Portugal Legionnaires' disease outbreak kills five

Symptoms of Legionnaires' disease include high fever, muscle pain and persistent cough

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An outbreak of Legionnaires' disease has killed five people and infected more than 230 others in Portugal, the authorities there say.

Most of the cases have been in Vila Franca de Xira, a town about 25km (16 miles) north-east of Lisbon.

The World Health Organisation (WHO) says the outbreak constitutes a "major public health emergency".

Legionnaires' disease is a pneumonia-like lung infection caused by the legionella bacteria.

The source of the outbreak is yet to be found. Local media report that the bacteria has been discovered in a cooling tower in Vila Franca de Xira, but it is thought there may be other sources.

'Unusual and unexpected'

Thirty-eight people are being treated in intensive care, officials say. Facilities in many of the capital's hospitals were stretched because of the outbreak, Portuguese media reported.

"This is the biggest Legionnaire's disease (outbreak) in Portugal and is considered a major public health emergency," WHO spokesman Christian Lindmeier said.

The outbreak was "unusual and unexpected", Mr Lindmeier added.

Portuguese President Anibal Cavaco Silva has expressed his condolences to the victims. He said the public should trust the health authorities to deal with the outbreak.

Legionnaires' disease is caught by inhaling infected water. The bacteria can grow in cooling towers, air conditioning and other artificial water supply systems.

It mostly affects people aged over 50, with those already in poor health most at risk.

It was first identified in the US in the 1970s following an outbreak at a hotel hosting a veteran organisation known as the American Legion.

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Ebola outbreak: MSF says new Liberia tactics needed

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Ebola outbreak

• Ebola's undertakers
• Testing times
• Orphans' plight
• Are cases levelling off?

New rapid response tactics are needed to defeat the Ebola virus in Liberia, according to the charity Medecins Sans Frontieres (MSF).

More than 6,600 people have been infected in the country, but figures suggest the number of new infections has started to fall.

MSF says it now has more hospital capacity than patients and called for a shift in tactics.

It wants rapid response teams to tackle Ebola hotspots when they flare up.

Liberia has been the worst-hit country in the Ebola epidemic with nearly half of all cases.

However, it is the first to begin to turn around its fortunes - the rate of new infections is continuing to increase in Guinea and Sierra Leone.

The World Health Organization said it was feeling confident that it was getting the upper hand on the virus in Liberia.

MSF said that its treatment centre in the capital Monrovia had 250 beds but was treating just 50 patients.

Meanwhile a site in Foya, in the north of the country, has not had a single patient since 30 October.

Ebola cases

MSF's head of operations in Liberia, Fasil Tezera, said: "The international response is finally getting off the ground.

"Isolation units in Monrovia and some other parts of the country now have adequate capacity and we must adapt the strategy if we want to stay ahead of the curve and beat the epidemic."

Sudden outbreaks of Ebola will continue to emerge in towns and villages in Liberia as the epidemic progresses.

Mr Tezera said: "Priority should be given to a more flexible approach that allows a rapid response to new outbreaks and gets the regular healthcare system safely up and running again."

Such teams would specialise in isolating patients, tracing those who came into contact with the sick, organising safe burials, decontamination and mobilising local communities.

US, Britain and other countries have been building treatment centres and training healthcare workers in the affected countries.

Hospitals

Alongside these teams, MSF called for efforts to support the few remaining hospitals in the country.

It is setting up Ebola screening points next to hospitals so that fear of Ebola does not force them to close.

In order to achieve their new strategy, MSF is calling on governments to be more flexible with the money they pledge to tackling Ebola.

Dr Nico Heijenberg, the MSF emergency coordinator, said: "Much of the international aid funding for the Ebola response is earmarked for specific projects.

"Instead, international donors and implementing organisations should deploy their resources with flexibility so that they can be used where they are needed most."

However, there remains concern that the number of cases could go up again in Liberia. There have already been false dawns in Guinea, where the number of patients increased following earlier drops in hospital admissions.

Meanwhile in Liberia, President Ellen Johnson Sirleaf says four soldiers and their commanding officer will be punished after a boy was killed during protests against quarantine measures in Monrovia.

The boy was shot and others were injured in the incident in August.

A disciplinary board found the soldiers were "guilty of indiscretion and exhibited indiscipline".

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Ebola: How bad can it get?

The death toll has passed 2,000 and shows every sign of getting worse

This isn't just the worst single Ebola outbreak in history, it has now killed more than all the others combined.

Healthcare workers are visibly struggling, the response to the outbreak has been damned as "lethally inadequate" and the situation is showing signs of getting considerably worse.
The outbreak has been running all year, but the latest in an ongoing stream of worrying statistics shows 40% of all the deaths have been in just the past three weeks.
So what can we expect in the months, and possibly years, to come?
Taking off Crystal ball gazing can be a dangerous affair.
Particularly as this is uncharted territory, previous outbreaks have been rapidly contained, affecting just dozens of people, this one has already infected more than 3,900.
But the first clues are in the current data.
Dr Christopher Dye, the director of strategy in the office of the director general at the World Health Organization, has the difficult challenge of predicting what will happen next.
He told the BBC: "We're quite worried, I have to say, about the latest data we've just gathered."

Man outside his home just outside the Liberian capital Monrovia

Up until a couple of weeks ago the outbreak was raging in Liberia especially close to the epicentre of the outbreak in Lofa County and in the capital Monrovia.
However, the two other countries primarily hit by the outbreak, Sierra Leone and Guinea, had been relatively stable. Numbers of new cases were not falling, but they were not soaring either.
That is no longer true, with a surge in cases everywhere except some parts of rural Sierra Leone in the districts of Kenema and Kailahun.
"In most other areas, cases and deaths appear to rising, that came as a shock to me," said Dr Dye.
Cumulative deaths - up to 5 September

Only going up The stories of healthcare workers being stretched beyond breaking point are countless.
A lack of basic protective gear such as gloves has been widely reported.

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“Start Quote

If current trends persist we would be seeing not hundreds of cases per week, but thousands of cases per week and that is terribly disturbing”

Dr Christopher Dye World Health Organization

The charity Medecins Sans Frontieres has an isolation facility with 160 beds in Monrovia. But it says the queues are growing and they need another 800 beds to deal with the number of people who are already sick.

