Effective Care are the common sense solutions that can save lives & money.

Evidence Based Guidance is a starting point.

Health care takes a team - educate with professional guidance.

As a dietitian or as anyone in our modern world, life gets busy and complicated. Jargon within your own field of interest can become difficult to keep up with let alone trying to understand and remember the lingo used in other industries or in the healthcare field in general. 

     I added a glossary to this site because that was a suggestion I received about a previous book and having a reference with all the diagnoses and recommendations for that diagnosis in one place is a convenience that dietitians are used to having in their toolbox. The standard in the nutrition world is by Sylvia Escott-Stump and it is a reference that every health professional would benefit from having on their desk. I referred to my copy frequently for the occasional odd diagnosis and for common diagnoses when writing or updating handouts. 

     In the internet age we get used to the search engine but prior to that a well organized encyclopedia like reference and condensed pocket versions to carry with when doing hospital or nursing home rounds were the norm. The comprehensive collection of information about lab tests and ethnic or other trends common to a diagnosis is still valuable for dietitians or others and having a condensed checklist of all the factors to consider asking about in one place can be life-saving for patients. 

     The body is complex, add the variety of different types of bodies of all the ethnic groups and genders and a comprehensive checklist of all the questions to think about for a diagnosis is really simply necessary. Who can remember everything all the time? Not many health professionals that I've met as a patient have asked many questions of me beyond standard ones. How are you feeling is vague. How is the surface of your tongue feeling when you eat is very specific and would be helpful to check B vitamin status. A visual inspection of the tongue's surface is also necessary for a thorough nutrition analysis. 

     If your health professional doesn't ask much then they may not be doing a very thorough analysis of your health needs or are likely to provide a very accurate diagnosis. It has been written or said that up to 80% of a medical diagnosis in our current system is based simply on the lab tests. Ask yourself, do you want to be seen as a test tube or as a whole person?

Something for every health professional's toolbox: Nutrition and Diagnosis-Related Care, 8th Ed. 2015, (Escott-Stump). The updated edition includes a section on oxidative stress/inflammation and a section on autism, both of which are topics I cover on this site, effectivecare.info, or the associated blog site, effectiveselfcare.info. The book Nutrition and Diagnosis-Related Care, 8th Ed. would be the reference to use for reliable evidence-based nutrition recommendations approved for use in hospitals and other healthcare facilities. The information on my websites includes information from peer reviewed articles but it also includes original recipes and ideas of mine that have not been peer reviewed at this time.

My first book was written for a general reading audience and hasn't made it to a finished format yet but later on the website I do share a link to a different book of images with a theme about change that I put together on a self publishing website. The information on this website is also available in a draft format of a book called Instinct & Policy: Effective Care and Best Practices for Promoting Health and Preventing Harassment and Discrimination.  (book document link

     The first twelve chapters are an overview of how and why to write policies, and why accurate research is important for helping to write effective policies. The second half of the site includes the Glossary and additional chapters on topics that go into more detail on oxidative stress, vitamin D and autoimmune disease, TRP channels and pre-eclampsia and other conditions that may be affected by overactive TRP channels, and recipes for promoting health that use ingredients that may help by increasing Nrf2 - some of this material is original work and some is summarized from other researchers discoveries.  

     This website has image collections in slideshow format which the book document does not have. However the document has a title sidebar which can make it easy to navigate between sections. Some of the sections are also available as shorter articles on the blog style website effectiveselfcare.info.

     My name is Jennifer Depew, R.D. and I am a Registered Dietitian with work experience helping prenatal clients and caregivers of young children primarily but I have also worked with home care and residential facility clients of all ages and varied diagnoses. Thanks for visiting, I will continue to work on improving this website and book draft. 

To be effective, care may need to be individualized.

Pumpkin seeds & The DASH Diet

Effective health care involves daily choices - healthy  habits.

Something as simple as our food choices, such as eating a handful of raw, unsalted shelled pumpkin seeds regularly, may help prevent or manage life threatening conditions such as the prenatal complication called pre-eclampsia. 

