Arizona College & Career Ready Standards ( aka Common Core)

I had the opportunity to listen to on of the valley's District Superintendents speak about the Arizona College and Career Ready Standards this evening. It was enlightening, and yet very disheartening. I attended the meeting to gain better perspective on the pro's and con's of this change in standards, and instead, I got to see a Ph.D. act as a federal cheerleader. All I heard was an endorsement for what Common Core is supposed to accomplish, a plug for "all-day" pre-K and Kindergarten, and a video of Arizona educators praising standards that have never been tested.
This is a topic fraught with political and ethical overtones and those came across loud and clear from this Superintendent. I recognize that standards are essential. I also recognize that we must come up with methods to quantifiably asses learning, however, standards based education has ruined the way we teach and learn. This has been well demonstrated over the last 10 years. Just "raising the bar" on the standard will not solve the problem. This was implemented only for bureaucratic convenience. Measurement of a mind's creativity, inspiration, and appreciation cannot be measured. We teach to free minds, to inspire and to equip. These skills are often un-measurable.

I guess I was expecting more clarification, but instead came away with none of that and was left feeling only an endorsement of the Superintendent's views.
As the adviser to young men in my church, a family physician, a health policy expert with thousands of patients affected by these standards, the President-Elect of my medical association, and more importantly, as a father who must navigate the ever darkening, murky waters of education with my children, this topic is of profound importance. I am asked about these standards regularly and must asses our youth, as their physician, and gauge their physical and mental capabilities in handling these standards when illness arises. Therefore, "I have significant skin in the game."
I have the following significant concerns about these standards and their implementation which have yet to be allayed:

1. Common Core is a big business, politically powerful advocacy collation that formed with an attempt to correct the last 10 years of failed 2002 "No Child Left Behind" legislation putting into place new federally mandated standards.
2. These standards were created in 2009 by the National Governors Association and the Council of Chief State School Officers in partnership with Achieve, Inc (who received $160 million dollars from the Bill and Melinda Gates foundation to create the standards). And, we know that when a private company funds standards with the government, that company will be involved in the monetary gain of testing of those standards. This is the epitome of "krony capitalism" at work.
3. To quote the Washington Post "Because federal law prohibits the federal government from creating national standards and tests, the Common Core project was ostensibly designed as a state effort . . ." But it was, in reality, contrived by an insular group of academic testing executives with only two qualified educational assessment experts, both of which never signed off on the program. "In all, there were 135 people on the review panels for the Common Core. Not a single one of them was a K-3 classroom teacher or early childhood professional." Parents were entirely missing. K-12 educators were mostly brought in after the fact to tweak and endorse the standards--and lend legitimacy to the results."
4. Dr. Sandra Stotsky, one of only two qualified education ESL specialists and member of the Common Core Validation Committee, recently testified against Common Core implementation before the Wisconsin Board of Education stating that it created an "empty skill set, lacking in literary knowledge"
5. Common Core was not voted upon at the federal level by Congress, the Board of Education, or by State/Local Governments, and in the state of Arizona, its implementation could only occur through the force of Gubernatorial Executive order due to its controversy in the house and senate, after its name was changed.
6. The measurement standards (PARCC Test) have not been fully implemented in Arizona and will require outside companies to formulate, read and grade our children's tests and thereby the teachers who are teaching those students. 

Upon finishing the meeting, two people also in attendance approached me as I left the building, one of which currently serves as a School Principle and another who serves as a college professor. They informed me that my concerns were "unfounded ultra-conservative delusions that have no place in the argument of school standards.

My perception of our meeting this evening is that a number of very uninformed people in our community will return home to their families with a flowery, lemming-like-acceptance of unproven, tax laden standards that, I believe, have significant potential to damage the educational and financial futures of our children.

Leadership Thoughts

A ship, to run a straight course, can have but one pilot and one steering wheel.  The same applies to the successful operation of a business.  There cannot be a steering wheel at every seat in the organization.