This is not a scenario for containing an epidemic, but fuelling one.
Dr Dye's tentative forecasts are grim: "At the moment we're seeing about 500 new cases each week, those numbers appear to be increasing.
"I've just projected about five weeks into the future and if current trends persist we would be seeing not hundreds of cases per week, but thousands of cases per week and that is terribly disturbing.
"The situation is bad and we have to prepare for it getting worse"
The World Health Organization is using an educated guess of 20,000 cases before the end, in order to plan the scale of the response.
But the true potential of the outbreak is unknown and the WHO figure has been described to me as optimistic by some scientists.
International spread?

The outbreak started in Gueckedou in Guinea, on the border with Liberia and Sierra Leone.
But it has spread significantly with the WHO reporting that "for the first time since the outbreak began" that the majority of cases in the past week were outside of that epicentre with the capital cities becoming major centres of Ebola.
Additionally one person took the infection to Nigeria, where it has since spread in a small cluster and there has been an isolated case in Senegal.
Prof Simon Hay, from the University of Oxford, will publish his scientific analysis of the changing face of Ebola outbreaks in the next week.
He warns that as the total number of cases increases, so does the risk of international spread.
He told me: "I think you're going to have more and more of these individual cases seeding into new areas, continued flows into Senegal, Cote d'Ivoire, and all the countries in between, so I'm not very optimistic at the moment that we're containing this epidemic."

Children watch as another dead body is taken from their village

There is always the risk that one of these cases could arrive in Europe or north America.
However, richer countries have the facilities to prevent an isolated case becoming an uncontrolled outbreak.
The worry is that other African countries with poor resources would not cope and find themselves in a similar situation to Guinea, Liberia and Sierra Leone.
"Nigeria is the one I look at with great concern, if things started to get out of control in Nigeria I really think that, because of its connectedness and size, that could be quite alarming," said Prof Hay.
End game? It is also unclear when this outbreak will be over.
Officially the World Health Organization is saying the outbreak can be contained in six to nine months. But that is based on getting the resources to tackle the outbreak, which are currently stretched too thinly to contain Ebola as it stands.
There have been nearly 4,000 cases so far, cases are increasing exponentially and there is a potentially vulnerable population in Sierra Leone, Liberia and Guinea in excess of 20 million.
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Ebola casualties

Up to 5 September

2,105

Ebola deaths - probable, confirmed and suspected

• 1,089 Liberia
  
• 517 Guinea
  
• 491 Sierra Leone
  
• 8 Nigeria
  

Source: WHO

Getty

Prof Neil Ferguson, the director of the UK Medical Research Council's centre for outbreak analysis and modelling at Imperial College London is providing data analysis for the World Health Organization.

He is convinced that the three countries will eventually get on top of the outbreak, but not without help from the rest of the world.
"The authorities are completely overwhelmed, all the trends are the epidemic is increasing, it's still growing exponentially, so there's certainly no reason for optimism.
"It is hard to make a long-term prognosis, but this is certainly something we'll be dealing with in 2015.
"I can well imagine that unless there is a ramp-up of the response on the ground, we'll have flair ups of cases for several months and possibly years."
It is certainly a time-frame which could see an experimental Ebola vaccine, which began safety testing this week, being used on the front line.
If the early trials are successful then healthcare workers could be vaccinated in November this year.
Here forever But there are is also a fear being raised by some virologists that Ebola may never be contained.
Prof Jonathan Ball, a virologist at the University of Nottingham, describes the situation as "desperate".
His concern is that the virus is being given its first major opportunity to adapt to thrive in people, due to the large number of human to human transmission of the virus during this outbreak of unprecedented scale.

Ebola is thought to come from fruit bats, humans are not its preferred host.
But like HIV and influenza, Ebola's genetic code is a strand of RNA. Think of RNA as the less stable cousin of DNA, which is where we keep out genetic information.
It means Ebola virus has a high rate of mutation and with mutation comes the possibility of adapting.
Prof Ball argues: "It is increasing exponentially and the fatality rate seems to be decreasing, but why?
"Is it better medical care, earlier intervention or is the virus adapting to humans and becoming less pathogenic? As a virologist that's what I think is happening."
There is a relationship between how deadly a virus is and how easily it spreads. Generally speaking if a virus is less likely to kill you, then you are more likely to spread it - although smallpox was a notable exemption.
Prof Ball said "it really wouldn't surprise me" if Ebola adapted, the death rate fell to around 5% and the outbreak never really ended.
"It is like HIV, which has been knocking away at human to human transmission for hundreds of years before eventually finding the right combo of beneficial mutations to spread through human populations."

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Sierra Leone's Ebola lockdown will not help, says MSF

Analysts say enforcing the lockdown in crowded areas will be difficult

A three-day lockdown announced by Sierra Leone to combat Ebola will not help contain the virus, medical charity Medecins Sans Frontieres (MSF) says.

The charity said a lockdown would force people underground, destroy trust between doctors and the public and ultimately help spread the disease.
Sierra Leone officials say the measure, due to begin on 19 September, will let health workers isolate new cases.
About 2,100 people in Sierra Leone, Liberia and Guinea have so far died.
MSF, whose staff are helping to tackle the outbreak, said in a statement that quarantines and lockdowns "end up driving people underground and jeopardising the trust between people and health providers".
"This leads to the concealment of potential cases and ends up spreading the disease further," the group said.
Continue reading the main story

Ebola casualties

Up to 5 September

2,105

Ebola deaths - probable, confirmed and suspected

• 1,089 Liberia
  
• 517 Guinea
  
• 491 Sierra Leone
  
• 8 Nigeria
  

Source: WHO

Getty

Sierra Leonean officials earlier said more than 20,000 people would be deployed to make sure residents stayed indoors.

Health Ministry spokesman Sidie Yahya Tunis told the BBC he did not expect the public to object.
"You follow or else you'll be breaking the law. If you disobey then you are disobeying the president," he said.
The BBC's West Africa correspondent Thomas Fessy says the Sierra Leone population's willingness to obey will be key for the plan to succeed.
A forcible implementation is likely to raise human rights issues and could potentially spark violent demonstrations, he says.
Last month, Liberia sealed off a large slum in the capital, Monrovia, for more than a week in an attempt to contain the virus.
The disease infects humans through close contact with infected animals, including chimpanzees, fruit bats and forest antelope.
It then spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments.
Officials in Nigeria have meanwhile decided to reopen schools in the country from 22 September. They were closed as a precaution to prevent the spread of the virus.