     The DASH Diet or other magnesium rich food plans such as the Mediterranean Diet or the Zone Diet plans may also help. (Mediterranean) (Zone)  The DASH Diet was developed for helping patients with hypertension manage their high blood pressure. The Dietary Approach to Stop Hypertension (DASH) Diet includes an extra food group for Nuts, Beans, and Seeds. My career involved helping women have healthy pregnancies with just inexpensive foods and solutions. Expensive supplements wouldn't be helpful if they couldn't be afforded so why mention them? Shelled pumpkin kernels have a similar texture to sunflower seeds but they contain more zinc. They are also a good source of vitamin K, magnesium, essential oils and other nutrients. Read more: 11 Benefits of Pumpkin Seeds, (healthline.com

     They are also a good source of phospholipids which will be discussed in more detail in I.Starvation or Addiction?.  (P.8 , 9, 10) Pumpkin seed kernel oil is being investigated as a medical treatment and was found to be more effective for wound healing in an animal study than the standard wound care ointment or no treatment control groups. (P.11)  While chocolate has a tiny amount of caffeine, its source cocoa beans also have a good supply of phospholipids, choose a lower sugar, lower fat dark chocolate or use Baker's chocolate and make your own chocolate treats to maximize the phospholipid and other antioxidant content. Pomegranate seeds also contain a good supply of phospholipids, (pomegranate seed oil analysis, P.14), and also cardamom spice, (P.15), and dark green leafy vegetables and herbs such as oregano, basil, and rosemary are also good sources.  Phospholipids are found in membranes and are more plentiful in nuts, seeds and other leafy vegetables. 

      Pomegranate seed oil has been investigated as a dietary supplement in an animal based study and found to positively affect fatty acid balance. The discussion suggests consideration as a dietary alternative source for the beneficial fatty acid CLA, Conjugated Linoleic Acid. (P.16

     I learned about the exceptional nutritional value of pumpkin seeds for providing zinc in a college nutrition class. It was an upper level class for dietitians and the assignment was either simple or complex depending on your lifestyle or your approach to homework. The challenge - record your diet for a week and calculate the nutrient content to see how well you were meeting your own nutritional needs. 

     At the time there was not an app for that (a software application that calculates the nutrient content of a meal or week of meals). Now there are a variety of software programs for helping calculate an estimate. Precise measuring of each ingredient in a recipe is necessary if you are figuring it out by hand. Then, at that time, there was a book of ingredients available which also included a few processed foods, with entries of the average nutrient content for the ingredient or processed food, for about twenty nutrients. So for a college assignment a person might choose to look at the list of processed foods and only eat those for the week for less tabulating and adding, or the college student could painstakingly hand measure everything they prepare and eat for the week and carefully add up the totals. I chose the second choice and the labor intensive task resulted in the information that raw pumpkin seeds added amazing amounts of nutrients to my diet, and I've been sharing the information ever since. 

     It is particularly useful information for people following a vegetarian or vegan diet because meats are a good source of zinc but very few vegetarian foods are rich in zinc. For several years during college I did eat a vegetarian diet and had read what I could find about making myself well-balanced meals. So, the take home-point may be eat raw pumpkin seeds or it might be to not cut corners when doing a difficult homework task.

      In the meantime, school is out, and pumpkin seed kernels are the inner green part that have been shelled. Their texture is similar to sunflower seed kernels but their oil content has a more health promoting nutrient balance than the oil content of sunflower seed kernels. Ideally shop for raw pumpkin seed kernels that are not salted. Salted, roasted pumpkin seeds may also be labeled Pepitos and the salt content may be excessive if eaten in much quantity. An 1/8th to 1/4 cup of raw pumpkin seed kernels, 2 to 4 Tablespoons might be a reasonable serving size of the unsalted type or lightly salted and roasted types. Roasting the seeds increases the phospholipid content but also increases some more negative oxidation chemicals which would decrease some of the benefits of the oil. (P.12) For freshness of the roasted snack, the raw pumpkin seed kernels can be lightly pan roasted for a few minutes with a dash of oil until they puff a little. Toss with a sprinkle of salt and let cool on a paper towel to absorb extra oil. Store any extra in an airtight container to retain crispiness and prevent further oxidation.