Carol of the Bells . . .

Amazing!! I'm now in the mood for the Holidays again. Thanks Pentatonix!

Little Drummer Boy . . . Pentatonix

One of my favorite renditions:

John Wayne on "Optimism"

Excerpts from a 1975 interview where he gives his perspective of liberal politics and political tactics sound like they could have been stated just yesterday. This is the reason John Wayne is still a true American hero. 

"The Duke's" take on liberalism is “they never listen to your point of view, and they make a decision as to what you think, and they’re articulate enough and in control of enough of the press to force that image out for the average person.”

 "Ok, Pilgrim," you just have to be a little more optimistic . . .  (I feel like I'm sitting at my grandfather's knee while listening to this bigger than life hero give a little advise.)  Thank you.
You just have to listen:

Open Letter to Legislators on Obesity

Dear Senators McCain, Senator Flake and Congressman Franks,
I am a Family Physician, Obesity Specialist and Health Policy Fellow.  I had the opportunity to meet with your staff a few months ago and would like you to consider co-sponsoring S-1184 and/or HR-2415 the "Treat and Reduce Obesity Act." Obesity affects 34% of the population and 33% of the population in the US is overweight. Obesity is affecting military readiness and our economy using 21% of all healthcare costs.
One of the challenges I find as a physician who treats obesity daily, is that medications and therapy that is effective in treatment is not covered by Medicare services.  S-1184 will allow me as a physician to use effective medications for obesity that patient's current cannot afford.
I would love to talk with you or your staff about this bill and its effect on our treatment ability.
Please consider co-sponsorship of this bill and feel free to contact me regarding this issue at any time.
Sincerely,
Adam S. Nally, D.O.
Board Certified Family Physician & Bariatrician
Health Policy Fellow

Open Letter to my Senators . . .

Dear Senators John McCain and Jeff Flake,

I am a family physician and health policy fellow, as well as a constituent in Arizona. I have a busy practice serving 5500+ patients in the Surprise, Sun City West area. I would strongly encourage you to vote to De-Fund the Affordable Care Act (Obamacare) as this bill has already increased the price of premiums 2-3 times the cost from last year and has made it nearly impossible for my Medicare patients (50%) of my practice to afford a supplemental health insurance plan. Allowing this bill to be funded will force me to lay off a minimum of 2 members of my office staff within the next year and may make it impossible to continue practicing medicine in the near future. 

I have personally heard you make the promise to stop this bill, on multiple occasions, and that reversing this bill was one of your priorities. Please keep your promise and vote to de-fund this atrocity.

Please stand with Senator Ted Cruz, Senator Mike Lee, and Senator Rand Paul in de-funding Obamacare!

Sincerely, Adam S. Nally, D.O.

ObamaCare & Medicaid . . . On the Road to the Great Depression

Robert Lewis Stevenson said, "Don't judge each day by the harvest you reap but by the seeds that you plant." So . . . I'm going to plant a seed.
The Arizona Osteopathic Medical Association has been asked to contribute Political Action Funds (PAC) to those congressional members supporting Arizona’s Medicaid expansion.  I seem to find myself in the physician minority as to my point of view on this subject. Do others not see the economic damage that the Affordable Care Act has caused and will cause in the future?  Does no-one see the sadness and depression on the faces of patient’s in the exam rooms? Does no-one put two and two together to see the effect that federal and state regulations imposed upon the small businesses of America have upon the average American family?  

I respect their points of view, however, I am very discouraged by the progressive position and mindset of many physicians around me.  Maybe I'm missing something? Maybe they see the world with a different set of spectacles? This kept me awake last night as I pondered the reasons. 

I recognize that the practice of medicine is, to say the least, life encompassing.  Often, it is all you can do just to keep up with the many demands upon the physician each day.  Understanding how the economy effects your practice is the last thing that many physicians want to do.  But I see it as one of the most important, especially as a physician who owns his own practice. 

