was smooth, taut and unlined. She had no wrinkles on her forehead, around her eyes or around her mouth. But guess what? She didn't look ten years younger. She looked like a 48 year old woman that had a lot of work done. Her face was mask-like, even when she smiled. You can see this look on a lot of celebrities (Courtney Cox, Nicole Kidman, Joan Rivers). Maybe that's why some people think it is the best way to fight the aging process. People love to emulate their favorite stars. Now I'm not against plastic surgery. Compared to only 10 years ago, plastic and cosmetic surgery has come a long way in helping people everywhere to look and feel younger. And perhaps that's the problem. Because it has become so much more affordable it is now the quick fix instead of the last resort. Too much plastic surgery or cosmetic procedures will not make you look 10 years younger. It will however make you look strange, unnatural and like a plastic surgery junkie. Anti Aging Trap #3 Setting the Bar Too Low When I ask women what they really want to achieve from all the effort they put into staying youthful, more often than not most of them respond with the following: "I want to look good for my age." The only way I know how to respond to this statement is "Why?" If you truly want to look good for your age, no matter if it's 30, 40 or 50+ then I say go for it. You could probably achieve your goal in a matter of months if you haven't done so already. But know this: You will never go to a college sporting event and be mistaken for a coed by 4 different students. You won't be able to wear a mini skirt and look "age appropriate". (Sorry to use that phrase. I actually despise it but that's a whole other article.) You will never go for a jog and have 3 seventeen year olds on scooters ask what college you go to. Why? Because "looking good for your age" is setting the bar way too low. Sure you look good, but only for your age. It's the equivalent of the comment: "you throw pretty good for a girl". You want to look good period. You want to look so good that no one can say you look good for your age because no one can tell how old you are. I know plenty of women aged 40+ who can and have been mistaken for a college coed. Who still have the ability to pull off a mini and flip flops. And who have 17 year old boys waving to them from their motorcycles and scooters Now that we discussed the 3 Anti Aging Traps and how easy they are to fall into, let's talk about the good news. Look at the following quote: "Anti Aging to us is a lifestyle. My wife and I decided a long time ago that we weren't going to age. We were going to eat right, constantly try new things, take care of our bodies. But most importantly, we set our mind to it and I guess we're doing all right."-from a 52 year old man and his 46 year old wife. This quote came from a married couple I recently met who I had guessed to be in their mid thirties. The man confessed to me that he was actually 52 years old and his wife was 46. I was pretty stunned. Being as obsessed as I am with anti aging, I can usually guess peoples' ages pretty well. So this really threw me for a loop. This couple looked, walked and talked like they were 35 years old. And a young 35 at that. It was truly amazing and I couldn't stop looking at them. So how were they able to look at least 10 to 15 years younger? Is it possible that they had some plastic surgery? They were very open and honest about their beauty regimen and upkeep. They told me they have had "absolutely no Botox". And no plastic surgery. They both have skin peels every six months to rejuvenate their skin. They eat no processed food whatsoever and a lot of fresh fruit and vegetables. They exercise 5 days a week, stretch extensively to stay flexible and agile and keep abreast of new innovations in the anti aging industry. Everything they told me was fascinating and their plan was obviously working for them. But I kept going back to their original quote: "My wife and I decided that we weren't going to age." That small statement is one of the key reasons why they are able to stay so vibrant and young looking. In their mind, they wouldn't accept the aging process and when they had that affirmation set firmly in their brain that set in motion a life-long plan of fighting aging at every turn. Once that affirmation was solidly in place, everything else that followed became second nature to them. And that is the true key to anti aging and staying young and vital. Believing with absolute certainty that you can. So stay passionate about anti aging, don't overload on cosmetic and plastic surgery and set that bar way up high. When you avoid these anti aging traps, you'll be surprised how quickly your body and mind respond. You may just wake up a couple months from now looking 10 years younger.

What Puts Fat Into Fat Cells, and What Takes it Out?

Body fatness at its most basic level is determined by the rate of fat going into vs. out of fat cells. This in/out cycle occurs regardless of conditions outside the cell, but the balance between in and out is influenced by a variety of external factors.  One of the arguments that has been made in the popular media about obesity goes something like this:  


A number of factors can promote the release of fat from fat cells, including:

Epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), glucagon, thyroid-stimulating hormone, melanocyte-stimulating hormone, vasopressin, and growth hormone

 But only two promote fat storage:

Insulin, and acylation-stimulating protein (ASP)*

Therefore if we want to understand body fat accumulation, we should focus on the latter category, because that's what puts fat inside fat cells.  Simple, right?

Can you spot the logical error in this argument?

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What Would Health Insurance Cost if the Supreme Court Overturns the Individual Mandate But Leaves the Insurance Reforms in Place?