      (Oxidation of seeds or nuts: spoilage of the oils due to contact with oxygen from the air. Storing all nuts and seeds in airtight containers in a cool or even freezing temperature extends their safe eating shelf life. Rancid oil has a recognizable odor and bad taste and nuts and seeds should be discarded rather than eaten if they have gotten too old and turned rancid as the oxidized oils can be unhealthy, especially if eaten in a larger quantity. One or two wouldn't be a problem but once the off-taste is noticed throw away the remainder of the package or possibly you might be able to return it to the store if it was a recent purchase. (P.13))  

Magnesium is a mineral found in many foods but it can also be easily become deficient due to increased urinary losses due to alcohol or other dietary choices. It is important in protecting against damage caused by oxidative stress. More information is available in section G3. Relaxation & Stress.

This website hasn't been peer reviewed yet and includes work from many fields of study so I would need to find a large number of specialists to read various sections, but in the meantime it could be life-saving information. The work has helped my health and was helpful to many of the clients I've worked with in the past. However if you prefer a short read on tips from managing stress a list of ten helpful is available on forbes.com. The tips mention the value of a deep breathing exercise and describes a meditative style without mentioning that simply getting more oxygen also helps. So skip the meditative style if you think that is nonsense and just remember to take a few deep breaths when you are stressed because we need oxygen and we have a tendency to hold our breath, to stop breathing for a moment, when under extreme stress. (forbes.com)

     This site is in a initial draft phase with some incomplete sections in addition to not having been peer reviewed yet, however when someone is really sick they just want help that is helpful and this information has been helpful for fifteen years worth of clients so I share it because I care. If it helps only one person, then I will be glad for that person.

     Individualized care is about providing guidance specific to that person or group of people. Outer differences in races and genders are associated with some underlying differences and providing guidance that helps one race is not racist if you are also providing other guidance that helps other races. Much of the Western world's medical research was based on experimental groups of white males, based on the premise that we are all similar. We are similar but we are also different. Individualized health care is not racist. Basing policies for all races and genders on medical research that was performed with groups of white males seems racist to me and potentially life threatening. Use your own judgement about how you feel with a medical treatment and ask for second opinions if it doesn't seem to be helping.

     Currently the U.S. government elected officials have been discussing legislation that would limit health care for women while continuing to provide coverage for Viagra type medications. That would likely lead to increased infant mortality and maternal deaths, but I wouldn't recommend jealousy. The policy of treating male symptoms with a symptom management pill is likely adding to male mortality as it is ignoring the likely underlying cause of early cardiovascular disease. Blueberries as a regular part of the diet would likely be a more effective long term solution for male health symptoms than Viagra (™). (blueberries) Bonus: Blueberries and walnuts may also help maintain brain function. (blueberries & walnuts) Any deep purple/blue/red berry or fruit is likely to have similar health benefits. (Flavanols and anthocyanins)

My goal is life is to enjoy it and it is difficult for me to enjoy life when I see so much pain and suffering when it is largely unnecessary for many people. I've never had a goal to have a star on Hollywood Blvd.. Helping Hollywood stars and everyone else to have as little unnecessary pain and suffering as possible has been my goal.

Pre-eclampsia can be life threatening for mom and expected baby.

Preeclampsia can be life threatening for the mother and baby and may increase the infant's later risk for developing autism. Roughly, in the US preeclampsia may affect approximately four percent of all pregnancies, or 4% of an average of 3,978,497 live births in the US per year. (cdc.gov) Simplifying slightly would give 4% of 4 million/year or 160,000 pregnancies each year- roughly. International averages are worse with 5-8% of pregnancies affected by preeclampsia and with a mortality rate that makes it the leading cause of pregnancy related death for women.

  • Read more: Pre-eclampsia a leading cause of pregnancy related death, (sfgate)

Preeclampsia is a severe form of hypertension that may have included severe nausea and vomiting and dehydration during early pregnancy or throughout the pregnancy. Excess fluid retention and difficulty clearing toxins can be symptoms.