Maybe this lack of interest is due to the declining physician ownership of practices. According to Becker’s Hospital Review, only 37% of physicians in 2013 have any ownership interest in their practice, down by almost 8% this year from last year.  This statistic, just over a third of physicians, seems in line with the number of physician that are opposed to expansion of Medicaid in Arizona and the Affordable Care Act or “Obamacare” in general.  

“Obamacare” and the employer mandate has made it nearly impossible to expand my practice, and the Medicaid expansion may make it worse.

How is Medicaid expansion bad?  Wayne Allen Root explains it better than I can: “Forget the 7.3 percent unemployment rate that is reported by the government. That’s pure fraud and propaganda. That figure goes down only because hundreds of thousands of Americans drop out of the workforce. In other words, if you stop looking for work, and go on food stamps and welfare, [our White House Administration] says the unemployment number just got better!

 “The only truth about unemployment is found in the Labor Force Participation Rate of 63 percent. That’s the lowest in four decades. For men it’s the lowest since record-keeping began in the 1940’s. What this means is 37 percent of the able-bodied, working age adults in America are not only not working, they’ve given up looking for work.

“Even worse, an unimaginable percentage of those who are employed have only part-time jobs. Seventy-seven percent of the new jobs created since January 1st are part-time jobs. That’s not good folks. Studies show 1-in-4 part-time workers live in poverty, while only 1-in-20 full-time workers live in poverty. So millions of Americans under Obama who show up as “employed” are merely working their way towards poverty. And millions of others who have full-time jobs are working at McDonalds, or working as waiters, or bartenders, or janitors.”  The American middle class is being moved to the intensive care unit.

“Here are the two most ironic points about this slow-motion train wreck called the Obama economy: “Obamacare” is the number one culprit destroying real jobs. Business owners are done. No smart business owner in all of America will lift a finger to create a full-time, high-paying job with benefits. It just makes no economic sense anymore. So Obama’s signature achievement has not only created a part-time economy, but all those people in part-time jobs don’t have health insurance. This should be a Saturday Night Live skit. The man has created nationalized health care so that everyone loses their jobs and no one has health care.” 

This is pure insanity . . . unless your goal is to create an entire nation dependent on government welfare.

Mr. Root continues, “Secondly, here’s the really sad, tragic, and ironic fact of the Obama economy . . .Obama’s policies are destroying the very people who elected and believed in him. It’s almost as if Obama is out to destroy his own voters. Let’s take a look at who is suffering the most from this Obama Great Depression.

“Obama won the 2012 election with a razor thin 51 percent of the vote. His biggest supporters were blacks (93 percent voted for Obama), Hispanics (71 percent), single women (67 percent), young people (60 percent), and those without a high school diploma (64 percent). This is the loyal foundation of Barack Hussein Obama. This is who made him President, without a single qualification, except being a community organizer.

“Now let’s look at how Obama repays his loyal fans. New research out just last week proves that since 2009 income for black heads of households dropped by 10.9 percent. For Hispanic heads of households it dropped by 4.5 percent. For single women head of households it dropped by 7 percent. For young people (under age 25) it dropped by 9.6 percent. For those with a high school diploma or less, income dropped by 8 percent.

“In dollar terms the numbers are even worse. Female incomes are down by $2,300 per year under Obama; black incomes are down over $4,000 per year; Hispanic incomes are down by $2,000 per year.

“How about actual unemployment figures for Obama’s fans? We see the same results. Reported unemployment (a bogus figure) is 7.3 percent. But among blacks (who voted 93 percent for Obama) it is an unimaginable 13.3 percent. Among Hispanics it’s 9.4 percent. Among black youth it’s 20.9 percent. Among teens it’s 23.7 percent.

“The black middle class is being destroyed. Black home ownership has slipped to the lowest level in decades.

“But perhaps the worst statistic of all is the unemployment plus under-employment rate for college graduates under age 25: 18.3 percent. That means new college graduates (also big supporters of Obama) not only can’t find a decent full-time job in the Obama economy, at the same time they are saddled with the highest student debt in history. That could be why we have the highest student loan default rates in history.”

The Medicaid Expansion in Arizona will just speed up the process already occurring across the country.  Our “lemming-like” acceptance of this expansion as physicians is leading to the further destruction of Arizona’s and America’s economy. Contributing PAC funds is like putting the proverbial nail in my businesses coffin. For the reasons above, I cannot in good conscience support the expansion of Medicaid in Arizona.  

First Fruits

Today was a lesson of "first fruits."  The preservation of life lies within the basic family unit.  Preservation of the family unit requires knowledge in the application of seeds. The "first fruits" are the harvest of knowledge applied as the nutrients and fertilizer of those seeds. 

Prior to the hybridization of seeds, our grandparents survived by taking a portion of their crops and using the seeds from them to plant crops the following year. Most of our grandparents understood this concept, however, unfortunately, most of us know nothing about it. Our grandparents used open-pollination seeds (seeds that are not genetically engineered not to reproduce).

Hybridization has been a boon to mass production in crops, but has it's down sides.  These seeds can no longer reproduce themselves and they also have changes to their colors, size and nutrient concentrations. 

This lesson was made clear to me today as I looked out over the expanse of a farmer's field while riding horseback with my family.  The basic unit of development in life is the family. It is where the lessons of life are taught and where knowledge is applied and becomes wisdom. Is it the only place this can occur? No. However, it is the most effective. My wife and I have been striving for more self sufficiency in our lives. We have been looking to improve the self sufficiency of our family and children. 

This morning we got a chance to talk about those seeds figuratively with the family.  Our children our our "first fruits" and helping them to become self sufficient is a liberating feeling. 

It was a majestic Arizona morning, the temperatures were wonderful and the horses were calm 

The great danger for most of us is not that our aim is too high and we miss it, but that our aim is too low and we reach it.

My Best Friend . . .

Social Medial Bacon Style . . .

Honesty is the Best Policy . . .

Andreas Eenfeldt, MD, a trusted low-carb colleague posted this today. Couldn't help but repost it here. Thanks Andreas!

Tears . . .

Give a Man a Fish . . .

The Skinny On Sweeteners

I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.

First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat. Most sugars are labeled with the ending “ose".

With an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream. Glucose (a carbohydrate in its most simple form) stimulates insulin to rise. A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day. Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.

Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides.

Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate. Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.

Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels. Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content. Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods. This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).

Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.

Aspartame
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™). Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days.

Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994, vol. 44: 1787). Most people enjoy without problem, however.

Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar. It also contains no carbohydrates. To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste. The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar. Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.). It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).

This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market. It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas. I have found in my private medical practice that this sweetener significantly limits weight loss.

Sucralose
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking. It is available as a bulk sweetener and actually measures equivalently to table sugar. Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127). 1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.

Saccharine
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners. It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.

Cyclamate
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.

Stevia
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves. It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter. Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release. Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.

Sugar Alcohols
Sugar alcohols are also called polyols. These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH). These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate. However, they are incompletely absorbed by the human intestine. This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates. In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals.

Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950). Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637).

So, in summary, which sweeteners will not cause weight gain or cholesterol changes? From the research that is presently available, aspartame, Stevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight. I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Three MOST Difficult Activities in the World

The top three MOST difficult things to do in the world:

1. Counting the hair on your head
2. Washing your eyes with soap
3. Breathing while your tongue is sticking out



Please, put your tongue back in your mouth . . .

Trey Gowdey Eplains Why IRS Shouldn't Have Your Medical Records

Clicking Will Change Your Life . . .

Hepatitis A Linked to Frozen Berry Mix

Hepatitis A has been linked to a contaminated batch of berries sold at Costco's in five different states. See the news video below . .  .

If you have eaten these berries and have symptoms of stomach pain, fatigue, nausea, diarrhea, or yellowing discoloration of the skin or white parts of the eye, see your doctor.

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