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One in 10 girls sexually abused, says UN report

About one in 10 girls had experienced rape or sexual assault by the age of 20, the UN says

About 120 million girls around the world - slightly more than one in 10 - have been raped or sexually assaulted by the age of 20, a UN report says.

The children's agency Unicef also says 95,000 children and teenagers - most of them in Latin America and the Caribbean - were murdered in 2012 alone.
It notes that children around the globe are routinely exposed to violence, including bullying.
The document draws on data from 190 countries.
'Lifelong repercussions' The violence "cuts across boundaries of age, geography, religion, ethnicity and income brackets,'' Unicef executive director Anthony Lake said.

Homicide is the leading cause of death among young males in many Latin American countries, the UN says

Violence against children

• 120m girls - one in 10 - are raped or sexually attacked by age of 20
• Boys also report experiences of sexual violence, but to a lesser extent than girls
• The most common form of sexual violence for both genders is cyber-victimisation
• 95,000 children and teenagers were murdered in 2012
• Slightly over one in three students aged 13-15 experience regular bullying in school
• Six out of 10 children aged between two and 14 are physically punished by carers

Source: Unicef report

"It occurs in places where children should be safe, their homes, schools and communities.
"Increasingly, it happens over the internet, and it's perpetrated by family members and teachers, neighbours and strangers and other children.''

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Women make up half the world, but do we really hear their stories?

The study revealed that about six out of 10 children aged between two and 14 were subjected to physical punishment from their carers on a regular basis.
One in three girls, aged between 15 and 19, who had at some time been in cohabiting relationships, had been victims of emotional, physical or sexual violence committed by their husbands or partners, the report said.
Partner violence appeared to be particularly prevalent in countries including the Democratic Republic of Congo, Uganda, Tanzania and Zimbabwe, the report said.
Of the countries surveyed, nearly half of all girls aged 15-19 believed that a husband was justified in hitting his wife under certain circumstances, the study added.
Grim audit Meanwhile, homicide was reported as the leading cause of death in boys and men aged 10-19 in many Latin American countries, such as Venezuela, Panama, Brazil and Colombia.
Nigeria had the highest number of child homicides - 13,000, while the US had the highest homicide rate among countries in Western Europe and North America.
Research showed that violence was "detrimental to all aspects of a child's growth... with sometimes lifelong repercussions," the report said.

The study said cyber-victimisation was the most common form of sexual violence for both genders

It noted that while there had been growing recognition in recent years about the impact of violence against children, it largely remained underreported and undocumented.
The report stressed that violence against children in some countries remained socially accepted or tacitly condoned, and quite often victims were too afraid to report the abuse.
Never before have so many statistics been gathered from so many different countries, and together they have produced a grim global audit of violence against children, the BBC's Nick Bryant at the UN says.

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Michelle Obama Should Launch A 'Fight Obesity, Go Straight' Campaign, Bryan Fischer Claims

The American Family Association's Bryan Fischer suggested Michelle Obama revise her childhood obesity initiative to include an anti-gay component.
Fischer, whose opposition to lesbian, gay, bisexual and transgender (LGBT) causes is well-established, pointed to a National Institutes of Health study which will reportedly examine why lesbians have a higher obesity rate than both gay men and heterosexual women in his argument.
"I would suggest that if Michelle Obama really cares about obesity, she should be out there leading the charge against normalizing lesbianism," Fischer said, according to Right Wing Watch. The U.S. first lady, he added, "should be at the head of a campaign to convince women not to get into lesbianism. Her slogan ought to be 'Fight Obesity, Go Straight.'"
Fischer has previously condemned President Barack Obama's stance on same-sex marriage and other LGBT rights.
"Homosexuals do not have a constitutional right to engage in sodomy," Fischer said at the time. Noting that sodomy was a felony for the first 200 years of America’s history, he added, “It’s absurd in the extreme, it’s ridiculous, it’s ludicrous for homosexuals to claim that they have some kind of constitutional right to engage in sexually deviant behavior."

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Not Everything Is Better With Bacon

If you’ve spent any serious time with the Food Network—I’ve probably logged enough hours in front of the TV to receive an honorary degree from the Culinary Institute of America—you’re all too familiar with one particular and constant banging of the rendering pot: “Everything’s better with bacon!”

My response: Hogwash.
Now, don’t get me wrong. I freely admit: I like bacon. A lot. And I eat it. There are few things in life as splendiferous as a late-summer BLT. I just don’t need this almighty divine swine taking over my bourbon and brownies, burgers and—especially!—brussels sprouts.
Part of the reason this over-proliferation of pork so gets my goat became clear when I was emailing recently with Nina Teicholz, author of the new saturated fat-debunking bible, The Big Fat Surprise. She was explaining why a food like bacon is actually good for you: It’s a nutrient-dense protein (as red meats are) packed with naturally occurring saturated fat, a dietary necessity that her decade-long delve into research shows has been unfairly misunderstood and maligned. What Teicholz also stressed, though, is to make sure “it’s a high-quality product,” free of additives and chemicals.
A “high-quality product” suggests belly meat that isn’t the weekly special, but actually special. Something from Sam the Butcher not Oscar the Mayer, in limited abundance, from a humanely raised animal that has been prepared with care. Something to use with thought and deliberation. Not something treated as if it comes from a salt shaker.
Bryan Mayer, a butcher friend who is co-owner of Philadelphia’s farm-to-table food haven Kensington Quarters, which exclusively uses locally sourced grass-fed and pasture-raised meats, furthered Teicholz’s thought for me: He says adding bacon to “everything” is a form of fetishization—food porn—that has become a sort of cooking shorthand for people who don’t really, well, know how to cook. It’s also sustainably unrealistic and … kind of gross.
“I don’t think everything’s better with bacon,” he says. “It’s an accessory. I would love a breakfast of an egg, some toast, an avocado, a slice of bacon—that’s awesome. A slice of bacon. I don’t need 16 slices of bacon, I don’t need bacon weave wrapped over my meatloaf—it’s overkill.” This coming from a guy who makes his livelihood off meat. Shortly after, he texted me a pretty disgusting photo of a giant mug made of bacon, filled with melted cheese. “I think this sums it up.”