     The condition has been found to be associated with twice the risk of autism in the children of mothers who had developed preeclampsia during their pregnancies. And the association was strong, the more severe the woman’s symptoms of preeclampsia had been, the more likely her child was to have gone on to develop autism.

     There may be a genetic issue involved in risk of preeclampsia because while it is not very common, occurring for 3-5% of pregnant women, for women who had the condition there is much greater likelihood that their daughters or sisters will also experience preeclampsia when they are pregnant. It is possible that eating and lifestyle habits are simply similar between close family members but the increased rate is interesting and suggests a potential area for more research:

  • “In the US, preeclampsia affects 3-5% of pregnant women, but among women who have had it, around 20-40% of their daughters and 11-37% of their sisters will also get the disorder, according to the World Health Organization (WHO).” (medicalnewstoday

A genetic difference in TRP ion channels may leave some women more at risk and the actual shape of the woman’s pelvis and the amount of space available within the abdominal cavity may also be involved. Fluid shifts across membranes through little protein tunnels called ion channels. Increased pressure from a large baby in a small space can increase the risk of too much fluid leaving one side of a membrane and collecting on the other side - where it doesn't belong.

     More information and some possible strategies that might help reduce risk to mom and baby are included in section G5. Preeclampsia and TRP channels.

Why did pumpkin seeds help preeclampsia? I started reading.

Current medical research didn't have answers for me regarding what I had observed regarding the DASH diet and prenatal hypertension, but I found help with vets and the care of dairy cows - magnesium deficiency is a common cause of health problems in dairy cows or all cattle if the grazing field has an imbalance in magnesium content which can occur in certain stages of spring growth.
    Magnesium deficiency can cause a variety of problems and I found there were quite a few alternative practitioners recommending more use of it but it is not a part of standard treatment for prevention of preeclampsia. It is used for the acute care of patients near delivery who are given intravenous magnesium which I was told feels like fire running through your veins. Many or several patients were very eager to never experience that again and were happy with the pumpkin seeds and DASH diet recommendation.
    An underlying problem with vitamin D may be involved in a tendency towards low magnesium levels as vitamin D is involved in calcium and magnesium metabolism. Someone with a darker skin complexion living in a northern climate or who works nights and doesn't get much sun exposure might be more at risk for low vitamin D levels. However it is included in many foods and in the prenatal or one-a-day supplements that are commonly used - so why would people be at risk when we don't have a large problem anymore with childhood rickets (children with dark skin complexions who are fully breastfed may be more at risk for the condition.)

     My reading lead me to more reading and public health issues involving low vitamin D became apparent at the population level. The average vitamin D level for US citizens was lower than that of Canadian citizens - who would be getting less sunlight on average. That information was a new puzzle which eventually led me to the disturbing information that glyphosate may be inhibiting the body's ability to form vitamin D with the help of sunlight. Are US citizens getting more glyphosate residue than the average Canadian? I don't know. What I did find out however is that vitamin D is essential for helping a mother or an allergy or autoimmune patient to be less overly allergic or sensitive to the baby's DNA - which is foreign to the mother's white blood cells.

More detail is included in section G4. Autoimmune Disease & Vitamin D. 

Policy guides our lives in ways many we don't realize.

 "Try to learn something about everything & everything about something". ~T.H.Huxley

Policy is a rule that a business or nation, or a family or an individual has decided to follow. Procedures are the steps that have been planned or tested and found to be effective for achieving the goal of the policy or for enforcing it. Evaluation of daily behavior is generally involved in measuring and showing that a plan is being carried out on a regular basis.
    Writing policy and procedures that will be effective is a skill that can be learned but it also involves an understanding of people and a respect for physics. None of us can perform tasks when there isn't enough time or resources or if the plan is based on incorrect information, or was based on information that simply changed - but the plan wasn't changed - yet. The best policies are clear and discussed on a regular basis as guidance rather than used as an after-the-fact punishment that goes into the employee record or is used to fire workers. A good overview of how to use policies effectively is included in an article about what to wear to work, and what to save for after hours by Liz Ryan, see forbes.com: Ten Things Never, Ever to Wear to Work. It is a Q/A article about wardrobe for setting customers and coworkers at ease which also discusses the value in having more flexible policies that are based on regular conversations during office hours rather than used as punitive, gotcha-breaking-the-policy reprimands that go into an employee record. (P.1