That will be the big question on Thursday if the Court throws out the mandate and the parallel insurance reforms that would require health plans to take all comers without regard to their health status and require insurers to cover pre-existing conditions.

But before we get to that scenario, let’s look at another possibility.

The Court Overturns Both the Individual Mandate and the Insurance

A Pressure Cooker for the 21st Century

Pressure cookers are an extremely useful kitchen tool.  They greatly speed cooking and reduce energy usage by up to 70 percent.  This is because as pressure increases, so does the boiling point of water, which is the factor that limits cooking speed in water-containing foods (most foods).  If it weren't for my pressure cooker, I'd rarely eat beets or globe artichokes.  Instead of baking, boiling or steaming these for 60-90 minutes, I can have them soft as butter in 30.  But let's face it: most people are intimidated by pressure cookers.  They fear the sounds, the hot steam, and the perceived risk of explosion.  I escaped this because I grew up around them.

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Health And Fitness Training – Fitting Fitness Into Your Busy Day

When it comes to health and fitness training time is always an issue. Some of us are busy, some of us are very busy, and some of us are so busy we don’t even know which way is up. Sound familiar? If you are the kind of person who is on the go the minute the alarm rings in the morning to the minute your head hits the pillow at night this article is for you. If you have kids who eat up all your time and you dream of a little time to yourself, this article is for you. If you want desperately to get fit but other commitments are making it next to impossible this article is for you. Here’s the good news, getting fit doesn’t take that much time. You need to address two areas in your life; exercise and diet. In fact, if you are stuck for time to workout, the diet portion is going to have more of a drastic effect on your fitness. Think about it, if you don’t have time to burn the calories then you need to cut them from your diet. Wait a minute! You are probably thinking to yourself that food is one of the only sources of pleasure in your busy day. I agree with you, it should be. Eating well better darn well also be delicious. If it isn’t then you are doomed to fail your diet. So understand what I am saying, you will eat well but you must also enjoy your food. I am not talking about a radical starvation diet or diet extremes where you avoid carbs or fats at all costs. Your diet should be well-balanced. Here are a few golden rules for dieting: 1. Drink 2 to 3 litres of water a day 2. Avoid processed foods 3. Avoid foods with refined sugar Here’s a last tip, if you are the type who eats a lot of fast food because you are so busy, just make better choices. Order water instead of pop with your meal. Have a salad instead of fries with your burger or sandwich. Have honey instead of sugar in your coffee. All these small choices made day after day will add up in the long run. Think about it, maybe you have been putting on 5 to 10 pounds a year for a few years. Not a lot of weight over the course of a year. This slow addition of fat has been because of all these small choices. So you don’t have to make big changes to reverse this weight gain. As for a fitness routine do one set of the following as you roll out of bed in the morning and just before you go to bed at night: 1. Push ups 2. Lunges (Take a long stride of a stance and do 1 set each for side) 3. Crunches (Remember to hold your hands by your ears, not inter-laced behind your head – don’t pull on your neck while you do these) 4. IF YOU ARE FEELING AMBITIOUS – Chin ups ( you can get a chin up bar that installs in a door frame for around $20 from most sports stores) If you follow a simple fitness routine like the one outlined above you will definitely get strong. This will result in a sleek and shapely physique. As you lose weight and shed fat you will reveal this new toned body. Fitness workout programs don’t have to be a one or two hour ordeal. It can be and short and sweet if that is all you have time to do. What is important is that you do something to keep your body strong and performing well. One day at some point in the future you just may have more free time to join a gym or a running club or whatever you like to do. When that day comes you will be ready for it because this little fitness exercise plan and simple diet has kept you fit.

New Study Demonstrates that Sugar has to be Palatable to be Fattening in Mice

Dr. Anthony Sclafani's research group just published a study definitively demonstrating that high palatability, or pleasantness of taste, is required for sugar to be fattening in mice (1).  Dr. John Glendinning was lead author. Dr. Sclafani's group has done a lot of excellent research over the years.  Among other things, he's the person who invented the most fattening rodent diet in the world-- the 'cafeteria diet'-- composed of human junk food. 

Mice and rats love sweet food and drinks, just like humans.  If you give them a choice between plain water and sugar water, they'll overconsume the sugar water and become obese.  I have argued, based on a large body of evidence, that the reward value and palatability* of these solutions are important to this process (2, 3, 4).  This is really just common sense honestly, because by definition if the solution weren't rewarding the mice wouldn't go out of their way to drink it instead of water, the same way people wouldn't go out of their way to get soda if it weren't rewarding.  But it's always best to confirm common sense with research.
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Sugar Intake and Body Fatness in Non-industrial Cultures

Around the world, non-industrial cultures following an ancestral diet and lifestyle tend to be lean. When they transition a modern diet and lifestyle, they typically put on body fat and develop the classic "diseases of civilization" such as diabetes and cardiovascular disease.  If we can understand the reasons why this health transition occurs, we will understand why these problems afflict us today.  Research has already identified a number of important factors, but today I'm going to discuss one in particular that has received a lot of attention lately: sugar.

There's an idea currently circulating that sugar is the main reason why healthy traditional cultures end up obese and sick.  It’s easy to find non-industrial cultures that are lean and don’t eat much sugar, and it’s easy to find industrial cultures that are obese and eat a lot of it.  But many factors are changing simultaneously there.  We could use the same examples to demonstrate that blue jeans and hair gel cause obesity.  If sugar is truly the important factor, then cultures with a high sugar intake, but an otherwise ancestral diet and lifestyle, should also be overweight and sick.  Let’s see if that's true. 

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The Solution to Anti-Aging Skin Care

The anti-aging skin care field has boomed, with hundreds of new products being introduced to the market on what feels like almost on a daily basis. This has resulted in what we may call "skin care overload." People have become overwhelmed and confused by the countless number of ingredients we are told are necessary for anti-aging. It has become impossible to access and apply even a fraction of these ingredients due to the cost and time involved. We feel compelled to buy multiple products every month and layer them on in order to do the most for our skin. But, as we fill our medicine cabinets with creams and serums, we are faced with the daily questions of which shall we use, which are safe and which actually work? It has been long overdue that the various categories of anti-aging and the anti-aging ingredients themselves be ordered and categorized so that a comprehensive approach to anti-aging may be put into place. Firstly, there are many features to skin aging and people will show one or more features over time, but may differ in the features of skin aging that plague them. For example, some people develop sagging or laxity to the skin due to genetic factors, but may have little or no sun damage. Others may be covered with sun spots but have no sagging or wrinkling. The following is a validated classification scheme which allows for each clinical feature of skin aging to be assessed separately on a 4-point grading scale (mild, moderate, advanced, severe): Classification of Skin Aging: Laxity (Sagging) Wrinkles Redness Brown discolorations Solar elastosis (Yellowing) Irregular texture Abnormal growths (keratoses).1 This classification scheme of skin aging includes a severity scale as mentioned above (0=None, 1=Mild, 2=Moderate, 3=Advanced, and 4=Severe) which allows researchers or users to rank each individual person's skin aging according to feature and severity. This scale was shown to be very useful in testing anti-aging treatments and has been published in the Journal of the American Academy of Dermatology.1 Older scales tended to lump different features together into broad categories, which became less useful as treatments became more specific in targeting various facets of skin aging; for example as anti-pigment or anti-redness or anti-wrinkle. With this current anti-aging scale, our anti-aging products may be quantitatively tested to determine which individual categories of skin aging they treat and how effective they are in each category. This also allows us to hone our anti-aging regimen to our needs and to compile or group the ingredients in each category that are most effective so as to cover all categories of anti-aging in a logical manner. The next challenge was to classify the plethora of anti-aging ingredients on the market based on the features of skin aging that they targeted or treated. I then created a classification scheme of the categories of anti-aging targeted by the ingredients that have emerged over the past decade: Anti-Wrinkle - DNA Defense - Barrier Fortification Anti-Redness - Cellular Restore - Emollient/Moisturizer Anti-Brown Discoloration - Damage Reversal - Pro-Skin Thickness Anti-Oxidants - Aging Repair - Re-Texturize With this classification scheme, we can appreciate why people have become so overwhelmed and why they have accumulated shopping bags full of skin creams in order to meet their needs! Nevertheless, as anti-aging ingredients have emerged targeting each of these categories, ideally one would want to incorporate the best ingredients of each category in a single daily regimen to optimally treat skin aging. Each individual may differ in which category of anti-aging they need most, yet in order to prevent and reverse all the signs of skin aging, it is still optimal for all categories to be covered by an anti-aging regimen. It is important to familiarize yourself with which ingredients fall in each category, so that you can incorporate several of each group into your skin regimen, or look for a product that covers the various categories of anti-aging in a logical way. Examples of key active ingredients shown to yield resulst in each category of anti-aging include: peptides for anti-wrinkles, plant-derived polyphenols and bisabolol for anti-redness, amino acids for anti-brown discolorations, vitamins C, E and ferulic acid for anti-oxidant, DNA repair molecules such as acetyl tyrosine and proline for DNA defense, resveratrol for cellular restore, bark extract or phoretin for damage reversal, Helianthus annuus and Ilex paraguensis extracts for aging repair, dimethicone for barrier repair, glycerin and soy lecithin for emollients, hyaluronic acid for boosting skin thickness, and mushroom extracts and sodium lactate for smoothening abnormal texture. In sum, the field of anti-aging now has validated classification systems for the various categories of skin aging and for the plethora of anti-aging ingredients so that we can assess and determine which anti-aging actives we want in our medicine cabinet and to make certain that we cover the various categories of anti-aging in our daily regimen. With this scientific basis, we may now intelligently assess anti-aging products for their ability to comprehensively cover all the various categories of skin aging and include the various categories of anti-aging ingredients available. Finally, these comprehensive, validated classification and grading scales provide a framework for solving the anti-aging conundrum with a system for categorizing skin aging and classifying anti-aging actives to make sure you cover all your skin's anti-aging needs. (C) NY Derm LLC, 2010. 1) Alexiades-Armenakas, M, et al. Journal of the American Academy of Dermatology 2008 May;58(5):719-37; quiz 738-40. Dr. Macrene Alexiades-Armenakas M.D., Ph.D., F.A.A.D., Derm-Scientist®, holds three Harvard degrees, a bachelors of arts (BA), a medical degree (MD) and a doctorate (PhD) in genetics, is double Board-Certification in Dermatology in the US and EU and Director of her own Private Practice and Research Clinic in Manhattan. Her 20+ year background in research included plant molecular biology, cell and developmental biology, genetics, photobiology and mammalian stem cell biology. She served as consultant to L'Oreal, ran clinical trials for pharmaceutical and laser companies, and serves as beauty judge to many magazines, including Allure and In Style. The go-to skin expert for identifying actives proven to deliver results in the laboratory, clinical trials and in practice, she developed a highly advanced technology 37 Extreme Actives® high performance anti-aging cream, capable of suspending and microtargeting the greatest variety and number of proven actives in a single cream, a comprehensive product logically designed to address all the categories of skin aging. The One-Step Skincare Solution™ is the breakthrough that revolutionizes skincare and does the thinking for you. This patented advanced cream technology was designed to suspend and microtarget 37 potent actives in a single cream, which have been proven by independent testing to deliver results in all categories of skin aging.

Headache Migraine Surgery - Things You Need to Know

It May Be Tempting If you have ever considered having headache migraine surgery, then I can bet that you have had one of those days where you thought your head was literally going to explode. Some of you may have a job, kids, and countless duties around the house, and headache migraine surgery may seem like a good idea for you. Well let me tell you right now that in brain surgery, the bad sides always overrule the good. A True Story I knew a person once names Sharon Bennett who had severe migraines every week. These migraines were such a disturbance in her life that she could not find a job, or even find time for her children. One day however, Sharon decided to take headache migraine surgery in an attempt to solve her migraine problems. The operation was successful, and it cut the migraine frequency down to every month rather than every week. What They Missed This sounds like a success story, but let me tell you this. The problem is that it involves injecting Botox into muscles located around the head, effectively paralyzing them. While headache migraine surgery is an effective way to reduce the frequency of headaches, it is a very unnatural and dangerous way to fight migraines. There are countless natural alternatives to fight migraines and even prevent them from occurring in a way that headache migraine surgery cant. You will save hundreds of dollars in using proven, natural methods. There really is no point to even consider headache migraine surgery. The facts speak for themselves: - It is unnatural - Can have almost fatal side effects - Very costly - Largely under proven, not enough cases to properly confirm benefits - Better results using natural methods - No conclusive long-term benefits Waste No More Time In Considering Unsafe, Unnatural Methods. Renew Your Body With The Natural Way! Are your migraines so intense and happen so often that they made you come to surgery as a last resort? You will be delighted to hear that there is one more proven, safe, and absolutely natural method to make migraines history! Your new life starts here, with this very helpful Free Mini-Guide. It teaches you all about what causes migraines and how they affect us, why medications are not the best way to treat migraines, and the most common triggers of migraine headaches. However, the only REAL, safe, and effective way to get rid of your migraines for good would be to purchase a guide. This guide will save you hundreds of dollars you would be spending on drugs and surgeries, so come see Natural Migraine Solutions, a powerhouse guide which will guarantee you a migraine free life with only natural methods. You will call yourself a fool for ever considering having surgery after using this guide, believe me.

Calories Still Matter

The Centers for Disease Control's NHANES surveys documented a massive increase in obesity in the United States between the 1960-62 and 2007-2008 survey periods (1).  In 1960, 13 percent of US adults were obese, while in 2008 that number had risen to 34 percent.  The prevalence of extreme obesity increased from 0.9 to 6.0 percent over the same time period!

Something has changed, but what?  Well, the most parsimonious explanation is that we're simply eating more.  Here is a graph I created of our calorie intake (green) overlaid on a graph of obesity prevalence (blue) between 1970 and 2008:

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