This might be too much bacon.
via Daily Fork

John Fraser was able to bring the whole idea home, helping me find the words for my “everything’s better with bacon” disdain, and why I might actually prefer the taste of brussels to bacon when it comes to my sprouts. Fraser is the executive chef of New York City’s Narcissa, whose cuisine has been lauded for showcasing and revering vegetables as much as any of the menu’s wonderful animal proteins. A man who likes meat, but understands its place.
“My baseline is on the side of the purist,” he begins. “Just the other night I had a baked potato for dinner. It was served with bacon bits. No one is going to argue that bacon and potatoes taste good together. However, I showed up for the flavor of the potato, which I added butter and salt to. If I told you I was going to put a slab of chicken breast on a steak, you would call me nuts—they both taste good separately, but together there is a tug of war in terms of flavor. In bacon’s case, it’s not a tug of war—it takes over without a fight. I try to understand what bacon brings to a dish and look to emulate it in the dish preparation. Staying with the brussels sprouts—they love smoke and salt. Bacon is their soulmate. However, if you toss them on the wood grill whole and sprinkle them with some sea salt to finish, my bet is that I can convince you that the bacon actually covers the flavor of the brussels. I would like to work under the assumption that brussels are delicious alone, and that the bacon is a distraction rather than an enhancer.”
So not everything is better with bacon, after all? “I would respond that bacon always becomes the loudest friend in the room, and that’s OK sometimes,” Fraser says, “but there is nuance that it doesn’t allow. Sometimes you should listen to the quiet friend in the corner.”
That will be me, peacefully enjoying my bacon-free brussels, thinking about my next BLT

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10 Day Juice Fast: What Does It FEEL Like?

In Tuesday's article, we talked about the potential health benefits of juicing but as a lifetime athlete, I’m always far more interested with people’s hands on experiences than I am with expert opinion.  My own experience doing this fast was as eye-opening as it was unpleasant.  Enjoy:

At around 9:17am on day one, I was hungry. This did not bode well. Let me clarify that actually, at around 9:17am on on day one, I was really really freakin hungry. I had been forewarned by my fellow acupuncturist/nutrition guru/fiancé that trying to survive on juice and juice alone with my current lifestyle, workout schedule and general output level was not a smart idea in any capacity. Staying to form, I ignored this advice and forged on.

Quite honestly, days one through three were pure hell. Hell, yes, but an eye-opening hell none the less. Eye opening in that as the days went on, I became less and less “hungry” but more and more ensconced in this idea that I needed to eat every 10 minutes or so. My desire to eat as I said, was less about become satiated, I was pounding juice and water to take care of that, but more so to satisfy the habit of eating. I didn’t have a desire for a 16 ounce steak, I simply wanted to put something in my mouth, chew it, swallow it and derive the familiar pleasure from doing so. I am addicted to eating!

Not only did I find I was addicted to the act of eating, I was far more addicted to the break that it afforded me. If I had a phone call that I didn’t want to make – maybe I should snack first. If I have to write an email – probably shouldn’t do it without a bite first. There’s a commercial on during the game – perfect time to grab some chips and salsa. It was very enlightening to see just how much time and energy food preparation, ingestion, satisfaction and enjoyment actually filled up of my day.

The morning of day four was fantastic. I’d had a very rough night the night before but woke up feeling energetic and with no desire to eat anything. I believe by this point I had broken my mental fascination with consuming whole foods. I happily headed down to the gym for another workout and even felt great lifting weights.

Then something weird happened. No longer was there a desire to snack or fill time, but after a hard workout I would find myself for all intents and purposes feeling mildly drunk. I couldn’t remember where I was going, if I had everything that I thought I had packed, who had called me that morning that I needed to get back to, nor did I really feel that I should be driving a car. This forgetfulness would slowly go away with a few more glasses of juice and a couple of passing hours, but it was rather disconcerting.

Unfortunately the forgetfulness was replaced with more intense forgetfulness and further alcohol consumption symptoms. I would stand up to go to the bathroom and have to sit back down to get the room to stop spinning, I would demonstrate a movement for my class and have to take a knee due to the exertion. I had lost three pounds at this point and Eric had lost six. This was not good as we really didn’t have weight that we could afford to lose.

On the morning of day six, the executive decision was made that perhaps (although I can never tell her) my better half’s advice to NOT try to train twice a day, give speeches, write amazingly informative yet humorous articles, coach classes, wrestle, kickbox, do yoga and um…take care of my relationship needs – all fueled by only drinking juice was actually quite sound.

So on that morning I decided to add in two eggs and a half of an avocado in the morning, drink juice all day, and additionally add two chicken drumsticks with some more avocado at night.  The extra calories and fat would hopefully make the difference in being able to sustain my current level of output while keeping true to a juice centered diet for the remaining days.

It is two days later and I feel significantly better and my workouts are great. My daily energy is still down slightly, but that’s manageable for the specific duration of this experiment. If I were to recommend a juice fast to a client and/or patient, I now have personal insight into the matter and would advise against doing a pure juice fast for any longer than four or five days if you’re an active athlete.

Please do watch Fat, Sick and Nearly Dead, even if you are none of the three. There are gems in there for people of all sizes, and levels of health. If you’ve got a juicer taking up space on your shelf, bust it out and give a whirl. Vegetables are great in all of their forms, but are only a benefit to us if we’re willing to consume them.

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How to Plan and Cook a Week’s Worth of Healthy, Tasty Meals

The two biggest objections I hear to eating healthier, whether it be paleo, primal, or whatever you want to call it, are that it’s too expensive and it’s hard to cook interesting meals. The truth is, neither of those things have to be the case.

My husband and I – who both eat a lot of food, by the way – spend between $150-200 each week on food. That money covers all our meals, as we eat out only once at the most. I cook meals every weeknight that are as various as they are nutritious. And preparing them is surprisingly uncomplicated once you get the hang of things.

It’s not that eating healthy is actually complicated and expensive; it’s that you don’t have a system for making it easier and more affordable. I’ve put a great deal of thought into creating this system for our household, and now I’m going to share it with you.

Step 1: Invest in Cookbooks

The first step meal planning is having good sources for your recipes. This means having cookbooks. There are plenty of websites out there with delicious recipes that you can access for free. Personally I like having a hard copy in the kitchen with me and I like the thematic aspects of a whole cookbook.

Some of my favorites are Paleo Slow Cooking, Paleo Comfort Foods, Well Fed, Practical Paleo, Weeknight Paleo, and Make It Paleo. I like each of them for different reasons. Paleo Slow Cooking has great, simple recipes. Well Fed has spicy, sassy recipes. Practical Paleo has great vegetable sides. And Make It Paleo has my favorite dessert recipes of any cookbook. Whatever your sources, make sure you’ve got the recipes from which to start your meal planning.

Step 2: Inventory Your Kitchen

When planning your meals you need to know your possible cooking mediums. Look around your kitchen at the tools you have. I have a new slow cooker, an old slow cooker, two microwaves, an oven, and a stovetop. I have discovered, through trial and error, that I’m a stressed out mess when I try to cook multiple things on the stovetop. I’m a chronic recipe-double-checker, so the timing of constantly checking the recipe and working my way through the steps of multiple dishes overloads my brain.

My solution is to never plan a meal that has more than one dish per cooking medium. So, if I have a main entrée and two side dishes, I have one each in the slow cooker, oven, and stovetop. As my multitasking abilities (and comprehension of how to adjust disparate recipe temperatures) in the kitchen are growing, I sometimes make a small amendment to this rule and allow two items in the oven.

My Personal Tip: A few years back I had no idea how to do anything in the kitchen. If you're where I was, sign up for some cooking classes. If you wanted to get better at Olympic lifting, you'd take lessons. So, consider doing the same if you want to get better at feeding yourself.

Step 3: Sit Down With Your Homework

Every Sunday I sit down in the living room with a notepad and a pile of cookbooks. I tell my fiance it’s time to do my “homework.” I spent thirty to sixty minutes going through my cookbooks, selecting my recipes, and creating the menu for the week. (See photo below for menu example.) From this menu I then generate my shopping list. Once I finish my homework, I head to the grocery store. All in, it’s at most a two-hour process that saves me time and money throughout the week.

Choose Your Meals Wisely

I plan meals for Monday through Friday nights. We eat leftovers every day for lunch. We cook a simple breakfast of eggs and sometimes sausage or veggies in the mornings. If I have time, some weeks I make a crustless quiche on Sundays to eat for breakfast throughout the week. On weekends we eat leftovers or something from the freezer, or we might go out for one meal. Every Sunday night we treat ourselves to a home-cooked steak dinner. As I mentioned, our grocery bill is consistently under $200 per week.

When I create the weekly menu I’m thinking about a number of things:

• Is there enough variety in the protein sources?
• Do we have green vegetables with every meal?
• Is there a source of starchy carbohydrates for my fiance?
• Is there a variety in color and type of vegetables over the week?
• Will there be enough left over for lunch?
• What vegetables are in season?
• What is on sale at the grocery store?
• Can my personal schedule handle this workload of recipes?

I often check the website of my grocery store to see what’s on sale in the meat department before I plan my weekly menu. We’ve had some great cuts of meat for dinner we wouldn’t have had if I hadn’t done this, and we saved money. I also try to stock up our freezer when I come across great sales and ease my work in the future.

The last question on that list - my personal schedule and workload - goes a long way toward alleviating stress. I have longer days on Tuesdays and Thursday because of my train commute to work. I always make sure to plan simpler recipes that require less preparation on those days. There’s no reason to make it harder on yourself if you’re planning things out ahead of time. Alternately, you can always chop all your veggies in advance to make things easier on busier days.

The key is to plan ahead and keep it simple. Cooking can feel overwhelming if you’re new to the kitchen, so start small – don’t start with extravagant meals. If I decide to try a new recipe, I make sure all the other recipes that evening are tried-and-true. So, if you’re new to cooking a certain entrée, then just steam some veggies for your side dish.

My Personal Tip: When I create my menu I also write the cookbook name and page number to the right of the recipe (see photo). This helps me not aimlessly page through cookbooks all week. Instead I can quickly pull out the right book and open to the correct page.

Once I have my menu planned for the week, I create my shopping list:

• First - I go to each recipe and write down all the ingredients I don’t have in my kitchen. I don’t worry about organizing them at first. Just write them all down so you can put your cookbooks away.
• Second – I get a blank piece of paper and rewrite the ingredients in a more organized fashion. I group them similarly to how the grocery store is organized – meat, vegetables/fruit, canned goods – so that I can quickly move through the store and not go in circles. (See the two versions in the photo below.)

Now, all I have to do is follow my own instructions. I go to the store and buy exactly what’s on the list. Each night I make the meals I’ve already planned out. If I have extra time I prep the vegetables for meals later in the week. It takes a lot less brainpower and a lot less time this way. We also never waste food anymore because everything is accounted for.

As your comfort in the kitchen grows, your ability as a cook will also evolve. I handle much more complicated meals now than I did a few months ago, and I’ve begun adding desserts to the weekly menu, too. You’ll find as you experiment each week that there are recipes you revisit and they become easier each time you make them. I keep track of these easily by putting stars next to them in my menu notebook. I keep all my meal plans in one notebook for easy reference and for looking back on previous weeks, as to what went well and what did not. I also make notes right in my cookbooks if I change the recipes so that I don't have to try to remember little details in the future. Remember, the goal is to use planning to make things easier.

So, it’s not that healthy cooking is necessarily complicated or expensive. It can be, but it doesn’t have to be. All you need is a system for moving forward. Once you create that system, before long you’ll be eating better with less work and for less money.

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High, Medium, and Low Protein Diets Put to the Test

Amino acids are of critical importance in the diet. Of course, the greatest source of dietary amino acids is protein from food sources. Protein provides the material for new muscle and the building blocks for countless other substances in the body, such as most of your enzymes, which are essential for life.

In other words, you need protein. In a recent Nutrition and Metabolism study, researchers examined what happens to the body when we eat different amounts of protein.

Many proteins can be synthesized by the body, meaning you don’t need to get them through diet. The ones that can't be made are usually called essential amino acids, although perhaps a better term is indispensable amino acids. The second term is finding more use these days, since the word essential can be a bit confusing. In nutrition, essential simply means that you need to eat it to get it. However, many non-essential proteins are essential for life in the way we usually we use the word.

Study Design

In the study 137 men and women were split into three different groups. Each group consumed a different amount of protein.

• Low Protein Group: Five percent of calories were from protein.
• Medium Protein Group: Fifteen percent of calories were from protein.
• High Protein Group: Thirty percent of calories were from protein.

The researchers considered the medium protein group to be the norm. To put the numbers in perspective, on a 2,000-calorie-per-day diet, fifteen percent of calories would amount to about 75 grams of protein. A paleo dieter might find their percentage to be higher, whereas a vegetarian might have to work to get there.

Each participant was tracked for twelve days, and urine samples were collected to determine nitrogen balance, which is one indicator of healthy muscle synthesis. Amino acids produce nitrogen, which in turn contributes to muscle maintenance or growth.

Their diets were also analyzed for levels of indispensable amino acids, and their protein sources were regulated as well. Five percent of the protein consumed daily came from wheat, which means all the people in the low protein group received protein exclusively from wheat sources. The medium- and high-protein diets included protein from either whey, soy, or beef sources to achieve the higher values.

Results

There was nitrogen balance even in the five-percent protein diet, which means enough protein was being taken in to at least maintain existing muscle. On the other two diets, nitrogen levels were positive, meaning more nitrogen was being taken in than lost. That means that a diet as low as fifteen percent is sufficient for putting the body in a state of growth over twelve days.

Bear in mind that exercise was not a factor in this study. That means the requirements for achieving balance and growth would likely go up on an individual basis, but they’re not likely to be higher than in the thirty-percent diet. In other words, you should have no problem attaining a positive nitrogen balance on a thirty-percent protein diet, as long as you are getting enough calories to maintain your weight.

Although nitrogen balance was reached on five-percent protein, the low-protein diet was still insufficient to attain all of the indispensable aminos, perhaps because all the protein came from wheat. In the diets that used soy products to increase protein intake, the amount of protein required to get all of the indispensable aminos was also higher than the diets that focused on whey or beef.

This study shows it doesn’t take much protein to achieve nitrogen balance, but more is better with active individuals. To achieve proper nutrition, ensure you are taking in at least a modest or high amount of protein. If you are a vegetarian, you may want to consume amounts above recommended for your size in order to get in a varety of indispensable amino acids.

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7 Simple Ways to Get More Greens in Your Diet

There’s no disputing that leafy green vegetables are the healthiest foods on the planet. The more you eat, the leaner and healthier you’ll be. Since they’re so nutrient-dense, full of fiber, and low in calories (around 100 calories per pound), you can consume them in virtually unlimited amounts.

Green vegetables are loaded with protein (100 calories of romaine lettuce has 7.2 grams) and contain a cornucopia of micronutrients, including folate, carotenoids such as lutein and zeaxanthin (which promote healthy vision), calcium, and omega-3 fatty acids. Some leafy greens, like kale, watercress, collards, arugula, and bok choy, belong to the cruciferous family of vegetables whose unique nutrients such as isothiocyanates have been shown to be some of the most powerful cancer fighters in existence.¹

But what if you don’t feel like eating enormous salads all the time? Not to worry. There are plenty of other ways to include more leafy greens in your meals. Some of the tricks below are even great for sneaking greens into a fussy child’s (or fussy adult’s) diet.

Blending and Juicing

Don’t like chomping down on greens for what seems like endless periods of time? Drink them instead. Blending your greens into a smoothie or making a cold-pressed juice with primarily vegetables (and a small amount of fruit, if necessary) helps to increase the bioavailability of beneficial micronutrients by breaking down the walls of plant cells, a feat that chewing alone might not accomplish adequately.² Even if you’re a big salad eater, including blended or juiced greens into your diet is worth trying if you’re not doing it already.

Breakfast Scrambles

If you’re making a big egg or tofu scramble, add in some chopped spinach, kale, or collards towards the end of the cooking process. You’ll be starting your day with a nice portion of greens, with plenty of fiber and protein to keep you full for a long time.

Stews, Chilis, and Soups

Just like with a scramble, you can easily add chopped greens to any one-pot meal you’re making. My favorite is Julieanna Hever’s Beans and Greens Chili recipe. Greens can also be blended into the base of soups, which accomplishes the same goal of increasing nutrient absorption just as smoothies do.

Sauces, Either Chopped or Blended

Greens also work well in savory sauces. Blend spinach into your fresh pesto sauce or add any kind of leafy greens to a tomato-based sauce. For sake of convenience, it’s useful to always keep a bag of frozen chopped greens on hand to toss into a sauce as it’s heating up.

Noodles and Pasta

If you’re making pasta (hopefully whole grain), add some greens into the boiling pasta water three minutes before the noodles are al dente, then drain and continue to prepare as normal. Not only have you boosted the micronutrient content of your pasta dish, you’ve also reduced the caloric density of the meal.

Collards in Place of Tortillas

Next time you make a wrap of burrito, grab some of the biggest collard green leaves you can find. First, trim the hard stems off the bottoms, and then blanch them in boiling water for one minute. Remove the leaves from the boiling water and dry them off. You’ve now got the most nutrient-dense tortilla on the planet.

Burger Patties or Meatballs

Whether you’re making a burger or meatballs out of beans, beef, or turkey, you can add some chopped spinach to the mixture as well. It might not amount to a huge portion of greens, but any time you can add more greens to a dish, it’s worth doing.

By incorporating any or all of these tips into your daily routine, you’ll end up flooding your body with the most beneficial disease-fighting nutrients possible in some of the least noticeable ways. So give some of the above techniques a try this week and let me know how it goes.

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Weightlifting Belts: Should You Use One? Pro and Con

Depending upon who you ask the question, "Should I wear a weightlifting belt?" you can end up getting an emphatic "yes", a condescending "no", or an uninterested "I don't care." For instance, powerlifters obsessively use specialized weightlifting belts while CrossFitters are proud they never do. Bodybuilders are split with some believing belts essential for both safety and performance reasons and others believing them to actually INCREASE your risk of injury over time. Olympic lifters don't really care either way.


Given all of that, it can be hard to parse out an easy answer to what seems like a simple question. I'm going to lay out the pros and cons.

QUICK SUMMARY
Belt Pros:

• May help prevent injury to the low back during heavy lifts.
• Can increase performance.

Belt Cons:

• Might inhibit motor learning in the abdominal muscles.
• Lower Back might not get as strong.

Should You Wear a Weightlifting Belt? Pros

All of the upsides to wearing a belt come down to the idea of intra-abdominal force or pressure. A study done by Miyamoto, et al. found that "Intra-muscular pressure of the erector spinae muscles increased significantly by wearing the abdominal belt during Valsalva maneuvers and during maximum isometric lifting exertions". In short, if you increase the pressure in the abdomen, then you better stabilize the whole area which makes for a safer environment for the spine and can increase your ability to lift heavier weights.

Another study by Kingma, et al., showed that, "Wearing a tight and stiff back belt while inhaling before lifting reduces spine loading. This is caused by a moment generated by the belt rather than by the IAP (intra abdominal pressure)", which suggests that there may be even more reasons why belts are beneficial.

Let's go over the three kinds of belts that are in use most widely and the potential benefits of each.

1. Powerlifting Belts


Powerlifters wear belts like the Inzer Forever Belt primarily because it allows them to squat and deadlift more weight. The potential safety benefit is a secondary concern.Belts designed specifically for the sport of powerlifting are heavy duty, stiff, and the same width all the way around. The fact that there is more surface area of your abs in contact with the belt, combined with the fact you've got a buckle that can be pulled as tight as you want without coming undone makes for a remarkable amount of internal pressure build up.

More pressure equals more stability equals more weight. It really is that simple.

2. Velcro Belts

Velcro belts, like the Harbinger I reviewed a few months ago, are on the opposite end. They are generally made of some synthetic material and because it is being held onto your body with only Velcro, there is a limit to how much force can be exerted against it before the Velcro simply pops off and your belt loosens. The amount of intra-abdominal pressure they generate is far less. You may get some added injury protection out of these, but you won't get much of a performance boost.

3. Bodybuilding or Traditional Belts

These belts, like the Bodybuilding.com version, are made of leather and are thicker in the back than in the front.They are only as thick as the belts that hold up your pants. They buckle and fasten in the same way as a powerlifting belt - they just aren't as strong.

What this means is that they provide less internal pressure than the powerlifting belts (because of a smaller front) but more pressure than a Velcro belt (because of their ability to be buckled very tight).

They are a hybrid in terms of what you are getting out of them.

Should You Wear a Weightlifting Belt? Cons

There are two major arguments against the use of a belt. Below I go over each, and my response to them.

1. Belts Mess With Motor Learning


The first concern is the belt might inhibit proper motor learning. Many of the best exercises in the gym require a correct pattern of recruitment of the abdominals (including the obliques and transverse abdominals). With beginners, weight belts circumvent their learning of how to "squeeze" their abs tightly and in the right ways during a heavy lift. The belt just takes over.

This issue, however, is pretty easy to get around if you have a good coach or you are paying attention. You should never use a belt in place of proper core work, stabilization, and technical learning. But that should be obvious.

2. Belts Make Your Lower Back Wimpy

The second concern is that wearing a weightlifting belt is going to cause your lower back to be weaker than it would have been without it. Why? Because it will take stress off the back and stress is what drives adaptation.

Let's think about this for a second. The strongest deadlifters in the world nearly all wear belts all the time in training and competitions. Do you really think they have weak lower backs because of their obsessive use of a belt? Putting on a belt MIGHT lower the amount of stress on the low back by some amount, but that difference is more than made up for by the additional weight you will lift via a boost from internal pressure or even just the psychological boost you get when you feel safer.

The correlation between those who wear belts and those who are crazy strong is very high.

So What Do I Recommend?

I'm in the "I don't care either way" crowd. What I will say is if you DO wear a belt, stick to the simple Velcro kind. Avoid use of the hard leather variety. I know they look cooler, but I'm against using belts for the specific purpose of performance enhancement unless you are a competitive powerlifter.

The Velcro belts will give you a performance boost, but it is rather minimal. The reason you decide to wear one or not should be based solely on whether you believe it will keep you more stable and therefore less injury prone. My recommendation, therefore, is based upon the use of the Velcro-style belts only.

Many of my own lifters wear a weightlifting belt, and many others never do. Some wear them on every lift - even warm ups! Others won't touch them except on their heaviest sets of clean and jerks, squats, and deadlifts. I can tell you from my own experience that when I'm wearing a belt for all of my heavy lifts I never hurt later. But, if I DON'T wear the belt, I DO hurt later. You might argue I simply didn't wear a belt for a long time that I'd eventually adapt. But, keep in mind I lifted very seriously for over a decade never wearing a belt. I've done both, each for quite some time. I prefer wearing a belt.

The point is wearing a belt is a highly personal decision, but it shouldn't be taken too seriously. If you feel more confident wearing it, wear it! If you find it awkward and uncomfortable, don't. All that matters is that you never let someone ELSE decide for you.

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Getting Stronger Through Mind Control: A 3-Step Meditation Plan

I say a lot of contradictory things when I'm coaching: "Go slow!", "Go fast!"; "Shoulders behind the bar", "Shoulders over the bar"; "Focus on ...", "Don't think!"

The last one is the worst. Not understanding the subtlety I'm driving at is the basis of all the problems that start to plague a lifter once they get past the first month or so of training. You know you need to do a series of complex movements in precisely the right way, but, ironically, if you think too hard about it, your body won't do it!

It's a fine line you have to walk. Think hard enough for long enough so you can stop thinking completely...sounds crazy, don't it?!

In my previous article on Knowing vs. Doing, I explained there is a world of difference between knowing WHAT you are supposed to do and actually being able to DO it. It may seem obvious that your brain can get in the way of your body, that if you don't shut it down then you won't ever snatch anything heavy. Period.

But, how in the world do you shut your brain down?

The Default Mode Network and Your Snatch

When your brain is in "focus" mode, it uses what is called the task-positive network. This is a series of brain regions that work together to make sure you can accomplish those tasks that require intense concentration. Its opposite is something called the default mode network. It's activated whenever you aren't trying to focus on anything in the external world. It's your brains "default" and it reverts back here ALL the time - even when you are trying to focus. I don't want to get into the details too much, but suffice it to say that the default mode network has a tendency to get hyperactive! Tell someone NOT to think and what happens? They think!

Getting yourself to shut down your brain and be mindless is no easy task. Why would you even want to, you ask? Because sometimes your brain gets in the way of your body. For instance, I'm typing this right now while completely ignoring what my fingers are doing. Anyone who's become a fast typist has developed this ability. Imagine how slow a typist you'd be if you had to stare at your fingers the whole time and focus intently on every keystroke!

You have to do the same thing with complex athletic tasks: hitting a tennis ball, swinging a golf club, and doing a snatch. They are all the same. First, you go through a period of intense skill learning. You try to focus all your mental energy on every step, every detail. Eventually those skills become more ingrained and you can do them without thinking so much.

At least that's the ideal.

Houston, We Have A Problem

Unfortunately, getting to the point where you can do a highly complex thing without thinking about it doesn't always "just happen." This is especially true when there is a component of fear involved. Fear causes you to worry that if you DON'T think and focus hard you'll screw up and then the bad thing you are worried about is sure to happen. But, that's the opposite of the truth. The intense focus is actually causing a self-fulfilling prophecy.

You know this, but your brain doesn't. Your default mode network is getting in your way. You currently have NO control over it, and it's natural hyperactivity is causing you to "process" way too much during times when you should be totally mindless, letting your body do the talking.

Thankfully, we have a way around this, and its name is Meditation. Meditation attacks the default mode network directly. It is a way of improving your Mind Control, thereby allowing you to lift more weight.

The Solution: How to Meditate

I'm going to give you the same plan I was taught when I first started meditating over 12 years ago. It is basic, it is easy to implement daily, and it doesn't take very much time. It is also highly effective.

You can get more complex later, but if you can't do this, any advanced forms of meditation are totally worthless. Given that you are using meditation in service of your strength and athletic goals, what we have here is MORE than enough.

• Step 1: Sit down
• Step 2: Shut up
• Step 3: Count your breath up to 100

Done. Don't overcomplicate the simple. Breath in, then out. That is one. Keep going up to 100. When counting, you WILL lose track, your mind will wander, and you'll get frustrated. That's the kind of thing you are trying to practice your control over.

The goal isn't just to be able to successfully count your breath (that alone would be silly). The goal is to get better about recognizing when your mind wanders, stopping it, returning to the task at hand, and doing all of that without ANY emotional reaction what-so-ever. Constantly getting frustrated with yourself every time you make a mistake in life is a serious hindrance to success. Highly successful people don't dwell. They don't get all pissy about their mistakes. They don't get down on themselves. They simply fix it and move on.

That's a skill that must be learned. This is how you learn it.

Meditate every day. It doesn't matter when, just do it. You don't need to sit in the lotus position, or cross legged, or "Japanese" style. You don't need to have a special meditation pillow, or incense, or other froo-froo accoutrements. You don't even need to close your eyes! (Though I think that helps.)

Over time your brain will get better at quieting itself. It is EXACTLY like working out your body. If you do this consistently you will improve. You don't have to resign yourself to the idea you are just "naturally" scatterbrained - and therefore will never be able to do what great athletes do: turn off your brain.

There is NO way on this green earth you will ever lift heavy weights on the Olympic lifts (that are in line with your strength levels) if you are over-thinking all your lifts. The same is true of any complicated athletic skill, or driving, or typing, etc. That said, there is also no way you can simply tell yourself to stop thinking and have that magically happen. Controlling the default mode network takes consistent work. But, once you start to get better at it, it will pay dividends in the gym.

Now go sit down, shut up, and count so that you can lift something heavy.

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10 Life-Changing Reasons to Drink More Water

Has it occurred to you today that you are thirsty? Guess what – by the time you experience the sensation of the thirst, you are already dehydrated. That thirst is your body calling for re-hydration.

Your body is composed of roughly 60% water¹. That means when we are dehydrated – and most of us spend our days constantly dehydrated to some degree – we are affecting the performance of the majority of our body. Nearly all of our systems do not function as well without the proper water intake.

So, really, what does this mean? Why should we drink more water?

1. If you don’t drink water, you will die. It's that important. Depending on our environment, we can live only a few days without water - maybe a week. We can live much longer without food. For most of us, we should prioritize the consumption of water far more than we currently do.
2. Prevent cancer. Yes, that’s right – various research says staying hydrated can reduce risk of colon cancer by 45%⁵, bladder cancer by 50%⁶, and possibly reduce breast cancer risk as well.⁷
3. Be less cranky. Research says dehydration can affect your mood and make you grumpy and confused.³ Think clearer and be happier by drinking more water.
4. Perform better. Proper hydration contributes to increased athletic performance. Water composes 75% of our muscle tissue!⁴ Dehydration can lead to weakness, fatigue, dizziness, and electrolyte imbalance.
5. Lose weight. Sometimes we think we are hungry, when actually we are thirsty. Our body just starts turning on all the alarms when we ignore it. For those of you trying to drop some pounds, staying hydrated can serve as an appetite suppressant and help with weight loss.
6. Have less joint pain. Drinking water can reduce pain in your joints by keeping the cartilage soft and hydrated. This is actually how glucosamine helps reduce joint pain, by aiding in cartilage’s absorption of water.
7. Flush out waste and bacteria. Our digestive system needs water to function properly. Waste is flushed out in the form of urine and sweat. If we don't drink water, we don't flush out waste and it collects in our body causing a myriad of problems. Also combined with fiber, water can cure constipation.
8. Prevent headaches. Sometimes headaches can be caused by dehydration, so drinking water can prevent or alleviate that nasty head pain. Next time your head hurts, try drinking water.
9. Make your skin glow. Our skin is the largest organ in our body. Regular and plentiful water consumption can improve the color and texture of your skin by keeping it building new cells properly. Drinking water also helps the skin do it's job of regulating the body's temperature through sweating.²
10. Feed your body. Water is essential for the proper circulation of nutrients in the body. Water serves at the body’s transportation system and when we are dehydrated things just can’t get around as well.

Quick rules of thumb for drinking water:

• Drink half your bodyweight in ounces of water (if you weight 160lbs, drink 80oz of water each day).
• Carry a bottle everywhere with you as a reminder to keep drinking.
• Eat raw fruits and vegetables – they are dense in water. You can get water from food, not just from beverages.
• Drink water and other fluids until you urinate frequently and with light color.

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