     The question of "normal" and how it differs for all of us somewhat is considered from the perspective of my own childhood - which was not typical and I'm sharing in part for that very reason - to show that people can be different and that is okay - or that people can be different and can benefit from individualized diet choices and health care. My ideas are presented as a ideas, not necessarily correct or incorrect, but simply ideas that might be worth adapting for your own use in some way that I couldn't possibly know because I don't have your set of unique experiences.
    Sharing is caring, pass it forward.

Templates are available for writing policy but based on one I started, note the logo is underway, it would be difficult to complete without more knowledge of the requirements. The template has guidance about what types of things to include and where to put them in the document but it doesn't really have guidance about what details you would be writing. More familiarity with the federal policy and what it requires would be needed before this template could be completed: (HIPAA policy template). It's a nice start - for someone who is familiar with the goals of the HIPAA legislation, (HIPAA) but for someone who is new to the job and told to write something it wouldn't be enough information. Once I had something more complete I might modify the logo but for now, it can stay. Discussion of differences itself isn't necessarily racist or discriminatory but can be necessary to help reveal strengths and how teamwork can help improve on weaknesses. No one can do everything and templates give you a team from the word processing company or other company you're working with. But even they need you to consider your individual company or personal values when you are developing a plan of action. A policy and the procedural steps are like a sports play or recipe card for a cook. Think about what efficient time management plus realistic ability can handle - and - write that - with the legal requirements in mind so when the inspectors happen to visit everyone isn't breaking the law - that would be bad.

     To save you the click through, "Needs work" is the joke - the logo is a drawing of a paper airplane. 

Who and what does your company care about, what is the story of the era?

A template is helpful but it can not tell you what your own place of business or your own group of workers' values might require for a policy to be easy to implement and effective without needing as much oversight or reprimands.

     The value in considering the underlying story or narrative of an economically significant point in history is discussed in the article Economics and the Human Instinct for Storytelling, (review.chicagobooth.edu). Past events are discussed. Climate change and the need for rapid changes in the way we as a species collectively and individually do things is an underlying narrative of our current time. But the changes in our environment are being denied or suppressed, or attacked, or desperately pleaded for, and planned and worked towards, by a variety of different groups. What are we to think? When two opposite beliefs are clashing in our minds it can add to stress. Cognitive dissonance is a term for when we are forced to cope with sets of different beliefs about a topic.

    Cognitive dissonance is an underlying narrative of our current time. 

The most effective health care is self care - the ultimate Do-It-Yourself Project.

Waiting for others to tell you to take a break or to go see the doctor may leave your body in worse shape than necessary. 

     Start early with healthy habits and the long term may take care of itself without needing long term chronic illness management. A variety of therapy ideas and resources to experiment with on your own are available online and in self-help type books but seeking out a group or individual therapist or nutritionist or exercise coach or health care specialist is a better now than never plan - Take charge of your health early and it may stick by you for the long run!

The evidence is clear - alcohol can be dangerous.

Alcohol is one of our earliest medicinal substances.

Alcohol was used to sterilize wounds and medical equipment. A shot of hard liquor was often given to someone who had received bad news or was in a state of shock. It was also one of the earliest mind altering substances that was produced by different cultures around the world. It also occurs naturally in fruit that is overripe so likely even cavemen and women enjoyed the occasional tipsy moment.

     Some cultures ban any use of alcohol or other mood altering drinks, even including coffee with its stimulating caffeine content. Alcohol has also been banned at certain points of time in the United States. However that led to increased crime and alcohol was still available to those willing to seek it out and pay whatever price was required for the illegal substance. 

     More recent medical research has shown that moderate use of alcohol may actually have heart healthy benefits, with moderate equally one alcohol serving for a smaller adult and two servings for a larger adult. Serving sizes and more information about the medical research regarding alcohol is available on the Harvard T. H. Chan School of Public Health website: Alcohol: Balancing Risks and Benefits. (P.alcohol)

     Alcohol can be a fun and healthy beverage but overdoing can lead to an increased loss of electrolytes which may lead to increased anger and tendency towards violence. Over imbibing can also increase recklessness due to less impulse control and also causes loss of physical skills of balance and muscle control. Walking can become a risk let alone driving a fast car or speedboat. 

Alcohol is a poison not just a beverage.

We as a human species are similar but we are also different somewhat in our body's capabilities. Genetically some people can drink more alcohol than others because their livers are better and quicker at detoxifying it. Bullies who can drink anyone else under the table are not cool they are bullies with phenomenal liver capacity to detoxify alcohol. Parents who simply warn their children, teenagers and young adults to never drink alcohol are not teaching them about the risks or about their body's capacity. Some people get drunk with a few drinks others can seem to tolerate a full bottle of hard liquor. Sending your young adult off to school with a just say no philosophy is not teaching them why or how or what to do if a yes was said. Once the first few are drunk then the inhibition and ability to say no to anything else is incapacitated. 

     The bully or person lucky enough to have a phenomenal liver capacity who can drink a full bottle of hard liquor might not realize their liver is not the same as the liver of the person they are harassing or encouraging into drinking more alcohol than is safe for that person. This is not about building up a tolerance, although that can occur in a chronic user of alcohol, but there can also be differences to start with. There can be a basic underlying difference in the body's capacity to detoxify. The bully or lucky liver-capacity person might be thinking the other person is weak for not being able to hold their liquor without realizing that there might simply be a basic difference between people and their body's physiology. Killing with alcohol is killing with a deadly poison. It is not cool or romantic. As a child I grew up seeing the occasional risks of too much alcohol at social settings. It left me cautious, or at least aware of the risks of too much alcohol and it likely helped protect me when I arrived at college where alcohol occasionally was freely available in some private party settings.

Binge Drinking Can Kill Without Drinking and Driving.

Alcohol is a poison that can be used to kill. Having a few drinks with your young adult before sending them off to college might not be legal drinking age wise but it might be wise to let the young adult know just how incapacitating a few alcoholic beverages can be. Elsewhere on this site I mention dedicating it to the goal of reducing the number of lives lost to overdosing on alcohol. You don't need to get behind the wheel of an automobile to be killed by alcohol. 

     Parents could also simply discuss the topic of moderation and eating some food and drinking some water when having an alcoholic beverage or a few. The most dangerous drinking is when alcohol is ingested rapidly with no additional water or food. The body needs water and nutrients to detoxify the alcohol. Bars used to provide free snacks such as popcorn or peanuts to bar patrons. The salt and other nutrients helps to replace the nutrients that are lost in excess urine or used up in the detoxification process.

     I've probably spent more sober hours in a bar than many people so I've observed a lot of drunkenness. Even one drink could affect my balance and I prefer to dance than drink. Live music is fun and so is staying alive. The message not to drive drunk is important but another important message is to know your limits and to pace yourself with some water or juice chasers and some salty snacks.

     Please warn your children that bullies with amazing liver capacity are not cool and can be lethal even though they might seem like the life of the party. Being a bully might be the in thing to do but it is not cool or romantic to be a killer or a bully.

     Alcoholism can become a problem later in life even with an unusual liver capacity. A deficiency in the cannabinoid receptor system may be involved. there are foods that contain cannabinoids that aren't controlled substances so that is not a suggestion to seek out illegal or controlled sources of cannabinoids (medical marijuana). See the section Addiction or Starvation? for more information about the potential genetic issues that may underlay a tendency towards binge eating disorder, alcoholism or overuse of opiates. Nicotine and other addictive behaviors may involve differences in the cannabinoid system, except cocaine/crack cocaine addiction does not seem to involve the cannabinoid receptor system.


Health can be a do-it-yourself project. Take charge everyday.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. 
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert).